A comparative analysis of particulate bovine bone substitutes for oral regeneration: a narrative review.

PURPOSE: Particulate bovine bone substitutes (BS) are commonly used in oral regeneration. However, more literature is needed focusing on comparative analyses among various particulate bovine BS. This study evaluates pre-clinical and clinical data of different particulate bovine BS in oral regeneration. METHODS: A narrative review was conducted by screening the PubMed database Included in the review were pre-clinical and clinical studies until 2024 comparing a minimum of two distinct particulate bovine BS. In addition to examining general data concerning manufacturing and treatment processes, biological safety, physical and chemical characteristics, and graft resorption, particular emphasis was placed on assessing pre-clinical and clinical data related to ridge preservation, sinus floor elevation, peri-implant defects, and various forms of alveolar ridge augmentation utilizing particulate bovine BS. RESULTS: Various treatment temperatures ranging from 300 to 1,250 °C and the employment of chemical cleaning steps were identified for the manufacturing process of particulate bovine BS deemed to possess biosecurity. A notable heterogeneity was observed in the physical and chemical characteristics of particulate bovine BS, with minimal or negligible graft resorption. Variations were evident in particle and pore sizes and the porosity of particulate bovine BS. Pre-clinical assessments noted a marginal inclination towards favorable outcomes for particulate bovine BS subjected to higher treatment temperatures. However, clinical data are insufficient. No distinctions were observed regarding ridge preservation, while slight advantages were noted for high-temperature treated particulate bovine BS in sinus floor elevation. CONCLUSIONS: Subtle variances in both pre-clinical and clinical outcomes were observed in across various particulate bovine BS. Due to inadequate data, numerous considerations related to diverse particulate bovine BS, including peri-implant defects, must be more conclusive. Additional clinical studies are imperative to address these knowledge gaps effectively.

Long-term outcome of implants exhibiting buccal soft tissue dehiscence in the esthetic zone.

OBJECTIVE: Increasing aesthetic demands require that the color and contour of the peri-implant soft tissues be in harmony with the neighboring teeth. Recession, migration toward the apical, is a frequent clinical finding. Its presence can lead to inflammation and increased marginal bone loss. These complications, in addition to affecting the aesthetic results of our treatment, are difficult to treat and can threaten the survival of the implant. There are fewer studies showing the outcome of treatment of soft-tissue defects around implants. The aim of this article is to describe the treatment of a soft-tissue defect around an implant-supported prosthesis treatment, performed on two neighboring implants, in the esthetic zone in a patient with a high smile and to evaluate both the coverage achieved and the patient's esthetic satisfaction. CLINICAL CONSIDERATIONS: This study showed that a mucogingival approach, using a surgical technique designed for the treatment of alveolar ridge defects, together with tissue management with temporaries and a new restoration, achieved an optimal result. CONCLUSIONS: The case has been closely followed up, for 10 years, and the authors have been able to confirm the long-term stability of the result. CLINICAL SIGNIFICANCE: The following paper shows the result of an innovative approach. Connective tissue platform technique, usually performed for soft-tissue augmentation, was used for a defect in soft-tissue dehiscence. The authors followed the results for 10 years, and the results achieved were satisfactory in terms of esthetic.

Concentrados plaquetarios para regeneración y tratamiento de tejidos duros y blandos / Platelet concentrates for regeneration and treatment of the hard and soft tissues

Debido a la alta frecuencia de las recesiones periodontales y sus repercusiones, de comparar los efectos de los diferentes derivados plaquetarios utilizados en el tratamiento de lesiones en tejidos blandos y duros orales. Se realizó una búsqueda en Pubmed/ Medline, EMBASE, el Registro de Ensayos del Cochrane Oral Health Group, Lilacs de ensayos clínicos que utilicen concentrados plaquetarios para el tratamiento de defectos periodontales y periimplantarios en comparación con los tratamientos convencionales. Los principales resultados observados no mostraron diferencias significativas en ninguna de las siguientes variables: profundidad de sondaje, nivel de inserción clínico, recubrimiento radicular mediante colgajo de avance coronal y grosor de encía queratinizada. La única variable estudiada en la que se encontraron diferencias significativas fue en la realización de un colgajo de acceso agregando concentrados plaquetarios y sin ellos. Podemos concluir en este estudio que los derivados plaquetarios como el plasma rico en plaquetas (PRP), plasma rico en fibrina (PRF) y el plasma rico en fibrina y leucocitos (L-PRF) pueden ser beneficiosos en el tratamiento y regeneración de tejidos blandos y duros periodontales y periimplantarios. No obstante, se necesita más investigación para analizar detalladamente el comportamiento de estos derivados sanguíneos. (AU)

This study was put forward as a result of the number and consequences of periodontal recessions, this review aims to compare the effects of different types of platelet concentrates used to treat hard and soft oral tissue defects. In order to do so, clinical trials were researched based on the usage of platelet concentrates, compared with conventional treatments were searched in PubMed/Medline, EMBASE, Cochrane Oral Health Group, and Lilacs. Within the main outcomes, there were not found remarkable differences in any of the following factors: probing depth, clinical attachment level, root coverage, coronal advance fl ap, keratinized gingival width. There was only signifi cant distinction on the studies that compared the usage of an access fl ap variable with and without platelet concentrates. To sum up, seems to be benefi cial the addition of platelet rich plasma (PRP), platelet rich fibrin (PRF) and leucocyte platelet rich fibrin (L-PRF) to the treatment when dealing with periodontal and periimplant defects. Nevertheless, further investigations and studies are needed in order to be able to analyze in detail the behavior of these blood products. (AU)

Influence of Removing or Leaving the Prosthesis after Regenerative Surgery in Peri-Implant Defects: Retrospective Study: 32 Clinical Cases with 2 to 8 Years of Follow-Up.

PURPOSE: The aim of this retrospective study was to compare the influence of removing or not removing a prosthesis after regenerative surgery on peri-implant defects. METHODS: Two different groups were compared (Group 1: removing the prosthesis; Group 2: maintaining the prosthesis), analyzing radiographic bone filling (n = 32 implants) after regenerative treatment in periapical radiographs. The peri-implant defects were measured before and after regenerative treatment using Bio-Oss® (Geistlich Pharma, Wohhusen, Switzerland) and a reabsorbable collagen membrane (Jason®, Botis, Berlin, Germany), the healing period was two years after peri-implant regenerative surgery. Statistical analysis was performed, and a Chi square test was carried out. To determine the groups that made the difference, corrected standardized Haberman residuals were used, and previously a normality test had been applied; therefore, an ANOVA or Mann-Whitney U test was used for the crossover with the non-normal variables in Group 1 and Group 2. RESULTS: The results obtained suggest that a regenerative procedure with xenograft, resorbable membrane, and detoxifying the implant surface with hydrogen peroxide form a reliable technique to achieve medium-term results, obtaining an average bone gain at a radiographic level of 2.84 mm (±1.78 mm) in patients whose prosthesis was not removed after peri-implant bone regenerative therapy and 2.18 mm (±1.41 mm) in patients whose prosthesis was removed during the healing period. CONCLUSIONS: There are no statistically significant differences in the response to treatment when removing or keeping the prosthesis after regenerative surgery in peri-implant defects.

Peri-implant bone defects: A 1-year follow-up comparative study of use of hyaluronic acid and xenografts.

OBJECTIVE: The aim of this study was to compare the efficacy of hyaluronic acid (HA) and xenografts on the repair of peri-implant dehiscence-type bone defects occur during implant placement. PATIENTS AND METHODS: Forty-two dehiscence Class I type defects located on the buccal surface of the implants were included in this study. Defects were divided into two main groups as small sized (height of <3 mm) and medium sized (height between 3 and 5 mm). Both of the main groups were further divided into two subgroups as HA plus xenograft plus collagen membrane (HAXC) or xenograft plus collagen membrane (XC) applied groups. After grafting, repair of defect site was evaluated with the help of the cross-sectional images on cone-beam computed tomography at 6th and 12th months. RESULTS: In both main groups, vertical bone height (VBH) was higher in defects repaired with HAXC (2.65 ± 1.12 mm) than in the XC (2.45 ± 1.10 mm) groups at the 6th month. However, the difference between two subgroups was not statistically significant (P > 0.05). Reduction in VBH was observed up to 6-12 months after prosthetic loading in all defect sites. This reduction was found statistically significant in medium-sized defects that grafted with XC (P < 0.05, paired t-test). However, in other subgroups, the difference between measurements at 6th and 12th months was not statistically significant (P > 0.05). CONCLUSIONS: According to the data obtained from this study, it can be concluded that HA did not have a significant positive effect on the repair of defects around dental implants.

Diagnostic Accuracy of Three Cone Beam Computed Tomography Systems and Periapical Radiography for Detection of Fenestration Around Dental Implants.

CONTEXT: Early detection of peri-implant bone defects is highly important to prevent further bone loss and implant failure. AIMS: This study aimed to assess the diagnostic accuracy of three cone-beam computed tomography (CBCT) systems and periapical radiography for detection of fenestration around dental implants. METHODS: Thirty-one titanium implants were placed in the bovine ribs, in which peri-implant fenestration were simulated. Using a round fissure bur, fenestration defects were created in the apical-third region of implants. CBCT and PA radiographs were obtained before and after creating the defects. The results were analyzed using Chi-square test; kappa coefficient; Cochran's Q-test; McNemar's test; and sensitivity, specificity, positive predictive value, and negative predictive value; and receiver operating characteristic curve. RESULTS: A significant agreement was noted between the two observers in the detection of defect-free samples in all imaging systems (P < 0.05). In detection of samples with defects, a significant agreement was observed between the two observers in use of Cranex three-dimensional and NewTom 3G systems (P < 0.05), but the agreement was not significant for detection of defects in use of Promax 3D (P > 0.05). The results showed no significant difference among the four imaging systems in detection of defect-free samples while the difference was significant among the four groups for detection of defects (P < 0.05). NewTom had the highest sensitivity (75.81%) and specificity (100%) for detection of fenestration. CONCLUSIONS: Within the limitations of CBCT systems different kVp used by different systems, artifacts and noises that influences image quality, difference in diagnostic value of different CBCT systems is due to the differences in type of detector and voxel size. In terms of the type of detector, our results showed that NewTom 3G, which has a higher (kVP) than other systems and the highest accuracy for detection of fenestration.

Accuracy of CBCT images in the assessment of buccal marginal alveolar peri-implant defects: effect of field of view.

OBJECTIVES: To investigate the reliability and accuracy of cone beam CT (CBCT) images obtained at different fields of view in detecting and quantifying simulated buccal marginal alveolar peri-implant defects. METHODS: Simulated buccal defects were prepared in 69 implants inserted into cadaver mandibles. CBCT images at three different fields of view were acquired: 40 × 40, 60 × 60 and 100 × 100 mm. The presence or absence of defects was assessed on three sets of images using a five-point scale by three observers. Observers also measured the depth, width and volume of defects on CBCT images, which were compared with physical measurements. The kappa value was calculated to assess intra- and interobserver agreement. Six-way repeated analysis of variance was used to evaluate treatment effects on the diagnosis. Pairwise comparisons of median true-positive and true-negative rates were calculated by the χ² test. Pearson's correlation coefficient was used to determine the relationship between measurements. Significance level was set as p < 0.05. RESULTS: All observers had excellent intra-observer agreement. Defect status (p < 0.001) and defect size (p < 0.001) factors were statistically significant. Pairwise interactions were found between defect status and defect size (p = 0.001). No differences between median true-positive or true-negative values were found between CBCT field of views (p > 0.05). Significant correlations were found between physical and CBCT measurements (p < 0.001). CONCLUSIONS: All CBCT images performed similarly for the detection of simulated buccal marginal alveolar peri-implant defects. Depth, width and volume measurements of the defects from various CBCT images correlated highly with physical measurements.

Assessment of buccal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode.

OBJECTIVES: To investigate the accuracy of cone beam CT (CBCT) images obtained with and without artefact reduction (AR) in detecting simulated buccal peri-implant and buccal periodontal defects. METHODS: 42 implants inserted into edentulous mandibles, and 38 teeth present in dry mandibles were used. Simulated buccal peri-implant defects (n = 22) and buccal periodontal defects (n = 22) were prepared. 20 implants and 18 teeth without simulated defects were the control group. Images of the mandibles were obtained using a Planmeca ProMax(®) 3D Max CBCT unit (Planmeca Oy, Helsinki, Finland). Image reconstructions were prepared without and with low, medium and high AR modes. Images were viewed randomly by six observers twice for the presence of defects. Kappa coefficient was calculated. F2_LD_F1 design for non-parametric analysis of longitudinal data was used. Area under curves (AUCs) were calculated for each observer. Significance level was taken as α = 0.05. RESULTS: Intraobserver kappa ranged from 0.140 to 0.792 for peri-implant and from 0.189 to 1.0 for periodontal defects. All factors were statistically significant (p < 0.001), except for image mode and implant brand. Pairwise interactions were found between periodontal defects and peri-implant defects (p < 0.001), observers (p < 0.001), observer and image mode (p < 0.001), defect model and observer (p < 0.001) and defect model, image mode and observer (p = 0.04). AUC values ranged from 0.39 to 0.52 for peri-implant and from 0.45 to 0.71 for periodontal defects. Higher AUC values were found for periodontal defects than for peri-implant defects. CONCLUSIONS: Buccal peri-implant defects were more difficult to detect than buccal periodontal defects. No difference was found among CBCT images obtained with and without AR modes.

Reconstrução imediata de diferentes defeitos peri-implantares em implantes pós-exodônticos: análise histomorfométrica em cães / Reconstruction of buccal different defects at implants placed immediately into extraction sockets: a histomorphometric analysis in dogs

Objetivo: A proposta deste estudo foi avaliar a regeneração óssea de defeitos criados cirurgicamente e naturais circunferenciais (gap) de implantes pósexodônticos. Materiais e método: Para este estudo foram utilizados 8 cães da raça labrador, nos quais foram instalados implantes imediatos (pós-exodônticos) nos alvéolos dos dentes P2 (2o pré-molar) e M1 (1o molar) inferiores bilaterais. Nos implantes da região dos 2º pré-molares bilaterais foram criados cirurgicamente defeitos peri-implantares vestibulares que foram preenchidos de um lado por osso autógeno – OA e do outro por osso bovino inorgânico Bio-Oss®- OB. Nos alvéolos correspondentes aos primeiros molares (M1) os implantes foram instalados e os gaps (defeitos naturais) existente entre a tábua óssea vestibular e o implante, foram preenchidos por Bone Ceramic® - (grupo BC) ou somente coágulo (grupo COA). Todos os sítios cirúrgicos foram posteriormente recobertos por membrana de colágeno reabsorvível (Biogide ®) e mantidos com cicatrizador. Após 4 meses de pós-operatório, os animais foram eutanasiados e os blocos ósseos processados laboratorialmente para análise histomorfométrica. Resultados: Os resultados obtidos nos implantes instalados na região do P2 mostraram que os valores do IS-C foram ligeiramente maior (2.3±0.8mm) no grupo OA, comparado ao grupo OB (1.7± 0.7 mm), enquanto o IS-B dos grupos OA e OB foram respectivamente de 2.7±0.7mm e 2.2±1.0 mm no lado vestibular e de 1.6±0.8mm e 0.8±0.5mm no lado lingual. As médias dos valores de PM-C, PM-B e PM-IS no grupo OA e OB foram respectivamente de 4.3±0.9mm, 4.7±0.9mm, 2.0±1.6mm e 4.3±0.6mm, 4.8±0.6mm, 2.5±0.8mm. A diferença estatística significativa foi observada somente na espessura da crista óssea vestibular de 2 a 5 mm em direção ao IS (“pescoço do implante”), incluindo o biomaterial (S-OCbt) que se apresentou maior no grupo OB. Nos implantes instalados na região do M1, o gap vestibular horizontal foi de 1.1 (COA) e 1.4 mm (BC) e vertical de 3 e...

Objective: The purpose of these studies were to evaluate bone regeneration at natural or surgically-created buccal defects at implants placed immediately into extraction sockets (IPIES). Material and methods: Eight Labrador dogswere used and implants were placed immediately into the extraction sockets of P2 (second premolar) and M1 (first molar), bilaterally. At P2, the buccal wall of the extraction sockets was removed bilaterally to create a standardized defect, 4 mm wide coronally, 2 mm wide apically, and 6 mm height. At P2 sites, Bio-Oss at the test (OB) or autogenous bone at the control (OA) sites were used to fill the defects. At M1 sites, Bone Ceramic ® at the test (BC) or the clot alone (COA) were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membraneand a non-submerged healing was allowed. After 4 months the animals were euthanized, bone blocks harvested and processed for histomorphometric analysis. Results: at P2 sites, IS- C values were slightly higher (2.3±0.8mm) in the OA compared to the OB (1.7±0.7 mm). IS- B were 2.7 ± 0.7mm and 2.2 ± 1.0mm on the buccal side and 1.6 ± 0.8mm and 0.8 ± 0.5mm on the lingual side at OA and OB groups, respectively. The average values of PM- C , B - PM and PM -IS in OA and OB groups were 4.3 ± 0.9mm , 4.7 ± 0.9mm , 2.0 ± 1.6mm and 4.3 ± 0.6mm , 4.8 ± 0.6mm , 2.5 ± 0.8mm, respectively. A statistically significant difference was only observed in the thickness of the buccal bony crest at 2-5 mm apically to IS (the implant neck) when the biomaterial (S -OCbt) was included in the measurement, which appeared to be higher in the OB group. At M1 sites, at the time of installation, the horizontal buccal gap was 1.1 at the COA and 1.4 mm at the BC sites while the vertical remaining defect was 3 mm and 4 mm deep in the control and test sites, respectively. At the buccal aspect, IS-C was higher in the COA (0.6 ± 1.6mm) compared to the BC (0.1 ± 1.8mm) groups and IS- B was...

Reconstrução imediata de diferentes defeitos peri-implantares em implantes pós-exodônticos: análise histomorfométrica em cães / Reconstruction of buccal different defects at implants placed immediately into extraction sockets: a histomorphometric analysis in dogs

Objetivo: A proposta deste estudo foi avaliar a regeneração óssea de defeitos criados cirurgicamente e naturais circunferenciais (gap) de implantes pósexodônticos. Materiais e método: Para este estudo foram utilizados 8 cães da raça labrador, nos quais foram instalados implantes imediatos (pós-exodônticos) nos alvéolos dos dentes P2 (2o pré-molar) e M1 (1o molar) inferiores bilaterais. Nos implantes da região dos 2º pré-molares bilaterais foram criados cirurgicamente defeitos peri-implantares vestibulares que foram preenchidos de um lado por osso autógeno – OA e do outro por osso bovino inorgânico Bio-Oss®- OB. Nos alvéolos correspondentes aos primeiros molares (M1) os implantes foram instalados e os gaps (defeitos naturais) existente entre a tábua óssea vestibular e o implante, foram preenchidos por Bone Ceramic® - (grupo BC) ou somente coágulo (grupo COA). Todos os sítios cirúrgicos foram posteriormente recobertos por membrana de colágeno reabsorvível (Biogide ®) e mantidos com cicatrizador. Após 4 meses de pós-operatório, os animais foram eutanasiados e os blocos ósseos processados laboratorialmente para análise histomorfométrica. Resultados: Os resultados obtidos nos implantes instalados na região do P2 mostraram que os valores do IS-C foram ligeiramente maior (2.3±0.8mm) no grupo OA, comparado ao grupo OB (1.7± 0.7 mm), enquanto o IS-B dos grupos OA e OB foram respectivamente de 2.7±0.7mm e 2.2±1.0 mm no lado vestibular e de 1.6±0.8mm e 0.8±0.5mm no lado lingual. As médias dos valores de PM-C, PM-B e PM-IS no grupo OA e OB foram respectivamente de 4.3±0.9mm, 4.7±0.9mm, 2.0±1.6mm e 4.3±0.6mm, 4.8±0.6mm, 2.5±0.8mm. A diferença estatística significativa foi observada somente na espessura da crista óssea vestibular de 2 a 5 mm em direção ao IS (“pescoço do implante”), incluindo o biomaterial (S-OCbt) que se apresentou maior no grupo OB. Nos implantes instalados na região do M1, o gap vestibular horizontal foi de 1.1 (COA) e 1.4 mm (BC) e vertical de 3 e...

Objective: The purpose of these studies were to evaluate bone regeneration at natural or surgically-created buccal defects at implants placed immediately into extraction sockets (IPIES). Material and methods: Eight Labrador dogswere used and implants were placed immediately into the extraction sockets of P2 (second premolar) and M1 (first molar), bilaterally. At P2, the buccal wall of the extraction sockets was removed bilaterally to create a standardized defect, 4 mm wide coronally, 2 mm wide apically, and 6 mm height. At P2 sites, Bio-Oss at the test (OB) or autogenous bone at the control (OA) sites were used to fill the defects. At M1 sites, Bone Ceramic ® at the test (BC) or the clot alone (COA) were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membraneand a non-submerged healing was allowed. After 4 months the animals were euthanized, bone blocks harvested and processed for histomorphometric analysis. Results: at P2 sites, IS- C values were slightly higher (2.3±0.8mm) in the OA compared to the OB (1.7±0.7 mm). IS- B were 2.7 ± 0.7mm and 2.2 ± 1.0mm on the buccal side and 1.6 ± 0.8mm and 0.8 ± 0.5mm on the lingual side at OA and OB groups, respectively. The average values of PM- C , B - PM and PM -IS in OA and OB groups were 4.3 ± 0.9mm , 4.7 ± 0.9mm , 2.0 ± 1.6mm and 4.3 ± 0.6mm , 4.8 ± 0.6mm , 2.5 ± 0.8mm, respectively. A statistically significant difference was only observed in the thickness of the buccal bony crest at 2-5 mm apically to IS (the implant neck) when the biomaterial (S -OCbt) was included in the measurement, which appeared to be higher in the OB group. At M1 sites, at the time of installation, the horizontal buccal gap was 1.1 at the COA and 1.4 mm at the BC sites while the vertical remaining defect was 3 mm and 4 mm deep in the control and test sites, respectively. At the buccal aspect, IS-C was higher in the COA (0.6 ± 1.6mm) compared to the BC (0.1 ± 1.8mm) groups and IS- B was...

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.