Vertical and horizontal ridge augmentation in anterior maxilla using autograft, xenograft and titanium mesh with simultaneous placement of endosseous implants

Socket preservation using a combination of propolis extract and bovine bone graft towards the expression of receptor activator of nuclear κB ligand and osteoprogerin

AIM

This study was undertaken to comprehend the effect of a combination of bovine bone graft (BBG) and propolis extract on the receptor activator of nuclear κB ligand (RANKL) and osteoprotegerin (OPG) expressions in post-extraction tooth sockets.

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.

Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments

After tooth loss, bone resorption is irreversible, leaving the area without adequate bone volume for successful implant treatment. Bone grafting is the only solution to reverse dental bone loss and is a well-accepted procedure required in one in every four dental implants. Research and development in materials, design and fabrication technologies have expanded over the years to achieve successful and long-lasting dental implants for tooth substitution. This review will critically present the various dental bone graft and substitute materials that have been used to achieve a successful dental implant. The article also reviews the properties of dental bone grafts and various dental bone substitutes that have been studied or are currently available commercially. The various classifications of bone grafts and substitutes, including natural and synthetic materials, are critically presented, and available commercial products in each category are discussed. Different bone substitute materials, including metals, ceramics, polymers, or their combinations, and their chemical, physical, and biocompatibility properties are explored. Limitations of the available materials are presented, and areas which require further research and development are highlighted. Tissue engineering hybrid constructions with enhanced bone regeneration ability, such as cell-based or growth factor-based bone substitutes, are discussed as an emerging area of development.

Development prospects of curable osteoplastic materials in dentistry and maxillofacial surgery

The article presents classification of the thermosetting materials for bone augmentation. The physical, mechanical, biological, and clinical properties of such materials are reviewed. There are two main types of curable osteoplastic materials: bone cements and hydrogels. Compared to hydrogels, bone cements have high strength features, but their biological properties are not ideal and must be improved. Hydrogels are biocompatible and closely mimic the extracellular matrix. They can be used as cytocompatible scaffolds for tissue engineering, as can protein- and nucleic acid-activated structures. Hydrogels may be impregnated with osteoinductors such as proteins and genetic vectors without conformational changes. However, the mechanical properties of hydrogels limit their use for load-bearing bone defects. Thus, improving the strength properties of hydrogels is one of the possible strategies to achieve the basis for an ideal osteoplastic material.

Evaluation of Alveolar Ridge Height Gained by Vertical Ridge Augmentation Using Titanium Mesh and Novabone Putty in Posterior Mandible

Aim

The purpose of this case series was to report the clinical and radiographical outcomes of vertical ridge augmentation in edentulous posterior mandible using a combination of titanium mesh with novabone putty.

Material and Method

Twenty patients were included, and grafting was done using alloplastic novabone putty supported by titanium mesh as the barrier for guided bone regeneration.

Results

Sixteen patients exhibited good soft tissue healing. Postoperative flap dehiscence occurred relatively early in the healing period in one patient followed by graft extrusion and delayed healing in other three patients. The mean vertical height of augmented bone was 4.825 ± 1.1387 mm.

Conclusion

This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh and novabone putty for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely resorbed alveolar ridge.

[Biocompatibility and osteoinductive properties of collagen and fibronectin hydrogel impregnated with rhBMP-2]

The study aimed to demonstrate the biocompatibility and osteoinductive properties of a hydrogel based on highly purified collagen and fibronectin impregnated with rhBMP-2. In vitro and in vivo experiments have shown that the minimum effective dosage of rhBMP-2 is 10 μg/ml. The cytocompatibility of the collagen-fibronectin gel was determined using MTT test and staining with PKH-26. There was no inflammation reaction when the material was subcutaneously implanted in rats (n=30) in vivo. The collagen-fibronectin hydrogel containing 10 μg/ml rhBMP-2 showed high osteogenic properties. By the end of 28 days 8±4% of its volume was replaced by newly formed bone tissue in case of subcutaneous implantation, 17±10% in intramuscular implantation and 26±11% in intraosseous implantation in the calvarial critical-size. The optimal combination of biocompatible and osteogenic properties of collagen-fibronectin hydrogel impregnated with BMP-2 allows us to consider it as a promising basis for creating the new generation of osteoplastic materials for dentistry.

Alveolar bone plate measurements of maxillary anterior teeth: A retrospective Cone Beam Computed Tomography study, AlMadianh, Saudi Arabia

Purpose

To study bone profile (facial bone thickness and height of alveolar bone crest) of anterior maxillary teeth in the aesthetic area among Saudi dentulous adults.

Methods

This retrospective study was conducted at Taibah University College of Dentistry and Hospital, AlMadinah; Saudi Arabia. The analysis included 490 adult patients' Cone Beam Computed Tomography (CBCT) retrieved from Kodak Carestream-R4 database. Alveolar bone thicknesses and crest bone-height for maxillary anterior teeth were measured directly on CBCT images using built-in digital caliper. Descriptive statistics and comparative analysis were performed.

Results

Of the 490 CBCTs 186 were found useable for the study purpose. The mean age of the patients was 34.65 ± 11.57and 109 (59%) were males. Statistically significant (P < 0.001) differences were found between the mean ± SD facial plate thickness of the central incisors, lateral incisors, and canines (1.12 ± 0.28 mm, 1.14 ± 0.31 mm, and 1.03 ± 0.24 mm, respectively). In addition, facial plate height increased statistically significantly positively with age for the central incisors, lateral incisors, and canines (r = 0.543, n = 186, p = 0.001; r = 0.515, n = 186, p = 0.001; r = 0.474, n = 186, p = 0.001, respectively). Genderwise, males had statistically significantly (P < 0.00) higher facial bone thickness e.g. in central incisor (males 1.20 ± 0.29 VS females 1.04 ± 0.25, p = 0.001) and increased bone height (Males 2.62 ± 0.77VS females 2.09 ± 0.66, p = 0.001) compared to females.

Conclusion

In this study, the significant differences in bone thickness and crest height between anterior maxillary teeth in the aesthetic area was highlighted. Notably, increases in facial plate crest height was linked to age and male and female differed on both facial bone thickness and bone height.

[The prospects of hydrogels usage as a basis for curable osteoplastic materials]

The article deals with the main types of the polymers used in hydrogel preparation. Their biological, physical and chemical properties was compared. Ways of polymers hardening and prospects of medical application were considered. The prospect of use of chitosan hydrogels activated by osteoinductors as a material for bone augmentation were concluded.

Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review

Periodontal disease is categorized by the destruction of periodontal tissues. Over the years, there have been several clinical techniques and material options that been investigated for periodontal defect repair/regeneration. The development of improved biomaterials for periodontal tissue engineering has significantly improved the available treatment options and their clinical results. Bone replacement graft materials, barrier membranes, various growth factors and combination of these have been used. The available bone tissue replacement materials commonly used include autografts, allografts, xenografts and alloplasts. These graft materials mostly function as osteogenic, osteoinductive and/or osteoconductive scaffolds. Polymers (natural and synthetic) are more widely used as a barrier material in guided tissue regeneration (GTR) and guided bone regeneration (GBR) applications. They work on the principle of epithelial cell exclusion to allow periodontal ligament and alveolar bone cells to repopulate the defect before the normally faster epithelial cells. However, in an attempt to overcome complications related to the epithelial down-growth and/or collapse of the non-rigid barrier membrane and to maintain space, clinicians commonly use a combination of membranes with hard tissue grafts. This article aims to review various available natural tissues and biomaterial based bone replacement graft and membrane options used in periodontal regeneration applications.

Zinc-modified titanium surface enhances osteoblast differentiation of dental pulp stem cells in vitro

Zinc is an essential trace element that plays an important role in differentiation of osteoblasts and bone modeling. This in vitro study aimed to evaluate the osteoblast differentiation of human dental pulp stem cells (DPSCs) on zinc-modified titanium (Zn-Ti) that releases zinc ions from its surface. Based on real-time PCR, alkaline phosphatase (ALP) activity and Western blot analysis data, we investigated osteoblast differentiation of DPSCs cultured on Zn-Ti and controls. DPSCs cultured on Zn-Ti exhibited significantly up-regulated gene expression levels of osteoblast-related genes of type I collagen (Col I), bone morphogenetic protein 2 (BMP2), ALP, runt-related transcription factor 2 (Runx2), osteopontin (OPN), and vascular endothelial growth factor A (VEGF A), as compared with controls. We also investigated extracellular matrix (ECM) mineralization by Alizarin Red S (ARS) staining and found that Zn-Ti significantly promoted ECM mineralization when compared with controls. These findings suggest that the combination of Zn-Ti and DPSCs provides a novel approach for bone regeneration therapy.

Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation

Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.