Background : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
Different techniques and grafting materials have been used for the horizontal reconstruction of deficient alveolar processes before implant placement, resulting in different degrees of predictability and clinical outcomes [1]. Among the grafting materials, particulated xenogeneic materials have been extensively studied in both experimental and clinical studies and when combined with porcine-derived natural collagen membranes have resulted in predictable clinical and histological outcomes [2].This combined treatment has shown to be safe and efficacious in horizontal ridge augmentations resulting in regenerated bone with similar implant survival rates when compared to implants placed in pristine bone and demonstrating a low degree of morbidity and a low rate of post-operative complications [3, 4]. However, in clinical situations with severe bone resorption of the alveolar process, which results in non-self-containing bone defects, the use of particulate bone replacement grafts with its inherent weak volumetric stability may limit the predictability of the regenerative therapy [5, 6]. In these cases, dental implants are usually placed staged to the lateral bone augmentation procedure and autogenous bone blocks have been the state of the art procedure, resulting in superior results in mean horizontal bone gains when compared with guided bone regeneration with particulate bone grafts [4, 7, 8]. The use of bone blocks, however, has been associated with increased surgical time, morbidity [9, 10], and a higher frequency of post-operative complications [11, 12]. Moreover, the availability for harvesting intraoral bone blocks is limited [13, 14] and these autologous bone grafts may suffer a high degree of bone resorption during healing [15].
To overcome these limitations, the use of xenogeneic bone grafts as an alternative to autogenous bone blocks has been proposed [16]. Recently, a new equine-derived collagen containing xenogeneic bone block (CCXBB) was evaluated in preclinical studies [17, 18], demonstrating to be safe and adequate for ridge augmentation and better graft integration when compared to other xenogeneic bone blocks. Its performance in humans has been recently tested on 10 patients where these xenogeneic bone blocks were placed in single-tooth alveolar bone defects [19]. Clinically, a mean horizontal gains of 3.88 ± 1.75 mm was reported and the histological outcomes resulted in a homogeneous new bone formation within the CCXBB. These results were concordant with a recent histological study also reporting that equine bone grafts were biocompatible and underwent advanced remodelling at the time of implant placement [20]. Although this preliminary evidence on the performance and histological behaviour of equine bone blocks seems promising, there is still limited information when used in staged horizontal bone augmentation of large osseous defects. It was, therefore, the aim of this prospective study to evaluate the histological outcomes of CCXBB blocks used for lateral bone augmentation in large alveolar horizontal defects of at least two adjacent missing teeth.
Serial posts:
- Abstract : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Background : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Methods : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [1]
- Methods : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [2]
- Methods : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [3]
- Methods : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [4]
- Results : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [1]
- Results : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [2]
- Discussion : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [1]
- Discussion : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [2]
- Discussion : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [3]
- Conclusions : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Abbreviations : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- References : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [1]
- References : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [2]
- References : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [3]
- References : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [4]
- References : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [5]
- Acknowledgements : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [1]
- Acknowledgements : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement [2]
- Author information : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
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- About this article : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Table 1 Clinical and histomorphometry assessments (i.e., dehiscences, mineralized bone, CCXBB, bone marrow, connective tissue, and implant lost) : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Table 2 Quantitative histological analysis : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Table 3 Immunohistochemical markers proportions (i.e., TRAP, OPN, ALP, and OSC) : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Table 4 Implant loss and tissue characteristics : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement
- Fig. 1. Study chart and follow-up visits : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b Perforations and adaptation of the cortical layer. c Shaping, pre-wetting and fixation of CCXBB with titanium screws. d Horizontal contour and peripheral gap between CCXBB and bone layer. e Outlying DBBM filling. f CM stabilized with pins : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Horizontal bone augmentation. c Screws and pins removal and bone trephine sampling. d Implants placement and buccal bone width from the implant shoulder. e Primary flap closure. f Implants submerged healing : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 4. Histological samples. a CCXBB control without implantation. b Histologic samples with acute inflammatory infiltration. c Histologic sample with limited remaining CCXBB and large bone ingrowth : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 5. Histomorphometric analysis of the same sample. a Ground section stained with Levai-Laczkó. b Tissue identification of the ROI. c Closer view aarrow pointing a cement line between new mineralized bone and CCXBB. d Closer view of b : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 6. Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 7. Second stage surgery of patient in Fig. 1. a Vestibular depth reduction after augmentation and implant placement. b Partial thickness and apical repositioned flap. c CMX healing and soft tissue dehiscence with CCXBB exposure. d Dehiscence healing after re-contouring and buccal emergency profile. e Buccal aspect of the final restoration. f Buccal ridge contour : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant
- Fig. 8. Soft tissue dehiscence (a) CCXBB exposure 15 weeks after bone augmentation, the dehiscence healed 2 weeks later after reducing the graft exposure (b) after soft tissue augmentation and abutment connection leading to the loss of the mesial implant. After partial removal of the bone graft and place a connective tissue graft the area healed properly and a month later it was possible to replace the implant : Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant