Therapeutic Efficacy of Bromelain in Alveolar Ridge Preservation

The Role of Bone Tacks in Sinus Floor Lift Surgery: A Single-Center Experience

Background: Maxillar atrophy is a prevalent condition associated with diminished bone volume, which precludes the conventional placement of dental implants. Sinus floor lift is a surgical procedure that aims to address this atrophy through the insertion of a graft within the sinus cavity. A multitude of techniques have been documented in the international literature for the management of the sinus bone window, though each approach has its own set of advantages and disadvantages. Methods: The present study is a retrospective analysis of traditional sinus floor lift surgery, comparing the outcomes of two surgical approaches: placement of a collagen membrane over the maxillary lateral bone window with or without bone tacks. The study enrolled a total of 48 consecutive patients. Twenty-four patients underwent sinus floor lift surgery, with the placement of a collagen membrane over the maxillary lateral bone window without bone tacks (control group). The remaining 24 patients underwent the same procedure, but with bone tacks (study group). All patients received an amoxicillin 875 mg + clavulanic acid 125 mg administration for six days and underwent Cone Beam Computed Tomography (CBCT) before the sinus floor lift surgery and six months later before the implant surgery. The parameters measured on the preoperative Cone Beam Computed Tomography (CBCT) scan included residual bone, the preoperative thickness of the lateral bone in the center, and the distance between the lateral wall and the medial wall of the sinus. Only the bone height increment was measured on the postoperative CBCT scan. Postoperative complications and the visual analogue scale (VAS) score were also recorded. A statistical analysis was performed, and the correlation between the parameters was evaluated using Pearson's correlation coefficient. A comparison of the mean of the parameters between the treatment group and the control group was conducted using the t-test. Results and Conclusions: The study group was found to have superior outcomes in terms of bone height increment (p = 0.001) and VAS after 7 days (p = 0.11) compared to the control group. The novel application of bone tacks on the collagen membrane over the bone window following sinus elevation surgery was associated with superior outcomes in terms of bone height and reduced pain at seven days, as measured by the VAS, with no postoperative complications.

The Effect of Age on the Regenerative Potential of Adipose Stem-cell-derived Apoptotic Extracellular Vesicles in Rat Skin Wound Healing

Introduction: Skin, being the body's largest organ, is susceptible to injuries. Despite the adoption of common treatments such as debridement, wound dressing, and infection control measures for skin injuries, the outcomes remain unsatisfactory, especially in diabetic patients or elderly patients. The use of adipose stem cell-derived apoptotic extracellular vesicles (apoEVs-ASCs) has been shown great therapeutic potential in wound repair. The effect of the donor age on the biological properties and functions of apoEVs-ASCs has not been reported. Methods: In this study, we isolated apoEVs-ASCs from young and aged rats. Transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA) were applied for the characteristics of apoEVs-ASCs. For aged and young apoEVs-ASCs groups, the proliferative and migration abilities in vitro, and wound healing function in vivo were contrastively evaluated and quantified for statistical analysis. Results: Our results showed that both young and aged apoEVs-ASCs induced skin healing and reduced scar formation. In addition, young apoEVs-ASCs had significantly higher proliferation, migration of fibroblasts and endothelial cells, and increased neo-angiogenesis ability, when compared with that of aged apoEVs-ASCs. Conclusion: Young apoEVs-ASCs should be employed for wound repair, which is associated with its superior promoting effect on wound healing.

Surface-modified deproteinized human demineralized tooth matrix for bone regeneration: physicochemical characterization and osteoblast cell biocompatibility

Tooth presents an intriguing option as a bone graft due to its compositional similarity to bone. However, the deproteinized human demineralized tooth matrix (dpDTM), developed to overcome the limited availability of autologous tooth grafts, has suboptimal pore size and surface roughness. This study aimed to fabricate a surface-modified dpDTM using acid etching and collagen coating, followed by in vitro evaluation of physicochemical and biological properties. The dpDTM was modified into two protocols: Acid-modified dpDTM (A-dpDTM) and collagen-modified dpDTM (C-dpDTM). Results demonstrated that A-dpDTM and C-dpDTM had increased pore sizes and rougher surfaces compared to dpDTM. Collagen immobilization was evidenced by nitrogen presence exclusively in C-dpDTM. All groups had a Ca/P molar ratio of 1.67 and hydroxyapatite as the sole constituent, with 65-67% crystallinity. Degradation rates significantly increased to 30% and 20% for C-dpDTM and A-dpDTM, respectively, compared to 10% for dpDTM after 120 days. Cumulative collagen release of C-dpDTM on Day 30 was 45.16 µg/ml. Osteoblasts attachment and proliferation were enhanced on all scaffolds, especially C-dpDTM, which displayed the highest proliferation and differentiation rates. In conclusion, surface modified of dpDTM, including A-dpDTM and C-dpDTM, significantly enhances bioactivity by altering surface properties and promoting osteoblast activity, thereby demonstrating promise for bone regeneration applications.

Current Knowledge on the Healing of the Extraction Socket: A Narrative Review

The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures performed in the dental clinic. Understanding this healing process is of utmost importance because the outcome has a direct bearing on future prosthetic rehabilitation and, by extension, on patients' esthetics and masticatory function, among others. This mini review, therefore, summarized the current knowledge on the different stages of socket healing, including the biologic and clinical events that occur following tooth extraction up until the complete closure of the socket. Additionally, the modeling of the alveolar bone/process post extraction, and the resultant dimensional changes that, altogether, shape the bone, were reviewed and documented. The effects of various socket preservation interventions to mitigate these dimensional changes, and therefore preserve the alveolar process in a condition suitable for future prosthetic rehabilitation, were highlighted. Finally, a review of some of the factors that influence the entire process was also carried out.

Bromelain: a review of its mechanisms, pharmacological effects and potential applications

The utilization of plant-derived supplements for disease prevention and treatment has long been recognized because of their remarkable potential. Ananas comosus, commonly known as pineapple, produces a group of enzymes called bromelain, which contains sulfhydryl moieties. Recent studies have shown that bromelain exhibits a wide range of activities, including anti-inflammatory, anti-diabetic, anti-cancer, and anti-rheumatic properties. These properties make bromelain a promising drug candidate for the treatment of various diseases. The anti-inflammatory activity of bromelain has been shown to be useful in treating inflammatory conditions such as osteoarthritis, rheumatoid arthritis, and asthma, whereas the anti-cancer activity of bromelain is via induction of apoptosis, inhibition of angiogenesis, and enhancement of the body's immune response. The anti-diabetic property of bromelain is owing to the improvement in glucose metabolism and reduction in insulin resistance. The therapeutic potential of bromelain has been investigated in numerous preclinical and clinical studies and a number of patents have been granted to date. Various formulations and delivery systems are being developed in order to improve the efficacy and safety of this molecule, including the microencapsulated form to treat oral inflammatory conditions and liposomal formulations to treat cancer. The development of novel drug delivery systems and formulations has further ameliorated the therapeutic potential of bromelain by improving its bioavailability and stability, while reducing the side effects. This review intends to discuss various properties and therapeutic applications of bromelain, along with its possible mechanism of action in treating various diseases. Recent patents and clinical trials concerning bromelain have also been covered.

Success of Xenografts in Alveolar Ridge Preservation Based on Histomorphometric Outcomes

Different xenograft approaches in alveolar ridge preservation (ARP) are essential to understand relative to their histomorphometric outcomes. Therefore, the aim of this study involved studying biomaterials of a xenograft nature that are used in ARP procedures, to compare the different approaches and evaluate their efficacy in relation to histomorphometric data. An electronic search was completed using the databases: Ovid (Medline), Google Scholar and Wiley Online Library, including a hand search for relevant articles and grey literature. Only randomised controlled trials, using xenograft biomaterials for alveolar ridge preservation procedures involving human studies, dated from 2010-2022 were included in the review. An initial search yielded 4918 articles, after application of the eligibility criteria, 18 studies were deemed eligible for inclusion in the systematic review. The two main xenograft groups found were of bovine origin and of porcine origin. The main histomorphometric outcomes evaluated included new bone percentage (N.B%) and residual graft percentage (R.G%). The mean N.B% for the bovine and porcine groups were 33.46% and 39.63% respectively and the mean R.G% for the bovine and porcine groups were 19.40% and 18.63% respectively. The current evidence suggests that the two main xenograft biomaterials used in ARP procedures after tooth extraction, which are of bovine and porcine origin, displayed effectiveness in producing new bone.

Evaluation of a Granular Bone Substitute for Bone Regeneration Using an Optimized In Vivo Alveolar Cleft Model

Alveolar cleft is a common congenital deformity that requires surgical intervention, notably using autologous bone grafts in young children. Bone substitutes, in combination with mesenchymal stem cells (MSCs), have shown promise in the repair of these defects. This study aimed to evaluate the regenerative capabilities of a granular bone substitute using an optimized alveolar cleft model. Thirty-six rats underwent a surgical procedure for the creation of a defect filled with a fragment of silicone. After 5 weeks, the silicone was removed and the biomaterial, with or without Wharton's jelly MSCs, was put into the defect, except for the control group. The rats underwent μCT scans immediately and after 4 and 8 weeks. Analyses showed a statistically significant improvement in bone regeneration in the two treatment groups compared with control at weeks 4 and 8, both for bone volume (94.64% ± 10.71% and 91.33% ± 13.30%, vs. 76.09% ± 7.99%) and mineral density (96.13% ± 24.19% and 93.01% ± 27.04%, vs. 51.64% ± 16.51%), but without having fully healed. This study validates our optimized alveolar cleft model in rats, but further work is needed to allow for the use of this granular bone substitute in the treatment of bone defects.

Sirt6 Activation Ameliorates Inflammatory Bone Loss in Ligature-Induced Periodontitis in Mice

Periodontitis is an inflammatory disease caused by microorganisms that induce the destruction of periodontal tissue. Inflamed and damaged tissue produces various inflammatory cytokines, which activate osteoclasts and induce alveolar bone loss and, eventually, tooth loss. Sirt6 expression suppresses inflammation and bone resorption; however, its role in periodontitis remains unclear. We hypothesized that Sirt6 has a protective role in periodontitis. To understand the role of Sirt6 in periodontitis, we compared periodontitis with ligature placement around the maxillary left second molar in 8-week-old control (C57BL/6J) male mice to Sirt6-overexpressing Tg (Sirt6Tg) mice, and we observed the resulting phenotypes using micro-CT. MDL801, a Sirt6 activator, was used as a therapy for periodontitis through oral gavage. Pro-inflammatory cytokines and increased osteoclast numbers were observed in alveolar bone tissue under periodontitis surgery. In the same condition, interestingly, protein levels from Sirt6 were the most downregulated among sirtuins in alveolar bone tissue. Based on micro-CT and CEJ-ABC distance, Sirt6Tg was observed to resist bone loss against ligature-induced periodontitis. Furthermore, the number of osteoclasts was significantly reduced in Sirt6Tg-ligated mice compared with control-ligated mice, although systemic inflammatory cytokines did not change. Consistent with this observation, we confirmed that bone loss was significantly reduced when MDL801, a Sirt6 activator, was included in the ligation mouse model. Our findings demonstrate that Sirt6 activation prevents bone loss against ligature-induced periodontitis. Thus, a Sirt6 activator may provide a new therapeutic approach for periodontitis.

The Effect of Diosmin, Escin, and Bromelain on Human Endothelial Cells Derived from the Umbilical Vein and the Varicose Vein-A Preliminary Study

In this study, we investigated the properties of human varicose vein (VV) endothelial cells (HVVEC) in comparison to the human umbilical vein endothelial cells (HUVEC). The cells were treated with three bioactive compounds with proven beneficial effects in the therapy of patients with VV, diosmin, escin, and bromelain. Two concentrations of tested drugs were used (1, 10 mg/mL), which did not affect the viability of either cell type. Escin led to a slight generation of reactive oxygen species in HUVEC cells. We observed a slight release of superoxide in HVVEC cells upon treatment with diosmin and escin. Diosmin and bromelain showed a tendency to release nitric oxide in HUVEC. Using membrane fluorescent probes, we demonstrated a reduced fluidity of HVVEC, which may lead to their increased adhesion, and, consequently, a much more frequent occurrence of venous thrombosis. For the first time, we show the mechanism of action of drugs used in VV therapy on endothelial cells derived from a VV. Studies with HVVEC have shown that tested drugs may lead to a reduction in the adhesive properties of these cells, and thus to a lower risk of thrombosis.

Cone-Beam Computed Tomography and Histological Findings for Socket Preservation Techniques Using Different Grafting Materials: A Systematic Review

OBJECTIVE

Socket preservation techniques have been used to maintain the ridge dimension following tooth extraction. The materials used influence the quality and quantity of newly formed bone. Therefore, the aim of this article was to systematically review the literature reporting both histological and radiographic outcomes of socket preservation techniques after tooth extraction in human subjects.

MATERIAL AND METHOD

A systematic electronic search was performed in the electronic databases. English language clinical studies that were published between 2017 and 2022 and included both histological and radiographic findings for the test and control groups. Our primary search produced 848 articles, and of these, 215 were duplicate studies. A total of 72 articles were then eligible for full-text reading.

RESULTS

The review included eight studies that met its inclusion criteria. Three outcomes were compared in the included studies. The percentage of newly formed bone ranged from 21.34 ± 9.14% to more than 50% of new bone formation. The materials that showed more than 50% of newly formed bone formation were demineralized dentin graft, platelet-rich fibrin, freeze-dried bone allograft, corticocancellous porcine, and autogenous bone. Four Studies did not report the percentage of the residual graft materials, while those who reported showed a variable range of a minimum 1.5% to more than 25%. One study did not report the changes in horizontal width at the follow-up period, while other studies ranged from 0.6 mm to 10 mm.

CONCLUSION

Socket preservation represents an efficient technique to preserve the ridge contour with satisfactory newly formed bone in the augmented site and maintaining the vertical and horizontal dimensions of the ridge.

Decellularized Scaffolds of Nopal (Opuntia Ficus-indica) for Bioengineering in Regenerative Dentistry

Opuntia Ficus-indica, or nopal, is traditionally used for its medicinal properties in Mexico. This study aims to decellularize and characterize nopal (Opuntia Ficus-indica) scaffolds, assess their degradation and the proliferation of hDPSC, and determine potential pro-inflammatory effects by assessing the expression of cyclooxygenase 1 and 2 (COX-1 and 2). The scaffolds were decellularized using a 0.5% sodium dodecyl sulfate (SDS) solution and confirmed by color, optical microscopy, and SEM. The degradation rates and mechanical properties of the scaffolds were determined by weight and solution absorbances using trypsin and PBS and tensile strength testing. Human dental pulp stem cells (hDPSCs) primary cells were used for scaffold-cell interaction and proliferation assays, as well as an MTT assay to determine proliferation. Proinflammatory protein expression of COX-I and -II was discovered by Western blot assay, and the cultures were induced into a pro-inflammatory state with interleukin 1-β. The nopal scaffolds exhibited a porous structure with an average pore size of 252 ± 77 μm. The decellularized scaffolds showed a 57% reduction in weight loss during hydrolytic degradation and a 70% reduction during enzymatic degradation. There was no difference in tensile strengths between native and decellularized scaffolds (12.5 ± 1 and 11.8 ± 0.5 MPa). Furthermore, hDPSCs showed a significant increase in cell viability of 95% and 106% at 168 h for native and decellularized scaffolds, respectively. The combination of the scaffold and hDPSCs did not cause an increase in the expression of COX-1 and COX-2 proteins. However, when the combination was exposed to IL-1β, there was an increase in the expression of COX-2. This study demonstrates the potential application of nopal scaffolds in tissue engineering and regenerative medicine or dentistry, owing to their structural characteristics, degradation properties, mechanical properties, ability to induce cell proliferation, and lack of enhancement of pro-inflammatory cytokines.

Frozen Stored Teeth: Autogenous Dentin as an Alternative Augmentation Material in Dentistry

Tooth Shell Technique (TST) with the use of autologous dentin has proven to be a suitable method of grafting in the context of lateral ridge augmentation. This present feasibility study aimed to retrospectively evaluate the preservation by lyophilization of processed dentin. Thus, the frozen stored processed dentin matrix (FST: 19 patients with 26 implants) was re-examined with that of processed teeth used immediately after extraction (IUT: 23 patients with 32 implants). Parameters of biological complications, horizontal hard tissue loss, osseointegration, and buccal lamella integrity were used for evaluation. For complications, the observation period was 5 months. Only one graft was lost (IUT group). In the area of minor complications, without the loss of an implant or augmentation, there were two cases of wound dehiscence and one case with inflammation and suppuration (IUT: n = 3, FST: n = 0). Osseointegration and integrity of the buccal lamella were present in all implants without exception. Statistically, there was no difference between the groups studied for the mean resorption of the crestal width and the buccal lamella. Results of this study show that prepared autologous dentin preserved with a conventional freezer had no disadvantage compared to immediately use autologous dentin in terms of complications and graft resorption in the context of TST.

Socket Preservation after Tooth Extraction: Particulate Autologous Bone vs. Deproteinized Bovine Bone

Background: The technique of socket preservation after tooth extraction allows for less volumetric decrease after tooth extraction. The aim of this retrospective study was to evaluate differences between alveolar socket preservation performed with deproteinized bovine bone graft and autologous particulate bone graft taken from the mandibular ramus. Materials and Methods: This retrospective study enrolled a total of 21 consecutive patients. A total of 11 patients underwent socket preservation with deproteinized bovine bone graft and collagen matrix (group A), and 10 patients underwent socket preservation performed with particulate autologous bone taken from the mandibular ramus and collagen matrix (group B). All patients received cone beam computed tomography (CBCT) before socket preservation and after four months. Alveolar bone width (ABW) values and alveolar bone height (ABH) values were measured at the first and second CBCT, and the reduction of the values in the two groups was compared. Statistical analysis was performed using Student’s t-test for independent variables, and p values < 0.05 were considered statistically significant. Results: There were no statistically significant differences between ABW reduction of group A and ABW reduction of group B (t-test value p = 0.28). There were no statistically significant differences between ABH reduction of group A and ABH reduction of group B (t-test value p = 0.10). Conclusions: In this retrospective study, no statistical differences were found between the group that received autologous particulate bone compared to the group that received deproteinized bovine bone in socket preservation.

Histological and Histomorphometric Evaluation of Implanted Photodynamic Active Biomaterials for Periodontal Bone Regeneration in an Animal Study

Recently, our group developed two different polymeric biomaterials with photodynamic antimicrobial surface activity for periodontal bone regeneration. The aim of the present study was to analyze the biocompatibility and osseointegration of these materials in vivo. Two biomaterials based on urethane dimethacrylate (BioM1) and tri-armed oligoester-urethane methacrylate (BioM2) that additionally contained ß-tricalcium phosphate and the photosensitizer mTHPC (meso-tetra(hydroxyphenyl)chlorin) were implanted in non-critical size bone defects in the femur (n = 16) and tibia (n = 8) of eight female domestic sheep. Bone specimens were harvested and histomorphometrically analyzed after 12 months. BioM1 degraded to a lower extent which resulted in a mean remnant square size of 17.4 mm², while 12.2 mm² was estimated for BioM2 (p = 0.007). For BioM1, a total percentage of new formed bone by 30.3% was found which was significant higher compared to BioM2 (8.4%, p < 0.001). Furthermore, BioM1 was afflicted by significant lower soft tissue formation (3.3%) as compared to BioM2 (29.5%). Additionally, a bone-to-biomaterial ratio of 81.9% was detected for BioM1, while 8.5% was recorded for BioM2. Implantation of BioM2 caused accumulation of inflammatory cells and led to fibrous encapsulation. BioM1 (photosensitizer-armed urethane dimethacrylate) showed favorable regenerative characteristics and can be recommended for further studies.

The Applications and Potentials of Extracellular Vesicles from Different Cell Sources in Periodontal Regeneration

Periodontitis is a chronic infectious disease worldwide that can cause damage to periodontal supporting tissues including gingiva, bone, cementum and periodontal ligament (PDL). The principle for the treatment of periodontitis is to control the inflammatory process. Achieving structural and functional regeneration of periodontal tissues is also essential and remains a major challenge. Though many technologies, products, and ingredients were applied in periodontal regeneration, most of the strategies have limited outcomes. Extracellular vesicles (EVs) are membranous particles with a lipid structure secreted by cells, containing a large number of biomolecules for the communication between cells. Numerous studies have demonstrated the beneficial effects of stem cell-derived EVs (SCEVs) and immune cell-derived EVs (ICEVs) on periodontal regeneration, which may be an alternative strategy for cell-based periodontal regeneration. The production of EVs is highly conserved among humans, bacteria and plants. In addition to eukaryocyte-derived EVs (CEVs), a growing body of literature suggests that bacterial/plant-derived EVs (BEVs/PEVs) also play an important role in periodontal homeostasis and regeneration. The purpose of this review is to introduce and summarize the potential therapeutic values of BEVs, CEVs and PEVs in periodontal regeneration, and discuss the current challenges and prospects for EV-based periodontal regeneration.

A Histologic, Histomorphometric, and Immunohistochemical Evaluation of Anorganic Bovine Bone and Injectable Biphasic Calcium Phosphate in Humans: A Randomized Clinical Trial

Following trauma, chronic periapical process, or tooth extraction, a large loss of bone volume is noticed during the healing process. To facilitate the placement of dental implants, various surgical procedures are used for an optimal alveolar ridge profile, while maintaining adequate bone dimensions. The main aim of this study was to determine the healing ability (histologically and immunohistologically) of alveolar bone defects during augmentation with two different biomaterials: injectable biphasic calcium phosphate (BCP) and anorganic bovine bone (ABB). Thirty-eight subjects were randomly divided into two groups. The first group received the tested bone substitute biomaterial (BSB), i.e., BCP (maxresorb inject®), and the second group received an alternative to the gold standard, i.e., ABB (Bio-Oss®). The histopathological, histomorphometric, and immunohistochemical analyses gave comparable results for these bone substitute materials in terms of newly formed bone: (BCP: 39.91 ± 8.49%, ABB: 41.73 ± 13.99%), residual biomaterial (BCP: 28.61 ± 11.38%, ABB: 31.72 ± 15.52%), and soft tissue (BCP: 31.49 ± 11.09%, ABB: 26.54 ± 7.25%), with no significant difference found between the groups (p < 0.05, t-test), proving that BCP is equally suitable and successful for alveolar bone regeneration.

Microbiological Retention on PTFE versus Silk Suture: A Quantitative Pilot Study in Third Molar Surgery

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25–40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery.

Regeneration of Horizontal Bone Defect in Edentulous Maxilla Using the Allogenic Bone-Plate Shell Technique and a Composite Bone Graft—A Case Report

An insufficient volume of the alveolar bone may prevent implants from being placed in the prosthetically optimal position. Complex restoration of bony structures is required to achieve long-term peri-implant bone stability and represents an adequate prosthetic solution. Background and Objectives: The shell technique has become a widespread and important method for guided bone regeneration in dentistry. Allogeneic bone materials appear to be the most similar substitution for autogenous bone transplants. However, there are few studies using cortical bone allografts in combination with a mix of autogenous and xenograft materials for the augmentation of horizontal ridge defects. This combination offers the advantage of reduced patient morbidity while adding adequate volume and contour to the alveolar ridge. Case report: The present case study aimed to clinically and radiographically evaluate the efficacy of allogenic cortical bone lamina combined with a composite bone graft in the augmentation of a horizontal bone defect in the edentulous maxilla during a 6-year follow-up period. Three CB CT scans taken before treatment, 6 months after the augmentation period/before implant placement, and after a 6-year follow-up period, were analyzed using stable referent points. After the 6 -year follow-up period, the average resorption rate was 21.65% on the augmented buccal side, with no implant exposure being observed. Conclusions: The bone shell technique used in conjunction with allogenic bone plates combined with autogenous bone, xenografts, and collagen membranes is an effective technique to manage horizontal ridge defects.

Diosmin and Bromelain Stimulate Glutathione and Total Thiols Production in Red Blood Cells

Diosmin and bromelain are bioactive compounds of plant origin with proven beneficial effects on the human cardiovascular system. We found that diosmin and bromelain slightly reduced total carbonyls levels and had no effect on TBARS levels, as well as slightly increased the total non-enzymatic antioxidant capacity in the RBCs at concentrations of 30 and 60 µg/mL. Diosmin and bromelain induced a significant increase in total thiols and glutathione in the RBCs. Examining the rheological properties of RBCs, we found that both compounds slightly reduce the internal viscosity of the RBCs. Using the MSL (maleimide spin label), we revealed that higher concentrations of bromelain led to a significant decrease in the mobility of this spin label attached to cytosolic thiols in the RBCs, as well as attached to hemoglobin at a higher concentration of diosmin, and for both concentrations of bromelain. Both compounds tended to decrease the cell membrane fluidity in the subsurface area, but not in the deeper regions. An increase in the glutathione concentration and the total level of thiol compounds promotes the protection of the RBCs against oxidative stress, suggesting that both compounds have a stabilizing effect on the cell membrane and improve the rheological properties of the RBCs.

Dynamics of CSBD Healing after Implementation of Dentin and Xenogeneic Bone Biomaterial

Autologous dentin is frequently used in guided bone regeneration due to its osteoinductive properties, which come from its similarity to native bone. On the other hand, the xenogeneic bone biomaterial Cerabone^® serves as a biocompatible, but hardly resorbed biomaterial. During bone healing, an inflammatory, vascular, and osteogenic response occurs in which cytokines such as tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF), and osteopontin (OPN) are released locally and systemically. The aim was to follow up the dynamics (on days 3, 7, 15, 21, and 30) of critical-sized bone defect (CSBD) healing after the implantation of bovine devitalized dentin, rat dentin, and xenogeneic bone biomaterial. For this purpose, histological and histomorphometric methods were employed. Additionally, serum concentrations of TNF-α, VEGF, and OPN were monitored in parallel to better understand the biomaterial-dependent systemic response in rats. At the last time interval, the results showed that the bone defect was bridged over in all three groups of biomaterials. The rat dentin group had the highest percentage of bone volume (BV/TV) and the least percentage of residual biomaterial (RB), which makes it the most optimal biomaterial for bone regeneration. Serum concentrations of the TNF-α, VEGF, and OPN refer to systemic response, which could be linked to intense bone remodeling between days 15 and 21 of the bone healing.

Three-Dimensional Impression of Biomaterials for Alveolar Graft: Scoping Review

Craniofacial bone defects are one of the biggest clinical challenges in regenerative medicine, with secondary autologous bone grafting being the gold-standard technique. The development of new three-dimensional matrices intends to overcome the disadvantages of the gold-standard method. The aim of this paper is to put forth an in-depth review regarding the clinical efficiency of available 3D printed biomaterials for the correction of alveolar bone defects. A survey was carried out using the following databases: PubMed via Medline, Cochrane Library, Scopus, Web of Science, EMBASE, and gray literature. The inclusion criteria applied were the following: in vitro, in vivo, ex vivo, and clinical studies; and studies that assessed bone regeneration resorting to 3D printed biomaterials. The risk of bias of the in vitro and in vivo studies was performed using the guidelines for the reporting of pre-clinical studies on dental materials by Faggion Jr and the SYRCLE risk of bias tool, respectively. In total, 92 publications were included in the final sample. The most reported three-dimensional biomaterials were the PCL matrix, β-TCP matrix, and hydroxyapatite matrix. These biomaterials can be combined with different polymers and bioactive molecules such as rBMP-2. Most of the included studies had a high risk of bias. Despite the advances in the research on new three-dimensionally printed biomaterials in bone regeneration, the existing results are not sufficient to justify the application of these biomaterials in routine clinical practice.