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Nam JH, Almansoori AA, Kwon OJ, Seo YK, Kim B, Kim YK, Lee JH, Pang K. Sinus augmentation with poly(ε)caprolactone-β tricalcium phosphate scaffolds, mesenchymal stem cells and platelet rich plasma for one-stage dental implantation in minipigs. J Periodontal Implant Sci 2023; 53:53.e16. [PMID: 37336521 DOI: 10.5051/jpis.2300660033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 04/03/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE This study evaluated the efficacy of a tube-shaped poly(ε) caprolactone - β tricalcium phosphate (PCL-TCP) scaffold with the incorporation of human umbilical cord-derived mesenchymal stem cells (hUCMSCs) and platelet-rich plasma (PRP) for bone regeneration in the procedure of single-stage sinus augmentation and dental implantation in minipigs. METHODS Implants were placed in the bilateral sides of the maxillary sinuses of 5 minipigs and allocated to a PCL-TCP+hUCMSCs+PRP group (n=5), a PCL-TCP+PRP group (n=5), and a PCL-TCP-only group (n=6). After 12 weeks, bone regeneration was evaluated with soft X-rays, micro-computed tomography, fluorescence microscopy, and histomorphometric analysis. RESULTS Four implants failed (2 each in the PCL-TCP+hUCMSCs+PRP and PCL-TCP+hUCMSC groups). An analysis of the grayscale levels and bone-implant contact ratio showed significantly higher mean values in the PCL-TCP+hUCMSCs+PRP than in the PCL-TCP group (P=0.045 and P=0.016, respectively). In fluoromicroscopic images, new bone formation around the outer surfaces of the scaffolds was observed in the PCL-TCP+hUCMSCs+PRP group, suggesting a tenting effect of the specially designed scaffolds. Bone regeneration at the scaffold-implant interfaces was observed in all 3 groups. CONCLUSIONS Using a tube-shaped, honeycombed PCL-TCP scaffold with hUCMSCs and PRP may serve to enhance bone formation and dental implants' osseointegration in the procedure of simultaneous sinus lifting and dental implantation.
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Affiliation(s)
- Jeong-Hun Nam
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Akram Abdo Almansoori
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
- Dental Life Science Research Institute, Innovation Research & Support Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
| | - Oh-Jun Kwon
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Young-Kwon Seo
- Department of Chemical and Biochemical Engineering, College of Engineering, Dongkuk University, Seoul, Korea
| | - Bongju Kim
- Dental Life Science Research Institute, Innovation Research & Support Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
| | - Young-Kyun Kim
- Department of Oral & Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Ho Lee
- Dental Life Science Research Institute, Innovation Research & Support Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
- Oral Oncology Clinic, National Cancer Center, Ilsan, Korea
| | - KangMi Pang
- Department of Oral & Maxillofacial Surgery, Seoul National University Gwanak Dental Hospital, Seoul, Korea.
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Abstract
The lateral sinus lift procedure has been extensively investigated and described as a reliable surgical solution aimed at facilitating implant placement and rehabilitation when the posterior upper maxilla is atrophic. The standard technique consists in a lateral antrostomy, the careful raising of the sinus membrane, and following apposition of a bone substitute between the membrane and the sinus floor. The present technical note illustrates a new conservative technique enabling lateral sinus lift without the use of bone substitutes and with predictable outcomes.
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Ortega-Mejia H, Estrugo-Devesa A, Saka-Herrán C, Ayuso-Montero R, López-López J, Velasco-Ortega E. Platelet-Rich Plasma in Maxillary Sinus Augmentation: Systematic Review. MATERIALS 2020; 13:ma13030622. [PMID: 32019255 PMCID: PMC7040697 DOI: 10.3390/ma13030622] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
Background: Sinus augmentation can be performed with or without grafting biomaterials, and to date, there is no quality evidence regarding the augmentation of the sinus floor using only platelet concentrates, which can improve the healing period and enhance bone regeneration by stimulating angiogenesis and bone formation. The main objective of this paper was to assess the effect of the sole use of platelet concentrates in sinus augmentation in terms of newly formed bone, augmented bone height, and clinical outcomes and to assess the additional beneficial effects of platelet-rich fibrin (PRF) in combination with other grafting biomaterials. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pooled analyses were performed with the Review Manager software. Results: For sinus elevation only using platelet concentrates, 11 studies met the inclusion criteria and were included for qualitative synthesis. Only one study was a clinical trial, which reported improved outcomes for the allograft group compared to the titanium-PRF (T-PRF) group. A total of 12 studies where PRF was used in addition to grafting biomaterials met eligibility criteria and were included in the review. Results from meta-analyses provided no additional beneficial effects of PRF in sinus augmentation in terms of bone height and percentage of soft tissue area. There was a statistically significant lower percentage of residual bone substitute material in the PRF (+) group compared to the PRF (−) group. The percentage of newly formed bone was slightly higher in the PRF (+) group, but this was not statistically significant. Conclusion: There is no robust evidence to make firm conclusions regarding the beneficial effects of the sole use of platelet concentrates in sinus augmentation. However, studies have shown favorable outcomes regarding implant survival, bone gain, and bone height. The use of PRF with other grafting biomaterials appears to provide no additional beneficial effects in sinus lift procedures, but they may improve the healing period and bone formation. Well-conducted randomized clinical trials (RCTs) are necessary to confirm the available results to provide recommendations for the clinical practice.
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Affiliation(s)
- Holmes Ortega-Mejia
- Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain; (H.O.-M.); (C.S.-H.)
| | - Albert Estrugo-Devesa
- Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain; (A.E.-D.); (R.A.-M.)
| | - Constanza Saka-Herrán
- Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain; (H.O.-M.); (C.S.-H.)
| | - Raúl Ayuso-Montero
- Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain; (A.E.-D.); (R.A.-M.)
| | - José López-López
- Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain; (A.E.-D.); (R.A.-M.)
- Service of the Medical-Surgical Area of Dentistry Hospital, University of Barcelona, 08970 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-402-42-71; Fax: +34-93-402-42-48
| | - Eugenio Velasco-Ortega
- Department of Stomatology, Faculty of Dentistry, University of Seville, 41013 Seville, Spain
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Donos N, Dereka X, Calciolari E. The use of bioactive factors to enhance bone regeneration: A narrative review. J Clin Periodontol 2019; 46 Suppl 21:124-161. [DOI: 10.1111/jcpe.13048] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/08/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nikos Donos
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research (COCR); Institute of Dentistry, Barts & The London School of Medicine & Dentistry; Queen Mary University of London (QMUL); London UK
| | - Xanthippi Dereka
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research (COCR); Institute of Dentistry, Barts & The London School of Medicine & Dentistry; Queen Mary University of London (QMUL); London UK
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
| | - Elena Calciolari
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research (COCR); Institute of Dentistry, Barts & The London School of Medicine & Dentistry; Queen Mary University of London (QMUL); London UK
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Aghaloo TL, Tencati E, Hadaya D. Biomimetic Enhancement of Bone Graft Reconstruction. Oral Maxillofac Surg Clin North Am 2019; 31:193-205. [DOI: 10.1016/j.coms.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kolerman R, Nissan J, Rahmanov M, Calvo-Guirado JL, Green NT, Tal H. Sinus augmentation analysis of the gradient of graft consolidation: a split-mouth histomorphometric study. Clin Oral Investig 2019; 23:3397-3406. [PMID: 30617584 DOI: 10.1007/s00784-018-2793-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to histomorphometrically test the hypothesis that graft consolidation originates from the sinus floor. MATERIALS AND METHODS This prospective, randomized split-mouth study investigated patients undergoing bilateral maxillary lateral sinus floor augmentation using either freeze-dried bone allografts (FDBAs) or biphasic calcium phosphate (BCP) bone substitute. Apico-coronal core biopsies were harvested during implant placement 9 months after sinus floor augmentation, processed for histological observation, and measured histomorphometrically. RESULTS Biopsies were taken from 26 bilateral sites in 13 patients. The density of new bone (NB) decreased with increasing distance from the sinus floor. The percentage mean surface of NB ranged from 31 ± 9.5% at 2 mm from the sinus floor (G1) to 27.7 ± 11.2% at 4 mm (G2) for the FDBA specimens and from 30.0 ± 11.0% at G1 to 23.5 ± 9.9% at G2 for the BCP specimens. Evaluation of the residual graft particle (GP) area alone as a function of distance from the floor revealed a clear inverse gradient of 7.1 ± 6.6 to 9.1 ± 10.3 between G1 and G2 for the FDBA allografts, with the same tendency for the BCP alloplasts (21.9 ± 9.9 to 27.7 ± 6.6, respectively). CONCLUSION Our results support the concept that osteogenesis initiates in regions proximal to the bony walls of the maxillary sinus and may be enhanced by them. CLINICAL RELEVANCE The nature of the grafting material had a greater influence on the degree of NB formation in regions distant from the native walls where there is reduced inherent osteogenic potential.
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Affiliation(s)
- Roni Kolerman
- Department of Periodontology, the Maurice and Gabriela Goldschleger School of Dental Medicine, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Joseph Nissan
- Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marina Rahmanov
- Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - José Luis Calvo-Guirado
- Department of General and Implant Dentistry, Faculty of Medicine and Dentistry, University of Murcia, Murcia, Spain
| | - Nirit Tager Green
- Department of Periodontology, the Maurice and Gabriela Goldschleger School of Dental Medicine, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Tal
- Department of Periodontology, the Maurice and Gabriela Goldschleger School of Dental Medicine, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
Maxillary sinus augmentation through a lateral window is reported as one of the most predictable bone augmentation procedures before implant placement. The elevation of the membrane represents a delicate and crucial step that allows the creation of the space for the bone graft material. If the elevation is not completed, the regenerated bone might be inadequate for the implant placement. In this case, a new intervention will be necessary to complete the bone augmentation. Reaccessing from a lateral window, however, would be challenging due to thickness of the buccal boney wall because of the first grafting procedure; therefore, a different approach has to be used. The aim of this case report is to present the palatal window technique for treating incompletely augmented maxillary sinus. The detailed step-by-step diagnostic and surgical procedures are described, and the advantages and limitations of the technique are discussed through a review of the literature.
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Lee JW, Wen HB, Gubbi P, Romanos GE. New bone formation and trabecular bone microarchitecture of highly porous tantalum compared to titanium implant threads: A pilot canine study. Clin Oral Implants Res 2017; 29:164-174. [PMID: 28971532 PMCID: PMC6084354 DOI: 10.1111/clr.13074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 12/23/2022]
Abstract
Aim This study evaluated new bone formation activities and trabecular bone microarchitecture within the highly porous region of Trabecular Metal™ Dental Implants (TM) and between the threads of Tapered Screw‐Vent® Dental Implants (TSV) in fresh canine extraction sockets. Materials and methods Eight partially edentulated dogs received four implants (4.1 mmD × 13 mmL) bilaterally in mandibular fresh extraction sockets (32 TM, 32 TSV implants), and allowed to heal for 2, 4, 8, and 12 weeks. Calcein was administered to label mineralizing bone at 11 and 4 days before euthanasia for dogs undergoing all four healing periods. Biopsies taken at each time interval were examined histologically. Histomorphometric assay was conducted for 64 unstained and 64 stained slides at the region of interest (ROI) (6 mm long × 0.35 mm deep) in the midsections of the implants. Topographical and chemical analyses were also performed. Results Histomorphometry revealed significantly more new bone in the TM than in the TSV implants at each healing time (p = .0014, .0084, .0218, and .0251). Calcein‐labeled data showed more newly mineralized bone in the TM group than in the TSV group at 2, 8, and 12 weeks (p = .045, .028, .002, respectively) but not at 4 weeks (p = .081). Histologically TM implants exhibited more bone growth and dominant new immature woven bone at an earlier time point than TSV implants. The parameters representing trabecular bone microarchitecture corroborated faster new bone formation in the TM implants when compared to the TSV implants. TM exhibited an irregular faceted topography compared to a relatively uniform microtextured surface for TSV. Chemical analysis showed peaks associated with each implant's composition material, and TSV also showed peaks reflecting the elements of the calcium phosphate blasting media. Conclusions and clinical implications Results suggest that the healing pathway associated with the highly porous midsection of TM dental implant could enable faster and stronger secondary implant stability than conventional osseointegration alone; however, prospective clinical studies are needed to confirm these potential benefits in patients with low bone density, compromised healing, or prior implant failure.
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Affiliation(s)
| | - Hai Bo Wen
- Zimmer Biomet, Palm Beach Gardens, FL, USA
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Bone Morphogenetic Protein-7 Enhances Degradation of Osteoinductive Bioceramic Implants in an Ectopic Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1375. [PMID: 28740783 PMCID: PMC5505844 DOI: 10.1097/gox.0000000000001375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the degradation pattern of highly porous bioceramics as well as the bone formation in presence of bone morphogenetic protein 7 (BMP-7) in an ectopic site. METHODS Novel calcium phosphate ceramic cylinders sintered at 1,300°C with a total porosity of 92-94 vol%, 45 pores per inch, and sized 15 mm (Ø) × 5 mm were grafted on the musculus latissimus dorsi bilaterally in 10 Göttingen minipigs: group I (n = 5): hydroxyapatite (HA) versus biphasic calcium phosphate (BCP), a mixture of HA and tricalcium phosphate (TCP) in a ratio of 60/40 wt%; group II (n = 5): TCP versus BCP. A test side was supplied in situ with 250 μg BMP-7. Fluorochrome bone labeling and computed tomography were performed in vivo. Specimens were evaluated 14 weeks after surgery by environmental scanning electron microscopy, fluorescence microscopy, tartrate-resistant acid phosphatase, and pentachrome staining. RESULTS Bone formation was enhanced in the presence of BMP-7 in all ceramics (P = 0.001). Small spots of newly formed bone were observed in all implants in the absence of BMP-7. Degradation of HA and BCP was enhanced in the presence of BMP-7 (P = 0.001). In those ceramics, osteoclasts were observed. TCP ceramics were almost completely degraded independently of the effect of BMP-7 after 14 weeks (P = 0.76), osteoclasts were not observed. CONCLUSIONS BMP-7 enhanced bone formation and degradation of HA and BCP ceramics via osteoclast resorption. TCP degraded via dissolution. All ceramics were osteoinductive. Novel degradable HA and BCP ceramics in the presence of BMP-7 are promising bone substitutes in the growing individual.
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Arnalich F, Rodriguez AE, Luque-Rio A, Alio JL. Solid Platelet Rich Plasma in Corneal Surgery. Ophthalmol Ther 2016; 5:31-45. [PMID: 27179661 PMCID: PMC4909678 DOI: 10.1007/s40123-016-0051-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 02/07/2023] Open
Abstract
Abstract Solid eye platelet-rich plasma (E-PRP) concentrates platelets in a small volume of plasma which contains a high concentration of important growth factors and cell adhesion molecules. These cell adhesion molecules and growth factors occupy a major role in wound healing and enhance the physiological procedure at the site of the injury or the surgery. There are different materials used to tectonically maintain the solid clot attached at the site where treatment is necessary. Although AM may be used for this purpose, other biomaterials such a bovine pericardium or autologous fibrin membrane are at least as effective with less interdonor variations, no biological hazards, providing a better surgical alternative than the biologically so variable amniotic membrane patch. Solid platelet-rich plasma in the form obtained in ophthalmology, E-PRP, is a reliable and effective surgical coadjuvant to promote corneal wound healing in severe corneal ulcers and corneal perforations, and may be associated with other ocular surface reconstruction procedures. Funding Supported in part by a grant from the Spanish Ministry of Science and Innovation, Centro para el Desarrollo Tecnológico Industrial (CDTI), CENIT: “Customized Eye Care”, CeyeC (CEN-20091021).
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Affiliation(s)
| | | | | | - Jorge L Alio
- Department of Cornea and Refractive Surgery, VISSUM, Alicante, Spain. .,School of Medicine, Miguel Hernandez University, Alicante, Spain.
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Abstract
Forty years ago Marshal R. Urist discovered a substance in bone matrix that had inductive properties for the development of bone and cartilage, until date, at least 20 bone morphogenetic proteins (BMPs) have been identified, some of which have been shown in vitro to stimulate the process of stem cell differentiation into osteoblasts in human and animal models. The purpose of this paper is to give a brief overview of BMPs and to review critically the clinical data currently available on the use of BMPs in various periodontal applications. The literature on BMPs was reviewed. A comprehensive search was designed. The articles were independently screened for eligibility. Articles with authentic controls and proper randomization and pertaining specifically to their role in periodontal applications were included. The available literature was analyzed and compiled. The analysis indicates BMPs to be a promising, as well as an effective novel approach to reconstruct and engineer the periodontal apparatus. Here, we represent several articles, as well as recent texts that make up a special and an in-depth review on the subject. On the basis of the data provided in the studies that were reviewed BMPs provide revolutionary therapies in periodontal practice.
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Affiliation(s)
- Supreet Kaur
- Department of Periodontics, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India
| | - Vishakha Grover
- Department of Periodontics, National Dental College and Hospital, Dera Bassi, Punjab, India
| | - Harkiran Kaur
- Department of Periodontics, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India
| | - Ranjan Malhotra
- Department of Periodontics, National Dental College and Hospital, Dera Bassi, Punjab, India
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Lemos CAA, Mello CC, dos Santos DM, Verri FR, Goiato MC, Pellizzer EP. Effects of platelet-rich plasma in association with bone grafts in maxillary sinus augmentation: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 45:517-25. [PMID: 26775635 DOI: 10.1016/j.ijom.2015.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/06/2015] [Accepted: 07/15/2015] [Indexed: 01/13/2023]
Abstract
This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A comprehensive review of articles listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases covering the period January 2000 to January 2015 was performed. The meta-analysis was based on bone formation for which the mean difference (MD, in millimetres) was calculated. Implant survival was assessed as a dichotomous outcome and evaluated using the risk ratio (RR) with 95% confidence interval (CI). The search identified 3303 references. After inclusion and exclusion criteria were applied, 17 studies were selected for qualitative analysis and 13 for quantitative analysis. A total of 369 patients (mean age 51.67 years) and 621 maxillary sinus augmentations were evaluated. After the data analysis, additional analyses were performed of the implant stability quotient, marginal bone loss, and alveolar bone height measured by MD. The results showed no significant difference in implant stability (P=0.32, MD 1.00, 95% CI -0.98 to 2.98), marginal bone loss (P=0.31, MD 0.06, 95% CI -0.05 to 0.16), alveolar bone height (P=0.10, MD -0.72, 95% CI -1.59 to 0.14), implant survival (P=0.22, RR 1.95, 95% CI 0.67-5.69), or bone formation (P=0.81, MD -0.63, 95% CI -5.91 to 4.65). In conclusion, the meta-analysis indicates no influence of PRP with bone graft on bone formation and implant survival in maxillary sinus augmentation.
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Affiliation(s)
- C A A Lemos
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - C C Mello
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - D M dos Santos
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - F R Verri
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - M C Goiato
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - E P Pellizzer
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil.
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Ayranci F, Gungormus M, Omezli MM, Gundogdu B. The Effect of Alendronate on Various Graft Materials Used in Maxillary Sinus Augmentation: A Rabbit Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e33569. [PMID: 26756022 PMCID: PMC4706848 DOI: 10.5812/ircmj.33569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022]
Abstract
Background: Increasing sinus pneumatization and the accompanying alveolar bone resorption complicate dental implant placement. This problem can be overcome today by raising the maxillary sinus floor with graft materials. Bisphosphonates are commonly used to accelerate the recovery of the graft materials and to prevent resorption. Objectives: The purpose of this study is to investigate whether systemic administration of a bisphosphonate (alendronate) would improve new bone formation and reduce fibrous tissue formation over a 6-week follow-up in rabbits treated with two different grafting materials for maxillary sinus floor augmentation. Materials and Methods: This experimental animal study was conducted at the Experimental Medical Application and Research Center at Erzurum/ Turkey. Twelve New Zealand rabbits, each weighing between 2.7 and 3.3 kg, were used. Twenty-four maxillary sinus floor elevation operations were performed, two on each animal (n = 24). Each elevation was repaired with either deproteinized bovine bone (xenograft) or autogenous bone graft obtained from the iliac crest. Both groups were divided into 2 subgroups: saline-treated and alendronate-treated. All groups underwent the same surgical procedures and evaluation, and were sacrificed at the 6th postoperative week. Sinuses augmented with deproteinized bovine bone (xenograft) and autogenous bone graft were examined histopathologically and histomorphometrically. Results: At 6 weeks, the bone area was significantly larger in the Xenograft-Alendronate group (33.0% ± 5.0%) than in the Xenograft-Saline group (20.8% ± 4.9%) and the bone area was significantly larger in the Autogenous-Alendronate group (43.3% ± 3.8%) than in the Autogenous-Saline group (37.5% ± 6.6%) (P = 0.001). The histomorphometric and histopathological results consistently showed that alendronate stimulated bone formation and reduced fibrous tissue formation in maxillary sinus augmentation grafts, especially in the deproteinized bovine bone group (xenograft). Conclusions: Alendronate may be considered a therapeutic option for improving the bone formation process and reducing resorption in different bone grafting procedures. Further detailed studies should focus on dosage and time-dependent effects of alendronate on bone remodeling.
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Affiliation(s)
- Ferhat Ayranci
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
- Corresponding Author: Ferhat Ayranci, Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Ordu University, 52200, Ordu, Turkey. Tel: +90-4522125005, Fax: +90-4522121289, E-mail:
| | - Metin Gungormus
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Melih Omezli
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
| | - Betul Gundogdu
- Department of Pathology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Wagner F, Dvorak G, Pillerstorff R, Traxler H, Nemec S, Pietschmann P, Seemann R. Anatomical preconditions for the palatal sinus floor augmentation—A three-dimensional feasibility study. J Craniomaxillofac Surg 2015; 43:1303-8. [PMID: 26169998 DOI: 10.1016/j.jcms.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/26/2015] [Accepted: 06/08/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the anatomical feasibility of palatal sinus floor augmentation. MATERIAL AND METHODS In 100 men and 100 women, both sinuses were analyzed using computed tomography. The patients were divided into four anatomical groups according to the remaining alveolar bone height: group 1 (0 ≤ × < 4), group 2 (4 ≤ × < 8), group 3 (8 ≤ × < 12), and group 4 (≥12). RESULTS The 400 maxillary sinuses consisted of 23.5% (n = 94) group 1, 42.75% (n = 171) group 2, 23.5% (n = 98) group 3, and 9.25% (n = 37) group 4 sinuses. Optimal anatomical preconditions for palatal sinus floor augmentations (i.e., ≥5 mm height and <5 mm thickness of the window lid) were found in 93.6% of group 1 sinuses, 73.7% of group 2 sinuses, 23.5% of group 3 sinuses, and 5.4% of group 4 sinuses. CONCLUSION The palatal approach is feasible in 93.6% of patients with remnant alveolar height of up to 4 mm. Limitations are alveolar heights of ≤5 mm as well as great palatal thickness and thus limited dimensions for a possible palatal window.
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Affiliation(s)
- F Wagner
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University Vienna, Austria
| | - G Dvorak
- Bernhard Gottlieb Dental University Clinic, Medical University Vienna, Austria.
| | - R Pillerstorff
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University Vienna, Austria
| | - H Traxler
- Department for Systematic Anatomy, Medical University Vienna, Austria
| | - S Nemec
- University Clinic for Radiology, Medical University Vienna, Austria
| | - P Pietschmann
- Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
| | - R Seemann
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University Vienna, Austria
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Kyllar M, Štembírek J, Danek Z, Hodan R, Stránský J, Machoň V, Foltán R. A porcine model: surgical anatomy of the orbit for maxillofacial surgery. Lab Anim 2015; 50:125-36. [PMID: 25925960 DOI: 10.1177/0023677215577923] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to its similarity to humans, the pig has proven to be a suitable biomodel for both research purposes and for training medical professionals, particularly in surgical specializations. For example, new implant materials have been tested on pig jaws and pigs have also been used in the development of new surgical techniques. For optimizing the effectiveness of such research or training, detailed data on the anatomy of their particular features are needed. At present, however, only limited information related to surgical and imaging anatomy of the facial and orbital areas of the pig and its comparison to human structures from the experimental surgery point of view is available in the literature. The aim of this study was to obtain such data and to compare the morphological structures of the porcine and human orbital regions and to lay down the foundation for practical use in experimental surgery. Ten pig heads were examined using computed tomography (CT) and magnetic resonance imaging (MRI) and, subsequently, a dissection of the orbit was carried out. Attention was focused on the structure of the orbit (floor, rim and nerves) frequently affected by pathological processes in humans (such as trauma, infection or tumours) and which consequently are frequently the subject of maxillofacial surgery. The porcine orbit is suitable for use in experimental medicine. However, if used in experiments, its anatomical peculiarities must be taken into consideration. Our study presents a foundation of basic knowledge for researchers who plan to use the pig as a biomedical model to investigate alternative treatments in the head region.
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Affiliation(s)
- Michal Kyllar
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic Companion Care Animal Surgery, Broadstairs, Kent, UK
| | - Jan Štembírek
- Institute of Animal Physiology and Genetics, V.v.i., Academy of Sciences of Czech Republic, Brno, Czech Republic Department of Oral and Maxillofacial Surgery, University Hospital, Ostrava, Ostrava-Poruba, Czech Republic
| | - Zdenek Danek
- Department of Oral and Maxillofacial Surgery, University Hospital Brno, Brno, Czech Republic
| | - Radek Hodan
- Department of Oral and Maxillofacial Surgery, University Hospital, Ostrava, Ostrava-Poruba, Czech Republic
| | - Jiří Stránský
- Department of Oral and Maxillofacial Surgery, University Hospital, Ostrava, Ostrava-Poruba, Czech Republic
| | - Vladimír Machoň
- Department of Oral and Maxillofacial Surgery, University Hospital Prague, Prague, Czech Republic
| | - René Foltán
- Department of Oral and Maxillofacial Surgery, University Hospital Prague, Prague, Czech Republic
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Brockmeyer P, Lange K, Hahn W, Schliephake H, Matthias Gruber R. Increase of homogenous new bone formation using osteoinductive factor rhGDF-5 during sinus floor augmentation in Goettingen Minipigs. Clin Oral Implants Res 2014; 26:1321-7. [PMID: 25039481 DOI: 10.1111/clr.12457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that recombinant human growth and differentiation factor-5 (rhGDF-5) induces an increased and homogenous distribution of new bone formation across the entire volume of sinus floor augmentation in 12 Goettingen Minipigs. MATERIAL AND METHODS In a randomized split-mouth design, one maxillary sinus was augmented with the bone substitute β-TCP, whereas a combination of β-TCP and the osteoinductive growth factor rhGDF-5 was used on the contralateral side. To evaluate the influence of dose and time on the effectiveness of the factor, two different concentrations of rhGDF-5 (400 μg and 800 μg) and healing periods (4 and 12 weeks) were each analysed. RESULTS After 4 weeks, a homogenous gradient of bone formation could be observed for all dosage groups, with decreasing bone density from the local bone towards the sinus membrane. Both test groups, however, achieved a higher total level of bone formation compared with the control group, which was only significant in the low-dose group (P = 0.0184). After 12 weeks, the influence of the growth factor significantly depends on the region (P = 0.023). In the low-dose group, the new bone formation did not differ significantly within the examined regions of the graft (P = 0.1118), suggesting a homogeneous bone formation over the entire augmentation. The gradient of the high-dose group was similar to the control group with a decrease of local bone development. CONCLUSIONS rhGDF-5 delivered on a β-TCP scaffold material leads to an increase in homogeneous new bone formation across the entire volume of the sinus floor augmentation.
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Affiliation(s)
- Phillipp Brockmeyer
- Department of Oral and Maxillofacial Surgery, University of Goettingen, Goettingen, Germany
| | - Katharina Lange
- Department of Medical Statistics, University of Goettingen, Goettingen, Germany
| | | | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University of Goettingen, Goettingen, Germany
| | - Rudolf Matthias Gruber
- Department of Oral and Maxillofacial Surgery, University of Goettingen, Goettingen, Germany
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Catros S, Molenberg A, Freilich M, Dard M. Evaluation of a Polyethylene Glycol-Osteogenic Protein-1 System on Alveolar Bone Regeneration in the Mini-Pig. J ORAL IMPLANTOL 2014; 41:e96-e101. [PMID: 24673473 DOI: 10.1563/aaid-joi-d-13-00307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Alveolar bone regeneration associated with the local release of osteogenic protein-1 (OP-1) from a polyethylene glycol (PEG) scaffold was evaluated in 14 mini-pigs. Following extraction of mandibular teeth and 26-weeks of healing time, standardized bone defects were created bilaterally in the posterior mandibles (3 sites for each hemimandible) that were randomly assigned to treatment groups. Seven treatments groups were compared: 4 different concentrations of the PEG/OP-1 test system (n = 14 for each), a positive control (collagen/OP-1, n = 14), a negative control (PEG only, n = 7) and nontreated defects (n = 7). Each animal provided all test and control groups. The animals were sacrificed after 3 weeks of healing and samples were processed for histology and histomorphometry. Three weeks after implantation, there were positive clinical responses for all test groups. Earlier bone maturation was observed in the test groups that had higher concentrations of OP-1 (0.25, 0.5, or 1 mg/mL) compared to the negative control group (PEG alone), the low concentration group (0.1 mg/mL), and the positive control group (collagen/OP-1). However, histomorphometric quantitative analyses did not reveal any statistical difference between any of the groups. No residual PEG biomaterial or inflammatory responses to the biomaterial or growth factor were observed. This study confirmed the safe local delivery of OP-1 from PEG hydrogel. Alveolar bone regeneration was not statistically different between tests groups, negative control (PEG alone) or commercial positive control (collagen/OP-1). The semi-quantitative analysis, however, showed a trend in favor of the higher concentrations of OP-1 to induce faster bone maturation.
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Affiliation(s)
- Sylvain Catros
- 1 Inserm U1026, BioTis, Bordeaux Segalen University, Bordeaux, France.,2 CHU de Bordeaux, Pôle d'Odontologie et de Santé Buccale, Bordeaux, France
| | | | - Martin Freilich
- 4 Department of Reconstructive Sciences, Center for Biomaterials, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Michel Dard
- 3 Institut Straumann AG, Basel, Switzerland.,5 Department of Periodontology and Implant dentistry, College of Dentistry, New York University, New York, NY
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Mardas N, Dereka X, Donos N, Dard M. Experimental Model for Bone Regeneration in Oral and Cranio-Maxillo-Facial Surgery. J INVEST SURG 2013; 27:32-49. [DOI: 10.3109/08941939.2013.817628] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Seemann R, Wagner F, Ewers R, Ulm C. Palatal Sinus Elevation Revisited: A Technical Note. J Oral Maxillofac Surg 2013; 71:1347-52. [DOI: 10.1016/j.joms.2013.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/25/2013] [Accepted: 04/19/2013] [Indexed: 11/25/2022]
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20
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Jensen SS, Aaboe M, Janner SFM, Saulacic N, Bornstein MM, Bosshardt DD, Buser D. Influence of Particle Size of Deproteinized Bovine Bone Mineral on New Bone Formation and Implant Stability after Simultaneous Sinus Floor Elevation: A Histomorphometric Study in Minipigs. Clin Implant Dent Relat Res 2013; 17:274-85. [DOI: 10.1111/cid.12101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Simon S. Jensen
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Oral and Maxillofacial Surgery; Copenhagen University Hospital (Rigshospitalet); Copenhagen Denmark
| | - Merete Aaboe
- Department of Oral and Maxillofacial Surgery and Oral Pathology; School of Dentistry, Health, Aarhus University; Aarhus Denmark
| | - Simone F. M. Janner
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Nikola Saulacic
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Cranio-Maxillofacial Surgery; Bern University Hospital; Bern Switzerland
| | - Michael M. Bornstein
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Dieter D. Bosshardt
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
- Robert K. Schenk Laboratory of Oral Histology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Daniel Buser
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
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Gassling V, Purcz N, Braesen JH, Will M, Gierloff M, Behrens E, Açil Y, Wiltfang J. Comparison of two different absorbable membranes for the coverage of lateral osteotomy sites in maxillary sinus augmentation: a preliminary study. J Craniomaxillofac Surg 2012; 41:76-82. [PMID: 23218506 DOI: 10.1016/j.jcms.2012.10.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 10/24/2012] [Accepted: 10/26/2012] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Barrier membranes, both absorbable and non-absorbable, have been used in sinus augmentation for many years. Some years ago, a new autologous blood substrate called Platelet-Rich-Fibrin (PRF) was introduced, and to date, the supporting effect on bone regeneration has been controversial. This study aimed to evaluate the effect of PRF on bone regeneration when used as a barrier membrane at the lateral osteotomy site in sinus augmentation. MATERIAL AND METHODS Twelve sinuses from six patients requiring bilateral sinus floor augmentation were treated with a two-stage surgical technique using sinus augmentation and implant placement after 5 months. The sinuses were grafted with autologous bone and bone-substitute material (Bio-Oss(®)) mixed in a 1:1 ratio and were covered in a randomized split-mouth design with a PRF or a conventional collagen membrane (Bio-Gide(®)), respectively. Five months later threaded titanium dental implants were inserted and bone specimens harvested with a trephine burr were evaluated histomorphometrically. RESULTS Bone quality seemed to be equal at both sites of the grafted sinuses. Mean vital bone formation after 5 months was 17.0% and 17.2%, for the PRF and collagen sites, respectively. The mean of residual bone-substitute was 15.9% and 17.3% for PRF and collagen, respectively. No local complications, such as dehiscences or membrane exposures, were detected at either site in any of the treated patients. After 12 months all implants reached primary stability in the augmented maxillary sinus floor without any peri-implant tissue inflammation. CONCLUSIONS Within the limits of the study the coverage of the lateral sinus window with two different absorbable membranes has been shown to result in a similar amount of vital bone formation and residual bone-substitute.
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Affiliation(s)
- Volker Gassling
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Thoma DS, Martin IS, Mühlemann S, Jung RE. Systematic review of pre-clinical models assessing implant integration in locally compromised sites and/or systemically compromised animals. J Clin Periodontol 2012; 39 Suppl 12:37-62. [PMID: 22533946 DOI: 10.1111/j.1600-051x.2011.01833.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim was to systematically search the dental literature for pre-clinical models assessing implant integration in locally compromised sites (part 1) and systemically compromised animals (part 2), and to evaluate the quality of reporting of included publications. METHODS A Medline search (1966-2011) was performed, complimented by additional hand searching. The quality of reporting of the included publications was evaluated using the 20 items of the ARRIVE (Animals in Research In Vivo Experiments) guidelines. RESULTS One-hundred and seventy-six (part 1; mean ARRIVE score = 15.6 ± 2.4) and 104 (part 2; 16.2 ± 1.9) studies met the inclusion criteria. The overall mean score for all included studies amounted to 15.8 ± 2.2. Housing (38.3%), allocation of animals (37.9%), numbers analysed (50%) and adverse events (51.4%) of the ARRIVE guidelines were the least reported. Statistically significant differences in mean ARRIVE scores were found depending on the publication date (p < 0.05), with the highest score of 16.7 ± 1.6 for studies published within the last 2 years. CONCLUSIONS A large number of studies met the inclusion criteria. The ARRIVE scores revealed heterogeneity and missing information for selected items in more than 50% of the publications. The quality of reporting shifted towards better-reported pre-clinical trials within recent years.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
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Jhaveri-Desai H, Khetarpal S. Tissue Engineering in Regenerative Dental Therapy. JOURNAL OF HEALTHCARE ENGINEERING 2011. [DOI: 10.1260/2040-2295.2.4.405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Stavropoulos A, Becker J, Capsius B, Açil Y, Wagner W, Terheyden H. Histological evaluation of maxillary sinus floor augmentation with recombinant human growth and differentiation factor-5-coated β-tricalcium phosphate: results of a multicenter randomized clinical trial. J Clin Periodontol 2011; 38:966-74. [DOI: 10.1111/j.1600-051x.2011.01754.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cabbar F, Güler N, Kürkcü M, Işeri U, Sençift K. The effect of bovine bone graft with or without platelet-rich plasma on maxillary sinus floor augmentation. J Oral Maxillofac Surg 2011; 69:2537-47. [PMID: 21798642 DOI: 10.1016/j.joms.2011.03.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 03/15/2011] [Accepted: 03/30/2011] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to compare Unilab Surgibone (USB) (Mississauga, Ontario, Canada), a bone xenograft (bovine), with platelet-rich plasma (PRP) and USB without PRP to augment the human maxillary sinus in preparation to receive dental implants. PATIENTS AND METHODS Patients who had bilateral pneumatized maxillary sinuses were included. Sinuses on one side were augmented with the USB-PRP combination and formed the study group, whereas the opposite-side sinuses were augmented with USB alone and served as controls. Bone biopsy specimens were taken during implant placement at 6.8 ± 0.9 months after maxillary sinus floor augmentation. Resonance frequency analysis measurements were performed at implant placement (first control) and before the prosthetic stage (second control), at 6.5 ± 0.7 months after implant surgery. RESULTS There were 10 patients (7 men and 3 women; mean age, 53.7 ± 0.8 years). Integration between new bone and residual grafts was histologically observed in all samples. The volumes of soft tissue were 59.9% ± 7.5% and 57.8% ± 4.4% in the control and study groups, respectively; residual graft, 21.9% ± 6.6% and 23.6% ± 5.9%, respectively; new bone, 15.8% ± 4.8% and 16.0% ± 3.8%, respectively; and trabecular bone, 64.7% ± 22.5% and 69.1% ± 18.6%, respectively. A positive correlation was found between new bone volume and trabecular bone volume (P = .0001). The mean Implant Stability Quotient (ISQ) values were 71.7 ± 4.9 and 70.3 ± 5.7 in the control and study groups, respectively, at first control and 75.4 ± 6.4 and 74.4 ± 6.4, respectively, at second control. The mean ISQ values at second control in both groups were significantly higher than at first control (P = .043 and P = .028, respectively). No statistically significant differences were observed between groups (P > .05). CONCLUSION The combination of USB and PRP does not have any effect on new bone formation and implant stabilization.
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Affiliation(s)
- Fatih Cabbar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Stelzle F, Benner KU. An animal model for sinus floor elevation with great elevation heights. Macroscopic, microscopic, radiological and micro-CT analysis: ex vivo. Clin Oral Implants Res 2011; 21:1370-8. [PMID: 20497438 DOI: 10.1111/j.1600-0501.2010.01958.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Different animal models are used for research and training concerning sinus floor elevation. However, there is little information regarding an animal model for elevation heights of approximately 10 mm. The aim of this study was to explore the anatomical aspects of the maxillary sinus of adult pigs and to investigate the suitability of this animal as a model for sinus floor elevation training and research with great elevation heights. MATERIAL AND METHODS Thirty-four bisected heads of adult domestic pigs were examined 6 h postmortem. Direct sinus floor elevation was performed with an elevation height of 10 mm. Localization, diameters, volume and septa of the maxillary sinus were recorded on lateral X-rays and macroscopically. The thickness and structure of the maxillary sinus were investigated microscopically. The osseous microstructure of the lateral sinus wall was assessed microscopically and via micro-CT. RESULTS The maxillary sinus of the adult pig exhibits an average length of 51±6.2 mm, a height of 31±4.1 mm, a width of 19±1.6 mm and a volume of 31±7.6 cm(3) . At least one septum could be observed on the floor of each sinus. The mucosal thickness amounted to a mean of 1692±138 μm, and the lateral bony wall of the sinus to a mean of 3±0.3 mm. A laceration of the Schneiderian membrane occurred in 25% during the elevation process. CONCLUSION The maxillary sinus of adult domestic pigs is a suitable model for sinus floor elevation training and research with greater elevation heights of up to 10 mm.
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Affiliation(s)
- Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Erlangen, Germany.
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Wang L, Zou D, Zhang S, Zhao J, Pan K, Huang Y. Repair of bone defects around dental implants with bone morphogenetic protein/fibroblast growth factor-loaded porous calcium phosphate cement: a pilot study in a canine model. Clin Oral Implants Res 2011; 22:173-81. [DOI: 10.1111/j.1600-0501.2010.01976.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Lee KS, Kwon YH, Herr Y, Shin SI, Lee JY, Chung JH. Incomplete bone formation after sinus augmentation: A case report on radiological findings by computerized tomography at follow-up. J Periodontal Implant Sci 2010; 40:283-8. [PMID: 21246019 PMCID: PMC3021169 DOI: 10.5051/jpis.2010.40.6.283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 10/12/2010] [Indexed: 11/22/2022] Open
Abstract
Purpose The aim of this case report is to present a case of incomplete bone formation after sinus augmentation. Methods A patient having alveolar bone resorption of the maxillary posterior edentulous region and advanced pneumatization of the maxillary sinus was treated with sinus elevation using deproteinized bovine bone in the Department of Periodontology, Kyung Hee University School of Dentistry and re-evaluated with computed tomography (CT) follow-up. Results Even though there were no significant findings or abnormal radiolucency on the panoramic radiograph, incomplete bone formation in the central portion of the augmented sinus was found fortuitously in the CT scan. The CT scan revealed peri-implant radiolucency in the apical portion of the implant placed in the augmented maxillary sinus. Nevertheless, the dental implants placed in the grafted sinus still functioned well at over 15 months follow-up. Conclusions The result of this case suggests that patients who received maxillary sinus augmentation may experience incomplete bone formation. It is possible that 1) osteoconductive graft material with poor osteogenic potential, 2) overpacking of graft material that restricts the blood supply, and 3) bone microbial contamination may cause the appearance of incomplete bone formation after sinus augmentation. Further studies are needed to elucidate the mechanism of this unexpected result and care must be taken to prevent it.
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Affiliation(s)
- Kyung-Shil Lee
- Department of Periodontology, Kyung Hee University School of Dentistry, Seoul, Korea
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Quantifying migration and polarization of murine mesenchymal stem cells on different bone substitutes by confocal laser scanning microscopy. J Craniomaxillofac Surg 2010; 38:580-8. [DOI: 10.1016/j.jcms.2010.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 11/21/2022] Open
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Huang S, Wang Z. Influence of platelet-rich plasma on proliferation and osteogenic differentiation of skeletal muscle satellite cells: an in vitro study. ACTA ACUST UNITED AC 2010; 110:453-62. [PMID: 20452253 DOI: 10.1016/j.tripleo.2010.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 01/22/2010] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Platelet-rich plasma (PRP) is a new application of tissue engineering and a developing area for researchers and clinicians. The aim of this study was to assess the effect of PRP on the proliferation and osteogenic differentiation of skeletal muscle satellite cell (MSC) population and the ability of PRP to induce the production of some osteogeneic-related factors in vitro. STUDY DESIGN The PRP was obtained from Sprague-Dawley rats using 2 centrifugation techniques. Primary cultures of rat MSCs were exposed to various concentrations of PRP (0.16 × 10(8), 0.625 × 10(8), and 2.5 × 10(8) thrombocytes/carrier) on MSC proliferation using an MTT proliferation assay. Alkaline phosphatase (ALP) activity, Alizarin red S (AR) staining, calcium analyses and real-time reverse-transcription polymerase chain reaction (RT-PCR) of osteogenic-related genes were performed to study the effect of PRP on osteogenic differentiation of cultured MSCs population. RESULTS The platelet concentration and growth factors (GFs) in our PRP preparations were significantly higher than in the whole blood. PRP showed a dose-dependent stimulation of cell proliferation. The maximum effect was achieved with a concentration of 0.625 × 10(8) thrombocytes/carrier. ALP activity, AR staining, and calcium analyses showed enhanced cell osteogenic differentiation in the PRP group. The real-time RT-PCR results showed that PRP up-regulated osteocalcin at day 14 and type I collagen and osteopontin at day 7 compared with the control group. CONCLUSIONS The results of this study suggest that PRP containing osteoinductive GFs stimulates cell proliferation and osteogenic differentiation of rat-derived MSCs in vitro.
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Affiliation(s)
- Shengyun Huang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Tongji University, Shanghai, China
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Susin C, Qahash M, Polimeni G, Lu PH, Prasad HS, Rohrer MD, Hall J, Wikesjö UME. Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-7 (rhBMP-7/rhOP-1): histological observations. J Clin Periodontol 2010; 37:574-81. [PMID: 20345394 DOI: 10.1111/j.1600-051x.2010.01554.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pre-clinical studies have shown that recombinant human bone morphogenetic protein-2 (rhBMP-2) coated onto purpose-designed titanium porous-oxide surface implants induces clinically relevant bone formation and osseointegration. The objective of this study was to examine the potential of rhBMP-7, also known as recombinant human osteogenic protein-1 (rhOP-1), coated onto titanium porous-oxide surface implants to support vertical alveolar ridge augmentation and implant osseointegration. MATERIALS AND METHODS Bilateral, critical-size, 5 mm, supraalveolar peri-implant defects were created in six young adult Hound Labrador mongrel dogs. The animals received implants coated with rhBMP-7 at 1.5 or 3.0 mg/ml randomized to contra-lateral jaw quadrants. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at 3, 4, 7, and 8 weeks post-surgery when they were euthanized for histological evaluation. RESULTS Without striking differences between treatments, the implant sites exhibited a swelling that gradually regressed to become hard to palpation disguising the implant contours. The histological evaluation showed robust bone formation; the newly formed bone assuming characteristics of the contiguous resident bone, bone formation (height and area) averaging 4.1+/-1.0 versus 3.6+/-1.7 mm and 3.6+/-1.9 versus 3.1+/-1.8 mm(2); and bone density 56%versus 50% for implants coated with rhBMP-7 at 1.5 and 3.0 mg/ml, respectively. Both treatments exhibited clinically relevant osseointegration, the corresponding bone-implant contact values averaging 51% and 47%. Notable peri-implant resident bone remodelling was observed for implants coated with rhBMP-7 at 3.0 mg/ml. CONCLUSIONS rhBMP-7 coated onto titanium porous-oxide surface implants induces clinically relevant local bone formation including osseointegration and vertical augmentation of the alveolar ridge, the higher concentration/dose associated with some local side effects.
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Affiliation(s)
- Cristiano Susin
- Medical College of Georgia School of Dentistry, Augusta, GA, USA.
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Abstract
Bone morphogenetic proteins (BMPs) have shown osteoinductive properties, and favorable regenerative responses to the graft materials containing BMPs have been reported. Maxillary sinus augmentation with placement of dental implants is a well-established technique for functional and aesthetic dental rehabilitation of partially or completely edentulous patients with severe maxillary atrophy, and attempts have been made to promote the bone formation using BMPs with different carriers in various animal models in sinus augmentation procedures.In this review, the summary was done on various carriers and the dosages for BMPs in sinus augmentation procedures.
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Busenlechner D, Huber CD, Vasak C, Dobsak A, Gruber R, Watzek G. Sinus augmentation analysis revised: the gradient of graft consolidation. Clin Oral Implants Res 2009; 20:1078-83. [DOI: 10.1111/j.1600-0501.2009.01733.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Hamdan AAS, Loty S, Isaac J, Bouchard P, Berdal A, Sautier JM. Platelet-poor plasma stimulates the proliferation but inhibits the differentiation of rat osteoblastic cells in vitro. Clin Oral Implants Res 2009; 20:616-23. [PMID: 19515037 DOI: 10.1111/j.1600-0501.2008.01687.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Recent studies have shown that the use of platelet preparations in bone and implant surgery might stimulate bone formation. However, the biological mechanisms are not well understood. Moreover, few studies have attempted to evaluate the effect of platelet-poor plasma (PPP), which is a product of the platelet-rich plasma preparation process. OBJECTIVE Thus, this study investigated the behavior of osteoblasts isolated from fetal rat calvaria cultivated in the presence of homologous PPP. MATERIAL AND METHODS PPP was obtained by centrifugation of the rat mother's blood and used in replacement of fetal calf serum, which is classically used in primary culture procedures. Proliferation was measured by an MTT assay at 24, 48, and 72 h. Real-time PCR was performed to study the expression of Runx2, Dlx5, and osteocalcin (OC) on days 0 (4 h), 1, 3, 7, and 12. RESULTS Alkaline phosphatase (ALP) biochemical activity was evaluated on days 0 (4 h), 1, 3, 7, and 12. Observations by phase-contrast microscopy showed that osteoblasts were able to differentiate until the mineralization of the matrix in the presence of PPP. PPP enhanced the proliferation significantly compared with the control group (P< or =0.001). PCR results showed that Runx2, Dlx5, and OC were expressed by cells in the experimental group at lower levels compared with the control group. Biochemical assay of ALP showed a lower activity in the experimental group compared with the control group (P<0.001). CONCLUSION These results suggest that, in the presence of homologous PPP, rat osteoblastic cells are able to maintain their phenotype, with a higher rate of proliferation. However, PPP seems to inhibit osteoblastic differentiation.
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Bertoldi C, Pinti M, Zaffe D, Cossarizza A, Consolo U, Ceccherelli GB. Morphologic, histochemical, and functional analysis of platelet-rich plasma activity on skeletal cultured cells. Transfusion 2009; 49:1728-37. [DOI: 10.1111/j.1537-2995.2009.02190.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Estaca E, Cabezas J, Usón J, Sánchez-Margallo F, Morell E, Latorre R. Maxillary sinus-floor elevation: an animal model. Clin Oral Implants Res 2009; 19:1044-8. [PMID: 18828821 DOI: 10.1111/j.1600-0501.2008.01557.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To find an animal model for modified Caldwell-Luc procedure training. The animal model should have (1) a proper cortical thickness in the lateral wall; (2) a similar morphology and resistance of the Schneiderian membrane in humans; and, finally, (3) an oral approach. MATERIALS AND METHODS Twelve fresh heads (four Merino sheep, four Murciano-Granadina goats and four Large-White pigs). Two skulls from each of these species were also used. Several three-dimensional imagings from the skulls of each species were acquired using a C-arm. Two fresh heads of each species were used to perform the modified Caldwell-Luc procedure. Two fresh heads of each species were firstly frozen at -30 degrees C for 48 h and then sawed in blocks containing only the target region of the maxillary sinus. RESULTS The average thickness was 2.03 mm in goat and sheep and 2.80 in pig. Releasing and elevation of the Schneiderian membrane from the sinus floor were easy in the three species. The approach of the maxillary sinus in sheep, goat and pig from the buccal vestibule required a previous surgical enlargement of the buccal vestibule. CONCLUSIONS In conclusion, the cortical bone thickness and Schneider membrane characteristics in Merina sheep and Murciano-Granadina goat allow a perfect training for the modified Caldwell-Luc procedure. However, the approach from the oral cavity needs, in these species, a previous enlargement of the buccal vestibule. The excessive thickness of the cortical bone restricts the use of pigs for this technique.
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Affiliation(s)
- Elisa Estaca
- Minimally Invasive Surgery Centre, Cáceres, Spain
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Sun XJ, Zhang ZY, Wang SY, Gittens SA, Jiang XQ, Chou LL. Maxillary sinus floor elevation using a tissue-engineered bone complex with OsteoBone and bMSCs in rabbits. Clin Oral Implants Res 2009; 19:804-13. [PMID: 18705812 DOI: 10.1111/j.1600-0501.2008.01577.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex with OsteoBone(trade mark) and bone marrow stromal cells (bMSCs) in rabbits. MATERIAL AND METHODS Autologous bMSCs from adult New Zealand rabbits were cultured and combined with OsteoBone(trade mark) at a concentration of 20 x 10(6) cells/ml in vitro. Twenty-four animals were used and randomly allocated into groups. For each time point, 16 maxillary sinus floor elevation surgeries were made bilaterally in eight animals and randomly repaired by bMSCs/material (i.e. OsteoBone), material, autogenous bone and blood clot (n=4 per group). A polychrome sequential fluorescent labeling was also performed post-operatively. The animals were sacrificed 2, 4 and 8 weeks after the procedure and evaluated histologically as well as histomorphometrically. RESULTS New bone area significantly decreased from weeks 2 to 8 in the blood clot group, while bone area in the autologous bone reduced from weeks 4 to 8. In both groups, a significant amount of fatty tissue appeared at week 8. Accordingly, augmented height in both groups was also significantly decreased from weeks 2 to 8. The bone area in the material-alone group as well as in the bMSCs/material group, on the other hand, increased over time. Significantly more newly formed bone area and mineralization was observed in the center of the raised space in the bMSCs/material group than in the material-alone group. The augmented height was maintained in these two groups throughout the course of this study. CONCLUSION These results suggest that OsteoBone can successfully be used as a bone graft substitute and that the combination of this material with bMSCs can effectively promote new bone formation in sinus elevation.
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Affiliation(s)
- X-Juan Sun
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Gruber RM, Ludwig A, Merten HA, Pippig S, Kramer FJ, Schliephake H. Sinus floor augmentation with recombinant human growth and differentiation factor-5 (rhGDF-5): a pilot study in the Goettingen miniature pig comparing autogenous bone and rhGDF-5. Clin Oral Implants Res 2008; 20:175-82. [PMID: 19077151 DOI: 10.1111/j.1600-0501.2008.01628.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to test the hypothesis that recombinant human growth and differentiation factor-5 (rhGDF-5) in combination with a beta-tricalcium phosphate (beta-TCP) scaffold material results in superior bone formation in sinus floor augmentations in miniature pigs compared with a particulated autogenous bone graft combined with the scaffold material. MATERIAL AND METHODS Six adult female Goettingen minipigs underwent a maxillary sinus floor augmentation procedure. In a split-mouth design, the sinus floors were augmented with beta-TCP mixed with autogenous cortical bone chips, in a ratio of approximately 1 : 1, on one side. The contralateral test site was augmented using beta-TCP coated with two concentrations of rhGDF-5 (400 microg rhGDF-5/g beta-TCP or 800 microg rhGDF-5/g beta-TCP; three animals in each case). Simultaneously, one dental implant was inserted into each sinus floor augmentation. After 12 weeks, a histological and histomorphometric assessment of non-decalcified histological specimens was made. RESULTS There were significantly higher mean values of volume density of newly formed bone using beta-TCP coated with two concentrations of rhGDF-5 (400 microg: 32.9%; 800 microg: 23.9%) than with the corresponding control (autogenous bone/beta-TCP) (14.6%, 12.9%) (P=0.012, P=0.049). The bone-to-implant contact rates (BIC) were significantly enhanced in test sites (400 microg: 84.2%; 800 microg: 69.8%) compared with the corresponding control sites (24.8%, 40.8%) (P=.027, P=.045). CONCLUSION rhGDF-5 delivered on beta-TCP significantly enhanced bone formation compared with beta-TCP combined with autogenous bone in sinus lift procedures in miniature pigs.
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Affiliation(s)
- Rudolf Matthias Gruber
- Department of Oral and Maxillofacial Surgery, Georgia Augusta University, Goettingen, Germany.
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Hallman M, Thor A. Bone substitutes and growth factors as an alternative/complement to autogenous bone for grafting in implant dentistry. Periodontol 2000 2008; 47:172-92. [PMID: 18412581 DOI: 10.1111/j.1600-0757.2008.00251.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Huang YH, Polimeni G, Qahash M, Wikesjö UME. Bone morphogenetic proteins and osseointegration: current knowledge – future possibilities. Periodontol 2000 2008; 47:206-23. [DOI: 10.1111/j.1600-0757.2007.00240.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pieri F, Lucarelli E, Corinaldesi G, Iezzi G, Piattelli A, Giardino R, Bassi M, Donati D, Marchetti C. Mesenchymal stem cells and platelet-rich plasma enhance bone formation in sinus grafting: a histomorphometric study in minipigs. J Clin Periodontol 2008; 35:539-46. [PMID: 18422697 DOI: 10.1111/j.1600-051x.2008.01220.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Autologous, allogenic, and alloplastic materials for sinus augmentation have specific drawbacks, which has stimulated an ongoing search for new materials and tissue-engineering constructs. We investigated whether mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) seeded on a fluorohydroxyapatite (FH) scaffold can improve bone formation and bone-to-implant contact (BIC) in maxillary sinus grafting. MATERIAL AND METHODS Bilateral sinus augmentation procedures were performed in eight minipigs. MSCs, PRP, and FH scaffold (test site) or FH alone (control site) were grafted in each maxillary sinus. Distal to the osteotomy, one dental implant per sinus was placed in the grafting material through the facial sinus wall. The animals were killed 3 months after grafting, and block sections of the implant sites were harvested and prepared for histomorphometric analysis. RESULTS After 12 weeks, a significant increase in bone formation occurred in the test sites compared with the control sites (42.51%versus 18.98%; p=0.001). In addition, BIC was significantly greater in the test sites compared with the control sites in the regenerated area (23.71%versus 6.63%; p=0.028). CONCLUSIONS These findings show that sinus augmentation with MSCs-PRP, combined with FH may enhance bone formation and osseointegration of dental implants compared with FH alone in minipigs.
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Affiliation(s)
- Francesco Pieri
- Department of Odontostomatological Sciences, University of Bologna, Bologna, Italy.
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Liu Y, Springer ING, Zimmermann CE, Açil Y, Scholz-Arens K, Wiltfang J, Terheyden H. Missing osteogenic effect of expanded autogenous osteoblast-like cells in a minipig model of sinus augmentation with simultaneous dental implant installation. Clin Oral Implants Res 2008; 19:497-504. [PMID: 18371097 DOI: 10.1111/j.1600-0501.2007.01504.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES With natural bovine bone mineral (BioOss) as carrier, the study aimed at investigating the effect of autogenous osteoblast-like cells on bone regeneration in an orthotopic (maxillary sinus) and an ectopic (muscle) site. MATERIALS AND METHODS Autogenous osteoblast-like cells were isolated from iliac cancellous bone of six minipigs and expanded in an autogenous serum-supplemented osteogenic medium. After confirmation of osteogenicity, the expanded cells were precultivated on BioOss granules for 1 week. Four milliliter of cell-seeded BioOss were used for sinus augmentation of right sinus and a Straumann solid screw (dental) implant was simultaneously installed. The contralateral (control) side was filled with cell-free BioOss. Besides, 2 ml of the corresponding granules were placed in a pouch in the latissimus dorsi muscles bilaterally. Polychrome sequential labeling was performed postoperatively. Specimens were harvested at week 6. Undecalcified sections were evaluated with microradiography, fluorescence microscopy, histology and histomorphometry. RESULTS In the test side, the coronal part of dental implant demonstrated higher bone-implant contact (BIC) than the apical part (34.88+/-28.86% vs. 16.68+/-13.80%, P=0.039), as well as higher bone density (BD) in the corresponding zone (14.88+/-6.37% vs. 11.10+/-4.54%, P=0.021). However, the test side demonstrated no advantage over control side in either BD (12.25+/-4.22% vs. 8.45+/-11.04%, P=0.473) or BIC (24.15+/-21.97% vs. 22.05+/-19.00%, P=0.270). Rare bone was formed in the muscles in both sides. CONCLUSIONS The expanded autogenous osteoblast-like cells failed to enhance bone formation in the minipig model of sinus augmentation.
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Affiliation(s)
- Yanming Liu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Roldán JC, Knueppel H, Schmidt C, Jepsen S, Zimmermann C, Terheyden H. Single-stage sinus augmentation with cancellous iliac bone and anorganic bovine bone in the presence of platelet-rich plasma in the miniature pig. Clin Oral Implants Res 2008; 19:373-8. [PMID: 18261122 DOI: 10.1111/j.1600-0501.2007.01465.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM The aim of the present study was to evaluate the osseointegration of dental implants and bone formation in maxillary sinus grafting with autologous and anorganic bovine bone in the presence of platelet-rich plasma (PRP) in an established animal model. MATERIAL AND METHODS We performed bilateral maxillary sinus augmentation with 50% anorganic bovine bone and simultaneously inserted a titanium screw implant in five minature pigs. Six hundred microlitre autologous PRP were added to the left side (test). The right side (no PRP) served as control. Polychrome sequential labeling was performed. The animals were sacrificed 6 weeks after surgery. Undecalcified ground sections were evaluated by microradiography, digitized histomorphometry and under fluorescent light. RESULTS The mean bone implant content in the test and control group was 8.4% and 17.3% respectively (P=0.042). The mean height of newly formed mineralized bone in the augmented area of the test group was 3.6 mm and 5.7 mm respectively (P=0.342). In the PRP group, the mean area of newly formed bone in the base of the sinus was enhanced (75.23%) as compared to the control side (51.8%) (P=0.020(*)). Although PRP enhanced bone formation at the base of the maxillary sinus, it neither improved osseointegration of dental implants nor bone in-growth into the bone substitute under the selected experimental conditions.
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Affiliation(s)
- J Camilo Roldán
- Department of Oral and Maxillofacial Surgery, University of Regensburg, Germany.
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Radiographic and histomorphometric analysis of bone healing using autogenous graft associated with platelet-rich plasma obtained by 2 different methods. ACTA ACUST UNITED AC 2008; 105:e13-8. [DOI: 10.1016/j.tripleo.2007.07.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 06/28/2007] [Accepted: 07/23/2007] [Indexed: 02/04/2023]
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Bone Morphogenetic Proteins: A Realistic Alternative to Bone Grafting for Alveolar Reconstruction. Oral Maxillofac Surg Clin North Am 2007; 19:535-51, vi-vii. [DOI: 10.1016/j.coms.2007.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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de Vasconcelos Gurgel BC, Gonçalves PF, Pimentel SP, Ambrosano GMB, Nociti Júnior FH, Sallum EA, Casati MZ. Platelet-rich plasma may not provide any additional effect when associated with guided bone regeneration around dental implants in dogs. Clin Oral Implants Res 2007; 18:649-54. [PMID: 17877464 DOI: 10.1111/j.1600-0501.2007.01383.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate histometrically bone healing in surgically created dehiscence-type defects around titanium implants treated with an association of platelet-rich plasma (PRP) and guided bone regeneration (GBR). MATERIALS AND METHODS Ten male adult mongrel dogs were used, from which the three low premolars (P2, P3, P4) and the first molar were extracted. Three months after teeth extraction, two implant sites were bilaterally drilled, buccal bone dehiscences were created and four titanium implants were placed. Dehiscences were randomly assigned to the following groups: (1) PRP, (2) GBR, (3) PRP+GBR and (4) control. After 3 months, the animals were sacrificed and the implants and adjacent hard tissues were processed for undecalcified sections. Bone-to-implant contact (BIC), bone density within the limits of implant threads (BW), bone density (BD) and new bone area (BA) in a zone lateral to the implant corresponding to bone defects were obtained and measured. RESULTS Intergroup analysis (two-way ANOVA -alpha=5%) demonstrated that when PRP was utilized,no differences were observed for all parameters (P>0.05). However, significant differences were observed for BIC and BW toward membrane-treated groups (P<0.05). CONCLUSION Within the limits of this study, it was concluded that PRP does not exert additional effects on bone healing in bone defects created around dental implants and treated by GBR.
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Affiliation(s)
- Bruno César de Vasconcelos Gurgel
- Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba/Unicamp, São Paulo, Brazil
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Browaeys H, Bouvry P, De Bruyn H. A Literature Review on Biomaterials in Sinus Augmentation Procedures. Clin Implant Dent Relat Res 2007; 9:166-77. [PMID: 17716261 DOI: 10.1111/j.1708-8208.2007.00050.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sinus augmentation is a common procedure to increase bone volume and allow for proper implant placement in the atrophic posterior maxilla. Although the patient's own bone is considered the best grafting material, various synthetic or bovine-derived alternatives are used to simplify the grafting procedure. PURPOSE The overall objective of this review was to assess the efficacy of different graft materials used in sinus augmentation procedures as demonstrated in animal studies. MATERIALS AND METHODS A specific and sensitive database was initially created via PUBMED, focusing on studies published in English peer-reviewed journals between 1995 and 2004 and kept updated until 2006. RESULTS Twenty-six articles were available for comparison and discussion; none concerned the use of alloplastic materials; 24 were comparative histomorphometric; and two were biomechanical studies. Because of a great variability in study designs, different implant types, great range in follow-up, and lack of specific integration or loading period, a comparison of the studies and the biomaterials used was difficult. CONCLUSIONS In general, autogenous bone is the most predictable material of choice for augmentation procedures, despite a 40% resorption, because it is highly osteoconductive and less dependent on sinus floor endosteal bone migration. The addition of bovine bone mineral to autogenous bone can be beneficial for graft success because it acts as a slowly resorbing space maintainer. Porous hydroxyapatite is suitable when mixed with autogenous bone because it enhances bone formation and bone-to-implant contact in augmented sinuses. Histological evaluation showed that demineralized freeze-dried bone is inferior to other materials. Within the limitation of the animal studies examined in this review and only based on histological examination, the initial osseointegration of implants seems independent of the biomaterial used in grafting procedures.
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Affiliation(s)
- Hilde Browaeys
- Department of Maxillofacial Surgery, Dental School University of Ghent, Belgium.
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Alio JL, Abad M, Artola A, Rodriguez-Prats JL, Pastor S, Ruiz-Colecha J. Use of Autologous Platelet-Rich Plasma in the Treatment of Dormant Corneal Ulcers. Ophthalmology 2007; 114:1286-1293.e1. [PMID: 17324465 DOI: 10.1016/j.ophtha.2006.10.044] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 10/30/2006] [Accepted: 10/30/2006] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the potential role of autologous platelet-rich plasma in promoting healing in dormant corneal ulcers. DESIGN Prospective, consecutive, interventional, noncomparative, nonrandomized, observational study. PARTICIPANTS Forty eyes of 38 patients with dormant corneal ulcers. METHODS Autologous platelet-rich plasma was used in a total of 40 eyes with dormant corneal ulcers divided into 2 groups: group I, 26 eyes treated with topical eyedrops of autologous platelet-rich plasma (12 neurotrophic, 9 herpetic, and 5 immunological ulcers), and group II, 14 eyes treated surgically with a solid clot of autologous platelet-rich plasma combined with amniotic membrane transplantation in perforated corneas or with impending perforation. The treatment was used in patients with chronic nonhealing ulcers (mean, 2 years of evolution) that had been unresponsive to conventional topical therapy. Autologous blood from each patient was obtained by venipuncture, and platelet-rich plasma was prepared from each blood sample without additives. MAIN OUTCOME MEASURES Ulcer size, inflammation, healing, visual acuity, and patient's subjective symptoms. RESULTS Autologous platelet-rich plasma promoted healing of ulcers. In group I, 13 eyes healed, 11 eyes improved significantly, and 2 eyes showed no change. In group II, 10 eyes healed and 4 eyes improved significantly. Inflammation and subjective symptoms, particularly pain, improved in all patients. Vision remained stable or improved in all cases. CONCLUSION Autologous platelet-rich plasma promoted healing of dormant corneal ulcers even in eyes threatened by corneal perforation and was accompanied by a reduction in pain and inflammation.
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Affiliation(s)
- Jorge L Alio
- Department of Cornea and Refractive Surgery, VISSUM, Instituto Oftalmológico de Alicante, Alicante, Spain.
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Gerard D, Carlson ER, Gotcher JE, Jacobs M. Effects of platelet-rich plasma at the cellular level on healing of autologous bone-grafted mandibular defects in dogs. J Oral Maxillofac Surg 2007; 65:721-7. [PMID: 17368369 DOI: 10.1016/j.joms.2006.09.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 09/23/2006] [Accepted: 09/28/2006] [Indexed: 12/13/2022]
Abstract
PURPOSE This study describes the effect of platelet-rich plasma (PRP) at the cellular level on immediate autologous bone grafts in dog mandibles. MATERIALS AND METHODS Twelve adult dogs weighing 40 to 50 pounds received bilateral inferior mandibular border resections measuring 2 cm x 1 cm. The right side was grafted with milled autologous iliac corticocancellous bone along with 2 cc of PRP taken from the same animal. The left side had the same amount of milled bone placed in the defect without PRP. Three animals were sacrificed at 1, 2, 3, and 6 months postsurgery. Ten and 3 days before sacrifice, all dogs received 10 mg/kg body weight of intravenous tetracycline. At sacrifice, the grafts along with adjacent native bone were harvested and immediately fixed in Carson's fixative for 48 to 72 hours. The samples were then dehydrated over a 2-week period in a graded ethanol series and embedded in Spurr's plastic. Two 100-micron sections from the center of each graft were cut, mounted on glass slides, ground to 40 microns, and stained. A digitally generated grid was superimposed over each section, to give 32 fields of 2.5 mm2. Each of these fields was examined at a magnification of x100 to determine the number of osteoblasts and osteoclasts present. RESULTS The mean average of the total numbers of osteoblasts and osteoclasts were significantly higher in the PRP graft sites than in the non-PRP graft sites at 1 month. However, if specific fields were compared, then 14 of the 32 fields showed no difference in the number of osteoblasts and osteoclasts. At 2, 3, and 6 months, there was no significant difference in the total number of osteoblasts or osteoclasts in the PRP and non-PRP grafts, or in any of the 32 fields. CONCLUSIONS At the cellular level, PRP increased the number of osteoblasts and osteoclasts recruited to the graft site at 1 month, and this overall increase was more evident at the superior and lateral margins of the graft than in other areas. Fields along the inferior margin showed the fewest number of cells for both the PRP and non-PRP grafts. At later times there was no significant difference in the number of osteoblasts and osteoclasts in the PRP and non-PRP graft sites in any region of the grafts. This study indicates that the increased number of osteoblasts and osteoclasts in the graft sites due to the addition of PRP was short-lived, and that autologous bone grafts without PRP had similar numbers of active bone cells after 1 month in this animal model.
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Affiliation(s)
- David Gerard
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
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Consolo U, Zaffe D, Bertoldi C, Ceccherelli G. Platelet-rich plasma activity on maxillary sinus floor augmentation by autologous bone. Clin Oral Implants Res 2007; 18:252-62. [PMID: 17348891 DOI: 10.1111/j.1600-0501.2006.01330.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This work aims to evaluate the regenerative potential of platelet-rich plasma (PRP) on an implant site of peculiar clinical impact, such as sinus augmentation. MATERIAL AND METHODS Sixteen consenting patients (11 females and five males), with symmetrical maxillary sinus atrophy, underwent bilateral sinus floor augmentation, using autologous (iliac crest) bone on one side and PRP plus autologous bone contralaterally. Implants were inserted 4, 5, 6 and 7 months after surgery in the patients randomly split into four groups. Orthopantomographies, computed tomography with transverse image digital reconstructions and densitometries were used to monitor the treatment progress. A core biopsy was performed at the site of implant. RESULTS Clinical performance across both sites showed no statistical significance (P=0.414). Densitometric values were higher at PRP sites (mean Hounsfield units approximately +57%), even if densitometry converged in the two sites 8 months after surgery. Histology documents enhanced bone activities in sites treated with PRP, 4 months after surgery. Reduced bone activity was observed in both sites 5, 6 and 7 months after surgery. Bone amount, higher in sites treated with PRP (mean trabecular bone volume approximately +37%), decreased in both sites over time. CONCLUSIONS Our results seem to indicate a certain regenerative potential of PRP when used with autologous bone. The effect of this enhancement of bone regeneration appeared to be restricted to shorter treatment times. A progressive extinguishment of the PRP effect is recorded after an interval longer than 6-7 months.
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Affiliation(s)
- Ugo Consolo
- Department of Neurosciences, Head-Neck, Rehabilitation, Section of Dentistry and Maxillofacial Surgery, University of Modena and Reggio Emilia, Modena, Italy
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