Oily Calcium Hydroxide Suspension Research Articles

Clinical evaluation of oily calcium hydroxide suspension alone and in combination with β-tricalcium phosphate in the treatment of periodontal intrabony defects

Background: An oily calcium hydroxide suspension (OCHS) has been proved to be efficient in promoting bone regeneration in periodontal intrabony defects. However, the outcome of regenerative therapy using an OCHS as an adjunct to open-flap debridement is believed to be compromised by its low consistency. Thus, the present study was carried out to evaluate an OCHS alone and in combination with β-tricalcium phosphate (β-TCP) as a bone graft material in the treatment of periodontal intrabony defects. Materials and Methods: Twenty-six intrabony defects in 10 patients were divided into experimental and control sites. The experimental sites were debrided and grafted with a combination of OCHS and β-TCP. The control sites were debrided and grafted with OCHS alone. Probing pocket depth (PPD), clinical attachment level (CAL), and gingival margin position were recorded at baseline and at 3, 6, and 9 months. Results: No differences in any of the investigated parameters were observed at the baseline between the two groups. At 9 months postoperatively, the experimental group showed a reduction in mean PPD from 7.56 ± 1.15 to 4.19 ± 1.42 mm (P Conclusion: Overall, both therapies led to significant PPD reduction and CAL gain. The combination of an OCHS and β-TCP as a bone graft material was more effective in terms of improving clinical parameters than OCHS alone.

Bone tissue response to an oily calcium hydroxide suspension in tibial defects. An experimental pilot study in minipigs

ObjectivesThe present study was conducted to evaluate the bone tissue response after the application of an oily calcium hydroxide suspension (OCHS) into defects created in the tibial bone of minipigs. Materials and methodsStandardized defects (2 ccm) were created into the tibia of 4 Goettinger minipigs. Defects in the test group (n = 4) were filled with OCHS (Osteora, DFS-Diamon, Riedenburg, Germany). Defects in the control group (n = 4) were filled with venous blood. Animals were sacrificed after healing periods of 4 and 8 weeks. Tibias were dissected, soft tissues removed and processed for histological analysis. Digital images (×200) were evaluated using the software CellD (Soft Imaging System, Münster, Germany). The following histomorphometrical landmarks were identified: defect size, mineralized tissue, non-mineralized tissue and residual OCHS. ResultsHealing was uneventful in all four animals. In the test group, new bone formation was observed in the vicinity of the defect margins whereas the centre of the defect was dominated by non-mineralized tissue. Mean percentages of mineralized tissue after 4 weeks were 23.01% in the test group vs. 43.45% in the control group. The mean value for residual OCHS was 7,11% at 4 weeks. After 8 weeks mean percentages of mineralized tissue were 28.15% in the test group vs. 44.39% in the control group as well as 7.05% for residual OCHS. ConclusionWithin the limits of the present pilot study it can be concluded that OCHS did not have a beneficial effect on new bone formation. To prove an osteoinductive potential of OCHS further studies based on a higher number of samples are needed.

In vitro-activity of oily calcium hydroxide suspension on microorganisms as well as on human alveolar osteoblasts and periodontal ligament fibroblasts

BackgroundFindings from animal and human studies have indicated that an oily calcium hydroxide suspension (OCHS) may improve early wound healing in the treatment of periodontitis. Calcium hydroxide as the main component is well known for its antimicrobial activity, however at present the effect of OCHS on the influence of periodontal wound healing/regeneration is still very limited. The purpose of this in vitro study was to investigate the effect of OCHS on periodontopathogenic bacteria as well as on the attachment and proliferation of osteoblasts and periodontal ligament fibroblasts.MethodsHuman alveolar osteoblasts (HAO) and periodontal ligament (PDL) fibroblasts were cultured on 3 concentrations of OCHS (2.5, 5 and 7.5 mg). Adhesion and proliferation were counted up to 48 h and mineralization was assayed after 1 and 2 weeks. Furthermore potential growth inhibitory activity on microorganisms associated with periodontal disease (e.g. Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans) as well as the influence of periodontopathogens and OCHS on the HAO and PDL fibroblasts counts were determined.ResultsMore than a 2-fold increase in adherent HAO cells was observed at 4 h following application of OCHS when compared to the control group (p = 0.007 for 2.5 mg). Proliferation of HAO cells at 48 h was stimulated by moderate concentrations (2.5 mg; 5 mg) of OCHS (each p < 0.001), whereas a high concentration (7.5 mg) of OCHS was inhibitory (p = 0.009). Mineralization was observed only for HAO cells treated with OCHS. OCHS did not exert any positive effect on attachment or proliferation of PDL fibroblasts. Although OCHS did not have an antibacterial effect, it did positively influence attachment and proliferation of HAO cells and PDL fibroblasts in the presence of periodontopathogens.ConclusionsThe present data suggests that OCHS promotes osteoblast attachment, proliferation and mineralization in a concentration-dependent manner and results are maintained in the presence of periodontal pathogens.

Early root surface colonization by human periodontal ligament fibroblasts following treatment with different biomaterials

Objectives. The present in-vitro study examined the effects of different biomaterials on early root surface colonization by human periodontal ligament (PDL) fibroblasts using confocal-laser-scanning-microscopy (CLSM). Materials and methods. Fifteen periodontally-diseased teeth were extracted, treated with scaling/root planing and longitudinally cut to obtain 30 root fragments. Fragments were treated either with 24% EDTA following application of enamel matrix derivative (EMD), 24% EDTA or EMD only, nanocrystalline hydroxyapatite (NHA) paste or oily calcium hydroxide suspension (OCHS) for 1 h each. The analogue untreated root specimens served as controls. Root fragments were incubated with human PDL fibroblasts and cellular proliferation and morphology were evaluated after 1, 3, 5 and 8 days using CLSM-visualization and image recognition software. Results. The rate of cellular proliferation was different among treatment modalities examined (p = 0.019). Except treatment with NHA paste all treatment modalities improved cellular proliferation on root surfaces at all different points of time compared with the control specimens. A significant difference between treatment modalities was observed between EMD and NHA paste (p = 0.008). No synergistic effect could be demonstrated comparing root surface conditioning with 24% EDTA and EMD application compared to 24% EDTA or EMD application only. Conclusion. The present results suggest that initial root surface colonization by PDL fibroblasts may be enhanced by root surface conditioning with 24% EDTA and application of EMD, application of 24% EDTA or EMD alone and OCHS. The addition of 24% EDTA for root surface conditioning prior to EMD application provided no synergistic effects in terms of early root surface colonization by PDL fibroblasts.

Influence of different biomaterials on the viability of Aggregatibacter actinomycetemcomitans

ObjectivesThe aim of the present in vitro study was to evaluate the effects of different biomaterials used for regenerative periodontal surgery on the growth of the periodontopathogen Aggregatibacter actinomycetemcomitans. MethodsThree commercially available biomaterials of synthetic origin (hydroxyapatite/beta-tricalcium phosphate, nanostructured hydroxyapatite paste, oily calcium hydroxide suspension), a bovine-derived xenograft as well as an enamel matrix derivative (EMD) were added in different concentrations to calibrated suspensions of A. actinomycetemcomitans ATCC 43718/33384 (serotype b/c). Equal aliquots (0.1ml) for the viability assay were taken after 5min, 1h, 3h, 8h and 24h, plated on blood agar and incubated in an anaerobic environment for 48h at 37°C. Viable cell counts were expressed as colony forming units (cfu)/0.1ml. ResultsThe results demonstrated that none of the investigated biomaterials could inhibit the growth of A. actinomycetemcomitans serotype b. A marked growth reduction of A. actinomycetemcomitans serotype c was observed in the presence of oily calcium hydroxide suspension and nanostructured hydroxyapatite. In contrast, no significant growth inhibition could be observed in the presence of hydroxyapatite/beta-tricalcium phosphate, enamel matrix derivative and bovine-derived xenograft. ConclusionsThe results of the present study suggest that none of the investigated biomaterials possesses antimicrobial properties against A. actinomycetemcomitans serotype b. Therefore, the use of these biomaterials for regenerative procedures should be weighted critically in the presence of A. actinomycetemcomitans serotype b.

Simultaneous in vivo comparison of bone substitutes in a guided bone regeneration model

A direct, simultaneous comparison of bone substitutes is hampered by the limited number of samples that can be tested simultaneously. The goal of this study was to establish a preclinical model for guided bone regeneration that offers testing of different bone substitutes in a one-wall defect situation. We show here that up to eight titanium hemispheres can be placed on the calvaria of minipigs. To establish our model, titanium hemispheres were filled with and without Bio-Oss ®, a deproteinized bovine bone mineral, Ostim ®, an aqueous paste of synthetic nanoparticular hydroxyapatite, and Osteoinductal ®, an oily calcium hydroxide suspension, before being positioned on the calvaria. After 6 and 12 weeks, titanium hemispheres were subjected to histological and histomorphometric analysis. We show here that bone filled approximately one-tenth of the area below the hemispheres which were left empty, indicating a critical size model for guided bone regeneration. In accordance with the documented osteoconductive properties of Bio-Oss ® and Ostim ®, titanium hemispheres were almost completely filled with bone. Moreover, the expected degradation profile of Bio-Oss ® and Ostim ® could be confirmed by histologic and histomorphometric analysis. Under the same conditions, Osteoinductal ® failed to exert osteoconductive properties, rather a progressive resorption of the host bone was observed. These results demonstrate that the preclinical model presented here is suitable to simultaneously compare bone substitutes with different material properties. Our model based on the titanium hemispheres allows evaluation of graft consolidation under standardized conditions thereby avoiding intra-individual variations.

Oily calcium hydroxide suspension (Osteoinductal) used as an adjunct to guided bone regeneration: an experimental study in rats

To evaluate whether an oily calcium hydroxide suspension (OCHS) promotes bone healing when used as an adjunct to guided bone regeneration (GBR). Rigid, hemispherical, teflon capsules were placed with their open part facing the lateral surface of the ramus on both sides of the mandible in 10 adult Wistar rats. In each animal, one capsule was filled out with an OCHS (test) before placement, while the capsule on the other side was left empty (control). After 4 months of healing, the animals were sacrificed and histological sections containing the capsules and the neighboring soft and hard tissues were prepared. On three to four sections taken by uniformly random sampling from each specimen, the relative volumes of (1) the newly formed bone (mineralized bone and marrow), (2) the soft connective tissue, (3) the residual OCHS, and (4) the acellular (empty) space inside the capsule were estimated by a point-counting technique, and expressed as percentage of the space originally created by the capsule. There was no new bone formation inside the capsules in all but one test specimen, where only a minimal amount of newly formed bone could be observed in continuation with the lateral surface of the ramus. OCHS had a homogenous appearance and occupied the major portion (79.4%) of the space created by the capsule. No signs of active resorption of the material could be observed. On the contrary, 31.5% of the space provided by the capsule was filled out with newly formed bone in the control group. The new bone had a trabecular appearance with large marrow spaces filled with hematopoietic and fatty marrow. The rest of the capsule space in the controls appeared empty. OCHS may hamper bone healing when used as an adjunct to GBR.

Effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy

The purpose of the present study was to evaluate clinically the effect of an oily calcium hydroxide suspension on early wound healing after nonsurgical periodontal therapy. A total of 19 patients with chronic periodontitis were enrolled in the study. Each subject had three sites in each of two contra-lateral jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding on probing (BoP+). All teeth received scaling and root planing under local anesthesia followed by irrigation with sterile saline. An oily calcium hydroxide suspension (Osteoinductal) was applied subgingivally to the test sites at random. All sites were reexamined after 1, 2 [gingival index (GI) and BoP], and 3 weeks (GI, BoP, and PPD). Treatment success was defined as no signs of GI (GI=0), no BoP (BoP-), and pocket closure (PPD< or =4 mm). At all three different points in time, there were improvements in both GI and BoP at the control and test sites, which were in favor of the test therapy (p<0.05). For PPD change, no differences were found between the test and the control sites. The results of the study suggest that the topical application of an oily calcium hydroxide suspension (Osteoinductal), after nonsurgical periodontal therapy, improves early periodontal wound healing.

Healing of intrabony defects following treatment with an oily calcium hydroxide suspension (Osteoinductal). A controlled clinical study

The purpose of the present clinical study was to evaluate the healing of deep intrabony defects following the application of an oily calcium hydroxide suspension (OCHS). Thirty patients suffering from chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery (AFS) and the application of OCHS (test) or with AFS alone (control). The following clinical parameters were recorded at baseline and at 6 months after therapy: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. At 6 months after therapy, the test group showed a reduction in mean PD from 7.7+/-1.5 to 2.9+/-0.9 mm (P<0.001) and a change in mean CAL from 9.6+/-2.1 to 5.5+/-2.5 mm (P<0.001). In the control group, the mean PD was reduced from 6.9+/-0.9 to 3.7+/-0.9 mm (P<0.001) and the mean CAL changed from 8.5+/-2.5 to 6.4+/-2.7 mm (P<0.001). OCHS resulted in statistically significant higher PD reductions (P<0.01) and CAL gains (P<0.05) than AFS alone. Within the limits of the present study, it can be concluded that: (1) at 6 months after surgery both therapies resulted in statistically significant PD reductions and CAL gains and (2) treatment with OCHS resulted in statistically significant higher CAL gains than treatment with AFS alone.

Effect of an oily calcium hydroxide suspension (Osteoinductal) on healing of intrabony periodontal defects. A pilot study in dogs

The aim of the present study was to evaluate histologically in dogs the effect of treating intrabony defects with an oily calcium hydroxide suspension (OCHS). Intrabony defects were surgically created bilaterally at the distal aspects of the maxillary first premolars and at the mesial aspects of the third premolars in two mongrel dogs. Subsequently, the defects were randomly treated with (a) access flap surgery followed by the application of an OCHS or (b) access flap surgery alone. After 8 weeks of healing, the animals were killed. Dissected blocks containing the experimental specimens were fixed in formalin, decalcified in EDTA, and embedded in paraffin. The formation of new cementum and bone was assessed histomorphometrically. In the control group, healing was predominantly characterized by the formation of a long junctional epithelium along the root surface and limited periodontal regeneration at the most apical part of the defect. The OCHS-treated defects consistently revealed periodontal regeneration (i.e., new periodontal ligament, new cementum with inserting collagen fibers, and new bone). Within the limits of the present study, it can be concluded that OCHS may favor periodontal regeneration in acute-type intrabony periodontal defects.