S53p4 bioactive glass putty in the local treatment of cavitary chronic osteomyelitis / Biovidro ativo s53p4 em pasta no tratamento local da osteomielite crônica cavitária

ABSTRACT Objective: Evaluating the clinical results of bioactive glass S53P4 putty for the treatment of cavitary chronic osteomyelitis. Methods: Retrospective observational study, including patients of any age with clinical and radiological diagnosis of chronic osteomyelitis, who underwent surgical debridement and implantation of bioactive glass S53P4 putty (BonAlive® Putty, Turku, Finland). Patients who underwent any plastic surgery on the soft tissues of the affected site or had segmental bone lesions or septic arthritis were excluded. Statistical analysis was performed using Excel®. Demographic data, as well as data on the lesion, treatment, and follow-up, were collected. Outcomes were classified as "disease-free survival," "failure," or "indefinite." Results: This study included 31 patients, of which 71% were men and had with a mean age of 53.6 years (SD ± 24.2). In total, 84% were followed-up for at least 12 months and 67.7% had comorbidities. We prescribed combination antibiotic therapy for 64.5% of patients. In 47.1%, Staphylococcus aureus was isolated. Finally, we classified 90.3% of cases as "disease-free survival" and 9.7% as "indefinite." Conclusion: Bioactive glass S53P4 putty is safe and effective to treat cavitary chronic osteomyelitis, including infections by resistant pathogens, such as methicillin-resistant S. aureus. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar a atividade do vidro bioativo S53P4 em pasta no tratamento de osteomielite crônica. Métodos: Estudo observacional retrospectivo, com inclusão de indivíduos de qualquer idade com diagnóstico clínico e radiológico de osteomielite que realizaram tratamento cirúrgico com limpeza e desbridamento, seguido do preenchimento da cavidade com biovidro S53P4 em pasta (BonAlive ® Putty, Turku, Finland). Foram excluídos pacientes submetidos a procedimentos de cirurgia plástica nos tecidos moles do local afetado, com lesões ósseas segmentares e com presença de artrite séptica. A análise estatística foi realizada em Excel ® . Foram coletados dados demográficos, sobre a lesão, o tratamento e o acompanhamento. O desfecho foi classificado em "sobrevida livre de doença", "falha" ou "indeterminado". Resultados: Dos 31 pacientes analisados, 71% eram homens, com idade média de 53,6 anos (DP ± 24,26). Do total, 84% foram acompanhados por no mínimo 12 meses, e 67,7% apresentaram comorbidades. A terapia antibiótica combinada foi realizada em 64,5% dos pacientes, sendo o patógeno mais frequente o Staphylococcus aureus (47,1%). Ao final, 90,3% dos pacientes obtiveram "sobrevida livre de doenças" e 9,7% foram considerados "indeterminados". Conclusão: O vidro bioativo S53P4 em pasta é seguro e eficaz no tratamento da osteomielite cavitária e de infecções por patógenos resistentes, incluindo o S. aureus multirresistente. Nível de Evidência IV, Série de Casos.

Application of plasmatrix in horizontal bone augmentation for implant placement / 口腔疾病防治

@#Tooth loss is accompanied by alveolar bone absorption or defect, resulting in insufficient bone and soft tissue. In addition to restoring the masticatory function of missing teeth, implant treatment should also needs to restore the contour and shape of the dental arch. Guided bone regeneration is a common means of bone increase. Xenogeneic granular bone substitute materials are widely used in the field of clinical bone augmentation due to their advantages of long degradation time and low immunogenicity, but other problems, such as inconvenient operation and low osteogenic activity, remain. Plasmatrix can effectively improve the effect of oral tissue regeneration and reduce the occurrence of postoperative complications, and its application in oral tissue regeneration is gradually increasing. This article first introduces the main application forms of plasmatrix in horizontal bone augmentation (mainly solid plasmatrix membrane and plasmatrix bone block), and reclassifies horizontal bone defects according to commonly used decision-making schemes in clinical bone augmentation, in other words, whether the implant can be placed in the ideal position and whether there is bone dehiscence after implantation. Type Ⅰ defects refers to the situation where the bone at the implant site can allow the insertion of an implant with ideal size, and there is no bone dehiscence around the implant, but the alveolar bone contour is not ideal; type Ⅱ defects refers to the situation that when an ideal size implant is placed at the implant site determined by the future prosthesis position, there will be bones on three sides of the implant, but there is bone dehiscence in the buccal bone wall (the length of bone dehiscence is less than 50% of the implant length); type Ⅲ defects refers to the situation where the bone volume at the implant site is not enough to for the placement of the ideal size implant at the ideal position, and bone grafting is required to restore the bone volume before the implant placement. The application of plasmatrix in different types of bone defects is then described. In type Ⅰ bone defects, the solid plasmatrix membrane is used instead of the collagen membrane; in type Ⅱ bone defects, the bone defect around the implant is filled by plasmatrix bone block and then covered with collagen membrane and solid plasmatrix membrane; and in type Ⅲ bone defects, plasmatrix bone block is used to replace autogenous bone block to fill the defect area, and titanium screws are used for fixation. The defect is then covered with a collagen membrane and a solid plasmatrix membrane. This article aims to provide oral clinicians with a comprehensive understanding of plasmatrix and simplify the guidelines for bone regeneration operations.

Application of plasmatrix in vertical bone augmentation for implant placement / 口腔疾病防治

@#Vertical bone augmentation surgery still faces considerable challenges in clinical practice due to various problems, such as difficulty in restoring the ideal alveolar bone height and biological complications, and because it is highly technically sensitive. Plasmatrix is derived from patients’ own blood, and it can effectively promote the vascularization of the regenerated area, recruit stem cells, and reduce inflammation when used in vertical bone augmentation. Based on studies published worldwide, this article first divides vertical bone augmentation into 3 categories according to the height of the expected alveolar ridge, namely, type Ⅰ, the required vertical bone gain is less than 4 mm; type Ⅱ, the required vertical bone gain is between 4-8 mm; and type Ⅲ, the required vertical bone gain is greater than 8 mm. In the type Ⅰ vertical bone augmentation, the plasmatrix bone block is directly placed in the defect area and covered with the plasmatrix membrane before tension-free suturing; in the type Ⅱ vertical bone augmentation, the plasmatrix bone block should be placed in the defect area and fixed with titanium nails and then covered with an absorbable collagen membrane and plasmatrix membrane with a tension-free suture; in the type Ⅲ vertical bone augmentation, additional active ingredients (such as bone morphogenetic protein, autologous bone, etc.) should be added to the plasmatrix bone block and strong fixation (such as titanium nails) should be used. Absorbable collagen and plasmatrix membranes should be used to cover the surface of the bone block, and the flap should be sutured. According to different types of vertical bone augmentation categories, the above methods optimize the vertical bone augmentation effect. This article aims to provide a reference and guidelines for oral clinicians to fully understand plasmatrix and simplify the classification and operation of vertical bone augmentation.

Clinical and histological evaluations of the effects of concentrated growth factor combined with deproteinated bovine bone mineral in site preservation / 口腔疾病防治

Objective@#To evaluate the osteogenic effect of concentrated growth factor (CGF) combined with deproteinated bovine bone mineral (DBBM) in site preservation using clinical and histomorphometric observations.@*Methods @#A total of 26 patients who needed extraction of affected teeth and received staged implantation after site preservation were selected. The patients were randomly divided into the DBBM group (Bio-Oss was implanted simultaneously after extraction) and CGF+DBBM group (CGF+Bio-Oss was implanted simultaneously after extraction), with 13 patients in each group, and both groups were covered with Bio-Gide collagen membrane. Cone beam computed tomography (CBCT) was performed preoperatively and 6 months later to measure the changes in alveolar bone height and width, and the bone specimens were drilled 6 months after site preservation during implant surgery for histological analyses.@*Results@# CBCT showed that the height and width of alveolar bone were absorbed 6 months after site preservation in the CGF+DBBM and DBBM groups, and the reduction in alveolar ridge width in the CGF+DBBM group was statistically less than the DBBM group (P <0.05). The histomorphometry results showed that the percentage of new bone in the CGF+DBBM and DBBM groups were 35.30% ± 3.56% and 26.38% ± 5.04%, respectively, and the amount of new bone in the CGF+DBBM group was statistically higher than the DBBM group (P<0.05). @*Conclusion @#CGF combined with DBBM is superior to DBBM in maintaining the alveolar bone volume and shape in site preservation, which creates favorable conditions for implant restoration.

Valuation of angiogenesis in bovine xenografts implanted in intracorporal sites of rabbits as models of in-vivo bioreactors / Avaliação da angiogênese em xenoenxertos bovinos implantados em sítios intracorpóreos de coelhos como modelos de biorreatores in vivo

The aim of this study was to evaluate neovascularization of bovine xenografts implanted in intracorporeal sites of rabbits (bioreactors). 30 rabbits were used, divided into 6 groups, according to the evaluation time (7, 15, 30, 45, and 60 days); each animal received xenogenic implants in 3 different intracorporeal sites (A1 - omentum bag; A2 - intermuscular space of quadriceps femoris; A3 - subperiosteal of ilium bone). Histological assessments graded the presence of angiogenesis, the number of inflammatory cells, newly formed bone tissue, and the presence of giant cells. Histological analyses showed intense angiogenesis in all implanted xenografts. Presence of inflammatory infiltrate and giant cells at the A1 implant site and presence of bone neoformation at the A3 implant site were noted. Degeneration of implants and formation of a fibrous capsule were noted. When comparing the interaction of the site with the days of evaluation, statistical analysis showed a significant difference (p≤0.05) in any time of neovascularization analysis. The vascular endothelial growth factor (VEGF) and inflammatory cells of the omentum in its structure, may have contributed to the greater presence of neovessels and inflammatory cells, a fact that may indicate functionality as a possible bone substitute.(AU)

O objetivo deste estudo foi avaliar a neovascularização de xenoenxertos bovinos implantados em sítios intracorpóreos de coelhos (biorreatores). Foram utilizados 30 coelhos, os quais foram divididos em seis grupos, de acordo com o tempo de avaliação (sete, 15, 30, 45 e 60 dias); cada animal recebeu implantes xenogênicos em três diferentes sítios intracorpóreos (A1 - bolsa de omento; A2 - espaço intermuscular do quadríceps femoral; A3 - subperiosteal do osso ílio). Avaliações histológicas classificaram a presença de angiogênese, o número de células inflamatórias, de tecido ósseo neoformado e a presença de células gigantes. As análises histológicas mostraram intensa angiogênese em todos os xenoenxertos implantados. Observou-se presença de infiltrado inflamatório e células gigantes no local do implante A1 e presença de neoformação óssea no local do implante A3. Ao mesmo tempo, a degeneração dos implantes e a formação de uma cápsula fibrosa foram observadas. Ao comparar a interação do local com os dias de avaliação, a análise estatística mostrou diferença significativa (P≤0,05) em qualquer momento da análise de neovascularização. O fator de crescimento endotelial vascular (VEGF) e as células inflamatórias do omento em sua estrutura podem ter contribuído para a maior presença de neovasos e células inflamatórias, fato que pode indicar funcionalidade como possível substituto ósseo.(AU)

Management principle and clinical suggestions of osteotomy gap of opening wedge high tibial osteotomy / 中国修复重建外科杂志

Objective: To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO). Methods: The related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed. Results: Delayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not. Conclusion: No matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.

In vitro antibacterial activity and biocompatibility of a porous scaffold containing magnesium / 中国组织工程研究

BACKGROUND: The three-dimensional organic/inorganic scaffold materials using polymer/bioceramic composites can endow the necessary physical and chemical properties and enhance the mechanical properties of the materials. However, most bone substitution materials cannot prevent infection at the defect site. It has been found that the degradation of magnesium can produce local alkaline environment, so that magnesium has certain antibacterial activity. OBJECTIVE: To investigate the in vitro antibacterial activity and cytocompatibility of magnesium-containing scaffolds. METHODS: Polylactic acid/β-tricalcium phosphate/magnesium porous scaffolds were prepared by low-temperature rapid prototyping technology. The PTM (2:1) and PTM (1:2) groups referred to two mixing mass ratios (β-tricalcium phosphate:magnesium = 2:1 and 1:2), respectively. Two scaffolds of polylactic acid (P group) and polylactic acid/β-tricalcium phosphate (PT group) were also prepared by low-temperature rapid prototyping technology. The surface morphology, pore size, porosity and compression modulus of the scaffolds were measured. Staphylococcus aureus (ATCC 35923) was seeded on the scaffolds of each group for 24 hours. The antibacterial activity of the scaffolds was observed through spread plate method and confocal laser scanning microscopy. Mouse preosteoblasts MC3T3-E1 were co-cultured with the scaffolds of each group. The cell attachment and proliferation were evaluated by cell counting kit-8 assay. RESULTS AND CONCLUSION: (1) A relatively uniform porous structure was found on the scaffold surfaces in each group. There were no significant differences in the pore size and porosity among groups (P > 0.05). (2) The compression modulus in the PTM (2:1) and PTM (1:2) groups were significantly higher than those in the P and PT groups (P 0.05). (4) After 6 hours of culture, the number of attached cells in the PT, PTM (2:1) and PTM (1:2) groups was greater than that in the P group (P 0.05). (5) At 1 day of culture, the cell proliferation in the PT group was superior to that in the P group (P 0.05). (6) These results indicate that the polylactic acid/β-tricalcium phosphate/magnesium scaffold not only possesses good antibacterial activity, but also exhibits excellent cytocompatibility and certain anti-compressive ability.

In vivo study on the repairment of distal femur defects in rabbit with nano-pearl powder bone substitute / 中南大学学报(医学版)

OBJECTIVES@#To evaluate the repairing ability of nano-pearl powder bone substitute in rabbit with defect of distal femur bone.@*METHODS@#Thirty-two New Zealand rabbits were randomly divided into four groups: a nano-pearl powder/recombinant human bone morphogenetic protein 2 (rhBMP-2)/hyaluronic acid group, a nano-pearl powder/hyaluronic acid group, a nano-pearl powder group and a blank control group (=8 in each group). A defect with the diameter of 7 mm and height of 10 mm was prepared at the distal femoral metaphysis line of the rabbit.Different bone substitutes were planted, and the effect of repair was evaluated by macroscopic observation, imaging examination, and histopathological examination.@*RESULTS@#The results of imageology showed that: the bone repairing effect in the nano-pearl powder/rhBMP-2/hyaluronic acid group was better than that in the pure pearl powder group and the nano-pearl powder/hyaluronic acid group, and which in the 3 experimental groups was better than that in the blank control group; The results of histology showed that: at the 4th, 8th and 12th weeks after the modeling operation, the speed of bone repair in the nano-pearl powder/rhBMP-2/hyaluronic acid group was faster than that in the pure pearl powder group and the nano-pearl powder/hyaluronic acid group, and which in the blank control group was far slower than that in the 3 experimental groups. The results of immunohistochemistry staining for osteocalcin antibody showed that: the osteogenic effect in the nano-pearl powder/rhBMP-2/hyaluronic acid group was better than that in the pure pearl powder group and the nano-pearl powder/hyaluronic acid group (both 0.05); however, there was significant difference between the pure pearl powder group and the blank control group (0.05), but the osteogenic effect in the nano-pearl powder/hyaluronic acid group was better than that in the pure pearl powder group and the blank control group (both <0.05).@*CONCLUSIONS@#Nano-pearl powder and its bone substitute can promote the repair of bone defect, and the nano-pearl powder which contains rhBMP-2 has better osteogenic and repairing effect on defect.

Clinical application of autogenous dentin as a bone graft material / 口腔疾病防治

@#Autogenous dentin is a promising biological material that can be used as a substitute for autologous bone. It has been used in postextraction site preservation, maxillary sinus floor elevation, and alveolar ridge augmentation. The clinical application methods of autologous dentin have showed great diversity without uniform standard. The present article reviewed the clinical application of autogenous dentin to provide new ideas for its future development. The literature review results show that dentin materials require several preparations before transplantation, among which the demineralization is a common chemical processing method. Demineralization can enhance the osteoconductive and osteoinductive properties of dentin, but the complex and time-consuming operation process has limited its application to a certain extent. Partial demineralization may be a more appropriate choice. During transplantation, the morphology of dentin depends on the condition of the bone defect and the surgical method. Granular materials with different diameters are convenient for filling irregular defects. Block materials are conducive to maintaining the space of the reconstruction site. Hollow frame materials are slightly more complicated to process but can combine the advantages of granular and block grafts. In addition to being used alone, dentin can also be transplanted in combination with multiple biological materials. Platelet-rich plasma combined with dentin materials has shown ideal results in clinical studies. Plaster of paris and calcium phosphate ceramics have also been combined with dentin materials in animal experiments. But since they have not been applied in humans, their clinical effects require further research.

Clinical effect of platelet-rich fibrin combined with bone substitute in alveolar ridge preservation / 口腔疾病防治

Objective@#To study the clinical outcomes of implanting platelet rich fibrinogen (PRF) mixed with Bio-Oss® in the extraction socket for alveolar ridge preservation and to provide evidence for clinical application. @*Methods@#Thirty-six patients who underwent alveolar ridge preservation were enrolled. Thirty-six extraction sites were divided into two groups: PRF mixed with Bio-Oss® group (test group) and Bio-Oss® alone (control group). Bone dimensional changes in height and width were measured by CBCT before and 6 months after surgery, and early soft tissue healing and postoperative pain sensation were evaluated clinically 1 week after surgery.@* Results @# There was no significant difference in the alveolar bone height (-1.48 ± 0.40) mm between the test group and the control group. The difference in the alveolar bone width between the test group (-1.09 ± 0.42) mm and the control group (-1.35 ± 0.22) mm was statistically significant (z=-2.63, P=0.01). The postoperative pain score of the test group was 2.39 ± 1.20, and that of the control group was 3.39 ± 1.65, the difference was statistically significant (t=-2.083, P=0.045). There was no significant difference in soft tissue healing between the test group and the control group.@*Conclusion @#The use of PRF mixed with Bio-Oss ®in the alveolar ridge preservation procedure can reduce alveolar bone absorption and postoperative pain.

PLA/PGA and its co-Polymers in Alveolar Bone Regeneration. A Systematic Review / PLA/PGA y sus Copolímeros en Regeneración Ósea Alveolar. Una Revisión Sistemática

ABSTRACT: The aim of this research was to perform a systematic review to identify the most frequent uses of PLA/ PGA in alveolar bone regeneration and their results. A study was designed to answer the question: What are the most frequent uses of PLA/PLGA and their copolymers in alveolar bone regeneration?. A systematic search was done on MEDLINE, EMBASE and LILACS from April 1993 to December 2017. The search string used on MEDLINE was: (((polylactic acid) OR PLA) OR PLA-based copolymers) OR PLA blends) OR PLA scaffolds)) AND ((("Bone Regeneration"[Mesh]) OR bone regeneration) OR guided bone regeneration). The search was complemented by a manual review of the references from the articles included. Most of the studies selected were weak and, regarding the most frequent uses of PLA/PGA, 13 studies used it as a resorbable membrane, two as an absorbable mesh, one as an absorbable screw and three as filling material. Based on our results, the authors consider that PLA/PGA requires a delicate relation between the mechanical resistance and the degradation process. PLA/PGA does not interrupt bone regeneration; however, the influence in cellular events related to bone regeneration and later osseointegration have not been identified.

RESUMEN: El objetivo de esta revisión fue realizar una revisión sistemática de la literatura para identificar los usos más frecuentes de PLA/PGA en regeneración ósea en área maxilofacial y sus resultados. Se diseñó un estudio para responder a la pregunta: ¿Cuáles son los usos más frecuentes de PLA/PLGA y sus copolímeros en regeneración ósea en el sector maxilofacial?. Los estudios seleccionados fueron en su mayoría débiles y sobre los usos más frecuentes de PLA/PGA, 13 estudios lo utilizaron como membrana reabsorbible, 2 estudios como malla absorbible, un estudio como tornillo absorbible y 3 estudios como material de relleno. En base a nuestros resultados, los autores estiman que PLA/PGA requiere una delicada relación entre la resistencia mecánica que ofrece y la degradación que se produce; PLA/ PGA no interrumpe la regeneración ósea, sin embargo, no se ha identificado la potencialidad o influencia que presenta en los eventos celulares de la regeneración y posterior oseointegración.

Eight-week healing of grafted calvarial bone defects with hyperbaric oxygen therapy in rats

PURPOSE: The purpose of this study was to evaluate the synergistic effect of adjunctive hyperbaric oxygen (HBO) therapy on new bone formation and angiogenesis after 8 weeks of healing. METHODS: Sprague-Dawley rats (n=28) were split into 2 groups according to the application of adjunctive HBO therapy: a group that received HBO therapy (HBO group [n=14]) and another group that did not receive HBO therapy (NHBO group [n=14]). Each group was divided into 2 subgroups according to the type of bone graft material: a biphasic calcium phosphate (BCP) subgroup and an Escherichia coli-derived recombinant human bone morphogenetic protein-2-/epigallocatechin-3-gallate-coated BCP (mBCP) subgroup. Two identical circular defects with a 6-mm diameter were made in the right and left parietal bones of each rat. One defect was grafted with bone graft material (BCP or mBCP). The other defect was not grafted. The HBO group received 2 weeks of adjunctive HBO therapy (1 hour, 5 times a week). The rats were euthanized 8 weeks after surgery. The specimens were prepared for histologic analysis. RESULTS: New bone (%) was higher in the NHBO-mBCP group than in the NHBO-BCP and control groups (P<0.05). Blood vessel count (%) and vascular endothelial growth factor staining (%) were higher in the HBO-mBCP group than in the NHBO-mBCP group (P<0.05). CONCLUSIONS: HBO therapy did not have a positive influence on bone formation irrespective of the type of bone graft material applied after 8 weeks of healing. HBO therapy had a positive effect on angiogenic activity.

Improvement of the osteogenic potential of ErhBMP-2-/EGCG-coated biphasic calcium phosphate bone substitute: in vitro and in vivo activity

PURPOSE: The aim of this study was to evaluate the enhancement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with Escherichia coli-derived recombinant human bone morphogenetic protein-2 (ErhBMP-2) and epigallocatechin-3-gallate (EGCG). METHODS: The cell viability, differentiation, and mineralization of osteoblasts was tested with ErhBMP-2-/EGCG solution. Coated BCP surfaces were also investigated. Standardized, 6-mm diameter defects were created bilaterally on the maxillary sinus of 10 male New Zealand white rabbits. After removal of the bony windows and elevation of sinus membranes, ErhBMP-2-/EGCG-coated BCP was applied on one defect in the test group. BCP was applied on the other defect to form the control group. The animals were sacrificed at 4 or 8 weeks after surgery. Histologic and histometric analyses of the augmented graft and surrounding tissue were performed. RESULTS: The 4-week and 8-week test groups showed more new bone (%) than the corresponding control groups (P<0.05). The 8-week test group showed more new bone (%) than the 4-week test group (P<0.05). CONCLUSIONS: ErhBMP-2-/EGCG-coated BCP was effective as a bone graft material, showing enhanced osteogenic potential and minimal side effects in a rabbit sinus augmentation model.

Influence of wound closure on volume stability with the application of different GBR materials: an in vitro cone-beam computed tomographic study

PURPOSE: To assess the influence of using different combinations of guided bone regeneration (GBR) materials on volume changes after wound closure at peri-implant dehiscence defects. METHODS: In 5 pig mandibles, standardized bone defects were created and implants were centrally placed. The defects were augmented using different combinations of GBR materials: xenogeneic granulate and collagen membrane (group 1, n=10), xenogeneic granulate and alloplastic membrane (group 2, n=10), alloplastic granulates and alloplastic membrane (group 3, n=10). The horizontal thickness was assessed using cone-beam computed tomography before and after suturing. Measurements were performed at the implant shoulder (HT0) and at 1 mm (HT1) and 2 mm (HT2) below. The data were statistically analysed using the Wilcoxon signed-rank test to evaluate within-group differences. Bonferroni correction was applied when calculating statistical significance between the groups. RESULTS: The mean horizontal thickness before suturing was 2.55±0.53 mm (group 1), 1.94±0.56 mm (group 2), and 2.49±0.73 mm (group 3). Post-suturing, the values were 1.47±0.31 mm (group 1), 1.77±0.27 mm (group 2), and 2.00±0.48 mm (group 3). All groups demonstrated a loss of horizontal dimension. Intragroup changes exhibited significant differences in group 1 (P < 0.001) and group 3 (P < 0.01). Intergroup comparisons revealed statistically significant differences of the relative changes between groups 1 and 2 (P=0.033) and groups 1 and 3 (P=0.015). CONCLUSIONS: Volume change after wound closure was minimized by using an alloplastic membrane. The stability of the augmented horizontal thickness was most ensured by using this type of membrane irrespective of the bone substitute material used for membrane support.

Comparison of clinical effects of three kinds of bone graft in the treatment of periodontal intra-bony defects / 国际生物医学工程杂志

Objective To compare the clinical effects of guided tissue regeneration (GTR) combined with different bone graft materials, including Bio-Gene, Bone3 and Bio-Oss, in the treatment of periodontal intra-bony defects. Methods Eighteen patients with chronic periodontitis with periodontal intra-bony defects were randomly divided into the Bio-Gene group, the Bone3 group and Bio-Oss group. After periodontal debridement, periodontal bone grafting combined with GTR surgery was performed in all patients. The clinical and radiographic parameters of patients were collected before surgery, suture removal (2 weeks after surgery), and 6 months after surgery, including periodontal exploration depth (PD), clinical attachment loss (CAL), gingival recession (GR), and residual alveolar bone height (RBH). Results The wounds healed well in all patients when the suture was removed. The stage Ⅰ healing was obtained without infection or wound dehiscence, and the postoperative discomfort was acceptable. At 6 months after periodontal bone grafting combined with GTR treatment, the PD and CAL indexes in the three groups were significantly improved compared with those before surgery (all P<0.05), and there was no significant difference in PD and CAL between the three groups (all P>0.05). Imaging results showed that new bone formation was observed in the original bone defect area in all three groups after 6 months of the treatment, the bone density was similar to the surrounding bone tissue. Besides, the RBH％increased significantly compared with that before the treatment (all P<0.05), and there was no significant difference in RBH％among the three groups (all P>0.05). Conclusions Bio-Gene, Bone3 and Bio-Oss are all reliable bone graft materials for the treatment of alveolar bone defects caused by periodontitis, which can significantly improve the osteogenesis effect.

Osteogenic potential of recombinant human bone morphogenetic protein-2 combined with Bio-oss bone substitute in implant restorations in anterior esthetic region / 口腔疾病防治

Objective@#To study the osteogenic potential of recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with Bio-oss bone substitute in the implant restoration of bone defects in the anterior esthetic region. @*Methods@# Twelve patients who underwent the immediate placement of 20 implants with a bone augmentation procedure using rhBMP-2 and Bio-oss were included in this study. Changes in the height and thickness of the buccal bone over 6 months were measured, and the soft tissue was evaluated using the pink esthetic score (PES) after crown placement. @*Results@# All 20 implants were successfully osseointegrated, and the average increase in bone height was 1.9 mm; different degrees of bone height growth were observed for 17 (85%) implants sites. In one case, there was a severe bone fracture on the buccal side before the operation, resulting in bone plate resorption and decreased alveolar bone height. The bone height did not change significantly in 2 cases. The thickness of the buccal bone plate for all implants was greater than 1 mm. The average thickness was 1.9 mm, and the average PES was 9.8 points. @*Conclusion@# rhBMP-2 combined with Bio-oss bone substitute has a preferable effect on the restoration of bone defects in the anterior esthetic area, and can achieve good aesthetic effect.

Histomorphometric evaluation of bone healing capacity of epigallocatechin-3-gallate-loaded β-TCP bone substitute in rabbit calvarial defects / 대한치과재료학회지

This study investigated the effect of epigallocatechin-3-gallate (EGCG)-loaded microporous β-tricalcium phosphate (β-TCP) bone substitute in the bone healing of rabbit calvarial defects. New bone formation induced by β-TCP incorporating two different dose of EGCG [1 mg EGCG/200 mg β-TCP (TCP-1), 10 mg EGCG/200 mg β-TCP (TCP-10)] was compared with unloaded β-TCP (TCP-0). Calvarial defects 8 mm diameter created in 14 adult male New Zealand White rabbits were filled with three types of bone substitutes. The amount of newly formed bone was evaluated histomorphometrically at 4 and 8 weeks after implantation. The TCP-1 group exhibited increased bone healing capacity and numerous blood vessel formation compared with the other two groups. New bone formation was observed in the cental area of TCP-1 filled defects at 8 weeks. Histomorphometric analysis revealed significantly greater newly formed bone area in the TCP-1 group when compared with unloaded TCP-0 (p < 0.05 at 4 and 8 weeks) and 10 mg EGCG-loaded TCP-10 groups (p < 0.05 at 8 weeks). No difference was observed in new bone area between TCP-0 and TCP-10 groups. These results suggest that local delivery of 1 mg EGCG to β-TCP bone substitute by simple adsorption promotes bone regeneration in the healing of rabbit calvarial osseous defect and higher EGCG dose (in this study, 10 mg per defect) does not exert any positive effect on bone healing capacity of β-TCP. Thus, local delivery of EGCG to β-TCP bone substitute seems to be an effective approach for the treatment of osseous defects.

Effects of calcium ion on the migration and osteogenic differentiation of human osteoblasts / 华西口腔医学杂志

OBJECTIVE@#This study aimed to investigate the effect of calcium ion (Ca²⁺) on the migration and osteogenic differentiation of human osteoblasts and explore the proper concentration and correlation mechanism.@*METHODS@#A series of Ca²⁺ solutions with different concentrations was prepared. Osteoblast migration was assessed by Transwell assay, and proliferation was studied via the CCK-8 colorimetric assay. The mRNA expression of osteogenic genes was examined via reverse transcription-polymerase chain reaction (RT-PCR), and the mineralized nodule was examined by alizarin red-S method. After calcium sensitive receptor (CaSR) antagonism, Ca²⁺-induced migration and osteogenic differentiation were analyzed.@*RESULTS@#In the migration experiment, 2, 4, and 6 mmol·L⁻¹ Ca²⁺ could promoted osteoblast migration at three timepoints (8, 16, and 24 h), whereas 10 mmol·L⁻¹ Ca²⁺ considerably inhibited migration at 8 h. The Ca²⁺ concentration range of 2-10 mmol·L⁻¹ could promote proliferation, osteogenic differentiation, and mineralization of human osteoblasts. Moreover, mineralization was predominantly induced by 8 and 10 mmol·L⁻¹ Ca²⁺. CaSR antagonism could reduce Ca²⁺-induced migration and osteogenic differentiation of human osteoblasts.@*CONCLUSIONS@#Low Ca²⁺ concentration favored osteoblast migration, whereas high Ca²⁺ concentration favored osteogenic differentiation. The Ca²⁺ concentrations of 4 and 6 mmol·L⁻¹ could substantially induce osteoblast migration and osteogenic differentiation, and the Ca²⁺-CaSR pathway participated in signal transduction.

Coralline hydroxyapatite for ridge preservation in the maxillary anterior zone:A cone beam CT analysis / 医学研究生学报

Objective Coralline hydroxyapatite (CHA),in comparison with Bio-Oss bone meal,is a material with extensive resources but no immunogenicity or risk of disease-transmission. The aim of this article was to study the clinical application of CHA in ridge preservation in the maxillary anterior zone. Methods Twenty-six patients underwent extraction of maxillary anterior teeth (n=26) for chronic periodontitis or periapical periodontitis. The patients were randomly assigned into a CHA and a control group of equal number to receive ridge preservation with CHA and Bio-Oss bone meal respectively. Cone beam computed tomography (CBCT) was performed immediately and at 4 months after ridge preservation to compare the vertical and horizontal alterations of the alveolar ridge be-tween the two groups of patients. Results After ridge preservation,both the CHA and control groups showed a reduction in the width ([1.1±0.7] vs [1.3±1.9] mm) and height of the alveolar ridge ([1.3±1.6] vs [1.2±1.4] mm),but with no statistically significant differences between the two groups (P<0.05). Conclusion For ridge preservation in the maxillary anterior zone,CHA has a similar effect to that of Bio-Oss bone meal and therefore is an ideal material for bone graft.

Uma atualização sobre biomateriais em implantodontia / Biomaterials in Implantology: an update

O processo alveolar é uma estrutura dente dependente que sofre alterações dimensionais após a exodontia. Defeitos ósseos resultantes prejudicam a colocação de implantes e o sucesso em longo prazo. Diversas técnicas cirúrgicas e biomateriais tem sido apresentados como opções terapêuticas para preservação e recuperação dos rebordos edêntulos. Assim, o objetivo desta revisão narrativa é evidenciar o estado atual dos biomateriais disponíveis bem como as possíveis perspectivas futuras. A utilização de biomateriais para cirurgias de reconstrução e manutenção de rebordo alveolar com sucesso é evidente. As cirurgias de reconstrução e preservação de rebordo alveolar com a utilização de novos biomateriais apresentam sucesso evidente. A impressão em 3D de estruturas biocompatíveis, fatores de crescimento, a matriz de dentina desmineralizada (DDM), parafusos e membranas reabsorvíveis podem ser as perspectivas futuras.

The alveolar bone depends on the presence of teeth and dimensional changes occurs after tooth extraction. The resulting bone defects impair both implant installation and long term success. Surgical procedures and biomaterials are considered as treatment options for maintenance and recovery of edentulous ridge. Thus, the aim of this narrative review is to present the current biomaterials as well as future perspectives. Surgical procedures for alveolar ridge preservation and reconstruction with new biomaterials are successful. 3D-Printed biocompatible scaffolds, growth factors, decellularized extracellular matrix (dECM), resorbable pins and membranes could be the future perspectives.