Clinical application of autogenous dentin as a bone graft material / 口腔疾病防治

@#Autogenous dentin is a promising biological material that can be used as a substitute for autologous bone. It has been used in postextraction site preservation, maxillary sinus floor elevation, and alveolar ridge augmentation. The clinical application methods of autologous dentin have showed great diversity without uniform standard. The present article reviewed the clinical application of autogenous dentin to provide new ideas for its future development. The literature review results show that dentin materials require several preparations before transplantation, among which the demineralization is a common chemical processing method. Demineralization can enhance the osteoconductive and osteoinductive properties of dentin, but the complex and time-consuming operation process has limited its application to a certain extent. Partial demineralization may be a more appropriate choice. During transplantation, the morphology of dentin depends on the condition of the bone defect and the surgical method. Granular materials with different diameters are convenient for filling irregular defects. Block materials are conducive to maintaining the space of the reconstruction site. Hollow frame materials are slightly more complicated to process but can combine the advantages of granular and block grafts. In addition to being used alone, dentin can also be transplanted in combination with multiple biological materials. Platelet-rich plasma combined with dentin materials has shown ideal results in clinical studies. Plaster of paris and calcium phosphate ceramics have also been combined with dentin materials in animal experiments. But since they have not been applied in humans, their clinical effects require further research.

Osteosíntesis Bioreabsorbible Bioactivo (Hidroxiapatita/Poly L-lactido) en Osteotomía Le Fort I Segmentada / Bioresorbable Bioactive Osteosynthesys (Hidroxiapatite/Poly L-lactide) in Le Fort I Segmented Osteotomy

RESUMEN: El objetivo de este artículo es presentar un caso clínico con la utilización de un innovador sistema de osteosíntesis basado en la mezcla de hidroxiapatita (HA) y acido poliláctico (PLLA). La paciente fue admitida en el Hospital Abraham González Peña de Lautaro (Chile) debido a una deformidad facial que exigió realizar una cirugía ortognática monomaxilar para avance y aumento transversal del maxilar; se utilizaron placas de tipo L y tornillos de HA/PLLA de 5 mm para la fijación maxilar, realizando la cirugía sin complicaciones; el proceso técnico y alta hospitalaria se ejecutó de forma convencional. Se realizó un análisis de la literatura donde se analiza la versatilidad, la seguridad y la estabilidad de segmentos cuando se utiliza este innovador material y se concluye que este tipo de osteosíntesis es aplicable a cirugía maxilofacial, exigiendo una curva de aprendizaje por parte del cirujano, necesaria para obtener resultados adecuados.

ABSTRACT: The aim of this paper is to show a clinical case, where was used an innovative osteosynthesys system based on the mixture of hidroxiapatite (HA) and polilactic acid (PLLA). The patient was admitted into Abraham González Peña Hospital (Chile), showing a facial deformity to treat with monomaxillary orthognathic surgery for advance and transversal increase of the maxilla.; were used type L plates and 5 mm screws of HA/PLLA for the internal fixation, performing the surgery without complications; the technical process and the ALTA hospital was realized in a conventional strategy. Was realized a literature review showing the versatility, safe and stability of bone segment when used this innovative material and it´s concluded that this osteosynthesis system can be used normally in maxillofacial surgery; a learning curve to learn about this material is needed by surgeons.

Caracterización morfológica y Evaluación clínica de sustitutos óseos de origen porcino de la casa 3Biomat para su aplicación en lesiones óseas bimaxilares / Morphological characterization and clinical evaluation of porcine bone substitutes of the 3Biomat house for its application in bimaxillary bone lesions

Resumen Objetivo. Realizar la caracterización morfológica y la evaluación clínica de sustitutos óseos de origen porcino, como material para la regeneración y reconstrucción de tejido óseo afectado en lesiones óseas bimaxilares. Método. Se analizaron características morfológicas de los materiales para regeneración (dispositivos médicos implantables) Biomec Cx y Biomod, el primero es una membrana acelular de submucosa intestinal y el segundo es sustituto óseo particulado y desmineralizado, ambos de origen porcino, por medio de técnicas de coloración y microscopía, con el objetivo de ver celularidad, organización de las fibras colágenas y tamaños de las partículas. Adicionalmente, se realizó un estudio de tipo comparativo prospectivo, con una muestra intencional de 31 pacientes, en los que se hicieron un total de 83 implantes. Los procedimientos quirúrgicos efectuados fueron: implante pos exodoncia más injerto óseo, implante dental e injerto óseo en el mismo tiempo quirúrgico e injerto óseo con un tiempo de 4 meses de integración para la colocación de implantes dentales. Para la evaluación del efecto regenerativo en los diferentes procedimientos quirúrgicos se interpretaron controles clínicos y radiográficos en los que se miró el comportamiento de la cresta ósea marginal. También se realizaron análisis histológicos de biopsias de tejido óseo regenerado. Resultados. En la caracterización morfológica se encontró que los materiales para regeneración son acelulares. La matriz formada por las fibras de colágeno del sustituto Biomec CX presenta una organización y espacios intersticiales que permiten una buena migración celular. El producto Biomod mostró una densidad y tamaño de partícula adecuada para el proceso regenerativo. En la evaluación clínica, todas las diferencias (mesial y distal) de los meses evaluados en relación con la ganancia de hueso, son estadísticamente significativas; prueba t pareada, p < 0,01 y ANOVA. El aumento promedio en 4 meses fue 0,235mm por mesial (57,3%) y 0,237mm por distal (56,7%). Conclusiones. A partir de los resultados obtenidos tanto en las características morfológicas como en la evaluación clínica de los sustitutos Biomec CX y Biomod, se comprobó que son materiales aptos para su uso en procesos regenerativos en los que se presenten lesiones óseas bimaxilares.

Abstract Objective. To perform the morphological characterization and clinical evaluation of porcine bone substitutes as a material for the regeneration and reconstruction of affected bone tissue in bimaxillary bone lesions. Method. Morphological characteristics of Biomec Cx and Biomod (implantable medical devices) regeneration materials were analyzed, the first is an acellular membrane of the intestinal submucosa and the second is a particle and demineralized bone substitute, both of porcine origin, by techniques of coloration and microscope with the objective of search the cellularity, organization of collagen fibers and particle sizes. Then a prospective comparative study was conducted with an intentional sample of 31 patients in which a total of 83 implants were made. The surgical procedures were: Post-extraction implant plus bone graft, dental implant- bone graft at the same time and bone graft with a time of 4 months of integration for the placement of dental implants. For the evaluation of the regenerative effect in the different surgical procedure we interpreted clinical and radiographic controls with the behavior of the marginal bone crest. Histological analyzes of biopsies of regenerated bone were also performed. Results. In the morphological characterization it was found that the materials for regeneration are acellular. The matrix formed by the collagen fibers of the substitute Biomec CX presents an organization and interstitial spaces that allow a good cellular migration. The Biomod product showed a density and particle size suitable for the regenerative process. In the clinical evaluation, all the differences (mesial and distal) of the months evaluated in relation to the bone gain, are statistically significant; T-test, p <0.01 and ANOVA. The average increase in 4 months was 0.235mm per mesial (57.3%) and 0.237mm per distal (56.7%). Conclusions. Based on the results obtained both in the morphological characteristics and in the clinical evaluation of the substitutes Biomec CX and Biomod, it was verified that they are suitable materials for use in regenerative processes in which bimaxillary bone lesions are present.

Orbital Wall Reconstruction with Osteoconductive Unsintered Hydroxyapatite/Poly L-Lactide

PURPOSE: To evaluate the effect of orbital wall reconstruction with absorbable osteoconductive unsintered hydroxyapatite/poly L-lactide by assessment of the orbital volume via orbital computed tomography. METHODS: 24 patients who followed up at least 6 months after orbital wall reconstruction with unsintered hydroxyapatite/poly L-lactide were included. Retrospective clinical chart reviews for clinical manifestations and complications were performed, and orbital volume measurements were taken using the Eclipse Treatment Planning System (ver.13.0, Varian Medical System Inc., Palo Alto, CA, USA) through orbital computed tomography, which were taken before operation, right after operation, and at last follow up. RESULTS: Fourteen patients (58.3%) showed diplopia and extraocular muscle movement limitation preoperatively. Diplopia was resolved at last follow up and extraocular muscle movement limitation was improved at postoperative 6 months for all cases. The mean volumes of the fractured orbit and the unaffected orbit before operation were 23.62 ± 0.45 cm3 and 21.95 ± 1.01 cm3, respectively (p = 0.003). The mean volumes of the fractured orbit and the unaffected orbit right after operation were 21.65 ± 0.91 cm3 and 21.78 ± 0.83 cm3, respectively (p = 0.542). The mean volumes of the fractured orbit and the unaffected orbit at last follow up were 21.84 ± 0.93 cm3 and 21.81 ± 0.91 cm3, respectively (p = 0.889). CONCLUSIONS: Absorbable osteoconductive unsintered hydroxyapatite/poly L-lactide was effective for clinical improvement and orbital volume assessment in cases of orbital wall reconstruction and it can be used safely without definite implant related complications.

Orbital Wall Reconstruction with Osteoconductive Unsintered Hydroxyapatite/Poly L-Lactide

PURPOSE: To evaluate the effect of orbital wall reconstruction with absorbable osteoconductive unsintered hydroxyapatite/poly L-lactide by assessment of the orbital volume via orbital computed tomography. METHODS: 24 patients who followed up at least 6 months after orbital wall reconstruction with unsintered hydroxyapatite/poly L-lactide were included. Retrospective clinical chart reviews for clinical manifestations and complications were performed, and orbital volume measurements were taken using the Eclipse Treatment Planning System (ver.13.0, Varian Medical System Inc., Palo Alto, CA, USA) through orbital computed tomography, which were taken before operation, right after operation, and at last follow up. RESULTS: Fourteen patients (58.3%) showed diplopia and extraocular muscle movement limitation preoperatively. Diplopia was resolved at last follow up and extraocular muscle movement limitation was improved at postoperative 6 months for all cases. The mean volumes of the fractured orbit and the unaffected orbit before operation were 23.62 ± 0.45 cm3 and 21.95 ± 1.01 cm3, respectively (p = 0.003). The mean volumes of the fractured orbit and the unaffected orbit right after operation were 21.65 ± 0.91 cm3 and 21.78 ± 0.83 cm3, respectively (p = 0.542). The mean volumes of the fractured orbit and the unaffected orbit at last follow up were 21.84 ± 0.93 cm3 and 21.81 ± 0.91 cm3, respectively (p = 0.889). CONCLUSIONS: Absorbable osteoconductive unsintered hydroxyapatite/poly L-lactide was effective for clinical improvement and orbital volume assessment in cases of orbital wall reconstruction and it can be used safely without definite implant related complications.

Evaluación Clínica y radiográfica de injertos biocerámicos tipo Hidroxiapatita como alternativa en la reconstrucción de alveolos dentarios postexodoncia / Clinical and radiographic evaluation of grafts biocerámicos type Hidroxiapatita like alternative in the reconstruction of alveoli toothworts postexodoncia

Evaluar el comportamiento de la cresta ósea marginal con la plataforma del implante como referencia, en casos de pacientes con injerto aloplástico de la casa farmacéutica Madrob®con el fin de mantener la integridad ósea como elemento fundamental en la colocación de implantes dentales. Materiales y métodos: Se llevó a cabo un estudio de tipo comparativo y prospectivo, con una muestra intencional de 30 pacientes para un total de 81 implantes con previo requisito de injerto aloplásticos en alveolos pos exodoncia y posterior implante dental. Se realizaron controles clínicos y radiográficos a los 3, 6, 9, 12, 24 y 36 meses para evaluar el comportamiento de la cresta ósea marginal. Resultados: Hay mayor aumento de pérdida ósea por mesial que por distal entre los 12 y 36 meses. Entre 24 y 36 meses, el aumento es igual por mesial que por distal y es de solo 0,05mm. Las diferencias entre tiempos son todas significativas p<0,001. El ANOVA indica que todas las varianzas son homogéneas y pequeñas entre 0,18mm y 0,22mm...

This work is aimed at evaluating the response of the marginal bone crest using the implant's platform as a reference. The study considered patients with alloplastic grafts from Madrob® to establish the role of bone integrity in locating dental implants. Materials and Methods: The benchmark and prospective studies were conducted on 30 subjects .A total of 81 alveoli alloplastic implants were analyzed post-exodontia. The response of the marginal bone crest was evaluated after 3, 6, 9, 12, 24 and 36 months via clinical and radiographic controls Results: For the period between 12 and 36 months, mesial prevailed over distal bone loss. Mesial and distal gains of about 0,05 mm were equally important for the period between 24 and 36 months. p-values less than 0,001 indicate that differences between times are all significant. The ANOVA indicates that all the variances are homogeneous and small between 0,18mm and 0,22mm...

Aspecto radiológico e macroscópico de matriz óssea mineralizada heteróloga fragmentada e polimetilmetacrilato autoclavados em falha óssea de tíbia de coelho / Radiological and macroscopic aspects of autoclaved heterologous fragmented mineralized bone matrix and polymethylmethacrylate in bone defect in tibia of rabbits

Foi realizada falha segmentar com 6mm de diâmetro na região metafisária medial de tíbias de 12 coelhos, onde foi implantado uma associação de micro e macrofragmentos de matriz óssea cortical heteróloga fragmentada conservada em glicerina (98%) e polimetilmetacrilato autoclavados, para a sua reconstrução, e avaliados radiológica e macroscopicamente aos 30, 60, 90 e 120 dias. Houve adesão, em relação ao tempo, dos micro e macrocompósitos ao leito receptor, em 100% dos casos, mostrando ser biologicamente biocompatível, pois promoveram a reparação de falhas ósseas, sem sinais de infecção, migração e/ou rejeição, podendo, dessa forma, ser mais uma opção como substituto para preencher grandes defeitos ósseos.

A segmental defect of 6mm diameter was performed in the medial metaphyseal region of the tibia of 12 rabbits. For the bone defect reconstruction there was implanted a combination of micro and macro fragments of heterologous fragmented cortical bone matrix preserved in glycerin (98%) and polymethylmethacrylate, both autoclaved. Radiological and macroscopic evaluation was performed at 30, 60, 90 and 120 days. Adhesion in relation to time of the micro and macro composites to the recipient bed was observed in 100% of the cases. This showed that this implant is biologically biocompatible, since it promoted bone defects repair, with no signs of infection, migration and/or rejection. In this way, this implant can be classified as one more option of substitute to fill large bone defects.

Guide bone regeneration using autogenous teeth: case reports

The authors installed implants combined with guided bony regeneration (GBR) using autogenous tooth bone graft material in the patients. In one patient, GBR and simultaneous implant placement were performed. In two patients, GBR was performed and the implants were placed after 6 months. All patients achieved favorable clinical outcomes. Excellent osteoconductive bony healing was observed in the 6 month histology examination after the bone graft.

Orthopaedic applications of bone graft & graft substitutes: a review.

Treatment of delayed union, malunion, and nonunion is a challenge to the orthopaedic surgeons in veterinary and human fields. Apart from restoration of alignment and stable fixation, in many cases adjunctive measures such as bone-grafting or use of bone-graft substitutes are of paramount importance. Bone-graft materials usually have one or more components: an osteoconductive matrix, which acts as scaffold to new bone growth; osteoinductive proteins, which support mitogenesis of undifferentiated cells; and osteogenic cells, which are capable of forming bone in the appropriate environment. Autologous bone remains the “gold standard” for stimulating bone repair and regeneration, but its availability may be limited and the procedure to harvest the material is associated with complications. Bone-graft substitutes can either substitute autologous bone graft or expand an existing amount of autologous bone graft. We review the currently available bone graft and graft substitutes for the novel therapeutic approaches in clinical setting of orthopaedic surgery.

Bone formation induced by purified BMP and by recombinant human BMP-2 / 实用口腔医学杂志

Objective: To study the biodegradable of coral PLA composite artifical bone combined with bBMP or rhBMP as a new kind of bone substitute material. Methods: The composites were implanted into the muscle pouches of mice after combined with rhBMP-2 or bBMP respectively. Ectopic osteoinductive activity of rhBMP-2 or bBMP was examined and compared by histology and histo-morphometry.Results: rhBMP-2 and bBMP had different osteoinductivety. rhBMP-2 appeared to induce less bone and more angioid tissue and marrow. While bBMP seemed to have opposite effects. Conclusion: bBMP is more osteoinductive than rhBMP-2.

Spinal Fusion with B.O.P.(Biocompatible Osteoconductive Polymer)

Spinal fusion has performed for instability and anatomical reconstruction since 1985 by Barthe. Bone grafts and synthetic materials has been used for spinal fusion, but they have several limitations and complications. Recently a new synthetic polymer B.O.P.(Biocompatible Osteoconductive Polymer) was developed and it overcome the limitations of other materials. The B.O.P. showed no foreign body reaction and gave scaffolding for the osteoconduction and osteointegration. Authors operated 35 cases of spinal fusion with B.O.P. and the results and literature reviews were discussed.