Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions.

AIM: To evaluate the haemostatic efficacy and the histologic tissue responses after the application of different haemostatic agents used in periradicular surgery. METHODOLOGY: The study was conducted in the calvarium of six rabbits. Standardized bone defects (diameter 4 mm) were trephined, and different haemostatic agents were applied and compared with control defects: bone wax (left for 10 min), Stasis (ferric sulphate, left for 5 s), Expasyl (aluminium chloride, left for 2 min and left permanently in situ), and a combination of Expasyl (2 min) and Stasis (5 s). The sites were photographed before the application and after the removal of the haemostatic agents. Three independent examiners judged the initial and final bleeding (on the photographs) using a bleeding score for each site and treatment. The results were compared using Wilcoxon's signed rank test. For the histologic analysis, three animals were killed after 3 weeks and three animals after 12 weeks. Transverse, nondecalcified sections were stained with combined basic fuchsin and toluidine blue for descriptive histology. RESULTS: The most efficient haemorrhage control was provided by Expasyl in combination with Stasis and by Expasyl alone, whereas bone wax had the weakest bleeding reduction effect. The histologic analysis after 3 weeks demonstrated an inflammatory and foreign body tissue response towards all haemostatic agents. At 12 weeks, this tissue response was less pronounced but still present in sites treated with bone wax or Expasyl. In general, the inflammatory tissue reactions were limited to the bone defects, and never extended into the surrounding tissues. CONCLUSIONS: Expasyl alone or in combination with Stasis appeared to be the most efficient of tested agents to control the bleeding within the bony defects created in a rabbit calvarium model.

Peri-implant inflammation defined by the implant-abutment interface.

An implant-abutment interface at the alveolar bone crest is associated with sustained peri-implant inflammation; however, whether magnitude of inflammation is proportionally dependent upon interface position remains unknown. This study compared the distribution and density of inflammatory cells surrounding implants with a supracrestal, crestal, or subcrestal implant-abutment interface. All implants developed a similar pattern of peri-implant inflammation: neutrophilic polymorphonuclear leukocytes (neutrophils) maximally accumulated at or immediately coronal to the interface. However, peri-implant neutrophil accrual increased progressively as the implant-abutment interface depth increased, i.e., subcrestal interfaces promoted a significantly greater maximum density of neutrophils than did supracrestal interfaces (10,512 +/- 691 vs. 2398 +/- 1077 neutrophils/mm(2)). Moreover, inflammatory cell accumulation below the original bone crest was significantly correlated with bone loss. Thus, the implant-abutment interface dictates the intensity and location of peri-implant inflammatory cell accumulation, a potential contributing component in the extent of implant-associated alveolar bone loss.

Enhanced bone apposition to a chemically modified SLA titanium surface.

Increased surface roughness of dental implants has demonstrated greater bone apposition; however, the effect of modifying surface chemistry remains unknown. In the present study, we evaluated bone apposition to a modified sandblasted/acid-etched (modSLA) titanium surface, as compared with a standard SLA surface, during early stages of bone regeneration. Experimental implants were placed in miniature pigs, creating 2 circular bone defects. Test and control implants had the same topography, but differed in surface chemistry. We created the test surface by submerging the implant in an isotonic NaCl solution following acid-etching to avoid contamination with molecules from the atmosphere. Test implants demonstrated a significantly greater mean percentage of bone-implant contact as compared with controls at 2 (49.30 vs. 29.42%; p = 0.017) and 4 wks (81.91 vs. 66.57%; p = 0.011) of healing. At 8 wks, similar results were observed. It is concluded that the modSLA surface promoted enhanced bone apposition during early stages of bone regeneration.

Persistent acute inflammation at the implant-abutment interface.

The inflammatory response adjacent to implants has not been well-investigated and may influence peri-implant tissue levels. The purpose of this study was to assess, histomorphometrically, (1) the timing of abutment connection and (2) the influence of a microgap. Three implant designs were placed in the mandibles of dogs. Two-piece implants were placed at the alveolar crest and abutments connected either at initial surgery (non-submerged) or three months later (submerged). The third implant was one-piece. Adjacent interstitial tissues were analyzed. Both two-piece implants resulted in a peak of inflammatory cells approximately 0.50 mm coronal to the microgap and consisted primarily of neutrophilic polymorphonuclear leukocytes. For one-piece implants, no such peak was observed. Also, significantly greater bone loss was observed for both two-piece implants compared with one-piece implants. In summary, the absence of an implant-abutment interface (microgap) at the bone crest was associated with reduced peri-implant inflammatory cell accumulation and minimal bone loss.

Evaluation of a prototype trilayer membrane (PTLM) for lateral ridge augmentation: an experimental study in the canine mandible.

The objective of this animal study was to evaluate a biodegradable/bioresorbable prototype trilayer membrane (PTLM) consisting of two collagen layers and an internal polylactide layer for lateral ridge augmentation in conjunction with two different bone grafting materials: particulate autograft or deproteinized bovine bone mineral (DBBM). In four mongrel dogs, two lateral bone defects per side were created in the mandible. The four defects per dog were randomly subjected to the following grafting treatments 3 months later: 1. PTLM+DBBM, 2. PTLM+particulate autograft, 3. ePTFE membrane+DBBM, 4. ePTFE membrane+particulate autograft. After a healing period of 4 1/2 months, the dogs were sacrificed for histological and histomorphometrical analysis. Percentage calculations for areas showing bone regeneration within the former defect outline were 56.8% for PTLM+DBBM, 85.2% for PTLM+autograft, 52.3% for ePTFE+DBBM, and 96.9% for ePTFE+autograft (differences between autograft and DBBM sites were significant at P<0.01 to P<0.05). Measurements of ridge enlargement (horizontal bone gain) were also significantly better for autograft+ePTFE sites compared to the other three grafting treatments. Histology demonstrated for most PTLM sites a moderate infiltration of lymphocytes and plasma cells adjacent to empty spaces corresponding to polylactide fragments. In addition, these reactions appeared to provoke subsequent resorption of newly formed bone. No such findings were seen in ePTFE sites. The tested prototype membrane cannot be recommended for clinical application.

Biologic Width around one- and two-piece titanium implants.

Gingival esthetics around natural teeth is based upon a constant vertical dimension of healthy periodontal soft tissues, the Biologic Width. When placing endosseous implants, however, several factors influence periimplant soft and crestal hard tissue reactions, which are not well understood as of today. Therefore, the purpose of this study was to histometrically examine periimplant soft tissue dimensions dependent on varying locations of a rough/smooth implant border in one-piece implants or a microgap (interface) in two-piece implants in relation to the crest of the bone, with two-piece implants being placed according to either a submerged or a nonsubmerged technique. Thus, 59 implants were placed in edentulous mandibular areas of five foxhounds in a side-by-side comparison. At the time of sacrifice, six months after implant placement, the Biologic Width dimension for one-piece implants, with the rough/smooth border located at the bone crest level, was significantly smaller (P<0.05) compared to two-piece implants with a microgap (interface) located at or below the crest of the bone. In addition, for one-piece implants, the tip of the gingival margin (GM) was located significantly more coronally (P<0.005) compared to two-piece implants. These findings, as evaluated by nondecalcified histology under unloaded conditions in the canine mandible, suggest that the gingival margin (GM) is located more coronally and Biologic Width (BW) dimensions are more similar to natural teeth around one-piece nonsubmerged implants compared to either two-piece nonsubmerged or two-piece submerged implants.

Influence of the size of the microgap on crestal bone changes around titanium implants. A histometric evaluation of unloaded non-submerged implants in the canine mandible.

BACKGROUND: Endosseous implants can be placed according to a non-submerged or submerged approach and in 1- or 2-piece configurations. Recently, it was shown that peri-implant crestal bone changes differ significantly under such conditions and are dependent on a rough/smooth implant border in 1-piece implants and on the location of an interface (microgap) between the implant and abutment/restoration in 2-piece configurations. Several factors may influence the resultant level of the crestal bone under these conditions, including movements between implant components and the size of the microgap (interface) between the implant and abutment. However, no data are available on the impact of possible movements between these components or the impact of the size of the microgap (interface). The purpose of this study was to histometrically evaluate crestal bone changes around unloaded, 2-piece non-submerged titanium implants with 3 different microgap (interface) dimensions and between implants with components welded together or held together by a transocclusal screw. METHODS: A total of 60 titanium implants were randomly placed in edentulous mandibular areas of 5 hounds forming 6 different implant subgroups (A through F). In general, all implants had a relatively smooth, machined suprabony portion 1 mm long, as well as a rough, sandblasted, and acid-etched (SLA) endosseous portion, all placed with their interface (microgap) 1 mm above the bone crest level and having abutments connected at the time of first-stage surgery. Implant types A, B, and C had a microgap of < 10 microns, approximately 50 microns, or approximately 100 microns between implant components as did types D, E, and F, respectively. As a major difference, however, abutments and implants of types A, B, and C were laser-welded together, not allowing for any movements between components, as opposed to types D, E, and F, where abutments and implants were held together by abutment screws. Three months after implant placement, all animals were sacrificed. Non-decalcified histology was analyzed histometrically by evaluating peri-implant crestal bone changes. RESULTS: For implants in the laser-welded group (A, B, and C), mean crestal bone levels were located at a distance from the interface (IF; microgap) to the first bone-to-implant contact (fBIC) of 1.06 +/- 0.46 mm (standard deviation) for type A, 1.28 +/- 0.47 mm for type B, and 1.17 +/- 0.51 mm for type C. All implants of the non-welded group (D, E, and F) had significantly increased amounts of crestal bone loss, with 1.72 +/- 0.49 mm for type D (P < 0.01 compared to type A), 1.71 +/- 0.43 mm for type E (P < 0.02 compared to type B), and 1.65 +/- 0.37 mm for type F (P < 0.01 compared to type C). CONCLUSIONS: These findings demonstrate, as evaluated by non-decalcified histology under unloaded conditions in the canine mandible, that crestal bone changes around 2-piece, non-submerged titanium implants are significantly influenced by possible movements between implants and abutments, but not by the size of the microgap (interface). Thus, significant crestal bone loss occurs in 2-piece implant configurations even with the smallest-sized microgaps (< 10 microns) in combination with possible movements between implant components.

Porous tricalcium phosphate and transforming growth factor used for anterior spine surgery.

Harvesting autologous bone graft from the iliac crest is associated with considerable secondary morbidity. Bone graft substitutes such as porous ceramics are increasingly used for spinal surgery. This paper presents the results of an animal study in which beta-tricalcium phosphate (beta-TCP) bone substitutes were used for anterior spinal surgery in sheep and baboons. The presented baboon study also investigated the effect of impregnating the ceramic material with transforming growth factor (TGF). In the first study, using the sheep model, a stand-alone instrumented anterior fusion was performed. The animals were randomized into three treatment groups: autologous bone, beta-TCP granules, and sham group. The results were analyzed biomechanically and histologically at three survival intervals: 8, 16 and 32 weeks. An additional animal group was added later, with ceramic pre-filled implants. In the second study, a baboon model was used to assess the osteointegration of a 15-mm-diameter porous beta-TCP block into the vertebral body. The experiment was partially motivated by a new surgical procedure proposed for local bone graft harvest. Three treatment groups were used: beta-TCP plug, beta-TCP plug impregnated with TGF-beta3, and a sham group with empty defect. The evaluation for all animals included computer tomograms at 3 and 6 months, as well as histology at 6 months. In the sheep model, the mechanical evaluation failed to demonstrate differences between treatment groups. This was because massive anterior bone bridges formed in almost all the animals, masking the effects of individual treatments. Histologically, beta-TCP was shown to be a good osteoconductor. While multiple signs of implant micromotion were documented, pre-filling the cages markedly improved the histological fusion outcomes. In the baboon study, the beta-TCP plugs were completely osteointegrated at 6 months. For the group that used ceramic plugs impregnated with TGF-beta3, no incremental advantage was seen as a result of this particular application. However, TGF-beta3 is a potent growth factor at a very low dose. Not only does it speed up the ceramic material resorption, but it is also responsible for massive regional new bone formation. More experiments are required to better understand the biological effects of this growth factor in relation to bone formation, and to be able to take clinical advantage of them.

Crestal bone changes around titanium implants: a methodologic study comparing linear radiographic with histometric measurements.

Generally, endosseous implants can be placed according to a nonsubmerged or a submerged technique and in 1-piece or 2-piece configurations. Recently, it has been shown that peri-implant crestal bone reactions differ significantly radiographically as well as histometrically under such conditions and are dependent on a rough/smooth implant border in 1-piece implants and on the location of a microgap (interface) between the implant and the abutment/restoration in 2-piece configurations. The purpose of this study was to evaluate whether standardized radiography as a noninvasive clinical diagnostic method correlates with peri-implant crestal bone levels as determined by histometric analysis. Fifty-nine implants were placed in edentulous mandibular areas of 5 foxhounds in a side-by-side comparison in both submerged and nonsubmerged techniques. Three months after implant placement, abutment connection was performed in the submerged implant sites. At 6 months, all animals were sacrificed, and evaluations of the first bone-to-implant contact (fBIC), determined on standardized periapical radiographs, were compared to similar analyses made from nondecalcified histology. It was shown that both techniques provide the same information (Pearson correlation coefficient = 0.993; P < .001). The precision of the radiographs was within 0.1 mm of the histometry in 73.4% of the evaluations, while the level of agreement fell to between 0.1 and 0.2 mm in 15.9% of the cases. These data demonstrate in an experimental study that standardized periapical radiography can evaluate crestal bone levels around implants clinically accurately (within 0.2 mm) in a high percentage (89%) of cases. These findings are significant because crestal bone levels can be determined using a noninvasive technique, and block sectioning or sacrifice of the animal subject is not required. In addition, longitudinal evaluations can be made accurately such that bone changes over various time periods can be assessed. Such analyses may prove beneficial when trying to distinguish physiologic changes from pathologic changes or when trying to determine causes and effects of bone changes around dental implants.

Lateral ridge augmentation and implant placement: an experimental study evaluating implant osseointegration in different augmentation materials in the canine mandible.

The present study investigated the osseointegration of dental implants with a titanium plasma-sprayed surface (TPS) in regenerated and native bone in an experimental dog study. Initially, lateral bone defects were created in the alveolar ridge on both sides of the mandible. Two months later, lateral ridge augmentation was performed with (1) autogenous corticocancellous block grafts, (2) autogenous corticocancellous block grafts and e-PTFE membrane, (3) tricalcium phosphate particles and e-PTFE membrane, or (4) canine-derived demineralized freeze-dried bone allograft particles and e-PTFE membrane. After 4 months, membranes were removed, and non-submerged titanium implants were placed in regenerated bone (test implants) and in native bone (control implants). Two months later, the animals were sacrificed and non-decalcified orofacial sections were evaluated histometrically. All implants demonstrated high percentages (59% to 75%) of bone-to-implant contact, with no significant differences across the various treatment groups. The different grafting techniques did not significantly influence the location of first bone-to-implant contact and the horizontal bone width at the most coronal bone level.

Lateral ridge augmentation using different bone fillers and barrier membrane application. A histologic and histomorphometric pilot study in the canine mandible.

Lateral ridge augmentation has become a standard treatment option to enhance the bone volume of deficient recipient sites prior to implant placement. In order to avoid harvesting an autograft and thereby eliminating additional surgical procedures and risks, bone grafting materials and substitutes are alternative filler materials to be used for ridge augmentation. Before clinical recommendations can be made, such materials must be extensively studied in experimental models simulating relevant clinical situations. The present pilot study was conducted in three dogs. Different grafting procedures were evaluated for augmentation of lateral, extended (8 x 10 x 14 mm) and chronic bone defects in the mandibular alveolar ridge. Experimental sites received tricalcium phosphate (TCP) granules or demineralized freeze-dried bone allograft (DFDBA) particles. Barrier membranes (ePTFE) were placed for graft protection. These approaches were compared to ridge augmentation using autogenous cortico-cancellous block grafts, either with or without ePTFE-membrane application. After a healing period of six months, the sites were analyzed histologically and histomorphometrically. Autografted sites with membrane protection showed excellent healing results with a well-preserved ridge profile, whereas non-protected block grafts underwent bucco-crestal resorption, clearly limiting the treatment outcome. The tested alloplastic (TCP) and allogenic (DFDBA) filler materials presented inconsistent findings with sometimes encapsulation of particles in connective tissue, thereby reducing the crestal bone width. The present pilot study supports the use of autografts with barrier membranes for lateral ridge augmentation of extended alveolar bone defects.

Periodontal regeneration with an autogenous bone-Bio-Oss composite graft and a Bio-Gide membrane.

This study evaluated the clinical, radiographic, and histologic response to the composite use of Bio-Oss porous bone mineral and autogenous bone in combination with a Bio-Gide bilayer collagen membrane to achieve regeneration when treating human periodontal bone defects. Preoperative recordings for four treatment areas included radiographs, clinical probing depths, and attachment levels; these recordings were repeated at 9 months. Histologic evaluation revealed new cementum with inserting collagen fibers and new bone formation on the surface of both types of graft materials. This grafting combination not only compared favorably with the previous use of Bio-Oss and Bio-Gide, but exceeded that result with almost complete periodontal regeneration. This human histologic study demonstrates that autogenous bone in combination with porous bone mineral matrix, together with the Bio-Gide collagen membrane, has the capacity to stimulate substantial new bone and cementum formation with Sharpey's fiber attachment.

Crestal bone changes around titanium implants. A histometric evaluation of unloaded non-submerged and submerged implants in the canine mandible.

BACKGROUND: Today, implants are placed using both non-submerged and submerged approaches, and in 1- and 2-piece configurations. Previous work has demonstrated that peri-implant crestal bone reactions differ radiographically under such conditions and are dependent on a rough/smooth implant border in 1-piece implants and on the location of the interface (microgap) between the implant and abutment/restoration in 2-piece configurations. The purpose of this investigation was to examine histometrically crestal bone changes around unloaded non-submerged and submerged 1- and 2-piece titanium implants in a side-by-side comparison. METHODS: A total of 59 titanium implants were randomly placed in edentulous mandibular areas of 5 foxhounds, forming 6 different implant subgroups (types A-F). In general, all implants had a relatively smooth, machined coronal portion as well as a rough, sandblasted and acid-etched (SLA) apical portion. Implant types A-C were placed in a non-submerged approach, while types D-F were inserted in a submerged fashion. Type A and B implants were 1-piece implants with the rough/smooth border (r/s) at the alveolar crest (type A) or 1.0 mm below (type B). Type C implants had an abutment placed at the time of surgery with the interface located at the bone crest level. In the submerged group, types D-F, the interface was located either at the bone crest level (type D), 1 mm above (type E), or 1 mm below (type F). Three months after implant placement, abutment connection was performed in the submerged implant groups. At 6 months, all animals were sacrificed. Non-decalcified histology was analyzed by evaluating peri-implant crestal bone levels. RESULTS: For types A and B, mean crestal bone levels were located adjacent (within 0.20 mm) to the rough/smooth border (r/s). For type C implants, the mean distance (+/- standard deviation) between the interface and the crestal bone level was 1.68 mm (+/- 0.19 mm) with an r/s border to first bone-to-implant contact (fBIC) of 0.39 mm (+/- 0.23 mm); for type D, 1.57 mm (+/- 0.22 mm) with an r/s border to fBIC of 0.28 mm (+/- 0.21 mm); for type E, 2.64 mm (+/- 0.24 mm) with an r/s border to fBIC of 0.06 mm (+/- 0.27 mm); and for type F, 1.25 mm (+/- 0.40 mm) with an r/s border to fBIC of 0.89 mm (+/- 0.41 mm). CONCLUSIONS: The location of a rough/smooth border on the surface of non-submerged 1-piece implants placed at the bone crest level or 1 mm below, respectively, determines the level of the fBIC. In all 2-piece implants, however, the location of the interface (microgap), when located at or below the alveolar crest, determines the amount of crestal bone resorption. If the same interface is located 1 mm coronal to the alveolar crest, the fBIC is located at the r/s border. These findings, as evaluated by non-decalcified histology under unloaded conditions, demonstrate that crestal bone changes occur during the early phase of healing after implant placement. Furthermore, these changes are dependent on the surface characteristics of the implant and the presence/absence as well as the location of an interface (microgap). Crestal bone changes were not dependent on the surgical technique (submerged or non-submerged).

Biologic width around titanium implants. A physiologically formed and stable dimension over time.

Research in implant dentistry has mainly focused on hard tissue integration with much less data available with regards to soft tissue integration involving epithelium and connective tissue. In the present study, the implantogingival junction of unloaded and loaded non-submerged titanium implants has been analyzed histometrically in the canine mandible. In 6 foxhounds, 69 implants were placed. Dogs in the unloaded group were sacrificed 3 months after implant placement. Loaded implants were restored with gold crowns and those dogs were sacrificed after 3 months and 12 months of loading. Non-decalcified histologic sections were analyzed histometrically measuring the dimensions of the Sulcus Depth (SD), the Junctional Epithelium (JE), and the Connective Tissue Contact (CTC). Histometric evaluation revealed that significant changes within tissue compartments (SD, JE, CTC) occurred over time (P < 0.05). Sulcus Depth had a mean of 0.49 mm and 0.50 mm after 3 months and 6 months of healing, but after 15 months was 0.16 mm which was significantly different. Similarly, the length of the Junctional Epithelium after 3 months and 6 months of healing was 1.16 mm and 1.44 mm, respectively, and these values were significantly different from measurements taken after 15 months (1.88 mm). The area of Connective Tissue Contact showed a different pattern of change in that after 3 months of healing (1.36 mm) it was significantly different from the same area after 6 months and 15 months which were 1.01 mm and 1.05 mm, respectively. Interestingly, the sum of SD, JE, and CTC, forming the Biologic Width, did not change over the observation period (P > 0.05). These data indicate that the Biologic Width is a physiologically formed and stable structure over time in the case of non-submerged, one-piece titanium implants as evaluated histometrically under unloaded and loaded conditions. Dynamic changes did occur, however, within the overall Biologic Width dimension. Thus, the use of non-submerged, one-piece implants allow for stable overall peri-implant soft tissues as evaluated under loaded conditions for up to 12 months.

Alveolar ridge repair in a canine model using rhTGF-beta 1 with barrier membranes.

In both normal and membrane-assisted situations, healing events are modulated by the activity of endogenous protein molecules known as cytokines. Due to its mitogenic and chemotactic characteristics, the addition of rhTGF-beta 1 should increase the rate of osteogenesis or increase the potential for bone regeneration in oral osseous defects. This study evaluates the effects of an osteoconductive biodegradable matrix incorporating human recombinant transforming growth factor beta 1 (rhTGF-beta 1) in conjunction with barrier membranes on bone regeneration in canine alveolar ridge defects. A matrix of calcium carbonate and hydroxyethyl starch served as the carrier for test concentrations of 2.0 micrograms/0.8 ml and 20.0 micrograms/0.8 ml of rhTGF-beta 1. One surgically prepared site in each of 13 adult male fox-hounds received 1 of 4 experimental treatment regimens, with 6 sites utilizing barrier membranes. Four sites in each of 2 additional animals, two containing carrier matrix only and 2 with the additional barrier membrane, served as controls. Specimens were retrieved after 2 months of healing and processed for routine light microscopy. The quantity and composition of regenerated bone was examined. Analysis of variance revealed a statistically significant increase (P < 0.05) in the development of bone with the use of rhTGF-beta 1. Likewise, a statistically significant increase in regeneration was found in membrane-protected sites over nonmembrane-protected sites. No statistically significant difference was noted between the low and high dose treatments. The authors conclude that the use of rhTGF-beta 1 in conjunction with a barrier membrane greatly enhances bone regeneration in osseous oral defects.

Clinical and histologic evaluation of human gingival recession treated with a subepithelial connective tissue graft and enamel matrix derivative (Emdogain): a case report.

A mandibular canine with significant gingival recession was selected for a pilot study to measure the attachment modalities resulting from mucogingival surgery. The tooth had 6 mm of recession as measured from the cementoenamel junction to the gingival margin, minimal pocketing, and no keratinized gingiva. The treatment regimen consisted of a subepithelial connective tissue graft (SCTG) plus Emdogain applied to the root surface. The tooth was extracted en bloc 6 months after surgery and processed histologically in a buccolingual plane. The tooth demonstrated a 2-mm gain of attachment and a 3-mm gain in keratinized tissue. The histologic study evidenced the migration of the junctional epithelium 1.2 mm apical to the sulcus. New cementum, evidence of newly formed woven bone, and connective tissue fibers anchored in the new cementum were evident.

Human histologic evaluation of bioactive ceramic in the treatment of periodontal osseous defects.

This study examined the healing of intrabony defects around 5 teeth treated with bioactive glass ceramic (PerioGlas). Healing was evaluated by clinical measurements, radiographic observation, and histologic analysis. The protocol included a presurgical phase of scaling and root planing therapy, with measurements obtained immediately prior to the surgical procedures and after 6 months of healing. Following therapy there was a mean of 2.7 mm of probing depth reduction, 2.2 mm of clinical attachment gain, and 0.5 mm of recession. The histologic analysis revealed healing by a long junctional epithelium with minimal new connective tissue attachment to the teeth, except in one case where the intrabony region demonstrated new cementum formation and new connective tissue attachment. Graft particles were found to be biocompatible, as evidenced by being embedded in a stroma of dense connective tissue with minimal inflammatory infiltrate. There was minimal new bone formation limited to the most apical borders of the defects. No signs of periodontal regeneration as defined by new cementum, periodontal ligament, and bone formation on a previously diseased root surface were observed. Although the clinical results are encouraging and radiographs evidenced radiopacities within the defects, histologic analysis revealed that as a periodontal grafting material, bioactive glass ceramic has only limited regenerative properties.

Quantitative assessment of angiogenesis and osteogenesis after transplantation of bone: comparison of isograft and allograft bone in mice.

We performed a vital microscopic study in mice bearing dorsal skinfold chambers to characterize microvascular perfusion and leukocyte/endothelium interaction and their effects on elongation and mineralization of neonatal isograft and allograft bone. Isograft (C57/BL to C57/BL) and allograft bone (C57/ BL to BALB/C) revascularized simultaneously. However, vascular perfusion and density were lower in allograft bone than in isograft bone. Leukocyte/endothelium interaction was the same in isograft and allograft bones. Revascularization was not detected in allograft bone transplanted to presensitized recipients. Moreover, in preexisting vessels at the transplantation site, leukocyte/endothelium interaction was altered in allograft bone of presensitized recipients, despite a normal systemic leukocyte count. Femoral growth resulting from thickening of both epiphyses did not differ between experimental groups, however, mineralization occurred in isograft bone only. Isograft bone was histologically intact, allograft bone hypovital and allograft bone in presensitized recipients necrotic 12 days after implantation. Our findings suggest that graft incorporation or rejection is mediated by the microvasculature and that presensitizing of recipients accelerates rejection of allograft bone.

Interface shear strength of titanium implants with a sandblasted and acid-etched surface: a biomechanical study in the maxilla of miniature pigs.

The purpose of the present study was to evaluate the interface shear strength of unloaded titanium implants with a sandblasted and acid-etched (SLA) surface in the maxilla of miniature pigs. The two best documented surfaces in implant dentistry, the machined and the titanium plasma-sprayed (TPS) surfaces served as controls. After 4, 8, and 12 weeks of healing, removal torque testing was performed to evaluate the interface shear strength of each implant type. The results revealed statistically significant differences between the machined and the two rough titanium surfaces (p <.00001). The machined surface demonstrated mean removal torque values (RTV) between 0.13 and 0.26 Nm, whereas the RTV of the two rough surfaces ranged between 1.14 and 1.56 Nm. At 4 weeks of healing, the SLA implants yielded a higher mean RTV than the TPS implants (1.39 vs. 1. 14 Nm) without reaching statistical significance. At 8 and 12 weeks of healing, the two rough surfaces showed similar mean RTVs. The implant position also had a significant influence on removal torques for each implant type primarily owing to differences in density in the periimplant bone structure. It can be concluded that the interface shear strength of titanium implants is significantly influenced by their surface characteristics, since the machined titanium surface demonstrated significantly lower RTV in the maxilla of miniature pigs compared with the TPS and SLA surfaces.