Reconstruction Of Alveolar Bone Defects Research Articles

Silk Fibroin/Collagen/Hydroxyapatite Scaffolds Obtained by 3D Printing Technology and Loaded with Recombinant Human Erythropoietin in the Reconstruction of Alveolar Bone Defects.

The fast osteogenesis of the large alveolar fossa and the maintenance of the height of the alveolar ridge after tooth extraction have always been a clinical challenge. Therefore, this work describes the creation of innovative silk fibroin/collagen/hydroxyapatite (SCH) biological scaffolds by 3D printing technology, which are loaded with recombinant human erythropoietin (rh-EPO) for the reconstruction of bone defects. Low-temperature 3D printing can maintain the biological activity of silk fibroin and collagen. The SCH scaffolds showed the ideal water absorption and porosity, being a sustained-release carrier of rh-EPO. The optimized scaffolds had ideal mechanical properties in vitro, and MC3T3-E1 cells could easily adhere and proliferate on it. In vivo experiments in rabbits demonstrated that the composite scaffolds gradually degraded and promoted the accumulation and proliferation of osteoblasts and the formation of collagen fibers, significantly promoting the reconstruction of mandibular defects. In this study, a novel composite biological scaffold was prepared using 3D printing technology, and the scaffold was innovatively combined with the multifunctional growth factor rh-EPO. This provides a new optimized composite material for the reconstruction of irregular mandible defects, and this biomaterial is promising for clinical reconstruction of alveolar bone defects.

Does an autogenous demineralized dentin (ADDM) graft has the ability to form a new bone?

Aim:This aimed to evaluate a new bone formation and to provide a single-stage treatment, i.e., extraction of tooth followed by autogenous dentin demineralized (ADDM) graft in the same extraction socket (ES) – for adult patients who require tooth extraction.Materials and Methods:Two hundred teeth extractions were performed to investigate the efficacy of ADDM graft in the formation of new bone. After demineralization of dentin graft parameters such as exposure of graft, any signs of infections/pus/exudates, pain, and bone density were evaluated.Results:On follow-up, exposure of graft was recorded in five sockets at 1 month and infection was recorded in four sockets. Pain was significantly high at postoperative day 1 and least with 3rd and 6th months. There was a highly significant bone formation (P < 0.01, 0.05) in the ES group at various time intervals, while there were no significant differences in the adjacent bone group.Conclusion:Using ADDM graft in providing a single-stage treatment plan, i.e., extraction of tooth followed by autogenous demineralized dentin graft in the same ES in adult patients – is an alternative for the immediate reconstruction of alveolar bone defects to facilitate the future prosthesis. It also saves the cost of other graft materials which are commercially available in market for the patient and also reduces the infective dental waste globally.

Autogenous Dentin Shell Grafts Versus Bone Shell Grafts for Alveolar Ridge Reconstruction: A Novel Technique with Preliminary Results of a Prospective Clinical Study.

This prospective pilot study presents a novel method using the dentin shell technique for the three-dimensional reconstruction of alveolar bone defects. Autogenous dentin shell (≤ 2 mm) harvested from impacted third molars was fixed at the recipient site as an external barrier. The space between the dentin shell and residual bone was filled with deproteinized bovine bone mineral particles mixed with concentrated growth factor (CGF) pieces. Autogenous bone (gold standard for bone graft) was applied to prepare shell grafts as the control. A total of 13 patients were included in the study and received bone reconstruction with the dentin shell technique (dentin group, n = 7) or bone shell technique (bone group, n = 6), respectively. At 24 weeks postsurgery, cone beam computed tomography results showed no statistically significant difference between the two groups regarding vertical bone gain and vertical and horizontal bone resorption. Histologic and microcomputed tomography analyses revealed significant newly formed bone connecting directly to the resorbed dentin shells. The dentin shell technique restored bone volume successfully without major complications.

Clinical application of partially demineralized autogenous dentin prepared at chairside for alveolar bone regeneration‐ 149 human cases

Background Although Urist and many other investigators have reported a bone regeneration capacity of demineralized tooth since 1967, cumbersome procedures including long demineralization time limit their clinical use. An ultrasonic device operating under periodic negative pressure and a bioreactor tube system can ensure rapid and aseptic preparation of partially demineralized dentin for alveolar bone grafting immediately after extraction in clinic. Using this approach, it took us 2 hrs (block type) or less Aim/Hypothesis This study shows that preparation of partially demineralized autogenous dentin in clinic is a safe and useful method for immediate reconstruction of alveolar bone defects and can be a good alternative to the use of autogenous bone. Material and Methods This clinical trial was performed at two centers in Korea. Consecutive 149 patients who needed both extraction of teeth (for endodontic or periodontal reasons or pericoronitis of third molar) and alveolar bone regeneration were included in this study. The reasons for bone grafting were vertical or horizontal alveolar bone deficiency for dental implant restoration or pre-existing periodontal defect on the distal aspect of the lower second molar (LM2) due to the impacted third molar. Two hours or less after tooth extraction, patients were prepared for bone grafting. Bony defects were restored just after extraction with the teeth from the original sites (113 cases) or third molars of other site (36 cases). Results There were no significant differences among the cases in relation to age and gender. All cases showed an uneventful healing process. No significant complications such as compromised wound healing including uncontrolled dehiscence, local wound infection, graft failure or dental implant failure were observed. A few cases (n = 4) showed minor wound dehiscence in early stage of soft tissue healing, but they were healed completely by secondary intention within 4 weeks. All culture tests showed no bacterial growth. Conclusion and Clinical Implications Bone graft material prepared as partially demineralized autogenous dentin on the day of extraction would be convenient for both patients and clinicians. We conclude that availability of instant partially demineralized dentin after extraction would have a strong positive effect on clinical use of tooth as bone graft material, although further studies should be performed to confirm its osteogenic effect and biological safety.

Effect of Simultaneous Immediate Implant Placement and Guided Bone Reconstruction with Ultra-Fine Titanium Mesh Membranes on Radiographic and Clinical Parameters after 18 Months of Loading.

Background: The aim of the present prospective case series study was to evaluate the implant and prosthetic survival rates, complications and marginal bone loss using ultra-fine titanium mesh membrane with simultaneous implant placement, to provide space maintenance mandatory for guided bone reconstruction of alveolar bone defects. Materials and Methods: patients were recruited and treated at a private clinic in Rome, Italy, between March 2016 and October 2017. Self-tapping tapered implants were placed through a computer-guided template-assisted approach. Autogenous bone was placed alone over the exposed implant surface, then mixed with inorganic bovine bone material. Finally, the membrane was connected and shaped in order to securely enclose the graft area, and the healing cap was connected and screwed onto the height connector. Outcome measures were: implant and prosthetic failure, biological and mechanical complications, marginal and volumetric bone level changes, esthetic evaluation performed according to the pink aesthetic score (PES). Results: in total, seven patients (five women, two men) with a mean age of 52.7 ± 20.3 years (range: 27–71) received 10 self-tapping tapered implants and simultaneous guided bone regeneration with ultra-fine titanium mesh membranes. No implants and no prostheses failed during the entire follow-up period. One slightly membrane exposure was observed one month after implant placement in one patient. The mean marginal bone loss (MBL) at implant loading was 0.13 ± 0.09 mm (95% CI 0.08–0.19). At the 18-month follow-up examination, the mean MBL was 0.28 ± 0.33 mm (95% CI 0.07–0.50) The difference was not statistically significant (0.15 ± 0.31; 95% CI 0.05–0.35; P = 0.1888). The mean horizontal alveolar ridge width was 3.72 ± 1.08 mm (95% CI 3.22–4.22 mm). At the II-stage surgery, the mean bone width was 8.79 ± 0.98 mm (95% CI 8.51–9.07 mm). The mean bone gain was 5.06 ± 1.13 mm (95% CI 4.68–5.44 mm; P = 0.000). The mean volume of the grafted bone calculated using the superimposition technique was 0.99 ± 0.38 CC (95% CI 0.75–1.23 CC). The mean PES at implant loading was 8.2 ± 0.8 mm (95% CI 7.7–8.7). At the 18-month follow-up examination, the mean PES was 12.0 ± 0.7 mm (95% CI 11.5–12.5) The difference was statistically significant (3.8 ± 0.4; 95% CI 3.5–4.1; P = 0.0000); Conclusion: with the limitation of the present prospective study, the guided bone reconstruction using an ultra-fine titanium mesh membrane with simultaneous implant placement seems to provide good and stable results in implant/prosthesis success. Further research with a longer follow-up and a higher sample size are needed to confirm the results from this preliminary report.

Personalized scaffolding technologies for alveolar bone regenerative medicine.

The reconstruction of alveolar bone defects associated with teeth and dental implants remains a clinical challenge in the treatment of patients affected by disease or injury of the alveolus. The aim of this review was to provide an overview on advances made in the use of personalized scaffolding technologies coupled with biologics, cells and gene therapies that offer future clinical applications for the treatment of patients requiring periodontal and alveolar bone regeneration. Over the past decade, advancements in three-dimensional (3D) imaging acquisition technologies such as cone-beam computed tomography (CBCT) and precise scaffold fabrication methods such as 3D bioprinting have resulted in personalized scaffolding constructs based on individual patient-specific anatomical data. Furthermore, 'fiber-guiding' scaffold designs utilize topographical cues to guide ligamentous fibers to form in orientation towards the root surface to improve tooth support. Therefore, a topic-focused literature search was conducted looking into fiber-guiding and image-based scaffolds and their associated clinical applications.

Autotransplantation of Teeth and the Reconstruction of Alveolar Bone Defects Using Artificial Bone: A Case Series

The aim of this study was to evaluate the outcome of autotransplantation or replantation of extracted teeth combining with reconstruction of alveolar bone defects in use of artificial bone grafting clinically and radiographically. This article presents a more useful and convenient method for repairing tooth and reconstruction of bone defecting with some interesting cases. Eleven patients (seven men and four women) in whom teeth with complete root formation were extracted and autotransplanted, the bone of receiving area was Insufficient. All transplanted teeth were stabilized with orthodontic wire and resin or 4-0 silk sutures; at the same time, artificial bone powder was filled. In 11 cases, the missing teeth were restored by autogenous teeth and the alveolar bone defect was restored by artificial bone, the improvement in the radiographic and clinical parameters strongly suggest that it may be a useful therapy to solve the problem of the missing teeth and alveolar bone insufficiency simultaneously. However, the risk of replacement root resorption remains.

Guided Bone Regeneration for the Reconstruction of Alveolar Bone Defects.

Background:Guided bone regeneration (GBR) is the most common technique for localized bone augmentation.Purpose:The purpose of this review was to categorize and assess various GBR approaches for the reconstruction of human alveolar bone defects.Materials and Methods:Electronic search of four databases including PubMed/Medline, EMBASE, Web of Science, and Cochrane and hand searching were performed to identify human trials attempting GBR for the reconstruction of alveolar bony defects for at least 10 patients from January 2000 to August 2015. To meet the inclusion criteria, studies had to report preoperative defect dimensions in addition to outcomes of bone formation and/or resorption.Results:Twenty-five human clinical trials were included of which 17 used conventional technique that is the use of space maintaining membrane with bone grafting particles (GBR I). Application of block bone graft with overlying membrane and particulate fillers was reported in seven studies (GBR II), and utilizing cortical bone block tented over a defect preserving particulate fillers was reported by one study (GBR III). A wide range of initial defects’ sizes and treatment results were reported.Conclusions:This review introduces a therapeutically oriented classification system of GBR for treating alveolar bone defects. High heterogeneity among studies hindered drawing definite conclusions in regard to superiority of one to the other GBR technique.

Autogenous fresh demineralized tooth graft prepared at chairside for dental implant.

BackgroundThis study aimed to evaluate the clinical usefulness of autogenous fresh demineralized tooth (auto-FDT) graft prepared at the chairside for alveolar bone grafting during dental implant surgery.MethodsIn total, 38 patients requiring both tooth extraction (for endodontic or periodontal reasons or third molar extraction) and alveolar bone regeneration for dental implant placement were included. Within 2 h after clean extraction, the teeth were prepared at the chairside to serve as bone graft material. In the same sitting, blocks or chips of this graft material were used to reconstruct defects at the osteotomy site simultaneously with or before implant placement. Twelve months after prosthesis fabrication and placement, the clinical findings and implant success rates were evaluated. Histological studies were randomly conducted for selected cases.ResultsClinical evaluation showed favorable wound healing with minimal complications and good bone support for the implants. No implant was lost after 12 months of function following prosthetic rehabilitation. Histological examination revealed new bone formation induced by the graft material.ConclusionsChairside preparation of autogenous fresh demineralized teeth after extraction can be a useful alternative to the use of autogenous bone or other graft materials for the immediate reconstruction of alveolar bone defects to facilitate subsequent implant placement.

Donor site morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in cleft patients—111 consecutive patients

The aim of this study was to assess the objective and subjective morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in patients with cleft lip and palate. One hundred and eleven patients born between 1995 and 1999, who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 2000 through 2011, were included. A survey of medical records was conducted. Subjective morbidity after reconstruction was assessed using a questionnaire. Medical records revealed few postoperative incidents; 5.6% reported persistent sensory disturbances in the donor area. Postoperative pain averaged 3.6±2.1 (scale 0–10). The overall satisfaction with the surgical result was 8.7±1.7 (scale 0–10). This study revealed that chin bone harvesting for reconstruction of alveolar defects in patients with cleft lip and palate is a safe and predictable procedure, highly appreciated by the patients, and characterized by only minor postoperative incidents. Patients must be informed of the risk of sensory disturbances in the donor area.

Evaluation of Allogenic Cellular Bone Graft for Ridge Augmentation: A Case Report

Introduction: The reconstruction of alveolar bone defects is often necessary to support successful implant therapy. Although multiple technologies are available to achieve ridge augmentation, the most widely used approaches combine an acellular graft material with guided bone regeneration. Recent advances in tissue banking make it possible to preserve mesenchymal stem cells and osteoprogenitor cells as part of an allogeneic cellular bone matrix that can further enhance the ability of the graft material to provide optimal results for ridge augmentation.Case Presentation: This case report describes the clinical application and results of an allogenic bone matrix product retaining mesenchymal stem and osteoprogenitor cells for alveolar ridge augmentation before implant rehabilitation. The cellular bone matrix supported a radiographic gain of 4 to 6 mm in horizontal ridge width, permitting the placement of dental implants without secondary augmentation.Conclusion: Cellular bone matrix appears to provide an important clinical alternative to acellular bone replacement grafts, particularly in light of its potential to achieve substantial gains in bone volume.

Reconstruction of Alveolar Bone Defects Using Bone Morphogenetic Protein 2 Mediated Rabbit Dental Pulp Stem Cells Seeded on Nano-Hydroxyapatite/Collagen/Poly(L-lactide)

The objective of the present study was to evaluate the capacity of a tissue-engineered bone complex of recombinant human bone morphogenetic protein 2 (rhBMP-2)-mediated dental pulp stem cells (DPSCs) and nano-hydroxyapatite/collagen/poly(L-lactide) (nHAC/PLA) to reconstruct critical-size alveolar bone defects in New Zealand rabbit. Autologous DPSCs were isolated from rabbit dental pulp tissue and expanded ex vivo to enrich DPSCs numbers, and then their attachment and differentiation capability were evaluated when cultured on the culture plate or nHAC/PLA. The alveolar bone defects were treated with nHAC/PLA, nHAC/PLA+rhBMP-2, nHAC/PLA+DPSCs, nHAC/PLA+DPSCs+rhBMP-2, and autogenous bone (AB) obtained from iliac bone or were left untreated as a control. X-ray and a polychrome sequential fluorescent labeling were performed postoperatively and the animals were sacrificed 12 weeks after operation for histological observation and histomorphometric analysis. Our results showed that DPSCs expressed STRO-1 and vementin, and favored osteogenesis and adipogenesis in conditioned media. DPSCs attached and spread well, and retained their osteogenic phenotypes on nHAC/PLA. The rhBMP-2 could significantly increase protein content, alkaline phosphatase activity/protein, osteocalcin content, and mineral formation of DPSCs cultured on nHAC/PLA. The X-ray graph, the fluorescent, histological observation, and histomorphometric analysis showed that the nHAC/PLA+DPSCs+rhBMP-2 tissue-engineered bone complex had an earlier mineralization and more bone formation inside the scaffold than nHAC/PLA, nHAC/PLA+rhBMP-2, and nHAC/PLA+DPSCs, or even autologous bone. Implanted DPSCs' contribution to new bone was detected through transfected eGFP genes. Our findings indicated that stem cells existed in adult rabbit dental pulp tissue. The rhBMP-2 promoted osteogenic capability of DPSCs as a potential cell source for periodontal bone regeneration. The nHAC/PLA could serve as a good scaffold for autologous DPSC seeding, proliferation, and differentiation. The tissue-engineered bone complex with nHAC/PLA, rhBMP-2, and autologous DPSCs might be a better alternative to autologous bone for the clinical reconstruction of periodontal bone defects.

Decontamination of autogenous bone grafts collected during dental implant site preparation: A pilot study

Dental implant site preparation produces bone particles that can be used as autogenous bone graft material for the reconstruction of alveolar bone defects; however, collected bone particles are contaminated with oral microorganisms that may cause augmentation failure due to complications associated with infection. The stringent aspiration protocol, preoperative oral chlorhexidine rinsing, and antibiotic prophylaxis were implemented before collecting bone particles. Nonetheless, collected bone particles were still contaminated with bacteria, and, therefore, decontamination of the collected bone particles with chlorhexidine or clindamycin was considered. The aims of this study were to quantitatively determine the degree of bacterial contamination of collected bone particles and to quantitatively evaluate the efficacy of treating collected bone particles with clindamycin or chlorhexidine solutions. Both of the agents effectively decontaminated the collected bone particles. Comparison between these antimicrobials in further studies could be useful in determining which is most effective.

Reconstruction of alveolar bone defects after extraction of mandibular third molars: A pilot study

Introduction A documented complication of mandibular third molar extraction is the development of bony defects on the distal aspect of the adjacent second molar. The primary study purpose was to determine the efficacy of grafting third molar extraction sites with demineralized bone powder to prevent the formation of periodontal defects. Material/Methods With a randomized clinical trial study design and a third molar extraction surgical model, we enrolled a study sample composed of patients who required extraction of bilateral third molars. Demineralized bone powder was placed in one randomly selected extraction site per patient. The remaining extraction site served as a control. Patients served as their own controls. To assess periodontal healing, we measured plaque and gingival indexes and periodontal attachment loss on the distobuccal aspect of the adjacent second molar preoperatively and 6 months postoperatively. Results Of 14 patients enrolled, 7 patients with a mean age of 21.7±3.7 years completed the study protocol. No statistically significant differences were noted between patients who did and did not complete the study protocol (all p values ≥0.42). There were no statistically significant differences for the various anatomic, operative, or periodontal measures between the control and treatment teeth preoperatively (all p values ≥0.46). Six months postoperatively, there were no statistically significant changes in the plaque or gingival indexes for the control or experimental sites. At the control sites, there was a nonstatistically significant decrease in mean attachment loss from 3.1±1.3 mm preoperatively to 1.4±1.6 mm 6 months postoperatively ( p=0.06). At experimental sites, there was a statistically significant decrease in mean attachment loss from 3.3±1.4 mm preoperatively to 0.6±0.8 mm 6 months postoperatively ( p=0.02). Conclusions The study results suggest that demineralized bone powder may decrease attachment loss on the distal aspect of the second molar after extraction of the adjacent third molar. Additional studies are indicated to confirm the results of this pilot study. We recommend that future studies limit their study samples to patients at high risk for developing periodontal defects after third molar extraction.

Autogenous rib graft for reconstruction of alveolar bone defects in cleft patients. Long term follow-up results

In a retrospective study (mean follow-up 76 months), the use of a free autogenous rib graft for reconstruction of anterior residual bone defects in seventeen cleft patients is evaluated on a long term basis. The results show recurrence of a palatal oronasal fistula in 2 out of 17 patients. 6 patients had acceptable results, while 9 had good to excellent scores at all sites. The costal graft material does not prevent permanent upper cuspids from erupting into this bone, after its incorporation. It is concluded that autogenous rib bone is a good material for secondary bone grafting of the residual alveolar and palatal defect in cleft patients.

Autogenous rib graft for reconstruction of alveolar bone defects in cleft patients: Long term follow-up results

In a retrospective study (mean follow-up 76 months), the use of a free autogenous rib graft for reconstruction of anterior residual bone defects in seventeen cleft patients is evaluated on a long term basis. The results show recurrence of a palatal oronasal fistula in 2 out of 17 patients. 6 patients had acceptable results, while 9 had good to excellent scores at all sites. The costal graft material does not prevent permanent upper cuspids from erupting into this bone, after its incorporation. It is concluded that autogenous rib bone is a good material for secondary bone grafting of the residual alveolar and palatal defect in cleft patients.