Bone Gain Research Articles

Customized Titanium Mesh for Guided Bone Regeneration with Autologous Bone and Xenograft.

The augmentation of the alveolar crest after the loss of one or several teeth can be carried out using different bone augmentation techniques. These techniques include bone distraction, ridge expansion, bone block grafts, etc. Guided bone regeneration is an alternative to increase the volume of the hard tissues for the subsequent placement of the implants in the optimal three-dimensional position. The objective of this paper is to show a case report of the use of customized titanium mesh for posterior vertical bone regeneration. Case report and Results: A 59-year-old woman comes to rehabilitate edentulous spaces with implants. After taking the anamnesis and the intra and extraoral exploration, a vertical and horizontal bone defect is observed in the third quadrant. After the radiological study with CBCT, a bone height of 6.04 mm to the inferior alveolar nerve and a width of the bone crest of 3.95 mm was observed. It was decided to carry out a regeneration with a preformed titanium mesh (Avinent®, Santpedor, Spain) and four microscrews (Avinent®, Santpedor, Spain). The flap was closed without tension. Regular check-ups were performed without complications. At 7 months, the mesh was removed and two osteoingrated implants (Avinent®, Santpedor, Spain) were placed with a torque greater than 45 N/cm and an ISQ of 82 and 57 N/cm, respectively. The bone gain obtained was 1.84 and 1.92 mm in width and 4.2 and 3.78 mm in height for positions 3.5 and 3.6. The newly formed bone, obtained by trephine, was well-structured and histologically indistinguishable from the previous bone. Conclusion: The use of a customized pre-formed titanium mesh together with the mixture of autologous bone and xenograft is a feasible and predictable technique for vertical bone regeneration.

Low Bone Turnover Due to Hypothyroidism or Anti-Resorptive Treatment Does Not Affect Whole-Body Glucose Homeostasis in Male Mice.

Bone is a large and dynamic tissue and its maintenance requires high amounts of energy as old or damaged bone structures need to be replaced during the process of bone remodeling. Glucose homeostasis is an essential prerequisite for a healthy bone and vice versa, the skeleton can act as an endocrine organ on energy metabolism. We recently showed that hypothyroidism in mice leads to an almost complete arrest of bone remodeling. Here, we aimed to investigate whether the profound suppression of bone remodeling affects whole-body glucose homeostasis. To that end, male C57BL/6JRj mice were rendered hypothyroid over 4 weeks using methimazole and sodium perchlorate in the drinking water. We confirmed trabecular bone gain due to decreased bone turnover in hypothyroid mice with decreased cortical but increased vertebral bone strength. Further, we found impaired glucose handling but not insulin resistance with hypothyroidism. In hypothyroid bone, glucose uptake and expression of glucose transporter Glut4 were reduced by 44.3% and 13.9%, respectively, suggesting lower energy demands. Nevertheless, hypothyroidism led to distinct changes in glucose uptake in muscle, liver, and epididymal white adipose tissue (eWAT). Reduced glucose uptake (−30.6%) and Glut1/Glut4 transcript levels (−31.9%/−67.5%) were detected in muscle tissue. In contrast, in liver and eWAT we observed increased glucose uptake by 25.6% and 68.6%, respectively, and upregulated expression of glucose transporters with hypothyroidism. To more specifically target bone metabolism and discriminate between the skeletal and systemic effects of hypothyroidism on energy metabolism, male mice were treated with zoledronate (ZOL), a bisphosphonate, that led to decreased bone turnover, trabecular bone gain, and reduced local glucose uptake into bone (−40.4%). However, ZOL-treated mice did not display alterations of systemic glucose handling nor insulin tolerance. Despite the close mutual crosstalk of bone and glucose metabolism, in this study, we show that suppressing bone remodeling does not influence whole-body glucose homeostasis in male mice.

Clinical and radiographic outcomes of customized allogeneic bone block versus autogenous bone block for ridge augmentation: 6 Month results of a randomized controlled clinical trial.

To evaluate the efficacy of customized allogeneic bone block (CABB) for ridge augmentation compared with autogenous bone block. Patients (N=24) in need of ridge augmentation were randomly assigned to one of two treatment modalities: CABBs (CABB group) and autogenous bone blocks (ABB group). The primary outcome of the present study was the horizontal bone gain at 1 mm below the alveolar ridge crest (HBG1 ). Secondary outcomes were the bone gain at other levels, bone resorption rate, ridge width, operative time, postoperative pain score, and histological results. The data obtained from the current study were analysed using a generalized linear mixed effects model, two-sample t-test, or a Mann-Whitney U-test. Twenty-four patients completed a 6-month follow-up. One patient in the CABB group exhibited block exposure. The CABB group had significantly more horizontal bone gain (HBG1 ) and less horizontal bone resorption (HBRR1 ) at 1 mm below the alveolar ridge crest when compared with those in the ABB group (HBG1 : CABB group [4.29 ± 1.48 mm] and ABB group [1.12 ± 3.25 mm]; HBRR0 : CABB group [42.15 ± 14.03%] and ABB group [92.52 ± 55.78%], p < .05). In addition, a longer operative time was reported in the ABB group compared with the CABB group (p < .05). The histological observation indicated a new bone formation in both groups. The use of CABBs resulted in more horizontal bone gain and less horizontal bone resorption at 1 mm below the alveolar ridge crest at 6months post-surgery compared with ABBs while reducing the operative time in the treatment of ridge augmentation.

The Prognostic Outcome of Transalveolar Sinus Floor Elevation With or Without Grafting Materials: A Meta-analysis.

To assess the effect of nongrafted and grafted materials on transalveolar sinus floor elevation (TSFE) with implant placement. Relevant studies published between January 1, 1994, and July 31, 2021, were selected by searching Embase, PubMed/MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The study subjects were restricted to humans, and the language was limited to English. The study was confined to randomized controlled trials, controlled clinical trials, and observational studies (prospective and retrospective cohort) related to TSFE with and without bone-grafting materials. Two reviewers independently extracted study data and conducted quality assessments according to the Cochrane handbook and NOS scale. RevMan 5.3 and Stata 15.1 software were then used to analyze the research data that met the inclusion criteria. A total of nine articles were included, including 421 implants in the graft group and 502 implants in the nongraft group. Meta-analysis showed that there was no significant difference in the implant failure rate (RR = 1.03, 95% CI: 1.00, 1.06, P = .08) or marginal bone loss (SMD = 0.06, 95% CI: -0.23, -0.35, P = .69) between implants with and without graft materials after TSFE. The amount of endosinus bone gain in the nongraft group was significantly lower than that in the graft group (SMD = -1.07, 95% CI: -1.73: -0.41, P = .0001). TSFE in implants with or without grafting can achieve similar results, but there may be more bone gain in TSFE with grafting.

Bone Morphogenetic Protein as Bone Additive around Dental Implant and its Impact on Osseointegration: a Systematic Review.

Bone morphogenetic protein (BMP), a potential osteoinductive agent, was systematically reviewed for merits and demerits when used as a bone additive that was intervened during the surgical phase of dental implant placement; and suitable drug carriers that could withstand the functional load and deliver BMP at its lowest concentration. To identify the carriers and concentration of BMP acceptable during surgical phase of implant placement and evaluate its efficacy in bone gain and osseointegration. The study design was systematic review. Literature search as per PICO format was carried out within a time range from 2000 to July 2021. The review fol-lowed PRISMA guidelines and registered with the PROSPERO (CRD42020171667). The focus question included the population with an intra-oral implant placed in both animal and human models that were intervened with BMP-2 as an external additive biomaterial during the surgical phase. 2631 articles selected from the initial search were systematically filtered and yielded 16 articles that were qualitatively analysed. The inter-rater reliability and level of agreement were 93.71%, κ(Kappa)>0.81 re-spectively. Results revealed the collagen carrier was commonly used for BMP delivery but lacked the property to withstand functional load and sustained release. BMP concentration varied in the range of 0.215μg to 0.8mg and the study revealed significantly indifferent out-come with low dose compared to the highest dose. BMP supplement showed better osseointe-gration in comparison with non-supplemented sites during the early period (within 6 months). BMP at lower concentrations and with appropriate carriers, collagen sponge, hydroxyapatite/tricalcium phosphate (HA/TCP) with a bio ceramic bulking agent, and poly (D, L-lactide-co-glycolic acid) (PLGA) reinforced with gelatin/HA/TCP accelerated bone growth during the initial stages of healing. Further long-term clinical trials for dental implant, analysing the sustained release of BMP with biodegradable and load-bearing carriers should be considered.

Single-Tooth Immediate Placement and Provisionalization with Subcrestally Angulated Implants in Sites with Hard and Soft Tissue Facial Dehiscence in the Esthetic Zone: An Observational Study with 2 to 5 Years of Follow-up.

This study evaluated the survival and esthetic outcome of flapless postextraction placement and provisionalization in compromised single tooth sites in the esthetic area. Ten patients were included in the study, and 10 subcrestally angled (SCA) tapered implants were placed. Only maxillary central or lateral incisors and canines were included. Implants showed 100% survival rate, a limited mean marginal bone loss of 0.43 ± 0.23 mm, and a mean gain in coronal gingival level of 1.6 ± 1.17 mm; the mean vertical alveolar bone gain was 4.0 ± 1.5 mm, and the average pink esthetic score was 12.5 at a mean 3.5-year follow-up (range: 2 to 5 years). These results show that immediate replacement and restoration of a tooth with compromised hard and soft tissue condition in the esthetic area, with simultaneous use of connective tissue, bone graft, and membrane, could be a valid alternative to a more complex staged approach.

Reconstruction of extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton: case report

Reconstruction of extensive bone loss in the foot requires a set of strategies involving various surgical techniques and orthopedic devices. Semicircular Ilizarov external fixator combined with a structural homologous bone graft may be advantageous in pediatric patients. This case report describes the technique of reconstructing an extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton. The combination of the external fixator and the homologous graft provided sufficient bone volume without recurrent infection, minimal complications, substantial length gain of the metatarsal bone, and improved soft tissue conditions. It is a viable treatment option for severe foot injuries in immature skeletons. Level of Evidence V, Therapeutic Studies, Expert Opinion.

Assessment of narrow alveolar ridge expansion by ossiodensification vs. ridge splitting technique for dental implant placement

Objectives: Comparing osseodensification vs. ridge splitting techniques in dental implant placement regarding implant stability, insertion torque, bone width and density. Patients and Method: Twenty individuals with a narrow ridge width of 3-6 mm at crestal bone level were included in this study. They were divided into two groups: Group I Osseodensification technique, Group II Ridge splitting technique with bone expanders and sticky bone augmentation. Implant stability, insertion torque, surgical procedure duration, bone width, and density were all evaluated by CBCT. Results: Group (I) had showed higher statistically significant Insertion torque than group (II). While group (II) had showed statistically significant increase in mean ISQ reading after 6 months (p&lt;0.001). Group (II) showed statistically significant higher surgical time than group (I). Group (II) showed a higher increase in bone gain than group (I). Group (I) had showed statistically significant increase in mean bone density postoperatively, after 3 and 6 months (p&lt;0.001*). While group (II) had showed statistically significant increase in mean bone density postoperatively, after 3 and 6 months (p&lt;0.001). Conclusion: Osseodensification technique had been shown to increase ridge width while maintaining primary implant stability and bone density around dental implants without sacrificing bone.

Custom Bone Regeneration (CBR): An Alternative Method of Bone Augmentation-A Case Series Study.

We performed this clinical study in order to evaluate the reliability of the Guided Bone Regeneration (GBR) surgical technique through the use of customized CAD CAM titanium meshes (Yxoss CBR® Reoss) in order to show an alternative method of bone augmentation. Materials and methods: Nine patients presenting 10 bone defects were referred to solve oral dysfunction due to edentulous atrophic ridges. Guided bone regeneration was performed with titanium meshes combined with autogenous bone grafting and heterologous bovine bone mineral grafting, and exclusively a “poncho technique” soft tissue approach for all the cases. After a mean 9 months of graft healing (range 6–12 months), titanium meshes were removed, and implant surgery was subsequently performed. The results we obtained were positive in terms of volumetric increases in height, length and thickness of the atrophic ridges without biological complications detectable before implant surgery. Results: Out of nine, one site met titanium mesh exposure: however, in all 10 sites a three-dimensional volumetric bone implementation was obtained. The statistical results were estimated by uploading and superimposing cbct scans before and after CBR surgery for each patient, so it was possible evaluate the maximum linear vertical and horizontal bone gain through dedicated Cad Cam software (Exocad GmbH®). The average horizontal gain was 6.37 ± 2.17 mm (range 2.78–9.12 mm) and vertical gain was 5.95 ± 2.06 mm (range 2.68–9.02 mm). A total of 18 implants were placed into the grafted sites with a 100% survival rate (clearly they are relative percentages to be compared to the short time elapsed). Conclusions: The results we obtained in this study suggest that this CBR procedure (Yxoss® by Reoss) is reliable and safe for bone regeneration to allow implant-prosthetic restoration in horizontal, vertical and combined bone defects. The soft tissue management is diriment: all the cases were managed with a “poncho” flap approach to decrease exposure complication.

Evaluation of bone gain in horizontal ridge augmentation using titanium mesh in combination with different flap advancement techniques: a randomized clinical trial

The aim of this study was to investigate and compare the clinical and radiographic bone gain in guided bone regeneration with titanium mesh, for four different advancement techniques: periosteal releasing incision (PRI), double flap incision (DFI), modified periosteal releasing incision (MPRI), and coronally advanced lingual flap (CALF). Forty patients with a partially edentulous mandible were allocated randomly to four study groups (PRI, DFI, MPRI, CALF; 10 patients in each). Clinical bone gain (primary outcome) and radiographic bone gain were evaluated. In addition, correlations between study variables (clinical and radiographic bone gain, flap advancement, mesh exposure area and percentage exposure, pain, and swelling) were explored. CALF exhibited the highest mean clinical bone gain (4.12 ± 1.37 mm) and PRI the lowest (2.60 ± 1.36 mm); the mean clinical bone gain differed significantly among the groups (P < 0.001). The highest mean radiographic bone gain was seen in the CALF group (3.54 ± 1.65 mm) and the lowest in the PRI group (2.06 ± 1.11 mm); the mean radiographic bone gain also differed significantly among the groups (P < 0.001). The correlation analysis revealed positive correlations between flap advancement and radiographic bone gain (P = 0.003) and between swelling and pain (P = 0.007). An inverse correlation was found between flap advancement and swelling (P = 0.049), mesh exposure area and clinical bone gain (P = 0.022), and mesh exposure percentage and clinical bone gain (P = 0.017). In summary, the highest clinical and radiographic bone gain was observed for CALF, while the lowest was observed for PRI.

Localized ridge augmentation with simultaneous implant placement followed by soft tissue augmentation in the maxillary anterior region: A case report

A deficient alveolar ridge in the maxillary anterior site often warrants ridge augmentation prior to prosthetic rehabilitation, in order to enhance functional and esthetic outcomes. In particular, if implant therapy is planned in a deficient jaw, ridge augmentation is preferred before or simultaneous to implant placement in order to overcome the anatomic limitations of the residual jaw bone crest. Guided bone regeneration (GBR) is the gold standard technique for bone regeneration in patients with atrophic ridges, and it is regarded as one of the most predictable techniques for ridge augmentation. Non‑resorbable membranes, such as titanium mesh are preferred in the GBR procedure, due to the enhanced rigidity and microporous structure, facilitating vascularity. However, the most common disadvantage of non‑resorbable membranes, when used in vertical augmentation, is the soft tissue dehiscence. However, tissue stability is essential for the long‑term successful outcomes of GBR. The present study focuses on the evaluation of the clinical and radiographic outcomes of a patient undergoing GBR using customized titanium mesh and xenograft simultaneous to implant placement in the maxillary anterior region. In addition to the hard tissue augmentation, soft tissue augmentation was performed using injectable platelet‑rich fibrin and a collagen membrane. Following 6 months of GBR, the augmentation site exhibited clinically and radiographically significant gain in ridge dimensions, with an average bone gain of 2.8 and 3.1 mm in horizontal and vertical dimensions, respectively with stable soft tissue support.

Peri-Implant Marginal Bone Changes around Dental Implants with Platform-Switched and Platform-Matched Abutments: A Retrospective 5-Year Radiographic Evaluation.

Preserving the marginal bone level (MBL) is essential for the long-term success of dental implant therapy, and bone remodeling around dental implants is considered to vary with time. Numerous studies comparing the platform-switching (PS) and platform-matching (PM) dental implants have indicated that PS dental implants showed a lesser reduction for the MBL, and the majority of them had a relatively short period. This study aimed to evaluate vertical and horizontal bone defects by using digital periapical radiographs to examine the changes in MBL around PM and PS dental implants over 5 years after functional loading. The vertical MBL (vMBL) was measured from the implant–abutment junction to the first bone-to-implant contact. The horizontal MBL (hMBL) was measured from the implant–abutment junction to the bone crest. All data were presented as means ± standard errors. Paired and independent t-tests with Welch’s correction were used to analyze the data. A total of 61 dental implants in 38 patients after 5 years of functional loading were evaluated. Over time, PS dental implants were more likely to gain bone; by contrast, PM dental implants were more likely to lose bone during the observation time. Changes in vMBL for PS dental implants were significantly less than those for PM dental implants at 1-year (p = 0.045), 3-year (p = 0.021), and 5-year (p = 0.010) loading. Likewise, changes in hMBL for PS dental implants were significantly smaller than in those for PM dental implants at 3-year (p = 0.021) and 5-year (p = 0.006) loading; however, the changes were minimal in both approaches. PS dental implants had a significant increment in the percentage of bone integration, whereas that for PM dental implants dropped over time, with no significance. In PS dental implants that occlude with natural teeth, vertical and horizontal bone gain was observed, and it was significant at 3 years (p = 0.023). A significant horizontal bone gain was observed in the opposing natural teeth at 3-year (p = 0.002) and 5-year loading (p = 0.002). The PS concept appears to preserve more MBL around dental implants by stabilizing the vMBL and hMBL over a 5-year period. A minimal marginal bone change was detected in both concepts. The opposing natural teeth at PS dental implants showed a favorable effect on marginal bone tissues.

Clinical and radiographic outcomes following transcrestal maxillary sinus floor elevation with injectable xenogenous bone substitute in gel form: a prospective multicenter study

PurposeTo investigate clinical and radiographic outcomes of transcrestal maxillary sinus floor elevation performed with an injectable xenograft in gel form, analyzing general, local and surgical variables possibly influencing the results.MethodsPatients with residual crestal height < 5 mm underwent transcrestal sinus floor elevation with xenograft in gel form to allow the placement of a single implant. Simultaneous implant placement was performed when primary stability was ≥ 15 Ncm. Graft height was measured immediately after surgery (T0) and after 6 months of healing (T1). Univariate and multivariate regression models were built to assess associations between clinical variables with implant survival and graft height at T1.Results71 patients underwent transcrestal sinus floor elevation and 54 implants were simultaneously placed. Delayed implant placement (at T1) was possible in 5 cases out of 17 (29.4%), whereas in 12 patients (70.6%) implant insertion was not possible or required additional sinus grafting. Implant survival rate, with a follow-up varying from 12 to 32 months after loading, was 100%. Mean pre-operative bone height was 3.8 ± 1.0 mm, at T0 was 13.9 ± 2.2 mm and at T1 was 9.9 ± 2.8 mm. Bone height at T1 was negatively influenced by membrane perforation at surgery (p = 0.004) and positively influenced by immediate implant insertion (p < 0.001).ConclusionsTranscrestal sinus floor elevation performed with injectable xenograft gel resulted in 100% implant survival rate. However, immediate implant insertion seems a crucial factor to preserve vertical bone gain: one-stage technique seems to be the most predictable approach to optimize clinical outcomes with this approach.Trial registration clinicaltrials.gov, NCT05305521. Registered 31 March 2022—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05305521.

ALVEOLAR RIDGE VERTICAL AUGMENTATION USING TENTING POLE, POLYTETRAFLUOROETHYLENE (PTFE) AND TITANIUM MESH TECHNIQUES

Background: Vertical bone resorption begins as soon as the tooth is extracted and, if not stopped, continues until the alveolar bone is completely atrophic. Various ma­terials and techniques are used to rebalance the bone, which helps to restore the stable height of the alveolar bone. Three techniques are reviewed in this study: po­lytetrafluoroethylene membrane (PTFE), titanium mesh (Ti-mesh), and tenting pole. This systematic review aimed to evaluate the effectiveness of three different vertical augmentation techniques. Methods: A systematic review of the literature was per­formed according to the PRISMA guidelines in search of clinical trials published between 2017 and 2022. Electronic literature searches were conducted inde­pendently by two authors. Results: Studies indicate a vertical gain of alveolar bone from 2.36 ± 0.28 mm to 5.6 ± 2.6 mm, when using PTFE, and the mean vertical gain of alveolar bone was from 1.5 ± 1.6 mm to 6.36 mm when using Ti-mesh, and 1.72 ± 0.78 mm to 2.87 ± 0.79 mm bone gain using tenting pole technique. Conclusion: Three used techniques: polytetrafluoroethy­lene membrane (PTFE), titanium mesh (Ti-mesh), and tenting pole showed acceptable results in the process of vertical augmentation. However, this study did not find robust evidence of which technique is the most effective.

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.

Low Window Sinus Elevation Technique: Bone Gain and Postsurgical Discomfort. A Retrospective Case Series.

Recently, the Low Window technique was proposed to facilitate sinus augmentation and reduce postsurgical patient discomfort. It was shown to be both safe and effective. This case series evaluates the postsurgical discomfort of patients undergoing Low Window sinus augmentation, the bone gain achieved, and whether these factors correlate with the osteotomy area. Records of patients (n = 26) who underwent a sinus elevation using the Low Window approach (n = 34 interventions), followed by implant placement and prosthetic rehabilitation (n = 97 implants), were assessed retrospectively. The analyzed outcomes were the medial, middle, and lateral bone gain ≥ 9 months after augmentation; pain at 5 to 6 hours postsurgery, evaluated on a visual analog scale (VAS; 0 to 100); pain, swelling, and hematoma formation every day up to 7 days postsurgery, evaluated by VAS; implant and prosthetic success and survival rates; and rate of complications. The average follow-up time was 62.1 ± 14.9 months. No intraoperative sinus membrane perforations or other complications occurred. Medial, middle, and lateral bone gains were 10.1 ± 1.7 mm, 11.6 ± 0.8 mm, and 10.7 ± 0.9 mm, respectively. At the last follow-up, the implant success rate was 99%. Postsurgical VAS pain 5 to 6 hours postsurgery was 12.3 ± 8.0 and decreased significantly thereafter. Swelling prevalence was 29.4% at 1 day postsurgery, 20.6% at 2 days, and 2.9% the following day. No swelling was observed from day 4 onward. Prevalence of hematoma was 8.8% for 2 days postsurgery, 2.9% the day after, and no hematoma was observed thereafter. Only the osteotomy area correlated with immediate postsurgical pain, but not with other discomfort outcomes or with bone gain. Low Window sinus elevation might allow bone gain and medium-term implant and prosthetic success rates similar to that of other access window designs. Prospective, comparative studies are needed to investigate whether the technique is more advantageous than traditional approaches.

Histologic and Clinical Evaluation of Ridge Augmentation of Extraction Sockets with Severe Bone Defects: A Clinical Prospective Study.

To primarily evaluate the dimensional changes of bone and soft tissue following ridge augmentation in compromised molar regions. The secondary objective was to evaluate the histologic composition of augmented sites. The study included 27 patients who underwent augmentation of extraction sites with grafts covered by a collagen membrane. CBCT was taken immediately after augmentation (T2) and after 8 months of healing, before implant placement (T3). The width and height of the extraction sites were recorded at extraction (T1) and reentry surgery (T4). A histomorphometric analysis was performed. Data were evaluated in terms of bone crest level, implant survival rates, and change in mucogingival junction. According to clinical measurement, horizontal and vertical bone gain was 10.15 ± 1.00 mm and 8.80 ± 1.86 mm, respectively. Radiographic measurement showed that the horizontal width changes were 1.46 ± 0.52 mm, 0.98 ± 1.29 mm, and 1.29 ± 0.82 mm, respectively, at 1, 3, and 5 mm apical to the crestal level. Vertical bone change was 2.34 ± 0.90 mm in the center of the socket. Histomorphometric analysis showed that percentages of mineralized bone, nonmineralized tissue, and bone substitute were 32.31% ± 13.25%, 25.36% ± 12.24%, and 42.34% ± 9.54%, respectively. The mucogingival junction shift was 0.6 ± 1.1 mm. Implant survival rates and crestal bone resorption were 100% and 0.78 ± 0.58 mm, respectively, after 1 year of loading. Ridge augmentation can be performed successfully to manage extraction sockets. Membrane coverage combined with primary wound closure could be conducive to new bone regeneration and peri-implant tissue health.

Anti-sclerostin antibodies and abaloparatide have additive effects when used as a countermeasure against disuse osteopenia in female rats.

Prolonged disuse and substantial mechanical unloading are particularly damaging to skeletal integrity. Preclinical studies in rodents and clinical studies have highlighted the need for potent bone anabolic drugs to counteract disuse-induced osteopenia. The aim of present study was to compare the efficacy of romosozumab (Scl-Ab) and abaloparatide (ABL), alone or in combination, to prevent botulinum toxin (BTX) induced bone loss in a rat model. Eighty female Wistar rats were divided into the following six groups: 1. Baseline (n=12); 2. Control (Ctrl) (n=12); 3. BTX (n=12); 4. BTX+Scl-Ab (n=16); 5. BTX+ABL (n=12); and 6. BTX+Scl-Ab + ABL (n=16). Disuse was achieved by injecting 4IU BTX into the hind limb musculature at study start. Scl-Ab (25mg/kg) was injected s.c. twice weekly, while ABL (80μg/kg) was injected s.c. five days a week for four weeks. Hind limb disuse dramatically decreased muscle mass and skeletal integrity and deteriorated the cortical morphology and trabecular microstructure. Treatment with Scl-Ab alone prevented most of the adverse cortical and trabecular effects of disuse, while ABL monotherapy mainly attenuated the disuse-induced loss of femoral areal bone mineral density (aBMD). Moreover, the combination of Scl-Ab and ABL not only counteracted most of the negative skeletal effects of unloading, but also increased aBMD (+10% and +20%), epiphyseal trabecular bone volume fraction (BV/TV) (+25% and +73%), and metaphyseal bone strength (+18% and +30%) significantly above that of Scl-Ab or ABL monotherapy, respectively. The potent and additive osteoanabolic effect of Scl-Ab and ABL, when given in combination, is highly intriguing and underlines that an osteoanabolic bone gain can be maximized by utilizing two pharmaceuticals targeting different cellular signaling pathways. From a clinical perspective, a combination treatment may be warranted in patients where the osteoanabolic effect of either monotherapy is not sufficient, or if a dose-reduction is required due to adverse effects.

Radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning: one-year results of a randomized controlled trial

The objective of this study was to perform a comparative evaluation of the radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning (BLSFE and LSFE, respectively) when applied concomitantly with implant placement. A randomized controlled clinical trial was conducted between February 1, 2016 and May 1, 2017 including 26 individuals with at least one missing tooth. Participants were randomized 1:1 to undergo BLSFE (10 participants, 16 implants) or LSFE (13 participants, 19 implants). Bovine-derived xenograft was used in both groups and the implants were inserted concomitantly. In the BLSFE group, the antrostomy was covered with a repositioned bone window and then with a concentrated growth factors (CGF) membrane. In the LSFE group, the antrostomy was covered with a CGF membrane. Panoramic radiographs were taken before surgery (T0), immediately postoperative (T1), and at 12 months postoperative (6 months after loading) (T2). Marginal bone loss (MBL), apical bone gain, augmented alveolar bone height, and intra-sinus bone augmentation were evaluated on panoramic radiographs at T2. A linear regression analysis with generalized estimating equation models was performed. The implant survival rate was 100% at 1 year after implant surgery. The residual alveolar bone height at T0 was comparable in the BLSFE and LSFE groups (3.58 ± 1.49 mm vs 4.12 ± 1.61, P = 0.32), as was the alveolar bone height at T1 (13.61 ± 1.82 mm vs 12.38 ± 1.82 mm, P = 0.06). At T2, significantly higher alveolar bone height, intra-sinus bone augmentation, and apical bone gain, and lower distal MBL were observed in the BLSFE group when compared to the LSFE group, with adjusting for covariates (β = 2.44, 95% CI 1.42–3.46, P < 0.0001; β = 2.38, 95% CI 1.35–3.41, P < 0.0001; β = 2.33, 95% CI 1.23–3.42, P < 0.0001; and β = −0.43, 95% CI −0.83 to −0.02, P = 0.038, respectively). No significant difference was observed for mesial MBL or apical bone resorption at T2. Lateral sinus floor elevation with bone window repositioning may result in higher bone augmentation after 1 year than the traditional approach. Further research is needed to elucidate the effect of lateral sinus floor elevation with bone window repositioning.

Repositioning of the bone window in lateral sinus floor elevation with simultaneous implant placement: Aretrospective radiographic study.

To retrospectively evaluate whether repositioning the bone window leads to a better outcome of three-dimensional sinus augmentation in lateral sinus floor elevation (LSFE) with simultaneous implant placement. 34 patients with a total of 40 implants (14: test group, 26: control group) receiving LSFE with simultaneous implant placement were included in this retrospective research. CBCT images were taken before surgery, immediately and 6months after surgery. The two-dimensional augmentation parameters, including apical bone height (ABH), endo-sinus bone gain (ESBG), and palatal/buccal bone height (PBH/BBH), and three-dimensional parameters, including augmentation volume (AV) and palatal/buccal augmentation volume (PAV/BAV), were measured. The lateral defect length (LDL) and lateral window length (LWL) were also measured to evaluate the lateral antrostomy recovery. At the 6-month follow-up, the reduction rates at ABH, ESBG, and BBH of the test group (ABH: 10.41% ± 30.30%, ESBG: 2.55% ± 8.91%, BBH: 2.50% ± 8.65%) were significantly lower than those of the control group (ABH: 25.10% ± 22.02%, ESBG: 11.47% ± 9.79%, BBH: 7.10% ± 5.37%; p< .05). In addition, the test group showed better three-dimensional augmentation stability on the buccal side (BAV reduction: 15.51% ± 10.86% vs. 27.15% ± 12.61%; p< .05). Moreover, the LDL/LWL ratio of the test group was significantly lower than that of the control group (p< .05). Within the limitations of this study, repositioning of the bone window in LSFE with simultaneous implant placement could contribute to endo-sinus augmentation stability on the buccal side at the 6-month follow-up. Moreover, it would also facilitate recovery of the lateral antrostomy defect.