Soft tissue substitutes in non-root coverage procedures: a systematic review and meta-analysis

Objectives The present systematic review compared the effectiveness of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) in non-root-coverage procedures to increase keratinized tissue (KT) width around teeth. Materials and methods Included studies fulfilled the following main eligibility criteria: (a) preclinical in vivo or human controlled trials using FGG as control, (b) non-root-coverage procedures, and (c) assessment of KT width. Meta-analysis was performed on the gain in KT width (primary outcome variable) and several secondary variables. Results Eight human trials with short observation time evaluating five different STSs were identified. FGG yielded consistently significantly (p < 0.001) larger increase in KT width irrespective whether the comparison regarded an acellular matrix or a tissue-engineered STS. Further, FGG yielded consistently ≥2 mm KT width postoperatively, while use of STS did not, in the few studies reporting on this outcome. On the other hand, STSs resulted in significantly better aesthetic outcomes and received greater patient preference (p < 0.001). Conclusions Based on relatively limited evidence, in non-root-coverage procedures, FGG (1) resulted consistently in significantly larger increase in KT width compared to STS and (2) yielded consistently ≥2 mm KT width postoperatively, while STSs did not. STSs yielded significantly better aesthetic outcomes, received greater patient preference, and appeared safe. Clinical relevance Larger and more predictable increase in KT width is achieved with FGG, but STSs may be considered when aesthetics is important. Clinical studies reporting relevant posttreatment outcomes, e.g., postop KT width ≥2 mm, on the long-term (>6 months) are warranted. Electronic supplementary material The online version of this article (doi:10.1007/s00784-016-2044-4) contains supplementary material, which is available to authorized users

Osteoblast cell response to nanoscale SiO2/ZrO2 particulate-reinforced titanium composites and scaffolds by powder metallurgy

The strength of porous pure titanium (Ti) scaffold decreases dramatically with the introduction of porosity and might become lower than that of natural bone when with high porosity. To simultaneously meet the requirements of low-elastic modulus and appropriate strength for implant materials, it is necessary to develop new biocompatible Ti-based composites that are stronger than those currently available while providing low-elastic modulus and adequate strength when they are scaffolded into a porous structure. In this study, new particulatereinforced Ti-based composites with nanoscale oxide particles of SiO2 and ZrO2 were prepared using a powder metallurgical method. The strengths of the new particulatereinforced titanium composites were found to be signifi- cantly higher than that of a pure Ti. Cell culture results revealed that the articulate-reinforced titanium composites showed excellent biocompatibility and cell adhesion. Human osteoblast-like SaOS2 cells grew and spread well on the surfaces of the new titanium composites. The present study illustrated the feasibility of using the particulate-reinforced titanium composites as an orthopaedic implant materia