Bone Replacement Graft Research Articles

Using Growth Factors in Human Extraction Sockets: A Histologic and Histomorphometric Evaluation of Short-Term Healing

Ridge preservation protocols reduce crestal remodeling after tooth extraction. There is insufficient evidence on bone grafting in combination with platelet-rich plasma (PRP) or recombinant human platelet-derived growth factor (rhPDGF-BB). The aim of this study is to evaluate healing of grafted and nongrafted sockets and the effect of PRP and rhPDGF-BB on early remodeling. Forty-one patients whose treatment plan included extraction of anterior or premolar teeth were randomized into four groups. Group 1: collagen plug (control). Group 2: mineralized freeze-dried bone allograft (FDBA)/β-tricalcium phosphate (β-TCP)/collagen plug. Group 3: FDBA/β-TCP/PRP/collagen plug. Group 4: FDBA/β-TCP/rhPDGF-BB/collagen plug. At 8 weeks, a core was harvested from the center of 41 sockets. Histomorphometric analysis took place. Differences were analyzed using one-way analysis of variance (ANOVA) or chi-square tests for continuous and categorical data. Pairwise comparisons were tested using least squares means. Spearman correlation coefficients were used to evaluate the relationship of bone growth with potential confounders. A P value < .05 was considered statistically significant. ANOVA did not indicate statistical significance in age, gender, smoking, ethnicity, or race distribution. Significant differences in tissue distribution were identified between groups and between different thirds of harvested core. More new bone and amorphous organic matrix was noted in the control group. In sites where bone graft was combined with growth factors, the amount of residual particles was less than in sites where bone graft was used alone. Inclusion of bone replacement graft suppressed new bone formation during early healing. Inclusion of PRP and rhPDGF-BB produced less residual bone graft material, indicating more rapid turnover of bone graft. All treatment modalities achieved a significant amount of new vital bone at 8 weeks postextraction.

How to Select Replacement Grafts for Various Periodontal and Implant Indications

Focused Clinical Question: How are bone replacement grafts for various periodontal and implant indications properly selected?Summary: The purpose of this paper is to review the properties of available bone replacement materials and provide guidelines of how to choose certain graft materials for different clinical indications (e.g., periodontal defects, peri‐implant defects, socket augmentation, ridge augmentation, and sinus augmentation).Conclusion: Full understanding of material properties and meticulous case selection may help to maximize the benefit of bone replacement grafts in tooth‐ and implant‐related regeneration.

A Prospective, Randomized Controlled Preclinical Trial to Evaluate Different Formulations of Biphasic Calcium Phosphate in Combination With a Hydroxyapatite Collagen Membrane to Reconstruct Deficient Alveolar Ridges

Many patients and clinicians would prefer a synthetic particulate bone replacement graft, but most available alloplastic biomaterials have limited osteogenic potential. An alloplast with increased regenerative capacity would be advantageous for the treatment of localized alveolar ridge defects. This prospective, randomized controlled preclinical trial utilized 6 female foxhounds to analyze the osteogenic impact of different formulations of biphasic calcium phosphate (BCP) in combination with an hydroxyapatite-collagen membrane and their ability to reconstruct deficient alveolar ridges for future implant placement. The grafted sites were allowed to heal 3 months, and then trephine biopsies were obtained to perform light microscopic and histomorphometric analyses. All treated sites healed well with no early membrane exposure or adverse soft tissue responses during the healing period. The grafted sites exhibited greater radiopacity than the surrounding native bone with BCP particles seen as radiopaque granules. The graft particles appeared to be well-integrated and no areas of loose particles were observed. Histologic evaluation demonstrated BCP particles embedded in woven bone with dense connective tissue/marrow space. New bone growth was observed around the graft particles as well as within the structure of the graft particulate. There was intimate contact between the graft particles and newly formed bone, and graft particles were bridged by the newly formed bone in all biopsies from the tested groups. The present study results support the potential of these BCP graft particulates to stimulate new bone formation. Clinical studies are recommended to confirm these preclinical findings.

Use of Fisiograft in Intrabony Defects- A Clinical and Radiological Study

To evaluate the efficacy of Polylactic Acid/Polygycolic Acid (PLA/PGA -Fisiograft®) with Open Flap Debridement (OFD) and OFD alone in the treatment of intrabony defects over a period of 9 months. Twenty Nine systemically healthy subjects with total of 30 defects were included in the present, randomized, controlled and two arm parallel study. Tests were treated with OFD along with Fisiograft® and controls with OFD alone. On intra-group comparison, clinical parameters at 6 and 9 months showed statistically significant results. On comparing between the two groups, the reduction in Defect Specific Bleeding Score (DSBS), Defect Specific Plaque Score (DSPS), Probing Depth (PD) and gain in Clinical Attachment Level (CAL) revealed no statistical significances other than Recession Depth (REC) which was more in controls. The mean radiographic parameters at 9 months post-operatively in both the groups were statistically significant. However, the inter-group comparison revealed no statistically significant values. The overall results at the end study proved that the adjunctive use of Fisiograft® was not beneficial when compared with OFD alone. Synthetic bone replacement graft materials are commonly used for periodontal regeneration. The present study was conducted by using PLA/PGA reveals no additional benefit over OFD alone in treatment of intrabony defects.

Minimally Invasive Sinus Lift Implant Device: A Multicenter Safety and Efficacy Trial Preliminary Results

In cases of advanced maxillary sinus atrophy of the bone (pneumatization), the sinus floor has to be augmented in order to obtain acceptable bone volume for implantation. The objective of the present study is to evaluate a new procedure and device, designed as a closed sinus lift using a dedicated dental implant that allows for Schneiderian membrane elevation and the placement of a flowable bone replacement graft. Eighteen patients (8 males, 10 females) underwent 23 procedures. All procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No membrane tears were noted. No intraoperative or postoperative adverse events were observed in any of the cases. There were no postprocedural emergency or distress calls. The patients' average age was 52 (range 38-72). The mean residual alveolar ridge height was 5.5 mm (range 4.0-7.0). The average bone gain was 11.2 mm (range 9-13) after an average healing period of 8.7 months (range 6.7-13.1). All implants achieved clinical stability and prosthetic rehabilitation was uneventful. A closed sinus floor elevation procedure can be accomplished using a dedicated dental implant that allows for hydraulic elevation of the Schneiderian membrane and placement of a flowable bone replacement graft and dental implant placement all at the same time with minimal patient discomfort.

Biomaterials for periodontal regeneration

Periodontal disease is characterized by the destruction of periodontal tissues. Various methods of regenerative periodontal therapy, including the use of barrier membranes, bone replacement grafts, growth factors and the combination of these procedures have been investigated. The development of biomaterials for tissue engineering has considerably improved the available treatment options above. They fall into two broad classes: ceramics and polymers. The available ceramic-based materials include calcium phosphate (eg, tricalcium phosphate and hydroxyapatite), calcium sulfate and bioactive glass. The bioactive glass bonds to the bone with the formation of a layer of carbonated hydroxyapatite in situ. The natural polymers include modified polysaccharides (eg, chitosan,) and polypeptides (collagen and gelatin). Synthetic polymers [eg, poly(glycolic acid), poly(L-lactic acid)] provide a platform for exhibiting the biomechanical properties of scaffolds in tissue engineering. The materials usually work as osteogenic, osteoconductive and osteoinductive scaffolds. Polymers are more widely used as a barrier material in guided tissue regeneration (GTR). They are shown to exclude epithelial downgrowth and allow periodontal ligament and alveolar bone cells to repopulate the defect. An attempt to overcome the problems related to a collapse of the barrier membrane in GTR or epithelial downgrowth is the use of a combination of barrier membranes and grafting materials. This article reviews various biomaterials including scaffolds and membranes used for periodontal treatment and their impacts on the experimental or clinical management of periodontal defect.

A Review on Alveolar Ridge Preservation Following Tooth Extraction

Context The question that clinicians face is whether the use of bone replacement grafts and/or barrier membranes enhance their ability to provide for the future placement of a dental implant or to maximize ridge dimensions following the extraction of a tooth versus no additional treatments.Evidence Acquisition The evidence was obtained by search of Entrez PubMed and manual search of The International Journal of Oral and Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implant Research, The Journal of Periodontology, The Journal of Clinical Periodontology, and The Compendium of Continuing Education in Dentistry. Key search words included Guided Bone Regeneration, Dental Extraction, Tooth Extraction, Bone Replacement Graft, Alveolar Ridge. The years of search included from January 2011 through February 2012.Evidence Synthesis The recurring theme was that there was considerable heterogeneity to study designs, time periods, and methods of evaluation. This created great difficulty in trying to answer with good high-quality evidence questions about the techniques and materials to be used for maximizing regeneration at the time of tooth extraction or in which situations this ought to be used.Conclusions There appears to be consensus from the reviewed literature supporting ridge preservation techniques as a whole. Multiple studies demonstrated less ridge resorption occurring when alveolar ridge preservation procedures were used versus the placement of no graft material in fresh alveolar sockets. The analysis did not show any grafting materials demonstrating a clear benefit over any others or that a barrier membrane is necessary. The evidence is also too premature about whether socket preservation efforts require primary closure. In the emerging area of growth factors, there is no high-quality evidence to either support or refute their use.Background Tooth extraction is one of the most widely performed procedures in dentistry today and it has been historically well documented that this procedure may induce significant dimensional changes of the alveolar ridge. The dilemma that clinicians face is how to manage tooth extractions to provide for the future placement of a dental implant or to maximize ridge dimensions for the fabrication of a fixed or removable prosthesis. If performed inadequately, the resulting deformity can be a considerable obstacle to the esthetic, phonetic, and functional results that both our patients and we clinicians expect at this current time.

Maxillary Sinus Elevation by Lateral Window Approach: Evolution of Technology and Technique

Context: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity.Evidence Acquisition: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors.Evidence synthesis: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation.Conclusions: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.

Clinical and Radiographic Evaluation of the Effect of Bovine-derived Hydroxyapatite (Bio-Oss®) and A Synthetic HA/β-TCP (Osteon®) in the Treatment of Class II Furcation Defects in Mandibular Molars

Background and aims. There are some studies comparing bone replacement grafts. The aim of this study was clinical evaluation of the effect of Osteon® (as a new bone material) and Bio-Oss® (Bovine-derived hydroxyapatite) in the treatment of mandibular molar class II furcation defects in humans. Materials and methods. Eleven patients (10 females and 1 male, age range of 27-59 years ; mean age of 45.5±11.8 years) who had at least 22 mandibular class II buccal or lingual furcation defects were treated either with Osteon (as the case group) or Bio-Oss (as the control group). Each defect was randomly assigned to either the case group or the control group. Clinical parameters and the soft tissue and hard tissue measurements, including plaque index (PI), gingival index (GI), gingival recession of furcation area (GR), pocket depth (PD), clinical attachment level (CAL), horizontal defect depth (HDD), vertical defect depth (VDD) were recorded at baseline and six months after surgery. Data were analyzed using t-test or Wilcoxon's test. Results. Similar healing results were observed for both treatments. The results showed significant probing depth reduction (case group: 0.77 mm and control group: 0.84 mm) and HDD reduction (case group: 0.51 mm and control group: 0.8 mm) and PI reduction. There was not statistically significant difference between the groups in all soft and hard tissue parameters. Conclusion. The results of this study showed that the effect of using Osteon as a bone graft material is the same as that of Bio-Oss in the treatment of mandibular class II furcation defects.

Mechanical Debridement of a Peri‐Implant Osseous Defect With a Novel Titanium Brush and Reconstruction With Porous Titanium Granules: A Case Report With Reentry Surgery

Introduction: The scientific evidence for one specific treatment strategy for peri‐implant osseous defects is scarce. It will be important to develop methods for efficient decontamination of ailing implants and for reconstruction of lost peri‐implant osseous attachment. Access for instrumentation of narrow peri‐implant defects is difficult, and to the best of our knowledge, this case report describes, for the first time, the use of a novel titanium brush for mechanical debridement of the implant surface and the defect. Histologic evidence that porous titanium granules (PTGs) support reosseointegration has recently been reported.Case Presentation: A healthy female patient had two implants placed for prosthetic rehabilitation of teeth #21 and #23. In conjunction with second‐stage surgery, a buccal osseous defect was disclosed at the most anterior implant. The narrow and deep defect was debrided with a novel titanium brush, chemically decontaminated with 3% H2O2, and filled with PTGs. In conjunction with second‐stage surgery, after 6 months of submerged healing, the peri‐implant defect was almost completely healed, with only a 3 mm osseous defect remaining at the coronal part of the implant. The PTG bone replacement graft appeared completely integrated in new bone, with no signs of loose particles. At clinical and radiographic examinations, 24 months after surgical treatment, no signs of inflammation or reoccurring bone loss were seen.Conclusion: To the best of our knowledge, this case report demonstrates, for the first time, that debridement with a titanium brush, 3% H2O2, and reconstruction with PTGs is a potential treatment modality of narrow peri‐implant osseous defects.

Allograft for Maxillary Sinus Floor Augmentation

The aim of this study is to demonstrate the clinical applicability and efficacy of an allograft for maxillary sinus augmentations in patients requiring placement of dental implants. Sixty consecutive patients underwent a total of 90 sinus augmentations. Twenty-nine were women and 31 men, with a mean age of 54 years. Twenty-six patients received a bilateral procedure and 34 unilateral. All cases were treated with the lateral wall technique. Allograft consisted of demineralized freeze-dried blocks in 6 cases, particulate in 82 cases, and a combination of both in 2 cases. In 30 patients, it was combined with platelet-rich plasma. A total of 84 implants were inserted. Bone samples of grafted areas were obtained in two patients for histological examination. Seventy-three implants were clinically successful at the reentry time. Eleven implants in seven patients were removed between 15 days and 6 months after their placement. Seven of these implants were replaced and received prostheses as well, for an overall postloading success rate of 95.2%. Follow-up for all patients after final restoration was between 12 and 96 months. Specimen's histological evaluation revealed bone formation and evidence of inflammatory infiltrate. Based on the findings of this study, it can be suggested that the use of the demineralized freeze-dried bone allograft from the Banco de Huesos y Tejidos Fundación Cosme y Damian for sinus augmentation is effective and constitutes a feasible therapeutic alternative for implant placement.

The Use of Guided Tissue Regeneration Techniques among Endodontists: A Web-based Survey

Introduction The purpose of this study was to determine factors and clinical situations that influence an endodontist’s decision to use guided tissue regeneration (GTR) techniques during endodontic root-end surgery. Methods An invitation to participate in a web-based survey was e-mailed to 3,750 members of the American Association of Endodontists. Data were collected from 1,129 participants, representing a 30.1% completion rate. The number of questions varied from 3 to 11 depending on individual responses. Results 40.7% of respondents who perform root-end surgeries also use GTR techniques. The clinical situation in which GTR techniques are used most often is for transosseous lesions. Barrier membranes and bone replacement grafts are each used by more than 85% of respondents using GTR techniques. Insufficient training and insufficient evidence in support of its use were selected as the predominant reasons for not using GTR techniques at 42.4% and 32%, respectively. Conclusions Although over 40% of respondents are currently using GTR techniques in conjunction with their root-end surgeries, a majority of those who do not use GTR indicated they would consider using these techniques with better evidence and available training.

Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology

Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology

Efficacy of a bioactive alloplast, in the treatment of human periodontal osseous defects-a clinical study

Presently, bone replacement grafts are one of the modalities of therapy for which there is histologic evidence of regeneration coronal to the base of the previous osseous defect. Bioactive glasses are used extensively in medicine and dentistry. This study evaluated the additional efficacy of a bioactive alloplast, Perioglas, in comparison with open flap debridement only. 8 systemically healthy volunteers were chosen, each having 2 collateral sites with ≥6 mm clinical probing depth and radiographic evidence of an intrabony defect. Randomly, one defect was treated with open flap debridement plus bioactive glass (test) and the other with open flap debridement alone (control). At baseline, 3, 6, 9 months measurements were recorded which included plaque index, gingival index, pocket probing depth, clinical attachment level, and increase in gingival recession. Standardized radiographs were used to measure defect fill and alveolar crest resorption. The data were subjected to statistical analysis. Both treatments showed no significant differences between the two groups at any point of time. However, radiographically, bioactive glass group showing significant improvement in bone fill over the sites treated with open flap debridement alone. The alloplastic bone graft material, PerioGlas, demonstrated clinical advantages beyond that achieved by debridement alone.

8C-14 骨置換材の表面電荷によるラット骨髄細胞の骨分化促進に関する研究(OS-2(2) 臨床応用を目指した骨・関節力学(3))

8C-14 骨置換材の表面電荷によるラット骨髄細胞の骨分化促進に関する研究(OS-2(2) 臨床応用を目指した骨・関節力学(3))

β-tricalcium phosphate as bone substitute material: properties and clinical applications

Aim As the scope of implant dentistry widens, hard tissue augmentation is becoming more common. The previous “gold standard” for bone augmentation, autogenous bone, is limited in availability and restricted in harvesting due to increased peri- and postoperative complications. This paper gives guidance to the surgeon about various classes of bone replacement graft substitutes relative to their origin, ability to resorb and their replacement with vital, osseointegratable bone. A synthetic graft, pure phase β-tricalcium phosphate, has been documented in human and animal studies to be resorbed and replaced by vital bone in a 6 to 12-month time period. Conclusion The cases and literature shown in this paper demonstrate the predictability and effectiveness of this type of graft material in dental implant-related surgical applications.

Osteoblast response to commercially available demineralized bone matrices - Anin-vitrostudy

Reconstruction of lost attachment apparatus is a major goal of periodontal therapy. Although various osteoinductive bone replacement grafts (BRGs) have been used with apparent clinical success, unequivocal evidence of osteoinductivity may be obtained only through the demonstration of increased osteoblastic/osteoclastic differentiation following exposure to these materials. Bone marrow stem cells (BMSCs) obtained from rat femur were cultured in Dulbecco's Modified Eagles Medium (DMEM) and 10% fetal bovine serum (FBS). They were then exposed to two demineralized bone matrices (DBM's)--Grafton and Osseograft, and divided into three groups, comprising of a negative control (BMSC + DMEM + 10% FBS), Grafton, Osseograft. An osteogenic medium (OM) (10 hm dexamethasone, 10 hm b-glycerophosphate, and 50 microg/ml ascorbic acid) was added to create three subgroups comprising of a positive control (OM), Grafton with OM, Osseograft with OM. After an initial phase (up to day 5), both Grafton and Osseograft induced an increased proliferative activity in the BMSCs, which reached a plateau after day 10. These grafts also induced increased alkaline phosphatase activity when compared to the control groups and to BMSCs with an OM. Both Osseograft and Grafton are capable of inducing osteoblastic proliferation and differentiation.

Periodontal regeneration

The ultimate goal of periodontal therapy is the regeneration of the tissues destroyed as a result of periodontal disease. Currently, two clinical techniques, based on the principles of "guided tissue regeneration" (GTR) or utilization of the biologically active agent "enamel matrix derivative" (EMD), can be used for the regeneration of intrabony and Class II mandibular furcation periodontal defects. In cases where additional support and space-making requirements are necessary, both of these procedures can be combined with a bone replacement graft. There is no evidence that the combined use of GTR and EMD results in superior clinical results compared to the use of each material in isolation. Great variability in clinical outcomes has been reported in relation to the use of both EMD and GTR, and these procedures can be generally considered to be unpredictable. Careful case selection and treatment planning, including consideration of patient, tooth, site and surgical factors, is required in order to optimize the outcomes of treatment. There are limited data available for the clinical effectiveness of other biologically active molecules, such as growth factors and platelet concentrates, and although promising results have been reported, further clinical trials are required in order to confirm their effectiveness. Current active areas of research are centred on tissue engineering and gene therapy strategies which may result in more predictable regenerative outcomes in the future.

Needs and trends for corals in oral and maxillofacial defects

Reconstruction with bone grafts has long been a challenge to surgeons. Research on the feasibility of using natural corals such as a resorbable bone graft substitute has been underway from past three decades. Natural coral porous calcium carbonate appears to be a clinically useful bone replacement graft material that gains essentially or slightly better responses in osseous defects than other replacement graft material. The objective of this paper is to evaluate the ease of preparing a potential alloplastic bone substitute and its use for different bone grafting procedure for application as grafting material filling various oral and maxillofacial defects.

Predictability of Clinical Outcomes Following Regenerative Therapy in Intrabony Defects

Demineralized bone matrix (DBM) and guided tissue regeneration (GTR) support substantial gains in clinical attachment level (CAL), reductions in probing depth (PD), and gains in defect fill compared to open flap debridement (OFD) in intrabony defects. Although these regenerative therapies support improvements in mean clinical parameters, it is unclear whether the procedures improve the predictability of clinical outcome. The purpose of this study was to examine the relative variability in clinical outcome measures, independent of the magnitude of gains, in regenerative studies comparing DBM or GTR to OFD therapy for the management of intrabony defects. For comparative purposes, a similar analysis was performed evaluating the consistency of clinical outcomes with other (non-DBM) bone replacement graft (BRG) materials relative to OFD alone. Fifty-five randomized controlled clinical trials comparing regenerative therapy (seven DBM, 22 BRG, and 26 GTR) to OFD and meeting inclusion criteria provided mean change scores (pretreatment to post-treatment) and variance estimates for CAL, PD, and bone fill, allowing for calculation of a coefficient of variability (CV) for each measure within studies. The mean CV for each measure was submitted to an analysis of variance or covariance with repeated measures (P < or =0.05) to compare relative variation in treatment outcomes. DBM was associated with a significantly lower relative variability (mean +/- SE) in CAL gain (96.3 +/- 38.6 versus 137.7 +/- 30.9) and defect fill (69.1 +/- 11.2 versus 133.1 +/- 15.3) compared to OFD alone. As a group, other BRGs were found to support significant reductions in variation in CAL and defect fill. GTR therapy was associated with significantly lower CV for CAL compared to OFD (50.6 +/- 5.0 versus 68.7 +/- 8.2, respectively). Variability in defect fill was similar for GTR and OFD. DBM and GTR therapy support more consistent improvements in clinical parameters; however, with the exception of defect fill following bone grafting, the reduction in variability in clinical outcomes was relatively modest compared to OFD alone. Overall, the treatment of intrabony defects is associated with a relatively high degree of variability in clinical outcome, regardless of therapeutic approach.