Maxillary Sinus Augmentation With Recombinant Human Bone Morphogenetic Proteinâ 2 and Particulate Allograft Without an Absorbable Sponge: A Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141930/1/cap0175.pd

Clinical and histologic comparison of two different composite grafts for sinus augmentation: a pilot clinical trial

Background and objectives : Sinus augmentation is a procedure used for augmenting insufficient bone height that is often observed in the maxillary posterior areas. Many different techniques as well as bone graft regimens have been suggested for performing this procedure. It was the goal of this study to compare, clinically and histologically, two different composite grafting regimens used for sinus augmentation. Material and methods : Five patients, needing a bilateral sinus augmentation to allow implant placement, were recruited for this study. Right sinuses were grafted with cortical bone (collected from overlying the sinus membrane) and bovine hydroxyapatite (HA), while the left side sinuses were grafted with overlying autologous bone plus a bioglass (BG) material. Bone core biopsies were taken at 6 months after sinus graft or at the time of implant insertion. A waiting period of 6 additional months was granted to allow healing, before prosthetic restoration and functional loading. The level of peri-implant bone was evaluated 12 months after loading. A comparative histomorphometric analysis was conducted and a statistical analysis was performed. Results : All implants in both groups were functional after a 12-month loading period. No bone loss was observed radiographically or clinically in both groups. Histologic analysis revealed that both composite grafts had a high biocompatibility. In the bovine HA-containing group, minimal xenogenic graft absorption was noted. In contrast, BG group samples presented a high absorption rate with some remaining particles imbedded in new normal bone. Conclusions : Sinus augmentation using a combination of autogenous bone plus either bovine HA or BG is a predictable technique. To cite this article: Galindo-Moreno P, Ávila G, FernÁndez-Barbero JE, Mesa F, O'Valle-Ravassa F, Wang H-L. Clinical and histologic comparison of two different composite grafts for sinus augmentation: a pilot clinical trial. Clin. Oral Impl. Res . 19 , 2008; 755–759 doi: 10.1111/j.1600-0501.2008.01536.xPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73800/1/j.1600-0501.2008.01536.x.pd

Treatment Options for the Atrophic Posterior Maxilla

Maxillary sinus augmentation has been shown to be a predictable surgical procedure used to enhance bone volume for the placement of dental implants in the atrophic posterior maxilla. Therefore, various techniques have been proposed in order to achieve the necessary bone dimension for the insertion of implants in previously compromised sites. Careful case and material selection corresponding to different indications can be beneficial to achieving predictable and consistent treatment outcomes in the posterior atrophic maxilla. The purpose of this review was to discuss the indications, contraindications, limitations, and case selection criteria used to determine treatment options for the different techniques. It is necessary to define case selection criteria according to the remaining crestal bone and the anatomy of the sinus cavit

Clinical outcomes of peri‐implantitis treatment and supportive care: A systematic review

To report the clinical outcomes for patients with implants treated for peri-implantitis who subsequently received supportive care (supportive peri-implant/periodontal therapy) for at least 3 years. A systematic search of multiple electronic databases, grey literature and hand searching, without language restriction, to identify studies including ≥10 patients was constructed. Data and risk of bias were explored qualitatively. Estimated cumulative survival at the implant- and patient-level was pooled with random-effects meta-analysis and explored for publication bias (funnel plot) at different time intervals. The search identified 5,761 studies. Of 83 records selected during screening, 65 were excluded through independent review (kappa = 0.94), with 18 retained for qualitative and 13 of those for quantitative assessments. On average, studies included 26 patients (median, IQR 21-32), with 36 implants (median, IQR 26-45). Study designs (case definitions of peri-implantitis, peri-implantitis treatment, supportive care) and population characteristics (patient, implant and prosthesis characteristics) varied markedly. Data extraction was affected by reduced reporting quality, but over 75% of studies had low risk of bias. Implant survival was 81.73%-100% at 3 years (seven studies), 74.09%-100% at 4 years (three studies), 76.03%-100% at 5 years (four studies) and 69.63%-98.72% at 7 years (two studies). Success and recurrence definitions were reported in five and two studies respectively, were heterogeneous, and those outcomes were unable to be explored quantitatively. Therapy of peri-implantitis followed by regular supportive care resulted in high patient- and implant-level survival in the medium to long term. Favourable results were reported, with clinical improvements and stable peri-implant bone levels in the majority of patients

Influence of Different Decontamination Approaches on Bone Substitute Adhesion to Peri-Implantitis Affected Implant Surfaces: An SEM Proof of Principle Study

Background: During healing, clot blended graft materials may retract away from implant surfaces creating microgaps that compromise re-osseointegration. The present study aimed to evaluate different surface decontamination materials’ effect on adhesion of the graft materials to peri-implantitis affected parts, a factor that can resist clot blended graft retraction improving re-osseointegration. Methods: Eighteen peri-implantitis affected implants diagnosed as hopeless and designated for removal contributed in this prospective, masked trial. Samples were randomly distributed into three groups, each of six implants. Group one (G1) was coated with hydroxyapatite of a micro particle size of 250 to 1000 µm after saline surface decontamination for two minutes. Group two (G2) peri-implantitis affected parts were treated with the graft material following two minutes of chlorhexidine gluconate 0.12% (CHX) surface treatment. Group three (G3) implants were coated with the graft material after citric acid (CA) (pH = 1) surface conditioning for two minutes. Implants in all groups were agitated in phosphate-buffered saline (PBS) by using an automatic tissue processor agitator for three minutes. Implants were prepared for surface scanning evaluation. Results: Scanning electron microscopy (SEM) observation of G1 saline treated control implants were devoid of bone particles adherent to peri-implantitis affected surfaces. The surface area covered by grafted particles in G2 was statistically higher than that of G1 (P<0.01). Group three (CA-treated) showed nearly complete coverage of peri-implantitis affected parts by the graft material covering 88.8% of examined surface areas which was statistically higher than that of G2 (P<0.05). Conclusion: Citric acid implant surface conditioning could improve implant re-osseointegration through enhancement of the graft adhesion to the implant surface. Smear layer barrier effect seemed to be the most important factor that compromised graft adhesion to preri-implantitis affected parts of the implant surfaces

Socket preservation using deproteinized horse-derived bone mineral

Purpose: The healing process following tooth extraction apparently results in a pronounced resorption of the alveolar ridge. As a result, the width of alveolar ridge is reduced and severe alveolar bone resorption occurs. The purpose of this experiment is to clinically and histologically evaluate the results of using horse-derived bone mineral for socket preservation. Methods: The study comprised 4 patients who were scheduled for extraction as a consequence of severe chronic periodontitis or apical lesion. The extraction was followed by socket preservation using horse-derived bone minerals. Clinical parameters included buccal-palatal width, mid-buccal crest height, and mid-palatal crest height. A histologic examination was conducted. Results: The surgical sites healed uneventfully. The mean ridge width was 7.75±2.75 mm at baseline and 7.00±2.45 mm at 6 months. The ridge width exhibited no significant difference between baseline and 6 months. The mean buccal crest height at baseline was 7.5±5.20 mm, and at 6 months, 3.50±0.58 mm. The mean palatal crest height at baseline was 7.75±3.10 mm, and at 6 months, 5.00±0.82 mm. There were no significant differences between baseline and 6 months regarding buccal and palatal crest heights. The amount of newly formed bone was 9.88±2.90%, the amount of graft particles was 42.62±6.57%, and the amount of soft tissue was 47.50±9.28%. Conclusions: Socket preservation using horse-derived bone mineral can effectively maintain ridge dimensions following tooth extraction and can promote new bone formation through osteoconductive activities. Copyright © 2010 Korean Academy of Periodontology.

Evaluation of the Osteogenic Potential of Growth Factorâ Rich Demineralized Bone Matrix In Vivo

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Periodontal regeneration capacity of equine particulate bone in canine alveolar bone defects

Purpose: This study was performed to evaluate the periodontal wound healing effect of particulate equine bone mineral on canine alveolar bone defects. Methods: Twelve adult male beagle dogs were used as study subjects. The mandibular second and fourth premolars were extracted prior to the experimental surgery, and the extraction sites were allowed to heal for 8 weeks. After periodontal probing, two-walled defects were created at the mesial and distal sides of the mandibular third premolars bilaterally, and the defects were filled with equine particulate bone with collagen membrane or bovine particulate bone with collagen membrane, or collagen membrane alone. The defects without any treatment served as negative controls. After probing depth measurement, animals were sacrificed at 10, 16, and 24 post-surgery weeks for micro-computed tomographic and histomorphometric analysis. Results: The equine particulate bone-inserted group showed significantly decreased values of probing depth and first bone contact compared to the negative control and collagen membrane alone groups at weeks 10, 16, and 24 (P < 0.05). There were no significant differences in the new cementum length, newly-formed bone area, or newly-formed bone volume between equine particulate bone- and bovine particulate bone-inserted groups, both of which showed significantly increased values compared to the negative control and collagen membrane alone groups (P < 0.05). Conclusions: Equine particulate bone showed significant differences in probing depth, first bone contact, new cementum length, newly formed bone area, and bone volume fraction values when compared to the negative control and collagen membrane alone groups. There were no significant differences between equine and bovine particulate bone substitutes in these parameters; therefore, we can conclude that equine particulate bone is equivalent to bovine bone for periodontal regeneration. (C) 2010 Korean Academy of Periodontology.

Histomorphometric comparison of maxillary pristine bone and composite bone graft biopsies obtained after sinus augmentation

Sinus grafting is a technique oriented to facilitate implant placement in posterior atrophic maxillae. Several modifications of the original technique and a wide variety of materials have been proposed; most of them associated with implant survival rates. However, the quality of the bone obtained after the application of certain grafting materials has not been fully elucidated yet. The aims of this multicenter study were to analyse histomorphometrical samples obtained 6 months after sinus grafting using a composite graft consisting of anorganic bovine bone (ABB)+ autologous bone (AB), and to compare these samples with maxillary pristine bone biopsies.Ninety maxillary sinus augmentations were performed for delayed implant placement ( N =90) in 45 consecutive patients (test group). Bone cores were harvested 6 months after grafting for histomorphometric and ultrastructural study. Control pristine bone biopsies were taken from the posterior maxilla of 10 patients (control). Bone radiographic changes were assessed up to 24 months after implant loading.The total mean values after analysis of test cores revealed a proportion of 46.08±16.6% of vital bone, 42.27±15.1% of non-mineralized connective tissue, and 37.02±25.1% of the remaining ABB particles. Significant bone remodeling activities were noticed in sinus grafting samples when compared with pristine bone. A statistically significant difference was observed in the number of osteoid lines between two groups, with higher values in the test one (15.1±11.48% vs. 2.5±2.2%, P =0.0005). Ultrastructural study showed that vital trabecular bone was in intimal contact with ABB particles. Radiographic analysis revealed that the higher the proportion of remaining ABB, the lower the total vertical resorption of the graft.Sinus grafting constitutes an excellent model for the study of de novo bone formation patterns and graft consolidation, when a combination of different bone substitutes is applied. The combination of ABB+AB yields highly satisfactory outcomes from both a clinical and a histologic perspective. To cite this article: Galindo-Moreno P, Moreno-Riestra I, Ávila G, Fernández-Barbero JE, Mesa F, Aguilar M, Wang H-L, O'Valle F. Histomorphometric comparison of maxillary pristine bone and composite bone graft biopsies obtained after sinus augmentation. Clin. Oral Impl. Res . 21 , 2009; 122–128.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78644/1/j.1600-0501.2009.01814.x.pd

Clinical and radiographic evaluation of early loaded narrow diameter implants – 1‐year follow‐up

Objective To evaluate the clinical performance of A stra T ech O sseo S peed™ TX 3.0 S implants using one‐stage surgical procedure and early loading in the anterior region. Material and methods This is a prospective, single arm, multi‐centre study. Patients missing teeth at positions 12, 22 and 32–42 were eligible to enter the study. The implants ( O sseo S peed™ TX 3.0 S ) used in the study were of 3 mm diameter and of different lengths. One‐stage surgery was performed, and healing abutments were used during the 6–10 weeks healing period. Clinical and radiographic examinations were assessed at implant installation, loading and at the 6‐ and 12‐month follow‐up visits. Results Ninety‐seven implants were placed in 69 patients at six different study centres in D enmark, G ermany, I taly, S pain, S weden and the U nited K ingdom. The survival rate was 95.9%. No implants have been lost after loading (100% survival rate after loading). Mean marginal bone loss 1 year after installation was 0.065 mm ( SD  = 1.018). The frequency of bone loss ≥1 mm was 6.6% and 51.3% of the implants demonstrated no bone loss or even bone gain from the surgical visit to the first year follow‐up visit. Mean probing pocket depth and gingival zenith score were stable from crown placement to the 6‐ and 1‐year follow‐up visits. Conclusion Treatment with O sseo S peed™ TX 3.0 S implants is a safe and predictable option in the anterior region where physical space is limited. Minimal marginal bone loss was observed during the first year follow‐up.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91103/1/clr2254.pd