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Engineering
placement becomes a challenge and often resulting in recession and dehiscence around the implant that leads to subsequent gingival recession. To correct such defect, soft tissue
autografting and allografting to correct a buccal dehiscence
around a malpositioned implant placed by a different surgeon
is used. Platelet-rich fibrin (PRF) belongs to a new generation
of platelet concentrates, with simplified processing and without biochemical blood handling, it is a strictly autologous
fibrin matrix containing a large quantity of platelet and leukocyte cytokines. The use of platelet gel to improve soft and
hard tissue regeneration is a recent technique in implantology.
So in this case the PRF is used to the dehiscence.
Aim: The aim is to cover the exposed implant threads using
PRF instead of using bone grafts and connective tissue grafts.
Methods: A healthy 24-year-old woman presented with chief
complaint of my implant is showing through my gingival tissue. Patient was wondering if there is any periodontal treatment available to mask the showing of implant threads
through the gingival tissue and prevent further recession.
With excellent oral hygiene, upon clinical examination, there
was minimal buccal gingival thickness around the implant in
upper central incisor. Her recent dental history included
extraction of permanent tooth #24, and an immediate implant
was placed in site #24. Her previous dental treatment was rendered by a different surgeon. The patient presented to Dental
smile center 4 months after implant placement. The implant
appeared to be osseointegrated with a buccal dehiscence and
1020% of facial implant showing through gingival tissue due
to minimal bone width. Since the implant was osseointegrated, removal of implant was not considered fearing damage
to adjacent teeth when trephining the implant. Also, due to
loss of buccal bone cortex, The positioning of implant outside
the bony envelope and possible sloughing of fragile buccal
Gingival tissue-guided bone regeneration were not recommended. Faced with the esthetic concerns and possible future
recession around that implant, soft tissue gingival grafting
was recommended to augment the keratinized gingiva and
improve esthetics.
Results: From a radiologic and histologic point of view at
4 months after surgery, the use of PRF as the sole filling or
covering material stabilized a high volume of natural regenerated bone and soft tissue over the exposed implant threads.
Choukrouns PRF is a simple and inexpensive biomaterial,
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Titanium micromesh
Giulio Conti
Italy
Background: Different techniques for atrophic alveolar bone
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ceramic three-dimensional scaffolds for bone tissue regeneration in defect site. For a successful performance the ideal
scaffold should be a 3D interconnected porous structure able to
promote cell adhesion, proliferation and vascularisation, while
enabling a controlled supply of bioactive substances that might
influence the behaviour of incorporated or ingrown cells.
Aim: To investigate a novel cellulose-based porous composites with hydroxyapatite for the bone scaffold.
Methods: The composites were fabricated by saponification of
diacetylcellulose adding hydroxyapatite. After the reaction the
obtained gel of regenerated cellulose was homogeneously
immobilized with hydroxyapatite. In order to create suitable
matrix the composites were freeze-dried.
Results: It was found out that the conditions of lyophilisation
highly influenced the morphology of the matrix. The porosity
of the scaffolds was up to 75% with pores of different sizes up
to 770 lm. The results of bioactivity test in vitro showed that
bone-like apatite appeared onto the surface after 7 days of
immersion in simulated body fluid. Furthermore, the behaviour of MG-63 human osteoblastic-cells on investigated cellulose matrix was examined. It was found that the scaffolds are
not cytotoxic and induce the growth of the cells.
Conclusions and clinical implications: From the obtained results
it could be concluded that prepared scaffolds have a great
potential for bone tissue ingrowth in vivo. Attained results
substantiate the suitable application of cellulose/hydroxyapatite scaffolds in bone tissue engineering applications.
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collagen membranes was analysed by the water soluble tetrazolium (WST-1) test.
Results: The increase of ALPA as an indicator of osteoblastic
differentiation was higher in cultures on PRF clots and membranes compared to collagen membranes. The BrdU test
showed a higher proliferation of human osteoblasts cultured
with eluates from PRF membranes than with eluates from collagen membranes, respectively. This is in accordance with the
findings of the WST-1-proliferation test that showed higher
cell proliferation for the human osteoblasts cultured on PRF
membranes than on collagen membranes.
Conclusions and clinical implications: PRF clots and membranes has been shown to be suitable as scaffold for human
osteoblast cell cultivation.
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Computertomography-based evaluation of
volumetric changes after sinus floor
augmentation
Markus Hof, Bernhard Pommer, Michael Girardi,
Patrick Heimel, Georg Watzek, Werner Zechner
Department of Oral Surgery, Bernhard Gottlieb University of
Dentistry, Vienna, Austria
Background: Maxillary sinus floor augmentation through a
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Hiroshima, Japan
Background: When implant fixtures are lost or a large bone
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apply autogenous bone and artificial bone such as hydroxyapatite (HA) for bone reconstruction. However, the reports of
osseointegration at reconstructed area with HA are few.
Aim: This study evaluated the aspects of osseointegration of
the implants placed in the reconstructed bone by interconnected porous calcium hydroxyapatite (IP-CHA).
Methods: This study design was approved by the Research
Facilities Committee for Laboratory Animal Science at Hiroshima University School of Medicine. Cylinder-type IP-CHAs
(75% porosity, diameter: 4.3 mm, height: 10.0 mm, NEOBONE, Covalent Materials, Japan) as a bone graft material
was placed into eight bone sockets (diameter: 4.3 mm, depth:
10.0 mm) at both sides of the femur of four male HBD Dogs
(weight: 2025 kg). IP-CHA at the left side was a 24-week sample. After 12 weeks of IP-CHA placement, titanium implant
(diameter: 3.3 mm, length: 10.0 mm, Br mark System MkIII
TiUnite, Nobel Biocare, Sweden) was placed into half side of
the IP-CHA at the right femur. (A half portion of the implant
was contacted to the reconstructed IP-CHA and a half of the
femur itself). IP-CHA was also placed into the another bone
socket as a 12-week sample. Implant placement was performed
by Br mark System protocol. After 12 weeks of implant placement, dogs were sacrificed and the bone tissues involved the
implant and or not were obtained. The block without implant
was decalcified and stained with HE. The block with implant
was prepared as undecalcified polishing specimens and stained
with toluidine blue. These samples were examined histologically with a light microscope. The ratio of bone formation at
cortical bone area of the femur was measured histomorphometrically at 12- and 24-week decalcified samples and boneimplant contact (BIC) ratio was measured histomorphometrically at 12-week undecalcified samples.
Results: New bone formation was observed in both of the host
bone and IP-CHA sides. Implant and IP-CHA were integrated
with osseoconduction. Histomorphometrically, new bone formation area was superior in the IP-CHA 24-week sample
rather than IP-CHA 12-week sample. From the BIC ratio,
osseointegration was achieved at the surface between implant
and IP-CHA. Osseointegration was obtained around the
implant in reconstructed bone by IP-CHA.
Conclusions and clinical implications: Based on the limited
results of this study, IP-CHA cylinder might be expected to be
a possible bone graft material to reconstruct bone for implant
placement.
Witten, Germany
Background: Most recent consensus considers non-resorbable
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and bacterial infections lead to the failure of titanium (Ti)based orthopedic and dental implants.
Aim: The aim of this study is to develop novel Ti implants
that enhance osteoblast functions, while simultaneously
decreasing bacterial infections.
Methods: First, the surface of pristine Ti was functionalized
with heparin-dopamine by mimicking a mussel adhesion
mechanism. Gentamicin sulfate (GS) and/or bone morphogenic protein-2 (BMP-2) was then sequentially immobilized to
the heparinized-Ti (Hep-Ti) surface. The compositions of pristine Ti and Hep-Ti with or without gentamicin and/or BMP-2
were characterized by X-ray photoelectron spectroscopy (XPS)
and the growth of Staphylococcus aureus on the substrates
was assayed. Osteoblast functions of all Ti substrates were
investigated by cell proliferation assays, alkaline phosphatase
(ALP) activity, and calcium deposition.
Results: The results showed that the growth of bacteria on
GS/Hep-Ti and GS/BMP-2/Hep-Ti was significantly lower
compared to that on the pristine Ti and BMP-2/Hep-Ti. In
addition, BMP-2/Hep-Ti and GS/BMP-2/Hep-Ti significantly
enhanced ALP activity and calcium mineral deposition of
osteoblast cells. Taken together, GS/BMP-2/Hep-Ti could
achieve the dual functions of excellent antibacterial activity
and osteoblast function promotion.
Conclusions and clinical implications: Therefore, dual drug
(antibiotics and osteoinductive protein)-eluting Ti substrates
such as GS/BMP-2/Hep-Ti are a promising material for the
enhanced osteointegration and implant longevity in orthopedics and dentistry.
body bone graft offer several advantages such as making intraoral approach possible for surgical access, facilitating the clinician to operate in the same field as the recipient site, low
resorption rate and short healing period due to its cortical
characteristics, needless of horizontal osteotomy near the root
apex, less risk of nerve injury.
Aim: The aim of this study was to evaluate the morphology of
atrophic mandible using Cone-Beam Computed Tomography
(CBCT) for mandibular body bone (MBB) graft and to purpose the
usefulness of MBB as a good donor site for autogenous bone graft.
Methods: The subjects consisted of 26 patients undergoing
mandibular body bone graft in atrophic mandible (n = 26).
Using cross-sectional computed tomography (CT) images, the
distance of alveolar bone width, the distance from mandibular
canal to alveolar crest, the thickness of buccal cortical bone
and the distance from mandibular canal to buccal cortical
bone were measured at the premolar (PM), the first molar
(M1), the second molar (M2) and anterior border of ramus
(RM) of edentulous mandible.
Results: Average alveolar bone width were 6.25 mm (PM),
6.7 mm (M1), 7.51 mm (M2), 10.98 mm (RM). average alveolar
bone height were 13.26 mm (PM), 12.67 mm (M1), 11.26 mm
(M2), 10.82 mm (RM). Cortical bone thickness were 1.96 mm
(PM), 2.29 mm (M1), 2.51 mm (M2), 2.59 mm (RM). Distance
from the mandibular canal to buccal cortical bone were
2.50 mm (PM), 4.31 mm (M1), 5.51 mm (M2), 6.28 mm (RM).
Conclusions and clinical implications: A 2.0 mm thickness and
from the first molar to the second molar about 20~25 mm
buccal cortical bone could be harvested at atrophic mandible.
Atrophic mandibular body bone graft is a safe technique and a
good donor site. Based on the results of the present study, surgeon can gain sufficient amount of cortical bone required for
bone graft, in spite of the patients atrophic stage of mandible.
In addition, by calculating the distance from the nerve canal
using pre-operative CBCT data and 3-D imaging program, the
safety of surgical procedure can be improved especially using
mandibular body bone graft or ramal graft.
Yangsan, Korea
enous bone graft include mandibular symphysis, ramus, mandibular body, etc. Among these donor materials, mandibular
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Kocar Miha
Department of Maxillofacial and Oral Surgery, University
Clinical Center Ljubljana, Ljubljana, Slovenia
Background: Tongue pedicle flap (TPF) is known for recon-
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are buried in lacunae. Density and area of the osteocyte lacunae changes with increasing maturation of the newly formed
bone. Evaluation of osteocyte lacunae can therefore provide
insights into the process of graft consolidation.
mens, 6 and 12 weeks after the sinus of minipigs was augmented with Bio-Oss, a deproteinized bovine bone mineral,
and Ostim (Chris Arts et al. 2006), an aqueous paste of synthetic nanoparticular hydroxyapatite (Busenlechner et al.
2009). The two bone substitutes show a different degradation
profile. This study is based on the assumption that osteocyte
lacunar density and area decreases with the maturation of
newly formed bone in the augmented site.
Methods: Here we determined the osteocyte lacunar density
and the osteocyte lacunar area in histological specimens, 6
and 12 weeks after the sinus of minipigs was augmented with
Bio-Oss, a deproteinized bovine bone mineral, and Ostim,
an aqueous paste of synthetic nanoparticular hydroxyapatite.
The region of interest was defined by the following criteria: (1)
>1 mm from the host bone, (2) >0.5 mm from the sinus
mucosa, (3) minimum area of 0.2 mm2, and (4) bone tissue
spanning at least two bone substitute particles.
Results: The osteocyte lacunar density significantly decreased
within the observation period in the Bio-Oss group and in
the Ostim group. The lacunar area distribution was similar
between the Bio-Oss group at 6 weeks and the Ostim
groups at 6 and 12 weeks. A more narrow distribution towards
a lower lacunar area was observed in the Bio-Oss group at
12 weeks.
Conclusions and clinical implications: These results suggest
that the osteocyte lacunar density and the area decrease in the
newly formed bone within the augmented sinus in this particular model situation. These measures provide insights into
the maturation of the newly formed bone in the augmented
sinus.
Korea
Background: Absorbable collagen sponge is available as an
approved carrier system for recombinant human bone morphogenetic protein-2 (rhBMP-2) for maxillofacial indications.
However, its rapid resorption rate and lack of structural durability might be inappropriate for maxillary sinus augmentation. Biphasic calcium phosphate (BCP), which is a synthetic
bone substitute, could be an alternative carrier system for
better space maintenance against pneumatization.
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Minas Leventis,1 Orestis Vasiliadis,1 Nadia Theologielygidakis,1 Peter Fairbairn,2 Ioannis Iatrou1
1
United Kingdom
Regeneration
MRC
Korea
Background: Dimensional alterations of extraction socket is
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following tooth extraction, the alveolar bone becomes markedly reduced as a result of resorption of the edentulous ridge.
This can negatively influence bone volume that is needed for
future implant placement. It is suggested that the ridge dimensions can be preserved by socket grafting at the time of tooth
extraction with the use of various bone graft substitutes.
Aim: To evaluate the clinical efficacy of a biphasic synthetic
bone grafting material consisting of b-tricalcium phosphate in
a hydroxyl sulphate matrix for socket preservation and
implant integration at the post-extraction site.
Methods: In 4 of a series of 10 patients, requiring extraction of
a posterior tooth of the mandible or the maxilla, b-tricalcium
phosphate in a hydroxyl sulphate matrix (Fortoss VITAL, Biocomposites, Etruria, Stoke-on-Trent, England) was utilized as
a grafting material for socket preservation using the Bio-Col
technique. The horizontal ridge dimensions were measured
after tooth extraction and at implant placement after
3 months. Bone core biopsies were obtained prior to implant
placement for histologic, histomorphometric and microcomputed tomography analysis. Primary implant stability was
evaluated by resonance frequency analysis (Osstell ISQTM,
Goteborg, Sweden).
Results: Analysis of the data showed that b-tricalcium phosphate in a hydroxyl sulphate matrix preserved adequately the
width of the alveolar ridge 3 months after tooth extraction.
Histologic, histomorphometric and microcomputed tomography analysisrevealed pronounced bone regeneration and resonance frequency analysis showed high ISQ levels at implant
placement.
Conclusions and clinical implications: The preliminary results
of this clinical study showed that b-tricalcium phosphate in a
hydroxyl sulphate matrix can be used successfully as a grafting material for socket preservation prior to implant placement. The completion of all cases with detailed evaluation of
all results, the statistical analysis of the data and the comparison with other grafting materials will complete this prospective study in the near future.
botissdental GmbH, Berlin, Germany) or resorbable membranes (Jason membrane, botissdental GmbH, Berlin, Germany) for ridge preservation and augmentation prior to
implant placement. Minimally invasive protocols were followed in all cases. Bone regeneration and site preservation/
augmentation was evaluated clinically and radiographically
with plain radiographs and/or cone-beam computed tomography prior to tooth extraction, at implant placement and after
prosthetic restoration.
Results: Bone grafting materials such as allografts or alloplasts
that induce a high local turnover of new bone formation and
graft resorption produced excellent results in preserving the
sites where implants were placed in a second stage. Xenografts
that are characterized by slow resorption and fast integration
by the new-formed bone gave excellent results in augmenting
the residual ridges bucally in areas adjacent to implant sites
where dimensional stability is important.
Conclusions and clinical implications: The presented cases
highlight the use of specific regenerative materials to preserve
the alveolar ridge after tooth extraction and augment the bone
prior to implant placement in order to achieve optimal results
following minimal invasive surgical protocols.
individuals required dental implants is increasing. Unfortunately, clinical studies have revealed T2DM patients have
higher implant and bone grafting failure rates than the general
population, likely due to inferior bone healing. A tissue engineering technique based on adipose-derived stem cells (ASCs)
with proven capacity to differentiate along osteogenic lineages
has long been used to promote bone regeneration in bone
defects in healthy anmimals and humans.
Aim: We sought to investigate whether ASCs combined
withanorganic bovine bone (Bio-Oss) improve bone repair and
mineralization in calvarial critical-sized defects (CSD) in
T2DM rats.
Methods: High-fat diet (4 weeks) with a low-dose of streptozotocin (30 mg/kg) was used to induce a T2DM model. ASCs
were harvested from inguinal fat pads of healthy SD rats.
Calvarial CSDs (d = 5 mm) in T2DM rats (four groups, n = 12)
were prepared and randomly filled with Bio-Oss alone or BioOss seeded with 3 9 105, 3 9 106 or 3 9 107 ASCs/graft. Specimens were assayed using micro-CT, energy disperse spectroscopy (EDS) and histomorphometry at 4 and 8 weeks postimplantation. The statistic analysis of two-way classification
ANOVA was used.
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Spain
Background: Bioceramics, especially calcium phosphate ceram-
ics, have been widely used for bone tissue repair in orthopedic
and dental applications due to their good biocompatibility and
osteoconductivity. The possibility of adding osteoinductive
bioactive components that allow greater integration of the
block, preventing its loss and encapsulation, has become
another focus of recent study. The addition of silicon to TCP
can improve stability, provide better structural properties and
stimulate new bone formation.
Aim: The aim of this research, therefore, was to investigate
whether new blocks of TCPss with different concentrations of
Si stimulate bone deposition on their surfaces, coupled with
Granada, Spain
Background: A detailed in situ study and precise visualization
Granada, Spain
Background: Determining the volume of bone deficit for pur-
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brings a series of advantages compared to traditional stereolithography, which is based on a subtraction model to obtain an
object, whilst composite powder molding builds in layers and
then refines them, achieving greater precision.
Aim: The aim of our study was to obtain, from helical CAT
scans, volumetric biomodels of bone for precisely determining
the biomaterial required for bone regeneration procedure, this
in order to validate the use of biomodels for calculating bone
volumes prior to planning bone regeneration surgery.
Methods: A casecontrol comparison with a total sample size
of 20 cases, 10 control and 10 test samples. Biomodels were
generated from helical CAT scans with 0.5 mm slices, without 3D reconstruction or image filters. Bone defects in premolar and molar areas were treated with titanium mesh and
xenograft (MP3) combined with resorbable carriers. Time
taken to carry out procedures with and without the use of biomodels (in minutes), discrepancies between the grafts performed with and without biomodels and bone defects (mm),
and postoperative complications were registered.
Results: No significant differences were recorded for measurements of width and length of bone defect between patient
bone and the biological models.
Conclusions and clinical implications: The use of biomodels
obtained by rapid prototyping is effective in treatment planning. Biomodels generated by rapid prototype composite molding is an effective tool for planning and a valid and reliable
resource for surgery. The precision of bioreplicas make it possible to obtain a graft from a donor site accurately and, by
doing so, reduce the time taken to carry out surgical procedures and also reduce morbidity.
Granada, Spain
Background: Few studies have included EDX analysis as a tool
degradation process of new highly porous (95%) biphasic calcium phosphate (hydroxyapatite 60%/B-tricalcium phosphate
40%), used to fill critical size defects in rabbit tibiae, supplementing histomorphometric findings with radiographic
thermal imaging, EDX analysis and Ca/P ratio mapping at
different time stages.
Methods: Two critical size defects of 6 mm diameter were
created in both tibiae of 21 New Zealand rabbits, test group
(Ossceram) and control group. Histomorphometric, radio-
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Granada, Spain
Background: Dental extraction results in reduction of the vol-
ing period and had to be removed. The remaining grafts provided sufficient bone and a correct orientation to retain dental
implants. While iliac crest grafts provide adequate bone volume in vertical and horizontal dimension, primary stability in
fibula and scapula grafts is higher, however, bone volume is
reduced. This results in an unfavourable implant-to-crown
ratio making sufficient prosthetic rehabilitations, especially in
partial edentulous patients, difficult. Due to the even lower
vertical and horizontal dimension of the scapular graft,
implant retained rehabilitation are difficult with this graft.
Conclusions and clinical implications: Microvascular bone
grafts can help to functionally rehabilitate patients after resective surgery. All grafts can provide sufficient primary stability.
crest, the fibula and the scapula are most commonly used to
reconstruct maxillary and mandibular bone defects after resective tumor surgery to successfully rehabilitate patients. Functional and aesthetic aspects have to be considered during bone
positioning to achieve sufficient facial support, but the bone
graft should also deliver sufficient bone in a correct threedimensional position to allow for a subsequent dental rehabilitation as well.
Aim: The aim of this study was to evaluate microvascular
bone grafts under the aspect of supplying adequate bone to
successfully retain dental implants and permitting a later prosthetic rehabilitation. Additionally the outcome of dental
implants placed in free microvascular bone grafts was analysed.
Methods: Sixty-two microvascular bone reconstructions were
performed after resective tumour surgery between September
2010 and February 2012 in the department of oral and maxillofacial surgery of the Heidelberg University. Thirty-five microvascular iliac crest grafts, 24 fibula grafts and three scapular
grafts were performed. The microvascular bone grafts were
checked for suitability to retain dental implants by using postoperative computed tomography and orthopanographs. Bone
dimension and bone orientation were analysed.
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dure, Straumann SLA implants were placed, and the superstructure was seated 4 months later. Progress remains favorable.
Conclusions and clinical implications: Navigation enables easy
monitoring of the lateral window technique via images. The
lateral window could be opened precisely at the most anterior
part of the maxillary sinus using the navigation system. In
addition, only a small access hole, almost the same size as the
head of the surgical instruments. Since new bone usually generated from host bone into cavity, leaving as large space of
host bone as possible, effectively induced bone generation.
Consequently this system is considered useful for performing
minimally invasive surgery.
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extraction sockets has been recently studied in different investigations Scarce data are available about the role and sequence
of vascularization during the alveolar bone healing and about
the interactions between angiogenesis and osteogenesis of the
provisional matrix in socket healing.
Aim: The aim of the present immunohistological investigation was to define and compare the osteogenic potential to the
vascularization of the provisional matrix in grafted and
ungrafted extraction sockets after 4 and 12 weeks of healing.
Methods: A total of 33 Patients with 65 extraction sites participated in this study. After tooth extraction the sockets were
augmented with Bio-Oss collagen or non-augmented. At
implant placement after 4 or 12 weeks bone biopsies were
obtained. Within the specimens the osteogenic and endothelial potential of mesenchymal cells was analyzed in the provisional matrix using immunohistochemical analysis with three
monoclonal antibodies Cbfa1/Runx2, Osteocalcin (OC), and
CD31. Statistical analysis was performed using Mann-Whitney
U-test, Spearmans rank-order correlation coefficient, and the
two-factorial analysis for repeated measurements.
Results: Of the 65 extraction sockets, 25 (13 non-augmented,
12 augmented) sites after 4 weeks healing time and 40 (19
non-augmented, 21 augmented) sites after 12 weeks healing
time were involved in the study. No signs of acute or chronic
inflammation were noted in any specimens. After 4 weeks, a
median amount of 56% (1085%) of Cbfa1 positive cells and a
median amount of cells expressing OC was 21% (542%) was
measured. A median CD31 score of 5 was observed. After
12 weeks, a median amount of 61% (1990%) positive cells
expressed by Cbfa1/Runx2 staining a median amount of OC
positive cells of 9% (217%) was measured. The results at
12 weeks revealed a median score of CD31 positive cells of 3.
Conclusions and clinical implications: The results have shown
show that with increasing age a decreasing endothelial potential was observed not after 4 weeks but after 12 weeks thus it
suggests that the angiogenesis is diminished in older patients
in the later phase of healing in extraction sockets. Osteoblas-
Results: There
Beijing, China
Background: Traditional extraction site preservation need bone
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Laurent Ohayon
Campinas, Brazil
tion procedures is well known in dentistry. However, corticocancellous allograft bone blocks from iliac crest, are not
considered the first choice, because they are stigmatized by
some unpredictable behavior. Nonetheless, severe atrophy of
the edentulous maxilla requiring bone augmentation as a prerequisite for further successful implant placement has converted the use of allogenic bone graft materials into an
important alternative that overcomes limitations in available
self-donor sites and the need for added surgical procedures.
Aim: This study evaluated the dimensional changes of iliac
crest allografts adapted over the vestibular surface of the edentulous maxilla.
Methods: Eleven consecutive patients with 43 corticocancellous fresh-frozen bone blocks from a Musculoskeletal Tissue
Bank, 32 of these from the anterior area (group I) and 11 from
the posterior area (group II) were included in this study fulfilling the following inclusion criteria: requirement of bone augmentation in the maxilla, minimum of 10 mm height in
residual alveolar ridge; absence of debilitating systemic diseases; treatment protocol acceptance. The allografts were
thawed for 30 min prior to surgery, and then the blocks were
sculpted with rotary instruments. At surgery, the residual
crests were measured and a perfect adaptation and fixation of
bone blocks was pursued allowing further measurements.
After a 6-months healing period, a two-stage approach was
performed and a third measurement was obtained before
implants placement into the grafted ridge. Analysis of variance
was used to evaluate changes.
Results: The statistical analysis of the different measurements
between the first and the second surgery stage showed an horizontal bone augmentation mean of 4.61 mm and 4.4 mm for
groups l and ll, respectively. Considering bone resorption the
results were 12.14% and 13.00%, respectively.
Conclusions and clinical implications: Corticocancellous freshfrozen bone blocks from iliac crest can be considered a suitable and predictable alternative to autogenous grafts in the
reconstruction of atrophic maxilla.
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intraoral harvesting sites of bone graft for alveolar reconstruction of atrophied alveolar ridges. While their clinical pros and
cons as bone grafts are well known, their potential as cell
source for bone tissue engineering procedures has not yet been
explored.
Aim: Thus, we aimed at comparing in vitro osteoblasts
derived from human mandibular symphysis and ramus by
evaluating cell growth (MTT assay), alkaline phosphatase
(Alp) activity (thymolphthalein releasing), mineralized matrix
formation (alizarin red staining), and gene expression (qPCR)
of the osteoblast markers: runt-related transcription factor 2
(Runx2), collagen type 1 (Col1), bone sialoprotein (Bsp), osteopontin (Op), and osteocalcin (Oc).
Methods: Osteoblasts from mandibular symphysis and ramus
fragments from the same patient (n = 3) were enzymatically
released, expanded, and cultured in osteogenic medium for up
to 17 days and all comparisons were donor-matched. Data
were analysed by ANOVA and MannWhitney tests.
Results: Cells derived from symphysis and ramus displayed
the same growth pattern increasing from day 3 to 7 and being
steady from day 7 to 10, without any difference related to cell
origin (P = 0.24). Alp activity assayed at days 7, 10 and 14 was
higher in cultures derived from symphysis (P = 0.0001) peaking at 10 days (P = 0.03) and mineralized matrix formation
evaluated at day 17 was the same in both cultures (P = 0.5).
qPCR was carried out at 10 days and showed that the expression of Runx2, Bsp, and Op was higher in osteoblasts derived
from ramus (P = 0.02 for all of them) while the expression of
Col1 and Oc was not affected by the cell source.
Conclusions and clinical implications: These results were not
related to either the patients, as the comparisons were donormatched, or the culture conditions that were kept rigorously
identical. Such findings reveal that cells from symphysis and
ramus despite sharing the same embryonic origin are different
in terms of phenotype and genotype expression. Apparently
these differences did not drive the cultures toward distinct
osteogenic potential as cells from symphysis and ramus exhibited similar mineralizing capacity. Based on this, it would be
worth to carry out further in vitro and in vivo investigations
to determine the best site as cell source to be used for bone
reconstruction based on tissue engineering principles. Financial support: FAPESP and CNPq.
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(ADM) and anorganic bovine bone matrix with synthetic cellbinding peptide P-15 (ABM/P-15) to preserve alveolar bone
after tooth extraction.
Methods: Eighteen patients in need of extraction of maxillary
anterior teeth were selected and randomly assigned to the Test
Group (ADM plus ABM/P-15) or the Control Group (ADM
only). Clinical measurements of external vertical palatal measurement (EVPM), external vertical buccal measurement
(EVBM), and alveolar horizontal measurement (AHM) were
recorded initially and at 6 months after ridge-preservation procedures. Bone biopsies were taken 6 months after ridge preservation procedures in ten patients, during the placement of
implants, and histomorphometric measurements of the
amount of newly formed bone area (NBA) and fibrous tissue
plus marrow spaces (FTMS) were analyzed.
Results: Clinical measurements showed no statistically significant differences between test and control groups initially and at
6 months, and intragroup analysis showed a statistically significant reduction in the measurements for both groups. Considering 06 month variations, the differences in EVPM and EVBM
were not statistically significant; however, there was a statistically significant difference in AHM (P < 0.05), showing less variation in test group. The histomorphometric analysis showed
38.66% of new bone tissue and 54.5% of fibrous tissue and marrow spaces in the control group. The experimental group presented 29.13% of new bone area, 42.4% of fibrous tissue plus
marrow space and 20.67% of residual graft particles. The NBA
and FTMS parameters showed higher values for the control
group, and these differences were statistically significant when
compared to the test group (P = 0.03).
Conclusions and clinical implications: It was concluded that:
ADM acted as a membrane; the group with ADM alone histomorphometrically presented more new bone formation after
6 months (probably because the bone substitute is still undergoing resorption process); and the association of ABM/P-15
with ADM resulted in better quantitative clinical results and
should be used, instead of ADM alone, for preservation of the
alveolar ridge after extraction of anterior maxillary teeth.
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membrane is known as the Open Barrier Regeneration Technique, or the Open Barrier Membrane Technique (OBMT).
Due its high density and small porosity size, the possibility
for bacterial contamination is limited.
2007; Fermergard 2009; Cricchio 2011; Volpe 2011) have demonstrated that the elevation of the Schneiderian membrane
with simultaneous implants placement result in bone formation.
Aim: To evaluate the radiographic results of bone formation
around implants inserted in a void space created by the elevation of the sinus membrane without adding any bone grafting
material.
Methods: Twenty-eight patients with 2.59 mm of residual
alveolar bone were consecutively included from January 2009
to September 2011. Thirty-seven AstraTech dental implants
(913 mm) were placed in 28 sinus. Sixteen sinus elevations
was performed with a lateral approach technique and 12 using
an alveolar approach. The sinus mucosal lining was elevated
and implants were installed in the residual subantral bone
without adding any bone grafting material in the void space.
One or two stage procedures were used depending on primary
stability. CBCT or periapical radiographs (with angulator and
silicon re-positional key) were performed pre-surgically, immediately post surgically, 46 months post surgically and then
annually to evaluate bone formation below the sinus membrane and marginal bone loss.
Results: All implants were stable after 6 months of healing.
No implants were lost at this time. The Radiographic examination demonstrated new bone formation in 78.7% of the
cases after 6 months. The average bone gain in the sinus was
5.81 mm +/- 2.22 mm after a minimum of 6 months. No relationship was observed between bone formation height and the
length of implants not covered with bone at T0.
Conclusions and clinical implications: Sinus membrane elevation and immediate implant placement without the use of
additional bone grafting material was found to be a predictable
technique for bone augmentation of the maxillary sinus. We
assume that the formation of new bone was obtained according to the same mechanisms as the ones described in guided
bone regeneration. We believe that this technique reduces the
risks of morbidity associated with bone graft harvesting. Further histologic analysis are needed to confirm these findings.
Nantes, France
Background: The autologous platelet concentrates PlateletBackground: Implant supported prosthetic restorations in the
severly atrophic posterior maxilla have been successfully performed for the last two decades with various sinus augmentation techniques. The use of grafting material is anticipated to
be necessary. However, recent studies (Lundgren 2004; Thor
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Ankara, Turkey
Background: Oro-antral communications (OACs) commonly
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regeneration and graft resorption followed by histological analysis to qualitatively access new bone formation, and evaluate
the host response to the implant material and remodelling.
Results: The synthetic bone graft material demonstrated a significant bone regenerative response within a short time frame.
Biopsies indicated almost complete resorbtion of the graft
material coupled with virtually complete replacement with
new viable bone. Integration of residual graft material into
new bone tissue was evident. No acute inflammation or lymphatic response from the host was observed in response to the
material. Successful subsequent implant placement was
achieved in each patient.
Conclusions and clinical implications: The results from the
pilot study indicate that the synthetic material has efficient
osteoregenerative capability with the regeneration of new viable bone almost complete within 12 weeks. These findings
indicate the material may offer clinical advantages for early
implant placement.
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is important. Mucogingival surgery around implants is generally performed after placing the implants, which complicates
implant therapy. Therefore, as pretreatment to simplify the
implant therapy, we performed a modified free gingival graft
in the edentulous area in one patient and a connective tissue
graft in another.
Aim: To evaluate the effectiveness of soft-tissue augmentation as implant pretreatment.
Methods: Case 1 was a 70-year-old male with generalized
severe chronic periodontitis who had four implants placed in
the right and left mandible molar regions. There was insufficient keratinized mucosa, and the mucogingival junction was
adjacent to the alveolar crest in both regions. Consequently, a
free gingival graft following vestibular extension using a splitflap technique was performed. The recipient site was prepared
with a partial thickness flap reflected with an alveolar crest
incision approximately 2 mm lingual from the mucogingival
junction and a mesiodistal longitudinal incision. The transplant was autografted to the edge of the alveolar crest side at
the recipient site. The reflected split flap was displaced and
sutured to the apical edge of the transplant. Case 2 was a 61year-old female with localized moderate-to-severe chronic
periodontitis and an all-ceramic bridge in a portion missing
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from a left maxillary first premolar. Although there was sufficient keratinized mucosa, the alveolar crest was narrow and
Class I in Seiberts classification. There was also an approximately 3-mm Miller Class I recession at the adjacent cuspid
tooth. Therefore, a connective tissue graft was performed for
ridge augmentation and root coverage. Subsequently, the
patient changed her mind and requested implant placement.
Therefore, implants were placed, and the superstructures were
fixed in both cases. Both patients received maintenance care.
Results: These proposed techniques augmented the keratinized mucosa or ridge width at the residual ridge before
implant therapy. Generally, no scar tissue forms after soft-tissue grafts; the keratinized mucosa around the implants
exceeded 2 mm, and favorable peri-implant tissue was maintained.
Conclusions and clinical implications: The results suggest that
these techniques simplify implant therapy when there is
insufficient keratinized mucosa or ridge width around the
planned implant sites.
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time passed, the amount of newly formed bone was progressively increased for experimental and control sites. The immunostaining intensity and thepercentage of positively stained
cells for VEGF in experimental group were greater than control group at week 1 post-surgery
Conclusions and clinical implications: PRF application improve
repair and angiogenesis on rabbit calvarium wounds and
increase the amount of newly formed bone, especially in the
early bony healing phase.
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