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Bone Grafting (bone + grafting)
Terms modified by Bone Grafting Selected AbstractsQuantitation of Mandibular Symphysis Volume as a Source of Bone GraftingCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2010Fernando Verdugo DDS ABSTRACT Background: Autogenous intramembranous bone graft present several advantages such as minimal resorption and high concentration of bone morphogenetic proteins. A method for measuring the amount of bone that can be harvested from the symphysis area has not been reported in real patients. Purpose: The aim of the present study was to intrasurgically quantitate the volume of the symphysis bone graft that can be safely harvested in live patients and compare it with AutoCAD® (version 16.0, Autodesk, Inc., San Rafael, CA, USA) tomographic calculations. Materials and Methods: AutoCAD software program quantitated symphysis bone graft in 40 patients using computerized tomographies. Direct intrasurgical measurements were recorded thereafter and compared with AutoCAD data. The bone volume was measured at the recipient sites of a subgroup of 10 patients, 6 months post sinus augmentation. Results: The volume of bone graft measured by AutoCAD averaged 1.4 mL (SD 0.6 mL, range: 0.5,2.7 mL). The volume of bone graft measured intrasurgically averaged 2.3 mL (SD 0.4 mL, range 1.7,2.8 mL). The statistical difference between the two measurement methods was significant. The bone volume measured at the recipient sites 6 months post sinus augmentation averaged 1.9 mL (SD 0.3 mL, range 1.3,2.6 mL) with a mean loss of 0.4 mL. Conclusion: AutoCAD did not overestimate the volume of bone that can be safely harvested from the mandibular symphysis. The use of the design software program may improve surgical treatment planning prior to sinus augmentation. [source] Measurements of Buccal Tissue Volumes at Single-Implant Restorations after Local Bone Grafting in Maxillas: A 3-Year Clinical Prospective Study Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2003Odont PhD, Torsten Jemt LDS ABSTRACT Purpose: The purpose of this study was to measure changes in buccal and proximal tissue volumes after local bone grafting and single-implant treatment. Materials and Methods: Ten patients were provided with buccal bone grafts 6 months prior to implant treatment in central upper incisor regions. Following a healing time of 6 months, abutments and single-implant crowns were installed and followed up for 2 years. Clinical photographs and impressions were taken prior to the surgical intervention as well as after crown placement and at first and second annual checkups. The photographs and study models were analyzed with regard to papilla regeneration and changes in buccal crest volume during the study period by means of a clinical papilla index and optical scanning of study models. Results: All bone grafts healed without problems. A significant reduction of the buccal crest volume (-50%, p <.01) was observed in the grafted area before abutment connection. However, a significant increase of tissue volume (+100%, p <.05) was noticed at the subsequent crown placement, followed by a second but slow reduction of the volume during the following 2 years of function. The interdental papillae increased significantly (p <.05) in volume during the first year, almost completely filling up the embrasure areas after 2 years. Conclusions: It may be concluded that local bone grafting seems to be a valuable protocol to create sufficient bone volume for implant placement. However, significant resorption of the graft may be present, which reduces the impact of grafting on the esthetic outcome. Instead, placement of the abutment cylinder and the crown seems to play a more important role for reestablishing the tissue volume at the implant-supported single crowns. [source] The Acetabular Reamer: A Unique Tool for Anterior Iliac Crest Bone Graft HarvestingTHE LARYNGOSCOPE, Issue 3 2005David G. Gossman MD Abstract Bone grafting is often required in craniofacial reconstruction. Morselized corticocancellous bone grafts are particularly useful in applications such as filling and contouring irregular bony defects. Obtaining grafts of this consistency by traditional methods is difficult. An efficient harvesting method that can produce such grafting material in clinically useful quantities is needed. We report the use of a mechanical acetabular reamer for the purpose of harvesting a bone graft from the iliac crest. [source] Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defectsAUSTRALIAN DENTAL JOURNAL, Issue 1 2010M Esposito Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source] Single-tooth implant treatment in the anterior region of the maxilla for treatment of tooth loss after trauma: a retrospective clinical and interview studyDENTAL TRAUMATOLOGY, Issue 3 2003Lars Andersson Abstract,,, The aim of this study was to evaluate the results of single-tooth implant treatment in patients where teeth have been lost as a result of trauma. Also, the patients' and professionals' opinions regarding the final outcome of treatment were assessed. Thirty-four patients with 42 lost teeth were evaluated by clinical and radiographic examinations and interviews 2,5 years after treatment. A professional who had not taken part in the treatment evaluated the implant crowns. Central maxillary incisors were the most frequently lost and replaced teeth after trauma (75%) followed by lateral incisors (21%). In patients with incomplete growth, implant treatment was generally postponed until completion of growth. Lack of space was treated by presurgical orthodontics (7%) or by selecting an implant with a reduced diameter (5%). Deficiency of bone was seen in 17% and was treated by bone grafting or local augmentation prior to implant surgery. Patients who had lost two or more teeth after trauma were all subjected to bone grafting. Preservation of roots in the alveolar process seemed to maintain the bone volume enabling better conditions for later implant placement. Forty-one implants (97.6%) were integrated successfully. Complications were few and of minor importance (9.5% before and 12% after cementation of crowns) and could all be managed. No or minimal bone loss was seen. In general, the patients felt that they received good care and that they were well informed about their treatment. Some patients reported that the local anesthesia procedure was not pain-free, but 71% of the patients experienced the treatment as pain-free. For each of the variables (color, shape, height, and size of the crowns), the highest degree of satisfaction was noted in 93,98% of the patients and 91,95% of the single evaluating professional. Given that the patients have finished growth and a careful treatment planning and timing are performed, the functional and esthetical outcome of single-tooth implant treatment today is excellent and can be recommended for replacing tooth losses after trauma in the anterior region of the maxilla. [source] An economic evaluation of different sinus lift techniquesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010Stefan Listl Listl S, Faggion CM. An economic evaluation of different sinus lift techniques. J Clin Periodontol 2010; 37: 777-787 doi: 10.1111/j.1600-051X.2010.01577.x. Abstract Purpose: To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence. Methods: We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation. Results: When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches. Conclusions: On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights. [source] Dentoalveolar reconstruction of a missing premaxilla using bone graft and endosteal implantsJOURNAL OF ORAL REHABILITATION, Issue 1 2003M. Fukuda summary We report here on a patient with bilateral cleft lip and palate (BCLP) and a missing premaxilla, who underwent dentoalveolar reconstruction of the cleft and premaxillary alveolus using endosteal implants after bone grafting. The patient, whose maxillary incisors and premaxilla were missing, had corticocancellous bone grafting from the iliac crest, followed by excellent bone formation at the anterior alveolus. After the placement of the endosteal implants and the completion of the pre-surgical orthodontic alignment, orthognathic surgery was performed for the restoration of a Class III open bite. After post-operative orthodontic preparation, the final fixed prostheses were completed. This treatment procedure offers an option of dentoalveolar reconstruction for BCLP patients with an excised premaxilla. [source] Genetic marking with the ,LNGFR-gene for tracing goat cells in bone tissue engineering,JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2004M. C. Kruyt Abstract The use of bone marrow derived stromal cells (BMSC's) for bone tissue engineering has gained much attention as an alternative for autologous bone grafting. Little is known however, about the survival and differentiation of the cells, especially in the clinical application. The aim of this study was to develop a method to trace goat BMSC's in vivo. We investigated retroviral genetic marking, which allows stable expression of the label with cell division. Goat BMSC's were subjected to an amphotropic envelope containing a MoMuLV-based vector expressing the human low affinity nerve growth factor receptor (,LNGFR). Labeling efficiency and effect on the cells were analyzed. Furthermore, transduced cells were seeded onto porous ceramic scaffolds, implanted subcutaneously in nude mice and examined after successive implantation periods. Flow cytometry indicated a transduction efficiency of 40,60%. Immunohistochemistry showed survival and subsequent bone formation of the gene-marked cells in vivo. Besides, marked cells were also found in cartilage and fibrous tissue. These findings indicate the maintenance of the precursor phenotype following gene transfer as well as the ability of the gene to be expressed following differentiation. We conclude that retroviral gene marking with ,LNGFR is applicable to trace goat BMSC's in bone tissue engineering research. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Healing of dorsal pancarpal arthrodesis in the dogJOURNAL OF SMALL ANIMAL PRACTICE, Issue 3 2003U. Michal The purpose of this study was to assess radiographically the healing process in dogs which had undergone dorsal pancarpal arthrodesis with autologous cancellous bone grafting. The medical records of 17 dogs that had undergone dorsal pancarpal arthrodesis with complication-free dynamic compression plate fixation were reviewed. Postoperative healing was evaluated radiographically. It started five weeks after surgery and progressed for six to 12 weeks in all dogs. After this time period no further progression of healing was observed. Between weeks 6 and 8, bony fusion progressed significantly more rapidly in the intercarpal joint than in the radiocarpal joint. The following criteria had no influence on healing time: gender, age, bodyweight, and immediate versus delayed surgery after trauma. The major difficulties noted with respect to the interpretation of postoperative radiographs were irregular bony bridging, mainly caused by inadequate palmar curettage, and oblique projection of articular surfaces resulting in superimposition of joint spaces and solid bone. [source] Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft,MICROSURGERY, Issue 6 2004Roberto Adani M.D. Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993,2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16,65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6,13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10,93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5,8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna. © 2004 Wiley-Liss, Inc. Microsurgery 24:423,429, 2004. [source] Monitoring angiogenesis in soft-tissue engineered constructs for calvarium bone regeneration: an in vivo longitudinal DCE-MRI studyNMR IN BIOMEDICINE, Issue 1 2010Marine Beaumont Abstract Tissue engineering is a promising technique for bone repair and can overcome the major drawbacks of conventional autogenous bone grafting. In this in vivo longitudinal study, we proposed a new tissue-engineering paradigm: inserting a biological soft-tissue construct within the bone defect to enhance angiogenesis for improved bone regeneration. The construct acts as a resorbable scaffold to support desired angiogenesis and cellular activity and as a vector of vascular endothelial growth factor, known to promote both vessel and bone growth. Dynamic contrast- enhanced magnetic resonance imaging was performed to investigate and characterize angiogenesis necessary for bone formation following the proposed paradigm of inserting a VEGF-impregnated tissue-engineered construct within the critical-sized calvarial defect in the membranous parietal bone of the rabbit. Results show that a model-free quantitative approach, the normalized initial area under the curve metric, provides sensitive and reproducible measures of vascularity that is consistent with known temporal evolution of angiogenesis during bone regeneration. Copyright © 2009 John Wiley & Sons, Ltd. [source] Treatment of aseptic nonunion after intramedullary nailing fixation with locking plateORTHOPAEDIC SURGERY, Issue 4 2009Sheng-bao Chen MD Objective:, To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. Methods:, Thirty-eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non-union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9,70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. Results:, All patients were followed up for 6,20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4,8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow-up. Conclusion:, Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion. [source] Use of a retrograde femoral nail in a patient with McCune,Albright syndromeANZ JOURNAL OF SURGERY, Issue 12 2003John D. Garvan McCune,Albright Syndrome is a rare condition characterized by endocrine abnormalities, precocious puberty, pigmented skin lesions and polyostotic fibrous dysplasia with consequent fractures and limb deformity. Patients with this syndrome might have had multiple operations on a limb and might also have extensive internal fixation in-situ. We review the case of a 41-year-old woman with McCune,Albright syndrome, who presented with a pathological fracture of her left femur below a long plate and screws. Our management of this challenging problem included the use of a retrograde femoral nail, which, because of the need to retain pre-existing internal fixation, had to be locked proximally through a hole in a femoral plate. This technique, combined with reaming, and thus bone grafting of the fracture, and also perioperative infusions of pamidronate, allowed an early recovery and return to premorbid function for the patient. In the present study we detail our technique and discuss its advantages over other possible methods of treatment. [source] Relation Between Vertical Orientation and Stability of Acetabular Component in the Dysplastic Hip Simulated by Nonlinear Three-dimensional Finite Element MethodARTIFICIAL ORGANS, Issue 11 2004Hisashi Oki Abstract:, In acetabular dysplasia, more vertical orientation of the acetabular component is often used to minimize the superolateral bone grafting. This study was designed to determine the effects of vertical orientation of the cup on the stability and polyethylene wear of the acetabular component in uncemented total hip arthroplasty (THA). Three-dimensional finite element models of the hemipelvis with dysplastic acetabulum were developed. Metal-backed hemispherical cups were placed in the true acetabulum with abduction angles of 35, 45, 55, and 65 degrees. It was found that more vertical orientation of the cup was associated with larger relative motion of the metal shell between the acetabulum and metal shell. Furthermore, tilting and torsional shear stresses in the model of the cup abduction angle of 65 degrees were found to be 1.7 times larger than that in the model with 35 degrees at the bone,metal shell interface. More vertically oriented cups caused larger contact stresses at the articulating surfaces of the polyethylene liners. The results suggest that the abduction angle of the acetabular component significantly influences cup loosening and polyethylene wear in, THA. [source] Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defectsAUSTRALIAN DENTAL JOURNAL, Issue 1 2010M Esposito Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source] Outcomes of dental implants placed in a surgical training programmeAUSTRALIAN DENTAL JOURNAL, Issue 4 2009LP Smith Abstract Background:, This study evaluates surgical outcomes and survival rates of implants placed in a multidisciplinary implant teaching programme. Methods:, A retrospective review of all implant surgery performed over a 6-year period by accredited oral and maxillofacial surgery trainees at the Royal Dental Hospital of Melbourne was undertaken. Patients were reviewed for a minimum of 6 months post-implant placement. Implant survival was defined as those implants which were not removed, were clinically integrated as assessed by torque testing and in an appropriate position to receive a subsequent prosthesis. Kaplan-Meier analysis was used to assess overall survival and univariate factors affecting survival. Multivariate analysis used Cox proportional hazards models. Results:, Over 6 years, 127 patients were treated. Follow-up data were present for 105 patients with 236 implants placed. Survival of implants at 1 and 5 years was 94 per cent and 92.8 per cent, respectively. The only univariate and multivariate factor which affected implant survival was perioperative bone grafting. All failed implants were single stage. Other factors such as patient age, smoking status, implant site, anaesthetic type, immediate or delayed placement, implant length and diameter, and medical comorbidities did not significantly affect implant survival. Conclusions:, A satisfactory implant survival rate was found in a tertiary teaching centre. Perioperative bone grafting significantly increased the risk of implant failure. [source] Single Implants and Buccal Bone Grafts in the Anterior Maxilla: Measurements of Buccal Crestal Contours in a 6-Year Prospective Clinical StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2005Odont Dr/PhD, Torsten Jemt DDS ABSTRACT Background: Patients provided with buccal bone grafts seem to lose a substantial part of the graft in the short term. Purpose: To measure long-term changes in buccal and proximal tissue volumes after local bone grafting and single implant treatment. Materials and Methods: Eight of 10 originally treated male patients were followed up for 6 years after treatment with buccal bone grafts in the central incisor region. After a healing time of 6 months, a two-stage implant surgery procedure was performed followed by single crown placement. Clinical photographs and impressions were taken prior to the surgical interventions and after crown placement and at first and fifth annual checkups. The photographs were analyzed with regard to papilla regeneration by means of a clinical papilla index. The models were used to measure the clinical length of teeth and tooth movements adjacent to the implants. Changes in buccal crest volume during the study period were measured by means of optical scanning of obtained study models. Results: Papillae volume increased significantly (p < .05) during the first year, thereafter showing a slow further increase during the 4 following years. Three of the patients (38%) presented small movements of their adjacent central incisor in a vertical or palatal direction of less than 1 mm during the follow-up period. All patients showed resorption during the first year after grafting (p < .01), in which three patients (38%) had lost basically all of increased volume at second surgery. After abutment or crown placement, all patients showed an increased volume (p < .01), followed by an average reduction during the first year, reaching a significant level in the apical part of the crest (p < .05). Thereafter, a relatively stable average situation was observed during the following 4 years, with individual variations, however. Conclusion: Local bone grafting seems to create sufficient bone volume for implant placement after 6 months, but individual variations in resorption pattern make the grafting procedure unpredictable for long-term prognosis. Instead, the abutment and the crown seem to play a more important role for building up and maintaining the buccal contour in the coronal part of the crest long term. [source] Ramus or Chin Grafts for Maxillary Sinus Inlay and Local Onlay Augmentation: Comparison of Donor Site Morbidity and ComplicationsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2003Jaime Clavero DDS ABSTRACT Background: The placement of endosseous implants in edentulous areas is frequently limited by inadequate bone volume of the residual ridge. Local bone grafts from the mandible are a convenient source of autogenous bone for alveolar reconstruction prior to implant placement. Purpose: The aim of the present study was to document and compare the morbidity and the frequency of complications occurring at two intraoral donor sites: the mandibular symphysis and the mandibular ramus. Material and Methods: This study reviewed 53 consecutively treated patients:29 with autogenous bone grafts from the mandibular symphysis and 24 with mandibular ramus bone grafts. Each patient received a questionnaire 18 months after surgery regarding problems that may have occurred during the postoperative period. Results: In the patients in whom bone was harvested from the mandibular ramus, there were fewer postoperative symptoms immediately after the operation than with mandibular symphysis harvesting. Twenty-two of the 29 patients with symphysis grafts experienced decreased sensitivity in the skin innervated by the mental nerve 1 month after the operation. Five of the 24 patients with ramus grafts experienced decreased sensitivity in the vestibular mucosa corresponding to the innervation of the buccal nerve. Eighteen months after the surgery, 15 of the 29 patients in the symphysis group still had some decreased sensitivity and presented with permanent altered sensation. Only one of the patients grafted from the mandibular ramus presented with permanent altered sensation in the posterior vestibular area. No major complication occurred in the donor sites in any of the 53 patients. Conclusion: The results of this study favored the use of the ascending mandibular ramus as an intraoral donor site for bone grafting. [source] Measurements of Buccal Tissue Volumes at Single-Implant Restorations after Local Bone Grafting in Maxillas: A 3-Year Clinical Prospective Study Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2003Odont PhD, Torsten Jemt LDS ABSTRACT Purpose: The purpose of this study was to measure changes in buccal and proximal tissue volumes after local bone grafting and single-implant treatment. Materials and Methods: Ten patients were provided with buccal bone grafts 6 months prior to implant treatment in central upper incisor regions. Following a healing time of 6 months, abutments and single-implant crowns were installed and followed up for 2 years. Clinical photographs and impressions were taken prior to the surgical intervention as well as after crown placement and at first and second annual checkups. The photographs and study models were analyzed with regard to papilla regeneration and changes in buccal crest volume during the study period by means of a clinical papilla index and optical scanning of study models. Results: All bone grafts healed without problems. A significant reduction of the buccal crest volume (-50%, p <.01) was observed in the grafted area before abutment connection. However, a significant increase of tissue volume (+100%, p <.05) was noticed at the subsequent crown placement, followed by a second but slow reduction of the volume during the following 2 years of function. The interdental papillae increased significantly (p <.05) in volume during the first year, almost completely filling up the embrasure areas after 2 years. Conclusions: It may be concluded that local bone grafting seems to be a valuable protocol to create sufficient bone volume for implant placement. However, significant resorption of the graft may be present, which reduces the impact of grafting on the esthetic outcome. Instead, placement of the abutment cylinder and the crown seems to play a more important role for reestablishing the tissue volume at the implant-supported single crowns. [source] The Marius Implant Bridge: Surgical and Prosthetic Rehabilitation for the Completely Edentulous Upper Jaw with Moderate to Severe Resorption: A 5-Year Retrospective Clinical StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2002Yvan Fortin DDS ABSTRACT Background: Patients seeking replacement of their upper denture with an implant-supported restoration are most interested in a fixed restoration. Accompanying the loss of supporting alveolar structure due to resorption is the necessity for lip support, often provided by a denture flange. Attempts to provide a fixed restoration can result in compromises to oral hygiene based on designs with ridge laps. An alternative has been an overdenture prosthesis, which provides lip support but has extensions on to the palate and considerations of patient acceptance. The Marius bridge was developed as a fixed bridge alternative offering lip support that is removable by the patient for hygiene purposes, with no palatal extension beyond normal crown-alveolar contours. Purpose: Implant-supported restorative treatment of completely edentulous upper jaws, as an alternative to a complete denture, is frequently an elective preference, and it requires significant patient acceptance beyond the functional improvement of chewing. Patients with moderate to severe bone resorption and thin ridges present additional challenges for adequate bone volume and soft-tissue contours. The purpose of this investigation was to develop a surgical and prosthetic implant treatment protocol for completely edentulous maxillae in which optimal lip support and phonetics is achieved in combination with substantial implant anchorage without bone grafting. Materials and Methods: The Marius bridge is a complete-arch, double-structure prosthesis for maxillae that is removable by the patient for oral hygiene. The first 45 consecutive patients treated by one person (YF) in one center with this concept are reported, with 245 implants followed for up to 5 years after prostheses connection. Results: The cumulative fixture survival rate for this 5-year retrospective clinical study was 97%. Five fixtures failed before loading, in five different patients, and two fixtures in the same patient failed at the 3-year follow-up visit. None of the bridges failed, giving a prostheses survival rate of 100%. The complications were few and mainly prosthetic: nine incidences of attachment component complications, one mesobar fracture, and three reports of gingivitis. All complications were solved or repaired immediately, with minimal or no interruption of prostheses use. Conclusions: Satisfactory medium-term results of survival and patient satisfaction show that the Marius bridge can be recommended for implant dentistry. The technique may reduce the need for grafting, because it allows for longer implants to be placed with improved bone anchorage and prostheses support. [source] The use of porous calcium phosphate scaffolds with transforming growth factor beta 1 as an onlay bone graft substituteCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2004An experimental study in rats Abstract Objectives: Autogeneous bone grafting is regarded to be the golden standard for onlay grafts, but it requires a harvesting procedure and the remodeling pattern over time is unpredictable. New materials are constantly being sought to overcome these problems. An in vivo experiment was carried out to evaluate whether (1) porous calcium phosphate cement is a suitable biomaterial for onlay bone grafting, and (2) the addition of transforming growth factor beta 1 (TGF-,1) accelerates de novo bone formation inside the cement porosity. Material and methods: A carrier of porous calcium phosphate cement (Calcibon®) was designed and 16 rats received one preshaped implant each. In 8 out of 16 implants 0.75 ,g TGF-,1 was applied. The animals were killed after 4 weeks and the characteristics of tissue ingrowth into the onlay graft were evaluated. Results: Histologic and quantitative histomorphometrical measurements demonstrated osteoid-like tissue formation in both experimental groups. The addition of TGF-,1 did not induce significantly more osteoid-like tissue formation. On the other hand, in TGF-,-loaded implants, a higher number of pores contained an inflammatory infiltrate. Conclusion: This study indicated that porous calcium phosphate cement is a promising material for clinical situations where bone formation has to be supported. Résumé La greffe osseuse autogčne est considérée comme la meilleure technique actuelle pour les greffons onlay mais elle requiert un processus de prélevement et le remodelage qui s'en suit est imprévisible. De nouveaux matériaux sont donc constamment recherchés. Cette étude in vitro a essayé d'évaluer si 1) le cément phosphate calcium poreux était un biomatériel favorable pour le greffage osseux onlay, 2) si l'addition de TGF-,1 accélérait la néoformation osseuse ŕ l'intérieur de la porosité du cément. Un porteur de cément phosphate calcium poreux (Calcibon®) a été fabriqué et seize rats ont reçu chacun un implant prédécoupé. Au niveau de huit des seize implants 0,75 ,g de TGF ,1 a été appliqué. Les animaux ont été euthanasiés aprčs quatre semaines et les caractéristiques de la croissance interne tissulaire dans le greffon onlay ont étéévaluées. Les mesures histologiques et histomorphométriques quantitatives ont démontré une formation tissulaire semblable ŕ l'ostéogénie dans les deux groupes expérimentaux. L'addition de TGF-ß1 n'induisait pas plus de formation tissulaire ressemblant ŕ celle d'ostéogénie. D'un autre côté, dans les implants chargés de TGF-,1, un nombre plus important de pores contenaient un infiltrat inflammatoire. Cette étude indique que le cément phosphate calcium poreux est un matériau prometteur pour les situations cliniques dans lesquelles la formation osseuse doit ętre améliorée. Zusammenfassung Ziel: Die Transplantation von autologem Knochen wird heute als Goldstandard für die Onlay-Transplantate betrachtet. Es braucht dazu aber einen zusätzlichen Eingriff für die Entnahme und eine Prognose bezüglich der anschliessenden Remodellationsvorgänge sind kaum möglich. Man sucht ständig nach neuen Produkten, um diese Probleme zu überwinden. Man führte eine in vivo Studie durch und untersucht, ob (1) ein poröser Kalziumphosphatzement ein brauchbares Biomaterial für ein Onlay-Transplantat ist, und (2) der Zusatz von TGF-,1 die Neubildung von Knochen in den Porositäten des Zementes positiv beeinflusst. Material und Methode: Man entwickelte einen Trägerzement aus porösem Kalziumphosphat (Calcibon®) und 16 Ratten erhielten je ein vorgeformtes Implantat eingesetzt. Bei 8 der 16 Implantate fügte man zusätzlich 0.75 ,g TGF-,1 dazu. Vier Wochen später opferte man die Tiere und konnte nun die Charakteristika des in die Implantate einwachsenden Gewebes untersuchen. Resultate: Die histologischen und quantitativen histomorphometrischen Messungen zeigten in beiden experimentellen Gruppen osteoidähnliche Gewebsbildungen. Der Zusatz von TGF-,1 bewirkte keine signifikante Zunahme dieser osteoidähnlichen Gewebsbildungen. Die mit TGF-,1 durchsetzten Implantate enthielten aber mehr mit entzündlichem Infiltrat angefüllte Poren. Zusammenfassung: Diese Arbeit zeigte uns, dass ein poröser Kalziumphosphatzement bei klinischen Situationen, wo die Knochenbildung unterstützt werden muss, ein erfolgsversprechendes Material ist. Resumen Objetivos: El injerto de hueso autógeno está considerado como el estándar de oro para injertos superpuestos, pero requiere un procedimiento de recolección y el patrón de remodelado a lo largo del tiempo es impredecible. Constantemente se están buscando materiales nuevos para superar estos problemas. Se llevó a cabo un experimento in vivo para evaluar si (1) el cemento de fosfato cálcico poroso es un biomaterial apropiado para injerto óseo superpuesto, y (2) la adición de TGF-,1 acelera la formación de hueso de novo dentro de la porosidad del cemento. Material y Métodos: Se diseńó un portador de cemento de fosfato cálcico (Calcibon®) y 16 ratas recibieron un implante preformado cada una. En 8 de 16 implantes se aplicaron 0.75 ,g de TGF-,1. Los animales se sacrificaron tras 4 semanas y se evaluaron las características del tejido crecido hacia adentro del injerto superpuesto. Resultados: Las mediciones histológicas e histomorfométricas cuantitativas demostraron formación de tejido tipo osteoide en ambos grupos experimentales. La adición de TGF-,1 no indujo significativamente más formación de tejido tipo osteoide. Por otro lado, en los implantes cargados con TGF-,1, un mayor número de de poros contenían infiltrado inflamatorio. Conclusión: Este estudio indica que el cemento de fosfato cálcico poroso es un material prometedor para situaciones clínicas donde la formación de hueso ha de ser favorecida. [source] High concentrations of bioactive glass material (BioGran®) vs. autogenous bone for sinus floor elevationCLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2002Histomorphometrical observations on three split mouth clinical cases Abstract: In this study, high concentrations of bioactive glass (BG) particles were compared with autogenous bone in their capacity to augment maxillary bone when grafted in the human sinus floor using a split mouth design. Three female patients with severe maxillary atrophy underwent bilateral sinus floor elevation and bone grafting using 80,100% BG particles (300,355 ,m in size) mixed with 20% to 0% iliac crest bone particles at one (experimental) side, and 100% iliac crest derived bone particles at the other (control) side. A total of 22 bone biopsies was taken at the time of fixture installation; that is, at 4, 6 and 15 months after grafting, and processed for histology and histomorphometry. At the control (autogenous bone) sides, trabecular bone amounted to 39% of the biopsy volume in the graft (site) at 4 months, almost 41% at 6 months, and 42% at 15 months. This bone contained viable osteocytes and was mostly of mature, lamellar type. At the experimental (BG particles) sides, the graft consisted of 27% of mostly woven (and some lamellar) bone at 4 months, 36% (woven and lamellar) bone at 6 months, and 39% (mainly lamellar) bone at 15 months. The grafted BG particles started to excavate at 4 months and their centers gradually filled with bone tissue. As a consequence, the volume of BG particles in the biopsy decreased from 29% at 4 months to 15% at 6 months and 8% at 15 months. The BG particles appeared to resorb within 1,2 years by dissolution rather than by osteoclastic activity. Parameters for bone turnover (% osteoid surface, % resorption surface) indicated that bone remodeling was very active at both experimental and control sides, during more than 6 months. These results suggest that mixtures of mainly (80,90%) BG particles and some (10,20%) autogenous bone are effective for bone regeneration in the augmented sinus offer 6 months healing time, while about 12 months healing time is needed for 100% BG particles. [source] | ||||||||||||||||||||||