Anorganic Bone Mineral Research Articles

Maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: A one-year single-blinded randomized controlled trial.

The objective was to assess the one year implant treatment outcome and patient-related outcome measures (PROMs) following maxillary sinus floor augmentation (MSFA) with autogenous bone graft (ABG) from the zygomatic buttress (control) compared with 1:1 mixture of ABG and anorganic porcine bone mineral (APBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients (34 females, 26 males) were randomly allocated to either control or test groups. Outcome measures included survival of suprastructures and implants, implant stability quotient, health status of peri-implant tissue, peri-implant marginal bone loss, frequency of complications, and PROMs using Oral Health Impact Profile-14 combined with questionnaire assessing patient perception of peri-implant soft tissue, prosthetic solution, implant function, and implant treatment outcome using visual analogue scale. Mean differences were expressed with standard deviation and 95% confidence interval. Level of significance was .05. All suprastructures and implants were well-functioning after one year of functional implant loading. There was no significant difference between control and test groups in any of the applied outcome measures. The implant stability significantly increased from implant placement to abutment connection within all groups (p < .001). High patient satisfaction and significant improvement in oral health-related quality of life was also reported within all groups. This study demonstrates that MSFA with composite grafts containing minimal amounts of ABG reveals comparable implant treatment outcomes as compared with ABG alone, after one year of functional implant loading. Extensive ABG harvesting in conjunction with MSFA therefore seems not to be needed.

Immediate placement and loading of implants with laser-microgrooved collar in combination with an anorganic porcine bone mineral matrix in the esthetic zone. Twelve-month results of a prospective multicenter cohort study.

Many techniques have been proposed to address post-extraction ridge resorption, which often represents a concern, especially in the esthetic region. The purpose of the present, prospective, multicenter, single cohort study was to investigate, up to 1 year of function, the effectiveness of a protocol for alveolar ridge preservation involving implants with laser-microgrooved surface immediately placed in fresh extraction sockets. Twenty eight patients candidate to tooth extraction in the esthetic zone (site 15-25 and 35-45) were treated by immediate placement of a single laser-microgrooved implants with the adjunct of a highly porous anorganic porcine bone mineral matrix and a collagen wound dressing. Peri-implant marginal bone level (MBL) was evaluated at time of loading, 3 and 12 months after loading. Gingival index, plaque index, probing depth, and bleeding on probing were measured at 3, 6, and 12 months after loading. Dimensional changes at implant sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Implant aesthetic score (IAS) as well as patients' post-operative quality of life were also evaluated at 12 months. Comparisons between data relative to thick and thin gingival phenotypes were made using Student's t-test or Mann-Whitney test, as appropriate. The significance level was set at p = 0.05. No patient dropped out, and 28 implants were evaluated at 12 months post-loading. The overall MBL was found to be 0.92 ± 1.11 mm. Volumetric analysis of superimposed models showed an alveolar bone tissue displacement at the buccal aspect of -0.57 ± 0.52 mm in thin phenotypes and -0.46 ± 0.31 mm in thick phenotypes (p = 0.58, unpaired Student's t-test). No signs of soft tissue recession or esthetically unpleasant buccal gingiva were reported. The clinical protocol herein employed showed benefits in maintaining marginal bone levels and soft tissue contour around post-extraction implants in the esthetic zone.

Comparing bone tissue engineering efficacy of HDPSCs, HBMSCs on 3D biomimetic ABM-P-15 scaffolds in vitro and in vivo

Human bone marrow mesenchymal stem cells (HBMSCs) has been the gold standard for bone regeneration. However, the low proliferation rate and long doubling time limited its clinical applications. This study aims to compare the bone tissue engineering efficacy of human dental pulp stem cells (HDPSCs) with HBMSCs in 2D, and 3D anorganic bone mineral (ABM) coated with a biomimetic collagen peptide (ABM-P-15) for improving bone-forming speed and efficacy in vitro and in vivo. The multipotential of both HDPSCs and HBMSCs have been compared in vitro. The bone formation of HDPSCs on ABM-P-15 was tested using in vivo model. The osteogenic potential of the cells was confirmed by alkaline phosphatase (ALP) and immunohistological staining for osteogenic markers. Enhanced ALP, collagen, lipid droplet, or glycosaminoglycans production were visible in HDPSCs and HBMSCs after osteogenic, adipogenic and chondrogenic induction. HDPSC showed stronger ALP staining compared to HBMSCs. Confocal images showed more viable HDPSCs on both ABM-P-15 and ABM scaffolds compared to HBMSCs on similar scaffolds. ABM-P-15 enhanced cell attachment/spreading/bridging formation on ABM-P-15 scaffolds and significantly increased quantitative ALP specific activities of the HDPSCs and HBMSCs. After 8 weeks in vivo implantation in diffusion chamber model, the HDPSCs on ABM-P-15 scaffolds showed extensive high organised collagenous matrix formation that was positive for COL-I and OCN compared to ABM alone. In conclusion, the HDPSCs have a higher proliferation rate and better osteogenic capacity, which indicated the potential of combining HDPSCs with ABM-P-15 scaffolds for improving bone regeneration speed and efficacy.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study.

This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials. Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05. A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction. Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

I-Factor™ Bone Graft vs Autograft in Anterior Cervical Discectomy and Fusion: 2-Year Follow-up of the Randomized Single-Blinded Food and Drug Administration Investigational Device Exemption Study.

i-Factor™ Bone Graft (Cerapedics Inc, Westminster, Colorado) is a composite bone substitute material consisting of P-15 synthetic collagen fragment adsorbed onto anorganic bone mineral suspended in an inert biocompatible hydrogel carrier. A pivotal, noninferiority, US FDA Investigational Device Exemption study demonstrated the benefits of i-Factor™ compared to local autograft bone in single-level anterior cervical discectomy and fusion at 1-yr postoperative. To report 2-yr follow-up. Subjects randomly received either autograft (n =154) or i-Factor™ (n =165) in a cortical ring allograft and followed using radiological, clinical, and patient-reported outcomes. At 2 yr, the fusion rate was 97.30% and 94.44% in i-Factor™ and autograft subjects, respectively (P= .2513), and neurological success rate was 94.87% (i-Factor™) and 93.79% (autograft; P= .7869). Neck Disability Index improved 28.30 (i-Factor™) and 26.95 (autograft; P= .1448); Visual Analog Scale arm pain improved 5.43 (i-Factor™) and 4.97 (autograft) (p = .2763); Visual Analog Scale neck pain improved 4.78 (i-Factor™) and 4.41 (autograft; P= .1652), Short Form-36 (SF-36v2) Physical Component Score improved 10.23 (i-Factor™) and 10.18 (autograft; P= .4507), and SF36v2 Mental Component Score improved 7.88 (i-FactorTM) and 7.53 (autograft; P= .9872). The composite endpoint of overall success (fusion, Neck Disability Index improvement >15, neurological success, and absence of re-operations) was greater in i-Factor™ subjects compared to autograft subjects (69.83% and 56.35%, respectively, P= .0302). Twelve (7.45%) i-Factor™ subjects and 16 (10.53%) autograft subjects underwent re-operation (P= .3411). There were no allergic reactions associated with i-Factor™. Use of i-Factor™ in anterior cervical discectomy and fusion is effective and safe, and results in similar outcomes compared to local autograft bone at 2 yr following surgery.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study.

This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials. Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05. A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction. Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

Safety and Efficacy of i-FACTORTM Bone Graft in Anterior Cervical Discectomy and Fusion: A Prospective, Randomized, Controlled, Multi-Center, Investigational Device Exemption Study

Introduction The objective of the study was to evaluate i-FACTOR Putty and local autologous bone in a non-inferiority model when applied in instrumented ACDF using a structural allograft ring in subjects with cervical degenerative disc disease. I-FACTOR Putty is a composite bone graft material consisting of a synthetic peptide (P-15) adsorbed onto anorganic bone mineral (ABM). The P-15 fragment is a short chain peptide that mimics a cell binding domain of Type I collagen, that facilitates cell attraction, attachment and activation on the ABM scaffold. Material and Methods A prospective, randomized, controlled, multi-center trial was designed to investigate the safety and efficacy of i-FACTOR Putty against an autograft control group. The pre-determined statistical plan was that the i-FACTOR Putty was non-inferior to autologous bone. Twelve-month evaluations were considered to be the primary endpoint. Primary endpoints chosen for the purpose of this study included radiographic evidence of fusion, neurological, outcomes, functional outcomes, and assessment of complication rates. A blinded, independent third party was utilized to assess safety, radiologic outcomes, and neurologic outcomes. Adult patients with radiographic evidence of degenerative disc disease and with evidence of a history of arm/shoulder pain, decreased reflexes, decreased strength, and/or abnormal sensation were randomized for inclusion in this trial. Surgeons performed an anterior cervical discectomy. The control arm received an allograft ring filled with autologous bone. The investigational arm received an allograft ring filled with i-FACTOR Putty. Successful arthrodesis was based upon radiographic examinations and neck disability index (NDI) was scored as the absolute difference between the baseline and the 12-month scores. Neurological status was determined by comparing the preoperative status to maintenance or improvement over the twelve-month period. Adverse outcomes were also assessed. Overall success was judged by success in all primary endpoints. Results A total of 313 patients participated in the study (161 pts.-i-FACTOR Putty: 152 pts.-Autologous bone). Preoperative patient demographics were statistically similar in both populations. The study demonstrated the non-inferiority of i-FACTOR Putty compared with autologous bone for fusion status, change in NDI, and neurological success at 12 months. Fusion rates were 89% in the i-FACTOR Putty group and 86% in the Autologous bone group ( p = 0.0004 for non-inferiority test). NDI scores improved a mean of 29 points in the i-FACTOR Putty group and 27 points in the Autologous bone group ( p &lt; 0.0001 for non-inferiority test). The neurological success rates was 94% in the i-FACTOR Putty group and 93% in the Autologous group ( p &lt; 0.0001 for non-inferiority test). The proportion of subjects with any adverse event at 12 months was not different between both groups ( p = 0.8814). The overall success rate was significantly higher in the i-FACTOR Putty group than the Autologous bone group. The proportion of subjects who achieved fusion success, NDI success, neurological success, and safety success was 69% in the i-FACTOR Putty group and 58% in the Autologous bone group ( p = 0.0382). Conclusion In summary, the above data strongly support the safety and effectiveness of i-FACTOR Putty for its anticipated intended use. The i-FACTOR Putty subjects demonstrated a high rate of fusion, improvement in pain and function, similar adverse event rates to the Control group, and a low rate of subsequent surgeries or device-related adverse events.

Porcine anorganic bone mineral for guided bone regeneration in dental surgeries. Part II: In vivo animal study and human case study

Event Abstract Back to Event Porcine anorganic bone mineral for guided bone regeneration in dental surgeries. Part II: In vivo animal study and human case study Hui-Chen Chen1, Natsuyo Shishido Lee1, Debbie Yuen1 and Shu-Tung Li1 1 Collagen Matrix, Inc., Research and Development, United States Introduction: The development and in vitro characterization of the Porcine Anorganic Bone Mineral (PABM) were presented in part I of this series. In part II we summarize the results from a canine intrabony defect model to validate the characteristics of PABM as an effective bone conductive matrix in supporting bone growth and regeneration. The use of PABM for maxillary bone augmentation in sinus lifting and socket bone augmentation in humans is presented. Methods: In Vivo Intrabony Defect Study in Canines: Five beagle dogs had the third pre-molars (P3) extracted from the mandible. After 14 weeks post-extraction healing, each animal had a bilateral defect created, filled with PABM and covered with a marketed collagen membrane (MatrixDerm®, Collagen Matrix, Inc.). At pre-determined time points (4, 8 and 12-weeks), explants were collected, fixed, and processed for histological analysis. Key parameters evaluated included cellular responses, bone healing activity and residual implant material. Human Case Studies: Case 1 was a maxillary sinus GBR procedure, using PABM and a collagen membrane (MatrixDerm®, Collagen Matrix, Inc.), performed on a 50-year-old female patient (See Fig. 2 for details of the procedure). Case 2 was a bone augmentation in a socket extraction site on a 65-year-old male. The defect site was filled with PABM, covered with a collagen membrane (MatrixFlex®, Collagen Matrix, Inc.) and sutured in place. Implant placement was performed 5 months post grafting and healing was uneventful. The tooth was fully restored (photos not shown). Results and Discussion: In Vivo Intrabony Defect Study in Canines: Histologically, the total amount of bone and mature lamellar bone increased over time. Implantation of PABM supported bone regeneration (Fig. 1). The amount of implant material decreased slightly over the course of the study. PABM was nonirritant at all time intervals. Human Case Study: Figure 2 showed an example of use of PABM and collagen membrane to augment maxillary bone defect. The quality and maturity of bone formation at 6 months were adequate for implant placement and final restoration. The clinical cases presented here demonstrate that the combination of PABM and collagen membrane can work in various dental implant surgeries requiring GBR procedures. Conclusion: The use of a bone conductive matrix in conjunction with a membrane for GBR procedure has become a prerequisite step in the overall success of dental implantology. Our overall goal is to develop an ideal bone conductive matrix that will be accessible to clinicians. The in vitro characterization, animal study and human case studies presented here have demonstrated that PABM can fulfill the requirements for GBR applications. The animal study was conducted at NAMSA. We thank Dr. John JH Choi and Dr. Cory Wanatick for performing the clinical case studies. Keywords: Bone Regeneration, in vivo, biomedical application, Bone repair Conference: 10th World Biomaterials Congress, Montréal, Canada, 17 May - 22 May, 2016. Presentation Type: General Session Oral Topic: Bone substitutes in clinics Citation: Chen H, Lee N, Yuen D and Li S (2016). Porcine anorganic bone mineral for guided bone regeneration in dental surgeries. Part II: In vivo animal study and human case study. Front. Bioeng. Biotechnol. Conference Abstract: 10th World Biomaterials Congress. doi: 10.3389/conf.FBIOE.2016.01.02705 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Mar 2016; Published Online: 30 Mar 2016. Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Hui-Chen Chen Natsuyo Shishido Lee Debbie Yuen Shu-Tung Li Google Hui-Chen Chen Natsuyo Shishido Lee Debbie Yuen Shu-Tung Li Google Scholar Hui-Chen Chen Natsuyo Shishido Lee Debbie Yuen Shu-Tung Li PubMed Hui-Chen Chen Natsuyo Shishido Lee Debbie Yuen Shu-Tung Li Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Porcine anorganic bone mineral for guided bone regeneration in dental surgeries Part I: Development and in vitro characterization

Event Abstract Back to Event Porcine anorganic bone mineral for guided bone regeneration in dental surgeries Part I: Development and in vitro characterization Hui-Chen Chen1, Debbie Yuen1 and Shu-Tung Li1 1 Collagen Matrix, Inc., Research and Development, United States Introduction: Guided Bone Regeneration (GBR) has reached the state of standard care in Dental Implantology. In this procedure, a bone conductive matrix is placed in the defect site and a cell barrier membrane is then placed over the bone conductive matrix to prevent the infiltration of epithelial and connective tissue cells. Clinical outcomes from this procedure have been reproducible and bone regeneration is generally satisfactory for implant placement in 4 to 6 months. It is desirable that the bone conductive matrix be resorbable, porous, having a structure similar to the native bone mineral to guide and support bone growth and facilitate in vivo remodeling. In part I of this series we present the development and in vitro characterization of a newly developed Porcine Anorganic Bone Mineral (PABM) as a bone conductive matrix to guide bone regeneration in GBR procedures. Results of in vivo study in a canine intrabony defect model as well as human case studies are presented in Part II. Materials: PABM was isolated from epiphysis of the porcine femoral head. The adhering tissues were removed and the bone was ground into particles. After thorough rinsing with hot water (90-100°C) to remove blood and water soluble materials, the particles were subjected to a combination of chemical and heat treatment to remove organic moieties without significantly change the native mineral structure. The PABM thusly prepared was ground, sieved, packaged and sterilized. Methods: SEM: Micrographs were recorded using a scanning electron microscope (JEOL Ltd. JSM 6100). Pore size was measured from SEM images. X-Ray Diffraction (XRD): Analysis was conducted using PHILIPS PW 1710 X-ray diffractometer to obtain key reflections for the identification of mineral structure. FTIR Spectroscopy: Samples were analyzed using Perkin Elmer 983G FTIR spectrophotometer to determine the functional groups. Volume Fill Measurement: A unit weight of mineral material was poured into a small volumetric cylinder and the volume occupied by the mineral was recorded and expressed as cm3/g. Results and Discussion: Fig. 1 revealed the porous structure and rough surface appearance of PABM. The majority of macropores are in the range of 0.1mm to 1.0mm. These properties are favorable for cell adhesion and bone conduction. Fig. 2 showed the results of XRD and FTIR spectroscopy performed on PABM. The XRD diffraction pattern is close to the mature native bone diffraction pattern of apatite nature with low degree of crystallinity [1]. The major IR absorption peaks for PABM is consistent with bone mineral structure containing carbonate, including the phosphate ion bands, carbonate ion (CO3) band, and the carbonyl (CO) band. Results from volume fill measurement (Table 1) indicates that PABM provides ample intra- and inter-particle space for osteoconduction and new bone deposition. The percent volume fill decreases with decreasing particle size as some of the pores have lost from the change in particle sizes. Conclusion: The PABM retains the natural mineral structure. It can provide a high degree of osteo-conductivity and yet minimizes the amount of implant material left behind post bone regeneration. These properties are desirable for GBR procedures.

Evaluation of anorganic bovine-derived hydroxyapatite matrix/cell binding peptide as a bone graft material in the treatment of human periodontal infrabony defects: A clinico-radiographic study.

Background:Various bone graft materials have been used in the treatment of periodontal defects. A synthetic bone substitute material composed of P-15 with anorganic bone mineral has been scantly studied. Hence, the present study was aimed to evaluate and compare the efficacy of anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) in human periodontal infrabony defects with that of open flap debridement (OFD) alone.Materials and Methods:A split-mouth, randomized controlled clinical study was designed to investigate the efficacy of ABM/P-15. In this clinical trial, 10 patients having bilateral periodontal infrabony defects were treated either with ABM/P-15 or OFD and followed for a period of 9 months. At baseline and at 9 months probing pocket depth (PPD), relative attachment level (RAL), depth of a defect, and radiographic bone level were measured; and compared between test and control sites.Results:A statistically significant reduction (P < 0.001) in PPD was observed in test sites compared to control sites. Both sites showed a gain in RAL without any significant difference. Similarly, the radiographic evaluation revealed significantly higher radiographic defect fill in test sites as compared to control sites (P < 0.001).Conclusion:ABM/P-15 bone graft material appears to be useful and beneficial in the treatment of human periodontal infrabony defects.

Effects of P-15 Peptide Coated Hydroxyapatite on Tibial Defect Repair In Vivo in Normal and Osteoporotic Rats.

This study assessed the efficacy of anorganic bone mineral coated with P-15 peptide (ABM/P-15) on tibia defect repair longitudinally in both normal and osteoporotic rats in vivo. A paired design was used. 24 Norwegian brown rats were divided into normal and osteoporotic groups. 48 cylindrical defects were created in proximal tibias bilaterally. Defects were filled with ABM/P-15 or left empty. Osteoporotic status was assessed by microarchitectural analysis. Microarchitectural properties of proximal tibial defects were evaluated at 4 time points. 21 days after surgery, tibias were harvested for histology and histomorphometry. Significantly increased bone volume fraction, surface density, and connectivity were seen in all groups at days 14 and 21 compared with day 0. Moreover, the structure type of ABM/P-15 group was changed toward typical plate-like structure. Microarchitectural properties of ABM/P-15 treated newly formed bones at 21 days were similar in normal and osteoporotic rats. Histologically, significant bone formation was seen in all groups. Interestingly, significantly increased bone formation was seen in osteoporotic rats treated with ABM/P-15 indicating optimized healing potential. Empty defects showed lower healing potential in osteoporotic bone. In conclusion, ABM/P-15 accelerated bone regeneration in osteoporotic rats but did not enhance bone regeneration in normal rats.

Effects of Zoledronate on Irradiated Bone In Vivo: Analysis of the Collagen Types I, V and Their Cross-links Lysylpyridinoline, Hydroxylysylpyridinoline and Hydroxyproline

Radiotherapy can lead to a reduction of bone density with an increased risk of pathological fractures. Bisphosphonates may represent a preventive treatment option by increasing the density of anorganic bone mineral. Yet it is unknown how bisphosphonates act on irradiated collagen cross-links, which play an essential role for the mechanical stability of bone. The aim of this study was to evaluate the effects of zoledronate on bone collagens and their cross-links after irradiation. The right femur of 37 rats was irradiated with a single dose of 9.5 Gy at a high dose rate using an afterloading machine. Half of the rats (n=18) received additionally a single dose zoledronate (0.1 mg/kg body weight). Fourteen and 100 days after irradiation the femora were collected for histologic evaluation and determination of the collagen cross-links lysylpyridinoline, hydroxylysylpyridinoline, and hydroxyproline. The collagen types were characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Fourteen days after treatment the lysylpyridinoline levels of all treatment groups were significantly lower compared to the untreated control. After 100 days, in the combined radiotherapy+zoledronate group significantly lower lysylpyridinoline values were determined (p=0.009). Radiotherapy and/or zoledronate did not change significantly the level of hydroxylysylpyridinoline. The concentration of hydroxyproline was 14 days after irradiation significantly higher in the combined treatment group compared to the control. No significant differences were observed 100 days after treatment. Zoledronate does not have the ability to restore the physiological bone collagen cross-link levels after radiotherapy. However, this would be necessary for regaining the physiological mechanical stability of bone after irradiation and therefore to prevent effectively radiation-induced fractures.

Use of Titanium Mesh in Lieu of a Fixation Screw to Stabilize an Autogenous Block Graft: A Case Report

Localized alveolar augmentation is carried out either before, during, or sometimes after implant placement. The placement of autogenous graft as a block or a particulate alone or in combination with an organic bone mineral has been practiced with a great deal of success. The block graft is secured in place with a screw and protected by a membrane. This case report describes the treatment of a female patient with a bucco-lingual bone deficiency grafted with autogenous block and a titanium mesh. Five months later, implant was placed in the grafted area. The definitive prosthesis was cemented 6 months later and followed up for 2 years.

An evaluation of platelet-rich plasma without thrombin activation with or without anorganic bone mineral in the treatment of human periodontal intrabony defects

The efficacy of platelet-rich plasma (PRP) in periodontal regeneration is not well understood and the definite clinical viability of blood derived platelets lacks clarity. Also, the use of thrombin for platelet activation is disputed. Hence, the purpose of this study was to evaluate the efficacy of blood derived platelets without thrombin activation, alone or in combination with bovine anorganic bone mineral (ABM), in the treatment of human periodontal intrabony defects. PRP was prepared using a simple tabletop centrifuge and activated using calcium chloride without the addition of thrombin. This PRP was used alone (in Group A) and in combination with bovine ABM (in Group B) in the treatment of human periodontal angular defects. Both the control and the test groups showed definite improvement in clinical parameters. On comparison, however, there was a statistically significant improvement in the probing pocket depths and relative attachment level in Group B over Group A at 3 and 6 months intervals, whereas at the end of 9 months this difference was not statistically significant. There was no statistically significant difference between the groups with respect to the relative defect depth. Within the limitations of this study and the type of PRP used, i.e. without thrombin mediated activation, it can be concluded that both PRP and PRP combined with bovine ABM results in significant clinical improvement. Albeit statistically insignificant, there is a preponderance of better clinical results with the addition of ABM to PRP. Further studies need to be carried out on a larger sample size to confirm the results of the present study.

Comparative study on the cellular activities of osteoblast-like cells and new bone formation of anorganic bone mineral coated with tetra-cell adhesion molecules and synthetic cell binding peptide

PurposeWe have previously reported that tetra-cell adhesion molecule (T-CAM) markedly enhanced the differentiation of osteoblast-like cells grown on anorganic bone mineral (ABM). T-CAM comprises recombinant peptides containing the Arg-Gly-Asp (RGD) sequence in the tenth type III domain, Pro-His-Ser-Arg-Asn (PHSRN) sequence in the ninth type III domain of fibronectin (FN), and the Glu-Pro-Asp-Ilu-Met (EPDIM) and Tyr-His (YH) sequence in the fourth fas-1 domain of βig-h3. Therefore, the purpose of this study was to evaluate the cellular activity of osteoblast-like cells and the new bone formation on ABM coated with T-CAM, while comparing the results with those of synthetic cell binding peptide (PepGen P-15).MethodsTo analyze the cell viability, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed, andto analyze gene expression, northernblot was performed. Mineral nodule formations were evaluated using alizarin red stain. The new bone formations of each group were evaluated using histologic observation and histomorphometrc analysis.ResultsExpression of alkaline phosphatase mRNA was similar in all groups on days 10 and 20. The highest expression of osteopontin mRNA was observed in the group cultured with ABM/P-15, followed by those with ABM/T-CAM and ABM on days 20 and 30. Little difference was seen in the level of expression of collagen type I mRNA on the ABM, ABM/T-CAM, and ABM/P-15 cultured on day 20. There were similar growth and proliferation patterns for the ABM/T-CAM and ABM/P-15. The halo of red stain consistent with Ca2+ deposition was wider and denser around ABM/T-CAM and ABM/P-15 particles than around the ABM particles. The ABM/T-CAM group seemed to have bone forming bioactivity similar to that of ABM/P-15. A complete bony bridge was seen in two thirds of the defects in the ABM/T-CAM and ABM/P-15 groups.ConclusionsABM/T-CAM, which seemed to have bone forming bioactivity similar to ABM/P-15, was considered to serve as effective tissue-engineered bone graft material.

Simultaneous Vertical Guided Bone Regeneration and Guided Tissue Regeneration in the Posterior Maxilla Using Recombinant Human Platelet-Derived Growth Factor: A Case Report

This clinical case report describes and demonstrates successful use of recombinant human platelet-derived growth factor (rhPDGF-BB) in conjunction with autogenous bone, anorganic bone mineral, and barrier membranes to reconstruct severe alveolar bone defects. A combined sinus augmentation and vertical alveolar ridge augmentation was successfully performed. In addition, a significant amount of periodontal bone gain was achieved in close apposition to a previously denuded root surface, which is significant from a periodontal standpoint, given the possibility of vertical periodontal regeneration.

Anorganic Bone Mineral Coated with Tetra-Cell Adhesion Molecule Enhances Bone Formation in Rabbit Calvarial Defects

This study was performed to evaluate the effect of anorganic bone mineral (ABM) coated with Tetra-Cell Adhesion Molecule (T-CAM) for bone formation in rabbit calvarial defects and compare the capability of bone formation in ABM coated with T-CAM (ABM/T-CAM) to that in commercially available ABM coated with a synthetic peptide (P-15) which mimics the cell-binding domain of type I collagen, PepGen P-15TM. T-CAM composed of four cell adhesion molecules (RGD, PHSRN, EPDIM, and YH) was synthesized and ABM/T-CAM were prepared by absorbing T-CAM on ABM (OsteoGraf/N-300; Densply Friadent Ceramed Corp., USA). Two 9-mm diameter, full-thickness calvarial defects were made in each rabbit parietal bone and sixteen adult male rabbits were used in this experiment. The defects were reconstructed according to four treatment groups: unfilled, BM-grafted, PepGen P-15TM-grafted, and ABM/T-CAM-grafted. The animals were sacrificed at 2 and 4 weeks after surgery for histologic and histomorphometric evaluation. An active new bone formation were observed in the defects of ABM/T-CAM and PepGen P-15TM grafted groups at 2 and 4 weeks of healing in histologic observation. The results of histomorphometric analysis revealed higher new bone formation in ABM/T-CAM-grafted (14.62±0.6% at 2 weeks, 15.33±2.4% at 4 weeks) and PepGen P-15TM-grafted (12.46±1.0% at 2 weeks, 18.14±1.7% at 4 weeks) groups than in unfilled control (7.03±2.3% at 2 weeks, 8.71±3.4% at 4 weeks) and ABMgrafted (6.59±1.7% at 2 weeks, 9.25±0.8% at 4 weeks) groups at 2 and 4 weeks of healing with statistical significance (P&lt;0.01). The results of this study indicated that the immobilizing T-CAM on ABM enhances the capability of bone substitutes to serve as an effective habitat for bone forming cells in vivo. In conclusion, we suggested that this composite graft material, ABM/T-CAM may be served as an effective tissue-engineered bone graft material in osseous reconstructive surgery.

Maxillary Sinus Augmentation Using a Peptide-Modified Graft Material in Three Mixtures: A Prospective Human Case Series of Histologic and Histomorphometric Results

This prospective study assessed vital bone quality and quantity after grafting maxillary sinuses with anorganic bone mineral containing a cell binding peptide (ABM/P-15) in combination with DFDBA (Mix I), hydrogel/ABM/P-15 (Mix II), or PRP (Mix III). Fifteen maxillary sinuses in 12 patients were grafted with the ABM/P-15 mixtures and after 4 to 5 months, cores were taken and analyzed histologically and histomorphometrically. Fifty-nine screw-type implants were placed. Mixes containing a spacer material (Mix I and II) produced greater average vital bone, more mature bone, and more interconnected bone bridges from the cortical (oral) end to the most apical portion, compared to a mix that lacked a spacer material (Mix III). None of the 59 implants failed with any graft material up to 5 months following implant placement. The study demonstrates that new trabecular bone is formed after grafting ABM/P-15 in the sinus floor; that more vital bone is formed when ABM/P-15 is mixed with a spacer material than without; and that implants can be successfully placed.

Enhanced cell attachment and osteoblastic activity by P-15 peptide-coated matrix in hydrogels

The cells in bone grow on a composite matrix made up of mineral and organic (mainly type-I collagen) components. In this study, anorganic bone mineral (ABM) particles were coated with a cell-binding domain of type-I collagen (P-15 peptide) to mimic the bone matrix components and suspended in injectable hyaluronate (Hy) hydrogels. The ABM/P-15/Hy was compared to ABM/Hy—the same matrix without P-15 peptide. Osteoblast-like HOS cells migrated through the hydrogels around ABM/P-15 or ABM particles; however, more cells adhered to ABM/P-15/Hy particles, and the cells formed better surface coverage and had more stress fibers on ABM/P-15/Hy. HOS cells cultured on ABM/P-15/Hy had increased osteogenic gene expression for alkaline phosphatase and bone morphogenetic proteins, and deposited more mineralized matrix. Studies with two different hydrogels (carboxymethylcellulose and sodium alginate) showed similar enhanced cell attachment and mineralization. The studies suggest that the ABM/P-15 in hydrogels can be used as an injectable biomimetic matrix to facilitate bone repair.

PENGGUNAAN BONE GRAFT PADA PERAWATAN KERUSAKAN TULANG PERIODONTAL (Used Bone Graft for Periodontal Defect Treatment)

Generally the signs and symptoms of advances periodontal disease are periodontal pockets formation to alveolar bone defect. Bone defect treated with placement a preparation material to promote new bone formation. Tissue transplantation were developed, to recontsruct bone defect with the placement of bone graft material. This paper will discuss the used of demineralied freeze dried bone allograft (DFDBA) and anorganic bone mineral combined with synthetic 15 amino acid sequence within type I collagen (PepGen P-15) the potential healing of bone defect to enhance the optimum treatment of periodontal disease.