Clinical and histologic evaluation of anorganic bovine bone collagen with or without a collagen barrier

This study evaluated an anorganic bovine-derived xenograft (Bio-Oss Collagen) in the treatment of human periodontal defects. Four patients with intrabony defects on teeth that were treatment planned for extraction were enrolled in the study. Presurgical measurements of probing depth, attachment level, and recession were recorded. The surgical procedure consisted of flap reflection, debridement of the osseous defects and root surface, placement of a notch through calculus into the root surface, topical application of a tetracycline paste to the root surface, grafting with Bio-Oss Collagen, and flap closure. Three of the eight defects examined received a resorbable collagen barrier (Bio-Gide) in addition to the bone graft. Patients were seen every 2 weeks for plaque control and review of oral hygiene measures. Six months postsurgery, clinical parameters were rerecorded prior to en bloc resection of teeth and adjacent graft sites. The majority of sites showed a favorable clinical response with respect to probing depth reduction and clinical attachment gain. Histologic analysis demonstrated new bone, cementum, and periodontal ligament coronal to the reference notch in two of the eight specimens. Two sites demonstrated new attachment, and four showed a long junctional epithelium. Periodontal regeneration is possible following a bone-replacement graft of Bio-Oss Collagen.     

Socket preservation using bovine bone mineral and collagen membrane: a randomized controlled clinical trial with histologic analysis

After tooth extraction, varying amounts of bone resorption occur because of qualitative and quantitative changes at the edentulous site of the alveolar process. The aims of this randomized controlled clinical trial were (1) to compare the postextraction changes in residual ridge dimensions during spontaneous healing with those during socket preservation, (2) to analyze the histologic and histomorphometric aspects of the grafted sockets, and (3) to compare probing procket depth (PPD) and clinical attachment level (CAL) changes at teeth adjacent to extraction sites. Forty-eight teeth were extracted from 41 patients referred for extraction of 1 or more maxillary or mandibular premolars or molars. The edentulous sites were randomly assigned to the control (EXT, extraction alone) or experimental groups (SP, extraction and socket preservation). In the SP group, the sockets were filled with bovine bone mineral and covered with porcine collagen membrane. At baseline and after 4 months, PPD, gingival recession (REC), and CAL were measured at teeth adjacent to the edentulous sites. The changes in ridge dimensions from baseline to 4 months were assessed on dental casts. At 4 months, bone was harvested from the grafted areas in the SP group and the edentulous areas in the EXT group. PPD, REC, and CAL were comparable between groups. However, from baseline to 4 months, the SP group showed significantly less reduction in ridge width (1.04 ± 1.08 mm vs 4.48 ± 0.65 mm, P < .001) and height (0.46 ± 0.46 mm vs 1.54 ± 0.33 mm, P < .001). Histologically, the grafted sockets exhibited various stages of bone maturation and formation without inflammatory responses. No significant difference in the mineralized and nonmineralized fractions was noted between the groups. Socket preservation using bovine bone mineral and porcine collagen membrane considerably limits the amount of horizontal and vertical bone resorption when compared with extraction alone.     

Bone reactions to anorganic bovine bone (Bio-Oss) used in sinus augmentation procedures: a histologic long-term report of 20 cases in humans

Many materials are used for sinus augmentation procedures. Anorganic bovine bone (Bio-Oss) has been reported to be osteoconductive, and no inflammatory responses have been observed with the use of this biomaterial. One of the main questions pertaining to Bio-Oss concerns its biodegradation and substitution by host bone. Some investigators have observed rapid replacement by host bone, while other researchers observed slow resorptive activity or no resorption at all. The aim of the present study was to conduct a long-term histologic analysis of retrieved specimens in humans where Bio-Oss was used in sinus augmentation procedures. Specimens were retrieved from 20 patients after varying periods from 6 months to 4 years and were processed to obtain thin ground sections. Bio-Oss particles were surrounded for the most part by mature, compact bone. In some Haversian canals it was possible to observe small capillaries, mesenchymal cells, and osteoblasts in conjunction with new bone. No gaps were present at the interface between the Bio-Oss particles and newly formed bone. In specimens retrieved after 18 months and 4 years, it was also possible to observe the presence of osteoclasts in the process of resorbing the Bio-Oss particles and neighboring newly formed bone. Bio-Oss appears to be highly biocompatible and osteoconductive, is slowly resorbed in humans, and can be used with success as a bone substitute in maxillary sinus augmentation procedures.     

Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results

PURPOSE: The aim of the present retrospective study was to evaluate the survival rate of titanium plasma spray-coated cylindric and machined screw-type implants placed in sinuses grafted with anorganic bovine bone mixed with demineralized freeze-dried bone allograft (DFDBA) or with anorganic bovine bone alone. MATERIALS AND METHODS: The patients included in this study were treated with a 1- or 2-stage technique, according to the volume of residual bone. This determined the possibility of primary stabilization and the duration of the treatment, which was 9 or 12 months, respectively. RESULTS: The overall implant survival rate was 94.5% after a mean functioning period of 6.5 +/- 1.9 years. The Implant survival rate was better in sinuses grafted with anorganic bovine bone alone than with a mixture of anorganic bovine bone with DFDBA (96.8% versus 90%). The implant survival rate was similar for cylindric and screw-type implants in sinuses grafted with anorganic bovine bone alone. DISCUSSION: Because of the good bone quality, the implant survival rate was similar for cylindric and screw-type implants in sinuses grafted with anorganic bovine bone. CONCLUSION: Anorganic bovine bone used alone appears to be a suitable material for sinus floor augmentation.     

Treatment of maxillary ridge resorption by sinus augmentation with iliac cancellous bone, anorganic bovine bone, and endosseous implants: a clinical and histologic report

In this clinical study, a 1:1 mix of particulate cancellous bone and marrow (PCBM) and bovine deproteinized bone (Bio-Oss) was used to fill cavities after elevating the sinus mucosa for major sinus dehiscences. Ten patients with edentulous posterior maxillae were treated with 12 sinus augmentation procedures according to a 2-stage technique, and 30 Frialit-2 endosseous implants were used to complete the implant-prosthetic rehabilitation. Bone cylinders were removed at second-stage surgery immediately prior to implant placement (5 to 7 months after grafting), and histologic evaluation was performed. The results showed that Bio-Oss is a reliable osteoconductive material and its association with PCBM leads to the formation of new bone with an increased overall density.     

Ridge enlargement using deproteinized bovine bone and a bioresorbable collagen membrane: a tomodensitometric, histologic, and histomorphometric analysis

The aim of this paper was to study, through a clinical case report, the behavior of deproteinized bovine bone (Bio-Oss) covered with a resorbable barrier membrane (Bio-Gide) when used as an onlay grafting material to obtain alveolar bone ridge enlargement. The presence of an existing bone edge allowed placement of an MK III groovy implant and creation of the required space for ridge enlargement, using xenograft particles (Bio-Oss) covered with a resorbable barrier membrane (Bio-Gide), during the same surgical stage. Recording of anatomical landmarks in the three dimensions of space in relation to implant position allowed precise assessment of the graft behavior during the tomodensitometric examinations performed at 6 and 18 months postsurgery. A biopsy was performed at 9 months postsurgery for histologic and histomorphometric analyses. The tomodensitometric images allowed observation of the preservation of the grafted bone volume. The histologic analysis revealed vital bone formation with the remaining Bio-Oss particles; the histomorphometric analysis, at this stage, provided similar percentages of Bio-Oss (27.94%) and newly formed bone (24.07%). This clinical example confirms the biocompatible and osseoconductive properties of Bio-Oss, as well as stability of the bone graft volume. These different elements testify to the advantage of its use for alveolar ridge enlargement.     

Periodontal and peri-implant bone regeneration: clinical and histologic observations.

The principle of guided tissue regeneration by barrier membranes to restore lost periodontal tissue around natural teeth has also been used around osseointegrated implants in an attempt to restore alveolar ridge defects. While most periodontal procedures in the literature describe root coverage by mucogingival surgery, which achieves healing through soft tissue attachment, regeneration of denuded root surfaces is performed by guided tissue regeneration using expanded polytetrafluoroethylene barrier membranes and demineralized freeze-dried bone allografts as inductive/conductive materials. In this study the technique is applied in two partially exposed cylindrical hydroxyapatite-coated implants in extraction sites in one patient. Surgical reentry in both sites is presented, with histologic examination revealing new bone formation on the exposed root surface and the hydroxyapatite-coated implants.     

Eighteen-month radiographic and histologic evaluation of sinus grafting with anorganic bovine bone in the chimpanzee.

Maxillary sinus grafting procedures are currently the treatment of choice when the alveolar crest of the posterior maxilla is in close approximation to the maxillary sinus. The short-term histologic and radiographic healing following sinus grafting with natural bone mineral (Bio-Oss) in the chimpanzee has been evaluated. We have previously shown by histomorphometric and radiographic analysis that the percentage of vital bone area, the vertical height, and the density of new bone in the maxillary sinus was significantly greater with anorganic bovine bone compared to bovine Type I collagen matrix. The purpose of this in vivo study was to determine the bone mineral density (BMD) of the sinus grafts, the vertical height stability, the vital bone area, and the extent of anorganic bovine bone replacement 18 months postoperatively in 4 maxillary sinuses from 4 different animals. Radiographic analysis of computed tomographic scans taken at 1.5 years revealed an average BMD of 658 mg/mL, which was not significantly different from the values found at 6.5 months. The radiographic vertical height was maintained between the 6.5- and 18-month time points. On average, the grafts were found to have a height of 14 mm. Lateral wall biopsy specimens at 7.5 months were compared to those at 18 months. With the anorganic bovine bone treatment, the percentage of vital bone area increased from 62 +/- 3% to 70 +/- 7% and the percentage of natural bone mineral area decreased from 19 +/- 14% to 6 +/- 3%. The bovine Type I collagen matrix vital bone percentage at 7.5 months was 34 +/- 21%. These results demonstrate that sinus grafting with anorganic bovine bone maintains radiographic evidence of density and height stability of 1.5 years. In addition, histologic evidence supports the hypothesis that anorganic bovine bone is replaced by vital bone.     

Ten-year follow-up in a maxillary sinus augmentation using anorganic bovine bone (Bio-Oss). A case report with histomorphometric evaluation

Several bone grafting materials have been used in sinus augmentation procedures. Bio-Oss (deproteinized and sterilized bovine bone) has shown to have osteoconductive properties and no inflammatory or adverse responses have been published. In spite of these successful results, histologic data regarding bone augmentation using Bio-Oss in humans is scarce. The purpose of this study was to analyse the amount of Bio-Oss ossification in a case of maxillary sinus augmentation, recording and comparing histomorphometric data 8 months, 2 and 10 years after surgery. This long-term histologic evaluation of retrieved specimens has been performed, comparing histomorfometric measures at different times. Eight months after surgery we observed in 20 different thin sections of the specimen a mean amount of bone tissue (including medullar spaces) of 29.8% (and 70.2% of Bio-Oss) +/- 2.6. At 2 years the bone tissue increased to 69.7% + 2.7 and 10 years after surgery it was 86.7% +/- 2.8. The comparison of the means for each time has shown a highly significant increasing trend in bone formation associated with Bio-oss resorption: at 8 months, 2 and 10 years.     

Maxillary sinus augmentation with anorganic bovine bone (Bio-Oss) and autologous platelet-rich plasma: preliminary clinical and histologic evaluations

The present article introduces preliminary clinical and histologic evidence on the combination of a platelet-rich plasma and anorganic bovine bone in maxillary sinus augmentation procedures. The clinical and histologic results from 10 patients underline the different clinical and biologic advantages offered by the combined use of a well-known osteoconductive material, anorganic bovine bone, and a new technique that consists of stimulating bone regeneration using the local increase of growth factors contained in autologous platelet-rich plasma.     

Sinus grafting using recombinant human tissue factor, platelet-rich plasma gel, autologous bone, and anorganic bovine bone mineral xenograft: histologic analysis and case reports

PURPOSE: The purpose of this study was to analyze healthy bone formation by means of histology and immunohistochemistry after grafting with a mixture of autologous ground calvarial bone, inorganic xenograft, platelet-rich plasma (PRP), and recombinant human tissue factor (rhTF). MATERIALS AND METHODS: Maxillary sinus floor augmentation was performed on 3 patients by grafting with 5 to 10 mL of a paste consisting of autologous powder from calvarial bone (diameter < 1 mm), 50% v/v anorganic bovine bone mineral xenograft (PepGen P-15, a new tissue-engineered bone replacement graft material), PRP (1.8 x 10(6) platelets/mm3 plasma), and about 1 microg rhTF. Six and 10 months after grafting, bone cores were extracted for implant fixation and analyzed. RESULTS: Histology demonstrated a high degree of inorganic xenograft integration and natural bone regeneration. Both the xenograft and newly synthesized bone were colonized with osteocytes and surrounded by osteoblasts. Six-month-old bone cores demonstrated a ratio of synthesized bone to xenograft particles ratio of 0.5, whereas 10-month-old cores demonstrated a ratio of 2. A low degree of inflammation could also be observed using S100A8 immunohistochemistry. DISCUSSION: Autologous grafting in edentulous patients is a complex procedure; the successful substitution of synthetic analogs for ground bone is a major challenge. CONCLUSION: In this investigation, it was shown that inorganic xenograft in the harvested bone paste could be safe for patients and had high bone regeneration capacity over time. The sinus graft showed intense bone formation 6 months after grafting and a further increase in bone growth 10 months after grafting.     

Combined periodontal regenerative technique in human intrabony defects by collagen membranes and anorganic bovine bone. A controlled clinical study

BACKGROUND: Combined periodontal regenerative technique (CPRT) is a surgical procedure that combines the use of barrier membranes with a filling material in the treatment of periodontal defects. The effectiveness of CPRT has been evaluated in many studies in comparison to GTR with membranes alone, but conflicting results have been obtained by different clinicians, particularly in the treatment of intrabony defects. The aim of the present study was to compare CPRT to GTR with collagen membranes in the treatment of human intrabony defects characterized by a relevant 1-wall component. METHODS: Thirty-four (34) healthy, non-smoking patients affected by moderate to severe chronic periodontitis participated in this study. Each patient had good oral hygiene and at least 1 radiographically detectable intrabony defect > or = 4 mm, with a 1-wall component of at least 50% of the defect, involving 2 tooth surfaces or more with a probing depth (PD) > or = 6 mm. Seventeen (17) subjects were randomly assigned to the test group and underwent CPRT by anorganic bovine bone and a collagen membrane, and 17 randomly assigned to the control group who received GTR with a collagen membrane alone. Pre- and post-therapy clinical parameters (probing depth [PD]; clinical attachment level [CAL]; gingival recession [GR]) and intrasurgical parameters (depth of intraosseous component [IOC]; level of the alveolar crest [ACL]) were compared between test and control groups 1 year after treatment. Vertical bone gain (VBG) from the base of the defect to the cemento-enamel junction was also evaluated in both groups. RESULTS: At the 1-year examination, clinical and intrasurgical parameters showed statistically significant changes within each experimental group from baseline. A statistically greater CAL gain was reported in the test group (P<0.05), whereas the control group exhibited more GR and alveolar crest resorption at a statistically significant level (P<0.01). VBG was significantly greater (P<0.01) at test sites (5.23 +/- 1.30 mm) compared to controls (3.82 +/- 1.28 mm). CONCLUSIONS: The results suggest that the use of CPRT may be preferred when bioabsorbable membranes are used to treat intrabony defects characterized by unfavorable architecture.     

The free connective tissue autograft: a clinical and histologic wound healing study in humans.

In this report a new method for the management of the soft tissue autograft, based on the concept that some form of control lies in the connective tissue of the periodontium which determines the type and character of the overlying epithelial tissues is presented, along with an insight into the wound healing process.     

Histologic and histomorphometric evaluation of an implant retrieved 8 years after insertion in a sinus augmented with anorganic bovine bone and anorganic bovine matrix associated with a cell-binding peptide: a case report

Few histologic and histomorphometric reports are present in the literature regarding the peri-implant bone response around implants inserted in sinuses grafted with different biomaterials. Anorganic bovine bone (ABB) and anorganic bovine matrix with the addition of an active cell-binding peptide (PepGen P-15) are xenogenic materials that have been reported to present biocompatibility and osteoconductivity. A monolateral sinus augmentation procedure with ABB (50%) and PepGen P-15 (50%) was performed in a 54-year-old man. Two titanium implants with a sandblasted and acid-etched surface were inserted after 6 months. After an additional 6 months, a fixed prosthetic restoration was fabricated. One implant fractured in the coronal portion after an 8-year loading period and was removed using a 5-mm trephine bur. Few particles of both grafting materials were present in the peri-implant bone. No graft material particles were found in contact with the implant surface, and bone was always interposed between the graft materials and surface. No inflammatory cell infiltrate, multinucleated giant cells, or foreign body reaction cells were found. The tissues around the implant were composed of 51.4% ± 4.8% bone, 6.2% ± 0.7% ABB particles, 2.4% ± 0.5% PepGen P-15, and 40.0% ± 7.1% marrow spaces. The bone-implant contact percentage was 78.4% ± 4.1%. A sinus augmentation procedure using ABB and PepGen P-15 produced bone formation with subsequent implant osseointegration, which was still present after 8 years of implant loading.     

Bone healing and graft resorption of autograft, anorganic bovine bone and beta-tricalcium phosphate. A histologic and histomorphometric study in the mandibles of minipigs

OBJECTIVE: The purpose was to qualitatively and quantitatively compare the bone formation and graft resorption of two different bone substitutes used in both orthopedic and oral surgery, with autogenous bone as a positive control. MATERIALS AND METHODS: Three standardized bone defects were prepared in both mandibular angles of 12 adult minipigs. The defects were grafted with either autograft, anorganic bovine bone (ABB), or synthetic beta-tricalcium phosphate (beta-TCP). Sacrifice was performed after 1, 2, 4, and 8 weeks for histologic and histomorphometric analysis. RESULTS: At 2 weeks, more new bone formation was seen in defects filled with autograft than with ABB (P approximately 0.0005) and beta-TCP (P approximately 0.002). After 4 weeks, there was no significant difference between beta-TCP and the two other materials. Defects grafted with ABB still exhibited less bone formation as compared with autograft (P approximately 0.004). At 8 weeks, more bone formation was observed in defects grafted with autograft (P approximately 0.003) and beta-TCP (P approximately 0.00004) than with ABB. No difference could be demonstrated between beta-TCP and autograft. beta-TCP resorbed almost completely over 8 weeks, whereas ABB remained stable. CONCLUSION: Both bone substitutes seemed to decelerate bone regeneration in the early healing phase as compared with autograft. All defects ultimately regenerated with newly formed bone and a developing bone marrow. The grafting materials showed complete osseous integration. Both bone substitutes may have a place in reconstructive surgery where different clinical indications require differences in biodegradability.     

Evaluation of the use of iliac cancellous bone and anorganic bovine bone in the reconstruction of the atrophic maxilla with titanium mesh: a clinical and histologic investigation.

The present article describes a titanium mesh procedure used for bone augmentation in the treatment of severe maxillary atrophy. A mix of iliac cancellous bone and anorganic bovine bone in a 1:1 ratio is proposed for achieving the best bone quality at the time of implant placement, which is performed 5 to 6 months after the augmentation surgery. This procedure provides for 3-stage surgery using a titanium mesh (which is removed 4 to 5 months later) to retain the cancellous bone/Bio-Oss mixture. Bone specimens taken 5 to 6 months after the augmentation procedure showed bone regeneration and the presence of vessels, indicating bone vitality.     

Tomodensitometric and histologic evaluation of the combined use of a collagen membrane and a hydroxyapatite spacer for guided bone regeneration: a clinical report

In this report, the problems of insufficient bone and soft tissue after extraction of maxillary incisors were addressed concurrently prior to endosseous implant placement, by combining the use of a diphenylphosphorylazide-cross-linked Type I collagen membrane and a resorbable space-making biomaterial composed of 200-micron porous hydroxyapatite granules blended in Type I collagen and chondroitin-4-sulfate. Upon flap reflection 8 months postsurgery, the horizontal deficiencies were almost completely resolved, membranes completely resorbed and the defects filled with hard, bonelike tissue, with a few superficial hydroxyapatite granules. Histologic evaluation of the bone biopsies obtained at the implantation sites revealed dense, well-reconstructed alveolar bone with a few traces of hydroxyapatite granules that had been completely resorbed. Tomodensitometric evaluation indicated that bone regeneration ranged from 14% to 58%, with an average bone gain of 29.77%. Four nonsubmerged ITI titanium implants placed in the augmented bone have been in function for more than 5 years, with no clinical or radiographic signs of hard or soft tissue breakdown. Bacterial sampling at dental sites with periodontitis 1 month prior to periodontal therapy and at implant sites for up to 30 months demonstrated rapid colonization of implant surfaces by periodontopathogens without causing any detrimental effect to implant integration.     

Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans

BACKGROUND: Tooth extraction typically leads to loss of ridge width and height. The primary aim of this 6-month randomized, controlled, blinded, clinical study was to determine whether ridge preservation would prevent post-extraction resorptive changes as assessed by clinical and histologic parameters. METHODS: Twenty-four patients, 10 males and 14 females, aged 28 to 76 (mean 51.5 +/- 13.6), requiring a non-molar extraction and delayed implant placement were randomly selected to receive either extraction alone (EXT) or ridge preservation (RP) using tetracycline hydrated freeze-dried bone allograft (FDBA) and a collagen membrane. A replaced flap, which did not completely cover the sockets, was used. Following extraction, horizontal and vertical ridge dimensions were determined using a modified digital caliper and an acrylic stent, respectively. Prior to implant placement, a 2.7 x 6.0 mm trephine core was obtained and preserved in formalin for histologic analysis. RESULTS: The width of the RP group decreased from 9.2 +/- 1.2 mm to 8.0 +/- 1.4 mm (P<0.05), while the width of the EXT group decreased from 9.1 +/- 1.0 mm to 6.4 +/- 2.2 mm (P<0.05), a difference of 1.6 mm. Both the EXT and RP groups lost ridge width, although an improved result was obtained in the RP group. Most of the resorption occurred from the buccal; maxillary sites lost more width than mandibular sites. The vertical change for the RP group was a gain of 1.3 +/- 2.0 mm versus a loss of 0.9 +/- 1.6 mm for the EXT group (P<0.05), a height difference of 2.2 mm. Histologic analysis revealed more bone in the RP group: about 65 +/- 10% versus 54 +/- 12% in the EXT group. The RP group included both vital bone (28%) and non-vital (37%) FDBA fragments. CONCLUSIONS: Ridge preservation using FDBA and a collagen membrane improved ridge height and width dimensions when compared to extraction alone. These dimensions may be more suitable for implant placement, especially in areas where loss of ridge height would compromise the esthetic result. The quantity of bone observed on histologic analysis was slightly greater in preservation sites, although these sites included both vital and non-vital bone. The most predictable maintenance of ridge width, height, and position was achieved when a ridge preservation procedure was employed.     

Rabbit bone marrow response to bovine osteoinductive proteins and anorganic bovine bone.

The effects caused by the implantation of bioabsorbable hydroxyapatite (HA) bound to a pool of bone morphogenetic proteins (BMPs) and other bone noncollagenous hydrophobic proteins mixed with anorganic bovine bone inside rabbit bone marrow were assessed. Within the interior of hollow cylindric titanium prototypes, the following biomaterials were inserted: (1) test group: HA containing a pool of BMPs and noncollagenous hydrophobic proteins mixed with anorganic bovine bone; (2) control group: HA without any protein mixed with anorganic bovine bone; and (3) negative control group: blood clot. The cylinders were placed surgically into the medial portion of the tibiae of 7 rabbits in a manner that allowed the biomaterials to contact just the bone marrow. Morphometric analysis showed that: (1) the biomaterials containing the protein mixture resulted in significantly less new bone than the biomaterials without such a mixture; (2) the group without the protein pool formed larger amounts of bone within the cylinder when compared to the negative control (blood clot only); and (3) the biomaterials containing the protein pool did not show any difference in relation to the negative control. It was concluded that a pool of BMPs and other bone noncollagenous hydrophobic proteins had an inhibitory effect on osteogenesis, and that the biomaterials without a protein pool formed a favorable substrate to bone formation.