Reconstructive Peri-Implantitis Therapy by Using Bovine Bone Substitute with or without Hyaluronic Acid: A Randomized Clinical Controlled Pilot Study

Effect of Applying 1% Metformin on Guided Bone Regeneration Processes with Bovine-Derived Xenografts

Background: Although xenografts have shown successful results in GBR procedures due to their osteoconductive properties, many authors have opted to add co-adjuvant drugs to favor osteogenesis and differentiate cells into an osteoblastic lineage. Metformin has been shown to have bone-protective properties, regulating osteoclast differentiation, as well as the ability to promote osteoblast mineralization and differentiation. The present study aimed to evaluate the effect of the local application of a 1% metformin solution on bone neoformation in the treatment of an experimental bone defect in a guided bone regeneration animal model with a particulated bovine hydroxyapatite xenograft with hyaluronate. Methods: With this purpose in mind, two critical defects with 8 mm diameter and 0.5 mm depth were created in eight male New Zealand rabbit calvarias. Titanium cylinders were fixed in each defect and filled with particulate hydroxyapatite of bovine origin and sodium hyaluronate, with sterile injectable saline added to the control group and sterile 1% metformin solution added to the test group. At 6 weeks, the animals were euthanized, and samples were obtained and prepared for histomorphometric analysis. Results: A higher percentage of new bone formation was observed in the metformin samples than in the control samples, both in the region closest to the animal's calvaria and in the most distal region analyzed. A higher average bone-biomaterial contact percentage was observed in the samples, with metformin in both the proximal and distal regions. There was no statistically significant difference in the mean value in either region in both parameters. Conclusion: The local application of a 1% metformin solution in an animal model of guided bone regeneration with particulate bovine hydroxyapatite and hyaluronate resulted in greater bone neoformation and xenograft osseointegration than in the control group.

Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis

STATEMENT OF PROBLEM

Extensive research has been carried out on the various aspects of diagnosing and treating peri-implantitis. However, clinical guidelines for the management of peri-implantitis based on high quality evidence are lacking.

PURPOSE

The purpose of this systematic review with network meta-analysis was to analyze the current evidence on nonsurgical and surgical interventions for the treatment of peri-implantitis and synthesize clinical guidelines based on high quality evidence.

MATERIAL AND METHODS

A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until July 2023. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023451056). A network meta-analysis was performed on data from randomized controlled trials that assessed nonsurgical and surgical interventions for the treatment of peri-implantitis. The interventions were ranked according to their efficacy using surface under the cumulative ranking (SUCRA) system. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to assess the level of certainty of evidence.

RESULTS

A total of 45 articles were included in the quantitative analysis. The GRADE approach determined a moderate to high level of certainty of evidence. Among the nonsurgical interventions, mechanical debridement with adjunctive systemic antibiotics was significant in improving probing depth at 3 months and beyond 6 months, clinical attachment loss at 3 months, and clinical attachment loss beyond 6 months. Mechanical debridement with adjunctive topical antibiotics was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive photodynamic therapy was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive systemic antibiotics and photodynamic therapy was significant in improving probing depth beyond 6 months. Among surgical interventions, open flap debridement with implant surface decontamination and open flap debridement with decontamination and adjunctive photodynamic therapy were significant in improving probing depth at 3 months.

CONCLUSIONS

Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy results in improved clinical outcomes.

The response of human osteoblasts on bovine xenografts with and without hyaluronate used in bone augmentation

The aim of the in vitro study was to asses the effect of hyaluronate in conjunction with bovine derived xenografts on the viability, proliferation on day 4, 7 and 10, expression of early osteogenic differentiation marker Alkaline phosphatase on day 14 and 21, collagen, calcium deposition on day 14, 21 and 28 and cellular characteristics, as assessed through live cell image analysis, confocal laser scanning microscopy and scanning electron microscopy, in primary human osteoblasts compared to three bovine xenografts without hyaluronate. All experiments were performed in triplicates. Data were compared between groups and timepoints using one-way analysis of variance (ANOVA). Bonferroni post hoc test were further used for multiple comparison between groups (p < .05) An increase in cell viability (p < .05) and enhanced ALP activity was observed in all xenografts. Specimens containing hyaluronate showed a highest significant difference (23755 ± 29953, p < .0001). The highest levels of calcium (1.60 ± 0.30) and collagen (1.92 ± 0.09, p < .0001) deposition were also observed with hyaluronate loaded groups. The osteoblasts were well attached and spread on all xenograft groups. However, a higher number of cells were observed with hyaluronate functionalized xenograft (76.27 ± 15.11, (p < .0001) in live cell image analysis and they migrated towards the graft boundaries. The biofunctionalization of xenografts with hyaluronate improves their in vitro performance on human osteoblasts. This suggests that hyaluronate might be able to improve the bone regeneration when using such xenografts.

Applications of selected polysaccharides and proteins in dentistry: A review

In the last ten years, remarkable characteristics and a variety of functionalities have been created in biopolymeric materials for clinical dental applications. This review gives an overview of current knowledge of natural biopolymers (biological macromolecules) in terms of structural, functional, and property interactions. Natural biopolymers such as polysaccharides (chitosan, bacterial cellulose, hyaluronic acid, and alginate) and polypeptides (collagen and silk fibroin) have been discussed for dental uses. These biopolymers exhibit excellent properties alone and when employed with other composite molecules making them ideal for treatment of periodontitis, endodontics, dental pulp regeneration and oral wound healing. These biopolymers together with the composite materials exhibit better biocompatibility, inertness, elasticity and flexibility which makes them a leading candidate to be used for other dental applications like caries management, oral appliances, dentures, dental implants and oral surgeries.

First Clinical Case Report of a Xenograft-Allograft Combination for Alveolar Ridge Augmentation Using a Bovine Bone Substitute Material with Hyaluronate (Cerabone® Plus) Combined with Allogeneic Bone Granules (Maxgraft®)

BACKGROUND

A patient had lost the first left maxillary incisor in the esthetic zone.

METHODS

The defect in the alveolar ridge was reconstructed for an implant-supported restoration using a new xenogeneic bone substitute containing hyaluronate, which was used in combination with allogeneic bone granules.

RESULTS

After three years of follow-up, the dental implant was stable and showed no signs of infection.

CONCLUSIONS

This is the first case report with a long-term follow-up time of three years of a successful clinical application of a xenograft-allograft combination (cerabone® plus combined with maxgraft®) for alveolar ridge augmentation before dental implantation. Cerabone® plus offers volume stability, provides reliable and efficient structural support of the oral soft tissues in the augmented region (particularly crucial in the aesthetic zone), and preserves the alveolar ridge shape.

Evaluation between Biodegradable Magnesium Metal GBR Membrane and Bovine Graft with or without Hyaluronate

Bone substitutes and barrier membranes are widely used in dental regeneration procedures. New materials are constantly being developed to provide the most optimal surgical outcomes. One of these developments is the addition of hyaluronate (HA) to the bovine bone graft, which has beneficial wound healing and handling properties. However, an acidic environment that is potentially produced by the HA is known to increase the degradation of magnesium metal. The aim of this study was to evaluate the potential risk for the addition of HA to the bovine bone graft on the degradation rate and hence the efficacy of a new biodegradable magnesium metal GBR membrane. pH and conductivity measurements were made in vitro for samples placed in phosphate-buffered solutions. These in vitro tests showed that the combination of the bovine graft with HA resulted in an alkaline environment for the concentrations that were used. The combination was also tested in a clinical setting. The use of the magnesium metal membrane in combination with the tested grafting materials achieved successful treatment in these patients and no adverse effects were observed in vivo for regenerative treatments with or without HA. Magnesium based biodegradable GBR membranes can be safely used in combination with bovine graft with or without hyaluronate.