Histomorphometric evaluation of bovine bone and equine bone matrix in maxillary sinus floor augmentation: a systematic review.

The aim of this study was to evaluate the efficiency of bovine and equine bone substitute materials used in sinus augmentation techniques. The research protocol was carried out using the PubMed database, including articles from October 2019 until February 2020 and those in English only. The search on PubMed (MED-LINE) was carried out with the following keywords: sinus augmentation OR sinus lift AND bovine bone graft OR equine bone matrix. The articles identified included randomised clinical trials, cross-sectional studies and case series. Outcomes were the percentage of newly formed bone, remaining graft particles and soft tissue in a follow-up at least of 5 months. The use of bovine bone graft (ABB) as a graft material in maxillary sinus elevation was evaluated in 9 studies. According to the quality assessment, 4 of the 9 studies were analysed and an arithmetic mean was performed showing the following results: newly formed bone (NFB 22.74%), residual grafts (RG 29.36%) and soft tissue percentage (SF 48.51%). The use of equine bone matrix (EBM) was assessed in four different studies including an RCT, a cross-sectional study and two case series; a mean percentage calculated by the extracted data of the four studies was estimated with newly formed bone (NFB 44.51%), residual grafts (RG 17.24%) and soft tissue percentage (SF 36.62%). EBM appears to be as effective as ABB for the maxillary sinus floor augmentation procedure.

Propolis extract and bovine bone graft combination in the expression of VEGF and FGF2 on the preservation of post extraction socket.

AIM: To determine the potential of propolis extract and BBG combination on the quantity of fibroblast growth factor 2 (FGF-2), vascular endothelial growth factor (VEGF), and osteoblasts in the preservation of tooth extraction socket on days 3 and 7. SETTINGS AND DESIGN: Laboratory in vivo reseach using animal model. MATERIALS AND METHODS: Fifty-six Cavia cobaya were divided into eight groups containing seven animals in each group. The extraction socket on the lower left incisor was filled with polyethylene glycol (PEG) at a concentration of 2% (Groups I and II) as a control; active materials consisted of propolis extract and PEG (Groups III and IV); active materials consisted of BBG and PEG (Groups V and VI); and active materials consisted of propolis extract, BBG, and PEG (Groups VII and VIII). Then, an examination was done using immunohistochemistry to perform an expression of VEGF, FGF2, as well as histology of osteoblasts. STATISTICAL ANALYSIS USED: The statistical analysis performed using a one-way ANOVA and Tukey's honestly significant difference test. RESULTS: Propolis extract, BBG and PEG had the most significant result related to the formation of FGF2, VEGF, and osteoblasts. CONCLUSION: The combination of propolis extract with BBG and PEG in socket preservation is effective in increasing the expression of FGF2, VEGF, and osteoblasts.

Safe sinus lift: use of acrylic stone trimmer to avoid sinus lining perforation.

Iatrogenic injury to the maxillary sinus membrane is a common complication during direct sinus lift procedures. The most common cause is perforation of the Schneiderian membrane using a tungsten-carbide round bur no.6. We propose a safe technique in which an acrylic stone trimmer is used to create a window in the maxillary antrum thereby minimizing the risk of injury to the delicate sinus membrane.

Expression and ratio of receptor activator of nuclear factor kappa-B ligand and osteoprotegerin following application of Nigella sativa/bovine bone graft combination in post tooth extraction sockets.

Aims: The aim of this study was to analyze the induction effect of a combination of N. sativa and bovine bone graft on the expression and ratio of receptor activator of nuclear factor kappa-B ligand expression (RANKL) and osteoprotegerin (OPG) on alveolar bone socket preservation on days 7 and 14. Settings and Design: The research incorporated a posttest-only control group design. A total of 56 Cavia cobaya were divided into four groups: a control group, an N. sativa group, a bovine bone graft group, and a combined N. sativa and bovine bone graft group. Materials and Methods: The lower incisors of the C. cobaya were extracted with material subsequently being applied to the resulting socket. After the 7th and 14th days, the experimental animals were terminated to enable observation of the socket. Following processing, the tissue was subjected to immunohistochemistry staining consisting of RANKL and OPG antibodies before being observed under a light microscope at × 400. Statistical Analysis Used: Statistical analysis was carried out using the one-way ANOVA and Tukey's honestly significant difference tests. Results: A combination of N. sativa and bovine bone graft reduced both RANKL expression and the RANKL/OPG ratio while increasing OPG expression in comparison to the other groups. In all the results obtained, the N. sativa and bovine bone graft combination was significant (P < 0.05) when compared to the control group on both the 7th and 14th days. Conclusion: A combination of N. sativa and bovine bone graft reduced both RANKL expression and the RANKL/OPG ratio while increasing OPG expression.

Laddec® versus Bio-Oss®: The effect on the healing of critical-sized defect - Calvaria rabbit model.

The aim of this study was to evaluate the in vivo performance of two different deproteinized bovine bone (DBB) grafting materials: DBBB (Bio-Oss®) and DBBL (Laddec®), for the regeneration of critically sized (8 mm) defects in rabbit's calvaria. Three round-shaped defects were surgically created in the calvaria of 13 New Zealand White rabbits proximal to the coronal suture in the parietal bone. Two of the defects were filled with one of the grafting materials while a third was left empty to serve as a negative control. Bone regeneration properties were evaluated at 4- and 8-weeks after implantation by means of histological and histomorphometrical analyses. Statistical analyses were performed through a mixed model analysis with fixed factors of time and material. Histological evaluation of the control group evidenced a lack of bridging bone formation across the defect sites at both evaluation time points. For the experimental groups, new bone formation was observed around the defect periphery and to progress radially inwards to the center of the defect site, regardless of the grafting material. Histomorphometric analyses at 4 weeks demonstrated higher amount of bone formation through the defect for DBBB group. However, at 8 weeks, DBBL and DBBB demonstrated osteoconductivity and low resorption rates with evidence of statistically similar bone regeneration through the complete boney defect. Finally, DBBB presented lower soft tissue migration within the defect when compared to DBBL at both evaluation time points. DBBB and DBBL presented similar bone regeneration performance and slow resorption rates. Although both materials promoted bone regeneration through the complete defect, DBBB presented lower soft tissue migration within the defects at 4- and 8-weeks.

Decellularized xenogenic bone graft for repair of segmental bone defect in rabbits.

Background: Bone grafting is a preferred treatment option for the healing of large diaphyseal bone defects and is useful in the management of nonunion, delayed union, and tumor resection. Aims: To investigate a decellularization protocol of bovine cancellous bone for xenogenic implantation in radial bone defects in rabbits. Methods: Bovine bone scaffolds fabricated with various decellularization protocols viz phosphate buffer saline (PBS), 1% sodium dodecyl sulfate (SDS), and rapid freeze and thaw technique. The manufactured scaffolds were characterized by biomechanical testing, histological staining, and scanning electron microscopy. A 10 mm rabbit radius bone defect was repaired with autograft and SDS treated and rapid freeze and thaw in groups A, B, and C respectively. Healing was evaluated by radiography and histopathology at 0, 30, 60, and 90 days. The grafts were also checked for host tissue reaction and incorporation into the defect. Results: The freeze and thaw group showed complete elimination of all cellular nuclei, regular arrangement of collagen fiber, and no significant difference in tensile strength compared to 1% SDS treated and native groups. The in vivo radiographic and histopathological study showed that the rapid freeze and thaw group had complete bridging of the bone gap defect with new bone formation and they were immunologically less reactive compared to group B. Conclusion: The in vitro and in vivo evaluation of the grafts suggested that freeze and thaw technique was most superior to all other techniques for effective decellularization and augmentation of bone healing with better integration of the graft into the host.

Data on the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians.

Grade II furcation defect has a great potential for regeneration. Attempts have been made to regenerate lost periodontium in furcation defects through variety of approaches. A total of 22 patients with Grade II furcation defect were examined. The patients were sequentially grouped into three groups namely, (Group A) subepithelial connective tissue graft as a barrier membrane, (Group B) bovine bone graft material Bio-OssTM and (Group C) with the combination of the two. The treatment modalities show that there was a strong improvement in the resolution of the grade II furcation defects. The reduction in horizontal furcation defect measurement was 20.63% for group A. The change was found to be moderate (p=0.023*). The % change is 20.97% for group B and it is statistically significance (p = 0.001**). The % change was 20.78% in Group C with a good statistical significance (p=0.003**). Complete obliteration of the defect clinically and radio-graphically was observed for grade II furcation defect. Thus, the effect of sub-epithelial connective tissue graft with hydroxyl-apatite for furcation treatment in Indians is documented in this report.

Ethanol extract of propolis-bovine bone graft combination as a prospective candidate for socket preservation: Enhancing BMP7 and decreasing NFATc1.

OBJECTIVE: To analyse the expression of BMP7 in osteoblasts and NFATc1 in osteoclasts during the bone healing process in the extraction socket and the possible relationship between the expression of BMP7 and NFATc1. METHODOLOGY: This study represented a post-test only control group design consisting of four groups, namely; a control group (polyethylene glycol), an ethanol extract of propolis (EEP) group, a bovine bone graft (BBG) group, and a EEP-BBG group. 56 Cavia cobaya were split randomly into four groups. The mandibula left incisors of the subjects were extracted, treated with certain materials according to their group, and sutured. The expression of BMP7 and NFATc1 was observed on day 7 and day 14 by means of immunohistochemical staining. Statistical analysis was performed using a combination of one-way ANOVA, Games-Howell post-hoc, and Pearson tests. RESULTS: The propolis-BBG combination group showed the highest BMP7 expression, on both day 7 and day 14. With regard to NFATc1 expression, the combination group experienced the lowest expression on day 7 and day 14. The combination group showed significant differences in all expressions compared to the control group. The BMP7 and NFATc1 expressions showed a strong relationship (r = -0.598, r > 0.5). CONCLUSION: Propolis-BBG combination increases BMP7 expression and reduces NFATc1 expression in the extraction socket. This study confirmed a strong relationship between the expressions of BMP7 and NFATc1.

Comparison of Bovine Bone-Autogenic Bone Mixture Versus Platelet-Rich Fibrin for Maxillary Sinus Grafting: Histologic and Histomorphologic Study.

Numerous grafting materials have been used to augment the maxillary sinus floor for long-term stability and success for implant-supported prosthesis. To enhance bone formation, adjunctive blood-born growth factor sources have gained popularity during the recent years. The present study compared the use of platelet-rich fibrin (PRF) and bovine-autogenous bone mixture for maxillary sinus floor elevation. A split-face model was used to apply 2 different filling materials for maxillary sinus floor elevation in 22 healthy adult sheep. In group 1, bovine and autogenous bone mixture; and in group 2, PRF was used. The animals were killed at 3, 6, and 9 months. Histologic and histomorphologic examinations revealed new bone formation in group 1 at the third and sixth months. In group 2, new bone formation was observed only at the sixth month, and residual PRF remnants were identified. At the ninth month, host bone and new bone could not be distinguished from each other in group 1, and bone formation was found to be proceeding in group 2. PRF remnants still existed at the ninth month. In conclusion, bovine bone and autogenous bone mixture is superior to PRF as a grafting material in sinus-lifting procedures.

Dentascan an excellent tool for assessment of variations in the management of periodontal defects.

BACKGROUND: The purpose of the present study was to envisage the effectiveness of demineralized freeze-dried bone allograft (DFDBA) and bovine bone graft (BBG) for promoting defect fill in periodontal intrabony defects using dentascan. MATERIALS AND METHODS: A total of 13 subjects (15 intrabony defects) aged between 24 and 56 years affected by moderate to severe periodontitis were randomly divided into Control (CG) and Test groups (TG1 and TG2). In CG only debridement, TG1 debridement plus DFDBA, and TG2 debridement plus BBG were performed. The clinical parameters probing pocket depth (PPD), clinical attachment level (CAL) was used. The radiological analysis was done by dentascan, which is a single-slice spiral computed tomographic scanner. Six months after, regenerative treatment clinical measurements were recorded. The bone fill was assessed using Dentascan as previously mentioned. RESULTS: PPD reduction and CAL gain were significant in all the groups after 6 months whereas, on intergroup comparisons, insignificant finding was observed both at baseline and after 6 months. Coronoapical bone status decreased significantly in all groups, buccolingual measurements decreased significantly in TG1 and TG2, but no such trend was seen in CG. Significant reduction in mesiodistal bone status was noticed only in TG1 whereas insignificant on intergroup comparisons. CONCLUSION: Dentascan-based analysis attested that DFDBA was superior to BBG.

Increased Expression of RUNX2 and ALP Resulting from a Combination of Propolis Extract and Bovine Bone Graft in Socket Preservation Material

Abstract The aim of this study was to determine the inductive effect of a combination of propolis and BBG extract on RUNX2 and ALP expression in the tooth extraction sockets of Cavia cobaya. Fifty- six Cavia cobaya were divided into four groups: polyethylene glycol (PEG), propolis extract + PEG, BBG + PEG, and propolis extract + BBG + PEG. The lower left incisor was extracted, and the socket subsequently filled with material according to the specific group of which the subject was a member. The subjects were sacrificed on the 14th and 30th days. Immunohistochemical staining was carried out under a light microscope at 400x magnification. Statistical analysis was then carried out by means of One-Way ANOVA and Tukey HSD tests. The mean number of RUNX2 and ALP expressions in each group was significantly different. The highest number of RUNX2 and ALP expressions occurred in the propolis + BBG + PEG group on the 30th day, while the lowest expressions were observed in the control group on the 14th day. A combination of propolis and BBG extract at a concentration of 2% of active substance effectively increases the expression of RUNX2 and ALP in preserving the tooth extraction sockets of Cavia cobaya.

Bovine xenograft application for treatment of a metatarsal nonunion fracture in an alpaca (Vicugna pacos).

CASE HISTORY: A 15-year-old female huacaya alpaca (Vicugna pacos) was referred because of a non-weight-bearing lameness (4/4) in the left pelvic limb caused by a grade three open metatarsal fracture. The referring veterinarian treated the fracture with conservative management using bandages, but it progressively evolved to a non-union. CLINICAL FINDINGS AND DIAGNOSIS: Clinical examination revealed external wounds on the medial and lateral surfaces of the metatarsus. Radiographs confirmed an open, nonarticular, displaced, diaphyseal fracture of the left metatarsus. TREATMENT AND OUTCOME: Cancellous bone was sourced from bovine proximal and distal femur epiphyses, followed by a thermal shock procedure to achieve decellularisation, to produce a xenograft. Open reduction and internal fixation of the fracture using locking plates was performed. Alignment of the fracture fragments was corrected and the xenograft was placed at the debrided fracture site to stimulate and harness osteogenesis in situ. Clinical and radiographic follow-up was performed up to 40 weeks postoperatively. Clinical evaluations revealed that the alpaca gradually increased weight bearing following bandage removal 10 days after surgery. Serial radiographs showed correct alignment of the left metatarsus, progressive bone modelling and, complete bone union at 12 weeks. Ten months postoperatively the alpaca showed no signs of lameness and resumed normal activity. CLINICAL RELEVANCE: For management of a metatarsal non-union, a combination of bovine xenograft application and angular stable internal fixation progressed toward an excellent long-term recovery.

Effects of Light-Emitting Diode Photobiomodulation Therapy and BioOss as Single and Combined Treatment in an Experimental Model of Bone Defect Healing in Rats.

The present study assesses histopathologically and histomorphometrically the effects of light-emitting diode (LED) photobiomodulation therapy (LPT) on bone healing in BioOss-filled femoral defects of rats. It has been reported that LPT modulates cellular metabolic processes, leading to an enhanced regenerative potential for biological tissues. Thirty-six male Wistar rats with femoral bone defects were divided into 4 groups: defect group (empty bone defect, without application of LPT), graft group (bone defect filled with BioOss, without application of LPT), (defect+LPT) group (empty bone defect, with application of LPT), and (graft+LPT) group (bone defect filled with BioOss, with application of LPT). An OsseoPulse LED device (wavelength: 618 nm; output power: 20 mW/cm(2)) was initiated 24 hours postsurgery and performed every 24 hours for 7, 14, and 21 days. The LPT-applied and BioOss-filled defects presented a higher amount of new bone formation with trabeculae formation. These defects showed statistically significant lower values of inflammation severity, and fewer remnants of biomaterial were present. Within the limitations of this study, LPT has positive effects on bone healing histopathologically and histomorphometrically for the defects filled with BioOss 3 weeks after the rats' femora injury.

Sinus Augmentation With Platelet-Rich Fibrin in Combination With Bovine Bone Graft Versus Bovine Bone Graft in Combination With Collagen Membrane.

The purpose of this study was to compare the efficacy between the use of bovine bone graft material and platelet-rich fibrin (PRF) mixture (test group) and bovine bone graft material and collagen membrane combination (control group) in 2-stage maxillary sinus augmentation. According to specific inclusion/exclusion criteria, patients treated between 2008 and 2012 were selected. Panoramic radiographs were used for radiologic assessments. To evaluate the relationship between sinus-graft height and each implant, the bone level (BL) was divided by implant length (IL). To evaluate the change in the height of grafted sinus, the grafted sinus floor above the lowest part of the original sinus height (GSH) was divided by the original sinus height (OSH). Samples taken during implant surgery were used for histologic and histomorphometric analyses. Twenty-five patients, 32 augmentation surgeries, and 66 one-stage implants were included in the study. No implant loss or complication was observed in either group. There were no statistical differences according to new bone formation (P = .61) and biomaterial remnant (P = .87). During the evaluation period, the test group showed statistically less change in the BL/IL ratio (P = .022). The difference of GSH/OSH ratio was found to be insignificant between groups (P = .093). It was observed that the grafted sinus covering the implant apex and sinus floor was above the original sinus height in both groups. It may be concluded from this study that both combinations can be successfully used for sinus augmentation. Further studies evaluating different graft materials and PRF combinations in the early phases of healing would be beneficial.

Sinus floor elevation using a new bovine bone grafting material: case report and bone grafting materials update / Actualización en materiales de relleno óseo: reporte de un caso clínico de elevamiento del piso del seno maxilar usando un nuevo material de relleno óseo bovino

Bone grafting is important to preserve the alveolar bone ridge height and volume for dental implant placement. Even though implant-supported overdentures present highly successful outcomes, it seems that a great number of edentulous individuals have not pursued implant-based rehabilitation. The cost of the treatment is one of the reasons of discrepancy between highly successful therapy and its acceptance. Therefore, the development of biomaterials for bone grafting with comparable characteristics and biological effects than those renowned internationally, is necessary. In addition, domestic manufacture would reduce the high costs in public health arising from the application of these biomaterials in the dental feld. The purpose of this clinical case report is to provide preliminary clinical evidence of the efficacy of a new bovine bone graft in the bone healing process when used for sinus floor elevation. (AU)

El uso de injertos óseos es importante para preservar la altura y el volumen de la cresta alveolar para la colocación de implantes dentales. Si bien las sobredentaduras implanto-soportadas presentan resultados altamente exitosos, la mayoría de las personas desdentadas no han sido rehabilitadas mediante implantes dentales. Uno de los principales motivos por los cuales los pacientes no aceptan este tipo de tratamiento, altamente exitoso, es el elevado costo del mismo. Por ello, es necesario el desarrollo de biomateriales de injerto óseo con características y efectos biológicos comparables a los reconocidos internacionalmente. Asimismo, la fabricación nacional reduciría los altos costos en Salud Pública derivados de la aplicación de estos biomateriales en el campo dental. El objetivo de esta comunicación es presentar un caso clínico a fin de proporcionar evidencia preliminar acerca de la eficacia de un nuevo injerto de hueso bovino en el proceso de cicatrización ósea en el levantamiento del piso del seno maxilar. (AU)

Preliminary study on the biocompatibility and osteoconductive properties of a new bovine bone graft / Estudio preliminar sobre las propiedades de biocompatibilidad y osteoconductividad de un nuevo injerto de hueso bovino

To prevent post-extraction resorption and preserve the integrity of the alveolar ridges, the placement of bone grafts at the time of extraction is recommended. Bovine bone grafts are biocompatibile and osteoconductive, allowing new bone apposition by osteoprogenitor cells. Although there are trademarks recognized internationally regarding bovine bone grafts, they are expensive and even difficult to acquire. Therefore, domestic industry development of high quality biomaterials will reduce the public health high costs in the dental field. Here, we evaluated and compared the effects of an Argentinean manufactured bovine bone graft (Synergy Bone Matrix) with a bovine bone graft recognized for its osteoconductive effects (Bio-Oss), on bone healing in an experimental model in rats. We created critical sized bone defects in rat tibiae and filled them with either one of the bovine bone grafts or control. Clinical responses, X-ray findings, bone mineral density, and histological parameters were evaluated. No abscess, encapsulation, suppuration or inflammation of lymphatic nodes were observed. Radiographically, all implants were amalgamated to the surrounding bony margins, suggesting proper healing. On the other hand, control tibiae exhibited no signs of recovery and remained either unfilled or showed fibrous tissue formation. No statistical differences were observed in BMC and BMD between tibiae filled with Synergy Bone Matrix or Bio-Oss. Histological analysis revealed particles of both bone grafts surrounded by laminar bone tissue indicating osteoconductivity, without any inflammatory sign. This preliminary study suggests that Synergy Bone Matrix, as well as Bio-Oss, present similar properties of biocompatibility and osteoconductivity. (AU)

Para prevenir la resorción post-exodoncia y preservar la integridad de los rebordes alveolares, se recomienda la colocación de injertos óseos en el momento de la extracción. Los injertos de hueso bovino son biocompatibles y osteoconductivos, permitiendo nueva aposición ósea por células osteoprogenitoras. Existen marcas internacionales de injertos de hueso bovino, pero resultan caros e incluso difíciles de adquirir. Por ello, la elaboración de biomateriales de alta calidad, nacionales, reduciría los altos costos de salud pública en odontología. En este estudio, se evaluaron y compararon los efectos de un injerto de hueso bovino fabricado en Argentina (Synergy Bone Matrix) versus un injerto de hueso bovino reconocido por sus efectos osteoconductivos (Bio-Oss), en el proceso de cicatrización ósea en un modelo experimental en ratas. Para ello, creamos un defecto óseo crítico en tibia de rata el cual se rellenó con uno de los injertos de hueso bovino o control. Se evaluó: respuesta clínica y radiográfica, densidad mineral ósea e histología. No se observaron abscesos, encapsulación, supuración o inflamación de los ganglios linfáticos. Radiográficamente, todos los implantes se integraron a los márgenes óseos circundantes, sugiriendo una cicatrización adecuada. Por el contrario, las tibias control no mostraron signos de recuperación con formación de tejido fibroso. No se observaron diferencias estadísticas en las BMC y BMD entre las tibias Synergy Bone Matrix o Bio-Oss. La histología reveló partículas de ambos injertos óseos rodeadas por tejido óseo laminar indicando osteoconductividad sin signos inflamatorios. Este estudio preliminar sugiere que Synergy Bone Matrix presenta propiedades similares de biocompatibilidad y osteoconductividad que Bio-Oss. (AU)