Osteocalcin and Runx2 Expression in Anterior Maxillary Reconstructions Using Bone Xenografts Associated to Bone Marrow Aspirate Concentrate.

Background: It is known that a large number of mediators involved in osteogenesis can influence bone development and repair; however, whether these mediators could be used as markers of bone maturity has yet to be determined. Aim: To evaluate the expression of osteocalcin (OC) and Runt-related transcription factor 2 (Runx2) in bone biopsies obtained during the reconstruction of atrophic anterior maxillae using particulate bone xenografts with or without association of autogenous bone marrow aspirate concentrate (BMAC). Materials and Methods: Ten patients were distributed into two groups (n = 5), according to the type of grafting material used: Control group (CG), particulate bone xenograft alone, and test group (TG), particulate bone xenograft combined with BMAC. A bone specimen was removed from the graft area 4 months after grafting, before implant placement. The specimens were processed and submitted to immunohistochemical analysis for detection of OC and Runx2. Histomorphometry was used to ascertain the percentage of stained areas in both groups. The Wilcoxon Mann-Whitney U-Test was used in the statistical analysis (P < 0.05). Results: The immunohistochemical analysis revealed a significantly higher OC expression in the TG than in the CG, namely 27.40 ± 1.34% and 11.40 ± 2.70%, respectively (P < 0.05), and a significantly higher Runx2 expression in the TG than in the CG, namely 2.80 ± 0.84% and 0.40 ± 0.55%, respectively (P < 0.05). Conclusion: The OC and Runx2 expression levels were higher when BMAC was associated with the bone xenograft than when it was not.

Análise comparativa entre técnicas cirúrgicas de enxertia óssea em reabilitação de maxila atrófica: transplante celular odontológico (TCO) e técnica convencional de enxertia óssea ­ relato de caso clínico / Comparative analysis between surgical techniques of bone grafting in rehabilitation of atrophic maxilla: dental cell transplantation (OCT) and conventional bone grafting technique - a case report

A reabilitação de maxila atrófica se apresenta ainda nos dias de hoje como um desafio anatômico/fisiológico para os profissionais da área odontológica que visam buscar a instalação de implantes para futuras reabilitações protéticas, tendo em vista o grau de dificuldade de reconstituição do rebordo alveolar perdido. Com o intuito de reabilitar essas maxilas frente às adversidades, diferentes técnicas são propostas tais como enxertos ósseos autógenos, homógenos, substitutos ósseos alógenos, xenógenos e aloplásticos e suas respectivas técnicas. O objetivo deste trabalho foi apresentar um relato de caso clínico, no qual duas técnicas de reconstituição de rebordo alveolar de hemi-arco foram realizadas na mesma maxila utilizando biomaterial em bloco, visando comparar os resultados histológicos e clínicos. Após 5 meses da realização da enxertia, foi coletado material dos enxertos alveolares bilateralmente utilizando-se brocas trefinas para estudo histológico. Através da metodologia empregada, pode-se observar maior formação de estrutura óssea no lado em que foi praticada a metodologia transplantes celular odontológico (TCO), que preconiza a associação de sangue medular mandibular ao biomaterial, em relação a técnica contralateral em que utilizou a metodologia convencional, que preconiza a associação ao biomaterial do sangue periférico. Pode-se observar através da metodologia empregada que a utilização de biomateriais potencializados com sangue medular mandibular apresentou maior crescimento de estrutura óssea, incrementando em torno de 35% a mais na neoformação.de osso vital.

The rehabilitation of atrophic maxilla is still presented today as an anatomical/physiological challenge for professionals in the dental field who aim to seek the installation of implants for future prosthetic rehabilitations, in view of the degree of difficulty in reconstituting the lost alveolar ridge. In order to rehabilitate these jaws in the face of adversity, different techniques are proposed such as autogenous, homogenous bone grafts, allogeneic, xenogenous and alloplastic bone substitutes and their respective techniques. The aim of this study was to present a clinical case report, in which two hemi-arch alveolar ridge reconstruction techniques were performed in the same maxilla using biomaterial en bloc, in order to compare the histological and clinical results. After 5 months of grafting, material was collected from the alveolar grafts bilaterally using trephine burs for histological study. Through the used methodology, it was possible to see greater bone formation of structure on the side in which the dental cell transplantation (TCO) methodology was practiced, which advocates the association of mandibular medullary blood to the biomaterial, in relation to the contralateral technique in which the methodology was used conventional method, which advocates the association with peripheral blood biomaterial. It can be observed through the used methodology that the use of biomaterials potentiated with mandibular medullary blood showed greater growth of bone structure, increasing around 35% more in the neoformation of vital bone.

Clinical, Histological, and Scintigraphic Comparative Study of the Use of Mandibular Bone Marrow and Peripheral Blood in Bone Neoformation.

MATERIALS AND METHODS: The study included 16 patients with maxillary atresia. The region was grafted with xenograft blocks associated with the following treatments: G1, the patient's peripheral blood during surgery, and G2, dripping of mandibular bone marrow blood until the xenograft was completely wet. After 7 and 14 days, scintigraphic images of the regions of interest (ROI) were taken to quantify pixels, which indicate osteogenic activity. Additionally, trephined samples obtained at the time of implant placement were stained in H&E, and newly formed bone tissue was quantified. The data were tabulated and statistically analyzed at a significance level of 5%. RESULTS: Scintigraphic data showed greater osteogenic activity with mandibular bone marrow blood (G2) at all times evaluated (p < 0.05). As for the histomorphometric analysis, a greater amount of bone tissue was observed in samples treated with mandibular bone marrow blood (G2) compared to peripheral blood (G1) (p < 0.05). CONCLUSIONS: The appositional bone reconstruction technique in the block associated with mandibular bone marrow blood increased bone neoformation and osteogenic activity compared to conventional graft treatment with peripheral blood.

Use of Bone Allograft With or Without Bone Marrow Aspirate Concentrate in Appositional Reconstructions: A Tomographic and Histomorphometric Study.

OBJECTIVES: To evaluate bone allograft associated to bone marrow aspirate concentrate (BMAC), in maxillary reconstructions. MATERIALS AND METHODS: Ten patients with alveolar bone deficiency in the anterior maxilla were randomly divided into control group (CG) and test group (TG). A bone block allograft was placed in both groups, but the graft was impregnated with BMAC only in TG. Computed tomography was performed 7 days (T1) and 6 months (T2) after the grafting procedure, and volume and bone density measurements were carried out. Histomorphometric analysis was performed at T2. RESULTS: Bone volume loss from T1 to T2 was significant only in TG. The bone density in the buccal region of the graft was significantly higher in TG than in CG. There was no significant difference between the groups, in respect to mineralized tissue (MT) and nonmineralized tissue (NMT), in that MT values were 37.77% ± 15.19% and 43.85% ± 10.94%, and NMT values were 62.15% ± 14.90% and 56.30% ± 10.72%, respectively, for CG and TG. The intragroup difference for the MT/NMT ratio was statistically significant in CG but not significant in TG. CONCLUSIONS: The use of BMAC resulted in an improved pattern of bone formation, with higher bone density in the peripheral regions of the graft.

Can bone marrow aspirate concentrate change the mineralization pattern of the anterior maxilla treated with xenografts? A preliminary study.

OBJECTIVE: To evaluate bony reconstruction of the atrophic anterior maxilla using particulate grafts with or without autologous bone marrow aspirate concentrate (BMAC). MATERIALS AND METHODS: Eight patients with atrophy of the anterior maxilla due to teeth loss were selected and split into groups according to the type of material used: Control Group (CG) (n = 4) - particulate xenograft only and Test Group (TG) (n = 4) - a combination of particulate xenograft and BMAC. Both groups received a collagen membrane to cover the xenograft. After 4 months, during implant placement, a sample of bone was removed from the graft area using a 2 mm diameter trephine bur. The specimens were fixed and preserved for histomorphometric evaluation, which included the following parameters: Mineralized tissue (MT) and non-MT (NMT). Cone beam computed tomography was performed at 3 time intervals to measure bone thickness: (1) Before grafting, (2) 4 months and (3) 8 months postgrafting, using localized bone gain (mm) as the outcome variable. RESULTS: Tomographic analysis revealed bone gain in CG of 3.78 ± 1.35 mm and 4.34 ± 1.58 mm at 4 and 8 months, respectively. TG showed an increase of 3.79 ± 0.52 mm and 4.09 ± 1.33 mm after 4 and 8 months, respectively. Histomorphometric analysis revealed that, for CG, MT- and NMT-related values were 52.3% ± 16.78% and 47.70% ± 5.55%, respectively, whereas for TG, they were 65.04% ± 20.98% and 34.96 ± 10.38, respectively. CONCLUSION: Although radiographic bone gain appeared similar between the groups, the use of BMAC obtained via the BMAC(®) method revealed an increased mineralization trend in the anterior maxilla. It must be highlighted, however, that this is a preliminary study with a relatively small sample population and further studies with larger sample sizes are needed to verify these results.

Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans.

Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p < 0.05) of vital mineralized tissue in TG when compared to the CG (55.15 ± 20.91% and 27.30 ± 5.55%, resp.). For nonvital mineralized tissue, TG presented a statistically higher level of Bio-Oss resorption (p < 0.05) when compared with the CG (6.32 ± 12.03% and 22.79 ± 9.60%, resp.). Both groups (TG and CG) showed no significantly different levels (p > 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.

Implantes carregados imediatamente em maxila reconstruída com enxerto de ilíaco: 14 e 30 meses de avaliação / Immediately loaded implants in severely resorbed maxilla reconstructed with iliac bone grafts: an evaluation of 14 and 30 months

A atrofia da maxila é um dos maiores desafios da Implantodontia. A expectativa dos pacientes e a falta de colaboração em ficar sem as próteses dificultam os resultados e tornam restritas a indicação do tratamento. Baseados nestes fatos, os autores realizaram a reconstrução de maxilas atróficas através de enxerto de crista ilíaca com instalação dos implantes em carga imediata. Quatro pacientes portadores de atresia severa de maxila foram submetidos a reconstrução com osso de ilíaco. Após cinco meses os implantes foram instalados e quatro foram submetidos à carga imediata. Seis meses depois os demais implantes foram colocados em função e nova prótese foi confeccionada. Foram instalados 52 implantes, sendo 36 de maneira convencional e 16 em carga imediata. O índice de sucesso obtido foi de 89% nos implantes instalados de maneira convencional (perda de quatro implantes) e de 100% nos implantes instalados em carga imediata. Diante dos resultados obtidos, foi possível concluir que a técnica de reconstrução de maxila através da enxertia, cuja área doadora é a crista ilíaca, apresenta alta previsibilidade, além de se enquadrar nas expectativas do paciente. Os implantes colocados em carga imediata como proposto neste estudo facilitam a aceitação do paciente frente ao tratamento.

Jawbone atrophy is one of the largest challenges of the current implantology. The patients' expectation, along with the lack of cooperation in avoiding the use of their prostheses, hinders the results and treatment indication. Based on these facts the authors accomplished the reconstruction of atrophic jaws through iliac bone crest grafts with immediate loading implant placement. Four patients with severe atrophic maxillary or mandibular deficiencies underwent reconstructive procedures. After five months, the implants were installed and four were submitted to immediate loading. Six months later, the other implants were put into function and new prostheses made. Fifty-two implants were installed, being 36 in a conventional way and 16 immediate loaded. The success rate was 89% for conventional loaded implant (four implants were lost) and 100% in the immediate load protocol. It was possible to conclude that jawbone reconstruction with iliac bone crest graft presents high predictability and responds to patient's expectations. The implants immediately loaded in this treatment planning facilitate patient's acceptance.