Radiographic changes after alveolar ridge preservation using autogenous raw tooth particles versus xenograft: A prospective controlled clinical trial.

OBJECTIVE: The use of extracted teeth has been introduced as an option for bone grafting. However, the current method requires special machines and solutions, posing significant time and cost. The aim of this study was to evaluate the clinical performance of autogenous raw tooth particles (RTP), a grafting material made from a ground tooth using basic equipment, for alveolar ridge preservation. MATERIALS AND METHODS: Twenty-three patients (12 study/11 control), having 14 and 13 sites were included for the study and control groups (commercially available xenograft), respectively. Radiographic measurements were taken at the baseline and the 4-month follow-up appointment. Furthermore, a questionnaire survey concerning the general preference of the type of graft to receive (if needed), before and after knowing the price, was distributed at the completion of the procedure for patients to answer. RESULTS: Alveolar ridge width change was -1.03 ± 0.64 and -0.84 ± 0.35 for the study and the control groups, respectively. Regarding the height, the study group showed a buccal and lingual change of -0.66 ± 0.48 and -0.78 ± 0.81, respectively, while this was -0.78 ± 0.56 and -0.9 ± 0.41 for the xenograft group. There was no statistically significant difference between the groups. Patients preferred the raw tooth particles over other grafting materials (p = .01). CONCLUSION: No core biopsies were taken to evaluate bone formation, which should be done in future studies. Within its limitations, the current study demonstrated that RTP graft could be an alternative graft for bone augmentation, offering a new cost-effective option for clinicians when available.

Hyaluronic Acid in Bone Regeneration: Systematic Review and Meta-Analysis.

AIM: The aim of this systematic review and meta-analysis was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when hyaluronic acid (HA) was added and mixed with graft materials in bone regeneration. MATERIALS AND METHODS: This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute of Health Research (registration number CRD42024530030). Electronic research was performed, and involved studies published up to 29 February 2024 using a specific word combination. The primary outcome was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when HA was added and mixed with graft materials in bone regeneration. The search resulted in 138 potential studies. Meta-analyses were performed using the fixed and random effects model to identify significant changes in new bone formation and in the remaining graft particles. RESULTS: After screening procedures, only three randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. The effect size of HA in the new bone formation was not statistically significant at 95% CI (Z = 1.734, p-value = 0.083, 95 % CI -,399; 6516). The effect size of HA in the remaining graft particles was not statistically significant at 95% CI (Z = -1.042, p-value = 0.297, CI -,835; 255). CONCLUSIONS: Within the limitations of the present systematic review and meta-analysis, the addition of HA to bone graft did not result in significant changes in bone regeneration procedures in terms of new bone formation and residues, even if the included studies showed encouraging and promising results.

In vivo experimental study comparing alveolar ridge preservation versus guided bone regeneration after unassisted socket healing at intact and damaged sites in narrow alveolar ridges.

BACKGROUND: To compare bone regeneration and dimensional alteration of alveolar ridge at intact and damaged extraction sockets after alveolar ridge preservation (ARP) and implant placement versus unassisted socket healing followed by guided bone regeneration (GBR) with simultaneous implant placement. METHODS: In 6 beagle dogs, 3 types of extraction sockets in the mandible were created: (1) intact sockets, (2) 1-wall defect sockets and (3) 2-wall defect sockets. The sockets were allocated to undergo either (1) ARP and implant placement 8 weeks later (ARP group) or (2) GBR with simultaneous implant placement after 8 weeks of unassisted socket healing (GBR group). After an additional healing period of 8 weeks, bone regeneration and dimensional changes were evaluated radiographically and histologically. RESULTS: GBR showed superior bone formation and greater bone gains compared to ARP, regardless of the initial extraction-socket configuration. Although ARP maintained the preexisting alveolar ridge dimensions, peri-implant bone defects were still detected at 8 weeks of follow-up. Histomorphometric analyses confirmed that GBR increased dimensions of the alveolar ridge compared to baseline, and the augmentation and bone regeneration were greater with GBR than with ARP. CONCLUSION: Early implant placement with ARP can mitigate alveolar ridge changes in the narrow alveolar ridge. However, early implant placement with simultaneous GBR creates the conditions for enhanced bone regeneration around the implant and greater ridge augmentation compared to ARP, irrespective of the extraction-socket configuration.

Clinical evaluation of implants placed within or beyond the boundaries of the alveolar ridge preservation: a retrospective case series with 10 weeks of observations in 28 patients.

PURPOSE: This study investigated the effect of implant vertical positioning within alveolar ridge preservation (ARP) sites on implant stability quotient (ISQ) values, which were measured 10 weeks post-implantation. METHODS: Patients who underwent ARP using collagenized deproteinized bovine bone mineral, followed by implant placement in the posterior area, were divided into 2 groups: the within-ARP group and the beyond-ARP group. In the within-ARP group, osteotomy and implant placement occurred within the ARP boundary. In contrast, in the beyond-ARP group, these procedures were performed beyond the ARP boundary, incorporating 3 mm of pristine bone at the implant's apex. Bone quality was assessed by tactile sense, and both insertion torque during implant surgery and ISQ values at 10 weeks post-implant surgery were measured. Multiple linear regression analysis and Pearson correlation analysis were used to explore the relationship between insertion torque and ISQ values. RESULTS: In total, 30 ARP sites in 28 patients were analyzed. There was no significant difference in bone quality, as determined by tactile sense, between the within-ARP and beyond-ARP groups. At the time of implant placement, the beyond-ARP group exhibited a higher insertion torque (33.33±13.39 Ncm) compared to the within-ARP group (17.08±11.17 Ncm). However, the ISQ values were similar between the 2 groups 10 weeks after implant placement. A positive correlation between insertion torque and ISQ values was confirmed at 10 weeks post-implant. CONCLUSIONS: The engagement of pristine bone may facilitate high insertion torque during the placement of implants in ARP sites. Nevertheless, by 10 weeks post-implantation, the ISQ values were found to be comparable, irrespective of the implant's position.

Fish scale-derived hydroxyapatite for alveolar ridge preservation.

Alveolar ridge resorption following tooth extraction poses significant challenges for future dental restorations. This study investigated the efficacy of fish scale-derived hydroxyapatite (FSHA) as a socket preservation graft material to maintain alveolar bone volume and architecture. FSHA was extracted from *Labeo rohita* fish scales and characterized using Fourier transform infrared (FTIR) analysis. In vitro, biocompatibility and osteogenic potential were assessed using Saos-2 human osteosarcoma cells. Cell viability, migration, and proliferation were evaluated using MTT and scratch assays. In vivo performance was assessed in a rat model, and FSHA was compared to a commercial xenograft (Osseograft) and ungrafted controls. Histological analysis was performed at 8-week post-implantation to quantify new bone formation. FTIR confirmed the purity and homogeneity of FSHA. In vitro, FSHA enhanced Saos-2 viability, migration, and proliferation compared to controls. In vivo, FSHA demonstrated superior bone regeneration compared to Osseograft and ungrafted sites, with balanced graft resorption and new bone formation. Histological analysis revealed an active incorporation of FSHA into new bone, with minimal gaps and ongoing remodeling. Approximately 50%-60% of FSHA was resorbed by 8 weeks, closely matching the rate of new bone deposition. FSHA stimulated more bone formation in the apical socket region than in coronal areas. In conclusion, FSHA is a promising biomaterial for alveolar ridge preservation, exhibiting excellent biocompatibility, osteogenic potential, and balanced resorption. Its ability to promote robust bone regeneration highlights its potential as an effective alternative to currently used graft materials in socket preservation procedures.

Comparison of the healing process of xenografts with three different sources in critical-size bone defects: An in vivo study.

Background: Xenograft bone substitutes can be obtained from different animals and processed using various methods. The present in vivo study evaluated bone regeneration after using three types of xenografts with different sources in critical-sized bone defects in rabbit calvaria. Methods: Four 8-mm defects were created in calvaria of 14 New Zealand and white male rabbits. Three out of four defects were filled with xenografts of bovine, camel, and ostrich sources. The fourth defect was left unfilled as the control group. Seven rabbits were sacrificed after eight weeks and seven others after 12 weeks. Micro-CT imaging and histologic evaluation were further performed on dissected calvarias. Results: After 8 and 12 weeks, the highest and lowest percentages of new bone formation were observed in the camel (27.71% and 41.92%) and control (11.33% and 15.96%) groups, respectively. In the case of residual material, the ostrich group had the most value after eight weeks (53%), while after 12 weeks, it was highest in the camel group (37%). Micro-CT findings were consistent with histologic results. Conclusion: Although all three xenografts can be good choices for treating bone defects, camel-sourced xenograft seemed to be better than the other two groups. The origin and processing procedures of xenografts affected their final characteristics, which should be considered for clinical use.

Comparative assessment of the physical structure of antler and bovine bone substitutes: An in vitro study.

Background: The use of bone graft materials has significantly increased. Given the inherent variations in structure and functionality between different grafting materials, this evaluated and compared the physical attributes of antler and bovine femur bone substitutes. Methods: In the present in vitro investigation, the surface morphological architecture of the two bone substitutes with different origins was assessed through scanning electron microscopy. Furthermore, the Brunauer-Emmett-Teller (BET) technique was employed to measure the porosity, specific surface area (SSA), and pore morphology. Results: Scanning electron microscopy observations indicated that the surface of the bovine particles appeared smoother, while the antler particles exhibited a rougher surface texture. The BET analysis revealed that both samples exhibited identical pore morphology. The SSA was 15.974 m2/g in the antler particles compared with 18.404 m2/g in the bovine sample. The total porosity volume in the antler and bovine femur bone substitutes were 0.2172 cm3/g and 0.2918 cm3/g, respectively. Additionally, the antler particles had a porosity percentage of 40%, whereas the bovine femur bone substitute showed a porosity percentage of 43.5%. Conclusion: Based on the results of this study, it seems that the two samples of bone grafting materials have comparable physical structures.

Osteoimmunological Principles Adapted to Achieve Mechanically Superior Posterolateral Fusion in a New Zealand White Rabbit Model Using Antigen-Coated, Electrospun Beta-Tricalcium Phosphate.

Introduction Triggering the immune system via antigenic stimulation at the time of spinal fusion surgery may enhance bone morphogenesis and result in successful bony arthrodesis. We sought to demonstrate that bone morphogenesis could be enhanced via antigenic immunologic stimulation of a surgical fusion site. Methods New Zealand white rabbits underwent non-instrumented posterolateral fusion of L5-6 with implantation of either an immunologically activated graft (inert beta-tricalcium phosphate) or harvested autograft. Fusion was evaluated using plain radiographs, micro-computed tomography (CT), mechanical palpation, and biomechanical testing. The final evaluation was carried out at 12 weeks postoperatively. Results Eight rabbits received immunologically activated grafts; 10 received autografts and served as historical controls. Fusion rates were identical between groups (both 50%). Radiographs and micro CT of the fusion mass showed no significant difference between groups, and both showed good incorporation of the transverse processes into the fusion masses with radiographic evidence confirming trabeculation and bone remodeling. However, mechanical testing of the fusion sites showed superior fusion strength in the rabbits that received immunologically activated grafts, approaching a factor of two on flexion/extension, lateral bending, and axial rotation. Little to no graft material was appreciable in the non-fused antigen-treated specimens. Conclusions There is a long-standing need for a graft material that can replace autograft bone, due to the negative clinical consequences and financial costs pertaining to autologous bone harvesting. No allograft bone substitute to date has been able to reliably replicate the success of harvested autograft bone. This study suggests that immunological enhancement of inert beta-tricalcium phosphate can potentially be a substitute for allograft bone that can meet and even exceed the success of harvested autograft bone.

Bovine-originated xenografts versus synthetic bone grafting materials in lateral maxillary sinus floor augmentation: A systematic review and meta-analysis.

AIMS: This study aimed to systematically compare the patients undergoing lateral MSFA therapies utilizing bovine-originated xenografts versus varied synthetic bone grafting materials. METHODS: Pubmed, Scopus, Embase, and Cochrane Library were searched up to April 2023, compensated by a manual search in selected journals. Studies reporting histological outcomes (residual bone graft, newly formed bone, non-mineralized tissue) and clinical outcomes (implant survival, ISQ value) were included. Several analyses were performed, including meta-analysis, sensitivity study, and Egger's regression tests. RESULTS: Sixteen clinical/randomized control trials were included in this systematic review, among which 12 were enrolled in a meta-analysis. The percentage of newly formed bone within the grafted sinuses by hybrid HA/TCP was significantly higher than those by xenografts (WMD 2.85, 95%CI [0.72; 4.99]), but those grafted by pure HA (WMD -1.72, 95%CI [-3.15; -0.29]) or TCP (WMD -7.10, 95%CI [-13.02; -1.17]) were significantly lower than xenograft counterparts. The residual bone graft and non-mineralized tissue yielded by synthetic HA, TCP, and HA/TCP showed no significant differences with the xenograft group. CONCLUSION: The chemistry of grafted bone substitutes in lateral MSFA influenced the quantity of newly formed bone. Those grafted with hybrid HA/TCP yielded the highest amount of new bone compared to bovine-originated HA. However, this influence was not significant on residual bone graft and non-mineralized tissue.

Long-term success and influencing factors of regenerative surgery for intra-bony defects: A retrospective cohort study.

BACKGROUND: The composite outcome measure (COM) more comprehensively assesses the clinical efficacy of regenerative surgery than a single probing measurement. We aimed to assess long-term success defined by the COM (clinical attachment level [CAL] gain of ≥3 mm and postsurgery probing pocket depth [PPD] ≤ 4 mm) and influencing factors of regenerative surgery using bone substitutes and resorbable collagen membrane (RM) for intra-bony defects (IBDs). METHODS: We retrospectively collected data from patients who underwent regenerative surgery using deproteinized bovine bone mineral (DBBM) and RM for IBDs. CAL and PPD values were compared at baseline (preoperative), 1 year (short-term), and at the last follow-up (5-10 years). Multivariate logistic regressions were performed to identify factors influencing COM-based long-term success. RESULTS: Eighty-one defects in 75 teeth of 33 patients who completed follow-up (6.5 ± 1.4 years) were included. One tooth was lost. All defects with complete follow-up exhibited long-term average CAL gain (3.00 ± 2.00 mm, 95% confidence interval [CI]: 2.56-3.44 mm, p < 0.001) and PPD reduction (2.06 ± 1.91 mm, 95% CI: 1.64-2.49 mm, p < 0.001). Long-term success was achieved in 38.8% of IBDs. CAL and PPD values were comparable between 1 year and the last follow-up. Logistic regression analyses revealed that male sex (odds ratio [OR] = 0.23, 95% CI: 0.07-0.75) and bleeding on probing (BOP) during supportive periodontal therapy (OR = 0.96, 95% CI: 0.94-0.99) were risk factors for long-term success. CONCLUSIONS: Regenerative surgery with DBBM and RM for IBDs can achieve some degree of long-term success defined by COM. However, within this study's limitations, male sex and higher BOP incidence postoperatively are negatively associated with optimal long-term success. CLINICAL TRIAL NUMBER: ChiCTR2300069016.

Additive Manufacturing Titanium Dental Implants Placed in Sinuses Grafted with 70HA:30-TCP: A One-Year Retrospective Study for Evaluation of Survival Rate.

The present short-term retrospective study evaluated the implant survival rate and peri-implant bone loss around additive-manufactured titanium implants placed in sinuses grafted with Plenum Osshp (Plenum Bioengenharia, Jundia, SP, Brazil) (70HA:30ß-TCP) material. A total of 39 implants were inserted after 23 sinus floor elevation procedures in 16 consecutive patients. Prosthetic rehabilitation included fixed partial prostheses (three units), single crowns (eleven units), and fixed full arches (three units). Clinical and radiographic parameters of implant-supported restorations were evaluated after at least one year of occlusal loading. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility, an average distance between the implant shoulder and the first visible bone contact (DIB) < 1.0 mm from the initial surgery, and the absence of prosthetic complications at the implant-abutment interface. The overall cumulative implant survival rate was 97.43%. No prosthetic complications at the implant-abutment interface were reported. After one year, the mean DIB was 0.23 mm ± 0.14. Within the limits of this retrospective study, it can be concluded that 70 HA:30 ß-TCP allowed stable and reliable bone support to maintain healthy conditions around titanium dental implants produced by additive manufacturing.

Effect of mineralized dentin matrix on the prognosis of bone defect and retained root after coronectomy.

OBJECTIVE: To investigate the impact of mineralized dentin matrix (MDM) on the prognosis on bone regeneration and migration of retained roots after coronectomy. MATERIALS AND METHODS: Patients were divided into three groups based on the type of bone graft after coronectomy: Group C (n = 20, collagen), Group T (n = 20, tricalcium phosphate (TCP) + collagen), and Group D (n = 20, MDM + collagen). CBCT scans, conducted immediately and 6 months after surgery, were analyzed using digital software. Primary outcomes, including changes in bone defect depth and retained root migration distance, were evaluated 6 months after surgery. RESULTS: After 6 months, both Groups D and T exhibited greater reduction of the bone defect and lesser retained root migration than Group C (p < 0.001). Group D had greater regenerated bone volume in the distal 2 mm (73 mm3 vs. 57 mm3, p = 0.011) and lesser root migration (2.18 mm vs. 2.96 mm, p < 0.001) than Group T. The proportion of completely bone embedded retained roots was also greater in Group D than in Group C (70.0% vs. 42.1%, p = 0.003). CONCLUSIONS: MDM is an appropriate graft material for improving bone defect healing and reducing retained root migration after coronectomy. CLINICAL RELEVANCE: MDM is an autogenous material prepared chairside, which can significantly improve bone healing and reduce the risk of retained root re-eruption. MDM holds promise as a routine bone substitute material after M3M coronectomy.

The effect of platelet-rich fibrin (PRF) versus freeze-dried bone allograft (FDBA) used in alveolar ridge preservation on the peri-implant soft and hard tissues: a randomized clinical trial.

BACKGROUND: The effectiveness of alveolar ridge preservation on bone regeneration and tissue healing has been thoroughly documented in the literature. This study aimed to evaluate the peri-implant soft and hard tissue changes after alveolar ridge preservation using either platelet-rich fibrin (PRF) or freeze-dried bone allograft (FDBA) over a 12-month period following the prosthetic loading of implants. METHODS: In this randomized clinical trial, 40 individuals were recruited for alveolar ridge preservation using (1) FDBA or (2) PRF in incisal/premolar areas. At two follow-up sessions (six- and 12-months post-implant insertion), radiographic imaging and clinical examinations assessed marginal bone loss and soft tissue factors, including gingival recession and bleeding on probing. The differences between study groups were analyzed using Generalized estimating Equations, the Binary logistic regression model, and Cochran's Q test. RESULTS: There was a statistically significant difference regarding gingival recession at both follow-up evaluations; values in the PRF group were considerably lower compared to the FDBA group (p < 0.05). The mean values for vertical marginal bone loss and bleeding on probing showed no significant differences between the two study groups (p > 0.05). CONCLUSIONS: Except for gingival recession, applying PRF yielded comparable clinical results to FDBA after one year of implant loading and could be recommended as a potential biomaterial for alveolar ridge preservation following tooth extractions. CLINICAL TRIAL REGISTRATION: The research protocol was registered in the Protocol Registration and Results System on 13/08/2021, available at https://clinicaltrials.gov/ (NCT05005377).

Preclinical comparison study of experimental peri-implantitis between alveolar ridge preservation and spontaneous healing sites in infected and noninfected tooth: a randomized blinded in vivo study.

BACKGROUND: This study compared the progression of experimental peri-implantitis between alveolar ridge preservation (ARP) and spontaneous healing (SH) sites in infected (IT) and noninfected tooth (NIT). METHODS: Bilateral mandibular third or fourth premolars of six beagle dogs were randomly assigned to IT and NIT groups. Before extraction, chronic dehiscence defects were created at the mesial root of mid-buccal area in IT group. Four weeks later, the mesial roots of the third and fourth premolars were extracted in all groups.ARP procedure was randomly conducted on one side of the extraction sockets using collagenated bovine bone substitutes and resorbable collagen membrane, and contralateral side was allowded spontaneous healing. After 12 weeks of healing, bone-level implants (ϕ 3.6 × 8.0 mm) were placed at the extraction sockets. Three months of ligature induced peri-implantitis and three months of spontaneous progression were allowed, with radiographs taken at each phase. Biopsies were retrieved at the implant site for histomorphometric, immunohistochemical, and polarized light-microscopic analyses. RESULTS: Radiography demonstrated that the changes in the marginal bone level during the spontaneous progression period showed no significant differences between ARP and SH sites. Only small and/or nonsignificant differences in the progression of peri-implantitis were observed between ARP and SH sites in histomorphometric, immunohistochemical, and polarized light microscopic analyses. Additionally, the IT and NIT groups exhibited similar outcomes for most parameters. CONCLUSION: ARP with xenogenic bone substitutes might provide similarly robust results as SH sites regarding the progression of experimental peri-implantitis, irrespective of the infected or noninfected nature of the site before tooth extraction.

Effects of intentional early dense-polytetrafluoroethylene membrane removal on vertical ridge augmentation.

BACKGROUND: Vertical ridge augmentation (VRA) requires long healing times for bone maturation. This case study deals with the intentional early removal of a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane that allowed for treatment times reduction and improvement of bone quality. METHODS: A TR-dPTFE membrane was used for VRA in the premolar region of the upper right maxilla. The defect was filled with a mix of particulate autogenous bone and porcine xenograft in a 1:1 ratio. After a 4-month uneventful healing period, the membrane was removed, and the thick keratinized palatal tissue was moved toward the buccal side via a pedicle flap. Implants insertion and healing abutments application were carried out 3 months later, when bone graft could have been revascularized and nourished by the periosteum. RESULTS: The histologic evaluation of a bone sample harvested during implant bed preparation revealed a huge amount of mature newly formed bone even in the most coronal part. Two screw-retained crowns were delivered 2 months after implant insertion and the 3.5-year follow-up showed perfectly maintained hard and soft tissues. CONCLUSIONS: Intentional early removal of TR-dPTFE membrane after a 4-month healing time, with simultaneous soft tissue augmentation via a buccally reposioned pedicle flap, allowed graft revascularization from the periosteum, and resulted in optimal quantity and quality of the regenerated bone. This process shortened the overall treatment times, taking only 9 months from VRA to prosthetic loading. Both augmented hard and soft tissues allowed for crestal bone maintenance around implants. KEY POINTS: Titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membranes, due to their closed structure, do not allow the passage of cells and vessels from the periosteum, and revascularization from the residual bone alone is not enough for proper graft maturation and long-term crestal bone maintenance. Early removal of TR-dPTFE membrane allows graft revascularization from the periosteum, and results in optimal quantity and quality of the regenerated bone. Increasing the thickness of the soft tissues, increasing the width of the keratinized mucosa, and repositioning the mucogingival line, via a free gingival graft or a pedicle flap, should be performed simultaneously in the membrane removal phase to reduce the number of surgical interventions, decrease patient morbidity, and shorten the total treatment time.

Time to full weight-bearing with the use of a calcium sulfate-calcium phosphate bone substitute as a bone void filler following extended curettage in the treatment of primary benign bone tumours.

PURPOSE: The primary objective of this study was to determine time to full weight-bearing after the use of a calcium-sulfate-calcium phosphate bone substitute (CaSO4/CaPO4) as a bone void filler in the treatment of primary benign bone tumours following intralesional curettage. The secondary objectives were to determine surgical complications and recurrence rates. METHODS: Retrospective review of patients identified from a surgeon-specific orthopaedic oncology database, who underwent curettage of benign bone tumours and subsequent bone void filling with CaSO4/CaPO4. RESULTS: A total of 39 patients (20 males, 19 females) met inclusion criteria with an average age of 31 years (range: 13 to 62 years), a median follow-up of 3.7 years, and a maximum follow-up of 11 years. The most common tumour diagnosis was giant cell tumour of bone (GCT) (n = 19), and the most common location was the proximal tibia (n = 9). The mean volume of tumour excised was 74.1 cm3 including extraosseous bone expansion due to tumour growth, with a mean of volume of 21.4 mL of CaSO4/CaPO4 used to fill the intraosseous cavitary defects to restore normal bone anatomy. None of the lesions required additional internal fixation. The primary outcome measure, average time to full weight-bearing/full range of motion, was 11 weeks and 6 weeks for upper and lower extremity lesions, respectively. Secondary outcomes included tumour recurrence requiring reoperation in five patients and infection requiring reoperation in two patients. CONCLUSION: This study demonstrates that CaSO4/CaPO4 is a viable option as a bone void filler in the reconstruction of cavitary defects following removal of primary benign bone tumours. CaSO4/CaPO4 provides sufficient bone regeneration early in the post-operative period to allow progression to full weight-bearing within weeks without the need for internal fixation. There were no graft-specific complications noted.

Radiographic Study of Transcrestal Sinus Floor Elevation Using Osseodensification Technique with Graft Material: A Pilot Study.

This pilot study aimed to evaluate the level of implant success after transcrestal sinus floor elevation (tSFE) using the osseodensification technique (OD) combined with beta-tricalcium phosphate (ß-TCP) by analyzing clinical and radiographic results. Moreover, the increase in bone height was analyzed immediately after surgery, 3 months after, and before loading by taking standardized radiographic measurements. Thirteen patients, four males and nine females, with a mean age of 54.69 ± 5.86 years, requiring the placement of one implant in the upper posterior maxilla, with a residual bone height of <8 mm and a minimum bone width of 5 mm, participated in the study. The bone gain data was obtained using cone-beam computed tomography (CBCT) immediately after surgery and twelve months after the placement. The correlation between initial and final bone height with implant stability was also assessed. The results were analyzed using SPSS 23 software (p < 0.05). The results of the study indicated a 100% implant success rate after a follow-up period of twelve months. Preoperative main bone height was 5.70 ± 0.95 mm. The osseodensification technique allowed a significant increase of 6.65 ± 1.06 mm immediately after surgery. After a twelve-month follow-up, a graft material contraction of 0.90 ± 0.49 mm was observed. No correlation was observed between the bone height at the different times of the study and the primary stability of the implant. Considering the limitations of the size sample of this study, the osseodensification technique used for transcrestal sinus lift with the additional bone graft material (ß-TCP) may provide a predictable elevation of the maxillary sinus floor, allowing simultaneous implant insertion with adequate stability irrespective of bone height limitations.

Combination of a Synthetic Bioceramic Associated with a Polydioxanone-Based Membrane as an Alternative to Autogenous Bone Grafting.

The purpose of this study was to evaluate the repair process in rat calvaria filled with synthetic biphasic bioceramics (Plenum® Osshp-70:30, HA:ßTCP) or autogenous bone, covered with a polydioxanone membrane (PDO). A total of 48 rats were divided into two groups (n = 24): particulate autogenous bone + Plenum® Guide (AUTOPT+PG) or Plenum® Osshp + Plenum® Guide (PO+PG). A defect was created in the calvaria, filled with the grafts, and covered with a PDO membrane, and euthanasia took place at 7, 30, and 60 days. Micro-CT showed no statistical difference between the groups, but there was an increase in bone volume (56.26%), the number of trabeculae (2.76 mm), and intersection surface (26.76 mm2) and a decrease in total porosity (43.79%) in the PO+PG group, as well as higher values for the daily mineral apposition rate (7.16 µm/day). Histometric analysis presented material replacement and increased bone formation at 30 days compared to 7 days in both groups. Immunostaining showed a similar pattern between the groups, with an increase in proteins related to bone remodeling and formation. In conclusion, Plenum® Osshp + Plenum® Guide showed similar and sometimes superior results when compared to autogenous bone, making it a competent option as a bone substitute.

A Comparison of Guided Bone Regeneration vs. the Shell Technique Using Xenogeneic Bone Blocks in Horizontal Bone Defects: A Randomized Clinical Trial.

In cases of severe horizontal atrophy, implant placement requires bone reconstruction procedures. The aim of this randomized controlled trial is to compare the outcomes of bone augmentation with simultaneous implant placement using the shell technique to the outcomes of guided bone regeneration (GBR) in cases of severely horizontal bone atrophy. This study was designed as a monocentric, parallel-group, randomized controlled trial with a six-month follow-up. Among the primary outcomes of this study, peri-implant bone regeneration and peri-implant bone defect closure were selected. Forty-four patients were recruited and equally divided between two groups. In the GRB group, a horizontal regeneration of 2.31 ± 0.23 mm was observed opposed to a horizontal regeneration of 2.36 ± 0.17 mm in the shell group (p = 0.87). A volumetric increase was observed in both groups, with an increase of 0.30 ± 0.12 cm3 in the GBR group and an increase of 0.39 ± 0.09 cm3 in the shell group, highlighting a significant difference between the two groups (p = 0.02). In conclusion, bone augmentation with simultaneous implant placement using the shell technique or guided bone regeneration in horizontal bone atrophy are both predictable therapeutic options.

Strontium and Copper Co-Doped Multifunctional Calcium Phosphates: Biomimetic and Antibacterial Materials for Bone Implants.

ß-tricalcium phosphate (ß-TCP) is a promising material in regenerative traumatology for the creation of bone implants. Previously, it was established that doping the structure with certain cations can reduce the growth of bacterial activity. Recently, much attention has been paid to co-doped ß-TCP, that is explained by their ability, on the one hand, to reduce cytotoxicity for cells of the human organism, on the other hand, to achieve a successful antibacterial effect. Sr, Cu-co-doped solid solutions of the composition Ca9.5-xSrxCu(PO4)7 was obtained by the method of solid-phase reactions. The Rietveld method of structural refinement revealed the presence of Sr2+ ions in four crystal sites: M1, M2, M3, and M4. The M5 site is completely occupied by Cu2+. Isomorphic substitution of Ca2+ → (Sr2+and Cu2+) expands the concentration limits of the existence of the solid solution with the ß-TCP structure. No additional phases were formed up to x = 4.5 in Ca9.5-xSrxCu(PO4)7. Biocompatibility tests were performed on cell lines of human bone marrow mesenchymal stromal cells (hMSC), human fibroblasts (MRC-5) and osteoblasts (U-2OS). It was demonstrated that cytotoxicity exhibited a concentration dependence, along with an increase in osteogenesis and cell proliferation. Ca9.5-xSrxCu(PO4)7 powders showed significant inhibitory activity against pathogenic strains Escherichia coli and Staphylococcus aureus. Piezoelectric properties of Ca9.5-xSrxCu(PO4)7 were investigated. Possible ways to achieve high piezoelectric response are discussed. The combination of bioactive properties of Ca9.5-xSrxCu(PO4)7 renders them multifunctional materials suitable for bone substitutes.