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Zhao R, Yang R, Cooper PR, Khurshid Z, Shavandi A, Ratnayake J. Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments. Molecules 2021; 26:3007. [PMID: 34070157 PMCID: PMC8158510 DOI: 10.3390/molecules26103007] [Citation(s) in RCA: 160] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
After tooth loss, bone resorption is irreversible, leaving the area without adequate bone volume for successful implant treatment. Bone grafting is the only solution to reverse dental bone loss and is a well-accepted procedure required in one in every four dental implants. Research and development in materials, design and fabrication technologies have expanded over the years to achieve successful and long-lasting dental implants for tooth substitution. This review will critically present the various dental bone graft and substitute materials that have been used to achieve a successful dental implant. The article also reviews the properties of dental bone grafts and various dental bone substitutes that have been studied or are currently available commercially. The various classifications of bone grafts and substitutes, including natural and synthetic materials, are critically presented, and available commercial products in each category are discussed. Different bone substitute materials, including metals, ceramics, polymers, or their combinations, and their chemical, physical, and biocompatibility properties are explored. Limitations of the available materials are presented, and areas which require further research and development are highlighted. Tissue engineering hybrid constructions with enhanced bone regeneration ability, such as cell-based or growth factor-based bone substitutes, are discussed as an emerging area of development.
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Affiliation(s)
- Rusin Zhao
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
| | - Ruijia Yang
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
| | - Paul R. Cooper
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Amin Shavandi
- BioMatter Unit—École Polytechnique de Bruxelles, Université Libre de Bruxelles (ULB), Avenue F.D. Roosevelt, 50—CP 165/61, 1050 Brussels, Belgium;
| | - Jithendra Ratnayake
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
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Koduru S, Aghanashini S, Nadiger S, Apoorva SM, Bhat D, Puvvalla B. A Clinical and Radiographic Evaluation of the Efficacy of Nanohydroxyapatite (Sybograf™) versus Bioactive Calcium Phosphosilicate Putty (Novabone ®) in the Treatment of Human Periodontal Infrabony Defects: A Randomized Clinical Trial. Contemp Clin Dent 2020; 10:16-23. [PMID: 32015636 PMCID: PMC6974983 DOI: 10.4103/ccd.ccd_52_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study is to compare and to evaluate clinically and radiographically the bone regeneration and the amount of bone fill (BL) between nanocrystalline hydroxyapatite (Nc-HA) (Sybograf™) and bioactive synthetic NovaBone Putty in the treatment of intrabony component of periodontal osseous defects. Materials and Methods: Twenty sites in 20 patients, within the age range of 25–55 years, showing intrabony defects were selected and divided into Group I (Nc-HA) and Group II (Bioactive synthetic NovaBone Putty). All the selected sites were assessed with the clinical and radiographic parameters such as plaque index, gingival index, sulcus bleeding index, probing pocket depth, clinical attachment level, gingival recession, and radiographic BL. All the clinical and radiographic parameter values obtained at different intervals (baseline, 3, and 6 and 9 months) were subjected to statistical analysis. Results: A statistically significant reduction in pocket depth of 4.400 ± 0.843 mm (Group I), 3.800 ± 0.789 mm (Group II) and gain in clinical attachment level of 6.2 mm (Group I), 5.9 mm (Group II) were recorded at the end of the study. A slight increase in gingival recession was observed. The mean percentage changes in the amount of radiographic BL of Group II and Group I were significant, However, when compared between the groups, there is no significant difference in BL observed. Conclusion: Both the graft materials appear to have nearly comparable effects, with nanocrystalline hydroxyapatite (Sybograf™), displaying slightly superior effect over bioactive glass especially in relation to clinical parameters. However, long-term, controlled clinical trials are required to confirm these findings.
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Affiliation(s)
- Sravani Koduru
- Department of Periodontology, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
| | - Suchetha Aghanashini
- Department of Periodontology, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
| | - Sapna Nadiger
- Department of Periodontology, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
| | - S M Apoorva
- Department of Periodontology, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
| | - Divya Bhat
- Department of Periodontology, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
| | - Bhavana Puvvalla
- Department of Periodontology, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
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Clinical and Radiographic Evaluation of Nanohydroxyapatite Powder in Combination with Polylactic Acid/Polyglycolic Acid Copolymer as Bone Replacement Graft in the Surgical Treatment of Intrabony Periodontal Defects: A Retrospective Case Series Study. MATERIALS 2020; 13:ma13020269. [PMID: 31936143 PMCID: PMC7014298 DOI: 10.3390/ma13020269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/22/2019] [Accepted: 01/06/2020] [Indexed: 01/25/2023]
Abstract
The aim of this retrospective case series was to evaluate the clinical efficacy of nanohydroxyapatite powder (NHA) in combination with polylactic acid/polyglycolic acid copolymer (PLGA) as a bone replacement graft in the surgical treatment of intrabony periodontal defects. Medical charts were screened following inclusion and exclusion criteria. Periodontal parameters and periapical radiographs taken before surgery and at 12-month follow-up were collected. Intra-group comparisons were performed using a two-tailed Wilcoxon signed-rank test. Twenty-five patients (13 males, 12 females, mean age 55.1 ± 10.5 years) were included in the final analysis. Mean probing depth (PD) and clinical attachment level (CAL) at baseline were 8.32 ± 1.41 mm and 9.96 ± 1.69 mm, respectively. Twelve months after surgery, mean PD was 4.04 ± 0.84 mm and CAL was 6.24 ± 1.71 mm. Both PD and CAL variations gave statistically significant results (p < 0.00001). The mean radiographic defect depth was 5.54 ± 1.55 mm and 1.48 ± 1.38 mm at baseline and at 12-month follow-up, respectively (p < 0.0001). This case series, with the limitations inherent in the study design, showed that the combination of NHA and PLGA, used as bone replacement graft in intrabony periodontal defects, may give significant improvements of periodontal parameters at 12-month follow-up.
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Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple ILC, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000 2015; 68:182-216. [DOI: 10.1111/prd.12086] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
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Esfahanian V, Golestaneh H, Moghaddas O, Ghafari MR. Efficacy of Connective Tissue with and without Periosteum in Regeneration of Intrabony Defects. J Dent Res Dent Clin Dent Prospects 2015; 8:189-96. [PMID: 25587379 PMCID: PMC4288907 DOI: 10.5681/joddd.2014.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 12/08/2013] [Indexed: 11/18/2022] Open
Abstract
Background and aims. Connective tissue grafts with and without periosteum is used in regenerative treatments of bone and has demonstrated successful outcomes in previous investigations. The aim of present study was to evaluate the effectiveness of connective tissue graft with and without periosteum in regeneration of intrabony defects. Materials and methods. In this single-blind randomized split-mouth clinical trial, 15 pairs of intrabony defects in 15 patients with moderate to advanced periodontitis were treated by periosteal connective tissue graft + ABBM (test group) or non-periosteal connective tissue graft + ABBM (control group). Probing pocket depth, clinical attachment level, free gingival margin position, bone crestal position, crest defect depth and defect depth to stent were measured at baseline and after six months by surgical re-entry. Data was analyzed by Student’s t-test and paired t-tests (α=0.05). Results. Changes in clinical parameters after 6 months in the test and control groups were as follows: mean of PPD reduction: 3.1±0.6 (P<0.0001); 2.5±1.0 mm (P<0.0001), CAL gain: 2.3±0.9 (P<0.0001); 2.2±1.0 mm (P<0.0001), bone fill: 2.2±0.7 mm (P<0.0001); 2.2±0.7 mm (P<0.0001), respectively. No significant differences in the position of free gingival margin were observed during 6 months compared to baseline in both groups. Conclusion. Combinations of periosteal connective tissue graft + ABBM and non-periosteal connective tissue graft + ABBM were similarly effective in treating intrabony defects without any favor for any group. Connective tissue and perio-steum can be equally effective in regeneration of intrabony defects.
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Affiliation(s)
- Vahid Esfahanian
- Assistant Professor, Department of Periodontics, Dental School, Islamic Azad University Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Hedayatollah Golestaneh
- Assistant Professor, Department of Periodontics, Dental School, Islamic Azad University Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Omid Moghaddas
- Assistant Professor, Department of Periodontics, Dental School, Islamic Azad University, Tehran, Iran
| | - Mohammad Reza Ghafari
- Postgarduate Student, Department of Periodontics, Dental School, Islamic Azad University Isfahan (Khorasgan) Branch, Isfahan, Iran
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D’lima JP, Paul J, Palathingal P, Varma BRR, Bhat M, Mohanty M. Histological and Histometrical Evaluation of two Synthetic Hydroxyapatite Based Biomaterials in the Experimental Periodontal Defects in Dogs. J Clin Diagn Res 2014; 8:ZC52-5. [PMID: 25386523 PMCID: PMC4225975 DOI: 10.7860/jcdr/2014/9892.4860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/25/2014] [Indexed: 11/24/2022]
Abstract
AIM The present study was to evaluate histologically and histometrically the efficacy of Chitra granules in the regeneration of alveolar bone and to compare it with that of OsteoGenR (HA Resorb)(TM) in iatrogenically created alveolar bone defects in mongrel dogs. MATERIALS AND METHODS Four dogs (16 sites) were used for this split-mouth study. The animals were divided randomly into two groups of two animals. Same animals were used as control and test. Each dog had four implantation sites. The periodontal defects were prepared by acute defect model. Animals were sacrificed at 3 months (n=2), 6 months (n=2) and histologic and histometric evaluation was carried out. STATISTICAL ANALYSIS The data was analysed using statistical package Graph pad Software. Comparison of the hard and soft tissue parameters in the two groups was done using the Wilcoxan (Man Whitney), two tailed t-test. A p-value less than 0.05 were considered significant. RESULTS Maturing bone with immature periodontal ligament fibers were observed at three months and advanced osteogenesis at six months with both the types of bone graft materials. The mean values showed that amount of new bone formed with OsteoGenR (HA Resorb)(TM) was slightly more than that obtained by Chitra granules in histometric evaluation. CONCLUSION Histological study showed similar healing pattern with both the types of bone graft materials with maturing bone at 3 months and advanced osteogenesis at six months in experimental intraosseous periodontal defects in dogs. However, histological evaluation for longer period is necessary to determine the time taken for complete replacement of the bone graft materials with new bone.
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Affiliation(s)
| | - Jose Paul
- Professor, Department of Periodontics, Annoor Dental College, Ernakulam, India
| | - Plato Palathingal
- Senior Lecturer, Department of Periodontics, Annoor Dental College, Ernakulam, India
| | - BRR Varma
- Professor, Department of Periodontics, Manipal College of Dental Surgery, Manipal, India
| | - Mahalinga Bhat
- Professor, Department of Periodontics, Manipal College of Dental Surgery, Manipal, India
| | - Mira Mohanty
- Scientist, Department of Pathophysiology, Sri Chitra Tirunal Institiute of Medical Science and Technology, Trivandrum, India
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Delgado-Ruiz RA, Abboud M, Romanos G, Aguilar-Salvatierra A, Gomez-Moreno G, Calvo-Guirado JL. Peri-implant bone organization surrounding zirconia-microgrooved surfaces circularly polarized light and confocal laser scanning microscopy study. Clin Oral Implants Res 2014; 26:1328-37. [DOI: 10.1111/clr.12461] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Marcus Abboud
- School of Dental Medicine; Stony Brook University; Stony Brook NY USA
| | - Georgios Romanos
- School of Medicine and Dentistry; Granada University; Granada Spain
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Esfahanian V, Farhad S, Sadighi Shamami M. Comparison of ADM and Connective Tissue Graft as the Membrane in Class II Furcation Defect Regeneration: A Randomized Clinical Trial. J Dent Res Dent Clin Dent Prospects 2014; 8:101-6. [PMID: 25093054 PMCID: PMC4120901 DOI: 10.5681/joddd.2014.018] [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: 01/08/2013] [Accepted: 05/17/2014] [Indexed: 11/17/2022] Open
Abstract
Background and aims. Furcally-involved teeth present unique challenges to the success of periodontal therapy and influence treatment outcomes. This study aimed to assess to compare use of ADM and connective tissue membrane in class II furcation defect regeneration. Materials and methods. 10 patient with 2 bilaterally class II furcation defects in first and/or second maxilla or man-dibular molar without interproximal furcation involvement, were selected. Four weeks after initial phase of treatment, before and thorough the surgery pocket depth (PD), clinical attachment level to stent (CAL-S), free gingival margin to stent(FGM-S) , crestal bone to stent (Crest-S), horizontal defect depth to stent (HDD-S) and vertical defect depth to stent (VDD-S) and crestal bone to defect depth measured from stent margin. Thereafter, one side randomly treated using connective tissue and DFDBA (study group) and opposite side received ADM and DFDBA (control group). After 6 months, soft and hard tissue parameters measured again in re-entry. Results. Both groups presented improvements after therapies (P & 0.05). No inter-group differences were seen in PD re-duction (P = 0.275), CAL gain (P = 0.156), free gingival margin (P = 0.146), crest of the bone (P = 0.248), reduction in horizontal defects depth (P = 0.139) and reduction in vertical defects depth (P = 0.149). Conclusion. Both treatments modalities have potential of regeneration without any adverse effect on healing process. Connective tissue grafts did not have significant higher bone fill compared to that of ADM.
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Affiliation(s)
- Vahid Esfahanian
- Assistant Professor, Department of Periodontology, Faculty of Dentistry, Islamic Azad University Khorasgan (Isfahan) Branch, Isfahan, Iran
| | - Shirin Farhad
- Assistant Professor, Department of Periodontology, Faculty of Dentistry, Islamic Azad University Khorasgan (Isfahan) Branch, Isfahan, Iran
| | - Mehrnaz Sadighi Shamami
- Assistant Professor, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
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Bansal M, Kaushik M, Khattak BBP, Sharma A. Comparison of nanocrystalline hydroxyapatite and synthetic resorbable hydroxyapatite graft in the treatment of intrabony defects: A clinical and radiographic study. J Indian Soc Periodontol 2014; 18:213-9. [PMID: 24872631 PMCID: PMC4033889 DOI: 10.4103/0972-124x.131329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/28/2013] [Indexed: 11/22/2022] Open
Abstract
Background: The aim of this study is to compare, clinically and radiographically, the effectiveness of nanocrystalline hydroxyapatite (NHA) and synthetic resorbable hydroxyapatite (HA) in the treatment of intrabony defects. Materials and Methods: Ten subjects with bilateral defects, with probing depth (PD) 6-9 mm and radiographic evidence of an intraosseous component ≥4 mm participated in the present study. Subjects were allocated randomly to treatment with NHA (test group) or HA (control group). At baseline, 3 and 6 months after surgery, the following clinical parameters were recorded: Plaque index, gingival index, PD, relative attachment level (RAL), and radiographic reduction in intrabony defect. Results: At 6 months following therapy, the test group showed a reduction in mean PD from 6.4 ± 0.843 to 3.3 ± 0.8232 mm and a change in mean RAL from 12.9 ± 1.197 to 10.1 ± 0.7378 mm, whereas in the control group the mean PD decreased from 7.65 ± 1.8566 to 3.9 ± 1.1005 mm, and mean RAL decreased from 13.9 ± 0.9944 to 10.7 ± 0.6749 mm. On comparison of the mean difference in probing depth between the two groups after the unpaired t-test was applied at baseline, 3 months and 6 months, scores were found to be statistically non-significant (P > 0.01). Conclusion: The results of the present study indicate that both NHA and conventional HA led to the improvement of clinical and radiographic parameters over the course of the study. However, the test group did not show any significant improvement over the control group.
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Affiliation(s)
- Mansi Bansal
- Department of Periodontics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Mayur Kaushik
- Department of Periodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Brig B P Khattak
- Department of Periodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Anamika Sharma
- Department of Periodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
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Malathi KG, Dev JN, Kumar KS, Srikanth C, Ravi Chandra PV, Paul A. A clinical evaluation of a bioresorbable membrane and porous hydroxyapatite in the treatment of human molar class II furcations. J Indian Soc Periodontol 2013; 17:617-23. [PMID: 24174756 PMCID: PMC3808017 DOI: 10.4103/0972-124x.119276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/13/2013] [Indexed: 11/11/2022] Open
Abstract
Background: The ultimate goal of periodontal therapy is predictable regeneration of a functional attachment apparatus destroyed as a result of periodontitis. Reconstructive procedures have been used with varying success during the past decades to accomplish this goal. Aim: To evaluate whether the use of porous hydroxyapatite alone or a bioresorbable membrane alone would enhance the clinical results in the treatment of class II furcation defects in human lower molars. Materials and Methods: Fifteen patients with chronic periodontitis, aged between 39 and 49 years, with a pair of similar bilateral class II furcation defects (classification of Hamp et al.) in mandibular first molars were selected. A split-mouth design was incorporated and the selected 30 furcation defects were assigned to one of the two treatment groups, i.e., Group I treated with a bioresorbable membrane from bovine-derived collagen guided tissue regeneration membrane and Group II treated using porous hydroxyapatite bone graft material on the contralateral sides. Evaluation of clinical parameters, probing depths and attachment levels, and radiographs was done preoperatively and 6 months postoperatively. Results: Both the groups showed statistically significant mean reduction in probing depths and gain in clinical attachment levels and linear bone fill. Comparison between Group I and Group II showed insignificant difference. Conclusion: Within the limits of this study, both the treatment modalities are beneficial for the treatment of human mandibular class II furcation defects.
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Affiliation(s)
- K Gita Malathi
- Department of Periodontics, SVS Institute of Dental Sciences, Appannapally, Mahabubnagar, India
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Treatment of a Large Cystic Lesion in Anterior Maxilla Using Glass Reinforced Hydroxyapatite – A Case Report. ACTA ACUST UNITED AC 2013. [DOI: 10.4028/www.scientific.net/ssp.207.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Jaw cysts are common lesions in the maxillofacial area. Their treatment varies from surgical enucleation alone to enucleation followed by bone grafting depending on the size of the lesion. Various bone substitutes ranging from autografts, allografts, xenografts and alloplasts have been tried and tested with varying degrees of success. Here, the author present a case report of large cystic lesion of anterior maxilla and its treatment using a glass reinforced hydroxyapatite composite (Bonelike®) following enucleation. One year follow up demonstrated satisfactory clinical and radiological treatment outcomes.Keywords: Jaw cyst, enucleation, defect filling, alloplast, Bonelike®, bone grafts.
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Rastogi P, Saini H, Singhal R, Dixit J. Periodontal regeneration in deep intrabony periodontal defect using hydroxyapatite particles with platelet rich fibrin membrane-a case report. J Oral Biol Craniofac Res 2011; 1:41-3. [PMID: 25756017 PMCID: PMC3942002 DOI: 10.1016/s2212-4268(11)60010-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Growth factors such as platelet-derived growth factors exert potent effect on wound healing including the regeneration of periodontium. Platelet-rich fibrin (PRF) membrane provides a concentrate of such growth factors, accelerating the wound healing process. MATERIALS AND METHODS In this case report, regeneration of the deep periodontal intrabony defect was attempted using hydroxyapatite particles mixed in the PRF membrane to assess if regeneration of new bone is possible. RESULTS AND CONCLUSION This resulted in a rapid and complete healing with the decrease in the pocket depth and a gain in the clinical attachment level. Rapid regeneration of the periodontium can be achieved with bone substitutes by incorporating the various growth factors from autogenous blood.
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Affiliation(s)
- Pavitra Rastogi
- Assistant Professor, Department of Periodontics, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College), Lucknow, India
| | - Himani Saini
- Postgraduate Student, Department of Periodontics, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College), Lucknow, India
| | - Rameshwari Singhal
- Lecturer, Department of Periodontics, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College), Lucknow, India
| | - Jaya Dixit
- Professor and Head, Department of Periodontics, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University (Erstwhile King George Medical College), Lucknow, India
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Sreedevi PV, Varghese NO, Varugheese JM. Prognosis of periapical surgery using bonegrafts: A clinical study. J Conserv Dent 2011; 14:68-72. [PMID: 21691510 PMCID: PMC3099119 DOI: 10.4103/0972-0707.80743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 05/12/2010] [Accepted: 07/14/2010] [Indexed: 11/21/2022] Open
Abstract
AIM to evaluate and compares the healing clinically and radiographically following periapical surgery with and without using hydroxyapatite graules. MATERIALS AND METHODS Twenty patients were selected for the study & the nature of healing is compared with that of conventional periapical surgery. In the present clinical study chitra hydroxyapatite granules, a freeze-dried hydroxyapatite, is used to fill the osseous defects following periapical surgery. Following surgery all patients were assessed both clinically & radiographically for a period of nine months. RESULTS On clinical evaluation the test group did not show any significant immediate or delayed local tissue reactions. Radiographically in the follow up period of 6 - 9 months the bone graft became indistinguishable from the surrounding bone which indicates complete bone regeneration. Where as in the control group ever after 9 months the radiographs showed inadequate bone fills. CONCLUSION The bone regeneration following periapical surgery can be facilitated by using bone graft. Hydroxyapatite is found to be very effective alloplastic material. Based on this study it might be concluded that in large bone destruction caused by periradicular lesion bone regeneration can be facilitated by effective bone replacing materials like hydroxyapatite.
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Affiliation(s)
- PV Sreedevi
- Department of Conservative Dentistry & Endodontics, Farooqia Dental College, Mysore, Karnataka, India
| | - NO Varghese
- Department of Conservative Dentistry, Govt. Dental College Thiruvananthapuram, India
| | - Jolly Mary Varugheese
- Department of Conservative Dentistry, Govt. Dental College Thiruvananthapuram, India
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Mardas N, Chadha V, Donos N. Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clin Oral Implants Res 2010; 21:688-98. [PMID: 20636724 DOI: 10.1111/j.1600-0501.2010.01918.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this randomized, controlled clinical trial was to compare the potential of a synthetic bone substitute or a bovine-derived xenograft combined with a collagen membrane to preserve the alveolar ridge dimensions following tooth extraction. METHODS Twenty-seven patients were randomized into two treatment groups following single tooth extraction in the incisor, canine and premolar area. In the test group, the alveolar socket was grafted with Straumann Bone Ceramic (SBC), while in the control group, Bio-Oss deproteinized bovine bone mineral (DBBM) was applied. In both groups, a collagen barrier was used to cover the grafting material. Complete soft tissue coverage of the barriers was not achieved. After 8 months, during re-entry procedures and before implant placement, the horizontal and vertical dimensions of the residual ridge were re-evaluated and trephine biopsies were performed for histological analysis in all patients. RESULTS Twenty-six patients completed the study. The bucco-lingual dimension of the alveolar ridge decreased by 1.1+/-1 mm in the SBC group and by 2.1+/-1 in the DBBM group (P<0.05). Both materials preserved the mesio-distal bone height of the ridge. No differences in the width of buccal and palatal bone plate were observed between the two groups. The histological analysis showed new bone formation in the apical part of the biopsies, which, in some instances, was in direct contact with both SBC and DBBM particles. The coronal part of the biopsies was occupied by a dense fibrous connective tissue surrounding the SBC and DBBM particles. CONCLUSION Both biomaterials partially preserved the width and the interproximal bone height of the alveolar ridge.
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Affiliation(s)
- Nikos Mardas
- Periodontology Unit, UCL - Eastman Dental Institute, London, UK
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Nieri M, Saletta D, Buti J, Pagliaro U, Guidi L, Rotundo R, Pini Prato G. From initial case report to randomized clinical trial through 20 years of research in periodontal therapy. J Clin Periodontol 2009; 36:39-43. [DOI: 10.1111/j.1600-051x.2008.01341.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Takenaka Y, Iijima M, Kawano S, Akita Y, Yoshida T, Doi Y, Sekine I. The Development of Carbonate-containing Apatite/Collagen Composite for Osteoconductive Apical Barrier Material. J Endod 2008; 34:1096-100. [DOI: 10.1016/j.joen.2008.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 05/30/2008] [Accepted: 06/17/2008] [Indexed: 11/29/2022]
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Zucchelli G, Mele M, Checchi L. The papilla amplification flap for the treatment of a localized periodontal defect associated with a palatal groove. J Periodontol 2006; 77:1788-96. [PMID: 17032124 DOI: 10.1902/jop.2006.050333] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Teeth with a palatal groove often present with severe localized periodontal attachment loss including pocket formation and alveolar bone loss. The aim of the present case report was to describe the regenerative surgical treatment of periodontal and bone lesions associated with the subgingival extension of a palatal groove affecting a maxillary lateral incisor. METHODS The left maxillary lateral incisor of a systemically healthy young subject presented with a palatal probing depth of 10 mm with no gingival recession at the buccal and palatal surfaces; the neighboring interdental papillae were intact. The radiograph showed a radiolucency area distal to the affected tooth. Treatment procedures consisted of: 1) the papilla amplification flap with the use of enamel matrix proteins as the regenerative periodontal material; 2) the elimination/flattening of the radicular portion of the palatal groove; and 3) the sealing of the coronal portion of the groove with composite flow. RESULTS The clinical examination at 1 year revealed a clinical attachment gain (8 mm) with a shallow residual probing depth (2 mm) and no increase in gingival recession. The radiographic examination showed the complete disappearance of the radiolucency area suggesting bone fill. CONCLUSIONS The present study indicated that localized periodontal defects associated with a palatal groove can be successfully treated by means of the papilla amplification flap with the use of enamel matrix protein as the regenerative material. The long-term stability of such successful results needs to be determined.
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Affiliation(s)
- Giovanni Zucchelli
- Alma Mater Studiorum, Department of Periodontology, Bologna University, Bologna, Italy.
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Wang HL, Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco RJ. Position Paper: Periodontal Regeneration. J Periodontol 2005; 76:1601-22. [PMID: 16171453 DOI: 10.1902/jop.2005.76.9.1601] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression,but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces,reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the periodontium and of procedures used to restore periodontal tissues around natural teeth. Targeted audiences for this paper are periodontists and/or researchers with an interest in improving the predictability of regenerative procedures. This paper replaces the version published in 1993.
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Abstract
The purpose of this study was to clinically and radiographically evaluate the use of bone grafting therapy for treatment of osseous defects before implant surgery. After bone graft reconstruction, implants may be placed in previous areas of osseous defect with the expectation of long-term positive results.
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Affiliation(s)
- Gagik Hakobyan
- Medical Center Prometey, Department of Surgical Stomatology, State Medical University of Yerevan, Yerevan, Armenia.
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21
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Imbronito AV, Scarano A, Orsini G, Piattelli A, Arana-Chavez VE. Ultrastructure of bone healing in defects grafted with a copolymer of polylactic/polyglycolic acids. J Biomed Mater Res A 2005; 74:215-21. [PMID: 15948203 DOI: 10.1002/jbm.a.30350] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bone substitutes have been used for the treatment of bone defects. The objective of this study was to ultrastructurally evaluate the healing pattern of bone defects filled with a copolymer of polylactic/polyglycolic acid (FisiograftR) at a time point in which it is expected to be only partially degraded, with the purpose to ultrastructurally analyze how the bone is forming around the grafting material. Three 5-mm-diameter bone defects were created in each tibia from 5 rabbits (average weight 2.5 kg) in which the material was randomly implanted. Animals were sacrificed 30 days after surgery and the 30 bone defects were fixed in 2% glutaraldehyde-2.5% formaldehyde, under microwave irradiation, decalcified in EDTA, embedded in Spurr resin, and examined in a Jeol 1010 TEM. All the bone defects were filled with connective tissue, interspersed with different amounts of the filling material and newly formed bone trabeculae. In areas where the degrading copolymer was present in small amounts, newly formed bone matrix was detected; it was deposited by osteoblast-like cells in close relation to the copolymer. In areas where the degrading copolymer formed accumulates, an amorphous multilayered material was identified between the connective tissue and the copolymer. In summary, the copolymer of PLA/PGA studied appears to be an osteoconductive material when it is used to fill bone defects.
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Affiliation(s)
- Ana Vitoria Imbronito
- Laboratory of Mineralized Tissue Biology, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, SP, Brazil
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Pan MH, Wu YW, Yen RF, Tzen KY, Liao SL, Kao CH. Different fibrovascularization rate between coralline hydroxyapatite and high density porous polyethylene (Medpore) measured by 99mTc-MDP bone scintigraphy 6 months after intraorbital implantation. Nucl Med Commun 2004; 24:1237-41. [PMID: 14627850 DOI: 10.1097/00006231-200312000-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Many materials and types of implant have been used to achieve a cosmetic effect and prosthesis motility in the anophthalmic socket. Hydroxyapatite remains the implant material of choice for producing the most natural prosthesis motility while porous polyethylene shows promising characteristics as another useful material. The aim of this study was to compare the fibrovascular ingrowth rates of orbital implants between coralline hydroxyapatite and high density porous polyethylene (Medpore). The fibrovascularization rate is determined by bone imaging using 99mTc methylene diphosphonate (99mTc-MDP) 6 months after implantation. Our study included 29 patients with coralline, and nine patients with Medpore implants. Our results showed that groups with coralline implants appearing to achieve complete fibrovascularization at a much more rapid rate than those with Medpore. The differences in rate were statistically significant.
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Affiliation(s)
- M-H Pan
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei
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23
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Bilkay U, Alper M, Celik N, Erdem O, Kerem H, Ozek C, Zekioglu O, Delen Y, Songur E, Cagdas A. Comparing the Osteogenic Capacities of Bone Substitutes: Hydroxyapatite, High-Density Porous Polyethylene, and Bone Collagen: A Biochemical and Histological Analysis. J Craniofac Surg 2004; 15:585-93; discussion 594. [PMID: 15213535 DOI: 10.1097/00001665-200407000-00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Several inorganic materials have been shown previously to hold some osteogenic capacity. The purpose of this study is to compare the bone-forming abilities of hydroxyapatite ceramic, high-density porous polyethylene, and bone collagen within the periosteal island flap of rabbit tibia using histological and biochemical analysis. With this goal, four discrete experimental groups were formed, each comprising 22 New Zealand male rabbits. A sac was created on each rabbit tibial periosteum flap in each of the groups, and each of the previously mentioned materials was placed within this sac separately. One of these groups was thought as a control group without any material being placed inside the periosteal sac. Biopsies were taken at weeks 1, 2, 4, and 8 for biochemical analysis and at weeks 2 and 8 for histological evaluation. Neo-osteogenesis was evaluated quantitatively by determination of alkaline phosphatase and osteocalcin levels biochemically as well as by the percentage of new bone formation inside the periosteal sac histologically. Results show statistically that the osteogenic effect of high-density porous polyethylene is greater than that of the other materials used in this study (P < 0.05).
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Affiliation(s)
- Ufuk Bilkay
- Department of Plastic and Reconstructive Surgery, Ege University, Izmir, Turkey.
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24
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Itoh M, Shimazu A, Hirata I, Yoshida Y, Shintani H, Okazaki M. Characterization of CO3Ap-collagen sponges using X-ray high-resolution microtomography. Biomaterials 2004; 25:2577-83. [PMID: 14751743 DOI: 10.1016/j.biomaterials.2003.09.071] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For reconstruction and regeneration of hard tissues, scaffold biomaterials with large size pores and high porosity are important, in addition to their roles as supporting frames. To develop a new biodegradable scaffold biomaterial, CO3Ap, which has crystallinity and a chemical composition similar to bone, was synthesized at pH 7.4 and 60 degrees C. Then, the CO3Ap was mixed with a neutralized collagen gel and the CO3Ap-collagen mixtures with different kinds of CO3Ap contents and porosity were lyophilized into sponges. Scanning electron micrography (SEM) observation of CO3Ap-collagen sponges showed favorable pores for cell invasion. Approximately 50-300 microm size pores appeared to continue through the bulk. Higher magnification of the sponge showed a better adhesion between CO3Ap crystals and collagen. X-ray high-resolution microtomography revealed a clear image of the 3D structure of the sponges. The porosity of 0, 70 and 90%(w/w) CO3Ap-collagen sponges was 79.2 +/- 2.8%, 72.6 +/- 2.4% and 48.9 +/- 6.1%, respectively. The 70%(w/w) CO3Ap-collagen sponge appeared to be the most favorable biomaterial from the viewpoint of natural bone properties. Mouse osteoblast MC3T3-E1 cells were cultured in alphaMEM with 10% FCS for 2 weeks. Hematoxylin-eosin staining confirmed osteoblast cells invaded well into the CO3Ap-collagen sponge. These sponges are expected to be used as hard tissue scaffold biomaterials for therapeutic uses.
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Affiliation(s)
- M Itoh
- Department of Operative Dentistry and Dental Materials, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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25
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Yamasaki Y, Yoshida Y, Okazaki M, Shimazu A, Kubo T, Akagawa Y, Uchida T. Action of FGMgCO3Ap-collagen composite in promoting bone formation. Biomaterials 2003; 24:4913-20. [PMID: 14559004 DOI: 10.1016/s0142-9612(03)00414-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To improve the biological properties of materials as bone substitutes, functionally graded CO3 apatite crystals containing magnesium, FGMgCO3Ap, were synthesized to be mixed with atelocollagen and made into a composite pellet. A radio-labeled cell adhesion experiment showed that the degree of adherence of mouse MC3T3E1 osteoblast-like cells to the FGMgCO3Ap-collagen composite was better than to CO3Ap-collagen and much better than to the Ti plate. When the composites were implanted beneath the periosteum cranii of rats, the FGMgCO3Ap-collagen composite was metabolized faster than the CO3Ap-collagen composite and better formation of new bone and osteoblast arrangement at the interface between the composite and the periosteum cranii was observed. When the composites were implanted into the femur of rabbits, clear bone formation with a higher degree of bone density was observed for the FGMgCO3Ap-collagen composite. These results suggest that the Mg2+ ions taken into the apatite crystals may contribute to the acceleration of osteoblast adhesion to apatites and promote bone formation, cross-talking with osteoblasts at the molecular level.
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Affiliation(s)
- Y Yamasaki
- Department of Biomaterials Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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26
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Zucchelli G, Amore C, Montebugnoli L, De Sanctis M. Enamel Matrix Protines Bovine Porous Bone Mineral in the Treatment of Intrabony Defects: Comparative Controlled Clinical Trial. J Periodontol 2003; 74:1725-35. [PMID: 14974812 DOI: 10.1902/jop.2003.74.12.1725] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Various clinical studies have demonstrated that applying commercially available enamel matrix proteins (EMP) on the instrumented root surface during access flap surgery promotes clinically significant gains of clinical attachment and bone in intrabony defects. The aim of the present controlled clinical trial was to evaluate the adjunctive effect of filling the intrabony lesion with bovine porous bone mineral (BPBM) to a simplified papilla preservation (SPP) flap and EMP surgical procedure. METHODS Sixty deep interproximal intrabony lesions in 60 patients with chronic periodontitis were treated with the SPP flap and EMP. In the 30 test defects, the intrabony component was filled with BPBM particles previously reconstituted with the EMP gel. A stringent infection control program was adopted for 1 year. The clinical and radiographical reevaluation was made 1 year after surgery. RESULTS Both techniques resulted in clinically and statistically significant improvements between baseline and 1 year, in terms of clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill; however, the BPBM test treatment showed statistically significantly greater CAL (5.8 +/- 1.1 versus 4.9 +/- 1.0) and radiographic bone (DEPTH) level gains (5.3 +/- 1.1 versus 4.3 +/- 1.5), and less increase in gingival recession (0.4 +/- 0.6 versus 0.9 +/- 0.5) than the control surgical procedure. CONCLUSION The present study data supported the hypothesis that the adjunctive use of BPBM in grafting intrabony defects has the ability to improve clinical and radiographical outcomes achievable with EMP alone.
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Affiliation(s)
- G Zucchelli
- Department of Stomatologic Science, Bologna University, Bologna, Italy.
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27
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Shirakura M, Fujii N, Ohnishi H, Taguchi Y, Ohshima H, Nomura S, Maeda T. Tissue response to titanium implantation in the rat maxilla, with special reference to the effects of surface conditions on bone formation. Clin Oral Implants Res 2003; 14:687-96. [PMID: 15015943 DOI: 10.1046/j.0905-7161.2003.00960.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tissue responses to titanium implantation with two different surface conditions in our established implantation model in rat maxillae were investigated by light and transmission electron microscopy and by histochemistry for tartrate-resistant acid phosphatase (TRAPase) activity. Here we used two types of implants with different surface qualities: titanium implants sandblasted with Al2O3 (SA-group) and implants coated with hydroxyapatite (HA-group). In both groups, bone formation had begun by 5 days postimplantation when the inflammatory reaction had almost disappeared in the prepared bone cavity. In the SA-group, however, the bone formation process in the bone cavity was almost identical to that shown in our previous report using smooth surfaced implants (Futami et al. 2000): new bone formation, which occurred from the pre-existing bone toward the implant, was preceded by active bone resorption in the lateral area with a narrow gap, but not so in the base area with a wide gap. In the HA-group, direct bone formation from the implant toward the pre-existing bone was recognizable in both lateral and base areas. Many TRAPase-reactive cells were found near the implant surface. On the pre-existing bone, new bone formation occurred with bone resorption by typical osteoclasts. Osseointegration around the implants was achieved by postoperative day 28 in both SA- and HA-groups except for the lateral area, where the implant had been installed close to the cavity margin. These findings indicate that ossification around the titanium implants progresses in different patterns, probably dependent on surface properties and quality.
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Affiliation(s)
- Masaki Shirakura
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Gakkocho-dori, Niigata, Japan
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28
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Rafter M, Baker M, Alves M, Daniel J, Remeikis N. Evaluation of healing with use of an internal matrix to repair furcation perforations. Int Endod J 2002; 35:775-83. [PMID: 12449029 DOI: 10.1046/j.1365-2591.2002.00566.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The purpose of this study was to evaluate healing responses following repair of furcation perforations, with and without an internal matrix. Two matrix materials, HAPSET (65% non-resorbable hydroxyapatite and 35% plaster of paris) and hydroxyapatite were compared. METHODOLOGY Four adult female baboons (Papio anubis) served as experimental models. Furcation perforations were made in the molar and premolar teeth, which were then randomly assigned to one of the five groups, according to the method of perforation repair: 1 Experimental group 1 (16 teeth): The matrix material was HAPSET and the sealing material, amalgam. 2 Experimental group 2 (16 teeth): The matrix material was hydroxyapatite and the sealing material, amalgam. 3 Experimental group 3 (16 teeth): No matrix was placed. The sealing material was amalgam. 4 Positive control group (16 teeth): The perforation was not sealed. 5 Negative control group (16 teeth): No perforation was made. The animals were sacrificed at 1 week and 1, 3 and 7 months. Specimens were prepared for examination with light microscopy. RESULTS The data revealed that when amalgam was used alone without a matrix, there was marked extrusion of the material into the underlying bone with an associated severe inflammatory response, which continued throughout the observational period. When an internal matrix was used, there was an initial acute inflammatory response that diminished with time such that at 7 months, 75% of these specimens were free of inflammation. There was no difference in the tissue response to the different matrix materials. HAPSET and hydroxyapatite underwent connective tissue encapsulation in the early stages followed by new bone deposition in direct contact with the materials. CONCLUSIONS Within this animal model healing responses are better when an internal matrix, whether HAPSET or hydroxyapatite, is used in the repair of furcation perforations.
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Affiliation(s)
- M Rafter
- University of Illinois at Chicago, Chicago, IL, USA.
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29
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Rupprecht RD, Horning GM, Towle HJ. A clinical evaluation of hydroxyapatite cement in the treatment of Class III furcation defects. J Periodontol 2001; 72:1443-50. [PMID: 11699488 DOI: 10.1902/jop.2001.72.10.1443] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Calcium hydroxyapatite cement (HAC) has been demonstrated in both animal models and human craniofacial defects to be safe, absorbable, osteoconductive, and possibly osteoinductive. This pilot study evaluated a novel technique using HAC to surgically obturate Class III mandibular molar furcation defects. METHODS Following flap reflection, affected teeth in 6 patients were root planed and etched with citric acid. Experimental sites were grafted with HAC and coronally positioned flaps (CPF), while controls were treated by CPF only. A variety of clinical parameters were recorded initially, and at re-entry surgery 9 months later. RESULTS At re-entry, all experimental sites exhibited granulation tissue interposed between the HAC and the alveolar bone, and clinical findings were unsatisfactory. Mean probing depth, clinical attachment loss, and recession increased by 0.8 mm, 1.9 mm, and 1.2 mm, respectively, in experimental sites. In controls, mean probing depth decreased by 0.8 mm, and clinical attachment loss and recession increased by 0.3 mm and 1.2 mm, respectively. There was a mean 1.6 mm loss in osseous crest height and a mean 2.2 mm worsening in osseous defect depth for experimental sites, but only a 0.5 mm loss in osseous crest and 0.5 mm increase in osseous defect depth in control sites. CONCLUSIONS Experimental sites lost 1.0 to 1.5 mm in bone and attachment compared to controls, without any significant clinical benefit. While the concept of surgically obturating Class III furcation defects with a safe, osteoconductive material remains attractive, HAC did not promote repair or regeneration in this technique.
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Affiliation(s)
- R D Rupprecht
- Dental Corps, U.S. Navy, Department of Periodontics, Naval Dental Center Far East, Yokosuka, Japan
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30
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Park JS, Suh JJ, Choi SH, Moon IS, Cho KS, Kim CK, Chai JK. Effects of pretreatment clinical parameters on bioactive glass implantation in intrabony periodontal defects. J Periodontol 2001; 72:730-40. [PMID: 11453234 DOI: 10.1902/jop.2001.72.6.730] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The various methods for regeneration of periodontal tissue that have been developed can be classified into guided tissue regeneration and bone implantation. Since the implantation materials have shown both deficiencies and merits, dentists have begun exploring the bioactive glass first used in plastic surgery. This paper examines the effectiveness of this new material on periodontal intrabony defects. METHODS Clinical effects of bioactive glass implantation in intrabony periodontal defects were evaluated 6 months after surgery in 38 intrabony defects from 38 patients with chronic periodontitis. Twenty-one experimental defects received bioactive glass implantation (test group), while 17 control defects were treated with a flap procedure only (control group). The criteria for comparative observation were preoperative and postoperative probing depth (PD), clinical attachment level (CAL), bone probing depth (BPD), and gingival recession. RESULTS Reductions in PD were observed in both groups (P<0.01). The reduction in PD was significantly greater in the test group when preoperative PD exceeded 7 mm (P<0.01). Improvements in CAL were also observed in both groups (P<0.01), with the test group showing significantly greater gains (P<0.05). In those cases where preoperative CAL was less than 7 mm, there was no statistically significant difference between the two groups. Reduction in BPD was observed in both groups, with the test group showing significantly greater reduction (P <0.01). There was no significant difference in BPD change, however, when preoperative BPD was < or =7 mm. Significantly greater reduction of BPD in the test group was observed when intrabony defect depth was >4 mm (P <0.05). Significant improvements in PD, CAL, and BPD were noted in the test group when the crestal involvement exceeded 100 degrees. Correlation test between various clinical parameters indicated that greater changes in PD and CAL in the test group were observed when preoperative CAL was large (P<0.001), and greater changes in PD (P<0.05), CAL (P<0.01), and BPD (P<0.05) were noted when preoperative BPD was large. Correlation between crestal involvement and CAL change was noted only in the control group (P<0.01). High correlations were observed between PD changes and CAL changes and between CAL changes and BPD changes in both groups. CONCLUSIONS Use of a bone substitute in a flap operation resulted in significantly greater improvements in CAL and BPD over flap operation alone and seemed to have positive effects in postoperative PD, CAL, and BPD in those cases with more severe preoperative CAL and BPD.
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Affiliation(s)
- J S Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seodaemun-gu, Seoul, Korea
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31
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Yukna RA, Krauser JT, Callan DP, Evans GH, Cruz R, Martin M. Multi-center clinical comparison of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) and ABM in human periodontal osseous defects. 6-month results. J Periodontol 2000; 71:1671-9. [PMID: 11128913 DOI: 10.1902/jop.2000.71.11.1671] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intraosseous periodontal defects present a particular treatment problem. New bone replacement grafts offer promise for improved results. METHODS The role of a synthetic cell-binding peptide (P-15), combined with anorganic [corrected] bovine-derived hydroxyapatite bone matrix (ABM), was compared to ABM alone in human periodontal osseous defects in a controlled, monitored, multi-center trial. Following appropriate initial preparation procedures, flap surgery with defect and root debridement was performed. Two osseous defects per patient were treated randomly with each procedure after surgical preparation. Appropriate periodontal maintenance schedules were followed, and at 6 to 7 months, re-entry flap surgery was performed for documentation and finalization of treatment. RESULTS T test and Mann-Whitney U analyses of patient mean values from 33 patients revealed that the combination ABM/P-15 grafts demonstrated significantly better mean defect fill of 2.9 +/- 1.2 mm (72.9%) versus a mean defect fill of 2.2 +/- 1.4 mm (50.67%) for defects treated with ABM (P<0.05). Other hard tissue findings showed similar clinically superior results with the use of ABM/P-15. Relative defect fill results showed 81% positive (50% to 100% defect fill) responses with ABM/P-15 and 67% positive responses with ABM. There were 3.5 times as many optimal results (> or = 90% defect fill) with ABM/P-15 and twice as many failures (minimal response) with ABM. Soft tissue findings showed no significant differences between treatments. CONCLUSIONS These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than the ABM alone in intrabony periodontal defects.
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Affiliation(s)
- R A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119-2799, USA
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32
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Wilson J, Low SB. Bioactive ceramics for periodontal treatment: comparative studies in the Patus monkey. JOURNAL OF APPLIED BIOMATERIALS : AN OFFICIAL JOURNAL OF THE SOCIETY FOR BIOMATERIALS 1999; 3:123-9. [PMID: 10147709 DOI: 10.1002/jab.770030208] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Four bioactive ceramic materials currently recommended for regeneration of osseous tissues in treatment of periodontal disease have been compared with Bioglass particulates, of equivalent size in two compositions, in a monkey model. Both Bioglass materials were found to be easily manipulated, were haemostatic and osteoproductive allowing restoration of both alveolar bone and periodontal ligament. Epithelial downgrowth was inhibited and epithelial attachment was close to the preimplantation level. The other materials were slower to act and epithelial downgrowth was to the same level as in unfilled control defects.
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Affiliation(s)
- J Wilson
- Bioglass Research Center and Department of Periodontology, University of Florida, Gainesville 32610
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Abstract
Bone replacement grafts will play a continuing role in periodontal and other regenerative therapy. Several choices are available to the clinician including autogenous, allogeneic, xenogeneic and a variety of alloplastic materials. Except for fresh autogenous bone, bone replacement graft(s) do not provide the cellular elements necessary for osteogenesis nor can they reliably be considered truly osteoinductive, but instead are mostly osteoconductive, providing a scaffold for bone deposition. Currently, significant decrease in clinical probing depth and gain of clinical attachment have been reported following use of bone replacement grafts when compared to flap debridement surgery alone for periodontal osseous defects. Reported differences among bone replacement grafts (autogenous, allogeneic, xenogeneic, and alloplastic) occur with respect to histological outcomes. Overall, probing depth reduction, attachment level gain and degree of defect fill are similar for all bone replacement grafts.
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Affiliation(s)
- H F Nasr
- Department of Periodontics, School of Dentistry, Louisiana State University Medical Center, New Orleans, USA
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34
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Kwan SK, Lekovic V, Camargo PM, Klokkevold PR, Kenney EB, Nedic M, Dimitrijevic B. The use of autogenous periosteal grafts as barriers for the treatment of intrabony defects in humans. J Periodontol 1998; 69:1203-9. [PMID: 9848529 DOI: 10.1902/jop.1998.69.11.1203] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to evaluate the clinical effectiveness of a connective tissue graft including periosteum used as a barrier for guided periodontal tissue regeneration in interproximal bony defects. An open flap debridement of a comparable interproximal bony defect in the same patient was used as a control. This study was performed at 2 different clinical centers. Six paired defects were treated at one center, and 16 paired defects at the other. Reentry surgeries were performed at 6 months. Preoperative comparisons of control and experimental sites with respect to clinical parameters and osseous measurements were similar. Post-surgical experimental sites produced more gain in clinical attachment (1.25 mm on buccal and 1.25 mm on lingual sites at center A and 1.26 mm on buccal and 1.18 mm on lingual sites at center B) and osseous defect fill (1.84 mm on buccal and 2.00 mm on lingual sites at center A and 1.66 mm on buccal and 2.04 mm on lingual sites at center B) when compared to control sites. The results of this trial indicate that clinical resolution of interproximal periodontal defects can be obtained with periosteal grafts used as barriers.
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Affiliation(s)
- S K Kwan
- University of California, Los Angeles, School of Dentistry, Section of Periodontics, 90095, USA
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35
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Yukna RA, Callan DP, Krauser JT, Evans GH, Aichelmann-Reidy ME, Moore K, Cruz R, Scott JB. Multi-center clinical evaluation of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) as a bone replacement graft material in human periodontal osseous defects. 6-month results. J Periodontol 1998; 69:655-63. [PMID: 9660334 DOI: 10.1902/jop.1998.69.6.655] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A synthetic cell-binding peptide (P-15) combined with anorganic bovine-derived hydroxyapatite bone matrix (ABM) was compared to demineralized freeze-dried bone allograft (DFDBA) and open flap debridement (DEBR) in human periodontal osseous defects in a controlled, monitored, multi-center trial. Following appropriate initial preparation procedures, flap surgery with defect and root debridement was performed. Three osseous defects per patient were treated randomly with one of three procedures after surgical preparation. Appropriate periodontal maintenance schedules were followed, and at 6 to 7 months re-entry flap surgery was performed for documentation and finalization of treatment. Analysis of variation (ANOVA) and t test analyses of patient mean values from 31 patients revealed that the combination ABM/P-15 grafts demonstrated significantly better mean defect fill of 2.8 +/- 1.2 mm (72.3%) versus a mean defect fill of 2.0 +/- 1.4 mm (51.4%) for defects treated with DFDBA (P <0.05) and a mean defect fill of 1.5 +/- 1.3 mm (40.3%) (P <0.05) for defects treated with DEBR. Other hard tissue findings showed similar clinically superior results with the use of ABM/P-15. Relative defect fill results showed 87% positive (50% to 100% defect fill) responses with ABM/P-15, 58% positive responses with DFDBA, and 41% positive responses with DEBR. There were 8 to 9 times more failures (minimal response) with DFDBA and DEBR (26% to 29% frequency) than with ABM/P-15. Soft tissue findings showed no significant differences among treatments except for greater clinical attachment level gain with ABM/P-15 compared to DEBR. These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than either DFDBA or DEBR. Further studies are needed to determine the relative roles of the ABM and/or the P-15 in these improved results.
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Affiliation(s)
- R A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119-2799, USA
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36
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Evian CI, Karateew ED, Rosenberg ES. Periodontal soft tissue considerations for anterior esthetics. JOURNAL OF ESTHETIC DENTISTRY 1998; 9:68-75. [PMID: 9468855 DOI: 10.1111/j.1708-8240.1997.tb00920.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C I Evian
- University of Pennsylvania, Philadelphia, USA
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37
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Fricain JC, Bareille R, Rouais F, Basse-Cathalinat B, Dupuy B. "In vitro" dissolution of coral in peritoneal or fibroblast cell cultures. J Dent Res 1998; 77:406-11. [PMID: 9465173 DOI: 10.1177/00220345980770020901] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous studies have shown that in vivo coral resorption involves a biphasic process: First, the edges of the coral block become powdery, then extracellular fluid and phagocytosis contribute to the dissolution of the crystals. The authors examined some types of cells that could be involved in phagocytosis, particularly the ability of both dermal fibroblasts and mouse-resident peritoneal cells to phagocytose and dissolve coral powder "in vitro". Radioactive coral was incubated for 24, 48, or 72 hrs with cells in the presence or absence of cytochalasin B (a phagocytic inhibitor) or chloroquine (a lysosomotropic agent). Furthermore, to specify the role of crystal cell contacts in the solubilization process, they incubated radioactive coral in conditioned media (obtained from two-day human fibroblastic or macrophagic cell culture in the presence or absence of non-radioactive coral) or at a distance from the cells using culture inserts. Measurements of the radioactivity in the different supernatants were performed. Transmission electron microscopy was carried out on the cells cultivated in the presence or absence of radioactive coral. The data suggest that both fibroblasts and macrophages dissolve the coral, and that the intracellular degradation in phagolysosomes is one of the mechanisms explaining coral powder dissolution.
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Affiliation(s)
- J C Fricain
- INSERM-U443-146, Université de Bordeaux II, France
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38
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Brown GD, Mealey BL, Nummikoski PV, Bifano SL, Waldrop TC. Hydroxyapatite cement implant for regeneration of periodontal osseous defects in humans. J Periodontol 1998; 69:146-57. [PMID: 9526913 DOI: 10.1902/jop.1998.69.2.146] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A newly developed calcium phosphate cement used to promote bone regeneration in craniofacial defects was examined to determine its potential for treatment of periodontal osseous defects. Sixteen patients with moderate to severe periodontal disease and 2 bilaterally similar vertical bony defects received initial therapy including scaling and root planing followed by treatment with either calcium phosphate cement, flap curettage (F/C) or debridement plus demineralized freeze-dried bone allograft (DFDBA). Standardized radiographs were exposed at baseline and 12 months postsurgery for computer assisted densitometric image analysis (CADIA). The extent of the bony defect was determined during initial and 12 month re-entry surgery. Within 6 months of implant placement, 11 of 16 patients treated with calcium phosphate cement exfoliated all or most of the implant through the gingival sulcus. At all 16 test sites, a narrow radiolucent gap formed by 1 month postsurgery at the initially tight visual interface between the radiopaque calcium phosphate cement and the walls of the bony defect. Mean probing depth reduction and clinical attachment gain at sites treated with calcium phosphate cement were 1.6 mm and 1.3 mm, respectively at 1 year. Minimal bony defect fill was accompanied by mean crestal resorption of 1.4 mm. Alveolar crestal resorption at sites with calcium phosphate cement was statistically significant (P=0.001). These findings contrasted with the more favorable outcomes for controls treated with DFDBA or F/C. DFDBA sites exhibited probing depth reduction of 3.1 mm, clinical attachment gain of 2.9 mm, and defect fill of 2.4 mm. Respective clinical changes at F/C sites were 2.4 mm, 1.4 mm, and 1.1 mm. CADIA revealed clinically significant trends between the three treatment modalities at various areas-of-interest. Based on the findings of this study, there is no rationale available to support the use of hydroxyapatite cement implant in its current formulation for the treatment of vertical intrabony periodontal defects.
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Affiliation(s)
- G D Brown
- Department of Periodontics, Davis-Monthan AFB, AZ 85707-4405, USA
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39
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Bertrand B, Doyen A, Eloy P. Triosite implants and fibrin glue in the treatment of atrophic rhinitis: technique and results. Laryngoscope 1996; 106:652-7. [PMID: 8628099 DOI: 10.1097/00005537-199605000-00026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nine patients with primary or secondary atrophic rhinitis were treated by narrowing of the nasal fossae using a new surgical technique (derived from the Eryes procedure) in which a Triosite and fibrin glue mixture is implanted via the labial vestibule route. The results were good or excellent in seven patients. No rejections occurred. Osseocoalescence, as evaluated by computed axial tomography at 6 months, was good. Inspiratory intrasnasal pain in patients with postsurgical atrophic rhinitis improved following the operation. The surgical technique, which is quick and easy to perform, avoids the discomfort of nostril closure or the implantation of grafts from other parts of the body. Complicated flap procedures are also avoided.
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Affiliation(s)
- B Bertrand
- ENT-HNS Department at the University of Louvain, Yvoir, Belgium
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40
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Flanders AE, De Potter P, Rao VM, Tom BM, Shields CL, Shields JA. MRI of orbital hydroxyapatite implants. Neuroradiology 1996; 38:273-7. [PMID: 8741201 DOI: 10.1007/bf00596547] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Our aim was to use MRI for the postsurgical assessment of a new form of integrated orbital implant composed of a porous calcium phosphate hydroxyapatite substrate. We studied ten patients 24-74 years of age who underwent enucleation and implantation of a hydroxyapatite ball; 5-13 months after surgery, each patient was examined by spinecho MRI, with fat suppression and gadolinium enhancement. Fibrovascular ingrowth was demonstrated in all ten patients as areas of enhancement at the periphery of the hydroxyapatite sphere that extended to the center to a variable degree. The radiologist should aware of the MRI appearances of the coralline hydroxyapatite orbital implant since it is now widely used following enucleation. MRI is a useful means to determine successful incorporation of the substrate into the orbital tissues. The normal pattern of contrast enhancement should not be mistaken for recurrent tumor or infection.
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Affiliation(s)
- A E Flanders
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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41
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Okazaki M, Fukumoto M, Takahashi J. Damped oscillation analysis of natural and artificial periodontal membranes. Ann Biomed Eng 1996; 24:234-40. [PMID: 8678355 DOI: 10.1007/bf02667352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The mechanical mobility of human teeth was studied by using a wave data treatment system with an accelerometer attached to a personal computer. The healthy teeth in different generations of men and women, who ranged in age from their teens to their forties, showed similar damped oscillation patterns. The spring constant and coefficient of viscous damping were estimated by using a viscoelastic model of damped oscillation with 1 degree of freedom. The coefficient of viscous damping increased dramatically with increases in the damping factor, whereas the spring constant scarcely varied. Silicone membranes were used as model periodontal membranes. The coefficient of viscous damping decreased with increases in silicone membrane thickness. Collagen membranes, which are expected to function as artificial periodontal membranes, were adhered to the model tooth by drying collagen gel and fixed with apatite-collagen composites. The collagen membranes showed damped oscillation wave patterns similar to those of human periodontal membranes.
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Affiliation(s)
- M Okazaki
- Department of Dental Materials Science and Technology, Osaka University Faculty of Dentistry, Suita, Japan
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42
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Francis JR, Brunsvold MA, Prewett AB, Mellonig JT. Clinical Evaluation of an Allogeneic Bone Matrix in the Treatment of Periodontal Osseous Defects. J Periodontol 1995. [DOI: 10.1902/jop.1995.66.12.1074] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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43
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Mora F, Ouhayoun JP. Clinical evaluation of natural coral and porous hydroxyapatite implants in periodontal bone lesions: results of a 1-year follow-up. J Clin Periodontol 1995; 22:877-84. [PMID: 8550865 DOI: 10.1111/j.1600-051x.1995.tb01787.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study examines the suitability of 2 bone graft substitutes, natural coral skeleton (NCS) and porous hydroxyapatite (PHA) for treating periodontal bone defects in human subjects, and compares them to debridement alone (DEBR). A total of 30 sites in 10 patients were treated. Measurements were made before treatment and during surgical reexamination 12 months after treatment on lesions filled with NCS (10 sites), PHA (10 sites), or DEBR (10 sites). There was no significant difference in the use of NCS or PHA for 1, 2 wall, or combined defects for the group of parameters measured in this study (clinical probing depth, clinical attachment, gingival recession, bone fill, % bone fill, and crest remodelling). Statistical analysis (Wilcoxon non-parametric test for paired values and ANOVA for repeated measurements) revealed the beneficial effects of using each the biomaterials (57.4% for NCS, 58.1% for PHA, p < 0.86) as opposed to simple debridement (22.2%; p < 0.002; p < 0.004).
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Affiliation(s)
- F Mora
- Department of Periodontology, School of Dentistry, University Paris, France
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44
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Sugar AW, Thielens P, Stafford GD, Willins MJ. Augmentation of the atrophic maxillary alveolar ridge with hydroxyapatite granules in a Vicryl (polyglactin 910) knitted tube and simultaneous open vestibuloplasty. Br J Oral Maxillofac Surg 1995; 33:93-7. [PMID: 7772594 DOI: 10.1016/0266-4356(95)90207-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A modified technique for augmentation of the severely atrophic edentulous maxillary alveolar ridge is described. The augmentation was carried out using a knitted polyglactin 910 mesh tube filled with porous hydroxyapatite granules, the tube being inserted through the access achieved by an open vestibuloplasty. The results of an in-vivo animal study showed that the absorption of the mesh was complete between 49 and 70 days. The clinical study included 11 patients in all of whom there was severe maxillary ridge atrophy and major prosthetic problems; follow-up was for a mean of 25 months. The procedure was without significant complication and produced a mean immediate absolute augmentation of 5.5 mm and substantially increased vestibular depth. A gradual reduction of ridge height was found over time. Nevertheless all patients showed significantly increased ability to wear their dentures. The technique is presented as a safe and predictable alternative to the use of bone grafts and titanium implants in these severely atrophic cases.
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Affiliation(s)
- A W Sugar
- Maxillofacial Department, Welsh Centre for Burns, Plastic and Maxillofacial Surgery, St. Lawrence Hospital, Chepstow, Gwent, UK
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45
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Shields CL, Shields JA, De Potter P, Singh AD. Problems with the hydroxyapatite orbital implant: experience with 250 consecutive cases. Br J Ophthalmol 1994; 78:702-6. [PMID: 7947552 PMCID: PMC504910 DOI: 10.1136/bjo.78.9.702] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.
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Affiliation(s)
- C L Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107
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46
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Naaman Bou-Abboud N, Patat JL, Guillemin G, Issahakian S, Forest N, Ouhayoun JP. Evaluation of the osteogenic potential of biomaterials implanted in the palatal connective tissue of miniature pigs using undecalcified sections. Biomaterials 1994; 15:201-7. [PMID: 8199293 DOI: 10.1016/0142-9612(94)90068-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Calcium phosphate or calcium carbonate biomaterials are widely used as bone substitutes in periodontal surgery. This study evaluates the osteogenic potential of five different alloplastic biomaterials implanted in the connective tissue of the palatal papilla in miniature pigs. A porous hydroxyapatite (PHA), a dense hydroxyapatite (DHA), a semi-porous hydroxyapatite (SPHA), a tricalcium phosphate (TCP) and a calcium carbonate natural coral (NC) were implanted in a tunnel in the palatal papillae of seven miniature pigs. Undecalcified sections were examined histologically at 1, 2, 3, 4, 8, 12 and 24 wk intervals. Resorbable materials (TCP and NC) were totally resorbed by 24 wk. DHA, PHA and HA showed very limited resorption, although there were multinucleated giant cells in contact with PHA and SPHA. There was no histologically detectable bone formation in contact with or near any of the biomaterials tested. However, several particles of NC, and sometimes of PHA, were surrounded by a dense, mineralized matrix. It is concluded that none of these biomaterials, in their presently available forms, has any bone inducing capacity.
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47
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Abstract
The recently introduced hydroxyapatite orbital implant was designed to provide improved motility of the prosthesis in patients who have undergone enucleation. To date, little has been written about the use of the hydroxyapatite orbital implant in eyes that harbored malignant neoplasms. We have performed hydroxyapatite orbital implantation in approximately 200 patients, including children as young as 1 month of age, who underwent enucleation primarily for malignant intraocular tumors. During a median follow-up of 24 months, no cases of orbital hemorrhage, orbital infection, implant extrusion, or implant migration have occurred. Three patients have had conjunctival erosion, which was successfully repaired. Motility of the socket and fornices has been excellent, and all patients have cosmetically satisfactory motility of the prosthesis. Use of the hydroxyapatite implant has had no adverse effect on the clinical course of the intraocular neoplasms, and it has not hindered postoperative evaluation for recurrent orbital tumor. Overall, the hydroxyapatite orbital implant seems to be well tolerated, provides improved motility of the prosthesis, and is associated with few complications.
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Affiliation(s)
- J A Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
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48
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Baslé MF, Chappard D, Grizon F, Filmon R, Delecrin J, Daculsi G, Rebel A. Osteoclastic resorption of Ca-P biomaterials implanted in rabbit bone. Calcif Tissue Int 1993; 53:348-56. [PMID: 8287324 DOI: 10.1007/bf01351842] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The nature of the multinucleated cells involved in the resorption processes occurring inside macroporous calcium-phosphate biomaterials grafted into rabbit bone was studied using light microscopy, histomorphometric analysis, enzymatic detection of tartrate-resistant acid phosphatase (TRAP) activity, scanning, and electron microscopy. Samples were taken at days 7, 14, and 21 after implantation. As early as day 7, osteogenesis and resorption were observed at the surface of the biomaterials, inside the macropores. Resorption of both newly formed bone and calcium-phosphate biomaterials was associated with two types of multinucleated cells. Giant multinucleated cells were found only at the surface of the biomaterials; they showed a large number of nuclei, were TRAP negative, developed no ruffled border, and contained numerous vacuoles with large accumulation of mineral crystals from the biomaterials. Osteoclasts exhibited TRAP positivity and well-defined ruffled border. They were observed at the surface of both newly formed bone and biomaterials, around the implant, and inside the macropores. In contract with the biomaterials, infoldings of their ruffled border were observed between the mineral crystals, deeply inside the microporosity. The microporosity of the biomaterials (i.e., the noncrystalline spaces inside the biomaterials) increased underneath this type of cell as compared with underneath giant cells or to the depth of the biomaterials. These observations demonstrate that macroporous calcium-phosphate biomaterials implanted in bone elicit osteogenesis and the recruitment of a double multinucleated cell population having resorbing activity: giant multinucleated cells that resorb biomaterials and osteoclasts that resorb newly formed bone and biomaterials.
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Affiliation(s)
- M F Baslé
- Laboratoire d'Histologie-Embryologie, Faculté de Médecine, Angers, France
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49
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Mellonig JT. Autogenous and allogeneic bone grafts in periodontal therapy. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1992; 3:333-52. [PMID: 1391415 DOI: 10.1177/10454411920030040201] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article is limited to a review of bone autografts and allografts, as used in periodontal therapy. The various graft materials are discussed with respect to case reports, controlled clinical trials, and human histology. Other reviewed areas are wound healing with periodontal bone grafts, tissue banking and freeze-dried bone allografts, and the use of bone grafts in guided tissue regeneration.
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Affiliation(s)
- J T Mellonig
- Department of Periodontics, University of Texas, San Antonio 78284
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50
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De Potter P, Shields CL, Shields JA, Flanders AE, Rao VM. Role of magnetic resonance imaging in the evaluation of the hydroxyapatite orbital implant. Ophthalmology 1992; 99:824-30. [PMID: 1375714 DOI: 10.1016/s0161-6420(92)31918-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The role of magnetic resonance imaging (MRI) in the assessment of fibrovascular ingrowth in the integrated hydroxyapatite orbital implant is evaluated. Fifteen patients who underwent enucleation and placement of a hydroxyapatite orbital implant were evaluated for degree of implant vascularity with gadolinium-DPTA-enhanced MRI with surface coil before drilling the implant. On T1-weighted images, the hydroxyapatite sphere appeared with intermediate signal. After gadolinium-DPTA administration, all patients showed an enhancement in the implant consistent with the presence of fibrovascular ingrowth. The enhancement was most notable in the peripheral portions of the sphere and was seen as early as 5 months after implantation. Comparison of gadolinium-DPTA-enhanced MRI with contrast-enhanced computed tomography, ultrasonography, and color Doppler imaging suggests that these latter techniques are not as helpful in the detection of the fibrovascular tissue in the orbital implant. Bone scan, a technique used by many surgeons, demonstrates fibrovascular ingrowth, but it is limited by its one-dimensional low-resolution image. Because of its three-dimensional capability and its highest resolution, contrast-enhanced MRI with surface coil appears to be the best imaging method for evaluating the hydroxyapatite orbital implant and its fibrovascular ingrowth.
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Affiliation(s)
- P De Potter
- Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107
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