Maxillary sinus floor lifting using freeze-dried homologous bone and tibia autologous bone: report on radiographic and histological results / Elevación del piso del seno maxilar usando hueso homólogo liofilizado y hueso autólogo de tibia: reporte de resultados radiográficos e histológicos

ABSTRACT. Introduction: autologous bone grafts for maxillary sinus floor lifting are widely accepted to reconstruct alveolar ridge defects; however, there are donor sites that have not been fully explored and can be valid alternatives for this type of procedures. The objective of this study was to evaluate the behavior of tibia autologous grafts compared with freeze-dried homologous bone in maxillary sinus floor lifting. Methods: prospective, controlled, randomized study in 11 patients requiring maxillary sinus elevation. Panoramic radiographs were taken in three different moments (pre-surgery, immediately after surgery, and 6 months post-surgery) in the two groups (tibia and freeze-dried), measuring the alveolar ridge height in the posterior maxilla. Bone biopsies were taken in the grafted area 6 months after the procedure. Results: A significant reduction in bone height was found in the group grafted with freeze-dried bone. The group grafted with tibia autologous bone showed greater stability between baseline and 6 months after surgery. The histological sections showed equal conditions between the two groups. Conclusion: tibia bone shows greater stability in the evaluated period in terms of the height obtained in maxillary sinus floor lifting procedures, with clinical and histological characteristics suitable for the placement of implants. This study should be complemented with a larger sample to provide more representative results that can be applied to the general population.

RESUMEN. Introducción: los injertos de hueso autólogo para elevación del piso del seno maxilar son ampliamente aceptados para la reconstrucción de defectos en el reborde alveolar; sin embargo, existen sitios donantes que no han sido debidamente explorados y que pueden representar opciones válidas para este tipo de procedimientos. El objetivo de este estudio consistió en evaluar el comportamiento de los injertos autólogos de tibia, comparados con injertos homólogos de hueso liofilizado en la elevación de seno maxilar. Métodos: estudio prospectivo, controlado, aleatorio, que incluyó a 11 pacientes que requerían elevación del seno maxilar. Se tomaron radiografías panorámicas en tres momentos (prequirúrgico, posquirúrgico inmediato y posquirúrgico a 6 meses) en los dos grupos (tibia y liofilizado). En estas se midió la altura del reborde alveolar en el maxilar posterior. Se tomaron biopsias de hueso en la zona injertada 6 meses después del procedimiento. Resultados: Se encontró una disminución significativa de la altura ósea en el grupo injertado con hueso liofilizado. El grupo injertado con hueso autólogo de tibia presentó mayor estabilidad entre el periodo de la cirugía y 6 meses después. En los cortes histológicos se evidenció igualdad de condiciones entre ambos grupos. Conclusión: el hueso de tibia muestra mayor estabilidad en el periodo investigado, en términos de altura obtenida en procedimientos de elevación de piso del seno maxilar, con características clínicas e histológicas adecuadas para la colocación de implantes. Este estudio debe complementarse con una muestra mayor para aportar resultados más representativos aplicables a la población.

Decalcified freeze-dried bone allograft combined with rich platelet derivatives for the treatment of human periodontal intrabony defects: a Meta-analysis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This review aims to systematically evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) combined with rich platelet derivatives on the treatment of human periodontal intrabony defects.</p><p><b>METHODS</b>A search in PubMed, Web of Science, Embase, Cochrane Library, CNKI, and other electronic databases was conducted to identify randomized controlled trials (RCT) of the use of DFDBA combined with rich platelet derivatives in the treatment of human periodontal intrabony defects, performed before May 2016. The quality of the RCTs was assessed. RevMan 5.3 software was applied for Meta-analysis.</p><p><b>RESULTS</b>A total of nine RCTs were included. A total of 194 patients and 303 defects were involved. Short-term (6 months) and long-term (12 to 18 months) groups were included. Meta-analysis results revealed that DFDBA combined with rich platelet derivatives was superior to DFDBA or rich platelet derivatives alone for probing depth reduction in the short-term [MD=0.75 mm, 95% confidence intervals (CI) (0.31 mm, 1.20 mm), P=0.001 0] and longterm groups [MD=0.87 mm, 95%CI (0.02 mm, 1.72 mm), P=0.04], clinical attachment level gain in the short-term [MD=
0.65 mm, 95%CI (0.08 mm, 1.22 mm), P=0.03] and long-term groups [MD=1.31 mm, 95%CI (0.60 mm, 2.01 mm), P<0.000 3], gingival recession reduction in the long-term group [MD=-0.58 mm, 95%CI (-0.78 mm, -0.38mm), P<0.000 01], bone fill gain in the short-term [MD=0.52 mm, 95%CI (0.03 mm, 1.00 mm), P=0.04] and long-term groups [MD=1.26 mm, 95%CI (0.65 mm, 1.86 mm), P<0.000 1].</p><p><b>CONCLUSIONS</b>DFDBA combined with platelet rich derivatives is probably effective in the treatment of human periodontal intrabony defects. It is probably superior to DFDBA or platelet rich derivatives alone. Considering the limitation of the included studies, high-quality and large-sample RCTs are required to evaluate the effect.</p>

Comparison of the bone healing capacity of autogenous bone, demineralized freeze dried bone allograft, and collagen sponge in repairing rabbit cranial defects

OBJECTIVES: This study sought to evaluate the efficacy of collagen graft materials, as compared to other graft materials, for use in healing calvarial defects in rabbits. MATERIALS AND METHODS: Ten mm diameter calvarial defects were made in ten rabbits. The rabbits were then divided into 4 groups: control, autogenous bone graft, SureOss graft, and Teruplug graft. Bone regeneration was evaluated using histological and radiographic methods. RESULTS: Based on visual examination, no distinct healing profile was observed. At 4 weeks after treatment, histological analysis showed there was no bone regeneration in the control group; however, at 8 weeks after treatment, new bone formation was observed around the margin of the defective sites. In the autogenous bone graft group, new bone formation was observed at 4 weeks after treatment and mature bone was detected around the grafted bone after 8 weeks. In the SureOss graft group, at 4 weeks after treatment, acute inflammatory and multinuclear cells were noted around the grafted materials; at 8 weeks after treatment, a decrease in graft materials coupled with new bone formation were observed at the defective sites. In the Teruplug graft group, new bone formation was detected surrounding the bone margin and without signs of inflammation. There were statistically significant differences observed between the graft and control group in terms of bone density as evidenced by radiographic analysis using computed tomography (P<0.05), particularly for the autogenous bone graft group (P<0.001). CONCLUSION: These results suggested that autogenous bone, SureOss and Teruplug have the ability to induce bone regeneration as compared to an untreated control group. The osteogenic potential of Teruplug was observed to be lower than that of autogenous bone, but similar to that of SureOss.

Bone substitute in the repair of the post-extraction alveolus

In recent years there has been increasing interest in the choice of the best material for bone substitutes. Experimental models enable estimation of biological potential, efficacy and safety of a biomaterial before its clinical application. The aim of this study was to evaluate the response of a bone substitute, UNC bone matrix powder (MOeP-UNC), for repairing the postextraction alveolus in Wistar rats. Rats' first lower molars were extracted. The right alveoli were filled with MOeP-UNC hydrated with physiological saline (Experimental Group, EG), and the left alveoli were used as Control Group (CG). Thirty days after extraction, the animals were killed and the samples processed. Histological sections were made in vestibular- lingual direction at the level of the mesial alveolus of the first inferior molar (Guglielmotti et al. J. Oral Maxillofac. Surg. 1985;43(5):359-364). Repair of the alveoli at 30 days after extraction was evaluated histologically. Repair of the alveolus was optimum in the control group at 30 days, and the EG showed presence of MOeP-UNC particles in close contact with newly formed bone tissue (osseointegration). In the experimental model used, at 30 days post-surgery, the MOeP-UNC particles integrate compatibly with newly formed bone tissue.

En los ultimos anos se ha incrementado el interes por la eleccion del material mas adecuado como sustituto oseo. Los modelos experimentales permiten estimar el potencial biologico, la eficacia y seguridad de un biomaterial, previo a su aplicacion clinica. El objetivo del presente estudio fue evaluar la respuesta de un sustituto oseo, matriz osea-UNC en polvo (MOeP-UNC), en la reparacion alveolar post-exodoncia en ratas Wistar. Se realizo la exodoncia de los primeros molares inferiores. En los alveolos derechos se coloco MOeP-UNC hidratada con solucion fisiologica (Grupo Experimental, GE). Los alveolos izquierdos, fueron utilizados como Grupo Control (GC). A los 30 dias post-exodoncia los animales fueron sacrificados y las muestras obtenidas se procesaron, se realizaron cortes histologicos en sentido vestibulo-lingual a la altura del alveolo mesial del primer molar inferior (Guglielmotti et al. J Oral Maxillofac Surg. 1985;43(5):359-364). Se realizo la evaluacion histologica de la reparacion de los alveolos a los 30 dias post cirugia. El grupo control presento una optima reparacion alveolar a los 30 dias y en el GE se evidencio la presencia de las particulas de MOeP-UNC en intimo contacto con el tejido oseo neoformado (oseointegracion). En el modelo experimental utilizado, a los 30 dias post-cirugia las particulas MOePUNC se integran de manera compatible con el tejido oseo neoformado.

The effect of new bone formation of titanium mesh and demineralized freeze-dried bone / 대한치주과학회지

This study was performed to evaluate bone formation in the calvaria of rabbit by the concept of guided bone regeneration with titanium mesh membrane and demineralized freeze-dried bone. The animal was sacrificed at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the surgery. Non-decalcified specimens were processed for histologic analysis. 1. The titanium mesh but the biocompatibility was excellent the cell-occlusiveness was feeble. 2. The cell-occlusiveness was feeble and also the soft tissue growth of the upper part of the newly-formed bone after operating was excellent in early stage. 3. The maintenance ability of the space for the GBR very was excellent. 4. The titanium mesh the tissue-integration was superior the wound fixation ability excellent. 5. The demineralized freeze-dried bone did not promote the bone regeneration. 6. With the lapse of time, formation quantity of the bone some it increased, it increased quantity very it was feeble. Within the above results, the titanium mesh for the guided bone regeneration was excellent, the demineralized freeze-dried bone confirmed does not promote bone regeneration.

Space-maintaining and osteopromotive effect of freezedried bone graft in the procedure of GBR / 대한치주과학회지

This study was performed to evaluate the effect of freeze-dried bone graft on space-making capacity and bone formation in the procedure of guided bone regeneration with titanium reinforced ePTFE membrane. After decortication in the calvaria, GBR procedure was performed on 8 rabbits with titanium reinforced ePTFE membrane filled with human FDBA(Rocky Mountain Tissue Bank, Aurora Co., USA). Decortication was performed to induce the effect of bone forming factor from bone marrow. The animals were sacrificed at 2 weeks, 4 weeks, 8 weeks and 12 weeks after the surgery. Non-decalcified specimens were processed for histologic analysis. The results of this study were as follows: 1. Titanium reinforced-ePTFE membrane was biocompatable and capable of maintaining the space-making. 2. FDBA particle was surrounded with connective tissues but there was no evidence on new bone formation. 3. FDBA particle resorbed continuously but it remained until 12weeks after the surgery. Within the above results, TR-ePTFE membrane could be used effectively for Guided bone regeneration but It was assumed that FDBA does not appear to contribute to bone formation.

Guided Bone Regeneration Of Calvarial Bone Defects Using Bioabsorbable Membrane And Demineralized Freeze Dried Bone In Rats

The purpose of this study was to evaluate new bone formation and healing process in rat calvarial bone defects using BioMesh(R) membrane and DFDB. Forty eight rats divided equally into 4 groups of 1 control group and 3 experimental groups. Standardized transosseous circular calvarial defects (8 mm in diameter) were made midparietally. In the control group, the defect was only covered with the soft tissue flap. In the experimental group 1, it was filled with DFDB only, in the experimental group 2, it was covered BioMesh(R) membrane only, and in the experimental group 3, it was filled DFDB and covered with membrane. At the postoperative 1, 2, 4, 8 weeks, rats were sacrificed and histologic and histomorphometric analysis were performed. These results were as follows. In histomorphometric analysis, It showed the greatest amount of new bone formation through experimental in the experimental group 3 (P < 0.001). The amount of new bone formation at the central portion of the defect was greater in the experimental group 3 than experimental group 2. BioMesh(R) membrane began to resorb at 1 week and resorbed almost completely at 8 weeks after operation. The collapse of membrane into the defect was observed through the experimental periods in the experimental group 2. In the area of collapsed membrane, new bone formation was restricted. These results suggest that maintenance of some space for new bone to grow is required in the use of BioMesh(R) membrane alone in the defect. It is also thought that use of the membrane may promote new bone growth in DFDB graft.

The Effect of Demineralized Freeze-Dried Bone Allograft in Guided Bone Regeneration on Supra-Alveolar Peri-Implant Defects in Dogs / 대한치주과학회지

The purpose of this study was to evaluate the adjunctive combined effect of demineralized freeze-dried bone allograft(DFDB) in guided bone regeneration on supra-alveolar peri-implant defect. Supra-alveolar perio-implant defects, 3mm in height, each including 4 IMZ titanium plasma-sprayed implants were surgically created in two mongrel dogs. Subsequently, the defects were treated with 1 of the following 3 modalities: Control) no membrane or graft application, Group1) DFDB application, Group2) guided bone regeneration using an expanded polytetrafluoroethylene membrane, Group3) guided bone regeneration using membrane and DFDB. After a healing period of 12-week, the animals were sacrificed, tissue blocks were harvested and prepared for histological analysis. Histologic examination were as follows; 1. New bone formation was minimal in Control and Group 1, but considerable new bone formation was observed in Group 2 and Group 3. 2. There was no osteointegration at the implant-bone interface in the high-polished area of Group2 and Group 3. 3. In fluorescent microscopic examination, remodeling of new bone was most active during week 4 and week 8. There was no significant difference in remodeling rate between group 2 and group 3. 4. DFDB particles were observed, invested in a connective tissue matrix. Osteoblast activity in the area was minimal. The results suggest that guided bone regeneration shows promising results in supra-alveolar peri-implant defects during the 12 week healing period although it has a limited potential in promoting alveolar bone regeneration in the high-polished area. There seems to be no significant adjunctive effect when DFDB is combined with GBR.

Evaluation of the Interfaces Between Implants And Regenerated Bone Using Bone Morphogenetic Protein and Demineralized Freeze-dried Bone

Various methods and graft materials have been used to fill in the defect adjacent to the implants and considered as clinically acceptable. But it is not clear whether the regenerated bone increases the implant-bone contact and supports the implant. The purpose of this study is to evaluate regenerated bone surrounding implants using bone morphogenetic protein(BMP) and demineralized freeze-dried bone(DFDB), and the interfaces between implants and regenerated bone. bBMP was extracted and partially purified from the bovine bone matrix using heparine chromatography. Demineralized freeze-dried bone was made from the dog. Inactive insoluble collagenous bone matrix(IBM) of dog was used as carrier of bBMP. Interfaces of titanium coated epoxy resin implants were processed for demineralized section for transmission electron microscopy(TEM) and those of screw type implants were for nondemineralized section for light and fluoromicroscopic examination. Implants were inserted in the inferior border of mandible of adult dogs and artificial bony defects (3x3x4mm) were made at the mesial and distal side of implants. Defects were filled with BMP(BMP group) and DFDB(DFDB group). For the fluoromicroscopic examination, the fluorescent dyes (oxytetracycline, calcein green, alizarin red) were injected 2, 4, 6, 8, 12 weeks after implantation. The experimental animals were sacrificed at the 6th and the 12th week and their mandible were extirpated and processed for examination with light microscopy, fluoromicroscopy and TEM. The obtained results were as follows : 1. By the light microscopic findings, the defects were filled with woven bone at the 6th week and compact bone at the 12th week, and the osseointegrations were seen in both groups. There was no histological difference between them. 2. On the basis of the histomorphometric analysis, BMP group (6th week: 40.25%, 12th week: 56.04%) had higher bony contact ratio than DFDB group (38.37%, 42.63%). There was significant difference between two groups at the 12th week (P<0.05). 3. The amount of bone formation in BMP group was more prominent than in DFDB group. Significant difference was noted among two groups at the 6th and the 8th week (P<0.05). 4. By the transmission electron microscopic findings, 0.4-2micrometer soft tissue layer was found in adjacent to the interfaces and over the collagen fibrils of bone at the 6th week. However, about 100nm amorphous layer was noted at the interface or collagen fibrils directly extended to the titanium surface at the 12th week. There was no significant difference between two groups. 5. These results suggest that BMP and DFDB can be used as good graft materials in the regeneration of bone adjacent to implant, and BMP is more valuable as a bone inducer than DFDB.

A Study on Freeze / 대한정형외과학회잡지

I had an opportunity to visit U.S. Naval Tissue Bank and observed tissue procurement and preservation by freeze-drying method and its clinical application while I stayed in the Naval Hospital, Bethesda in 1954. The freeze-dried tissues, especially bone graft, has shown excellent bone repair experimentally and clinically. Recently the mechanisms of osteoinduction have observed by many researchers and isolated the substance, bone morphogenetic protein, and clarified the interaction between BMP and the determined or inducible osteoprogenitor cells.