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Insua A, Galindo-Moreno P, Miron RJ, Wang HL, Monje A. Emerging factors affecting peri-implant bone metabolism. Periodontol 2000 2024; 94:27-78. [PMID: 37904311 DOI: 10.1111/prd.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.
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Affiliation(s)
- Angel Insua
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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2
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Monje A, Pons R, Nart J, Miron RJ, Schwarz F, Sculean A. Selecting biomaterials in the reconstructive therapy of peri-implantitis. Periodontol 2000 2024; 94:192-212. [PMID: 37728141 DOI: 10.1111/prd.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
Peri-implantitis is a pathogenic inflammatory condition characterized by progressive bone loss and clinical inflammation that may compromise the stability of dental implants. Therapeutic modalities have been advocated to arrest the disorder and to establish peri-implant health. Reconstructive therapy is indicated for bone defects exhibiting contained/angular components. This therapeutic modality is based upon the application of the biological and technical principles of periodontal regeneration. Nonetheless, the comparative efficacy of reconstructive therapy and nonreconstructive modalities remains unclear. Therefore, the aim of this narrative review is to address major clinical concerns regarding the efficacy, effectiveness, and feasibility of using biomaterials in peri-implantitis therapy. In particular, the use of bone grafting materials, barrier membranes, and biologics is comprehensively explored.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Ramón Pons
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Frankfurt, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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3
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Avila-Ortiz G, Vegh D, Mukaddam K, Galindo-Moreno P, Pjetursson B, Payer M. Treatment alternatives for the rehabilitation of the posterior edentulous maxilla. Periodontol 2000 2023; 93:183-204. [PMID: 37486029 DOI: 10.1111/prd.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
Rehabilitation of the edentulous maxilla with implant-supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision-making processes and optimize the outcomes of therapy.
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Affiliation(s)
- Gustavo Avila-Ortiz
- Private Practice, Gonzalez + Solano Atelier Dental, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Dániel Vegh
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Khaled Mukaddam
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
- University Center of Dental Medicine, Department of Oral Surgery, University of Basel, Basel, Switzerland
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - Bjarni Pjetursson
- Department of Reconstructive Dentistry, University of Iceland, Reykjavik, Iceland
| | - Michael Payer
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
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Correia F, Gouveia SA, Pozza DH, Felino AC, Faria-Almeida R. A Randomized Clinical Trial Comparing Implants Placed in Two Different Biomaterials Used for Maxillary Sinus Augmentation. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1220. [PMID: 36770223 PMCID: PMC9919245 DOI: 10.3390/ma16031220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study was to compare marginal bone loss, surgical and clinical complications, and dental implant survival rate in bilateral maxillary sinus augmented by autologous or porcine xenograft. A randomized controlled clinical trial using split-mouth design enrolled 12 consent adult patients (59.7 ± 8.7 years), who received bilateral maxillary sinus floor augmentation for oral rehabilitation with implant-supported prosthesis. Each patient received both the autologous bone from the mandible (control) or porcine xenograft (test) during the random bilateral sinus lift surgery. A total of 39 dental implants were placed in the posterior maxilla of the 12 patients after 6 months, being rehabilitated after the respective osseointegration period. Both graft materials demonstrated a high implant survival rate at 12 months: 95% for the xenograft side, only 1 implant without osseointegration, and 100% for the autologous side. Radiographic bone loss was low and similar for both groups: control group with a mean of 0.063 ± 0.126, and test group with a mean of 0.092 ± 0.163. No major surgical-related complications have occurred. Only one patient had several prosthetic complications due to fractures of prosthetic components. The maxillary sinus augmentation procedure, both with autologous bone and porcine xenograft materials, is an excellent clinical option procedure for the prosthetic rehabilitation of atrophic maxillae, with low marginal bone loss after one year follow-up, few clinical complications, and a high implant survival rate.
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Affiliation(s)
- Francisco Correia
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Sónia Alexandre Gouveia
- Intelligent Systems Associate Laboratory (LASI), Department of Electronics, Telecommunications and Informatics (DETI), Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Histology, Faculty of Nutrition and Food Sciences, University of Porto, 4150-177 Porto, Portugal
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - António Campos Felino
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Ricardo Faria-Almeida
- Department of Oral Surgery and Periodontology, Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
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Galindo-Moreno P, Martín-Morales N, Olaechea A, Hernández-Cortes P, Verdugo-Escamilla C, Martinez-Ruiz F, Carrillo-Galvez AB, O'Valle F, Padial-Molina M. Physico-chemical and biological characterization of a new bovine bone mineral matrix available for human usage. Clin Implant Dent Relat Res 2023; 25:370-380. [PMID: 36709952 DOI: 10.1111/cid.13184] [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: 12/07/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anorganic bovine bone has been deeply studied for bone regeneration in the oral cavity. Different manufacturing processes can modify the final composition of the biomaterial and the responses that induce. AIM To evaluate the physico-chemical characteristics of a bovine bone mineral matrix and the clinical, radiographical, histological, and mRNA results after using it for maxillary sinus floor augmentation in humans. MATERIALS AND METHODS First, the physical-chemical characteristics of the biomaterial were evaluated by X-ray powder diffraction, X-ray fluorescence, and electron microscopy. A frequently used biomaterial with the same animal origin was used as comparator. Then, a clinical study was designed for evaluating clinical, radiographical, histological, and mRNA outcomes. Patients in need of two-stage maxillary sinus floor augmentation were included in the study. Six months after the grafting procedure, a bone biopsy was collected for evaluation. RESULTS In terms of physico-chemical characteristics, no differences were found between both biomaterials. Clinically, 10 patients were included in the study. After 6 months, clinical and radiographical data showed adequate outcomes for allowing implant placement. Histological, immunohistochemical and mRNA analyses showed that the biomaterial in use provides biological support to induce responses similar to those of other commonly used biomaterials. CONCLUSION Bovine bone mineral matrix (Creos™ Xenogain) used as a single material for maxillary sinus floor augmentation shows adequate biological, clinical, and radiological outcomes. In fact, the results from this study are similar to those reported in the literature for another bovine bone-derived biomaterial with whom it shares composition and micro- and nanoscale characteristics.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Natividad Martín-Morales
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,Department of Pathology, School of Medicine, University of Granada, Granada, Spain.,PhD Program in Biomedicine, University of Granada, Granada, Spain
| | - Allinson Olaechea
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,PhD Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Pedro Hernández-Cortes
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,Department of Surgery, School of Medicine, University of Granada, Granada, Spain
| | | | | | - Ana Belen Carrillo-Galvez
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Francisco O'Valle
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,Department of Pathology, School of Medicine, University of Granada, Granada, Spain.,Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
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Sharifi M, Kheradmandi R, Salehi M, Alizadeh M, Ten Hagen TLM, Falahati M. Criteria, Challenges, and Opportunities for Acellularized Allogeneic/Xenogeneic Bone Grafts in Bone Repairing. ACS Biomater Sci Eng 2022; 8:3199-3219. [PMID: 35816626 DOI: 10.1021/acsbiomaterials.2c00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As bone grafts become more commonly needed by patients and as donors become scarcer, acellularized bone grafts (ABGs) are becoming more popular for restorative purposes. While autogeneic grafts are reliable as a gold standard, allogeneic and xenogeneic ABGs have been shown to be of particular interest due to the limited availability of autogeneic resources and reduced patient well-being in long-term surgeries. Because of the complete similarity of their structures with native bone, excellent mechanical properties, high biocompatibility, and similarities of biological behaviors (osteoinductive and osteoconductive) with local bones, successful outcomes of allogeneic and xenogeneic ABGs in both in vitro and in vivo research have raised hopes of repairing patients' bone injuries in clinical applications. However, clinical trials have been delayed due to a lack of standardized protocols pertaining to acellularization, cell seeding, maintenance, and diversity of ABG evaluation criteria. This study sought to uncover these factors by exploring the bone structures, ossification properties of ABGs, sources, benefits, and challenges of acellularization approaches (physical, chemical, and enzymatic), cell loading, and type of cells used and effects of each of the above items on the regenerative technologies. To gain a perspective on the repair and commercialization of products before implementing new research activities, this study describes the differences between ABGs created by various techniques and methods applied to them. With a comprehensive understanding of ABG behavior, future research focused on treating bone defects could provide a better way to combine the treatment approaches needed to treat bone defects.
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Affiliation(s)
- Majid Sharifi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Rasoul Kheradmandi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran.,Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Morteza Alizadeh
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Timo L M Ten Hagen
- Laboratory Experimental Oncology, Department of Pathology, Erasmus MC, 3015GD Rotterdam, The Netherlands
| | - Mojtaba Falahati
- Laboratory Experimental Oncology, Department of Pathology, Erasmus MC, 3015GD Rotterdam, The Netherlands
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Galindo-Moreno P, Abril-García D, Carrillo-Galvez AB, Zurita F, Martín-Morales N, O'Valle F, Padial-Molina M. Maxillary sinus floor augmentation comparing bovine versus porcine bone xenografts mixed with autogenous bone graft. A split-mouth randomized controlled trial. Clin Oral Implants Res 2022; 33:524-536. [PMID: 35224778 PMCID: PMC9313845 DOI: 10.1111/clr.13912] [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: 10/03/2021] [Revised: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
Aim To compare the effectiveness of two xenografts for maxillary sinus floor augmentation in terms of clinical, radiographical, histologic, and molecular outcomes. Materials and methods A split‐mouth randomized clinical trial was conducted at the University of Granada. Ten consecutive patients in need of bilateral two‐staged maxillary sinus floor augmentation were included. Each patient received both biomaterials (porcine bone mineral and anorganic bovine bone), which were randomly assigned for bilateral sinus augmentation. The maxillary autogenous bone scraped from the sinus access window was mixed with each xenograft at a 20:80 ratio. After a healing period of 6 months, bone biopsies were collected with a trephine during the implant placement in the regenerated area. Histologic, histomorphometrical, immunohistochemical, and molecular outcomes were analyzed. Clinical and radiographical data throughout the treatment phases were also evaluated. Results The resulting anatomic features were similar between both groups. After six months of graft consolidation, the graft resorption rates were similar between both biomaterials. The histologic, histomorphometrical, and immunohistochemical results showed no statistical differences between groups. Conclusion Anorganic bovine bone and porcine bone mineral combined with maxillary autogenous cortical bone show similar biologic and radiologic features in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Dario Abril-García
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Ana Belen Carrillo-Galvez
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Federico Zurita
- Department of Genetics, School of Sciences, University of Granada, Granada, Spain
| | - Natividad Martín-Morales
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Department of Pathology, School of Medicine, University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology, School of Medicine, University of Granada, Granada, Spain.,Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), and Institute of Biosanitary (ibs-Granada), University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
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Solakoğlu Ö, Ofluoğlu D, Schwarzenbach H, Heydecke G, Reißmann D, Ergun S, Götz W. A 3-year prospective randomized clinical trial of alveolar bone crest response and clinical parameters through 1, 2, and 3 years of clinical function of implants placed 4 months after alveolar ridge preservation using two different allogeneic bone-grafting materials. Int J Implant Dent 2022; 8:5. [PMID: 35102440 PMCID: PMC8804085 DOI: 10.1186/s40729-022-00402-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to longitudinally evaluate changes in alveolar bone crest (ABC) levels and differences in resorption rates (RR) between the tested grafting materials following alveolar ridge preservation (ARP) after tooth extraction after 1, 2, and 3 years (T1–T8) of clinical function.
Methods Patients were randomly assigned to two different bone allografts (group 1 maxgraft®, group 2 Puros®) for ARP. Non-restorable teeth were minimal traumatically extracted. Sockets were augmented with the tested materials and covered with a pericardium membrane. After 4 months of healing, 36 implants were placed and sites were clinically and radiographically monitored in the mesial (ABC-M), the distal (ABC-D, T1–T8), the bucco-lingual (ABC-BL), buccal (ABC-B) and oral (ABC-O) aspect (T1–T4). Results Changes in (ABC-M), (ABC-D), (ABC-BL), (ABC-B), and (ABC-O) levels showed statistically highly significant differences between T1 and T2 for both bone allografts (p < 0.001). Changes at the ABC-M and ABC-BL levels between T2 and T3 of group 1 showed a statistically significant difference (p < 0.001). Both groups achieved and maintained increased ABC levels without statistically significant differences throughout the monitoring periods of 1–3 years (T6–T8) of clinical function. No failures or adverse events were observed. Conclusions To the best of our knowledge, this study is within its limitations the first study to directly compare ABC-changes and differences in RR of two different allogeneic grafting materials for a period of 3 years after ARP. It was demonstrated to be, despite significant differences in RR, a successful method of preserving increased ABC levels through 1, 2, and 3 years of clinical function. Trial registration DRKS00013010, registered 07/30/2018, http://apps.who.int/trialsearch
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Affiliation(s)
- Önder Solakoğlu
- Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. .,Specialty Dental Practice Limited to Periodontology and Implant Dentistry, Hamburg, Germany.
| | - Duygu Ofluoğlu
- Department of Oral Medicine and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Heidi Schwarzenbach
- Institute of Tumor Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthodontics Dental, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Reißmann
- Department of Prosthodontics Dental, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sertan Ergun
- Department of Oral Medicine and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Werner Götz
- Laboratory for Oral Biologic Basic Science, Department of Orthodontics, University of Bonn, Bonn, Germany
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Stacchi C, Rapani A, Lombardi T, Bernardello F, Nicolin V, Berton F. Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study. Clin Oral Implants Res 2022; 33:322-332. [PMID: 34978096 PMCID: PMC9306466 DOI: 10.1111/clr.13891] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate histomorphometric outcomes of lateral maxillary sinus augmentation in different areas of the same cavity and to correlate results to bucco-palatal sinus width (SW) and residual bone height (RBH). MATERIAL AND METHODS Patients needing maxillary sinus floor elevation (RBH <5 mm) to insert two nonadjacent implants were treated with lateral augmentation using a composite graft. Six months later, two bone-core biopsies (mesial/distal) were retrieved in implant insertion sites. SW and RBH were measured on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were evaluated by multivariate linear regression analysis. RESULTS Twenty patients underwent sinus augmentation, and eighteen were included in the final analysis (two dropouts for membrane perforation). Mean newly formed mineralized tissue percentage (%NFMT) after 6 months in mesial and distal sites was 17.5 ± 4.7 and 11.6 ± 4.7, respectively (p = .0004). Multivariate linear regression showed a strong negative correlation between SW and %NFMT (β coefficient=-.774, p < .0001) and no correlation between RBH and %NFMT (β coefficient =-.038, p = .825). CONCLUSIONS The present study confirms that %NFMT after lateral sinus augmentation occurs at different rates in different anatomical areas of the same maxillary sinus, showing a strong negative correlation with SW, whereas no influence of RBH was observed. Clinicians should regard SW as a guide for graft selection and to decide duration of the healing period. Researchers should consider SW as a predictor variable, when comparing regenerative outcomes of different biomaterials by using maxillary sinus as an experimental model.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Teresa Lombardi
- Department of Health Sciences, University 'Magna Graecia', Catanzaro, Italy
| | | | - Vanessa Nicolin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Federico Berton
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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10
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Galindo-Moreno P, Padial-Molina M, Lopez-Chaichio L, Gutiérrez-Garrido L, Martín-Morales N, O'Valle F. Algae-derived hydroxyapatite behavior as bone biomaterial in comparison with anorganic bovine bone: A split-mouth clinical, radiological, and histologic randomized study in humans. Clin Oral Implants Res 2020; 31:536-548. [PMID: 32072685 DOI: 10.1111/clr.13590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 12/13/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To analyze a modified biphasic phycogenic biomaterial in comparison with anorganic bovine bone in maxillary sinus floor elevation in humans. MATERIAL AND METHODS Eight male patients in need of bilateral two-stage sinus floor elevation were consecutively recruited for this randomized split-mouth study. A combination of autogenous cortical bone (ACB, 20%) and anorganic bovine bone (ABB, 80%) (ACB + ABB group) or ACB (20%) and modified biphasic phycogenic material (BP, 80%) (ACB + BP group) were randomly assigned to graft each sinus. Patients were followed up for 6 months post-surgery when bone samples were collected for analysis. RESULTS Radiographically, bone height gain was statistically higher in the ACB + ABB versus the ACB + BP group. While the analysis of the biological compartments showed differences in non-mineralized tissue (39.15 ± 20.97% vs. 65.87 ± 28.59%, ACB + ABB vs. ACB + BP respectively; p = .018) and remnant biomaterial particles (22.62 ± 17.01% vs. 7.96 ± 8.57%, respectively; p = .028), the percentage of mineralized tissue (38.23 ± 17.55% vs. 24.14 ± 24.66%, respectively; p = .398) showed no statistically significant difference. In contrast, ACB + ABB biopsies showed higher Musashi-1-positive cells per mm2 compared to ACB + BP biopsies (811.49 ± 875.30 vs. 236.90 ± 280.81; p < .018), where the fusiform cells corresponded mainly with fibroblasts, as demonstrated by ultrastructural analysis. CONCLUSION Both combinations of materials exhibited bone formation after 6 months of healing in the maxillary sinus cavity. However, the combination with biphasic phycogenic biomaterial induced a higher radiographical vertical resorption and graft collapse in comparison with the combination with anorganic bovine bone, possibly due to a higher remodeling of the graft.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Lucia Lopez-Chaichio
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Lourdes Gutiérrez-Garrido
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Natividad Martín-Morales
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Instituto Biosanitario de Granada (ibs.GRANADA), University of Granada, Granada, Spain
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Radiological and Histomorphometric Outcomes of Homologous Bone Graft in Postextractive Implant Sites: A 6-Year Retrospective Analysis. IMPLANT DENT 2019; 28:472-477. [PMID: 31232716 DOI: 10.1097/id.0000000000000920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim was to investigate the in vivo efficacy of a cancellous particulate allograft bone in the regeneration of postextractive atrophic sites. MATERIAL AND METHODS Ten patients were selected, and after a minimally invasive extraction of the teeth (T0), a cone beam computed tomography was performed (T1). Seven days after extraction, Puros cancellous particulate homologous graft was inserted into the elected sites together with a membrane (T2). After 4 months, a cone beam computed tomography of the sites was performed (T3). After 5 months, samples of the regenerated sites were taken contextually to implant insertion (T4). The samples were histologically and histomorphometrically analyzed. Intraoral periapical radiographs were accomplished at T4 and at the 6-year follow-up appointment (T5). RESULTS The mean vertical bone augmentation was of 4.1 mm in the lower jaw and of 3.35 mm in the maxilla at T3 appointment. The mean horizontal bone augmentation in the lower jaw was 2.02 and 2.15 mm in the maxilla. At T4, the mean total bone was 60.01% and the mature bone was 98.41. At the 6-year follow-up visit, the mean periimplant bone resorption was 0.14 mm (range 0-0.5 mm). CONCLUSIONS Cancellous particulate allograft bone demonstrated excellent bone regeneration behavior both in terms of quantity and quality, and stable results over a 6-year period. CLINICAL RELEVANCE Cancellous allograft bone can be successfully used to regenerate atrophic sites.
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Solakoglu Ö, Götz W, Heydecke G, Schwarzenbach H. Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans. Clin Implant Dent Relat Res 2019; 21:1002-1016. [PMID: 31424173 PMCID: PMC6899623 DOI: 10.1111/cid.12824] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 12/20/2022]
Abstract
Background Preclinical studies have hypothesized a possible immunological reponse to allogeneic materials due to detection of remnants of potential immunogenic molecules. However, their impact on integration, bone remodeling and immunological reaction after the augmentation procedure is largely unknown and a direct correlation of analytical data and evaluation of human biopsies is missing. Purpose The present study aimed to compare two commercially available allogeneic materials regarding their content of cellular remnants as well as the bone remodeling, and integration and potential immunologic reactions on a histological and immunohistochemical level, integrating also in vitro analytical evaluation of the specific batches that were used clinically. Materials and Methods Twenty patients were randomly assigned to treatment with Maxgraft or Puros for lateral ridge augmentation in a two‐stage surgery. After a mean healing period of 5 months, implants were placed and biopsies were taken for histological, immunhistochemical, and histomorphometrical evaluation regarding bone remodeling and inflammation, protein concentrations in vitro and the presence of MHC molecules of the same batches used clinically. Results No differences in clinical outcome, histological, immunohistochemical, and in vitro protein analysis between the two bone grafting materials were observed. Active bone remodeling, amount of newly formed bone, and residual grafting material was independent of the materials used, but varied between subjects. MHC1 residues were not detected in any sample. Conclusions Within the limitations of this study, both tested materials yielded equivalent results in terms of clinical outcome, new bone formation, and lack of immunological potential on a histological and immunohistochemical level.
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Affiliation(s)
- Önder Solakoglu
- Dental Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Specialty Dental Practice limited to Periodontology and Implant Dentistry, FPI-Hamburg, Germany, Hamburg
| | - Werner Götz
- Laboratory for Oral Biologic Basic Science, Department of Orthodontics, University of Bonn, Bonn, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heidi Schwarzenbach
- Institute of Tumor Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Olaechea A, Mendoza-Azpur G, O Valle F, Padial-Molina M, Martin-Morales N, Galindo-Moreno P. Biphasic hydroxyapatite and ß-tricalcium phosphate biomaterial behavior in a case series of maxillary sinus augmentation in humans. Clin Oral Implants Res 2019; 30:336-343. [PMID: 30809862 DOI: 10.1111/clr.13419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate and compare the morphometric components and the histological properties of pristine bone and bone grafted with a biphasic ß-tricalcium phosphate in humans using the maxillary sinus model. Reparative mesenchymal stem cells in the pristine bone and graft were also evaluated. MATERIALS AND METHODS For this prospective case series, sinus augmentation was performed using a biphasic ß-tricalcium phosphate. After 6 months of healing, a core of remnant native alveolar bone and grafted bone was collected with a trephine. Histological, histomorphometrical, and immunohistochemical techniques were performed. Radiological analysis through cone beam computerized tomography was also conducted. RESULTS A total of 10 patients were enrolled in this study. Radiologically, patients showed an average increase of crestal bone of 8.03 ± 1.72 mm. Morphologically, the grafted area was composed by 34.93 ± 14.68% of new mineralized tissue, 9.82 ± 11.42% of remnant biomaterial particles, and 55.23 ± 11.03% non-mineralized tissue. Histologically, we found no differences in the number of osteocytes per mm2 (p = 0.674), osteoblasts (p = 0.893), and blood vessels (p = 0.894) in the grafted area compared to the pristine bone. Differences were found on the number of osteoclasts (15.57 ± 27.50 vs. 5.37 ± 16.12, p = 0.027). The number of Musashi-1 positive mesenchymal cells (239.61 ± 177.4 vs. 42.11 ± 52.82, p = 0.027) was also significantly higher in the grafted area than in the pristine bone. CONCLUSION Biphasic ß-tricalcium phosphate is a suitable biomaterial to be used in the formation of new bone in sinus floor elevation procedures in humans, not only from the histomorphometrical point of view, but also regarding the cellular and vascular quality of the regenerated bone.
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Affiliation(s)
- Allinson Olaechea
- Department of Periodontics, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Gerardo Mendoza-Azpur
- Department of Periodontics, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Francisco O Valle
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Instituto Biosanitario de Granada (ibs.GRANADA), Universidad de Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Natividad Martin-Morales
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
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14
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Characterization of circulating DNA in plasma of patients after allogeneic bone grafting. Clin Oral Investig 2019; 23:4243-4253. [DOI: 10.1007/s00784-019-02867-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022]
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15
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Solakoglu Ö, Götz W, Kiessling MC, Alt C, Schmitz C, Alt EU. Improved guided bone regeneration by combined application of unmodified, fresh autologous adipose derived regenerative cells and plasma rich in growth factors: A first-in-human case report and literature review. World J Stem Cells 2019; 11:124-146. [PMID: 30842809 PMCID: PMC6397807 DOI: 10.4252/wjsc.v11.i2.124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Novel strategies are needed for improving guided bone regeneration (GBR) in oral surgery prior to implant placement, particularly in maxillary sinus augmentation (GBR-MSA) and in lateral alveolar ridge augmentation (LRA). This study tested the hypothesis that the combination of freshly isolated, unmodified autologous adipose-derived regenerative cells (UA-ADRCs), fraction 2 of plasma rich in growth factors (PRGF-2) and an osteoinductive scaffold (OIS) (UA-ADRC/PRGF-2/OIS) is superior to the combination of PRGF-2 and the same OIS alone (PRGF-2/OIS) in GBR-MSA/LRA. CASE SUMMARY A 79-year-old patient was treated with a bilateral external sinus lift procedure as well as a bilateral lateral alveolar ridge augmentation. GBR-MSA/LRA was performed with UA-ADRC/PRGF-2/OIS on the right side, and with PRGF-2/OIS on the left side. Biopsies were collected at 6 wk and 34 wk after GBR-MSA/LRA. At the latter time point implants were placed. Radiographs (32 mo follow-up time) demonstrated excellent bone healing. No radiological or histological signs of inflammation were observed. Detailed histologic, histomorphometric, and immunohistochemical analysis of the biopsies evidenced that UA-ADRC/PRGF-2/OIS resulted in better and faster bone regeneration than PRGF-2/OIS. CONCLUSION GBR-MSA with UA-ADRCs, PRGF-2, and an OIS shows effectiveness without adverse effects.
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Affiliation(s)
- Önder Solakoglu
- External Visiting Lecturer, Dental Department of the University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- Clinic for Periodontology and Implantology, Hamburg 22453, Germany.
| | - Werner Götz
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Bonn 53111, Germany
| | - Maren C Kiessling
- Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich 80336, Germany
| | | | - Christoph Schmitz
- Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich 80336, Germany
| | - Eckhard U Alt
- InGeneron GmbH, Munich 80331, Germany
- InGeneron, Inc., Houston, TX 77054, United States
- Isar Klinikum Munich, 80331 Munich, Germany
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16
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Mendoza-Azpur G, Olaechea A, Padial-Molina M, Gutiérrez-Garrido L, O'Valle F, Mesa F, Galindo-Moreno P. Composite Alloplastic Biomaterial vs. Autologous Platelet-Rich Fibrin in Ridge Preservation. J Clin Med 2019; 8:E223. [PMID: 30744095 PMCID: PMC6406621 DOI: 10.3390/jcm8020223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 01/17/2023] Open
Abstract
AIM The aim of this study was to examine the clinical and histological differences of using a combination of alloplastic beta triphasic calcium phosphate (β-TCP) and a cross-linked collagen membrane versus autologous platelet-rich fibrin (PRF-L) in ridge preservation after dental extraction. MATERIAL AND METHODS Fifty-one patients were included in this observational case-series study. Dental extractions were performed, after which 25 patients were grafted with β-TCP and 26 with PRF-L. After four months of healing, clinical, radiological, histomorphometric and histological evaluations were performed. RESULTS A significantly higher percentage of mineralized tissue was observed in samples from the PRF-L grafted areas. Cellularity was higher in PRF-L grafted areas (osteocytes in newly formed bone per mm² = 123.25 (5.12) vs. 84.02 (26.53) for PRF-L and β-TCP, respectively, p = 0.01). However, sockets grafted with PRF-L showed a higher reduction in the bucco-lingual dimension after four months of healing (2.19 (0.80) vs. 1.16 (0.55) mm, p < 0.001), as well as a higher alteration in the final position of the mid muco-gingival junction (1.73 (1.34) vs. 0.88 (0.88) mm, p < 0.01). CONCLUSION PRF-L concentrate accelerates wound healing in post-extraction sockets in terms of new mineralized tissue component. However, the use of β-TCP biomaterial appears to be superior to maintain bucco-lingual volume and the final position of the muco-gingival junction.
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Affiliation(s)
- Gerardo Mendoza-Azpur
- Department of Periodontology, School of Dentistry, Cientifica del Sur University, 15067 Lima, Peru.
| | - Allinson Olaechea
- Department of Periodontology, School of Dentistry, Cientifica del Sur University, 15067 Lima, Peru.
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain.
| | - Lourdes Gutiérrez-Garrido
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain.
| | - Francisco O'Valle
- Department of Pathology & Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), University of Granada, 18071 Granada, Spain.
| | - Francisco Mesa
- Department of Periodontology, School of Dentistry, University of Granada, 18071 Granada, Spain.
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain.
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Comparative Histological and Histomorphometric Results of Six Biomaterials Used in Two-Stage Maxillary Sinus Augmentation Model after 6-Month Healing. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9430989. [PMID: 30050947 PMCID: PMC6040296 DOI: 10.1155/2018/9430989] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/20/2018] [Indexed: 12/18/2022]
Abstract
Objectives To evaluate the performances of six different bone substitute materials used as graft in maxillary sinus augmentation by means of histological and histomorphometric analysis of bone biopsies retrieved from human subjects after a 6-month healing period. Materials and Methods Six consecutive patients (3 males, 3 females, aged 50-72 years), healthy, nonsmokers, and with good oral hygiene, presenting edentulous posterior maxilla with a residual bone crest measuring ≤ 4 mm in vertical height and 3 to 5 mm in horizontal thickness at radiographic examination, were selected to receive sinus augmentation and delayed implant placement. Under randomized conditions, sinus augmentation procedures were carried out using mineralized solvent-dehydrated bone allograft (MCBA), freeze-dried mineralized bone allograft (FDBA), anorganic bovine bone (ABB), equine-derived bone (EB), synthetic micro-macroporous biphasic calcium-phosphate block consisting of 70% beta-tricalcium phosphate and 30% hydroxyapatite (HA-β-TCP 30/70), or bioapatite-collagen (BC). After 6 months, bone core biopsies were retrieved and 13 implants were placed. Bone samples were processed for histological and histomorphometric analysis. CT scans were taken before and after surgery. After 4 months of healing, patients were restored with a provisional fixed acrylic resin prosthesis, as well as after further 2-4 months with a definitive cemented zirconia or porcelain-fused-to-metal crowns. Results There were no postoperative complications or implant failures. The histological examination showed that all biomaterials were in close contact with newly formed bone, surrounding the graft granules with a bridge-like network. No signs of acute inflammation were observed. The histomorphometry revealed 20.1% newly formed bone for MCBA, 32.1% for FDBA, 16.1% for ABB, 22.8% for EB, 20.3% for HA-β-TCP 30/70, and 21.4% for BC. Conclusions Within the limitations of the present investigation, all the six tested biomaterials showed good biocompatibility and osteoconductive properties when used in sinus augmentation procedures, although the FDBA seemed to have a better histomorphometric result in terms of newly formed bone and residual graft material. This trial is registered with ClinicalTrials.gov Identifier (Registration Number): NCT03496688.
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18
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Stacchi C, Lombardi T, Ottonelli R, Berton F, Perinetti G, Traini T. New bone formation after transcrestal sinus floor elevation was influenced by sinus cavity dimensions: A prospective histologic and histomorphometric study. Clin Oral Implants Res 2018; 29:465-479. [PMID: 29569763 DOI: 10.1111/clr.13144] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this multicenter prospective study was to analyze clinically and histologically the influence of sinus cavity dimensions on new bone formation after transcrestal sinus floor elevation (tSFE). MATERIAL AND METHODS Patients needing maxillary sinus augmentation (residual crest height <5 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in implant insertion sites. Bucco-palatal sinus width (SW) and contact between graft and bone walls (WGC) were evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of forward multiple linear regression analysis. RESULTS Fifty consecutive patients were enrolled and underwent tSFE procedures, and forty-four were included in the final analysis. Mean percentage of newly formed bone (NFB) at 6 months was 21.2 ± 16.9%. Multivariate analysis showed a strong negative correlation between SW and NFB (R2 = .793) and a strong positive correlation between WGC and NFB (R2 = .781). Furthermore, when SW was stratified into three groups (<12 mm, 12 to 15 mm, and >15 mm), NFB percentages (36%, 13% and 3%, respectively) resulted significantly different. CONCLUSIONS This study represented the first confirmation based on histomorphometric data that NFB after tSFE was strongly influenced by sinus width and occurred consistently only in narrow sinus cavities (SW <12 mm, measured between buccal and palatal walls at 10-mm level, comprising the residual alveolar crest).
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | | | - Federico Berton
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Perinetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Tonino Traini
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
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19
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Galindo-Moreno P, de Buitrago JG, Padial-Molina M, Fernández-Barbero JE, Ata-Ali J, O Valle F. Histopathological comparison of healing after maxillary sinus augmentation using xenograft mixed with autogenous bone versus allograft mixed with autogenous bone. Clin Oral Implants Res 2017; 29:192-201. [PMID: 29071736 DOI: 10.1111/clr.13098] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the clinical and histologic outcomes of two different grafting materials (allograft and xenograft) when combined with autogenous bone and covered with a collagen membrane for sinus augmentation. MATERIAL AND METHODS A parallel case series of fourteen patients in need of a unilateral sinus augmentation was evaluated in this study. Seven patients received a graft composed by autologous cortical bone (ACB) and anorganic bovine bone in a ratio of 1:1; the other seven patients received ACB mixed with an allograft in the same ratio. Bone biopsies were obtained 6 months after sinus augmentation at the time of implant placement. Comparative histomorphometrical, histopathological, and immunohistochemical analyses were conducted and statistically analyzed. RESULTS After 12 months of functional loading, all implants in both groups were clinical and radiographically successful. Histomorphometrically, although the initial bone formation was not significantly different between groups (new mineralized tissue: 41.03(12.87)% vs. 34.50(13.18)%, p = .620; allograft vs. xenograft groups), the graft resorbed faster in the allograft group (remnant graft particles: 9.83[7.77]% vs. 21.71[17.88]%; p = .026; allograft vs. xenograft groups). Non-mineralized tissue did not statistically differ either (49.00[14.32]% vs. 43.79[19.90]%; p = .710; allograft vs. xenograft groups). The histologic analyses revealed higher cellular content, four times more osteoid lines, and higher vascularization in the xenograft group. Musashi-1 (mesenchymal stromal cell marker) was also more intensively expressed in the xenograft group (p = .019). CONCLUSIONS Both composite grafts generate adequate substratum to receive dental implants after healing. Compared with the xenograft composite, allograft composite shows faster turnover and a quicker decrease in biological action after 6 months.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Juan G de Buitrago
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | | | - Javier Ata-Ali
- Public Dental Health Service, Arnau de Vilanova Hospital & Department of Dentistry, European University of Valencia, Valencia, Spain
| | - Francisco O Valle
- Department of Pathology & Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), University of Granada, Granada, Spain
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Wang F, Zhou W, Monje A, Huang W, Wang Y, Wu Y. Influence of Healing Period Upon Bone Turn Over on Maxillary Sinus Floor Augmentation Grafted Solely with Deproteinized Bovine Bone Mineral: A Prospective Human Histological and Clinical Trial. Clin Implant Dent Relat Res 2016; 19:341-350. [PMID: 27862924 DOI: 10.1111/cid.12463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the influence of maturation timing upon histological, histomorphometric and clinical outcomes when deproteinized bovine bone mineral (DBBM) was used as a sole biomaterial for staged maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS Patients with a posterior edentulous maxillary situation and a vertical bone height ≤ 4 mm were included in this study. A staged MSFA was carried out. After MSFA with DBBM as a sole grafting material, biopsy cores were harvested with simultaneous implant placement followed by a healing period of 5, 8, and 11 months, respectively. Micro-CT, histologic and histomorphometric analyses were performed. RESULTS Forty-one patients were enrolled and 38 bone core biopsies were harvested. Significantly greater BV/TV was observed between 5- and 8-month healing from micro-CT analysis. Histomorphometric analyses showed the ratio of mineralized newly formed bone increased slightly from 5 to 11 months; however, no statistically significant difference was reached (p = .409). Residual bone substitute decreased from 37.3 ± 5.04% to 20.6 ± 7.45%, achieving a statistical significant difference from of 5 up to 11 months (p < .01). Moreover, no implant failure, biological or technical complication occurred after 12-month follow-up of functional loading. CONCLUSION DBBM utilized as sole grafting material in staged MSFA demonstrated to be clinically effective regardless of the healing period. Histomorphometrical and micro-CT assessments revealed that at later stages of healing (8 and 11 months) there is a higher proportion of newly-bone formation compared to earlier stages (5 months). Moreover, the longer the maturation period, the substantially lesser remaining biomaterial could be expected. Even though, these facts did not seem to negatively impact on the implant prognosis 1-year after loading.
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Affiliation(s)
- Feng Wang
- Assistant professor, Department of Oral Implantology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China, 200011
| | - Wenjie Zhou
- Second Dental Clinic, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China, 200011
| | - Alberto Monje
- Research fellow, Department of Periodontics and Oral Medicine, The University of Michigan, MI, USA
| | - Wei Huang
- Professor, Department of Oral Implantology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China, 200011
| | - Yueping Wang
- Faculty, Second Dental Clinic, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China, 200011
| | - Yiqun Wu
- Professor, Department of Oral Implantology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China, 200011
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