Sequential morphometric evaluation at UnicCa® and SLActive® implant surfaces. An experimental study in the dog.

AIM: To study sequential osseointegration around implants with nano-technologically modified surfaces at different periods of healing. MATERIALS AND METHODS: After 3 months, two different implant systems with different nano-technologically modified surfaces were randomly installed in the edentulous molar regions of the mandible of 12 dogs. One surface was acid-etched surface, and subsequently modified with calcium ions (UnicCa® ), while the other was a hydrophilic sandblasted with large grit and acid-etched (SLActive® ) surface. The implants were fully submerged, and biopsies were obtained representing the healing after 1, 2, 4 and 8 weeks (n = 6 per period). A morphometric evaluation of densities of new soft tissues (provisional matrix and immature bone marrow), new and old bone, mature bone marrow, vessels and other tissues (bone debris/particles and clot) was performed in the spongiosa compartment of the sites of implantation. RESULTS: After 1 week of healing, the soft tissues, mainly composed of provisional matrix, were present at 41.5 ± 23.9% and 30.1 ± 20.0% at the UnicCa® and SLActive surfaces, respectively. These percentages were >40% at both surfaces after 2 weeks of healing, presenting greater amount of immature bone marrow. Subsequently, these percentages decreased up to disappear after 8 weeks of healing. New bone increased progressively between 1 and 8 weeks of healing from 8.2 ± 3.0% to 77.1 ± 6.4% and from 6.8 ± 2.8% to 67.9 ± 6.8% at the UnicCa® and SLActive® , respectively. Old bone decreased progressively over time. CONCLUSIONS: The patterns of healing at highly hydrophilic surfaces occurred through the early formation of a provisional matrix followed by the formation of new bone and marrow at various stages of maturation. The healing was similar to those described in different animal models, anatomical sites and surgical procedures.

Sequential morphometric evaluation at UnicCa® and DCD® implant surfaces. An experimental study in the dog.

AIM: To study tissue components adjacent to implants with nanotechnologically modified surfaces at different periods of healing. MATERIAL & METHODS: In 12 beagle dogs, two different implant systems with different surface configurations were randomly installed in the edentulous premolar regions of the mandible. One surface was first acid-etched and subsequently, nanotechnologically modified with calcium ions (UnicCa® ), while the other was first sandblasted and acid-etched, and then additionally treated with a nanometer calcium phosphate deposition (discrete crystalline deposition; DCD® ). The implants were fully submerged; surgeries and sacrifices were planned to harvest biopsies after 1, 2, 4 and 8 weeks of healing (n = 6 per period). A morphometric evaluation of percentages of new and old bone, bone debris/particles and clot, new soft tissues (provisional matrix and immature marrow), mature bone marrow and vessels was performed in the spongiosa compartment adjacent to the implant surface up to a distance of about 0.4 mm from the surface. RESULTS: After 2 weeks of healing, the soft tissues were represented by 41.0% at the UnicCa® and 37.9% at the DCD® surfaces, in both cases mainly being composed of provisional matrix. These percentages decreased over time, being composed of greater amounts of immature bone marrow, and disappeared after 8 weeks. New bone increased progressively between 1 and 8 weeks of healing from 9.7 ± 6.3% to 70.0 ± 8.4% and from 8.2 ± 3.5% to 67.0 ± 6.1% at the UnicCa® and DCD® surfaces, respectively. Pristine bone was progressively resorbed. CONCLUSIONS: Throughout the periods of healing observed, the formation of a provisional matrix followed by the formation of new bone and marrow was revealed in a similar fashion as for other modified surface configurations.

Sequential healing events of osseointegration at UnicCa(®) and SLActive(®) implant surfaces: an experimental study in the dog.

AIM: To study the sequential events in osseointegration at implants with highly hydrophilic surfaces. MATERIAL AND METHODS: All premolars and the first molars were bilaterally extracted in 12 Beagle dogs. After 3 months, full-thickness flaps were elevated and two different implants systems with various surfaces were randomly installed in the edentulous premolar region in one side of the mandible. One surface was acid etched and further modified with calcium ions (UnicCa(®)), while the other was sandblasted with large grits and acid etched (SLActive(®)). The flaps were sutured to allow a fully submerged healing. The surgery on the other side of the mandible and the sacrifices were planned in such a way to obtain biopsies representing the healing after 1, 2, 4, and 8 weeks (n = 6 per period). RESULTS: After one week of healing, new bone apposition was found at both surfaces with percentages of 6.9 ± 3.3% and 6.1 ± 4.6% at UnicCa(®) and SLActive(®), respectively. After 2 weeks, the percentages had increased to 29.1 ± 11.9% and 21.6 ± 14.3%, respectively. After 4 and 8 weeks of healing, mean values of 46.3 ± 7.3% and 58.7 ± 15.1% at UnicCa(®) and 51.2 ± 16.1% and 68.9 ± 15.4% at SLActive(®) surfaces were found, respectively. None of the differences in percentages were statistically significant. Concomitantly, the old bone was resorbed at both surfaces from about 21-22% after 1 week to about 4-6% after 8 weeks of healing. CONCLUSIONS: The osseointegration process onto moderately rough titanium implant surfaces of high hydrophilicity was very similar for two implant systems that were both nanotechnologically modified.

Healing of BoneCeramic™ at buccal dehiscence defects at implants installed immediately into extraction sockets. An experimental study in dogs.

OBJECTIVE: To assess the healing outcomes at buccal dehiscence defects after 4 months following implant placement immediately into extraction sockets (IPIES) and filled with a mixture of synthetic hydroxyl apatite (HA) 60% and ß-tri-calcium phosphate (ß-TCP) 40% in comparison with leaving a blood clot. MATERIAL AND METHODS: Eight Labrador dogs were used, and an implant was placed immediately following tooth extraction into the distal alveolus of the third premolars, bilaterally. Standardized buccal defects, 8 mm in depth and 4 mm in width at the coronal and 2 mm in width at the apical outlines were created. A mixture of synthetic HA 60% and ß-TCP 40% was used to fill the defects at the test sites, while the control sites were left unfilled. Collagen membranes were used to cover the defects at both sides, and a non-submerged healing was allowed. After 4 months of healing, biopsies were obtained and processed for morphometric analysis. RESULTS: A vertical gain in the extent of the bony crest and of osseointegration levels of 4.2 ± 2.4 and 3.3 ± 2.1 mm at the test sites and of 5.0 ± 0.8 and 4.6 ± 1.0 mm at the control sites, respectively, were observed. BIC% within the buccal defects reached similar levels (37-42%) both at test and control sites. None of the means of the variables differed significantly between the two groups. New bone formation within the defects was higher, and the percentage of the connective tissue was lower at the control (65.7 ± 11.7% and 2.5 ± 3.3%, respectively) compared to the test sites (16.8 ± 11.3% and 48.9 ± 29.5%, respectively). These differences were statistically significant. CONCLUSIONS: The use of a mixture of synthetic HA 60% and ß-TCP 40% to fill surgically created buccal dehiscence defects at IPIES sites covered with a collagen membrane did not improve osseointegration in the defect area.

Healing at implant sites prepared conventionally or by means of Sonosurgery ®. An experimental study in dogs.

OBJECTIVE: To compare peri-implant tissue healing at implants installed in sites prepared with conventional drills or a sonic device. MATERIAL AND METHODS: In six Beagle dogs, the mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness muco-periosteal flaps were elevated and recipient sites were prepared in both sides of the mandible. In the right side (control), the osteotomies were prepared using conventional drills, while, at the left side (test), a sonic device (Sonosurgery(®)) was used. Two implants were installed in each side of the mandible. After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. RESULTS: The time consumed for the osteotomies at the test was more than double compared to the conventional control sites. No statistically significant differences were found for any of the histological variables evaluated for hard and soft tissue dimensions. Although not statistically significant, slightly higher mineralized bone-to-implant contact was found at the test (65.4%) compared to the control (58.1) sites. CONCLUSIONS: Similar healing characteristics in osseointegration and marginal hard tissue remodeling resulted at implants installed into osteotomies prepared with conventional drills or with the sonic instrument (Sonosurgery(®)).

Sub-crestal positioning of implants results in higher bony crest resorption: an experimental study in dogs.

OBJECTIVE: To compare peri-implant soft- and hard-tissue integration at implants installed juxta- or sub-crestally. Furthermore, differences in the hard and soft peri-implant tissue dimensions at sites prepared with drills or sonic instruments were to be evaluated. MATERIAL AND METHODS: Three months after tooth extraction in six dogs, recipient sites were prepared in both sides of the mandible using conventional drills or a sonic device (Sonosurgery(®)). Two implants with a 1.7-mm high-polished neck were installed, one with the rough/smooth surface interface placed at the level of the buccal bony crest (control) and the second placed 1.3 mm deeper (test). After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. RESULTS: The buccal distances between the abutment/fixture junction (AF) and the most coronal level of osseointegration (B) were 1.6 ± 0.6 and 2.4 ± 0.4 mm; between AF and the top of the bony crest (C), they were 1.4 ± 0.4 and 2.2 ± 0.2 mm at the test and control sites, respectively. The top of the peri-implant mucosa (PM) was located more coronally at the test (1.2 ± 0.6 mm) compared to the control sites (0.6 ± 0.5 mm). However, when the original position of the bony crest was taken into account, a higher bone loss and a more apical position of the peri-implant mucosa resulted at the test sites. CONCLUSIONS: The placement of implants into a sub-crestal location resulted in a higher vertical buccal bone resorption and a more apical position of the peri-implant mucosa in relation to the level of the bony crest at implant installation. Moreover, peri-implant hard-tissue dimensions were similar at sites prepared with either drills or Sonosurgery(®).

Deproteinized bovine bone mineral particles and osseointegration of implants without primary bone contact: an experimental study in dogs.

OBJECTIVES: To evaluate the influence on osseointegration of Deproteinized bovine bone mineral (DBBM) particles used to fill defects of at least 1 mm around implants having no primary contact with bone. MATERIAL AND METHODS: Premolars and first molars were extracted bilaterally from the mandible of six Labrador dogs. After 3 months of healing, mucoperiosteal full-thickness flaps were elevated, and one recipient site was prepared in the molar region of each hemi-mandible to place implants. These were installed with a deliberate circumferential and periapical space to the bone walls of 1.2 mm. All implants were stabilized with passive fixation plates to maintain the implants in situ and without any contact with the implant bed. The control sites were left to be filled with coagulum, while at the test sites, the residual gap was filled with DBBM. After 3 months of submerged healing, the animals were sacrificed. Ground sections were prepared and analyzed histomorphometrically. RESULTS: Mineralized bone-to-implant contact was 4.0% and 3.9% for control and test sites, respectively. The width of the residual defects was 0.48 mm and 0.88 mm at the control and test sites, respectively. The percentage of implant surface covered by a layer of dense connective tissue of 0.12 mm of width on average was 84.9% and 88.5% at the control and test sites, respectively. CONCLUSION: A minor and not predictable degree of contact or distance osteogenesis was obtained on the implant surface when primary contact of the implant surface with the implant bed had deliberately been avoided. DBBM grafting of the artificial gap did not favor osseointegration. Neither did it enhance the ability to bridge the gap with newly formed bone in an artificial defect wider than 1 mm.

Short-term evaluation of grafts fixed with either N-butyl-2-cyanocrylate or screws.

PURPOSE: N-butyl-2-cyanoacrylate (NB-Cn) is an alternative method for onlay graft fixation and might be efficient for preserving the graft volume. Our aim was to analyze the gene expression and mineralized tissue variations of calvarial bone grafting fixed in the mandible with either NB-Cn or a titanium screw (TiS). MATERIALS AND METHODS: New Zealand rabbits had bilateral calvarial grafts fixed at both sides of the mandible with either NB-Cn or a TiS. The rabbits were sacrificed at 4 and 8 days, and micro-computed tomography analysis was performed. For molecular analysis, the gene expression of interleukin-6, interleukin-10, and tumor necrosis factor-α was assessed. Quantification using real-time polymerase chain reaction was performed. Statistical analysis was performed using the paired Student t test (P < .05). RESULTS: Bone graft fixation with NB-Cn promoted superior volume and density preservation. The percentage of mineralized tissue at the center portion and border of the graft was very similar (NB-Cn, 50.6% ± 8.3% and 50.3% ± 10.6%, respectively) and superior than in the TiS group (32.5% ± 3.5% and 33.8% ± 6%, respectively). Genes from the NB-Cn group were upregulated compared with those in the TiS group at the initial phases of bone healing (4 days), with the profile reversed at the 8-day point. At day 8, the osteoclastogenesis-related genes were upregulated in the TiS group. CONCLUSIONS: Onlay bone grafts fixed with screws induced more inflammation during the initial remodeling process than did NB-Cn. The differences in the incorporation into the host bed suggest that the use of adhesives for graft fixation will promote superior volume and density preservation.

Comparisons between Bio-Oss(®) and Straumann(®) Bone Ceramic in immediate and staged implant placement in dogs mandible bone defects.

OBJECTIVE: To compare immediate and staged approach implant placement in circumferential defects treated with deproteinized bovine bone mineral (DBBM); hidroxyapatite/tricalcium phosphate (HA/TP); autogenous bone (Ab); and coagulum (Cg); upon implant stability, osseointegration and alveolar crest maintenance. MATERIALS AND METHODS: Six dogs underwent extractions of lower premolars, bilaterally. Twelve weeks later four bone defects (6 mm wide/4 mm long) were drilled at one side and randomly filled with DBBM; HA/TP; Ab; and Cg, respectively, and left to heal (staged approach). Eight weeks later one implant (Osseospeed(™) , AstraTech) was placed in experimental sites. At the same session four defects were drilled on contra-lateral side and implants were inserted immediately after biomaterials grafting (immediate approach). Animals were euthanized 8 weeks later. Implant stability was measured by resonance frequency analysis (RFA) at installation and after sacrifice. Ground sections were prepared for bone contact (BIC); bone area (BA); distance implant shoulder-bone crest (IS-C); distance implant shoulder first bone contact (IS-B); and areas occupied by soft tissue. RESULTS: The BA and BIC were superior in the staged approach. The Cg exhibited higher BIC and BA as compared with other materials at the total implant body (P = 0.004 and 0.012, respectively). The DBBM, HA/TP and Ab groups rendered similar BA and BIC. The immediate approach resulted in less crest resorption compared to staged approach. The biomaterials did not affect the IS-C and IS-B measurements. Particles area tended to be higher in DBBM group than HA/TP (P = 0.15), while soft tissue infiltrate was higher in DBBM group when used in the immediate approach (P = 0.04). The RFA indicated gain in stability in the staged approach (P = 0.002). The correlation test between RFA vs. BIC and BA demonstrated inferior stability for DBBM group in immediate approach (P = 0.01). CONCLUSIONS: Implants placed in healed defects resulted in better stability as a consequence of higher BIC and BA. The Cg alone rendered increased BIC compared to other materials in both approaches. Immediate approach should be preferable to staged approach in terms of alveolar crest maintenance. The BIC and BA values did not vary between micro and macro-threads in this experimental model. Implants installed in sites filled with DBBM in immediate approach were less stable.

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

AIM: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Osteogenesis at implants without primary bone contact - an experimental study in dogs.

AIM: To evaluate the healing at implants with a moderately rough surface placed and stabilized in recipient sites of dimensions deeper and larger than that of the implants to avoid any contact between parent bone and the implant. MATERIAL & METHODS: In six Labrador dogs, premolars and first molars were extracted bilaterally in the mandible. After 3 months of healing, mucoperiosteal full-thickness flaps were elevated and the premolar area of the alveolar bony crest was selected. Three recipient sites were prepared to place three implants. One implant was used as control. The other two were placed in recipient sites which left a circumferentially and periapical prepared defect of 0.7 mm (small) and 1.2 mm (large), respectively. All implants were stabilized with passive fixation plates to maintain the implants stable and without any contact with the implant bed. After 3 months of submerged healing, the animals were sacrificed. Ground sections were prepared and analyzed histomorphometrically. RESULTS: The BIC% was 5.3% and 0.3% for implants placed in small and large defect sites, respectively, whereas it was 46.1% for control implants. The differences were statistically significant. The width of the residual defects was 0.4 and 0.5 mm at the small and large defects, respectively. An approximately 0.09 mm layer of dense connective tissue (DCT) rich in fibers and fibroblast-like cells was observed adherent to the implant surfaces. The percentage of implant surface covered by DCT was 92.8% and 95.6% at the small and large defects, respectively. CONCLUSION: Osseointegration was observed at the test sites, and the dimensions of the defects influenced the outcomes. However, the degree of osseointegration at both small and large defects was very low compared with the control sites.

Healing outcomes at implants installed in grafted sites: an experimental study in dogs.

AIM: To evaluate the integration of implants installed using a surgical guide in augmented sites with autologous bone or deproteinized bovine bone mineral (DBBM) blocks, concomitantly with a collagen membrane. MATERIAL AND METHODS: Mandibular molars were extracted bilaterally in six Labrador dogs, the buccal bony wall was removed, and a box-shaped defect was created. After 3 months, flaps were elevated, a bony graft was harvested from the ascending ramus, and secured to the lateral wall of the defect by means of screws. In the left mandibular side, a DBBM block was fixed into the defect. A resorbable membrane was applied at both sides, and the flaps were sutured. After 3 months, flaps were elevated, and a customized device was used as surgical guide to prepare the recipient sites in the interface between grafts and parent bone. One implant was installed in each side of the mandible. After 3 months, biopsies were harvested, and ground sections were prepared for histologic evaluation. RESULTS: One autologous bone block graft was lost before implant installation. The width of the alveolar crest at the test sites (DBBM) was 5.4 ± 1.2 mm before, 9.4 ± 1.2 mm immediately after grafting, and 9.3 ± 1 mm at implant installation. At the control sites (autologous bone), the corresponding values were: 5.2 ± 1, 9 ± 1.2, and 8.7 ± 0.9 mm, respectively. All implants installed were available for histologic evaluation (n = 5). The autologous bone grafts, rich in vessels and cells, were integrated in the parent bone, and only little non-vital bone was found. The BIC% was 56.7 ± 15.6% and 54.2 ± 13.2% at the buccal and lingual aspects, respectively. At the test sites, the DBBM appeared to be embedded into connective tissue, and very little newly formed bone was encountered within the grafts. The BIC% was 5.8 ± 12.3% and 51.3 ± 14.2% at the buccal and lingual aspects, respectively. CONCLUSIONS: Autologous bone blocks used to augment the alveolar bony crest horizontally allowed the complete osseointegration of implants installed after 3 months of healing. However, similar blocks of DBBM did not promote osseointegration, although the installed implants were stable owing to the osseointegration in the sites of the parent bone.

Role of teeth adjacent to implants installed immediately into extraction sockets: an experimental study in the dog.

AIM: To evaluate the influence of the presence of both adjacent teeth on the level of alveolar bony crest at sites where implants were installed into the socket immediately after tooth extraction. MATERIAL AND METHODS: Six Labrador dogs were used. Extractions of all teeth from the second premolar to the first molar were performed in the right side of the mandible, after full-thickness flap elevation. In the left side of the mandible, an endodontic treatment of the mesial root of the third and fourth premolars was performed. Full-thickness flaps were elevated, the teeth hemi-sected, and the distal roots removed. Immediately after, implants were bilaterally installed with the margin flush to the buccal bony crest. The implants were placed in the center of the alveolus at the third premolars and toward the lingual bony plate of the alveolus at the fourth premolars. After 3 months of healing, the animals were euthanized. RESULTS: All implants were integrated in mature bone. More bone resorption was observed at the test compared to the control sites. At the buccal aspect, a resorption of 2.8 ± 0.5 and 1.6 ± 0.4 mm at the third premolars and of 2.4 ± 0.6 and 0.8 ± 0.7 mm at the fourth premolars were found, at the test and control sites, respectively. At the lingual aspect, the bony crest was apically located in relation to the implant shoulder 1.5 ± 0.3 and 0.5 ± 0.5 mm at the third premolars and 1.6 ± 0.6 and 0.3 ± 1.1 mm at the fourth premolars, at the test and control sites, respectively. A lower buccal bone resorption was found at the control implants placed lingually. CONCLUSION: Multiple extractions of teeth adjacent to a socket into which implants were installed immediately after, tooth extraction induced more alveolar bone recession compared to sites where the adjacent teeth were preserved. Moreover, an implant placed more lingually yielded less recession of the buccal aspect of the implant.

Determination of relative in vivo osteoconductivity of modified potassium fluorrichterite glass-ceramics compared with 45S5 bioglass.

Potassium fluorrichterite (KNaCaMg(5)Si(8)O(22)F(2)) glass-ceramics were modified by either increasing the concentration of calcium (GC5) or by the addition of P(2)O(5) (GP2). Rods (2 × 4 mm) of stoichiometric fluorrichterite (GST), modified compositions (GC5 and GP2) and 45S5 bioglass, which was used as the reference material, were prepared using a conventional lost-wax technique. Osteoconductivity was investigated by implantation into healing defects in the midshaft of rabbit femora. Specimens were harvested at 4 and 12 weeks following implantation and tissue response was investigated using computed microtomography (µCT) and histological analyses. The results showed greatest bone to implant contact in the 45S5 bioglass reference material at 4 and 12 weeks following implantation, however, GST, GC5 and GP2 all showed direct bone tissue contact with evidence of new bone formation and cell proliferation along the implant surface into the medullary space. There was no evidence of bone necrosis or fibrous tissue encapsulation around the test specimens. Of the modified potassium fluorrichterite compositions, GP2 showed the greatest promise as a bone substitute material due to its osteoconductive potential and superior mechanical properties.

Effects of early functional loading on maintenance of free autogenous bone graft and implant osseointegration: an experimental study in dogs.

PURPOSE: The aim of the present study was to investigate the healing, integration, and maintenance of autogenous onlay bone grafts and implant osseointegration either loaded in the early or the delayed stages. MATERIALS AND METHODS: A total of 5 male dogs received bilateral blocks of onlay bone grafts harvested from the contralateral alveolar ridge of the mandible. On one side, the bone block was secured by 3 dental implants (3.5 mm x 13.0 mm, Osseospeed; AstraTech AB, Mölndal, Sweden). Two implants at the extremities of the graft were loaded 2 days after installation by abutment connection and prosthesis (simultaneous implant placement group); the implant in the middle remained unloaded and served as the control. On the other side, the block was fixed with 2 fixation screws inserted in the extremities of the graft. Four weeks later, the fixation screws were replaced with 3 dental implants. The loading procedure (delayed implant placement group) was performed 2 days later, as described for the simultaneous implant placement sites. The animals were sacrificed 12 weeks after the grafting procedure. Implant stability was measured through resonance frequency analysis. The bone volume and density were assessed on computed tomography. The bone to implant contact and bone area in a region of interest were evaluated on histologic slides. RESULTS: The implant stability quotient showed statistical significance in favor of the delayed loaded grafts (P = .001). The bone-to-implant contact (P = .008) and bone area in a region of interest (P = 0.005) were significantly greater in the delayed group. Nevertheless, no difference was found in terms of graft volume and density between the early loaded and delayed-loaded approaches. CONCLUSIONS: The protocol in which the implant and bone graft were given delayed loading allows for effective quality of implant osseointegration and stabilization, with healing and remodeling occurring in areas near the implant resulting in denser bone architecture.

Immunohistochemical, tomographic and histological study on onlay iliac grafts remodeling.

The information concerning the molecular events taking place in onlay bone grafts are still incipient. The objective of the present study is to correlate the effects of perforation of resident bone bed on (1) the timing of onlay autogenous graft revascularization; (2) the maintenance of volume/density of the graft (assessed through tomography); and (3) the occurrence of bone remodeling proteins (using immunohistochemistry technique) delivered in the graft. Thirty-six New Zealand White rabbits were subjected to iliac crest onlay bone grafting on both sides of the mandible. The bone bed was drill-perforated on one side aiming at accelerating revascularization, whereas on the other side it was kept intact. After grafts fixation and flaps suture all animals were submitted to tomography on both mandible sites. Six animals were sacrificed, respectively, at 3, 5, 7, 10, 20 and 60 days after surgery. A second tomography was taken just before sacrifice. Histological slides were prepared from each grafted site for both immunohistochemistry analysis [osteopontin, osteocalcin, type I collagen and vascular endothelial growth factor (VEGF) anti-bodies] and histometric analysis. The values on bone volume measured on tomography showed no statistic significance (P>or=0.05) between perforated and intact sites. Grafts placed on perforated beds showed higher bone density values compared with non-perforated ones at 3 days (P

Reconstruction of mandibular segmental defects using the guided-bone regeneration technique with polylactide membranes and/or autogenous bone graft: a preliminary study on the influence of membrane permeability.

PURPOSE: Bone maintenance after mandibular reconstruction with autogenous iliac crest may be disappointing due to extensive resorption in the long term. The potential of the guided-bone regeneration (GBR) technique to enhance the healing process in segmental defects lacks comprehensive scientific documentation. This study aimed to investigate the influence of polylactide membrane permeability on the fate of iliac bone graft (BG) used to treat mandibular segmental defects. MATERIALS AND METHODS: Unilateral 10-mm-wide segmental defects were created through the mandibles of 34 mongrel dogs. All defects were mechanically stabilized, and the animals were divided into 6 treatment groups: control, BG alone, microporous membrane (poly L/DL-lactide 80/20%) (Mi); Mi plus BG; microporous laser-perforated (15 cm(2) ratio) membrane (Mip), and Mip plus BG. Calcein fluorochrome was injected intravenously at 3 months, and animal euthanasia was carried out at 6 months postoperatively. RESULTS: Histomorphometry showed that BG protected by Mip was consistently related to larger amounts of bone compared with other groups (P

Effects of granule size on the osteoconductivity of bovine and synthetic hydroxyapatite: a histologic and histometric study in dogs.

Two bovine hydroxyapatites (BHAs), one with granule size of 150 to 200 microm and one with granule size of 300 to 329 micro, and 2 synthetic hydroxyapatites (SHAs), with granule size of 150 and 300 microm, respectively, were compared for effectiveness in repairing circumferential bone defects in dogs. The hydroxyapatites (HAs) were characterized through powder x-ray diffraction (XRD) analysis and scanning electron microscopy (SEM). Three trephined bone defects (5.0 mm wide x 4 mm long) were created in the humeruses of 8 dogs. In a random manner, the defects on each side were treated with either BHA with small granules (BHA[s]), BHA with large granules (BHA[L]), SHA with small granules (SHA[s]), SHA with large granules (SHA[L]), or left to heal unaided (bilateral control). Four dogs were sacrificed after 6 and 12 postoperative weeks, respectively. Ground sections of each defect were submitted to histologic and histomorphometric analysis (percentage of area occupied by bone, bone marrow, and biomaterial). As a rule, the HA granules exhibited direct bone contact, regardless of the origin and the size of the granules. Control sites were related and had an increased amount of connective tissue infiltration. At 12 weeks, BHA(s) exhibited improved bone formation compared with SHA(s) and SHA(L). The SHA(s) delivered reduced amounts of bone compared with the remaining groups (control included). The area of bone measured in BHA(s) sites was significantly higher at 12 weeks than 6 weeks. The XRD revealed the tested HA samples to be highly crystalline, while BHA appeared with rougher surface at SEM analysis. The BHA(s) performed better than the SHA(s) and SHA(L), as assessed by the amount of bone measured in both implantation sites at 12 weeks. The BHA's material characteristic itself rather than granules size accounted for the distinctive biological behavior. The increased roughness of the BHAs' surface, as assessed through SEM, seemed to benefit the osteoconduction process.

Bone reformation and implant integration following maxillary sinus membrane elevation: an experimental study in primates.

BACKGROUND: Recent clinical studies have described maxillary sinus floor augmentation by simply elevating the maxillary sinus membrane without the use of adjunctive grafting materials. PURPOSE: This experimental study aimed at comparing the histologic outcomes of sinus membrane elevation and simultaneous placement of implants with and without adjunctive autogenous bone grafts. The purpose was also to investigate the role played by the implant surface in osseointegration under such circumstances. MATERIALS AND METHODS: Four tufted capuchin primates had all upper premolars and the first molar extracted bilaterally. Four months later, the animals underwent maxillary sinus membrane elevation surgery using a replaceable bone window technique. The schneiderian membrane was kept elevated by insertion of two implants (turned and oxidized, Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in both sinuses. The right sinus was left with no additional treatment, whereas the left sinus was filled with autogenous bone graft. Implant stability was assessed through resonance frequency analysis (Osstell, Integration Diagnostics AB, Göteborg, Sweden) at installation and at sacrifice. The pattern of bone formation in the experimental sites and related to the different implant surfaces was investigated using fluorochromes. The animals were sacrificed 6 months after the maxillary sinus floor augmentation procedure for histology and histomorphometry (bone-implant contact, bone area in threads, and bone area in rectangle). RESULTS: The results showed no differences between membrane-elevated and grafted sites regarding implant stability, bone-implant contacts, and bone area within and outside implant threads. The oxidized implants exhibited improved integration compared with turned ones as higher values of bone-implant contact and bone area within threads were observed. CONCLUSIONS: The amount of augmented bone tissue in the maxillary sinus after sinus membrane elevation with or without adjunctive autogenous bone grafts does not differ after 6 months of healing. New bone is frequently deposited in contact with the schneiderian membrane in coagulum-alone sites, indicating the osteoinductive potential of the membrane. Oxidized implants show a stronger bone tissue response than turned implants in sinus floor augmentation procedures.

Sequential Healing at Implants with Different Configuration and Modified Surfaces: An Experimental Study in the Dog.

PURPOSE: To evaluate the peri-implant soft and hard tissue adaptation at implants with different modified surfaces and configurations. MATERIALS AND METHODS: Six Beagle dogs were used. Mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness flaps were elevated, and two different types of trans-mucosal implants (ICX-Gold®, Medentis Medical GmbH, Dernau, Germany and SLActive®, Institute Straumann, Bern, Switzerland) and two different surfaces were randomly installed in the distal regions of one side of the mandible. Abutments were applied, and a nonsubmerged healing was allowed. After 1 month, the procedures were performed in the other side of the mandible, and after a further month, the animals were sacrificed, biopsies were collected, and ground sections prepared for histological examination. RESULTS: Similar results in marginal bone and soft tissues dimensions were observed after 1 month of healing at the two implant systems used, and no major changes could be observed after 2 months of healing. After 1 month, the percentage of new bone was 69.0% and 68.8% at ICX-Gold and SLActive surfaces, respectively. After 2 months, the percentage of new bone was 67.8% and 71.9% at ICX-Gold Medentis and SLActive surfaces, respectively. No statistically significant differences in osseointegration were found. CONCLUSION: The two implant systems used resulted in similar osseointegration after 1 and 2 months of healing.