Autologous Graft Material Research Articles

Comparison of porcine small intestinal submucosa and autologous graft material for repairing tympanic membrane perforation: a systematic review and meta-analysis.

To perform a systematic review and meta-analysis exploring the effectiveness of porcine small intestinal submucosa(pSIS) compared with autologous grafts for tympanic membrane perforation repair. A prospective meta-analysis protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) on June 5th, 2024, under protocol CRD42024551979. PubMed, Embase/Ovid and Cochrane Central databases were searched from inception to 28/05/2024 for studies comparing the use of pSIS versus autologous grafts (perichondrium, cartilage, temporalis fascia or cartilage-perichondrium) for tympanic membrane perforation repair. The outcomes evaluated were persistent perforation after surgery, operative time and hearing outcome. Statistical analyses were performed using the online Review Manager (Cochrane Collaboration). A subgroup analyses were carried out for the paediatric population. We included 1,407 patients (1447 ears) from seven records; six retrospective cohort studies and one randomised controlled trial (RCT). pSIS graft was used in 563 ear surgeries (38.1%). Four studies included children with a mean age ranging from 7.3 to 11.7 years and the other 3 studies included adults with a mean age ranging from 30.8 to 48.4 years. Follow-up ranged from 2 to 132 months. There was no statistically significant difference in the failure rate (persistent perforation) between pSIS graft and autologous graft (RR 0.95; 95% CI 0.67-1.33; p = 0.76). However, reduced operative time was associated with using pSIS grafts (MD -16.12min; 95% CI -22.94-9.31; p = < 0.00001). Tympanic membrane perforation repair with pSIS grafts had a similar failure rate and hearing outcome compared to autologous grafts and demonstrated an association with reduced operative time.

Advances in autogenous dentin matrix graft as a promising biomaterial for guided bone regeneration in maxillofacial region: A review.

Autogenous dentin matrix (ADM), derived from a patient's extracted tooth, can be repurposed as an autologous grafting material in reconstructive dentistry. Extracted teeth provide a source for ADM, which distinguishes itself with its low rejection rate, osteoinductive capabilities and ease of preparation. Consequently, it presents a viable alternative to autogenous bone. Animal studies have substantiated its effective osteoinductive properties, while its clinical applications encompass post-extraction site preservation, maxillary sinus floor augmentation, and guided bone tissue regeneration. Nevertheless, the long-term efficacy of ADM applied in bone regeneration remains underexplored and there is a lack of standardization in the preparation processes. This paper comprehensively explores the composition, mechanisms underlying osteoinductivity, preparation methods, and clinical applications of ADM with the aim of establishing a fundamental reference for future studies on this subject.

Long term results with medpor® reconstruction of the anterior skull base at a single institute

Objectives To evaluate a technique of multi-layered CSF repair following endonasal anterior skull base surgery using medpor graft. Design Retrospective review of consecutive case series from a single centre. Subjects 68 cases of repair of CSF leaks utilising medpor identified from a larger prospectively maintained database of endonasal endoscopic procedures at our centre. Methods Retrospective review of a database of consecutive anterior skull base cases from 2016–2022, and further data collection from electronic hospital records. Results During follow up there were 7 cases of post-op CSF leak (10.3%). There were no radiological complications, and no cases of medpor removal or extrusion. Rates of infection were low, there were 3 (4.4%) cases of confirmed bacterial meningitis within our cohort. The mean length of stay was 4.7 days (median 3 days), with 16 cases discharged on the first post-operative day. Conclusions Our experience of using medpor in anterior skull base reconstruction demonstrates that medpor is a readily available, easily handled, and reliable graft option with relatively low rates of infection and post-op CSF leak. Its use reduces the use of autologous graft materials and the associated donor site morbidity. Our long term follow up data further demonstrates the safety and efficacy of this technique.

Role of lingual mucosa as a graft material in the surgical treatment of Peyronie's disease.

Peyronie's disease (PD) is a localized fibrosis of tunica albuginea, which causes the anatomical and functional changes to the penis. Corporoplasty with grafting is indicated in severe (>60°) and complex curvature. Buccal mucosa is the most favored autologous graft material nowadays. The ventrolateral aspect of lingual mucosa has similar histological features to the rest of the oral cavity. This study aimed to test the efficacy, safety, durability, and reproducibility of corporoplasty with lingual mucosal graft (LMG) in the surgical treatment of PD in terms of surgical outcome, sexual function, and donor site complications. This prospective study included 19 patients of PD with severe and complex curvature, who underwent corporoplasty with LMG. Surgical and functional outcomes were assessed at follow-up planned at 2 weeks, 3 months, 6 months, 1 year, and 2 years. The mean operative time was 126.31 ± 21.45 min. Additional Nesbit's plication to correct the residual deformity was required in 26% (5 / 19) of patients. Straightening of the penis (curvature <10°) was achieved in 89% (17 / 19) of patients. Increase in the penile length (>1 cm) postoperatively was achieved in 63% (12 / 19) of patients and a shortening of penis occurred in 5% (1 / 19) of patients. Newer onset erectile dysfunction developed in 11% (2 / 19) of patients, and patient and partner satisfaction rates were 89% (17 / 19) and 84% (16 / 19), respectively, in a mean follow-up of 20.66 ± 5.37 months. Donor site complications were minimal and no patient had any salivary changes or speech disturbances. LMG provided excellent short-term results in terms of deformity correction, improved sexual function, and minimal donor site morbidity. The method is simple and reproducible, and multicenter studies with larger number of cases with longer follow-up are required to confirm these favorable results.

An intelligent controlled release hydrogel with photothermal effect for the treatment of bone defects

To solve the difficulty of natural healing in patients with severe bone defects, and the challenges of insufficient autologous bone graft material and large incisions in conventional surgery, we were designed an intelligent co-regulated hydrogel system with NIR response. The goal is to be able to prevent inflammation and bacterial adhesion, thereby promoting repair and development of the bone defect area. The hydrogel system consisted of hyaluronic acid, carboxymethyl chitosan and Pht-loaded PDA-encapsulated ZIF-8 NPs (Pht@ZIF-8@PDA) by Schiff base reaction. Compared to high-temperature photothermal therapy (PTT), which destroyed surrounding healthy cells, the present study was based on a new strategy of mild photothermal therapy (42.5 ± 1.2 °C) and leaded to a better promotion of osteogenesis. NIR activated the photothermal properties of PDA in scaffolds, intelligently released Pht and Zn2+, inhibited Escherichia coli and Staphylococcus aureus (inhibition rate ≥ 96 %), and promoted bone regeneration in the rat model. Meanwhile, it could promote bone regeneration by upregulating osteogenic factors and stimulating the expression of proteins related to BMP/SMAD signaling pathway. The research highlights the potential applications of synergistically modulated hydrogels, which opens up a new application path for this material in bone tissue engineering, regenerative medicine, and other related fields.

Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: Resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone. Keywords: Dental enamel proteins; Bone transplantation; Autologous transplantation; Alveolar bone loss; Periodontal diseases; Bone regeneration.

Finite element analysis of repairing tympanic membrane perforation using autologous graft material and biodegradable bionic cobweb scaffold

Background and objectiveAs for repairing the perforated tympanic membranes (TM), temporalis fascia and tragal cartilage are popular in clinics as autologous graft materials. However, there is a significant hearing loss after repairing the TM with autologous graft materials, which needs to be addressed in biomechanical engineering. MethodsThe finite element model of normal middle ear is improved from two aspects: the repair method of tympanic fibrous layer and the bionic spider web tympanic scaffold. By creating the solid-shell coupling condition and strong coupling boundary condition to simulate the repair, TM umbo and stapes footplate displacement-frequency response are explored in 200–8000 Hz. ResultsThe tympanic membrane perforation (TMP) causes a significant conductive hearing loss in high frequency region, which is positively correlated with perforation area. Both temporalis fascia and tragal cartilage still perform a certain degree of high-frequency hearing loss after repairing TMP. The TM attachment the magnesium alloy scaffold (MAS) prevents appropriately the high frequency hearing loss after autologous graft repair and makes the sound transmission closer to the normal condition. Significantly, the density of graft material has a negative effect on high-frequency sound transmission without the MAS. The modal-motion of TM repaired with temporalis fascia and tragal cartilage is improved significantly after attaching the MAS. In addition, the MAS restores effectively the configuration and vibration frequency of the repaired TM, which is similar to that of the native TM. ConclusionThe area size of TMP is studied through the finite element method, which includes autologous graft materials, the MAS, parameter sensitivity analysis, modal analysis of graft material and the MAS in biological form on the effect of middle ear sound transmission. Relevant conclusions provide some references for clinical trial protocol and the follow-up repair ideas of TM of tympanoplasty.

Safety and Efficacy of Autologous Cartilage Graft in Augmentation Rhinoplasty.

Augmentation rhinoplasty or commonly known as "nose jobs" is one of the most common plastic surgical procedures aimed to improve cosmetic appearance. This procedure is considerably safer, less time consuming with faster recovery and immediate cosmetic effect. This procedure needs of highly experienced and well-trained plastic surgeon. According to facial analysis you can select the type of rhinoplasty. Open discussion with the patient to select appropriate surgical technique and its possible risks with your plastic surgeon to ensure the highest level of safety and satisfaction. Autologous grafting materials are safe, efficient and also the first choice for rhinoplasty due to it can survive without a vascular supply, the resorption rate of cartilage is much lower than that of a bone graft. Autologous grafting materials are stable and resistant to infection and extrusion over time so, they are successfully used for dorsal augmentation. To perform successful augmentation rhinoplasty, surgeons should be highly experienced and well-trained and augmentation materials that are currently available and understand their risks, benefits and uses. Autologous cartilage graft regarded as the graft of choice in augmentation rhinoplasty because of their lower rate of infection, rejection, resorption, extrusion, donor site morbidity, easy reshaping.

Cranioplasty-Autologous Bone graft Vs Titanium Mesh

Background: Cranioplasty (CP) is a neurosurgical procedure performed after decompressive craniectomy using autologous bone graft or various artificial materials. Aim: To find differences in complications between patients who underwent CP using an autologous bone flap versus a titanium mesh as well as to identify significant risk factors for post-CP complications Study Design: Comparative cross-sectional study. Methodology: A total of 46 patients were included in this study, out of which 37 were males (80.4%) and 9 were females (19.6%). All patients underwent cranioplasty using titanium mesh or autologous bone graft. Results: Comparison of outcome between autologous graft and titanium implant was done. In 45.7% patients, autologous bone graft was used while titanium implant was used in 54.7%. 23.9% patients had developed different types of complications in both groups, out of which 81.9% were from autologous group and 18.1% belonged to titanium graft group. Surgical site infection was noted in 18.1% of patients (equally) in both groups. Craniopalsty infection was noted in 45.4% patients who underwent autologous graft. Hematoma was encountered in 2 patients; both with autologous bone graft and none in patients who had titanium mesh cranioplasty. Removal of autologous bone graft was done in one patient whileremoval was not done in the other arm of study. Bone resorption was seen in five patients, all of which had autologous bone graft. Learning curve is that this technique be followed by neurosurgeons for better outcome. Practical implicatio Titanium mesh cranioplasty is a technique to be followed by junior neurosurgeons for learning and good outcome, decrease duration of hospital stay and preservation of precious resources of hospital. Conclusion: Cranioplasty in which titanium mesh is used is superior to autologous bone grafting as it has lessercomplications. Keywords: Autologous graft, bone resorption, cranioplasty, hematoma, infection, titanium mesh.

Outcomes of surgical management and implant consideration for depressed skull fractures: A systematic review.

Traumatic brain injuries (TBIs) are associated with high mortality and morbidity. Depressed skull fractures (DSFs) are a subset of fractures characterized by either direct or indirect brain damage, compressing brain tissue. Recent advances in implant use during primary reconstruction surgeries have shown to be effective. In this systematic review, we assess differences in titanium mesh, polyetheretherketone (PEEK) implants, autologous pericranial grafts, and methyl methacrylate (PMMA) implants for DSF treatment. A literature search was conducted in PubMed, Scopus, and Web of Science from their inception to September 2022 to retrieve articles regarding the use of various implant materials for depressed skull fractures. Inclusion criteria included studies specifically describing implant type/material within treatment of depressed skull fractures, particularly during duraplasty. Exclusion criteria were studies reporting only non-primary data, those insufficiently disaggregated to extract implant type, those describing treatment of pathologies other than depressed skull fractures, and non-English or cadaveric studies. The Newcastle-Ottawa Scale was utilized to assess for presence of bias in included studies. Following final study selection, 18 articles were included for quantitative and qualitative analysis. Of the 177 patients (152 males), mean age was 30.8 years with 82% implanted with autologous graft material, and 18% with non-autologous material. Data were pooled and analyzed with respect to the total patient set, and additionally stratified into those treated through autologous and non-autologous implant material.There were no differences between the two cohorts regarding mean time to encounter, pre-operative Glasgow coma scale (GCS), fracture location, length to cranioplasty, and complication rate. There were statistically significant differences in post-operative GCS (p < 0.0001), LOS (p = 0.0274), and minimum follow-up time (p = 0.000796). Differences in measurable post-operative outcomes between implant groups were largely minimal or none. Future research should aim to probe these basic results deeper with a larger, non-biased sample.

Mechanical properties of extensive calcified costal cartilage: An experimental study

BackgroundAutologous costal cartilage is widely used as nasal augmentation or nasal reconstruction material. However, no study has focused on the mechanical difference between no calcified costal cartilage and extensive calcified costal cartilage at present. Our study aims to study the loading behavior of calcified costal cartilage under tensile and compressive stress. MethodHuman costal cartilage specimen was obtained from five extensive calcified costal cartilage patients and classified into four groups (group A: no calcified costal cartilage; group B: calcified costal cartilage; group C: no calcified costal cartilage after transplantation in BALB/c nude mice for half a year; group D: calcified costal cartilage after transplantation in BALB/c nude mice for half a year). Young's modulus, stress relaxation slope, and relaxation amount were analyzed through tensile and compressive tests using a material testing machine. ResultsWe included five female patients with extensive calcified costal cartilage. Group B exhibited significantly higher Young's modulus in both the tensile and compressive tests (p < 0.05 in tensile test, p < 0.01 in compressive test), higher relaxation slope (P < 0.01) and higher relaxation amount (p < 0.05 in compression test). After transplantation, the Young's modulus of calcified and non-calcified costal cartilage decreased, except that the calcified costal cartilage increased slightly in the tensile test. The final relaxation slope and relaxation amount had increased at different degrees, but the changes did not change significantly before and after transplantation (P > 0.05). ConclusionOur results showed that the stiffness of calcified cartilage would increase 30.06% under tension and 126.31% under compression. This study may provide new insights to researchers focusing on extensive calcified costal cartilage can be used for autologous graft material.

A simple surgical technique for sellar closure after transsphenoidal resection of pituitary adenomas in the context of risk factors for cerebrospinal fluid leaks and meningitis.

The transsphenoidal approach is the standard for most pituitary tumors. Despite low morbidity, postoperative CSF fistulas and meningitis are specific complications. Various surgical closure techniques for intraoperative CSF (iCSF) leak and sellar reconstruction have been described. For many years the authors have applied synthetic materials for iCSF leak repair and sellar closure in a standardized fashion in their department. Here they analyze the surgical outcome as well as risk factors for iCSF leak and meningitis. All patients with transsphenoidal resection of a pituitary adenoma performed by the same surgeon between January 2013 and December 2019 were screened retrospectively. A small amount of iCSF flow without a diaphragmatic defect was classified as a minor leak, and obvious CSF flow with or without a diaphragmatic defect was classified as a major leak. In case of iCSF leak, a fibrin- and thrombin-coated sponge was used to cover the diaphragmatic defect and another one was used for the sellar opening. A gelatin sponge was placed in the sphenoid sinus as an abutment. The primary and secondary outcomes were the number of postoperative CSF (pCSF) leaks and meningitis, respectively. Clinical, histological, and perioperative data from medical records were collected to identify risk factors for CSF leak and meningitis. Of 417 transsphenoidal surgeries, 359 procedures in 348 patients with a median age of 54 years were included. There were 96 iCSF leaks (26.7%; 37.5% major, 62.5% minor). In 3 of 359 cases (0.8%) a pCSF fistula occurred, requiring revision surgery in 2 patients and a lumbar drain in 1 patient. Meningitis occurred in 3 of 359 cases (0.8%). All 3 patients recovered without sequelae after antibiotic therapy. According to univariate analysis, risk factors for iCSF leak were macroadenoma (p = 0.006) and recurrent adenoma (p = 0.032). An iCSF leak was found less often in functioning adenomas (p = 0.025). In multivariate analysis recurrent tumors remained as a risk factor (p = 0.021) for iCSF leak. Patients with iCSF leak were at increased risk for a pCSF leak (p = 0.005). A pCSF leak in turn represented the key risk factor for meningitis (p = 0.033). Patients with macroadenomas and recurrent adenomas are especially at risk for iCSF leak. An iCSF leak in turn increases the risk for a pCSF leak, which carries the risk for meningitis. The authors' surgical technique leads to a very low rate of pCSF leaks and meningitis without using autologous graft materials. Hence, this technique is safe and improves patient comfort by avoiding the disadvantages of autologous graft harvesting.

Human Histologic Analysis of Implant Osseointegration in a Healed Site Grafted with Nondemineralized Autologous Tooth-Derived Graft Material

Autologous tooth-derived grafts (ATDGs) have gained popularity as bone substitute biomaterials, owing to their promising healing dynamics in vivo and to patient preference for repurposing hopeless teeth. Nonetheless, concerns exist regarding the biologic response of these ATDGs in preparation for implant placement and subsequent osseointegration. After 12 weeks of extraction socket healing, an implant with an acid-etched surface was placed using osseodensification osteotomy preparation and was retrieved after 16 weeks of integration. Histologic analysis revealed ≥ 64% of direct bone-to-implant contact at multiple regions of interest along the implant surface. Residual dentin particles were scarce and were never found in contact with the implant, suggesting that the ATDG did not interfere with implant osseointegration. Despite the overall trabecular structure of the adjacent maxillary bone with large marrow spaces, the implant surface was delineated with a continuous dense mineralized zone (thickness of 2 to 5 cell layers) with vital osteoblasts in the lacunae. These results suggest that the healing dynamics of ATDG are well aligned with implant osseointegration dynamics.

Derived Dentin Graft as Autologous Bone Regeneration in Implant Surgery: A Histological and Radiographic Investigation

Background: This study has been conducted to evaluate the dentin regeneration potential as an autologous graft material for the preservation of the bone volume in the post-extraction socket. Tooth Transformer has been used as the device required to demineralize the dentin got from the extracted elements, which led to obtaining a granular material rich in collagen and growth factors. Methods: All 8 patients selected for the study underwent two surgical procedures. During the first surgery, the affected elements have been extracted, the Tooth Transformer protocol has been run, and the material has been grafted into the existing bone defects and post-extraction socket. After three months, the biopsy of the regenerated areas has been performed and the implants required for prosthetic rehabilitation were placed in the same site. For two of the 8 patients, the implant has been placed with the support of a surgical guide. Result: CBCT and histological analysis’ results after 3 months confirmed the actual replacement of grafted material and the regeneration of bone tissue suitable for implant rehabilitation. Conclusion: Thus, the Tooth Transformer proves to be an effective device to produce an innovative autologous material from dentin, which is capable of predictable viable bone tissue regeneration able to support prosthetic implant rehabilitation in edentulous sites.

EFFECT OF AUTOGENOUS BONE GRAFT SITE ON DENTAL IMPLANT SURVIVAL AND DONOR SITE COMPLICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

This systematic review and meta-analysis was undertaken to answer the following focus questions: Is the implant survival in augmented bone utilizing iliac crest bone grafts the same as while using intraoral autologous bone grafts? Is the incidence of postoperative donor site complications the same when using iliac crest bone grafts as opposed to intraoral grafts? Systematic searches of electronic databases (PubMed, Embase, CENTRAL) were performed to identify studies which reported on implant survival and postoperative complications for dental implants placed in grafted partially/completely edentulous human jaws. Studies were included if: they reported on 2-piece micro-rough surface root form dental implants placed in bone-augmented completely or partially edentulous human jaws, and the jaws must have been augmented with autologous bone graft materials. Time and nature of postoperative complications must have been reported. Two investigators performed data extraction and a Cohen's unweighted kappa was calculated for inter-investigator reliability. A meta-analysis was performed for the extracted data on implant survival rate in both iliac crest grafts and intra-oral grafts. A qualitative analysis was performed on the information extracted on graft donor site complications. Quality assessment of the included studies were done using the Cochrane collaboration tool and the Newcastle-Ottawa scales. A total of 23 studies were included in the final analysis. The calculated kappa ranged between 0.77-0.89 for the literature search and identification process. Fourteen studies were included with data on implant survival including five randomized controlled clinical trials. The meta-analysis of included studies revealed that the implant survival rate of dental implants placed in jaws augmented with iliac crest grafts was lower than those placed in jaws augmented with intra-oral bone grafts at 6-months [ICG = 95.8% IOG = 98.4%; P < .001], 12-months [ICG = 97.0%, IOG = 98.4%; P < .001], 24-months [ICG = 85.9%, IOG = 98.2%; P < .001], 60-months [ICG = 90.0%, IOG = 91.5%; P < .001], and at 120-months [ICG = 88.8%, IOG = 95.2%; P < .001] follow-up periods. Iliac crest grafts were also frequently associated with donor site complications including pain / discomfort, gait disturbance, and sensory disturbance. This systematic review and meta-analysis demonstrates that implant survival is consistently higher in bone harvested from intraoral sites compared to iliac crest grafts. Donor site complications seemed to be a frequent finding with iliac crest grafts and mental grafts. None. The review protocol was registered with PROSPERO: International prospective register of systematic reviews (CRD42021283738).

Radiological and Microbiological Evaluation of the Efficacy of Alveolar Bone Repair Using Autogenous Dentin Matrix—Preliminary Study

Dental procedures for alveolar bone augmentation may be carried out using autologous bone graft material derived from the patient’s own tooth. The material obtained is subjected to strict procedures aimed at reducing the amount of bacteria in the autograft. The aim of this study was the evaluation of the efficacy of the autogenous dentine matrix produced by grinding the patient’s own tooth for the augmentation of maxillary bone defects and the evaluation of the microbiological status of the material obtained. Alveolar bone repair was performed with an autogenous dentin matrix in four patients. In each case, an autogenous bone graft substitute obtained by grinding the patient’s own tooth was used. The tooth-derived material was then used for alveolar augmentation. The obtained material was tested to assess its microbiological profile. For the purpose of comparison, other materials and tissues were also subjected to microbiological testing. Bone healing was assessed by CBCT (cone beam computed tomography) scanning before and 6 months after surgery using the Hounsfield scale and the ImageJ software. Analysis of the bone regeneration process based on the bone density score in Hounsfield units showed significant differences in measurements on CBCT scans carried out on the treatment site, before surgery, and 6 months after it, using ImageJ software. All bacteria detected in the bone augmentation material constituted the patient’s bacterial flora. The microorganisms present in the augmentation material were also present in the patient’s bone and soft tissues. The use of an autogenous dentin matrix for alveolar bone repair ensures that the proper volume is obtained and that alveolar bone shape is preserved and does not introduce pathogenic microorganisms into the patient. The procedure for preparing and using an autogenous dentin matrix is described based on one clinical case.

Effects of platelet-rich fibrin on osteogenic differentiation of Schneiderian membrane derived mesenchymal stem cells and bone formation in maxillary sinus

BackgroundThe existence of mesenchymal stem cells (MSCs) in Schneiderian membrane has not been determined. The aim of this study is to investigate whether there are MSCs in Schneiderian membrane, and the effect of platelet-rich fibrin (PRF) on osteogenic differentiation of these cells and on new bone formation in maxillary sinus after maxillary sinus floor elevation.MethodsSchneiderian membrane derived mesenchymal stem cells (SM-MSCs) were isolated from rabbit maxillary sinus. Cells were identified by flow cytometry and multipotential differentiation. Real-time cell analysis assay, fluorescence staining, transwell assay, and wound healing assay were used to determine the effects of PRF stimulation on cell proliferation and migration. The osteogenic differentiation ability of cells stimulated by PRF or osteoinductive medium was evaluated by alkaline phosphatase staining, alizarin red staining, PCR and Western blot. Equivalent volume Bio-oss and the mixture of Bio-oss and PRF were used as bone graft materials for maxillary sinus floor elevation. Micro-CT, bone double-staining, HE staining, Masson staining, and toluidine blue staining were used to evaluate the osteogenic effect in 8 and 12 weeks after surgery.ResultsThe cell surface markers were positive for expression of CD90, CD105, and negative for expression of CD34, CD45. SM-MSCs had the ability of osteogenic, adipogenic and chondrogenic differentiation. PRF could stimulate proliferation, migration and osteogenic differentiation of SM-MSCs, which was achieved by up-regulating ERK 1/2 signaling pathway. PRF could accelerate the formation of new bone in maxillary sinus and increase the amount of new bone formation.ConclusionsMSCs existed in Schneiderian membrane, and PRF stimulation could promote cell proliferation, migration and osteogenic differentiation. The application of PRF in maxillary sinus floor elevation could accelerate bone healing and increase the quantity and quality of new bone. PRF, as autologous graft materials, might offer a promising strategy for the clinical bone formation during MSFE procedure.Graphical abstract6kDexyoSUyN5j1q7bTF377Video .

Racial Differences in Iliac Crest Cancellous Bone Composition: Implications for Preoperative Planning in Spinal Fusion Procedures.

This was a retrospective cohort study. The objective of this study was to determine whether race, specifically American white and American black, correlates with the ratio of cancellous to total bone at the iliac crest. Studies have demonstrated higher proximal femur bone density in American blacks than American whites. However, whether differences occur at the iliac crest, a common site for autologous graft material in spinal fusion surgery, is not well studied. Understanding such differences could aid orthopedic surgeon decision-making regarding graft options. A retrospective review was performed on 133 sequential patients ages 18-75 who underwent computed tomography scan of the pelvis, at a single academic medical center from January 1, 2014, to January 1, 2016. The cohort included 46 American white (21 females, 25 males) and 87 American black participants (40 females, 37 males), an average age of 51.8 years. Groups were matched regarding age, sex, body mass index, and Charlson Comorbidity Score. Measurements of cortical and cancellous bone thickness in the right and left iliac crests were performed using bone window protocol on computed tomography scans. Statistical significance was determined using a 2-tailed t test. The interobserver interclass correlation coefficient reliability (N=2) for measurements at the right iliac crest is 0.895 (95% confidence interval, 0.852-0.925), and the interclass correlation coefficient for the left iliac crest is 0.912 (95% confidence interval, 0.877-0.938). A statistically significant difference in the mean cancellous bone ratio was found between American black (0.667±0.065) and American white (0.750±0.051) groups (P<0.001). At the iliac crest, American black patients had a lower mean ratio of cancellous to the total bone as compared with American white patients. This population may benefit from alternative graft options. While iliac crest autograft remains the first option for fusion surgeries, alternative options should be considered to ensure that each patient receives the best-personalized care.

Effectiveness of Chemical Disinfection in Discarding Pathogenic Bacteria of Human Particulate Tooth Graft

Introduction: Extracted teeth are utilized in dentistry as particulate autologous dentin for immediate grafting of the extraction site after mechanical cleaning and chemical disinfection. The objective of this study was to determine the effectiveness of 0.5M sodium hydroxide in 20% ethanol (Dentin Cleanser™) in eliminating three different types of pathogenic bacteria in comparison to ethylenediaminetetraacetic acid (EDTA) or citric acid. Seven naive extracted teeth were mechanically cleaned, dried, and sectioned to separate the crown from the roots. Each tooth was separately crushed using the Smart Dentin Grinder® device. The sterile particles of crown or root were subdivided into three equal-size groups where each was then contaminated and incubated in an oven at 37°C under low pressure and oxygen flow over 48 h for Escherichia coli (Group A) and Enterococcus faecalis (Group B) and over 72 h for Porphyromonas gingivalis (Group C), respectively. On each agar Petri dish, four paper discs, each loaded with one of the following solutions: Dentin Cleanser (sodium hydroxide plus ethanol), 10% EDTA, phosphate-buffered saline (PBS), or 10% citric acid, were placed in the safe distance for not interfering with disinfectant agent activity. All pathogenic bacteria were highly sensitive to Dentin Cleanser and EDTA disinfectant activity while citric acid or PBS exhibited low or no sensitivity. No difference in sensitivity was found between crown and root particulate or particle size. Our findings show that Dentin Cleanser is most effective in eliminating those pathogenic bacteria without demineralizing the particulate. Context: The experiment was done in the University Laboratory. Aims: The objective of this study was to determine the effectiveness of 0.5M sodium hydroxide in 20% ethanol (Dentin Cleanser™) in eliminating three different types of pathogenic bacteria in comparison to EDTA or citric acid, before tooth graft will be used as a biomaterial. Settings and Design: The study protocol was approved by the Catholic University of Murcia Ethics Committee (UCAM; registration number 6781; July 21, 2017). Seven human teeth were extracted from a 60-year-old patient due to advanced periodontal disease (two central upper incisors, one upper canine, one upper premolar, two lower molars, and one lower canine). The patient received no financial compensation for participating in this study. Materials and Methods: Seven naïve extracted teeth were mechanically cleaned, dried, and sectioned to separate the crown from the roots. Each tooth was separately crushed using the Smart Dentin Grinder® device (KometaBio Inc., Cresskill, NJ, USA). The particles were sieved to obtain particles ranging from 400 to 600 um and 800–1200 um in size, all sterilized using an autoclave. The sterile particles of crown or root were subdivided into three equal-size groups where each was then contaminated and incubated in an oven at 37°C under low pressure and oxygen flow over 48 h for E. coli (Group A) and E. faecalis (Group B) and over 72 h for P. gingivalis (Group C), respectively. Then, each subgroup was immersed in 15 agar Petri dishes and again each was inoculated with the same bacteria allowing full growth of bacteria. On each agar Petri dish, four paper discs, each loaded with one of the following solutions: Dentin Cleanser (sodium hydroxide plus ethanol), 10% EDTA, PBS, or 10% citric acid, were placed in the safe distance for not interfering with disinfectant agent activity. Statistical Analysis Used: Statistical analysis was performed using PASW Statistics v. 18.0.0 software (SPSS). One-way analysis of variance was applied for the comparison of the means for halos, assuming a level of significance of 95% (P &lt; 0.05). Kolmogorov–Smirnov and Shapiro–Wilk tests were applied for normality. Results: The results of the present study show that the 0.5M sodium hydroxide with 20% ethanol also termed as Dentin Cleanser presented the widest diameter halo of free bacterial growth, most effective against P. gingivalis (15.76 ± 0.28), less effective against E. faecalis (13.21 ± 0.72) and E. coli (12.14 ± 0.12). Similarly, EDTA was effective in eliminating the same strains of bacteria, while citric acid was not effective according to the Duraffourd halo inhibition scale. PBS had no effect in inhibiting bacterial growth. Both the Dentin Cleanser and EDTA were significantly effective in inhibiting bacterial growth in comparison to PBS and citric acid. No significant differences were observed between the dentin particulate and the dentin–enamel mix particulate or human bone marrow related to the level of sensitivity measured for each of the disinfectants tested. Conclusions: The use of the Dentin Cleanser (sodium hydroxide plus ethanol) or EDTA 10% appears to be an effective disinfectant method of tooth particulate prior to use of such particulate as autologous grafting material. Although E. coli, P. gingivalis, and E. faecalis were found to be sensitive to the presence of these disinfectants, additional bacterial types should be further investigated.

The effect of autogenous tooth bone graft material without organic matter and type I collagen treatment on bone regeneration

ObjectivesThe aim of this study is to examine the effect of particulate autogenous tooth graft removed with organic matter and type I collagen addition on bone regeneration and to validate the possibility of useful allograft material for jaw defects.Material and methodsAutogenous tooth bone maker (Korean Dental Solution® KOREA) made particulate autogenous tooth not including organic matter. We used to the developed tooth grafts for experiment. Cell adhesion test with hemacytometer and energy dispersive X-ray spectroscopy (Supra40 VP®, Carl Zeiss, Germany) analysis about the particulate autogenous tooth and type I collagen were performed. Rabbits were divided into three groups: bone graft with organic matter (OM) removing particulate autogenous tooth group, bone graft with OM removing particulate autogenous tooth and type I collagen group, and a control group. Bone grafting was performed in rabbit’s calvaria. The rabbits were sacrificed at different interval at 1, 2, 4, and 6 weeks after bone grafting for the histopathologic observation and observed the effect of bone regeneration by SEM, H-E & Masson stains, osteocalcin IHC staining.ResultIn vitro cytopathological study showed affinity for cells, cell attachment pattern, and cell proliferation in the order of control group, OM-removed and collagen-treated group, OM-removed particulate autogenous tooth group. The results of the degree of mineralization were opposite to those of the previous cell experimental results, and the OM-removed group, OM-removed group and collagen-treated group were relatively higher than the control group. Histopathologic analysis showed that vascularization and neonatal bone formation were higher in particulate autogenous tooth group with removing OM and with addition of collagen than control group and group of OM removed only. Immunohistochemical analysis showed that osteocalcin (OSC) expression was not observed in the control group, but at 4 weeks groups, OSC expression was observed the OM removed and OM-removed-collagen-treated particulate autogenous tooth, and the degree of expression was somewhat stronger in group of the OM removed and collagen additionally treated particulate autogenous tooth.ConclusionParticles that do not contain organic matter, the saint tooth, was responsible for sufficient bone graft material through the role of space maintenance and bone conduction, and further improved bone formation ability through additional collagen treatment. Therefore, research on various extracellular substrates and autologous bone grafting materials is necessary, and through this, it is possible to lay the foundation for a new type of autologous bone grafting material with excellent academic and technical utility.