Autogenous Particulate Bone Graft Research Articles

Experimental maxillary sinus augmentation using a highly bioactive glass ceramic.

Physicochemical characteristics of a biomaterial directly influence its biological behavior and fate. However, anatomical and physiological particularities of the recipient site also seem to contribute with this process. The present study aimed to evaluate bone healing of maxillary sinus augmentation using a novel bioactive glass ceramic in comparison with a bovine hydroxyapatite. Bilateral sinus augmentation was performed in adult male rabbits, divided into 4 groups according to the biomaterial used: BO-particulate bovine HA Bio-Oss(®) (BO), BO+G-particulate bovine HA + particulate autogenous bone graft (G), BS-particulate glass ceramic (180-212 μm) Biosilicate(®) (BS), and BS+G-particulate glass ceramic + G. After 45 and 90 days, animals were euthanized and the specimens prepared to be analyzed under light and polarized microscopy, immunohistochemistry, scanning electron microscopy (SEM), and micro-computed tomography (μCT). Results revealed different degradation pattern between both biomaterials, despite the association with bone graft. BS caused a more intense chronic inflammation with foreign body reaction, which led to a difficulty in bone formation. Besides this evidence, SEM and μCT confirmed direct contact between newly formed bone and biomaterial, along with osteopontin and osteocalcin immunolabeling. Bone matrix mineralization was late in BS group but became similar to BO at day 90. These results clearly indicate that further studies about Biosilicate(®) are necessary to identify the factors that resulted in an unfavorable healing response when used in maxillary sinus augmentation.

Additive manufacturing to assist prosthetically guided bone regeneration of atrophic maxillary arches

Purpose– The purpose of this paper is to describe two different approaches for manufacturing pre-formed titanium meshes to assist prosthetically guided bone regeneration of atrophic maxillary arches. Both methods are based on the use of additive manufacturing (AM) technologies and aim to limit at the minimal intervention the bone reconstructive surgery by virtual planning the surgical intervention for dental implants placement.Design/methodology/approach– Two patients with atrophic maxillary arches were scheduled for bone augmentation using pre-formed titanium mesh with particulate autogenous bone graft and alloplastic material. The complete workflow consists of four steps: three-dimensional (3D) acquisition of medical images and virtual planning, 3D modelling and design of the bone augmentation volume, manufacturing of biomodels and pre-formed meshes, clinical procedure and follow up. For what concerns the AM, fused deposition modelling (FDM) and direct metal laser sintering (DMLS) were used.Findings– For both patients, a post-operative control CT examination was scheduled to evaluate the progression of the regenerative process and verify the availability of an adequate amount of bone before the surgical intervention for dental implants placement. In both cases, the regenerated bone was sufficient to fix the implants in the planned position, improving the intervention quality and reducing the intervention time during surgery.Originality/value– A comparison between two novel methods, involving AM technologies are presented as viable and reproducible methods to assist the correct bone augmentation of atrophic patients, prior to implant placement for the final implant supported prosthetic rehabilitation.

Bone grafting materials in critical defects in rabbit calvariae. A systematic review and quality evaluation using ARRIVE guidelines.

To perform a systematic literature review of the regenerative potential of bone substitutes used to fill critical size defects (CSDs) in rabbit calvariae; to determine the quality of the included studies using ARRIVE guidelines. An Internet search was performed in duplicate using MEDLINE, PubMed and Google Scholar databases (without restrictions on publication date) for studies reporting the regenerative potential of bone substitutes in CSDs in rabbit calvariae. Four parameters were analyzed by histomorphometry: new bone formation (NB); defect closure (DC); residual graft (RG); and connective tissue (CT). Animal Research Reporting in In Vivo Experiments (ARRIVE) guidelines (a list of 20 aspects for scoring texts and ensuring comparison between different experimental studies in animals) were used to evaluate the quality of the selected works. Twenty-one manuscripts were included. CSDs with 15mm were predominant (57.14%). Only one study described the four histomorphometric parameters. NB formation was analyzed in 15 studies (71.42%) and was higher for particulate autogenous bone grafts (range 52.1-82%) after 12weeks. DC was evaluated in six studies (28.57%) and was higher for fragmented adipose tissue grafts (range 53.33-93.33%) after 12weeks. RG was evaluated in four studies (19.04%) and was higher for hydroxyapatite/beta-tricalcium phosphate grafts with silica (HA/ß-TCP + Si) (range 35.78-47.54%) at 12weeks. CT was evaluated in two studies (9.5%) and was higher for HA/ß-TCP + membrane (44.2%) at 12weeks. Quality evaluation identified three items (title, introduction/objectives and experimental procedure) (15%) with excellent scores, 10 items (abstract, introduction/background, methods/ethical statement, experimental animals, experimental outcomes, statistics, results/baseline data, outcome/estimation and discussion interpretation/scientific implications) (50%) with average scores, and seven items (housing and husbandry, sample size, allocation, numbers analyzed, adverse effects, general applicability/relevance and funding) (35%) obtained poor scores. Only one manuscript obtained a quality evaluation considered as excellent. Autogenous bone grafts increase NB. DC is enhanced by the use of fragmented adipose tissue. RG remains in the defect for longer when hydroxyapatite/beta-tricalcium phosphate with silica is used, and more CT can be expected when hydroxyapatite/beta-tricalcium phosphate with silica grafts are covered by a membrane. The addition of stem cells of different origins to grafting materials enhances bone formation in early healing periods. The ARRIVE guidelines are still insufficiently used and the overall quality of studies remains low.

Use of a Titanium Mesh "Shelter" Combined with the Soft Tissue Matrix Expansion (Tent Pole) Grafting in the Reconstruction of a Severely Resorbed Edentulous Mandible. Technical Note.

Patients wearing complete dentures for a long time usually exhibit lack of bone and keratinized mucosa in the bearing area due to bone resorption. The patients suffering from this phenomenon usually have unstable and non-retentive complete denture, which result in constant trauma to the mucosa, pain, functional limitations and worsening of facial esthetics. An innovative technique has been described in which a novel surgical approach using osseointegrated dental implants as "tent poles" was applied concomitant with particulate autogenous bone graft. The authors claim that the control and maintenance of the surgically expanded soft tissue volume should prevent graft resorption in the long term. Nevertheless, resorption of the bone graft is usually more significant where the bone mass is poorer, in the mandibular body. This paper describes a case of severely resorbed edentulous mandible in which the "tent pole" technique was applied with some modifications. Use of the titanium mesh "shelters" and two additional implants was effective in "protecting" the bone graft in the posterior portion of the mandibular body increasing bone mass volume in this area. Furthermore, we believe that this kind of graft "protection" on the whole residual alveolar ridge can increase the width of bone mass gain optimizing the "tent pole" technique.

Block versus particulate/titanium mesh for ridge augmentation for mandibular lateral incisor defects: clinical and histologic analysis.

The purpose of this study was to clinically, histologically, and immunohistochemically evaluate the quantity and quality of newly regenerated bone by means of direct clinical measuring and biopsy specimens of alveolar ridges augmented by autogenous cortical bone or titanium micromesh-both filled with autogenous particulate bone graft in the anterior jaws. For the preliminary study, 10 alveolar bone defects in five partially edentulous patients (two men and three women), between 19 and 35 years old (mean: 25.4, SD: 5.94) were selected. Bone defects were randomly (coin toss) divided into two groups: A (micromesh) and B (bone block). The donor site was the mandibular symphysis in all cases. On the return appointment, operative grafts appeared well incorporated into the native bone, which suggests that good contact and fit between the graft and the recipient site had been obtained during the first surgery. Histologic investigations confirmed excellent integration and revascularization of the graft in both study groups, with formation of new bone tissue without any relevant inflammation.

Use of titanium mesh for staged 3D localized alveolar ridge augmentation

Guided bone regeneration has been used successfully for the regeneration of bone for the placement of oral implants when ridge deformities are present. The present case provides a clinical description of the use of titanium mesh along with bone graft for anterior maxillary bone reconstruction. Bone augmentation with titanium mesh and autogenous particulate bone graft is a successful technique and a predictable approach for the regeneration of bone.

Immediate reconstruction of the mandible after resection for aggressive odontogenic tumours: a cohort study

The results are reported of a clinical follow-up study on 32 selected but consecutive patients with mandibular ameloblastoma. They were all treated by a segmental resection and reconstructed, using two 2.3mm reconstruction plates and an autogenous particulate bone graft, taken from the anterior iliac crest, and platelet rich plasma. Follow-up ranged from 12 to 39 months, with an average of 27.9 months. Undisturbed healing occurred in 29 patients, while three had postoperative infections, but in only one case did that result in failure of the graft. The patients’ appreciation was measured using an adapted quality of life questionnaire. The results were compared with a similar group who did not undergo reconstruction. The eating of solid food, appearance and speech were considerably better in the reconstructed group. The conclusion is that this means of reconstruction is appropriate for patients with benign but aggressive odontogenic tumours of the mandible, particularly in developing countries, since the expenses seem to be affordable.

A novel bioactive vitroceramic presents similar biological responses as autogenous bone grafts

Bioactive glasses represent an interesting class of bone substitute's biomaterials. The present study investigated the repair of bone defects filled with a novel bioactive vitroceramic (Biosilicate(®)), alone or in association with particulate autogenous bone grafts in calvaria defects of rabbits. After 7, 14, and 30 days the specimens were retrieved for histological, histomorphometric and immunohistochemistry analysis. Satisfactory bone formation was observed in all groups, and direct bone-biomaterial surface was noted. Histomorphometric assessment did not show statistically significant differences in bone formation among the groups and periods, except for BG group at day 14. Immunoexpression of Runx-2 was similar among the groups containing the graft and the biomaterial, being more intense than in control group. Similar result was observed for VEGF expression, especially in the last experimental period. These results revealed that Biosilicate(®) presented a favorable behavior, comparable to autogenous bone graft.

Sinus augmentation using rhBMP‐2/ACS in a mini‐pig model: relative efficacy of autogenous fresh particulate iliac bone grafts

Implant dentistry in the posterior maxilla often requires bone augmentation. The gold standard, autogenous bone graft, requires additional surgery with associated morbidity, while bone biomaterials may not support relevant bone formation. Recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS), however, induces significant, clinically relevant bone formation in several settings including the maxillary sinus floor. The objective of this study was to compare local bone formation and osseointegration following maxillary sinus augmentation using rhBMP-2/ACS or a particulate autogenous cancellous bone graft obtained from the iliac crest in conjunction with immediate placement of dental implants. Bilateral sinus augmentation using an extraoral approach including rhBMP-2 (0.43mg/ml)/ACS or the autogenous bone graft, alternated between left and right sinus cavities in five adult male Yucatan mini-pigs, was performed. Two 12-mm dental implants were inserted into the sinus wall protruding approximately 8mm into the sinus cavity. Surgical sites were closed and sutured in layers; block biopsies collected for histometric analysis at 8weeks. rhBMP-2/ACS induced bone of significantly greater and consistent quality compared with the iliac crest autogenous bone graft; bone density averaging 51.9±3.0% vs. 32.9±2.5% (P=0.01). However, there were only numerical differences in augmented bone height (9.3±0.5 vs. 8.6±0.7mm) and bone-implant contact (37.4±3.0% vs. 30.7±5.9%) between treatments. rhBMP-2/ACS induces bone of superior quality compared with an iliac crest particulate autogenous cancellous bone graft when used for maxillary sinus augmentation, and should perhaps be considered the new standard for this indication.

Reconstruction of the mandible with an autogenous corticocancellous bone graft and fibrin glue: An animal experiment

This paper reports on an experimental animal study evaluating a method of mandibular reconstruction in dogs using autogenous corticocaneclous bone graft and fibrin glue. Eight animals underwent a resection at the mandibular body and primary reconstruction was carried out using osteosynthesis plates and screws. The defect was bridged with an autogenous particulate bone graft from the anterior iliac crest. To accelerate bone healing, fibrin glue (FG) was mixed with particulate bone graft. The hypothesis of this study was based on the presumption that bone healing, in segmental reconstruction of the dog mandible with a particulate cancellous bone graft mixed with FG, would be successful. All dogs had eventful healing. The histological results were less favorable with regard to bone remodeling than the results obtained in similar experiments with a particulate corticocancellous bone graft.

Marginal Bone‐Level Alterations at Implants Installed in Block versus Particulate Onlay Bone Grafts Mixed with Platelet‐Rich Plasma in Atrophic Maxilla. A Prospective 5‐Year Follow‐Up Study of 15 Patients

Extensive atrophy of the alveolar process may require a bone-grafting procedure prior to implant treatment. Autogenous bone grafts from the iliac crest, used as onlay block and particulate bone, have been used together with sinus-lift procedure in order to rehabilitate patients with extremely resorbed maxillae. However, there are to our knowledge no 5-year follow-up studies evaluating the extent of bone-level change in patients treated with respectively block and particulate autogenous bone grafts. The purpose of this prospective clinical study was to conduct a 5-year follow-up analysis with focus on bone-level alteration in block versus particulate onlay bone grafts. Fifteen out of originally 19 patients who were treated with iliac bone grafts and oral implants in the maxilla have been followed through the first 5 postoperative years. In a first study conducted on 19 patients, the role of platelet-rich plasma in conjunction with autogenous bone was evaluated. In this 5-year follow-up study, the marginal bone alterations have been documented at base line, 1 year and 5 years of loading to the nearest 0,1 mm at mesial and distal surfaces of the implants. Two implants were installed on each side of the midline in either block or particulate bone grafts giving test and control sides in each patient. Additionally, two implants on each side were installed in residual bone/grafted sinus floor. Marginal bone alteration in the anterior maxilla appeared larger at the side augmented by block bone at baseline, and after 1 and 5 years of loading, but the change was not statistically significant. Moreover, there was a significantly higher degree of marginal alteration during the first year of loading, compared with the examinations after 5 years. The present follow-up study showed that there is no significant difference in the extension of resorption between block- and particulate autogenous bone grafts over a 5-year period. Most of the resorption occurred during the first year in function.

Exchange Cranioplasty Using Autologous Calvarial Particulate Bone Graft Effectively Repairs Large Cranial Defects

Autogenous particulate cranial bone graft has been proven to be effective for inlay cranioplasty but does not provide structural contour. This limitation can be overcome using an exchange cranioplasty technique. This study probes the effectiveness of this method for large (>5 cm(2)) or complicated cranial defects. The authors conducted a retrospective review of patients managed with autologous exchange cranioplasty between 2005 and 2010. Full-thickness calvarial bone was removed from the intact cranium; particulate bone graft was harvested from the graft endocortex or ectocortex of intact cranium. The original defect was repaired with the full-thickness graft and the donor site was covered with particulate graft. Patient records were reviewed for age at cranioplasty, operative indication, size and location of defect, operative time, blood loss, and length of follow-up. Outcome variables included complications, osseous defects, and need for revision cranioplasty. Twenty patients underwent exchange cranioplasty at a mean age of 8.3 ± 6.2 years. Average values for the group included length of procedure, 4.7 hours; estimated blood loss, 288 ml; hospital stay, 3.1 days; and follow-up, 1.57 years (range, 24 weeks to 3.7 years). Eighty-five percent of patients underwent postoperative computed tomographic scanning to document healing. Fifteen patients had complete healing; five patients had residual bone defects (four by computed tomography and palpation, and one by computed tomography only). The cranial defect area decreased 96 percent on average from a preoperative mean of 85.2 cm(2) to a postoperative combined defect size (donor plus recipient) of 3.3 cm(2). Autologous exchange cranioplasty using particulate bone graft is safe and highly effective for reconstructing even large cranial defects.

Alveolar Ridge Reconstruction with Titanium Mesh and Autogenous Particulate Bone Graft: Computed Tomography‐Based Evaluations of Augmented Bone Quality and Quantity

The purpose of this study was to evaluate the quality and quantity of augmented bone following alveolar ridge reconstruction with titanium mesh and autogenous particulate bone graft for implant placement in terms of the preoperative bone defect. Forty-one patients (50 sites) rehabilitated between September 2000 and May 2009 with autogenous particulate intraoral bone or iliac cancellous bone marrow grafts and micro-titanium meshes were enrolled. We classified the bone defects by means of shape as complex horizontal-vertical (HV), horizontal (H), and socket (S) types, and the augmented bone was evaluated based on preoperative computed tomographic data. The postsurgical complications were assessed during the healing period and after implant superstructure placement. The bone defects were successfully augmented using the titanium mesh technique. The HV-type defect was the most difficult to augment (mean horizontal gain, 3.7 ± 2.0 [SD] mm; mean vertical gain, 5.4 ± 3.4 [SD] mm). The mean horizontal gain with the H-type defect was 3.9 ± 1.9 mm. The S-type defect achieved the most efficient bone augmentation (mean horizontal gain, 5.7 ± 1.4 [SD] mm; mean vertical gain, 12.4 ± 3.1 [SD] mm). The major postsurgical complications were mesh exposure, infection, total or partial bone resorption, and temporary neurological disturbances. Implant failure was observed in one case. The HV-type defect showed significantly higher bone resorption (p < .05) than the other defect types. Autogenous bone grafting with titanium mesh allows adequate vertical and horizontal alveolar bone reconstruction both quantitatively and qualitatively for implant placement. However, the clinical outcome of augmentation depends on the type of preoperative bone defect.

Poster Board Number: 09: A Comparison of Allogenous Bone Graft Versus Particulate Autogenous Bone Graft to Gain Increase in Vertical and Horizontal Dimension Prior to Implant Placement—A Human Clinical Study

Poster Board Number: 09: A Comparison of Allogenous Bone Graft Versus Particulate Autogenous Bone Graft to Gain Increase in Vertical and Horizontal Dimension Prior to Implant Placement—A Human Clinical Study

Experimental study of the shaped titanium mesh combined with autogenous particulate bone graft and simultaneous implant for reconstructing segmental mandibular defect

To observe the healing and bone formation of the autogenous particulate bone graft and osseointegration of the implants in shaped titanium mesh with autogenous particulate bone graft and simultaneous implant for reconstructing segmental mandibular defect in dogs. Five Beagle dogs were prepared with unilateral 40 mm segmental mandibular defect. Titanium mesh was shaped according to the mandibular defect and was fixed with titanium screws. The ablated mandibular bone and iliac bone were crashed to approximately 2 mm particulates which then filled the titanium mesh tightly (cortical bone:cancellous bone, 3:1). Two implants were placed in the autogenous particulate bone graft. The dogs were sacrificed after six months. X-ray films, histological sections, Scanning electron microscopy(SEM) and Energy disperse analysis of the reconstructed mandibles were examined to evaluate the bone formation of the bone graft and osseointegration of the implants. The outline of the reconstructed mandible was satisfactory and its function was excellent. The ossific fusion among the particulate bone grafts was fine and no resorption was found. All implants showed excellent osseointegration with the bone graft. The bone near the implant was more compact than the bone away from it. The structure of the bone near implant was optimized because of simultaneous implant in shaped titanium mesh. The shaped titanium mesh with autogenous particulate bone graft is a good method for reconstructing segmental mandibular defect, and simultaneous implant is feasible in the reconstructed mandible in dogs.

O.573 Long-term evaluation of dental implants placed at the time of or after alveolar ridge augmentation with autogenous bone grafts and titanium meshes: a 3-8 year retrospective study

The objective of this systematic review was to test the hypothesis of no difference in implant treatment outcomes when using Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone grafts for lateral ridge augmentation. A search of the MEDLINE, Cochrane Library, and Embase databases in combination with a hand-search of relevant journals was conducted. Human studies published in English from 1 January 1990 to 1 May 2016 were included. The search provided 337 titles and six studies fulfilled the inclusion criteria. Considerable variation prevented a meta-analysis from being performed. The two treatment modalities have never been compared within the same study. Non-comparative studies demonstrated a 3-year implant survival of 96% with 50% Bio-Oss mixed with 50% autogenous bone graft. Moreover, Bio-Oss alone or Bio-Oss mixed with autogenous bone graft seems to increase the amount of newly formed bone as well as the width of the alveolar process. Within the limitations of this systematic review, lateral ridge augmentation with Bio-Oss alone or in combination with autogenous bone graft seems to induce newly formed bone and increase the width of the alveolar process, with high short-term implant survival. However, long-term studies comparing the two treatment modalities are needed before final conclusions can be drawn.

Particulate Inlay Nasal Graft With Immediate Dental Implant Placement in a Patient With Repaired Alveolar Cleft: Case Report

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

Reconstruction of the Maxilla and Mandible With Particulate Bone Graft and Titanium Mesh for Implant Placement

The purpose of the study was to evaluate the magnitude of ridge augmentation with titanium mesh, overall graft success, anatomic location of ridge defects and their relationship to mesh exposure. This retrospective study evaluated 44 patients who received mandibular or maxillary reconstruction with autogenous particulate bone graft and titanium mesh for the purpose of implant placement. Autogenous bone graft was harvested from the iliac crest, tibia, and mandibular symphysis. A total of 45 sites were included in the study. Average augmentation bone heights were measured and compared. Statistical analysis was done with ANOVA and Student's t test. Histomorphometric analysis was performed on the soft tissue specimen found between the mesh and the bone graft. Twenty-nine sites underwent mandibular reconstruction and 16 underwent maxillary reconstruction. The mean augmentation in partial maxillary defects was 11.33 +/- 1.56 mm, and in complete maxillary augmentation, the height achieved was 14.3 +/- 1.39 mm. In the mandible, mean increase in height for partial defects was 14 +/- 1.42 mm and for complete augmentation it was 13.71 +/- 1.14 mm. The mean augmentation for all sites was 13.7 mm (12.8 mm in the maxilla and 13.9 mm in the mandible). A total of 82 implants were placed in the maxilla and 92 implants were placed in the mandible. In the maxillary group, 7 sites had exposure of the titanium mesh and 16 sites were exposed in the mandible. The success of the bone grafting procedure was 97.72%. Porous titanium mesh is a reliable containment system used for reconstruction of the maxilla and the mandible. This material tolerates exposure very well and gives predictable results.

Clinical Investigation of Dental Implant Reconstruction for Grafted Alveolar Cleft Patients

The purpose of this study was to evaluate the clinical application of endosseous implants for management of grafted alveolar cleft. Four patients (1 male and 3 female; mean age 26.6 years; age ranging from 21.5 to 30.4 years at first implant surgery) with unilateral cleft lip and palate were evaluated. All patients received autogenous particulate cancellous bone and marrow graft (PCBM) to close the alveolar cleft. After bone bridge formation, implant treatment was performed. All patients with insufficient alveolar bone height, chin or ramus of mandible bone, onlay grafting was performed 4 months before implant installment. A total of 5 implants were placed in the grafted alveoli. The length of implants ranged from 10.0 to 13.0 mm. The follow-up period ranged from 2.2 to 4.1 years after implant placement. The clinical result was acceptable in all patients. The survival rate of implants was 100%. Implant treatment for grafted alveolar cleft was studied and the outcome of treatment was acceptable.

WITHDRAWN: Use of platelet rich plasma (PRP) in the reconstruction of mandibular bony defects: Clinical and radiographic follow-up

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the effect of adding platelet rich plasma (PRP) to a particulate autogenous bone graft in the healing of bony defects following ablative surgery to resect malignancies of the mandible. MATERIAL AND METHODS: Ten patients, who underwent curative surgical therapy for a malignant tumour and who needed reconstruction of the body of the mandible were selected for this study. The patients were randomly divided into two groups of five patients. In the first group, the defect was reconstructed using an autogenous free bone graft taken from the anterior iliac crest. The five patients in the second group underwent the same treatment, except that the bone graft was mixed with platelet rich plasma (PRP). Panoramic radiographs were taken immediately, at 1 month, 3 months and at 9 months intervals, after reconstruction. Radiographic evaluation took place in a standardized way by two independent examiners. RESULTS: The clinical outcome of the surgical reconstruction was satisfactory. The initial bone healing in all patients was uneventful. The postoperative successive radiographs showed adequate consolidation of the bone in all cases. Bone healing, as manifested by the obliteration of the bone gaps at the osteotomy sites, was particularly present in the PRP group at 3 months period. This was found to be statistically significant (Chi-square test, P<0.05). CONCLUSION: The use of PRP appeared to enhance bone healing considerably. PRP and autogenous free bone grafts might have a potential for routine clinical use to reconstruct bony defects.