Effects of Bone Grafting and Non-Bone Grafting on Implant Stability and New Bone Formation in Patients Undergoing Maxillary Sinus Floor Elevation Combined with Bicon Short Implants.

Objective: To compare the effects of bone grafting versus non-bone grafting on implant stability and new bone formation in patients undergoing maxillary sinus floor lift combined with placement of a Bicon short dental implant. Methods: We recruited 60 patients with posterior maxillary tooth loss and insufficient jaw bone mass from December 2017 to December 2019, and the patients were divided into 2 groups in accordance with the surgical method: the bone grafted group (n = 32) and the non-bone grafted group (n = 28). Both groups underwent maxillary sinus floor elevation combined with Bicon short dental implant placement. No bone-grafting materials were used in the non-bone grafted group, and autologous bone chips mixed with Bicon bone substitute were used for bone grafting in the bone grafted group. The 2 groups were compared for their peri-implant index and periodontal bleeding index immediately after the operation, as well as at 3, 6, and 12 months postoperatively. The study also compared the sub-sinus-membrane height, peri-implant bone density, implant stability quotient, and alveolar bone height in the implant area at 3, 6, and 12 months after the operation, as well as the implant survival rate and complications (infection, bleeding, mucosal perforation, sinus-floor cyst, and bone-graft displacement) 12 months after the operation. Results: The peri-implant index and periodontal bleeding index immediately after the operation in the bone grafted group were higher than those in the non-bone grafted group (all P < .05), but there were no significant differences in the 2 indices between the 2 groups at 3, 6, and 12 months after the operation (all P > .05). The sub-sinus-membrane height, peri-implant bone density, implant stability quotient, and alveolar bone height in the bone grafted area were higher in the bone grafted group than in the non-bone grafted group at 3, 6, and 12 months after the operation (all P < .05). Although the implant survival rate in the bone grafted group was slightly higher than that in the non-bone grafted group at 12 months after the operation, the difference was not statistically significant (P > .05). One case of mucosal perforation occurred in the bone grafted group, but there was no significant difference in the complication rate between the 2 groups (P > .05). Conclusion: The findings of this study support the use of autologous bone chips mixed with Bicon bone substitute in maxillary sinus floor elevation combined with Bicon short dental implant placement for improved implant stability and new bone formation. Further research is needed to evaluate long-term outcomes and potential complications associated with this technique.

Long-Term Safety of Bone Regeneration Using Autologous Stromal Vascular Fraction and Calcium Phosphate Ceramics: A 10-Year Prospective Cohort Study.

This prospective cohort study aimed to assess long-term safety, dental implant survival, and clinical and radiological outcomes after maxillary sinus floor elevation (MSFE; lateral window technique) using freshly isolated autologous stromal vascular fraction (SVF) combined with calcium phosphate ceramics. All 10 patients previously participating in a phase I trial were included in a 10-year follow-up. They received either ß-tricalcium phosphate (ß-TCP; n = 5) or biphasic calcium phosphate (BCP; n = 5) with SVF-supplementation on one side (study). Bilaterally treated patients (6 of 10; 3 ß-TCP, 3 BCP) received only calcium phosphate on the opposite side (control). Clinical and radiological assessments were performed on 44 dental implants at 1-month pre-MSFE, and 0.5- to 10-year post-MSFE. Implants were placed 6 months post-MSFE. No adverse events or pathology was reported during a 10-year follow-up. Forty-three dental implants (98%) remained functional. Control and study sides showed similar peri-implant soft-tissue quality, sulcus bleeding index, probing depth, plaque index, keratinized mucosa width, as well as marginal bone loss (0-6 mm), graft height loss (0-6 mm), and graft volume reduction. Peri-implantitis was observed around 6 implants (control: 4; study: 2) in 3 patients. This study is the first to demonstrate the 10-year safety of SVF-supplementation in MSFE for jawbone reconstruction. SVF-supplementation showed enhanced bone regeneration in the short term (previous study) and led to no abnormalities clinically and radiologically in the long term.

Radiographic outcome after maxillary sinus floor augmentation with allogeneic adipose tissue-derived stem cells seeded on deproteinized bovine bone mineral. A randomized controlled experimental study.

The objective was to test the hypothesis of no difference in radiographic outcome after maxillary sinus floor augmentation (MSFA) with allogeneic adipose tissue-derived stem cells (ASCs) seeded on deproteinized bovine bone mineral (DBBM) (test) compared with excipient on DBBM (control). Eighteen minipigs were assigned into three groups of six animals and euthanised after one month (T1), two months (T2), and four months (T3), respectively. Each maxillary sinus was randomly allocated to either test or control with an equal volume of graft. Computed tomography scans (CTs) after MSFA (T0) were compared with CTs after euthanasia to evaluate graft volume (GV) changes and bone density (BD) using three-dimensional measurements and Hounsfield units. GV was larger in test compared with control at T1 (P = 0.046), whereas GV was larger in control compared with test at T3 (P = 0.01). BD increased from T0 to T1-T3 (P < 0.001) with both treatments. Higher BD was observed in control compared with test at T3 (P = 0.01), while no significant difference was observed at T1 and T2. Conclusively, the present study demonstrate that allogeneic ASCs seeded on DBBM in conjunction with MSFA seemed not to improve the radiographic outcome compared with excipient on DBBM. However, radiological outcomes need to be supplemented by bone histomorphometry before definitive conclusions can be provided about the beneficial use of allogeneic ASCs seeded on DBBM in conjunction with MSFA compared with DBBM alone.

Comparison of Biological Characteristics of Different Paranasal Sinus Mucosa in Goats.

BACKGROUND/PURPOSE: Prosthetic implants are the primary treatment for patients with edentulism. This study aims to explore and compare the biological characteristics of mucosal thickness and tensile strength of the paranasal sinuses (maxillary and frontal sinuses) in goats, thereby providing a theoretical basis and guidance for mucosa-related problems involved in maxillary sinus lifting. MATERIALS AND METHODS: The paranasal sinus mucosa (maxillary sinus crest, maxillary sinus floor and frontal sinus mucosa) was obtained from the goats for use in maxillary sinus lifting. The mucosa was made into tissue section specimens and evaluated by a computer with built-in screenshot software and an optical microscope with a graduated eyepiece. A total of 3 readings were randomly selected and recorded. The mucosa was clamped with a laboratory-made clamp device. After connecting the push-pull meter, the mucosa exposed by the inner ring of the clamp device was pressed vertically and uniformly until it ruptured. The strength value was read and recorded. The left and right ends of the mucosa were connected with the clamp device; horizontal tension was applied evenly to the mucosa until the mucosa ruptured. The strength value was read and recorded. The normality test, analysis of variance, LSD pairwise comparison and linear regression were performed for each group of data. RESULTS: The thicknesses of the maxillary sinus crest mucosa, floor mucosa and frontal sinus mucosa in goats were 410.03 ± 65.97 um, 461.33 ± 91.37 um and 216.90 ± 46.47 um, respectively. There were significant differences between the maxillary sinus crest and frontal sinus and the maxillary sinus floor and frontal sinus (P < .05). The range of tensile strength of the maxillary sinus crest mucosa, floor mucosa and frontal sinus mucosa in goats was 0.48 ± 0.10 kg, 0.54 ± 0.11kg and 0.20 ± 0.05kg, respectively. There were significant differences between the maxillary sinus crest and frontal sinus and the maxillary sinus floor and frontal sinus (P < .05). Tensile strength was positively correlated with the thickness of the mucosa of the maxillary and frontal sinuses (P < .05). CONCLUSION: The mucosal thickness and tensile strength of the maxillary sinus crest and floor were greater than those of the frontal sinus mucosa. There was a positive correlation between the tensile strength and the thickness of the mucosa.

Greek gods and the double-edged sword of liver regeneration.

In the current issue of the Biomedical Journal we gain an insight into the regeneration of liver tissue and how an over-the-counter supplement, stem cells and two plant extracts counteract liver damage. Furthermore the advances against hepatitis C virus are presented, the role of long non-coding RNA elucidated as well as the potential of an adhesion G protein-coupled receptor. In another contribution, the definition and evolutionary impact of copy number variants is clarified. Also, the polymorphism of a scaffolding caspase is investigated. We furthermore learn about the relation between SARS-CoV2 mutants in dependence of geography and explore the challenges of telemedicine in a complex healthcare field. A novel approach to engineering artificial grafts is presented, the challenges of total knee arthroplasty discussed as well as a possible mean of sinus floor elevation for dental implants. At last the concept of flipped classroom is scrutinized in terms of usefulness for a hospital in Taiwan.

Patient's perception of recovery after maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: a single-blinded randomized controlled trial.

BACKGROUND: Autogenous bone graft is considered as the preferred grafting material for maxillary sinus floor augmentation (MSFA). However, harvesting of extraoral or intraoral autogenous bone graft is associated with risk of donor site morbidity and supplementary surgery. From a clinical and patient perspective, it would therefore be an advantage, if postoperative discomfort could be minimized by diminishing the need for autogenous bone graft harvesting. The objective of the present study was to test the hypothesis of no difference in patient's perception of recovery after MSFA with autogenous bone graft from the zygomatic buttress (control) compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral (DPBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients were randomly allocated to either control or test groups. Oral Health-related Quality of Life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment. Recovery was estimated by self-administrated questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment and discomfort after 1 week and 1 month. Descriptive statistics was expressed as mean with standard deviation (SD). Correlation between OHRQoL at enrollment and recovery were assessed by linear regression. p-value below 0.05 was considered significant. RESULTS: Treatment satisfaction and willingness to undergo similar surgery were high in all groups. Average numbers of days with pain and sick leave were 3.5 (SD 3.9) and 0.5 (SD 1.2), respectively, with no significant difference between groups. Moreover, no significant difference in eating and speaking ability, physical appearance, work performance and sleep impairment were seen between groups. Mean OHIP-14 score at enrollment was 9.30 (SD 9.25) (control), 9.95 (SD 7.96) (Test I) and 8.15 (SD 9.37) (Test II), with no significant differences between groups. Impaired OHRQoL, gender or age seems not to predispose for delayed recovery or increased postoperative discomfort. CONCLUSIONS: MSFA with diminutive autogenous bone graft harvesting is associated with high patient satisfaction, limited postoperative discomfort and willingness to undergo similar surgery. Presurgical OHRQoL, gender or age seems not to be associated with impaired patient's perception of recovery.

The Effect of Hyperbaric Oxygen on Bone Healing Efficiency After Maxillary Sinus Lateral Augmentation Using Xenograft: An In Vivo Pilot Study on Histomorphometric Analysis.

It was hypothesized that hyperbaric oxygen (HBO) could increase bone healing efficiency according to a protocol with a special window of healing time when maxillary sinus lateral augmentation is performed with only xenograft. The histomorphometric efficiency of HBO on the maxillary sinus lateral augmentation was examined by designing five different in vivo healing periods. Five patients receiving maxillary sinus lateral augmentation with xenograft each received a different treatment healing protocol: 6 weeks natural healing (control [Ctl]), 5 weeks with HBO (T1), 6 weeks with HBO (T2), 9 weeks with HBO (T3), and 13 months natural healing (TM). Biopsy samples were harvested, and quantitative histomorphometric analysis was performed regarding key factors BMP-2 and RUNX2. Analysis of variance and Tukey test were used for pairwise comparisons. Time-dependent relationships of the factors' expression densities were conducted using quadratic regression fitting. There were statistically significant differences among the groups, except for T2/T3 and T2/TM for BMP-2 and for T2/T3 and TM/Ctl for RUNX2. Both BMP-2 and RUNX2 showed quadratic trends, presenting an initial upward trend and eventually a downward trend depending on T1, T2, and T3 groups. Early stimulation, achieved by keeping HBO until 6 to 9 weeks after maxillary sinus lateral augmentation with xenograft, seemed to be the time window that benefitted bone healing efficiency the most.

The Effect of Autologous Platelet Concentrates on Maxillary Sinus Augmentation: A Meta-Analysis of Randomized Controlled Trials and Systematic Review.

INTRODUCTION: To assess the efficacy of the autologous platelet concentrates (APCs) combined with autologous bone or bone substitute for the maxillary sinus floor lifting by a meta-analysis. MATERIALS AND METHODS: Electronic databases (PUBMED, Web of Science, EMBASE through OVID, and Cochrane Library) were searched until Dec 31, 2019, and only randomized controlled trials (RCTs) in English were identified. Outcome variables included histologic evaluation, the implant stability quotient values, and radiographic evaluation. Data were analyzed by Revman5.3; the estimate of effect sizes was expressed as the 95% confidence interval; and the risk of bias was evaluated using the Cochrane Collaboration tool. RESULTS: 11 RCTs involving 141 patients (214 sites) were included in our meta-analysis, which indicated that the differences in the percentage of contact length among newly formed bone (2.61%, 95% CI, -1.18% to 7.09%), soft tissue area (-0.15%, 95% CI, -0.54% to 0.24%), and residual bone substitute material (-5.10%, 95% CI, -10.56% to 0.36%) in the APC group lacked statistical significance. Besides, there was the same effect on the implant stability quotient (ISQ) values of APC group who underwent implant placement 4 months after sinus augmentation and control group who received implant placement 8 months after sinus augmentation (-0.48, 95% CI, -1.68 to 0.72). No significant effect of APCs on the bone density was found (1.05%, 95% CI, -1.69% to 3.82%). CONCLUSIONS: The use of APCs in sinus augmentation may be further shorten the time required for bone graft maturation and allow earlier implant placement, but cannot enhance the bone formation in the long term. It is not currently recommended for routine use APCs as an osteoinductive material to bone grafting in sinus augmentation.

The impact of graft remodeling on peri-implant bone support at implants placed concomitantly with transcrestal sinus floor elevation: A multicenter, retrospective case series.

OBJECTIVES: To evaluate the impact on peri-implant bone support (as assessed on periapical radiographs) of the remodeling dynamics of varying graft biomaterials used for transcrestal sinus floor elevation (tSFE). METHODS: The study is a multicenter, retrospective series of cases undergone tSFE (performed according to the Smart Lift technique) and concomitant implant placement. At operator's discretion, tSFE was performed with bone core (BC) alone or supplemented by deproteinized bovine or porcine bone mineral (DBBM and DPBM, respectively), synthetic hydroxyapatite in a collagen matrix (S-HA), or ß-tricalcium phosphate (ß-TCP). Immediately after surgery, at 6-12 months post-surgery, and at later (≥24 months) follow-up intervals, the percentage proportion of the implant surface in direct contact with the radiopaque area was calculated for the entire implant surface (totCON%). Also, the height of the graft apical to the implant apex (aGH) was assessed. RESULTS: At 6-12 months following tSFE, median totCON% was 100%, with a median aGH of 1.4 mm. A tendency of aGH to decrease in height was observed at later follow-up intervals for sites treated with all grafting procedures. In all treatment groups, the majority of the implant surface was still surrounded by the radiopaque area at the longest follow-up visits. CONCLUSIONS: Although the height of the peri-implant radiopaque area apical to the implant apex tends to reduce overtime at sites which have received tSFE, the peri-implant bone support seems to be maintained long term irrespective of the graft material used.

[Nursing cooperation during maxillary sinus lateral fenestration and bone grafting].

PURPOSE: To summarize the experience and effect of holistic quality nursing during perioperative period of maxillary sinus lateral fenestration. METHODS: From January 2010 to December 2016, there were a total of 26 patients with maxillary sinus lateral fenestration in the First Dental Clinic Department. Through observation and analysis of nursing cooperation combined with psychological nursing in the perioperative period, coordination and postoperative nursing, the overall experience and effect of holistic quality nursing were summarized. RESULTS: All 26 patients received effective bone increment after operations without any complications. Nursing cooperation and psychological nursing were essential and effective during perioperative period of maxillary sinus lateral fenestration. CONCLUSIONS: Modern holistic quality nursing embodied thoughtful preoperative preparation, suitable psychological nursing, accurate nursing cooperation and postoperative meticulous care follow up, which plays an important role in the success of maxillary sinus lateral fenestration.

Simplificando o tratamento de paciente em uso de rivaroxabana através da cirurgia guiada ­ relato de caso / Simplifying treatment for patient using rivaroxaban through guided surgery ­ case report

O número de pacientes em tratamento com anticoagulantes necessitando de tratamento odontológico cresceu consideravelmente nos últimos anos. Dessa forma, os clínicos que trabalham com Implantodontia devem estar preparados para esses pacientes e possíveis complicações. O presente estudo objetiva fazer um relato de caso sobre o manejo clínico de paciente de 70 anos de idade com histórico de hemorragia severa associada ao uso do anticoagulante rivaroxabana, mostrando como o uso da cirurgia guiada pode simplificar e viabilizar reabilitações com implantes dentários em pacientes com essa condição. Para isso, foi realizado escaneamento intraoral e planejamento virtual em software específico para instalação de dois implantes Straumann em região posterior direita, onde já havia sido realizado um levantamento de seio maxilar. O procedimento cirúrgico transcorreu de forma rápida e sem complicações, com alta aceitação por parte do paciente, que recebeu a reabilitação protética final aproximadamente 3 meses após a instalação dos implantes. Concluiu-se que a cirurgia guiada é uma excelente alternativa para reduzir morbidade e risco de hemorragia em pacientes fazendo uso de rivaroxabana (AU).

The number of patients receiving anticoagulants requiring dental treatment has increased considerably in recent years. Thus, clinicians working with Implantology should be prepared to treat these patients and possible complications. This study aims to present a case report on the clinical management of a 70-year-old patient with a history of severe hemorrhage associated with the use of rivaroxaban anticoagulant, showing how the use of guided surgery can simplify and enable rehabilitation with dental implants in patients with this condition. In order to do this, we performed intraoral scan and virtual planning in specific software for the placement of two Straumann implants in the right posterior region, where a maxillary sinus lift had already been performed. The surgical procedure was performed quickly and without complications, with high acceptance by the patient, who received the final prosthetic rehabilitation approximately 3 months after implant placemenet. It is concluded that guided surgery is an excellent alternative to reduce morbidity and risk of hemorrhage in patients taking rivaroxaban (AU).

Bone Formed After Maxillary Sinus Floor Augmentation by Bone Autografting With Hydroxyapatite and Low-Level Laser Therapy: A Randomized Controlled Trial With Histomorphometrical and Immunohistochemical Analyses.

PURPOSE: The aim of this study was to evaluate the bone formed after maxillary sinus floor augmentation (MSFA) by bone autografting combined with hydroxyapatite (HA) that had been either treated with low-level laser therapy (LLLT) or not. MATERIALS AND METHODS: Twelve biopsies were obtained from patients 6 months after MSFA using a combination of 50% of autogenous bone (AB) and 50% of HA (AB/HA group, n = 6) followed by LLLT (AB/HA-LLLT group, n = 6). The laser used in this study was gallium-aluminium-arsenide laser with a wavelength of 830 nm (40 mW; 5.32 J/point; 0.57 W/cm). Samples obtained were subjected to histological, histometric, and immunohistochemical analysis for detection of tartrate-resistant acid phosphatase and runt-related transcription factor 2. The data were submitted to statistical analysis (Shapiro-Wilk and Student t tests; α = 5%). RESULTS: Statistical analysis revealed no significant difference in vital bone presence and immunohistochemical analysis between the groups. There was no reduction in bone marrow or fibrous tissue in the AB/HA group and AB/HA-LLLT group. There was a decrease in the amount of remaining biomaterial between the groups (P = 0.0081). CONCLUSION: LLLT did not increase the formation of new bone; instead, it accelerated the bone remodeling process.

In-vitro and in-vivo design and validation of an injectable polysaccharide-hydroxyapatite composite material for sinus floor augmentation.

OBJECTIVE: Polysaccharide-based composite matrices consisting of natural polysaccharides, pullulan and dextran supplemented with hydroxyapatite (Matrix-HA) have recently been developed. The principal objective of this study was to evaluate the capacities of this composite material to promote new bone formation in a sinus lift model in the sheep. Secondary objectives were to evaluate in vitro properties of the material regarding cell adhesion and proliferation. METHODS: In this report, once such composite matrix was prepared as injectable beads after dispersion in a physiological buffer, and evaluated using a large animal model (sheep) for a sinus lift procedure. RESULTS: In vitro studies revealed that these microbeads (250-550µm in diameter) allow vascular cell adhesion and proliferation of Endothelial Cells (EC) after 1 and 7 days of culture. In vivo studies were performed in 12 adult sheep, and newly formed tissue was analyzed by Cone Beam Computed Tomography (CBCT scanning electron microscopy (SEM) and by histology 3 and 6 months post-implantation. CBCT analyses at the implantation time revealed the radiolucent properties of these matrices. Quantitative analysis showed an increase of a dense mineralized tissue in the Matrix-HA group up to 3 months of implantation. The mineralized volume over total volume after 6 months reached comparable values to those obtained for Bio-Oss® used as positive control. Histological examination confirmed that the Matrix-HA did not induce any long term inflammatory events, and promoted direct contact between the osteoid tissue and lamellar bone structures and beads. After 6 months, we observed a dense network of osteocytes surrounding both biomaterials as well as a newly vascularized formed tissue in close contact to the biomaterials. SIGNIFICANCE: In conclusion, the absence of animal components in Matrix-HA, the osteoconductive property of Matrix-HA in sheep, resulting in a dense bone and vascularized tissue, and the initial radiolucent property to follow graft integration offer great promises of this composite material for clinical use.

Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review.

AIM: To analyse the effect of leucocyte- and platelet-rich fibrin (L-PRF) on bone regeneration procedures and osseointegration. MATERIALS AND METHODS: An electronic and hand search was conducted in three databases (MEDLINE, EMBASE and Cochrane). Only randomized clinical trials, written in English where L-PRF was applied in bone regeneration and implant procedures, were selected. No follow-up restrictions were applied. RESULTS: A total of 14 articles were included and processed. Three subgroups were created depending on the application: sinus floor elevation (SFE), alveolar ridge preservation and implant therapy. In SFE, for a lateral window as well as for the trans-alveolar technique, histologically faster bone healing was reported when L-PRF was added to most common xenografts. L-PRF alone improved the preservation of the alveolar width, resulting in less buccal bone resorption compared to natural healing. In implant therapy, better implant stability over time and less marginal bone loss were observed when L-PRF was applied. Meta-analyses could not be performed due to the heterogeneity of the data. CONCLUSIONS: Despite the lack of strong evidence found in this systematic review, L-PRF might have a positive effect on bone regeneration and osseointegration.

Lateral approach for maxillary sinus membrane elevation without bone materials in maxillary mucous retention cyst with immediate or delayed implant rehabilitation: case reports

This case series study demonstrates the possibility of successful implant rehabilitation without bone augmentation in the atrophic posterior maxilla with cystic lesion in the sinus. Sinus lift without bone graft using the lateral approach was performed. In one patient, the cyst was aspirated and simultaneous implantation under local anesthesia was performed, whereas the other cyst was removed under general anesthesia, and the sinus membrane was elevated in a second process, followed by implantation. In both cases, tapered 11.5-mm-long implants were utilized. With all of the implants, good stability and appropriate bone height were achieved. The mean bone level gain was 5.73 mm; adequate bone augmentation around the implants was shown, the sinus floor was moved apically, and the cyst was no longer radiologically detected. Completion of all of the treatments required an average of 12.5 months. The present study showed that sufficient bone formation and stable implantation in a maxilla of insufficient bone volume are possible through sinus lift without bone materials. The results serve to demonstrate, moreover, that surgical treatment of mucous retention cyst can facilitate rehabilitation. These techniques can reduce the risk of complications related to bone grafts, save money, and successfully treat antral cyst.

Manejo de tejidos blandos en regeneración/reconstrucción ósea mediante la técnica quirúrgica ‘Double Flap Incision Technique modificada’. Técnica de preservación del periostio / Oral surgery management of soft tissues with a new ‘Double Flap Incision Technique’ A periosteal preservation technique

Introducción: Las técnicas implantológicas demandan la existencia de unas estructuras óseas adecuadas en calidad y cantidad para alojar las fijaciones oseointegradas de un modo predecible. En ocasiones, el sustrato óseo es insuficiente, por lo que son necesarias técnicas de reconstrucción/regeneración ósea que precisan de un cierre primario completo para asegurarnos que los fenómenos que conducirán a la formación de nuevo tejido óseo se sucedan. El objetivo de este estudio es mostrar una serie de ocho casos clínicos donde la ‘Double Flap Incision Technique modificada’ nos sirve para reconstruir zonas de defecto óseo en la región mandibular posterior que limitaban la colocación de fijaciones oseointegradas. Métodos: Se realiza un estudio prospectivo de ocho casos clínicos procedentes de nuestra práctica privada, con déficit óseo en la zona posterior mandibular en pacientes demandantes de un tratamiento rehabilitador con prótesis fija implantosoportada. En todos los casos se utilizó la denominada ‘Double Flap Incision Technique modificada’ (DFITm). Resultados: En todos los casos conseguimos un cierre primario completo a los 15 días y fue posible la colocación de los implantes en la zona regenerada con criterio protésicamente guiado. Conclusión: La técnica de doble colgajo ‘Double Flap Incision Technique modificada’ nos permite llevar a cabo un adecuado cierre primario sin tensión en casos que requieran una reconstrucción o regeneración ósea, evitando la aparición de dehiscencias que conllevarían al fracaso del tratamiento (AU)

Introduction: Dental implants’ techniques needed to appropiate high-quality bones structures which can support osteointegration bindings in a predictable way. Occasionally, bone substrate is not the suitable one, it is for that reason that we need bone reconstruction and regeneration techniques in which we have to make a complete wound healing in order to guarantee bone regeneration in a correct way. The aim of this article is to comment eight case reports in which we used ‘Double flap incision technique’ to repair bone loss in posterior mandibular region. Methods: We have carried out a pilot study in about eight cases reports whose patients had bone loss in posterior mandibular region and treated with a dental implants’ repair treatment. ‘New Double Flap Incision Technique’ was used in all the cases we report. Results: We obtained an appropiate and complete wound healing in 15 days. In addition, dental implants were positionated in regenerated region correctly in all cases. Conclusion: This ‘New Double Flap Incision Technique’ provide us a way to obtain complete wound healing with no strain in cases which needed bone regeneration or reconstruction, avoid the presence of dehiscences which fail the treatment (AU)

Bone Regeneration Using the Freshly Isolated Autologous Stromal Vascular Fraction of Adipose Tissue in Combination With Calcium Phosphate Ceramics.

: In patients undergoing maxillary sinus floor elevation (MSFE) for dental implant placement, bone substitutes are currently evaluated as alternatives for autologous bone. However, bone substitutes have only osteoconductive properties and lack osteoinductive potential. Therefore, this phase I study evaluated the potential additive effect on bone regeneration by the addition of freshly isolated, autologous but heterologous stromal vascular fraction (SVF), which is highly enriched with adipose stromal/stem cells when compared with native adipose tissue. From 10 patients, SVF was procured using automatic processing, seeded on either ß-tricalcium phosphate (n = 5) or biphasic calcium phosphate carriers (n = 5), and used for MSFE in a one-step surgical procedure. Primary objectives were feasibility and safety. The secondary objective was efficacy, evaluated by using biopsies of the augmented area taken 6 months postoperatively, concomitant with dental implant placement. Biopsies were assessed for bone, graft, and osteoid volumes. No adverse effects were reported during the procedure or follow-up (≥3 years). Bone and osteoid percentages were higher in study biopsies (SVF supplemented) than in control biopsies (ceramic only on contralateral side), in particular in ß-tricalcium phosphate-treated patients. Paired analysis on the six bilaterally treated patients revealed markedly higher bone and osteoid volumes using microcomputed tomography or histomorphometric evaluations, demonstrating an additive effect of SVF supplementation, independent of the bone substitute. This study demonstrated for the first time the feasibility, safety, and potential efficacy of SVF seeded on bone substitutes for MSFE, providing the first step toward a novel treatment concept that might offer broad potential for SVF-based regenerative medicine applications. SIGNIFICANCE: This is the first-in-human study using freshly isolated, autologous adipose stem cell preparations (the stromal vascular fraction [SVF] of adipose tissue) applied in a one-step surgical procedure with calcium phosphate ceramics (CaP) to increase maxillary bone height for dental implantations. All 10 patients received CaP plus SVF on one side, whereas bilaterally treated patients (6 of 10) received CaP only on the opposite side. This allowed intrapatient evaluation of the potential added value of SVF supplementation, assessed in biopsies obtained after 6 months. Feasibility, safety, and potential efficacy of SVF for bone regeneration were demonstrated, showing high potential for this novel concept.

Implant Stability Development of Photofunctionalized Implants Placed in Regular and Complex Cases: A Case-Control Study.

PURPOSE: The objective of this study was to compare the rate of implant stability development of as-received and photofunctionalized dental implants in regular and complex cases. MATERIALS AND METHODS: Forty-nine implants (24 as-received and 25 photofunctionalized) placed in regular or complex cases (simultaneous guided bone regeneration, sinus elevation, or fresh extraction sockets) were studied. Photofunctionalization was performed by ultraviolet (UV) treatment of implants for 15 minutes using a photo device immediately prior to placement, and the generation of superhydrophilicity was confirmed. Implant stability was evaluated by measuring the implant stability quotient (ISQ) at placement (ISQ1) and at stage-two surgery (ISQ2). The rate of implant stability development was evaluated by calculating the osseointegration speed index (OSI), defined as the ISQ increase per month ([ISQ2-ISQ1]/healing time in months). The percentage of innate bone support at placement was evaluated clinically and radiographically. RESULTS: The average OSI was considerably greater for photofunctionalized implants (3.7 ± 2.9) than for as-received implants (0.0 ± 1.0). The OSI in complex cases was 4.2 ± 3.2 for photofunctionalized implants and 0.2 ± 0.9 for as-received implants. The OSI in cases with simultaneous sinus elevation was 5.5 ± 3.5 for photofunctionalized implants and 0.2 ± 1.1 for as-received implants. Photofunctionalized implants showed significantly higher ISQ2 values than as-received implants. Photofunctionalized implant ISQ2 values were greater than 60, regardless of primary stability and innate bone support at placement. In multivariate analysis including the effects of photofunctionalization, age and sex of patients, and diameter and length of implants, photofunctionalization showed the strongest influence on the OSI for both regular and complex cases, while other factors influenced the OSI only in certain conditions. CONCLUSION: Photofunctionalization accelerated the rate and enhanced the final level of implant stability development compared with as-received implants, particularly for implants placed into poor-quality bone and other complex cases. Photofunctionalization was a stronger determinant of implant stability than all the other tested implant- and host-related factors.

Systemic vitamin D supplementation and local bone formation after maxillary sinus augmentation - a randomized, double-blind, placebo-controlled clinical investigation.

OBJECTIVES: Maxillary sinus augmentation procedures with bone replacement grafts aimed to increase bone height in the posterior maxilla. During healing, bone particles are partially resorbed and replaced by the patient's own bone. Vitamin D plays an essential role in calcium homeostasis and is critical for bone formation and remodeling. MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical investigation studied whether oral supplementation with vitamin D3 (5000 IU) combined with calcium (600 mg) impacts bone formation and remodeling after maxillary sinus augmentation compared to a placebo medication containing calcium alone (n = 10/group). Bone cores were harvested at the time of implant placement (6-8 months) for histological analysis. RESULTS: Serum 25-hydroxyvitamin D (25-OHD) levels were comparable between both groups at the baseline (P = nonsignificant [n.s.]). Vitamin D3+ calcium supplementation improved significantly serum 25-OHD levels (placebo vs. vitamin D3 group: 25-OHD ng/ml: 31.13 ± 7.06 vs. 61.11 ± 20.42, P ≤ 0.01); however, no statistically significant difference in bone formation or graft resorption was detected between groups. However, in the vitamin D3 group, a significant association was found between increased vitamin D levels and number of bone-resorbing osteoclasts around graft particles suggesting that local bone remodeling might be more pronounced when serum vitamin D levels were improved (r = 0.92, P ≤ 0.05). CONCLUSIONS: Vitamin D3+ calcium supplementation improves serum vitamin D levels and potentially impacts local bone remodeling on a cellular level. However, no statistically significant difference in bone formation or graft resorption was detected between groups.

Hyaluronic Acid Versus Ultrasonic Resorbable Pin Fixation for Space Maintenance in Non-Grafted Sinus Lifting.

PURPOSE: An ultrasonic resorbable pin (SonicWeld, KLS Martin, Mühlheim, Germany) was compared with hyaluronic acid (Hyaloss Matrix, Anika Therapeutics, Bedford, MA) for their ability to maintain space in non-grafted sinus lifting. MATERIALS AND METHODS: A comparative split-mouth study was designed and implemented. Six women and 4 men were included (mean age, 56.7 yr). The primary predictors hyaluronic acid (HA) application and ultrasonic resorbable pin fixation (URPF) were coded as binary variables. The primary outcome variables were height of alveolar bone (HAB) and reduction in sinus volume (RSV). Secondary outcomes were bone density and implant survival. RESULTS: The postoperative mean HAB was significantly higher than the preoperative mean HAB on the 2 sides (P < .05). Mean increases in HAB and RSV on the URPF side were significantly greater than those on the HA side (P < .05). In total, patients were treated with 40 implants. No type I bone quality was identified; 14 (35%) implants were inserted in type II bone, 22 (50%) in type III bone, and 6 (15%) in type IV bone. There was no statistically meaningful difference between the 2 sides for implant survival or bone quality. At 6 months, all implants were clinically stable and the definitive prostheses were functional, resulting in a survival rate of 100%. CONCLUSIONS: There was sufficient bone height to eventually place implants on the 2 sides in all patients. The 2 techniques yielded predictable outcomes in implant survival and bone quality. However, HAB and RSV were considerably greater on the URPF side.