Evaluation of bone availability for grafts in different donor sites, through computed tomography.

OBJECTIVE: To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. METHODOLOGY: For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. RESULTS: The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. CONCLUSIONS: Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

Evaluation of bone availability for grafts in different donor sites, through computed tomography

Abstract Objective To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. Methodology For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. Results The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. Conclusions Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

Vital Bone Formation After Grafting of Autogenous Bone and Biphasic Calcium Phosphate Bioceramic in Extraction Sockets of Rats: Histological, Histometric, and Immunohistochemical Evaluation.

PURPOSE: The study aimed to investigate through histology, histometry, and immunohistochemistry the vital bone formation after grafting of biphasic calcium phosphate bioceramic (BC) in combination with calvarial autogenous bone into the dental sockets of rats. MATERIALS AND METHODS: Forty-five male rats were submitted to upper right incisor extraction and divided according to the grafted material in: control, bioceramic (BC), and bioceramic + autogenous bone (BC + AB). The animals were killed 7, 21, and 42 days after surgery for histological, histometric, and immunohistochemistry analysis. RESULTS: Histomorphometric results demonstrated, for BC + AB group, formation of trabecular bone between the particles of BCs and autogenous bone, connecting them, as well as higher percentage of vital bone in comparison with BC. Immunohistochemical reactions showed intense labeling for Runx2-positive cells in the group BC + AB. CONCLUSIONS: Autogenous bone was able to stimulate bone turnover enabling a larger amount of vital bone synthesis and can be recommended as a viable grafting material in combination with synthetic biphasic BC.

Influence of Platelet-Poor Plasma on Angiogenesis and Maintenance of Volume in Autogenous Bone Grafts.

PURPOSE: The aim of this study was to evaluate the effect of different storage media on angiogenesis and maintaining autogenous bone graft volume in rabbits. MATERIAL AND METHODS: Two grafts were removed bilaterally from the calvaria of 18 rabbits. One graft was removed and immediately fixed in the right mandibular angle (control group). The other graft was stored for 30 minutes in 1 of the following storage media (n = 6): saline solution (saline group), air exposure (dry group), or platelet-poor plasma (PPP group) and then retained by a screw in the right mandibular angle in the same animal. Four weeks later the animals were euthanized, and the grafted areas were harvested, fixed in 10% phosphate buffered formaldehyde solution, and embedded in paraffin. The 5-µm semi-serial sections were stained in hematoxylin and eosin and Mallory trichrome. RESULTS: Histologic analysis of all groups showed the bone graft was vascularized and well incorporated into the recipient site. The number of blood vessels decreased in the saline and dry groups compared with the control group (P < .03); in contrast, the number of blood vessels increased in the PPP group (P < .05). There were fewer osteoclasts in the saline group compared with the control group (P < .05). Furthermore, the saline group showed larger numbers of blood vessels than the dry group (P < .01). The PPP group showed larger bone graft volumes compared with the dry and saline groups (P < .01). In addition, the saline group showed larger bone graft volumes than the dry group (P < .01). CONCLUSIONS: PPP improved angiogenesis, maintained the volume of the autogenous bone graft, and was a better storage medium during the trans-surgical period than the dry and saline media.

To what extent does hyaluronic acid affect healing of xenografts? A histomorphometric study in a rabbit model.

Among the many graft materials that have been used for the treatment of bone defects in oral and maxillofacial regions is xenograft. To improve osteoconductive effects of xenografts, they have been combined with various biocompatible materials, such as hyaluronic acid and bone morphogenetic protein. To determine bone-healing capacity of high molecular weight hyaluronic acid (HA) combined with xenograft in rabbit calvarial bone defects. Ten adult male New Zealand rabbits (mean weight 3 kg) were included in the study. Three 6-mm-diameter bicortical cranial defects were created on calvarial bone of all rabbits. These defects were filled as follows: a) xenograft; b) HA+xenograft; c) autograft. One month after the first operation, rabbits were sacrificed. Specimens were evaluated histomorphometrically. Considering multiple comparisons, differences regarding new bone were statistically significant between all groups (p<0.05). The volume of residual graft was significantly decreased in HA group compared to xenograft group (p=0.035). Marrow space, trabecular thickness (TbTh), trabecular width (TbWi), trabecular separation (TbSp), and number of node: number of terminus (NNd:NTm) in the autograft group were significantly better than xenograft and HA groups (p<0.05). However, regarding marrow space, TbTh, TbWi, TbSp, and NNd:NTm values, xenograft and HA groups showed similar results and the difference were not significant (p>0.05). These results support that high molecular weight hyaluronic acid could contribute to the healing of xenograft by improving the percentage of new bone formation and reducing the percentage of residual graft. However, HA did not significantly affect the quality of newly formed bone assessed by microarchitectural parameters.

To what extent does hyaluronic acid affect healing of xenografts? A histomorphometric study in a rabbit model

ABSTRACT Among the many graft materials that have been used for the treatment of bone defects in oral and maxillofacial regions is xenograft. To improve osteoconductive effects of xenografts, they have been combined with various biocompatible materials, such as hyaluronic acid and bone morphogenetic protein. Objective: To determine bone-healing capacity of high molecular weight hyaluronic acid (HA) combined with xenograft in rabbit calvarial bone defects. Material and methods: Ten adult male New Zealand rabbits (mean weight 3 kg) were included in the study. Three 6-mm-diameter bicortical cranial defects were created on calvarial bone of all rabbits. These defects were filled as follows: a) xenograft; b) HA+xenograft; c) autograft. One month after the first operation, rabbits were sacrificed. Specimens were evaluated histomorphometrically. Results: Considering multiple comparisons, differences regarding new bone were statistically significant between all groups (p<0.05). The volume of residual graft was significantly decreased in HA group compared to xenograft group (p=0.035). Marrow space, trabecular thickness (TbTh), trabecular width (TbWi), trabecular separation (TbSp), and number of node: number of terminus (NNd:NTm) in the autograft group were significantly better than xenograft and HA groups (p<0.05). However, regarding marrow space, TbTh, TbWi, TbSp, and NNd:NTm values, xenograft and HA groups showed similar results and the difference were not significant (p>0.05). Conclusion: These results support that high molecular weight hyaluronic acid could contribute to the healing of xenograft by improving the percentage of new bone formation and reducing the percentage of residual graft. However, HA did not significantly affect the quality of newly formed bone assessed by microarchitectural parameters.

Repair of a Complicated Calvarial Defect: Reconstruction of an Infected Wound With rhBMP-2.

BACKGROUND: Management of the previously infected craniofacial defect remains a significant clinical challenge, posing obstacles such as wound healing complications, lack of donor site availability, and predisposition to failure of the repair. Optimal therapy would reconstruct like with like, without donor site morbidity. The purpose of this study was to compare the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)-mediated bone regeneration with the current standard of autologous bone graft for repair of previously infected calvarial defects. METHODS: Nineteen adult New Zealand white rabbits underwent subtotal calvariectomy. Bone flaps were inoculated with Staphylococcus aureus and replanted. After 1 week of infection, bone flaps were removed, and wounds were debrided, followed by 10 days of antibiotic treatment. After 6 weeks, animals underwent scar debridement followed by definitive reconstruction in 1 of 4 groups: empty control (n = 3), vehicle control (buffer solution on absorbable collagen sponge [ACS], n = 3), autologous bone graft (n = 3), or rhBMP-2 repair (rhBMP-2/ACS, n = 10). Animals underwent computed tomography imaging at 0, 2, 4, and 6 weeks postoperatively, followed by euthanization and histological analysis. Percent healing was determined by 3-dimensional analysis. A (time × group) 2-way analysis of variance was performed on healing versus treatment group and postoperative time. RESULTS: At 6 weeks postoperatively, rhBMP-2/ACS and autologous bone graft resulted in 93% and 68% healing, respectively, whereas the empty and vehicle control treatment resulted in 27% and 26% healing (P < 0.001). Histologically, compared to autologous bone graft, bone in the rhBMP-2/ACS group was more cellular and more consistently continuous with wound margins. CONCLUSIONS: The rhBMP-2 therapy is effective in achieving radiographic coverage of previously infected calvarial defects.

Avaliação da disponibilidade óssea para enxertos, na região de calota craniana, por meio da tomografia computadorizada de feixe cônico / Evaluation of available bone for grafting in the cranial bone region by means of cone beam computed tomography

A reabsorção óssea dos processos alveolares da maxila e mandíbula, após exodontias, é um grande problema para sua reabilitação estético-funcional. Entre as opções de tratamento, os enxertos ósseos são realizados com o objetivo de resolver esta carência de osso, e a escolha das possíveis áreas doadoras de osso para este tipo de reconstrução depende, principalmente, do volume de osso que se necessita e do tipo de defeito ósseo a ser corrigido, podendo ser proveniente de áreas doadoras intrabucais ou extrabucais. Quando a quantidade necessária de osso é pequena, pode-se utilizar áreas doadoras intrabucais. Para reconstruções maiores, as áreas doadoras extrabucais, como a crista do ilíaco, calota craniana, tíbia, fíbula e costelas são os locais de escolha. Entretanto, o volume de osso disponível nas diferentes áreas doadoras ainda é avaliado de forma empírica. Neste estudo foi considerada uma região correspondente à área doadora de formato hexagonal medindo 8cm de comprimento e 6cm de largura e logo em seguida foi calculado a área desse hexágono. Foram também realizadas medidas da espessura de osso cortical, osso medular e osso total, em 9 regiões da calota craniana, em 50 tomografias computadorizadas de feixe cônico (TCFC). Essas medidas foram realizadas com a ferramenta distância do software i-CAT Vision®, utilizado para a visualização dos exames em reformatações sagitais e coronais. O resultado da área do hexágono correspondente a área doadora multiplicado pela média de espessura dos 9 pontos da calota craniana foi de 2.499mm³.(AU)

The bone resorption of the alveolar processes of the maxilla and mandible, after exodontia, is a great problem for its aesthetic-functional rehabilitation. Among the treatment options, bone grafts are performed with the aim of solving this bone deficiency, and the choice of possible bone donor areas for this type of reconstruction depends, mainly, of the volume of bone required and the type of osseous defect to be corrected, which may be from intraoral or extraoral donor areas. When the required amount of bone is small, intraoral donor areas may be used. For larger reconstructions, extraoral donor areas, such as iliac crest, skull cap, tibia, fibula, and ribs are the sites of choice. However, the volume of bone available in the different donor areas is still evaluated empirically. In this study was considered a region corresponding to donor area of hexagonal shape measuring 8cm in lenght and 6cm in widht and then calculated the area of this hexagono. In this study, measurements of the thickness of cortical bone, medullary bone and total bone were performed in 9 regions of the skull cap in 50 conical beam computed tomography (CBCT) scans. These measurements were performed with the distance tool of the i-CAT Vision® software, used to visualize the exams in sagittal and coronal reformations. The result of hexagon area corresponding to donor area multiplies by average of the thickness of 9 points of skull cap was 2.499mm³.(AU)

Efeito da desmineralização do enxerto ósseo autógeno particulado no reparo de defeitos críticos em calvária de ratos. Estudo microscópico e microtomográfico / Effect of demineralization of particulate autogenous bone graft in critical size defects in rat calvaria. Microscopic and microtomográfic study

O processo de desmineralização óssea tem sido mostrado vantajoso em procedimentos de enxertia óssea empregando blocos osseos, porem a sua utilização na periodontia em enxertos osseos autógenos particulados não esta ainda descrita na literatura. De acordo com a literatura é possível observar que existem diferentes agentes demineralizantes na pratica clinica os quais podem ser empregados no processo de desmineralização óssea, razão pela qual este estudo teve como objetivo comparar dois diferentes agentes desmineralizantes de enxertos ósseos autógenos particulados (ácido cítrico pH1 a 50% e tetraciclina hidroclorada a 50mg/ml) em diferentes tempos de aplicação, quanto ao efeito produzido no reparo de defeitos críticos em calvária de ratos. Foram utilizados 120 ratos adultos machos com aproximadamente 4 meses de vida. Neste estudo foi utilizado o modelo de defeito crítico de 8 mm, esses animais foram divididos em 8 grupos de estudo formados por 15 animais (5 em cada período experimental): CN (controle negativo): os defeitos permaneceram sem enxerto; CP (controle positivo): os defeitos foram preenchidos por osso particulado não desmineralizado; AC 15: os defeitos foram preenchidos com osso particulado desmineralizado por ácido cítrico durante 15 segundos; AC 30: os defeitos foram preenchidos com osso particulado desmineralizado por ácido cítrico durante 30 segundos; AC 60: os defeitos foram preenchidos com osso particulado desmineralizado por ácido cítrico durante 60 segundos; TCN 15: os defeitos foram preenchidos com osso particulado desmineralizado por tetraciclina durante 15 segundos; TCN 30: os defeitos foram preenchidos com osso particulado desmineralizado por tetraciclina durante 30 segundos; TCN 60: os defeitos foram preenchidos com osso particulado desmineralizado por tetraciclina durante 60 segundos. Foi realizada aeutanasia dos animais aos 7, 30 e 60 dias para realização de microtomografia computadorizada e analise histomorfometrica, para avaliar a área, volume e densidade óssea nos defeitos após os tempos experimentais definidos. Aos 7 dias, não era esperada formação de tecido ósseo significante, mas surpreendentemente, os espécimes desmineralizados com ácido cítrico demonstraram precocidade na produção de eventos regenerativos já nesse período. Durante os períodos experimentais foi possível observar como os espécimes tratados com acido cítrico apresentavam maior formação óssea nos defeito quando comparados com os controles e com os grupos onde empregados tetraciclina. Efeito provavelmente relacionado com a eliminação da parte mineral do osso e liberação de Proteinas morfogeneticas ósseas e fatores de crescimentos, liberados a partir da matriz ossea Concluiu-se que a desmineralização com ácido cítrico do osso autógeno particulado enxertado em defeitos críticos promoveu maior área, volume e densidade de formação óssea do que a desmineralização com tetraciclina e do que a não desmineralização. Observando-se melhores resultados aos 15 e 30 segundos de desmineralização.(AU)

Bone demineralization process has been shown useful in bone grafting procedures using onlay bone grafting, however its use in periodontics in bony autogenous particulate graft is not yet described in the literature. According to the literature you can see that there are different demineralizantes agents in clinical practice which can be used in bone demineralization process, which is why this study was to compare two different demineralization agents of bone autogenous particulate graft (citric acid pH1 the 50% tetracycline Hydrochloride and 50mg / ml) in different application time, the effect produced in the repair of critical defects in rat calvarium. 120 adult male rats with approximately 4 months of age were used. In this study we used the 8mm critical defect model, the animals were divided into 8 study groups consisting of 15 animals (5 in each experimental period): CN (negative control): the defect remained free graft; CP (positive control): the defects were filled by nondemineralized bone particles; AC 15: The defects were filled with demineralized bone particles of citric acid for 15 seconds; AC 30: defects were filled with demineralized bone particles of citric acid for 30 seconds; AC 60: The defects were filled with demineralized bone particles of citric acid for 60 seconds; TCN 15: defects were filled with demineralized bone particles tetracycline for 15 seconds; TCN 30: defects were filled with demineralized bone particles tetracycline for 30 seconds; TCN 60: defects were filled with demineralized bone particles tetracycline for 60 seconds. aeutanasia animals was performed at 7, 30 and 60 days for performing computed microtomography and histomorphometric analysis to assess the area, bone volume and density of the defects after the defined experimental times. At 7 days, it was not expected significant formation of bone tissue, but surprisingly, samples demineralized with citric acid demonstrated earliness in the production of regenerative events already during this period. During the experimental periods was possible to observe how the specimens treated with citric acid showed increased bone formation in defects when compared to controls and to groups where employees tetracycline. Effect probably related to the disposal of the mineral part of bone and release of bone morphogenetic proteins and factors of growth, released from the bone matrix concluded that the demineralisation by citric acid particulate autogenous bone graft in critical defects caused greater area, volume formation and bone density than tetracycline demineralization and demineralization that do not. Observing better results at 15 and 30 seconds demineralization.(AU)

Survival rate of osseointegrated implants in atrophic maxillae grafted with calvarial bone: a retrospective study.

The aim of this study was to evaluate the clinical survival rate of osseointegrated implants placed in the atrophic maxilla that has been reconstructed by means of autogenous bone grafts harvested from a cranial calvarial site. Further, we sought to analyse the level of peri-implant bone after prosthetic rehabilitation and to determine subjective patient satisfaction with the treatment performed. This study conformed to the STROBE guidelines regarding retrospective studies. Twenty-five patients who had received osseointegrated implants with late loading in the reconstructed atrophic maxilla were included in the study. The survival rate and level of peri-implant bone loss were evaluated. A questionnaire related to the surgical and prosthetic procedures was completed. The observed implant survival rate was 92.35%. The mean bone loss recorded was 1.76mm in the maxilla and 1.54mm in the mandible. The results of the questionnaire indicated a high level of patient satisfaction, little surgical discomfort, and that the patients would recommend the procedure and would undergo the treatment again. From the results obtained, it is concluded that the cranial calvarial site is an excellent donor area; calvarial grafts provided stability and maintenance of bone volume over the course of up to 11 years.

Paired evaluation of calvarial reconstruction with prototyped titanium implants with and without ceramic coating

PURPOSE:To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating.METHODS:Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy.RESULTS:The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants.CONCLUSION:Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity.(AU)

Management of pure medial orbital wall fracture with autogenous bone graft.

The orbit is an irregular conical cavity formed from 7 bones including the frontal, sphenoid, zygomatic, maxillary, ethmoid, lacrimal, and palatine bones. Fractures of the internal orbit can cause a number of problems, including diplopia, ocular muscle entrapment, and enophthalmos. Although muscle entrapment is relatively rare, diplopia and enophthalmos are relatively common sequelae of internal orbital fractures. Medial orbital wall fracture is relatively uncommon and represents a challenge for its anatomical reconstruction. In this context, autogenous bone graft has been the criterion standard to provide framework for facial skeleton and orbital walls. Therefore, it is possible to harvest grafts of varying size and contour, and the operation is performed through the bicoronal incision, which is the usual approach to major orbital reconstruction. Thus, this article aimed to describe a patient with a pure medial orbital wall fracture, and it was causing diplopia and enophthalmos. The orbital fracture was treated using autogenous bone graft from calvarial bone. The authors show a follow-up of 12 months, with facial symmetry and without diplopia and enophthalmos. In addition, a computed tomography scan shows excellent bone healing at the anterior and posterior parts of the medial orbital wall reconstruction.

Cyclooxygenase-2 inhibition does not impair block bone grafts healing in rabbit model.

Success of alveolar reconstructions using onlay autogenous block bone grafts depends on their adequate integration to the recipient bed influenced by a number of local molecules. Considering the fundamental role of cyclooxygenase (COX-2) in bone repair, the aim of this study was to analyze the effect of its inhibition in the integration of endochondral (EC) iliac crest, and intramembranous (IM) calvaria bone grafts. Thirty-two rabbits were divided into 4 groups: Calvaria Control (CC) and Iliac Control--treated with oral 0.9 % saline solution, and Calvarial-NSAID (C-NSAID) and Iliac-NSAID (I-NSAID) groups--treated with oral 6 mg/Kg non-steroidal anti-inflammatory drug etoricoxib. After 7, 14, 30 and 60 days the animals were euthanized and the specimens removed for histological, histomorphometric and immunohistochemistry analysis. At day 60, a tight integration of IM blocks could be seen with the presence of remodeling bone, whereas integration of EC grafts was mainly observed at the edges of the grafts. A significant higher percentage of bone matrix in the interface region of the CC grafts in comparison to C-NSAID only at day 14, whereas no differences were detected comparing the EC grafts. No differences were observed in Runx-2 and vascular endothelial growth factor (VEGF) immunolabeling when comparing CC and C-NSAID groups, while a significant weaker Runx-2 and VEGF labeling was detected in I-NSAID group at day 60. Although some influence was detected in osteogenesis, it is concluded that drug induced inhibition of COX-2 does not impair onlay bone grafts' healing of both embryologic origins in rabbits.

Tomographic, histological, and immunohistochemical evidences on the use of N-butyl-2-cyanoacrilate for onlay graft fixation in rabbits.

BACKGROUND: The bone tissue responses to Cyanoacrylate have been described in the literature, but none used N-butyl-2-cyanoacrilate (NB-Cn) for bone graft fixation. PURPOSE: The aims of the study were: (a) to analyze the bone grafts volume maintenance fixed either with NB-Cn or titanium screw; (b) to assess the incorporation of onlay grafts on perforated recipient bed; and (c) the differences of expression level of tartrate-resistant acid phosphatase (TRAP) protein involved in bone resorption. MATERIALS AND METHODS: Eighteen New Zealand White rabbits were submitted to calvaria onlay grafting on both sides of the mandible. On one side, the graft was fixed with NB-Cn, while on the other hand the bone graft was secured with an osteosynthesis screw. The computed tomography (CT) was performed just after surgery and at animals sacrifice, after 1 (n = 9) and 6 weeks (n = 9), in order to estimate the bone grafts volume along the experiments. Histological sections of the grafted areas were prepared to evaluate the healing of bone grafts and to assess the expression of TRAP protein. RESULTS: The CT scan showed better volume maintenance of bone grafts fixed with NB-Cn (p ≤ 0.05) compared with those fixed with screws, in both experimental times (analysis of variance). The immunohistochemical evaluation showed that the TRAP expression in a 6-week period was significantly higher compared with the 1-week period, without showing significant difference between the groups (Wilcoxon and Mann-Whitney). Histological analysis revealed that the NB-Cn caused periosteum damage, but provided bone graft stabilization and incorporation similar to the control group. CONCLUSION: The perforation provided by screw insertion into the graft during fixation may have triggered early revascularization and remodeling to render increased volume loss compared with the experimental group. These results indicate that the NB-Cn possesses equivalent properties to titanium screw to be used as bone fixation material in osteosynthesis.

Radiographic evaluation of the effect of porcine submucosamembrane graft and bioactive glass on bone filling in rat calvaria / Avaliação radiográfica do efeito de membrana de submucosa suína e vidro bioativo no preenchimento ósseo em calvária de rato

Objectives: The aim of this study was to radiographically evaluate the filling of standardized bone defectsin rat calvaria treated with bioactive glass and with porcine submucosa membrane, alone or in combination,when compared to defects filled with clot. Materials and methods: Eighty male Wistar rats, weighing 250to 300 g, were divided into four groups, with trial period of two and eight weeks. Standardized bone woundswere surgically created in the calvaria measuring 6 mm in diameter and treated with bioactive glass, porcinesubmucosa membrane, combination of both or only clot. After two or eight weeks, the animals wereeuthanized and bone specimens were collected for evaluation with standard radiographs and digitized foranalysis with ImageJ image analyzer to compare the percentage of filling of the defects by measuring thevariations of levels of gray. Data were scored and analyzed statistically (ANOVA and Tukey HSD, p < 0.05).Results: The association of bioactive glass and submucosa membrane showed the best result of filling ofbone cavities, followed by the single use of bioactive glass. Membrane alone showed similar results withthe clot group. Conclusion: It was possible to conclude that the association of bioactive glass and porcinesubmucosa membrane could be good option for bone filling of bone defects.

Objetivos: O objetivo deste estudo foi avaliar radiograficamente o preenchimento de defeitos ósseos padronizados em calvária de ratos, tratados com vidro bioativo e com membrana de submucosa suína, isolados ou em associação, quando comparados com defeitos preenchidos com coágulo. Materiais e métodos: Oitenta ratos Wistar machos, pesando de 250 a 300 g, foram separados em quatro grupos, com períodos de avaliação de duas ou oito semanas. Defeitos ósseos padronizados foram cirurgicamente criados na calvária medindo 6 mm de diâmetro e tratados com vidro bioativo, membrana submucosa suína, combinação de ambos ou apenas com coágulo. Após duas ou oito semanas, os animais foram mortos e os espécimes ósseos foram coletados para avaliação com radiografias padronizadas e digitalizadas para análise com programa ImageJ, visando a comparar a porcentagem de preenchimento dos defeitos por meio da variação dos níveis de cinza. Os dados foram obtidos e avaliados estatisticamente (ANOVA e Tukey HSD, p < 0,05). Resultados: A associação do vidro bioativo com a membrana submucosa suína demonstrou os melhores resultados de preenchimento das cavidades ósseas,seguido pelo uso isolado do vidro bioativo. A membrana isolada demonstrou resultados semelhantes ao grupo coágulo. Conclusão: Foi possível concluir que a associação do vidro bioativo e da membrana submucosa suína pode ser uma boa opção para o preenchimento de defeitos ósseos.

Histomorphometric analysis of the repair process of autogenous bone grafts fixed at rat calvaria with cyanoacrylate.

OBJECTIVE: The purpose of this study was to perform histological and histometric analyses of the repair process of autogenous bone grafts fixed at rat calvaria with ethyl-cyanoacrylate adhesive. MATERIAL AND METHODS: Thirty-two rats were divided into two groups (n=16), Group I - Control and Group II - Adhesive. Osteotomies were made at the right parietal bone for graft obtainment using a 4-mm-diameter trephine drill. Then, the bone segments were fixed with the adhesive in the parietal region of the opposite side to the donor site. After 10 and 30 days, 8 animals of each group were euthanized and the calvarias were laboratorially processed for obtaining hematoxylin and eosin-stained slides for histological and histometric analyses. RESULTS: An intense inflammatory reaction was observed at the 10-day period. At 30 days, this reaction was less intense, despite the presence of adhesive at the recipient-site/graft interface. Graft incorporation to the recipient site was observed only at the control group, which maintained the highest graft size at 10 and 30 days. CONCLUSIONS: Although the fragment was stable, the presence of adhesive in Group II did not allow graft incorporation to the recipient site, determining a localized, discrete and persistent inflammatory reaction.

Histomorphometric analysis of the repair process of autogenous bone grafts fixed at rat calvaria with cyanoacrylate

OBJECTIVE: The purpose of this study was to perform histological and histometric analyses of the repair process of autogenous bone grafts fixed at rat calvaria with ethyl-cyanoacrylate adhesive. MATERIAL AND METHODS: Thirty-two rats were divided into two groups (n=16), Group I - Control and Group II - Adhesive. Osteotomies were made at the right parietal bone for graft obtainment using a 4-mm-diameter trephine drill. Then, the bone segments were fixed with the adhesive in the parietal region of the opposite side to the donor site. After 10 and 30 days, 8 animals of each group were euthanized and the calvarias were laboratorially processed for obtaining hematoxylin and eosin-stained slides for histological and histometric analyses. RESULTS: An intense inflammatory reaction was observed at the 10-day period. At 30 days, this reaction was less intense, despite the presence of adhesive at the recipient-site/graft interface. Graft incorporation to the recipient site was observed only at the control group, which maintained the highest graft size at 10 and 30 days. CONCLUSIONS: Although the fragment was stable, the presence of adhesive in Group II did not allow graft incorporation to the recipient site, determining a localized, discrete and persistent inflammatory reaction.

Avaliação da resistência a tração de diferentes enxertos em calvária de ratos / Evaluation of the tensile strength of different grafts in rat calvaria

A perda do osso alveolar como resultado de doença periodontal ou secundariamente à cirurgia são fontes de inúmeras complicações para os cirurgiões dentistas, e a solução para tal problema se baseiam em procedimentos regenerativos, que é realizada através de enxertos ósseos que estabelecem um arcabouço para a reparação tecidual, aumentando os tecidos ósseos nos defeitos resultantes de trauma ou cirurgias, preenchendo os alvéolos após extração para preservar a altura e espessura do rebordo alveolar e aumentando e/ou reconstruindo o rebordo alveolar. Este projeto tem como objetivo determinar a resistência à tração do osso neoformado com a utilização de diferentes biomateriais. Foram utilizados 60 animais divididos em 3 grupos. O grupo 1A (n=10): GenO; Grupo 1B (n=10): GenMix; Grupo1C (n=10): Bio-Oss; Grupo 2a (n=10): PerioGlas; Grupo 2b (n=10): Polímero de mamona e Grupo 3 (n=10): coágulo. Após 3 meses de nascimento os animais foram submetidos a anestesia intraperitonial e confecção de defeito não critico (3mm de diâmetro) na calvária dos animais, que foram preenchidos com os biomateriais correspondentes a cada grupo. Após 6 meses da cirurgia foi realizada a morte dos animais, os espécimes foram coletados e submetidos ao teste em uma máquina de teste universal. Observa-se que o grupo que obteve maior média de resistência à tração foi o grupo de polímero de mamona (10,932±4,529MPa). Consequentemente, obteve-se uma comparação descrescente na seguinte ordem: Coágulo (9,563±3,74MPa), Bio-Oss (8,706±4,087MPa), GenMix (8,587±3,602MPa), GenOx (7,709±2,416MPa), PerioGlas (7,185±6,837MPa), não notando-se diferença estatisticamente significante entre os grupos. Nas microscopias eletrônicas de varredura na maioria dos grupos observou-se presença de fibras colágenas ao redor do tecido ósseo neoformado e dos remanescentes de enxerto. Conclui-se que o material foi indiferente para o resultado final da resistência à tração, demonstrando uma...

The loss of alveolar bone as a result of periodontal disease or secondary to surgery are numerous sources of complications for the dentists, and the solution to this problem are based on regenerative procedures, which is conducted through bone grafts that provide a scaffold for tissue repair by increasing the bone tissues in the defects resulting from trauma or surgery, filling the alveoli after extraction to preserve the height and thickness and increasing the alveolar ridge and/or reconstructing the alveolar ridge. This project aims to determine the tensile strength of newly formed bone with the use of different biomaterials. We used 60 animals divided into three groups. Group 1A (n = 10): GenOx; Group 1B (n = 10): GenMix; Group 1C (n = 10): Bio-Oss; Groups 2a (n = 10): PerioGlas; Group 2b (n = 10): castor bean polymer; Group 3 (n = 10): clot. After 3 months of birth the animals were anesthetized intraperitoneally and making non critical defect (3mm diameter) in the calvaria of the animals, which were filled with biomaterials for each group. After 6 months of surgery was performed the animals' death, the specimens were collected and tested in a universal testing machine. It is observed that the group had a higher average tensile strength was the castor oil polymer group (10.932 ± 4.529 MPa). Consequently, we obtained a comparison descended in the following order: Clot (9.563 ± 3.74 MPa), Bio-Oss (8.706 ± 4.087 MPa), GenMix (8.587 ± 3.602 MPa), GenOx (7.709 ± 2.416 MPa), PerioGlas (7.185 ± 6.837 MPa), not noticing a significant difference between the groups. In scanning electron microscopies in most groups there was presence of collagen fibers around the newly formed bone and remaining graft. It is concluded that the material was irrelevant to the final result of the tensile strength, showing a good quality of materials used, both when comparing products as their source (xenogenic, polymeric or clot), or its origin of manufacture (national or imported).

Avaliação histomorfométrica comparativa do processo de reparo de defeitos ósseos perenes em calvária de ratos tratados com -fosfato tricálcio, hidroxiapatita sintética, hidroxiapatita sintética + beta-fosfato tricálcio e osso autógeno / Histomorphometric comparative evaluation of the repair of perennial bone defects in rats skulls treated with -tricalcium phosphate, synthetic hydroxyapatite, synthetic hydroxyapatite + beta-tricalcium phosphate and autogenous graft

Os objetivos do trabalho foram caracterizar as biocerâmicas a base de hidroxiapatita (HA), -fosfato tricálcio (TCP) e o compósito HA/TCP na proporção 60:40 pela análise microestrutural e por Espectrometria de Energia Dispersiva de Raios-X (EDS) ao microscópio eletrônico de varredura, e comparar histomorfometricamente o processo de reparo ósseo de defeitos cranianos perenes tratados com essas três diferentes cerâmicas e o enxerto autógeno nos períodos de 0, 30, 90 e 180 dias pós-operatório. Microestruturalmente, a HA apresentou superfície irregular com concavidades, fendas e grande quantidade de microporos; o TCP exibiu superfície irregular e baixa resistência mecânica; a HA/TCP apresentou superfície lisa com raras concavidades e ausência de porosidades. As cerâmicas estavam constituídas pelos elementos O, P e Ca, sendo que a relação Ca/P seguiu a ordem: HA/TCP > HA > TCP. Morfometricamente, o volume inicial enxertado foi aproximadamente de 60 mm3 para todos os tratamentos. Entre 30 e 180 dias, o volume total da região do enxerto (Vtre) e do material enxertado (VM) manteve-se constante nos defeitos tratados com osso autógeno (Vtre = 53,61 mm³, VM =20,11 mm³), HA (Vtre = 60,13mm³, VM = 32,72 mm³), HA/TCP (Vtre = 57,60mm³, VM = 31,61 mm³), TCP (Vtre = 38,27mm3, VM = 10,07 mm³). Aos 30 dias, o volume de tecido ósseo no grupo autógeno foi de 22,06 mm³, ocupando quase a totalidade dos espaços entre as partículas, enquanto que, nos grupos HA e HA/TCP foi de apenas 7,62 mm³, sendo parte dos espaços (19,10 mm3), constituído por tecido conjuntivo fibroso. Entre 30 e 180 dias, o volume de tecido ósseo não apresentou diferenças estatísticas significantes (p>0,05). O número absoluto de osteoblastos e osteócitos no grupo autógeno foi, respectivamente, de 118,57 x102 e 178,57 x102 células, aos 30 dias, diminuindo 40,16% e 29,09% aos 90 dias, decorrente do processo de remodelação óssea. Nos grupos HA e HA/TCP, o número absoluto de osteoblastos e osteócitos foram...

The aim of the work was to characterize the ceramics: hydroxyapatite (HA), -tricalcium phosphate (TCP) and the composite HA/TCP (60:40) through scaning electron microscope - energy dispersive system (SEM-EDS) analysis and to compare histomorphometrically the repair of perennial skull defects treated with these three different ceramics and autogenous graft at 0, 30, 90 and 180 days post-operatively. Microstructurally, HA showed irregular surface with concavities, cracks and several pores. TCP also presented irregular surface and low mechanical strength. HA/TCP showed smooth surface with rare concavities and pores. The ceramics were constituted by the elements O, P and Ca, and the relation Ca/P follow the order: HA/TCP > HA > TCP. Morphometrically, the initial graft volume was approximately 60 mm3 for all treatments. Between 30 and 180 days, the total volume of the grafted area (Vtga) and of the implanted material (Vim) were constant in the following groups: autogenous (Vtga = 53,61 mm³; Vim = 20,11 mm3), HA (Vtga = 60,13mm³; Vim = 32,72 mm3), HA/TCP (Vtga = 57,60mm³; Vim = 31,61 mm3) and TCP (Vtga = 38,27mm³; Vim = 10,07 mm3). At 30 days, the bone tissue volume was of 22,06 mm3 in the autogenous group, occupying totally the space among the particles, while in the HA and HA/TCP groups was only 7,62 mm3. At 30 and 180 days, the bone tissue volume did not show statistical differences (p>0.05). The total number of osteoblasts and osteocytes in the autogenous group was respectively, 118, 57 x 102 and 178,57 x 102 cells, at 30 days, reducing 40,16% e 29,09%, at 90 days, due to bone remodeling. In the HA and HA/TCP groups, a similar and stable number of osteoblasts and osteocytes were observed during all periods, with mean of 39,13 x 102 and 132,20 x 102 cells, respectively. In the TCP group, the bony tissue volume was of 4,16 mm3, at 30 days, increasing 70,27% at 90 days. Concomitantly, the...

Avaliação da resistência a tração de diferentes enxertos em calvária de ratos / Evaluation of the tensile strength of different grafts in rat calvaria

A perda do osso alveolar como resultado de doença periodontal ou secundariamente à cirurgia são fontes de inúmeras complicações para os cirurgiões dentistas, e a solução para tal problema se baseiam em procedimentos regenerativos, que é realizada através de enxertos ósseos que estabelecem um arcabouço para a reparação tecidual, aumentando os tecidos ósseos nos defeitos resultantes de trauma ou cirurgias, preenchendo os alvéolos após extração para preservar a altura e espessura do rebordo alveolar e aumentando e/ou reconstruindo o rebordo alveolar. Este projeto tem como objetivo determinar a resistência à tração do osso neoformado com a utilização de diferentes biomateriais. Foram utilizados 60 animais divididos em 3 grupos. O grupo 1A (n=10): GenO; Grupo 1B (n=10): GenMix; Grupo1C (n=10): Bio-Oss; Grupo 2a (n=10): PerioGlas; Grupo 2b (n=10): Polímero de mamona e Grupo 3 (n=10): coágulo. Após 3 meses de nascimento os animais foram submetidos a anestesia intraperitonial e confecção de defeito não critico (3mm de diâmetro) na calvária dos animais, que foram preenchidos com os biomateriais correspondentes a cada grupo. Após 6 meses da cirurgia foi realizada a morte dos animais, os espécimes foram coletados e submetidos ao teste em uma máquina de teste universal. Observa-se que o grupo que obteve maior média de resistência à tração foi o grupo de polímero de mamona (10,932±4,529MPa). Consequentemente, obteve-se uma comparação descrescente na seguinte ordem: Coágulo (9,563±3,74MPa), Bio-Oss (8,706±4,087MPa), GenMix (8,587±3,602MPa), GenOx (7,709±2,416MPa), PerioGlas (7,185±6,837MPa), não notando-se diferença estatisticamente significante entre os grupos. Nas microscopias eletrônicas de varredura na maioria dos grupos observou-se presença de fibras colágenas ao redor do tecido ósseo neoformado e dos remanescentes de enxerto. Conclui-se que o material foi indiferente para o resultado final da resistência à tração, demonstrando uma...

The loss of alveolar bone as a result of periodontal disease or secondary to surgery are numerous sources of complications for the dentists, and the solution to this problem are based on regenerative procedures, which is conducted through bone grafts that provide a scaffold for tissue repair by increasing the bone tissues in the defects resulting from trauma or surgery, filling the alveoli after extraction to preserve the height and thickness and increasing the alveolar ridge and/or reconstructing the alveolar ridge. This project aims to determine the tensile strength of newly formed bone with the use of different biomaterials. We used 60 animals divided into three groups. Group 1A (n = 10): GenOx; Group 1B (n = 10): GenMix; Group 1C (n = 10): Bio-Oss; Groups 2a (n = 10): PerioGlas; Group 2b (n = 10): castor bean polymer; Group 3 (n = 10): clot. After 3 months of birth the animals were anesthetized intraperitoneally and making non critical defect (3mm diameter) in the calvaria of the animals, which were filled with biomaterials for each group. After 6 months of surgery was performed the animals' death, the specimens were collected and tested in a universal testing machine. It is observed that the group had a higher average tensile strength was the castor oil polymer group (10.932 ± 4.529 MPa). Consequently, we obtained a comparison descended in the following order: Clot (9.563 ± 3.74 MPa), Bio-Oss (8.706 ± 4.087 MPa), GenMix (8.587 ± 3.602 MPa), GenOx (7.709 ± 2.416 MPa), PerioGlas (7.185 ± 6.837 MPa), not noticing a significant difference between the groups. In scanning electron microscopies in most groups there was presence of collagen fibers around the newly formed bone and remaining graft. It is concluded that the material was irrelevant to the final result of the tensile strength, showing a good quality of materials used, both when comparing products as their source (xenogenic, polymeric or clot), or its origin of manufacture (national or imported).