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Pfaff AS, Bumpers AP, Swenson DT, Ange BL, Wikesjö UME, Johnson TM. Overlay Analysis of Cone-Beam Computed Tomography Volumes Acquired before and after Horizontal Alveolar Ridge Augmentation. Med J (Ft Sam Houst Tex) 2021:40-49. [PMID: 34714921] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The objective of this study was to illustrate the efficacy of a novel imaging analysis technology to capture horizontal and vertical dimensional changes following horizontal alveolar ridge augmentation (HRA). METHODS Cone-beam computed tomography (CBCT) volumes from 65 HRA sites in 57 patients were available for evaluation, employing a three-dimensional analysis software to overlay preoperative and post-augmentation CBCT volumes. Horizontal and vertical alveolar ridge dimensional (HRD/VRD) changes were recorded considering a panel of patient-, site-, and procedure-related explanatory variables. RESULTS VRD changes ranged from -2.9 to 3.0 mm, more than half anterior sites losing alveolar ridge height. Mean HRD increase at the 3- and 5-mm levels apical to the alveolar crest amounted to 2.3±1.6 and 2.4±1.3 mm, respectively, membrane fixation and non-resorbable membrane use associated with significantly greater gains. CONCLUSIONS To date, studies reporting dimensional changes following HRA predominantly rely on serial in situ orofacial caliper recordings omitting vertical alterations. The protocol employed in this study allows simultaneous HRD and VRD evaluations and assures baseline and post-augmentation recordings are made at the same alveolar ridge position. Compared with in situ recording, CBCT overlay analysis may achieve a more complete characterization of dimensional changes following HRA.
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Affiliation(s)
- Aaron S Pfaff
- Resident, Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA
| | - April P Bumpers
- Resident, Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA
| | - Dane T Swenson
- Chief of Periodontics, US Army Dental Health Activity, Fort Bliss, TX
| | - Brittany L Ange
- Assistant Professor, Department of Population Health Sciences Biostatistics and Data Science Division, Medical College of Georgia, Augusta University, Augusta, GA
| | - Ulf M E Wikesjö
- Professor, Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA; and Director of the Laboratory for Applied Periodontal and Craniofacial Research, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Thomas M Johnson
- Professor, Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA
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Reiniger APP, Maier J, Wikesjö UME, Moreira CHC, Kantorski KZ. Correlation between dental plaque accumulation and gingival health in periodontal maintenance patients using short or extended personal oral hygiene intervals. J Clin Periodontol 2021; 48:834-842. [PMID: 33751652 DOI: 10.1111/jcpe.13448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/25/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 01/12/2023]
Abstract
AIMS To evaluate the correlation between bacterial dental plaque accumulation and gingival health in subjects with history of periodontitis attending a maintenance programme including personal oral hygiene measures (pOH) at short and extended intervals. This study is a secondary analysis of a randomized clinical trial. MATERIALS AND METHODS Forty-two subjects were randomized into groups performing pOH at 12-, 24- or 48-h intervals. The Plaque Index (PlI), Gingival Index (GI) and bleeding on probing (BoP) were recorded at baseline, 30 and 90 days. For the analysis, pOH groups were collapsed into subjects performing pOH at daily (G12/24) or extended (G48) intervals. Summary statistics and Spearman correlations between plaque accumulation and gingival inflammation are presented. RESULTS G12/24 and G48 subjects showed significant increases in plaque scores and percentage sites with gingival inflammation over the course of study. At 90 days, G48 subjects showed significantly greater GI and BoP scores than G12/24 subjects. While PlI/GI correlations were not affected by pOH interval, PlI/BoP correlations remained unchanged with short to increase with extended pOH intervals. CONCLUSION pOH interval influences the correlation between bacterial dental plaque accumulation and gingival inflammation. Subjects using extended pOH intervals exhibit an increased correlation allowing accumulation of bacterial dental plaque to the detriment of gingival health. (ClinicalTrials.gov: 50208115.9.0000.5346). Clinical Trials: ClinicalTrials.gov: NCT02684682.
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Affiliation(s)
- Ana P P Reiniger
- Post-Graduate Program in Oral Science (Periodontology Unit, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Juliana Maier
- Post-Graduate Program in Oral Science (Periodontology Unit, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Research, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Carlos H C Moreira
- Post-Graduate Program in Oral Science (Periodontology Unit, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Karla Z Kantorski
- Post-Graduate Program in Oral Science (Periodontology Unit, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
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Kwon DH, Lee SJ, Wikesjö UME, Johansson PH, Johansson CB, Sul YT. Cover Image. J Clin Periodontol 2017. [DOI: 10.1111/jcpe.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Susin C, Fiorini T, Lee J, de Freitas RM, Chiu HC, Prasad HS, Buxton AN, Wikesjö UME. Sinus augmentation using a mini-pig model: Effect of ceramic and allogeneic bone biomaterials. J Clin Periodontol 2017. [PMID: 28644556 DOI: 10.1111/jcpe.12766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Present clinical practice broadly relies on off-the-shelf allogeneic, xenogeneic or synthetic bone biomaterials in support of sinus augmentation. Also, recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier (rhBMP-2/ACS) has been shown to support clinically relevant bone formation when used to augment the maxillary sinus. OBJECTIVES To evaluate local bone formation/dental implant osseointegration following implantation of two particulate bone biomaterials using the mini-pig sinus augmentation model. METHODS Nine adult Göttingen mini-pigs were used for evaluation of a biphasic ceramic (15%/85% HA/ß-TCP) and an allogeneic mineralized bone biomaterial. Treatments randomized to contralateral sinus sites included sham-surgery (control) and biomaterials. Two threaded dental implants (ø4.0 × 11.5 mm) were placed at each sinus site. The animals were euthanized at 8 weeks for histologic analysis. RESULTS Execution of the surgical protocol and healing was unremarkable. Limited infraorbital swelling was observed until suture removal. The biphasic ceramic and allogeneic bone biomaterials produced significantly increased bone formation (5.2 ± 1.9 mm and 4.9 ± 1.6 mm vs. 2.6 ± 0.5 mm, p < 0.05) and osseointegration (18.0 ± 6.0% and 25.1 ± 18.2% vs. 10.1 ± 8.0%, p < 0.05) over the sham-surgery control. No significant differences were observed between biomaterials. CONCLUSIONS Implantation of biphasic ceramic or allogeneic bone biomaterials enhances bone formation in the mini-pig maxillary sinus, however, dental implant bone support is incomplete resulting in overall limited osseointegration.
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Affiliation(s)
- Cristiano Susin
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Tiago Fiorini
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Jaebum Lee
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Rubens Moreno de Freitas
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Hsien-Chung Chiu
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Hari S Prasad
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Amanda N Buxton
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR), Augusta University
- Dental College of Georgia, Augusta, GA, USA
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Kim JJ, Ben Amara H, Schwarz F, Kim HY, Lee JW, Wikesjö UME, Koo KT. Is ridge preservation/augmentation at periodontally compromised extraction sockets safe? A retrospective study. J Clin Periodontol 2017. [PMID: 28643883 DOI: 10.1111/jcpe.12764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to evaluate the safety of ridge preservation/augmentation procedures when performed at compromised extraction sockets. METHODS Patients subject to ridge preservation/augmentation at periodontally compromised sockets at Seoul National University Dental Hospital (SNUDH) were evaluated in a chart review. Tooth extractions due to acute infection were not included in our study as chronically formed lesions are the only lesions that can be detected from radiographic images. If inflammatory symptoms persisted following ridge preservation/augmentation and antimicrobial and anti-inflammatory therapy, the patient was categorized as a re-infection case and implanted biomaterial removed. RESULTS Of 10,060 patients subject to tooth extractions at SNUDH, 2011 through 2015, 297 cases meeting inclusion criteria were reviewed. The severity and type of lesions were not specific because extracting data was only done by radiographic images and chart records. The review identified eight patients exhibiting inflammatory symptoms that required additional antimicrobial and anti-inflammatory therapy. Within this group, re-infection occurred in two patients requiring biomaterials removal. The final safety rate for the ridge preservation/augmentation was 99.3%. None of the demographic factors, systemic conditions or choice of biomaterial affected the safety of ridge preservation/augmentation. CONCLUSION Alveolar ridge preservation/augmentation at periodontally compromised sockets appears safe following thorough removal of infectious source.
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Affiliation(s)
- Jung-Ju Kim
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Heithem Ben Amara
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Frank Schwarz
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Hae-Young Kim
- Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Korea
| | - Jung-Won Lee
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
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Kwon DH, Lee SJ, Wikesjö UME, Johansson PH, Johansson CB, Sul YT. Bone tissue response following local drug delivery of bisphosphonate through titanium oxide nanotube implants in a rabbit model. J Clin Periodontol 2017; 44:941-949. [PMID: 28703333 DOI: 10.1111/jcpe.12776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether surface chemistry-controlled TiO2 nanotube structures may serve as a local drug delivery system for zoledronic acid improving implant-bone support. METHODS Twenty-four screw-shaped Ti implants with surface chemistry-controlled TiO2 nanotube structures were prepared and divided into a zoledronic acid-formatted test and a native control group. The implants were inserted into contra-lateral femoral condyles in 12 New Zealand White rabbits. Bone support was evaluated using resonance frequency analysis (RFA) and removal torque (RTQ), as well as histometric analysis following a 3-weeks healing interval. RESULTS Zoledronic acid-formatted TiO2 nanotube test implants showed significantly improved implant stability and osseointegration measured using RFA and RTQ compared with control (p < 0.05), and showed significantly enhanced new bone formation within the root of the threads compared with control (p < 0.05). CONCLUSIONS TiO2 nanotube implants may prove to be a significant delivery system for drugs or biologic agents aimed at supporting local bone formation. Additional study of candidate drugs/agents, optimized dosage and release kinetics is needed prior to evaluation in clinical settings.
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Affiliation(s)
- David H Kwon
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Periodontics, 618th Dental Company, Camp Humphreys, Pyeongtaek, Korea
| | - Sang J Lee
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Departments of Periodontics and Oral Biology, Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Petra H Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Young-Taeg Sul
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kim JH, Koo KT, Capetillo J, Kim JJ, Yoo JM, Ben Amara H, Park JC, Schwarz F, Wikesjö UME. Periodontal and endodontic pathology delays extraction socket healing in a canine model. J Periodontal Implant Sci 2017; 47:143-153. [PMID: 28680710 PMCID: PMC5494309 DOI: 10.5051/jpis.2017.47.3.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/02/2017] [Accepted: 05/21/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of the present exploratory study was to evaluate extraction socket healing at sites with a history of periodontal and endodontic pathology. METHODS The mandibular 4th premolar teeth in 5 adult beagle dogs served as experimental units. Periodontal and endodontic lesions were induced in 1 premolar site in each animal using wire ligatures and pulpal exposure over 3 months (diseased sites). The contralateral premolar sites served as healthy controls. The mandibular 4th premolar teeth were then extracted with minimal trauma, followed by careful wound debridement. The animals were sacrificed at days 1, 7, 30, 60, and 90 post-extraction for analysis, and the healing patterns at the healthy and diseased extraction sites were compared using radiography, scanning electron microscopy, histology, and histometry. RESULTS During the first 7 days of healing, a significant presence of inflammatory granulation tissue was noted at the diseased sites (day 1), along with a slightly accelerated rate of fibrin clot resolution on day 7. On day 30, the diseased extraction sites showed a greater percentage of persistent fibrous connective tissue, and an absence of bone marrow formation. In contrast, healthy sites showed initial signs of bone marrow formation on day 30, and subsequently a significantly greater proportion of mature bone marrow formation on both days 60 and 90. Radiographs exhibited sclerotic changes adjoining apical endodontic lesions, with scanning electron microscopy showing collapsed Volkmann canals protruding from these regions in the diseased sites. Furthermore, periodontal ligament fibers exhibited a parallel orientation to the alveolar walls of the diseased sites, in contrast to a perpendicular arrangement in the healthy sites. CONCLUSIONS Within the limitations of this study, it appears that a history of periodontal and endodontic pathology may critically affect bone formation and maturation, leading to delayed and compromised extraction socket healing.
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Affiliation(s)
- Jung-Hoon Kim
- Department of Periodontology and Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Joseph Capetillo
- US Army Advanced Education Program in Periodontics, Ft. Gordon, GA, USA
| | - Jung-Ju Kim
- Department of Periodontology and Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Jung-Min Yoo
- Department of Periodontology and Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Heithem Ben Amara
- Department of Periodontology and Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Jung-Chul Park
- Department of Periodontology, Dankook University College of Dentistry, Cheonan, Korea
| | - Frank Schwarz
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Augusta University Dental College of Georgia, Augusta, GA, USA
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Ramos UD, Suaid FA, Wikesjö UME, Susin C, Taba M, Novaes AB. Comparison between two antimicrobial protocols with or without guided bone regeneration in the treatment of peri-implantitis. A histomorphometric study in dogs. Clin Oral Implants Res 2017; 28:1388-1395. [DOI: 10.1111/clr.12998] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Umberto Demoner Ramos
- Department of Bucco-Maxillo-Facial Surgery and Traumatology, and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirao Preto SP Brazil
| | - Flavia Adelino Suaid
- Department of Bucco-Maxillo-Facial Surgery and Traumatology, and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirao Preto SP Brazil
| | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Dental College of Georgia; Augusta University; Augusta GA USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Dental College of Georgia; Augusta University; Augusta GA USA
| | - Mario Taba
- Department of Bucco-Maxillo-Facial Surgery and Traumatology, and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirao Preto SP Brazil
| | - Arthur Belém Novaes
- Department of Bucco-Maxillo-Facial Surgery and Traumatology, and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirao Preto SP Brazil
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Susin C, Fiorini T, Lee J, De Stefano JA, Dickinson DP, Wikesjö UME. Wound healing following surgical and regenerative periodontal therapy. Periodontol 2000 2015; 68:83-98. [DOI: 10.1111/prd.12057] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/17/2022]
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Kim JH, Susin C, Min JH, Suh HY, Sang EJ, Ku Y, Wikesjö UME, Koo KT. Extraction sockets: erratic healing impeding factors. J Clin Periodontol 2014; 41:80-5. [PMID: 24117498 DOI: 10.1111/jcpe.12173] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of this exploratory study was to analyse prevalence of extraction sockets showing erratic healing and evaluate factors potentially impeding healing. METHODS Erratic healing was defined as extraction sites showing clinical observations of fibrous scar tissue occupying the extraction site rather than bone following 12 or more weeks of healing. Computerized tomography was used to evaluate characteristics and calculate Hounsfield unit scores for sites showing erratic healing. RESULTS A total of 1226 dental records from Seoul National University Dental Hospital archives including patients subject to extractions prior to implant placement were evaluated. Seventy subjects (5.71%) and 97 sites (4.24%) exhibited erratic extraction socket healing. Maxillary incisor/canine sites showed the lowest (0.47%), whereas mandibular molar sites the highest (5.41%) occurrence. In the multivariable analysis, erratic healing was more likely to occur in subjects <60 years old (OR = 2.23, 95%CI = 1.26-3.94), subjects with hypertension (OR = 2.37, 95%CI = 1.24-4.55), in molar sites (OR = 4.91, 95%CI = 1.41-17.07), and following single tooth extractions (OR = 2.98, 95%CI = 1.36-6.53). Computerized tomography showed the highest incidence of bone loss for the buccal wall (49.3%). CONCLUSION Erratic extraction socket healing appears a not uncommon sequel and local factors seem to be major contributors to its occurrence.
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Affiliation(s)
- Jung-Hoon Kim
- School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
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Skodje A, Idris SBM, Sun Y, Bartaula S, Mustafa K, Finne-Wistrand A, Wikesjö UME, Leknes KN. Biodegradable polymer scaffolds loaded with low-dose BMP-2 stimulate periodontal ligament cell differentiation. J Biomed Mater Res A 2014; 103:1991-8. [DOI: 10.1002/jbm.a.35334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/22/2014] [Accepted: 09/10/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Anders Skodje
- Faculty of Medicine and Dentistry; Department of Clinical Dentistry - Periodontics; University of Bergen; Bergen Norway
| | - Shaza Bushra M. Idris
- Faculty of Medicine and Dentistry; Department of Clinical Dentistry - Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Yang Sun
- Department of Fibre and Polymer Technology; KTH Royal Institute of Technology; Stockholm Sweden
| | - Sushma Bartaula
- Faculty of Medicine and Dentistry; Department of Clinical Dentistry - Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Kamal Mustafa
- Faculty of Medicine and Dentistry; Department of Clinical Dentistry - Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Anna Finne-Wistrand
- Department of Fibre and Polymer Technology; KTH Royal Institute of Technology; Stockholm Sweden
| | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Georgia Regents University; Augusta GA, USA
| | - Knut N. Leknes
- Faculty of Medicine and Dentistry; Department of Clinical Dentistry - Periodontics; University of Bergen; Bergen Norway
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Lee J, Fiorini T, Gamborena I, Wenzel BA, Schüpbach P, Wikesjö UME, Susin C. Effect of Platform Shift/Switch on Crestal Bone Levels and Mucosal Profile Following Flapless Surgery and Crestal/Subcrestal Implant Placement. Clin Implant Dent Relat Res 2014; 18:73-81. [PMID: 24889401 DOI: 10.1111/cid.12243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Crestal remodeling/bone loss appears a common sequel to dental implant placement. Several hypotheses and clinical strategies have been advanced to explain and avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of clinical protocol uncertain. OBJECTIVE The objective of the present study was to provide a histologic record of crestal versus subcrestal implant placement on crestal remodeling and mucosal profile comparing platform shift/switch and standard abutments following flapless implant surgery using a dog model. METHODS Four dental implants each were placed into the left and right edentulated posterior mandibles in five adult male hound-Labrador mongrel dogs using a flapless approach including crestal versus subcrestal placement and using platform shift versus standard abutments. Block biopsies were collected for histological/histometric analysis following an 8-week healing interval. RESULTS Both crestal and subcrestal implant installation resulted in significant crestal remodeling and bone loss, in particular at buccal sites, without significant differences between platform shift/switch and standard abutments. Implants installed subcrestally exhibited a significantly taller mucosal profile over crestal-level implants without significant differences between platform shift/switch and standard abutments; the epithelial attachment at all times arrested on the abutment surface. CONCLUSIONS Comparing platform shift/switch versus standard abutments using a minimally invasive flapless approach including crestal or subcrestal implant placement, the platform shift/switch abutments offer no selective advantage over standard abutments.
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Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
| | - Tiago Fiorini
- Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Inãki Gamborena
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA.,Clinica Dental Gamborena, San Sebastian, Spain
| | - Brent A Wenzel
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
| | - Peter Schüpbach
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA.,Peter Schüpbach GmbH, Horgen, Switzerland
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
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Abstract
In this review, we reflect upon advances and hindrances encountered over the last three decades in the development of strategies for periodontal regeneration. In this soul-searching pursuit we focus on revisiting lessons learned that should guide us in the quest for the reconstruction of the lost periodontium. We also examine beliefs and traditions that should be unlearned so that we can continue to advance the field. This learned/unlearned body of knowledge is consolidated into core principles to help us to develop new therapeutic approaches to benefit our patients and ultimately our society.
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Wenzel BA, Gamborena I, Lee J, Fiorini T, Schüpbach P, Wikesjö UME, Susin C. Effect of Platform Shift on Crestal Bone Levels and Mucosal Profile Following Flap Surgery and Subcrestal Implant Placement in Presence/Absence of Gap Defects. Clin Implant Dent Relat Res 2014; 18:217-25. [PMID: 24629102 DOI: 10.1111/cid.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physiologic remodeling resulting in crestal bone loss appears a common corollary to dental implant surgery. Several hypotheses and clinical strategies have been advanced to explain and avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of clinical protocols uncertain. PURPOSE The objective of the present study was to provide a histologic account of crestal bone levels and mucosal profile at implant sites receiving platform shift/switch and standard abutments following conventional flap surgery and subcrestal implant placement in presence or absence of crestal gap defects using a dog model. MATERIALS AND METHODS Four dental implants were placed into the left/right edentulated posterior mandible in five adult male Hound Labrador mongrel dogs using flap surgery including subcrestal placement with/without a 1 × 5 mm (width × depth) gap defect, and using platform shift/switch and standard abutments. Block biopsies were collected for histological/histometric analysis following an 8-week healing interval. RESULTS No significant differences in crestal resorption were observed among experimental groups; crestal resorption being significantly more advanced at buccal than at lingual sites (p < .001). Similarly, crestal bone-implant contact was not significantly different among groups; crestal bone-implant contact being consistently below the implant platform at buccal sites (p < .01). Moreover, the peri-implant mucosal profile was not statistically different among groups, the mucosal height being significantly greater at buccal than at lingual sites (p < .001). Also, no significant differences among groups were observed for the apical extension of the epithelial attachment, the epithelial attachment being arrested more than 2 mm above the implant platform at both platform shift/switch and standard abutments. CONCLUSIONS Using a clinical strategy including flap surgery and subcrestal implant placement, implant technology comparing platform shift/switch with standard abutments, surgical approach, and abutment selection seems to have a limited impact on crestal remodeling, associated bone loss, and mucosal profile.
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Affiliation(s)
- Brent A Wenzel
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA
| | - Inãki Gamborena
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA.,Clinica Dental Gamborena, San Sebastian, Spain
| | - Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA
| | - Tiago Fiorini
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA.,Section of Periodontology, School of Dentistry, Federal University Rio Grande do Sul, Porto Alegre, Brazil
| | - Peter Schüpbach
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA.,Peter Schüpbach Ltd, Horgen, Switzerland
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Georgia Regents University, Augusta, GA, USA
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15
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Gamborena I, Lee J, Fiorini T, Wenzel BA, Schüpbach P, Wikesjö UME, Susin C. Effect of Platform Shift/Switch and Concave Abutments on Crestal Bone Levels and Mucosal Profile following Flap and Flapless Implant Surgery. Clin Implant Dent Relat Res 2014; 17:908-16. [PMID: 25881715 DOI: 10.1111/cid.12208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Crestal remodeling/bone loss appears to be a common sequel to dental implant placement. Several hypotheses/clinical strategies have been proposed to explain/avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of these clinical approaches uncertain. OBJECTIVE The objective of the present study was to provide a histological account of crestal bone levels and mucosal profile at platform shift/switch and concave abutments following flapless and conventional flap surgery and subcrestal implant placement using a dog model. METHODS Four dental implants each were placed in the left/right mandibular posterior jaw quadrants in five adult male Hound/Labrador mongrel dogs using flap surgery with a 1 × 5 mm gap defect or using a flapless approach, both involving placement 2 mm subcrestally and platform shift/switch versus concave abutments. Block biopsies for histological/histometric analysis were collected at 8 weeks. RESULTS No significant differences were observed regarding crestal bone levels, with all groups showing mean bone levels above the implant platform. Similarly, crestal bone-implant contact was not significantly different among groups. Moreover, peri-implant mucosal profiles were not statistically different among groups for buccal sites; average mucosal height reached 4.1 to 4.9 mm above the implant platform. Comparison between buccal and lingual sites showed a nonsignificant tendency toward greater crestal resorption at buccal sites, adjusting for other factors. Mean crestal bone-implant contact level approximated the implant platform for lingual sites while consistently remaining below the platform at the buccal sites. Peri-implant mucosal height was significantly higher at buccal than at lingual sites, with the epithelial attachment located a significant distance away from the implant platform at buccal sites. CONCLUSIONS The surgical approaches (subcrestal implant placement by flap surgery or a flapless approach) and abutment designs (platform shift/switch or concave) used in this study seem to have a limited impact on crestal remodeling, associated bone loss, and mucosal profile. Bioclinical strategies should be developed to circumvent the limitations of current clinical protocol.
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Affiliation(s)
- Inãki Gamborena
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA.,Clinica Dental Gamborena, San Sebastian, Spain
| | - Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
| | - Tiago Fiorini
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA.,Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Brent A Wenzel
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
| | - Peter Schüpbach
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA.,Peter Schüpbach GmbH, Horgen, Switzerland
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University, Augusta, GA, USA
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Herberg S, Susin C, Pelaez M, Howie RN, Moreno de Freitas R, Lee J, Cray JJ, Johnson MH, Elsalanty ME, Hamrick MW, Isales CM, Wikesjö UME, Hill WD. Low-dose bone morphogenetic protein-2/stromal cell-derived factor-1β cotherapy induces bone regeneration in critical-size rat calvarial defects. Tissue Eng Part A 2014; 20:1444-53. [PMID: 24341891 DOI: 10.1089/ten.tea.2013.0442] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Increasing evidence suggests that stromal cell-derived factor-1 (SDF-1/CXCL12) is involved in bone formation, though underlying molecular mechanisms remain to be fully elucidated. Also, contributions of SDF-1β, the second most abundant splice variant, as an osteogenic mediator remain obscure. We have shown that SDF-1β enhances osteogenesis by regulating bone morphogenetic protein-2 (BMP-2) signaling in vitro. Here we investigate the dose-dependent contribution of SDF-1β to suboptimal BMP-2-induced local bone formation; that is, a dose that alone would be too low to significantly induce bone formation. We utilized a critical-size rat calvarial defect model and tested the hypotheses that SDF-1β potentiates BMP-2 osteoinduction and that blocking SDF-1 signaling reduces the osteogenic potential of BMP-2 in vivo. In preliminary studies, radiographic analysis at 4 weeks postsurgery revealed a dose-dependent relationship in BMP-2-induced new bone formation. We then found that codelivery of SDF-1β potentiates suboptimal BMP-2 (0.5 μg) osteoinduction in a dose-dependent order, reaching comparable levels to the optimal BMP-2 dose (5.0 μg) without apparent adverse effects. Blocking the CXC chemokine receptor 4 (CXCR4)/SDF-1 signaling axis using AMD3100 attenuated the osteoinductive potential of the optimal BMP-2 dose, confirmed by qualitative histologic analysis. In conclusion, SDF-1β provides potent synergistic effects that support BMP-induced local bone formation and thus appears a suitable candidate for optimization of bone augmentation using significantly lower amounts of BMP-2 in spine, orthopedic, and craniofacial settings.
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Koo KT, Kim MH, Kim HY, Wikesjö UME, Yang JH, Yeo IS. Effects of implant drill wear, irrigation, and drill materials on heat generation in osteotomy sites. J ORAL IMPLANTOL 2013; 41:e19-23. [PMID: 24313461 DOI: 10.1563/aaid-joi-d-13-00151] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study evaluated the effects of drill wear on bone temperature during osteotomy preparation with 3 types of drills and compared heat production between drills. The drills used in this study were titanium nitride-coated metal, tungsten carbide carbon-coated metal, and zirconia ceramic drills. An osteotomy 11 mm in depth was formed in bovine scapular bone following the manufacturer's recommended drill sequences. Drilling was performed without irrigation and repeated 20 times; temperature was measured every 5 times. Next, 200 rounds of drilling during irrigation were performed for each drill, with temperature change monitored until round 200. Analysis of variance statistics were used for analyses of the measured data. Drilling without irrigation showed significant thermal increase at all time points compared to drilling with irrigation (P < .001). No significant difference was found between drill materials. Under irrigation, the frequency of previous drilling had minimal effects on thermal change. The repeated-measures analysis of variance revealed major thermal change at the initial time point (P < .0001), and the multiple comparison tests revealed a significant difference in temperature between the initial drills that had been used 50 or fewer times and those that had been used more than 50 times, irrespective of the drill material. The results of this study indicate that the initial drill should be changed in osteotomy preparation with irrigation after they have been used 50 times. Irrigation may be a more critical factor for the control of temperature elevation than is the drill material.
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Affiliation(s)
- Ki-Tae Koo
- 1 Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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18
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Chiu HC, Chiang CY, Tu HP, Wikesjö UME, Susin C, Fu E. Effects of bone morphogenetic protein-6 on periodontal wound healing/regeneration in supraalveolar periodontal defects in dogs. J Clin Periodontol 2013; 40:624-30. [PMID: 23646981 DOI: 10.1111/jcpe.12075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Application of a synthetic BMP-6 polypeptide in a rat periodontal fenestration defect model enhanced periodontal wound healing/regeneration including new bone and cementum formation. The purpose of this study was to translate the relevance of these initial observations into a discriminating large animal model. METHODS Critical-size (4-5 mm) supraalveolar periodontal defects were created at the 2(nd) and 3(rd) mandibular premolar teeth in 11 Beagle dogs. Experimental sites received BMP-6 at 0.25, 1.0 and 2.0 mg/ml soak-loaded onto an absorbable collagen sponge (ACS) carrier or ACS alone (control) each condition repeated in four jaw quadrants. The animals were euthanized at 8 weeks when block biopsies were collected and processed for histologic/histometric analysis. RESULTS BMP-6 at 0.25, 1.0 and 2.0 mg/ml soak-loaded onto the ACS yielded significantly enhanced new bone (0.99 ± 0.07 versus 0.23 ± 0.13 mm/BMP-6 at 0.25 mg/ml) and cementum (2.45 ± 0.54 versus 0.73 ± 0.15 mm/BMP-6 at 0.25 mg/ml) formation including a functionally oriented periodontal ligament compared with control (p < 0.05). A significant inverse linear association between BMP-6 dose and new bone (β = -0.21 ± 0.09 mm, p = 0.016) and cementum height (β = -0.34 ± 0.15 mm, p = 0.023) was observed. Minimal root resorption was observed without significant differences between groups. Ankylosis was not observed for any of the experimental groups. CONCLUSIONS Surgical application of BMP-6/ACS onto critical-size supraalveolar defects enhanced periodontal wound healing/regeneration, in particular cementogenesis including a functionally oriented periodontal ligament; the low BMP-6 0.25 mg/ml concentration apparently providing the most effective dose.
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Affiliation(s)
- Hsien-Chung Chiu
- Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC
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19
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Freitas RMD, Spin-Neto R, Marcantonio Junior E, Pereira LAVD, Wikesjö UME, Susin C. Alveolar ridge and maxillary sinus augmentation using rhBMP-2: a systematic review. Clin Implant Dent Relat Res 2013; 17 Suppl 1:e192-201. [PMID: 24102703 DOI: 10.1111/cid.12156] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this systematic review was to evaluate clinical and safety data for recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier when used for alveolar ridge/maxillary sinus augmentation in humans. MATERIALS AND METHODS Clinical studies/case series published 1980 through June 2012 using rhBMP-2/ACS were searched. Studies meeting the following criteria were considered eligible for inclusion: >10 subjects at baseline and maxillary sinus or alveolar ridge augmentation not concomitant with implant placement. RESULTS Seven of 69 publications were eligible for review. rhBMP-2/ACS yielded clinically meaningful bone formation for maxillary sinus augmentation that would allow placement of regular dental implants without consistent differences between rhBMP-2 concentrations. Nevertheless, the statistical analysis showed that sinus augmentation following autogenous bone graft was significantly greater (mean bone height: 1.6 mm, 95% CI: 0.5-2.7 mm) than for rhBMP-2/ACS (rhBMP-2 at 1.5 mg/mL). In extraction sockets, rhBMP-2/ACS maintained alveolar ridge height while enhancing alveolar ridge width. Safety reports did not represent concerns for the proposed indications. CONCLUSIONS rhBMP-2/ACS appears a promising alternative to autogenous bone grafts for alveolar ridge/maxillary sinus augmentation; dose and carrier optimization may expand its efficacy, use, and clinical application.
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Affiliation(s)
- Rubens Moreno de Freitas
- Department of Oral Diagnosis and Surgery - Periodontics, UNESP - Universidade Estadual Paulista, Araraquara Dental School, Araraquara, SP, Brazil; Laboratory for Applied Periodontal & Craniofacial Regeneration, Department of Periodontics and Oral Biology, College of Dental Medicine, Department of Orthopedic Surgery, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
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20
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de Freitas RM, Susin C, Spin-Neto R, Marcantonio C, Wikesjö UME, Pereira LAVD, Marcantonio E. Horizontal ridge augmentation of the atrophic anterior maxilla using rhBMP-2/ACS or autogenous bone grafts: a proof-of-concept randomized clinical trial. J Clin Periodontol 2013; 40:968-75. [DOI: 10.1111/jcpe.12148] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Rubens Moreno de Freitas
- Department of Diagnosis and Surgery - Periodontics; UNESP - Univ Estadual Paulista, Araraquara Dental School; Araraquara SP Brazil
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; College of Dental Medicine; Augusta GA USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; College of Dental Medicine; Augusta GA USA
- Department of Orthopedics, Medical College of Georgia; Georgia Regents University; Augusta GA USA
| | - Rubens Spin-Neto
- Department of Diagnosis and Surgery - Periodontics; UNESP - Univ Estadual Paulista, Araraquara Dental School; Araraquara SP Brazil
- Department of Dentistry; Oral Radiology; Aarhus University; Aarhus; Denmark
| | - Claudio Marcantonio
- Department of Diagnosis and Surgery - Periodontics; UNESP - Univ Estadual Paulista, Araraquara Dental School; Araraquara SP Brazil
| | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; College of Dental Medicine; Augusta GA USA
- Department of Orthopedics, Medical College of Georgia; Georgia Regents University; Augusta GA USA
| | | | - Elcio Marcantonio
- Department of Diagnosis and Surgery - Periodontics; UNESP - Univ Estadual Paulista, Araraquara Dental School; Araraquara SP Brazil
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21
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Lu SX, Fiorini T, Lee J, Prasad HS, Buxton AN, Bisch FC, Dixon DR, Susin C, Wikesjö UME. Evaluation of a compression resistant matrix for recombinant human bone morphogenetic protein-2. J Clin Periodontol 2013; 40:688-97. [DOI: 10.1111/jcpe.12109] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sheldon X. Lu
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Regents University College of Dental Medicine; Augusta GA USA
- U.S. Army Advanced Education Program in Periodontics; Fort Gordon GA USA
| | - Tiago Fiorini
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Regents University College of Dental Medicine; Augusta GA USA
| | - Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Regents University College of Dental Medicine; Augusta GA USA
| | - Hari S. Prasad
- Hard Tissue Research Laboratory; University of Minnesota; Minneapolis MN USA
| | | | - Fredrick C. Bisch
- U.S. Army Advanced Education Program in Periodontics; Fort Gordon GA USA
| | - Douglas R. Dixon
- U.S. Army Advanced Education Program in Periodontics; Fort Gordon GA USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Regents University College of Dental Medicine; Augusta GA USA
| | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Regents University College of Dental Medicine; Augusta GA USA
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22
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Dickinson DP, Coleman BG, Batrice N, Lee J, Koli K, Pennington C, Susin C, Wikesjö UME. Events of wound healing/regeneration in the canine supraalveolar periodontal defect model. J Clin Periodontol 2013; 40:527-41. [PMID: 23461721 DOI: 10.1111/jcpe.12055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/28/2012] [Accepted: 12/05/2012] [Indexed: 11/28/2022]
Abstract
AIM The objective of this research was to elucidate early events in periodontal wound healing/regeneration using histological and immunohistochemical techniques. METHODS Routine critical-size, supraalveolar, periodontal defects including a space-providing titanium mesh device were created in 12 dogs. Six animals received additional autologous blood into the defect prior to wound closure. One animal from each group was killed for analysis at 2, 5, 9, 14 days, and at 4 and 8 weeks. RESULTS Both groups behaved similarly. Periodontal wound healing/regeneration progressed through three temporal phases. Early phase (2-5 days): heterogeneous clot consolidation and cell activation in the periodontal ligament (PDL) and trabecular bone was associated with PDL regeneration and formation of a pre-osteoblast population. Intermediate phase (9-14 days): cell proliferation (shown by PCNA immunostaining)/migration led to osteoid/bone, PDL and cementum formation. Late phase (4-8 weeks): primarily characterized by tissue remodelling/maturation. Fibrous connective tissue from the gingival mucosa entered the wound early, competing with regeneration. By day 14, the wound space was largely filled with regenerative and reparative tissues. CONCLUSION Activation of cellular regenerative events in periodontal wound healing/regeneration is rapid; the general framework for tissue formation is broadly outlined within 14 days. Most bone formation apparently originates from endosteally derived pre-osteoblasts; the PDL possibly acting as a supplementary source, with a primary function likely being regulatory/homeostatic. Blood accumulation at the surgical site warrants exploration; supplementation may be beneficial.
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Affiliation(s)
- Douglas P Dickinson
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Georgia Regents University College of Dental Medicine, Augusta, GA, USA.
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23
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Chiu HC, Shen EC, Lin SJ, Susin C, Wikesjö UME, Fu E. Periodontal repair in dogs: space-provision supports alveolar bone and cementum formation. J Clin Periodontol 2013; 40:358-63. [DOI: 10.1111/jcpe.12071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Hsien-Chung Chiu
- Department of Periodontology; School of Dentistry; National Defense Medical Center and Tri-Service General Hospital; Taipei Taiwan ROC
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR); Georgia Health Sciences University; Augusta GA USA
| | - E-Chin Shen
- Department of Periodontology; School of Dentistry; National Defense Medical Center and Tri-Service General Hospital; Taipei Taiwan ROC
- Department of Dentistry; Buddhist Tzu Chi General Hospital, Taipei Branch; Taipei Taiwan ROC
| | - Shu-Jiun Lin
- Department of Dentistry; Cardinal Tien Hospital; Taipei Taiwan ROC
| | - Cristiano Susin
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR); Georgia Health Sciences University; Augusta GA USA
| | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal and Craniofacial Regeneration (LAPCR); Georgia Health Sciences University; Augusta GA USA
| | - Earl Fu
- Department of Periodontology; School of Dentistry; National Defense Medical Center and Tri-Service General Hospital; Taipei Taiwan ROC
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24
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Stancoven BW, Lee J, Dixon DR, McPherson JC, Bisch FC, Wikesjö UME, Susin C. Effect of bone morphogenetic protein-2, demineralized bone matrix and systemic parathyroid hormone (1-34) on local bone formation in a rat calvaria critical-size defect model. J Periodontal Res 2012; 48:243-51. [PMID: 22970744 DOI: 10.1111/jre.12001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
Abstract
AIM To determine the potential of recombinant human bone morphogenetic protein-2 (rhBMP-2) soak-loaded on to an absorbable collagen sponge (ACS) to induce local bone formation compared with the clinical reference demineralized bone matrix (DBM) and to investigate potential additive/synergistic effects of exogenous parathyroid hormone (PTH). METHODS Critical-size (8 mm), through-through calvaria osteotomy defects in 160 adult male Sprague-Dawley rats were randomized to receive one of eight interventions: rhBMP-2/ACS, DBM, ACS, or serve as controls (empty defects) combined or not with systemic PTH. Ten animals from each group were followed for 4 and 8 wks for radiographic and histometric analysis. Multivariable analysis was used to assess the effect of experimental intervention and healing time on local bone formation. RESULTS In the multivariable analysis, rhBMP-2/ACS exhibited significantly greater histologic bone formation than control (β ± SE: 54.76 ± 5.85, p < 0.001) and ACS (β ± SE: 9.14 ± 3.31, p = 0.007) whereas DBM showed significantly less bone formation than control (β ± SE: -32.32 ± 8.23, p < 0.001). Overall, PTH did not show a significant effect on bone formation (β ± SE: 2.72 ± 6.91, p = 0.70). No significant differences in histological defect closure were observed between 4 and 8 wks for all but the control group without PTH. CONCLUSION rhBMP-2/ACS significantly stimulates local bone formation whereas bone formation appears significantly limited by DBM. Systemic application of PTH provided no discernible additive/synergistic effects on local bone formation.
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Affiliation(s)
- B W Stancoven
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Departments of Periodontics and Oral Biology, Georgia Health Sciences University, Augusta, GA 30912, USA
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25
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Leknes KN, Yang J, Qahash M, Polimeni G, Susin C, Wikesjö UME. Alveolar ridge augmentation using implants coated with recombinant human growth/differentiation factor -5 (rhGDF-5). Radiographic observations. Clin Oral Implants Res 2012; 24:1185-91. [PMID: 22882602 DOI: 10.1111/j.1600-0501.2012.02564.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Application of growth factors onto dental implant surfaces is being considered to support local bone formation. Bone morphogenetic protein-2 (BMP-2) and BMP-7 have been shown to support local bone formation, but are also associated with adverse events including seroma formation, extensive bone remodeling, and implant displacement captured in the radiographic evaluation. This report presents mineralized tissue formation and associated adverse events following implantation of recombinant human growth/differentiation factor-5 (rhGDF-5) coated onto a purpose-designed titanium porous-oxide implant surface. MATERIAL AND METHODS Twelve young adult Labrador dogs were used. Three 10-mm titanium implants/jaw quadrant were placed 5 mm into the alveolar ridge in the posterior mandible following surgical extraction of the premolar teeth and reduction of the alveolar ridge. Six animals received implants coated with rhGDF-5 at 30 or 60 μg/implant in contralateral jaw quadrants. Six animals received implants coated with rhGDF-5 at 120 μg/implant or uncoated implants (sham-surgery control) using the same split-mouth design. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants. Radiographic recordings were made immediately postsurgery (baseline), and at week 4 and 8 (end of study). Two masked examiners performed the analysis using computer enhanced radiographic images. RESULTS rhGDF-5 coated implants displayed mineralized tissue formation significantly exceeding that of the sham-surgery control in a dose-dependent order. The greatest increase was observed for implants coated with rhGDF-5 at 60 μg and 120 μg amounting to approximately 2.2 mm for both groups at 8 weeks. Importantly, none of the implants showed evidence of peri-implant bone remodeling, implant displacement, or seroma formation. The newly formed mineralized tissues assumed characteristics of the resident bone. CONCLUSIONS rhGDF-5 coated onto a titanium porous-oxide implant surface exhibits a dose-dependent potential to stimulate local mineralized tissue formation. Application of rhGDF-5 appears safe as it is associated with limited, if any, adverse events.
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Affiliation(s)
- Knut N Leknes
- Department of Clinical Dentistry - Periodontology, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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26
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Lee J, Hurson S, Tadros H, Schüpbach P, Susin C, Wikesjö UME. Crestal remodelling and osseointegration at surface-modified commercially pure titanium and titanium alloy implants in a canine model. J Clin Periodontol 2012; 39:781-8. [PMID: 22671935 DOI: 10.1111/j.1600-051x.2012.01905.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ti-6Al-7Nb alloys exhibit enhanced mechanical properties and corrosion resistance and may represent an improvement to present commercially pure (CP) titanium oral implant technology. OBJECTIVES To evaluate crestal remodelling and osseointegration at CP titanium compared with Ti-6Al-7Nb alloy oral implants using a canine model. METHODS Two threaded anodized CP titanium and two Ti-6Al-7Nb alloy anodized oral implants (ø4.5 × 6.1 mm) were placed into each jaw quadrant in the edentulated posterior mandible in six adult male Hound Labrador mongrel dogs. Abutments were placed onto the implants, and the mucogingival flaps were adapted and sutured for transmucosal wound healing. Block biopsies were collected for histometric analysis following an 8-week healing interval. RESULTS Healing was uneventful. Bone density outside and within the root of the threads averaged (± SE) 49.0 ± 4.5% and 38.7 ± 5.1% for CP titanium implants and 43.2 ± 3.6% and 34.2 ± 4.8% for Ti-6Al-7Nb alloy implants. Mean osseointegration reached 68.0 ± 4.4% and 62.8 ± 2.5% for CP titanium and Ti-6Al-7Nb alloy implants, respectively. Although crestal resorption at lingual sites averaged 0.2 ± 0.1 mm for both technologies, crestal resorption at buccal sites averaged 0.9 ± 0.2 and 1.0 ± 0.6 mm for CP titanium and Ti-6Al-7Nb alloy implants, respectively. There were no statistically significant differences between implant technologies for any parameter assessed. Notably, advanced/advancing buccal crestal resorption exposing the implant threads was observed in 50% of the implants (four of six animals) regardless of implant technology; osteoclastic resorption still observed at 8 weeks following implant placement. CONCLUSION Within the limitations of study, anodized Ti-6Al-7Nb alloy implants may represent a feasible alternative to benchmark anodized CP titanium implants. Remodelling of the buccal crestal plate resulting in advanced bone loss appears a major impediment to oral implant osseointegration and possibly, in extension, implant maintenance.
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Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Department of Periodontics, Georgia Health Sciences University College of Dental Medicine, Augusta, GA 30912, USA.
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Lee J, Lee EN, Yoon J, Chung SM, Prasad H, Susin C, Wikesjö UME. Comparative study of Chinese hamster ovary cell versus Escherichia coli-derived bone morphogenetic protein-2 using the critical-size supraalveolar peri-implant defect model. J Periodontol 2012; 84:415-22. [PMID: 22612368 DOI: 10.1902/jop.2012.110369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chinese hamster ovary (CHO) cell-derived recombinant human bone morphogenetic protein-2 (rhBMP-2) has been introduced for spine, long bone, and craniofacial indications. Escherichia coli- (E. coli) derived rhBMP-2 displays comparable efficacy to CHO cell-derived rhBMP-2 in vitro and in small-animal models. The objective of this study is to evaluate the efficacy of E. coli-derived rhBMP-2 compared to the benchmark CHO cell-derived rhBMP-2 using an established large-animal model. METHODS Contralateral, critical-size supraalveolar peri-implant defects in six adult male Hound Labrador mongrel dogs received CHO cell- or E. coli-derived rhBMP-2 (0.2 mg/mL) in an absorbable collagen sponge (ACS) carrier. In each quadrant, three dental implants were placed. A titanium mesh device was used to support space provision. The animals received fluorescent bone markers for qualitative evaluations. Animals were euthanized at 8 weeks for histopathologic and histometric evaluation. RESULTS Clinical healing included significant swelling, but none of the animals experienced wound dehiscences. CHO cell- and E. coli-derived rhBMP-2 supported comparable bone formation (new bone area, 35.8 ± 3.6 versus 30.1 ± 2.2 mm(2); bone density, 31.8% ± 1.6% versus 35.6% ± 2.5%; and osseointegration, 32.9% ± 7.4% versus 33.7% ± 8.1%) without statistically significant differences between treatments. Newly formed immature delicate trabecular bone in fibrovascular marrow filled the space underneath the titanium mesh and extended coronally above the mesh. Seroma formation was frequently observed. There were no discernable qualitative histologic differences between treatments. CONCLUSION CHO cell- and E. coli-derived rhBMP-2 in an ACS carrier appear equally effective at inducing local bone formation in support of dental implant osseointegration.
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Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Department of Periodontics, Georgia Regents University College of Dental Medicine, Augusta, GA 30912, USA.
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Park JC, Wikesjö UME, Koo KT, Lee JS, Kim YT, Pippig SD, Bastone P, Kim CS, Kim CK. Maturation of alveolar bone following implantation of an rhGDF-5/PLGA composite into 1-wall intra-bony defects in dogs: 24-week histometric observations. J Clin Periodontol 2012; 39:565-73. [DOI: 10.1111/j.1600-051x.2012.01868.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Jung-Chul Park
- Department of Periodontology; Research Institute for Periodontal Regeneration; College of Dentistry; Yonsei University; Seoul; Korea
| | - Ulf M. E. Wikesjö
- Departments of Periodontics and Oral Biology; Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Ki-Tae Koo
- Department of Periodontology; College of Dentistry; Seoul National University; Seoul; Korea
| | - Jung-Seok Lee
- Department of Periodontology; Research Institute for Periodontal Regeneration; College of Dentistry; Yonsei University; Seoul; Korea
| | - Yong-Tae Kim
- Department of Periodontology; Research Institute for Periodontal Regeneration; College of Dentistry; Yonsei University; Seoul; Korea
| | | | | | - Chang-Sung Kim
- Department of Periodontology; Research Institute for Periodontal Regeneration; College of Dentistry; Yonsei University; Seoul; Korea
| | - Chong-Kwan Kim
- Department of Periodontology; Research Center for Orofacial Hard Tissue Regeneration (MRC); College of Dentistry; Yonsei University; Seoul; Korea
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Lee JS, Wikesjö UME, Park JC, Jang YJ, Pippig SD, Bastone P, Choi SH, Kim CK. Maturation of periodontal tissues following implantation of rhGDF-5/β-TCP in one-wall intra-bony defects in dogs: 24-week histological observations. J Clin Periodontol 2012; 39:466-74. [DOI: 10.1111/j.1600-051x.2012.01862.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ulf M. E. Wikesjö
- Departments of Periodontics and Oral Biology; Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
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Lee J, Susin C, Rodriguez NA, de Stefano J, Prasad HS, Buxton AN, Wikesjö UME. Sinus augmentation using rhBMP-2/ACS in a mini-pig model: relative efficacy of autogenous fresh particulate iliac bone grafts. Clin Oral Implants Res 2012; 24:497-504. [DOI: 10.1111/j.1600-0501.2011.02419.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Nancy A. Rodriguez
- Laboratory Animal Services; Georgia Health Sciences University; Augusta; GA; USA
| | - Jamie de Stefano
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
| | - Hari S. Prasad
- Hard Tissue Research Laboratory; Division of Oral and Maxillofacial Pathology; University of Minnesota School of Dentistry; Minneapolis; MN; USA
| | | | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration; Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine; Augusta; GA; USA
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Stavropoulos A, Windisch P, Gera I, Capsius B, Sculean A, Wikesjö UME. A phase IIa randomized controlled clinical and histological pilot study evaluating rhGDF-5/β-TCP for periodontal regeneration. J Clin Periodontol 2011; 38:1044-54. [DOI: 10.1111/j.1600-051x.2011.01778.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2011] [Indexed: 01/20/2023]
Affiliation(s)
| | - Peter Windisch
- Department of Periodontology; Semmelweis University; Budapest; Hungary
| | - Istvan Gera
- Department of Periodontology; Semmelweis University; Budapest; Hungary
| | | | - Anton Sculean
- Department of Periodontology; University of Berne; Bern; Switzerland
| | - Ulf M. E. Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR); Departments of Periodontics and Oral Biology; Georgia Health Sciences University College of Dental Medicine and College of Graduate Studies; Augusta; GA; USA
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Windisch P, Stavropoulos A, Molnár B, Szendröi-Kiss D, Szilágyi E, Rosta P, Horváth A, Capsius B, Wikesjö UME, Sculean A. A phase IIa randomized controlled pilot study evaluating the safety and clinical outcomes following the use of rhGDF-5/β-TCP in regenerative periodontal therapy. Clin Oral Investig 2011; 16:1181-9. [PMID: 21887500 DOI: 10.1007/s00784-011-0610-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 08/10/2011] [Indexed: 11/30/2022]
Abstract
To present the safety profile, the early healing phase and the clinical outcomes at 24 weeks following treatment of human intrabony defects with open flap debridement (OFD) alone or with OFD and rhGDF-5 adsorbed onto a particulate β-tricalcium phosphate (β-TCP) carrier. Twenty chronic periodontitis patients, each with at least one tooth exhibiting a probing depth ≥6 mm and an associated intrabony defect ≥4 mm entered the study. Ten subjects (one defect/patient) were randomized to receive OFD alone (control) and ten subjects OFD combined with rhGDF-5/β-TCP. Blood samples were collected at screening, and at weeks 2 and 24 to evaluate routine hematology and clinical chemistry, rhGDF-5 plasma levels, and antirhGDF-5 antibody formation. Plaque and gingival indices, bleeding on probing, probing depth, clinical attachment level, and radiographs were recorded pre- and 24 weeks postsurgery. Comparable safety profiles were found in the two treatment groups. Neither antirhGDF-5 antibody formation nor relevant rhGDF-5 plasma levels were detected in any patient. At 6 months, treatment with OFD + rhGDF-5/β-TCP resulted in higher but statistically not significant PD reduction (3.7 ± 1.2 vs. 3.1 ± 1.8 mm; p = 0.26) and CAL gain (3.2 ± 1.7 vs. 1.7 ± 2.2 mm; p = 0.14) compared to OFD alone. In the tested concentration, the use of rhGDF-5/β-TCP appeared to be safe and the material possesses a sound biological rationale. Thus, further adequately powered, randomized controlled clinical trials are warranted to confirm the clinical relevance of this new approach in regenerative periodontal therapy. rhGDF-5/β-TCP may represent a promising new techology in regenerative periodontal therapy.
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Affiliation(s)
- Péter Windisch
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Poulos NM, Rodriguez NA, Lee J, Rueggeberg FA, Schüpbach P, Hall J, Susin C, Wikesjö UME. Evaluation of a novel calcium phosphate-coated titanium porous oxide implant surface: a study in rabbits. Int J Oral Maxillofac Implants 2011; 26:731-738. [PMID: 21841981] [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 To evaluate osseointegration of a novel calcium phosphate (CaP)-coated titanium porous oxide implant surface. MATERIALS AND METHODS Twenty adult male New Zealand White rabbits were used. Each animal received two titanium porous oxide-surfaced implants (benchmark control: TiUnite, Nobel Biocare) and two novel CaP-coated titanium porous oxide-surfaces implants; they were randomly allocated to contralateral tibia implant sites. The animals were sacrificed after 2 or 4 weeks, and tissues were evaluated histometrically. RESULTS Healing was generally uneventful. A removal torque analysis showed significantly higher mean (± SE) peak values for the control implants than for the test implants at 2 weeks (31.4 ± 2.5 Ncm versus 20.4 ± 1.8 Ncm) and 4 weeks (48.4 ± 5.5 Ncm versus 30.3 ± 3.9 Ncm). Light microscopy showed no significant differences in local bone density around control and test implants at 2 and 4 weeks (range, 85% to 91% within the thread area and 91% to 95% immediately outside the threads). At 2 weeks, bone-implant contact for control and test implants averaged 81.8% ± 2.8% and 75.7% ± 4.6%, respectively, and at 4 weeks the bone-implant contact values were 79.4% ± 2.8% and 73.5% ± 4.2%, respectively; these differences were not significant. Backscatter scanning electron microscopy also showed no significant differences in local bone density at control and test implants at 2 and 4 weeks (range, 55% to 72% within the thread area and 75% to 81% immediately outside the threads). At 2 weeks, bone-implant contact for control and test implants averaged 66.4% ± 2.9% and 61.5% ± 5.1%, respectively, and at 4 weeks mean values were 60.1% ± 4.2% and 53.3% ± 4.6% (differences not significant). CONCLUSIONS The results suggest that the novel CaP-coated surface effectively supports osseointegration.
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Affiliation(s)
- Nicholas M Poulos
- Department of Periodontics, Georgia Health Science University, Augusta, Georgia, USA
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Min CK, Wikesjö UME, Park JC, Chae GJ, Pippig SD, Bastone P, Kim CS, Kim CK. Wound healing/regeneration using recombinant human growth/differentiation factor-5 in an injectable poly-lactide-co-glycolide-acid composite carrier and a one-wall intra-bony defect model in dogs. J Clin Periodontol 2011; 38:261-8. [DOI: 10.1111/j.1600-051x.2010.01691.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Nygaard-Østby P, Bakke V, Nesdal O, Susin C, Wikesjö UME. Periodontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresorbable barrier device when combined with autogenous bone grafting. A randomized-controlled trial 10-year follow-up. J Clin Periodontol 2010; 37:366-73. [PMID: 20447260 DOI: 10.1111/j.1600-051x.2010.01532.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this 10-year randomized-controlled trial follow-up was to evaluate the stability of treatment outcomes following the implantation of autogenous bone graft with or without guided tissue regeneration (GTR) in the treatment of deep intra-bony periodontal defects. MATERIALS AND METHODS Forty patients exhibiting deep intra-bony periodontal defects were included in a randomized-controlled trial evaluating the adjunctive effect of GTR to autogenous bone graft. Twenty-six of 39 patients completing the original study were available for follow-up 10 years post-treatment. The patients had been included in a structured maintenance programme and were evaluated using the criteria of the original study by the same investigators. RESULTS Significant improvements in the probing depth and clinical attachment level were observed for both groups between baseline and 9 months. Whereas the autogenous bone graft+GTR group showed significant improvements in probing bone levels and increased gingival recession at 9 months, no significant differences were observed for the autogenous bone graft group. Nine-month within-group results were maintained throughout the 10-year follow-up. Nevertheless, between-group comparisons at 10 years showed that the autogenous bone graft+GTR group exhibited significantly greater probing depth reduction (mean +/- SE: 4.2 +/- 0.5 versus 2.7 +/- 0.5 mm, p=0.023) and probing bone-level gain (3.9 +/- 0.8 versus 1.3 +/- 0.9 mm, p=0.034) than the autogenous bone graft group. Borderline significant differences between the autogenous bone graft+GTR and the autogenous bone graft groups were observed for clinical attachment level gain at 10 years (3.8 +/- 0.5 versus 2.2 +/- 0.7 mm, p=0.067), whereas no significant differences were observed for gingival recession (0.7 +/- 0.3 versus 0.6 +/- 0.5 mm, p>0.05). CONCLUSIONS The results of this randomized study suggest that statistically significant differences were found with the adjunct use of GTR to an autogenous bone graft at 10 years. Nevertheless, these results should be interpreted with caution in light of its clinical relevance and biological rationale. Importantly, resolution of deep intra-bony periodontal defects can be maintained in the presence of a structured maintenance programme emphasizing high oral hygiene standards.
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Affiliation(s)
- Per Nygaard-Østby
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Geitmyrsveien 71, 0458 Oslo, Norway.
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Lee JS, Wikesjö UME, Jung UW, Choi SH, Pippig S, Siedler M, Kim CK. Periodontal wound healing/regeneration following implantation of recombinant human growth/differentiation factor-5 in a beta-tricalcium phosphate carrier into one-wall intrabony defects in dogs. J Clin Periodontol 2010; 37:382-9. [PMID: 20447262 DOI: 10.1111/j.1600-051x.2010.01544.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Recombinant human growth/differentiation factor-5 (rhGDF-5) is being evaluated as a candidate therapy in support of periodontal regeneration. The objective of this study was to evaluate periodontal wound healing/regeneration following the application of rhGDF-5 on a particulate beta-tricalcium phosphate (beta-TCP) carrier using an established defect model. MATERIALS AND METHODS Bilateral 4 x 5 mm (width x depth), one-wall, critical-size, intrabony periodontal defects were surgically created at the mandibular second and fourth pre-molar teeth in 15 Beagle dogs. Unilateral defects in five animals received rhGDF-5/beta-TCP (Scil Technology GmbH); five animals received beta-TCP solo; and five animals served as sham-surgery controls. Contralateral sites received treatments reported elsewhere. The animals were sacrificed following an 8-week healing interval for histological examination. RESULTS Clinical healing was generally uneventful. Sites implanted with rhGDF-5/beta-TCP exhibited greater enhanced cementum and bone formation compared with beta-TCP and sham-surgery controls; cementum regeneration averaged (+/- SD) 3.83 +/- 0.73 versus 1.65 +/- 0.82 and 2.48 +/- 1.28 mm for the controls (p<0.05). Corresponding values for bone regeneration height averaged 3.26 +/- 0.30 versus 1.70 +/- 0.66 and 1.68 +/- 0.49 mm (p<0.05), and bone area 10.45 +/- 2.26 versus 6.31 +/- 2.41 and 3.00 +/- 1.97 mm(2) (p<0.05). Cementum regeneration included cellular/acellular cementum with or without a functionally oriented periodontal ligament. A non-specific connective tissue attachment was evident in the sham-surgery control. Controls exhibited mostly woven bone with primary osteons, whereas rhGDF-5/beta-TCP sites showed a noticeable extent of lamellar bone. Sites receiving rhGDF-5/beta-TCP or beta-TCP showed some residual beta-TCP granules apparently undergoing biodegradation without obvious differences between the sites. Sites receiving beta-TCP alone commonly showed residual beta-TCP granules sequestered in the connective tissue or fibrovascular marrow. CONCLUSION rhGDF-5/beta-TCP has a greater potential to support the regeneration of the periodontal attachment. Long-term studies are necessary to confirm the uneventful maturation of the regenerated tissues.
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Affiliation(s)
- Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Kwon DH, Bennett W, Herberg S, Bastone P, Pippig S, Rodriguez NA, Susin C, Wikesjö UME. Evaluation of an injectable rhGDF-5/PLGA construct for minimally invasive periodontal regenerative procedures: a histological study in the dog. J Clin Periodontol 2010; 37:390-7. [PMID: 20447263 DOI: 10.1111/j.1600-051x.2010.01546.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the injectability, biocompatibility, safety, and periodontal wound healing/regeneration following application of a novel bioresorbable recombinant human growth/differentiation factor-5 (rhGDF-5)/poly(lactic-co-glycolic acid) (PLGA) construct. MATERIAL AND METHODS Periodontal pockets (3 x 6 mm, width x depth) were surgically created over the buccal roots of the second and fourth mandibular pre-molars in eight adult Hound Labrador mongrel dogs. Surgeries including injection of the rhGDF-5/PLGA construct into the pockets were sequenced that four animals provided 2-/4-week and four animals 6-/8-week observations of sites receiving rhGDF-5/PLGA or serving as sham-surgery control. RESULTS The rhGDF-5/PLGA construct was easy to prepare and apply. Approximately 0.2 ml (93 microg rhGDF-5)/tooth was used. Clinical and radiographic healing was exemplary without adverse events. Healing was characterized by a non-specific connective tissue attachment, acellular/cellular cementum, periodontal ligament (PDL), bone regeneration, and a junctional epithelium. PLGA fragments were observed in 4/7, 2/8, and 1/8 sites at 2, 4, and 6 weeks, respectively. Associated inflammatory reactions exhibited no limiting effect on periodontal wound healing/regeneration. Root resorption/ankylosis was not observed. Bone formation showed apparent increased maturity (lamellar bone) at 6 weeks in sites receiving rhGDF-5/PLGA compared with the control. Both protocols exhibited significant increases in PDL, cementum, and bone regeneration over time, without significant differences between treatments. In time, PDL and cementum regeneration was twofold greater for the control at 4 weeks (p=0.04) while increased bone formation was observed at sites receiving rhGDF-5/PLGA (p<0.01). CONCLUSIONS In conclusion, the rhGDF-5/PLGA construct appears to be a safe technology for injectable, ease-of-use application of rhGDF-5-stimulated periodontal wound healing/regeneration. Additional work to optimize the polymer carrier and rhGDF-5 release kinetics/dose might be required before evaluating the efficacy of this technology in clinical settings using minimally invasive approaches.
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Affiliation(s)
- David H Kwon
- US Army Advanced Education Program in Periodontics, Ft. Gordon, GA, USA
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Decker JF, Lee J, Cortella CA, Polimeni G, Rohrer MD, Wozney JM, Hall J, Susin C, Wikesjö UME. Evaluation of implants coated with recombinant human bone morphogenetic protein-2 and vacuum-dried using the critical-size supraalveolar peri-implant defect model in dogs. J Periodontol 2010; 81:1839-49. [PMID: 20629551 DOI: 10.1902/jop.2010.100220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Endosseous implants coated with recombinant human bone morphogenetic protein-2 (rhBMP-2) in a laboratory bench setting and air-dried induce relevant bone formation but also resident bone remodeling. Thus, the objective of this study is to evaluate the effect of implants fully or partially coated with rhBMP-2 and vacuum-dried using an industrial process on local bone formation and resident bone remodeling. METHODS Twelve male adult Hound Labrador mongrel dogs were used. Critical-size, supraalveolar, peri-implant defects received titanium porous oxide surface implants coated in their most coronal aspect with rhBMP-2 (coronal-load, six animals), or by immersion of the entire implant in a rhBMP-2 solution (soak-load, six animals) for a total of 30 μg rhBMP-2 per implant. All implants were vacuum-dried. The animals were sacrificed at 8 weeks for histometric evaluation. RESULTS Clinical healing was unremarkable. Bone formation was not significantly affected by the rhBMP-2 application protocol. New bone height and area averaged (± SE) 3.2 ± 0.5 versus 3.6 ± 0.3 mm, and 2.3 ± 0.5 versus 2.6 ± 0.8 mm(2) for coronal-load and soak-load implants, respectively (P >0.05). The corresponding bone density and bone-implant contact registrations averaged 46.7% ± 5.8% versus 31.6% ± 4.4%, and 28% ± 5.6% versus 36.9% ± 3.4% (P >0.05). In contrast, resident bone remodeling was significantly influenced by the rhBMP-2 application protocol. Peri-implant bone density averaged 72.2% ± 2.1% for coronal-load versus 60.6% ± 4.7% for soak-load implants (P <0.05); the corresponding bone-implant contact averaged 70.7% ± 6.1% versus 47.2% ± 6.0% (P <0.05). CONCLUSIONS Local application of rhBMP-2 and vacuum-drying using industrial process seems to be a viable technology to manufacture implants that support local bone formation and osseointegration. Coronal-load implants obviate resident bone remodeling without compromising local bone formation.
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Affiliation(s)
- John F Decker
- Department of Periodontics, School of Dentistry, Medical College of Georgia, Augusta, GA 30912, USA
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Kwon HR, Wikesjö UME, Park JC, Kim YT, Bastone P, Pippig SD, Kim CK. Growth/differentiation factor-5 significantly enhances periodontal wound healing/regeneration compared with platelet-derived growth factor-BB in dogs. J Clin Periodontol 2010; 37:739-46. [PMID: 20618546 DOI: 10.1111/j.1600-051x.2010.01576.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recombinant human growth/differentiation factor-5 (rhGDF-5) in a particulate beta-tricalcium phosphate (beta-TCP) carrier is being evaluated to support periodontal regeneration. The objective of this study was to evaluate periodontal wound healing/regeneration following an established clinical (benchmark) protocol including surgical implantation of rhGDF-5/beta-TCP in comparison with that following implantation of recombinant human platelet-derived growth factor-BB (rhPDGF) combined with a particulate beta-TCP biomaterial using an established canine defect model. MATERIALS AND METHODS Bilateral, 4 x 5 mm (width x depth), one-wall, critical-size, intrabony periodontal defects were surgically created at the mandibular second and fourth pre-molar teeth in five adult Beagle dogs. Defect sites were randomized to receive rhGDF-5/beta-TCP or the rhPDGF construct followed by wound closure for primary intention healing. The animals were sacrificed following an 8-week healing interval for histological and histometric examination. RESULTS Clinical healing was generally uneventful. Sites receiving rhGDF-5/beta-TCP exhibited a significantly enhanced cementum formation compared with sites receiving the rhPDGF construct, averaging (+/-SD) 4.49+/-0.48 versus 2.72+/-0.91 mm (p<0.001). Similarly, bone regeneration height and area were significantly enhanced at sites receiving rhGDF-5/beta-TCP versus that of the rhPDGF construct averaging, 3.08+/-0.74 versus 1.29+/-0.78 mm (p<0.001) and 6.03+/-1.28 versus 2.98+/-2.61 mm(2) (p<0.01), respectively. Cementum regeneration included cellular/acellular mixed (extrinsic/intrinsic) fibre cementum at sites receiving rhGDF-5/beta-TCP; sites receiving the rhPDGF/beta-TCP showed a pre-dominantly acellular cementum. Newly formed cementum generally extended above the adjoining alveolar bone. Both protocols displayed beta-TCP residues apparently undergoing resorption. Application of both materials appears safe, as they were associated with limited, if any, adverse events. CONCLUSION rhGDF-5/beta-TCP shows a significant potential to support/accelerate periodontal wound healing/regeneration. Application of rhGDF-5/beta-TCP appears safe and should be further evaluated in human clinical trials.
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Affiliation(s)
- Hyuk-Rak Kwon
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Polimeni G, Wikesjö UME, Susin C, Qahash M, Shanaman RH, Prasad HS, Rohrer MD, Hall J. Alveolar ridge augmentation using implants coated with recombinant human growth/differentiation factor-5: histologic observations. J Clin Periodontol 2010; 37:759-68. [PMID: 20500538 DOI: 10.1111/j.1600-051x.2010.01579.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In vitro and in vivo preclinical studies suggest that growth/differentiation factor-5 (GDF-5) may induce local bone formation. The objective of this study was to evaluate the potential of recombinant human GDF-5 (rhGDF-5) coated onto an oral implant with a purpose-designed titanium porous oxide surface to stimulate local bone formation including osseointegration and vertical augmentation of the alveolar ridge. MATERIALS AND METHODS Bilateral, critical-size, 5 mm, supraalveolar peri-implant defects were created in 12 young adult Hound Labrador mongrel dogs. Six animals received implants coated with 30 or 60 microg rhGDF-5, and six animals received implants coated with 120 microg rhGDF-5 or left uncoated (control). Treatments were alternated between jaw quadrants. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at weeks 3, 4, 7, and 8 post-surgery when they were euthanized for histologic evaluation. RESULTS The clinical examination showed no noteworthy differences between implants coated with rhGDF-5. The cover screw and implant body were visible/palpable through the alveolar mucosa for both rhGDF-5-coated and control implants. There was a small increase in induced bone height for implants coated with rhGDF-5 compared with the control, induced bone height averaging (+/-SD) 1.6+/-0.6 mm for implants coated with 120 microg rhGDF-5 versus 1.2+/-0.5, 1.2+/-0.6, and 0.6+/-0.2 mm for implants coated with 60 microg rhGDF-5, 30 microg rhGDF-5, or left uncoated, respectively (p<0.05). Bone formation was predominant at the lingual aspect of the implants. Narrow yellow and orange fluorescent markers throughout the newly formed bone indicate relatively slow new bone formation within 3-4 weeks. Implants coated with rhGDF-5 displayed limited peri-implant bone remodelling in the resident bone; the 120 microg dose exhibiting more advanced remodelling than the 60 and 30 microg doses. All treatment groups exhibited clinically relevant osseointegration. CONCLUSIONS rhGDF-5-coated oral implants display a dose-dependent osteoinductive and/or osteoconductive effect, bone formation apparently benefiting from local factors. Application of rhGDF-5 appears to be safe as it is associated with limited, if any, adverse effects.
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Affiliation(s)
- Giuseppe Polimeni
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Department of Periodontics & Oral Biology, Medical College of Georgia School of Dentistry, Augusta, GA 30912, USA.
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Kwon DH, Bisch FC, Herold RW, Pompe C, Bastone P, Rodriguez NA, Susin C, Wikesjö UME. Periodontal wound healing/regeneration following the application of rhGDF-5 in a beta-TCP/PLGA carrier in critical-size supra-alveolar periodontal defects in dogs. J Clin Periodontol 2010; 37:667-74. [PMID: 20492073 DOI: 10.1111/j.1600-051x.2010.01569.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The objective of this study was to evaluate the effect of a novel recombinant human GDF-5 (rhGDF-5) construct intended for onlay and inlay indications on periodontal wound healing/regeneration. METHODS Contralateral, surgically created, critical-size, 6-mm, supra-alveolar periodontal defects in five adult Hound Labrador mongrel dogs received rhGDF-5 coated onto beta-tricalcium phosphate (beta-TCP) particles and immersed in a bioresorbable poly(lactic-co-glycolic acid) (PLGA) composite or the beta-TCP/PLGA carrier alone (control). The rhGDF-5 and control constructs were moulded around the teeth and allowed to set. The gingival flaps were then advanced; flap margins were adapted 3-4 mm coronal to the teeth and sutured. The animals were euthanized at 8 weeks post-surgery when block biopsies were collected for histometric analysis. RESULTS Healing was generally uneventful. A few sites exhibited minor exposures. Three control sites and one rhGDF-5 site (in separate animals) experienced more extensive wound dehiscencies. The rhGDF-5 and control constructs were easy to apply and exhibited adequate structural integrity to support the mucoperiosteal flaps in this challenging onlay model. Limited residual beta-TCP particles were observed at 8 weeks for both rhGDF-5/beta-TCP/PLGA and beta-TCP/PLGA control sites. The rhGDF-5/beta-TCP/PLGA sites showed significantly greater cementum (2.34 +/- 0.44 versus 1.13 +/- 0.25 mm, p=0.02) and bone (2.92 +/- 0.66 versus 1.21 +/- 0.30 mm, p=0.02) formation compared with the carrier control. Limited ankylosis was observed in four of five rhGDF-5/beta-TCP/PLGA sites but not in control sites. CONCLUSIONS Within the limitations of this study, the results suggest that rhGDF-5 is a promising candidate technology in support of periodontal wound healing/regeneration. Carrier and rhGDF-5 dose optimization are necessary before further advancement of the technology towards clinical evaluation.
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Affiliation(s)
- David H Kwon
- U.S. Army Advanced Education Program in Periodontics, Ft. Gordon, GA, USA.
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Stavropoulos A, Wikesjö UME. Influence of defect dimensions on periodontal wound healing/regeneration in intrabony defects following implantation of a bovine bone biomaterial and provisions for guided tissue regeneration: an experimental study in the dog. J Clin Periodontol 2010; 37:534-43. [DOI: 10.1111/j.1600-051x.2010.01566.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee J, Decker JF, Polimeni G, Cortella CA, Rohrer MD, Wozney JM, Hall J, Susin C, Wikesjö UME. Evaluation of implants coated with rhBMP-2 using two different coating strategies: a critical-size supraalveolar peri-implant defect study in dogs. J Clin Periodontol 2010; 37:582-90. [PMID: 20345393 DOI: 10.1111/j.1600-051x.2010.01557.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implants coated with recombinant human bone morphogenetic protein-2 (rhBMP-2) induce relevant bone formation but also resident bone remodelling. OBJECTIVES To compare the effect of implants fully or partially coated with rhBMP-2 on new bone formation and resident bone remodelling. MATERIALS AND METHODS Twelve, male, adult, Hound Labrador mongrel dogs were used. Critical-size, supraalveolar, peri-implant defects received titanium porous oxide surface implants coated in their most coronal aspect with rhBMP-2 (coronal-load/six animals) or by immersion of the entire implant in an rhBMP-2 solution (soak-load/six animals) for a total of 30 mug rhBMP-2/implant. All implants were air-dried. The animals were euthanized at 8 weeks for histometric evaluation. RESULTS Clinical healing was uneventful. Supraalveolar bone formation was not significantly affected by the rhBMP-2 application protocol. New bone height and area averaged (+/- SE) 3.4 +/- 0.2 versus 3.5 +/- 0.4 mm and 2.6 +/- 0.4 versus 2.5 +/- 0.7 mm(2) for coronal-load and soak-load implants, respectively (p>0.05). The corresponding bone density and bone-implant contact (BIC) recordings averaged 38.0 +/- 3.8%versus 34.4 +/- 5.6% and 25.0 +/- 3.8%versus 31.2 +/- 3.3% (p>0.05). In contrast, resident bone remodelling was significantly influenced by the rhBMP-2 application protocol. Bone density outside the implants threads averaged 74.7 +/- 3.8% and 50.8 +/- 4.1% for coronal-load and soak-load implants, respectively (p<0.05); bone density within the thread area averaged 51.8 +/- 1.2% and 37.8 +/- 2.9%, and BIC 70.1 +/- 6.7% and 43.3 +/- 3.9% (p<0.05). CONCLUSION Local application of rhBMP-2 appears to be a viable technology to support local bone formation and osseointegration. Coronal-load implants obviate resident bone remodelling without compromising new bone formation.
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Affiliation(s)
- Jaebum Lee
- Department of Periodontics, Medical College of Georgia School of Dentistry, Augusta, GA 30912, USA.
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Susin C, Qahash M, Polimeni G, Lu PH, Prasad HS, Rohrer MD, Hall J, Wikesjö UME. Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-7 (rhBMP-7/rhOP-1): histological observations. J Clin Periodontol 2010; 37:574-81. [PMID: 20345394 DOI: 10.1111/j.1600-051x.2010.01554.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pre-clinical studies have shown that recombinant human bone morphogenetic protein-2 (rhBMP-2) coated onto purpose-designed titanium porous-oxide surface implants induces clinically relevant bone formation and osseointegration. The objective of this study was to examine the potential of rhBMP-7, also known as recombinant human osteogenic protein-1 (rhOP-1), coated onto titanium porous-oxide surface implants to support vertical alveolar ridge augmentation and implant osseointegration. MATERIALS AND METHODS Bilateral, critical-size, 5 mm, supraalveolar peri-implant defects were created in six young adult Hound Labrador mongrel dogs. The animals received implants coated with rhBMP-7 at 1.5 or 3.0 mg/ml randomized to contra-lateral jaw quadrants. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at 3, 4, 7, and 8 weeks post-surgery when they were euthanized for histological evaluation. RESULTS Without striking differences between treatments, the implant sites exhibited a swelling that gradually regressed to become hard to palpation disguising the implant contours. The histological evaluation showed robust bone formation; the newly formed bone assuming characteristics of the contiguous resident bone, bone formation (height and area) averaging 4.1+/-1.0 versus 3.6+/-1.7 mm and 3.6+/-1.9 versus 3.1+/-1.8 mm(2); and bone density 56%versus 50% for implants coated with rhBMP-7 at 1.5 and 3.0 mg/ml, respectively. Both treatments exhibited clinically relevant osseointegration, the corresponding bone-implant contact values averaging 51% and 47%. Notable peri-implant resident bone remodelling was observed for implants coated with rhBMP-7 at 3.0 mg/ml. CONCLUSIONS rhBMP-7 coated onto titanium porous-oxide surface implants induces clinically relevant local bone formation including osseointegration and vertical augmentation of the alveolar ridge, the higher concentration/dose associated with some local side effects.
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Affiliation(s)
- Cristiano Susin
- Medical College of Georgia School of Dentistry, Augusta, GA, USA.
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Moore YR, Dickinson DP, Wikesjö UME. Growth/differentiation factor-5: a candidate therapeutic agent for periodontal regeneration? A review of pre-clinical data. J Clin Periodontol 2010; 37:288-98. [DOI: 10.1111/j.1600-051x.2009.01527.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lee J, Tran Q, Seeba G, Wikesjö UME, Susin C. The critical-size supraalveolar peri-implant defect model: reproducibility in histometric data acquisition of alveolar bone formation and osseointegration. J Clin Periodontol 2010; 36:1067-74. [PMID: 19929958 DOI: 10.1111/j.1600-051x.2009.01487.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this report is to present the reproducibility of outcomes assessments in the Critical-Size Supraalveolar Peri-Implant Defect Model. MATERIALS AND METHODS Two examiners without specific experience in histological analysis and one experienced examiner performed the histometric evaluation. A comprehensive training program in data acquisition and histological analysis was established, the inexperienced examiners underwent approximately 12 h of training over multiple sessions. A custom-designed image analysis software macro and a computer-based image system were used to analyse digital images generated by a microscope camera system. Nine parameters for newly formed and resident bone were evaluated. Examiners performed histometric analysis using 36 histologic sections selected from critical-size supraalveolar peri-implant defects in 12 male Hound Labrador Mongrel dogs. Buccal and lingual measurements were performed in 72 sites. Intra- and inter-examiner reproducibility were evaluated using the concordance correlation coefficient (CCC) and means +/- SD of the differences. Systematic errors were evaluated using an F-test for equality of means and variances. RESULTS Intra-examiner reproducibility was high for all parameters evaluated, the lowest CCC observed being 0.87. Inter-examiner reproducibility was also high, most CCCs exceeding 0.90. Minor systematic errors for intra- and inter-examiner comparisons were occasionally observed. The results imply a high temporal stability because recordings were performed 3 months apart. Measurement errors were stable throughout the range of observations for all parameters. CONCLUSIONS High examiner reproducibility and temporal stability can be achieved for histometric data acquisition using the Critical-Size Supraalveolar Peri-Implant Defect Model. Examiner reproducibility should be routinely assessed, reported, and accounted for to assure the quality of evidence generated by preclinical studies.
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Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal and Craniofacial Regeneration, Departments of Periodontics and Oral Biology, Medical College of Georgia, School of Dentistry, Augusta, GA, USA
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Abstract
Several growth and differentiation factors have shown potential as therapeutic agents to support periodontal wound healing/regeneration, although optimal dosage, release kinetics, and suitable delivery systems are still unknown. Experimental variables, including delivery systems, dose, and the common use of poorly characterized preclinical models, make it difficult to discern the genuine efficacy of each of these factors. Only a few growth and differentiation factors have reached clinical evaluation. It appears that well-defined discriminating preclinical models followed by well-designed clinical trials are needed to further investigate the true potential of these and other candidate factors. Thus, current research is focused on finding relevant growth and differentiation factors, optimal dosages, and the best approaches for delivery to develop clinically meaningful therapies in patient-centered settings.
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Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration (LAPCR), Departments of Periodontics and Oral Biology, Medical College of Georgia School of Dentistry, 1120 5th Street AD1434, Augusta, GA 30912, USA
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Wikesjö UME, Qahash M, Huang YH, Xiropaidis A, Polimeni G, Susin C. Bone morphogenetic proteins for periodontal and alveolar indications; biological observations - clinical implications. Orthod Craniofac Res 2009; 12:263-70. [PMID: 19627529 DOI: 10.1111/j.1601-6343.2009.01461.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgical placement of endosseous oral implants is governed by the prosthetic design and by the morphology and quality of the alveolar bone. Nevertheless, often implant placement may be complexed, if at all possible, by alveolar ridge irregularities resulting from periodontal disease, and chronic and acute trauma. In consequence, implant positioning commonly necessitates bone augmentation procedures. One objective of our laboratory is to evaluate the biologic potential of bone morphogenetic proteins (BMP) and other candidate biologics, bone biomaterials, and devices for alveolar ridge augmentation and implant fixation using discriminating large animal models. This focused review illustrates the unique biologic potential, the clinical relevance and perspectives of recombinant human BMP-2 (rhBMP-2) using a variety of carrier technologies to induce local bone formation and implant osseointegration for inlay and onlay indications. Our studies demonstrate a clinically relevant potential of a purpose-designed titanium porous oxide implant surface as stand-alone technology to deliver rhBMP-2 for alveolar augmentation. In perspective, merits and shortcomings of current treatment protocol including bone biomaterials and guided bone regeneration are addressed and explained. We demonstrate that rhBMP-2 has unparalleled potential to augment alveolar bone, and support implant osseointegration and long-term functional loading. Inclusion of rhBMP-2 for alveolar augmentation and osseointegration will not only enhance predictability of existing clinical protocol but also radically change current treatment paradigms.
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Affiliation(s)
- U M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Department of Periodontics, Medical College of Georgia School of Dentistry, Augusta, GA 30912, USA.
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Lee J, Sieweke JH, Rodriguez NA, Schüpbach P, Lindström H, Susin C, Wikesjö UME. Evaluation of nano-technology-modified zirconia oral implants: a study in rabbits. J Clin Periodontol 2009; 36:610-7. [PMID: 19538335 DOI: 10.1111/j.1600-051x.2009.01423.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to screen candidate nano-technology-modified, micro-structured zirconia implant surfaces relative to local bone formation and osseointegration. MATERIALS AND METHODS Proprietary nano-technology surface-modified (calcium phosphate: CaP) micro-structured zirconia implants (A and C), control micro-structured zirconia implants (ZiUnite), and titanium porous oxide implants (TiUnite) were implanted into the femoral condyle in 40 adult male New Zealand White rabbits. Each animal received one implant in each hind leg; thus, 20 animals received A and C implants and 20 animals received ZiUnite and TiUnite implants in contralateral hind legs. Ten animals/group were euthanized at weeks 3 and 6 when biopsies of the implant sites were processed for histometric analysis using digital photomicrographs produced using backscatter scanning electron microscopy. RESULTS The TiUnite surface demonstrated significantly greater bone-implant contact (BIC) (77.6+/-2.6%) compared with the A (64.6+/-3.6%) and C (62.2+/-3.1%) surfaces at 3 weeks (p<0.05). Numerical differences between ZiUnite (70.5+/-3.1%) and A and C surfaces did not reach statistical significance (p>0.05). Similarly, there were non-significant differences between the TiUnite and the ZiUnite surfaces (p>0.05). At 6 weeks, there were no significant differences in BIC between the TiUnite (67.1+/-4.2%), ZiUnite (69.7+/-5.7%), A (68.6+/-1.9%), and C (64.5+/-4.1%) surfaces (p>0.05). CONCLUSION TiUnite and ZiUnite implant surfaces exhibit high levels of osseointegration that, in this model, confirm their advanced osteoconductive properties. Addition of CaP nano-technology to the ZiUnite surface does not enhance the already advanced osteoconductivity displayed by the TiUnite and ZiUnite implant surfaces.
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Affiliation(s)
- Jaebum Lee
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Department of Periodontics & Oral Biology, Medical College of Georgia School of Dentistry, Augusta, GA 30912, USA.
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Kim TG, Wikesjö UME, Cho KS, Chai JK, Pippig SD, Siedler M, Kim CK. Periodontal wound healing/regeneration following implantation of recombinant human growth/differentiation factor-5 (rhGDF-5) in an absorbable collagen sponge carrier into one-wall intrabony defects in dogs: a dose-range study. J Clin Periodontol 2009; 36:589-97. [DOI: 10.1111/j.1600-051x.2009.01420.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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