Histologic evaluation of edentulous alveolar ridge horizontal bone augmentations using a xenogeneic bone substitute and autologous platelet concentrates: a case series

OBJECTIVES

This case series aimed to assess the efficacy of a novel horizontal ridge augmentation modality using histology. Combinations of "sticky bone" and tenting screws without autologous bone were used as augmentative materials.

METHOD AND MATERIALS

Five individuals presenting healed, atrophic, partially edentulous sites that required horizontal bone augmentation before implant placement were enrolled. Patients underwent the same augmentation type and 5 months of postoperative reentry procedures. The first surgery served as implant site development, whereas the biopsy and corresponding implant placement were performed during reentry. The bone was qualitatively analyzed using histology and histomorphometry and quantitatively evaluated using CBCT.

RESULTS

Four individuals healed uneventfully. Early wound dehiscence occurred in one case. Histology showed favorable bone substitute incorporation into the newly formed bone and intimate contact between de novo bone and graft material in most cases. Histomorphometry revealed an average of 48 ± 28% newly formed bone, 19 ± 13% graft material, and 33 ± 26% soft tissue components. The CBCT-based mean alveolar ridge horizontal increase was 3.9 ± 0.6 mm at 5 months postoperatively.

CONCLUSIONS

The described augmentation method appears suitable for implant site development resulting in favorable bone quality according to histology. However, clinicians must accommodate 1 to 2 mm of resorption in augmentative material width at the buccal aspect.

The Association of Nanostructured Carbonated Hydroxyapatite with Denatured Albumin and Platelet-Rich Fibrin: Impacts on Growth Factors Release and Osteoblast Behavior

Platelet-rich Fibrin (PRF), a second-generation blood concentrate, offers a versatile structure for bone regeneration due to its composition of fibrin, growth factors, and cytokines, with adaptations like denatured albumin-enriched with liquid PRF (Alb-PRF), showing potential for enhanced stability and growth factor dynamics. Researchers have also explored the combination of PRF with other biomaterials, aiming to create a three-dimensional framework for enhanced cell recruitment, proliferation, and differentiation in bone repair studies. This study aimed to evaluate a combination of Alb-PRF with nanostructured carbonated hydroxyapatite microspheres (Alb-ncHA-PRF), and how this association affects the release capacity of growth factors and immunomodulatory molecules, and its impact on the behavior of MG63 human osteoblast-like cells. Alb-PRF membranes were prepared and associated with nanocarboapatite (ncHA) microspheres during polymerization. MG63 cells were exposed to eluates of both membranes to assess cell viability, proliferation, mineralization, and alkaline phosphatase (ALP) activity. The ultrastructural analysis has shown that the spheres were shattered, and fragments were incorporated into both the fibrin mesh and the albumin gel of Alb-PRF. Alb-ncHA-PRF presented a reduced release of growth factors and cytokines when compared to Alb-PRF (p < 0.05). Alb-ncHA-PRF was able to stimulate osteoblast proliferation and ALP activity at lower levels than those observed by Alb-PRF and was unable to positively affect in vitro mineralization by MG63 cells. These findings indicate that the addition of ncHA spheres reduces the biological activity of Alb-PRF, impairing its initial effects on osteoblast behavior.

Presentation of a novel surgical technique in periodontally accelerated osteogenic orthodontics. CBCT assessment of the buccal alveolar dimensional changes: a proof-of-concept report of four cases

OBJECTIVES

The aim of this report was to present the effectiveness of a novel augmented corticotomy performed before orthodontic treatments in the prevention of buccal alveolar dehiscence and gingival recession.

METHOD AND MATERIALS

Four periodontally healthy individuals presenting crowding and thin bone morphotype in the mandibular front area were treated with a double-layer tunnel flap, piezotomy, hard- and soft tissue augmentation. Patients were divided into two groups according to the utilized graft material. The exclusive use of a demineralized bovine bone minerals (group 2) was compared to the use of autologous concentrated growth factor-enriched bone graft matrix, "sticky bone" (group 1). CBCT measurements were performed before- and six months after surgery. Orthodontic treatment was initialized one week after surgery.

RESULTS

Postoperative wound healing was uneventful, while tooth alignments were successful in all cases. Postoperative buccal hard tissue dimensions were favorable in both groups with no occurring bone dehiscence or gingival recession. The seemingly better results of group 2, in terms of quantitative hard tissue changes, did not have any clinical significance according to the objective to be achieved. Whereas, qualitative radiographic analysis testified a more homogenous tissue formation around teeth in group 1.

CONCLUSION

It can be concluded that the presented preorthodontic treatment approach seems to be successful in preventing alveolar dehiscence and gingival recession around buccally inclined mandibular front teeth.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT05264480.

CBCT Evaluation of Sticky Bone in Horizontal Ridge Augmentation with and without Collagen Membrane-A Randomized Parallel Arm Clinical Trial

Guided bone regeneration (GBR) is a reliable technique used to treat ridge deficiencies prior or during implant placement. Injectable-platelet rich fibrin (i-PRF) laced with a bone substitute (sticky bone) has heralded the way for advancing the outcomes of bone regeneration. This study evaluated the efficacy of sticky bone in horizontal ridge augmentation with and without collagen membrane. A total of 20 partially edentulous patients (Group-I n = 10; Group-II n = 10) that indicated GBR were included, and the surgical procedure was carried out. In Group-I, the sticky bone and collagen membrane were placed in ridge-deficient sites and Group-II received only sticky bone. At the end of 6 months, 20 patients (Group-I (n = 10); Group-II (n = 10)) completed the follow-up period. A CBCT examination was performed to assess changes in the horizontal ridge width (HRW) and vertical bone height (VBH). A statistically significant increase in HRW (p < 0.05) was observed in both groups with mean gains of 1.35 mm, 1.55 mm, and 1.93 mm at three levels (crest, 3 mm, and 6 mm) in Group-I and 2.7 mm, 2.8 mm, and 2.6 mm at three levels in Group-II. The intergroup comparison revealed statistical significance (p < 0.05) with respect to HRW and KTW (Keratinised tissue width) gains of 0.775 at the 6-month follow-up. Sticky-bone (Xenogenic-bone graft + i-PRF) served as a promising biomaterial in achieving better horizontal bone width gain.

Randomized, controlled clinical trial to evaluate efficacy of sticky bone and concentrated growth factor in the management of intrabony defects: 12 months follow-up study

Background

Platelet derivatives are enriched growth factors that ameliorate various cellular processes in regeneration. The present clinical trial aimed to evaluate and compare the effects of sticky bone and concentrated growth factors (CGFs) in the treatment of intrabony osseous defects by cone-beam computed tomography (CBCT).

Materials and Methods

The study included 20 patients having 40 intrabony defects. 20 sites each were included in both test group (Sticky bone) and Control group (CGF alone). The clinical parameters including probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline and 6 and 12 months posttherapy. The radiographic parameters including the depth, mesiodistal (MD), and the buccolingual (BL) width of the defect to assess the amount of bone fill were examined at baseline and after 12 months using CBCT.

Results

Twelve months posttherapy clinical results indicated a significant reduction of PPD and gain in CAL in both the study groups. Similar observations were recorded with CBCT radiographic parameters where the intrabony defect depth and MD defect width for the test group and control group significantly reduced after 12 months' posttherapy (P < 0.0001). However, no significant reduction in BL defect width was observed in control group (P = 0.577) in contrast to the test group (P = 0.028) after 12 months' posttherapy.

Conclusion

Intrabony defects treated with sticky bone showed improved clinical and radiographic parameters indicative of enhanced periodontal regeneration as compared to CGF alone treated sites.

Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial

BACKGROUND

Facial resorption of maxillary alveolar ridges is a challenging situation for implant rehabilitation, which mandates a preparatory surgery of bone augmentation. Guided bone regeneration using a 1:1 mixture of autogenous particulate and anorganic bovine bone mineral (ABBM) showed reliable outcomes in treating horizontally deficient ridges.

METHODS

Twenty-eight patients were randomly assigned into two groups; in the control group, the 1:1 mixture of particulate autogenous bone and ABBM was covered with native collagen membrane, while in the study group, it was mixed with autologous fibrin glue (AFG) to make a sticky bone that was covered by concentrated growth factor (CGF) membrane. For each proposed implant site, the average bone width gain was calculated preoperatively, immediately after augmentation and after 6 months. Implants were placed after 6 months and the implant stability quotient (ISQ) was measured after insertion and after 6 more months.

RESULTS

The graft consolidation period went uneventful in both groups; however, two cases in the sticky bone group showed total resorption of the graft upon re-entry. The mean horizontal bone width after 6 months was 9 mm ± 0.71 in the guided bone regeneration (GBR) group which was higher than 7.9 mm ± 0.92 for the sticky bone group. The mean primary stability was higher in the GBR group; 67.19 ± 2.23 compared to 66.7 ± 3.22 for the sticky bone group, while the mean secondary stability was higher in the sticky bone group; 72 ± 2.15 compared to 71.7 ± 2.27 for the GBR group. Results of Shapiro-Wilk's for bone width data and model residuals were both statistically not significant (p > 0.05).

CONCLUSION

Comparing CGF membrane versus native collagen membrane as barriers for GBR showed no statistically significant difference regarding bone gain. However, from a clinical point of view, CGF membrane is not a predictable barrier for guided bone regeneration.

Immediate postoperative complications after lateral ridge augmentation - a clinical comparison between bone shell technique and sticky bone

Nowadays, implant dentistry is strongly interconnected to bone augmentation procedures. Lateral ridge augmentation is often an imperative treatment stage for successful, prosthetic-driven implant placement. This study aimed to comparatively analyze the immediate postoperative complications of two horizontal bone grafting procedures: sticky bone and bone shell technique. Records of patients with lateral ridge augmentation were analyzed to identify immediate postoperative complications. The study group included 80 patients divided into 40 control (bone-shell technique - BS) and 40 tests (sticky bone -SB). More patients reported moderate and severe pain in the BS - group (11 patients - 27.5%) than in the SB group (6 patients - 15%). In the BS group, the incidence of severe and moderate trismus, neurosensory disturbances, and important hematoma was higher. There was an increased inflammatory response following the bone shell technique, while the sticky bone technique proved reduced surgical morbidity. There was no difference between the two groups in the risk of dehiscence or infection.

Fibrinogen Concentrations in Liquid PRF Using Various Centrifugation Protocols

Liquid platelet-rich fibrin (PRF) is produced by fractionation of blood without additives that initiate coagulation. Even though liquid PRF is frequently utilized as a natural source of fibrinogen to prepare sticky bone, the concentration of fibrinogen and the overall amount of "clottable PRF" components have not been evaluated. To this aim, we prepared liquid PRF at 300, 700, and 2000 relative centrifugal force (RCF), for 8 min and quantified the fibrinogen levels by immunoassay. We report here that, independent of the RCF, the fibrinogen concentration is higher in the platelet-poor plasma (PPP) compared to the buffy coat (BC) fraction of liquid PRF and further decreases in the remaining red fraction. We then determined the weight of the clotted PRF fractions before and after removing the serum. The PPP and BC fractions consist of 10.2% and 25.3% clottable matrix suggesting that more than half of the weight of clottable BC is caused by cellular components. Our data provide insights into the distribution of fibrinogen in the different fractions of liquid PRF. These findings suggest that PPP is the main source of clottable fibrinogen, while the BC is more a cell source when it comes to the preparation of sticky bone.

"Sticky Bone" Preparation Device: A Pilot Study on the Release of Cytokines and Growth Factors

Sticky bone, a growth factor-enriched bone graft matrix, is a promising autologous material for bone tissue regeneration. However, its production is strongly dependent on manual handling steps. In this sense, a new device was developed to simplify the confection of the sticky bone, named Sticky Bone Preparation Device (SBPD^®). The purpose of this pilot study was to investigate the suitability of the SBPD^® to prepare biomaterials for bone regeneration with autologous platelet concentrates. The SBPD^® allows the blending of particulate samples from synthetic, xenograft, or autogenous bone with autologous platelet concentrates, making it easy to use and avoiding the need of further manipulations for the combination of the materials. The protocol for the preparation of sticky bone samples using the SBPD^® is described, and the resulting product is compared with hand-mixed SB preparations regarding in vitro parameters such as cell content and the ability to release growth factors and cytokines relevant to tissue regeneration. The entrapped cell content was estimated, and the ability to release biological mediators was assessed after 7 days of incubation in culture medium. Both preparations increased the leukocyte and platelet concentrations compared to whole-blood samples (p < 0.05), without significant differences between SB and SBPD^®. SBPD^® samples released several growth factors, including VEGF, FGFb, and PDGF, at concentrations physiologically equivalent to those released by SB preparations. Therefore, the use of SBPD^® results in a similar product to the standard protocol, but with more straightforward and shorter preparation times and less manipulation. These preliminary results suggest this device as a suitable alternative for combining bone substitute materials with platelet concentrates for bone tissue regeneration.

Bone-Shell Technique in Horizontal Ridge Augmentation: A Retrospective Study

Background: The purpose of this study was to compare clinical results of two different horizontal ridge augmentation techniques: guided bone regeneration with sticky bone (SB) and the bone-shell technique (BS). Methods: Records of patients who underwent horizontal ridge augmentation with SB (test) and BS (control) were screened for inclusion. Pre-operative and 6-month post-operative ridge widths were measured on cone beam computer tomography (CBCT) and compared. Post-operative complications and implant survival rate were recorded. Results: Eighty consecutive patients were included in the present study. Post-operative complications (flap dehiscence, and graft infection) occurred in ten patients, who dropped out from the study (12.5% complication rate). Stepwise multivariate logistic regression analysis showed a significant inverse correlation between the occurrence of post-operative complications and ridge width (p = 0.025). Seventy patients (35 test; 35 control) with a total of 127 implants were included in the final analysis. Mean ridge width gain was 3.7 ± 1.2 mm in the test and 3.7 ± 1.1 mm in the control group, with no significant difference between the two groups. No implant failure was recorded, with a mean follow-up of 42.7 ± 16.0 months after functional loading. Conclusions: SB and BS showed comparable clinical outcomes in horizontal ridge augmentation, resulting in sufficient crestal width increase to allow implant placement in an adequate bone envelope.

Efficacy of Sticky Bone as a Novel Autologous Graft for Mandibular Third Molar Extraction Socket Healing - An Evaluative Study

Introduction

Recently, initiation and enhancement of extraction socket healing has been amplified by platelet concentrates, whereas the positive role of Sticky bone has been focused on maintaining alveolar bone dimensions. This study aimed to determine the effectiveness of Sticky Bone for socket grafting of mandibular third molars (M3Ms) in terms of soft- and hard-tissue healing.

Materials and Methods

This split-mouth prospective trial constituted prophylactic removal of M3Ms with Sticky bone grafted in the study site as a primary predictor variable. Patients underwent 3 months of mandatory follow-up where pain, swelling, interincisal mouth opening, and gingival healing were measured on the 3^rd, 7^th, and 14^th day using the Numeric Rating Scale, anatomic landmarks, steel metric ruler, and criteria given by Landry et al. respectively. Radiological healing was calculated based on the height of the socket, Kelly's Index, and histogram values immediately after the procedure at 1 week, 1 month, and 3 months, respectively. Statistical comparison was made using Paired t-test. P < 0.05 was considered significant.

Results

Forty-seven patients (mean 26.83 ± 6.58 years) demonstrated significantly lesser pain, swelling, and better gingival healing at the study site on multiple periods of follow-up. Rapid bone formation with superior density, lesser alveolar resorption, earlier bone blending, and trabecular formation were noticed on the study site with a significant difference at all time intervals.

Discussion

Sticky bone was chosen as the graft owing to advantages such as simple preparation, convenient handling characteristics, safety, evident postoperative patient comfort, better retention of the clot, enhanced soft-tissue healing, absence of infection, and decreased osseous deformation as compared to the control site. This study validated the role of Sticky bone as an indispensable component of regenerative therapy in the orofacial osseous tissues as it was an ideal biologic graft with fibrin rich structure.

Conclusion

This study validated the role of Sticky bone as an indispensable component of regenerative therapy in the orofacial osseous tissues as it was an ideal biologic graft with fibrin rich structure.

Concentrated Growth Factor - Surgical Management of Large Periapical Lesion Using a Novel Platelet Concentrate in Combination with Bone Graft

Although endodontic therapy is typically successful, in approximately 10%-15% of the cases, symptoms can persist or reoccur. Periapical surgery is the preferred treatment of choice in failed root canal therapy, chronic periapical lesion, persistent apical periodontitis, etc., i.e., when conventional treatment modalities fail. Over the past few decades, although the list of indications for endodontic surgery has diminished, there exist definite cases in which the tooth cannot be retained without surgery. This case report, however, sheds light on the incorporation of a novel autologous platelet concentrate-concentrated growth factor (CGF) coupled with an osseograft in surgical endodontic procedure to ensure a swift and successful recovery of the periapical region subjected to extensive lesions. The use of an osseograft combined with CGF has numerous advantages as well due to the formation of sticky bone. There are no articles published in the literature with respect to the potent application of CGF and bone graft (sticky bone) in large periapical lesions to aid in the reparative process. In this case report, the 1-year follow-up radiographs and cone-beam computed tomography showed complete healing of the hard and soft-tissue lesions that conform to achieving repair and regeneration at a rapid rate in extensive periapical lesions.

Bone augmentation with sticky bone and platelet-rich fibrin by ridge-split technique and nasal floor engagement for immediate loading of dental implant after extracting impacted canine

Nowadays, dental implants are the best treatment option for tooth loss, but implant placement requires sufficient bone volume. In defect area of alveolar ridge, augmentation is done by various available methods. Utilizing the growth factors such as platelet-rich fibrin (PRF) derived from patient's blood platelets improve treatment outcome. PRF accelerates the wound healing, enhances osteogenic activity as well as regulates the inflammation. Bone grafting, guided bone regeneration, and ridge-split technique promote new bone formation. The aim of this case report is to demonstrate an efficient method of bone augmentation using sticky bone along with PRF membrane, followed by ridge-split technique and engagement of nasal floor to place implant.

Platelet-Rich Plasma and Platelet-Rich Fibrin in Periodontal Regeneration: A Review

Platelet concentrates (PCs; platelet-rich plasma and platelet-rich fibrin) are autologous bioactive substances that have found varied application in medical and dental fields, particularly in oral and maxillofacial surgery, plastic surgery, and sports medicine. The rationale of these technologies is to extract all the elements from patient’s own blood sample, which could be used to improve healing by promoting tissue regeneration. PCs have evolved a long way since its introduction in 1954. PCs have been used successfully in periodontics and implant dentistry. However, the preparation protocol, processing time, transfer of concentrates, centrifugation temperature, vibration, etc., being not standardized are various factors for the mixed results reported in the literature. This review intends to discuss evolution of PCs, their preparation techniques, and their clinical and technical aspects and applications.