Autogenous Particulate Bone Research Articles

Effects of intentional early dense‐polytetrafluoroethylene membrane removal on vertical ridge augmentation

AbstractBackgroundVertical ridge augmentation (VRA) requires long healing times for bone maturation. This case study deals with the intentional early removal of a titanium‐reinforced dense polytetrafluoroethylene (TR‐dPTFE) membrane that allowed for treatment times reduction and improvement of bone quality.MethodsA TR‐dPTFE membrane was used for VRA in the premolar region of the upper right maxilla. The defect was filled with a mix of particulate autogenous bone and porcine xenograft in a 1:1 ratio. After a 4‐month uneventful healing period, the membrane was removed, and the thick keratinized palatal tissue was moved toward the buccal side via a pedicle flap. Implants insertion and healing abutments application were carried out 3 months later, when bone graft could have been revascularized and nourished by the periosteum.ResultsThe histologic evaluation of a bone sample harvested during implant bed preparation revealed a huge amount of mature newly formed bone even in the most coronal part. Two screw‐retained crowns were delivered 2 months after implant insertion and the 3.5‐year follow‐up showed perfectly maintained hard and soft tissues.ConclusionsIntentional early removal of TR‐dPTFE membrane after a 4‐month healing time, with simultaneous soft tissue augmentation via a buccally reposioned pedicle flap, allowed graft revascularization from the periosteum, and resulted in optimal quantity and quality of the regenerated bone. This process shortened the overall treatment times, taking only 9 months from VRA to prosthetic loading. Both augmented hard and soft tissues allowed for crestal bone maintenance around implants.Key points Titanium‐reinforced dense polytetrafluoroethylene (TR‐dPTFE) membranes, due to their closed structure, do not allow the passage of cells and vessels from the periosteum, and revascularization from the residual bone alone is not enough for proper graft maturation and long‐term crestal bone maintenance. Early removal of TR‐dPTFE membrane allows graft revascularization from the periosteum, and results in optimal quantity and quality of the regenerated bone. Increasing the thickness of the soft tissues, increasing the width of the keratinized mucosa, and repositioning the mucogingival line, via a free gingival graft or a pedicle flap, should be performed simultaneously in the membrane removal phase to reduce the number of surgical interventions, decrease patient morbidity, and shorten the total treatment time.

Combination of a Synthetic Bioceramic Associated with a Polydioxanone-Based Membrane as an Alternative to Autogenous Bone Grafting.

The purpose of this study was to evaluate the repair process in rat calvaria filled with synthetic biphasic bioceramics (Plenum® Osshp-70:30, HA:βTCP) or autogenous bone, covered with a polydioxanone membrane (PDO). A total of 48 rats were divided into two groups (n = 24): particulate autogenous bone + Plenum® Guide (AUTOPT+PG) or Plenum® Osshp + Plenum® Guide (PO+PG). A defect was created in the calvaria, filled with the grafts, and covered with a PDO membrane, and euthanasia took place at 7, 30, and 60 days. Micro-CT showed no statistical difference between the groups, but there was an increase in bone volume (56.26%), the number of trabeculae (2.76 mm), and intersection surface (26.76 mm2) and a decrease in total porosity (43.79%) in the PO+PG group, as well as higher values for the daily mineral apposition rate (7.16 µm/day). Histometric analysis presented material replacement and increased bone formation at 30 days compared to 7 days in both groups. Immunostaining showed a similar pattern between the groups, with an increase in proteins related to bone remodeling and formation. In conclusion, Plenum® Osshp + Plenum® Guide showed similar and sometimes superior results when compared to autogenous bone, making it a competent option as a bone substitute.

Bone Scrapers for Intraoral Bone Harvesting: A Comparative Review

Abstract Background: Dental implants are a standard treatment, but bone defects can complicate their placement. Alveolar ridge augmentation using autogenous bone (AB) grafts, harvested with tools such as bone scrapers, is a well-established solution. This review compares three famous bone scrapers: Ebner, Safe and 1/2 Buser Double-ended. Objective: This review aimed to compare the effectiveness, versatility and clinical outcomes of three commonly used bone scrapers for intraoral bone harvesting: Ebner scraper, Safescraper and 1/2 Buser Double-ended scraper. Methods: A systematic search identified ten relevant articles evaluating the use of these scrapers in intraoral bone harvesting procedures. The review compared the physical characteristics of the scrapers and summarised the clinical outcomes reported in the literature. Results: All three scrapers were effective for intraoral bone harvesting, offering advantages such as precision, cost-effectiveness and minimal risk of damage to surrounding tissues. However, they differed in their blade design, preferred harvesting site and amount of bone obtained. The Ebner scraper was most suitable for convex surfaces, the Safescraper for flat surfaces and the 1/2 Buser Double-ended scraper for irregular surfaces. Studies also showed that bone scrapers can effectively collect AB particles for optimal integration and healing. Conclusion: Bone scrapers are the valuable tools for intraoral bone harvesting procedures. The choice of scraper should be based on the specific clinical scenario and the desired amount of bone to be harvested. This review provides clinicians with information to select the most appropriate tool for their needs.

A New Collector Device for the Immediate Use of Particulate Autogenous Bone Grafts

A New Collector Device for the Immediate Use of Particulate Autogenous Bone Grafts

Modified 3-Dimensional Alveolar Ridge Augmentation in the Anterior Maxilla: A Prospective Clinical Feasibility Study.

Vertical and horizontal reconstruction of the alveolar ridge, especially in the anterior maxilla, is considered a clinical challenge for dentists. There is still a lack of a standard technique to address the hurdles in 3-dimensional bone regeneration in the anterior maxilla. In this clinical feasibility study, we aimed to modify Khoury's technique by combining the conventional guided bone regeneration standards with the principles of this technique. The autogenous bone blocks were harvested from the retromolar area and grafted into the deficient anterior maxillae by mini-screws, and the gap was filled with xenogenic bone particles. The grafted site was covered with multilayered resorbable collagen membranes. Cone-beam computerized tomographic scans were obtained at the 6-month follow-ups, and the changes in ridge width and height were measured. Five subjects with multiple missing teeth at the anterior maxilla were included. The radiographic outcomes of the 6-month follow-ups revealed 1.2 mm of height and 3.5 mm of width gain. Between the 4- and 6-month visits, approximately 2 mm resorption in height and 0.3 mm in width occurred. No complications occurred. The proposed modification for Khoury's technique can serve as a feasible method in the 3-dimensional reconstruction of the anterior maxilla without additional autogenous bone particles.

Shell Technique with a Xenogeneic Cortical Bone Lamina and Particulate Bone Graft for Horizontal Ridge Augmentation: A Case Series

The aim of this prospective case series was to evaluate the efficacy and safety of a xenogeneic cortical bone lamina utilized as a "shell" on the buccal aspect of narrow alveolar ridges for horizontal bone augmentation. Fifteen patients requiring multiple implant restorations at sites with moderate to severe horizontal bone deficiency were consecutively enrolled. Horizontal bone augmentation was performed using a xenogeneic cortical bone lamina (XCBL), that was fixed on the buccal aspect of the ridge using titanium screws, and a mixture of particulate autogenous bone graft and porcine hydroxyapatite. Cone-beam computed tomography (CBCT) scans were taken at baseline and 6 months after bone augmentation. The healing was uneventful, with no intra- or post-operative complications. Twenty-seven dental implants were placed in the augmented sites. The calculated average horizontal bone gain from CBCT scans was 4.79 ± 1.64 mm, 5.59 ± 1.51 mm, and 5.79 ± 2.53 mm at 1-, 3- and 5-mm reference points apical to the buccal bone crest, respectively. The present case series demonstrated that the shell technique with the xenogeneic cortical bone lamina and particulate bone graft can be an effective approach for horizontal bone augmentation prior to implant placement.

Particulate autogenous bone graft in treatment of infected non‐union mandible fracture: A case report

Oral SurgeryAccepted Articles LETTER TO THE EDITOR Particulate autogenous bone graft in treatment of infected non-union mandible fracture: A case report Rodrigo dos Santos Pereira, Corresponding Author Rodrigo dos Santos Pereira [email protected] orcid.org/0000-0003-2509-8633 University of Grande Rio-UNIGRANRIO, Rio de Janeiro, Brazil General Hospital of Nova Iguacu in Rio de Janeiro, Brazil Correspondence Email: [email protected]Search for more papers by this authorGustavo Lima Latini, Gustavo Lima Latini General Hospital of Nova Iguacu in Rio de Janeiro, BrazilSearch for more papers by this authorIzabela Lopes Pessanha, Izabela Lopes Pessanha University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorRodrigo Santos Batista Martins, Rodrigo Santos Batista Martins University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorAdam Lowenstein, Adam Lowenstein Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this authorCarlos F. Mourão, Carlos F. Mourão Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this author Rodrigo dos Santos Pereira, Corresponding Author Rodrigo dos Santos Pereira [email protected] orcid.org/0000-0003-2509-8633 University of Grande Rio-UNIGRANRIO, Rio de Janeiro, Brazil General Hospital of Nova Iguacu in Rio de Janeiro, Brazil Correspondence Email: [email protected]Search for more papers by this authorGustavo Lima Latini, Gustavo Lima Latini General Hospital of Nova Iguacu in Rio de Janeiro, BrazilSearch for more papers by this authorIzabela Lopes Pessanha, Izabela Lopes Pessanha University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorRodrigo Santos Batista Martins, Rodrigo Santos Batista Martins University of Grande Rio-UNIGRANRIO, Rio de Janeiro, BrazilSearch for more papers by this authorAdam Lowenstein, Adam Lowenstein Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this authorCarlos F. Mourão, Carlos F. Mourão Tufts University School of Dental Medicine, Division of Dental Research, Administration, Department of Periodontology, Boston, MA, USASearch for more papers by this author First published: 27 May 2023 https://doi.org/10.1111/ors.12823 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ors.12823. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Impact of Harvesting Method and Donor Age on the Behavior of Human Osteoblast-Like Cells.

Autogenous particulate bone grafts are being utilized in oral implantology for minor grafting procedures. This study aimed to investigate the influence of the bone-harvesting technique, donor age, and donor site on proliferation and differentiation of human primary osteoblast-like cells in the cell culture. Autogenous bone particles (20 samples) were harvested from the maxilla and mandible during surgery using two different protocols, and two types of particulate bone grafts were collected: bone chips and bone sludge. Bone samples were cultured in growth medium and, after 2 to 3 weeks, the cells that grew from bone grafts were cultured in the normal and osteogenic medium for 0, 4, 7, and 20 days. DNA, alkaline-phosphatase (ALP), calcium-content measurements, and Alizarin red/toluidine blue staining were performed. Data were analyzed by repeated-measures analysis of variance with Bonferroni test. The level of statistical significance was set at 5% (P < .05). Total DNA, ALP, and calcium content were significantly higher for the bone chip samples compared to the bone sludge samples. Total DNA and ALP content were significantly higher for the patients in age group 1 (≤ 60 years) compared to age group 2 (> 60 years) and was significantly higher for mandibular samples than maxillary samples on day 20. However, the calcium measurement showed no significant difference concerning donor age and donor site. Data analysis revealed that harvesting technique (bone chips vs bone sludge), donor age (≤ 60 years vs > 60 years), and donor site (maxilla vs mandible) influenced the osteogenic potential of the collected particulate bone graft. The bone chips were superior in terms of osteogenic efficacy and should be considered a suitable option for particulate bone graft collection.

Evaluation of Particulate Autogenous Bone Graft Harvested by Auto Chip Maker versus Milling of Block Bone Graft (Experimental Study with Biochemical and Genetic Assessment)

Evaluation of Particulate Autogenous Bone Graft Harvested by Auto Chip Maker versus Milling of Block Bone Graft (Experimental Study with Biochemical and Genetic Assessment)

Effect of ozone therapy on the modulation of inflammation and on new bone formation in critical defects of rat calvaria filled with autogenous graft

ObjectiveThe aim of this study was to evaluate the effect of ozone therapy on new bone formation and inflammation modulation in defects of rat calvaria filled with autogenous bone. Material and methodsCritical size defects were created in the calvaria of 24 male Wistar rats. The animals were randomly divided into four groups according to the treatment: G1: clot; G2: clot and covered with xenogenic membrane; G3: particulate autogenous bone graft; G4: autogenous bone graft and application of 3 mL O2/O3 gas mixture (10 µg/ml). The defects were filled immediately after surgery with a bilateral retroauricular application, in the region immediately above the incision. After 21 days, the animals were euthanized, and the samples were processed for morphometric evaluations designed to measure both the intensity of the inflammatory infiltrate, and the presence of new bone formation in the defect. ResultsThe results showed a lower inflammation score and higher mean of newly formed bone in the region of the defect for the group associated with ozone therapy (G4). The bone formed in the region of the defect could be observed as being more lamellar and mineralized in the case of associated ozone therapy. ConclusionOzone therapy represents a promising adjuvant therapy to accelerate tissue regeneration.

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

Facial resorption of maxillary alveolar ridges is a challenging situation for implant rehabilitation, which mandates a preparatory surgery of bone augmentation. Guided bone regeneration using a 1:1 mixture of autogenous particulate and anorganic bovine bone mineral (ABBM) showed reliable outcomes in treating horizontally deficient ridges. Twenty-eight patients were randomly assigned into two groups; in the control group, the 1:1 mixture of particulate autogenous bone and ABBM was covered with native collagen membrane, while in the study group, it was mixed with autologous fibrin glue (AFG) to make a sticky bone that was covered by concentrated growth factor (CGF) membrane. For each proposed implant site, the average bone width gain was calculated preoperatively, immediately after augmentation and after 6 months. Implants were placed after 6 months and the implant stability quotient (ISQ) was measured after insertion and after 6 more months. The graft consolidation period went uneventful in both groups; however, two cases in the sticky bone group showed total resorption of the graft upon re-entry. The mean horizontal bone width after 6months was 9 mm ± 0.71 in the guided bone regeneration (GBR) group which was higher than 7.9 mm ± 0.92 for the sticky bone group. The mean primary stability was higher in the GBR group; 67.19 ± 2.23 compared to 66.7± 3.22 for the sticky bone group, while the mean secondary stability was higher in the sticky bone group; 72 ± 2.15 compared to 71.7± 2.27 for the GBR group. Results of Shapiro-Wilk's for bone width data and model residuals were both statistically not significant (p> 0.05). Comparing CGF membrane versus native collagen membrane as barriers for GBR showed no statistically significant difference regarding bone gain. However, from a clinical point of view, CGF membrane is not a predictable barrier for guided bone regeneration.

Severely resorbed mandible treatment: a 12-years follow-up case report

Rehabilitation of severely atrophic jaws has been a major problem for elderly patients and dentists. When conventional rehabilitation treatments are not possible, bone intervention is deemed necessary. Mandibles with less than 12 millimeters (mm) in height imply insufficient retention of the prosthesis, intolerance to mucosal load, pain and, consequently, incapacity of oral functions and decreased facial aesthetics. Endosseous implants are a widely accepted therapy for SRM rehabilitation, but it depends on the amount of bone available for a good prognosis. The Tent Pole technique is based on the addition of bone graft and expansion of the soft tissue matrix, mainly for cases of SRM with 6 mm or less of bone height available for rehabilitative treatments with endosseous dental implants. The objective of this report is to present and update a previously published clinical case of SRM reconstruction and rehabilitation using the tent pole technique, with 12 years of follow-up. The female patient, who underwent treatment at 63 years of age, received treatment using the Tent Pole surgical technique for mandibular reconstruction with cranial autogenous particulate bone graft. The treatment was favorable during the 12 years of control, the CT scan showed that the grafted bone was stable in volume and the mandible was enlarged in three dimensions.

Autogenous Bone is Still the Gold Standard of Graft Materials in 2022.

I read with interest the recent editorial entitled “Is Autogenous Bone Grafting Still the “Gold Standard” in Oral Bone Grafting?”.1 As the authors pointed out, I wrote a similar editorial in 2010 and concluded that indeed autogenous bone was the gold standard of graft materials.2 However, the authors have challenged my conclusion. To support their opinion, they referenced two publications on sinus bone grafting evaluating histomorphometric results and implant survival.3,4 They claimed these studies found that “bone substitutes either performed in a like manner or superior to autogenous bone alone”. However, the histomorphometric analysis showed autogenous bone resulted in the highest amount of new bone formation compared to bone substitutes, but bone substitutes seem to be a good alternative.3 The systematic review on sinus bone grafting concluded implant survival rates using bone substitutes were as effective as autogenous bone when used alone or in combination with autogenous bone.4 Although the implant survival was lower with 100% autogenous bone (87.7%) compared to autograft with bone substitutes (94.9%) or bone substitutes alone (96%), the data clearly shows that the majority of machined implants were placed in sinuses grafted with autogenous bone. The review found rough surface implants had superior survival rates compared to machined implants (96% vs. 85.6%), so this explains the lower implant survival rate in autogenous grafts. Pjetursson et al5 performed a systematic review evaluated the grafting of pneumatized sinuses that had 6.0 mm or less residual bone height. Focusing on outcomes using only rough surface implants they found high implant survival rates for all types of grafts (> 96%). However, rough implants placed in particulate autogenous bone had a significantly higher estimated three-year survival (99.8%). There are limitations in using a secondary outcome measure, such as implant survival, to evaluate graft success. The assumption is that if the implant survived the graft was successful. The influence of the amount of native bone supporting the implant is unknown in some studies unless the residual bone limit was defined, such as in the Pjetursson et al study.Another important distinction is the relationship of the augmentation to the osseous defect. Bone defects inside the bony contour, such as sockets and the maxillary sinus floor, are much easier and predictable to reconstruct than horizontal and vertical augmentation outside the bone contour. Intrabony defects have a greater number of bone walls with a higher regenerative capacity. There is also greater ease in achieving soft tissue coverage, space maintenance, graft stability and protection. As such bone substitutes perform well in treating these types of contained defects. However, horizontal and vertical bone augmentation outside the bone contour is more biologically challenging. The greater the distance from the native bone, the more difficult it may become for vascular ingrowth, cell migration and bone formation at the outer limits of the graft. As such a graft material with greater regenerative capacity may be needed to obtain the required bone gains. Autogenous bone has superior biologic qualities compared to osteoconductive bone substitutes. It is the only bone graft material that fulfills all three aspects of the tissue engineering triad - osteogenesis, osteoinduction and osteoconduction. Autogenous bone contains osteocompetent cells and osteoconductive growth factors that can positively influence bone formation. Although cancellous bone contains a higher amount of osteoblasts and mesenchymal stem cells, cortical bone grafts contain cells that have the ability to proliferate and differentiate into the osteogenic lineage, suggesting that these cells can also contribute to bone regeneration following transplantation.6 Research has found cortical bone chips contain over 40 different growth factors that can modulate the cellular aspects of bone regeneration.7 The healing time of autogenous bone grafts also is shorter than bone substitutes.8Rather than focus on implant survival, it would be more clinically relevant to evaluate horizontal and vertical bone gains produced by different graft materials. When reviewing studies measuring bone gains it becomes evident that autogenous bone is needed for larger bone augmentations and vertical gains.9,10,11,12 While I agree with my colleagues that bone substitutes may be used effectively in many clinical situations, I still maintain that autogenous bone is the gold standard of graft materials. This does not mean it is the first choice option, but it does offer biologic advantages unmatched by bone substitutes. The use of a local donor site and bone scrapers can decrease the morbidity of bone harvest. In addition, some donor sites for block grafting, such as the mandibular ramus, have a lower incidence of postoperative complications.13 Surgeons should weigh the advantages and disadvantages of each material and select an approach that has the highest likelihood of clinical success.14

Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: a micro‐computed tomography and positron emission tomography study in rabbits

AimThe purpose of this study was to evaluate using microCT and positron emission tomography (PET) analysis, the influence on bone healing of the placement of particulate autogenous bone in the antrostomy, and in the subjacent region after maxillary sinus elevation with xenograft.Material and methodsThe sinus mucosa was elevated in sixteen male New Zealand rabbits and they were both grafted with a collagenated cortico-cancellous porcine bone. The antrostomy and the near subjacent region were filled with either the same xenograft (control site) or with particulate autogenous bone (test site) harvested from the tibia. The antrostomies were covered with collagen membranes. MicroCT (measured in Hounsfield Units) and microPET (kBq/cm3) using sodium fluoride infiltration (18F-NaF) were performed at the time of euthanasia that was performed after 1 and 8 weeks of healing, using 8 animals in each group. The Wilcoxon test was used for analysis.ResultsAt the microCT analysis, after 1 and 8 weeks of healing, no statistically significant differences were found between groups. Bone increased and xenograft decreased significantly between the two periods of healing. At the microPET analysis, the percentage of bone increased significantly over time in both test and control groups and no significant differences were found between groups.ConclusionThe placement of autogenous bone in the antrostomy and the subjacent region after maxillary sinus elevation did not enhance bone formation compared with sites where only xenograft was used. Both microCT and microPET showed increase bone formation over time.

Microscopic analysis of the repair of critical bone defects in rabbits calvaria after the use of particulated autogenous bone or particulate autogenous bone associated with inorganic biomaterial

The aim of this study was to evaluate, through microscopic analysis, the repair of critical defects in rabbit calvaria after the use of particulate autogenous bone or particulate autogenous bone associated with inorganic biomaterial. Six male albino rabbits, New Zealand, were used, in which 4 defects were performed in each calvaria and randomly divided into 4 equitable groups: Group I – performed bone defect; Group II – performed bone defect and filled with particulate autogenous bone; Group III – performed bone defect and filled with particulate inorganic material (Bio-Oss®, Geistlich from Brazil); Group IV – performed bone defect and filled with particulate autogenous bone associated with particulate inorganic material (Bio-Oss® - Geistlich from Brazil) with proportion being 20:80. The analyze time of the procedure was 60 days. The microscopic analyze allowed to conclude that the autogenous, the Bio-Oss® and the Bio-Oss® associated with autogenous bone groups showed a bone neoformation on the defects, characterizing the material osteoconductive. However, the complete defect closure occurred on the autogenous bone and the autogenous bone associated with the inorganic bone, showing that the presence of the autogenous bone improves the characteristics of the biomaterial. The use of inorganic bone associated with the autogenous bone allowed a complete bone neoformation of the critic defect in the calvaria of rabbits.

Efficiency of guided bone regeneration in vertical bone augmentation with titanium-reinforced PTFE membrane and platelet-rich fibrin

Objective: Guided bone regeneration (GBR) for vertical bone augmention is an easy-to-implement approach and has a good prognosis. However, there are many different procedures that lead to different clinical outcomes. The use of platelet-rich fibrin (PRF) can improve outcomes in regenerative treatments. Therefore, this study aimed to evaluate the effectiveness of vertical bone grafting by guided bone reconstruction with titanium-reinforced PTFE membrane combined with PRF. Materials and Methods: Nine patients who come to the Department of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, have a need for implant treatment and have mild to moderate vertical bone deficiency. Patients are treated with bone grafting by GBR technique: using a mixture of bone grafts including autogenous bone and deproteinized bovine bone (Geistlich Bio-Oss) at a ratio of 1:1, mixed with injectable form PRF in the form of sticky bone. The vertical bone defects were protected by a titanium-reinforced d-PTFE membrane and covered by an A-PRF+ membrane. The bone gain was measured using a cone-beam computed tomography at baseline and after a period of 8 months. Results: Analyzing the research results on 9 patients, 15 research units corresponding to 15 bone grafting sites, the GBR procedures an increase in bone height (p &lt; 0,05) after treatment. In the two-staged approach, the vertical bone gain was 3.97 ± 0.92 mm; in the group of simultaneous one-staged procedure, the vertical bone gain was 3.89 ± 1.13 mm. In general, the bone height of the study sample achieved an average of 94.16 ± 10.7% compared to the ideal bone height. Conclusion: GBR technique using a mixture of particulate autogenous bone and xenogenous bone and PRF is effective for vertical bone augmentation in maxillary and mandibular regions, ensuring favorable bone morphology, permitting sufficient bone gain to future implant placement and prosthetics.

Vertical Ridge Augmentation of Edentulous Posterior Inferior Jaw Using Lumina Bone Porous Large®: A Clinical Case Report

The use of guided bone regeneration (GBR) has been gaining more and more ground in the field of implant dentistry, due to higher confidence in the materials available. As this is a highly versatile technique, the same biological basis-cell exclusion–can be used to treat any type of defect. Vertical augmentation in the alveolar ridge is currently treated by the GBR principle, predictably and with high success rates, using a rigid framework associated with a mix of hydroxyapatite and autogenous bone. Lyophilized bovine bone is the hydroxyapatite of choice for this condition because it allows bone volume to be maintained over a long period of time, due to its slow resorption. Another important char-acteristic found in hydroxyapatite is its porosity since it allows – in addition to graft neo-vascularization–a greater ease of cell adhesion when compared to crystalline materials. Thus, this clinical case presents the use (for the first time in the literature) of a vertical augmentation of an atrophic ridge using Criteria Lumina Bone Porous® as the hydroxy-apatite of choice for association with autogenous bone particles.

A Modified Zygomatic Implant Placement Technique: A Prospective Study up to 6-year Follow-up

PurposeThis study proposed a new modified technique for zygomatic implant placement and evaluated the up-to-6-year survival rate of endosseous zygomatic implants of the technique and its effects in preventing related complications, such as peri-implantitis, sinusitis, and implant failure. Materials and methodsThis study included 28 patients (15 females, 13 males; mean age: 53.4 years) with a severely atrophic edentulous maxilla (class VI maxillary atrophy, according to the Cawood and Howell classification) combined with a flat buccal sinus wall (zygoma anatomy-guided approach class 0 or 1, according to Aparicio) who received zygomatic implants using the modified technique. There are 3 key points regarding this technique: 1) the zygomatic implant was placed toward the buccal wall of the maxillary sinus, resulting in the implant head being near or on the alveolar crest and allowing less bulky prostheses to facilitate oral hygiene and to prevent soft-tissue infection; 2) autogenous bone block graft material was utilized to reinforce the buccal wall and increase the stability of the implant head; and 3) sinus grafting was performed using a mixture of autogenous particulate bone, bone graft material and platelet-rich fibrin, which created maximum bone coverage around the implant head to consolidate along with the implant. All implant surgeries were carried out under general anesthesia. Implant-supported provisional prostheses were delivered immediately, except in 7 cases in which the zygomatic implant did not achieve initial stability (< 35 N/cm). All patients were scheduled for regular follow-ups every 3 months. Definitive prostheses were provided 6 months after the surgery. ResultsOf the 28 patients treated, a total of 82 zygomatic implants were installed, in conjunction with 52 conventional implants. All of the implants exhibited good osseointegration; in particular, bone coverage was observed around the implant head and the entire length of the implant. Two patients presented complications. One patient exhibited a soft-tissue infection with pus discharge after 1 month of wearing the provisional prosthesis. The other patient exhibited implantitis 4 years after implant placement. Both patients showed buccal bone resorption but no oroantral fistulas, and the sinus membrane remained intact, with no sinusitis. Overall, the survival rate of both the zygomatic and standard implants was 100%. The zygomatic-implant-supported prostheses improved both functional and esthetic aspects for the patients. No cases of sinusitis or soft-tissue inflammation were reported. The mean follow-up period was 35.7 months (range, 0-72 months). ConclusionThis study illustrates that zygomatic implant placement with the new modified technique with the implant head on or near the alveolar bone, onlay bone block augmentation, and extended simultaneous sinus grafting is a successful and important treatment option when rehabilitating the atrophic maxilla. This modified technique yields a high long-term success rate and prevents complications such as peri-implantitis, sinusitis, and implant failure.Intraoral and radiographic images illustrating the procedure A, B, Intraoral images before and after six-month implant placement. C, D, E, F, Intraoral images showed the four zygomatic implants were placed toward the buccal wall of the maxillary sinus resulting in the implant heads were near or on the alveolar crest. Autogenous block bone graft was utilized to reinforce the buccal wall and to increase the stability of the implant head, extended sinus graft was performed to create an maximum bone coverage around implant head to consolidate along the implant. G, H, I, J, K, Radiographic study of the secondary phase of implant placement six months later with bar connecting the four zygomatic implants. G, Orthopantomographic view. H, I, J, K, CT slices showed the osseous integration surrounding all four zygomatic implants.

Clinical, volumetric and densitometric evaluation of tissue engineered constructs for secondary alveolar cleft reconstruction: A randomized clinical trial

The objective of this study was to assess the efficacy of tissue engineered (TE) constructs compared to the standard autogenous anterior iliac crest (AIC) bone graft in secondary maxillary alveolar cleft reconstruction.This clinical trial was registered on (clinical trials.gov); the trial registry number is: NCT03563495. Patients with unilateral alveolar clefts were allocated on the basis of simple randomization. Selected patients were randomly divided into two equal groups: the AIC group (control) received autogenous particulate bone graft from anterior iliac crest, whereas the TE group received tissue engineered construct. Assessment included the newly formed bone volume and density at the grafted cleft sites, which were measured immediately, 6 and 12 months postoperatively on axial computed tomograms.The study population included 10 patients; each group comprised 5 patients. There was no statistically significant difference between the 2 groups regarding the mean volume of the newly formed bone (p = 0.91 at 6 months, p = 0.994 at 1 year) and the mean density of the newly formed bone (p = 0.364 at 6 months, p = 0.073 at 1 year). However, there was a significant increase of TE graft density from 6 months to 1 year (p = 0.048).Within the limitations of the study it seems that the tissue engineered construct (collagen/osteogenically differentiated bone marrow−derived mesenchymal stem cells) might be an alternative to autogenous bone for unilateral secondary alveolar cleftgrafting.

Stromal cell-derived factor (SDF)-1\u03b1 and platelet-rich plasma enhance bone regeneration and angiogenesis simultaneously in situ in rabbit calvaria

The current study aimed to evaluate the effects of chemokine stromal cell-derived factor (SDF)-1α and platelet-rich plasma (PRP) on bone formation and angiogenesis, and to assess whether SDF-1α and PRP could function synergistically. Four evenly distributed defects (8 mm in diameter) were generated in the calvarial bones of New Zealand white rabbits. All rabbits received four treatment regimens containing autogenous bone particles (AB), SDF-1α, or PRP. AB group presented significantly less bone formation compared with the other three groups 2 and 4 weeks after surgery. The amount of newly formed bone in the AB+PRP+SDF-1α group was similar to that in the AB + SDF-1α group at the 4-week time-point (p = 0.65), and was much greater than that in the AB and AB+PRP group (p < 0.001). Meanwhile, more new blood vessels were formed in the AB+PRP, AB+SDF-1α, and AB+PRP+SDF-1α group versus the AB group. AB+PRP+SDF-1α group showed statistically increased angiogenesis compared with the AB+PRP and AB+SDF-1α groups (both p < 0.05) after treatment for 2 and 4 weeks. These findings indicated that SDF-1α and PRP might exhibit synergistic effects to promote angiogenesis in early bone regeneration.