Deproteinized bovine bone mineral in marginal defects at implants installed immediately into extraction sockets: an experimental study in dogs

Aim: To evaluate the influence of deproteinized bovine bone mineral (DBBM) particles concomitant with the placement of a collagen membrane on alveolar ridge preservation and on osseointegration of implants placed into alveolar sockets immediately after tooth extraction. Material and methods: The pulp tissue of the mesial roots of ₃P₃ was removed in six Labrador dogs and the root canals were filled. Flaps were elevated in the right side of the mandible, and the buccal and lingual alveolar bony plates were exposed. The third premolar was hemi‐sectioned and the distal root was removed. A recipient site was prepared and an implant was placed lingually. After implant installation, defects of about 0.6 mm wide and 3.1 mm depth resulted at the buccal aspects of the implant, both at the test and at the control sites. The same surgical procedures and measurements were performed on the left side of the mandible. However, DBBM particles with a size of 0.25–1 mm were placed into the remaining defect concomitant with the placement of a collagen membrane. Results: All implants were integrated into mature bone. No residual DBBM particles were detected at the test sites after 4 months of healing. Both the test and the control sites showed buccal alveolar bone resorption, 1.8±1.1 and 2.1±1 mm, respectively. The most coronal bone‐to‐implant contact at the buccal aspect was 2±1.1 an 2.8±1.3 mm, at the test and the control sites, respectively. This difference in the distance was statistically significant. Conclusion: The application of DBBM concomitant with a collagen membrane to fill the marginal defects around implants placed into the alveolus immediately after tooth extraction contributed to improved bone regeneration in the defects. However, with regard to buccal bony crest preservation, a limited contribution of DBBM particles was achieved. To cite this article:
Caneva M, Botticelli D, Pantani F, Baffone GM, Rangel IG Jr, Lang NP. Deproteinized bovine bone mineral in marginal defects at implants installed immediately into extraction sockets: an experimental study in dogs.
Clin. Oral Impl. Res. 23 , 2012; 106–112.
doi: 10.1111/j.1600‐0501.2011.02202.x     

Applicability of equine hydroxyapatite collagen (eHAC) bone blocks for lateral augmentation of the alveolar crest. A histological and histomorphometric analysis in rats

This study assessed the mechanical characteristics, biocompatibility and osteoconductive properties of an equine hydroxyapatite collagen (eHAC) bone block when applied as a bone substitute for lateral augmentation of rat mandible. 96 rats underwent lateral augmentation of the mandible, using two substitute bone blocks (eHAC or Bio-Oss^® spongiosa) or autologous bone grafts. Signs of inflammation, amount of bone formation and ingrowth of bone into the bone blocks were assessed at 1 and 3 months. eHAC blocks were mechanically rigid and could be fixed firmly and easily. Bio-Oss^® spongiosa blocks were brittle and fixation was difficult. eHAC and Bio-Oss^® spongiosa blocks were biocompatible and induced few or no signs of inflammation. Inflammation prevalence between the groups was not statistically different. Bone formation and bone growth into the blocks was significantly higher in eHAC than Bio-Oss^® spongiosa blocks, but lower than in autologous bone grafts (after 1 and 3 months). Regression analysis showed that the autologous bone graft predicted new bone formation at both time points. The eHAC block was only a predictor at 1 month; a trend was found at 3 months. The application of biodegradable membranes was not related to more bone ingrowth.     

Deproteinized cancellous bovine bone (Bio-Oss) as bone substitute for sinus floor elevation. A retrospective,histomorphometrical study of five cases

OBJECTIVES: To study in detail the performance of deproteinized cancellous bovine bone (DPBB, Bio-Osso) granules as a bone substitute, a histomorphometric was performed on five patients treated with DPBB for reconstruction of the severely atrophic maxilla. MATERIAL AND METHODS: DPBB was used as mixture with autogenous bone particles, in concentrations that increased from 20% to 100% DPBB, with the time of healing increasing accordingly from 5 to 8 months. A total of 20 vertical biopsies was taken at the time of fixture installation and used for histomorphometry as undecalcified Goldner stained sections. RESULTS: The results show that in all cases, the DPBB granules had been interconnected by bridges of vital newly formed bone. The volume of bone in the grafted area correlated inversely with the concentration of DPBB grafted, and varied between 37% and 23%. However, the total volume of mineralized material (bone plus DPI3B granules) remained within the same range in all five patients (between 53% and 59%). The high values for osteoid and resorption surface, and the presence of tartrate-resistant acid phosphatase-positive multinucleated osteoclasts in resorption lacunae, indicated that bone remodeling was very active in all grafts. Osteoclasts were also observed in shallow resorption pits on DPBB surfaces. The percentage DPBB surface in contact with bone remained stable at about 35% and could not be related to the proportion of DPBB grafted. CONCLUSION: Although the number of patients examined was limited, the data suggest that deproteinized cancellous bovine bone, preferably combined with autogenous bone particles, is a suitable material for sinus floor elevation in the severely atrophic human maxilla.     

Healing patterns of critical size bony defects in rats after grafting with bone substitutes soaked in recombinant human bone morphogenetic protein-2: histological and histometric evaluation

The aim of the study was to evaluate the effect of different bone substitutes soaked in recombinant human bone morphogenetic protein-2 (rhBMP-2) on the healing of critical size defects in calvarial bone. Defects were created in 24 Sprague Dawley rats. The rhBMP-2 was diluted to obtain a final concentration of 0.2 mg/ml. Rats were divided into four groups and treated as follows: in the first group the defect was filled with anorganic bovine bone mineral (ABBM) and rhBMP-2, the second group was treated with freeze-dried bone allograft (FDBA) and rhBMP-2, and the third group was treated with autogenous bone (AUTO). In the control group the defects were left untreated. Animals were killed after 8 weeks and calcified histological sections prepared. Histometric measurements showed that mean (SD) bone formation was 4.00 (1.69) mm² in the ABBM group, 2.56 (1.06) mm² in the FDBA group, and 2.30 (0.34) mm² in the AUTO group. The difference between the ABBM group and the other 3 groups was significant (p < 0.0001) with a mean bone formation of 0.82 (0.25) mm² in the control group. There was no significant difference between the FDBA and the AUTO groups (p = 0.96). Within the limits of this study we concluded that the addition of rhBMP-2 to bone substitutes was efficacious in regenerating bone in critical size bone defects in calveria in rats.     

Platelet-rich plasma and bovine porous bone mineral combined with guided tissue regeneration in the treatment of intrabony defects in humans

BACKGROUND: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective in promoting clinical signs of periodontal regeneration in intrabony defects. As an initial attempt to clarify the role played by each of the three treatment components, this study was performed to compare the clinical effectiveness of two regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR vs. GTR. MATERIAL AND METHODS: Eighteen patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either an absorbable membrane made of polylactic acid for GTR or a combination of PRP/BPBM/GTR. Changes in pocket depth, attachment level and defect fill as revealed by 6-month reentry surgeries were evaluated. RESULTS: Both treatment modalities resulted in significant pocket depth reduction and clinical attachment gain as compared to baseline values. Pocket depth reduction was 4.98 +/- 0.96 mm on buccal and 4.93 +/- 0.92 mm on lingual sites of the PRP/BPBM/GTR group and 3.62 +/- 0.81 mm on buccal and 3.54 +/- 0.88 mm on lingual sites of the GTR group. The gain in clinical attachment observed was 4.37 +/- 1.31 mm on buccal and 4.28 +/- 1.33 mm on lingual sites of the PRP/BPBM/GTR group and 2.62 +/- 1.23 mm on buccal and 2.44 +/- 1.21 mm on lingual sites of the GTR group. The amount of defect fill observed was 4.78 +/- 1.26 mm on buccal and 4.66 +/- 1.32 mm on lingual sites of the PRP/BPBM/GTR group and 2.31 +/- 0.76 mm on buccal and 2.26 +/- 0.81 mm on lingual sites of the GTR group. All differences between the two groups were statistically significant in favor of the PRP/BPBM/GTR group. CONCLUSIONS: The results of this study suggest that PRP and BPBM provide an added regenerative effect to GTR in promoting the clinical resolution of intrabony defects on patients with severe periodontitis.     

GTR treatment of intrabony defects with PLA/PGA copolymer or collagen bioresorbable membranes in combination with deproteinized bovine bone (Bio-Oss)

The objectives of this study were to evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with two kinds of bioresorbable membranes, with deproteinized bovine bone (Bio-Oss) used as an adjunct. Twenty-eight patients with at least one intrabony defect with a probing pocket depth (PPD) 7 mm and radiographic evidence of an intrabony component (IC) 4 mm were randomly treated with either a polylactic/polyglycolic (PLA/PGA) acid copolymer or a collagen bioresorbable membrane combined with Bio-Oss implantation. Immediately prior to surgery (baseline) and after 1 year, the following parameters were recorded: (1) PPD, (2) gingival recession (REC), (3) probing attachment level (PAL), (4) presence/absence of plaque (PI), and (5) presence/absence of bleeding on probing (BOP). Occurrence of membrane exposure during healing and the smoking habits of the patients were also recorded. Statistical analysis was carried out using x²-tests and t-tests. There were no significant differences between the two membrane groups regarding the clinical parameters at baseline. Statistically significant clinical improvements (PAL gains, reduced PPDs) were observed 1 year after treatment in both groups. There were no significant differences, however, between the PLA/PGA and the collagen membrane groups regarding any of the evaluated parameters (mean PAL gain: 2.9 mm vs 3.9 mm; mean residual PPD: 4.8 mm vs 4.1 mm, respectively). The membrane material per se does not seem to be a critical factor for the outcome of GTR treatment of intrabony defects with bioresorbable membranes.     

Single stage surgery combining transmucosal implant placement with guided bone regeneration and bioresorbable materials

The aim of the present clinical study was to test whether peri-implant bone defects can successfully be filled with bone by applying bioresorbable materials for guided bone regeneration (GBR) procedures in conjunction with implants in the transmucosal healing position. Three women and 7 men ranging in age from 32 to 68 years (median 54.5) needed tooth replacement with dental implants. Eight to 14 weeks following careful tooth extraction, implants of the ITI Dental Implant System were placed at the extraction sites. At this time, all implants presented dehiscence defects of the alveolar bone partly exposing the rough titanium plasma sprayed (TPS) surfaces. GBR procedures were performed using deproteinized bovine bone mineral (Bio-Oss) as a membrane-supporting material and a bioresorbable collagen membrane (Bio-Gide) as a barrier. The membranes and the flaps were adjusted to fit around the necks of the implants, thus leaving the implants extending transmucosally into the oral cavity. Clinical measurements were taken at 6 sites around each implant (mesio-buccal, buccal, disto-buccal, disto-lingual, lingual, mesio-lingual) using a calibrated periodontal probe. These included: i) defect depth measured from the shoulder of the implant to the first bone-to-implant contact, ii) infrabony defect component measured from the bone crest to the first bone-to-implant contact, iii) defect width measured from the crest to the implant body in a direction perpendicular to the long axis of the implant. The Wilcoxon Matched Pairs Signed Rank Test was applied to detect differences over time. At baseline, the mean defect depth per patient amounted to 3.6 mm (Standard Deviation 1.6 mm, range 1.8-6.8 mm). The deepest extensions of the defects were located at the buccal aspects (mean 7.8 mm, SD 1.9 mm). At re-entry, the mean defect had decreased to 2.5 mm (SD 0.6 mm). This difference was statistically significant (P < 0.01). Initially, in 62% of sites the depth ranged from 0-3 mm, in 23% it ranged from 2-4 mm, and in 15% it amounted to more than 6 mm. Six to 7 months later, at re-entry, 95% of sites were 3 mm and less in depth and 5% ranged from 4-6 mm. Defect resolution, as assessed by the amount of coverage of the initially exposed rough implant surface, reached a mean value of 86% (SD 33%). One hundred percent resolution was accomplished at 8 out of 10 implants, 60% at one and 0% at another implant. The tissue at the latter implant showed signs of infection and inflammation during the healing phase. It is concluded that bioresorbable materials in GBR procedures at transmucosal implants can lead to successful bone regeneration into peri-implant defects.     

Five-year results of guided tissue regeneration in combination with deproteinized bovine bone (Bio-Oss) in the treatment of intrabony periodontal defects: a case series report

The aim of this study was to report on the clinical and radiographic results 5 years following treatment of intrabony defects with guided tissue regeneration (GTR) in combination with deproteinized bovine bone (DBB) (Bio-Oss). Fifteen patients, with at least one intrabony periodontal defect with probing pocket depth (PPD)≥7 mm and radiographic presence of an intrabony component (IC)≥4 mm, were treated with a PLA/PGA bioabsorbable membrane. Prior to placement of the membrane, the defect was filled with DBB impregnated with gentamicin sulfate 2 mg/ml. Standardized intraoral radiographs were taken prior to treatment and at the control examinations after 1 and 5 years. At baseline, the average PPD was 9.2±1.1 mm, and the average probing attachment level (PAL) was 10.1±1.6 mm; the radiographic bone level (RBL) was 10.4±2.45 mm, and an IC of 6.2±2.3 mm was present. One year after membrane placement, treatment had resulted in a PAL gain of 3.8±1.8 mm, a residual PPD of 4.2±1.3 mm, an RBL gain of 4.7±2.0 mm, and a residual IC of 2.1±1.2 mm. At the 5-year examination, two patients did not show up, and two patients had lost the treated tooth. However, both teeth were endodontically treated, and progressive periodontal destruction might not necessarily have been the reason for extraction. At the 5-year control (11 patients), the PAL gain was 4.1±1.6 mm, and the residual PPD was 4.6±1.2 mm; an RBL gain of 4.9±2.7 mm and a residual IC of 1.8±0.8 mm were observed. Statistically significant clinical improvements had occurred between baseline and the 1- and 5-year controls, whereas there were no significant differences between the 1- and 5-year results. The results of GTR with bioabsorbable membranes in combination with Bio-Oss in the treatment of periodontal intrabony defects are basically stable on a long-term basis.     

Guided tissue regeneration in intrabony periodontal defects following treatment with two bioabsorbable membranes in combination with bovine bone mineral graft. A clinical and radiographic study

AIM: Comparison of two bioabsorbable barriers (collagen and polylactic acid (PLA) membranes) combined with a bovine bone mineral (BBM) graft, with an access flap procedure (AFP) alone for treating intrabony defects. MATERIAL AND METHODS: Thirty-four subjects participated in this prospective, controlled clinical trial. Baseline clinical examination (probing depth (PD), clinical attachment level (CAL)) of selected sites was performed 2 months after completion of conservative treatment in conjunction with hard-tissue measurements to ascertain the depth of the defect (cementoenamel junction to the bottom of the defects). After randomly dividing patients into three groups (two membrane groups, one control group), full thickness flaps were elevated and exposed root surfaces planed before filling defects with bone graft and positioning a barrier membrane covering the defect. The control group was treated identically except for the barrier and bone graft placement. Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of PD and CAL. Radiographs at baseline and 12 months were compared using non-standardized digital radiography. RESULTS: A mean reduction in PD value of 5.08 mm and mean CAL gain of 4.39 mm occurred in the collagen-BBM group. Corresponding values for the PLA-BBM group were 4.72 and 3.71 mm, while access flap procedure (AFP) sites produced values of 2.50 and 2.43 mm. All improvements in clinical parameters were statistically significant (p<0.001) within groups for all variables. Both membranes produced statistically greater PD reduction and CAL gain compared with AFP treatment (p<0.05). Comparison between barrier groups failed to reveal any statistically significant difference in probing pocket depth reduction (p=0.56) or in CAL gain (p=0.34). CONCLUSION: Placement of the two barrier membranes used in the present study in combination with BBM graft significantly improved clinical and radiographic parameters of deep intrabony pockets and proved superior to access flap alone.     

Validation of new soft tissue software in orthognathic surgery planning

This study tests computer imaging software (SurgiCase-CMF^®, Materialise) that enables surgeons to perform virtual orthognathic surgical planning using a three dimensional (3D) utility that previews the final shape of hard and soft tissues. It includes a soft tissue simulation module that has created images of soft tissues altered through bimaxillary orthognathic surgery to correct facial deformities. Cephalometric radiographs and CT scans were taken of each patient before and after surgery. The surgical planning system consists of four stages: CT data reconstruction; 3D model generation of facial hard and soft tissue; different virtual surgical planning and simulation modes; and various preoperative previews of the soft tissues. Surgical planning and simulation is based on a 3D CT reconstructed bone model and soft tissue image generation is based on physical algorithms. The software rapidly follows clinical options to generate a series of simulations and soft tissue models; to avoid TMJ functional problems, pre-surgical plans were evaluated by an orthodontist. Comparing simulation results with postoperative CT data, the reliability of the soft tissues preview was >91%. SurgiCase^® software can provide a realistic, accurate forecast of the patient's facial appearance after surgery.     

富血小板血浆与多孔矿化骨修复兔下颌骨双皮质骨缺损作用

目的探讨富血小板血浆(PRP)与多孔矿化骨(BPBM)修复下颌双皮质骨缺损作用。方法 54只健康白兔分为3组,制作下颌双皮质骨缺损模型,治疗1组植入PRP+BPBM+GBR,治疗2组植入BPBM+GBR,对照组植入明胶海绵,用X线、光学显微镜、电子显微镜观察术后4、8、12周骨缺损修复情况,测定血中碱性磷酸酶(ALP)、钙磷变化。结果 PRP血小板为全血4.19⁴.43倍;X线片示在4、8、12周时治疗1和2组骨密度明显高于对照组;HE染色见在4周时治疗1组缺损边缘有少许新骨生成,移植物部分降解,治疗2组新骨形成较少;在8周时治疗1组新骨数量明显多于治疗2组;12周时治疗1组充填物吸收被新骨代替,新生骨骨小粱和骨陷窝增多;治疗2组成骨细胞和新骨数量比治疗1组少;对照组新骨形成明显减少。电镜发现,治疗1组各时间点成骨细胞突起和向移植物浸润能力、成骨细胞内线粒体和粗面内质网数量多于治疗2组,治疗2组成骨细胞内线粒体数量和成骨细胞突起向移植物浸润能力强于对照组。在4、8、12周时治疗1组和治疗2组碱性磷酸酶和钙磷含量与对照组比有显著性差异。结论联合PRP和BPBM及GBR技术对下颌双皮质骨缺损有良好修复能力,其作用与PRP中高浓度血小板分泌生长因子和BPBM多孔支架结构有关。     

自体牙本质颗粒与Bio-Oss骨粉植入引导骨再生治疗牙周骨缺损效果比较

目的: 评价自体牙本质颗粒与Bio-Oss骨粉植入引导骨再生治疗牙周骨缺损的效果。方法: 选择2018年5月—2020年5月张掖人民医院收治的82例行引导骨再生治疗的牙周骨缺损患者,依照随机数表法分为实验组和对照组,每组41例。对照组植入Bio-Oss骨粉,实验组植入自体牙本质颗粒。比较2组患者牙周袋深度和附着丧失,颊侧软组织剖面、颊侧软组织厚度,红色美学评分,修复成功率及并发症。采用SPSS 22.0软件包对数据进行统计学分析。结果: 术后1个月和术后1年,2组患者牙周袋深度和附着丧失均显著降低（P<0.05）;且术后1年,2组患者牙周袋深度和附着丧失均低于术后1个月（P<0.05）。术后1个月和术后1年,实验组患者牙周袋深度和附着丧失显著低于对照组（P<0.05）。术后1个月和术后1年,2组患者颊侧软组织剖面显著高于术前（P<0.05）;术后1年,2组颊侧软组织剖面显著低于术后1个月（P<0.05）。术后1年,实验组患者颊侧软组织剖面显著高于对照组（P<0.05）。术后1个月和术后1年,2组患者颊侧软组织厚度显著高于术前。各时间点,2组患者颊侧软组织厚度相比,差异无统计学意义（P>0.05）。术后1个月和术后1年,2组患者红色美学评分显著高于术前（P<0.05）;且术后1年2组红色美学评分显著高于术后1个月（P<0.05）。术后1个月和术后1年,实验组患者红色美学评分显著高于对照组（P<0.05）。术后1年,实验组和对照组修复成功率分别为90.24%（37/41）和85.37%（35/41）,2组修复成功率相比,差异无统计学意义（P>0.05）。2组患者并发症发生率无统计学差异（P>0.05）。结论: 自体牙本质颗粒引导骨再生治疗牙周骨缺损患者,能够降低牙周袋深度和附着丧失,提高颊侧软组织剖面和红色美学评分,且修复成功率与Bio-Oss骨粉植入相当,是一种安全可靠的治疗方法。     

The clinical use of deproteinized bovine bone mineral on bone regeneration in conjunction with immediate implant installation

Twenty-one c.p. titanium screw-shaped implants were immediately installed after extraction and thorough curettage of the alveoli in 15 patients. Granules of deproteinized bovine bone of 0.25-1.0 mm diameter were used to fill the remaining defect when the distance of the defect wall to the implant surface was > 3 mm. Dimensional measurements of the defect height and width were made with a pocket probe. Fourteen sites in the upper jaw and 7 sites in the lower jaw were thus treated. The mean defect depth varied between 7 mm vestibularly and 10 mm mesially. The mucoperiosteal flaps were hermetically closed. At re-entry, the particles were packed and firmly attached but still distinguishable from the surrounding bone. Of the 21 sites treated, 5 sites had an exposure of the implant cover screw during the healing period. An exposure of the granular material occurred in 4 sites, but loss of granules in only 3. Even in these sites no signs of infection or inflammation of the soft tissues were observed. At re-entry after 6 months, 10 sites were completely and 9 partially filled. For the partial fills, the mean remaining defect height was 1.6 mm (range: 0.6-3.0 mm). Two sites showed an increased defect of respectively 2.4 and 4.8 mm. No fixtures were lost. The present results indicate that deproteinized bovine bone is a safe filling material to fill remaining defects around implants installed in fresh extraction sockets.     

Wnt3a促进牙周膜干细胞成骨分化及实验性牙周炎牙槽骨再生的研究

目的:探究Wnt3a对人牙周膜干细胞（periodontal ligament stem cell,PDLSC）增殖、迁移和成骨分化的影响,确定Wnt3a对小鼠实验性牙周炎牙槽骨再生的作用。方法:分别用不同质量浓度的Wnt3a（0、20、100、200、500 μg/L）刺激PDLSC（计为5组）,培养2、4、7或10...     

Effect of GBR in combination with deproteinized bovine bone mineral and/or enamel matrix proteins on the healing of critical-size defects

OBJECTIVES: To evaluate the effect of guided bone regeneration (GBR) in combination with or without deproteinized bovine bone mineral (DBBM) and/or an enamel matrix derivative (EMD) on the healing of critical-size calvarial defects. MATERIAL AND METHODS: Forty rats were used. In all animals, a standardized critical-size calvarial defect was created surgically. The animals were randomly allocated into 4 groups of 10 animals each. Group A: One calvarial defect was left untreated, while the galeal and the cerebral aspect of the contralateral defect were covered with a bioresorbable membrane (GBR). Group B: One calvarial defect was filled with EMD, while the contralateral defect was treated with GBR and EMD. Group C: One defect was filled with DBBM, while the contralateral defect was treated with combination of GBR and DBBM. Group D: One defect was filled with DBBM combined with EMD, while the contralateral defect was treated with combination of GBR, DBBM and EMD. The healing period was 4 months. Five specimens from each group were macerated and the length, the width and the vertical dimension (thickness) of the remaining defect were evaluated by a stereomicroscope. The remaining specimens in each group were analyzed histologically. RESULTS: The defects of the macerated specimens that were left untreated or were treated only by EMD, DBBM and combination of EMD and DBBM did not present predictably complete healing of the defects. All the defects where GBR was applied alone or combined with DBBM and/or EMD presented always complete healing (P<0.05). The combined use of GBR with EMD and/or DBBM did not offer any significant advantage above GBR alone in terms of healing of the length and the width of the defect. However, the vertical dimension of the defect was significantly higher (P<0.05) in the GBR-treated specimens of Groups C and D. The histological analysis supported these findings. CONCLUSION: The predictability of bone formation in critical-size defects depends mainly on the presence or absence of barrier membranes (GBR). The combined use with deproteinized bovine bone mineral and/or enamel matrix proteins did not significantly enhance the potential for complete healing provided by the GBR procedure.