A collagenated porcine bone substitute for augmentation at neoss implant sites: a prospective 1-year multicenter case series study with histology.
ABSTRACT 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.
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ABSTRACT: The palatal sinus lift is a good choice for patients with scarred buccal soft tissue and those with poor wound healing such as smokers or diabetics or when visual side effects such as swelling must be concealed. We provide a surgical protocol for palatal sinus lifting without a vertical release incision. The incision is started in a slightly palatal aspect, at the distal end of the dental arch, and describes a curve laterally on the alveolar crest while running in a mesial direction. As a marginal incision, it can continue to the central incisor. Submucosal exposure will lift the gum and the greater palatine artery. After insertion of a tongue depressor, the sinus is opened on the palatal side, opposite the zygomaticoalveolar crest, using a rose bur or a piezotome. After sinus augmentation, the incision is easy to close, and the wound will heal smoothly.Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 08/2013; 71(8):1347-52. · 1.58 Impact Factor
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ABSTRACT: This study investigated the effects of magnesium ion (Mg) incorporation into the surface of deproteinized porcine cancellous bone in the bone healing of rabbit calvarial defects with the expectation of utilizing the integrin-ligand binding enhancement effect of Mg, and compared its bone healing capacity with that of untreated porcine cancellous bone and deproteinized bovine bone (Bio-Oss). Hydrothermal treatment was performed to produce Mg-incorporated porcine bone using an alkaline Mg-containing solution. The surface morphology and chemical composition of the samples were investigated using scanning electron microscopy, energy-dispersive X-ray spectrometry, and X-ray photoelectron spectroscopy. Defects 7 mm in diameter were created in the calvaria of 14 adult male New Zealand White rabbits and were filled with (1) untreated porcine bone (PB), (2) Bio-Oss, and (3) Mg-containing porcine bone (MG). The percentage of newly formed bone (NB%) was evaluated histomorphometrically at 2 and 4 weeks after implantation. Hydrothermal treatment resulted in a Mg-containing surface in porcine bone covered with nanostructures ~100 nm in size. The MG group supported better new bone formation compared with the other groups. Osteoconductive new bone formation was observed in the central defect area in the MG group at an early healing time-point. Histomorphometric analysis revealed significantly greater NB% in the MG group when compared with the untreated PB and Bio-Oss groups at 4 weeks (p < 0.05). The Mg-incorporated porcine bone with surface nanostructures achieved rapid new bone formation in the osseous defects of rabbit calvaria compared with untreated xenografts of porcine and bovine origin.Journal of Biomedical Materials Research Part A 03/2012; 100(4):834-40. · 2.83 Impact Factor
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ABSTRACT: The aim of this study was to evaluate and compare the histological and histomorphometric features of two different procedures carried out in extraction socket grafting; namely, the flapped and flapless technique. Patients considered eligible for the study were randomized to receive tooth extraction and ridge preservation with the porcine bone and collagen membrane, with a full thickness mucoperiosteal flap and primary soft tissue closure (control group), or, with a flapless procedure and a secondary soft tissue closure (test group). After 3 months of healing, the surgical re-entry procedure was performed and implants were inserted in the test as well as in the control sites. Bone core samples were harvested from both groups and processed to be observed under light microscopy. Outcome variables were percentages of newly formed bone, residual graft particles and marrow spaces. Thirty-four patients were enrolled in the study. All of the scheduled implants were placed. Histological and histomorphometrical analyses did not report significant differences between the two groups (with P-values ranging from 0.690 to 0.917). The mean percentages of newly formed bone, soft tissues and residual grafted particles were 22.5 and 22.5%, 59.3 and 59.4%, and 18.6 and 18.2% respectively for flap and flapless approach. No histological and histomorphometrical differences were observed when comparing the flap and the flapless technique for tooth extraction and socket grafting procedures.Clinical Oral Implants Research 03/2014; · 3.43 Impact Factor