Resorbable Collagen Membrane Research Articles

Clinical outcomes of using operating microscope for alveolar ridge preservation: A randomized controlled trial.

The use of the operating microscope (OM) for extraction and alveolar ridge augmentation (ARP) is increasing due to enhanced magnification and illumination. The primary objective was to compare the wound healing and crestal bone quality after the use of OM and dental loupes (DL) for ARP. Forty non-molar teeth with periapical lesions in need of extraction and ARP from 33 patients were randomly assigned to 2 groups: DL (control) or OM (test). All procedures were performed by 1 surgeon and assessments done by masked examiners. ARP was performed with an allograft and a resorbable collagen membrane. The presence of granulomatous tissue remnants after debridement was recorded. Cone-beam computed tomography (CBCT) and ultrasound (US) scans were taken during the healing phase up to 16-week visits. Bone cores were retrieved from implant osteotomies for histologic analysis. Patient-reported outcome measurements (PROMs) were assessed. All patients completed all study visits except 1 who dropped out before the last visit. After socket debridement, the test group exhibited significantly fewer sites with tissue remnants (p=0.01) and a better healing score at 2-week (p=0.04) and 4-week (p=0.01) time points. There were no significant differences in 12-week crestal bone healing by histology (p=0.1), US (p=0.85), and CBCT healing (p=0.64) at 12weeks, as well as PROMs (p>0.1). Within the limitation of the study, the use of OM for ARP resulted in significantly fewer tissue remnants and favorable early visual wound healing. CBCT and US-derived-crestal bone quality did not show a difference between the 2 groups. Alveolar ridge preservation (ARP) by placing bone particulates in the extraction socket, covered by a wound dressing material, is commonly applied immediately after tooth extraction to reduce jawbone shrinkage in preparation for implant placement later. The jawbone healing varies, depending largely on the ability to remove the etiology, socket features, extent of surgical trauma, and wound stability. Healed jawbone with good quality is favorable for easiness of implant placement and could be related to maintenance of long-term implant health. The surgical microscope with high magnification (up to ∼25×) and co-axial illumination is ideal for assistance in the removal of granulomatous tissue that is believed to interfere with healing, performance of minimally invasive extraction, and stabilization of the wound with meticulous tissue management and fine sutures. This study compared the use of the surgical microscope to dental loupes for ARP in a randomized controlled design. The microscope-assisted ARP is associated with a significantly higher chance of removing granulomatous tissue, favorable early healing, and similar crestal bone quality. Removal of granulomatous tissue is significant for immediate implant placement. This study serves as a model for testing the benefits of the surgical microscope for encouraging early healing in more challenging intraoral surgical procedures.

Demineralized, Freeze-Dried Allogeneic Bone Blocks With Suture Fixation Technique for Reconstruction of Maxillary Alveolar Bone Deficiency: A Case Series.

This study aims to evaluate the clinical outcomes of using demineralized, freeze-dried allogeneic bone blocks (DFDABB) combined with the periosteal vertical mattress suture (PVMS) technique for the reconstruction of severe horizontal alveolar bone deficiencies in the maxilla. In continuous horizontal maxillary defects cases, bone augmentation was performed using DFDABB and deproteinized bovine bone matrix (DBBM) filling the interstice. Subsequently, a resorbable collagen membrane was carefully placed over the graft surface, and both the membrane and bone graft were firmly secured using the PVMS technique. Linear changes were assessed through superimposed cone-beam computerized tomography scans obtained before the operation and after a healing period of 6-10 months. A total of 7 female patients with 10 bone blocks and 13 implants were included in this study. One of the wounds was slightly ruptured postoperatively without infection, and all implants showed successful osseointegration. The average alveolar ridge width at a point 5 mm below the crest was 4.52 ± 2.03 mm before bone graft and 9.79 ± 1.57 mm after implantation with an average increase of 5.26 ± 1.97 mm. Similarly, at a point 10 mm below the crest, the pregraft alveolar ridge width measured 7.23 ± 3.60 mm, and postimplantation, it expanded to 11.81 ± 2.90 mm, showing an average gain of 4.58 ± 2.01 mm. This case series demonstrates the successful application of DFDABB combined with the PVMS technique to achieve adequate bone width for implantation at severe continuous horizontal bone deficiency of the maxilla. DFDABB with the PVMS technique resulted in superior horizontal bone gain during maxillary bone augmentation with horizontal continuity deficiency. However, further studies are necessary to validate these findings.

Successful Treatment of Nasopalatine Duct Cyst After Maxillary Anterior Implant Surgery: A Case Report.

Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded 1 year after maxillary anterior implant placement following periodontally hopeless teeth extraction. The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. Seven years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

Horizontal Guided Bone Regeneration of the Posterior Mandible to Allow Implant Placement: 1-Year Prospective Study Results.

Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement. This open, prospective, single-cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post-GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health. Of 45 patients evaluated 8 months post-GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: -1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and - 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health-related quality of life improved. GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant-based tooth rehabilitation. Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017).

Changes in soft tissue dimensions following horizontal guided bone regeneration with a split-thickness flap design – evaluation of 8 cases with a digital method

BackgroundPeri-implant soft tissue corrections are often indicated following alveolar ridge augmentation, due to the distortion of the keratinized mucosa at the area of augmentation. The objective of the current study was to evaluate the dimensional soft tissue changes following horizontal guided bone regeneration (GBR) utilizing 3D digital data.Methods8 mandibular surgical sites with horizontal alveolar ridge deficiencies were treated utilizing a resorbable collagen membrane and a split-thickness flap design. Baseline and 6-month follow-up cone-beam computed tomography (CBCT) scans were reconstructed as 3D virtual models and were superimposed with the corresponding intraoral scan. Linear changes of supracrestal vertical- horizontal soft tissue alterations were measured in relation to the alveolar crest at the mesial- middle- and distal aspect of the surgical area. Soft tissue dimensions were measured at baseline and at 6-month follow-up.ResultsPreoperative supracrestal soft tissue height measured midcrestally averaged at 2.37 mm ± 0.68 mm, 2.37 mm ± 0.71 mm and 2.64 mm ± 0.87 mm at the mesial-, middle- and distal planes. Whereas postoperative supracrestal soft tissue height was measured at 2.62 mm ± 0.72 mm, 2.67 mm ± 0.67 mm and 3.69 mm ± 1.02 mm at the mesial, middle and distal planes, respectively. Supracrestal soft tissue width changed from 2.14 mm ± 0.72 mm to 2.47 mm ± 0.46 mm at the mesial, from 1.72 mm ± 0.44 mm to 2.07 mm ± 0.67 mm and from 2.15 mm ± 0.36 mm to 2.36 mm ± 0.59 mm at the mesial, middle and distal planes, respectively. Additionally the buccal horizontal displacement of supracrestal soft tissues could be observed.ConclusionsThe current study did not report significant supracrestal soft tissue reduction following horizontal GBR with a split-thickness flap. Even though there was a slight increase in both vertical and horizontal dimensions, differences are clinically negligible.Trail registrationThe trail was approved by the U.S. National Library of Medicine (www.clinicaltrials.gov); trial registration number: NCT05538715; registration date: 09/09/2022.

Investigation of the extent of post-extraction bone contraction and remodeling after 4 months. A prospective pilot study

ObjectivesTo investigate the correlation between the serum levels of 25(OH)D and the resorption of the alveolar bone walls and regeneration of the alveolar space after tooth extraction. Methods14 adults in need of extraction of hopeless teeth were enrolled. An intraoral digital impression was performed, and each patient was tested to assess serum vitamin D levels. Subsequently, extraction of teeth and contextual guided bone regeneration was performed using porcine origin graft material and a resorbable collagen membrane to covert the defect. After 4 months, an impression was taken, and the model was scanned using a professional scanner for lab. At the same time, a cone beam computed tomography was performed to plan implant insertion through fully digital computer guided surgery. Bone was collected to perform histological and histomorphometric analysis. Pre and postoperative scans were compared using a specific software to estimate the volumetric changes. Tests were applied to investigate the relationship between the different predictor variables and the outcome variables. Results14 patients were divided in 3 groups depending on the serum Vit-D levels, identifying three ranges corresponding to low (lower than 20), medium (between 20 and 30), and optimal vitamin D levels (higher than 30). Volumetric contraction after extraction was observed for all patients, without any significant difference between the groups. Focusing on the post-extraction regeneration, patients belonging to the group with lower levels of Vit-D displayed lower and more disorganized levels of bone. Immunohistochemistry analysis showed that Col1A1 and Osteocalcin had no physiological alteration. Osteopontin could be identified near the external surface of bone tissue granules. Runx2 signals were detected near the margins of bone trabeculae. ConclusionsSerum vit-D levels do not appear to influence the extent of post-extraction bone contraction; on the contrary, they seem to influence the post-extraction regeneration. Clinical SignificanceVit D serum levels may influence the regenerative aspect during post-extraction turn-over. This might suggest controlling and (in case of low levels) recommend Vit D supplement in the patient diet in case of extraction.

A comparative study of the effects of advanced platelet-rich fibrin and resorbable collagen membrane in the treatment of gingival recession: a split-mouth, randomized clinical trial

AimThis study aimed to assess the effectiveness of advanced platelet-rich fibrin (A-PRF) combined with the pinhole surgical technique (PST) for enhancing root coverage (RC) in individuals with Miller class I or II gingival recessions (GR). Additionally, it compared the clinical effect of A-PRF and resorbable collagen membrane (RCM).Materials and methodsA total of 18 patients, encompassing 36 treatment sides of 18 Miller class I or II, were randomly assigned to the PST + A-PRF side (18 sides) and the PST + RCM side (18 sides). Clinical assessments of various parameters, including plaque index (PI), clinical attachment level (CAL), keratinized tissue width (KTW), recession depth (RD), recession width (RW), and gingival thickness (GT) were conducted at baseline and three months after the surgical procedure. A numeric rating scale (NRS) was also evaluated during the 1st, 2nd, 3rd and 4th days. This study was formally recorded under the TCTR identification number TCTR20230613005 in the Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF) on 13/06/2023. Furthermore, it was ethically approved by Sana’a University’s Ethical Committee for Medical Research.ResultsWhen comparing the values of 3 months follow-up with the baseline values, intra-side comparison of the PST + A-PRF group showed significant improvements in PI (P = 0.02), CAL (P = 0.01), and RD (P = 0.04), and GT values (P < 0.01). The improvements in the PST + A-PRF group were through the reduction of baseline values of PI, CAL, and RD; the mean reductions in PI, CAL, and RD were 0.44 ± 0.71, 0.33 ± 0.45, and 0.22 ± 0.43 respectively, and a significant increase in GT value (0.44 ± 0.24). While there was an insignificant increase in KTW value with no change in RW values (4.50 ± 0.71, P = 1). In contrast, intra- side comparison of PST + RCM side showed only a significant reduction in PI value (0.44 ± 0.71, P = 0.02) and a significant increase in GT value (0.42 ± 0.26, P = < 0.01). Meanwhile, there were insignificant improvements in CAL (2.89 ± 0.95), KTW (3.97 ± 0.74), and RD (1.94 ± 0.87) values. Regarding inter-side comparison, there were no statistically significant among all variables (p > 0.05). The pain scores of the numeric rating scale were significantly lower on the PST + A-PRF sides compared with the PST + RCM sides, especially on the 1st, 2nd, and 3rd days (P < 0.001).ConclusionBoth A-PRF and RCM showed not wholly satisfactory outcomes in gingival recession treatment. Interestingly, the combination of PST with A-PRF has proven more effective than combining PST with RCM. Additionally, the localized application of A-PRF has been shown to reduce post-operative pain following the pinhole surgical technique.

Preclinical comparison study of experimental peri-implantitis between alveolar ridge preservation and spontaneous healing sites in infected and noninfected tooth: a randomized blinded in vivo study.

This study compared the progression of experimental peri-implantitis between alveolar ridge preservation (ARP) and spontaneous healing (SH) sites in infected (IT) and noninfected tooth (NIT). Bilateral mandibular third or fourth premolars of six beagle dogs were randomly assigned to IT and NIT groups. Before extraction, chronic dehiscence defects were created at the mesial root of mid-buccal area in IT group. Four weeks later, the mesial roots of the third and fourth premolars were extracted in all groups.ARP procedure was randomly conducted on one side of the extraction sockets using collagenated bovine bone substitutes and resorbable collagen membrane, and contralateral side was allowded spontaneous healing. After 12weeks of healing, bone-level implants (ϕ 3.6 × 8.0mm) were placed at the extraction sockets. Three months of ligature induced peri-implantitis and three months of spontaneous progression were allowed, with radiographs taken at each phase. Biopsies were retrieved at the implant site for histomorphometric, immunohistochemical, and polarized light-microscopic analyses. Radiography demonstrated that the changes in the marginal bone level during the spontaneous progression period showed no significant differences between ARP and SH sites. Only small and/or nonsignificant differences in the progression of peri-implantitis were observed between ARP and SH sites in histomorphometric, immunohistochemical, and polarized light microscopic analyses. Additionally, the IT and NIT groups exhibited similar outcomes for most parameters. ARP with xenogenic bone substitutes might provide similarly robust results as SH sites regarding the progression of experimental peri-implantitis, irrespective of the infected or noninfected nature of the site before tooth extraction.

Efficacy of the Sausage Technique in Rebuilding the Crestal Buccal Bone Thickness: A Retrospective Analysis.

The goal was to evaluate the efficacy of the sausage technique in reconstructing the crestal buccal bone thickness, focusing on the distribution shape of the regenerated volume. Ten implants were placed in five patients with Cawood-Howell class IV defects. A cone beam computed tomography (CBCT) was executed at T0 (before surgery). Guided bone regeneration (GBR) with the sausage technique utilized a resorbable collagen membrane, made of a 50% autologous bone and a 50% anorganic bovine bone matrix (ABBM) mixture. After 6 months, a CBCT (T1) was performed before implant placement. Using CBCT software, a plane parallel to the implant axis intersected perpendicular planes every 1.5 mm from the crest level. T0 and T1 CBCT sections were analyzed, yielding 140 measurements. Statistical analysis via SPSS revealed a significant increase in thickness (average 2.82 ± 1.79 mm). Maximum gains occurred at 4.5 mm from the coronal crest line (3.8 ± 1.51 mm). The GBR sausage technique was effective with minimal post-operative complications, yielding the biggest gain at the mid-ridge sagittal area. Within the analysis limitations, it can be assumed that the sausage technique is effective for horizontal GBR in the maxilla, but a lesser volume might be achieved at the crestal level because it seems to follow a bowed regeneration shape.

Enhancing guided bone regeneration with cross-linked collagen-conjugated xenogeneic bone blocks and membrane fixation: A preclinical invivo study.

To determine whether combining cross-linked (CL) collagen-integrated xenogeneic bone blocks stabilized with the fixation of resorbable collagen membranes (CM) can enhance guided bone regeneration (GBR) in the overaugmented calvarial defect model. Four circular defects with a diameter of 8 mm were prepared in the calvarium of 13 rabbits. Defects were randomly assigned to receive one of the following treatments: (i) non-cross-linked (NCL) porcine-derived collagen-embedded bone block covered by a CM without fixation (NCL + unfix group); (ii) NCL bone block covered by CM with fixation using bone-tack (NCL + fix group); (iii) cross-linked (CL) porcine-derived collagen-embedded bone block covered by CM without fixation (CL + unfix group); and (iv) CL bone block covered by CM with fixation using bone-tack fixation (CL + fix group). The efficacy of GBR was assessed through histological and molecular analyses after 2 and 8 weeks. At 2 weeks, there were no significant differences in histologically measured areas of newly formed bone among the groups. At 8 weeks, however, the CL + fix group exhibited a larger area of new bone (5.08 ± 1.09 mm2, mean ± standard deviation) compared to the NCL + unfix (1.62 ± 0.42 mm2; p < .0083), NCL + fix (3.97 ± 1.39 mm2) and CL + unfix (2.55 ± 1.04 mm2) groups. Additionally, the expression levels of tumour necrosis factor-alpha, fibroblast growth factor-2, vascular endothelial growth factor, osteocalcin and calcitonin receptor were significantly higher in the CL + fix group compared to the other three groups (p < .0083). Cross-linked bone blocks stabilized with collagen membrane fixation can significantly enhance GBR.

The effect of a barrier membrane on the incorporation of deproteinized bovine bone mineral (DBBM) in experimental defects at the time of early implant placement. A preclinical study

ObjectivesThis study aimed to assess membrane use with a bone substitute graft for guided bone regeneration (GBR) in experimental dehiscence defects.Materials and methodsMaxillary second incisors (I2) in 9 dogs were extracted. Six weeks later, implants were inserted and experimental dehiscence defects (5 × 3 mm) created on the buccal aspect. The defects and surrounding bone were grafted with deproteinized bovine bone mineral. One side (test) was covered with a resorbable collagen membrane whereas the contralateral side (control) was not. After 6 weeks, histomorphometrical analysis was performed to evaluate: (a) first bone-to-implant contact (fBIC), (b) buccal bone thickness at 1 mm increments from implant shoulder, (c) regenerated area (RA), (d) area and percentages of new bone (B), bone substitute (BS) and mineralized tissue (MT).ResultsThe histological appearance was similar between test and control sites. At central and lateral sections, there were no differences between groups for fBIC, buccal bone thickness, RA, BS, B, %B, MT and %MT. At central sections, membrane use favoured more %BS and %MT (p = 0.052). There was significantly more B, %B and MT at lateral compared to central sections.ConclusionsMembrane use tended to retain more bone substitute, but had no effect on new bone ingrowth. Lateral sections showed significantly more bone ingrowth and mineralized tissue compared to central sections, confirming that new bone ingrowth takes place mainly from the lateral walls of the defect.Clinical relevancePreclinical research to clarify the dynamics of bone regeneration in GBR procedures is relevant in clinical practice.

Evaluation of platelet-rich fibrin versus collagen membrane for enhancing healing of secondary grafted alveolar cleft: a randomised controlled trial

The purpose of this study was to compare the efficiency of using autologous platelet-rich fibrin versus a resorbable collagen membrane in secondary alveolar bone grafting. Patients were randomly allocated to the three treatment groups: Group 1 - twelve children in whom the nasal layers of the alveolar clefts were repaired using autologous platelet-rich fibrin with autogenous chin bone; Group 2 - twelve children in whom the nasal layers of the alveolar clefts were repaired using bovine collagen membrane type I (Colla-D) with autogenous chin bone; and Group 3 - twelve children in whom the bony alveolar clefts were grafted with autogenous chin bone after construction of a watertight nasal floor had been completed. The study population comprised 36 patients with alveolar clefts, ranging in age from seven to 12 years. At the last follow-up period all groups had stable healing conditions and good radiological outcomes in terms of the alveolar bone height bordering the teeth (both mesially and distally) and the incorporation of grafting material with the surrounding bone. The use of either a PRF membrane and a collagen membrane as an interpositional layer between the nasal layer and the autogenous chin bone graft enhanced bone formation and density in alveolar clefts compared with the control group.

Comparative study on the degradation rate and regulatory effects of two resorbable collagen membranes during the in vivo implantation

Objective: To explore the differences in the performance and tissue repair promotion effects of small intestinal submucosa membrane (SIS membrane) and Bio-Gide resorbable collagen membrane (Bio-Gide membrane) by performing the subcutaneous implantation models in mice. Methods: For in vivo studies, we stablished membrane implantation models using 6-8 week-old male C57BL/6 mice. The degradation rates were explored through HE staining analysis at different time points (1, 3, 5, 7, 14 and 28 d, 3 mice/group/time point). The influences of the two membranes on local macrophages and neovasculum were evaluated by immunofluorescence detection of F4/80 and CD31, and the mobilization effects of the two membranes on local stem cells were evaluated by immunohistochemical detection of Ki67 and CD146. For in vitro studies, mice periodontal ligament stem cells (mPDLSCs) were co-cultured with these two membrane materials, and the cell morphologies were observed by scanning electron microscopy. In addition, the gene expressions of Ki67, Cxcl1, Ccl1, Tnfa were investigated by real-time fluorescence quantitative PCR (RT-qPCR). Results: The results of in vivo studies showed that by day 28, there was no significant difference in degradation rate between these two membrane materials [SIS degradation rate: (16.84±4.00) %, Bio-Gide degradation rate: (24.07±3.97) %, P=0.090], illustrating that both of them could maintain the barrier effects for more than one month. In addition, there was no significant difference in the infiltration number of local F4/80 positive macrophages between these two groups by the day 3 after implantation [SIS: (20.67±5.69) cells/visual field, Bio-Gide: (25.33±2.52) cells/visual field, P=0.292]. However, compared with the Bio-Gide membrane, SIS membrane significantly promoted local CD31+vascular regeneration [SIS: (4.67±1.15) cells/visual field, Bio-Gide: (1.00±1.00) cells/visual field, P=0.015] and CD146+stem cell recruitment [SIS: (22.33±4.16) cells/visual field, Bio-Gide: (11.33±2.52) cells/visual field, P=0.025]. The RT-qPCR results also showed that SIS membrane promoted the gene expression of Cxcl1 (SIS vs Bio-Gide P<0.001) in mPDLSCs, but had no effect on the gene expression of Tnfa (SIS vs Bio-Gide P=0.885). Conclusions: SIS membrane showed a similar degradation rate compared with Bio-Gide membrane, and there was no significant difference in the effects of these two membranes on local inflammation or macrophages. Therefore, both of these membranes could meet the barrier effects required by guided tissue regeneration.

Autologous leucocyte and platelet rich in fibrin (L-PRF) - is it a competitive solution for bone augmentation in maxillary sinus lift? A 6-month radiological comparison between xenografts and L-PRF.

Much of the research published involves using artificial products, like xenografts and resorbable collagen membranes, after a prior Cone Beam Computer Tomography (CBCT) investigation. Nowadays, more accessible access, less financial costs, a biological approach, and faster healing are objectives that surround this procedure. Leucocytes and platelets rich in Fibrin (L-PRF) are a natural component with a high concentration of growth factors. Due to its regenerative properties and lack of complications, it is used in several medical fields, like orthopedics, dermatology, and oral surgery. This retrospective study aims to compare results in bone height and volume obtained through external sinus lift, either by using xenografts or autologous plasma rich in fibrin, by evaluating the quantity of new bone formation from a radiological point of view. Fifty-eight Caucasian patients were included in this retrospective study; 48 were submitted to xenograft procedure, and 10 were selected for L-PRF grafting material with simultaneous implant placement. Lack of clinical and histological studies performed on patients with L-PRF surgeries limited us in choosing a larger group for the radiological analysis. CBCT evaluation was performed before surgery and 6 months after. All patients selected for the study presented good general and oral health, acute oral and sinus infections excluded; smoking and periodontal disease were also criteria of exclusion. Two operators performed the measurements in pre-established landmarks in different time frames. The two independent groups were compared with the Wilcoxon rank-sum test for quantitative data. Qualitative characteristics were described as counts and percentages. All analyses were performed in an R environment for statistical computing and graphics. Mean bone height gain in the xenograft group in the regions was as follows: 7.44 for the anterior landmark, 12.14 for the median and 8.28 for the distal. The mean group height gained for the L-PRF group was 0.1 anteriorly, -0.18 for the median measurement, and 0.23 distally. We obtained excellent overall reliability for all the height measurements between the two operators. Further studies must be conducted to establish new sets of surgical protocols in case L-PRF alone is found to be a reliable, stable, biological alternative to the well-documented xenografts in external sinus lifts. Radiological results, although promising, must be further applied in long term clinical survival of the implants in the grafted sites. Also, studies combining L-PRF in conjunction with xenograft might bring improved clinical results in terms of reduced postoperative complications and accelerated healing.

Horizontal ridge augmentation using guided bone regeneration with an association of particulate allografts mixed with platelet-rich fibrin, collagen membrane and tent-screws: A prospective study

BackgroundGuided Bone Regeneration (GBR) is a versatile technique employed not only to correct pre-implant alveolar bone defects but also to facilitate bone defect correction during simultaneous implant placement. The effectiveness of GBR varies significantly among different protocols, as reported in the literature. This study specifically aimed to radiologically evaluate the horizontal bone gain obtained using a GBR procedure combining a particulate allograft, platelet-rich fibrin, resorbable collagen membrane, and screw tents. Materials and methodsA total of 42 patients with an insufficient alveolar bone width for dental implant placement were treated with a GBR technique using a mixture of particulate allograft (demineralised freeze-dried bone allograft 300–500 and 500–1000 µm), advanced platelet-rich fibrin (A-PRF), resorbable collagen membranes and screws tents (1.2 mm in diameter). Over the course of the study, a total of 63 GBR procedures were performed on these patients. Bone gains were measured by cone-beam computed tomography at 9.1 ± 2.0 months post-operative. ResultsA significant mean increase (P < 0.001) of 3.2 ± 0.9 mm at the sites of the greatest bone defect was observed. This improvement was consistent across various locations, including both maxillary and mandibular regions, and in cases of terminal and embedded edentulism, without any post-operative complications during the entire post-operative follow-up. All patients benefited from implant placement following the bone augmentation protocol. ConclusionGBR combining particulate allografts, A-PRF, collagen membranes, and screw tents achieves reliable, predictable, and reproducible clinical gains that allow for future implant placement.

The impact of synthetic bone grafting for tissue regeneration

Aims: This study aimed to examine the biological response of synthetic nanocomposite material on canine mandibular bone. Methods: Nine healthy adult male local breed dogs aged 12 to 18 months and weighing 10.2 to 15.2 kg were used in the study. Based on healing intervals of 1 and 2 months, the dogs were divided into 2 groups. Each group had 3 subgroups with 3 dogs each. The division was based on the grafting material used to fill the created defect: an empty defect (Control-ve), Beta-Tricalcium Phosphate, and nanocomposite (Beta-Tricalcium Phosphate and nanosilver 1%) . Surgery started after the dogs were anaesthetized. The surgical procedure began with a 5 cm parallel incision along the mandible’s lower posterior border. After exposing the periosteum, a three 5mm-diameter, 5-mmdeep critical-size holes were made, 5mm between each one. Each group’s grafting material had independent 3 holes. The defects were covered with resorbable collagen membranes followed by suturing of the mucoperiosteal flap. Results: Total densitometric analysis showed no significant differences between groups at 1-month intervals, with the nanocomposite group having a higher mean rank (165.66± 31.21) in comparison to other groups while at 2 months intervals that there was a highly significant difference between three groups as the P-value was (0.000) with the nanocomposite group having a higher mean rank (460.66± 26.40). Conclusions: In the current study, the use of nanocomposites improved osteoconductivity by accelerating new bone formation. Moreover, the encorporation of nanosilver enhanced growth factor activity. These attributes make nanocomposites a promising material for enhancing the bone healing process.

Comparative analysis of the results of using individual titanium frameworks and resorbable collagen membranes in alveolar bone reconstruction

This article describes a method of directed bone regeneration (DBR) of alveolar bone using 3D printed individual titanium framework membranes (ITFMs). Using computer modelling and additive technologies, we have designed and manufactured ITFMs for directed bone regeneration. The use of such membranes made it possible to reduce the duration of operations and obtain a larger volume of bone regenerate. Barrier membranes made of cross-linked collagen with a long resorption time were used as a comparison group.Results. The use of ICTM for alveolar bone reconstruction allowed us to achieve a maximum bone regenerate height of 6.28 mm, while using Lamina collagen membrane – 2.75 mm. The median difference of bone height before and after surgery with ICTM was 3.605 mm, for Lamina – 1.33 mm. The obtained results allowed us to recommend the use of Lamina membrane for restoration of alveolar bone width and/or height within 3 mm. In case of combined defects of alveolar bone width and height of more than 3 mm, we recommend the use of customized 3D printed titanium frame membranes.

Evaluation of Different Approaches for Sinus Membrane Perforation Repair During Sinus Elevation: A Systematic Review and Meta-analysis.

To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk. Electronic searches on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases were conducted for publications up to February 2021. All included articles reported SMPs submitted for repair. The proportion of implant loss in repaired SMP sites was calculated using a random-effects model meta-analysis. A total of 130 studies reporting SMP repair protocols were included in the systematic review, with 20 selected for meta-analysis. A total of 1,972 sinuses that were perforated and repaired during sinus elevation using different approaches were included in the qualitative analysis. The resorbable collagen membrane was the most commonly reported treatment. The presence of sinusitis was the most frequently described complication. Regarding bone parameters, the majority of studies described no differences between perforated and repaired sinuses and intact membranes. No difference in the implant loss proportion was observed between sites with repaired SMP compared to undetected SMP. The proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was 4% (95% CI: 2.0 to 8.0). In meta-regression analysis, no association was observed between the SMP size and implant loss proportion (P = .86). The materials and techniques indicated for SMP management seem to securely seal the maxillary sinus, without a negative effect on the ultimate survival of the implants placed in the affected sinuses.

Xenograft Combined with a Mixture of Polynucleotides and Hyaluronic Acid (PNs-HA) for Horizontal Alveolar Bone Regeneration: Clinical and Histologic Assessments in a Case Series.

The present case series aims to investigate the use of polynucleotides mixed with hyaluronic acid (PNs-HA) in the form of gel to promote bone regeneration in horizontal alveolar defects. Overall, 6 adult patients underwent localized horizontal guided bone regeneration by means of xenogeneic bone substitute and a resorbable barrier with a staged approach. The graft consisted in a mixture of deproteinized bovine bone mineral (DBBM) particles and PNs-HA gel in a 3:1 ratio, respectively. The material was covered by a resorbable collagen membrane fixed with pins to the underlying bone. Implant placement was performed after 5 months. Healing proceeded uneventfully, and, upon re-entry, the graft appeared well vascularized and firmly attached to the recipient bone. Histologically, the regenerated bone appeared highly mineralized, well-organized in lamellae and totally embedding the residual granules of the biomaterial. Histomorphometric evaluations revealed that newly formed bone occupied on average 41.2% ± 12.4% of the analysed samples. Linear measurements performed on CBCT scans yielded an overall linear horizontal bone gain of 4.91 ± 0.88 mm. These data suggest that a mixture of DBBM and PNs-HA can be safely used to promote bone regeneration in case of horizontal alveolar defects.

Evaluation of Porcine Collagen Membranes Used with Guided Bone Regeneration for Critical Defects: A Histological, Histomorphometric, Immunohistochemical, and Inflammatory Profile Analysis.

The objective of this study was to compare the effectiveness of two porcine collagen membranes of different origin used for guided bone regeneration procedures. Resorbable collagen membrane from porcine dermis (Bio-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) and resorbable collagen membrane from porcine pericardium (Jason, Institut Straumann AG, Peter Merian-Weg, Switzerland) were evaluated; histological, histometric, immunohistochemical, and inflammatory profile analyses were performed. The study was carried out on critical defects created in the calvaria of 72 rats (Rattus norvegicus albinus, Wistar variety) divided into three groups: coagulum group (Co), porcine pericardium group (JS), and porcine collagen group (BG). The defects were filled with clot, over which the membranes were placed. The animals were euthanized 7, 15, 30, and 60 days after surgery. The Shapiro-Wilk test was used to assess data distribution. Analysis of variance (ANOVA) and the Bonferroni multiple comparison test were used to compare the differences across the mean values of the variables. Nonparametric tests, Mann-Whitney and Wilcoxon W, were used for the quantitative analysis of the inflammatory profile. A significance level of 5% (p < 0.05) was adopted with a confidence interval of 95%. SPSS software version 2.0 was used. A total of 1,008 analyses were performed on 288 histological slides. It was noted that both types of collagen membranes used in this study were effective for the guided bone regeneration procedure, with a greater proportion and thickness of bone formation among recipients of the BG (735 points, p = 0.021). This membrane also had greater permeability (62.25). The animals in the JS group, which received the porcine pericardial membrane, showed early and accelerated bone formation from early bone tissue, milder osteopontin and osteocalcin levels, and greater inflammatory reaction (86.4). The collagen membrane from porcine dermis demonstrated a more orderly and physiological repair process, while the porcine pericardial membrane presented a more accelerated repair process that did not remain constant over time.