Deproteinized Bovine Bone Mineral With 10% Collagen Research Articles

The Assessment of Volumetric Changes for Alveolar Ridge Preservation or Reconstruction by Three-dimensional Analysis at Posterior Extraction Sites with Severe Bone Defects Using DBBM-C Collagen Membrane and PRF: A Prospective and Randomized Clinical Trial.

Volumetric resorption of the alveolar ridge often occurs following tooth extraction in both horizontal and vertical directions. There is a specific lack of evidence for alveolar ridge reconstruction at molar and premolar sites with severe bone resorption. This randomized and controlled trial aimed to use three dimensional and linear analyses to evaluate volumetric changes of the alveolar bone following alveolar ridge reconstruction (ARR) at molar and premolar sites with severe bone resorption as compared with non-assisted socket healing be implant placement. A total of 31 patients (15 males and 16 females) with more than 50% of hard tissue loss in one or more socket walls were recruited and randomized into either a test group (ARR after extraction using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and platelet-rich fibrin (PRF) with a resorbable collagen membrane) or a control group (natural healing after extraction). Then, the clinical, linear, volumetric implant-related and patient-reported outcomes were analyzed after a 4-month healing process. Linear bone assessments revealed significantly greater gains of ridge width in the test group (25% in the mesial, mid-facial and distal aspects) and less reduction of vertical bone ridge than in the control group (P＜0.05). Furthermore, volumetric bone remodeling was significantly higher in the test group (ARR=35.1±34.9%, control=14.2±12.8%, P＜0.05). Patient-reported discomfort and keratinized mucosal changes were comparable between groups. Alveolar ridge reconstruction with a combination of DBBM-C, PRF, and a resorbable membrane at posterior sites with severe socket wall deficiency (＞ 50% bone loss) is a safe and more capable therapeutic method when compared with natural healing and non-assisted sockets. Collectively, our analyses demonstrated that alveolar ridge reconstruction represents an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defects when assessed after four months of healing.

Early implant placement in sites with ridge preservation or spontaneous healing: histologic, profilometric, and CBCT analyses of an exploratory RCT.

The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48 mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

Alveolar ridge preservation of damaged or periodontally compromised extraction sockets with bovine- and porcine-derived block bone substitutes: A retrospective case-control study.

Alveolar ridge preservation (ARP) was introduced to minimize postextraction alveolar bone loss and extraction socket remodeling; however, current knowledge of the ARP procedure for nonintact extraction sockets is still limited and inconclusive. This retrospective study aimed to evaluate the difference between using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and deproteinized porcine bone mineral with 10% collagen (DPBM-C) when performing ARP procedures in damaged or periodontally compromised extraction sockets based on clinical, radiographic, and profilometric outcomes. In total, 108 extraction sockets were grafted with 67 DBBM-C and 41 DPBM-C. Changes in radiographic (horizontal width and vertical height) and profilometric outcomes were measured after the ARP procedure and before the implant surgery. Postoperative discomfort (including the severity and duration of pain and swelling), early wound healing outcomes (including spontaneous bleeding and persistent swelling), implant stability, and treatment modalities for implant placement were also assessed. Radiographically, the DBBM-C group decreased by -1.70 ± 2.26 mm (-21.50%) and - 1.39 ± 1.85 mm (-30.47%) horizontally and vertically, and the corresponding DPBM-C group decreased by -1.66 ± 1.80 mm (-20.82%) and -1.44 ± 1.97 mm (-27.89%) horizontally and vertically at an average of 5.6 months. There were no serious or adverse complications in any of the cases, and none of the measured parameters differed significantly between the groups. Within the limitations of this study, ARP with DBBM-C and DPBM-C showed similar clinical, radiographic, and profilometric outcomes in nonintact extraction sockets.

Reconstructive treatment of peri-implantitis infrabony defects of various configurations: 5-year survival and success.

AimTo present the 5 years outcomes of a reconstructive surgical protocol for peri‐implantitis defects with different morphologies, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC).Material and MethodsThe original population of this case series consisted of 75 patients with one crater‐like defect and probing depth (PD) ≥6 mm. After flap elevation, defects were assigned to one characteristic class and treated by means of DBBMC. Following healing, patients were enrolled in an individualized supportive periodontal/peri‐implant (SPT) program.ResultsFifty‐one patients reached the 5 years examination, as 11 patients were lost to follow‐up and 13 implants were removed. Overall treatment success was registered in 29 patients (45.3%). Mean PD and BOP significantly decreased at one year and remained stable for the rest of observation period. No correlation was found between implant survival rate and defect configuration (p = 0.213). Patients, who did not fully adhere to the SPT, experienced more complications and implant loss than those who regularly attended recall appointments (p = 0.009).ConclusionsThe proposed reconstructive treatment resulted in a high 5 years implant survival rate in patients who fully adhered to SPT. The resolution of the peri‐implantitis defect does not seem significantly associated with the defect configuration at the time of treatment.

Effects of hyaluronic acid and deproteinized bovine bone mineral with 10% collagen for ridge preservation in compromised extraction sockets.

The aim of this study was to evaluate the efficacy of deproteinized bovine bone mineral with 10% collagen (DBBM-C) soaked with hyaluronic acid (HA) for ridge preservation in compromised extraction sockets. Bilateral third, fourth premolars and first molar were hemisected, distal roots were extracted, and then combined endodontic periodontal lesion was induced in the remaining mesial roots. After 4 months, the mesial roots were extracted and the following four treatments were randomly performed: Absorbable collagen sponge (ACS), ACS soaked with HA (ACS+HA), ridge preservation with DBBM-C covered with a collagen membrane (RP), ridge preservation with DBBM-C mixed with HA and covered with a collagen membrane (RP+HA). Animals were sacrificed at 1 and 3 months following treatment. Ridge dimensional changes and bone formation were examined using microcomputed tomography, histology, and histomorphometry. At 1 month, ridge width was significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups, while the highest proportion of mineralized bone was observed in ACS+HA group. At 3 months, ridge width remained significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups. ACS+HA and RP+HA treatments featured the highest proportion of mineralized bone and bone volume density compared with the other groups. No statistical difference was observed between ACS+HA and RP+HA treatments. Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.

Implant survival after surgical treatment of peri-implantitis lesions by means of deproteinized bovine bone mineral with 10% collagen: 10-year results from a prospective study.

To evaluate the 10-year outcomes of a regenerative surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC). The original population consisted of 26 patients with one crater-like defect, around either SLA or TPS dental implants, with a probing depth ≥6mm and no implant mobility. After debridement and surface decontamination, the defects were filled with DBBMC. Subsequently, patients were placed in an individualized supportive peri-implant/periodontal therapy (SPT) program. Fourteen patients (eight SLA and six TPS) reached the 10-year examination. The overall implant survival rate was 67%, 80% for the SLA, and 55% for the TPS implants. During SPT, five patients were lost to follow-up, eight patients needed additional antibiotic and/or surgical therapy, and seven patients had the implant removed. PD was reduced from 6.6±1.3 to 3.2±0.7mm in SLA and from 7.2±1.5 to 3.4±0.6mm in TPS. BOP decreased from 75.0±31.2% to 7.5±12.1% (SLA) and from 90.0±12.9% to 30.0±19.7% (TPS). Treatment success was found in 5 of the 12 SLA (42%) and in 4 of the 14 TPS (29%). The proposed reconstructive treatment, followed by SPT, was able to maintain in function the majority of SLA implants, although the overall treatment success was limited and many of TPS implants were removed. Therefore, the decision to treat implants affected by peri-implantitis should be based on several factors, including surface characteristics.

Explorative randomized controlled study comparing soft tissue thickness, contour changes, and soft tissue handling of two ridge preservation techniques and spontaneous healing two months after tooth extraction.

To compare two ridge preservation techniques and spontaneous healing in terms of soft tissue thickness, contour changes, and soft tissue handling two months after tooth extraction. Thirty-six patients were included with buccal bone plate dehiscences of up to 50% after single-tooth extraction in the esthetic zone. They were randomly assigned to receive one of three procedures: a deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered with a collagen matrix (DBBM-C/CM), DBBM-C alone, or spontaneous healing (SH). Two months later, the status of soft tissue healing was assessed, and the thickness of the mucosa was measured at the center of the site. Thereafter, implants were placed and the need for further guided bone regeneration (GBR) to cover exposed implant surfaces was assessed. Thirty-six patients were evaluated at the day of implant placement. An invagination of the soft tissues was recorded in 41.7% (n=12), 53.8% (n=13), and 90.9% (n=11) of the sites in groups DBBM-C/CM, DBBM-C, and SH, respectively. The median thickness of the mucosa measured was 3.0mm in group DBBM-C/CM, 2.1mm in group DBBM-C, and 1.5mm in group SH. Additional GBR was necessary in 66.7% (n=12), 53.8% (n=13), and 90.9% (n=11) of the sites in groups DBBM-C/CM, DBBM-C, and SH, respectively. The present explorative study revealed slight tendencies for more favorable soft tissue conditions with less invaginations as well as increased soft tissue volume and thickness in groups having received an alveolar ridge preservation procedure compared to spontaneously healed sites at 8weeks of healing.

Evaluation of Horizontal and Vertical Buccal Ridge Dimensional Changes After Immediate Implant Placement and Immediate Temporization With and Without Bone Augmentation Procedures: Short-Term, 1-Year Results. A Randomized Controlled Clinical Trial.

This prospective randomized controlled clinical trial aimed to compare changes in the horizontal and vertical soft tissue and the alveolar ridge dimension over the course of 12 months following immediate implant placement and temporization with or without simultaneous augmentation with a deproteinized bovine bone mineral with 10% collagen (DBBM-C). Thirty-two patients with a hopeless maxillary anterior tooth and fully intact sockets received an immediate implant and provisional or custom healing abutment after a flapless extraction. Patients were randomized to a control group (n = 16), which received no graft, or to a test group (n = 16), which received DBBM-C grafts. Horizontal and vertical soft tissue changes as well as soft tissue thickness were compared digitally between groups on casts obtained from impressions made at baseline and 3, 6, and 12 months. The test group showed less horizontal dimensional change than the control group; however, the change between the two groups was not statistically significant. Vertical dimensional soft tissue changes from baseline to 12 months showed a statistically significant difference at the distal papilla, favoring the test group. No statistically significant difference was observed for vertical changes between both groups at mesial papillae and midbuccal soft tissue; however, the test group showed lower values overall. No statistically significant differences in soft tissue thickness between groups were detected. Immediate implant placement and temporization with and without adding DBBM-C demonstrate favorable clinical outcomes regarding horizontal and vertical soft tissue changes. Both groups showed loss of tissue volume. Adding DBBM-C in the gap of immediately placed implants slightly lowered the change in tissue parameters, which was not statistically significant, for the first 12 months after implant placement.

The clinical efficacy of deproteinized bovine bone mineral with 10% collagen in conjunction with localized piezosurgical decortication enhanced orthodontics: A prospective observational study.

Evidence exists on the clinical efficacy and safety of periodontally accelerated osteogenic orthodontics (PAOO) with "Piezocision"-a minimally invasive, flapless alternative to corticotomy for alveolar bone augmentation. Allograft has been extensively studied for alveolar bone augmentation in Piezocision; however, the use of deproteinized bovine bone mineral with 10% collagen (DBBM-C) in Piezocision for PAOO has not been investigated. This study is a prospective, observational, cohort study of 19 patients of Angle Class I malocclusion with a total of 692 teeth assessed for maintenance of health of the periodontal attachment apparatus. Patient-centered pain, sensitivity, and satisfaction outcomes, digital photographs and radiographs, and changes in probing depth, clinical attachment level, width of keratinized tissue, percussion sensitivity, pulp vitality tests, radiographic pathology, and root-crown-ratio were all recorded. Overall treatment was significantly faster (5 to 7days between clear aligner tray changes), periodontal parameters remained stable, and alveolar bone loss was not observed. Visual analog score for healing, sensitivity/duration, bleeding/duration, swelling/duration, appearance, and inflammation, demonstrated no significant differences between DBBM-C and control (no bone graft) groups. Patient-centered outcomes revealed high levels of satisfaction with Piezocision. Piezocision-treated teeth with DBBM-C tended to exhibit less root resorption, although it was not statistically significant (P=0.074). Within the limits of the study, our results show that the use of DBBM-C with piezosurgically enhanced orthodontics is effective and safe. This study was not designed to demonstrate equivalence with other materials that might be used in Piezocision. To understand whether there is an advantage to using DBBM-C, additional studies may be required.

Regenerative surgical therapy for peri-implantitis using deproteinized bovine bone mineral with 10% collagen, enamel matrix derivative and Doxycycline-A prospective 3-year cohort study.

There is limited evidence regarding the long-term efficacy of regenerative treatment for peri-implantitis. The aim of this study was to evaluate a combination therapy of deproteinized bovine bone mineral with 10% collagen (DBBMC), enamel matrix derivative (EMD) and Doxycycline in the regeneration of bone defects associated with peri-implantitis. Thirty patients diagnosed with peri-implantitis (BoP/suppuration, probing depth greater than 4mm, minimum radiographic bone loss of 20%, at least 2years in function) were enrolled in the study. Clinical measurements included probing depths, recession, radiographic bone fill, gingival inflammation and bleeding on probing/suppuration. Following surgical access and debridement, the implant surfaces were decontaminated with 24% EDTA for 2min, and the bone defects were filled with a combined mixture of DBBMC, EMD and Doxycycline powder. The defects were covered with connective tissue grafts where necessary. Clinical measurements were recorded after 12, 24 and 36months. The mean probing depth and bone loss at the initial visit was 8.9mm (±1.9) and 6.92mm (±1.26), respectively. Both mean probing depth and bone loss reduced significantly from baseline to 3.55mm (±0.50) and 2.85mm (±0.73) at 12months, 3.50 (±0.50) and 2.62mm (±0.80) at 24months and 3.50mm (±0.50) and 2.60mm (±0.73) at 36months. 56.6% of the implants were considered successfully treated (according to Successful Treatment Outcome Criterion: PD<5mm, no further bone loss >10%, no BoP/suppuration, no recession >0.5mm for anterior implants and >1.5mm for posterior implants) after 36months. Regenerative treatment of peri-implantitis using a combined mixture of DBBMC, EMD and Doxycycline achieved promising results. The benefits of this protocol incorporating EMD should be tested in randomized clinical trials.

Combined use of xenogeneic bone substitute material covered with a native bilayer collagen membrane for alveolar ridge preservation: A randomized controlled clinical trial.

The aim of this split-mouth randomized controlled study was to evaluate radiographic dimensional changes after tooth extraction in posterior sites treated with a ridge preservation technique or left for spontaneous healing. In a total of 18 patients, tooth extraction in posterior sites of the upper and lower jaw was performed in a split-mouth design. The post-extraction sockets were randomly assigned to the following two treatment modalities: deproteinized bovine bone mineral (DBBM) with 10% collagen (DBBM-C) covered with a native bilayer collagen membrane (NBCM) (test group) and spontaneous healing (control group). Cone beam computed tomography (CBCT) scans were performed after extractions, 3 and 6months later. The following parameters were measured: the height of the buccal bone plate (BH), height of the palatal bone plate (PH), horizontal width of the extraction socket at 1mm, 3mm, and 5mm (HW-1, HW-3, HW-5), and the horizontal width (thickness) of the buccal bone plate at 1mm, 3mm, and 5mm (BHP-1, BHP-3, BHP-5). Statistical analysis was performed applying a nonparametric Wilcoxon signed-rank test. The CBCT analysis showed a bone loss compared to baseline in test and control group. The measurements which have reached statistically significant differences at 6months were BH (test: -2.31% vs control: -13.11%), PH (test: -2.07% vs control: -15.32%), HW-1 (test: -17.14% vs control: -32.47%), and HW-3 (test: -11.65% vs control: -28.47%). The posterior ridge preservation technique using DBBM-C covered with a NBCM is a valid approach reducing the amount of the radiographic loss in alveolar ridge dimensions.

Cell therapy with allogenic canine periodontal ligament-derived cells in periodontal regeneration of critical size defects.

The objective of this in vivo experimental study to evaluate the regenerative potential of a cell therapy combining allogenic periodontal ligament-derived cells within a xenogeneic bone substitute in a similar experimental model. In nine beagle dogs, critical size 6-mm supra-alveolar periodontal defects were created around the PIII and PIV. The resulting supra-alveolar defects were randomly treated with either 1.4×106 allogenic canine periodontal ligament-derived cells seeded on de-proteinized bovine bone mineral with 10% collagen (DBBM-C) (test group) or DBBM-C without cells (control group). Specimens were obtained at 3months, and histological outcomes were studied. The histological analysis showed that total furcation closure occurred very seldom in both groups, being the extent of periodontal regeneration located in the apical third of the defect. The calculated amount of periodontal regeneration at the furcation area was comparable in both the test and control groups (1.93±1.14mm (17%) versus 2.35±1.74mm (22%), respectively (p=.37). Similarly, there were no significant differences in the amount of new cementum formation 4.49±1.56mm (41%) versus 4.97±1.05mm (47%), respectively (p=.45). This experimental study was unable to demonstrate the added value of allogenic cell therapy in supra-crestal periodontal regeneration.

Ridge Preservation After Maxillary Third Molar Extraction Using 30% Porosity PLGA/HA/β-TCP Scaffolds With and Without Simvastatin: A Pilot Randomized Controlled Clinical Trial.

To evaluate clinically and radiographically, in humans, the healing of maxillary third molars postextraction sockets after application of different ridge preservation techniques 3 months after tooth extraction. Twenty-six sockets (13 patients) were randomly assigned to 4 treatment modalities: deproteinized bovine bone mineral with 10% collagen (DBBM-C), poly(D,L-lactide-co-glycolide) with hydroxyapatite/β-TCP scaffold (PLGA/HA), PLGA/HA/β-TCP with 2.0% simvastatin scaffold (PLGA/HA/S), and spontaneous healing (control). Clinical complications were assessed, and cone-beam computed tomographies were taken in 5 patients 3 months after surgeries. For statistical purposes, the Fisher exact test was used (P < 0.05). After 3 months, 6 of 9 grafts from the PLGA/HA group were lost (P < 0.05). PLGA/HA/S' loss was only 2 of 8 (P > 0.05), but no loss was observed in the DBBM-C group. Pain was present in 3 of 8 sites that lost the graft (37.5%) (P > 0.05) and infection in 1 of 8 (12.5%) (P > 0.05), with these only occurring in the PLGA/HA group. Poly (D, L-lactide-co-glycolide) with hydroxyapatite/β-TCP (PLGA/HA/β-TCP) scaffolds, with and without simvastatin, failed to obtain the initial expected results and presented more complications. Scaffolds with simvastatin showed to be superior, with less clinical complications than scaffolds without simvastatin.

Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized bovine bone mineral with 10% collagen: 7-year-results.

The aim of this study was to evaluate the long-term results of the surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen (DBBMC). The original population consisted of 26 patients with one crater-like defect, around either sandblasted and acid-etched (SLA) or titanium plasma-sprayed (TPS) dental implants, with a probing depth (PD) ≥6mm and no implant mobility (Roccuzzo etal. J Clin Periodontol. 2011; 38: 738). Implants were mechanically debrided and treated using EDTA gel and chlorhexidine gel. The bone defects were filled with DBBMC, and the flap was sutured around the non-submerged implant. Patients were placed on an individually tailored supportive periodontal therapy (SPT). Two patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was necessary in eight implants, and four of these were removed for biologic complications. At 7-year, the survival rate was 83.3% for SLA implants and 71.4% for TPS. PD was significantly reduced from 6.6±1.3 to 3.2±0.7mm in SLA and 7.2±1.5 to 3.4±0.6mm in TPS. Bleeding on probing decreased from 75.0±31.2% to 7.5±12.1% (SLA) and from 90.0±12.9% to 30.0±19.7% (TPS). When successful therapy was defined as PD ≤5mm, absence of bleeding/suppuration on probing, and no further bone loss, treatment success was obtained in 2 of 14 (14.3%) of the TPS and in 7 of 12 (58.3%) of the SLA implants. Seven years after surgical treatment with DBBMC, patients, in an adequate SPT, maintained sufficient peri-implant conditions in many cases, particularly around SLA implants. Nevertheless, some patients required further treatment and some lost implants. The clinical decision on whether implants should be treated or removed should be based on several factors, including implant surface characteristics.

Radiographic and histological evaluation of deproteinized bovine bone mineral vs. deproteinized bovine bone mineral with 10% collagen in ridge preservation. A randomized controlled clinical trial.

The aims of this randomized clinical trial were to compare the dimensional changes and the histological composition after using deproteinized bovine bone mineral (DBBM) or deproteinized bovine bone mineral with 10% collagen (DBBM-C) and a collagen membrane in ridge preservation procedures. Patients who required an extraction and a subsequent implant-supported rehabilitation at a non-molar site were recruited. After extraction, a cone beam computed tomography (CBCT) was performed and sites were randomly treated either with DBBM or DBBM-C plus a collagen membrane. At 5months, before implant placement, a second CBCT was performed and a biopsy of the area was obtained. A blinded investigator superimposed the CBCTs and performed measurements to determine bone volume changes between the two time points. Additionally, a histomorphometric analysis of the biopsies was performed in a blinded manner. Eleven sites belonged to the DBBM group and eleven to the DBBM-C group. All together, a significant reduction in height and width was observed at 5months of healing, but no statistically significant differences were observed between the DBBM and the DBBM-C group. The histomorphometric analysis revealed a similar composition in terms of newly formed bone, connective tissue and residual graft particles in both groups. Deproteinized bovine bone mineral with 10% collagen showed a similar behaviour as DBBM not only in its capacity to minimize ridge contraction but also from a histological point of view. Thus, both graft materials seem to be suitable for ridge preservation procedures.