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Khan SN, Koldsland OC, Roos-Jansåker AM, Wohlfahrt JC, Verket A, Mdala I, Magnusson A, Salvesen E, Hjortsjö C. Non-surgical treatment of mild to moderate peri-implantitis with an oscillating chitosan brush or a titanium curette-12-month follow-up of a multicenter randomized clinical trial. Clin Oral Implants Res 2023. [PMID: 37139538 DOI: 10.1111/clr.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To study clinical and radiographic outcomes after non-surgical treatment of peri-implantitis using either an oscillating chitosan brush (OCB) or titanium curette (TC) and to observe changes in clinical signs of inflammation after repeated treatment. METHODS Thirty-nine patients with dental implants (n = 39) presented with radiographic bone level (RBL) of 2-4 mm, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly assigned to mechanical debridement with OCB (test) or TC (control). Treatment was performed at baseline and repeated at 3, 6, and 9 months in cases with > 1 implant site with BI ≥ 1 and PPD≥4 mm. Blinded examiners recorded PPD, BI, pus, and plaque. The radiographic bone level change between baseline and 12 months was calculated. A multistate model was used to calculate transitions of BI. RESULTS Thirty-one patients completed the study. Both groups exhibited a significant reduction in PPD, BI, and pus at 12 months compared to baseline. Radiographic analysis showed stable mean RBL in both groups at 12 months. There was no statistically significant difference in any of the parameters between the groups. CONCLUSIONS Within the limitations of this 12-month multicenter randomized clinical trial, non-surgical treatment of peri-implantitis with OCB or TC showed no statistically significant differences between the groups. Clinical improvements and, in some cases, disease resolution, was observed in both groups. However, persistent inflammation was a common finding which further puts emphasis on the need for further treatment.
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Affiliation(s)
- Sadia N Khan
- Department of Prosthetics and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Odd Carsten Koldsland
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ann-Marie Roos-Jansåker
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Periodontology, Blekinge Hospital, Karlskrona, Sweden
| | - Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Anders Verket
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Anna Magnusson
- Department of Periodontology, Faculty of Medicine and Health, School of Medical Sciences, Orebro University, Orebro, Sweden
| | | | - Carl Hjortsjö
- Department of Prosthetics and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Khan SN, Koldsland OC, Roos-Jansåker AM, Wohlfahrt JC, Verket A, Mdala I, Magnusson A, Salvesen E, Hjortsjö C. Non-surgical treatment of mild to moderate peri-implantitis using an oscillating chitosan brush or a titanium curette-A randomized multicentre controlled clinical trial. Clin Oral Implants Res 2022; 33:1254-1264. [PMID: 36207993 PMCID: PMC10092542 DOI: 10.1111/clr.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This prospective, parallel-group, examiner-blinded, multicentre, randomized, controlled clinical trial aimed to assess the efficacy of an oscillating chitosan brush (OCB) versus titanium curettes (TC) on clinical parameters in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS In five dental specialist clinics, 39 patients with one implant with mild to moderate peri-implantitis, defined as 2-4 mm radiographic reduced bone level, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly allocated to test and control groups, receiving OCB or TC debridement, respectively. Treatment was performed at baseline and three months. PPD, BI, and Plaque index (PI) were measured at six sites per implant and recorded by five blinded examiners at baseline, one, three, and six month(s). Pus was recorded as present/not present. Changes in PPD and BI were compared between groups and analysed using multilevel partial ordinal and linear regression. RESULTS Thirty-eight patients completed the study. Both groups showed significant reductions in PPD and BI at six months compared with baseline (p < .05). There was no statistically significant difference in PPD and BI changes between the groups. Eradication of peri-implant disease as defined was observed in 9.5% of cases in the OCB group and 5.9% in the TC group. CONCLUSIONS Within the limitations of this six-month multicentre clinical trial, non-surgical treatment of peri-implantitis with OCB and TC showed no difference between the interventions. Eradication of disease was not predictable for any of the groups.
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Affiliation(s)
- Sadia N Khan
- Department of Prosthetics and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Odd Carsten Koldsland
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ann-Marie Roos-Jansåker
- Department of Periodontology, Public Dental Health Services, Kristianstad, Sweden.,Department of Periodontology, Blekinge Hospital, Karlskrona, Sweden
| | - Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Anders Verket
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Anna Magnusson
- Department of Periodontology, Public Dental Health Services, Örebro, Sweden
| | | | - Carl Hjortsjö
- Department of Prosthetics and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Hussain B, Karaca EO, Kuru BE, Gursoy H, Haugen HJ, Wohlfahrt JC. Treatment of residual pockets using an oscillating chitosan device versus regular curettes alone-A randomized, feasibility parallel-arm clinical trial. J Periodontol 2022; 93:780-789. [PMID: 34710240 DOI: 10.1002/jper.21-0496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND A brush made of chitosan has shown to be an effective and harmless device for non-surgical treatment of mild to moderate peri-implantitis. To date, no study has evaluated the use of a chitosan brush in the non-surgical treatment of residual pockets in periodontal treatment. METHODS Seventy-eight patients with periodontitis were included in this multicenter, randomized, examiner-blind clinical trial of 6 months duration. Patients with residual probing pocket depth (PPD) of ≥5 mm and ≤7 mm following previous active periodontal treatment were included. Patients were assigned either subgingival treatment with curettes (control) or an oscillating chitosan brush (test). Changes in bleeding on probing (BoP) and PPD between baseline and terminal evaluation at 6 months were evaluated. RESULTS A significant reduction in both PPD and BoP was seen within both groups. There was no significant difference in BoP between test and control groups after 6 months, but the reduction in PPD was significantly improved in the test group (P ≤ 0.01). The combined outcome of no BOP and PPD ≤4 mm was significantly better in the test group (P ≤ 0.01). No adverse reactions were seen. CONCLUSION Treatment of residual periodontal pockets (PPD = 5 to 7 mm) with a chitosan brush disclosed equal or better clinical results as compared to regular curettes. This study supports that a chitosan brush can be used for subgingival biofilm removal and soft tissue curretage in the treatment of periodontitis.
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Affiliation(s)
- Badra Hussain
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Ebru Ozkan Karaca
- Department of Periodontology, Yeditepe University School of Dentistry, Istanbul, Turkey
| | - Bahar Eren Kuru
- Department of Periodontology, Yeditepe University School of Dentistry, Istanbul, Turkey
| | - Hare Gursoy
- Department of Periodontology, Yeditepe University School of Dentistry, Istanbul, Turkey
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.,Bjerke Tannmedisin, Oslo, Norway
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4
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Le Thieu MK, Homayouni A, Hæren LR, Tiainen H, Verket A, Ellingsen JE, Rønold HJ, Wohlfahrt JC, Cantalapiedra AG, Muñoz FMG, Mendaña MP, Lyngstadaas SP, Haugen HJ. Impact of simultaneous placement of implant and block bone graft substitute: an in vivo peri-implant defect model. Biomater Res 2021; 25:43. [PMID: 34823602 PMCID: PMC8620131 DOI: 10.1186/s40824-021-00245-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background Insufficient bone volume around an implant is a common obstacle when dental implant treatment is considered. Limited vertical or horizontal bone dimensions may lead to exposed implant threads following placement or a gap between the bone and implant. This is often addressed by bone augmentation procedures prior to or at the time of implant placement. This study evaluated bone healing when a synthetic TiO2 block scaffold was placed in circumferential peri-implant defects with buccal fenestrations. Methods The mandibular premolars were extracted and the alveolar bone left to heal for 4 weeks prior to implant placement in six minipigs. Two cylindrical defects were created in each hemi-mandible and were subsequent to implant placement allocated to treatment with either TiO2 scaffold or sham in a split mouth design. After 12 weeks of healing time, the samples were harvested. Microcomputed tomography (MicroCT) was used to investigate defect fill and integrity of the block scaffold. Distances from implant to bone in vertical and horizontal directions, percentage of bone to implant contact and defect fill were analysed by histology. Results MicroCT analysis demonstrated no differences between the groups for defect fill. Three of twelve scaffolds were partly fractured. At the buccal sites, histomorphometric analysis demonstrated higher bone fraction, higher percentage bone to implant contact and shorter distance from implant top to bone 0.5 mm lateral to implant surface in sham group as compared to the TiO2 group. Conclusions This study demonstrated less bone formation with the use of TiO2 scaffold block in combination with implant placement in cylindrical defects with buccal bone fenestrations, as compared to sham sites.
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Affiliation(s)
- Minh Khai Le Thieu
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0317, Oslo, Norway
| | - Amin Homayouni
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0317, Oslo, Norway
| | - Lena Ringsby Hæren
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0317, Oslo, Norway
| | - Hanna Tiainen
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0317, Oslo, Norway
| | - Anders Verket
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Jan Eirik Ellingsen
- Department of Prosthetic Dentistry and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Hans Jacob Rønold
- Department of Prosthetic Dentistry and Oral Function, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Antonio Gonzalez Cantalapiedra
- Universidade de Santiago de Compostela, Facultad de Veterinaria, Campus Universitario, s/n, 27002, Lugo, Spain.,Ibonelab S.L., Laboratory of Biomaterials, Avda. da Coruña, 500 (CEI-NODUS), 27003, Lugo, Spain
| | - Fernando Maria Guzon Muñoz
- Universidade de Santiago de Compostela, Facultad de Veterinaria, Campus Universitario, s/n, 27002, Lugo, Spain.,Ibonelab S.L., Laboratory of Biomaterials, Avda. da Coruña, 500 (CEI-NODUS), 27003, Lugo, Spain
| | - Maria Permuy Mendaña
- Universidade de Santiago de Compostela, Facultad de Veterinaria, Campus Universitario, s/n, 27002, Lugo, Spain.,Ibonelab S.L., Laboratory of Biomaterials, Avda. da Coruña, 500 (CEI-NODUS), 27003, Lugo, Spain
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0317, Oslo, Norway
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0317, Oslo, Norway.
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5
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Wohlfahrt JC, Aass AM, Koldsland OC. Treatment of peri‐implant mucositis with a chitosan brush—A pilot randomized clinical trial. Int J Dent Hyg 2019; 17:170-176. [DOI: 10.1111/idh.12381] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 07/02/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry University of Oslo Oslo Norway
| | - Anne M. Aass
- Department of Periodontology, Institute of Clinical Dentistry University of Oslo Oslo Norway
| | - Odd C. Koldsland
- Department of Periodontology, Institute of Clinical Dentistry University of Oslo Oslo Norway
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6
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Andersen H, Aass AM, Wohlfahrt JC. Porous titanium granules in the treatment of peri-implant osseous defects-a 7-year follow-up study. Int J Implant Dent 2017; 3:50. [PMID: 29199392 PMCID: PMC5712508 DOI: 10.1186/s40729-017-0106-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/12/2017] [Indexed: 01/06/2023] Open
Abstract
Background A great number of different treatment protocols for peri-implantitis have been suggested but there is no consensus regarding the most effective intervention. The aim of the present study was to evaluate the long-term clinical and radiographic results from a study on peri-implant osseous defect reconstruction. Patients having participated in a randomized clinical study 7 years earlier were invited for a re-examination. The treatment procedures included open flap debridement (OFD) with or without defect reconstruction with porous titanium granules (PTGs). Clinical parameters (probing pocket depth and bleeding on probing) and radiographic measurements were registered. Findings Of the original 32 patients, 12 patients with 12 implants were finally examined after 7 years (7.3 years [6.7–8]). Patients had been maintained one to two times yearly. The PTG group showed a mean probing pocket depth of 4.3 mm ± 2.4 compared with 3.5 mm ± 1.2 in the OFD group, at the deepest site. The change between the 12 months and the 7-year examination was similar in both groups. Five of the test implants and five of the control implants had at least one site with positive bleeding on probing score. The mean radiographic defect depth change as compared to 12 months was an increase of 1.9 mm ± 2.0 in the PTG group and a mean radiographic defect depth increase of 1.3 mm ± 1.4 in the OFD group. Due to the small number of patients, a statistical analysis was not performed, but the results indicated a minimal difference in osseous defect depth as compared with baseline and between groups. No PTG exposed to the oral cavity was observed, but the graft particles were seemingly scattered in the peri-implant soft tissue. Conclusions This long-term follow-up of surgical treatment of peri-implant osseous defects showed unpredictable results.
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Affiliation(s)
- Heidi Andersen
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Pb. 1109 Blindern, 0317, Oslo, Norway
| | - Anne Merete Aass
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Pb. 1109 Blindern, 0317, Oslo, Norway
| | - Johan Caspar Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Pb. 1109 Blindern, 0317, Oslo, Norway.
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7
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Wohlfahrt JC, Evensen BJ, Zeza B, Jansson H, Pilloni A, Roos-Jansåker AM, Di Tanna GL, Aass AM, Klepp M, Koldsland OC. A novel non-surgical method for mild peri-implantitis- a multicenter consecutive case series. Int J Implant Dent 2017; 3:38. [PMID: 28776288 PMCID: PMC5543013 DOI: 10.1186/s40729-017-0098-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/13/2017] [Indexed: 12/17/2022] Open
Abstract
AIM The aim of the present study was to evaluate the effect on peri-implant mucosal inflammation from the use of a novel instrument made of chitosan in the non-surgical treatment of mild peri-implantitis across several clinical centers. MATERIALS AND METHODS In this 6-month multicenter prospective consecutive case series performed in six different periodontal specialist clinics, 63 implants in 63 patients were finally included. The subjects had mild peri-implantitis defined as radiographic bone loss of 1-2 mm, pocket probing depth (PPD) ≥4 mm and a positive bleeding on probing (mBoP) score. The patients were clinically examined at baseline and after 2, 4, 12 and 24 weeks, and radiographs were taken at baseline and at 3 and 6 months. Treatment of the implants with the chitosan brush seated in an oscillating dental drill piece was performed at baseline and at 3 months. Reductions in the clinical parameters (PPD and mBoP) were compared between baseline and the later examination time points. RESULTS Significant reductions in both PPD and mBoP were observed at all time points compared with the baseline clinical measurements (p < 0.001). The mean PPD and mBoP at baseline were 5.15 mm (4.97; 5.32) and 1.86 (1.78; 1.93), respectively, whereas the mean PPD and mBoP at 6 months were 4.0 mm (3.91; 4.19) and 0.64 (0.54; 0.75), respectively. Stable reductions in PPD and mBoP were evident up to 6 months after the initial treatment and 3 months after the second treatment. All 63 implants were reported to have stable radiographic levels of osseous support. CONCLUSIONS This case series demonstrated that an oscillating chitosan brush is safe to use and seems to have merits in the non-surgical treatment of dental implants with mild peri-implantitis. To measure the effectiveness of the method, a multicenter randomized clinical trial needs to be undertaken.
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Affiliation(s)
- J C Wohlfahrt
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Pb. 1109 Blindern, 0317, Oslo, Norway.
| | | | - B Zeza
- Department of Dental and Maxillofacial Sciences, Section of Periodontology, Sapienza, University of Rome, Rome, Italy
| | - H Jansson
- Center for Oral Health, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - A Pilloni
- Department of Dental and Maxillofacial Sciences, Section of Periodontology, Sapienza, University of Rome, Rome, Italy
| | - A M Roos-Jansåker
- Department of Periodontology, Public Dental Health Service, Kristianstad, Sweden.,Department of Periodontology, Public Specialist Dental Clinic, Karlskrona, Sweden
| | - G L Di Tanna
- Center for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - A M Aass
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Pb. 1109 Blindern, 0317, Oslo, Norway
| | - M Klepp
- Private Practice, Stavanger, Norway
| | - O C Koldsland
- Department of Periodontology, Institute of Clinical Dentistry, University of Oslo, Pb. 1109 Blindern, 0317, Oslo, Norway
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8
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Verket A, Müller B, Wohlfahrt JC, Lyngstadaas SP, Ellingsen JE, Jostein Haugen H, Tiainen H. TiO2scaffolds in peri-implant dehiscence defects: an experimental pilot study. Clin Oral Implants Res 2015; 27:1200-1206. [DOI: 10.1111/clr.12725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Anders Verket
- Department of Biomaterials; Institute of Clinical Dentistry, University of Oslo; Oslo Norway
| | - Benjamin Müller
- Department of Biomaterials; Institute of Clinical Dentistry, University of Oslo; Oslo Norway
| | - Johan Caspar Wohlfahrt
- Department of Periodontology; Institute of Clinical Dentistry, University of Oslo; Oslo Norway
| | | | - Jan Eirik Ellingsen
- Department of Prosthodontics; Institute of Clinical Dentistry, University of Oslo; Oslo Norway
| | - Håvard Jostein Haugen
- Department of Biomaterials; Institute of Clinical Dentistry, University of Oslo; Oslo Norway
| | - Hanna Tiainen
- Department of Biomaterials; Institute of Clinical Dentistry, University of Oslo; Oslo Norway
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9
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Verket A, Lyngstadaas SP, Rasmusson L, Haanæs HR, Wallström M, Wall G, Wohlfahrt JC. Maxillary sinus augmentation with porous titanium granules: a microcomputed tomography and histologic evaluation of human biopsy specimens. Int J Oral Maxillofac Implants 2014; 28:721-8. [PMID: 23748302 DOI: 10.11607/jomi.2853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to assess bone ingrowth into porous titanium granules used for maxillary sinus augmentation. MATERIALS AND METHODS Eighteen biopsy specimens from 17 patients participating in a clinical trial on sinus augmentation using porous titanium granules (PTG) were received in the laboratory. The specimens (trephine cores of 4.5 mm) were obtained 6 months after PTG placement. After being embedded in methacrylate, the samples were scanned in a microcomputed tomography (micro-CT) scanner. Specimens were then cut along the long axis and central slices were ground to 70 μm before staining with hematoxylin and eosin. RESULTS The micro-CT analysis demonstrated an average bone fill of 19% (standard deviation [SD] 5.8%), whereas the graft material occupied 22.7% (SD 4.7%). The volume of newly formed bone decreased with the distance from the residual bone of the sinus floor. Two-dimensional histomorphometric analysis demonstrated a mean area of new bone of 16.1% (SD 9.4%). The PTG alone occupied 25.9% of the total mean area (SD 6.1%). The newly formed bone consisted mainly of woven bone growing in close contact with the granules and bridging the intergranular space. The remaining area was occupied predominantly by nonmineralized connective tissue. There were no signs of inflammation in any of the biopsy specimens. CONCLUSIONS After 6 months, new bone had formed at a similar rate and quality as has been reported for other well-recognized bone graft substitutes. The new bone formed in close contact with the PTG, suggesting that the material is osteoconductive.
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Affiliation(s)
- Anders Verket
- Department of Biomaterials, Institute of Clinical Odontology, University of Oslo, Oslo, Norway.
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10
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Henderson E, Schneider S, Petersen FC, Haugen HJ, Wohlfahrt JC, Ekstrand K, Ekfeldt A. Chemical debridement of contaminated titanium surfaces: an in vitro study. Acta Odontol Scand 2013; 71:957-64. [PMID: 23140518 DOI: 10.3109/00016357.2012.734423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the efficacy of different chemical solutions when used for chemical debridement of biofilm contaminated titanium surfaces in an in-vitro experimental study. MATERIALS AND METHODS Commercially pure titanium discs with a diameter of 6.2 mm and height of 2 mm, mirror-polished with a measured surface amplitude value SA = 0.037 μm ± 0.009 were used as test-surfaces. A biofilm was simulated with multi-layers of Staphylococcus epidermidis ATCC359844 covering the entire titanium surface. The chemical agents tested were: 3% H2O2, 0.2% Chlorhexidine, 24% EDTA-gel, 3% H2O2 mixed with 1.6 g/L TiO2 and sterile saline solution. The decontamination effect was evaluated by optical density analysis using spectrophotometry and with scanning electron microscopy (SEM) images of the remaining biofilm. RESULTS The suspensions of 3% H2O2 and 1.6 g/L TiO2 or 3% H2O2 alone were the most effective in removing S. epidermidis biofilms (p < 0.05), whereas 0.2% chlorhexidine or 24% EDTA gel had no significant effects. SEM images of the remaining biofilms supported the quantitative results indicating the higher efficacy of 3% H2O2 and 1.6 g/L TiO2 or 3% H2O2 alone. It also revealed that EDTA, despite a non-significant effect on reducing the amount of established biofilms, was able to alter the biofilm architecture, as demonstrated by increased interspaced regions. CONCLUSIONS In this in vitro study the decontamination potential of a suspension of 3% H2O2 and 1.6 g/L TiO2 or 3% H2O2 alone were encouraging. Whether such procedures would have a similar effect in vivo remains to be determined.
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Affiliation(s)
- Elisabet Henderson
- Department of Prosthetic Dentistry and Oral Function, Faculty of Dentistry,University of Oslo, Blindern, Oslo, Norway
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11
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Haugen HJ, Monjo M, Rubert M, Verket A, Lyngstadaas SP, Ellingsen JE, Rønold HJ, Wohlfahrt JC. Porous ceramic titanium dioxide scaffolds promote bone formation in rabbit peri-implant cortical defect model. Acta Biomater 2013; 9:5390-9. [PMID: 22985740 DOI: 10.1016/j.actbio.2012.09.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/07/2012] [Accepted: 09/10/2012] [Indexed: 11/25/2022]
Abstract
Titanium oxide (TiO₂) scaffolds have previously been reported to exhibit very low mechanical strength. However, we have been able to produce a scaffold that features a high interconnectivity, a porosity of 91% and a compressive strength above 1.2 MPa. This study analyzed the in vivo performance of the porous TiO₂ scaffolds in a peri-implant cortical defect model in the rabbit. After 8 weeks of healing, morphological microcomputed tomography analyses of the defects treated with the TiO₂ scaffolds had significantly higher bone volume, bone surface and bone surface-to-volume ratio when compared to sham, both in the cortical and bone marrow compartment. No adverse effects, i.e. tissue necrosis or inflammation as measured by lactate dehydrogenase activity and real-time reverse transcription polymerase chain reaction analysis, were observed. Moreover, the scaffold did not hinder bone growth onto the adjacent cortical titanium implant. Histology clearly demonstrated new bone formation in the cortical sections of the defects and the presence of newly formed bone in close proximity to the scaffold surface and the surface of the adjacent Ti implant. Bone-to-material contact between the newly formed bone and the scaffold was observed in the histological sections. Islets of new bone were also present in the marrow compartment albeit in small amounts. In conclusion, the present investigation demonstrates that TiO₂ scaffolds osseointegrate well and are a suitable scaffold for peri-implant bone healing and growth.
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Wohlfahrt JC, Lyngstadaas SP, Rønold HJ, Saxegaard E, Ellingsen JE, Karlsson S, Aass AM. Porous titanium granules in the surgical treatment of peri-implant osseous defects: a randomized clinical trial. Int J Oral Maxillofac Implants 2012; 27:401-410. [PMID: 22442781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
PURPOSE Porous titanium granules (PTG) may have potential as an osteoconductive bone graft substitute to treat peri-implant osseous defects. The aim of this study was to analyze clinical and radiographic outcomes of peri-implant osseous defects after treatment with PTG. MATERIALS AND METHODS This prospective, randomized, case-control, clinical 12-month study compared open-flap debridement and surface decontamination with titanium curettes and 24% ethylenediaminetetraacetic acid gel (n = 16) to the same protocol but with the addition of PTG (n = 16). One-, two-, and three-wall infrabony defects were included. Patients were given amoxicillin and metronidazole 3 days before surgery and for 7 days afterwards. Implants were submerged and allowed to heal for 6 months. Probing pocket depths, bleeding on probing, implant stability using resonance frequency analysis, and radiographic evaluation were performed at baseline and at 12 months. The threshold for significance was set at .05. RESULTS Change in radiographic defect height and percent fill of the peri-implant osseous defect significantly favored patients treated with PTG. Both treatment modalities demonstrated significant improvements in probing pocket depth, but significant differences between groups were not observed. The PTG-treated implants showed an increase in implant stability quotient (ISQ) of 1.6 units, compared with a decrease of 0.7 ISQ for the control group. No adverse effects were associated with PTG treatment. CONCLUSIONS Reconstruction with PTG resulted in significantly better radiographic peri-implant defect fill compared with controls; however, the results do not necessarily imply reosseointegration or osseointegration of PTG particles. Improvements in clinical parameters were seen in both groups, but no differences between groups were demonstrated.
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Bashara H, Wohlfahrt JC, Polyzois I, Lyngstadaas SP, Renvert S, Claffey N. The effect of permanent grafting materials on the preservation of the buccal bone plate after tooth extraction: an experimental study in the dog. Clin Oral Implants Res 2011; 23:911-7. [DOI: 10.1111/j.1600-0501.2011.02240.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wohlfahrt JC, Lyngstadaas SP, Heijl L, Aass AM. Porous titanium granules in the treatment of mandibular Class II furcation defects: a consecutive case series. J Periodontol 2011; 83:61-9. [PMID: 21563949 DOI: 10.1902/jop.2011.100769] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The osteoconductive potential of titanium is interesting from the perspective of periodontal surgery and reconstitution of osseous defects. The aim of the present consecutive case series is to evaluate a surgical strategy based on the use of porous titanium granules (PTG) in the treatment of Class II buccal furcation defects in mandibular molars in humans. METHODS Surgical intervention with PTG used as a bone graft substitute was performed in 10 patients with 10 mandibular Class II buccal furcation defects. Clinical parameters (probing depth (PD), clinical attachment level (CAL), gingival recession (GR), gingival index (GI), bleeding on probing (BOP), and horizontal and vertical bone sounding) and radiographic measurements of vertical furcation height were compared among baseline (presurgery), 6, and 12 months (post-surgery). The significance level (α) was set at 0.05. RESULTS With respect to vertical and horizontal bone sounding measurements, CAL, and GR, no significant improvements between baseline and the 12-month examination were seen. Both PD and radiographic vertical furcation height were significantly reduced between baseline and 12 months. When comparing the baseline to 12-month data, a significantly lower GI score was seen but the BOP score was unchanged. None of the treated teeth showed radiographic signs of root resorption. CONCLUSION This study suggests that PTG is safe to use in close proximity to root surfaces, but no significant improvements in clinical endpoints of defect resolution were observed.
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Affiliation(s)
- Johan Caspar Wohlfahrt
- Department of Biomaterials, Institute of Clinical Odontology, University of Oslo, Oslo, Norway.
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Wohlfahrt JC, Aass AM, Ronold HJ, Lyngstadaas SP. Micro CT and human histological analysis of a peri-implant osseous defect grafted with porous titanium granules: a case report. Int J Oral Maxillofac Implants 2011; 26:e9-e14. [PMID: 21365035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Treatment of peri-implant osseous defects represents a significant challenge for clinicians, and the need to evolve within predictable surgical procedures is important. This case report describes the surgical treatment and grafting with porous titanium granules (PTG) of one patient with a peri-implant osseous defect. The suggested thrombogenic properties of titanium are intriguing from the perspective of osseous reconstructive surgery. In an ongoing randomized clinical trial using PTG for treatment of peri-implant osseous defects, one patient with one test implant was excluded and scheduled for implant removal. The surgical therapy included open flap debridement with surface decontamination with 24% EDTA gel, grafting with PTG, and resubmersion of the implant. After 12 months of healing, the implant with surrounding tissues was excised en bloc and micro CT and histological analyses were performed. Analyses showed PTG in close contact with new bone and with bone growing both into the porosities of the graft material and onto the adjacent implant surface. Element analysis demonstrated calcium and phosphorus in the new tissue embedding the PTG and the implant. Int J Oral Maxillofac Implants 2011;26:e9-e14.
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Monjo M, Rubert M, Wohlfahrt JC, Rønold HJ, Ellingsen JE, Lyngstadaas SP. In vivo performance of absorbable collagen sponges with rosuvastatin in critical-size cortical bone defects. Acta Biomater 2010; 6:1405-12. [PMID: 19815101 DOI: 10.1016/j.actbio.2009.09.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 08/28/2009] [Accepted: 09/30/2009] [Indexed: 11/17/2022]
Abstract
Rosuvastatin (RSV) is a synthetic statin with favourable pharmacologic properties, but its local effect in bone has yet to be investigated. The aim of this study was to evaluate the potential of absorbable collagen sponge (ACS) as a carrier for RSV to enhance bone formation in critical-size cortical bone defects adjacent to titanium implants. ACS, treated with different concentrations of RSV (R1 = 8.7 + or - 1.8 microg; R2 = 52.0 + or - 4.4 microg; R3 = 259.1 + or - 8.8 microg) or phosphate-buffered saline alone, were placed into the bone marrow through a defect made in the proximal tibial cortical bone of New Zealand White rabbits. One empty defect (SHAM) served as an internal control in each animal. After a healing time of 4 weeks, a concentration-dependent increase of alkaline phosphatase activity in ACS treated with RSV was detected in the bone fluid after removing the implants. In addition, a significant concentration-dependent increase in BMP-2 mRNA levels was found in the cortical bone tissue adjacent to the RSV-treated ACS. The cortical architecture of bone defects analysed by micro-computed tomography showed a trend towards higher bone volume in the ACS+R1 group compared with SHAM, which was accompanied by an increase in the bone mineral density. Evaluation of histological sections showed new bone formation in ACS treated with RSV but not in untreated ACS. These results indicate that RSV, when administered locally in bone, may have a potential effect in stimulating bone formation.
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Affiliation(s)
- Marta Monjo
- Department of Biomaterials, Institute for Clinical Dentistry, University of Oslo, Oslo, Norway.
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Wohlfahrt JC, Monjo M, Rønold HJ, Aass AM, Ellingsen JE, Lyngstadaas SP. Porous titanium granules promote bone healing and growth in rabbit tibia peri-implant osseous defects. Clin Oral Implants Res 2009; 21:165-73. [PMID: 19912270 DOI: 10.1111/j.1600-0501.2009.01813.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to titanium implants. MATERIAL AND METHODS In this animal experimental study, calibrated defects were prepared in the tibias of 24 New Zealand rabbits. The defects were randomized into two tests and one control group. The test defects were grafted with either metallic or oxidized porous titanium granules (PTG or WPTG, respectively), whereas control defects were left empty (sham). The defects were closed with a submerged coin shaped titanium implant. Defects were left for healing for 4 weeks. After healing, the implants were removed and the new bone tissue formed onto the implant surface was analyzed for run x 2, osteocalcin, collagen-I, tartrate-resistant acid phosphatase, H(+)-ATPase, tumor necrosis factor-alpha, interleukin (IL)-6 and IL-10 gene expression using reverse transcriptase polymerase chain reaction. Wound fluid from the healed defects was analyzed for lactate dehydrogenase and alkaline phosphatase activity. Finally osteoconductivity was analyzed by micro-computed tomography and histology. RESULTS Significantly more new bone formed in PTG and WPTG grafted defects compared with sham. The new bone grew both through the porosities of the granules and onto the implant surfaces. The WPTG group showed significantly less expression of key inflammation markers, but with no significant difference in a marker for necrosis. The WPTG also showed a significant increase in collagen-I mRNA expression compared with PTG. CONCLUSION The results suggest that PTG and WPTG are both osteoconductive materials that can be used to promote bone formation in osseous defects adjacent to titanium implants without hampering implant osseointegration.
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Affiliation(s)
- Johan Caspar Wohlfahrt
- Department of Biomaterials, Institute of Clinical Odontology, University of Oslo, Oslo, Norway.
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Abstract
Emdogain (enamel matrix derivative, EMD) is well recognized in periodontology, where it is used as a local adjunct to periodontal surgery to stimulate regeneration of periodontal tissues lost to periodontal disease. The biological effect of EMD is through stimulation of local growth factor secretion and cytokine expression in the treated tissues, inducing a regenerative process that mimics odontogenesis. The major (>95%) component of EMD is Amelogenins (Amel). No other active components have so far been isolated from EMD, and several studies have shown that purified amelogenins can induce the same effect as the complete EMD. Amelogenins comprise a family of highly conserved extracellular matrix proteins derived from one gene. Amelogenin structure and function is evolutionary well conserved, suggesting a profound role in biomineralization and hard tissue formation. A special feature of amelogenins is that under physiological conditions the proteins self-assembles into nanospheres that constitute an extracellular matrix. In the body, this matrix is slowly digested by specific extracellular proteolytic enzymes (matrix metalloproteinase) in a controlled process, releasing bioactive peptides to the surrounding tissues for weeks after application. Based on clinical and experimental observations in periodontology indicating that amelogenins can have a significant positive influence on wound healing, bone formation and root resorption, several new applications for amelogenins have been suggested. New experiments now confirm that amelogenins have potential for being used also in the fields of endodontics, bone regeneration, implantology, traumatology, and wound care.
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Affiliation(s)
- S P Lyngstadaas
- Department of Biomaterials, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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