The Feltre/Fiera Di Primiero Implant Research Group, Feltre, Italy private practice, Milano and Legnano, Italy private practice, Feltre, Italy private practice, Fiera Di Primiero, Italy private practice, San Dona Di Piave, Italy private practice, Salerno, Italy private practice, Rome, Italy Department of Biomaterials, Institute Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Background: The presence of localized defects and/or small amounts of bone below the maxillary sinus is a common finding, which may compromise implant placement. There is therefore a need for predictable techniques for bone augmentation in such situations.
Purpose: The study aims to clinically and histologically evaluate a porcine bone (PB) substitute used for augmentation of the alveolar crest or the maxillary sinus floor prior to or in conjunction with implant placement.
Materials and Methods: Nineteen patients were treated with a porcine bone substitute and barrier membranes (OsteoBiol, Tecnoss Dental, Turin, Italy) for lateral bone augmentation (Group 1a) and healing of bone defects (Group 1b) or for augmentation of the maxillary sinus floor using either a replaceable (Group 2a) or an infractured bone window (Group 2b). A total of 34 implants (Neoss Ltd., Harrogate, UK) were placed in conjunction or 5 to 7 months after the procedure. Implants were followed with implant stability measurements at placement and abutment connection, and with intraoral radiographs at abutment connection and after at least 1 year of loading. A biopsy for histology and morphometry was taken at the first reentry operation.
Results: All but one of the procedures was successful (94.7%) as one maxillary sinus procedure (Group 2a) resulted in insufficient bone for implant placement. One of the 34 implants failed, giving an implant survival rate of 97.1% after 1 year. Implant stability measurements showed a mean stability of 71.9 ± 7.7 implant stability quotient (ISQ) at placement, which significantly increased to 75.3 ± 6.8 ISQ at abutment connection (p = .03). The average bone loss was 0.5 ± 0.7 mm during 1 year.
Histology revealed new bone formation at the PB surface, which formed bridges between particles and between particles and preexisting bone. The presence of scalloped resorption lacunae and new osteons inside the particles indicated ongoing resorption/remodeling of the particles. The histomorphometric analyses showed that the total specimen area consisted of, in average, 56.5 ± 15.7% mineralized tissue of which 24.8 ± 13.9% of the total area was PB particles.
Conclusion: This study showed good clinical results when using a PB substitute and barrier membranes for augmentation of the alveolar crest and maxillary sinus. Histology revealed bone condensation properties and indicated that the material can be resorbed with time.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare the histological behavior of three bone graft materials placed in human. The comparison was made among Bio-Oss® (BO), Engipore® (EP), and PepGen P-15® (P-15). Five biopsies for each group of biomaterial, retrieved 6 months after sinus lift augmentation, were analyzed. The investigation was carried out using light microscope (LM), scanning electron microscope (SEM) with an energy dispersive spectrometer (EDS), and circularly polarized light microscope (CPLM). Under LM, the amount of newly formed bone was significantly higher in BO than P-15 (P < .05), while the amount of residual graft material was significantly higher in P-15 than BO (P < .05). The extension of marrow spaces was significantly higher in EP than both BO and P-15 (P < .05). SEM-EDS analysis showed a Ca/P ratio of 1.8 for BO, 2.2 for EP, and 1.5 for P-15. Under CPLM, BO showed no significant difference for transverse (18.4 ± 2.7%) and longitudinal (16.3 ± 1.8%) bone collagen fibers (P = .195); EP showed a significant difference between transverse (4 ± 0.7%) and longitudinal (7.6 ± 2.5%) bone collagen fibers (P = .015); finally, P-15 showed no significant difference for transverse (3.8 ± 1.6%) and longitudinal (4.9 ± 1.2%) bone collagen fibers (P = .279). No investigated biomaterial was completely resorbed, but all the residual particles demonstrated a close bone integration to form a hybrid tissue. BO particles appeared perfectly osseointegrated in the trabecular bone. EP showed a tendency to concentrate the bone apposition into the microporosities; P-15 particles appeared bridged by newly formed bone trabeculae.
[Show abstract][Hide abstract] ABSTRACT: Various grafts or combination of graft materials have been used in sinus floor augmentations, and human histological reports on their performance are available, although limited in number. Histological analysis of the regenerated tissues will provide useful information regarding the nature and amount of newly formed bone. Aim of the present study was a histological and histomorphometric evaluation, in humans, of specimens retrieved from sinuses augmented with phycogene hydroxyapatite, biphasic calcium phosphate ceramics, calcium carbonate, porcine bone and anorganic bovine bone, after a healing period of 6 months.
A total of 15 patients, undergoing 30 sinus augmentation procedures with five different biomaterials, participated in this study. A total of 82 titanium dental implants were inserted in the augmented sinuses after a healing period of 6 months. A total of 60 bone cores, 2 for each augmented sinus, 12 for every biomaterial, were retrieved and all were stored immediately in 10% buffered formalin and processed to obtain thin ground sections.
In all biomaterials, many grafted particles were lined and, sometimes, bridged by newly formed bone. Some biomaterials particles appeared to be partially resorbed and substituted by newly formed bone. Histomorphometry showed that, in all biomaterials, newly formed bone and residual grafted material particles represented about 30%.
Longer term histological and histomorphometric studies will be necessary to understand better the resorption times of all these biomaterials. The high interconnecting microporosity allowed, in all the present biomaterials, the ingrowth of newly formed bone and vessels in the pores of the partially resorbed particles. In conclusion, within the limitations of the present study, the data provided support the fact that all these biomaterials can be used, successfully, in sinus augmentation procedures.
[Show abstract][Hide abstract] ABSTRACT: Purpose: The purpose of this study was to evaluate the effectiveness of the platelet-rich fibrin (PRF) used in combination with the porcine cancellous bone as a scaffold, in promoting bone regeneration in the bone defects ofthe rabbit calvaria. Methods: Ten rabbits were used in the study. Three round-shaped defects (diameter 8.0 mm) were created in the rabbit calvaria and were filled with nothing (control group), porcine cancellousbone (Experimental Group 1, porcine bone) and PRF-mixed porcine cancellous bone (Experimental Group 2). TS-GBB is a xenogenic bone-substitute product comprised of a high heat-treated mineralized porcine cancellous bone. Animals were sacrificed at 6 weeks and 12 weeks for the histological and radiographic evaluations. Results: In the micro computed tomography and histological results, the experimental groups 1 and 2 showed more bone formation, remodeling, and calcification than the control group. The new bone formation ratio showed theGroup 2 to be larger than Group 1 at6 and 12 weeks. However, there was no significant difference between the experimental groups 1 and 2 in the new bone formation area, at the 6 and 12 weeks (P>0.05). Conclusion: The PRF-mixed group showed more bone formation than the porcine cancellousbonegroup (TS-GBB), butthere was a no significant difference. The PRF may not lead to enhanced bone healing when grafted with the porcine cancellous bone.
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