Bone Graft Augmentation Research Articles

The Use of Tooth Derived Bone Graft Materials in Sinus Augmentation Procedures: a Systematic Review.

ABSTRACTObjectivesThe goal of this systematic review was to assess the current literature about sinus augmentation procedure using different types of tooth derived bone graft materials, thorough analysing the outcomes of sinus grafting with tooth grafts compared to sinus grafting with xenografts, allografts and alloplasts by radiography and histomorphometry.Material and MethodsAn electronic search in the MEDLINE (NCBI PubMed and PubMed Central) database was conducted to identify articles concerning application of tooth bone grafts in sinus augmentation. The search was restricted to English language articles published in the last 10 years (December 2009 to March 2019).ResultsIn total, 21 articles were found, out of which 7 met the inclusion criteria and were included in the final synthesis. According to the type of diagnostic tool, data about graft material outcome in sinus was extracted, and included the residual alveolar height, augmented graft height, resorption height as seen in panoramic radiography and histomorphometric analysis of new bone formation and residual graft material.ConclusionsWithin the limitations of our review, we suggest that tooth derived graft materials are as successful as xenografts, allografts and alloplasts in sinus augmentation procedures according to the radiographic and histomorphometric showings. Additional wider research should be conducted in order to determine whether tooth derived graft materials are superior to the currently used materials.

Reshapable hydrogel tissue expander for ridge augmentation: Results of a series of successive insertions at the same intraoral site.

Oral mucosa expansion before ridge augmentation is a procedure to reduce soft tissue exposure and to improve bone graft density and volume after augmentation. This study explored a novel, shapeable hydrogel tissue expander (HTE) in intraoral sites that had undergone previous expansion and surgery. Nine beagle dogs had all premolar teeth extracted and adjacent alveolar bone reduced. After at least 3 months healing hydrogels were placed at 4 sites in each dog: maxilla and mandible, right and left. After 6 weeks of expansion, the hydrogels were removed and measured for volume expansion and physical condition. Punch biopsies were taken of the expanded oral mucosa. After 3 months, a second hydrogel insertion was performed at each of the same sites. After this second expansion cycle, volume and hydrogel condition were recorded. Three dogs received ultrasound imaging of the hydrogels during the second expansion. Necropsy specimens were taken of both expanded and non-expanded oral mucosa. Within 2 weeks after HTE insertion in both first and second insertions, blood flow returned to the pre-insertion level. The first and second insertions resulted in linear oral mucosa gain of 8.13 mm, and 6.44 mm, respectively. First and second insertion hydrogels erupted from 4% of the first expansion sites, and 3% of the second expansion sites. There was no directional migration of the expanding hydrogel at any site. Histology found little inflammatory reaction to any hydrogel implant. Oral mucosa can be consistently and successfully expanded before bone graft for ridge augmentation even at sites with a history of prior surgeries.

Effectiveness of Platelet-Rich Fibrin as an Adjunctive Material to Bone Graft in Maxillary Sinus Augmentation: A Meta-Analysis of Randomized Controlled Trails.

Purpose To date, it remains unknown whether the addition of platelet-rich fibrin (PRF) to bone grafts actually improves the effectiveness of maxillary sinus augmentation. This study aimed to perform a meta-analysis to evaluate the efficacy of PRF in sinus lift. Materials and Methods PubMed, Embase, and the Cochrane Library were searched. Randomized controlled studies were identified. The risk of bias was evaluated using the Cochrane Collaboration tool. Results Five RCTs were included in our meta-analysis. Clinical, radiographic, and histomorphometric outcomes were considered. No implant failure or graft failure was detected in all included studies within the follow-up period. The percentage of contact length between newly formed bone substitute and bone in the PRF group was lower but lacked statistical significance (3.90%, 95% CI, -2.91% to 10.71%). The percentages of new bone formation (-1.59%, 95% CI, -5.36% to 2.18%) and soft-tissue area (-3.73%, 95% CI, -10.11% to 2.66%) were higher in the PRF group but were not significantly different. The percentage of residual bone graft was not significant in either group (4.57%, 95% CI, 0% to 9.14%). Conclusions Within the limitations of this review, it was concluded that there were no statistical differences in survival rate, new bone formation, contact between newly formed bone and bone substitute, percentage of residual bone graft (BSV/TV), and soft-tissue area between the non-PRF and PRF groups. Current evidence supporting the necessity of adding PRF to bone graft in sinus augmentation is limited.

Autografting for B2 Glenoids.

The Walch B2 glenoid is characterized by a biconcave glenoid deformity, acquired glenoid retroversion, and posterior subluxation of the humeral head. Surgical reconstruction of the B2 glenoid is often challenging due to the complexity of the deformity. Bone graft augmentation using humeral head autograft is a valuable adjunct to anatomic total shoulder arthroplasty in the B2 glenoid, particularly in the young, highly active patient with severe glenoid retroversion (>25°–30°). Although this technique affords the ability to correct glenoid version and simultaneously enhances glenoid bone stock, it is technically challenging. The potential for graft-related complications also exists, which may further impact glenoid implant longevity and functional outcome. This review article aims to describe the B2 glenoid morphology, discuss the challenges in managing the B2 deformity, and provide further insight specifically regarding autografting at the time of anatomic total shoulder arthroplasty for reconstruction of the B2 glenoid.

Using concentrated growth factors as an alternative to bone graft material in sinus augmentation to rehabilitate atrophic posterior maxilla

A larger number of senior patients want to eliminate the use of conventional overdenture such as Conventional Complete Denture or Removable Partial Denture and replace it by an Implant-supported fixed prosthesis or at least implant-supported overdenture with the purpose of restoring and improving the masticatory function, aesthetics besides helping them gain confidence to talk and smile. Most of those patients have lost their teeth and been posteriorly edentulous for extended periods of time, causing severe bone resorption and Pneumatized Maxillary Sinus that makes it impossible for conventional dental implant placement. This report reviews two successful cases of rehabilitation of the atrophic posterior maxilla with previous bilateral ridge augmentation in Pneumatized Maxillary Sinuses using solely Concentrated Growth Factors (CGF) without bone graft augmentation with simultaneous implant placement. Where CGF is obtained from the patient's which was collected in blood collection tubes and processed by a special centrifuge device.

Evaluation of Custom made Xenogenic Bone grafts in Mandibular Alveolar Ridge Augmentation versus Particulate bone graft with titanium mesh

Aim: This study was to evaluate clinically and radiographically the volume changes of alveolar ridge grafting using customized xenogenic bone graft.Materials and Methods: A total of 12 patients with mandibular horizontal and vertical alveolar ridge defects ≥ 3 mm were selected. They were divided into 2 groups: Group I (Test Group) included 6 patients in which mandibular alveolar ridges were reconstructed with customized Xenogenic bone graft Smartbone (IBI S.A., Switzerland). Group II (Control Group) included 6 patients in which mandibular alveolar ridges were reconstructed with particulate Xenogenic bone (Smart bone, IBI S.A., Switzerland) grafting to posterior mandibular ridge with titanium mesh was performed. Volume analysis of the changes in alveolar ridge in both Groups were obtained before and four months after the procedure using CBCT. Densitometric analysis of the Postoperative bone formed and compared with native bone. .Results: Four months postoperatively. Measurements made on cone-beam computerized tomograms, four months postoperative showed significance increase in bone volume by 40 % in the area of newly formed bone in Group I (Customized bone) compared with 23% in Control Group. Statistical significant changes was found in the density of newly formed bone four months post-operatively in both Groups, however there was no significant difference in bone density postoperatively between Group I (customized Bone) and Group II (Control).Conclusion: According to the results, the treatment of defective alveolar ridge augmentation of the mandibular ridge with customized xenogenic bone graft Smartbone (IBI S.A., Switzerland) is successful and produces results consistent with the control Group.

Microstructural volumetric analysis of lateral ridge augmentation using differently conditioned tooth roots.

Previous research revealed that autogenous tooth roots may be biologically equivalent to conventional bone grafts for lateral ridge augmentation. However, these analyses were limited to two dimensions, whereas healing is a volumetric process. The present study aimed at volumetrically assessing the microstructure following lateral ridge augmentation using extracted tooth roots. The roots of differently conditioned maxillary premolars (i.e., healthy: PM-C; endodontically treated: PM-E; ligature-induced periodontitis: PM-P) and retromolar cortical autogenous bone (AB) blocks were used for lateral ridge augmentation at chronic-type defects in the lower quadrants of n = 16 foxhounds. At 12weeks, titanium implants were inserted and left to heal for another 3weeks. Tissue biopsies were scanned using microcomputed tomography (μCT), and volumes of interest were separated at the buccal and oral aspects to measure bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and connectivity density (Conn.D). All groups investigated revealed comparable BV/TV, Tb.Th, Tb.Sp, and Conn.D values at either the augmented buccal or pristine oral aspects, respectively. A gradual but heterogeneous replacement of grafts was observed in all groups, but residual PM fragments were particularly noted in PM-C and PM-P groups. Differently conditioned PM and AB grafts were associated with a comparable bone microstructure within the grafted area. The duration of replacement resorption may vary considerably among the subjects. Autogenous tooth roots may serve as potential alternative to AB for localized alveolar ridge augmentation.

Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation for calcaneal fracture: A retrospective analysis of 42 patients

IntroductionThe treatment of intra-articular calcaneal fractures is still complex and controversial. Although open reduction and internal fixation (ORIF) is favored by many authors, several percutaneous techniques have been introduced to reduce complications and to obtain satisfactory clinical and radiological results. Among these percutaneous treatments, balloon reduction and bone graft augmentation is gaining an increasing popularity. Materials and methodsWe retrospectively examined a series of 42 patients treated operatively with a minimally invasive reduction technique using an inflatable bone tamp filled with tricalcium phosphate (calcaneoplasty) for Sander’s type II, III and IV calcaneal fractures between 2010 and 2015. Conventional X-rays and CT scan were performed pre-operatively, at 3 and 12 months post-operatively and at the last-follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland Foot Score (MFS) were used for clinical evaluation. Bohler’s angle and the Score Analysis of Verona (SAVE) were calculated to assess bone reduction. ResultsAll 42 patients were available for clinical and radiographic follow-up at an average of 665 months (range 38–92). At the last follow-up the mean AOFAS score was 82.1 (good) and the mean MFS was 80.8 (good). The mean Bohler’s angle improved from 1.29° pre-operatively to 27.8° at the last follow-up. The SAVE highlighted good and excellent results in 30 (72%) patients. There were only 3 (7.1%) cases of superficial skin infection with only 6 (14.2%) patients complaining of residual pain. No cases of adverse reaction or deep infection were observed. ConclusionsCalcaneoplasty appears to be a valid option of treatment for calcaneal fractures and a reliable alternative to ORIF. This technique allows stable fracture reduction and early weight-bearing combined with good clinical and radiological results and few complications.

Comparison of allogeneic and autogenous bone grafts for augmentation of alveolar ridge defects-A 12-month retrospective radiographic evaluation.

ObjectivesThe aim of this study was to compare three‐dimensional alterations following the use of autogenous versus allogeneic onlay grafts for augmentation at single tooth defects.Materials and methodsAlveolar bone width at specific implant sites were assessed using sagittal and cross‐sectional CBCT images prior grafting and at three subsequent time points. Twenty‐one patients received autogenous bone blocks harvested from the retromolar region and another 21 patients received freeze‐dried cancellous allogeneic bone blocks.ResultsThe vertical and horizontal dimensions did not significantly differ between autogenous and allogeneic bone grafts at any time point. In addition, there were no statistically significant differences in graft remodeling rates between autogenous (mean shrinkage rate after 12 months: 12.5% ± 7.8%) and allogeneic onlay grafts (mean shrinkage rate after 12 months: 14.4% ± 9.8%).ConclusionsFreeze‐dried cancellous allogeneic bone blocks showed equivalent volumetric shrinkage rates as autogenous bone blocks when used for treating circumscribed bone defects classified as Type‐II to Type‐IV according to the ITI‐treatment guide categories. Therefore, it is not necessary to over‐contour the alveolar ridge when using allogeneic blocks for treating single tooth defects, but to apply the same procedure as when using autogenous blocks.

Periprosthetic femoral nonunions treated with internal fixation and bone grafting

IntroductionPeriprosthetic femoral nonunions (PPFN) have a reported incidence of 3–9%. Literature on PPFN management is scarce. The study aim was to review combined results of two academic teaching hospitals using comparable PPFN treatment strategies. Materials and MethodsA retrospective review was conducted of all patients treated for a PPFN between February 2005 and December 2016. All patients treated with internal fixation for a PPFN with complete clinical and radiological follow-up until healing were included. Nineteen patients were identified (mean age 71.2 years, range 49–87). Treatment consisted of failed hardware removal, debridement, reduction, and rigid internal fixation with or without bone graft. For revision PPFN surgery, use of dual-plating and bone graft augmentation was common. ResultsEighteen of 19 patients (94.7%) progressed to osseous union. One patient was converted to a total femoral prosthesis. No patients were lost to follow-up. All were ambulatory at last follow-up and mean follow-up was 39.8 months. Fourteen patients (73.7%) united after our index nonunion surgery at mean 9.8 months. Five patients (26.3%) required revision surgery after our index nonunion treatment and in 4 of these cases union was achieved at mean 18.0 months. ConclusionsOur results suggest debridement, revision of fixation and liberal use of bone grafting can lead to reliable healing in the majority of PPFNs. For those PPFNs that do not heal following initial treatment, good healing potential persists with an additional procedure. Level of EvidencePrognostic Level III.

Augmentation versus No Augmentation for Immediate Postextraction Implants.

Purpose To assess the effects of augmentation versus no augmentation in patients restored with immediate postextraction single-tooth implants on implant failure and patient satisfaction. Materials and methods We searched the Cochrane Oral Health Group Trial Register, Cochrane Central Register of Controlled Trials, MEDLINE, and the WHO International Clinical Trial Registry Platform (22 March 2017). Two reviewers independently assessed trials for inclusion and risk of bias, extracted data, and checked for accuracy. We have expressed results as risk ratio or mean differences, together with their 95% confidence intervals. Results We included six studies (287 participants). Two trials compared no augmentation versus bone graft augmentation and reported no implant failures in both groups after a follow-up period of 6 months (20 implants) and 1 year (34 implants). One trial compared bone graft augmentation versus membrane augmentation and reported no difference in implant failure between both groups after 6 months (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.06 to 15.31) or 1 year of follow-up (RR 0.33, 95% CI 0.01 to 7.86), and no implants were lost after 3 years. Three trials compared membrane augmentation versus combined bone graft and membrane augmentation, and there was no difference between the groups after six months of follow-up in implant failure (RR 5.13, 95% CI 0.63 to 41.93) or after 1 year (RR 0.38, 95% CI 0.02 to 9.05). There was insufficient evidence regarding patient satisfaction in all the included trials. Conclusions In patients restored with immediate postextraction single-tooth implants, there is insufficient evidence to recommend simultaneous augmentation or a certain augmentation protocol to enhance implant survival and patient satisfaction. This trial is registered with PROSPERO (CRD42017054439).

Effects of systemic erythropoietin treatment and heterogeneous xenograft in combination on bone regeneration of a critical-size defect in an experimental model

The aim of the present study was to evaluate the effects of systemic EPO treatment alone or in combination with xenogenic bone graft augmentation on bone regeneration. Eleven adult male Sprague–Dawley rats were used in the present study. Rats were subjected to bilateral 5 mm critical size bone defects on the parietal bones under general anaesthesia. Right parietal bone defects were augmented with xenogenic bone graft and left parietal bone defect was left empty. Rats were randomly assigned for one of the two groups. One group of rats received (i) vehicle (n = 6) and other group received (ii) EPO (500IU kg/day) (n = 5). EPO treatment was continued for 28 days. Vascularization was analysed by immunohistochemical staining of CD31 (PECAM-1) and new bone formation was histomorphometrically evaluated. Xenogenic graft augmentation enhanced bone formation and vascularization significantly in either vehicle or EPO treated groups (p < 0.05). Histomorphometric results of angiogenesis was similar in the EPO treated group and the control group. However, angiogenesis was significantly higher in the combination of systemic EPO treatment with graft augmentation than graft augmentation alone (p < 0.01). Graft augmentation for treatment of critical size bone defects seems essential for proper bone healing. Results of the present study suggest that EPO potentiates the regenerative processes of augmented bone defects.

Conservative surgical management of simple monostotic fibrous dysplasia of the proximal femur in a 19-year-old basketballer: a case report

BackgroundFibrous dysplasia is a rare benign, intramedullary, fibro-osseous lesion. It is thought to be a developmental disorder of bone maturation where normal lamellar bone is replaced by irregular trabecular bone ensnared with fibrous dysplastic tissue that is unable to complete maturation resulting in significant loss of mechanical strength. This, together with the inability to mineralize sufficiently, leads to deformity, pain, and pathological fractures. It typically presents in young adults, with an equal representation in both genders. Surgical intervention is necessary in mild cases with chronic symptoms to prevent pathological fractures or to correct deformities.Case presentationA 19-year-old Chinese woman presented with non-traumatic, nonspecific left hip pain during basketball training. X-rays demonstrated a ground glass lesion, 10 cm in length, in her left femoral neck, which is a classic sign of fibrous dysplasia. No other deformities were noted. She was managed conservatively with analgesia for 6 months; however, her condition did not improve and a decision was made for surgical intervention. The lesion was a type 1 lesion according to the Ippolito radiological classification of fibrous dysplasia, which is a lesion with mild deformities. Therefore, we performed minimal curettage and insertion of a free autologous fibula strut harvested from her left leg, for structural stability. No implants were used. The operation was successful and her postoperative course was uneventful. Histology confirmed the diagnosis of fibrous dysplasia. She achieved partial weight bearing at 4 weeks postoperation, and full weight bearing at 8 weeks, and returned to basketball at 12 weeks. At 1-year follow-up, she returned to competitive basketball and remained pain free with no complications.ConclusionsFibrous dysplasia is a rare and benign fibrous tumor of the bone that presents mostly in a young patient population. From our case, we have shown that it is possible to treat young patients with uncomplicated Ippolito type 1 fibrous dysplasia with a minimally invasive approach of using a cortical bone graft for structural augmentation of the affected area, without the use of implants. They are able to fully return to an active and vigorous lifestyle without restriction of activities or long-term risks of orthopedic implant complications.

Does Patient Positioning and Portal Placement for Arthroscopic Subtalar Arthrodesis Matter?

Category: Arthroscopy Introduction/Purpose: Arthroscopic subtalar joint arthrodesis was first described over two decades ago. The procedure was originally performed with the patient in the lateral decubitus or supine position using anterolateral and posterolateral portals based on the fibula. More recently, several authors have advocated for prone positioning utilizing posteromedial and posterolateral portals. Proponents of the prone position cite improved intra-articular visualization with limited need for traction and more thorough preparation of the posterior facet. Multiple studies have compared arthroscopic to open subtalar arthrodesis and demonstrated similar fusion rates, lower morbidity, and a high level of patient satisfaction with the arthroscopic procedure. To our knowledge, this is the first study investigating how patient positioning and portal placement affects outcomes and morbidity for the arthroscopic procedure. Methods: A systematic review was performed according to PRISMA guidelines utilizing PubMed and Embase. All original studies with reported complication rates for arthroscopic subtalar arthrodesis were included. Two independent reviewers collected patient demographic data, operative positioning, complications, and outcomes including time to fusion and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Patients were placed into the prone group if they were positioned prone with posterior portals or the lateral group if they underwent lateral portal placement. The rate of complications related to portal placement, nonunion rate, rate of painful hardware, and rate of revision were also recorded. The proportions of patients with specific complications in each group were determined and transformed using the Freeman-Tukey double-arcsine method to stabilize variances. Heterogeneity across studies was present as determined using the Q and I2 statistics or likelihood ratio test. Inverse-variance weighted random-effects models were used to evaluate the pooled estimates using R software. Results: A total of 484 feet in 468 patients with a mean follow-up of 36.1 months were included for analysis. Thirteen studies examined patients in the prone position (n=302) and seven articles looked at lateral portals (n=182). Mean AOFAS scores improved from 46.3 to 81.6 following surgery. Fusion was seen in 95.8% of feet at a mean of 10.9 weeks. The total complication rate was similar (p=0.620) between the prone (18.2%) and lateral (17.6%) groups. There was no difference observed in the rate of complications secondary to portal placement (p=0.919), rate of painful hardware (p=0.534), and revision rate (p=0.400) between the two groups. The prone group sustained 20 nonunions (6.6%) which was significantly more than the 2 nonunions (1.1%) found in the lateral group (p=0.039). Conclusion: Arthroscopic subtalar arthrodesis is an effective treatment option for subtalar joint pathology. We found a higher rate of nonunion when the patient is positioned prone and the arthroscopic portals are placed posteriorly. There was no difference in the rate of nerve/tendon injury, painful hardware, and revision surgery. AOFAS scores were improved regardless of portal placement. Limitations of our study include the variability in fusion hardware and use of bone graft for fusion augmentation between studies. We also were unable to account for surgeon experience, operative volume, and comfort level with the procedure. Further large scale prospective studies are warranted.

Evaluation of custom made xenogenic bone grafts in mandibular alveolar ridge augmentation versus particulate bone graft with titanium mesh

Evaluation of custom made xenogenic bone grafts in mandibular alveolar ridge augmentation versus particulate bone graft with titanium mesh

Lateral alveolar ridge augmentation procedure using subperiosteal tunneling technique: a pilot study

BackgroundIn this research article, we evaluate the use of sub-periosteal tunneling (tunnel technique) combined with alloplastic in situ hardening biphasic calcium phosphate (BCP, a compound of β-tricalcium phosphate and hydroxyapatite) bone graft for lateral augmentation of a deficient alveolar ridge.MethodsA total of 9 patients with deficient mandibular alveolar ridges were included in the present pilot study. Ten lateral ridge augmentation were carried out using the sub-periosteal tunneling technique, including a bilateral procedure in one patient. The increase in ridge width was assessed using CBCT evaluation of the ridge preoperatively and at 4 months postoperatively. Histological assessment of the quality of bone formation was also carried out with bone cores obtained at the implant placement re-entry in one patient.ResultsThe mean bucco-lingual ridge width increased in average from 4.17 ± 0.99 mm to 8.56 ± 1.93 mm after lateral bone augmentation with easy-graft CRYSTAL using the tunneling technique. The gain in ridge width was statistically highly significant (p = 0.0019). Histomorphometric assessment of two bone cores obtained at the time of implant placement from one patient revealed 27.6% new bone and an overall mineralized fraction of 72.3% in the grafted area 4 months after the bone grafting was carried out.ConclusionsWithin the limits of this pilot study, it can be concluded that sub-periosteal tunneling technique using in situ hardening biphasic calcium phosphate is a valuable option for lateral ridge augmentation to allow implant placement in deficient alveolar ridges. Further prospective randomized clinical trials will be necessary to assess its performance in comparison to conventional ridge augmentation procedures.

Does the adjunctive use of platelet-rich plasma to bone graft during sinus augmentation reduce implant failure and complication? Systematic review and meta-analysis.

Prosthetic treatment of the posterior edentulous maxilla may require bone augmentation to enable the placement and integration of dental implants. This constitutes a complex healing situation, and resorption of the grafted bone and failure of the implants often occurs. The application of platelet-rich plasma (PRP) has been suggested to improve incorporation and preservation of bone grafts. The objective was to assess the effectiveness of PRP on the implant failure and complication rate, when used as an adjunctive material with bone graft in sinus floor augmentation. An electronic search of two databases (PubMed and Cochrane) was performed to identify randomized controlled trials (RCTs) in patients requiring sinus augmentation and implant placement in the posterior edentulous maxilla with or without using PRP as an adjunctive material to the bone graft. Data were extracted independently by two reviewers. The Cochrane tool was used for assessing the quality of included studies. Meta-analysis was performed for the included RCTs. Nine RCTs were identified, four of which were included in the study. Three of these trials were judged to be at unclear risk of bias and one was at low risk of bias. The meta-analysis revealed no difference between the PRP versus non-PRP groups regarding implant failure and complication rate. The meta-analysis revealed no statistically significant difference regarding implant failure and complication rate of implants placed in the atrophic posterior maxilla with sinus floor augmentation with or without PRP as an adjunctive material to the bone graft. This finding should be interpreted with great caution given the serious numerical limitations of the included studies.

Direct Maxillary Sinus Floor Augmentation for Simultaneous Dental Implant Placement.

Aim:The present study was done to evaluate the efficacy of platelet-rich fibrin (PRF) with bovine bone graft (Bio-Oss™) in direct sinus augmentation for simultaneously dental implant placement.Materials and Methods:The study included 14 patients who fulfill the inclusion criteria, among them 10 were male and 4 were female with PRF with Bio-Oss™. For each patient, bone level was assessed preoperatively and postoperatively after 1, 6, and 12 months with a panoramic X-ray and radiovisiography to evaluate the vertical bone height from the shoulder of the implant to the most apical end.Results:The outcome of the sinus lift and the implants placed was evaluated periodically at 1, 6, and 12 months postoperatively. All the patients underwent two-stage procedures. At the end of 20th week, implants were exposed; radiological parameters were assessed again for implant integration, and prosthetic rehabilitation was started after 2 weeks and it was completed by the end of 24 weeks (6 months postoperatively). Twelve months postoperatively, the endosinus bone gain noted was 7 mm, which indicated the use of PRF with bovine bone graft as a reliable filling material during simultaneous sinus lift and implantation.Conclusion:PRF with bone graft (Bio-Oss) is used as an augmentation material after direct maxillary sinus lift, and the resulting bone formation was adequate for placement of dental implant.

Bioactive treatments in bone grafts for implant-based rehabilitation: Systematic review and meta-analysis.

The use of bioactive proteins, such as rhBMP-2, may improve bone regeneration in oral and maxillofacial surgery. Analyze the effect of using bioactive proteins for bone regeneration in implant-based rehabilitation. Seven databases were screened. Only clinical trials that evaluated the use of heterologous sources of bioactive proteins for bone formation prior to implant-based rehabilitation were included. Statistical analyses were carried out using a random-effects model by comparing the standardized mean difference between groups for bone formation, and risk ratio for implant survival (P ≤ .05). Seventeen studies were included in the qualitative analysis, and 16 in the meta-analysis. For sinus floor augmentation, bone grafts showed higher amounts of residual bone graft particles than bioactive treatments (P ≤ .05). While for alveolar ridge augmentation bioactive treatments showed a higher level of bone formation than control groups (P ≤ .05). At 3 years of follow-up, no statistically significant differences were observed for implant survival (P > .05). Bioactive proteins may improve bone formation in alveolar ridge augmentation, and reduce residual bone grafts in sinus floor augmentation. Further studies are needed to evaluate the long-term effect of using bioactive treatments for implant-based rehabilitation.

Grafting of Alveolar Cleft Defects in Preparation for Endosseous Dental Implant Placement and Orthodontic Tooth Movement

Prosthodontic rehabilitation of patients with edentulous sites secondary to cleft palate has shown a paradigm shift towards implant placement in skeletally mature patients. Patients with residual alveolar cleft defects after secondary grafting at the optimal age of 8-11 years old have presented with persistent defects precluding implant placement. The purpose of this article is to revisit an approach to augmentation bone grafting of the residual maxillary alveolar cleft defect in preparation for endosseous dental implant placement.