Expression of MMP-2, 9 and 13 in newly formed bone after sinus augmentation using inorganic bovine bone in human

Bassil J, Senni K, Changotade S, Baroukh B, Kassis C, Naaman N, Godeau G. Expression of MMP‐2, 9 and 13 in newly formed bone after sinus augmentation using inorganic bovine bone in human. J Periodont Res 2011; 46: 756–762. © 2011 John Wiley & Sons A/S Background and Objective: The aim of the present study was to analyse the expression of MMP‐2, MMP‐9 and MMP‐13 in newly formed bone following maxillary sinus augmentation using inorganic bovine bone substitute, because these MMPs play a major role in bone remodeling and bone resorption. Material and Methods: Deproteinized bovine bone (Bio‐Oss^®) was used to fill cavities after elevating the sinus mucosa. Twenty patients with edentulous posterior maxilla were treated with 20 sinus‐augmentation procedures using a two‐stage technique. Forty‐nine Straumann^® endosseous implants were used to complete the implant‐prosthetic rehabilitation. One cylinder‐shaped bone biopsy from each patient was taken from the augmented maxillary region using trephine burs at the second stage of surgery, 8 months after grafting. A biopsy was also taken as a control from the upper molar region from six different patients who did not undergo the sinus procedure. All biopsies were subjected to biochemical analysis and staining for TRAP. Results: No implant losses or failures occurred. The large number of TRAP‐positive multinucleated osteoclasts in resorption lacunae indicated that the resorption was very active in all grafts, in contrast with the control group. Zymography and western blot analysis demonstrated a significantly increased expression of MMP‐2, MMP‐9 and MMP‐13 in the newly formed bone compared with controls (p < 0.05). Conclusion: The quantity of osteoclastic cells and the increased expression of proteolytic enzymes suggest that 8 months after grafting, inorganic bovine bone is slowly resorbing and is the site of important remodeling of the newly formed bone by means of resorption and synthesis.     

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.     

Osseointegration of subperiosteal implants using bovine bone substitute and various membranes

An earlier study revealed incomplete osseointegration of individually made titanium subperiosteal implants covered by ePTFE membranes and fixated to the rabbit tibial bone surface. In addition, the newly-formed bone was dominated by large marrow spaces. In this subsequent study, subperiosteal implants were also fixated on the bone surface of both tibia of 9 Copenhagen White rabbits. Bio-Oss particles were packed densely covering the entire implant surface. One of 3 different membranes covered the implant and the particles. The membranes used were the degradable Polyglactin 910 mesh, a degradable bilayer collagen membrane and the non-degradable ePTFE membrane. Undecalcified sections were prepared for histologic evaluation after a 12 weeks' observation period. All 18 subperiosteal implants were completely osseointegrated. In addition, the marrow spaces were reduced compared to our previous study. The Bio-Oss particles proved to be biocompatible and osteoconductive. The ePTFE membranes revealed neither signs of collapse nor adjacent infiltration of inflammatory cells. The Polyglactin 910 mesh and the bilayer collagen membranes collapsed slightly. There were signs of resorption of the surface of the newly-formed bone under the degradable membranes. The cause of resorption can not be documented.     

A collagenated porcine bone substitute for augmentation at Neoss implant sites: a prospective 1-year multicenter case series study with histology

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.     

Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft: a systematic review

Aims: The objective of the present systematic review was to test the hypothesis of no differences in the implant treatment outcome when Bio‐Oss or Bio‐Oss mixed with autogenous bone is used as graft for the maxillary sinus floor augmentation (MSFA) applying the lateral window technique. Material and methods: A MEDLINE (PubMed) search in combination with a hand search of relevant journals was conducted by including human studies published in English from January 1, 1990 to June 1, 2010. The search provided 879 titles and 35 studies fulfilled the inclusion criteria. Considerable variation in the included studies prevented meta‐analysis from being performed and no long‐term study comparing MSFA with the two treatment modalities was identified. Also, the survival of suprastructures after the two augmentation procedures was not compared within the same study. Results: The 1‐year implant survival was compared in one study demonstrating no statistically significant difference. The implant survival was 96% with Bio‐Oss and 94% with a mixture of 80% Bio‐Oss and 20% autogenous mandibular bone. Addition of a limited amount of autogenous bone to Bio‐Oss seemed not to increase the amount of new bone formation and bone‐to‐implant contact compared with Bio‐Oss. Conclusions: Therefore, the hypothesis of no differences between the use of Bio‐Oss or Bio‐Oss mixed with autogenous bone as graft for MSFA could neither be confirmed nor rejected. To cite this article : Jensen T, Schou S, Stavropoulos A, Terheyden H, Holmstrup P. Maxillary sinus floor augmentation with Bio‐Oss or Bio‐Oss mixed with autogenous bone as graft: a systematic review. Clin. Oral Impl. Res. 23, 2012; 263–273
doi: 10.1111/j.1600‐0501.2011.02168.x     

无机骨材料对上颌窦提升术后骨再生的影响

目的：研究兔上颌窦提升术后扩增区域内新生骨的改建过程和破骨细胞的分布情况,探讨无机骨颗粒对上颌窦提升术后骨再生的影响。方法：对8只日本大耳白兔施行上颌窦提升术。实验组扩增区植入无机骨颗粒,对照组仅使血凝块充满扩增区,不填充移植材料。结果：术后4周,对照组扩增区近窦黏膜处的新生骨表面可见大量破骨细胞。组织形态测量学分析表明,术后4周至8周实验组窦底提升高度显著大于对照组;术后8周时实验组新生骨面积较对照组明显增加。结论：上颌窦内存在的空气压力可导致上颌窦提升术后新生骨发生吸收。在上颌窦提升术中使用无机骨填充材料可抵抗上颌窦内的空气压力,并具有良好的骨重建效果。     

无机骨材料对上颌窦提升术后骨再生的影响

目的：研究兔上颌窦提升术后扩增区域内新生骨的改建过程和破骨细胞的分布情况,探讨无机骨颗粒对上颌窦提升术后骨再生的影响。方法：对8只日本大耳白兔施行上颌窦提升术。实验组扩增区植入无机骨颗粒,对照组仅使血凝块充满扩增区,不填充移植材料。结果：术后4周,对照组扩增区近窦黏膜处的新生骨表面可见大量破骨细胞。组织形态测量学分析表明,术后4周至8周实验组窦底提升高度显著大于对照组;术后8周时实验组新生骨面积较对照组明显增加。结论：上颌窦内存在的空气压力可导致上颌窦提升术后新生骨发生吸收。在上颌窦提升术中使用无机骨填充材料可抵抗上颌窦内的空气压力,并具有良好的骨重建效果。