Biocompatibility and effect on bone formation of a native acellular porcine pericardium: Results of in vitro and in vivo / 北京大学学报(医学版)

OBJECTIVE@#To examine the morphology and biocompatibility of a native acellular porcine pericardium (APP) in vitro and to evaluate its barrier function and effects on osteogenesis when used in guided bone regeneration (GBR) in vivo.@*METHODS@#First, the morphology of APP (BonanGenⓇ) was detected using a scanning electron microscope (SEM). Next, for biocompatibility test, proliferation of human bone marrow mesenchymal stem cells (hBMSCs) were determined using cell counting kit-8 (CCK-8) after being seeded 1, 3 and 7 days. Meanwhile, the cells stained with phalloidine and 4, 6-diamidino-2-phenylindole (DAPI) were observed using a confocal laser scanning microscopy (CLSM) to view the morphology of cell adhesion and pattern of cell proliferation on day 5. A 3-Beagle dog model with 18 teeth extraction sockets was used for the further research in vivo. These sites were randomly treated by 3 patterns below: filled with Bio-OssⓇand coverd by APP membrane (APP group), filled with Bio-OssⓇand covered by Bio-GideⓇmembrane (BG group) and natural healing (blank group). Micro-CT and hematoxylin-eosin (HE) were performed after 4 and 12 weeks.@*RESULTS@#A bilayer and three-dimensional porous ultrastructure was identified for APP through SEM. In vitro, APP facilitated proliferation and adhesion of hBMSCs, especially after 7 days (P < 0.05). In vivo, for the analysis of the whole socket healing, no distinct difference of new bone ratio was found between all the three groups after 4 weeks (P>0.05), however significantly more new bone regeneration was detected in APP group and BG group in comparison to blank group after 12 weeks (P < 0.05). The radio of bone formation below the membrane was significantly higher in APP group and BG group than blank group after 4 and 12 weeks (P < 0.05), however, the difference between APP group and BG group was merely significant in 12 weeks (P < 0.05). Besides, less resorption of buccal crest after 4 weeks and 12 weeks was observed in APP group of a significant difference compared in blank group (P < 0.05). The resorption in BG group was slightly lower than blank group (P>0.05).@*CONCLUSION@#APP showed considerable biocompatibility and three-dimentional structure. Performing well as a barrier membrane in the dog alveolar ridge preservation model, APP significantly promoted bone regeneration below it and reduced buccal crest resorption. On the basis of this study, APP is a potential osteoconductive and osteoinductive biomaterial.

Regeneración tisular guiada en paciente diabético: reporte de caso / Guided Tissue Regeneration in a Diabetic Patient: A Case Report

Se presenta el caso clínico del manejo de un defecto intraóseo de dos paredes con un procedimiento de regeneración tisular, guiada mediante el uso de una barrera de membrana reabsorbible de colágeno y aloinjerto óseo en una paciente de 56 años, diabética tipo 2 controlada, que acudió a la clínica de periodoncia de la Universidad Popular Autónoma del estado de Puebla en México. A 2 meses, el posoperatorio mostró una adecuada cicatrización de los tejidos, disminución de la profundidad al sondeo y una evidencia radiográfica de llenado del defecto y formación ósea a los 4 meses. A pesar de la relación bidireccional entre enfermedad periodontal y la diabetes tipo 2, queda demostrado que el tratamiento periodontal de un paciente diabético con buen control metabólico es muy similar a uno sin diabetes, que hace predecible el resultado de la terapia periodontal regenerativa con el uso de barrera de membrana reabsorbible y aloinjerto óseo.

A clinical case of the management of a two-wall intrabony defect with a guided tissue regeneration procedure by using a collagen resorbable barrier membrane and bone allograft in a 56 years old controlled diabetic patient who attended to the clinic periodontics of Popular Autonomous University of Puebla is presented. At 2 months, the postoperative period showed adequate scarring of the tissues, decreased depth of sounding and radiographic evidence of defect filling and bone formation at 4 months. Despite the bi-directional relationship between periodontal disease and type 2 diabetes, it was shown that the periodontal treatment of a diabetic patient with good metabolic control is very similar to one without diabetes, which makes the result of regenerative periodontal therapy predictable with the use of absorbable membrane barrier and bone allograft.

Preservación de alvéolos mediante fosfato tricálcico beta, con y sin membrana / Socket preservation using beta-tricalcium phosphate with or without membrane

El presente estudio evalúa los resultados de la utilización del fosfato tricálcico beta en la preservación de alvéolos postextracción al emplearlo solo o en conjunto con membranas no reabsorbibles. Se seleccionaron 18 dientes con indicación de extracción y con condiciones favorables para la preservación del alvéolo y posterior colocación de un implante oseointegrado. En 10 alvéolos se utilizó como relleno fosfato tricálcico beta en conjunto con membrana no reabsorbible, y 8 alvéolos fueron tratados solamente con fosfato tricálcico beta. Previo a la cirugía se evaluó el ancho y alto de cada alvéolo, mediante una tomografía computarizada de alta resolución, evaluación que fue repetida 6 meses después de realizada la intervención quirúrgica. Al momento de efectuar la técnica quirúrgica para la instalación de los implantes se tomaron muestras histológicas del sitio de colocación del implante para estudiar las características histológicas del sitio injertado después de 6 meses de realizada la cirugía de extracción dentaria y preservación de alvéolo. El uso de fosfato tricálcico beta, independiente o no del uso de membrana, mantuvo la altura del alvéolo transcurridos 6 meses desde su colocación, mientras que el ancho del alvéolo se mantuvo solo en el grupo sin membrana. Los resultados histológicos demostraron cantidades variables de regeneración ósea.

The present study evaluated the results of the post-extraction socket preservation technique using Beta-Tricalcium Phosphate with and without the use of a non-resorbable membrane. A total of 18 teeth with indication of extraction and socket preservation were selected, with 10 alveoli being treated with Beta-Tricalcium Phosphate combined with a non-resorbable membrane, and the other 8 with Beta-Tricalcium Phosphate only. The width and height of each socket was evaluated using computed tomography, prior to the extraction, and 6 months after the surgery. At the time of performing the surgical technique for installing the implants, histological specimens were taken from the implant site in order to study the graft site 6 months after the dental extraction surgery and alveoli preservation.The use of Beta-Tricalcium Phosphate, whether a membrane is used or not, maintained the alveolar height 6 months after the extraction, while the width of the alveolus only remained in the group without membrane. Histological results showed varying amounts of bone regeneration.

Desarrollo de sitio periimplantario mediante regeneración ósea guiada e injerto conectivo en el sector anterior / Peri-implant Site Development using Guided Bone Regeneration and Connective Tissue Graft in the Anterior Region

Condiciones desfavorables del reborde alveolar debido a atrofia, enfermedad periodontal o traumatismos pueden generar deficiencias de volumen óseo, produciendo como consecuencia una relación corona/implante inadecuada y un aspecto estético desfavorable. La presente serie de casos propone el uso de la técnica asociada a un injerto de tejido conectivo como método de desarrollo de sitio periimplantario, con el fin de corregir deficiencias del reborde alveolar, para permitir la posterior instalación de un implante óseo integrado. Ocho pacientes con indicación de extracción de una pieza anterior, asociada a ausencia de la tabla vestibular y a una pérdida de tejidos duros y blandos, fueron sometidos a un procedimiento de regeneración ósea guiada mediante el uso de una mezcla de xenoinjerto y hueso autólogo en conjunto con una membrana reabsorbible e injerto conectivo autólogo. A los 6 meses postratamiento, fue colocado el implante, y provisionalizado inmediatamente. En todos los casos se logró una mejora y una equiparación de los contornos periimplantarios con las piezas vecinas. No existieron complicaciones posoperatorias, la regeneración de tejidos fue exitosa en todos los casos intervenidos, y todos los implantes se integraron correctamente. La regeneración ósea guiada en conjunto con un injerto de tejido conectivo fue un método efectivo para el desarrollo de sitio periimplantario previo a la colocación de implantes en el sector anterior del maxilar.

Unfavorable conditions of the alveolar ridge, due to atrophy, periodontal disease or trauma, can lead to osseous volume deficiencies, producing an inadequate crown / implant relationship and an unfavorable esthetic appearance. The present case series proposes the use of guided bone regeneration (GBR) associated with a connective tissue graft, as a method for peri-implant site development, to correct alveolar ridge deficiencies, and to allow the subsequent placement of an osseointegrated implant. Eight patients with the indication of an anterior tooth extraction, associated with a loss of the vestibular plate and a hard and soft tissue deficiency, were treated with a GBR procedure using a mixture of xenograft-autogenous bone in conjunction with a resorbable membrane and an autogenous connective tissue graft. At 6 months post-treatment, the implant was installed and immediately provisionalized. In all the cases, an improvement and matching of the tissue contours with the neighboring teeth was achieved. There were no postoperative complications. The tissue regeneration was successful in all the cases, and all the implants achieved a correct integration. GBR, in conjunction with a connective tissue graft, was an effective method to perform a peri-implant site development prior to the implant installation in the maxillary anterior region.

The effect of non-resorbable barrier membrane on the change of buccal and lingual alveolar bone in immediate implant placement into periapically infected extraction sockets / 대한치주과학회지

PURPOSE: Many researches showed loss of alveolar bone in fresh extraction socket and even in case of immediate implant placement. The aim of this study was to evaluate the effect of non-resorbable barrier membrane on the change of buccal and lingual alveolar bone in immediate implant placement into periapically infected extraction sockets. MATERIALS AND METHODS: Immediate implants were placed into artificially induced periapical lesion of mandibular premolars after complete debridement using buccal bone defect made by a 6mm trephine bur in 4 mongrel dogs. Before flap repositioning, a non-resorbable barrier membrane was placed on the buccal defect in the experimental group. No membrane was placed in the control group. In 12 weeks after placement, the dogs were sacrificed and undecalcified histologic specimens were prepared. The vertical distance from the smooth-rough surface interface(SRI) to gingiva, 1st bone contact and bone crest were measured in buccal and lingual side. The horizontal thicknesses of gingiva and bone at 0, 1, 2 and 3 mm below SRI were measured. RESULTS: The buccal bone was resorbed more than lingual bone in both groups and there was statistical significance(p<0.05). The distances from SRI to 1st bone contact were 2.45+/-2.35 mm in experimental group and 4.49+/-3.10 mm in control group. In all vertical level, lingual bone was thicker than buccal bone(p<0.05). CONCLUSION: Buccal bone was reduced more than lingual bone in immediate implant placement into periapically infected extraction sockets. Placement of non-resorbable barrier membrane reduced the buccal bone resorption. However there was no statistical significance.

Effect of resorbable membrane on immediate placement of implant in extraction socket during periradicular surgery / 대한치주과학회지

PURPOSE: The guided bone regeneration (GBR) technique is widely used in periradicular surgery. However, there is still some controversy regarding the effectiveness of GBR in promoting bone healing after periradicular surgery. The purpose of this study was to evaluate the resorbable membrane on the osteointegration of immediate implants in sites with periradicular lesion that had been removed by periradicular surgery. MATERIALS AND METHODS: Six roots of lower second premolars and 15 roots of lower third and fourth premolars of dogs were used as control and experimental teeth, respectively. Periradicular lesions were induced only in the experimental teeth. Twelve weeks later, the control and experimental teeth were extracted and implants were placed immediately. Periradicular lesions were removed with osteotomy, curettage and saline irrigation. Resorbable membranes were used in experimental group 1 but not in experimental group 2. After 12 week of healing period, the implants were clinically not mobile and showed no signs of infection. Data obtained by histomorphometric analysis were analyzed by Kruskal-Wallis test. RESULTS: The control group showed a significantly higher bone to implant contact (BIC) (74.14+/-16.18) than experimental group 1 (40.28+/-15.96) and 2 (48.70+/-17.75)(p<0.05). However, there was no significant difference between experimental group 1 and 2. CONCLUSION: Although BIC in experimental groups were lower than in control group, immediate implant can be successfully placed at extraction socket with periradicular lesion and osseous defect. However, the use of resorbable membrane in bony defect created during periradicular surgery was questioned.

Guided tissue regeneration using resorbable membrane with or without xenograft in osseous defect / 대한치주과학회지

PURPOSE: In advanced case of periodontitis, surgical treatment without bone contouring may result in residual pockets inaccessible to proper cleaning during post-treatment maintenance. This problem can be avoided or reduced by applying guided tissue regeneration. MATERIALS AND METHODS: All of 3 patients had deep periodontal pocket depth and bleeding on probing, and radiograph revealed osseous defect, so we planned guided tissue regeneration using resorbable membrane with or without xenograft. RESULT: 6 months later, periodontal pocket depth and bleeding on probing was improved and gingiva was stable. CONCLUSION: Guided tissue regeneration using resorbable membrane with or without xenograft in osseous defect is predictable.

Resorbability and histological reaction of bioabsorbable membranes / 대한치주과학회지

The major goals of periodontal therapy are the functional regeneration of periodontal supporting structures already destructed by periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. With the development of non-resorbable membrane, GTR has proved to be the representive technique of periodontal regeneration. However, due to various clinical problems of non-resorbable membrane, resorbable membrane was developed and it showed to be clinically effective. The newly developed Para-Dioxanone membrane has a characteristic of non-woven fabric structures which is different from the generally used membranes with structure of mesh form. In addition, Chitosan membrane has been developed to apply its adventage maximally in GTR. Although a number of different types of membranes had been clinically used, researches on absorption rate of membranes were inadequate and limited to subjective opinions. However, since long term period of resorption and space maintenance are required in implant or ridge augmentation, accurate verification of resorption rate is clinically important. In this study, we had implanted Resolut(R), Biomesh(R), Para-Dioxanone membrane and Chitosan membrane (Size : 4mmx4mm) on dorsal side of Sprague Dawley rat, and sacrificed them after 4 weeks, 8 weeks, 12 weeks respectively. Histologic observation was carried out, and the following results were obtained by calculating the objective resorption rate. 1. In case of Resolut(R), external resorption took place initially, followed by internal resorption. Surface area are 5.76+/-2.37mm2, 4.91+/-1.06mm2, 4.90+/-0.98mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.6+/-4.5%, 52.8+/-9.4%, 56.4+/-5.1% respectively. 2. Biomesh(R) showed a pattern of folding, relatively slow resorption rate with small size of membrane. Surface area are 3.62+/-0.82mm2, 3.63+/-0.76mm2, 4.07+/-1.14mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 26.1+/-5.8%, 30.9+/-3.4%, 29.2+/-3.6%, respectively. 3. Para-Dioxanone membrane was surrounded by fibrous conncetive tissue externally, and resorption took place internally and externally. Surface area are 5.96+/-1.05mm2, 4.77+/-0.76mm2, 3.86+/-0.84mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 30.7+/-5.1%, 53.3+/-4.4%, 69.5+/-3.1%, respectively. 4. Each fiber of Chitosan membrane was surrounded by connective tissue and showed external resoption pattern. It showed little invasion of inflammatory cells and excellent biocompatability. The resorption rate was relatively slow. Surface area are 6.01+/-2.01mm2, 5.49+/-1.3mm2, 5.06+/-1.38mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.3+/-3.6%, 38.4+/-3.8%, 39.7+/-5.6%, respectively. Consequently, Para-Dioxanone membrane and Chitosan membrane are found to be clinically effective for their excellent tissue reaction and biocompatibility. Futhermore, the advantage of bone regenerating ability as well as the relatively long resorption period of Chitosan membrane, it might be widely used in implant or ridge augmentation.

Comparative study on tissue responses of 3 resorbable membranes in rats / 대한치주과학회지

The purpose of this study is to evaluate histologically the resorption and tissue response of various resorbable collagen membranes used for guided tissue regeneration and guided bone regeneration, using a subcutaneous model on the dorsal surface of the rat. In this study, 10 Sprague-Dawley male rats (mean BW 150gm) were used and the commercially available materials included acellular dermal matrix allograft, porcine collagen membrane, freeze-dried bovine dura mater. Animals were sacrificed at 2, 6 and 8 weeks after implantation of various resorbable collagen membranes. Specimens were prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. Resorption : Inner portion of porcine collagen membrane was resorbed a lot at 6 weeks, but its function was being kept for infiltration of another tissues were not observed. Freeze-dried bovine dura mater and acellular dermal allograft were rarely resorbed and kept their structure of outer portion for 8 weeks. 2. Inflammatory reactions : Inflammatory reaction was so mild and foreign body reaction didn't happen in all of resorbable collagen membranes, which showed their biocompatibility. 3. In all of resorbable collagen membranes, multinucleated giant cells by foreign body reactions were not observed. Barrier membranes have to maintain their function for 4-6 weeks in guided tissue regeneration and at least 8 weeks in guided bone regeneration. According to present study, we can find all of the resorbable collagen membranes kept their function and structure for 8 weeks and were rarely resorbed. Foreign body reaction didn't happen and inflammatory reaction was so mild histologically. Therefore, all of collagen membranes used in this experiment were considered proper resorbable membranes for guided tissue regeneration and guided bone regeneration.

Effects of the Guided Tissue Regeneration Using Polylactic/Polyglycolic Copolymer Membrane in the Furcation Involvement / 대한치주과학회지

The purpose of the present study was to evaluate the clinical efficacy of guided tissue regeneration(GTR) using resorbable polylactic/polyglycolic copolymer(PLA/PGA) membrane in mandibular class II furcation involvement and to compare it to the clinical efficacy of only flap operation. Both procedures were conducted in 5 patients with class II furcation involvements. After 6 months of follow up, the probing pocket depth, clincial attachment level, bone probing depth, and radiographic changes were compared, and the following results were obtained: 1. GTR using PLA/PGA demonstrated a statistically significant reduction in probing pocket depth and bone probing depth, and the control group demonstrated a statistically significant reduction in bone probing depth. 2. The comparison between the experimental and control group failed to demonstrate statistically significant difference in clinical improvement, but more reduction in probing pocket depth and bone probing depth were observed in the experimental group. The probing pocket depth and the bone probing depth were 2.2+/-1.6mm and 2.4+/-1.1mm respectively in the control group, while they were 2.4+/-1.3mm and 3.0+/- 1.2mm respectively in the experimental group. 3. Radiographic change was not detectable for the both groups during the 6 months of follow up. 4. Sites with deeper probing pocket depth at baseline examination showed greater amount of clinical improvement in both groups. Other clinical factors didn't have any significant effect on the treatment results. It is concluded that though there are some limitations, PLA/PGA membrane is effective for the treatment of mandibular class II furcation involvement.

The comparative study between Dura mater and Guidor(R) in the healing of the classIII furcation defects in dogs / 대한치주과학회지

There are various treatment methods including barrier membranes in attaining periodontal regeneration and regaining the function of destructed periodontal tissues due to periodontal disease.Barrier membranes consist of non-Resorbable and resorbable types such as Dura mater and Guidor(R) used in the treatment of intrabony defects and classII furcation defects have been shown to be effectively increased the amount of new bone and cementum.In our study we used premolars with class III furcation defects created by removing the bone 4mm apically from CEJ in adult dogs and placed resorbable membrane Dura mater and Guidor(R) for the test group and flap operation was carried out for the control groups. The effect of membrane on junctional epithelium, alveloar bone, cementum, and gingival connective tisssue in the regeneration and healing potential of periodontal tissues was evaluated and healing results were evaluated histologically and histometrically 8 weeks following the surgical procedure. 1. In the clinical observation, there was no exposure of furcation defects in the control group, whereas slight membrane exposure was noted in the test group. 2. New bone was formed up to the level of the notch in the control group, whereas in the test group new bone formation was observed above the level of the notch. 3. New cementum was formed in both groups of the experiment. 4. The connective tissue observed between the new cementum and new bone in the test group were functionally orientated, compared to the irregular formation of connective tissues found in the control group. 5. Root resorption or ankylosis was not observed in any of the groups 6. The mean and median of the control group were 4.31% and 2.23% and for the Dura mater group were 27.85% and 15.57% respectively. There was no significant difference between Dura mater and the control group. 7. The mean and median of the control group were 4.31% and 2.23% and for the Guidor(R) group were 37.27% and 37.19% respectively. There was a significant difference in these two groups(P<0.05). 8. The mean and median of the Dura mater group were 27.85% and 15.57% and for the Guidor(R) were 37.27% and 37.19%. There was no significant difference between the two test groups. Thus, by using Dura mater and Guidor in classIII furcation defects, the predictable amount of periodontal ligament and alveolar bone regeneration may result.