RESUMEN
OBJECTIVES: Assessment of the clinical performance of a porcine dentin-derived particulate bone graft material for bone regeneration after tooth extraction with implant placement at 4 months, in comparison to a commercially available porcine bone-derived graft. MATERIAL AND METHODS: This study was a randomized, parallel-group, semi-double-blinded clinical trial evaluating the clinical safety, tolerability, and performance of Ivory Dentin Graft™ in comparison with a commercial bone-derived material in alveolar ridge preservation following tooth extraction (registered at ClinicalTrials.gov, May 12th, 2017, Identifier NCT03150472). Extraction sites were grafted with test or comparator material and a titanium implant placed at 4 months after taking a graft site biopsy. Primary endpoints were the extent of new bone growth and bone-graft integration at 4 months. RESULTS: The dentin graft material had statistically significantly more new bone formation (60.75% vs 42.81%, p = 0.0084, N = 20 vs 16), better bone-graft integration scores (good integration in 85% vs 40%, p = 0.0066), and higher mean radiodensity of the bone (981.5HU vs 727.7HU, p = 0.0011) at the graft site compared to the bone-derived material. The mean implant insertion torque force was similar for the dentin and bone materials (34.75 Ncm vs 34.06 Ncm). Titanium implant placement was successful in 95% of patients with the dentin graft material compared to 81.25% for the bone graft. Both materials had similar clinical safety and tolerability as determined by adverse events and local site reactions. Physician-assessed ease of grafting and ease of implant placement on a 10-point scale showed no statistical differences (8.78 vs 8.27, p = 0.2355; 8.05 vs 8.75, p = 0.1118, respectively). CONCLUSIONS: A porcine dentin-derived bone graft material has clinical safety, tolerability, and performance for implant placement at 4 months after tooth extraction at least as good as a commercial bone-derived material. CLINICAL RELEVANCE: The availability of porcine dentin-derived bone graft material allows wider use of dentin-derived material which has so far only been available in the form of autologous dentin from the patient's own teeth.
Asunto(s)
Aumento de la Cresta Alveolar , Sustitutos de Huesos , Implantes Dentales , Animales , Porcinos , Implantación Dental Endoósea , Alveolo Dental/cirugía , Resultado del Tratamiento , Titanio/farmacología , Extracción Dental , Dentina , Trasplante ÓseoRESUMEN
The aim of this in vitro study was to investigate the commitment and behavior of dental pulp stem cells (DPSCs) seeded onto two different grafting materials, human dentin particulate (DP) and deproteinized bovine bone matrix (BG), with those cultured in the absence of supplements. Gene expression analyses along with epigenetic and morphological tests were carried out to examine odontogenic and osteogenic differentiation and cell proliferation. Compressive testing of the grafting materials seeded with DPSCs was performed as well. DPSC differentiation into odontoblast-like cells was identified from the upregulation of odontogenic markers (DSPP and MSX) and osteogenic markers (RUNX2, alkaline phosphatase, osteonectin, osteocalcin, collagen type I, bmp2, smad5/8). Epigenetic tests confirmed the presence of miRNAs involved in odontogenic or osteogenic commitment of DPSCs cultured for up to 21 days on DP. Compressive strength values obtained from extracellular matrix (ECM) synthesized by DPSCs showed a trend of being higher when seeded onto DP than onto BG. High expression of VEGF factor, which is related to angiogenesis, and of dentin sialoprotein was observed only in the presence of DP. Morphological analyses confirmed the typical phenotype of adult odontoblasts. In conclusion, the odontogenic and osteogenic commitment of DPSCs and their respective functions can be achieved on DP, which enables exceptional dentin and bone regeneration.
Asunto(s)
Osteogénesis , Células Madre , Adulto , Animales , Regeneración Ósea , Bovinos , Diferenciación Celular/fisiología , Proliferación Celular , Células Cultivadas , Pulpa Dental , Dentina , Humanos , Odontogénesis/fisiología , Osteogénesis/genética , Células Madre/metabolismoRESUMEN
Alveolar corticotomy has proven effective in shortening orthodontic treatments in adults. A new non-invasive and flapless surgical approach has, however, yielded the same results. This technique, based on prior osteogenic alveoli preparation, entails neither anatomical risk nor post-op pain. The present article describes this new protocol and uses a case report to illustrate it.
Asunto(s)
Proceso Alveolar/cirugía , Remodelación Ósea , Osteotomía/métodos , Técnicas de Movimiento Dental , Adulto , Densidad Ósea , Humanos , Osteotomía/instrumentación , Piezocirugía , Cirugía Asistida por Computador , Factores de TiempoRESUMEN
Rehabilitation of severely atrophic jaws is facilitated when basal disk implants are used after activation of the future bony implant bed with a purpose-designed instrument (Osteotensor) 45 to 90 days before implant surgery. Fabrication of a highly rigid, screw-secured fixed prosthesis that acts as an external orthopedic fixator permits immediate functional loading. This protocol also represents a second chance for patients who have experienced complete implant loss and/or bone graft failure.
Asunto(s)
Pérdida de Hueso Alveolar/rehabilitación , Regeneración Ósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado/instrumentación , Fijadores Externos , Procedimientos Quirúrgicos Preprotésicos Orales/métodos , Anciano , Pérdida de Hueso Alveolar/patología , Pérdida de Hueso Alveolar/cirugía , Densidad Ósea , Implantación Dental Endoósea/instrumentación , Implantación Dental Endoósea/métodos , Implantes Dentales , Restauración Dental Provisional , Retención de Dentadura/instrumentación , Dentadura Completa , Femenino , Humanos , Carga Inmediata del Implante Dental , Maxilar/patología , Maxilar/cirugía , Procedimientos Quirúrgicos Preprotésicos Orales/instrumentación , Estrés Mecánico , Resultado del TratamientoRESUMEN
The authors describe a case of squamous cell carcinoma of the oral cavity managed by ablative surgery, mandibular reconstruction with a fibula free flap, and implant placement during the same session. Immediate functional implant loading, respecting the principles of basal implantology, was performed 48 hours later using a highly rigid, screw-secured fixed prosthesis that served as an external fixator for the implants and grafted bone. Implant loading before external beam radiotherapy improves flap stability, bone consolidation, and quality of life. Functional and esthetic outcomes were evaluated 2 years after radiotherapy was completed.