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Lee Y, Lee JT, Han HS, Oh S, Cho YD, Kim S. Gingival biotype modification with collagen matrix or autogenous subepithelial connective tissue graft: Histologic and volumetric analyses in a beagle model. Heliyon 2023; 9:e15026. [PMID: 37151660 PMCID: PMC10161361 DOI: 10.1016/j.heliyon.2023.e15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives To evaluate the volumetric effect and biocompatibility of porcine tendon-derived type I collagen matrix graft (CG) in gingival biotype modification (GBM) compared with subepithelial connective tissue graft (SCTG) in a beagle model. Methods Surface analysis using scanning electron microscopy and a collagen degradation assay of CG was performed in vitro. Six adult dogs were used in in vivo experiment, and each received autologous SCTG or CG at the anterior side. Histometric and three-dimensional digital volume analyses were conducted to compare quantitative changes in CG and SCTG in GBM. Immunohistochemical analysis was performed for the qualitative evaluation of CG compared to SCTG. Results CG had a double-layered structure, and its degradation was slower than that of other well-reported materials. No critical problems were associated with the healing procedure. Changes in gingival thickness and volume in the CG and SCTG groups were equivalent, with no significant differences between the groups. Type I collagen and vascular endothelial growth factor expression levels were similar in both groups. Significance CG and SCTG had equivalent potential for GBM in terms of quantity and quality. Additionally, CG could be used as a reasonable substitute for SCTG, making surgery convenient and predicting successful clinical outcomes.
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Affiliation(s)
- Yoonsub Lee
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, South Korea
| | - Jung-Tae Lee
- Department of Periodontics, One-Stop Specialty Center, Seoul National University, Dental Hospital, Seoul 05698, South Korea
| | - Hee-seung Han
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, South Korea
| | - Seunghan Oh
- Department of Dental Biomaterials, The Institute of Biomaterial and Implant, School of Dentistry, Wonkwang University, Iksan, South Korea
| | - Young-Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, South Korea
| | - Sungtae Kim
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, South Korea
- Corresponding author. Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University ,101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
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Bienz SP, Vaquette C, Ioannidis A, Hämmerle CHF, Jung RE, Ivanovski S, Thoma DS. Tissue integration and biodegradation of soft tissue substitutes with and without compression: an experimental study in the rat. Clin Oral Investig 2023; 27:313-328. [PMID: 36255492 PMCID: PMC9877052 DOI: 10.1007/s00784-022-04726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/27/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To analyze the influence of compression on tissue integration and degradation of soft tissue substitutes. MATERIAL AND METHODS Six subcutaneous pouches in twenty-eight rats were prepared and boxes made of Al2O3 were implanted and used as carriers for soft tissue substitutes: a collagen matrix (MG), two volume-stable collagen matrices (FG/MGA), and a polycaprolactone scaffold(E). The volume-stable materials (FG/MGA/E) were further implanted with a twofold (2) and a fourfold (4) compression, created by the stacking of additional layers of the substitute materials. The samples were retrieved at 1, 2, and 12 weeks (10 groups, 3 time points, n = 5 per time point and group, overall, 150 samples). The area fraction of infiltrated fibroblasts and inflammatory cells was evaluated histologically. Due to within-subject comparisons, mixed models were conducted for the primary outcome. The level of significance was set at 5%. RESULTS The area fraction of fibroblasts increased in all groups over time. At 12 weeks, the densely compressed materials FG4 (1.1%), MGA4 (1.7%), and MGA2 (2.5%) obtained lower values as compared to the other groups, ranging between 4.7 (E2) and 6.5% (MG). Statistically significant differences (p ≤ 0.05) were observed between groups FG4 vs MG/FG2/E/E4 as well as between MGA4 vs MG/FG2/E/E4 and E vs MGA2. CONCLUSIONS Higher levels of compression led to delayed tissue integration. The effect of different compression levels was more distinct when compared to the differences between the materials. CLINICAL RELEVANCE All biomaterials demonstrated tissue integration and a minimal concomitant inflammatory reaction. Clinically, it might be more favorable to obtain a sufficient flap release or to reduce the material size to improve the tissue integration processes.
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Affiliation(s)
- Stefan P Bienz
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland.
| | - Cedryck Vaquette
- School of Dentistry, The University of Queensland, Herston, QLD, Australia
| | - Alexis Ioannidis
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | | | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Sašo Ivanovski
- School of Dentistry, The University of Queensland, Herston, QLD, Australia
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
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Lee CT, Lange M, Jureidini A, Bittner N, Schulze-Späte U. Clinical and patient-reported outcomes after recession coverage using modified vestibular incision subperiosteal tunnel access with a volume-stable collagen matrix as compared to a coronally advanced flap with a subepithelial connective tissue graft. J Periodontal Implant Sci 2022; 52:466-478. [PMID: 36468471 PMCID: PMC9807852 DOI: 10.5051/jpis.2105760288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/27/2022] [Accepted: 06/02/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Coronally advanced split-or full-thickness (CAST or CAFT) flaps in combination with subepithelial connective tissue grafts (SCTGs) are commonly used in root-coverage procedures despite postoperative pain and bleeding from the graft donor site. Therefore, the modified vestibular incision subperiosteal tunnel access procedure (VISTAX) uses a novel collagen matrix (VCMX) instead of autogenous tissue to address the limitations associated with autogenous tissue grafting. This retrospective study compared the clinical outcomes of VISTAX to the results obtained after using a CAST or CAFT flap in combination with SCTG for root coverage. METHODS Patients with single or multiple adjacent recession I/II defects were included, with 10 subjects each in the VISTAX, CAFT, and CAST groups. Defect coverage, keratinized tissue width, esthetic scores, and patients' perceived pain and dentinal hypersensitivity (visual analogue scale [VAS]) were assessed at baseline, 3 months, and 6 months. RESULTS All surgical techniques significantly reduced gingival recession (P<0.0001). Defect coverage, esthetic appearance, and the reduction in dentinal hypersensitivity were comparable. However, the VAS scores for pain were significantly lower in the VISTAX group than in the CAFT and CAST groups, which had similar scores (P<0.05). Furthermore, the clinical results of VISTAX and CAFT/CAST generally remained stable at 6 months. CONCLUSIONS The clinical outcomes of VISTAX, CAFT, and CAST were comparable. However, patients perceived significantly less pain after VISTAX, indicating a potentially higher patient acceptance of the procedure. A prospective trial with a longer follow-up period and a larger sample size should therefore evaluate VISTAX further.
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Affiliation(s)
- Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA.,Columbia University College of Dental Medicine, New York, NY, USA
| | - Marlena Lange
- Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Alain Jureidini
- Columbia University College of Dental Medicine, New York, NY, USA.,Private Office, Arlington, VA, USA
| | - Nurit Bittner
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Ulrike Schulze-Späte
- Columbia University College of Dental Medicine, New York, NY, USA.,Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Friedrich Schiller University, Jena, Germany
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De Annuntiis C, Testarelli L, Guarnieri R. Use of Xenogenic Collagen Matrices in Peri-Implant Soft Tissue Volume Augmentation: A Critical Review on the Current Evidence and New Technique Presentation. MATERIALS 2022; 15:ma15113937. [PMID: 35683237 PMCID: PMC9182004 DOI: 10.3390/ma15113937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023]
Abstract
Plastic peri-implant surgical procedures aiming to increase soft tissue volume around dental implants have long been well-described. These are represented by: pedicle soft tissue grafts (rotational flap procedures and advanced flap procedures) and free soft tissue grafts (epithelialized, also called free gingival graft (FGG), and non-epithelialized, also called, connective tissue graft (CTG) or a combination of both. To bypass the drawback connected with autologous grafts harvesting, xenogenic collagen matrices (XCM)s and collagen-based matrices derived from porcine dermis (PDXCM)s have been introduced, as an alternative, in plastic peri-implant procedures. Aim: This review is aimed to evaluate and to critically analyze the available evidence on the effectiveness of XCMs and PDXCMs in soft tissue volume augmentation around dental implants. Moreover, a clinical case with a new soft tissue grafting procedure technique (Guided Soft Tissue Regeneration, GSTR) is presented. Material and Methods: An electronic search was performed on the MEDLINE database, SCOPUS, Cochrane Library and Web of Science. The electronic search provided a total of 133 articles. One hundred and twenty-eight not meeting the inclusion criteria were excluded. Seven articles of human randomized clinical trials were selected. A total number of 108 patients were treated with CTG, and 110 patients with XCM. Results: in peri-implant soft tissue augmentation procedures, XCMs seem an effective alternative to CTGs, associated with lower patient morbidity and lower operative times.
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Affiliation(s)
| | - Luca Testarelli
- Department of Oral and Maxillofacial Sciences, University La Sapienza, 00100 Rome, Italy;
| | - Renzo Guarnieri
- Department of Oral and Maxillofacial Sciences, University La Sapienza, 00100 Rome, Italy;
- Correspondence:
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Peri-implant tissue augmentation by volume-stable collagen matrix transplantation: a study of dog mandibles. Odontology 2021; 110:81-91. [PMID: 34279761 DOI: 10.1007/s10266-021-00639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate histologically the amount of peri-implant tissue augmentation after volume-stable porcine collagen matrix transplantation. Six male beagle dogs were used in the experiment. P2, P4, and M1 distal roots were extracted under general anesthesia. After 6 months, implants were placed in the same sites, and volume-stable porcine collagen matrix transplantation was performed. Impressions were taken at 1 and 2 weeks and at 1, 2, and 3 months after transplantation. The dogs were euthanized at 3 months, and their mandibles were removed and scanned using micro-computed tomography. Standard Triangulated Language data were also obtained. Using preoperative models as a reference, the data for all time points were compared, and changes in the thickness of the cross-section of the implant sites were measured. The model created at 3 months was then compared with the mandible data, and the thickness of collected peri-implant soft tissue was measured under optical microscopy. Increased thickness was found at some of the sites on the buccal side. Regarding the peri-implant soft tissue, the thickness of the measured sites on the buccal side was significantly increased at 3 months in the experimental group. Histological observations of the internal structures of the tissue in the experimental group revealed irregular collagen fibers and a remnant collagen matrix. Endogenous tissue was observed within the collagen matrix, indicating good fusion with the surrounding autologous tissue. These results suggest that volume-stable porcine collagen matrix transplantation promotes peri-implant tissue augmentation on the buccal side.
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Impact of Cross-Linking of Collagen Matrices on Tissue Regeneration in a Rabbit Calvarial Bone Defect. MATERIALS 2021; 14:ma14133740. [PMID: 34279311 PMCID: PMC8269870 DOI: 10.3390/ma14133740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
The cross-linking of collagen matrices (Cl_CM) may provide volume-stable enhanced defect regeneration when compared to non-cross-linked matrices (Ncl_CM). The aim of the present study was to investigate the bone forming potential of collagen matrices (CMs) and the effects of cross-linking CMs in a rabbit calvaria defect model. (1) Empty controls (n = 6), (2) Ncl_CM (n = 8), and (3) Cl_CM (n = 8) were selected to be observed for the healing in 10 mm critical-sized calvarial bone defects. The potential for the bone as well as the connective tissue formation were evaluated by micro-CT and histomorphometry at three months post-surgery. There were no statistically significant differences in terms of new bone volume in the defects between the groups. However, the Cl_CM induced significantly greater fibrous tissue regeneration (5.29 ± 1.57 mm2) when compared to the controls (3.51 ± 0.93 mm2) by histomorphometry. The remnants of collagen fibers with immune cells, including macrophages and giant cells, were occasionally observed in the Cl_CM group but not in the Ncl_CM group. In conclusion, the cross-linking of collagen did not influence the potential for bone formation. Nevertheless, Cl_CM might be advantageous for the maintenance of fibrous tissue volume without disturbing bone formation in the defects.
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Alccayhuaman KAA, Tangl S, Blouin S, Hartmann MA, Heimel P, Kuchler U, Lee JS, Gruber R. Osteoconductive Properties of a Volume-Stable Collagen Matrix in Rat Calvaria Defects: A Pilot Study. Biomedicines 2021; 9:biomedicines9070732. [PMID: 34202317 PMCID: PMC8301482 DOI: 10.3390/biomedicines9070732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Volume-stable collagen matrices (VSCM) are conductive for the connective tissue upon soft tissue augmentation. Considering that collagen has osteoconductive properties, we have investigated the possibility that the VSCM also consolidates with the newly formed bone. To this end, we covered nine rat calvaria circular defects with a VSCM. After four weeks, histology, histomorphometry, quantitative backscattered electron imaging, and microcomputed tomography were performed. We report that the overall pattern of mineralization inside the VSCM was heterogeneous. Histology revealed, apart from the characteristic woven bone formation, areas of round-shaped hypertrophic chondrocyte-like cells surrounded by a mineralized extracellular matrix. Quantitative backscattered electron imaging confirmed the heterogenous mineralization occurring within the VSCM. Histomorphometry found new bone to be 0.7 mm2 (0.01 min; 2.4 max), similar to the chondrogenic mineralized extracellular matrix with 0.7 mm2 (0.0 min; 4.2 max). Microcomputed tomography showed the overall mineralized tissue in the defect to be 1.6 mm3 (min 0.0; max 13.3). These findings suggest that in a rat cranial defect, VSCM has a limited and heterogeneous capacity to support intramembranous bone formation but may allow the formation of bone via the endochondral route.
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Affiliation(s)
- Karol Alí Apaza Alccayhuaman
- Department of Oral Biology, Dental School, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (K.A.A.A.); (J.-S.L.)
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, School of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (P.H.)
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, School of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (P.H.)
- Austrian Cluster for Tissue Regeneration, Medical University of Vienna, 1200 Vienna, Austria
| | - Stéphane Blouin
- 1st Medical Department, Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, Hanusch Hospital, 1140 Vienna, Austria; (S.B.); (M.A.H.)
| | - Markus A. Hartmann
- 1st Medical Department, Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, Hanusch Hospital, 1140 Vienna, Austria; (S.B.); (M.A.H.)
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, School of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (P.H.)
- Austrian Cluster for Tissue Regeneration, Medical University of Vienna, 1200 Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
| | - Ulrike Kuchler
- Department of Oral Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Jung-Seok Lee
- Department of Oral Biology, Dental School, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (K.A.A.A.); (J.-S.L.)
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul 03722, Korea
| | - Reinhard Gruber
- Department of Oral Biology, Dental School, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (K.A.A.A.); (J.-S.L.)
- Austrian Cluster for Tissue Regeneration, Medical University of Vienna, 1200 Vienna, Austria
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +43-1-40070-2660
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Artzi Z, Renert U, Netanely E, Thoma DS, Vered M. Histologic composition of marginal mucosal tissue augmented by a resorbable volume-stable collagen matrix in soft tissue thickening procedures in humans: a morphometric observational study. Clin Oral Investig 2021; 26:427-435. [PMID: 34164734 DOI: 10.1007/s00784-021-04016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aims to examine the composition of lining and masticatory mucosa at the pre- and post-soft tissue augmentation procedures with a volume-stable cross-linking collagen matrix (VCMX) in humans. MATERIALS AND METHODS In 12 patients, single implant sites were augmented with a VCMX. Biopsies were obtained including masticatory (MM) and lining (LM) mucosa before augmentation and at 12 weeks post-augmentation procedures. Rete pegs density (RPD), length (RPL), and blood vessel density (BVD) were histomorphometrically analyzed at both time points. Picrosirius red staining under polarized light microscopy was used to evaluate collagen fiber organization. The effects of time and tissue type were evaluated by ANOVA with repeated measures. RESULTS Both MM and LM areas demonstrated an increase in mean RPL following augmentation, 382.6 µm ± 95.1 vs. 290.5 µm ± 79.3 and 335.6 µm ± 94.2 vs. 292.9 µm ± 77.0, respectively (p < .05). There was a significant difference in the numbers of RP per 1 mm length (RPD) between the MM (9.2 ± 1.7) and LM (6.1 ± 2.8) mucosa but not between the pre- and post-VCMX augmentation time points. The mean BVD in the LM was greater than in the MM (5.5 ± 2.4 and 6.3 ± 2.4 vs. 3.4 ± 3.3 and 3.7 ± 1.8, respectively, p < .05) but not between time points. The collagen fiber arrangements pre- and post-augmentation were not significantly different. CONCLUSION Augmentation with VCMX did not alter the composition of lining and masticatory mucosa at implant sites. CLINICAL RELEVANCE A thick soft tissue phenotype around the implant neck is an important factor to maintain peri-implant health. A non-autogenous cross-linking collagen matrix is proposed as an alternate graft substitute in soft tissue augmentation procedures in order to improve implant soft tissue phenotype.
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Affiliation(s)
- Zvi Artzi
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Uri Renert
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Netanely
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Marilena Vered
- Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Tonetti MS, Cortellini P, Bonaccini D, Deng K, Cairo F, Allegri M, Conforti G, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H. Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36-month follow-up of a randomized multicentre trial. J Clin Periodontol 2021; 48:962-969. [PMID: 33817812 DOI: 10.1111/jcpe.13466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
AIM To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. MATERIAL AND METHODS 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. RESULTS No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95% CI -0.17 to 0.29 mm). CONCLUSION CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision-making.
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Affiliation(s)
- Maurizio S Tonetti
- Department of Oral and Maxillofacial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,European Research Group on Periodontology, Genova, Italy
| | | | | | - Ke Deng
- Division of Periodontology and Implant Dentistry, Hong Kong University, Hong Kong, China
| | - Francesco Cairo
- European Research Group on Periodontology, Genova, Italy.,Unit of Periodontology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Mario Allegri
- European Research Group on Periodontology, Genova, Italy
| | | | - Filippo Graziani
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, University of Pisa, Pisa, Italy
| | | | - Jan Halben
- European Research Group on Periodontology, Genova, Italy
| | - Jacques Malet
- European Research Group on Periodontology, Genova, Italy.,U.F.R. of Odontology, Paris 5 - Descartes University Paris, Paris, France
| | - Giulio Rasperini
- European Research Group on Periodontology, Genova, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | - Heinz Topoll
- European Research Group on Periodontology, Genova, Italy
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Katagiri H, El Tawil Y, Lang NP, Imber JC, Sculean A, Fujioka-Kobayashi M, Saulacic N. Collagen-Based Matrices for Osteoconduction: A Preclinical In Vivo Study. Biomedicines 2021; 9:biomedicines9020143. [PMID: 33540647 PMCID: PMC7913003 DOI: 10.3390/biomedicines9020143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate the influence of additional hydroxyapatite (HA) in collagen-based matrices (CM) and membrane placement on bone formation in calvarial defects. Critical size defects in the calvaria of 16 New Zealand White Rabbits were randomly treated with CM or mineralized collagen-based matrices (mCM). Half of the sites were covered with a collagen membrane. Animals were euthanized after 12 weeks of healing. The samples were studied by micro-CT and histology. Newly formed lamellar bone was observed in all samples at the periphery of the defect. In the central areas, however, new bone composed of both woven and lamellar bone was embedded in the soft tissue. Samples treated with mCM showed more residual biomaterial and induced more small bony islands in the central areas of the defects than samples with CM. Nevertheless, a complete defect closure was not observed in any of the samples at 12 weeks. Membrane placement resulted in a decrease in bone density and height. Significant differences between the groups were revealed only between CM groups with and without membrane coverage for bone height in the central area of the defect. Neither mineralization of CM nor membrane placement improved the osteogenic capacity in this particular defect. Nevertheless, mineralisation influenced bone density without a membrane placement and bone volume underneath a membrane. CM may be used as a scaffold in bone regeneration procedures, without the need of a membrane coverage. Further preclinical studies are warrant to optimise the potential of mCM.
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Affiliation(s)
- Hiroki Katagiri
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Faculty of Medicine, University of Berne, CH-3010 Berne, Switzerland; (H.K.); (Y.E.T.); (N.P.L.); (M.F.-K.)
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Yacine El Tawil
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Faculty of Medicine, University of Berne, CH-3010 Berne, Switzerland; (H.K.); (Y.E.T.); (N.P.L.); (M.F.-K.)
| | - Niklaus P. Lang
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Faculty of Medicine, University of Berne, CH-3010 Berne, Switzerland; (H.K.); (Y.E.T.); (N.P.L.); (M.F.-K.)
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Berne, CH-3010 Berne, Switzerland; (J.-C.I.); (A.S.)
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Berne, CH-3010 Berne, Switzerland; (J.-C.I.); (A.S.)
| | - Masako Fujioka-Kobayashi
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Faculty of Medicine, University of Berne, CH-3010 Berne, Switzerland; (H.K.); (Y.E.T.); (N.P.L.); (M.F.-K.)
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Faculty of Medicine, University of Berne, CH-3010 Berne, Switzerland; (H.K.); (Y.E.T.); (N.P.L.); (M.F.-K.)
- Correspondence: ; Tel.: +41-31-632-8764
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Imber JC, Bosshardt DD, Stähli A, Saulacic N, Deschner J, Sculean A. Pre-clinical evaluation of the effect of a volume-stable collagen matrix on periodontal regeneration in two-wall intrabony defects. J Clin Periodontol 2021; 48:560-569. [PMID: 33471389 DOI: 10.1111/jcpe.13426] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/28/2020] [Accepted: 01/10/2021] [Indexed: 01/07/2023]
Abstract
AIM To histologically evaluate the effect of a new collagen matrix on periodontal regeneration. MATERIALS AND METHODS Two-wall intrabony defects were surgically created bilaterally distally to the maxillary first and third pre-molars in beagle dogs. The defects were randomly allocated to open flap debridement either with (test) or without (control) a volume-stable collagen matrix (VCMX). After 12 weeks, the dogs were euthanized, and the specimens histologically processed. Descriptive, histomorphometrical (vertical gain of periodontal tissues) and statistical analyses were then performed. RESULTS Healing was uneventful in most cases. Residual VCMX was still present and showed integration into new bone, new periodontal ligament, connective tissue and, in some specimens, into new cementum. Periodontal regeneration occurred to a varying extent in both groups. New continuous cementum and new bone formation were statistically significantly greater in the test group (4.12 mm and 3.28 mm, respectively) than in the control group (1.54 mm and 2.47 mm, respectively) (p = .009 and p = .037, respectively). The junctional epithelium was longer in the control group (2.21 mm) than in the test group (1.49 mm, p = .16). CONCLUSION The present results have for the first time provided histologic evidence for the potential of this novel VCMX to facilitate periodontal regeneration thus warranting further pre-clinical and clinical testing.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Periodontology and Operative Dentistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Dieter Daniel Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Faculty of Medicine, University Hospital, University of Bern, Bern, Switzerland
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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12
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De Angelis P, De Angelis S, Passarelli PC, Liguori MG, Pompa G, Papi P, Manicone PF, D'Addona A. Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants. Int J Oral Maxillofac Surg 2020; 50:956-963. [PMID: 33279377 DOI: 10.1016/j.ijom.2020.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
Abstract
Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.
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Affiliation(s)
- P De Angelis
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - P C Passarelli
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Liguori
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Pompa
- Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - P Papi
- Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - P F Manicone
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - A D'Addona
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Schmitt CM, Brückbauer P, Schlegel KA, Buchbender M, Adler W, Matta RE. Volumetric soft tissue alterations in the early healing phase after peri- implant soft tissue contour augmentation with a porcine collagen matrix versus the autologous connective tissue graft: A controlled clinical trial. J Clin Periodontol 2020; 48:145-162. [PMID: 33047372 DOI: 10.1111/jcpe.13387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/03/2020] [Accepted: 10/06/2020] [Indexed: 01/28/2023]
Abstract
AIM This study evaluates the early volumetric changes after buccal soft tissue contour augmentation around implants with a porcine collagen matrix (CM) vs. the subepithelial connective tissue graft (SCTG) from the palate. MATERIALS AND METHODS 14 patients were enrolled after early implant placement with simultaneous contour augmentation and persistent buccal tissue deficits. At implant exposure, buccal soft tissues were thickened with the CM (n = 7) or the SCTG (n = 7). Impressions were taken before and after surgery, after ten days, one, three and six months. Impressions were digitized and augmented regions 3D evaluated (soft tissue volume (mm3 , %)/thickness (mm)). RESULTS Volume increase (mm3 ) after 6 months was 19.56 ± 8.95 mm3 (CM) and 61.75 ± 52.69 mm3 (SCTG) (insignificant, p = .058). In percentage, this was a volume loss of the initially augmented soft tissue volume (100%) of 81.76% in the CM group and 56.39% in the SCTG group (6 months). The mean soft tissue thickness increase (mm) in the buccal contour after 6 months was 0.30 ± 0.16 mm (CM) and 0.80 ± 0.61 mm (SCTG) (insignificant, p = .071). CONCLUSION The early healing phase is associated with a significant volume loss of the soft tissues. The SCTG shows insignificant superiority compared to the CM.
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Affiliation(s)
- Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Karl A Schlegel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.,Private Practice, Munich, Germany
| | - Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ragai E Matta
- Department of Prosthodontics, University of Erlangen-Nuremberg, Erlangen, Germany
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14
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State of the Art on Biomaterials for Soft Tissue Augmentation in the Oral Cavity. Part II: Synthetic Polymers-Based Biomaterials. Polymers (Basel) 2020; 12:polym12081845. [PMID: 32824577 PMCID: PMC7465038 DOI: 10.3390/polym12081845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 01/10/2023] Open
Abstract
Most of the polymers used as biomaterials for scaffolds are naturally occurring, synthetic biodegradable, and synthetic non-biodegradable polymers. Since synthetic polymers can be adapted for obtaining singular desired characteristics by applying various fabrication techniques, their use has increased in the biomedical field, in dentistry in particular. The manufacturing methods of these new structures include many processes, such as electrospinning, 3D printing, or the use of computer-aided design/computer-aided manufacturing (CAD/CAM). Synthetic polymers show several drawbacks that can limit their use in clinical applications, such as the lack of cellular recognition, biodegradability, and biocompatibility. Moreover, concerning biodegradable polymers, the time for matrix resorption is not predictable, and non-resorbable matrices are preferred for soft tissue augmentation in the oral cavity. This review aimed to determine a new biomaterial to offset the present shortcomings in the oral environment. Researchers have recently proposed a novel non-resorbable composite membrane manufactured via electrospinning that has allowed obtaining remarkable in vivo outcomes concerning angiogenesis and immunomodulation throughout the polarization of macrophages. A prototype of the protocol for in vitro and in vivo experimentation with hydrogels is explained in order to encourage innovation into the development of promising biomaterials for soft tissue augmentation in the near future.
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15
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Naenni N, Walter P, Hämmerle CHF, Jung RE, Thoma DS. Augmentation of soft tissue volume at pontic sites: a comparison between a cross-linked and a non-cross-linked collagen matrix. Clin Oral Investig 2020; 25:1535-1545. [PMID: 32719982 PMCID: PMC7878233 DOI: 10.1007/s00784-020-03461-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/10/2020] [Indexed: 12/27/2022]
Abstract
AIM To assess histopathological and histomorphometric outcomes of soft tissue volume augmentation procedures at pontic sites using a volume-stable cross-linked collagen matrix (VCMX) and a non-cross-linked collagen matrix (XCM). MATERIALS AND METHODS In twelve adult beagle dogs, the mandibular premolars and first molar were hemisected and the mesial root extracted. Soft tissue augmentation was randomly performed using VCMX, XCM, or a sham-operated control. Sacrifice was performed after 4, 8, and 26 weeks. Non-decalcified sections were analyzed for histopathologic and histomorphometric measurements at four different levels below the crest (1.5, 2.5, 3.5, and 5.5 mm). RESULTS Group VCMX presented a greater overall amount of soft tissue at all healing time points, more pronounced fibroblast ingrowth, vascularization, and a substantial new collagen deposition. Over time, group XCM demonstrated faster signs of degradation compared with group VCMX. Four weeks after augmentation, group VCMX yielded a higher mean ridge width compared with groups XCM (2.22 mm VCMX, 0.89 mm XCM (at 2.5 mm); 2.05 mm VCMX, 0.80 mm XCM (at 3.5 mm) p < 0.05) and sham (0.59 mm sham (at 1.5 mm); 0.48 mm (at 2.5 mm); 0.44 mm (at 3.5 mm) p < 0.05). After healing periods of 8 and 26 weeks, measurements in group VCMX remained significantly higher compared with group sham both at 8 weeks (levels of 1.5 mm, 2.5 mm and 5.5 mm) and at 26 weeks (levels of 1.5 mm, 3.5 mm and 5.5 mm) (p < 0.05). CONCLUSION The use of a cross-linked collagen matrix resulted in a greater and more stable ridge width over time compared with control groups. CLINICAL RELEVANCE Soft tissue volume augmentation at pontic sites is more effective when using a cross-linked compared with a non-cross-linked collagen matrix.
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Affiliation(s)
- Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Prisca Walter
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland. .,Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry,, Yonsei University, Seoul, South Korea.
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16
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Song YW, Jung H, Han SY, Paeng KW, Kim MJ, Cha JK, Choi YJ, Jung UW. Effects of soft tissue grafting prior to orthodontic treatment on preventing gingival recession in dogs. J Periodontal Implant Sci 2020; 50:226-237. [PMID: 32643324 PMCID: PMC7443382 DOI: 10.5051/jpis.2000420021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/23/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study was conducted to assess the efficacy of prophylactic gingival grafting in the mandibular anterior labial area for preventing orthodontically induced gingival recession. METHODS Eight mongrel dogs received gingival graft surgery at the first (I1) and third (I3) mandibular incisors on both sides based on the following group allocation: AT group (autogenous connective tissue graft on I1), AT-control group (contralateral side in the AT group), CM group (xenogeneic cross-linked collagen matrix graft on I3) and CM-control group (contralateral side in the CM group). At 4 weeks after surgery, 6 incisors were splinted and proclined for 4 weeks, followed by 16 weeks of retention. At 24 weeks after surgery, casts were made and compared with those made before surgery, and radiographic and histomorphometric analyses were performed. RESULTS Despite the proclination of the incisal tip (by approximately 3 mm), labial gingival recession did not occur. The labial gingiva was thicker in the AT group (1.85±0.50 mm vs. 1.76±0.45 mm, P>0.05) and CM group (1.90±0.33 mm vs. 1.79±0.20 mm, P>0.05) than in their respective control groups. CONCLUSIONS The level of the labial gingival margin did not change following labial proclination of incisors in dogs. Both the AT and CM groups showed enhanced gingival thickness.
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Affiliation(s)
- Young Woo Song
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Heekyu Jung
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Seo Yeon Han
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyeong Won Paeng
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Myong Ji Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.
| | - Ui Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.
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17
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Zakrzewski W, Dobrzynski M, Rybak Z, Szymonowicz M, Wiglusz RJ. Selected Nanomaterials' Application Enhanced with the Use of Stem Cells in Acceleration of Alveolar Bone Regeneration during Augmentation Process. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E1216. [PMID: 32580409 PMCID: PMC7353104 DOI: 10.3390/nano10061216] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023]
Abstract
Regenerative properties are different in every human tissue. Nowadays, with the increasing popularity of dental implants, bone regenerative procedures called augmentations are sometimes crucial in order to perform a successful dental procedure. Tissue engineering allows for controlled growth of alveolar and periodontal tissues, with use of scaffolds, cells, and signalling molecules. By modulating the patient's tissues, it can positively influence poor integration and healing, resulting in repeated implant surgeries. Application of nanomaterials and stem cells in tissue regeneration is a newly developing field, with great potential for maxillofacial bony defects. Nanostructured scaffolds provide a closer structural support with natural bone, while stem cells allow bony tissue regeneration in places when a certain volume of bone is crucial to perform a successful implantation. Several types of selected nanomaterials and stem cells were discussed in this study. Their use has a high impact on the efficacy of the current and future procedures, which are still challenging for medicine. There are many factors that can influence the regenerative process, while its general complexity makes the whole process even harder to control. The aim of this study was to evaluate the effectiveness and advantage of both stem cells and nanomaterials in order to better understand their function in regeneration of bone tissue in oral cavity.
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Affiliation(s)
- Wojciech Zakrzewski
- Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-345 Wroclaw, Poland; (W.Z.); (Z.R.); (M.S.)
| | - Maciej Dobrzynski
- Department of Conservative Dentistry and Pedodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland;
| | - Zbigniew Rybak
- Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-345 Wroclaw, Poland; (W.Z.); (Z.R.); (M.S.)
| | - Maria Szymonowicz
- Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-345 Wroclaw, Poland; (W.Z.); (Z.R.); (M.S.)
| | - Rafal J. Wiglusz
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okolna 2, 50-422 Wroclaw, Poland
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18
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Suzuki KT, de Jesus Hernandez Martinez C, Suemi MI, Palioto DB, Messora MR, de Souza SLS, Novaes AB, Chaves Furlaneto FA, Taba M. Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial. Clin Oral Investig 2020; 24:4077-4087. [PMID: 32382931 DOI: 10.1007/s00784-020-03280-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/08/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the use of a porcine-derived acellular dermal matrix (MD) in root coverage procedures combined with extended coronally positioned flap (eCAF), in comparison to the subepithelial connective tissue graft (SCTG) associated with the eCAF. MATERIAL AND METHODS Eighteen adult patients presenting bilateral type 1 gingival recession were randomly assigned to SCTG or MD groups. Clinical and patient-based outcomes were recorded at 3 and 6 months after the surgical procedure. RESULTS Both groups showed a significant reduction in the mean recession height of 3.33 ± 0.89 mm to 1.24 ± 1.10 mm (MD) and 3.21 ± 0.8 mm to 0.83 ± 0.86 mm (SCTG) without difference between groups. Six patients in the test group and eight in the control group obtained complete root coverage. The keratinized tissue height and thickness (KTT) showed a significant increase after 3 and 6 months in both groups. The average KTT gains were 0.39 ± 0.4 mm (MD) and 0.51 ± 0.5 mm (SCTG) (p < 0.05). Performing multivariate analysis suggests that MD addition to coronally advanced flaps may be similar to SCTG. CONCLUSION The MD had similar results in comparison to SCTG and in the context of reducing patient morbidity it can be used as an alternative for the treatment of gingival recessions. CLINICAL RELEVANCE The SCTG is the gold standard therapy for root coverage. The MD has been widely used in mucogingival surgery as a substitute for SCTG and proposed similar results. A substitute is very important for clinicians and patients. It will give a better postoperative and possibilities to treat multiples recession. (Clinicaltrials.gov Identifier: NCT03675334).
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Affiliation(s)
- Kleber Tanaka Suzuki
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Cristhiam de Jesus Hernandez Martinez
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Milena Irie Suemi
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Daniela Bazan Palioto
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Michel Reis Messora
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Sérgio Luis Scombatti de Souza
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Arthur Belem Novaes
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Flavia A Chaves Furlaneto
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil
| | - Mario Taba
- Department of Oral & Maxillofacial Surgery, and Periodontology, School of Dentistry of Ribeirão Preto, University of Sao Paulo, Av. do Cafe, s/n, Ribeirão Preto, São Paulo, CEP: 14040-904, Brazil.
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19
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Stefanini M, Mounssif I, Barootchi S, Tavelli L, Wang HL, Zucchelli G. An exploratory clinical study evaluating safety and performance of a volume-stable collagen matrix with coronally advanced flap for single gingival recession treatment. Clin Oral Investig 2020; 24:3181-3191. [DOI: 10.1007/s00784-019-03192-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/27/2019] [Indexed: 10/24/2022]
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20
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Tissue Response to a Porous Collagen Matrix Used for Soft Tissue Augmentation. MATERIALS 2019; 12:ma12223721. [PMID: 31718004 PMCID: PMC6888327 DOI: 10.3390/ma12223721] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 01/05/2023]
Abstract
A short inflammatory phase and fast ingrowth of blood vessels and mesenchymal cells are essential for tissue integration of a biomaterial. Macrophages play a key role in this process. We investigated invasion of macrophages, blood vessels, and proliferating cells into a highly porous and volume-stable collagen matrix (VCMX) used for soft tissue augmentation around teeth and dental implants. The biomaterial was implanted in submucosal pouches in the canine maxilla, and the tissue response was analyzed at six different time points. Immunohistochemistry was done for proliferating cells (PCNA), macrophages (MAC387), multinucleated giant cells (CD86), and blood vessels (TGM2). Blood rapidly filled the VCMX pores. During the first week, MAC387+ cells populated the VCMX pores, blood vessels and PCNA+ cells invaded the VCMX, and CD86+ scattered cells were observed. At 15 days, MAC387+ cells were scanty, blood vessels had completely invaded the VCMX, the number of proliferating cells peaked, and fibroblasts appeared. At 30 days, MAC387+ were absent, the numbers of proliferating and CD86+ cells had declined, while blood vessel and fibroblast numbers were high. At 90 days, residual VCMX was well-integrated in soft connective tissue. In conclusion, the VCMX elicited a short inflammatory phase followed by rapid tissue integration.
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21
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Schmitt CM, Schlegel KA, Gammel L, Moest T. Gingiva thickening with a porcine collagen matrix in a preclinical dog model: Histological outcomes. J Clin Periodontol 2019; 46:1273-1281. [PMID: 31517397 DOI: 10.1111/jcpe.13196] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/27/2022]
Abstract
AIM To compare 10-month histological and immunohistological outcomes after soft tissue thickening around teeth with a porcine collagen matrix (CM) versus a subepithelial connective tissue graft (SCTG). MATERIAL AND METHODS In eight beagle dogs, soft tissue thickening of the buccal gingiva of upper canines was performed with the SCTG or the CM. Connective tissue thickness (CTT) was histomorphometrically measured in the augmented regions. The augmented connective tissues were also histologically characterized and the collagen I and vascular endothelial growth factor (VEGF) expressions immunohistologically quantified. RESULTS CTT significantly differed between groups (SCTG: 1.32 mm ± 0.44 mm; CM: 1.06 mm ± 0.27 mm; p = .008). Descriptive histological analyses revealed mature connective tissue that did not differ between groups. Immunohistological quantification of collagen I and VEGF expressions in the connective tissue also revealed no significant inter-group differences (collagen I: SCTG, 32.64% ± 7.09% vs. CM, 30.57% ± 7.83%; VEGF: SCTG, 39.06% ± 7.27% vs. CM, 37.15% ± 9.80%). CONCLUSION SCTG is superior to CM with regard to CTT in this experimental model. The CM and the SCTG lead to comparable connective tissue quality ten months after connective tissue thickening.
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Affiliation(s)
- Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.,Private Practice Prof. Schlegel and Colleagues, Munich, Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.,Private Practice Prof. Schlegel and Colleagues, Munich, Germany
| | - Lisa Gammel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Yoo SY, Lee JS, Cha JK, Kim SK, Kim CS. Periodontal healing using a collagen matrix with periodontal ligament progenitor cells in a dehiscence defect model in beagle dogs. J Periodontal Implant Sci 2019; 49:215-227. [PMID: 31485372 PMCID: PMC6713806 DOI: 10.5051/jpis.2019.49.4.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose To histologically characterize periodontal healing at 8 weeks in surgically created dehiscence defects in beagle dogs that received a collagen matrix with periodontal ligament (PDL) progenitor cells. Methods The bilateral maxillary premolars and first molars in 6 animals were used. Standardized experimental dehiscence defects were made on the buccal side of 3 premolars, and primary culturing of PDL progenitor cells was performed on the molars. Collagen matrix was used as a scaffold and a delivery system for PDL progenitor cells. The experimental sites were grafted with collagen matrix (COL), PDL progenitor cells with collagen matrix (COL/CELL), or left without any material (CTL). Histologic and histomorphometric analyses were performed after 8 weeks. Results The defect height from the cementoenamel junction to the most apical point of cementum removal did not significantly differ across the CTL, COL, and COL/CELL groups, at 4.57±0.28, 4.56±0.41, and 4.64±0.27 mm (mean ± standard deviation), respectively; the corresponding values for epithelial adhesion were 1.41±0.51, 0.85±0.29, and 0.30±0.41 mm (P<0.05), the heights of new bone regeneration were 1.32±0.44, 1.65±0.52, and 1.93±0.61 mm (P<0.05), and the cementum regeneration values were 1.15±0.42, 1.81±0.46, and 2.57±0.56 mm (P<0.05). There was significantly more new bone formation in the COL/CELL group than in the CTL group, and new cementum length was also significantly higher in the COL/CELL group. However, there were no significant differences in the width of new cementum among the groups. Conclusions PDL progenitor cells carried by a synthetic collagen matrix may enhance periodontal regeneration, including cementum and new bone formation.
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Affiliation(s)
- Seung-Yoon Yoo
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Seul-Ki Kim
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.,Department of Applied Life Science, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Chang-Sung Kim
- Department of Periodontology, Research Institute of Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.,Department of Applied Life Science, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea.,Department of Mechanical Engineering, Yonsei University College of Engineering, Seoul, Korea
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Seo GY, Thoma DS, Jung UW, Lee JS. Increasing the tissue thickness at implant sites using guided bone regeneration and an additional collagen matrix: Histologic observations in beagle dogs. J Biomed Mater Res B Appl Biomater 2019; 107:741-749. [PMID: 30080303 DOI: 10.1002/jbm.b.34168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/01/2018] [Accepted: 05/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To histologically determine the alteration in horizontal mucosal thickness at sites that received guided bone regeneration (GBR) with additional use of collagen matrix and to assess whether bone formation is affected by adding collagen matrix at GBR sites at 8 weeks of healing. MATERIALS AND METHODS Eight weeks after bilateral extraction of maxillary premolars, standardized defects were created on buccal side of edentulous ridges in four beagle dogs. One side was randomly allocated as control (biphasic calcium phosphate plus collagen membrane; GBR only), while contralateral side was allocated as test (biphasic calcium phosphate plus collagen membrane plus an additional layer of collagen matrix). Histologic observations, histomorphometric and micro-computed tomography analyses were performed after 8 weeks. RESULTS Membrane complex comprising residual collagen membrane and adjacent dense connective tissue was observed at both control and test sites. The thickness in the histologic analysis were 1.69 ± 0.23 mm (control) and 1.76 ± 0.07 mm (test) in histologic analysis and were 2.03 ± 0.26 mm (control) and 2.14 ± 0.24 mm (test) in radiographic analysis. The thickness of the membrane complex in soft-tissue layer were 723.0 ± 241.6 μm (control) and 984.6 ± 334.4 μm (test). The percentage of new bone formation were 22.30 ± 5.92% (control) and 25.50 ± 8.08% (test). All measured outcome did not show significant differences between control and test groups. CONCLUSION The addition of collagen matrix on top of standard GBR procedure did not increase the soft tissue thickness and dense connective tissue formation at 8 weeks of healing. Bone regeneration was not affected by the addition of collagen matrix. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 741-749, 2019.
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Affiliation(s)
- Gi-Young Seo
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Daniel Stefan Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center for Dental Medicine, University of Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Republic of Korea
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Sanz-Martín I, Encalada C, Sanz-Sánchez I, Aracil J, Sanz M. Soft tissue augmentation at immediate implants using a novel xenogeneic collagen matrix in conjunction with immediate provisional restorations: A prospective case series. Clin Implant Dent Relat Res 2018; 21:145-153. [DOI: 10.1111/cid.12696] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Carolina Encalada
- Section of Graduate Periodontology; University Complutense; Madrid Spain
| | - Ignacio Sanz-Sánchez
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Javier Aracil
- Section of Graduate Periodontology; University Complutense; Madrid Spain
| | - Mariano Sanz
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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25
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Song YW, Kim S, Waller T, Cha JK, Cho SW, Jung UW, Thoma DS. Soft tissue substitutes to increase gingival thickness: Histologic and volumetric analyses in dogs. J Clin Periodontol 2018; 46:96-104. [PMID: 30372547 DOI: 10.1111/jcpe.13034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 08/29/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate the histologic and volumetric changes of gingival tissues following grafting with collagen-based matrices at labial aspect of teeth in canines. MATERIALS AND METHODS Gingival augmentation was performed in the mandibular incisor area using two types of xenogeneic cross-linked collagen matrices (CCMs), bovine CCM for BCCM group and porcine CCM for PCCM group, whereas the contralateral sides remained untreated (B-control group and P-control group). Descriptive histology, histometric and volumetric analyses were performed after 12 weeks. For statistical comparison between each test group and respective control group, paired t test was used for histometric analysis, and repeated-measured analysis of variance was used for volumetric analysis (p < 0.05). RESULTS An increased number of rete pegs and an enhanced formation of new blood vessels were observed at both grafted sites compared to the corresponding control sites. There was statistically significant gain of horizontal thickness only in BCCM group (1.36 ± 0.27 mm vs. 1.26 ± 0.34 mm; p < 0.05) compared to the B-control groups. CONCLUSION BCCM was effective for gingival augmentation in terms of horizontal thickness at the labial aspect of teeth at 12 weeks post-surgery.
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Affiliation(s)
- Young Woo Song
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Korea
| | - Tobias Waller
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Sung-Won Cho
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Herford AS, Nguyen K, Miller M, Tandon R, Signorino F. Evaluation of the Safety and Efficacy of Soft Tissue Augmentation With a Compressive-Resistant Collagen Matrix in a Nonhuman Primate Model. J Oral Maxillofac Surg 2018; 77:615-628. [PMID: 30267705 DOI: 10.1016/j.joms.2018.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the safety and efficacy of the compression-resistant collagen-based cross-linked matrix for augmentation of maxillary and mandibular soft tissue defects in an animal model. MATERIALS AND METHODS Six rhesus macaque monkeys were subjected to soft tissue grafting in 4 sites intraorally; the anterior maxilla was subjected to hard and soft tissue grafting with implant placement. Each site was randomly assigned 1 of 3 treatments: a compressive-resistant collagen matrix membrane (CM), a subepithelial connective tissue autograft (SCTG), or sham treatment, in which a partial-thickness flap was elevated and then sutured closed with no further treatment (control). The following methods were used for data collection: in vivo evaluation by periodontal probing, ultrasound, shear modulus elasticity, polyether impressions for volumetric analysis, and in vitro analysis by histologic biopsy examinations. In vitro analysis provided by histologic measurements and evaluations was performed on nondecalcified sections. The follow-up period was 6 months. RESULTS The SCTG and CM showed favorable tissue integration. No adverse reaction to or deviation from the normal healing processes was detected. The CM integrated well in all sites, with a variable range of soft tissue volume increases. Volumetric discrepancies were appreciated in the histologic analyses and differences were found when the CM and SCTG were applied in the anterior maxilla in combination with hard tissue grafting and implant placement. Histologic evaluation showed favorable integration, no immunogenic response to the CM, and stable volumetric retention in autograft and CM sites during the experimental period. CONCLUSION The compressive-resistant CM could be a safe and efficacious alternative for soft tissue augmentation by obviating a donor site and the consequent morbidity. Although a similar performance between the CM and SCTG was observed, further studies will be necessary to estimate the clinical potentiality and describe the limits of the technique.
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Affiliation(s)
- Alan S Herford
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, CA.
| | - Katina Nguyen
- Resident, Department of Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, CA
| | - Meagan Miller
- Resident, Department of Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, CA
| | - Rahul Tandon
- Resident, Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Southwestern University, Dallas, TX
| | - Fabrizio Signorino
- Resident, Oral Surgery, Department of Dental Implants, University of Milan, Milan, Italy
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27
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Tonetti MS, Cortellini P, Pellegrini G, Nieri M, Bonaccini D, Allegri M, Bouchard P, Cairo F, Conforti G, Fourmousis I, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H, Wachtel H, Wallkamm B, Zabalegui I, Zuhr O. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol 2017; 45:78-88. [PMID: 29087001 PMCID: PMC5765511 DOI: 10.1111/jcpe.12834] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
Aim To evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient‐reported outcomes (PROM). Material and methods One hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. Results Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8). Conclusion Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.
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Affiliation(s)
- Maurizio S Tonetti
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, Hong Kong University, Hong Kong, Hong Kong
| | | | - Gaia Pellegrini
- European Research Group on Periodontology, Genova, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milano, Italy
| | - Michele Nieri
- European Research Group on Periodontology, Genova, Italy.,Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Mario Allegri
- European Research Group on Periodontology, Genova, Italy
| | - Philippe Bouchard
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, Service of Odontology, Rothschild Hospital, Denis Diderot University, Paris, France
| | - Francesco Cairo
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, University of Florence, Florence, Italy
| | | | | | - Filippo Graziani
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, University of Pisa, Pisa, Italy
| | | | - Jan Halben
- European Research Group on Periodontology, Genova, Italy
| | - Jacques Malet
- European Research Group on Periodontology, Genova, Italy.,University, U.F.R. of Odontology, Descartes University Paris, Paris, France
| | - Giulio Rasperini
- European Research Group on Periodontology, Genova, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milano, Italy
| | - Heinz Topoll
- European Research Group on Periodontology, Genova, Italy
| | - Hannes Wachtel
- European Research Group on Periodontology, Genova, Italy
| | - Beat Wallkamm
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, University of Bern, Berne, Switzerland
| | - Ion Zabalegui
- European Research Group on Periodontology, Genova, Italy
| | - Otto Zuhr
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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28
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Volumetric and linear changes at dental implants following grafting with volume-stable three-dimensional collagen matrices or autogenous connective tissue grafts: 6-month data. Clin Oral Investig 2017; 22:1185-1195. [DOI: 10.1007/s00784-017-2210-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
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29
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Cairo F, Barbato L, Tonelli P, Batalocco G, Pagavino G, Nieri M. Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial. J Clin Periodontol 2017; 44:769-776. [DOI: 10.1111/jcpe.12750] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Paolo Tonelli
- Research Unit in Periodontology and Periodontal Medicine; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | | | - Gabriella Pagavino
- Research Unit in Periodontology and Periodontal Medicine; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Michele Nieri
- Research Unit in Periodontology and Periodontal Medicine; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
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30
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Kissa J, El Kholti W, Laalou Y, El Farouki M. Augmentation of keratinized gingiva around dental implants. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:156-160. [PMID: 28411136 DOI: 10.1016/j.jormas.2017.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/04/2017] [Indexed: 11/25/2022]
Abstract
To date, there is no general consensus with respect to the amount of soft-tissue volume needed for esthetic and functional purposes on the buccal aspect of dental implants. Numerous studies have investigated the relationship between the width of keratinized mucosa and the health of peri-implant tissues. Our purpose was to discuss about the necessity of keratinized tissue to maintain the peri-implant health and to report clinical efficacy of different techniques used to increase the keratinized tissue around dental implants.
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Affiliation(s)
- J Kissa
- Service de Parodontologie, Faculté de Médecine Dentaire de Casablanca, Casablanca, Morocco
| | - W El Kholti
- Service de Parodontologie, Faculté de Médecine Dentaire de Casablanca, Casablanca, Morocco.
| | - Y Laalou
- Exercice Privé de Prothèse-implantologie à Casablanca, Casablanca, Morocco
| | - M El Farouki
- Service de Parodontologie, Faculté de Médecine Dentaire de Casablanca, Casablanca, Morocco
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31
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Lima RSRE, Peruzzo DC, Napimoga MH, Saba-Chujfi E, Dos Santos-Pereira SA, Martinez EF. Evaluation of the Biological Behavior of Mucograft® in Human Gingival Fibroblasts: An In Vitro Study. Braz Dent J 2017; 26:602-6. [PMID: 26963203 DOI: 10.1590/0103-6440201300238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/08/2015] [Indexed: 02/17/2023] Open
Abstract
Mucograft(r) is a resorbing porcine matrix composed of type I and type III collagen, used for soft tissue augmentation in guided tissue bony regeneration procedures. This in vitro study aimed to evaluate the biological behavior of Mucograft(r) in human gingival fibroblasts, as well as the ability of the matrix to induce production of extracellular matrix. Six resorbing Mucograft(r) matrices (MCG) were cut into 3 x 2 mm rectangles and 5 x 5 mm squares and were placed in 96- and 24-well plates, respectively. The control group (CTRL) consisted of cells plated on polystyrene without the MCG. After one, two, three and seven days, cell proliferation and viability were assessed using the Trypan exclusion method and MTT test, respectively. Type III collagen (COL 3A1) and vimentin (VIM) expression were also evaluated at 10 and 14 days, using Western blotting. Statistical analysis, using ANOVA with post hoc Bonferroni test, revealed that human gingival fibroblasts from MCG showed similar results (p>0.05) for proliferation and viability as the cells cultured on CTRL. After 14 days, a significant decrease in COL 3A1 expression (p<0.05) was observed when cultured with the MCG. VIM expression showed no significant difference at any time period (p>0.05). Although no increase in extracellular matrix secretion was observed in this in vitro study, Mucograft(r) presented cellular compatibility, being an option for a scaffold whenever it is required.
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Affiliation(s)
- Rafaela S R E Lima
- Department of Periodontology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Daiane C Peruzzo
- Department of Periodontology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Marcelo H Napimoga
- Department of Immunology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Eduardo Saba-Chujfi
- Department of Periodontology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | | | - Elizabeth F Martinez
- Department of Pathology and Cell Biology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
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32
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Zeltner M, Jung RE, Hämmerle CHF, Hüsler J, Thoma DS. Randomized controlled clinical study comparing a volume-stable collagen matrix to autogenous connective tissue grafts for soft tissue augmentation at implant sites: linear volumetric soft tissue changes up to 3 months. J Clin Periodontol 2017; 44:446-453. [PMID: 28107560 DOI: 10.1111/jcpe.12697] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 11/28/2022]
Abstract
AIM To test whether or not the use of a volume-stable collagen matrix (VCMX) results in soft tissue volume increase at implant sites non-inferior to an autogenous subepithelial connective tissue graft (SCTG). METHODS In 20 patients, soft tissue augmentation at implant sites was performed using VCMX or SCTG. Casts obtained prior to augmentation (BL), at 30 (FU-30) and 90 days (FU-90) were digitized and transferred to stereolithography (STL) files. BL, FU-30 and FU-90 STL files were superimposed and linear volumetric changes evaluated in crestal and buccal regions of interest (ROI). Descriptive analysis was computed for both groups and a test for non-inferiority was performed. RESULTS The median linear changes from BL to FU-90 in the crestal ROI amounted to 0.175 mm (0.06; 0.51) for VCMX (p = 0.002 over time) and to 0.51 mm (0.23; 0.94) for SCTG (p = 0.129). The differences between the two groups were not significant (p = 0.287). The respective values in the buccal ROI were 0.59 mm (0.26; 1.06) for VCMX (p = 0.002) and 0.94 mm (0.66; 1.13) for SCTG (p = 0.004). The differences between the two groups were not significant (crestal: p = 0.287; buccal: p = 0.534). Non-inferiority could be concluded for VCMX compared to SCTG for both ROI. CONCLUSION VCMX and SCTG can be used for soft tissue augmentation at implant sites resulting in an at least short-term increase in volume.
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Affiliation(s)
- Marco Zeltner
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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33
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Reino DM, Maia LP, Fernandes PG, Souza SLSD, Taba Junior M, Palioto DB, Grisi MFDM, Novaes AB. A Randomized Comparative Study of Two Techniques to Optimize the Root Coverage Using a Porcine Collagen Matrix. Braz Dent J 2017; 26:445-50. [PMID: 26647926 DOI: 10.1590/0103-6440201300353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/08/2015] [Indexed: 11/21/2022] Open
Abstract
The aim of this randomized controlled clinical study was to compare the extended flap technique (EFT) with the coronally advanced flap technique (CAF) using a porcine collagen matrix (PCM) for root coverage. Twenty patients with two bilateral gingival recessions, Miller class I or II on non-molar teeth were treated with CAF+PCM (control group) or EFT+PCM (test group). Clinical measurements of probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), keratinized tissue height (KTH), keratinized mucosa thickness (KMT) were determined at baseline, 3 and 6 months post-surgery. At 6 months, the mean root coverage for test group was 81.89%, and for control group it was 62.80% (p<0.01). The change of recession depth from baseline was statistically significant between test and control groups, with an mean of 2.21 mm gained at the control sites and 2.84 mm gained at the test sites (p=0.02). There were no statistically significant differences for KTH, PPD or CAL comparing the two therapies. The extended flap technique presented better root coverage than the coronally advanced flap technique when PCM was used.
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Affiliation(s)
- Danilo Maeda Reino
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Luciana Prado Maia
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Patrícia Garani Fernandes
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Sergio Luis Scombatti de Souza
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mario Taba Junior
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Bazan Palioto
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcio Fermandes de Moraes Grisi
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Arthur Belém Novaes
- Department of Surgery, Oral and Maxillofacial Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Bienz SP, Sailer I, Sanz-Martín I, Jung RE, Hämmerle CHF, Thoma DS. Volumetric changes at pontic sites with or without soft tissue grafting: a controlled clinical study with a 10-year follow-up. J Clin Periodontol 2017; 44:178-184. [DOI: 10.1111/jcpe.12651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Stefan P. Bienz
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Irena Sailer
- Division for Fixed Prosthodontics and Biomaterials; Center of Dental Medicine; University of Geneva; Geneva Switzerland
| | - Ignacio Sanz-Martín
- Section of Periodontology; Faculty of Odontology; University Complutense of Madrid; Madrid Spain
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
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Thoma DS, Naenni N, Benic GI, Hämmerle CHF, Jung RE. Soft tissue volume augmentation at dental implant sites using a volume stable three-dimensional collagen matrix - histological outcomes of a preclinical study. J Clin Periodontol 2017; 44:185-194. [PMID: 27716970 DOI: 10.1111/jcpe.12635] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to test whether or not soft tissue augmentation with a collagen matrix (VCMX) leads to a similar increase in ridge width around dental implants compared to the use of an autogenous subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS In 12 dogs, immediate dental implants were placed with simultaneous guided bone regeneration. Three months later, soft tissue volume augmentation was performed by randomly allocating three treatment modalities to these sites [VCMX, SCTG, sham-operated group (control)]. Dogs were sacrificed at 1 (n = 4), 2 (n = 4) or 6 months (n = 4). Descriptive histology and histomorphometric measurements for soft tissue thickness were performed on non-decalcified sections. RESULTS The horizontal soft tissue thickness was maximal at the most coronal level (alveolar crest) at 1 month (VCMX: 2.1 ± 1.6 mm; SCTG: 2.5 ± 1.7 mm; p = 0.877) and decreased until 6 months. At 6 months, the greatest mucosal thickness was at a level 3.5 mm below the crest (VCMX: 0.8 ± 0.3 mm; SCTG: 0.7 ± 0.2 mm) (p = 0.754). Control sites revealed no relevant soft tissue augmentation at any level and any time-point. Tissue integration for VCMX and SCTG were favourable with minimal inflammatory reactions. CONCLUSIONS Soft tissue volume augmentation at implant sites was obtained to a similar extent using VCMX and SCTG up to 2 months. Thereafter, degradation and remodelling processes were enhanced leading to a minimal increase in soft tissue thickness at 6 months for VCMX and SCTG.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nadja Naenni
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Goran I Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Thoma DS, Zeltner M, Hilbe M, Hämmerle CHF, Hüsler J, Jung RE. Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites. J Clin Periodontol 2016; 43:874-85. [PMID: 27310522 DOI: 10.1111/jcpe.12588] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/29/2022]
Abstract
AIM To test whether or not the use of a collagen matrix (VCMX) results in short-term soft tissue volume increase at implant sites non-inferior to an autogenous subepithelial connective tissue graft (SCTG), and to evaluate safety and tissue integration of VCMX and SCTG. METHODS In 20 patients with a volume deficiency at single-tooth implant sites, soft tissue volume augmentation was performed randomly allocating VCMX or SCTG. Soft tissue thickness, patient-reported outcome measures (PROMs), and safety were assessed up to 90 days (FU-90). At FU-90 (abutment connection), tissue samples were obtained for histological analysis. Descriptive analysis was computed for both groups. Non-parametric tests were applied to test non-inferiority for the gain in soft tissue thickness at the occlusal site. RESULTS Median soft tissue thickness increased between BL and FU-90 by 1.8 mm (Q1:0.5; Q3:2.0) (VCMX) (p = 0.018) and 0.5 mm (-1.0; 2.0) (SCTG) (p = 0.395) (occlusal) and by 1.0 mm (0.5; 2.0) (VCMX) (p = 0.074) and 1.5 mm (-2.0; 2.0) (SCTG) (p = 0.563) (buccal). Non-inferiority with a non-inferiority margin of 1 mm could be demonstrated (p = 0.020); the difference between the two group medians (1.3 mm) for occlusal sites indicated no relevant, but not significant superiority of VCMX versus SCTG (primary endpoint). Pain medication consumption and pain perceived were non-significantly higher in group SCTG up to day 3. Median physical pain (OHIP-14) at day 7 was 100% higher for SCTG than for VCMX. The histological analysis revealed well-integrated grafts. CONCLUSIONS Soft tissue augmentation at implant sites resulted in a similar or higher soft tissue volume increase after 90 days for VCMX versus SCTG. PROMs did not reveal relevant differences between the two groups.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Marco Zeltner
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Monika Hilbe
- Institute of Veterinary Pathology, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Schmitt CM, Matta RE, Moest T, Humann J, Gammel L, Neukam FW, Schlegel KA. Soft tissue volume alterations after connective tissue grafting at teeth: the subepithelial autologous connective tissue graft versus a porcine collagen matrix - a pre-clinical volumetric analysis. J Clin Periodontol 2016; 43:609-17. [PMID: 26990041 DOI: 10.1111/jcpe.12547] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 11/28/2022]
Abstract
AIM This study evaluates a porcine collagen matrix (CM) for soft tissue thickening in comparison to the subepithelial connective tissue graft (SCTG). MATERIAL AND METHODS In eight beagle dogs, soft tissue thickening was performed at the buccal aspects of the upper canines (SCTG and CM). Impressions were taken before augmentation (i1), after surgery (i2), after one (i3), three (i4) and ten month (i5). Casts were optically scanned with a 3D scanner and each augmented region (unit of analysis) evaluated (primary outcome variable: volume increase in mm(3) ; secondary outcome variables: volume increase in percent, mean and maximum thickness increases in mm). RESULTS 3D tissue measurements after surgery revealed a significant higher volume increase in the CM (86.37 mm(3) ± 35.16 mm(3) ) than in the SCTG group (47.65 mm(3) ± 17.90 mm(3) ). After 10 months, volume increase was non-significant between groups (SCTG:11.36 mm(3) ± 9.26 mm(3) ; CM: 8.67 mm(3) ± 13.67 mm(3) ). Maximum soft tissue thickness increase (i1-i5) was 0.66 mm ± 0.29 mm (SCTG) and 0.79 mm ± 0.37 mm (CM) with no significant difference. CONCLUSIONS Ten months after soft tissue thickening, the CM is statistically non-inferior to the SCTG in terms of soft tissue volume and thickness increase. Further 3D studies are needed to confirm the data.
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Affiliation(s)
- Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ragai E Matta
- Department of Prosthodontics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julia Humann
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lisa Gammel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich W Neukam
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Karl A Schlegel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Agarwal A, Gupta ND. Alveolar ridge augmentation by connective tissue grafting using a pouch method and modified connective tissue technique: A prospective study. Dent Res J (Isfahan) 2016; 12:548-53. [PMID: 26759591 PMCID: PMC4696357 DOI: 10.4103/1735-3327.170574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Localized alveolar ridge defect may create physiological and pathological problems. Developments in surgical techniques have made it simpler to change the configuration of a ridge to create a more aesthetic and more easily cleansable shape. The purpose of this study was to compare the efficacy of alveolar ridge augmentation using a subepithelial connective tissue graft in pouch and modified connective tissue graft technique. Materials and Methods: In this randomized, double blind, parallel and prospective study, 40 non-smoker individuals with 40 class III alveolar ridge defects in maxillary anterior were randomly divided in two groups. Group I received modified connective tissue graft, while group II were treated with subepithelial connective tissue graft in pouch technique. The defect size was measured in its horizontal and vertical dimension by utilizing a periodontal probe in a stone cast at base line, after 3 months, and 6 months post surgically. Analysis of variance and Bonferroni post-hoc test were used for statistical analysis. A two-tailed P < 0.05 was considered to be statistically significant. Results: Mean values in horizontal width after 6 months were 4.70 ± 0.87 mm, and 4.05 ± 0.89 mm for group I and II, respectively. Regarding vertical heights, obtained mean values were 4.75 ± 0.97 mm and 3.70 ± 0.92 mm for group I and group II, respectively. Conclusion: Within the limitations of this study, connective tissue graft proposed significantly more improvement as compare to connective tissue graft in pouch.
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Affiliation(s)
- Ashish Agarwal
- Department of Periodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Narinder Dev Gupta
- Department of Periodontics, Dr. Z. A. Dental College, Aligarh, Uttar Pradesh, India
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Zafiropoulos GG, Deli G, Hoffmann O, John G. Changes of the peri-implant soft tissue thickness after grafting with a collagen matrix. J Indian Soc Periodontol 2016; 20:441-445. [PMID: 28298828 PMCID: PMC5341321 DOI: 10.4103/0972-124x.181245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the treatment outcome of the use of a porcine monolayer collagen matrix (mCM) to increase soft-tissue volume as a part of implant site development. MATERIALS AND METHODS Implants were placed in single sites in 27 patients. In the test group, mCM was used for soft-tissue augmentation. No graft was placed in the control group. Soft-tissue thickness (STTh) was measured at the time of surgery (T0) and 6 months postoperatively (T1) at two sites (STTh 1, 1 mm below the gingival margin; STTh 2, 3 mm below the mucogingival margin). RESULTS Significant increases (P < 0.001) in STTh (STTh 1 = 1.06 mm, 117%; STTh 2 = 0.89 mm, 81%) were observed in the test group. Biopsy results showed angiogenesis and mature connective tissue covered by keratinized epithelium. CONCLUSIONS Within the limitations of this study, it could be concluded that mCM leads to a significant increase of peri-implant soft-tissue thickness, with good histological integration and replacement by soft tissue and may serve as an alternative to connective tissue grafting.
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Affiliation(s)
| | - Giorgio Deli
- Division of Periodontology, School of Dentistry, Catholic University, Rome, Italy
| | - Oliver Hoffmann
- Department of Periodontology, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - Gordon John
- Department of Oral Surgery, School of Dentistry, University of Duesseldorf, Duesseldorf, Germany
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Hoshi S, Akizuki T, Matsuura T, Ikawa T, Kinoshita A, Oda S, Tabata Y, Matsui M, Izumi Y. Ridge augmentation using recombinant human fibroblast growth factor-2 with biodegradable gelatin sponges incorporating β-tricalcium phosphate: a preclinical study in dogs. J Periodontal Res 2015; 51:77-85. [PMID: 26031712 DOI: 10.1111/jre.12285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Fibroblast growth factor-2 (FGF-2) regulates the proliferation and differentiation of osteogenic cells, resulting in the promotion of bone formation. Biodegradable gelatin sponges incorporating β-tricalcium phosphate (β-TCP) have been reported as a scaffold, which has the ability to control growth factor release, offering sufficient mechanical strength and efficient migration of mesenchymal cells. In this study, we evaluated the effects of the combined use of recombinant human FGF-2 (rhFGF-2) and gelatin/β-TCP sponge on ridge augmentation in dogs. MATERIAL AND METHODS Six male beagle dogs were used in this study. Twelve wk after tooth extraction, bilateral 10 × 5 mm (width × depth) saddle-type defects were created 3 mm apart from the mesial side of the maxillary canine. At the experimental sites, the defects were filled with gelatin/β-TCP sponge infiltrated with 0.3% rhFGF-2, whereas gelatin/β-TCP sponge infiltrated with saline was applied to the control sites. Eight wk after surgery, qualitative and quantitative analyses were performed. RESULTS There were no signs of clinical inflammation at 8 wk after surgery. Histometric measurements revealed that new bone height at the experimental sites (2.98 ± 0.65 mm) was significantly greater than that at the control sites (1.56 ± 0.66 mm; p = 0.004). The total tissue height was greater at the experimental sites (6.62 ± 0.66 mm) than that at the control sites (5.95 ± 0.74 mm), although there was no statistical significant difference (p = 0.051). Cast model measurements revealed that the residual defect height at the experimental sites (2.31 ± 0.50 mm) was significantly smaller than that at the control sites (3.51 ± 0.78 mm; p = 0.012). CONCLUSION The combined use of rhFGF-2 and gelatin/β-TCP sponge promotes ridge augmentation in canine saddle-type bone defects.
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Affiliation(s)
- S Hoshi
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Akizuki
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.,Division of Periodontology, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Kanagawa, Japan
| | - T Matsuura
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Ikawa
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - A Kinoshita
- Department of Educational Media Development, Institute for Library and Media Information Technology, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Oda
- Oral Diagnosis and General Dentistry, University Hospital of Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Tabata
- Department of Biomaterials, Kyoto University, Kyoto, Japan
| | - M Matsui
- Department of Biomaterials, Kyoto University, Kyoto, Japan
| | - Y Izumi
- Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Schmitt CM, Moest T, Lutz R, Wehrhan F, Neukam FW, Schlegel KA. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft ® ) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res 2015; 27:e125-e133. [PMID: 25720794 DOI: 10.1111/clr.12575] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Porcine collagen matrices are proclaimed being a sufficient alternative to autologous free gingival grafts (FGG) in terms of augmenting the keratinized mucosa. The collagen matrix Mucograft® (CM) already showed a comparable clinical performance in the early healing phase, similar histological appearance, and even a more natural appearance of augmented regions. Predictability for long-term stability does not yet exist due to missing studies reporting of a follow-up >6 months. MATERIAL AND METHODS The study included 48 patients with atrophic edentulous or partially edentulous lower jaw situations that had undergone an implant treatment. In the context of implant exposure, a vestibuloplasty was either performed with two FGGs from the palate (n = 21 patients) or with the CM (n = 27 patients). Surgery time was recorded from the first incision to the last suture. Follow-up examinations were performed at the following time points: 10, 30, 90, and 180 days and 1, 2, 3, 4, and 5 years after surgery. The width of keratinized mucosa was measured at the buccal aspect of each implant, and augmented sites were evaluated in terms of their clinical appearances (texture and color). RESULTS The groups showed similar healing with increased peri-implant keratinized mucosa after surgery (FGG: 13.06 mm ± 2.26 mm and CM: 12.96 mm ± 2.86 mm). The maximum follow-up was 5 years (5 patients per group). After 180 days, the width of keratinized mucosa had decreased to 67.08 ± 13.85% in the FGG group and 58.88 ± 14.62% in the CM group with no statistically significant difference. The total loss of the width of keratinized mucosa after 5 years was significant between the FGG (40.65%) and the CM group (52.89%). The CM group had significantly shorter operation times than the FGG group. Augmented soft tissues had a comparable clinical appearance to adjacent native gingiva in the CM group. FGGs could still be defined after 5 years. CONCLUSIONS The FGG and the CM are both suitable for the regeneration of the peri-implant keratinized mucosa with a sufficient long-term stability. With the CM, tissue harvesting procedures are invalid, surgery time can be reduced, and regenerated tissues have a more esthetic appearance.
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Affiliation(s)
- Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Falk Wehrhan
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich W Neukam
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Roman A, Cioban C, Stratul SI, Schwarz F, Muste A, Petrutiu SA, Zaganescu R, Mihatovic I. Ridge preservation using a new 3D collagen matrix: a preclinical study. Clin Oral Investig 2014; 19:1527-36. [DOI: 10.1007/s00784-014-1368-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 11/13/2014] [Indexed: 12/24/2022]
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Agis H, Collins A, Taut AD, Jin Q, Kruger L, Görlach C, Giannobile WV. Cell population kinetics of collagen scaffolds in ex vivo oral wound repair. PLoS One 2014; 9:e112680. [PMID: 25397671 PMCID: PMC4232419 DOI: 10.1371/journal.pone.0112680] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/09/2014] [Indexed: 01/05/2023] Open
Abstract
Biodegradable collagen scaffolds are used clinically for oral soft tissue augmentation to support wound healing. This study sought to provide a novel ex vivo model for analyzing healing kinetics and gene expression of primary human gingival fibroblasts (hGF) within collagen scaffolds. Sponge type and gel type scaffolds with and without platelet-derived growth factor-BB (PDGF) were assessed in an hGF containing matrix. Morphology was evaluated with scanning electron microscopy, and hGF metabolic activity using MTT. We quantitated the population kinetics within the scaffolds based on cell density and distance from the scaffold border of DiI-labled hGFs over a two-week observation period. Gene expression was evaluated with gene array and qPCR. The sponge type scaffolds showed a porous morphology. Absolute cell number and distance was higher in sponge type scaffolds when compared to gel type scaffolds, in particular during the first week of observation. PDGF incorporated scaffolds increased cell numbers, distance, and formazan formation in the MTT assay. Gene expression dynamics revealed the induction of key genes associated with the generation of oral tissue. DKK1, CYR61, CTGF, TGFBR1 levels were increased and integrin ITGA2 levels were decreased in the sponge type scaffolds compared to the gel type scaffold. The results suggest that this novel model of oral wound healing provides insights into population kinetics and gene expression dynamics of biodegradable scaffolds.
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Affiliation(s)
- Hermann Agis
- Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Conservative Dentistry and Periodontology, Medical University of Vienna, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Amy Collins
- Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrei D. Taut
- Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Qiming Jin
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Laura Kruger
- Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - William V. Giannobile
- Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
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Thoma DS, Nänni N, Benic GI, Weber FE, Hämmerle CHF, Jung RE. Effect of platelet-derived growth factor-BB on tissue integration of cross-linked and non-cross-linked collagen matrices in a rat ectopic model. Clin Oral Implants Res 2014; 26:263-70. [PMID: 25267409 DOI: 10.1111/clr.12496] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
Abstract
AIM To test whether or not the network structure and the addition of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to a chemically cross-linked collagen matrix (CCM)- and a non-cross-linked collagen matrix (NCCM)-influenced tissue integration, angiogenesis, and matrix degradation. MATERIALS AND METHODS Four treatment modalities were randomly assigned to four unconnected pouches in the back of 50 rats: (i) CCM-S (soaked in saline), (ii) CCM-P (plus rhPDGF-BB), (iii) NCCM-S (soaked in saline), and (iv) NCCM-P (plus rhPDGF-BB). The animals were sacrificed at 2, 4, 8, 16, and 24 weeks. Descriptive histology and histomorphometric assessments were performed thereby evaluating matrix thickness, the number of vessels (angiogenesis), and connective tissue formation. Means and standard deviations were calculated. Robust linear mixed modeling was used to test the effect of group (NCCM vs CCM), rhPDGF-BB, and time point of sacrifice (2, 4, and 8 weeks). RESULTS The thickness of NCCM groups revealed stability (range 440-570 μm) over 8 weeks, while the matrices were no longer present at 16 and 24 weeks. CCM matrices demonstrated a maximal thickness at 2 weeks (2689 ± 187 μm for CCM-S and 2693 ± 389 μm for CCM-P), a decrease of roughly 40% at 8 weeks, but were still present at 16 and 24 weeks. Vascularization of NCCM gradually increased over time with a peak (mean 17.0; SD 1.7) for NCCM-S and NCCM-P (22.0 ± 34.8) at 8 weeks. Angiogenesis in CCM was significantly more pronounced at early time points with a peak at 2 weeks (29.3 ± 16.8 for CCM-S and 30.3 ± 18.4 for CCM-P). No statistically significant effect of rhPDGF-BB was observed for any of the evaluated parameters (all P > 0.05). CONCLUSIONS The compact layer (in NCCM) delayed angiogenesis and connective tissue formation, while the spongeous cross-linked matrix of CCM facilitated early vascularization and demonstrated network presence over a longer time span.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zürich, Switzerland
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Castro Y, Grados S, Grados S. Peri-implant soft tissue augmentation with a porcine collagen matrix. JOURNAL OF ORAL RESEARCH 2014. [DOI: 10.17126/joralres.2014.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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46
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Thoma DS, Mühlemann S, Jung RE. Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000 2014; 66:106-18. [DOI: 10.1111/prd.12045] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
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47
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Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol 2014; 41 Suppl 15:S77-91. [DOI: 10.1111/jcpe.12220] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Borvornwut Buranawat
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Ulrike Held
- Horten Centre for Patient Oriented Research and Knowledge Transfer; University Hospital Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
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Vignoletti F, Nunez J, Sanz M. Soft tissue wound healing at teeth, dental implants and the edentulous ridge when using barrier membranes, growth and differentiation factors and soft tissue substitutes. J Clin Periodontol 2014; 41 Suppl 15:S23-35. [DOI: 10.1111/jcpe.12191] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Vignoletti
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Javier Nunez
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
| | - Mariano Sanz
- Department of Periodontology; University Complutense of Madrid; Madrid Spain
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49
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Sculean A, Gruber R, Bosshardt DD. Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 2014; 41 Suppl 15:S6-22. [DOI: 10.1111/jcpe.12206] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Anton Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Reinhard Gruber
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
- Laboratory of Oral Cell Biology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Dieter D. Bosshardt
- Department of Periodontology; 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
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50
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Rana R, Ramachandra SS, Lahori M, Singhal R, Jithendra KD. Combined soft and hard tissue augmentation for a localized alveolar ridge defect. Contemp Clin Dent 2014; 4:556-8. [PMID: 24403810 PMCID: PMC3883345 DOI: 10.4103/0976-237x.123090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ideal alveolar ridge width and height allows placement of a natural appearing pontic, which provides maintenance of a plaque-free environment. The contour of a partially edentulous ridge should be thoroughly evaluated before a fixed partial denture is undertaken. Localized alveolar ridge defect refers to a volumetric deficit of the limited extent of bone and soft-tissue within the alveolar process. These ridge defects can be corrected by hard tissue and/or soft-tissue augmentation. A 30-year-old male patient was referred to the Department of Periodontology for correction of Seibert's Class III ridge defect in the lower anterior region. Granulation tissue/connective tissue present at the base of the defect was removed after elevation of full thickness flap. MucoMatrixX, an animal derived, collagen based soft-tissue graft was sutured to the labial flap and bone graft was placed into the defect. If a soft-tissue graft material could be used to replace the palatal grafts, then all the possible complications associated with donor site would be eliminated and above all periodontal plastic surgery and ridge augmentation would be better accepted by patients.
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Affiliation(s)
- Ritu Rana
- Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India
| | | | - Manesh Lahori
- Department of Prosthodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India
| | - Reetika Singhal
- Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India
| | - K D Jithendra
- Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India
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