Fig. 20. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 20. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 19. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 19. Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration
Fig. 18. Finalized prosthetic restoration after 1Â year
Fig. 18. Finalized prosthetic restoration after 1Â year
Fig. 17. Histology of dentin augmentation. aactive process in the bone marrow lacunae with osteoblast rimming. No signs of necrosis or infection (H&E stain, Ă—100 magnification). b Larger magnification at Ă—200. c EvG (Elastica van Gieson) stain, Ă—200
Fig. 17. Histology of dentin augmentation. a Asterisk denotes incorporated dentin particle, surrounded by vital woven bone. Triangle shows rea...
Fig. 16. Single tooth X-ray, 1Â year post-implantation, showing the finalized crown
Fig. 16. Single tooth X-ray, 1Â year post-implantation, showing the finalized crown
Fig. 15. Single tooth X-ray, showing a constant bone level 7Â months after implant placement
Fig. 15. Single tooth X-ray, showing a constant bone level 7Â months after implant placement
Fig. 14. Single tooth X-ray immediately after the augmentation using autogenous dentin
Fig. 14. Single tooth X-ray immediately after the augmentation using autogenous dentin
Fig. 13.
Fig. 13. a, b Clinical situation prior to implant placement
Fig. 12. Axial view
Fig. 12. Axial view
Fig. 11. Sagittal view
Fig. 11. Sagittal view
Fig. 10. Soft tissue graft placed on the recipient site
Fig. 10. Soft tissue graft placed on the recipient site
Fig. 9. Soft tissue punch
Fig. 9. Soft tissue punch
Fig. 8. Autologous, particulated dentin in the alveolar socket
Fig. 8. Autologous, particulated dentin in the alveolar socket
Fig. 7. Autologous, particulated dentin mixed with blood from the operating site
Fig. 7. Autologous, particulated dentin mixed with blood from the operating site
Fig. 6. Autologous dentin with the desired particle size
Fig. 6. Autologous dentin with the desired particle size
Fig. 5. Autologous dentin in a bone mill
Fig. 5. Autologous dentin in a bone mill
Fig. 4. Removal of enamel and the cementum
Fig. 4. Removal of enamel and the cementum
Fig. 3. Removal of the pulp
Fig. 3. Removal of the pulp
Fig. 2. The remaining root of tooth 11
Fig. 2. The remaining root of tooth 11
Fig. 1. Extraction with the benex system
Fig. 1. Extraction with the benex system
Valdec, S., Pasic, P., Soltermann, A. et al. Alveolar ridge preservation with autologous particulated dentin—a case series. Int J Implant Dent 3, 12 (2017). https://doi.org/10.1186/s40729-017-0071-9
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Received: 07 December 2016
Accepted: 15 March 2017
Published: 30 March 2017
DOI: https://doi.org/10.1186/s40729-017-0071-9
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, University Hospital Zurich, Plattenstrasse 11, 8032, ZĂĽrich, Switzerland
Silvio Valdec, Pavla Pasic, Bernd Stadlinger & Martin Rücker
Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
Alex Soltermann
Clinic of Fixed and Removable Prosthodontics and Dental Mater...
We would like to express our thanks to Dr. Gabriel Bosch for the superimposition, calculation and illustration of the intraoral scans.
SV, BS and MR created the conception and study design. MR performed the surgical and DT the prosthodontic treatment. SV, PP and DT performed the data collection and AS the histological examination. SV, BS and AS analysed and interpreted the data. SV drafted the ma...
Sculean A, Berakdar M, Chiantella GC, Donos N, Arweiler NB, Brecx M. Healing of intrabony defects following treatment with a bovine-derived xenograft and collagen membrane. A controlled clinical study. J Clin Periodontol. 2003;30(1):73–80.
Sutton DN, Lewis BR, Patel M, Cawood JI. Changes in facial form relative to progressive atrophy of the edentulous jaws. Int J Oral Maxillofac Surg. 2004;33(7...
Liu X, Li Q, Wang F, Wang Z. Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: a comparative study in beagles. Arch Oral Biol. 2016;64:102–8. doi:10.1016/j.archoralbio.2016.01.004.
Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from ex...
Furhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16(6):639–44. doi:10.1111/j.1600-0501.2005.01193.x.
Guirado JL, Troiano M, Lopez-Lopez PJ, Ramirez-Fernandez MP, de Val JE, Marin JM, Gehrke SA. Different configuration of socket shield technique in peri-implant bone...
Al-Asfour A, Andersson L, Kamal M, Joseph B. New bone formation around xenogenic dentin grafts to rabbit tibia marrow. Dent Traumatol. 2013;29(6):455–60. doi:10.1111/edt.12045.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.
Andersson L. Den...
Within the limits of this case series, it has been shown that particulated dentin of autologous teeth may serve as an alternative to autologous bone for alveolar ridge preservation prior to implant therapy. However, randomized studies on this treatment option are necessary.
In humans, particulated tooth material has been used for sinus augmentation in order to enhance implant therapy. Preliminary results from five patients histologically showed an osteoconductive osteogenesis with partial resorption of tooth components [25].
In the present case series, all patients underwent socket preservation with AutoPD. In all cases, one or two upper frontal central incisors wer...
The aim of this case series is to demonstrate the efficacy and safety of this novel augmentative procedure for ridge preservation prior to implant therapy. This shall serve as a basis for a prospective study.
In all four cases, patients showed a stable volume of soft and hard tissues after the augmentation with AutoPD and good osseointegration of titanium implants, having been placed in this augm...
Four months post-extraction and augmentation with autologous, particulated dentin, all four patients received an implant placement in the augmented area. In all cases, a CBCT was taken in between the dentin augmentation and the implant placement.
During implant placement, a biopsy of the bone from the augmented area was taken for histological examination (Fig. 17).
The final prosthetic solution...
The 1-year follow-up examination of the presented case showed an implant success, according to the appropriate clinical criteria [2] (Figs. 14, 15 and 16).
The pink esthetic score (PES) was used for the evaluation of reproducible soft tissue around the final implant crown as a parameter for the aesthetic outcome [12]. Seven variables were evaluated comparing the soft tissue around the implant wi...
An autologous soft tissue graft was harvested from the patient’s palate using a soft tissue punch (Biopsy Punch, kai Europe GmbH, Solingen, Germany) (Fig. 9). The graft had a comparable dimension as the recipient site. The gingival graft was placed on top of the augmentation material, adapted and carefully sutured to the marginal gingiva after the sulcus epithelium was removed with a rotating d...
Four patients between 36 and 65Â years of age are presented in this case series. There was no financial compensation. All four patients suffered from a trauma, causing damage to one or two teeth of the anterior maxilla. The frontal tooth/teeth has/had to be extracted. The pulp of the extracted teeth of three patients and the root canal filling of one patient had to be removed. All patients were in...
Subsequent to tooth extraction, a resorption of the host bone as defined by atrophy of the alveolar ridge can be observed. Sutton et al. classified the different degrees of alveolar ridge atrophy [32]. Bone resorption especially occurs in the frontal and premolar area of the jaw in the region of the thin buccal lamella. This may lead to a change in contour [11, 28]. Physiological reason for this a...
Ridge preservation can be performed with autologous bone, alloplastic bone substitute material or a combination of both. Dentin is similar to bone in its chemical composition. In its use as bone substitute material, it undergoes a remodelling process and transforms to bone. The presented case report introduces a technique in which the extraction socket is augmented with autologous, particulated de...
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 5. Histomicrograph of a biopsy from the BC + EMD group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (d) and linearly polarized light (e and f). e, f Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized l...
Fig. 4. Histomicrograph of a biopsy from the BC group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (a) and linearly polarized light (b and c). b, c Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized light. In a...
Fig. 3. Histomicrograph of a biopsy from the BC + EMD group. Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC + EMD removed during histological processing (square) surrounded by newly formed bone (asterisk), with large numbers of osteocytes and soft tissue (arrow) can be observed. There is direct contact between the BC reminiscent, soft...
Fig. 2. Histomicrograph of a biopsy from the BC group. a Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC removed during histological processing (square) in direct contact with newly formed bone (asterisk), containing a large number of osteocytes, and with soft tissue (arrow) can be observed (hematoxylin-eosin stain)
Fig. 2. Histomicrograph ...
Fig. 1. Histomicrograph illustrating the various tissue areas measured on the sections: newly formed bone (green mask), soft tissues (purple mask), and “others”, including residual bone substitute particles and empty spaces either due to removal of the bone substitute particles during to the decalcification processing or due to artifacts (white mask)
Fig. 1. Histomicrograph illustrating t...
Nery, J.C., Pereira, L.A.V.D., Guimarães, G.F. et al. β-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.
Int J Implant Dent 3, 18 (2017). https://doi.org/10.1186/s40729-017-0080-8
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Received: 08 December 2016
Accepted: 22 April 2017
Published: 04 May 2017
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
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Correspondence to
James Carlos Nery.
Department of Implantology, SĂŁo Leopoldo Mandic Research Center, BrasĂlia, DF, Brazil
James Carlos Nery, George Furtado Guimarães & Fabiana Mantovani Gomes França
Department of Biochemistry and Tissue Biology, UNICAMP – State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
LuĂs AntĂ´nio Violin Dias Pereira
Department of Periodontology, UNESP – Univ. Estad...
Wikesjo UM, Sorensen RG, Kinoshita A, Wozney JM. RhBMP-2/alphaBSM induces significant vertical alveolar ridge augmentation and dental implant osseointegration. Clin Implant Dent Relat Res. 2002;4:174–82.
Carinci F, Brunelli G, Franco M, Viscioni A, Rigo L, Guidi R, et al. A retrospective study on 287 implants installed in resorbed maxillae grafted with fresh frozen allogenous bone. Clin Implant...
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–83.
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015;68:182â...
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;17:CD008397.
Jungner M, Cricchio G, Salata LA, Sennerby L, Lundqvist C, Hultcrantz M, et al. On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study. ...
The present study showed that maxillary sinus floor augmentation with BC resulted in adequate amounts of new bone formation allowing successful implant installation, while adding EMD did not have a significant effect.
Nevertheless, the amount of bone generated with BC or BC + EMD herein was adequate to support successful implant placement and osseointegration of implants. In fact, more or less similar amounts of bone formation have been reported in studies evaluating human sinus biopsies after grafting with a variety of biomaterials (bone formation ranging approximately from 30 to 50%) [19]. On the other ha...
The present study compared the histological and histomorphometrical outcome of healing after maxillary sinus floor augmentation with BC with or without EMD, based on human biopsies. The results showed that addition of EMD did not enhance the outcome of healing, neither in terms of quality nor quantity of new bone. Nevertheless, the amount of bone generated after maxillary sinus floor augmentation ...
All ten patients showed uneventful healing after the sinus floor augmentation procedure as well as after dental implant placement, with no overt postoperative inflammation or infection. Consistently, in all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implant...
The data for each tissue component from the three histological sections were averaged to represent the biopsy. Commercially available software (GraphPad Prism 5.0 for Windows, GraphPad Software Inc., USA) was utilized for statistical comparisons between groups and for drawing the graphics. The assumption of normality was checked using D’Agostino & Pearson omnibus test. The data for each evaluate...
Six months after grafting, another CBCT examination was carried out for implant planning. In the sequence, following the previously described antiseptic and anesthetic procedures, two implants with a sand-blasted and acid etching surface were installed in each of the grafted sinuses, i.e., 40 implants in total (32—Neoporous, Neodent, Curitiba, Paraná, Brazil; 8—SLA, Straumann, Basel, Switzerl...
This research project was approved by the Ethics Committee of the School of Dentistry and Dental Research Center SĂŁo Leopoldo Mandic, Brazil, under the protocol 2010/0360.
Ten consecutive patients (age range 35–75 years) with the need of bilateral maxillary sinus floor augmentation prior to the placement of four dental implants (two in each side of posterior maxilla) were selected for the stu...
The aim of the present study was to compare histomorphometrically the outcome of maxillary sinus floor augmentation with β-TCP/HA with or without enamel matrix proteins (BC + EMD and EMD, respectively) in humans.
Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Various bone graft materials are typically used for enhancing bone formation within the sinus cavity; autogenous bone (AB) is considered as the gold standard due to its osteogenic, osteoinductive, and osteoconductive...
It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.
In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the ot...
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 5. Histomicrograph of a biopsy from the BC + EMD group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (d) and linearly polarized light (e and f). e, f Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized l...
Fig. 4. Histomicrograph of a biopsy from the BC group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (a) and linearly polarized light (b and c). b, c Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized light. In a...
Fig. 3. Histomicrograph of a biopsy from the BC + EMD group. Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC + EMD removed during histological processing (square) surrounded by newly formed bone (asterisk), with large numbers of osteocytes and soft tissue (arrow) can be observed. There is direct contact between the BC reminiscent, soft...
Fig. 2. Histomicrograph of a biopsy from the BC group. a Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC removed during histological processing (square) in direct contact with newly formed bone (asterisk), containing a large number of osteocytes, and with soft tissue (arrow) can be observed (hematoxylin-eosin stain)
Fig. 2. Histomicrograph ...
Fig. 1. Histomicrograph illustrating the various tissue areas measured on the sections: newly formed bone (green mask), soft tissues (purple mask), and “others”, including residual bone substitute particles and empty spaces either due to removal of the bone substitute particles during to the decalcification processing or due to artifacts (white mask)
Fig. 1. Histomicrograph illustrating t...
Nery, J.C., Pereira, L.A.V.D., Guimarães, G.F. et al. β-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.
Int J Implant Dent 3, 18 (2017). https://doi.org/10.1186/s40729-017-0080-8
Download citation
Received: 08 December 2016
Accepted: 22 April 2017
Published: 04 May 2017
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
You can also search for this author in
PubMed Google Scholar
Correspondence to
James Carlos Nery.
Department of Implantology, SĂŁo Leopoldo Mandic Research Center, BrasĂlia, DF, Brazil
James Carlos Nery, George Furtado Guimarães & Fabiana Mantovani Gomes França
Department of Biochemistry and Tissue Biology, UNICAMP – State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
LuĂs AntĂ´nio Violin Dias Pereira
Department of Periodontology, UNESP – Univ. Estad...
Wikesjo UM, Sorensen RG, Kinoshita A, Wozney JM. RhBMP-2/alphaBSM induces significant vertical alveolar ridge augmentation and dental implant osseointegration. Clin Implant Dent Relat Res. 2002;4:174–82.
Carinci F, Brunelli G, Franco M, Viscioni A, Rigo L, Guidi R, et al. A retrospective study on 287 implants installed in resorbed maxillae grafted with fresh frozen allogenous bone. Clin Implant...
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–83.
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015;68:182â...
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;17:CD008397.
Jungner M, Cricchio G, Salata LA, Sennerby L, Lundqvist C, Hultcrantz M, et al. On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study. ...
The present study showed that maxillary sinus floor augmentation with BC resulted in adequate amounts of new bone formation allowing successful implant installation, while adding EMD did not have a significant effect.
Nevertheless, the amount of bone generated with BC or BC + EMD herein was adequate to support successful implant placement and osseointegration of implants. In fact, more or less similar amounts of bone formation have been reported in studies evaluating human sinus biopsies after grafting with a variety of biomaterials (bone formation ranging approximately from 30 to 50%) [19]. On the other ha...
The present study compared the histological and histomorphometrical outcome of healing after maxillary sinus floor augmentation with BC with or without EMD, based on human biopsies. The results showed that addition of EMD did not enhance the outcome of healing, neither in terms of quality nor quantity of new bone. Nevertheless, the amount of bone generated after maxillary sinus floor augmentation ...
All ten patients showed uneventful healing after the sinus floor augmentation procedure as well as after dental implant placement, with no overt postoperative inflammation or infection. Consistently, in all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implant...
The data for each tissue component from the three histological sections were averaged to represent the biopsy. Commercially available software (GraphPad Prism 5.0 for Windows, GraphPad Software Inc., USA) was utilized for statistical comparisons between groups and for drawing the graphics. The assumption of normality was checked using D’Agostino & Pearson omnibus test. The data for each evaluate...
Six months after grafting, another CBCT examination was carried out for implant planning. In the sequence, following the previously described antiseptic and anesthetic procedures, two implants with a sand-blasted and acid etching surface were installed in each of the grafted sinuses, i.e., 40 implants in total (32—Neoporous, Neodent, Curitiba, Paraná, Brazil; 8—SLA, Straumann, Basel, Switzerl...
This research project was approved by the Ethics Committee of the School of Dentistry and Dental Research Center SĂŁo Leopoldo Mandic, Brazil, under the protocol 2010/0360.
Ten consecutive patients (age range 35–75 years) with the need of bilateral maxillary sinus floor augmentation prior to the placement of four dental implants (two in each side of posterior maxilla) were selected for the stu...
The aim of the present study was to compare histomorphometrically the outcome of maxillary sinus floor augmentation with β-TCP/HA with or without enamel matrix proteins (BC + EMD and EMD, respectively) in humans.
Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Various bone graft materials are typically used for enhancing bone formation within the sinus cavity; autogenous bone (AB) is considered as the gold standard due to its osteogenic, osteoinductive, and osteoconductive...
It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.
In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the ot...
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
Fig. 6 Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC
ple. a Ground section stained with Levai-LaczkĂł. b Tissue identification of the ROI. c Closer view a bone and CCXBB. d Closer view of b
Fig. 5. Histomorphometric analysis of the same sample. a Ground section stained with Levai-LaczkĂł. b Tissue identification of the ROI. c Closer view a arrow pointing a cement line between new mineralized bone and CCXBB. d Closer view of b
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
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 ingr...
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
Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Ho...
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
Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b ...
Fig. 1. Study chart and follow-up visits
Fig. 1. Study chart and follow-up visits
Differentiated tissues
Implant lost (Yes/no)
Mean
SD
Percentage
SD (%)
...
Patient
TRAP (%)
OPN (%)
ALP (%)
OSC (%)
1
...
Tissue type
Mean
Standard deviation
Median
CI 95%
Mineralized bone
...
Patient
Soft tissue dehiscence
Mineralized bone (%)
CCXBB (%)
Bone marrow (%)
Connect...
Ortiz-VigĂłn, A., Martinez-Villa, S., Suarez, I. et al. Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement.
Int J Implant Dent 3, 24 (2017). https://doi.org/10.1186/s40729-017-0087-1
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Received: 21 March 2017
Accepted: 12 June 2017
Published: 21 Ju...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
ETEP Research Group, Facultad de OdontologĂa, Universidad Complutense de Madrid, Plaza RamĂłn y Cajal, 28040, Madrid, Spain
Alberto Ortiz-Vigón, Sergio Martinez-Villa, Iñaki Suarez, Fabio Vignoletti & Mariano Sanz
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We wish to acknowledge the dedication and scientific advise of Prof. Dr. Tord Berglundh on the histological analysis as well as the diligent work in processing the histological samples to Estela Maldonado for the immunohistochemistry and Asal Shikhan and Fernando Muñoz for the histomorphometry. The work of Esperanza Gross on the statistical analysis is highly acknowledged.
This study was partial...
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Dias RR, Sehn FP, de Santana Santos T, Silva ER, Chaushu G, Xavier SP. Corticocancellous fresh-frozen allograft bone blocks for augmenting atrophied posterior mandibles in humans. Clin Oral Implants Res. 2016;27:39–46.
Nissan ...
Cremonini CC, Dumas M, Pannuti C, Lima LA, Cavalcanti MG. Assessment of the availability of bone volume for grafting in the donor retromolar region using computed tomography: a pilot study. Int J Oral Maxillofac Implants. 2010;25:374–8.
Nkenke E, Weisbach V, Winckler E, Kessler P, Schultze-Mosgau S, Wiltfang J, et al. Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic...
Sanz M, Vignoletti F. Key aspects on the use of bone substitutes for bone regeneration of edentulous ridges. Dent Mater. 2015;31:640–7.
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Beretta M, Cicciu M, Poli PP, Rancitelli D, Bassi G, Grossi GB, et al. A Retrospective Evaluation of 192 Implants Placed in Augmented Bon...
Alkaline phosphatase
Cone beam computed tomography
Collagen containing xenogeneic bone block
Native collagen membrane
Deproteinized bovine bone mineral
Etiology and Therapy of Periodontal Diseases
Osteopontin
Osteocalcine
Tartrate-resistant acid phosphatase
Within the limitations of this clinical study, we may conclude that the use of CCXBB in combination with DBBM particles and a native bilayer collagen membrane for staged lateral bone augmentation in severe atrophic alveolar crests achieved significant horizontal crestal width allowing for staged implant placement in most of the patients. Histological analysis and implant survival records indicate ...
The immune-histochemical results reported expression of osteopontin mainly at the border between mineralized vital bone (MVB) with CCXBB, what coincides with findings from previous reports [38,39,40]. Alkaline phosphatase (ALP) is considered as an early osteoblast differentiation marker [41]. ALP-positive cells were detectable, in all specimens on the periphery of MVB, associated to areas of new b...
When correlating the clinical results and the histological outcomes, there was a positive association between the presence of soft tissue dehiscence with CCXBB exposure and a diminished amount of new mineralized bone (p = 0.06). This lower amount of new bone within the xenogeneic graft suggests a lack of full graft integration and diminished vascular supply, what may have caused the soft tissu...
The purpose of this investigation was to evaluate histologically and immunohistochemically the behavior of CCXBB blocks when used for staged lateral bone augmentation in severe human horizontal residual bone defects. Six months after the regenerative intervention using the CCXBB blocks, the mean increase in bone width was 4.12Â mm and hence, this outcome allowed for the placement of dental implant...
The results from the histomorphometric measurements are depicted in Table 2. Bone biopsies were composed by 21.37% (SD 7.36) of residual CCXBB, 26.90% (SD 12.21) of mineralized vital bone (MVB), 47.13% (SD 19.15) of non-mineralized tissue and 0.92% of DBBM (Fig. 5b). Biopsies from patients who lost their implants had a statistical significant lower amount of MVB (p = 0.01u) and a statistical...
Twenty-eight CCXBB blocks were placed in 15 patients that fulfilled the selection criteria (12 women and 3 men) with a mean age of 54.5 (SD 8.34).
The detailed clinical and radiographical outcomes have been reported previously [21]. In brief, one patient experienced pain and soft tissue dehiscence leading to removal of the graft material 3Â days after the regenerative procedure. Another patient r...
For the immunohistochemical analysis, the semi-thin sections were incubated over night with primary antibodies at 4 °C (Santa Cruz Biotechnology Inc., Santa Cruz, Calif., USA). The antibody dilutions used were alkaline phosphatase (ALP) 1:100, osteopontin (OPN) 1:100, osteocalcin (OSC) 1:100, and tatrate resistant acid phosphatase (TRAP) 1:100.
The obtained semi-thin sections were evaluated wit...
Twenty-six weeks after the regenerative procedure the patient returned for the re-entry intervention for placement of dental implants. After raising full-thickness flaps, the augmented area was exposed and horizontal crestal width measurements were performed. Then, the surgeon evaluated the bone availability and if implant placement was considered possible, a core bone biopsy was harvested with th...
CCXBB (Bio-Graft® Geistlich Pharma) is a bone substitute material in a natural block form. The dimensions of the Bio-Graft block are 10 mm in height, 10 mm in length and 5 mm in width. It consists of a natural cancellous bone structure of hydroxyapatite and endogenous collagen type I and III, equine origin and is a class III medical device according to the Medical Device Directive 93/42 EECsâ€...
The present manuscript reports the histological outcomes of a prospective single arm study evaluating the safety and clinical performance of CCXBB blocks when used as replacement bone grafts for lateral bone augmentation prior to staged implant placement. The results of the clinical and radiographic outcomes have been reported in a previous publication [21]. For correlation of the histological wit...
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-derive...
The osteoconductive properties of collagen containing xenogeneic bone blocks (CCXBB) remain unclear. The aim of this prospective single-arm clinical study was to assess the histological outcomes of CCXBB blocks used as bone replacement grafts for lateral bone augmentation procedures.
In 15 patients with severe horizontal alveolar ridge resorption, lateral augmentation procedures were performed us...
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification Ă—100)
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification Ă—100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification Ă—100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification Ă—100)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification Ă—10)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification Ă—10)
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 1. Images of patient # 5 (9-month healing time). a. Radiograph of the left maxillary sinus: situation 9 months after the maxillary sinus floor elevation procedure. b. With a trephine drill, the implant osteotomy is made and the biopsy is obtained. c. Clinical situation after placing two Straumann® SLA implants in the left posterior maxilla. d. Radiograph of two Straumann® SLA implants in...
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...
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Authors W.F. Bouwman, N. Bravenboer, J.W.F.H. Frenken, C.M. ten Bruggenkate and E.A.J.M. Schulten state that there are no conflicts of interest, either directly or indirectly.
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Correspondence to
E. A. J. M. Schulten.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
W. F. Bouwman, C. M. ten Bruggenkate & E. A. J. M. Schulten
Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
N. Bravenboer
Department of Oral and Maxillofacial Su...
Groeneveld EH, van den Bergh JP, Holzmann P, ten Bruggenkate CM, Tuinzing DB, Burger EH. Mineralization processes in demineralized bone matrix grafts in human maxillary sinus floor elevations. J Biomed Mater Res. 1999;48:393–402.
Schulten EAJM, Prins HJ, Overman JR, Helder MN, ten Bruggenkate CM, Klein-Nulend JA. Novel approach revealing the effect of collagenous membrane on osteoconduction in ...
Schopper C, Ziya-Ghazvini F, Goriwoda W, Moser D, Wanschitz F, Spassova E, Lagogiannis G, Auterith A, Ewers R. HA/TCP compounding of a porous CaP biomaterial improves bone formation and scaffold degradation—a long-term histological study. J Biomed Mater Res B Appl Biomater. 2005;74:458–67.
Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EA, ten Bruggenkate CM. The use of Strauma...
Beirne JC, Barry HJ, Brady FA, Morris VB. Donor site morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg. 1996;25:268–71.
Vermeeren JIJF, Wismeijer D, van Waas MAJ. One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants: a 5-year follow-up. Int J Oral Maxillofac Surg. 1996;2:112–5.
Nkenke E, Stel...
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30:207–29.
Del Fabbro M, Rosano G, Taschieri S. Implant survival rates after maxillary sinus augmentation. Eur J Oral Sci. 2008;116:497–506.
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systemat...
Based on clinical, radiological, histological, and histomorphometric analysis, this study confirms the suitability of BCP for vertical augmentation of the posterior maxilla by means of an MSFE procedure, allowing dental implant placement after 9 and 12Â months healing times. Yet, complete degradation of the BCP particles does not occur within a 12-month healing time. From a histological and histom...
In the cranial part of the biopsy, some osteoid islands with osteogenic activity were detected, possibly caused by osteoinductive properties from the lifted bony trap-door. In the present study, histomorphometric analyses revealed that the vital bone volume was higher in the 9-month healing time group than in the 12-month healing time group, while one would expect to find more newly formed bone in...
This study presents the clinical, radiological, histological and histomorphometric results on the use of a biphasic calcium phosphate (Straumann® bone ceramic) in a MSFE procedure with healing times of 9 and 12 months. During the clinical evaluation, it appeared that both 9-month and 12-month healing times resulted in integration of the grafted BCP with the original maxillary bone (sinus floor),...
Histological observations did not show inflammatory cells in the tissue adjacent to the bone substitute particles. Bone marrow-like tissue, which included blood vessels, was observed in between the bone trabeculae (Fig. 4). Reinforcement by lamellar bone was shown in some areas after 9 and 12 months (Figs. 5 and 6). No Howship’s lacunae could be detected on the characteristic outlines of the su...
None of the 10 patients showed postoperative inflammation or infection after the MSFE procedure nor during surgical re-entry for dental implant placement. When opening the area for dental implant insertion, the grafted area proved to be well vascularized and the tissue at the site of the former trap-door location was slightly flexible and had a fibrous aspect. Between the periosteum and the bone g...
Parameters evaluating vital bone mass/bone structure:
1: Vital bone volume (BV): percentage of the grafted section that is vital bone tissue (%)
2: Bone surface (BS): BS expressed as a fraction of the total vital bone volume (mm2/mm3)
3: Thickness of bone trabeculae (Tb.Th) (ÎĽm)
Parameters evaluating bone turnover:
1: Osteoid volume (OV): fraction of the vital bone tissue section that is ost...
All 22 inserted dental implants were clinically tested for good primary stability. Osseointegration at abutment connection was tested with a 35-Ncm torque. One experienced oral and maxillofacial surgeon (CB) carried out all follow-up examinations.
Panoramic radiographs were made at patient’s intake (T0); immediately after the MSFE procedure (T1); immediately after dental implant placement (T2);...
A midcrestal incision was made with vertical release incisions at the canine and tuberosity region. A full-thickness mucoperiosteal flap was elevated. The lateral maxillary sinus wall was prepared using a diamond burr with copious irrigation with sterile isotonic saline, regarding the contour of the maxillary sinus as observed on the preoperative panoramic radiograph. A bony top-hinge trap-door wa...
In this study, 10 consecutive healthy patients were selected for a unilateral MSFE procedure. Five patients received dental implants 9Â months after MSFE and five patients underwent dental implant surgery 12Â months after MSFE. In the 9-month group (three men and two women), the average age was 56.6Â years (range 40 to 64Â years); in the 12-month group (one man and four women), the average age was...
β-TCP is a biocompatible osteoconductive calcium phosphate that may provide a scaffold for potential bony ingrowth [24]. β-TCP resorbs rather quickly but not necessarily at the same rate as new bone formation [25,26,27]. Most research focused on either using the relative unresorbable HA as a scaffold or β-TCP as a degradable component [19, 24,25,26, 28, 29]. Zerbo et al. [30] concluded that due...
Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3Â years after dental implant placement [3]. According to Pjetursson [4] in his systematic r...
This study evaluates the clinical, radiological, histological, and histomorphometric aspects of a fully synthetic biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% Ăź-tricalcium phosphate), used in a human maxillary sinus floor elevation (MSFE) procedure with 9- and 12-month healing time.
A unilateral MSFE procedure, using 100% BCP, was performed in two series of five patients with hea...
Valdec, S., Pasic, P., Soltermann, A. et al. Alveolar ridge preservation with autologous particulated dentin—a case series.
Int J Implant Dent 3, 12 (2017). https://doi.org/10.1186/s40729-017-0071-9
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Received: 07 December 2016
Accepted: 15 March 2017
Published: 30 March 2017
DOI: https://doi.org/10.1186/s40729-017-0071-9
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, University Hospital Zurich, Plattenstrasse 11, 8032, ZĂĽrich, Switzerland
Silvio Valdec, Pavla Pasic, Bernd Stadlinger & Martin Rücker
Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
Alex Soltermann
Clinic of Fixed and Removable Prosthodontics and Dental Mater...
We would like to express our thanks to Dr. Gabriel Bosch for the superimposition, calculation and illustration of the intraoral scans.
SV, BS and MR created the conception and study design. MR performed the surgical and DT the prosthodontic treatment. SV, PP and DT performed the data collection and AS the histological examination. SV, BS and AS analysed and interpreted the data. SV drafted the ma...
Sculean A, Berakdar M, Chiantella GC, Donos N, Arweiler NB, Brecx M. Healing of intrabony defects following treatment with a bovine-derived xenograft and collagen membrane. A controlled clinical study. J Clin Periodontol. 2003;30(1):73–80.
Sutton DN, Lewis BR, Patel M, Cawood JI. Changes in facial form relative to progressive atrophy of the edentulous jaws. Int J Oral Maxillofac Surg. 2004;33(7...
Liu X, Li Q, Wang F, Wang Z. Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: a comparative study in beagles. Arch Oral Biol. 2016;64:102–8. doi:10.1016/j.archoralbio.2016.01.004.
Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from ex...
Furhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16(6):639–44. doi:10.1111/j.1600-0501.2005.01193.x.
Guirado JL, Troiano M, Lopez-Lopez PJ, Ramirez-Fernandez MP, de Val JE, Marin JM, Gehrke SA. Different configuration of socket shield technique in peri-implant bone...
Al-Asfour A, Andersson L, Kamal M, Joseph B. New bone formation around xenogenic dentin grafts to rabbit tibia marrow. Dent Traumatol. 2013;29(6):455–60. doi:10.1111/edt.12045.
Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.
Andersson L. Den...
Within the limits of this case series, it has been shown that particulated dentin of autologous teeth may serve as an alternative to autologous bone for alveolar ridge preservation prior to implant therapy. However, randomized studies on this treatment option are necessary.
In humans, particulated tooth material has been used for sinus augmentation in order to enhance implant therapy. Preliminary results from five patients histologically showed an osteoconductive osteogenesis with partial resorption of tooth components [25].
In the present case series, all patients underwent socket preservation with AutoPD. In all cases, one or two upper frontal central incisors wer...
The aim of this case series is to demonstrate the efficacy and safety of this novel augmentative procedure for ridge preservation prior to implant therapy. This shall serve as a basis for a prospective study.
In all four cases, patients showed a stable volume of soft and hard tissues after the augmentation with AutoPD and good osseointegration of titanium implants, having been placed in this augm...
Four months post-extraction and augmentation with autologous, particulated dentin, all four patients received an implant placement in the augmented area. In all cases, a CBCT was taken in between the dentin augmentation and the implant placement.
During implant placement, a biopsy of the bone from the augmented area was taken for histological examination (Fig. 17).
The final prosthetic solution...
The 1-year follow-up examination of the presented case showed an implant success, according to the appropriate clinical criteria [2] (Figs. 14, 15 and 16).
The pink esthetic score (PES) was used for the evaluation of reproducible soft tissue around the final implant crown as a parameter for the aesthetic outcome [12]. Seven variables were evaluated comparing the soft tissue around the implant wi...
An autologous soft tissue graft was harvested from the patient’s palate using a soft tissue punch (Biopsy Punch, kai Europe GmbH, Solingen, Germany) (Fig. 9). The graft had a comparable dimension as the recipient site. The gingival graft was placed on top of the augmentation material, adapted and carefully sutured to the marginal gingiva after the sulcus epithelium was removed with a rotating d...
Four patients between 36 and 65Â years of age are presented in this case series. There was no financial compensation. All four patients suffered from a trauma, causing damage to one or two teeth of the anterior maxilla. The frontal tooth/teeth has/had to be extracted. The pulp of the extracted teeth of three patients and the root canal filling of one patient had to be removed. All patients were in...
Subsequent to tooth extraction, a resorption of the host bone as defined by atrophy of the alveolar ridge can be observed. Sutton et al. classified the different degrees of alveolar ridge atrophy [32]. Bone resorption especially occurs in the frontal and premolar area of the jaw in the region of the thin buccal lamella. This may lead to a change in contour [11, 28]. Physiological reason for this a...
Ridge preservation can be performed with autologous bone, alloplastic bone substitute material or a combination of both. Dentin is similar to bone in its chemical composition. In its use as bone substitute material, it undergoes a remodelling process and transforms to bone. The presented case report introduces a technique in which the extraction socket is augmented with autologous, particulated de...
Nery, J.C., Pereira, L.A.V.D., Guimarães, G.F. et al. β-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.
Int J Implant Dent 3, 18 (2017). https://doi.org/10.1186/s40729-017-0080-8
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Received: 08 December 2016
Accepted: 22 April 2017
Published: 04 May 2017
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
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James Carlos Nery.
Department of Implantology, SĂŁo Leopoldo Mandic Research Center, BrasĂlia, DF, Brazil
James Carlos Nery, George Furtado Guimarães & Fabiana Mantovani Gomes França
Department of Biochemistry and Tissue Biology, UNICAMP – State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
LuĂs AntĂ´nio Violin Dias Pereira
Department of Periodontology, UNESP – Univ. Estad...
Wikesjo UM, Sorensen RG, Kinoshita A, Wozney JM. RhBMP-2/alphaBSM induces significant vertical alveolar ridge augmentation and dental implant osseointegration. Clin Implant Dent Relat Res. 2002;4:174–82.
Carinci F, Brunelli G, Franco M, Viscioni A, Rigo L, Guidi R, et al. A retrospective study on 287 implants installed in resorbed maxillae grafted with fresh frozen allogenous bone. Clin Implant...
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–83.
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015;68:182â...
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;17:CD008397.
Jungner M, Cricchio G, Salata LA, Sennerby L, Lundqvist C, Hultcrantz M, et al. On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study. ...
The present study showed that maxillary sinus floor augmentation with BC resulted in adequate amounts of new bone formation allowing successful implant installation, while adding EMD did not have a significant effect.
Nevertheless, the amount of bone generated with BC or BC + EMD herein was adequate to support successful implant placement and osseointegration of implants. In fact, more or less similar amounts of bone formation have been reported in studies evaluating human sinus biopsies after grafting with a variety of biomaterials (bone formation ranging approximately from 30 to 50%) [19]. On the other ha...
The present study compared the histological and histomorphometrical outcome of healing after maxillary sinus floor augmentation with BC with or without EMD, based on human biopsies. The results showed that addition of EMD did not enhance the outcome of healing, neither in terms of quality nor quantity of new bone. Nevertheless, the amount of bone generated after maxillary sinus floor augmentation ...
All ten patients showed uneventful healing after the sinus floor augmentation procedure as well as after dental implant placement, with no overt postoperative inflammation or infection. Consistently, in all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implant...
The data for each tissue component from the three histological sections were averaged to represent the biopsy. Commercially available software (GraphPad Prism 5.0 for Windows, GraphPad Software Inc., USA) was utilized for statistical comparisons between groups and for drawing the graphics. The assumption of normality was checked using D’Agostino & Pearson omnibus test. The data for each evaluate...
Six months after grafting, another CBCT examination was carried out for implant planning. In the sequence, following the previously described antiseptic and anesthetic procedures, two implants with a sand-blasted and acid etching surface were installed in each of the grafted sinuses, i.e., 40 implants in total (32—Neoporous, Neodent, Curitiba, Paraná, Brazil; 8—SLA, Straumann, Basel, Switzerl...
This research project was approved by the Ethics Committee of the School of Dentistry and Dental Research Center SĂŁo Leopoldo Mandic, Brazil, under the protocol 2010/0360.
Ten consecutive patients (age range 35–75 years) with the need of bilateral maxillary sinus floor augmentation prior to the placement of four dental implants (two in each side of posterior maxilla) were selected for the stu...
The aim of the present study was to compare histomorphometrically the outcome of maxillary sinus floor augmentation with β-TCP/HA with or without enamel matrix proteins (BC + EMD and EMD, respectively) in humans.
Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Various bone graft materials are typically used for enhancing bone formation within the sinus cavity; autogenous bone (AB) is considered as the gold standard due to its osteogenic, osteoinductive, and osteoconductive...
It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.
In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the ot...
Fig. 8. Soft tissue dehiscence (a) CCXBB exposure 15Â weeks after bone augmentation, the dehiscence healed 2Â 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 re...
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
Fig. 7. Second stage sur...
Fig. 6. Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC
Fig. 6. Immunohistochemical analysis of slices from the same sample with four different markers. a TRAP. b OPN. c ALP. d OSC
section stained with Levai-LaczkĂł. b Tissue identification of the ROI. c Closer view aized bone and CCXBB. d Closer view of b
Fig. 5. Histomorphometric analysis of the same sample. a Ground section stained with Levai-LaczkĂł. b Tissue identification of the ROI. c Closer view a arrow pointing a cement line between new mineralized bone and CCXBB. d Closer view of b
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
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 ingr...
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
Fig. 3. Re-entry procedure of patient in Fig. 1. a Buccal aspect of the augmented region. b Ho...
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
Fig. 2. Lateral bone augmentation of the alveolar crest (a) atrophic ridge. b ...
Fig. 1. Study chart and follow-up visits
Fig. 1. Study chart and follow-up visits
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Ortiz-VigĂłn, A., Martinez-Villa, S., Suarez, I. et al. Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement.
Int J Implant Dent 3, 24 (2017). https://doi.org/10.1186/s40729-017-0087-1
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Received: 21 March 2017
Accepted: 12 June 2017
Published: 21 Ju...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
ETEP Research Group, Facultad de OdontologĂa, Universidad Complutense de Madrid, Plaza RamĂłn y Cajal, 28040, Madrid, Spain
Alberto Ortiz-Vigón, Sergio Martinez-Villa, Iñaki Suarez, Fabio Vignoletti & Mariano Sanz
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We wish to acknowledge the dedication and scientific advise of Prof. Dr. Tord Berglundh on the histological analysis as well as the diligent work in processing the histological samples to Estela Maldonado for the immunohistochemistry and Asal Shikhan and Fernando Muñoz for the histomorphometry. The work of Esperanza Gross on the statistical analysis is highly acknowledged.
This study was partial...
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Beretta M, Cicciu M, Poli PP, Rancitelli D, Bassi G, Grossi GB, et al. A Retrospective Evaluation of 192 Implants Placed in Augmented Bon...
Alkaline phosphatase
Cone beam computed tomography
Collagen containing xenogeneic bone block
Native collagen membrane
Deproteinized bovine bone mineral
Etiology and Therapy of Periodontal Diseases
Osteopontin
Osteocalcine
Tartrate-resistant acid phosphatase
Within the limitations of this clinical study, we may conclude that the use of CCXBB in combination with DBBM particles and a native bilayer collagen membrane for staged lateral bone augmentation in severe atrophic alveolar crests achieved significant horizontal crestal width allowing for staged implant placement in most of the patients. Histological analysis and implant survival records indicate ...
The immune-histochemical results reported expression of osteopontin mainly at the border between mineralized vital bone (MVB) with CCXBB, what coincides with findings from previous reports [38,39,40]. Alkaline phosphatase (ALP) is considered as an early osteoblast differentiation marker [41]. ALP-positive cells were detectable, in all specimens on the periphery of MVB, associated to areas of new b...
When correlating the clinical results and the histological outcomes, there was a positive association between the presence of soft tissue dehiscence with CCXBB exposure and a diminished amount of new mineralized bone (p = 0.06). This lower amount of new bone within the xenogeneic graft suggests a lack of full graft integration and diminished vascular supply, what may have caused the soft tissu...
The purpose of this investigation was to evaluate histologically and immunohistochemically the behavior of CCXBB blocks when used for staged lateral bone augmentation in severe human horizontal residual bone defects. Six months after the regenerative intervention using the CCXBB blocks, the mean increase in bone width was 4.12Â mm and hence, this outcome allowed for the placement of dental implant...
The results from the histomorphometric measurements are depicted in Table 2. Bone biopsies were composed by 21.37% (SD 7.36) of residual CCXBB, 26.90% (SD 12.21) of mineralized vital bone (MVB), 47.13% (SD 19.15) of non-mineralized tissue and 0.92% of DBBM (Fig. 5b). Biopsies from patients who lost their implants had a statistical significant lower amount of MVB (p = 0.01u) and a statistical...
Twenty-eight CCXBB blocks were placed in 15 patients that fulfilled the selection criteria (12 women and 3 men) with a mean age of 54.5 (SD 8.34).
The detailed clinical and radiographical outcomes have been reported previously [21]. In brief, one patient experienced pain and soft tissue dehiscence leading to removal of the graft material 3Â days after the regenerative procedure. Another patient r...
For the immunohistochemical analysis, the semi-thin sections were incubated over night with primary antibodies at 4 °C (Santa Cruz Biotechnology Inc., Santa Cruz, Calif., USA). The antibody dilutions used were alkaline phosphatase (ALP) 1:100, osteopontin (OPN) 1:100, osteocalcin (OSC) 1:100, and tatrate resistant acid phosphatase (TRAP) 1:100.
The obtained semi-thin sections were evaluated wit...
Twenty-six weeks after the regenerative procedure the patient returned for the re-entry intervention for placement of dental implants. After raising full-thickness flaps, the augmented area was exposed and horizontal crestal width measurements were performed. Then, the surgeon evaluated the bone availability and if implant placement was considered possible, a core bone biopsy was harvested with th...
CCXBB (Bio-Graft® Geistlich Pharma) is a bone substitute material in a natural block form. The dimensions of the Bio-Graft block are 10 mm in height, 10 mm in length and 5 mm in width. It consists of a natural cancellous bone structure of hydroxyapatite and endogenous collagen type I and III, equine origin and is a class III medical device according to the Medical Device Directive 93/42 EECsâ€...
The present manuscript reports the histological outcomes of a prospective single arm study evaluating the safety and clinical performance of CCXBB blocks when used as replacement bone grafts for lateral bone augmentation prior to staged implant placement. The results of the clinical and radiographic outcomes have been reported in a previous publication [21]. For correlation of the histological wit...
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-derive...
The osteoconductive properties of collagen containing xenogeneic bone blocks (CCXBB) remain unclear. The aim of this prospective single-arm clinical study was to assess the histological outcomes of CCXBB blocks used as bone replacement grafts for lateral bone augmentation procedures.
In 15 patients with severe horizontal alveolar ridge resorption, lateral augmentation procedures were performed us...
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification Ă—100)
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification Ă—100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification Ă—100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification Ă—100)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification Ă—10)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification Ă—10)
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 1. Images of patient # 5 (9-month healing time). a. Radiograph of the left maxillary sinus: situation 9 months after the maxillary sinus floor elevation procedure. b. With a trephine drill, the implant osteotomy is made and the biopsy is obtained. c. Clinical situation after placing two Straumann® SLA implants in the left posterior maxilla. d. Radiograph of two Straumann® SLA implants in...
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Bouwman, W.F., Bravenboer, N., Frenken, J.W.F.H. et al. The use of a biphasic calcium phosphate in a maxillary sinus floor elevation procedure: a clinical, radiological, histological, and histomorphometric evaluation with 9- and 12-month healing times.
Int J Implant Dent 3, 34 (2017). https://doi.org/10.1186/s40729-017-0099-x
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Received: 22 May 2017
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Authors W.F. Bouwman, N. Bravenboer, J.W.F.H. Frenken, C.M. ten Bruggenkate and E.A.J.M. Schulten state that there are no conflicts of interest, either directly or indirectly.
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Correspondence to
E. A. J. M. Schulten.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
W. F. Bouwman, C. M. ten Bruggenkate & E. A. J. M. Schulten
Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
N. Bravenboer
Department of Oral and Maxillofacial Su...
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Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systemat...
Based on clinical, radiological, histological, and histomorphometric analysis, this study confirms the suitability of BCP for vertical augmentation of the posterior maxilla by means of an MSFE procedure, allowing dental implant placement after 9 and 12Â months healing times. Yet, complete degradation of the BCP particles does not occur within a 12-month healing time. From a histological and histom...
In the cranial part of the biopsy, some osteoid islands with osteogenic activity were detected, possibly caused by osteoinductive properties from the lifted bony trap-door. In the present study, histomorphometric analyses revealed that the vital bone volume was higher in the 9-month healing time group than in the 12-month healing time group, while one would expect to find more newly formed bone in...
This study presents the clinical, radiological, histological and histomorphometric results on the use of a biphasic calcium phosphate (Straumann® bone ceramic) in a MSFE procedure with healing times of 9 and 12 months. During the clinical evaluation, it appeared that both 9-month and 12-month healing times resulted in integration of the grafted BCP with the original maxillary bone (sinus floor),...
Histological observations did not show inflammatory cells in the tissue adjacent to the bone substitute particles. Bone marrow-like tissue, which included blood vessels, was observed in between the bone trabeculae (Fig. 4). Reinforcement by lamellar bone was shown in some areas after 9 and 12 months (Figs. 5 and 6). No Howship’s lacunae could be detected on the characteristic outlines of the su...
None of the 10 patients showed postoperative inflammation or infection after the MSFE procedure nor during surgical re-entry for dental implant placement. When opening the area for dental implant insertion, the grafted area proved to be well vascularized and the tissue at the site of the former trap-door location was slightly flexible and had a fibrous aspect. Between the periosteum and the bone g...
Parameters evaluating vital bone mass/bone structure:
1: Vital bone volume (BV): percentage of the grafted section that is vital bone tissue (%)
2: Bone surface (BS): BS expressed as a fraction of the total vital bone volume (mm2/mm3)
3: Thickness of bone trabeculae (Tb.Th) (ÎĽm)
Parameters evaluating bone turnover:
1: Osteoid volume (OV): fraction of the vital bone tissue section that is ost...
All 22 inserted dental implants were clinically tested for good primary stability. Osseointegration at abutment connection was tested with a 35-Ncm torque. One experienced oral and maxillofacial surgeon (CB) carried out all follow-up examinations.
Panoramic radiographs were made at patient’s intake (T0); immediately after the MSFE procedure (T1); immediately after dental implant placement (T2);...
A midcrestal incision was made with vertical release incisions at the canine and tuberosity region. A full-thickness mucoperiosteal flap was elevated. The lateral maxillary sinus wall was prepared using a diamond burr with copious irrigation with sterile isotonic saline, regarding the contour of the maxillary sinus as observed on the preoperative panoramic radiograph. A bony top-hinge trap-door wa...
In this study, 10 consecutive healthy patients were selected for a unilateral MSFE procedure. Five patients received dental implants 9Â months after MSFE and five patients underwent dental implant surgery 12Â months after MSFE. In the 9-month group (three men and two women), the average age was 56.6Â years (range 40 to 64Â years); in the 12-month group (one man and four women), the average age was...
β-TCP is a biocompatible osteoconductive calcium phosphate that may provide a scaffold for potential bony ingrowth [24]. β-TCP resorbs rather quickly but not necessarily at the same rate as new bone formation [25,26,27]. Most research focused on either using the relative unresorbable HA as a scaffold or β-TCP as a degradable component [19, 24,25,26, 28, 29]. Zerbo et al. [30] concluded that due...
Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3Â years after dental implant placement [3]. According to Pjetursson [4] in his systematic r...
This study evaluates the clinical, radiological, histological, and histomorphometric aspects of a fully synthetic biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% Ăź-tricalcium phosphate), used in a human maxillary sinus floor elevation (MSFE) procedure with 9- and 12-month healing time.
A unilateral MSFE procedure, using 100% BCP, was performed in two series of five patients with hea...