Three-dimensional volumetric assessment and stability of simultaneously placed implant following sinus floor augmentation with deproteinized human demineralized tooth matrix or deproteinized bovine bone mineral: a randomized controlled clinical trial.

PURPOSE: This study aimed to analyze and compare three-dimensional volumetric bone changes and stability of simultaneously placed dental implants following sinus augmentation using deproteinized human demineralized tooth matrix (dpDTM) and deproteinized bovine bone mineral (DBBM). METHODS: Twenty-four patients who required lateral maxillary sinus floor augmentation with simultaneous dental implant placement were randomly assigned to receive either dpDTM (n = 12) or DBBM (n = 12). Cone-beam computed tomography and resonance frequency analysis of implant stability were conducted immediately after surgery and 6 months postoperatively. Changes in the graft sinus floor and graft height volumes in the sagittal and coronal views, along with the implant stability quotient (ISQ), were analyzed and compared. RESULTS: Volumetric graft alteration was comparable between dpDTM (120.33 ± 77.48 mm3) and DBBM (108.51 ± 65.15 mm3) (p = 0.690). Reduction in the average graft height was also comparable: dpDTM group ranged from - 0.59 to - 0.93 mm and the DBBM group ranged from - 0.55 to - 0.82 mm (p > 0.05) at most examined levels. However, greater reduction in the mesial-graft height occurred in the dpDTM group (- 1.08 ± 0.70 mm vs. -0.58 ± 0.39 mm, p = 0.04). The ISQ values increased similarly in both groups to reach 70 at 6 months. CONCLUSION: dpDTM demonstrated comparable stability in graft volume and height during the healing process compared to DBBM and could serve as a viable alternative to DBBM for sinus floor augmentation with simultaneous implant placement.

Influence of freeze-dried bone allograft on free gingival graft survival and alveolar ridge maintenance in socket seal procedures: a randomized controlled clinical trial.

PURPOSE: This study aimed to investigate the viability of free gingival grafts (FGG) and assess clinical and radiographic changes in the alveolar ridge following socket seal surgery with or without freeze-dried bone allograft (FDBA). MATERIALS AND METHODS: Twenty-eight anterior and premolar tooth extractions were randomly allocated to 2 groups: socket graft of FDBA sealed with FGG (n = 15) and control with empty sockets sealed solely with FGG (n = 13). Photographs taken at 3, 7, 14, and 30 days post-surgery assessed FGG viability. Alveolar ridge volume was clinically evaluated via intraoral scanners before surgery and at 1 and 3 months post-surgery. CBCT scans taken immediately post-surgery and 3 months later assessed alveolar ridge dimensions. RESULTS: FGG viability in both groups increased from day 3 and reached the maximum score on day 14. Alveolar ridge volume reduction at 3 months in the FDBA group was comparable to the control group. Buccal alveolar bone height reduction was significantly higher in the FDBA group than the control group, while palatal alveolar bone height was comparable. Alveolar bone width reduction was evident but not statistically significant between the groups. The FDBA group exhibited a significant alteration in bone volume compared to the control group. CONCLUSION: Viability of FGG was not affected by graft filling materials. Sealing the socket with FGG effectively preserved socket integrity and ridge volume in minor socket defects using either graft filling material or not. This study was registered on 4 January 2021 on Thai Clinical Trials Registry (TCTR20210104001).

A Three-Dimensional Printed Polycaprolactone-Biphasic-Calcium-Phosphate Scaffold Combined with Adipose-Derived Stem Cells Cultured in Xenogeneic Serum-Free Media for the Treatment of Bone Defects.

The efficacy of a three-dimensional printed polycaprolactone-biphasic-calcium-phosphate scaffold (PCL-BCP TDP scaffold) seeded with adipose-derived stem cells (ADSCs), which were cultured in xenogeneic serum-free media (XSFM) to enhance bone formation, was assessed in vitro and in animal models. The ADSCs were isolated from the buccal fat tissue of six patients using enzymatic digestion and the plastic adherence method. The proliferation and osteogenic differentiation of the cells cultured in XSFM when seeded on the scaffolds were assessed and compared with those of cells cultured in a medium containing fetal bovine serum (FBS). The cell-scaffold constructs were cultured in XSFM and were implanted into calvarial defects in thirty-six Wistar rats to assess new bone regeneration. The proliferation and osteogenic differentiation of the cells in the XSFM medium were notably better than that of the cells in the FBS medium. However, the efficacy of the constructs in enhancing new bone formation in the calvarial defects of rats was not statistically different to that achieved using the scaffolds alone. In conclusion, the PCL-BCP TDP scaffolds were biocompatible and suitable for use as an osteoconductive framework. The XSFM medium could support the proliferation and differentiation of ADSCs in vitro. However, the cell-scaffold constructs had no benefit in the enhancement of new bone formation in animal models.

Effect of surgical mandibular setback on the occurrence of obstructive sleep apnea.

The aims were to assess the airway morphologic changes, and to evaluate sleep respiratory function and the occurrence of obstructive sleep apnea (OSA) after mandibular setback. Fifteen prognathism patients underwent bilateral sagittal split ramus (BSSRO) with or without maxilla surgery were grouped by distance of mandibular setback as group A (≤6 mm, n = 7) and group B (>6 mm, n = 8). Morphological changes were assessed using lateral cephalometric radiography and cone-beam computed tomography (CBCT) at preoperative (T0) and 6 months after surgery (T1). Sleep respiratory functions were evaluated using polysomonography. On lateral cephalometric radiography, group B showed significant decreased at Vp (p = 0.028) and PAS-p (p = 0.017). It also significant different between groups (p = 0.011 and p = 0.009 respectively). On CBCT, airway volume and AP width of airway, except Np, decreased in both groups but not significant different between groups. Only group A showed significant different between T0 and T1, cross-sectional area of Vp (p = 0.043), AP width of Vp (p = 0.043), Hp (p = 0.042), and PAS-t (p = 0.043). In group B, apnea hypopnea index increased at T1 (p = 0.043) and REM sleep differed between groups (p = 0.04). In conclusion, mandibular setback decreased the pharyngeal airway dimensions although no OSA occurred. It might be predisposing of OSA.

Alveolar Ridge Preservation Using Autologous Demineralized Tooth Matrix and Platelet-Rich Fibrin Versus Platelet-Rich Fibrin Alone: A Split-Mouth Randomized Controlled Clinical Trial.

OBJECTIVE: To assess the potential of using autologous demineralized tooth matrix (aDTM) in combination with platelet-rich fibrin (PRF) membrane (aDTM/PRF) or PRF membrane alone (control) to preserve the ridge dimension and facilitate bone healing after tooth extraction. MATERIALS AND METHODS: Forty premolar sockets were assigned to either the aDTM/PRF or control group. Horizontal and vertical ridge changes were evaluated at the baseline 2, 4, 6, and 8 weeks using cast-based and periapical radiographs. RESULTS: aDTM was well tolerated in all sites without incidences of postoperative complication. The change in horizontal ridge width was significantly greater in the control compared with the aDTM/PRF group. The overall vertical marginal bone resorption on the mesial, distal, and central site in the aDTM/PRF group was not statistically different from the control group. During the first 6 weeks, the bone healing density in the aDTM/PRF group was significantly higher than that of the control group, then it converged at week 8. CONCLUSION: Application of aDTM with PRF membrane is useful for ridge preservation by reducing the horizontal ridge collapse and promoting bone healing as shown clinically and radiographically.

The Accuracy of Cone-Beam Computed Tomography for Evaluating Bone Density and Cortical Bone Thickness at the Implant Site: Micro-Computed Tomography and Histologic Analysis.

The aim of this study was to evaluate the accuracy of cone-beam computed tomography (CBCT) for determining cortical thickness and the gray value, investigating its correlation with micro-computed tomography (CT) and histology analysis. Sixty-two bone samples from 4 anatomic regions of the jaw were analyzed. A radiographic surgical stent was used during CBCT and bone sample harvesting. The cortical thickness and gray value of the planned implant were evaluated by CBCT. Bone volumetric fractions, bone mineral density, and % porosity assessed by micro-CT and mineralized material by histology analysis from harvested bone samples were analyzed and assessed for the association with the CBCT using Pearson correlation. A correlation between cortical thickness measured from the CBCT and Micro-CT (r = 0.933, P < 0.01) was identified. There was no difference between gray values measured from the CBCT among regions, while bone density parameters from micro-CT and histologic analysis showed significant difference (P < 0.01) among regions. Bone density parameters from micro-CT and histologic analysis showed correlation with cortical thickness but not with the gray value. In conclusion, CBCT is highly accurate in linear measurements and demonstrated correlation with genuine bone density. However, the gray value could not demonstrate the true bone density according to a low correlation to bone density variable measured from micro-CT and histologic analysis.

Dimensional Change and Microstructure of Intraoral Bone Block Grafts Covered with Platelet-Rich Fibrin and a Barrier Membrane in Ridge Augmentation: A Pilot Investigation.

This study investigated the dimensional change and microstructure of intraoral bone block grafts covered with platelet-rich fibrin (PRF) and a barrier membrane in ridge augmentation. Seven patients were included, with 18 implant sites (10 ramus and 8 symphysis). The average final ridge width gains in the ramus from cast-based measurement (3.86 ± 0.87 mm) and cone beam computed tomography measurements (3.63 ± 1.38 mm) were not different from the symphysis (3.36 ± 2.26 mm and 3.44 ± 1.52 mm, respectively). Ridge width reduction of the ramus (-10.46 ± 10.55%) was higher than the symphysis (-5.04 ± 2.08%). The ramus showed bone volume fractions from the microcomputed tomography (84.66 ± 8.36%) and percentage of bone area from histomorphometry (80.29 ± 12.03%) that were comparable to those for the symphysis (83.13 ± 8.1% and 84.98 ± 14.50%, respectively). The dimensional change of the intraoral block graft covered with PRF and a resorbable membrane was minimal, and the symphysis graft was less resorbed than the ramus graft. Nevertheless, their microstructures were comparable.

Bone Regeneration Potential of Biphasic Nanocalcium Phosphate with High Hydroxyapatite/Tricalcium Phosphate Ratios in Rabbit Calvarial Defects.

PURPOSE: This study aimed to evaluate the effect of biphasic calcium phosphate (BCP) with high hydroxyapatite/tricalcium phosphate (HA/TCP) ratios on bone formation in rabbit calvarial defects. MATERIALS AND METHODS: Sixteen New Zealand white rabbits were randomly divided into two groups, a control group and an experimental group. In each animal, bilateral circular defects (10-mm diameter) were created on the calvarium. In the control group (three rabbits per time frame), defects were grafted with autogenous bone chips in one side and left empty in the other side. In the experimental group (five rabbits per time frame), defects were grafted with BCP1 (HA:TCP, 8:2) in one side and BCP2 (HA:TCP, 9:1) in the contralateral side. The animals were sacrificed at 2 and 8 weeks as designated. Bone formation and residual grafting material were assessed by radiographic densitometry, microcomputed tomography (micro-CT), and histomorphometric analysis. RESULTS: Histologic observation revealed that BCP1, BCP2, and the autogenous bone group preserved good contours of the defect, while the unfilled defect group showed connective tissue healing. Micro-CT analysis at 8 weeks showed the comparable percentages of bone volume fraction (% BV/TV) of BCP1 (20.70% ± 2.76%) and BCP2 (20.72% ± 3.97%) and two times higher than that of 2 weeks (9.90% ± 0.75%, 10.57% ± 0.85%). The autogenous group had a significantly (P < .005) greater % BV/TV (34.58% ± 8.85%) than other groups. The percentage of the material volume fraction of BCP1 and BCP2 was not different. The histomorphometry demonstrated a higher increase in newly formed bone from 2 to 8 weeks in all groups, and all were comparable (autogenous: 4.30% ± 0.76%, 12.83% ± 7.74%; unfilled: 2.82% ± 1.19%, 8.14% ± 6.35%; BCP1: 3.01% ± 2.57%, 8.81% ± 3.86%; BCP2: 3.24% ± 1.09%, 10.27% ± 3.98%). CONCLUSION: BCP with a high ratio of HA presented good osteoconductive properties and space-maintaining capacity and would be beneficial for long-term preservation or when stable graft volume is essential.

Interseptal bone reduction on the rate of maxillary canine retraction.

OBJECTIVE: To propose and evaluate a novel surgical approach with minimal trauma, termed interseptal bone reduction, combined with the use of a conventional orthodontic fixed appliance to accelerate canine retraction. MATERIALS AND METHODS: A split-mouth design study was conducted in 18 female subjects (mean age, 21.9 years) whose bilateral upper first premolars were extracted and who subsequently received canine distalization. The extraction socket on the experimental side was deepened, and interseptal bone distal to the maxillary canine was reduced in thickness using a surgical bur; conventional extraction was performed on the control side. The canines were then distalized using elastomeric chains on both the labial and palatal sides, with a net force of 150 g. The extent of canine movement and rotation was determined from study models, and the angulation was analyzed based on lateral cephalograms. RESULTS: A Wilcoxon signed rank test demonstrated that the extent of canine movement in the mesio-distal direction after 3 months was significantly greater on the experimental side than on the control side (5.4 and 3.4 mm, respectively, P  =  .002). However, there was no statistically significant difference in canine angulation or rotation after 3 months between the experimental and control sides. CONCLUSIONS: In combination with the use of conventional orthodontic appliances, interseptal bone reduction can enhance the rate of canine movement when interseptal bone is sufficiently reduced in both thickness and depth following surgical criteria.

Influence of platelet-rich fibrin on alveolar ridge preservation.

AIM: The aim of this study was to investigate the influence of platelet-rich fibrin (PRF) on early wound healing and preservation of the alveolar ridge shape following tooth extraction. METHODS: In this clinical trial, 20 symmetrical, premolar extraction sockets using split-mouth design were randomly selected with PRF or blood clot. The evaluations of wound healing, alveolar ridge contour changes, and crestal bone resorption were performed in dental casts and periapical radiographs (T0, initial; T1, 1 week; T2, 2 weeks; T4, 4 weeks; T6, 6 weeks; T8, 8 weeks). RESULTS: Platelet-rich fibrin clinically showed early healing of soft tissue covering socket orifices in the first 4 weeks. At the first week, the horizontal resorption on buccal aspect of PRF (1.07 ± 0.31 mm) was significantly less than that of the control (1.81 ± 0.88 mm). Platelet-rich fibrin demonstrated the tendency to enter the steady stage after the fourth week following tooth extraction, whereas in the control group the progression of buccal contour contraction was still detected through the eighth week. Radiographically, the overall resorption of marginal bone levels at mesial and distal to the extraction site in PRF (0.70, 1.23 mm) was comparable to that of the control (1.33, 1.14 mm). Although the PRF group demonstrated faster bone healing compared with the control, no statistically significant difference was detected. CONCLUSIONS: This preliminary result demonstrated neither better alveolar ridge preservation nor enhanced bone formation of PRF in the extraction socket. The use of PRF revealed limited effectiveness by accelerated soft-tissue healing on the first 4 weeks.

Effects of enamel matrix derivative on bioactive glass in rat calvarium defects.

Tissue engineering-based bone grafting has emerged as a viable alternative to biologic and synthetic grafts. The purpose of this study was to evaluate the effect of enamel matrix derivative (EMD; Emdogain gel, Biora AB, Malmö, Sweden) on bioactive glass in enhancing bone formation in rat calvarium defects. Twenty rats were used in the study. In all animals, 2 standardized critical-sized calvarial defects (5.0 mm diameter) were created surgically. The animals were randomly allocated into 4 groups of 5 animals each. Group AI: one calvarial defect was filled with bioactive glass plus EMD, while the contralateral defect was filled with bioactive glass alone. The healing period was 2 weeks. Groups AII and AIII: the animals were treated in the same manner as in group AI, but the healing periods were 4 and 8 weeks, respectively. Group B: one calvarial defect was filled with EMD only, while the contralateral defect was empty (CSD). The healing period was 8 weeks. New bone formation was evaluated by radiomorphometry and histomorphometry. Results of radiomorphometry showed no significant difference in the mean optical density between bioactive glass with EMD and bioactive glass alone; no defect completely regenerated with bone. The histologic analysis revealed that defects filled with bioactive glass plus EMD in all groups contained slightly more percentage of new bone than those filled with bioactive glass alone; however, the difference was not statistically significant. The highest percentage of new bone formation was present at 8 weeks in the bioactive glass plus EMD group. Bioactive glass particles, used with or without EMD, maintained the volume and contour of the area grafted in CSD. However, they did not lead to a significant difference in bone formation when compared with CSD 8 weeks postoperatively.