Alloplastic Graft Research Articles

Carbonated Hydroxyapatite Containing Propolis as an Antibacterial Agent Candidate against Aggregatibacter actinomycetemcomitans

One of the periodontal pathogenic bacteria that can cause periodontitis and alveolar bone destruction is Aggregatibacter actinomycetemcomitans. An alveolar bone defect can be treated using a bone graft. Carbonated hydroxyapatite (CHA) is an alloplastic graft material. Alloplastic materials do not have vascularization, which will increase the risk of bacterial adhesion. Therefore, adding an antibacterial agent is needed to prevent bacterial adhesion, which will improve periodontal healing. Propolis is a natural ingredient that has broad-spectrum antibacterial activity and does not cause bacterial resistance. This study aimed to assess the antibacterial activity of carbonated hydroxyapatite after being incorporated with propolis against Aggregatibacter actinomycetemcomitans. Carbonated hydroxyapatite was embedded into four different concentrations of propolis solution (2.5%, 5%, 7.5%, and 10%). An antimicrobial assay against Aggregatibacter actinomycetemcomitans was done using the disc diffusion test method. The inhibition zone was measured to determine the antibacterial ability of the specimens. The inhibition zone was found on the carbonated hydroxyapatite incorporated with propolis at all concentrations. Carbonated hydroxyapatite incorporated with 10% propolis showed the largest inhibition zone. Data analysis using the Kruskal–Wallis test showed a significant difference between the groups tested (p <.05). In conclusion, carbonated hydroxyapatite incorporated with propolis has antibacterial activity against Aggregatibacter actinomycetemcomitans

Treatment of Osseous Defects after Mandibular Third Molar Removal with a Resorbable Alloplastic Grafting Material: A Case Series with 1- to 2-Year Follow-Up.

Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.

Evaluation of poly lactic-co-glycolic acid-coated β-tricalcium phosphate for alveolar ridge preservation: A multicenter randomized controlled trial.

Alveolar ridge preservation via socket grafting (ARP-SG) is indicated to attenuate physiologic alveolar bone resorption as a consequence of tooth extraction. However, a specific bone grafting material that is patently superior has not been identified yet. The aim of this randomized controlled trial was to evaluate the efficacy of a moldable alloplastic graft, Poly Lactic-Co-Glycolic Acid-Coated β-Tricalcium Phosphate (PLGA-β-TCP), for ARP purposes [Group A] compared to freeze-dried bone allograft (FDBA) particles covered with a rapidly absorbable collagen dressing (RACD) (Group B) in function of a panel of radiographic, histomorphometric, and implant-related outcomes. Patients in need of extraction of a single posterior tooth (premolar or molar) and subsequent replacement with a dental implant were recruited and randomly allocated into one of the two treatment groups. Follow-up visits took place at 1, 2, 4, 8, and 16weeks. Cone-beam Computed Tomography (CBCT) scans were obtained at baseline and at 16weeks. Sites were re-entered at 20weeks for bone core biopsy harvesting and subsequent implant placement. After delivery of the final implant-supported restoration, follow-up visits were scheduled at 6 and 12 months to monitor peri-implant tissue health and marginal bone levels using standardized intraoral periapical radiographs. A total of 45 patients were initially enrolled in the study, of whom 43 received an implant and 32 completed the study. Healing was uneventful in all sites after ARP-SG and implant placement. No site required bone augmentation to allow for implant placement. CBCT scan analyses showed no statistically significant differences between groups in terms of reduction of horizontal width, midbuccal / midlingual height and ridge volume. Histomorphometric assessments revealed a statistically significant difference between both groups in terms of mineralized tissue formation (Group A=27.0% ± 22.1%versus Group B=38.2% ± 12.5%; P<0.05). On the contrary, no significant differences were observed regarding percent of remaining bone grafting material and non-mineralized tissue. No implant failed throughout the study period and marginal bone level change was negligible in both groups. Although a higher proportion of mineralized tissue was associated with the use of FDBA+RACD compared to PLGA-β-TCP alone, both ARP-SG approaches rendered comparable outcomes in terms of maintenance of alveolar bone dimensions, feasibility of implant placement, implant survival, and peri-implant bone level stability up to 12 months post-loading.

Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair

Background: Ultimate repair of alveolar defects is a greatchallenge in practical field, many bone graft materials havebeen evolved in the literatures for alveolar defect reconstructionas autogenous, allogenic, xenogenic, and alloplastic grafts[1], autogenous iliac crest bone graft is the gold standardamong other graft materials evaluated. However, the procedureassociated with a potential risk of early complications suchas graft resorption, graft leakage, infection, or graft failure,failure rate is about 30% [2].Objectives: To assess the efficacy of using Platelet RichPlasma (PRP) in alveolar cleft reconstruction; in combinationwith Iliac Crest Bone Graft (ICBG) in comparison to theconventional Iliac Crest Bone Grafting (ICBG).Patients and Methods: 20 patients underwent alveolarcleft reconstruction at the age of mixed dentition over a 3-year's period; their mean age was 8.8±2.3 years years andtheir mean post-operative follow-up was 13.4 months. Ofthese, 10 patients treated with ICBG combined with PRP(Group I), and 10 patients repaired by ICBG alone Group II(control group) results were assessed by rating the radiographsobtained 3, 6, and 12 months post-operatively according tocone beam CT (CBCT) volume and density assessment.Results: Alveolar cleft repairs using PRP combined cancellousbone (Group I) were 90 percent successful, alveolarcleft repairs using cancellous bone (Group I) were 70 percentsuccessful as regard; bone resorption reduction, bone volumegaining and improved bone density in CBCT at 3, 6, and 12months post-operative with decreased post-operative complicationrates.Conclusion: Application of PRP enhances bone formationin alveolar clefts when admixed with autologous bone graftharvested from the iliac crest as it leads to early bone formation,increased bone density, decreases bone resorption, low infectionrate and least post-operative complications.

Consensus of the Amapá society of implantodontics on the criteria for choosing a bone graft.

A bone graft may be used in a variety of clinically practiced implant surgeries, namely, guided bone regeneration, extraction socket preservation or reconstruction, ridge augmentation, and sinus membrane elevation. The bone graft is of various types depending on the material, for instance, autogenous bone graft, allograft, xenograft, alloplastic graft, and autogenous bone graft with demineralized dentin matrix, which may be used alone or with other materials. Bioactive agents that promote bone formation, such as recombinant human bone morphogenetic protein-2 (rhBMP-2), have been shown to exhibit a clinically beneficial effect on bone regeneration. Here, we intend to present surgical guidelines for bone grafts and criteria for selection of bone graft materials by referring to evidence-based studies and recent lectures on the subject of ‘bone grafts for implant dentistry’ at the Amapá society of implantodontics, 2020.

Effects of alloplastic graft material combined with a topical ozone application on calvarial bone defects in rats.

This study presents the evaluation of the damage in the bone tissue resulting from a calvarial defect in rats and the efficiency of exposure to an ozone application with an alloplastic bone graft on the calvarial bone damage. Wistar male rats (n = 56) were divided into four groups: a control group (n = 14), defect and ozone group (n = 14), defect and graft group (n = 14), and defect, graft, and ozone group (n = 14). Under anaesthesia, a circular full-thickness bone defect was created in all groups, and the experimental groups were further divided into two sub-groups, with 7 rats in each group sacrificed at the end of the 4th and 8th weeks. Bone samples were dissected, fixed in 10% formalin solution, and decalcified with 5% ethylene-diamine-tetraacetic acid (EDTA). After the routine follow-up on tissues, immunostaining of osteopontin and osteonectin antibodies was applied to sections and observed under a light microscope. The control group exhibited osteopontin and osteonectin expression in fibroblasts and inflammatory cells at the end of the 4th week with an acceleration at the 8th week. Ozone administration elucidated new trabecular bone formation by increasing osteoblastic activity. Lastly, our observations underscore that a combination of allograft and ozone application increased the osteoblast, osteocyte, and bone matrix development at the 4th and 8th weeks. Exposure to an ozone application with an alloplastic bone graft on calvarial bone damage may induce osteoblastic activity, matrix development, mature bone cell formation, and new bone formation in rats.

Loading and Release Profile Assay of Carbonated Hydroxyapatite Incorporated with Propolis as Bone Graft Material

Periodontitis can lead to the destruction of the alveolar bone. The loss of the alveolar bone can be treated using carbonated hydroxyapatite (CHA) as a bone graft material. However, CHA is an alloplastic graft whose primary function is to act as a scaffold, but it is unable to stimulate the process of bone regeneration. Carbonated hydroxyapatite is an avascular synthetic material, which will increase the risk of bacterial adhesion on site that can lead to unsuccessful periodontal therapy. The incorporation of propolis into CHA is expected to add antibacterial capability into CHA. Besides its antibacterial property, propolis also has a bone regenerating effect. Mixing CHA with propolis needs to consider the process of loading the active ingredients into the carrier. The release of propolis is expected to occur gradually over a lengthy period. The purpose of this study was to analyze the loading and releasing assay for propolis incorporated with CHA. A propolis solution of 5%, 7.5%, and 10% was each incorporated into 10 mg of CHA. The loading percentage and releasing assay of propolis were measured. The absorbance reading was done at 289 nm using a UV-vis. It was shown that a 10% propolis solution had the highest loading percentage (32.08%), while the 5% propolis solution had the smallest loading percentage (10.63%). The propolis releasing profiles in all concentration groups were similar. The difference in propolis concentration incorporated with CHA affected the loading percentage but did not affect the propolis releasing assay.

Complications of the nasal dorsum reconstruction using autologous or alloplastic grafts: evidence from systematic review and meta-analysis

IntroductionAugmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors. ObjectiveTo investigate the effect of different types of grafts and the association of the income level of the country on surgery complications. MethodsA comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999–2018, to study the incidence of these complications over time. ResultsThe overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I2 < 50%). ConclusionPatients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

Outcomes of a novel alloplastic technique for external auditory canal repair in tympanomastoidectomy.

ObjectiveTo analyze surgical outcomes of a novel alloplastic reconstruction technique for partial external auditory canal (EAC) defects in tympanomastoidectomy.MethodsRetrospective study of 51 patients with cholesteatoma who underwent repair of partial EAC defects during tympanomastoidectomy at a tertiary referral center over 8 years. Nineteen patients were treated with a novel alloplastic graft technique using hydroxyapatite cement and bone pâté for EAC repair. Thirty‐two patients treated with traditional cartilage repair of the EAC served as a control group. The primary outcomes measured were postoperative cholesteatoma recurrence rates, infection rates, and mean air‐bone gap (ABG).ResultsTwenty of the 51 cases (39.2%) were revision surgeries for cholesteatoma recidivism, with a greater proportion of revision surgeries in the alloplastic group (57.9% vs 28.1%, P = .04). There was no significant difference in postoperative cholesteatoma recurrence (P = 1.00) or infection rates (P = .64) between the two techniques, with the alloplastic group experiencing slightly lower rates of recurrence (36.8%) and infection (5.3%) than cartilage repair (37.5% recurrence, 12.5% infection). Mean postoperative ABGs were comparable between the alloplastic (21.5 dB) and cartilage group (26.0 dB, P = .10).ConclusionsComposite alloplastic and bone pâté reconstruction is an effective technique to repair partial EAC defects in tympanomastoidectomy, with comparable postoperative hearing outcomes and no increased risk of cholesteatoma recurrence or infection compared to traditional cartilage repair. Recidivism rates were relatively high in both groups, likely due to the high rate of revision surgeries and aggressive nature of cholesteatoma within the cohort.Level of EvidenceLevel 3B.

Implementación de procuramiento de plaqueta ósea para cranoplastia en pacientes neuroquirúrgicos en hospital San Pablo de Coquimbo

La craneoplastia para pacientes con cranectomia descompresiva es un procedimiento habitual en neurocirugía. El material con el que se realiza la reparación es un tema controvertido, actualmente la alternativas para este proce-dimiento son a través de hueso autologo o injertos aloplástico. De las alternativas aloplásticas se encuentran los metales como el titanio, las cerámicas y los polímeros, estos últimos son los más utilizados y con mejor resultado. Considerando que el hueso autólogo, el cual requiere un sistema de almacenaje a través de criopreservación y a través de la esterilización con rayos gamma, es una alternativa efectiva y con evidencia científica de seguridad de su uso. Se describe en este trabajo como se implementa el procedimiento de procuramiento e implante de este tipo de plaqueta en un hospital de mediana complejidad (Hospital San Pablo de Coquimbo), discutiendo cada uno de los procesos definidos. Considerando la etapa desde la obtención del hueso hasta la reinstalación, con seguridad y cum-pliendo estandares de seguridad. Dentro del analisis se determina los costos asociados al proceso de procuramiento e implante, comparandondola con las otras alternativas metálicas y de polímeros determinando el procuramiento de hueso autológo a través de la criopreservación como la de mayor costo efectividad.

TnR Nasal Mesh와 비강저 및 하비도 피판을 이용해 치유한 비중격 천공 1예

Nasal septal perforation is the destruction of the septal cartilage, bone, and mucosa due to previous septal surgeries, inflammation, trauma, drugs or malignancy. The surgical closure of nasal septal perforation is a challenging part. Many surgical techniques have been reported, but there is no standardized surgical method for treating septal perforation. We encountered a 63-year-old patient with a septal perforation. In this study the experiences with a new surgical material for closure of large perforations of the nasal septum are presented. This report suggests a new surgical technique of repairing septal perforation using a nasal floor and inferior meatus (NFIM) flap with TnR Nasal Mesh® as an alloplastic graft material. (J Clinical Otolaryngol 2020;31:98-102)

CBCT analysis of bone density in bicortical defects after augmentation with alloplastic and xenogeneic bone substitutes: A study on domestic pigs

Background/Aim. A significant benefit in bicortical defects healing can be achieved by guided tissue and guided bone regeneration. The aim of this study was a cone-beam computed tomography (CBCT) radiographic bone density analysis of bicortical defects healing when treated with guided bone regeneration and two bone substitutes ? bovine xenograft and alloplastic bone substitute. Methods. The research was performed on domestic pigs in two phases. In the first phase, extraction of all teeth in the intercanine sector was performed in the lower jaw and postextraction wounds were sutured. In the second phase, after the period required for healing, bicortical defects were formed ? following the elevation of mucoperiosteal flaps from the vestibular and lingual side in the area of the previously extracted teeth, surgical removal of the cambium layer of periosteum was performed in the area of future defects with sharp surgical scissors and curette. Two defects, 10 mm in diameter, on the left and right side of the medial line were formed and filled with alloplastic bone substitute on the left and xenograft on the right side afterward. After augmentation, the defects were covered by a collagen resorptive membrane on both sides, and the flap was repositioned and sutured. After 12 weeks, experimental animals were sacrificed. The surrounding native bone was used as a control. Results. Analysis of bone tissue density showed a statistically significant difference between the examined bone substitutes (p &lt; 0.01), with a better effect achieved by the use of alloplastic bone substitute. After applying Bonferroni correction, the difference was still statistically significant. Conclusion. Both bone substitutes used in the study showed good osteoconductive properties in the treatment of bicortical defects. Bone tissue density in defects filled with alloplastic bone graft was statistically significantly higher than that in the defects filled with xenograft.

Combination of platelet rich fibrin and carbonate hydroxyapatite alloplastic bone graft as periodontal tissue engineering in management of chronic periodontitis: a case report

Objective:Chronic periodontitis lesions include loss of attachment and bone and are regarded as irreversible. Conventional procedures cannot restore the periodontal tissue to its original form. Periodontal tissue engineering is regenerativemedicine novel therapy by either implanting biomaterials. Platelet Rich Fibrin (PRF) as second generation platelet and Carbonate Hydroxyapatite (CHA) alloplastic bone graft can be used in surgical therapy because ease, inexpensive method and does not need any addition of exogenous compounds and a second surgical site and procedure. This case report aims to evaluate the clinical and radiographic effectiveness combination of both for the treatment of chronic periodontitis.Methods:A 21-year-old female was reported with chief complaint tooth mobility. Initial examination revealed grade two mobility of 35 with 9 mm distobuccal and distolingual pocket depth. The Periapical radiograph revealed a large diffused periapical radiolucency in relation to 35. Periodontal surgery was done and the osseous defect was filled with CHA bone graft and PRF.Results:There was a significant change in pocket depth and grade of mobility six months after surgery to 3 mm and grade one mobility.Radiographs showed resolution of an osseous defect.Conclusion:It was concluded that combined PRF with CHA bone graft can be used to treat chronic periodontitis as simple technique periodontal tissue engineering.

Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study.

Introduction: Immediate placement of implants in a fresh post-extraction socket is an increasingly popular and established treatment option. However, active infection in the extraction site may adversely affect the outcome of this procedure. This study was designed to assess the clinical results of immediate placement of dental implants in infected extraction sockets using a standardized protocol, which included (a) the use of an Er,Cr:YSGG laser for the decontamination of the infected socket prior to implant insertion, and (b) the utilization of an in situ hardening alloplastic bone graft substitute to augment the gap between the implant surface and the labial plate of bone. Patients and Methods: A retrospective record review was used to identify 68 patients who had implants placed as per the described protocol. A total of 126 implants were placed in 68 patients (65 implants in the maxilla, 61 implants in the mandible). The implants were loaded 136 ± 73 days (mean ± standard deviation; range: 37-400 days) after implant placement. Eight patients (16 implants) were subsequently lost to follow up. Results: 105 of the 110 implants (95.45%) placed immediately in the infected sites using the described protocol survived after prosthetic loading. Conclusion: Immediate implant placement in previously infected sites using the protocols mentioned in our study with laser decontamination of the socket, grafting with an in situ hardening alloplastic bone graft material and non-submerged healing shows a similar survival rate to the published success rates for immediate implants placed in non-infected sites.

Three-Dimensional CAD in Skull Reconstruction: A Narrative Review with Focus on Cranioplasty and Its Potential Relevance to Brain Sciences

In patients suffering from severe traumatic brain injury and massive stroke (hemorrhagic or ischemic), decompressive craniectomy (DC) is a surgical strategy used to reduce intracranial pressure, and to prevent brainstem compromise from subsequent brain edema. In surviving patients, cranioplasty surgery helps to protect brain tissue, and correct the external deformity. The aesthetic outcome of cranioplasty using an asymmetrical implant can negatively influence patients physically and mentally, especially young patients. Advancements in the development of biomaterials have now made three-dimensional (3-D) computer-assisted design/manufacturing (CAD/CAM)-fabricated implants an optimal choice for the repair of skull defects following DC. Here, we summarize the various materials for cranioplasty, including xenogeneic, autogenous, and alloplastic grafts. The processing procedures of the CAD/CAM technique are briefly outlined, and reflected our experiences to reconstruct skull CAD models using commercial software, published previously, to assess aesthetic outcomes of regular 3-D CAD models without contouring elevation or depression. The establishment of a 3-D CAD model ensures a possibility for better aesthetic outcomes of CAM-derived alloplastic implants. Finally, clinical consideration of the CAD algorithms for adjusting contours and their potential application in prospective healthcare are briefly outlined.

Management of temporomandibudar joint ankylosis with costo-chondral graft application: Case report and review of literature

Introduction: Temporomandibular joint (TMJ) ankylosis is one of the most disruptive anomaly that affects the masticatory system and is referred as permanent movement disfunction of the mandible caused by bilateral or unilateral fibrous or bony adhesions and create problems. The etiology is congenital or idiopathic and include trauma, arthritis, infection, previous TMJ surgery etc. Management requires extensive resection of the ankylotic mass and reconstruction of the ramus-condyle unit with autogenous or alloplastic grafts. Most of the time, combination of surgical treatment with physiotherapy is needed in order to achieve maximum rehabilitation and functionality of the mandible.

Bilateral radicular cyst of mandible-mimicking odontogenic keratocyst treated using alloplastic calcium phosphate bone cement: An unusual case report

Inflammatory dental cysts of mandible are an incessant group of osteolytic lesions arising from the odontogenic epithelium having uncharacteristic appearances. The radicular cyst is, by far, the most comprehended inflammatory jaw cyst found mostly at the apices of the tooth (periapical cyst), lateral surface of the roots (lateral radicular cyst) and remains in the jaw after the removal of the offending tooth (residual cyst). They advance sluggishly and asymptomatically unless infected. Because of this, they can extent to big dimensions. Although bilateral symmetrical representation of these cysts is rare, many times, it is baffling to segregate radicular cysts from the obligatory preexisting chronic periapical periodontitis lesions or benign asymptomatic, osteolytic neoplasms radiographically, and hence, may create a challenge for the diagnosis. Herein, we describe the case of a 45-year-old female patient who presented with pain over the right and left side of the mandible. Orthopantomogram showed large, well-defined, corticated, and unilocular radiolucencies over the bilateral molar region. Fine-needle aspiration cytology was performed, and the patient was treated with beta-lactam antibiotics trailed by surgical enucleation of cystic sac, extraction of the transgressing tooth, and rehabilitation using the alloplastic graft as bone void filler. The patient responded well to prompt systemic antibiotics and local surgical measures with a complete resolution of the infection and spontaneous bone regeneration.

Evaluation of polycaprolactone scaffold for guided bone regeneration in maxillary and mandibular defects: A clinical study.

Objective:This study was carried out to assess bone regeneration following the use of polycaprolactone (PCL) scaffold in maxillary and mandibular osseous defects.Materials and Methods:This prospective study included ten patients with maxillary or mandibular osseous defects present due to enucleation of periapical cysts or alveolar clefts requiring bone grafting and for lateral ridge augmentation that were treated with PCL scaffold. The patients were assessed clinically for pain, swelling, infection, and graft exposure at 1 week, 3rd, and 5th month postoperatively and were also evaluated radiographically for bone fill using intraoral periapical and/or panoramic radiographs at 4th, 6th, and 9th month postoperatively.Results:PCL scaffold was used in a total of six alveolar clefts and three cases of periapical cysts and one case of lateral ridge augmentation. Nine out of ten cases demonstrated wound dehiscence and scaffold exposure in the oral cavity. Radiographically, on comparison to the control regions, all these nine cases failed to demonstrate appreciable bone density gain. Only one case of radicular cyst in the mandible was recorded to have satisfactory healing.Conclusion:Although PCL scaffold has the potential for bone regeneration in osseous defects, the scaffold exhibited marked tendency for dehiscence in intraoral defects that significantly affected bone healing. A long-term study designed with a larger sample size and categorization of the defects is required to assess its efficacy in varied defects. Moreover, comparative evaluation of PCL and autogenous or alloplastic bone grafting material could provide assenting results.

The Use of a Synthetic Ceramic Graft Mixed with Platelet-Rich Fibrin (PRF) in the Treatment of Bone Defects.An experimental study

The aim of this study is to investigate the effect of alloplatic graft and platelet rich fibrin (PRF) , alone or in combination, on bone regeneration in Wistar rats femural defects. Bone defects were prepared in adults male of 20 Wistar rats. In a group of ten, the defect was filled with synthetic ceramic graft as an alloplastic graft; the others 10 were grafted with this alloplastic graft mixed with PRF. All animals were sacrificed on the 90th postoperative day and the femural bones were removed, histologic sections were prepared and the experimental sites were examined microscopically. Histologic examination revealed more new bone formation in the defects filled with alloplastic graft mixed with PRF than in the defects grafted with alloplastic graft alone. The platelet rich fibrin combination effectively induces new bone formation.

Standard vs customized healing abutments with simultaneous bone grafting for tissue changes around immediate implants. 1-year outcomes from a randomized clinical trial.

Immediate implants have shown risks of esthetic complications. The hypothesis was that a customized healing abutment could improve the peri-implant tissue healing. To evaluate and compare the soft and hard tissue healing around immediate implants that received bone grafting and a customized vs a standard healing abutment. Patients, who required tooth extraction and who received an immediate implant (with an alloplastic graft material) were randomly assigned to a customized or a standard healing abutment group. Clinical and radiographic examinations were taken at baseline, at 4 and 12 months. Twenty-five patients out of 61 were excluded from the study because unsuitable for immediate implantation. In total, 36 patients were randomized in the two groups. There were 17 females and 19 males (age range 23-77). No prosthetic or implant failure was registered during the study period. The Papilla Index was significantly higher in the customized than in the standard group at 4 and 12 months (P = .0002). The bone loss at mesial sites was significantly higher in the control than in the test group (P = .0014). The customized healing abutment group showed the most favorable outcomes (in terms of PI and MBL) in case of immediate implant that received a peri-implant bone grafting procedure.