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Bone Augmentation (bone + augmentation)

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of Bone Augmentation

vertical bone augmentation

Selected Abstracts

Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2010
Jesús Torres
Torres J, Tamimi F, Alkhraisat MH, Manchón Á, Linares R, Prados-Frutos JC, Hernández G, López Cabarcos E. Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone. J Clin Periodontol 2010; 37: 943,951. doi: 10.1111/j.1600-051X.2010.01615.x. Abstract Objective: Bone augmentation with the titanium-mesh (Ti-mesh) technique is susceptible to a large rate of complications such as morbidity of bone graft donor site, and mesh exposure to the oral cavity. The purpose of this study was to evaluate the effectiveness of anorganic bovine bone (ABB) in alveolar bone augmentation with the Ti-mesh technique. In addition, we investigated the effect of platelet-rich plasma (PRP) in preventing mesh exposure by using it to cover the Ti-mesh. Patients and Methods: Patients included in the clinical trial were randomly allocated by a blinded assistant into two groups. The 30 patients recruited for this study underwent 43 alveolar bone augmentation with the Ti-mesh technique using ABB as graft material in all of them. In 15 patients, the Ti-meshes were covered with PRP (PRP group) whereas in the other 15 the Ti-meshes were not (control group). After 6 months, patients were called for clinical, radiographic, and histological evaluation, and implant placement surgery. A total of 97 implants were placed in the augmented bone and their evolution was followed up for a period of 24 months. Results: Significant differences were found between the two study groups in terms of complications and bone formation. In the control group, 28.5% of the cases suffered from mesh exposure, while in the PRP group, no exposures were registered. Radiographic analysis revealed that bone augmentation was higher in the PRP group than in the control group. Overall, 97.3% of implants placed in the control group and 100% of those placed in the PRP group were successful during the monitoring period. We suggest that the positive effect of PRP on the Ti-mesh technique is due to its capacity to improve soft tissue healing, thereby protecting the mesh and graft material secured beneath the gingival tissues. Conclusions: Alveolar bone augmentation using ABB alone in the Ti-mesh technique is sufficient for implant rehabilitation. Besides, covering the Ti-meshes with PRP was a determining factor in avoiding mesh exposure. Ti-mesh exposure provoked significant bone loss, but in most cases it did not affect the subsequent placement of implants. [source]

Bone augmentation by onlay implant using recombinant human BMP-2 and collagen on adult rat skull without periosteum

CLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2000
Masaru Murata
The purpose of this study was to determine whether bone augmentation could be obtained by the composite of recombinant human bone morphogenetic protein-2 (rhBMP-2) and bioabsorbable atelocollagen when the periosteum was resected, and to compare the efficacy of the rhBMP-2/collagen implant and the collagen alone implant. The onlay implant was inserted into the space between the elevated galea aponeurotica and the skull without the periosteum of 10-month-old rats. The rhBMP-2/collagen implant resulted in osteoblasts differentiation under the galea at 1 week and active bone formation without a prior formation of cartilage. At 4 weeks, the bony trabeculae were interconnected and connected directly with the compact bone of the skull. Histomorphometric analysis at 4 weeks demonstrated that the rhBMP-2/collagen implant showed 92.5% in the volume of bone tissue, whereas the collagen alone showed 0%. The implanted collagen was gradually replaced by bone tissue in the presence of rhBMP-2. Our present results indicate that rhBMP-2 stimulates undifferentiated mesenchymal cells in the galea overlying the implant to proliferate and differentiate directly into osteoblasts on the carrier collagen fibers. The collagen matrix was stably placed on the skull and suitable as a substitute for rhBMP-2. The rhBMP-2/collagen onlay implant might be clinically applicable for bone augmentation even under the condition without the periosteum. [source]

Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone

Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment

AUSTRALIAN DENTAL JOURNAL, Issue 1 2009
M Esposito
Background:, Dental implants require sufficient bone to be adequately stabilized. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. Objectives:, General objectives: To test the null hypothesis of no difference in the success, function, morbidity and patient satisfaction between different bone augmentation techniques for dental implant treatment. Specific objectives: (A) to test whether and when augmentation procedures are necessary; (B) to test which is the most effective augmentation technique for specific clinical indications. Trials were divided into three broad categories according to different indications for the bone augmentation techniques: (1) major vertical or horizontal bone augmentation or both; (2) implants placed in extraction sockets; (3) fenestrated implants. Search strategy:, The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 9 January 2008. Selection criteria:, Randomized controlled trials (RCTs) of different techniques and materials for augmenting bone for implant treatment reporting the outcome of implant therapy at least to abutment connection. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odd ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient. Main results:, Seventeen RCTs out of 40 potentially eligible trials reporting the outcome of 455 patients were suitable for inclusion. Since different techniques were evaluated in different trials, no meta-analysis could be performed. Ten trials evaluated different techniques for vertical or horizontal bone augmentation or both. Four trials evaluated different techniques of bone grafting for implants placed in extraction sockets and three trials evaluated different techniques to treat bone dehiscence or fenestrations around implants. Authors' conclusions:, Major bone grafting procedures of resorbed mandibles may not be justified. Bone substitutes (Bio-Oss or Cerasorb) may replace autogenous bone for sinus lift procedures of atrophic maxillary sinuses. Various techniques can augment bone horizontally and vertically, but it is unclear which is the most efficient. It is unclear whether augmentation procedures at immediate single implants placed in fresh extraction sockets are needed, and which is the most effective augmentation procedure, however, sites treated with barrier plus Bio-Oss showed a higher position of the gingival margin when compared to sites treated with barriers alone. Non-resorbable barriers at fenestrated implants regenerated more bone than no barriers, however it remains unclear whether such bone is of benefit to the patient. It is unclear which is the most effective technique for augmenting bone around fenestrated implants. Bone morphogenetic proteins may enhance bone formation around implants grafted with Bio-Oss. Titanium may be preferable to resorbable screws to fixate onlay bone grafts. The use of particulate autogenous bone from intraoral locations, also taken with dedicated aspirators, might be associated with an increased risk of infective complications. These findings are based on few trials including few patients, sometimes having short follow up, and often being judged to be at high risk of bias. [source]

Minimally Invasive Antral Membrane Balloon Elevation , Results of a Multicenter Registry

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2009
Efraim Kfir DMD
ABSTRACT Background and Purpose: Frequently, the posterior maxilla lacks sufficient bone mass to support dental implants. This multiphysician registry assessed the feasibility and safety of minimally invasive antral membrane balloon elevation (MIAMBE), followed by bone augmentation and implant fixation. Materials and Methods: One hundred twelve consecutive patients were referred for MIAMBE. Following pre-procedural assessment and informed consent, patients underwent alveolar crest exposure, and 3 mm osteotomy followed by MIAMBE. Platelet-rich fibrin and bone substitutes were injected under the antral membrane; implant placement and primary closure were executed at the same sitting. Implant loading was carried out 6 to 9 months later. Results: One hundred nine (97.3%) patients successfully concluded the initial procedure. Three patients had membrane tear requiring procedure abortion. One case of infection was documented at 4 weeks. Procedure time was 58 ± 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95% was observed at 6 to 9 months. Conclusion: MIAMBE can be applied to all patients in need of posterior maxilla bone augmentation with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. As it is minimally invasive and associated with minimal discomfort, MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation. [source]

Internal Sinus Manipulation (ISM) Procedure: A Technical Report

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2007
Jason M. Yamada DDS
ABSTRACT Background, The sinus augmentation procedure has facilitated dental implant treatment in the posterior maxilla where there is insufficient bone for implant placement. A modified Caldwell-Luc, lateral window technique can be applied in most cases needing sinus augmentation in order to create a larger bone volume. However, treatment morbidity can be a concern, especially in the form of postoperative swelling due to surgical trauma. Vertical augmentation using osteotomes has also been selected as a choice of treatment due to less invasive surgery and less postoperative trauma. Although the osteotome technique enables the surgeon to raise the sinus membrane internally through an implant osteotomy site, the quantity and predictability of bone augmentation can be limiting due to the elasticity of the Schneiderian sinus membrane, difficulty of the membrane to separate from the floor as well as the inability to have direct tactile access to "peel" the membrane off of the floor. Purpose, The objective of this report is to present a new, minimally invasive sinus augmentation technique, called the Internal Sinus Manipulation (ISM) procedure, which has been developed to facilitate sinus floor augmentation while reducing treatment morbidity and yet have direct tactile access to raise the membrane off of the sinus floor. Surgical Technique, Access to the Schneiderian sinus membrane is achieved without perforation of the membrane through a conventional osteotomy drilling procedure alone or combined with osteotome technique, followed by reflection of the membrane utilizing special ISM instrumentation and bone graft procedure laterally and vertically through the osteotomy site. A planned implant is then placed. Conclusion, The Internal Sinus Manipulation procedure can be used as an alternative treatment modality for sinus augmentation as compared to the external lateral window technique while reducing postoperative morbidity for the patients who need implant treatment in posterior maxillary areas. [source]

rhBMP-2/,BSM® Induces Significant Vertical Alveolar Ridge Augmentation and Dental Implant Osseointegration

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2002
Ulf M.E. Wikesjö DDS
ABSTRACT Background: Recombinant human bone morphogenetic protein 2 (rhBMP-2) in a carrier has been shown to induce significant bone formation. Several candidate carriers, however, lack structural integrity to offset compressive forces that may compromise rhBMP-2 bone induction, in particular, for challenging onlay indications such as alveolar ridge augmentation. Purpose: The objective of this study was to evaluate rhBMP-2 in a calcium-phosphate cement carrier, ,BSM, for vertical alveolar ridge augmentation and immediate dental implant Osseointegration. Materials and Methods: Six adult Hound Labrador mongrels with 5 mm critical size supra-alveolar peri-implant defects were used. Three animals received rhBMP-2/,BSM (rhBMP-2 at 0.40 and 0.75 mg/mL) in contralateral jaw quadrants (total implant volume/defect , 1.5 mL). Three animals received ,BSM without rhBMP-2 (control group). The animals were euthanized at 16 weeks post surgery, and block biopsies were processed for histologie and histometric analysis. Results: rhBMP-2/,BSM induced substantial augmentation of the alveolar ridge. Control sites exhibited limited new bone formation. Vertical bone augmentation averaged (SD) 4.9 ± 1.0 mm (rhBMP-2 at 0.40 mg/mL), 5.3 ± 0.3 mm (rhBMP-2 at 0.75 mg/mL), and 0.4 ± 0.4 mm (control); new bone area 8.5 ± 4.2 mm 2, 9.0 ± 1.9 mm 2, and 0.5 ± 0.4 mm 2; new bone density 55.1 ± 6.4%, 61.1 ± 6.0%, and 67.7 ± 9.5%; and new bone-implant contact 26.9 ± 17.5%, 28.5 ± 1.4%, and 24.6 ± 16.1%, respectively. Residual ,BSM comprised 1% of the new bone. Bone density for the contiguous resident bone ranged from 65 to 71%, and bone-implant contact ranged from 49 to 64%. Conclusions: Surgical implantation of rhBMP-2/,BSM appears an effective protocol for vertical alveolar ridge augmentation procedures and immediate dental implant Osseointegration and for onlay indications of lesser complexity. [source]

Augmentation of Exposed Implant Threads with Autogenous Bone Chips: Prospective Clinical Study

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2000
Göran Widmark DDS
ABSTRACT Background: Autogenous bone chips can be harvested during drilling of implant sites and may be used as a graft material for bone augmentation and coverage of exposed implant threads. Purpose: The aim of this prospective study was to evaluate the possibility of augmenting exposed implant threads with autogenous bone chips. Materials and Methods: Twenty-one consecutive patients treated with screw-shaped oral implants with exposed threads due to buccal fenestration or marginal defects were augmented with autogenous bone harvested with a bone trap during drilling of the implant site. Both marginal (9 sites) and fenestration defects (12 sites), with 4 to 14 exposed implant threads, were registered clinically and with photography. The number of exposed implant threads was measured before and at second-stage surgery 6 months after augmentation. Results: Complete bone coverage of the exposed implant threads was seen in 12 of the 21 implant sites. Six sites showed one to two remaining exposed threads, two showed about 40% coverage, and one showed flattening of the defect but with eight of nine exposed threads at 6 months follow-up. The mean bone gain was 81% in patients with a marginal defect and 82% in patients with a fenestration defect. Conclusion: The results from this clinical study show that it is possible to gain bone over exposed implant threads by augmentation with autogenous bone chips. Conclusion It is concluded that it is possible to achieve coverage of exposed implant threads by augmentation with autogenous bone chips harvested during drilling of implant sites. [source]

Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone.

CLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2009
Clinical, histological results up to one year after loading from a randomized-controlled clinical trial
Abstract Objectives: To compare two different techniques for vertical bone augmentation of the posterior mandible: bone blocs from the iliac crest vs. anorganic bovine bone blocs used as inlays. Materials and methods: Ten partially edentulous patients having 5,7 mm of residual crestal height above the mandibular canal had their posterior mandibles randomly allocated to both interventions. After 4 months implants were inserted, and after 4 months, provisional prostheses were placed. Definitive prostheses were delivered after 4 months. Histomorphometry of samples trephined at implant placement, prosthesis and implant failures, any complication after loading and peri-implant marginal bone-level changes were assessed by masked assessors. All patients were followed up to 1 year after loading. Results: Four months after bone augmentation, there was statistically significant more residual graft (between 10% and 13%) in the Bio-Oss group. There were no statistically significant differences in failures and complications. Two implants could not be placed in one patient augmented with autogenous bone because the graft failed whereas one implant and its prosthesis of the Bio-Oss group failed after loading. After implant loading only one complication (peri-implantitis) occurred at one implant of the autogenous bone group. In 16 months (from implant placement to 1 year after loading), both groups lost statistically significant amounts of peri-implant marginal bone: 0.82 mm in the autogenous bone group and 0.59 mm in the Bio-Oss group; however, there were no statistically significant differences between the groups. Conclusions: Both procedures achieved good results, but the use of bovine blocs was less invasive and may be preferable than harvesting bone from the iliac crest. [source]

Vertical bone augmentation with fluvastatin in an injectable delivery system: a rat study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 8 2009
Yohei Jinno
Abstract Objectives: HMG-CoA reductase inhibitors (statins) are widely used for hyperlipidemia. Previous studies demonstrate that statins stimulate bone morphogenetic protein-2 (BMP-2) expression and lead to bone formation. The aim of this study was to evaluate whether percutaneously injected statin with a novel statin delivery system achieved vertical bone augmentation. Material and methods: As experimental groups, atelocollagen-,-tricalcium phosphate (,TCP) composites containing 3.3 mg (low dose) or 6.7 mg (high dose) of fluvastatin were injected (one shot) subcutaneously over the calvarial periosteum of rats. The animals were then sacrificed 1, 2, and 4 weeks after injection. Vertically augmented bone was assessed by histomorphometric procedures, i.e., by measuring new bone thickness (NBT) and bone density (BD). Results: In control groups, no newly formed bone could be seen over the calvarial bone. In the experimental groups, in contrast, a large amount of newly formed bone could be seen over the preexisting calvarial bone. The newly formed bone was seen to be in direct contact with the preexisting bone. During the entire observation, significant NBT was observed in the experimental groups (P<0.05). At the final stage of observation (4 weeks), NBT was 66.7% (low-dose group) and 59.7% (high-dose group), while they were from 1% to 16.3% in the control groups. In the experimental groups, BD significantly increased in a time-dependent manner. Conclusion: Percutaneously applied fluvastatin (one shot) with a composite of ,TCP and collagen has great potential to augment the height of the bone. [source]

Bone repair and augmentation using block of sintered bovine-derived anorganic bone graft in cranial bone defect model

CLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2009
Tania Mary Cestari
Abstract Objective: To histomorphometrically investigate the repair of critical size defects (CSDs) and bone augmentation in cranial walls using block of sintered bovine-derived anorganic bone (sBDAB) graft. Material and methods: Forty guinea-pigs were divided into test (n=20) and CSD control (n=20) groups. In each animal, a full-thickness bone defect with 9.5 mm diameter was made in the frontal bone. The defects were filled with an sBDAB block soaked in blood in the test group and with blood clot in the CSD control group. The skulls were collected at 0 h (n=2) and 30, 90 and 180 days (n=6/group and period) postoperatively. The volume density and total volume of newly formed bone, sBDAB, blood vessels and connective tissue, vertical thickness of removed bone plug, sBDAB block and graft area were evaluated. Results: The vertical thickness of the adapted sBDAB block was 3.8 times higher than that of the removed bone plug and did not show significant difference between periods, filling in average 29.8% of the total graft region. The sBDAB block exhibited complete osseointegration with the borders of the defect at 90 days. At 90 and 180 days, the vertical thickness of the graft was 279% in the average, and the total volume of bone augmentation was, respectively, 78.8% and 148.5% higher compared with the removed bone plug. The defects of the CDS control group showed limited osteogenesis and filling by connective tissue plus tegument. Conclusion: The sBDAB block can be used to promote repair of CSDs and bone augmentation in the craniomaxillofacial region, due to its good osteoconductive and slow resorptive properties. [source]

Comparison between jaw bone augmentation by means of a stiff occlusive titanium membrane or an autologous hip graft: a retrospective clinical assessment

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2006
Liene Molly
Abstract Objectives: Patients in need of bone augmentation procedures can be treated with a traditional hip graft or by neogenesis under a stiff occlusive titanium membrane, custom-fit on the basis of CT-scan data. Material and methods: Eighteen patients treated by means of a hip graft (H) were compared with 11 patients using a full titanium membrane (M) for the rehabilitation of upper jaws. In the H group, 17 patients (62 implants) in the anterior region (Ha) and 14 patients (23 implants) in the posterior region (Hp) were included. In the M group, nine patients (30 implants) in the anterior region (Ma) and seven patients (16 implants) in the posterior region (Mp) were included. Results: In group Ha, the CFR was 13.3% after 14 years compared with group Ma where the CFR was 17.4% after 9 years. In group Hp, the CFR was 22.8% after 16 years compared with group Mp where the CFR was 23.4% after 6 years. The marginal bone loss for group Ha after 20 years was 2.7 mm, for group Ma it was not even 1 mm after 9 years; for group Hp, it was 2.5 mm after 15 years compared with less than 1 mm after 3 years in group Mp. Conclusions: The success rate of alveolar ridge augmentation therapy is lower than in a classical approach. These augmentation procedures, however, show acceptable results. The titanium membrane augmentation leads to less marginal bone loss probably because neo-formed bone has a better chance to adapt its mineralization to occlusal forces encountered. This technique could offer improvement if membrane exposure can be avoided. [source]

Significance of primary stability for osseointegration of dental implants

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2006
Natalia Lioubavina-Hack
Abstract Aim: To investigate the significance of the initial stability of dental implants for the establishment of osseointegration in an experimental capsule model for bone augmentation. Material and methods: Sixteen male rats were used in the study. In each rat, muscle-periosteal flaps were elevated on the lateral aspect of the mandibular ramus on both sides, resulting in exposure of the bone surface. Small perforations were then produced in the ramus. A rigid, hemispherical Teflon® capsule with a diameter of 6 mm and a height of 4 mm and with a hole in its middle portion, prepared to fit the circumference of an ITI® HC titanium implant of 2.8 mm in diameter, was fixed to the ramus using 4 mini-screws. On one side of the jaw, the implant was placed through the hole in such a way that its apex did not make contact with the mandibular ramus (test). This placement of the implant did not ensure primary stability. On the other side of the jaw, a similar implant was placed through the hole of the capsule in such a way that contact was made between the implant and the surface of the ramus (control). This provided primary stability of the implant. After placement of the implants, the soft tissues were repositioned over the capsules and sutured. After 1, 3, 6 and 9 months, four animals were sacrificed and subjected to histometric analysis. Results: The mean height of direct bone-to-implant contact of implants with primary stability was 38.8%, 52.9%, 64.6% and 81.3% of the implant length at 1, 3, 6 and 9 months, respectively. Of the bone adjacent to the implant surface, 28.1%, 28.9%, 52.6% and 69.6%, respectively, consisted of mineralized bone. At the test implants, no bone-to-implant contact was observed at any observation time or in any of these non-stabilized specimens. Conclusion: The findings of the present study indicate that primary implant stability is a prerequisite for successful osseointegration, and that implant instability results in fibrous encapsulation, thus confirming previously made clinical observations. [source]

Bone morphology and vascularization of untreated and guided bone augmentation-treated rabbit calvaria: evaluation of an augmentation model

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2005
Christer Slotte
Abstract Objectives: Cranial vault is widely used in experimental models on membranous bone healing in general, guided bone augmentation (GBA) studies being one example. To our knowledge, however, few studies on the characteristics of the untreated calvaria regarding bone density, vessel topography, and their intra/interindividual variations and associations are available. The aims of this investigation were to (1) map the large vessel topography of the skull vault, (2) describe the parietal bones of the adult rabbit histologically and morphometrically, and (3) histologically compare untreated parietal bone with parietal bone that had been treated with a GBA device. Material and methods: Ten adult untreated rabbits were microangiographed. General anesthesia was induced and the mediastinum was opened. Heparin and lidocaine were injected in the aorta followed by perfusion with India ink. After death, en bloc biopsies of the skull vault including the overlying soft tissues and dura mater were taken. The specimens were cleared with the Spalteholtz technique, microscopically examined, and digitally imaged. Thereafter, circular biopsies were harvested to obtain decalcified sections. In addition, sections from 14 GBA-treated rabbit skulls (of the same race, sex and age as the untreated animals) served as reference specimens for comparison. Histomorphometric examinations were carried out. Results: In the cleared specimens, all parietal bones were found to be supplied by one major branch of the meningeal artery. From each of these, separate branches supplied the dura wherein a fine vessel network covered the bone. No major vessels were found in the supracalvarial soft tissue. Numerous fine vessels were found within the periosteum and dura entering the cortical plates. The decalcified sections of the parietal bones revealed an outer and inner cortical plate enveloping a diploic space containing bone trabeculae, marrow tissue and larger sinusoids. Hollow connections were frequently found in both the outer and inner cortical plates in both the untreated and the GBA-treated specimens. These connections contained marrow tissue that extended to the periosteum and the dura. The morphometric measurements revealed similar proportions of cortical, trabecular, and marrow areas in the right and left untreated bones. The area of the outer cortical plate was significantly larger than the area of the inner cortical plate. Bone density was similar in the right and left untreated and GBA-treated specimens, as was the frequency and width of hollow connections through the cortical bone plates. Conclusions: The symmetry between the left and right parietal bones concerning the large vessel topography and the histomorphometric parameters assessed was high. Hollow connections in the cortical plates were frequently found. The bilateral use of the parietal bones is suggested to be reliable in experimental GBA models regarding the blood supply and bone quality. Résumé La voûte crânienne est souvent utilisée dans les modèles expérimentaux de guérison osseuse membranaire en général, l'augmentation osseuse guidée (GBA) étant un exemple. Peu d'études sur les crânes non-traités sont disponibles en ce qui concerne la densité osseuse, la topographie des vaisseaux et leurs variations intra/interindividuelles et leurs associations. Les buts de cette étude ont été 1) de cartographier la topographie des vaisseaux larges sur la voute crânienne, 2) de décrire les os pariétaux du lapin adulte histologiquement et morphométriquement et 3) de comparer histologiquement l'os pariétal non-traité avec celui traité par GBA. Dix lapins adultes non-traités ont subi une micro-angiographie. L'anesthésie générale a été effectuée et la partie médiane a été ouverte. De l'héparine et de la lidocaïne ont été injectées dans l'aorte suivies d'une perfusion avec de l'encre noire. Après la mort, des biopsies en blocs de la voûte crânienne comportant la dura mater et les tissus mous la recouvrant ont été prélevées. Les spécimens ont été estimés par la technique de Spalteholtz, examinés microscopiquement et des images digitales ont été réalisées. Des biopsies circulaires ont été prélevées pour obtenir des sections décalcifiées. Des sections de 14 crânes de lapins traités GBA (de même race, sexe et âge que les non-traités) ont servi de spécimens de référence pour comparaison. Des examens histomorphométriques ont été effectués. Dans les spécimens non-traités, tous les os pariétaux étaient irrigués par une branche majeure de l'artère méningée. De chacune de ces dernières, différentes branches abreuvaient la dura dans laquelle un réseau de vaisseau fins recouvrait l'os. Aucun vaisseau majeur n'a été trouvé dans le tissu mou ou sus-voûte. De nombreux vaisseaux fins ont été trouvés à l'intérieur du périoste et de la dura pénétrant qu'entre les bords corticaux. Les sections décalcifiées des os pariétaux ont révélé des bords corticaux interne et externe enveloppant un espace diploïque contenant de l'os trabéculaire, de la moelle osseuse et de larges sinusoïdes. Des connexions creuses étaient fréquemment trouvées tant dans les plaques corticales interne qu'externe et tant dans les spécimens non-traités que traités GBA. Ces connexions contenaient de la moelle qui allait jusqu'au périoste et la dura. Les mesures morphométriques ont révélé des proportions semblables de cortical, trabécules et moelle dans les les os non-traités. L'aire du bord cortical externe était significativement plus importante que l'aire du bord cortical interne. La densité osseuse était semblable dans les spécimens non-traités et traités GBA gauches et droits ainsi que la fréquence et la largeur des connexions creuses à travers les bords osseux corticaux. La symétrie entre les os pariétaux gauches et droits concernant la topographie des vaisseux larges et des paramètres histomorphométriques étaient importante. Les connexions creuses dans les bords corticaux était souvent trouvées. L'utilisation bilatérale des os pariétaux est proposée pour sa fiabilité dans les modèles GBA expérimentaux concernant l'apport sanguin et la qualité osseuse. Zusammenfassung Ziele:,Die Schädeldecke wird oft bei experimentellen Modellen zur bindegewebigen Knochenheilung verwendet. Ein Beispiel dafür sind Studien zur gesteuerten Knochenaugmentation (GBA). Soviel wir wissen, existieren jedoch nur wenige Studien über die Charakteristiken der unbehandelten Kalvaria bezüglich Knochendichte, Gefässtopographie und deren intra-/interindividuelle Variationen und Assoziationen. Die Ziele dieser Untersuchung waren (1) die Topographie der grossen Gefässe der Schädeldecke aufzuzeichnen, (2) die parietalen Knochen des ausgewachsenen Kaninchens histologisch und histomorphometrisch zu beschreiben, und (3) histologisch den unbehandelten parietalen Knochen mit parietalem Knochen, der mit einer GBA Einrichtung behandelt worden war, zu vergleichen. Material und Methoden:,Zehn ausgewachsene Kaninchen wurden mikroangiographisch untersucht. In Narkose wurde das Mediastinum eröffnet. Es wurde Heparin und Lidocain in die Aorta injiziert, darauf folgte die Perfusion mit India Tinte. Nach dem Tod wurden Blockbiopsien der Schädeldecke inklusive bedeckende Weichgewebe und Dura mater entnommen. Die Präparate wurden mittels der Spaltenholztechink gereinigt, mikroskopisch untersucht und digital aufgezeichnet. Danach wurden zirkuläre Biopsien gewonnen, um entkalkte Schnitte herzustellen. Zusätzlich dienten Schnitte von 14 GBA-behandelten Kaninchenschädeln (gleiche Rasse, Geschlecht und Alter wie die unbehandelten Tiere) als Referenzpräparate zum Vergleich. Es wurden histomorphometrische Untersuchungen durchgeführt. Resultate:,In den gereinigten Präparaten konnte gesehen werden, dass alle parietalen Knochen durch einen grossen Ast der Meningalarterie versorgt wurden. Separate Aeste dieser Arterie versorgten die Dura, wobei ein feines Gefässnetz den Knochen bedeckte. In den Weichgeweben auf der Kalvaria konnten keine grossen Gefässe gefunden werden. Im Periost und in der Dura waren zahlreiche feine Gefässe zu sehen, welche in die kortikalen Platten eintraten. Die entkalkten Schnitte der parietalen Knochen zeigten eine äussere und innere kortikale Platte, welche einen abgeschlossenen Raum mit Knochentrabekeln, Markgewebe und grossen Hohlräumen umschlossen. In der inneren und in der äusseren kortikalen Platte konnten oft sowohl bei den unbehandelten als auch bei den GBA-behandelten Präparaten hohle Verbindungen gefunden werden. Diese Verbindungen enthielten Markgewebe, dass sich bis zum Periost und der Dura erstreckte. Die morphometrischen Messungen zeigten sowohl in den rechten als auch in den linken unbehandelten Knochen ähnliche Proportionen zwischen kortikalem Knochen, trabekulärem Knochen und den Markarealen. Die Fläche der äusseren kortikalen Platte war signifikant grösser als die Fläche der inneren kortikalen Platte. Die Knochendichte war in den rechten und linken unbehandelten und in den GBA-behandelten Präparaten ähnlich, ebenso die Häufigkeit und die Breite der hohlen Verbindungen durch die kortikalen Platten. Schlussfolgerungen:,Die Symmetrie zwischen den rechten und linken parietalen Knochen bezüglich Topographie der grossen Gefässe und der untersuchten histomorphometrischen Parameter war gross. In den kortikalen Platten konnten häufig hohle Verbindungen gefunden werden. Es wird vorgeschlagen, dass die bilaterale Verwendung von parietalen Knochen bei experimentellen GBA-Modellen zuverlässig ist bezüglich Blutversorgung und Knochenqualität. Resumen Objetivos:,La bóveda craneal es ampliamente usada en modelos experimentales en cicatrización de hueso membranoso en general, siendo un ejemplo los estudios de regeneración ósea guiada (GBA). Que sepamos, sin embargo, se dispone de pocos estudios sobre las características del calvario no tratado con respecto a la densidad ósea, la topografía vascular, y sus variaciones intra/interindividuo y sus asociaciones. Las intenciones de esta investigación fueron (1) cartografiar la topografía de grandes vasos de la bóveda craneal, (2) describir histológica y morfométricamente los huesos parietales del conejo adulto, y (3) comparar histológicamente el hueso parietal no tratado con el hueso parietal tratado con un dispositivo de GBA. Material y Métodos:,Se llevaron a cabo microangiografías a diez conejos adultos sin tratar. Se indujo anestesia general y se abrió el mediastino Se inyectaron heparina y lidocaina en la aorta seguida por infusión de tinta de India. Tras la muerte, se tomaron biopsias en bloque de la bóveda craneal incluyendo los tejidos blandos superpuestos y de la duramadre. Los especimenes se aclararon con la técnica de Spalteholtz, se examinaron microscópicamente, y se tomaron imágenes digitales. Más adelante, se recogieron biopsias circulares para obtener secciones descalcificadas. Además, secciones de los cráneos de los conejos tratados con 14secciones descalcificadas. Además, secciones de los cráneos de los conejos tratados con 14 GBA (de la misma raza, sexo y edad que los animales no tratados) sirvieron como especimenes de referencia para la comparación. Se llevaron a cabo exámenes histomorfométricos. Resultados:,En los especimenes aclarados, todos los huesos parietales se encontró que estaban irrigados por una rama principal de la arteria meníngea. De cada una de estas, ramas separadas irrigaron la dura en donde una fina red de vasos cubrió el hueso. No se encontraron vasos mayores en el tejido blando supracalvario. Se encontraron numerosos vasos dentro del periostio y la dura entrando en las placas corticales. Las secciones descalcificadas de los huesos parietales revelaron una placa cortical interna y externa envolviendo un espacio diploico conteniendo trabéculas óseas, tejido medular y grandes sinusoides. Frecuentemente se encontraron conexiones huecas en las placas corticales internas y externas tanto en los especimenes sin tratar como en los tratados con GBA. Estas conexiones contenían tejido medular que se extendió hasta el periostio y la dura. Las medidas morfogenéticas revelaron proporciones similares de áreas corticales trabeculares y medulares en los huesos derecho e izquierdo no tratados. El área de la placa cortical externa fue significativamente mayor que el área de placa cortical interna. La densidad ósea fue similar en el lado derecho e izquierdo no tratados y en los especimenes tratados con GBA, así como la frecuencia y la anchura de las conexiones huecas a lo largo de las placas óseas corticales. Conclusiones:,La simetría entre los huesos parietales izquierdos y derechos concernientes a la topografía vascular y los parámetros histomorfométricos valorados fue alta. Las conexiones huecas en las placas corticales se encontraron con frecuencia. Se sugiere que el uso bilateral de huesos parietales es fiable como modelo experimental GBA respecto al suministro de sangre y calidad ósea. [source]

Simultaneous or staged installation with guided bone augmentation of transmucosal titanium implants

CLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2003
A 3-year prospective cohort study
Abstract: A prospective cohort study of 45 nonsmoking consecutively admitted patients was studied for the treatment outcomes following jaw bone augmentation in conjunction with installment of oral implants. Twenty-eight patients were treated for both bone augmentation and implant treatment simultaneously, while 17 patients were treated with a staged approach with the bone augmentation being performed 6,8 months prior to implant installation. Three months following this, prosthetic reconstructions were incorporated. One year thereafter, baseline data and 3 years after reconstruction, follow-up data were obtained. Moderately low mean scores for the bleeding on probing percentage were found at baseline (24%) and after 3 years of function (17%), while the corresponding values at the implant sites were 40.6% and 52.4%, respectively. However, the modified gingival index (mGI)=2 was found in only 4.8%, and 6.9% at the baseline and 3-year examinations. Peri-implant Probing depth (PPD) and level of attachment mean values did not vary between baseline and follow-up examinations. Only a small proportion of 1.8% yielded PPD=6.0 mm after 3 years of function. Radiographic bone level measurements showed that 18.2% of the implants lost 0.5 mm during the observation period. Seventy percent of the sites were considered completely stable. It was concluded that predictable treatment outcomes resulted for oral implant installation combined with or staged after jawbone augmentation. Only 6.5% of the sites had lost 1.5% crestal bone with the staged approach while 14% of the sites had lost 1.5 mm, when the implants were placed simultaneously. This suggests that the staged approach may have a lower risk for greater amounts of crestal bone loss as the simultaneous approach. In general, crestal bone loss encountered in the present study corresponded very well with that reported following placement of the same implant system into nonaugmented bone. Résumé Une étude prospective chez 45 non-fumeurs a été menée pour étudier le traitement suivant l'épaississement de l'os de la mâchoire en association avec le placement d'implants buccaux. Vingt-huit patients ont été traités pour un épaississement osseux et un traitement implantaire simultané tandis que 17 patients ont été traités par une approche de l'épaississement osseux effectuée six à huit mois avant le placement des implants. Trois mois après, les reconstructions prothétiques ont été placées. Une année plus tard les données de l'examen initial, et trois années après la reconstruction les données du suivi, ont été obtenues. Un pourcentage de BOP moyen modérément bas a été constaté lors de l'examen de départ (24%) et après trois années de mise en fonction (17%), tandis que les valeurs correspondantes au niveau des implants étaient respectivement de 41 et 52 %. Cependant, le mGI=2 était constaté seulement dans 5% et 7% lors des examens de départ et après trois ans. Les valeurs moyennes PPD et LA ne variaient pas entre l'examen de départ et les suivis. Seul une petite proportion de 2% avaient un PPD de 6,0 mm après trois années de mise en fonction. Les mesures du niveau osseux radiographique ont montré que 18% des implants perdaient 0,5 mm durant la période d'observation. Septante pour cent des sites étaient considérés complètement stables. Un traitement prévisible se produisait donc pour les implants osseux qu'ils aient été installés en une ou deux étapes. Seul 6,5% des sites avaient perdu 1,5% d'os crestal avec l'approche chirurgicale en une étape tandis que 14% des sites avaient perdu 1,5 mm lorsque les implants étaient placés en même temps que l'épaississement. L'approche en deux étapes pourrait s'accompagner d'un risque inférieur de perte osseuse importante au niveau crestal comparée à l'approche en une étape. En général, la perte osseuse crestale rencontrée dans l'étude présente correspondait très bien avec celle rapportée suivant le placement du même système d'implants dans l'os non-épaissi. Zusammenfassung In dieser prospektiven Kohortenstudie an 45 nichtrauchenden Patienten wurden die Behandlungsresultate nach Kieferkammaugmentation in Zusammenhang mit der Platzierung von oralen Implantaten untersucht. Bei 28 Patienten wurde die Knochenaugmentation und die Implantation in einem Eingriff durchgeführt, während bei 17 Patienten ein gestaffeltes Verfahren angewendet wurde, bei welchem die Knochenaugmentation 6,8 Monate vor der Implantatplatzierung stattfand. Drei Monate nach Implantation wurden die prothetischen Rekonstruktionen eingesetzt. Ein Jahr später wurden die Daten für die Ausgangsuntersuchung erhoben und drei Jahre nach Rekonstruktion wurden die Daten für die Nachuntersuchung aufgenommen. Bei der Ausgangsuntersuchung (24%) und nach drei Jahren in Funktion (17%) wurden relativ tiefe mittlere BOP % Werte gefunden, während die entsprechenden Werte bei den Implantatstellen 40.6% bzw. 52.4% betrugen. Jedoch wurde ein mGI=2 nur bei 4.8% anlässlich der Ausgangsuntersuchung und bei 6.9% bei der Nachuntersuchung gefunden. Die mittleren PPD und LA Werte variierten nicht zwischen der Ausgangs- und Nachuntersuchung. Nur ein kleiner Anteil von 1.8% zeigte eine PPD=6 mm nach drei Jahren in Funktion. Die Messung des radiologischen Knochenniveaus ergab, dass 18.2% der Implantate während der Beobachtungszeit einen Knochenverlust von 0.5 mm zeigten. 70% der Stellen wurde als komplett stabil angesehen. Es wurde die Schlussfolgerung gezogen, dass für die Eingliederung von oralen Implantaten zusammen mit Knochenaugmentation oder in einem gestaffelten Verfahren zu voraussagbaren Behandlungsresultaten führt. Nur 6.5% der Stellen im gestaffelten Vorgehen zeigten einen Knochenverlust von 1.5 mm während bei den gleichzeitig gesetzten Implantaten bei 14% der Stellen ein Knochenverlust von 1.5 mm auftrat. Dies lässt vermuten, dass das gestaffelte Vorgehen ein kleineres Risiko für grössere Knochenverluste haben könnte als das gleichzeitige Vorgehen. Generell betrachtet korrespondierte der in der vorliegenden Studie gesehene Knochenverlust sehr gut mit den Werten, die für das gleiche Implantatsystem nach dem Setzten in nichtaugmentierten Knochen berichtet werden. Resumen Se realizó un estudio prospectivo en serie sobre 45 pacientes no fumadores admitidos consecutivamente acerca de los resultados del tratamiento tras el aumento del hueso mandibular en conjunción con la instalación de implantes orales. Se trataron 28 pacientes para aumento del hueso y tratamiento de implantes simultáneamente mientras que 17 pacientes se trataron con un enfoque por fases con el aumento óseo realizado 6,8 meses antes de la instalación del implante. A los tres meses de esto, se incorporaron las reconstrucciones protésicas. Un año después, se obtuvieron datos de seguimiento, momento inicial y tres años tras la reconstrucción. Se encontró un % de BOP medio moderadamente bajo al inicio (24%) y tras tres años en función (17%), mientras que los valores correspondientes para los lugares de implante fueron 40.6% y 52.4%, respectivamente. De todos modos, el mGI=2 se encontró en solo 4.8%, y 6.9% al inicio y en el examen de los tres años. Los valores medios de PPD y LA no variaron entre el inicio y los exámenes de seguimiento. Solo una pequeña proporción del 1.8% produjo un PPD=6.0 mm tras tres años en función. Las mediciones del nivel radiográfico del hueso mostraron que el 18.2% de los implantes perdieron 0.5 mm durante el periodo de observación. El 70% de los lugares se consideraron completamente estables. Se concluyó que se obtuvieron unos resultados predecibles para instalación de implantes orales combinados con o en fases tras el aumento del hueso mandibular. Solo el 6.5% de los lugares perdió el 1.5% del hueso crestal con el enfoque por fases mientras que el 14% de los lugares perdieron 1.5 mm cuando los implantes se colocaron simultáneamente. Esto sugiere que el enfoque por fases puede tener un menor riesgo para mayores cantidades de perdida de hueso crestal que el enfoque simultaneo. En general, la perdida de hueso crestal encontrada en el presente estudio correspondió con muy buen con aquella informada tras la colocación del mismo sistema de implantes en hueso no aumentado. [source]

Histological assessment of augmented jaw bone utilizing a new collagen barrier membrane compared to a standard barrier membrane to protect a granular bone substitute material

CLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2002
A randomized clinical trial
Abstract: Successful bone augmentation requires predictable space maintenance and adequate exclusion of those cells that lack osteogenetic potential from the defect area. Natural bone mineral is considered to be osteoconductive and is used as space maker in combination with membrane barrier techniques. The aim of this study was to compare qualitative histological results achieved by using deproteinized bovine bone mineral (DBBM) as a space maintainer and a new collagen barrier (OssixÔ, test group) vs. the same bone substitute and the standard e-PTFE membrane (Gore-Tex®, control group). Twenty-eight patients were randomly assigned to the test or the control group. Seven months after augmentation procedures, biopsies were obtained at reentry and were analysed histomorphometrically. In all, 14 specimens of group I (test group, OssixÔ) and 13 specimens of group II (controls, PTFE-membranes) showed close qualitative similarity of their histologies. Histomorphometrically, total mineralized bone area was 42% ± 18% in group I vs. 39% ± 15% in group II. The unmineralized tissue area was 44% ± 15% vs. 46% ± 12% and the area of DBBM remnants 14% ± 9% and 15% ± 12%, respectively. The differences were statistically nonsignificant (Mann,Whitney test). The occurrence of barrier exposure did not interfere with the histological outcome either in the test or in the control group. The new collagen barrier combined with the DBBM provided qualitative bone regeneration comparable to the standard e-PTFE material combined with the same mineral. [source]