Use Of Graft Material Research Articles

Implant Survival Rates after Osteotome‐Mediated Maxillary Sinus Augmentation: A Systematic Review

The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials. MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included. Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in <5 mm ridge height and 96.9% for 2,525 implants inserted in ≥ 5 mm ridge height. The difference was significant (p = .0003). The transalveolar sinus augmentation technique could be a viable treatment in case of localized atrophy in the posterior maxilla even in case of minimal residual bone height. The prognosis can be more favorable when the residual ridge is at least 5 mm high.

Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: an experimental study in monkeys

To describe the early healing processes around the implants installed after elevation of the sinus mucosa applying the lateral access technique without the use of grafting material. Immediately after the elevation of the maxillary sinus Schneiderian membrane by the lateral approach in eight monkeys, implants were installed without the use of grafting material. The healing of the tissue around the implants was evaluated after 4, 10, 20 and 30 days. Ground sections were prepared and analyzed histologically. After 4 days of healing, the formation of coagulum and provisional matrix was documented within the elevated area. At 10-day interval, sprouts of woven bone were in continuity with the parent bone, and partly in contact with the implant surface at the base of the augmented area. While bone-to-implant contact increased after 20 and 30 days, the area underneath the Schneiderian membrane appeared reduced in volume and condensed toward the apex of the implants. The sinus mucosa was to some extent collapsed onto the implant surface and on the newly formed bone. The void initially occupied by the coagulum after sinus membrane elevation shrank substantially during the observation period. A lack of influence of the Schneiderian membrane in bone formation apical to implants was documented in the early phase of healing.

Use of a titanium device in lateral sinus floor elevation: an experimental study in monkeys

To evaluate the effect of a space-maintaining device fixed to the lateral wall of the maxillary sinus after the elevation of the sinus mucosa on bone filling of the sinus cavity. Immediately after the elevation of the maxillary sinus Schneiderian membrane accomplished through lateral antrostomy in four monkeys, a titanium device was affixed to the lateral sinus wall protruding into the sinus cavity to maintain the mucosa elevated without the use of grafting material. The healing of the tissue around the implants was evaluated after 3 and 6 months. Ground sections were prepared and analyzed histologically. The void under the elevated sinus membrane, originally filled with the blood clot, was reduced after 3 as well as after 6 months of healing of about 56% and 40.5%, respectively. In seven out of eight cases, the devices had perforated the sinus mucosa. The formation of mineralized bone and bone marrow amounted to about 42% and 69% after 3 and 6 months, respectively. The connective tissue represented about 53% and 23% of the newly formed tissue after 3 and 6 months, respectively. New bone formation was found below the devices. However, shrinkage of the newly formed tissue was observed both after 3 and 6 months of healing. Hence, the space-maintaining function of the devices used in the present study has to be questioned.

RETIRED: Transvaginal Mesh Procedures for Pelvic Organ Prolapse

To provide an update on transvaginal mesh procedures, newly available minimally invasive surgical techniques for pelvic floor repair. The discussion is limited to minimally invasive transvaginal mesh procedures. PubMed and Medline were searched for articles published in English, using the key words "pelvic organ prolapse," transvaginal mesh," and "minimally invasive surgery." Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis, and articles were incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1). Counselling for the surgical treatment of pelvic organ prolapse should consider all benefits, harms, and costs of the surgical procedure, with particular emphasis on the use of mesh. 1. Patients should be counselled that transvaginal mesh procedures are considered novel techniques for pelvic floor repair that demonstrate high rates of anatomical cure in uncontrolled short-term case series. (II-2B) 2. Patients should be informed of the range of success rates until stronger evidence of superiority is published. (II-2B) 3. Training specific to transvaginal mesh procedures should be undertaken before procedures are performed. (III-C) 4. Patients should undergo thorough preoperative counselling regarding (a) the potential serious adverse sequelae of transvaginal mesh repairs, including mesh exposure, pain, and dyspareunia; and (b) the limited data available comparing transvaginal mesh systems with traditional vaginal prolapse repairs or with traditional use of graft material in the form of augmented colporrhaphy and sacral colpopexy. (III-C) 5. Until appropriate supportive data are available, new trocarless kits should be considered investigative. (III-C).

Bladder Reconstruction Using Bovine Pericardium in a Case of Enterovesical Fistula

The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective. Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances. We report a case of a successful repair of an enterovesical fistula by use of bovine pericardium. The patient has remained well for 2.5 years. We suggest that bovine pericardium may be a suitable option as a bladder substitute.

Clinical evaluation of guided tissue regeneration combined with autogenous bone or autogenous bone mixed with bioactive glass in intrabony defects

Conflicting data exist on the combined use of grafting materials and barrier membranes in comparison to guided tissue regeneration (GTR) with membrane alone. The aim of the present study was to compare the clinical outcomes of GTR with collagen membrane (CM) alone (control group) or CM combined with autogenous bone graft (test group 1) or autogenous bone mixed with bioactive glass (test group 2) in intrabony defects. A total of 32 intraosseous defects in 22 subjects were treated randomly. After 6 months, significant probing depth reduction, clinical attachment level gain (CAL) and defect resolution were observed in all groups with significantly greater improvements in the test groups. There was no significant difference between the two test groups in any parameter. Results of the present study suggest that autogenous bone can be mixed with bioactive glass if the amount of the harvested bone is not sufficient.

Early healing after elevation of the maxillary sinus floor applying a lateral access: a histological study in monkeys

To describe the early healing within the void obtained after the elevation of the sinus mucosa and simultaneous implant installation without the use of any grafting material in monkeys. Implants were installed simultaneously with the elevation of the maxillary sinus using the lateral approach in eight monkeys without the use of grafting material. The healing after 4, 10, 20 and 30 days was evaluated in the area distal to the implants. Paraffin sections were prepared and analyzed using qualitative histological methods. The healing process was initiated by the formation of a coagulum and followed by a provisional matrix and woven bone. Subsequently, a parallel-fiber bone replaced woven bone. The dimension of the elevated area shrank during the healing process. Sprouts of woven bone, present to a moderate extent after 4 days, were more numerous after 10 and 20 days. Newly formed bone originated from the sinus walls and septa, while there was no evidence of participation of the Schneiderian membrane in this process. After 30 days, the window access appeared to be closed by a layer of newly formed trabecular bone. The coagulum that filled the void distal to the implant after simultaneous elevation of the sinus floor gave rise to newly formed bone. However, the void occupied by the coagulum shrank substantially. The Schneiderian membrane did not provide a basis for new bone formation in the early phase of healing.

Periodontal regeneration: a challenge for the tissue engineer?

Periodontitis affects around 15 per cent of human adult populations. While periodontal treatment aimed at removing the bacterial cause of the disease is generally very successful, the ability predictably to regenerate the damaged tissues remains a major unmet objective for new treatment strategies. Existing treatments include the use of space-maintaining barrier membranes (guided tissue regeneration), use of graft materials, and application of bioactive molecules to induce regeneration, but their overall effects are relatively modest and restricted in application. The periodontal ligament is rich in mesenchymal stem cells, and the understanding of the signalling molecules that may regulate their differentation has increased enormously in recent years. Applying these principles for the development of new tissue engineering strategies for periodontal regeneration will require further work to determine the efficacy of current experimental preclinical treatments, including pharmacological application of growth factors such as bone morphogenetic proteins (BMPs) or Wnts, use of autologous stem cell reimplantation strategies, and development of improved biomaterial scaffolds. This article describes the background to this problem, addresses the current status of periodontal regeneration, including the background biology, and discusses the potential for some of these experimental therapies to achieve the goal of clinically predictable periodontal regeneration.

The effectiveness and complications of graft materials used in vaginal prolapse surgery

In the last decade, there has been an increase in the use of graft materials in vaginal prolapse surgery. Most of the evidence available is based on case studies produced by the manufacturers, with few randomized controlled trials. In October 2008, the United States Food and Drug Administration issued a safety warning on the use of grafts in vaginal surgery. It has been suggested that there is a greater need to review the evidence on the effectiveness and complication of grafts. This article explores the recent literature on the use of grafts in vaginal prolapse surgery. The use of grafts versus standard techniques for vaginal wall repair is examined, looking at subjective and objective cure as well as complications. Despite the wide use of grafts in vaginal prolapse surgery, there is still a need for level 1 evidence to support their use, with long-term follow-up of 3 or 5 years. There is, however, good evidence to support the use of grafts in suburethral slings and abdominal sacrocolpopexy.

Osteoconductive carriers for integrated bone repair

Successful bone repair is judged in achieving restitution of space and mechanical integrity, and in regaining function. When the biology or anatomy are insufficient to attain a full repair, therapeutic use of graft material has been used to omit compliance features such as strain tolerance, reduced stiffness, and attenuated strength, and instead promote primary or membranous-type bone formation within the physical approximation of a graft material. The challenge of most conductive materials is that they emerge from a static platform and in placement force the living system to adapt to placement, dimension, different properties, and eventually are only successful in degradation and replacement, or in integration. The synergy and interdependency between adhesion, ECM, and proteolysis are important concepts that must be understood to engineer scaffolds capable of holding up to standards which are more than cell decoration. Moreover, the reactive specificity to loading, degradation, therapeutic delivery during absorption remains a key aim of both academic and industrial designs. Achieving conductivity comes with challenges of best fit integration, delivery, and in integrated modeling. The more liquid is the delivery, the more modular the components, and adaptive the matrix to meeting the intended application, the more likely that the conductivity will not be excluded by the morphology of the injury site. Considerations for osteoconductive materials for bone repair and replacement have developed conceptually and advanced parallel with a better understanding of not only bone biology but of materials science. First models of material replacements utilized a reductionist-constructionist logic; define the constituents of the material in terms of its morphology and chemical composition, and then engineer material with similar content and properties as a means of accommodating a replacement. Unfortunately for biologic systems, empiric formulation is insufficient to promote adequate integration in a timely fashion. Future matrices will need to translate their biological surfaces as more than a scaffold to be decorated with cells. Conductivity will be improved by formulations that enhance function, further extended from understanding what composition best suits cell attachment, and be adopted by conveniences of delivery that meet those criteria.

Biologic Patches for Management of Irreparable Rotator Cuff Tears

Large, massive, and irreparable rotator cuff tears are common in the clinics of shoulder specialists and general orthopedists alike. Surgical repair techniques have evolved from open transosseous to mini-open to all arthroscopic, but the solution to the irreparable tear has yet to be found. Even large tears that can be reapproximated and 'fixed' back to the bone have unacceptable rates of nonhealing. Poor healing and poor tissue quality has led surgeons to investigate the use of patch grafts to bridge or augment difficult tears. This article gives a comprehensive review of the historical use of graft materials, outlining the evolution to our current technique. Subsequently, the techniques of both arthroscopically bridging and augmenting difficult rotator cuff tears with human acellular dermal matrix are described in detail.

The biochemistry of wound healing in the pelvic floor: What have we learned?

Reviewing the biochemistry of wound healing in vaginal surgery is essential before embarking on reconstructive procedures. The use of graft materials requires the surgeon to consider the environment in which such a graft is being placed and its effect on healing. This review describes wound healing in general with special emphasis on pelvic reconstruction using biomaterials.

Management of Erosion of Graft Materials in Pelvic Floor Reconstruction

We present an overview of the current literature and management techniques for vaginal extrusion or urinary tract erosion of graft materials used in pelvic floor reconstruction. A MEDLINE search was performed to identify literature pertaining to the incidence and management of vaginal or urinary tract exposure of graft materials commonly used in anti-incontinence and pelvic floor reconstructive procedures. Dependent on the type of mesh material used, a vaginal extrusion rate of up to 77% has been reported. The currently accepted, loosely woven, monofilament type I polypropylene meshes appear to have acceptable lower exposure rates in the range of 1–3% for slings, but with the larger area of mesh used in prolapse repairs, the rate increases to up to 10%. With the current widespread use of graft materials to reinforce pelvic floor reconstructive techniques, it is imperative for surgeons to be familiar with potential complications related to the materials and proper management of these complications. Although it is beginning to appear that the benefit of using some synthetic materials may outweigh the risks, proper management and understanding of the risks is important in order to counsel our patients appropriately and responsibly prior to their surgeries.

Komplette Netzperforation nach bandunterstützter vorderer Scheidenwandplastik durch Infektion mit multiresistenten Escherichia coli – Fallbericht und Übersicht

Pelvic floor disorders are an increasing problem among elderly women with a high prevalence rate. In the search for new methods to decrease the incidence of recurrent prolapse the use of surgical mesh in pelvic floor surgery has grown in popularity. The use of synthetic materials has resulted in a new spectrum of complications including a mesh erosion rate of up to 19 %. CASE REPORT: A 47-year-old woman was transferred to our clinic under intubation for heavy vaginal bleeding 20 days after vaginal hysterectomy and anterior vaginal wall repair using a transobturator mesh. The mesh was completely visible at the anterior vaginal wall and covered with sanies. The bleeding had ceased by the time of the patient's arrival at our clinic. A blood transfusion was given. The microbiological smear revealed multiresistant Escherichia coli, which was the reason that the antibiotic therapy performed shortly after surgery remained unsuccessful. The visible parts of the mesh were surgically removed. The patient was discharged 2 days later. Six weeks later the vaginal walls appeared well fixed with only a very small erosion which was later removed in an outpatient setting. CONCLUSION: Despite the initial enthusiasm accompanying new surgical techniques we should not forget the special risks involved or the possibility to perform classical pelvic floor surgery. In our opinion, as data is still rare, the use of graft materials in vaginal reconstructive surgery should be limited to a carefully selected patient population. We would like to point out the importance of educating patients about the higher complication rates. Considering the increasing numbers of multiresistant germs, microbiological investigation is essential in cases of postoperative infection.

Simultaneous dental implant placement and endoscope‐guided internal sinus floor elevation: 2‐year post‐loading outcomes

To determine whether endoscope-guided sinus elevation procedures can be consistently used to create sufficient bone support for stable implant placement and long-term implant success. Sixty-two implants were surgically placed into 30 patients (14 men and 16 women) following internal sinus elevation without the use of graft material. Panoramic radiographs were made pre-, post-operative and after 24 months in order to evaluate the peri-implant bone and maxillary sinuses. Resonance frequency analysis (RFA) was used to evaluate implant stability immediately upon placement and just before prosthesis delivery. The average pre-operative height of the maxillary alveolar bone was 8.4+/-2.2 mm at the premolar and 7.3+/-3.1 mm at the molar regions. The average bone gain was 3.5+/-1.8 and 4.5+/-1.9 mm in the premolar and molar sites, respectively. Clinical parameters and the RFA (4 and 12 weeks post-operative) outcomes show sufficient stability (ISQ=60) of the inserted implants. Three implants failed during the healing period of 12 weeks. The overall implant success rate was 94%. After loading, no further implant failure was observed. The overall success rate after beginning of implant loading was 100%. Sinus floor elevation is a well-established procedure for augmentation of the atrophic maxillary posterior region. The minimally invasive internal sinus floor elevation procedure visually guided by an endoscope helped to prevent, diagnose and manage complications such as sinus membrane perforation. The clinical outcomes of this study show that endoscope-controlled internal sinus floor elevation combined with implant placement results in low intra operative trauma, good implant stability upon placement, low incidence of post-operative symptoms and high success rates after 24 months of loading.

Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials – biological foundation and preclinical evidence: A systematic review

Regenerative periodontal therapy aims to predictably restore the tooth's supporting periodontal tissues and should result in formation of a new connective tissue attachment (i.e. new cementum with inserting periodontal ligament fibres) and new alveolar bone. Histologic evidence from preclinical models has demonstrated periodontal regeneration following treatment with barrier membranes, various types of grafting materials or a combination thereof. However, it is still not clear to what extent a combination of barrier membranes and grafting materials may additionally enhance the regeneration process compared with barrier membranes alone, grafting materials alone or open flap debridement. To review with a systematic approach all preclinical (i.e. animal) studies presenting histologic support for periodontal regeneration using the combination of barrier membranes and grafting materials. Based on a focused question, an electronic and manual search was conducted for animal studies presenting histological data for the effect of the combined use of barrier membranes and grafting materials on the treatment of periodontal defects. A systematic approach was followed by two independent reviewers including eligibility criotateria for study inclusion, outcome measures determination, screening method, data extraction, data synthesis and drawing of conclusions. Ten papers completely fulfilling the inclusion criteria were selected. All relevant data from the selected papers were extracted and recorded in separate tables according to the types of periodontal defects treated (i.e. supra-alveolar defects, intrabony defects, furcation defects and fenestration defects) with the combination of barrier membranes and grafting materials. Most studies have demonstrated periodontal regeneration following the combination approach. Most studies demonstrated superior histologic healing following the combination of barrier membranes and grafting materials than following open flap debridement. Histologically superior healing following the combination of barrier membranes and grafting materials when compared with barrier membranes alone or grafting materials alone were only obtained in non-contained two wall intrabony and supraalveolar defects. Within its limits the present analysis indicates that: (a) The combination of barrier membranes and grafting materials may result in histological evidence of periodontal regeneration, predominantly bone repair. (b) No additional benefits of combination treatments were detected in models of three wall intrabony, Class II furcation or fenestration defects. (c) In supra-alveolar and two wall intrabony (missing buccal wall) defect models of periodontal regeneration, the additional use of a grafting material gave superior histological results of bone repair to barrier membranes alone. (d) In one study using a supra-alveolar model, combined graft and barrier membrane gave a superior result to graft alone.

The diagnosis and treatment of nasal valve collapse

The nasal valve is a complex structure that can be weakened from effects of aging, surgery, and trauma. A variety of methods have been described to strengthen the nasal valve region and prevent or treat nasal obstruction, such as batten grafts, spreader grafts, butterfly grafts, flare sutures, and suspension sutures. They will be briefly discussed here, but the intent of this review is to highlight the new developments in the treatment nasal valve collapse that have appeared in the literature over the last few years. Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. More specifically, minimally invasive and endoscopic approaches are being developed and improvements are made on the use of graft materials. Finally, alternatives to surgery are explored for the treatment of nasal valve collapse. The aim of the new advances in the treatment of nasal valve collapse is to maximize the benefit from the surgical intervention while minimizing disruption of the normal anatomy and physiology of the nose. Another trend in the new advances explores the nonsurgical options for the treatment of nasal valve collapse.

A Hypo-Echoic, Intramyocardial Space: Echocardiographic Characteristics of an Intramyocardial Dissecting Hematoma

A Hypo-Echoic, Intramyocardial Space: Echocardiographic Characteristics of an Intramyocardial Dissecting Hematoma

Bone Formation at the Maxillary Sinus Floor Following Simultaneous Elevation of the Mucosal Lining and Implant Installation Without Graft Material: An Evaluation of 20 Patients Treated With 44 Astra Tech Implants

Restoration of lost dentition in the severely artrophic posterior maxilla has for the last 2 decades been successfully treated with various sinus augmentation techniques and installation of dental implants. The use of graft material is anticipated to be necessary; however, recent studies have demonstrated that the mere lifting of the sinus mucosal lining and simultaneous placement of implants result in bone formation. This study was conducted in order to evaluate simultaneous sinus mucosal lining elevation and installation of dental implants without any graft material. Twenty patients were consecutively included from November 2001 to June 2004. Forty-four Astra ST dental implants (Astra Tech AB, Mölndal, Sweden) with a diameter of 4.5 mm or 5 mm were installed in 27 sinuses. A sinus lift was performed where a cortical window was removed from the maxillary anterior sinus wall. The sinus mucosal lining was elevated and implants installed in the residual subantral bone. The cortical window was thereafter replaced and the incision closed. The remaining bone height was recorded during surgery as well as perforations of the sinus mucosal lining. After 6 months of healing, abutments were connected (the series included 5 1-stage procedures). Clinical and radiological follow-up after loading was performed up to 4 years after implant installation. Patients tolerated the procedure well as few complications were observed. Firm primary stability was achieved for all implants at installation with bone levels in residual bone of 2 to 9 mm. Perforations of the maxillary sinus mucosal lining occurred in 11 of the 27 operated sinuses (41%). One implant was lost during a mean follow-up of 27.5 months (range, 14 to 45 months) giving an implant survival rate of 97.7%. The average gain of bone at the sinus floor was 6.51 mm (SD = 2.49, 44 implants) including all measured implants after a minimum of 1 year follow-up. Marked bone formation was observed around long implants and also when the residual bone below the sinus was diminutive. The present study including 20 patients showed consistent bone formation at the maxillary sinus floor following simultaneous mucosal lining elevation and installation of implants. It is suggested that the use of this technique can reduce the risk for morbidity related to harvesting of bone grafts and eliminate costs for grafting materials.

Vibration characteristics of grafts for the tympanic membrane

Perforation of the tympanic membrane occurs frequently as a result of infection, external trauma, and high-level impulsive sound pressure, such as that associated with an explosion. Many different surgical techniques can be used to repair the tympanic membrane and ossicles. Clinical operations such as tympanoplasty are undertaken to repair the damaged tympanic membrane and ossicles, thus improving hearing and reducing the chance of infection. The membrane is repaired or replaced with the use of graft materials, either from the patient's body or from artificial sources. The selection of graft material is very important because, as much as possible, it must exhibit the same dynamic behavior as the natural membrane. To compare various allograft materials, investigators developed a model of the ear on which different graft materials can be replaced. Three different membrane materials - irradiated allograft dura (Tutoplast Dura; IOP Inc., Costa Mesa, Calif), irradiated allograft fascia lata (Tutoplast Fascia Lata; IOP Inc.), and irradiated allograft fascia temporalis (Tutoplast Fascia Temporalis; IOP Inc.) - were used. Vibration responses of these membrane materials produced by defined sound signals with different frequencies were recorded by a small strain gauge; the spectra of sound for various corresponding input signals were recorded, and the results were compared with those of the sample graft material. Tutoplast Fascia Lata accomplished the best dynamic performance in vitro. Additional clinical and experimental data are needed, however, to determine which of these materials provides the best audiological and clinical performance.