Articulos Osteobiol

Articulos osteobiol
Regeneracin Alveolar
Bone Regeneration in Iliac Crestal Defects: An Experimental Study on Sheep.
Scarano A1, Lorusso F2, Ravera L2, Mortellaro C3, Piattelli A2.
Abstract
Background. Oral rehabilitation of partially fully edentulous patients with dental implants has become a routine
procedure in clinical practice. In a site with a lack of bone GBR is a surgical procedure that provides an augmentation
in terms of volume for the insertion of dental implants. Materials and Methods. In the iliac crest of six sheep 4 defects
were created where an implant was inserted, three of them with different biomaterials and a control site. All animals
were sacrificed after a 4-month healing period. All specimens were processed and analyzed with histomorphometry.
Statistical evaluation was done to evaluate percentage of bone defect filled by new bone. Results. All experimental
groups showed an increase of the new bone. Higher and highly statistically significant differences were found in the
percentages of bone defect filled by new bone in group filled with corticocancellous 250-1000 microns particulate
porcine bone mix. Conclusions. This study demonstrates that particulate porcine bone mix and porcine
corticocancellous collagenate prehydrated bone mix when used as scaffold are able to induce bone regeneration.
Moreover, these data suggest that these biomaterials have higher biocompatibility and are capable of inducing faster
and greater bone formation.
The use of a collagenated porcine cortical lamina in the reconstruction of alveolar
ridge defects. A clinical and histological study.
Rossi R1, Rancitelli D, Poli PP, Rasia Dal Polo M, Nannmark U, Maiorana C.
Abstract
BACKGROUND:
Alveolar ridge reconstruction by means of resorbable and non-resorbable membranes has been proposed to increase the hard tissue volume in deficient
sites. The purpose of this study was therefore to clinically and histologically evaluate the use of collagenated porcine bone lamina in case of horizontal and
vertical bone augmentation procedures in conjunction with particulated porcine xenograft.
METHODS:
Overall, 8 partially edentulous patients (6 females and 2 males) with a mean age of 45 years requiring bone regeneration procedures to achieve a
prosthetically driven implant placement were enrolled. All ridge defects were augmented using a xenogeneic cortical bone barrier in combination with
particulated heterologous bone. Bone biopsies were collected during the re-entry procedure.
RESULTS:
A total of 15 implants were placed both simultaneously or in a staged approach in the augmented sites. No complications occurred during the rehabilitation.
Histologically, the bone lamina was widely vascularized and integrated with the surrounding soft tissues and the native bone. The presence of osteoclastic
lacunae suggested an active remodelling of the particulated graft and a gradual substitution with the newly formed bone.
CONCLUSION:
Alveolar reconstruction by means of the collagenated cortical lamina gave promising clinical and histological results. The rigidity and the slow resorption
pattern allowed for the blood clot protection even in case of vertical defects, avoiding at the same time the re-entry surgery for its removal.
Experimental evaluation of the effects of Ankaferd Blood Stopper and collagenated
heterologous bone graft on bone healing in sinus floor augmentation.
Cakir M, Karaca R, Firat A, Kaymaz F, Bozkaya S.
Abstract
PURPOSE:
The aim of this study was to evaluate the effect of collagenated heterologous bone graft (CHBG) and Ankaferd Blood Stopper (ABS), a plant extract, on
bone healing after sinus floor augmentation.
MATERIALS AND METHODS:
Thirty-six New Zealand rabbits were used. Bilateral sinus augmentation was performed, and 72 bone defects were created. The maxillary sinuses were
grafted with four different biomaterials: blood clot (control group), CHBG (Apatos Mix, OsteoBiol, Tecnoss) (graft group), ABS (ABS group), and ABS +
CHBG (ABS+graft group). The rabbits were sacrificed at 1, 4, and 8 weeks after surgery. Histochemical and immunohistochemical examinations were
performed on all samples. Staining with hematoxylin-eosin and Masson trichrome was performed, and bone marker activity was evaluated.
RESULTS:
Lymphocyte infiltration was high at the first week in all groups and decreased from 1 to 8 weeks. All materials were biocompatible. Osteoclast numbers
increased in the control group from 1 to 8 weeks and decreased in the other groups. There was no new bone formation in week 1 in all groups. New
bone formation increased in all groups from 1 to 8 weeks, and at the fourth week, new bone formation was greater in the ABS and ABS+graft groups
than in the other groups. There were osteoclasts around the bone graft materials, but degeneration of the graft was seen only in the ABS+graft group at
week 8.
CONCLUSION:
ABS accelerates bone healing in sinus augmentation procedures and can be used alone or with CHBG. CHBG has osteoconductive properties, and
ABS can accelerate bone graft degeneration.
Clinical Outcomes of Implants Placed in Extraction Sockets and Immediately
Restored: A 7-Year Single-Cohort Prospective Study.
Barone A1,2, Marconcini S3,2, Giammarinaro E2, Mijiritsky E4, Gelpi F5, Covani U6.
Abstract
BACKGROUND:
The placement of implants immediately after tooth extraction has proven to be a predictable treatment strategy with a very high
success rate.
PURPOSE:
The aim of the present 7-year prospective single cohort study was to evaluate the success rate, marginal bone level (MBL), soft
tissue stability of implants placed in fresh extraction sockets and immediately restored.
MATERIAL AND METHODS:
This prospective cohort study included 37 implants in 32 patients (19 females and 13 males) with an average age of 40.113.3
(range: 21-63 years) who received immediate implants and immediate single unit restorations. Outcome evaluations were: implant
failures, complications, MBL, width of keratinized gingiva, facial soft tissue (FST) levels, modified Plaque Index and modified
Bleeding Index.
RESULTS AND CONCLUSIONS:
The cumulative survival rate was of 94.6% at 7-year visit. The mean MBL was -0.60.49 mm at baseline and 10.2 mm after 7
years. The FST Level was 0.40.69 mm at baseline and 0.020.70 mm at the 7-year follow-up. The Width of Keratinazed Gingiva
was 3.80.47 mm at baseline and 3.10.42 mm at 7-year follow-up. Implants placed immediately after tooth extraction and
immediately restored showed predictable clinical outcomes in this prospective study.
New bone formation in bone defects after melatonin and porcine bone grafts:
experimental study in rabbits.
Calvo-Guirado JL1, Gmez-Moreno G, Mat-Snchez JE, Lpez-Mar L, Delgado-
Ruiz R, Romanos GE.
Abstract
OBJECTIVE:
The aim of this study was to evaluate the effect of the topical application of melatonin compared with collagenized porcine bone grafts to accelerate bone formation 2
months after their insertion in tibiae rabbits.
Twenty New Zealand rabbits weighing 3,900-4,500 g were used. Twenty collagenized porcine bone (MP3) grafts, twenty melatonin-impregnated bone grafts, and twenty
control areas were placed in the proximal metaphyseal area of both rear tibias. Four groups were formed according to the moment in which animal killing was carried out:
Group I (15 days), Group II (30 days), Group III (45 days) and Group IV (60 days). Cortical width and cortical length of bone formation was measured. Following
implantation, an anteroposterior and lateral radiological study was carried out. Samples were sectioned at 5 m and stained using hematoxylin-Eeosin, Masson's
trichromic, and Gordon-Switt reticulin stains.
RESULTS:
After 60 days of treatment period, melatonin increased the length of cortical bone formation 99.03 0.61% like control 98.90 3.82% compared with porcine bone 92.73
1.08%. Related to perimeter of cortical bone of the tibiae melatonin new bone was 98.35 1.14% like control 98.0 1.43% more than porcine bone 92.05 1.03%.
Histomorphometric values related to porcine bone were connective tissue 49.16 2.4%, graft material (MP3) 23.52 2.3%, and new bone formation 27.32 1.4%
compared with test group with melatonin 24.5 1.2%, connective tissue 45.1 1.2%, and new bone formation of 30.4 1.0%.
CONCLUSION:
Melatonin has proven to regenerate the width and length of cortical bone in tibiae rabbits more quickly than collagenized porcine bone. Melatonin acts as a bone
stimulator compared with porcine bone and control sites.
2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Bone response to collagenized xenografts of porcine origin (mp3() ) and a bovine bone
mineral grafting (4BONE() XBM) grafts in tibia defects: experimental study in rabbits.
Calvo-Guirado JL1, Aguilar-Salvatierra A2, Ramrez-Fernndez MP1, Mat Snchez de Val
JE1, Delgado-Ruiz RA3,
Abstract
Gmez-Moreno G2.
OBJECTIVES:
This study aimed to carry out the evaluation of bone response of new bone formation to two different xenografts (bovine and porcine) biomaterials inserted in
rabbit tibiae.
The study used a total of 20 male New Zealand albino rabbits. They received a total of 40 grafts in the proximal metaphyseal areas of both tibiae. Two
biomaterials were evaluated: 20 porcine xenografts, as a bone granulate (OsteoBiol() MP3() ; Tecnoss srl, Giaveno, Italy), were placed in the proximal
metaphyseal area of the right tibia, 20 anorganic bovine bone mineral grafting (4BONE() XBM, MIS Implants Inc., BARLEV, Israel) were placed in the left
tibia. Following graft insertion, the animals were sacrificed in two groups of 10 animals, after 1 and 4 months, respectively. For each group, biomaterials were
analyzed: newly formed bone, residual graft materials and the connective tissue. Histomorphometric, EDX analysis and element mapping were performed at
1 and 4 months after graft insertion.
RESULTS:
At 4 months after treatment, the bone defects displayed radiological images that showed complete repair of osseous defects. Histomorphometric evaluation
showed that for the porcine xenograft, the study averages for newly formed bone represented 84.23 2.9%, while bovine matrix was 79.34 2.1%. For
residual graft material, the porcine biomaterial had 11.23 1.7% and the bovine graft 31.56 2.3%. Finally, the connective tissue for MP3 was 10.33 1.8%,
while for the 4BONE() XBM we obtained 14.34 2.9%. Element analysis revealed higher percentages of Ca (54 9%) and P (35 6%) in the group B than
group A and control group (P < 0.05).
CONCLUSIONS:
Defects of a critical size in a rabbit tibia model can be sealed using a bovine porous biphasic calcium phosphate and MP3 material; this supports new bone
formation, creates a bridge between borders, and facilitates bone ingrowth in both biomaterials. Furthermore, this study observed partial dissolution of the
mineral phase of four bone graft and complete resorption of porcine MP3 biomaterial and its incorporation into the surrounding bone. Depending on clinical
needs, each biomaterial could be useful in daily clinical practice.
Volumetric analysis of remodelling pattern after ridge preservation comparing use of
two types of xenografts. A multicentre randomized clinical trial.
Barone A1, Toti P, Quaranta A, Alfonsi F, Cucchi A, Calvo-Guirado JL, Negri B, Di
Felice R, Covani U.
Abstract
OBJECTIVES:
The aim of this randomized clinical trial was to analyse and compare the volumetric changes after ridge preservation procedures using two different biomaterials and to evaluate
associations between outcome variables and pristine three-dimensional aspects of the ridges.
Twenty-eight patients subjected to single-tooth alveolar ridge preservation were enrolled in the present multicentre, single-blind, prospective and randomized clinical trial.
Fourteen sites were randomly allocated to each experimental group. The experimental sites were grafted with pre-hydrated collagenated cortico-cancellous porcine bone (coll
group) or with a cortical porcine bone (cort group) and a collagen membrane; a secondary soft tissue healing was obtained for all experimental sites. Plaster casts were scanned
(preoperative, at 1 and 3 months postoperative). Analysis of volumes and areas was performed, and all measured variables were statistically compared.
RESULTS:
Intragroup analyses at 3 months revealed that when examining changes related to three-dimensional features of remodelling patterns (volume, surfaces, height and shape), the
two biomaterials showed similar behaviours with a minor loss in volume and ridge surface. Intergroup analysis at 3-month survey revealed that volume resorption of the coll group
(244 mm3 ) was significantly lower (P = 0.0140) than that of the cort group (349 mm3 ). The reduction for basal surface appeared significantly different between the two groups at
1-month survey only (P = 0.0137), while the final basal surface reduction was 4.9 and 12.2 mm2 for coll and cort group, respectively. The superior surface reduction was 40.8
mm2 for coll and 50.7 mm2 for cort group, with no significant difference between the two groups.
CONCLUSION:
At the 3rd month analysis, coll group showed a significantly lower reduction of ridge volume and a significantly smaller shrinkage of the basal area when compared to the cort
group; moreover, the coll group experienced a smaller superior surface shrinkage when compared to the cort group, even though no significance was evaluated.
Dimensional alterations of extraction sites after different alveolar ridge preservation
techniques - a volumetric study.
Thalmair T1, Fickl S, Schneider D, Hinze M, Wachtel H.
Abstract
OBJECTIVES:
The aim of this randomized controlled clinical study was to assess soft tissue contour changes after different alveolar ridge preservation procedures.
Following tooth extraction, 30 patients were randomly assigned to the following treatments (Tx) - Tx 1: xenogenic bone substitute (pre-hydrated
collagenated cortico-cancellous porcine bone) and free gingival graft; Tx 2: free gingival graft alone; Tx 3: xenogenic bone substitute; Tx 4: no further
treatment (control). Impressions were obtained before tooth extraction (baseline) and 4 months after surgery. Cast models were optically scanned,
digitally superimposed and horizontal measurements of the contour alterations between time points were performed using digital imaging analysis.
RESULTS:
All groups displayed contour shrinkage at the buccal aspect ranging from a mean horizontal reduction of -0.8 0.5 mm (Tx 1) to -2.3 1.1 mm
(control). Statistically significant differences were found between Tx 1 and Tx 4 as well as Tx 2 and Tx 4. A significant positive influence of the free
gingival graft on the maintenance of the ridge width was recorded (p < 0.001).
CONCLUSION:
In this study, alveolar ridge preservation techniques were not able to entirely compensate for alveolar ridge reduction. Covering the orifice of the
extraction socket with a free gingival tissue graft seems to have the potential to limit but not avoid the post-operative external contour shrinkage based
on optical scans.
The Clinical Outcomes of Immediate Versus Delayed Restoration Procedures on
Immediate Implants: A Comparative Cohort Study for Single-Tooth Replacement.
Barone A1,2, Toti P1,2, Quaranta A3, Derchi G1,2, Covani U1,2.
Abstract
BACKGROUND:
Immediate implant placement into fresh extraction sockets is generally considered a reliable procedure that offers several clinical advantages.
PURPOSE:
The primary aim of this study was to evaluate and compare the overall clinical outcomes of immediate and delayed restoration procedures for implants placed in
fresh extraction sockets by means of a flapless technique and resorbable membrane stabilizing a xenograft. Total costs and operating times were also compared.
In this prospective cohort study, changes of marginal bone level, facial soft tissue (FST), and width of keratinized gingiva (WKG), in addition to the papilla index,
underwent a pairwise comparison; correlations with pristine buccal bone thickness were also investigated.
RESULTS:
Although similar results were recorded for the two procedures, with a bone loss of -1.0 0.5 mm and -0.9 0.7 mm, respectively, for immediate and delayed
restoration, negative remodeling in the delayed restoration procedure was seen to occur from 4 to 12 months after implant placement. No significant differences
were recorded between the two procedures in terms of FST and WKG. A loss of the papillary soft tissues before restoration, followed by a reestablishment after
restoration, seemed to be verified for the delayed group, for which the papilla index went from the minimum of 0 at 4 months to a value of 2 at 24 months. Moreover,
the immediate restoration procedure seemed to be more promising in terms of healing times and costs.
CONCLUSION:
Immediate restoration of implants installed in fresh extraction sockets was at least as effective and safe as delayed restoration.
Buccal bone deficiency in fresh extraction sockets: a prospective single cohort
study.
Barone A1, Ricci M2, Romanos GE3, Tonelli P4, Alfonsi F2, Covani U1,2.
Abstract
OBJECTIVE:
The purpose of this prospective single cohort study was to evaluate the use of xenograft and collagen membranes in treating full or partial buccal bone
defects of fresh extraction sockets in the esthetic zone.
Thirty-three patients requiring tooth extraction in the anterior maxillary area and showing a complete or partial buccal bone plate deficiency (more than 2 mm)
were consecutively enrolled and treated. Corticocancellous porcine bone and platelet-rich fibrin (PRF) with a collagen membrane were used to graft the
extraction sockets, and the membranes were left exposed to the oral cavity with a secondary soft tissue healing. The outcome variables were as follows: width
of keratinized mucosa, facial soft tissue levels, clinical bone changes (measured with a clinical splint), implant and prosthesis failures, and peri-implant
marginal bone changes.
RESULTS:
All treated sites allowed the placement of implants; the width of keratinized mucosa at the mid-facial aspect showed an increase of 2.3 mm 5 months after the
grafting procedure, and its value was 3.2 0.6 mm at 1-year follow-up. The mean values of the facial soft tissue level indicated an increase over time. The
bone level showed an improvement of 0.8 0.1 mm and 0.7 0.1 mm at mesial and distal sites, respectively, when compared to the baseline measurements.
Finally, in the palatal area, no bone changes were observed. No implant failed during the entire observation period.
CONCLUSIONS:
Findings from this study showed that xenograft and PRF, used for ridge preservation of the extraction sockets with buccal bone plate dehiscence in the
esthetic zone, can be considered effective in repairing bone defects before implant placement. The secondary soft tissue healing over the grafted sockets
did not compromise bone formation; moreover, the soft tissue level and the width of keratinized gingiva showed a significant improvement over time.
Flap versus flapless procedure for ridge preservation in alveolar extraction sockets: a
histological evaluation in a randomized clinical trial.
Barone A1,2,3, Borgia V1,3, Covani U1,3, Ricci M1,3, Piattelli A4, Iezzi G4.
Abstract
OBJECTIVE:
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.
RESULTS:
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.
CONCLUSION:
No histological and histomorphometrical differences were observed when comparing the flap and the flapless technique for tooth extraction and socket
grafting procedures.
Porcine dermal matrix in the treatment of dehiscence-type defects--an experimental
split-mouth animal trial.
Fickl S1, Nannmark U2, Schlagenhauf U1, Hrzeler MB3, Kebschull M4.
Abstract
OBJECTIVES:
To describe histometrical outcomes (tissue thickness, tissue height) of a porcine dermal matrix (PDX) and subepithelial
connective tissue (CTG) in the treatment of dehiscence-type defects.
In five beagle dogs buccal dehiscence defects were created on both upper canines. The defects were covered in a split-
mouth design either with a porcine dermal matrix or subepithelial connective tissue. After 4 months histometrical
outcomes were evaluated using a nonparametric Brunner-Langer model.
RESULTS:
Neither in the test nor in the control specimen signs of inflammation or foreign body reaction was detected.
Histometrically, no significant difference was found for tissue thickness and height between both treatment groups.
CONCLUSIONS:
Porcine dermal matrix can be used for grafting of dehiscence-type defects. Augmentation of tissue thickness seems to be
comparable to subepithelial connective tissue.
Tissue changes of extraction sockets in humans: a comparison of spontaneous
healing vs. ridge preservation with secondary soft tissue healing.
Barone A1, Ricci M, Tonelli P, Santini S, Covani U.
Abstract
INTRODUCTION:
As a consequence of extraction, the height of the buccal wall tends to decrease and results in the disappearance of bundle bone. To modify bone remodelling after extraction, various
ridge preservation techniques have been proposed. The present research was drawn up with the following considerations in mind: to evaluate and to compare changes of hard and soft
tissues in post-extraction sockets which received a ridge preservation procedure, with post-extraction sockets which had healed naturally.
Each patient was randomly allocated to a test or control group using a specific software package. After extraction, the sockets were carefully inspected and any granulation tissue was
removed. The control sites received silk sutures to stabilize the clot without any grafting material. The test sites were grafted with corticocancellous porcine bone and a collagen
membrane. All experimental sites had the membranes left exposed to the oral cavity with a secondary wound healing. The thickness of the buccal alveolar bone, if present, was carefully
measured at the time of tooth extraction using a calliper at 1 mm from the edge of the wall. The following clinical parameters were evaluated at baseline and after 4 months at implant
placement: vertical bone changes, horizontal bone changes and width of keratinized gingiva. The length, diameter and need for additional bone augmentation were assessed for both
groups at the time of implant insertion.
RESULTS:
The control group showed vertical bone resorption of 1 0.7 mm, 2.1 0.6 mm, 1 0.8 mm and 2 0.73 mm at the mesial, vestibular, distal and lingual sites respectively. Moreover,
changes in horizontal dimension showed an average resorption of 3.6 0.72 mm. The test sites showed a horizontal bone remodelling of 0.3 0.76 mm, 1.1 0.96 mm, 0.3 0.85 mm,
0.9 0.98 mm at the mesial, vestibular, distal and lingual sites respectively. The horizontal bone resorption at the test sites was 1.6 0.55 mm. The keratinized gingiva showed a coronal
shift of 0.7 mm in the control group when compared to 1.1 mm in the test group. In addition, 42% of sites in the control group required an additional bone augmentation at implant
placement, when compared to 7% in the test sites.
CONCLUSIONS:
This study clearly points out that an alveolar ridge preservation technique performed with collagenated porcine bone and a resorbable membrane--according to the procedure reported
in this study--was able to limit the contour changes after tooth extraction. Finally, the test sites showed a better preservation of facial keratinized tissue when compared to control sites;
grafted sites allowed the placement of longer and wider implants when compared to implants inserted in non-grafted sites.
A randomized clinical trial to evaluate and compare implants placed in augmented
versus non-augmented extraction sockets: 3-year results.
Barone A1, Orlando B, Cingano L, Marconcini S, Derchi G, Covani U.
Abstract
BACKGROUND:
The alveolar ridge undergoes reabsorption and atrophy subsequent to tooth removal and thus exhibits a wide range of dimensional changes. Preservation of the alveolar
crest after tooth extraction is essential to enhance the surgical site before implant fixture placement. The aim of this randomized clinical study is to investigate and
compare the need for additional augmentation procedures at implant insertion, as well as the success rate and marginal bone loss for implants placed in the grafted sites
versus those placed in naturally healed sites.
METHODS:
Forty patients with 1 hopeless tooth were randomly allocated to: 1) a test group, receiving extraction and grafting corticocancellous porcine bone; and 2) a control group,
receiving extraction without any graft. After 7 months of healing, implants were inserted in each of the sites. The implants were submerged and loaded after 4 months with
metal-ceramic rehabilitation. The follow-up included evaluation of implant diameter and length, the need for additional augmentation procedures at implant placement,
implant failure, and marginal bone level changes. All patients were followed over a 3-year period.
RESULTS:
One implant failed in the control group at the second stage of surgery (6 months after placement); one implant failed in the test group after 2 years of loading. The
cumulative implant success rate at the 3-year follow-up visit reached 95% for both groups. No statistically significant differences were detected for marginal bone changes
between the two groups.
CONCLUSIONS:
It was concluded that implants placed into grafted extraction sockets exhibited a clinical performance similar to implants placed into non-grafted sites in terms of implant
survival and marginal bone loss. However, grafted sites allowed placement of larger implants and required less augmentation procedures at implant placement when
compared to naturally healed sites.
Porcine-derived xenograft combined with a soft cortical membrane versus extraction
alone for implant site development: a clinical study in humans.
Festa VM1, Addabbo F, Laino L, Femiano F, Rullo R.
Abstract
BACKGROUND:
An adequate alveolar crest is essential for implant placement in terms of esthetics and function. The objective of this randomized clinical trial was to compare
the preservation of the alveolar ridge dimensions following tooth extraction using porcine-derived xenograft combined with a membrane versus extraction-
alone (EXT) sites.
METHODS:
Fifteen patients who required double extraction of contralateral premolars and delayed implant placement were randomly selected to receive both ridge-
preservation procedure and EXT. The test sites (alveolar ridge preservation [ARP]) included 15 sockets treated using a corticocancellous porcine bone
xenograft (OsteoBiol Gen-Os; Tecnoss srl, Giaveno, Italy) associated with a soft cortical membrane (OsteoBiol Lamina; Tecnoss srl), while the
corresponding control sites (EXT) were left without grafting for EXT. Horizontal and vertical ridge dimensions were recorded at baseline and 6 months after
extractions.
RESULTS:
After 6 months, the EXT sites showed a significantly greater reabsorption of the buccolingual/palatal dimension of the alveolar ridge (3.7 1.2 mm) compared
with the ARP sites (1.8 1.3 mm). The mean vertical ridge height reduction in the control sockets was 3.1 1.3 mm at the buccal sites and 2.4 1.6 mm at
the lingual sites compared with 0.6 1.4 and 0.5 1.3 mm, respectively, in the test sockets. The differences between test and control sockets were not
significant for the mesial and distal measurements.
CONCLUSIONS:
The placement of a porcine xenograft with a membrane in an extraction socket can be used to reduce the hard tissue reabsorption after tooth extraction
compared with EXT.
Zygomatic implant placement in conjunction with sinus bone grafting: the "extended
sinus elevation technique." a case-cohort study.
Hinze M, Vrielinck L, Thalmair T, Wachtel H, Bolz W.
Abstract
PURPOSE:
The zygomatic implant is mainly indicated for the rehabilitation of extremely atrophied maxillae when bone augmentation should be avoided. One drawback of zygomatic
implants, which typically pass through the sinus, is initial or late bone resorption around the implant neck, which can result in oroantral communications followed by
possible infection of the sinus. To decrease the risk of sinus infection, a modified technique was developed to preserve the integrity of the sinus membrane and to
regenerate bone around zygomatic implants using an extended sinus grafting approach.
Patients with extremely atrophied maxillae were provided with one to four zygomatic implants in conjunction with sinus grafting, plus conventional auxiliary implants, for
immediate support of a provisional full-arch maxillary prosthesis. Definitive prostheses were delivered at 6 months after implant placement. All patients underwent clinical
and radiographic examinations at 6 months.
RESULTS:
Twenty-two zygomatic and 23 conventional auxiliary implants were placed in 10 patients. The overall 6-month implant survival rate was 90.9% for zygomatic implants and
100% for auxiliary implants placed in the anterior area. Only two minor technical complications were seen, and clinical indicators (including probing pocket depth,
keratinized tissue, and plaque and bleeding indices) were good in all patients. A substantial gain of radiographic bone around the zygomatic implants was observed.
CONCLUSION:
The proposed technique led to successful prosthetic function for all patients. With the described technique, exposed implant threads within the maxillary antrum are
eliminated and the potential for biologic complications is minimized.
Corticocancellous porcine bone in the healing of human extraction sockets:
combining histomorphometry with osteoblast gene expression profiles in vivo.
Crespi R1, Cappar P, Romanos GE, Mariani E, Benasciutti E, Gherlone E.
Abstract
PURPOSE:
Different graft materials have been proposed to minimize the collapse of alveolar bone after tooth extraction. The aim of this study was to examine
the use of porcine bone graft in fresh sockets via histomorphometric and in vivo gene expression profiling.
Thirty fresh extraction sockets with three bone walls in 15 patients were selected. A split-mouth design was employed. On one side of the arch, 15
sockets received corticocancellous porcine bone as a graft, and on the other side, 15 sockets were left unfilled and considered as controls. Four
months after surgery, four biopsy specimens were taken from each patient (two from the grafted site and two from the control site). The specimens
were analyzed by histomorphometry and ex vivo osteoblast expansion, followed by highly sensitive osteoblast-specific gene expression profiling
for Runx2, osteopontin, osteoprotegerin, type I collagen, and alkaline phosphatase by quantitative real-time reverse-transcriptase polymerase
chain reaction. Comparisons were made using the Student t test.
RESULTS:
After healing without complications, the grafted sites showed statistically significantly higher mean vital bone and lower mean connective tissue
values than the control sites. Statistically significant higher expression of alkaline phosphatase and the matrix formation markers type I collagen
and osteopontin were observed in the grafted group compared to the control group, whereas Runx2 and osteoprotegerin expression was
comparable.
CONCLUSIONS:
Within the limits of this study, histologic examination and biomolecular evaluation confirmed good biocompatibility and high osteoconductivity of
xenogeneic porcine bone in alveolar bone grafting.
Experimental model of bone response to collagenized xenografts of porcine origin
(OsteoBiol mp3): a radiological and histomorphometric study.
Calvo Guirado JL1, Ramrez Fernndez MP, Negri B, Delgado Ruiz RA, Mat
Snchez de-Val JE, Gmez-Moreno
Abstract
G.
BACKGROUND:
Adequate alveolar ridges are fundamental to successful rehabilitation with implants. There are diverse techniques for reconstructing atrophied ridges, of which
bone substitute grafts is one possibility.
PURPOSE:
The aim of this study was to carry out radiological and histomorphometric evaluations of bone response to collagenized porcine bone xenografts over a 4-month
period following their insertion in rabbits' tibiae.
Twenty New Zealand rabbits were used. Twenty collagenized porcine bone xenografts (Osteobiol mp3, Tecnoss Dental s.r.l., Torino, Italy), in granulated form of
600 to 1,000m, were inserted in the proximal metaphyseal area of the animals' tibiae and 20 control areas were created. Following implantation, the animals
were sacrificed in four groups of five, after 1, 2, 3, and 4months, respectively. Radiological and histomorphometric studies were made.
RESULTS:
After 4months, radiological images revealed bone defects with a decrease in graft volume and the complete repair of the osseous defect. No healed or residual
bone alterations attributable to the presence of the implants were observed. Histomorphometric analysis at 4months found mean values for newly formed bone,
residual graft material, and non-mineralized connective tissue of 25.41.8%, 36.373.0%, and 38.222.5%, respectively. There were no statistical
differences in the length of cortical formation with collagenized porcine xenograft (98.91.1%) compared with the control samples (99.10.7%) at the end
of the study period.
CONCLUSIONS:
The biomaterial used proved to be biocompatible, bioabsorbable, and osteoconductive and as such, a possible bone substitute that did not interfere with the
bone's normal reparative processes.
Planning implants in the esthetic zone using a new implant 3D navigation system.
Rossi R1, Morales RS, Frascaria M, Benzi R, Squadrito N.
Abstract
Guided implant surgery is becoming a clinical reality in the world of implant dentistry. In
recent years, a Computer Aided Implantology Academy has even appeared, confirming
the importance of this approach. Different navigation systems are available for the
planning of surgical and prosthetic reconstructions. These systems make available to the
surgeon and the prosthodontist the instruments necessary to plan a case and to work in a
team to deliver a fixed restoration at the time of the surgical procedure in a minimally
invasive and predictable way. This article evaluates the usefulness of this kind of planning
in the esthetic zone, where perfection is mandatory.
Dental implants placed in extraction sites grafted with different bone substitutes:
radiographic evaluation at 24 months.
Crespi R1, Cappar P, Gherlone E.
Abstract
BACKGROUND:
Reduction of alveolar height and width after tooth extraction may provide some problems in implant placement, especially in the anterior maxilla for esthetic
reasons. Different graft materials have been advocated to prevent bone-volume reduction. The aim of this study was to evaluate radiographic parameters of
implants positioned in grafted alveoli with three different biomaterials: magnesium-enriched hydroxyapatite (MHA), calcium sulfate (CS), and heterologous
porcine bone (PB).
METHODS:
In 15 patients, 45 fresh extraction sockets with three bone walls were selected. Fifteen sockets received MHA, 15 sockets received CS, and 15 sockets
received corticocancellous PB as a graft material. Three months after bone filling, titanium dental implants were placed in grafted sites. Three months after
implant placement, temporary restoration was performed. Follow-up examinations were conducted, and intraoral digital radiographs were taken at baseline
and 12 and 24 months after implant placement to evaluate the marginal bone level in each patient. Comparisons for marginal bone loss over time between
groups were performed by the Student two-tailed t test.
RESULTS:
At the 24-month follow-up, a survival rate of 100% was reported for all implants. For the MHA group, a mean mesial bone loss of -0.21 +/- 0.08 mm and a
mean distal bone loss of -0.22 +/- 0.09 mm (mean bone loss: 0.21 +/- 0.09 mm) were reported; for the CS group, a mesial bone loss of -0.14 +/- 0.07 mm and
a distal bone loss of -0.12 +/- 0.11 mm (mean bone loss: -0.13 +/- 0.09 mm) were measured; for the PB group, a mean mesial bone loss of -0.15 +/- 0.10 mm
and a mean distal bone loss of -0.16 +/- 0.06 mm (mean bone loss: -0.16 +/- 0.08 mm) were reported. No statistically significant differences were reported
among groups (P >0.05).
CONCLUSION:
At the 24-month follow-up, the present study showed that placement of implants in grafted sockets was not influenced by the three different biomaterials
because they did not negatively impact the clinical outcome.
Preservation of the postextraction alveolar ridge: a clinical and histologic study.
Cardaropoli D1, Cardaropoli G.
Abstract
The aim of this investigation was to assess the possibility of preserving the buccal and lingual plates
of a postextraction socket from resorption using bone filler after tooth extraction. In 10 patients, 10
single extraction sites in the posterior area received a bone substitute. The osteoconductive material
was covered by a collagen membrane in all cases. Contour changes of the alveolar process were
evaluated intraorally using a surgical caliper over a 4-month period. Four months after extraction, a
specimen was harvested from the area previously augmented with bone filler, and histologic analysis
was performed. The results demonstrated that it was possible to preserve about 85% of the initial
ridge dimensions, allowing for correct implant placement. From a histologic point of view, new bone
formation was detected in all sites, with a 25% average residual presence of the graft particles. This
investigation confirms the benefit of augmenting an extraction socket with bone substitutes.
Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical
and histomorphometric study.
Barone A1, Aldini NN, Fini M, Giardino R, Calvo Guirado JL, Covani U.
Abstract
BACKGROUND:
The preservation of bone volume immediately after tooth removal might be necessary to optimize the success of implant placement in terms of esthetics and function. The objectives of
this randomized clinical trial were two-fold: 1) to compare the bone dimensional changes following tooth extraction with extraction plus ridge preservation using corticocancellous
porcine bone and a collagen membrane; and 2) to analyze and compare histologic and histomorphometric aspects of the extraction-alone sites to the grafted sites.
METHODS:
Forty subjects who required tooth extraction and implant placement were enrolled in this study. Using a computer-generated randomization list, the subjects were randomly assigned to
the control group (EXT; extraction alone) or to the test group (RP; ridge-preservation procedure with corticocancellous porcine bone and collagen membrane). The following parameters
were assessed immediately after extraction and 7 months prior to implant placement: plaque index, gingival index, bleeding on probing, horizontal ridge width, and vertical ridge
changes. A bone biopsy was taken from the control and test sites 7 months after the surgical treatment. Histologic and histomorphometric analyses were also performed.
RESULTS:
A significantly greater horizontal reabsorption was observed at EXT sites (4.3+/-0.8 mm) compared to RP sites (2.5+/-1.2 mm). The ridge height reduction at the buccal side was
3.6+/-1.5 mm for the extraction-alone group, whereas it was 0.7+/-1.4 mm for the ridge-preservation group. Moreover, the vertical change at the lingual sites was 0.4 mm in the ridge-
preservation group and 3 mm in the extraction-alone group. Forty biopsies were harvested from the experimental sites (test and control sites). The biopsies harvested from the grafted
sites revealed the presence of trabecular bone, which was highly mineralized and well structured. Particles of the grafted material could be identified in all samples. The bone formed in
the control sites was also well structured with a minor percentage of mineralized bone. The amount of connective tissue was significantly higher in the extraction-alone group than in the
ridge-preservation group.
CONCLUSIONS:
The ridge-preservation approach using porcine bone in combination with collagen membrane significantly limited the resorption of hard tissue ridge after tooth extraction compared to
extraction alone. Furthermore, the histologic analysis showed a significantly higher percentage of trabecular bone and total mineralized tissue in ridge-preservation sites compared to
extraction-alone sites 7 months after tooth removal.
Clinical and histological study of a xenogenic bone substitute used as a filler in
postextractive alveolus.
[Article in English, Italian]
Arcuri C1, Cecchetti F, Germano F, Motta A, Santacroce C.
Abstract
AIM:
The development of oral implant techniques and the demand for the treatment of increasingly complex cases have drawn the attention of
researchers and clinicians towards those systems and materials able to promote bone regeneration. The aim of this paper is to evaluate the clinical
behavior and in particular the resorption times of the material used as a filler in postextractive alveolus with the intent of preserving the ridge
volume, a prerequisite for successive insertion of osteointegrated fixtures.
METHODS:
A group of 12 patients, aged between 30-40 years, have been selected at the Oral Surgery Unit of the San Giovanni Calibita Hospital in Rome.
They all required an endosseous implant following the loss of a dental element due to radicular fracture of periodontal pathology. The grafting
material used is OsteoBiol Putty, an antigen-free bone paste composed of 80% granulated mix and 20% pure collagen.
RESULTS:
The results emerging from the histological analysis show that 3 months after insertion of this osteoconductive material in the receiving site it can no
longer be detected in the samples collected and it has been completely substituted by trabecular bone tissue.
CONCLUSIONS:
The conclusion is drawn that the heterologous material used in this study shows excellent manageability allowing the operator to easily and
accurately remove and shape it in the receiving site.
Elevacin de Seno con
abordaje Crestal
Immediate loading of dental implant after sinus floor elevation with osteotome
technique: a clinical report and preliminary radiographic results.
Santagata M1, Guariniello L, Rauso R, Tartaro G.
Edentulous ridges in the posterior maxilla are often compromised by reduced bone volume. This anatomic
condition often limits dental implant placement of 10 mm in length without prior or simultaneous sinus
augmentation. The osteotome technique is an alternative and conservative technique for sinus floor
augmentation and immediate implant placement in the posterior region of the maxillary jaw. According to the
relevant literature, the osteotome technique appears to be a predictable and safe method for augmenting bone
at the sinus floor and to improve bone density and quality of the implant site sufficiently so that immediate
loading is possible. A 46-year-old male patient was referred to the authors to replace the single upper premolar
with an implant-supported crown restoration without interfering with the integrity and topography of the adjacent
gingival tissues. Only one clinical study analyzed minimally invasive implant and sinus lift surgery with
immediate loading. In that case report, the osteotomy was widened to its final diameter using a series of
incrementally larger twist drills. In our clinical case, a series of incrementally larger diameter osteotomes
improved bone density. This simplified treatment modality can make single tooth implant rehabilitation of the
atrophic premolar maxilla region more accessible, and immediate loading is facilitated by improved bone
density.
Implant placement in fresh extraction sockets and simultaneous osteotome sinus
floor elevation: a case series.
Barone A1, Cornelini R, Ciaglia R, Covani U.
Abstract
The purpose of this study was to evaluate the clinical success of implants placed in fresh extraction sockets
with simultaneous maxillary sinus floor elevation using the osteotome technique. Twelve patients were
included. All the patients required the extraction of a maxillary premolar--close to the maxillary sinus--and
were scheduled for immediate implant placement. One experimental implant was placed per patient, with an
18-month follow-up period. The graft materials used in both sinus augmentation and peri-implant bone
defects were a mixture of collagen gel and corticocancellous porcine bone particles. All implants were
allowed to heal for 6 months prior to prosthetic rehabilitation. One of the 12 experimental implants failed
because of an abscess during early healing. No implants failed after definitive prosthetic rehabilitation. No
significant bone loss was detected at the final follow-up visit. The mean bone height before sinus elevation
and implant placement was 7.8 mm. Eighteen months after surgery, the mean bone height was 12 mm. When
adequately performed, the surgical procedure described in the present study--immediate implant placement
and simultaneous sinus floor elevation--appears to be unproblematic and predictable in terms of clinical
success.
Dehiscencias y
fenestraciones
Bucco-Lingual Crestal Bone Changes Around Implants Immediately Placed in Fresh
Extraction Sockets in Association or not With Porcine Bone: A Non-Blinded
Randomized Controlled Trial in Humans.
Bottini LP1, Ricci L, Piattelli A, Perrotti V, Iezzi G.
Abstract
Background: The aim of the present randomized controlled clinical trial was to assess the bucco-lingual bone changes of
implants immediately placed in fresh extraction sockets in association or not with porcine bone. Methods: Forty patients
were included in the present study, and were randomly assigned to the control (n = 20) and test (n = 20) groups. Each
patient received a single implant placed into an immediate extraction site of a molar or a first upper premolar with a
flapless approach. In the control sites no grafting material was placed, while in the tests a deantigenated collagenated
bone substitute of porcine origin was used to fill the gaps between the implant and the extraction socket. The bucco-
lingual bone width was measured at different time points: at the time of surgery (T0), at 90 days (T1), at 110 days (T2) and
after 6 months of masticatory function (T3). The values were statistically analyzed between and within the treatment
groups (p>0.05). Results: All the implants were osseointegrated. Four control implants were excluded from the analysis
due to the exposure of the coronal portion of the fixture. At T1, T2 and T3, statistically significant differences were found
by comparing the mean width of the bucco-lingual bone between control and test groups. The mean values decreased
during the observation period in both groups; statistically significant differences within controls were detected at T1, T2
and T3, and at T2 and T3 within tests. Conclusions: The outcomes of present study suggested that porcine bone enabled
to avoid bucco-lingual crestal bone changes in implants immediately placed in fresh extraction sockets.
Surgical reconstruction of peri-implant bone defects with prehydrated and
collagenated porcine bone and collagen barriers: case presentations.
Slotte C1, Lindfors N, Nannmark U.
Abstract
BACKGROUND:
Surgical reconstruction of peri-implant defects is challenging and unpredictable due to, for example, the extent of the bone defect or the osteogenic potential of adjunctive
materials used.
PURPOSE:
To study the healing capacity of a new bone xenograft material in the treatment of peri-implant defects.
In three cases with advanced peri-implant defects, flap surgery was performed. After thorough debridement including cleaning of the exposed implant surface,
prehydrated and collagenated porcine bone (PCPB) particles were placed into the defect. A bioresorbable collagen barrier was adapted and placed over the defect and
the flaps were relocated. After 6 and 12 months of healing, clinical and radiographic examinations were done. In one case, the surgical procedure was repeated 6 months
postoperatively. One year after the second surgery, a bone biopsy was harvested and analyzed with histology.
RESULTS:
All defects healed uneventfully. At 6 months, probing depths were reduced by 3-4 mm with no bleeding on probing or pus formation. At 12 months, healthy peri-implant
conditions were found. Intra-oral radiographs showed gain of the marginal bone level by 2-4 mm. In the case where reconstructive surgery was repeated, histology
showed osteoconductive properties as bone formation with typical osteoblastic seams was observed directly on the surface of the grafted particles.
CONCLUSION:
The presented cases show that PCPB have favorable properties enhancing bone regeneration in peri-implant bone defect
Immediate implant placement after removal of a failed implant: a clinical and
histological case report.
Covani U1, Marconcini S, Crespi R, Barone A.
Abstract
The purpose of this study was to evaluate the clinical success of an implant placed
immediately after the explantation of a fractured blade implant. A healthy 58-year-old
male nonsmoker presented with a fractured blade implant that had been subjected
to biomechanical overload. A new blade implant was placed immediately after the
removal of the fractured one. The new implant was placed with a composite graft of
collagen gel and corticocancellous porcine bone and covered with a bioabsorbable
membrane. Radiographic evaluation at 6 months postoperation showed complete
bone healing. No residual bone defect was observed or probed during the
uncovering phase; moreover, no mobility, pain, suppuration, or presence of peri-
implant radiolucency were observed at the second-stage surgery.
Buccal bone augmentation around immediate implants with and without flap
elevation: a modified approach.
Covani U1, Cornelini R, Barone A.
Abstract
PURPOSE:
The aim of this study was to compare the clinical success and bone healing of implants placed in fresh extraction sockets using a flapless procedure
compared to those placed with flap elevation.
Twenty teeth in 20 patients were selected for this study and were scheduled for tooth extraction and immediate implant placement. Ten implants were
placed with flap elevation (control group), and 10 implants were placed without flap elevation (test group). All the sites selected showed a complete
bone defect at the facial wall. All the implants included in this study were 2-stage implants placed at the level of palatal/lingual bone in augmented
bone. Each surgical site was protected with a collagen membrane and, subsequently, a standardized radiograph was taken to evaluate the distance
between the implant shoulder and the first bone-implant contact (DIB). Six months after placement, both control and test implants underwent a second-
stage surgery and a clinical examination to determine the implant stability quotient, DIB, and the distance between implant shoulder and the crestal
bone at the midbuccal aspect (DIC).
RESULTS:
One implant failed in the test group. Only 1 implant (test group) showed bone growth over the implant neck at the re-entry procedure. Implant stability
quotient (ISQ) and DIB did not show any significant differences between the control and test group; however, a higher DIC was found in the test sites
compared to the control sites.
CONCLUSION:
Data from this study showed that immediate implants with and without a mucoperiosteal flap elevation can be successfully used even in the presence of
bone defects requiring augmentation procedures. It was also noted that the bone regenerated reached a higher coronal level in the group with flap
elevation than in the group without flap elevation.
Clinical outcome of implants placed immediately after implant removal.
Covani U1, Barone A, Cornelini R, Crespi R.
Abstract
BACKGROUND:
The purpose of this study was to evaluate the clinical success of implants placed immediately after the explantation of failed implants due to
fracture at 12 months.
METHODS:
Nine immediate implants were placed in nine patients following explantation of nine fractured implants. Five experimental implants did not require
any regenerative procedures; the remaining four immediate implants were grafted with deproteinized porcine bone particles and covered with
bioabsorbable membranes. All implants were restored with fixed prostheses. The follow-up period was 12 months.
RESULTS:
No residual bone defects were observed or probed around any implant at the second-stage surgery, and all implants were asymptomatic and
stable. All the implants were successful after prosthetic rehabilitation showing no mobility, pain, suppuration, or absence of peri-implant
radiolucency. The radiographic measurements showed no significant bone loss pattern at the 12-month follow-up visit.
CONCLUSION:
The findings of this study suggested that implants placed immediately after implant explantation due to biomechanical fracture could be
performed with results that are similar to results obtained with implants placed immediately after tooth extraction.
Regeneracin Horizontal
REGENERATION OF ATROPHIC CRESTAL RIDGES WITH RESORBABLE LAMINA:
TECHNICAL NOTE.
Lopez MA1, Andreasi Bassi M1, Confalone L1, Carinci F2.
Abstract
Several techniques have been proposed to increase the mandibular bone base, both horizontally and
vertically, for implant purposes in atrophic distal ridges. Block graft and titanium grids are frequently
used for this purpose. The former need to be fixed, in the case of an autologous bone block require a
donor site graft, and if not kept sufficiently vascularized could result in necrosis. The latter are
manageable with difficulties in the event of exposure and are removed with difficulty. In this work a
technique is proposed which makes use of resorbable cortical lamina in order to create recipient
sites which can be filled with prehydrated and collagenated granules covered by mesenchymal
resorbable membranes. We demonstrated with this technique the good vascularization of the graft
combined with the integration of the lamina, which do not need to be removed. Our results allow us to
propose this technique as a potential alternative to those used to date.
Delayed expansion of the atrophic mandible by ultrasonic surgery: a clinical and
histologic case series.
Scarano A, Piattelli A, Murmura G, Iezzi G, Assenza B, Mancino C.
Abstract
PURPOSE:
Ridge expansion is used to widen narrow ridges with adequate height for implant placement. This human case series presents the clinical
and histologic results of delayed expansion of mandibles by ultrasonic surgery.
Patients with residual alveolar ridge width between 2.3 and 4.1 mm in the coronal area of the posterior mandible were included in the study.
First, four linear corticotomies were carried out by ultrasonic surgical device. Four weeks later, adequate bone expansion with a combination
of scalpels, thin chisels, and threaded osteotomes that did not compromise cortical vascularization was performed, and two implants per
ridge were inserted. Any gaps were filled with corticospongious porcine biomaterial. Three months after implant placement, healing caps
were inserted, and bone cores were harvested from the regenerated areas for histologic analysis. Crestal width was recorded at each surgery.
RESULTS:
The postoperative course was uneventful in all 32 patients (64 implants) who took part in the study, and the implant success rate was 96.88%
at 3 months. The mean increase in ridge width was 5.17 0.86 mm. The histologic specimens showed a mixture of new bone and particles of
biomaterial, as well as newly formed bone. Histomorphometry demonstrated that 64% 3.1% of the specimen was composed of newly
formed bone, 8% 0.8% was made up of marrow spaces, and 27% 2.6% comprised the residual grafted biomaterial.
CONCLUSION:
This study showed that mandibular ridge expansion using a delayed split-crest technique by means of ultrasonic surgery and association with
biomaterial led to good horizontal bone gain, with no fractures of the buccal plate, and a high implant success rate. The histologic specimens
showed newly formed bone and good integration of the biomaterial.
Expansion of the alveolar bone crest with ultrasonic surgery device: clinical study in
mandible.
Scarano A1, Murmura G, Sinjiari B, Assenza B, Sollazzo V, Spinelli G, Carinci F.
Abstract
The purpose of this paper was to document the application to the split-crest mandibular procedure in two stage in order to avoid
cortical resorption due to periosteal detachment in buccal cortical bone of the alveolar crest. Twenty-two healthy patients with
non-contributory past medical history (14 women and 8 men, all non-smokers, mean age 59 years, range 54-65 years) were
included in this study. After buccal mucoperiosteal flap was followed by a sagittal corticotomy in the coronal area of the alveolar
crest and a second sagittal corticotomy, but in a lower (basal) position and two vertical corticotomies in the buccal wall, using a
ultrasonic surgery device (Surgysonic, Esacrom, Imola Italy). Adequate crest expansion was achieved without compromising
cortical vascularisation by utilising a combination of scalpel, thin chisels and threaded osteotomes (Bone System, Milano, Italy).
Postoperative results were assessed by panoramic and periapical radiographs. Ossification of the osteotomy lines was evident
and could be observed as sites with increasing radiopacity on panoramic and periapical radiographs 3 months after implants
insertion. No dehiscence of the mucosa was observed. No patient suffered from hypoaesthesia. The mean horizontal bone
increase in coronal area was 53 mm. Mandibular ridge expansion using a split-crest technique that included grafting the
implant sites with a ultrasonic surgery device is a viable therapeutic alternative for implant placement in this patient population.
A modified edentulous ridge expansion technique for immediate placement of
implants: a case report.
Santagata M1, Guariniello L, Tartaro G.
Abstract
This case report is focused on the possibility of treating atrophic ridge with a reduced number
of surgical procedures and a reduced healing time. A 43-year-old female patient affected by
edentulism associated with horizontal resorption of the ridge was treated by means of a
sagittal osteotomy and expansion of the ridge with the new modified edentulous ridge
expansion (MERE) technique to obtain a wider bony base for ideal implant placement. In the
same procedure 2 implants were placed and connective tissue graft, covering the bony
wound, was placed to achieve keratinized mucosa. The implants were placed immediately
after the split crest of the ridge and covered by a connective tissue graft. Postoperative
recovery was uneventful. Within the limits of this case report, the MERE technique appeared to
be reliable and simple, and it reduced morbidity compared with other techniques such as
autogenous bone grafts and guided bone regeneration.
The bone lamina technique: a novel approach for lateral ridge augmentation--a case
series.
Wachtel H1, Fickl S, Hinze M, Bolz W, Thalmair T.
Abstract
The goal of this case series is to present a novel treatment approach for lateral ridge augmentation.
Four systemically healthy patients (aged 48 to 59 years) with inadequate dental alveolar ridge widths
were selected for inclusion. All ridge defects were augmented using a xenogeneic cortical bone
shield in combination with particulated bone substitutes and a thin collagen barrier. At baseline and
after 6 months, digital cone beam computed tomography scans were performed. Biopsy specimens
were harvested at reentry surgery and processed for histologic analysis. The results revealed a
sufficient amount of bone structure for implant placement without additional augmentation
procedures. The histologic analysis demonstrated that new bone formation had taken place and the
bone shield had resorbed entirely. This case series indicates that the bone lamina technique has the
biologic and mechanical properties to successfully achieve hard tissue augmentation of deficient
ridges.
Calculation of bone graft volume using 3D reconstruction system.
Calvo-Guirado JL1, Mat-Snchez JE, Delgado-Ruiz R, Ramrez-Fernndez MP.
Abstract
OBJECTIVES:
To obtain bone bioreplicas for determining precisely the amount of biomaterial required for bone regeneration procedure.
STUDY DESIGN:
A case-control comparison with a total sample size of 20 cases, 10 control and 10 test samples. Bioreplicas were generated from
helical CAT scans with 0.5 mm slices, without 3D reconstruction or image filters. Bone defects in premolar and molar areas were
treated with titanium mesh and xenograft (MP3) combined with resorbable carriers. Time taken to carry out procedures with and
without the use of bioreplicas (in minutes), discrepancies between the grafts performed with and without bioreplicas and bone
defects (mm), and postoperative complications were registered.
RESULTS:
No significant differences were recorded for measurements of width and length of bone defect between patient bone and the
biological models.
CONCLUSIONS:
The use of bioreplicas obtained by rapid prototyping is effective in treatment planning.

Resonance frequency analysis of implants inserted with a simultaneous grafting
procedure: a 5-year follow-up study in man.
Cassetta M1, Ricci L, Iezzi G, Dell'Aquila D, Piattelli A, Perrotti V.
Abstract
The aim of this study was to measure implant stability quotient (ISQ) values in grafted
sites during 5 years of follow-up. Sixteen patients received a total of 36 implants
inserted in sites treated with autologous bone (group A) or porcine bone in addition
to autologous bone (group B). In both groups, resonance frequency analysis (RFA)
values increased during the observation period. At 2 months, statistical analysis
showed significantly lower ISQ values for group B than for group A (P = .0134) and
significantly higher ISQ values in the mandible than in the maxilla (P = .0251). RFA
measurements suggested stable long-term results for implants inserted in both
groups.
Ridge splitting technique in atrophic anterior maxilla with immediate implants, bone
regeneration and immediate temporisation: a case report.
Calvo Guirado JL1, Pardo Zamora G, Saez Yuguero MR.
Abstract
Narrow alveolar ridges remain a serious challenge for the successful placement of
endosseous implants. This article reports a technique for widening the atrophic ridge
by splitting the alveolar bone longitudinally and filling the bone gap with collagenised
pig bone, treatment of ridges as thin as 2.5mm at the alveolar crest and simultaneous
placement of dental implants. Treatment of a 22-year-old female patient with a
severely resorbed anterior maxilla is described. 4mm wide by 13mm long threaded
Osseotite implants were immediately placed within the split ridge and surrounded
with a mixture of autogenous tuberosity and collagenised pig bone. The advantages
of this technique for patients include less surgical trauma and reduced treatment
time.
Maxillary alveolar ridge reconstruction with nonvascularized autogenous block bone:
clinical results.
Barone A1, Covani U.
Abstract
PURPOSE:
The purposes of this study were to evaluate the clinical success of bone reconstruction of the severely atrophic maxilla using autogenous bone harvested from the
anterosuperior edge of iliac wing and to analyze the clinical success and the marginal bone level of dental implants placed 4 to 5 months after bone grafting and
before prosthetic rehabilitation.
PATIENTS AND METHODS:
Fifty-six patients (18 men, 38 women) aged 27 to 63 years were included in the study and required treatment for maxillary atrophy. All patients selected were
scheduled for onlay bone graft and titanium implants in a 2-stage procedure. The dental implants were inserted 4 to 5 months after grafting.
RESULTS:
No major complications were observed from the donor sites. A total of 129 onlay bone grafts were used to augment 56 severely resorbed maxillas. Three out of 129
bone grafts had to be removed because of early exposure occurring with bone grafts placed to increase the vertical dimension of the alveolar ridge. One hundred
sixty-two implants were placed in the area of bone augmentation. Seven implants failed to integrate and were successfully re-placed without any need for additional
bone grafting. The clinical measurements for bone resorption around implants revealed a mean bone loss of 0.05 mm (+/- 0.2); the marginal bone level evaluated
with periapical radiographies was 0.3 mm (+/- 0.4) at implant placement and 0.1 mm (+/- 0.3) 6 months after placement.
CONCLUSION:
The success rate of the block grafts was very good. The clinical and radiographic bone observations showed a very low rate of resorption after bone graft and
implant placement. Therefore, on the basis of this preliminary study, iliac bone grafts (from the anterosuperior edge of the iliac wing) can be considered a promising
treatment for severe maxillary atrophy.
Histomorphometric outcomes after lateral sinus floor elevation procedure: a
systematic review of the literature and meta-analysis.
Corbella S1,2, Taschieri S1,2, Weinstein R1,2, Del Fabbro M1,2.
Abstract
OBJECTIVES:
The aim of the present systematic review of the literature was to evaluate biomaterials performances considering new bone formation estimated through
histomorphometric analysis of bone biopsies from human subjects after maxillary sinus floor elevation.
An electronic and manual search was performed to retrieve articles showing histomorphometric data of bone biopsies performed after sinus floor elevation surgery.
Recorded data were statistically analyzed evaluating percentage of new bone volume, residual biomaterial, and connective/soft tissues in the biopsies. A meta-analysis of
comparative studies was also performed.
RESULTS:
After article selection process, 84 articles were included in the quantitative synthesis and 16 of them in the meta-analysis of comparative studies. The use of autogenous
bone (AB) alone led to a significantly higher new bone formation if compared with bovine bone (BB) alone (P = 0.04), while no significant difference was found when the
latter was compared with a mixture of AB and BB (P = 0.52). Grafts composed of BB showed significantly greater new bone formation as compared to hydroxyapatite (HA)
(P < 0.001) while a mixture of tricalcium phosphate (TCP) and HA achieved better outcomes than BB (P < 0.001).
CONCLUSIONS:
Based on histomorphometric evaluation, AB should still be taken into consideration when the highest possible new bone formation is the primary aim in maxillary sinus
surgery. When donor site morbidity is a concern, BB and a mixture of TCP and HA could be considered as predictable, showing promising results. More comparative
histologic studies are needed to confirm such results.
Spontaneous bone formation on the maxillary sinus floor in association with surgery
to remove a migrated dental implant: a case report.
Scarano A1, Piattelli A, Iezzi G, Varvara G.
Abstract
AIM:
A variety of surgical techniques have been developed to reconstruct the posterior maxilla when bone volume is insufficient. For some decades, sinus augmentation, using various
bone substitutes, has been used to reconstruct the posterior maxilla for dental implant placement. Even if new bone formation is achieved in the sinus after bone grafting, the
possibility of new bone formation with only a membrane elevation in the maxillary sinus has been reported in human and animal studies. The aim of this case report was to
document an unexpected healing pattern after the removal of a dental implant migrated in the maxillary sinus.
METHODS:
In October 2009 a 49-year-old man with a partially edentulous maxilla underwent implant placement. Specifically, a total of 5 implants were inserted, 2 in the left and 3 in the right
posterior maxilla. Four months later, at the time of abutment connection, the implant at the site of the maxillary left first molar was accidentally pushed in the sinus. A surgical
removal of the implant from the maxillary sinus was proposed and the patient consented to the surgical intervention. Computed axial tomography (CAT) scan images revealed
opacification of the left maxillary sinus with mucosal thickening, and the dental implant displaced within the sinus. The planned treatment sequence was: 1) removal of the
implant; 2) sinus augmentation procedure after 5 months; 3) implant insertion 5 months after the bone graft. The implant was removed. Five months later, the patient was admitted
for the bone-grafting augmentation procedure. A new CAT scan image revealed normal mucosal thickness and no opacification of the left maxillary sinus; bone formation was
evident. The surgery was undertaken with local anesthesia and conscious sedation.
RESULTS:
At reentry, the sinus wall was found to be totally healed. Newly formed bone (21.2%) with wide osteocyte lacunae and large marrow spaces (73.8%) were present with newly
formed vessels and no inflammatory cell infiltrate.
CONCLUSION:
The surgical trauma and the creation of a secluded space between the bone surfaces and the healed sinus mucosa resulted in a spontaneous bone formation in the maxillary
sinus. The surgical approach described may be used to achieve bone formation to enable placement of dental implants without the addition of any grafting material.
Bone formation in sinus augmentation procedures using autologous bone, porcine
bone, and a 50 : 50 mixture: a human clinical and histological evaluation at 2 months.
Cassetta M1, Perrotti V2, Calasso S1, Piattelli A2, Sinjari B2, Iezzi G2.
Abstract
OBJECTIVES:
The aim of this study was to perform a 2 months clinical and histological comparison of autologous bone, porcine bone, and a 50 : 50 mixture in
maxillary sinus augmentation procedures.
A total of 10 consecutive patients, undergoing two-stage sinus augmentation procedures using 100% autologous bone (Group A), 100% porcine
bone (Group B), and a 50 : 50 mixture of autologous and porcine bone (Group C) were included in this study. After a 2-month healing period, at the
time of implant insertion, clinical evaluation was performed and bone core biopsies were harvested and processed for histological analysis.
RESULTS:
The postoperative healing was uneventful regardless of the materials used for the sinus augmentation procedures. The histomorphometrical
analysis revealed comparable percentages of newly formed bone, marrow spaces, and residual grafted material in the three groups.
CONCLUSION:
The clinical and histological results of this study indicated that porcine bone alone or in combination with autologous bone are biocompatible and
osteoconductive materials and can be successfully used in sinus augmentation procedures.
Regeneration of human bone using different bone substitute biomaterials.
Traini T1, Piattelli A, Caputi S, Degidi M, Mangano C, Scarano A, Perrotti V, Iezzi G.
Abstract
PURPOSE:
The present study aimed to assess clinical and biological performances of several bone substitute biomaterials (BSBs).
The evaluation was conducted at 6 months and after several years on 295 patients undergoing sinus augmentation with 13 different BSBs; the data belonging
to previously published studies have been analyzed using innovative mathematical models to evaluate the bone regenerative index (Br) and the structural
density index (Ds).
RESULTS:
After 6 months, compared to the Ds index of native bone, the regenerated bone showed a D3 bone type; while, after several years, the regenerated bone
type was D2, with an evident increase in the density of the regenerated bone over time. Moreover, the values of Br were higher for combined biomaterials
indicating a fewer amount of residual particles and marrow spaces, while the values of Ds were higher for anorganic bovine bone indicating a greater new
bone formation and a lesser amount of marrow spaces. After 20 years, the bone regenerated using hydroxyapatite still had a D4 bone quality.
CONCLUSIONS:
After 6 months of healing, the regenerated bone had a composite structure resembling poor D3 bone type, and covered approximately one-third of the space
filled by BSBs. None of the evaluated biomaterials seemed to be ideal.
Simultaneous sinus augmentation with implant placement: histomorphometric
comparison of two different grafting materials. A multicenter double-blind
prospective randomized controlled clinical trial.
Silvestri M1, Martegani P, D'Avenia F,Abstract
Farneti M, Capri D, Paolantoni G, Landi L.
PURPOSE:
Sinus elevation via the lateral approach for implant rehabilitation of atrophic posterior maxillae is considered a safe and predictable therapy. Several xenogeneic
biomaterials of different biologic origin have been used as valid and predictable alternatives to autogenous bone. This multicenter randomized controlled double-
blind prospective clinical trial aimed to compare histomorphometrically two xenogeneic grafting materials used for sinus elevation with simultaneous implant
placement.
Seven private practices in Italy were involved. Patients presenting at least one site with a residual bone crest height between 2 and 4 mm were treated. Control sites
were grafted with 100% deproteinated particulated bovine bone (DPBB), while test sites were grafted with prehydrated corticocancellous porcine bone (PCPB).
Root-form implants were placed simultaneously. Insertion torque and clinical stability were assessed and recorded. At 6 months, a biopsy specimen was harvested
from each site, and histomorphometric analyses were performed.
RESULTS:
Thirty-seven patients received 42 sinus elevations (24 test and 18 control). Eighty-two implants with adequate primary stability were placed. Fifty-five implants were
placed in residual bone crests greater than 2 mm but less than 4 mm (average 2.7 mm) and achieved an average insertion torque of 22.8 11.3 N/cm. Nineteen
implants were placed in ridges greater than 3 mm but less than 5 mm, and eight were placed in ridges with more than 5 mm remaining. After 6 months, three
implants had failed to integrate, leading to a survival rate of 96.34%. Forty-two specimens were analyzed histomorphometrically. No significant differences in total
bone volume (PCPB 37.43%, DPBB 37.52%) or residual grafting material (PCPB 13.55%, DPBB 16.44%) were detected.
CONCLUSIONS:
In this study, PCPB compared well with DPBB as a grafting material for lateral sinus elevation.
Use of piezosurgery during maxillary sinus elevation: clinical results of 40
consecutive cases.
Cassetta M1, Ricci L, Iezzi G, Calasso S, Piattelli A, Perrotti V.
Abstract
The aim of this study was to evaluate the performance of piezoelectric devices during sinus
elevation to determine the percentage of sinus membrane perforation and the time required to
perform the antrostomy and elevation of the membrane. A total of 35 patients and 40 grafted
sinuses were included. The parameters recorded were bony window length and height, bone
thickness, osteotomy area, operative time, and number of perforations. Seven (17.5%)
membrane perforations were observed, which were repaired with resorbable membranes. The
mean length, height, and thickness of the osteotomy were 13.8 2.9 mm, 6.9 1.4 mm, and 1.4
0.4 mm, respectively. The mean osteotomy area was 96.8 32.2 mm(2), and the mean
operative time was 10.3 2.1 minutes. This study demonstrated that a piezoelectric device
could be an attractive alternative for successful sinus augmentation.
Posterior atrophic jaws rehabilitated with prostheses supported by 6 mm-long, 4 mm-
wide implants or by longer implants in augmented bone. Preliminary results from a
pilot randomised controlled trial.
Esposito M1, Cannizzaro G, Soardi E, Pistilli R, Piattelli M, Corvino V, Felice P.
Abstract
PURPOSE:
To evaluate whether 6 mm-long by 4 mm-wide dental implants could be an alternative to at least 10 mm-long implants placed in bone augmented with bone substitutes in posterior atrophic jaws.
Twenty patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height above the mandibular canal or below the maxillary sinus, were randomised
according to a split-mouth design to receive one to three 6 mm-long and 4 mm-wide implants or at least 10-mm long implants in augmented bone at two centres. Mandibles were vertically augmented with
interpositional equine bone blocks and resorbable barriers, and implants were placed after 3 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were
placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive screw-retained metal-ceramic prostheses were delivered. Outcome
measures were prosthesis and implant failures, any complication, time needed to fully recover mental nerve function (only for mandibular implants) and patient preference.
RESULTS:
All screened patients had sufficient bone width to support 4 mm-diameter implants. Patients were followed up to 5 months post-loading and none dropped out. There were no statistically significant differences in
graft, implant or prosthesis failures, though significantly more intra- and postoperative complications occurred at grafted sites. Fourteen complications occurred in 12 patients at augmented sites versus none at
short implants. All complications occurred before loading. Three complications were associated with the failure of the mandibular grafts (15%), determining the failures of 3 implants in one patient and 2 prostheses
could not be delivered. One patient was re-grafted and 2 patients received short implants instead. Apart from those complications associated with graft failures, there were 4 perforations of the sinus membrane
during sinus lifting and 7 temporary lower lip paraesthesiae lasting up to 4 days with no long-term consequences for the patients. All maxillary implants and prostheses were successful. All 20 patients treated with
mandibular implants and 15 patients treated with maxillary implants preferred short implants, whereas 5 patients treated with maxillary implants described both procedures as equally acceptable. These differences
were statistically significant.
CONCLUSIONS:
Short-term data (5 months after loading) indicate that 6 mm-long implants with a conventional diameter of 4 mm achieved similar if not better results than longer implants placed in augmented bone. Short implants
might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5- to 10-year post-loading data are
necessary before making reliable recommendations.
Ultrastructural study by backscattered electron imaging and elemental microanalysis
of bone-to-biomaterial interface and mineral degradation of porcine xenografts used
in maxillary sinus floor elevation.
Ramrez-Fernndez MP1, Calvo-Guirado JL, Mat-Snchez Del Val JE, Delgado-Ruiz
RA, Negri B, Barona-Dorado C.
Abstract
OBJECTIVES:
The aim of this study was to carry out an ultrastructural study of the biomaterial-to-bone interface and biomaterial mineral degradation in retrieved bone biopsies
following maxillary sinus augmentation using collagenized porcine xenografts (Osteobiol() Mp3) in 15 clinical cases.
Nine months after sinus lifting, bone cores were harvested from the maxillary sinus. The specimens were processed for observation under a scanning electron
microscope with backscattered electron imaging (SEM-BSE). In addition, chemical analysis and elemental mapping of the mineral composition were generated
using a microanalytical system based on energy-dispersive X-ray spectrometry (EDX).
RESULTS:
No clinical complications were evident during surgery. Scanning electron microscopy revealed that newly formed bone had become closely attached to the
xenograft. Statistical analysis showed a significantly high Ca/P ratio in the biomaterial (2.46 0.16) and at the bone interface (2.00 0.48) compared to bone (1.97
0.36), which suggests that there may be a gradual diffusion of Ca ions from the biomaterial into the newly forming bone at the interface as part of the biomaterial's
resorption process. EDX analysis of the residual porcine biomaterial at different points showed some particle categories with different mean ratios of Ca/P according
to size, pointing to different stages of the resorption process.
CONCLUSIONS:
The biomaterial proved to be biocompatible, bioreabsorbable and osteoconductive when used as a bone substitute for maxillary sinus elevation. SEM-BSE revealed
that newly formed bone had become closely attached to the xenografts. EDX analysis monitored the resorption process of the porcine bone xenograft. Elemental
mapping showed that there was a gradual diffusion of Ca ions from the biomaterial to the newly forming bone at the interface.
A 6-month histological analysis on maxillary sinus augmentation with and without use
of collagen membranes over the osteotomy window: randomized clinical trial.
Barone A1, Ricci M, Grassi RF, Nannmark U, Quaranta A, Covani U.
Abstract
INTRODUCTION:
Over the years, several modifications have been made to the sinus augmentation technique and to the materials used. However, there is still controversy about the need for using a
barrier concurrently with a graft in sinus augmentation procedures. On this basis, the aim of this randomized clinical study was to investigate the effect of resorbable collagen membrane
over the osteotomy window on maxillary sinus augmentation healing.
Patients who required maxillary sinus augmentation were evaluated and selected to enter the study. After maxillary sinus grafting, each patient was randomly assigned to control
(membrane over the osteotomy window) or test (no membrane) group. After 6 months, one bone biopsy was harvested from the lateral window and sent to the histology laboratory. The
Mann-Whitney nonparametric test was used for comparing the two groups. P-value was set at 5%.
RESULTS:
Eighteen patients entered the study and were randomly allocated in control (nine patients) or test group (nine patients). The histomorphometric measurements revealed that newly
formed bone was 30.7% 15.5% of the total volume from the membrane group (control). The average percentage of connective tissue was 50.6% 18.7% and residual graft
percentage was 18.4% 20.3%. On the other hand, data regarding the nonmembrane group (test) showed that the percentage of newly formed bone was 28.1% 19.4%. The mean
percentage of connective tissues was 59.3% 15.4% and 12.6% 12.4% for the residual graft particles. No significant difference was detected in the histomorphometrical evaluation
between the two groups.
DISCUSSION:
Our results showed that, compared with sites not covered, the use of the membrane did not substantially increase the amount of vital bone over a period of 6 months. On the other hand,
the use of membrane seems to reduce the proliferation of the connective tissue and the graft re-absorption rate. It is plausible that blood supply of maxillary sinus can play a role in such
a result. Further studies are needed to explore whether the use of membrane could really be advantageous for the sinus augmentation procedure and to evaluate what influence this
method can have on the amount and quality of reconstructed bone.
Comparative histological results of different biomaterials used in sinus augmentation
procedures: a human study at 6 months.
Iezzi G1, Degidi M, Piattelli A, Mangano C, Scarano A, Shibli JA, Perrotti V.
Abstract
OBJECTIVES:
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.
RESULTS:
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%.
CONCLUSIONS:
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.
Maxillary sinus augmentation in humans using cortical porcine bone: a histological
and histomorphometrical evaluation after 4 and 6 months.
Scarano A1, Piattelli A, Perrotti V, Manzon L, Iezzi G.
Abstract
BACKGROUND:
Bone substitutes, such as allografts, xenografts, and alloplasts, have been proposed in several augmentation procedures.
PURPOSE:
The aim of the present study was a histologic and histomorphometric evaluation of specimens retrieved 4 or 6 months after sinus
augmentation using cortical porcine bone augmentation material.
A total of 77 specimens, retrieved after 4 and 6 months from augmented sinuses, were used in this study. The specimens were processed to
be observed under light microscopy. Histomorphometric measurements were presented as means standard deviations.
RESULTS:
Most of the particles were surrounded by newly formed bone with large osteocyte lacunae. Histomorphometry showed that, after 4 months,
the newly formed bone represented 28%, marrow spaces 36%, the residual graft material 37%, while, after 6 months, the newly formed bone
represented 31%, marrow spaces 34%, while the residual graft material was 37%.
CONCLUSION:
The present results show that cortical porcine bone is a biocompatible, osteoconductive biomaterial that can be used for maxillary sinus
augmentation procedures without interfering with the normal reparative bone processes.
A collagenated porcine bone substitute for augmentation at Neoss implant sites: a
prospective 1-year multicenter case series study with histology.
Pagliani L1, Andersson P, Lanza M, Nappo A, Verrocchi D, Volpe S, Sennerby L.
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.
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.
Porcine bone used in sinus augmentation procedures: a 5-year retrospective clinical
evaluation.
Scarano A1, Piattelli A, Assenza B, Quaranta A, Perrotti V, Piattelli M, Iezzi G.
Abstract
PURPOSE:
Rehabilitation of the edentulous posterior maxilla with dental implants often represents a clinical challenge because of the insufficient bone
volume resulting from pneumatization of the maxillary sinus and crestal bone resorption. The aim of this study was a retrospective clinical
evaluation of maxillary sinus augmentation using porcine bone.
One hundred twenty-one healthy patients with a noncontributory medical history were included in this study. All patients underwent sinus
augmentation procedures with porcine bone. After a 4- to 6-month healing period, sandblasted and acid-etched implants were inserted.
RESULTS:
All grafted sinuses healed without major complications, except for 2 that showed no regeneration at the time of implant placement. A total of
21 implants were lost, 8 after the second-stage surgery and 13 in the 5 years' follow-up after loading. The cumulative survival rate was 92%
after a mean loading time of 5 years. Only minor peri-implant marginal bone resorption was found.
CONCLUSION:
Within the limitations of this study, porcine bone can be used with success in sinus augmentation procedures, and rougher-surfaced implants
are probably preferable.
Maxillary sinus augmentation using prehydrated corticocancellous porcine bone:
hystomorphometric evaluation after 6 months.
Barone A1, Ricci M, Covani U, Nannmark U, Azarmehr I, Calvo-Guirado JL.
Abstract
BACKGROUND:
Insufficient alveolar bone height often prevents the placement of standard dental implants in the posterior part of edentulous maxilla. In order
to increase adequately the vertical dimension of the reabsorbed alveolar process, a sinus lift procedure is often necessary. The aim of this
study was to evaluate histologic results of a prehydrated corticocancellous porcine bone used in maxillary sinus augmentation.
METHODS:
Patients (age 18-70 years) with a residual bone height requiring a maxillary sinus augmentation procedure to place dental implants were
eligible for this study. All patients were treated with the same surgical technique consisting of sinus floor augmentation via a lateral approach.
The space obtained by elevation of the mucosa wall was grafted with prehydrated and collagenated corticocancellous porcine bone.
Biopsies were harvested 6 months after the augmentation procedures.
RESULTS:
Twenty-four patients were enrolled. The mean percentage of new formed bone was 43.9 18.6% (range 7.5-100%), whereas the mean
percentage of residual graft material was 14.2 13.6% (range 0-41.9%). The new bone/residual graft material ratio in the maxillary sinuses
was 3.1. The mean soft tissues percentage was 41.8 22.7% (range 0-92.5%).
CONCLUSION:
The present study suggested that porcine bone showed excellent osteoconductive properties and could be used successfully for sinus
augmentation. Moreover, the porcine bone showed a high percentage of reabsorption after 6 months; this might be because of the presence
of collagen and the porosity of the graft material.
Atraumatic maxillary sinus elevation using threaded bone dilators for immediate
implants. A three-year clinical study.
Calvo-Guirado JL1, Gmez-Moreno G, Lpez-Mar L, Ortiz-Ruiz AJ, Guardia-Muoz
J.
Abstract
OBJECTIVE:
The aim of this study was to evaluate the efficacy of sinus floor elevation using sequential bone dilators.
Thirty patients took part in the study (18 women and 12 men) with ages ranging between thirty-six and sixty-three years, selected according to
inclusion and exclusion criteria, who showed a bone deficit in the upper posterior alveolar margin of 5-8 mm in height. Sixty expanded
platform internal connection implants were placed with diameters of 4/5/4 mm and lengths varying between 10 (n=10) and 11.5 mm (n= 50).
RESULTS:
Data obtained were analyzed using SPSS 15.0 software. The average intra-sinus bone gain with MP3 biomaterial of porcine origin was 4.13
+/- 0.97 SD mm at the moment of implant placement, 3.90 +/- 1.15 SD mm after twelve months, 3.74 +/- 1.05 SD mm after 24 months and 3.62
+/- 1.75 SD mm after 36 months. Two implants were lost at the moment of prosthesis placement.
CONCLUSIONS:
Alveolar lifting technique in the upper maxilla using bone dilators achieved a 96.6 % implant success rate after a three-year follow-up. Intra-
sinus bone biomaterial remodeling was 0.51 +/- 0.08 mm from day zero to the thirty-six-month follow-up. This is a procedure that reduces the
amount of surgery necessary and is of both aesthetic and functional benefit to the patient.
Removal, after 7 years, of an implant displaced into the maxillary sinus. A clinical and
histologic case report
Authors:
Antonio Scarano*, Maurizio Piattelli**, Francesco Carinci***, Vittoria Perrotti****
Background: The accidental displacement of dental implants into the maxillary sinus is a infrequent but possible complication in dental
clinical practice. The main cause of implant displacement is the inadequate bone height in the posterior maxilla. This event usually occurs
during surgery and it is more rarely reported in the post-operative period, especially at long-term followups. Here a case of an implant
migrated inside the maxillary sinus at the time of abutment connection and removed 7 years later is described. Postoperative recovery was
uneventful.
Conclusions: To the authors best knowledge, this case represents the first report concerning migration of an oral implant into the maxillary
sinus removed after 7 years.
Osteotomy and membrane elevation during the maxillary sinus augmentation
procedure. A comparative study: piezoelectric device vs. conventional rotative
instruments.
Barone A1, Santini S, Marconcini S, Giacomelli L, Gherlone E, Covani U.
Abstract
OBJECTIVES:
The aim of the present study was to investigate in a randomized-controlled clinical trial the performance of rotary instruments compared with a piezoelectric device during
maxillary sinus floor elevation.
Thirteen patients who required a bilateral maxillary sinus augmentation for implant-prosthetic rehabilitation were included in this study. A within-patient control study was
carried out. The osteotomy for sinus access was performed on one side of the maxilla using the piezosurgery (test sites) and on the other side using conventional rotary
diamond burs (control sites). The parameters recorded were as follows: bony window length (L), bony window height (H), bone thickness (T) and osteotomy area (A)--
calculated by multiplying L and H. In addition, the time necessary for the osteotomy and sinus membrane elevation as well as the number of surgical complications were
calculated.
RESULTS:
The mean length and height of the bone window were similar in both groups. The osteotomy area (A) obtained by multiplying L and H was wider in the control group
(151.2 +/- 20.4 mm(2)) compared with the test group (137 +/- 24.2 mm(2)). The time necessary for the osteotomy and the sinus membrane elevation with conventional
instruments was 10.2 +/- 2.4 min, while with the piezoelectric device it was 11.5 +/- 3.8 min. Moreover, membrane perforation occurred in 30% of the maxillary sinuses in
the test group and in 23% of the control group. None of the differences observed between the two groups reached a level of significance.
CONCLUSIONS:
Within the limits of the present study, it may be concluded that piezosurgery and conventional instruments did not show any differences in the clinical parameters
investigated for the maxillary sinus floor elevation.
Histologic and ultrastructural analysis of regenerated bone in maxillary sinus
augmentation using a porcine bone-derived biomaterial.
Orsini G1, Scarano A, PiattelliAbstract
M, Piccirilli M, Caputi S, Piattelli A.
BACKGROUND:
The purpose of the present study was the histologic and ultrastructural evaluation of a biomaterial composed of cortical pig bone in the form
of granules.
METHODS:
After maxillary sinus augmentation using this biomaterial, 10 specimens were retrieved after 5 months in 10 patients using this biomaterial.
The specimens were processed to be observed under light microscopy (LM) and transmission electron microscopy (TEM). Histomorphometric
measurements were presented by means +/- standard deviations.
RESULTS:
LM showed that most of the particles were surrounded by newly formed bone. In some areas, the osteoid matrix was present; however, mainly
compact bone was present at the interface. There was no evidence of an acute inflammatory infiltrate. The newly formed bone was 36% +/-
2.8% and marrow spaces were 38% +/- 1.6%, whereas residual grafted material was 31% +/- 1.6%. Under TEM, all phases of bone formation
(osteoid matrix, woven, and lamellar bone) were observed in proximity with the biomaterial particles. The bone-biomaterial interface showed a
close contact between the porcine bone particles and the surrounding bone that had mainly features of mature bone with numerous
osteocytes. A lamina limitans was sometimes present at this interface.
CONCLUSIONS:
According to our knowledge, this is the first study presenting data on TEM of a porcine bone-derived biomaterial used in sinus augmentation
procedures in humans. Our findings show that this is a biocompatible biomaterial that can be used for maxillary sinus augmentation
procedures without interfering with the normal reparative bone processes.
A clinical study of the outcomes and complications associated with maxillary sinus
augmentation.
Barone A1, Santini S, Sbordone L, Crespi R, Covani U.
Abstract
PURPOSE:
The aim of this study was to evaluate the rate of complications in maxillary sinus augmentation surgery and the impact of complications on subsequent implant treatment in a patient
population with severe maxillary atrophy scheduled for treatment under general anesthesia.
The study population consisted of 70 patients (124 sinuses) with severe maxillary atrophy who underwent maxillary sinus augmentation. Sixteen patients were scheduled to have a
unilateral procedure and 54 patients a bilateral procedure. Sinus augmentation was performed with autogenous bone alone in 93 sinuses; in 31 sinuses, a 1:1 mixture of autogenous
bone and corticocancellous pig bone particles was used. Twenty-six of 124 procedures involved both sinus augmentation and autogenous block grafting for the treatment of severely
atrophic maxillae.
RESULTS:
The most common intraoperative complication was the perforation of the sinus membrane, which was observed in 31 sinuses (25%). Seven (5.6%) sinuses in 7 patients exhibited
suppuration of the maxillary sinus. Five of the 7 patients with sinus infection were smokers, showing a prevalence of complications significantly greater in smokers compared to
nonsmokers. Moreover, the use of an onlay bone graft in conjunction with sinus augmentation appeared to significantly increase the rate of infective complications. Infections were
treated by drainage and the administration of systemic antibiotics. Two clinical cases showing persistent signs of infection required an endoscopic inspection of the maxillary sinus.
DISCUSSION AND CONCLUSION:
In the present study sinus membrane perforation was not shown to be a significant factor in the rate of implant complications. However, the combination of smoking and onlay bone
grafting could significantly increase the rate of postoperative infection following sinus grafting.
Maxillary sinus augmentation: histologic and histomorphometric analysis.
Barone A1, Crespi R, Aldini NN, Fini M, Giardino R, Covani U.
Abstract
PURPOSE:
Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and the presence of the maxillary sinus. In these situations,
sinus floor lifting and grafting frequently have been proposed as the best treatment. The aim of this study was to compare histologically the use of 100% autogenous bone
versus a combination of autogenous bone and corticocancellous pig bone for maxillary sinus augmentation.
Eighteen patients requiring bilateral maxillary sinus augmentation were selected for this study. Bone for grafting was harvested from the iliac crest. Each patient received
100% autogenous bone in 1 randomly selected sinus (control side) and a 1:1 mixture of autogenous bone and corticocancellous pig bone particles in the contralateral
sinus (test side). Five months after the augmentation procedure, bone biopsy specimens were taken at the time of implant placement.
RESULTS:
No complications were observed during the surgical procedures; all patients healed uneventfully. No signs or symptoms of maxillary sinus disease were observed during
the 5 months after surgery. No significant differences in bone percentages were observed in the bone biopsies from test and control sides.
DISCUSSION AND CONCLUSION:
It could be concluded from this study that corticocancellous pig bone particles can be successfully used in a 1:1 mixture with autogenous bone from the iliac crest for
maxillary sinus augmentation in cases of severely atrophic maxilla.
Aumento de tejidos blandos
Stage-two surgery using collagen soft tissue grafts: clinical cases and ultrastructural
analysis.
Fischer KR, Fickl S, Mardas N, Bozec L, Donos N.
Abstract
OBJECTIVE:
To present the application of two different soft tissue grafts around dental implants during stage-two surgery. Furthermore, the ultrastructure of
these materials is shown and discussed using scanning electron microscopy (SEM).
SUMMARY:
Although soft tissue autografts may be currently regarded as the gold standard, harvesting of these grafts might lead to higher morbidity,
longer chair time, and intra-/postoperative complications at the donor site. New developments in collagen scaff olds have provided an
alternative to successfully replace autologous grafts in clinical practice. The SEM pictures clearly show the different composition of a bilayer
scaff old (collagen matrix, CM) and a porcine acellular dermal matrix (ADM). These distinctive properties lead to different possible indications.
Within the presented cases, ADM was used to augment the ridge contour and was placed into a buccal pouch to achieve complete coverage
and an uneventful closed healing. On the other side, CM was left exposed to the oral cavity to successfully gain keratinized mucosa around
and between two dental implants.
Aumento vertical seo
Posterior atrophic jaws rehabilitated with prostheses supported by 5 x 5 mm implants
with a novel nanostructured calcium-incorporated titanium surface or by longer
implants in augmented bone. One-year results from a randomised controlled trial.
Pistilli R, Felice P, Piattelli M, Gessaroli M, Soardi E, Barausse C, Buti J, Corvino V.
Abstract
PURPOSE:
To evaluate whether 5 5 mm dental implants with a novel nanostructured calciumincorporated titanium surface could be an alternative to implants at least 10 mm long placed in bone augmented with bone
substitutes in posterior atrophic jaws.
A total of 40 patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the
maxillary sinus, were randomised according to a parallel group design to receive one to three 5 mm implants or one to three at least 10 mm-long implants in augmented bone at two centres. All implants had a
diameter of 5 mm. Mandibles were vertically augmented with interpositional bovine bone blocks and resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated
porcine bone via a lateral window covered with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later,
definitive screw-retained or provisionally cemented metal-ceramic or zirconia prostheses were delivered. Patients were followed up to 1 year post-loading and the outcome measures were prosthesis and implant
failures, any complications and peri-implant marginal bone level changes.
RESULTS:
One maxillary grafted patient dropped out before the 1-year evaluation. In mandibles, 1 grafted patient did not want to go ahead with the treatment because of multiple complications and graft failure, and another
grafted patient did not receive his prostheses due the loss of 2 implants. In maxillae, one 5 5 mm implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences
in prostheses and implant failures. Significantly more complications occurred at both mandibular and maxillary grafted sites: 17 augmented patients were affected by complications versus 8 patients treated with
short implants in the mandible (P = 0.0079; difference in proportion = -0.45; 95% CI -0.67 to -0.15), and 5 sinus-lift patients versus none treated with maxillary short implants (P = 0.047; difference in proportion =
-0.25; 95% CI -0.44 to -0.06). Patients with mandibular short implants lost on average 0.94 mm of peri-implant bone at 1 year and patients with 10 mm or longer mandibular implants lost 1.03 mm. Patients with
maxillary short implants lost on average 0.87 mm of peri-implant bone at 1 year and patients with 10 mm or longer maxillary implants lost 1.15 mm. There were no statistically significant differences in bone level
changes up to 1 year between short and longer implants in maxillae (mean difference -0.28 mm, 95% CI -0.56 to 0.01, P = 0.051) and in mandibles (mean difference -0.09 mm, 95% CI -0.26 to 0.08, P = 0.295).
CONCLUSIONS:
One year after loading, 5 5 mm implants achieved similar results compared to longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in
posterior mandibles since the treatment is faster, cheaper and associated with less morbidity, however 5 to 10 years of post-loading data are necessary before making reliable recommendations.
CONFLICT-OF-INTEREST STATEMENT:
MegaGen partially supported this trial and donated implants and prosthetic components used in this study, whereas Tecnoss donated the biomaterials. The data belonged to the authors and by no means did the
manufacturers interfere with the conduct of the trial or the publication of its results.
Posterior atrophic jaws rehabilitated with prostheses supported by 5 x 5 mm implants
with a novel nanostructured calcium-incorporated titanium surface or by longer
implants in augmented bone. Preliminary results from a randomised controlled trial.
Felice P1, Pistilli R, Piattelli M, Soardi E, Corvino V, Esposito M.
Abstract
PURPOSE:
To evaluate whether 5 5 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to at least 5 10 mm-long implants placed in bone augmented with bone
substitutes in posterior atrophic jaws.
Forty patients with atrophic posterior (premolar and molar areas) mandibles having 5 to 7 mm of bone height above the mandibular canal and 40 patients with atrophic maxillae having 4 to 6 mm below the maxillary
sinus, were randomised according to a parallel group design to receive one to three 5 5 mm implants or one to three at least 5 10 mm-long implants in augmented bone at two centres. Mandibles were vertically
augmented with interpositional bovine bone blocks and resorbable barriers and implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered
with resorbable barriers and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally
cemented metal-ceramic or zirconia prostheses were delivered. Outcome measures were prosthesis and implant failures as well as any complication.
RESULTS:
Patients were followed to 4 months post-loading with the exception of one patient who underwent mandibular augmentation and had multiple complications at and after grafting, and subsequent graft failure, who
did not want to go ahead with the treatment. This case was considered a complete failure. There were no statistically significant differences in prosthesis and implant failures. In mandibles, apart from the complete
graft failure, one 5 10 mm implant failed at placement of the provisional prosthesis. In maxillae, one 5 5 mm implant failed with its provisional crown 3 months after loading. All complications occurred before
loading. Significantly more intra- and postoperative complications occurred at both mandibular and maxillary grafted sites: 16 augmented patients were affected by complications versus 8 patients treated with
short implants in the mandible (P = 0.022; difference in proportion = 0.40; CI 95% 0.12 to 0.68), and 5 sinus-lifted patients versus none treated with maxillary short implants (P = 0.047; difference in proportion =
0.25; CI 95% 0.06 to 0.44).
CONCLUSIONS:
Short-term data (4 months after loading) indicate that 5 5 mm implants achieved similar results compared to longer implants placed in augmented bone. Short implants might be a preferable choice to bone
augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5 to 10 years of post-loading data are necessary before making reliable
recommendations.
Vertical ridge augmentation of an atrophic posterior mandible with an inlay technique
and cancellous equine bone block: a case report.
Felice P1, Piana L, Checchi L, Corvino V, Nannmark U, Piattelli M
Abstract
This report describes a successful implant prosthetic rehabilitation in an atrophic left

posterior mandible in a 62-year-old man using a cancellous equine bone block as
grafting material. Four months later, two bone specimens were retrieved for histologic
evaluation and two dental implants were placed. Computed tomography and
conventional radiography showed a 5-mm mean vertical bone gain. The biopsies
showed new bone formation within the cancellous portion of the blocks and no
foreign body reaction. Cancellous equine bone grafts may be an effective alternative
to autogenous bone and inorganic bovine bone grafting for reconstruction of the
posterior mandible using the inlay technique.
Vertical ridge augmentation of the atrophic posterior mandible with a 2-stage inlay
technique: a case report.
Felice P1, Piana L, Checchi L, Pistilli R, Pellegrino G.
Abstract
The use of a 2-stage inlay technique in atrophic posterior mandibles with more than
10-mm thickness and less than 5-mm height above the inferior alveolar nerve is
described. The first surgical procedure was a basic corticotomy of the buccal and
lingual bone. One month later, a complete inlay procedure was performed.
Computed tomography and conventional radiography showed a mean vertical bone
gain of 11.5 mm. This 2-stage inlay technique avoids the use of chisels to complete
bone osteotomy and reduces postsurgical nerve disturbances in atrophic posterior
mandibles. This technique reduces intraprocedure and postoperative patient
discomfort.
Posterior atrophic jaws rehabilitated with prostheses supported by 6 mm-long, 4 mm-
wide implants or by longer implants in augmented bone. Preliminary results from a
pilot randomised controlled trial.
Esposito M1, Cannizzaro G, Soardi E, Pistilli R, Piattelli M, Corvino V, Felice P.
Abstract
PURPOSE:
To evaluate whether 6 mm-long by 4 mm-wide dental implants could be an alternative to at least 10 mm-long implants placed in bone augmented with bone substitutes in posterior atrophic jaws.
Twenty patients with bilateral atrophic mandibles and 20 patients with bilateral atrophic maxillae, having 5 to 7 mm of bone height above the mandibular canal or below the maxillary sinus, were randomised
according to a split-mouth design to receive one to three 6 mm-long and 4 mm-wide implants or at least 10-mm long implants in augmented bone at two centres. Mandibles were vertically augmented with
interpositional equine bone blocks and resorbable barriers, and implants were placed after 3 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window and implants were
placed simultaneously. All implants were submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive screw-retained metal-ceramic prostheses were delivered. Outcome
measures were prosthesis and implant failures, any complication, time needed to fully recover mental nerve function (only for mandibular implants) and patient preference.
RESULTS:
All screened patients had sufficient bone width to support 4 mm-diameter implants. Patients were followed up to 5 months post-loading and none dropped out. There were no statistically significant differences in
graft, implant or prosthesis failures, though significantly more intra- and postoperative complications occurred at grafted sites. Fourteen complications occurred in 12 patients at augmented sites versus none at
short implants. All complications occurred before loading. Three complications were associated with the failure of the mandibular grafts (15%), determining the failures of 3 implants in one patient and 2 prostheses
could not be delivered. One patient was re-grafted and 2 patients received short implants instead. Apart from those complications associated with graft failures, there were 4 perforations of the sinus membrane
during sinus lifting and 7 temporary lower lip paraesthesiae lasting up to 4 days with no long-term consequences for the patients. All maxillary implants and prostheses were successful. All 20 patients treated with
mandibular implants and 15 patients treated with maxillary implants preferred short implants, whereas 5 patients treated with maxillary implants described both procedures as equally acceptable. These differences
were statistically significant.
CONCLUSIONS:
Short-term data (5 months after loading) indicate that 6 mm-long implants with a conventional diameter of 4 mm achieved similar if not better results than longer implants placed in augmented bone. Short implants
might be a preferable choice to bone augmentation, especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5- to 10-year post-loading data are
necessary before making reliable recommendations.
Vertical ridge augmentation of atrophic posterior mandible using an inlay technique
with a xenograft without miniscrews and miniplates: case series.
Scarano A1, Carinci F, Assenza B, Piattelli M, Murmura G, Piattelli A.
Abstract
BACKGROUND:
Rehabilitation of partially or totally edentulous posterior mandible with implant-supported prosthesis has become a common practice in the last few decades, with reliable long-term results. The use of miniscrews
and miniplates have been reported to increase the risk of fracture of the osteotomy segments. The purpose of this case series was to use an inlay technique, without the use of miniscrews and miniplates for
stabilization of the transported bone fragments.
Nine consecutive patients (six men and three women) aged between 26 and 51 years (mean 44 years) were enrolled in this study. A horizontal osteotomy was performed 2-3mm above the mandibular canal, and
two oblique cuts were made using a piezosurgery device. The final phase of the osteotomy was performed with chisels. The osteotomized segment was then raised in the coronal direction, sparing the lingual
periosteum. Two miniblocks of xenograft without miniscrews and miniplates were inserted mesially and distally between the cranial osteotomized segment and the mandibular basal bone. The residual space was
filled with particles of cortico-cancellous porcine bone. Four months after surgery, a panoramic X-ray was taken before implant insertion. A bone trephine with an internal diameter of 2 mm was used as the second
dental drill to take a bone core biopsy during preparation of the #35 and #37 or #45 and #47 implant sites.
RESULTS:
The postoperative course was uneventful in seven of the nine patients. No dehiscence of the mucosa was observed at the marginal ridge of the mobilized fragment. Newly formed bone was present near the
osteotomized segments, and was observed in the bottom half of the specimens and was identified by its higher affinity toward the staining. Newly formed bone was observed to be in close contact with the particles
of biomaterials. No gaps or connective tissue were present at the bone-biomaterial interface. Histomorphometry demonstrated that 442.1% of the specimens was composed by newly formed bone, 180.8% by
marrow spaces, and 332.4% by the residual grafted biomaterial.
CONCLUSION:
The rigidity of the equine collagenated block allowed to eliminate the use of miniscrews and miniplates and simplified the technique. Moreover, the rigidity of the block allowed maintenance of the space.

Articulos Osteobiol

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Articulos Osteobiol

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Articulos osteobiol

The use of bioreplicas obtained by rapid prototyping is effective in treatment planning.

Antonio Scarano, Maurizio Piattelli, Francesco Carinci, Vittoria Perrotti****

This report describes a successful implant prosthetic rehabilitation in an atrophic left

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