Evaluation of bone availability for grafts in different donor sites, through computed tomography

Abstract Objective To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. Methodology For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. Results The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. Conclusions Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

To what extent does hyaluronic acid affect healing of xenografts? A histomorphometric study in a rabbit model

ABSTRACT Among the many graft materials that have been used for the treatment of bone defects in oral and maxillofacial regions is xenograft. To improve osteoconductive effects of xenografts, they have been combined with various biocompatible materials, such as hyaluronic acid and bone morphogenetic protein. Objective: To determine bone-healing capacity of high molecular weight hyaluronic acid (HA) combined with xenograft in rabbit calvarial bone defects. Material and methods: Ten adult male New Zealand rabbits (mean weight 3 kg) were included in the study. Three 6-mm-diameter bicortical cranial defects were created on calvarial bone of all rabbits. These defects were filled as follows: a) xenograft; b) HA+xenograft; c) autograft. One month after the first operation, rabbits were sacrificed. Specimens were evaluated histomorphometrically. Results: Considering multiple comparisons, differences regarding new bone were statistically significant between all groups (p<0.05). The volume of residual graft was significantly decreased in HA group compared to xenograft group (p=0.035). Marrow space, trabecular thickness (TbTh), trabecular width (TbWi), trabecular separation (TbSp), and number of node: number of terminus (NNd:NTm) in the autograft group were significantly better than xenograft and HA groups (p<0.05). However, regarding marrow space, TbTh, TbWi, TbSp, and NNd:NTm values, xenograft and HA groups showed similar results and the difference were not significant (p>0.05). Conclusion: These results support that high molecular weight hyaluronic acid could contribute to the healing of xenograft by improving the percentage of new bone formation and reducing the percentage of residual graft. However, HA did not significantly affect the quality of newly formed bone assessed by microarchitectural parameters.

Radiographic evaluation of the effect of porcine submucosamembrane graft and bioactive glass on bone filling in rat calvaria / Avaliação radiográfica do efeito de membrana de submucosa suína e vidro bioativo no preenchimento ósseo em calvária de rato

Objectives: The aim of this study was to radiographically evaluate the filling of standardized bone defectsin rat calvaria treated with bioactive glass and with porcine submucosa membrane, alone or in combination,when compared to defects filled with clot. Materials and methods: Eighty male Wistar rats, weighing 250to 300 g, were divided into four groups, with trial period of two and eight weeks. Standardized bone woundswere surgically created in the calvaria measuring 6 mm in diameter and treated with bioactive glass, porcinesubmucosa membrane, combination of both or only clot. After two or eight weeks, the animals wereeuthanized and bone specimens were collected for evaluation with standard radiographs and digitized foranalysis with ImageJ image analyzer to compare the percentage of filling of the defects by measuring thevariations of levels of gray. Data were scored and analyzed statistically (ANOVA and Tukey HSD, p < 0.05).Results: The association of bioactive glass and submucosa membrane showed the best result of filling ofbone cavities, followed by the single use of bioactive glass. Membrane alone showed similar results withthe clot group. Conclusion: It was possible to conclude that the association of bioactive glass and porcinesubmucosa membrane could be good option for bone filling of bone defects.

Objetivos: O objetivo deste estudo foi avaliar radiograficamente o preenchimento de defeitos ósseos padronizados em calvária de ratos, tratados com vidro bioativo e com membrana de submucosa suína, isolados ou em associação, quando comparados com defeitos preenchidos com coágulo. Materiais e métodos: Oitenta ratos Wistar machos, pesando de 250 a 300 g, foram separados em quatro grupos, com períodos de avaliação de duas ou oito semanas. Defeitos ósseos padronizados foram cirurgicamente criados na calvária medindo 6 mm de diâmetro e tratados com vidro bioativo, membrana submucosa suína, combinação de ambos ou apenas com coágulo. Após duas ou oito semanas, os animais foram mortos e os espécimes ósseos foram coletados para avaliação com radiografias padronizadas e digitalizadas para análise com programa ImageJ, visando a comparar a porcentagem de preenchimento dos defeitos por meio da variação dos níveis de cinza. Os dados foram obtidos e avaliados estatisticamente (ANOVA e Tukey HSD, p < 0,05). Resultados: A associação do vidro bioativo com a membrana submucosa suína demonstrou os melhores resultados de preenchimento das cavidades ósseas,seguido pelo uso isolado do vidro bioativo. A membrana isolada demonstrou resultados semelhantes ao grupo coágulo. Conclusão: Foi possível concluir que a associação do vidro bioativo e da membrana submucosa suína pode ser uma boa opção para o preenchimento de defeitos ósseos.

Histomorphometric analysis of the repair process of autogenous bone grafts fixed at rat calvaria with cyanoacrylate

OBJECTIVE: The purpose of this study was to perform histological and histometric analyses of the repair process of autogenous bone grafts fixed at rat calvaria with ethyl-cyanoacrylate adhesive. MATERIAL AND METHODS: Thirty-two rats were divided into two groups (n=16), Group I - Control and Group II - Adhesive. Osteotomies were made at the right parietal bone for graft obtainment using a 4-mm-diameter trephine drill. Then, the bone segments were fixed with the adhesive in the parietal region of the opposite side to the donor site. After 10 and 30 days, 8 animals of each group were euthanized and the calvarias were laboratorially processed for obtaining hematoxylin and eosin-stained slides for histological and histometric analyses. RESULTS: An intense inflammatory reaction was observed at the 10-day period. At 30 days, this reaction was less intense, despite the presence of adhesive at the recipient-site/graft interface. Graft incorporation to the recipient site was observed only at the control group, which maintained the highest graft size at 10 and 30 days. CONCLUSIONS: Although the fragment was stable, the presence of adhesive in Group II did not allow graft incorporation to the recipient site, determining a localized, discrete and persistent inflammatory reaction.

Avaliação da resistência a tração de diferentes enxertos em calvária de ratos / Evaluation of the tensile strength of different grafts in rat calvaria

A perda do osso alveolar como resultado de doença periodontal ou secundariamente à cirurgia são fontes de inúmeras complicações para os cirurgiões dentistas, e a solução para tal problema se baseiam em procedimentos regenerativos, que é realizada através de enxertos ósseos que estabelecem um arcabouço para a reparação tecidual, aumentando os tecidos ósseos nos defeitos resultantes de trauma ou cirurgias, preenchendo os alvéolos após extração para preservar a altura e espessura do rebordo alveolar e aumentando e/ou reconstruindo o rebordo alveolar. Este projeto tem como objetivo determinar a resistência à tração do osso neoformado com a utilização de diferentes biomateriais. Foram utilizados 60 animais divididos em 3 grupos. O grupo 1A (n=10): GenO; Grupo 1B (n=10): GenMix; Grupo1C (n=10): Bio-Oss; Grupo 2a (n=10): PerioGlas; Grupo 2b (n=10): Polímero de mamona e Grupo 3 (n=10): coágulo. Após 3 meses de nascimento os animais foram submetidos a anestesia intraperitonial e confecção de defeito não critico (3mm de diâmetro) na calvária dos animais, que foram preenchidos com os biomateriais correspondentes a cada grupo. Após 6 meses da cirurgia foi realizada a morte dos animais, os espécimes foram coletados e submetidos ao teste em uma máquina de teste universal. Observa-se que o grupo que obteve maior média de resistência à tração foi o grupo de polímero de mamona (10,932±4,529MPa). Consequentemente, obteve-se uma comparação descrescente na seguinte ordem: Coágulo (9,563±3,74MPa), Bio-Oss (8,706±4,087MPa), GenMix (8,587±3,602MPa), GenOx (7,709±2,416MPa), PerioGlas (7,185±6,837MPa), não notando-se diferença estatisticamente significante entre os grupos. Nas microscopias eletrônicas de varredura na maioria dos grupos observou-se presença de fibras colágenas ao redor do tecido ósseo neoformado e dos remanescentes de enxerto. Conclui-se que o material foi indiferente para o resultado final da resistência à tração, demonstrando uma...

The loss of alveolar bone as a result of periodontal disease or secondary to surgery are numerous sources of complications for the dentists, and the solution to this problem are based on regenerative procedures, which is conducted through bone grafts that provide a scaffold for tissue repair by increasing the bone tissues in the defects resulting from trauma or surgery, filling the alveoli after extraction to preserve the height and thickness and increasing the alveolar ridge and/or reconstructing the alveolar ridge. This project aims to determine the tensile strength of newly formed bone with the use of different biomaterials. We used 60 animals divided into three groups. Group 1A (n = 10): GenOx; Group 1B (n = 10): GenMix; Group 1C (n = 10): Bio-Oss; Groups 2a (n = 10): PerioGlas; Group 2b (n = 10): castor bean polymer; Group 3 (n = 10): clot. After 3 months of birth the animals were anesthetized intraperitoneally and making non critical defect (3mm diameter) in the calvaria of the animals, which were filled with biomaterials for each group. After 6 months of surgery was performed the animals' death, the specimens were collected and tested in a universal testing machine. It is observed that the group had a higher average tensile strength was the castor oil polymer group (10.932 ± 4.529 MPa). Consequently, we obtained a comparison descended in the following order: Clot (9.563 ± 3.74 MPa), Bio-Oss (8.706 ± 4.087 MPa), GenMix (8.587 ± 3.602 MPa), GenOx (7.709 ± 2.416 MPa), PerioGlas (7.185 ± 6.837 MPa), not noticing a significant difference between the groups. In scanning electron microscopies in most groups there was presence of collagen fibers around the newly formed bone and remaining graft. It is concluded that the material was irrelevant to the final result of the tensile strength, showing a good quality of materials used, both when comparing products as their source (xenogenic, polymeric or clot), or its origin of manufacture (national or imported).

Avaliação da resistência a tração de diferentes enxertos em calvária de ratos / Evaluation of the tensile strength of different grafts in rat calvaria

A perda do osso alveolar como resultado de doença periodontal ou secundariamente à cirurgia são fontes de inúmeras complicações para os cirurgiões dentistas, e a solução para tal problema se baseiam em procedimentos regenerativos, que é realizada através de enxertos ósseos que estabelecem um arcabouço para a reparação tecidual, aumentando os tecidos ósseos nos defeitos resultantes de trauma ou cirurgias, preenchendo os alvéolos após extração para preservar a altura e espessura do rebordo alveolar e aumentando e/ou reconstruindo o rebordo alveolar. Este projeto tem como objetivo determinar a resistência à tração do osso neoformado com a utilização de diferentes biomateriais. Foram utilizados 60 animais divididos em 3 grupos. O grupo 1A (n=10): GenO; Grupo 1B (n=10): GenMix; Grupo1C (n=10): Bio-Oss; Grupo 2a (n=10): PerioGlas; Grupo 2b (n=10): Polímero de mamona e Grupo 3 (n=10): coágulo. Após 3 meses de nascimento os animais foram submetidos a anestesia intraperitonial e confecção de defeito não critico (3mm de diâmetro) na calvária dos animais, que foram preenchidos com os biomateriais correspondentes a cada grupo. Após 6 meses da cirurgia foi realizada a morte dos animais, os espécimes foram coletados e submetidos ao teste em uma máquina de teste universal. Observa-se que o grupo que obteve maior média de resistência à tração foi o grupo de polímero de mamona (10,932±4,529MPa). Consequentemente, obteve-se uma comparação descrescente na seguinte ordem: Coágulo (9,563±3,74MPa), Bio-Oss (8,706±4,087MPa), GenMix (8,587±3,602MPa), GenOx (7,709±2,416MPa), PerioGlas (7,185±6,837MPa), não notando-se diferença estatisticamente significante entre os grupos. Nas microscopias eletrônicas de varredura na maioria dos grupos observou-se presença de fibras colágenas ao redor do tecido ósseo neoformado e dos remanescentes de enxerto. Conclui-se que o material foi indiferente para o resultado final da resistência à tração, demonstrando uma...

The loss of alveolar bone as a result of periodontal disease or secondary to surgery are numerous sources of complications for the dentists, and the solution to this problem are based on regenerative procedures, which is conducted through bone grafts that provide a scaffold for tissue repair by increasing the bone tissues in the defects resulting from trauma or surgery, filling the alveoli after extraction to preserve the height and thickness and increasing the alveolar ridge and/or reconstructing the alveolar ridge. This project aims to determine the tensile strength of newly formed bone with the use of different biomaterials. We used 60 animals divided into three groups. Group 1A (n = 10): GenOx; Group 1B (n = 10): GenMix; Group 1C (n = 10): Bio-Oss; Groups 2a (n = 10): PerioGlas; Group 2b (n = 10): castor bean polymer; Group 3 (n = 10): clot. After 3 months of birth the animals were anesthetized intraperitoneally and making non critical defect (3mm diameter) in the calvaria of the animals, which were filled with biomaterials for each group. After 6 months of surgery was performed the animals' death, the specimens were collected and tested in a universal testing machine. It is observed that the group had a higher average tensile strength was the castor oil polymer group (10.932 ± 4.529 MPa). Consequently, we obtained a comparison descended in the following order: Clot (9.563 ± 3.74 MPa), Bio-Oss (8.706 ± 4.087 MPa), GenMix (8.587 ± 3.602 MPa), GenOx (7.709 ± 2.416 MPa), PerioGlas (7.185 ± 6.837 MPa), not noticing a significant difference between the groups. In scanning electron microscopies in most groups there was presence of collagen fibers around the newly formed bone and remaining graft. It is concluded that the material was irrelevant to the final result of the tensile strength, showing a good quality of materials used, both when comparing products as their source (xenogenic, polymeric or clot), or its origin of manufacture (national or imported).

Reconstrução mandibular utilizando calota craniana para reabilitação implantossuportada / Mandible reconstruction with calvarial bone graft to implant-supported rehabilitation

A perda dos dentes, juntamente com a utilização de próteses mucossuportadas, por longos períodos de tempos, podem causar reabsorção óssea levando à perda de volume e má qualidade óssea, diminuindo o sucesso na instalação de implantes. Foi realizada reconstrução de mandíbula atrófica com enxerto retirado da calota craniana e reabilitação protética sobreimplantes. A técnica utilizada mostrou ser adequada para reabilitar defeitos extensos em rebordos alveolares edêntulos que requerem grande quantidade óssea, pois apresentou osso em qualidade e quantidade ósseas suficientes com mínima reabsorção no período pós-operatório, preenchendo todos os quesitos funcionais e devolvendo a estética ao paciente.

Tooth loss and long-time wear of mucous-supported removable partial prostheses cause bone resorption leading to volume loss and poor bone quality, diminishing implant success. A case of reconstruction of atrophic mandible with calvarial bone graft and subsequent implant-supported prosthesis is presented. The technique was successfully performed, resulting in adequate rehabilitation of large defects in edentulous jaws that require large amounts of alveolar bone, showed sufficient bone quantity and quality with minimal resorption during the postoperative period, improving function and retrieving esthetics.