Bone Augmentation Research Articles

Triple Hybrid Tibial Anterior Cruciate Ligament Graft Fixation

Optimal graft fixation in anterior cruciate ligament reconstruction is critical. Several direct and indirect methods of graft fixation exist, each with advantages and disadvantages. This Technical Note describes a tibial hybrid anterior cruciate ligament graft fixation technique combining direct and indirect fixation methods, including autologous bone augmentation of the drill tunnel using cancellous bone fragments.

Tilted Implant Technique Solved Numerous Limitation of Straight Technique

Present of important anatomical structures in both upper and lower jaws make challenge during planning for implant procedures in the atrophic alveolar bone and to overcome this problem need bone augmentation which still complex and difficult procedures make it not accepted by large number of patient. In this study we spot light on the teeth implant in an area where short bone or insufficient height of alveolar ridge and inclined alveolar ridge so when we place implant should be tilted either palatelly, mesially or distally in bone around and we compare the success rate between angled placed implant and up right placed implant. 61 patients came to clinic asking for toot h or teeth implant, 300 implant fixtures were placed in both uppe r and lower arch 203 implants were straight and 97were tilted. A fter 24 months follow up in the upper and lower alveolar arche s of dental implant (97.54%) of upright implant were success and (97.94%) of tilted implant were success. Results indicate that the use of tilted implants effective and safe method over bone augmentation procedures and nerve transferring.

Carbonate apatite versus β-tricalcium phosphate for rat vertical bone augmentation: A comparison of bioresorbable bone substitutes using polytetrafluoroethylene tubes.

This study radiologically and histologically compared two bioresorbable bone substitutes with different compositions carbonate apatite (Cytrans® Granules; CGs) and β-tricalcium phosphate (β-TCP) for vertical bone augmentation on a rat skull using a polytetrafluoroethylene (PTFE) tubes. This PTFE tube was placed at the center of the skull, fixed with Super Bond, and augmented with CGs or β-TCP granules. Specimens with surrounding tissue were harvested at 4, 8, and 12 weeks postoperatively, and radiological and histological evaluations were performed. The bone volume to total volume ratio (BV/TV) of the β-TCP-implanted group was markedly higher than that of the CG-implanted group at 4 and 12 weeks postoperatively. Compared to CGs, β-TCP exhibited the ability to form blood vessels into the graft material for a short period after transplantation, as well as an elevated production of collagen into β-TCP granules during the bone formation process.

The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis

ObjectivesTo evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.Materials and methodsElectronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.Results24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants’ survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.ConclusionRecent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.Clinical relevanceThe ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.

Augmentation of single tooth extraction socket with deficient buccal walls using bovine xenograft with platelet-rich fibrin membrane

BackgroundDifferent techniques and materials such as bone grafts and bioactive agents have been used for alveolar ridge augmentation in extraction sockets with a defective wall, there is not a specific material or technique that has resulted in superior outcomes or prevented total bone loss.ObjectivesThis clinical study aims to evaluate radiographically the effectiveness of using bovine xenograft with platelet-rich fibrin (PRF) membrane on vertical and horizontal alveolar ridge dimensional changes following tooth extraction that are complicated by buccal bone loss.Materials and methodsThis study was conducted in Egypt on fourteen patients with a single posterior tooth indicated for extraction. A preoperative cone-beam computed tomography (CBCT) scan confirmed more than 50% loss in buccal bone in each tooth. Extraction sockets were packed with minced PRF clots mixed with a bovine xenograft. Each extraction socket was sealed by PRF membranes. CBCT scans, performed before tooth extraction and after 6 months, were used to assess alveolar ridge changes both vertically and horizontally.ResultsThere was a significant gain in the buccal and middle of the extraction socket bone height, recording 86.01% (6.33 mm) and 206.45% (9.6 mm), respectively. There was an insignificant bone loss in the lingual bone height and width, recording − 8.49% (-1.06 mm) and − 13.39% (1.05 mm), respectively. The results also showed a non-significant decrease in alveolar bone density (-14.06%) between pre-operative bone present apical to the extraction socket and newly formed bone inside the socket.ConclusionsRidge preservation/augmentation techniques using a bone graft mixed with PRF and covered by PRF membranes in fresh extraction sockets complicated by the loss of buccal bone result in buccal bone augmentation and a reduction in horizontal and vertical ridge collapse after tooth extraction.Clinical relevanceThe bovine xenograft in conjunction with PRF can be used immediately after extraction for ridge preservation, providing adequate bone width and height for implant placement.

Clinical and Radiographic evaluation of bone remodeling around implants placed in horizontally augmented bone: A Pilot Study

Introduction: Marginal bone loss after implant placement is one of the most used criteria to assess the success of osseointegrated implants over time. The type of implant connection and implant surface type are reported to have an influence on bone remodeling around the placed implants. This study aimed to evaluate marginal bone loss around two implant systems with different connections and surfaces in horizontally augmented sites. Methods: This randomized control pilot study included 8 implants placed in 3 patients who needed implant placement in previously horizontally grafted sites. The placed implants were divided into two groups: group 1 consisting of implants with external connection and a hybrid design, and group 2 including implants with an internal connection and a fully etched surface. Clinical and radiographical measurements were taken at baseline, during the surgery, and up to one year after loading to evaluate marginal bone loss around the two different implants placed in grafted sites. Results: All implants were retained at all follow-up periods and healing was uneventful. There were similar Marginal Bone Loss (MBL) and soft tissue changes around both types of implants. Group 2 implants had higher MBL, however, the difference was not statistically significative. Conclusions: Preliminary analysis suggest that full surface etching does not seem to negatively influence marginal bone loss around implants placed in augmented bone.

Double-Network DNA Macroporous Hydrogel Enables Aptamer-Directed Cell Recruitment to Accelerate Bone Healing.

Recruiting endogenous bone marrow mesenchymal stem cells (BMSCs) in vivo to bone defect sites shows great promise in cell therapies for bone tissue engineering, which tackles the shortcomings of delivering exogenous stem cells, including limited sources, low retention, stemness loss, and immunogenicity. However, it remains challenging to efficiently recruit stem cells while simultaneously directing cell differentiation in the dynamic microenvironment and promoting neo-regenerated tissue ingrowth to achieve augmented bone regeneration. Herein, a synthetic macroporous double-network hydrogel presenting nucleic acid aptamer and nano-inducer enhances BMSCs recruitment, and osteogenic differentiation is demonstrated. An air-in-water template enables the rapid construction of highly interconnective macroporous structures, and the physical self-assembly of DNA strands and chemical cross-linking of gelatin chains synergistically generate a resilient double network. The aptamer Apt19S and black phosphorus nanosheets-specific macroporous hydrogel demonstrate highly efficient endogenous BMSCs recruitment, cell differentiation, and extracellular matrix mineralization. Notably, the enhanced calvarial bone healing with promising matrix mineralization and new bone formation is accompanied by adapting this engineered hydrogel to the bone defects. The findings suggest an appealing material approach overcoming the traditional limitations of cell-delivery therapy that can inspire the future design of next-generation hydrogel for enhanced bone tissue regeneration.

Auto-dentin platelet-rich fibrin matrixis an alternative biomaterial for different augmentation procedures: A retrospective case series report.

Autologous dentin grafts derived from extracted teeth have shown promise as bone graft materials for promoting bone regeneration. This retrospective case series aimed to evaluate clinical, radiographic, and histologic outcomes of using autologous dentin matrices in various bone regeneration procedures. This case series included 26eligible patients and encompassed 4 socket preservation cases, 5 cases of guided tissue regeneration, 5 cases of guided bone regeneration (GBR), 10 cases of sinus augmentation procedures, 2 immediate placement implants, and 2 socket shields. Dentin grafts were prepared from extracted teeth, cleaned, and processed. These grafts were combined with platelet-rich fibrin (PRF) to create adhesive dentin matrices, then covered with collagen membranes for simultaneous guided bone augmentation cases. Cone beam computed tomography (CBCT) scans were conducted before surgery and 4 months postoperatively to assess ridge dimensions. Histologic evaluation was performed through bone core biopsies for socket preservation cases at the 4-month mark. A total of 42implants were placed in 26 patients, with an average follow-up of 32 months. Notably, two implant failures occurred following lateral maxillary sinus augmentation. CBCT scans at the 4-month interval revealed bone coverage over implant platforms in the majority of cases. Histologic analysis from two cases of socket preservation demonstrated dentin granules enveloped by newly formed bone undergoing continuous remodeling. The quantitative histomorphometric assessment revealed a bone area of 42.8 ± 3.56%, a remaining graft area of 19.05 ± 4.58%, and a viable bone of 38.15 ± 7.84%. The utilization of autologous dentin particles mixed with PRF proved effective as an alternative to conventional bone graft materials in GBRand maxillary sinus augmentation procedures. Larger controlled clinical trials are recommended to further substantiate these findings.

Smart-Responsive Multifunctional Therapeutic System for Improved Regenerative Microenvironment and Accelerated Bone Regeneration via Mild Photothermal Therapy.

The treatment of bone defects remains a substantial clinical challenge due to the lack of spatiotemporal management of the immune microenvironment, revascularization, and osteogenic differentiation. Herein, deferoxamine (DFO)-loaded black phosphorus nanosheets decorated by polydopamine layer are prepared (BPPD) and compounded into gelatin methacrylate/sodium alginate methacrylate (GA) hybrid hydrogel as a smart-responsive therapeutic system (GA/BPPD) for accelerated bone regeneration. The BPPD nanocomposites served as bioactive components and near-infrared (NIR) photothermal agents, which conferred the hydrogel with excellent NIR/pH dual-responsive properties, realizing the stimuli-responsive release of DFO and PO4 3 - during bone regeneration. Under the action of NIR-triggered mild photothermal therapy, the GA/BPPD hydrogel exhibited a positive effect on promoting osteogenesis and angiogenesis, eliminating excessive reactive oxygen species, and inducing macrophage polarization to the M2 phenotype. More significantly, through macrophage M2 polarization-induced osteoimmune microenvironment, this hydrogel platform could also drive functional cytokine secretion for enhanced angiogenesis and osteogenesis. In vivo experiments further demonstrated that the GA/BPPD system could facilitate bone healing by attenuating the local inflammatory response, increasing the secretion of pro-healing factors, stimulating endogenous cell recruitment, and accelerating revascularization. Collectively, the proposed intelligent photothermal hydrogel platform provides a promising strategy to reshape the damaged tissue microenvironment for augmented bone regeneration.

Cement extravasation as a complication for kyphoplasty and vertebroplasty procedure: a retrospective analysis of 171 cases

<p><strong>Aim</strong> <br />Kyphoplasty and vertebroplasty are minimally invasive procedures used in bone augmentation following vertebral fractures when conservative management has failed. Cement injection could leak into surrounding structures leading to post-operative sequelae, which could be symptomatic. This study compared the rate and site of cement extravasation in vertebroplasty, kyphoplasty, and a combined approach. The indications, aetiology, and factors influencing results and the effect of screws were considered.<br /><strong>Methods<br /></strong> A retrospective descriptive study of 171 patients was conducted between 2009 and 2021. Only 89 patients had available<br />imaging. The site of cement extravasation was evaluated postoperatively by CT-scan and X-ray.<br /><strong>Results <br /></strong>There was a statistically significant difference in the prevalence of cement extravasation between kyphoplasty and vertebroplasty procedures (p=0.004). Age and gender had no significant influence on the rate of cement extravasation. Patients who underwent kyphoplasty had the lowest rate of cement extravasation (46.9%) compared to vertebroplasty (85.2%) and the combined approach (69.2%). The most common site of leakage was in perivertebral veins (37.9%). The use of screws did not indicate a greater risk of cement leak (p=0.652). Bone metastases were the aetiology with the highest cement leakage rate (27.5%).<br /><strong>Conclusion <br /></strong>The use of kyphoplasty alone or in conjunction with vertebroplasty decreases the risk of cement extravasation and subsequent complications compared to vertebroplasty alone. The use of pedicle screws appears to be safe and was not found to increase the risk of cement extravasation.</p>

Efficacy of Cal-Cemex as bone substitute for tibial plateau fractures

BackgroundVarious factors influence treatment and outcomes in tibial plateau fractures. Bone defects are among them. Many materials have been proposed to address this problem: allograft, bone–cements and various bone substitutes (BSM). Cal-Cemex (β-tricalciophosphate and polymethylmethacrylate) is a new hybrid bi-component BSM. A retrospective multicenter study was conducted based on the clinical experience of three European Hospitals, to demonstrate its clinical effectiveness, versatility and safety.Materials and MethodsFrom December 2016 to March 2022, 45 displaced tibial plateau fractures were treated with internal fixation and augmentation using Cal-Cemex. The average age was 55.9 years. According to Schatzker classification, we included 13 type II, 24 type III, 3 type V and 4 type VI fractures. The postoperative follow-up (FU) consisted of clinical and radiological examinations at 6 and 12 weeks and 1 year after surgery. A CT scan was performed preoperatively and 1 year after surgery. Full weight bearing was permitted after less than 6 weeks. Clinical data were collected from patient charts, while functional data were evaluated using the Rasmussen knee function score, the KOOS score and the Hospital for Special Surgery knee rating score (HSS), to evaluate the range of motion, axis and functionality of the knee.ResultsThe average FU was 42.8 months. CT scans taken at 1 year demonstrated a good surface osteointegration without radiolucent lines or osteolysis with good evidence of interdigitation and even bone ingrowth. At 1-year FU, the mean Rasmussen score was 24.7, the mean KOOS score was 90.7 and the mean HSS was 89.9 and the average full weight-bearing period 34.9. No patients had hardware failure or fracture secondary displacement.DiscussionCal-Cemex combines biological features and good mechanical performances. It guarantees biocompatibility and osteoconductivity, although it is not fully reabsorbable; β-tricalciophosphate component gives macro- and microporosity that allow fluids to penetrate inside the material, to stimulate bone ingrowth.ConclusionsThe study suggests that Cal-Cemex is an option for tibial plateau fractures, where augmentation and support are necessary for early full weight bearing. The absence of major complications, ease of application, the possibility to cut and perforate this material support its extensive use in bone augmentation for trauma cases.

Enhancing the mechanical properties and surface morphology of individualized Ti-mesh fabricated through additive manufacturing for the treatment of alveolar bone defects.

Titanium meshes are widely utilized in alveolar bone augmentation, and this study aims to enhance the properties of titanium meshes through heat treatment (HT) and the synergistic finishing technology of electric field and flow field (EFSF). Our findings illustrate that the titanium mesh exhibits improved mechanical properties following HT treatment. The innovative EFSF technique, in combination with HT, has a substantial impact on improving the surface properties of titanium meshes. HT initiates grain fusion and reduces surface pores, resulting in enhanced tensile and elongation properties. EFSF further enhances these improvements by significantly reducing surface roughness and eliminating adhered titanium powder, a byproduct of selective laser melting printing. Increased hydrophilicity and surface-free energy are achieved after EFSF treatment. Notably, the EFSF-treated titanium mesh exhibits reduced bacterial adhesion and is non-toxic to osteoblast proliferation. These advancements increase its suitability for clinical alveolar bone augmentation.

Modified Dual-Zone Therapeutic Concept of Single Immediate Implants with Bone Augmentation of the Bone Zone and Soft Tissue Augmentation of the Soft Tissue Zone: Technical Report with 3 Cases.

While the addition of a connective tissue graft (CTG) has been found to increase gingival thickness and reduce facial gingival recession in immediate implant placement and provisionalization, it is associated with significant loss of buccal bone thickness. Loss of buccal bone thickness is thought to be related to preparation of the facial CTG recipient site. This technical report presents a modification of the dual-zone therapeutic concept where the bone zone is grafted with bone graft, and the tissue zone is grafted with tuberosity CTG without elevation a facial partial or full-thickness envelope.

BIO-RSA vs metal augmented baseplate in shoulder osteoarthritis with multiplanar glenoid deformity: a comparative study of radiographic findings and patient outcomes.

Reverse shoulder arthroplasty (RSA) requiring extensive reaming to address severe glenoid bone loss increases the risk of glenoid medialization and baseplate failure. We hypothesized that i) metal augmented baseplate prevents the medialization of the joint line and preserves glenoid bone stock similarly to BIO-RSA; ii) bone graft viability and healing in BIO-RSA patients become compromised over time. Eighty-one patients (83 shoulders) underwent glenoid lateralization with bone (BIO-RSA group, 44) or metal augmented baseplate (MIO-RSA group, 39) and a minimum follow-up of 24 months were included. The orientation and direction of glenoid erosion was identified and recorded using computerized 3D planning. Active range of motion, and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index were assessed before arthroplasty and at the last follow-up visits. Radiographic changes around the glenoid and humeral components were assessed. Healing and thickness of bone graft were evaluated by predefined criteria. Postoperative global glenoid inclination (β angle) and retroversion were also measured. Delta scores of active anterior elevation were higher in the MIO-RSA group (p= 0.027). The differences in the other planes of shoulder motion and in WOOS index scores between the groups were not significant. Preoperative glenoid retroversion was higher in BIO-RSA patients, glenoid inclination was similar in both groups. Type B2 and B3 glenoids had a posterior-central (91%) and posterior-superior (90%) erosion with a mean posterior humeral head subluxation of 76% and 78%, respectively. The direction of erosion in Type E2 and E3 glenoids was posterior-superior, with a mean posterior humeral head subluxation of 74%. The rate of high position of the glenosphere was higher in the BIO-RSA group (p = 0.022), while the values of β angle and postoperative retroversion were similar in the two groups. BIO-RSA group showed radiolucent lines < 2mm around the bone graft in 16 patients (36.4%) and decreased thickness in 15 (34.1%). Incomplete baseplate seating was found in 4 MIO-RSA patients (10%). We found higher rate of humerus condensation lines in MIO-RSA patients (p= 0.01) and higher rate of cortical thinning and tuberosity resorption in the BIO-RSA group (p= 0.027 and p = 0.004, respectively). Metal augmented glenoid is a suitable alternative to BIO-RSA to preserve bone and prevent the medialization of the joint line in arthritic glenoid with multiplanar glenoid deformity. Bone and metal augmentation provided satisfactory clinical outcomes. Bone graft resorption in BIO-RSA patient raise concern about the risk of baseplate loosening and requires further long term studies.

Postoperative Outcomes in the Surgical Rehabilitation of Alveolar Bone in Implant-Prosthetic Therapy: A Review

Surgical rehabilitation of the muco-osseous support in edentulous patients with severe alveolar bone resorption is a challenging stage for the specialists in implant-prosthetics and oral surgery. Various biomaterials including autogenic, allogenic, xenografts, and synthetic biomaterials are considered on-the-board options for implant-prosthetic therapy. The selection of the bone graft must consider the systemic status, the osteogenic potential of the recipient site, and the available growth time of the new bone. A large range of alveolar bone reconstruction techniques is available to implantologist or oral surgeon: guided bone regeneration (GBR), vertical/horizontal augmentation by onlay blocks, distraction osteogenesis, alveolar ridge splitting techniques, bone expansion techniques) Various research groups reported the bone gain both in vertical and horizontal augmentation techniques by xenografts. Lateral bone augmentation techniques were recommended in post-extraction areas. The potential of the vertical augmentation procedures was highlighted but the long-term success depends on clinician’ experience level. Various factors that can influence the implant success/failure rate when implants were placed in alveolar bone areas after reconstruction by grafting materials. The main factor responsible for the absence of graft integration, its migration, and the absence of implant integration in the grafted area is represented by the poor execution of the surgical technique and graft migration because of poor vascularization in the grafted area.

Antibiotic prescription in bone augmentation and dental implant procedures: a multi-center study

BackgroundAdherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections.MethodsMedical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010–2011 and 200 in 2014–2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012.ResultsThere was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010–2011 to 18.5% (n = 37/200) in 2014–2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010–2011 to 35% in 2014–2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines.ConclusionsAfter introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures.

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures-An Updated Narrative Review.

Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues.

Mussel-inspired cortical bone-adherent bioactive composite hydrogels promote bone augmentation through sequential regulation of endochondral ossification

Endochondral ossification (ECO) plays an integral part in bone augmentation, which undergoes sequential processes including mesenchymal stem cells (MSC) condensation, chondrocyte differentiation, chondrocyte hypertrophy, and mineralized bone formation. Thus, accelerating these steps will speed up the osteogenesis process through ECO. Herein, inspired by the marine mussels' adhesive mechanism, a bioactive glass-dopamine (BG-Dopa) hydrogel was prepared by distributing the micro-nano BG to aldehyde modified hyaluronic acid with dopamine-modified gelatin. By in vitro and in vivo experiments, we confirm that after implanting in the bone augmentation position, the hydrogel can adhere to the cortical bone surface firmly without sliding. Moreover, the condensation and hypertrophy of stem cells were accelerated at the early stage of ECO. Whereafter, the osteogenic differentiation of the hypertrophic chondrocytes was promoted, which lead to accelerating the late stage of ECO process to achieve more bone augmentation. This experiment provides a new idea for the design of bone augmentation materials.

Clinical Study of 14 Cases of Bone Augmentation with Selective Laser Melting Titanium Mesh Plates.

Additive manufacturing techniques are being used in the medical field. Orthopedic hip prostheses and denture bases are designed and fabricated based on the patient's computer-aided design (CAD) data. We attempted to incorporate this technique into dental implant bone augmentation. Surgical simulation was performed using patient data. Fourteen patients underwent bone augmentation using a selective laser melting (SLM) titanium mesh plate. The results showed no evidence of infection in any of the 14 patients. In 12 patients, only one fixation screw was used, and good results were obtained. The SLM titanium mesh plate was good adaptation in all cases, with bone occupancy greater than 90%. The average bone resorption of the marginal alveolar bone from the time of dental implant placement to the time of the superstructure placement was 0.69 ± 0.25 mm. Implant superstructures were placed in all cases, and bone augmentation with SLM titanium mesh plates was considered a useful technique.

A Novel Screwless Modification of the Khoury Plate Technique using an Innovative Bone Adhesive Formulated from Underwater Biomimetic Marine Proteins.

The Khoury plate technique has been widely utilized with much success over the past 2 decades to facilitate bone augmentations in critically deficient bone areas. Simply, the technique encompasses harvesting autogenous bone plates and utilizing them with external screw fixation. The rigidity of the bone plates enclosing the bony defect on both the buccal and lingual surfaces allows for tension free bone remodeling to occur favoring an ideal bone forming environment. Following, a 4-6 month healing period, a flap is raised, screws may be removed and implant placement then follows. With advancements made in tissue engineering, recently a novel mineral-organic resorbable bone adhesive (MORBA) formulated from underwater biomimetic marine proteins has been utilized for immediate fixation of either bone-to-bone or bone-to-metal. MORBA is a synthetic, injectable, self-setting, and resorbable load-bearing adhesive biomaterial that exhibits over 300 pounds of fixation strength. The unique adhesive properties of MORBA enable it to provide immediate stabilization of dental implants into host bone. The present article describes a novel modification of the Khoury plate technique by utilizing MORBA as a substitute for screws during the fixation of bone plates. A step by step protocol is described where this novel biomaterial was utilized as a substitute to screws favoring a more biological approach to this conventional technique. This novel modification is both surgically easier to conduct, and favors a more biocompatible option that avoids screw fixation and removal.