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Purpose: To review and compare the available literature on bone regeneration using titanium mesh and map the current evidence on bone gain outcomes and complications while comparing this scaffold with collagen membranes., Materials and Methods: A comprehensive electronic and manual search was performed to identify randomised and non-randomised prospective controlled clinical trials that involved the use of titanium mesh in at least one arm, with outcomes including complications and vertical and/or horizontal bone gain. The focused questions were defined as follows: What are the outcomes of using titanium mesh in ridge augmentation compared to other types of barrier membrane, and what is the complication rate (membrane exposure and infection) when titanium mesh is used in these procedures?, Results: A total of 22 articles were included in the qualitative analysis. Overall, the studies that measured bone gain resulted in 3.36 mm vertical (196 subjects; 95% confidence interval 2.44 to 4.64 mm, range 1.4 to 5.7 mm) and 3.26 mm horizontal augmentation (81 subjects; 95% confidence interval 2.93 to 3.63 mm, range 2.6 to 3.7 mm), with variability among studies. The most commonly noted complication was mesh exposure, regardless of the type of mesh used, and the second most common was graft failure. The overall pooled complications rate reported in clinical trials was 10.8%. The meta-analysis comparing titanium mesh and collagen membranes, controlling for the type of bone regeneration (staged or simultaneous with implant placement), failed to show a significant difference in horizontal bone gain between the two techniques., Conclusions: Within the limitations of the present study and acknowledging the heterogeneity among the articles included, titanium mesh can serve as a feasible protective scaffold for bone regeneration with a relatively acceptable complication rate and in defects requiring around 4 mm 3D reconstruction. Data on patient-reported outcomes were scarce., Conflict-Of-Interest Statement: None of the authors have any financial interests, either directly or indirectly, in the products or information mentioned in the present article.

Background: Classical guided bone regeneration (GBR) treatments can achieve favorable clinical results for ridge defects. However, extensive bone augmentation in the non-esthetic area in the posterior region for minor ridge defects is unnecessary. Therefore, this study used a collagen and Platelet-rich fibrin (PRF) mixture for bone augmentation on minor posterior ridge defects and evaluated the effects., Methods: 22 Seibert Class I ridge defects were treated with BC and covered with a PRF membrane (simplified guided bone regeneration, simplified GBR) and other 22 were treated with Bio-Oss and covered with Bio-Gide (classical GBR). Cone-beam computed tomography imaging was conducted 6 months post-surgery to compare the ridge's horizontal width (HW) and buccal ridge's horizontal width to assess the osteogenic effect. In addition, the buccal ridge contour morphology was studied and classified., Results: The buccal ridge contour of simplified GBR was Type A in 14 cases, Type B in 7 cases, and Type C in 1 case and it of classical GBR was Type A in 11 cases, Type B in 8 cases, and Type C in 3 cases. The mean HW significantly increased by 1.50 mm of simplified GBR treatment, while it increased by 1.83 mm in classical GBR treatment., Conclusion: The combined use of BC and PRF had a significant effect on bone augmentation and this treatment exhibited promising clinical results for correcting posterior Seibert Class I ridge defects. The morphological classification of the reconstructive effect in this study can be utilized in future clinical work., (© 2024. Korean Tissue Engineering and Regenerative Medicine Society.)

Objective: The aim of the sthudy. To study the influence of general and local factors on the regenerative potential of bone tissue to optimize augmentation mechanisms in the treatment of jaw atrophy., Materials and Methods: The influence of general and local factors on the regenerative potential of the bone during the augmentation operation of the alveolar process (part) of the jaw in 68 patients was studied. The survival rate of dental implants and the incidence of complications after completion of dental rehabilitation in the long-term follow-up period (more than 5 years) were evaluated. 18 indicators were studied, which were evaluated by qualitative and quantitative methods. The study of the effect of indicators on regeneration was carried out using an accurate Fischer test for conjugacy tables. The assessment of the strength of the influence was calculated as the ratio of the chances of developing an unfavorable outcome of bone grafting and dental implantation., Results: He highest chances of developing adverse outcomes were found in smoking patients with diabetes mellitus, high body mass index, low survival of bone walls, severe bone atrophy (5.6 and higher class according to Cawood & Howell), three-dimensional bone defect, in the absence of 3 or more bone walls, the presence of subcompensated and decompensated psychological state the patient. In the course of histological examination, the influence of these factors on the mechanisms of reparative osteogenesis morphologically manifested a lower degree of progress of regenerative processes and a lower degree of maturity of bone tissue., Conclusion: To reduce the chances of developing an unfavorable outcome, in the presence of negative general and local factors, it is not advisable to use dental implantation simultaneously with bone augmentation procedures. In order to reduce the pathophysiological impact of negative factors during sinus lifting, increase the proportion of autosteal material for potentiating the metabolic activity of bone tissue, as well as prescribe antioxidant, antihypoxant and membrane stabilizing therapy before surgery and in the early postoperative period.

Bone augmentation procedures are frequent today in implant patients, since an implant should be circumferentially anchored in bone at completion of bone healing to have a good long-term stability. The best documented surgical technique to achieve this goal is guided bone regeneration (GBR) utilizing barrier membranes in combination with bone fillers. This clinical review paper reflects 35 years of development and progress with GBR. In the 1990s, GBR was developed by defining the indications for GBR, examining various barrier membranes, bone grafts, and bone substitutes. Complications were identified and reduced by modifications of the surgical technique. Today, the selection criteria for various surgical approaches are much better understood, in particular, in post-extraction implant placement. In the majority of patients, biodegradable collagen membranes are used, mainly for horizontal bone augmentation, whereas bioinert PTFE membranes are preferred for vertical ridge augmentation. The leading surgeons are using a composite graft with autogenous bone chips to accelerate bone formation, in combination with a low-substitution bone filer to better maintain the augmented bone volume over time. In addition, major efforts have been made since the millenium change to reduce surgical trauma and patient morbidity as much as possible. At the end, some open questions related to GBR are discussed., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To test the hypothesis that the use of rhBMP2 in established defects requires additional growth factors such as rhVEGF to accomplish effective bone repair., Materials and Methods: Horizontal/vertical defects of 2 cm length and 1 cm height were created bilaterally in the alveolar crest of the maxillae of 18 minipigs together with the extraction of all premolar teeth and one molar tooth on both sides. After 3 months of healing, defects were augmented with 0.5 g particulate PDLLA/CaCO3 composite loaded with 400 µg rhBMP2/50 µg rhVEGF165 on one side and 800 µg rhBMP2 on the other in 12 test animals, whereas defects in six control animals were sham operated and left unfilled on one side and augmented with blank carriers on the other. After 4 and 13 weeks, the animals were evaluated each for area of new bone formation (mm²) and bone density (area %)., Results: Augmentations with carriers loaded with 800 g µrhBMP2 failed to induce significantly more bone than in the augmentations with unloaded carrier after 4 and 13 weeks (p = .1000, p = .381). Augmentations with carriers loaded with 400 µg rhBMP2 and 50 µg erhVEGF165 resulted in significantly increased bone formation after 13 weeks (p = .024) compared to blank carriers. Soft tissue in augmentations with combined rhBMP2/rhVEGF165 loading exhibited numerous microvessels compared to soft tissue in augmentations with rhBMP2., Conclusions: It is concluded that effective bone regeneration in augmentations of established alveolar ridge defects may require the application of rhVEGF additionally to rhBMP2., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: Although bone graft (BG) is the gold standard for bone augmentation, its use is hampered by donor site morbidity and limited quantity., Purpose: To evaluate the capabilities of bone formation by cortical bone repositioning (CBR) as the healing response following grafting of autogenous bone block without filling biomaterial at the gap between gap and recipient., Materials and Methods: Twelve Japanese White rabbits were divided into three groups (postoperative 2, 5, and 8 weeks). A cortical block was freed from the mandibular body, half of the block was positioned and fixed overlapped the original bone surface beside the defect and the other half remained only elevated above the defect. Three areas were decided for the evaluation; BG, CBR, and defect (D) area. Areas were evaluated by micro-CT, histology, and histomorphometric analysis., Results: There is no statistical difference between BG and CBR by evaluating distance and area in histomorphometrical analysis (P < .05). D area showed statistical decrease compared with BG and CBR at week 2. Histologically, new bone was evident at week 2, mature bone was observed in all three areas at week 8, D area disappeared and fused completely with the elevated bone block., Conclusion: CBR has potential for bone augmentation as BG induced from its own regenerative ability of healing process., (© 2019 Wiley Periodicals, Inc.)

The present study was designed to compare the bone augmentation ability of absorbable collagen sponge (ACS) with that of hydroxyapatite/collagen composite (HAP/Col) using a rat calvaria defect model. Bone defects were created artificially on the surface of the calvariae of 10-week-old male Fisher rats, and then cylindral plastic caps filled with ACS or HAP/Col were placed on the defects. This area was designated as the region of interest (ROI) and new bone formation was observed at 0, 4, 8, and 12 weeks after surgery using micro-CT. Histological examinations were performed using sections obtained from 12-week-old rats. Prominent new bone formation was observed in the HAP/Col group relative to the ACS group; onset of new bone augmentation was evident from 4 weeks after surgery in the HAP/Col group and from 8 weeks in the ACS group. Histological examination revealed that the entire area of the cap was filled with newly formed bone intermingled with the HAP/Col composite. Bone mineral density in the HAP/Col group was double that in the ACS group. These results indicate that the use of HAP/Col contributes significantly to new bone augmentation.

The guided bone regeneration (GBR) technique is often applied to provide sufficient bone for ideal implant placement. The objective of this study was to evaluate whether GC membrane ® , which has already been used for guided tissue regeneration (GTR), can also be available for GBR. Twenty-three implants in 18 patients were evaluated in the study. All patients underwent implant placement with GBR using GC membrane ® . Cone-beam computed tomography was performed at 13-30 weeks after surgery and the amount of augmented bone was assessed. The implant stability quotient (ISQ) was measured at the second operation to evaluate implant stability. Although wound dehiscence was observed at 4 of 23 regions (17.4%), all wounds closed quickly without any events by additional antibiotic administration. GBR-induced bone augmentation of 0.70-2.56 mm horizontally and 0-6.82 mm vertically. Only 0.18 mm of bone recession was observed at 16-24 months after implant placement. GBR with GC membrane ® induced sufficient bone augmentation, leading to successful implant treatment. The present results suggest that GC membrane ® is available not only for GTR, but also for GBR.

Objectives: To test whether or not one of two biological mediators (recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human platelet-derived growth factor (rhPDGF-BB)) is superior to the other and compared with control groups for bone regeneration around implants based on histomorphometrical outcome measures., Materials and Methods: Box-type defects (10 × 5 × 5 mm) were prepared on the buccal sides of the left and right edentulous ridge in ten mongrel dogs. Implants were placed at each site, the defects either received (i) bovine-derived particulated bone mineral (DBBM) mixed with rhBMP-2 and a collagen membrane (CM) (DBBM/BMP-2), (ii) DBBM mixed with rhPDGF-BB and CM (DBBM/PDGF), (iii) DBBM and CM (DBBM) and (iv) empty control (control). Animals were euthanized post-surgery at 8 weeks and 16 weeks. Histomorphometrical analyses were performed., Results: The mean percentages of regenerated area within total defect area amounted to 56.95% for DBBM/BMP-2, 48.86% for DBBM/PDFG, 33.44% for DBBM and 1.59% for control at 8 weeks, and 26.79% for DBBM/BMP-2, 23.78% for DBBM/PDFG, 30.21% for DBBM and 5.07% for control at 16 weeks with no statistically significant differences between the groups (P > 0.05). The mean amount of regenerated bone was 26.97% for DBBM/BMP-2, 22.02% for DBBM/PDFG, 5.03% for DBBM and 1.25% for control at 8 weeks, and at 16 weeks, these values were lower in the two groups with biological mediators (DBBM/BMP-2 = 13.35%; DBBM/PDGF = 6.96%) and only slightly increased in group DBBM (10.68%) and the control group (4.95%) compared with 8 weeks. The first bone-to-implant contact values on the buccal side were minimal for DBBM/BMP-2 (0.57 mm) and maximal for control (3.72 mm) at 8 weeks., Conclusions: The use of biological mediators (rhBMP-2 and rhPDGF-BB) can increase the amount of bone regeneration at dehiscence-type defects compared with controls at 8 weeks, but not at 16 weeks due to enhanced hard tissue remodeling processes., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Improvement in localized bone regeneration is needed to avoid the use of autogenous tissue. For that purpose, the use biologic mediators was proposed. The aim was to test whether or not one of two biologic mediators, recombinant human bone morphogenetic protein-2 (rhBMP-2) or recombinant platelet-derived growth factor (rhPDGF-BB), is superior to the other and to control groups for localized bone regeneration., Materials and Methods: Four cylinders (height: 5 mm; diameter: 7 mm) were screwed on the parietal and frontal bones at the cranium in 12 rabbits. The cylinders either received (i) deproteinized bovine bone mineral (DBBM) mixed rhBMP-2 (DBBM/BMP-2), (ii) DBBM mixed with rhPDGF-BB (DBBM/PDGF), (iii) DBBM (DBBM), and (iv) empty control (control). Rabbits were euthanized at 2 and 8 weeks (n = 6, respectively). Conventional histomorphometric and micro-CT analyses were performed. Parametric linear mixed models were applied for the analyses with Bonferroni correction for the multiple group comparisons., Results: The area of bone regeneration (histology; AA H isto values were 96.29% (DBBM/BMP-2), 46.37% (DBBM/PDFG), 39.66% (DBBM), and 35.98% (control) (DBBM/BMP-2 vs. all groups (P < 0.05)). At 8 weeks, bone regeneration was greatest for DBBM/BMP-2 (35.62%) with statistically significant differences compared to all other groups (P < 0.05). The area of bone regeneration (micro-CT; AA H isto values were 96.29% (DBBM/BMP-2), 46.37% (DBBM/PDFG), 39.66% (DBBM), and 35.98% (control) (DBBM/BMP-2 vs. all groups (P < 0.05)). At 8 weeks, bone regeneration was greatest for DBBM/BMP-2 (35.62%) with statistically significant differences compared to all other groups (P < 0.05). The area of bone regeneration (micro-CT; AA m- CT ) at 2 weeks amounted to 43.87% (DBBM/BMP-2), 42.81% (DBBM/PDFG), 48.71% (DBBM), and 0.96% (control). The control group demonstrated statistically significantly less AA m- CT compared to all groups (P < 0.05). At 8 weeks, mean AA m- CT values were 63.65% (DBBM/BMP-2), 50.21% (DBBM/PDFG), 44.81% (DBBM), and 4.57% (control) (P > 0.05)., Conclusions: The use of rhBMP-2 significantly enhanced bone regeneration compared to all other groups including the group with rhPDGF-BB., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The partial edentulous posterior mandible is often a challenge area that requires a bone reconstructive surgery for implants placement., Purpose: This RCT was aimed to evaluate complications rate and vertical bone gain after Guided Bone Regeneration (GBR) with dense non-resorbable d-PTFE titanium-reinforced membranes (Group A) versus titanium meshes covered by cross-linked collagen membranes (Group B)., Material and Methods: 40 partially edentulous patients with atrophic posterior mandible, were randomly divided into two study group: 20 patients were treated with one stage GBR by means of non-resorbable d-PTFE titanium-reinforced membranes (Group A); and 20 patients, by means of titanium mesh covered by cross-linked collagen membranes (Group B). All complications were recorded, distinguishing between "surgical" and "healing" and between "minor" or "major.". Primary implants stability and vertical bone gain were also evaluated., Results: In the group A, surgical and healing complication rates were 5.0% and 15.0%, respectively. In the group B, surgical and healing complication rates were 15.8% and 21.1%, respectively. No significant differences between two study group were observed regarding complications rate implant stability and vertical bone gain., Conclusions: Both GBR approaches for the restoration of atrophic posterior mandible achieved similar results regarding complications, vertical bone gain and implant stability., (© 2017 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.)

Objectives: Research across many fields of medicine now points towards the clinical advantages of combining regenerative procedures with platelet-rich fibrin (PRF). This systematic review aimed to gather the extensive number of articles published to date on PRF in the dental field to better understand the clinical procedures where PRF may be utilized to enhance tissue/bone formation., Materials and Methods: Manuscripts were searched systematically until May 2016 and separated into the following categories: intrabony and furcation defect regeneration, extraction socket management, sinus lifting procedures, gingival recession treatment, and guided bone regeneration (GBR) including horizontal/vertical bone augmentation procedures. Only human randomized clinical trials were included for assessment., Results: In total, 35 articles were selected and divided accordingly (kappa = 0.94). Overall, the use of PRF has been most investigated in periodontology for the treatment of periodontal intrabony defects and gingival recessions where the majority of studies have demonstrated favorable results in soft tissue management and repair. Little to no randomized clinical trials were found for extraction socket management although PRF has been shown to significantly decrease by tenfold dry sockets of third molars. Very little to no data was available directly investigating the effects of PRF on new bone formation in GBR, horizontal/vertical bone augmentation procedures, treatment of peri-implantitis, and sinus lifting procedures., Conclusions: Much investigation now supports the use of PRF for periodontal and soft tissue repair. Despite this, there remains a lack of well-conducted studies demonstrating convincingly the role of PRF during hard tissue bone regeneration. Future human randomized clinical studies evaluating the use of PRF on bone formation thus remain necessary., Clinical Relevance: PRF was shown to improve soft tissue generation and limit dimensional changes post-extraction, with little available data to date supporting its use in GBR.

Background: The success of bone augmentation to a major degree depends on the biomechanics and biological conditions of the surrounding tissues. Therefore, an animal model is needed providing anatomical sites with similar mechanical pressures for comparing its influence on different biomaterials for bone regeneration. The present report describes the new bone formation associated to biomaterial in a bursa created in the epidural space, between dura mater and cranial calvaria, under the constant pressure of cerebrospinal fluid., Methods: Five adult California rabbits were used for the trial. In each animal, two bursae were created in the epidural spaces, in the anterior part of the skull, below both sides of the interfrontal suture. The spaces between dura mater and cranial calvaria were filled with in-situ hardening biphasic calcium phosphate containing hydroxyapatite and beta tricalcium-phosphate (BCP), in-situ hardening phase-pure beta-tricalcium phosphate (β-TCP) or without any biomaterials (sham). After 90 days, the animals were sacrificed, and the defect sites were extracted and processed for histomorphometric analysis by optical and backscattered electron microscopy., Results: The cranial epidural spaces created (n = 10) could be preserved by the application both BCP (n = 3) and β-TCP biomaterials (n = 3) in all experimental sites. The sites augmented with BCP showed less new bone formation but a trend to better volume preservation than the sites augmented with β-TCP. However, the bone in the BCP sites seemed to be more mature as indicated by the higher percentage of lamellar bone in the sites. In contrast, the created space could not be preserved, and new bone formation was scarce in the sham-operated sites (n = 4)., Conclusion: The experimental bursae created bilaterally in the epidural space allows comparing objectively bone formation in relation to biomaterials for bone regeneration under permanent physiological forces from cerebrospinal fluid pressure.

Objectives: The aim of this study was to investigate the bone regenerative properties of a heat treated cross-linked GBR membrane with zinc hydroxyapatite powders in the rat calvarial defect model over a 6-week period., Material and Methods: In vitro physio-chemical characterization involved X-ray diffraction analysis, surface topology by scanning electron microscopy, and zinc release studies in physiological buffers. Bilateral rat calvarial defects were used to compare the Zn-HAp membranes against the commercially available collagen membranes and the unfilled defect group through radiological and histological evaluation., Results: The synthesized Zn-MEM (100 μm thick) showed no zinc ions released in the phosphate buffer solution (PBS) buffer, but zinc was observed under acidic conditions. At 6 weeks, both the micro-CT and histological analyses revealed that the Zn-MEM group yielded significantly greater bone formation with 80 ± 2% of bone filled, as compared with 60 ± 5% in the collagen membrane and 40 ± 2% in the unfilled control group., Conclusion: This study demonstrated the use of heat treatment as an alternative method to cross-linking the Zn-MEM to be applied as a GBR membrane. Its synthesis and production are relatively simple to fabricate, and the membrane had rough surface features on one side, which might be beneficial for cellular activities. In a rat calvarial defect model, it was shown that new bone formation was accelerated in comparison with the collagen membrane and the unfilled defect groups. These results would suggest that Zn-MEM has the potential for further development in dental applications., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To test whether or not bone regeneration using deproteinized bovine bone mineral (DBBM) is comparable to hydroxyapatite/silica oxide (HA/SiO) and to test the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) as an adjunct to DBBM for localized bone regeneration., Materials and Methods: In each of the 10 rabbits, 4 titanium cylinders were placed on the external cortical plates of their calvaria. Four treatment modalities were randomly allocated: (i) empty, (ii) HA/SiO, (iii) DBBM, and (iv) DBBM plus rhBMP-2 (DBBM/BMP). The animals were sacrificed at week 8. Descriptive histology and histomorphometric assessment using a superimposed test grid of points and cycloids were performed., Results: The mean number of points of the test grid coinciding with bone within the cylinder reached 124 ± 35 bone points for empty controls, 92 ± 40 bone points for DBBM, 98 ± 44 bone points for synthetic HA/SiO, and 146 ± 34 bone points DBBM/BMP. The P-value for DBBM with and without BMP reached a borderline statistical significance of 0.051. However, the area of bone regeneration within the cylinders peaked for DBBM/BMP and was statistically significantly higher compared with empty cylinders (P < 0.05). The bone-to-bone substitute contact ranged between 32.9% ± 21.7 for DBBM, 39.6 ± 18.4% for HA/SiO, and 57.8% ± 10.2 for DBBM/BMP. The differences between DBBM/BMP and controls (DBBM, HA/SiO) were statistically significant (P < 0.05)., Conclusions: DBBM and HA/SiO rendered comparable amounts of bone regeneration. The addition of rhBMP-2 to DBBM resulted in more favorable outcomes with respect to the area of bone regeneration and to bone-to-implant contact, thereby indicating the potential of this growth factor to enhance bone regeneration within this animal model., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Alveolar ridge plays a pivotal role in supporting dental prosthesis particularly in edentulous and semi-dentulous patients. However the alveolar ridge undergoes atrophic change after tooth loss. The vertical and horizontal volume of the alveolar ridge restricts the design of dental prosthesis; thus, maintaining sufficient alveolar ridge volume is vital for successful oral rehabilitation. Recent progress in regenerative approaches has conferred marked benefits in prosthetic dentistry, enabling regeneration of the atrophic alveolar ridge. In order to achieve successful alveolar ridge augmentation, sufficient numbers of osteogenic cells are necessary; therefore, autologous osteoprogenitor cells are isolated, expanded in vitro, and transplanted to the specific anatomical site where the bone is required. Recent studies have gradually elucidated that transplanted osteoprogenitor cells are not only a source of bone forming osteoblasts, they appear to play multiple roles, such as recruitment of endogenous osteoprogenitor cells and immunomodulatory function, at the forefront of bone regeneration. This review focuses on the current consensus of cell-based bone augmentation therapies with emphasis on cell sources, transplanted cell survival, endogenous stem cell recruitment and immunomodulatory function of transplanted osteoprogenitor cells. Furthermore, if we were able to control the mobilization of endogenous osteoprogenitor cells, large-scale surgery may no longer be necessary. Such treatment strategy may open a new era of safer and more effective alveolar ridge augmentation treatment options., (Copyright © 2015 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Aim: To assess whether guided bone regeneration (GBR) treatment of peri‐implantitis‐related bony defects could improve healing compared to open flap debridement (OFD) at 36 months. Materials and Methods: In a multi‐centre, randomized clinical trial, 32 individuals received OFD (control group [CG]) and 34 GBR treatment (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP) suppuration (SUP), mucosal recession (MREC) and patient‐reported outcomes (PROs) were evaluated at 36 months. Results: Fifty individuals attended a supportive peri‐implant therapy program and completed the 36‐month follow‐up. GBR treatment resulted in an RDF of 2.13 ± 1.26 mm compared to 1.64 ± 1.54 mm following OFD (p =.18). No difference was found in PPD, BOP, SUP, REC or PROs between the groups. Successful treatment (no additional bone loss, PPD ≤ 5 mm, no BOP and no SUP) was achieved in 46.2% in TG and 20% in CG (p =.053). Treatment results obtained at 12 months were generally maintained up to 36 months. No significant changes were noticed between 12 and 36 months. Conclusions: At 36 months, treatment results obtained at 1 year were sustained following both GBR and OFD in patients attending supportive peri‐implant therapy. GBR resulted in more RDF and higher composite treatment success rate than OFD (ClinicalTrials.gov Identifier [NCT02375750]). [ABSTRACT FROM AUTHOR]

Purpose: To histologically and radiographically investigate the effect of plasma rich in growth factor (PRGF) mixed with bone grafts on ossification in the early period. Materials and Methods: A total of 12 New Zealand male rabbits (weighing between approximately 2.5 to 3 kg) were included in this study. Subjects were randomly divided into two sets of groups: control and experiment. Autograft, DFDBA (demineralized freeze-dried bone allograft), and DBBM (deproteinized bovine bone mineral) were applied to different defects in the control groups, and autograft + PRGF, DFDBA + PRGF, and DBBM + PRGF were applied in the experimental groups. All subjects were euthanized 28 days after surgery. The volumes of the bone, new connective tissue, and new capillaries were evaluated stereologically, and the bone density in the defects was investigated radiographically. Results: Regarding the stereologic evaluation, the volumes of the bone and capillaries were significantly higher in the experimental groups than in the control groups. In contrast, the connective tissue volume was considerably lower (P < .001, in all groups). Similarly, radiographic examinations showed that the bone density measurements in the experimental groups were higher than in the control groups. However, these differences were statistically significant only between the DFDBA + PRGF and DFDBA groups (P < .011). Conclusions: The present study provides evidence that the addition of PRGF to autograft, DFDBA, and DBBM enhances osteogenesis in the early period compared to using these grafts alone. It also accelerates the remodeling of connective tissue to bone in defects. [ABSTRACT FROM AUTHOR]

Aims: (1) To assess the effectiveness of the Sausage Technique™ when applied for lateral bone augmentation by multiple experienced clinicians; (2) To identify risk indicators for a poor outcome and to assess the need for adjunctive surgery. Materials and Methods: All patients who had been treated with the Sausage Technique™ for lateral bone augmentation by three experienced surgeons between January 2019 and December 2021 were included in a retrospective case series. The Sausage Technique™ technique includes the use of autogenous bone chips and deproteinized bovine bone mineral (1:1 ratio), covered with a stretched and pinned collagen membrane. The increase in alveolar width between the pre‐operative situation and 9 months was assessed at different levels on superimposed cone‐beam CT scans. Results: Twenty‐five augmentations performed in 25 patients (17 males, 8 females, mean age 51 years) were available for evaluation. Mean alveolar width increased from 4.35 to 7.43 mm at 3 mm below the crest. The mean increase of 3.08 mm (95% CI 2.10–4.06; p < 0.001) was significant. The outcome of non‐containing single implant sites was significantly worse than the outcome of other sites (MD 2.67 mm; p = 0.008). The need for regrafting was 4% and the need for soft tissue augmentation was 48%. Twenty percent of the patients needed soft tissue augmentation due to a lack of keratinized mucosa width, and 32% due to a lack of buccal convexity. The former was mainly needed at multiple implant sites, whereas the latter was mainly required at single implant sites. All implant survived and remained healthy until the final follow‐up. Conclusion: The Sausage Technique™ is an effective bone augmentation technique. Non‐containing single implant sites were associated with a poor outcome and adjunctive soft tissue augmentation was needed in about half of the patients. [ABSTRACT FROM AUTHOR]

Objective: The limitations of spontaneous bone healing underscore the necessity for exploring alternative strategies to enhance bone regeneration in maxillary radicular cyst cases. This retrospective study aimed to assess the impact of a bone substitute material (i.e., Bio-Oss) on bone volume regeneration following maxillary radicular cyst enucleation using cone-beam computed tomography (CBCT). Materials and methods: Seventy-three patients with maxillary radicular cysts were divided into two groups: one undergoing guided bone regeneration (GBR) with Bio-Oss and absorbable collagen membrane (n = 35), and the other receiving cyst excision alone (n = 38). Volumetric measurements using Amira software on CBCT scans evaluated bone regeneration, with cystic lesion shrinkage rates calculated. Intergroup comparisons utilized independent sample t-tests (P < 0.05), and linear regression analysis assessed the influence of preoperative cyst volume and group on bone healing. Results: Both groups showed similar success rates in bone formation at the 12-month follow-up, with no significant differences between them (mean (SD), control: 75.16 (19.17) vs. GBR: 82 (20.22), P > 0.05). Linear regression analysis revealed a negative correlation between preoperative cyst volume and bone regeneration in both groups (P < 0.05). Conclusion: Bio-Oss may not significantly enhance bone augmentation in maxillary radicular cysts. In addition, preoperative cyst volume negatively affected the shrinkage rate of cystic lesions. Clinical relevance: Clinicians should consider patient-specific factors such as anatomy and lesion size when determining the need for bone substitute materials. Future research could focus on optimizing treatment protocols and alternative regenerative strategies to improve patient outcomes in maxillary cyst cases. [ABSTRACT FROM AUTHOR]

Dental implant placement frequently requires preceding bone augmentation, for example, with hydroxyapatite (HA) or β-tricalcium phosphate (β-TCP) granules. However, HA is degraded very slowly in vivo and for β-TCP inconsistent degradation profiles from too rapid to rather slow are reported. To shorten the healing time before implant placement, rapidly resorbing synthetic materials are of great interest. In this study, we investigated the potential of magnesium phosphates in granular form as bone replacement materials. Spherical granules of four different materials were prepared via an emulsion process and investigated in trabecular bone defects in sheep: struvite (MgNH 4 PO 4 ·6H 2 O), K-struvite (MgKPO 4 ·6H 2 O), farringtonite (Mg 3 (PO 4) 2) and β-TCP. All materials except K-struvite exhibited promising support of bone regeneration, biomechanical properties and degradation. Struvite and β-TCP granules degraded at a similar rate, with a relative granules area of 29% and 30% of the defect area 4 months after implantation, respectively, whereas 18% was found for farringtonite. Only the K-struvite granules degraded too rapidly, with a relative granules area of 2% remaining, resulting in initial fibrous tissue formation and intermediate impairment of biomechanical properties. We demonstrated that the magnesium phosphates struvite and farringtonite have a comparable or even improved degradation behavior in vivo compared to β-TCP. This emphasizes that magnesium phosphates may be a promising alternative to established calcium phosphate bone substitute materials. [Display omitted] • Fabrication of three different magnesium phosphate granules (struvite, K-struvite, farringtonite) via emulsion technique. • Magnesium phosphate granules show an accelerated degradation behavior (K-struvite > farringtonite > struvite) in sheep. • Magnesium phosphate granules appear highly promising as bone substitutes for future clinical use. [ABSTRACT FROM AUTHOR]

Abstract Introduction Bone augmentation procedures are established tools for reshaping the alveolar ridge and increasing bone volume. Different approaches are being used to measure postoperative bone volume gain. This study aimed to develop an objective and automated volume measurement tool equally as precise as manual slice-by-slice annotation. Materials and methods To evaluate the proposed workflow, we performed an in vitro study with 20 pig mandibles that were grafted using three different grafting techniques—autogenous full block, split block bone and shell augmentation. The pig jaws were scanned pre- and postoperatively using an intraoral scanner. The resulting surface files (baseline, full block, split block, shell) were processed using the new volume-measuring workflow as well as using manual slice-by-slice annotation at baseline (t0) and at 6 months (t1) using the same population. Two TOSTs (Test of One-Sided Significance) and NHSTs (Null Hypothesis Significance Test) were used to compare the two workflows. The intra-rater reliability between t0 and t1 was determined using intraclass correlation coefficients. Results The mean difference for the full block augmentation technique was − 0.015 cm3 (p

Bone allografts are widely used as osteoconductive support to guide bone regrowth. Bone allografts are more than a scaffold for the immigrating cells as they maintain some bioactivity of the original bone matrix. Yet, it remains unclear how immigrating cells respond to bone allografts. To this end, we have evaluated the response of mesenchymal cells exposed to acid lysates of bone allografts (ALBA). RNAseq revealed that ALBA has a strong impact on the genetic signature of gingival fibroblasts, indicated by the increased expression of IL11, AREG, C11orf96, STC1, and GK—as confirmed by RT-PCR, and for IL11 and STC1 by immunoassays. Considering that transforming growth factor-β (TGF-β) is stored in the bone matrix and may have caused the expression changes, we performed a proteomics analysis, TGF-β immunoassay, and smad2/3 nuclear translocation. ALBA neither showed detectable TGF-β nor was the lysate able to induce smad2/3 translocation. Nevertheless, the TGF-β receptor type I kinase inhibitor SB431542 significantly decreased the expression of IL11, AREG, and C11orf96, suggesting that other agonists than TGF-β are responsible for the robust cell response. The findings suggest that IL11, AREG, and C11orf96 expression in mesenchymal cells can serve as a bioassay reflecting the bioactivity of the bone allografts. [ABSTRACT FROM AUTHOR]

Background: Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections. Methods: Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010–2011 and 200 in 2014–2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012. Results: There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010–2011 to 18.5% (n = 37/200) in 2014–2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010–2011 to 35% in 2014–2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines. Conclusions: After introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures. [ABSTRACT FROM AUTHOR]

Introduction: Bone augmentation procedures are established tools for reshaping the alveolar ridge and increasing bone volume. Different approaches are being used to measure postoperative bone volume gain. This study aimed to develop an objective and automated volume measurement tool equally as precise as manual slice-by-slice annotation. Materials and methods: To evaluate the proposed workflow, we performed an in vitro study with 20 pig mandibles that were grafted using three different grafting techniques—autogenous full block, split block bone and shell augmentation. The pig jaws were scanned pre- and postoperatively using an intraoral scanner. The resulting surface files (baseline, full block, split block, shell) were processed using the new volume-measuring workflow as well as using manual slice-by-slice annotation at baseline (t0) and at 6 months (t1) using the same population. Two TOSTs (Test of One-Sided Significance) and NHSTs (Null Hypothesis Significance Test) were used to compare the two workflows. The intra-rater reliability between t0 and t1 was determined using intraclass correlation coefficients. Results: The mean difference for the full block augmentation technique was − 0.015 cm3 (p < 0.001); for the split block technique, it was − 0.034 cm3p = 0.01, and for the shell technique, it was − 0.042 cm3. All results were statistically not different from zero and statistically equivalent to zero. The results also showed an excellent absolute intra-rater agreement. Conclusions: The semiautomatic volume measurement established in this article achieves comparable results to manual slice-by-slice measuring in determining volumes on STL files generated by intraoral scanners and shows an excellent intra-rater reliability. [ABSTRACT FROM AUTHOR]

To evaluate the formation of reactive oxygen species in human leukocytes promoted by bone substitutes that are different in origin and morphology used for jawbone tissue regeneration. Materials and Methods: This preclinical prospective randomized crossover study involved 10 subjects, from whom venous blood samples were taken. Leukocytes were separated and standardized. Sixty experimental samples consisted of leukocytes incubated with allogeneic, xenogeneic, or alloplastic bone substitutes at different bone weights (12.5 and 25 mg). The control samples consisted only of incubated leukocytes. Reactive oxygen species were quantitatively determined with the fluorimetric method. Statistical analysis was carried out using SPSS 23 software. Results: The highest average reactive oxygen species values were obtained in the allogeneic bone substitute group (P < .05), while the xenogeneic bone substitute group and control group presented equal reactive oxygen species formation rates (P > .05). A proportional difference (P < .05) of reactive oxygen species emission was obtained between different masses of bone substitute in the samples. Conclusion: Allogeneic and alloplastic bone substitutes affect leukocytes and promote reactive oxygen species emission. Xenogeneic bone substitute presents no leukocyte stimulation and maintains anti-inflammatory conditions. Larger bone substitute mass provokes greater oxidative stress. [ABSTRACT FROM AUTHOR]

Purpose: Intraoral bone blocks from the external oblique are the gold standard for alveolar ridge bone grafting, but the limited amount of available bone limits their use for larger defects. The objective of this study was to compare whether different graft designs of intraoral bone blocks could affect the amount of bone gain. Materials and Methods: In this in vitro study, 20 pig jaws were used to harvest bone blocks and subsequently augment single-wall bone defects. Each bone graft was first used as a full block, and then the same block was divided lengthwise into two blocks, with one block fixed at a distance as a cortical shell and the second block particulated to fill the gap between graft and bone. Three stereolithographic (STL) files (pre-OP, full block, split block) were generated using an intraoral scanner. All STL files were evaluated for volume gain and horizontal bone dimensions. Results: A mean volume gain of 0.36 cm2 (SD: 0.09) was achieved for the full block and 0.78 cm2 (SD: 0.14) for the split block using the same block. The difference was statistically significant (P < .0001). A mean horizontal bone gain of 4.37 mm (SD: 0.93) was achieved with a full block and 5.77 mm (SD: 0.85) with the shell technique (P < .0001). Conclusion: With the same amount of bone removed, first as a full block and then as a split block, the split-block technique achieved a significantly higher bone gain compared with the full-block design. [ABSTRACT FROM AUTHOR]

Purpose: Bone regeneration procedures are often evaluated based on biologic aspects only. As regenerated bone also has to ensure primary implant stability, the goal of this study was to determine the mechanical quality of regenerated bone. Materials and Methods: Six adult minipigs were allocated for this experiment with four mandibular study sites each established following tooth removal. Two different types of bovine bone mineral as well as autogenous bone were used for augmenting three-walled defects, while native bone served as the control. Implants were placed after 12, 18, and 24 weeks of healing, and bone quality was determined using intraoperative compressive testing (BoneProbe), insertion torque measurements, and resonance frequency analysis. The mandibles were then harvested for determining bone mineral density (BMD) and bone-to-implant contact (BIC). Statistical analysis was based on two-way analysis of variance of aligned rank transformed data and Spearman's rank correlation tests (a = .05). Results: The effects of the factors healing time and material on the parameters tested were too small to be significant (P ranging from .34 to .98). Weak correlations were observed for implant insertion torque with BoneProbe measurements in the cortical (0.481; P = .032) and in the trabecular area (0.639; P = .002). BoneProbe measurements in the trabecular part and in the cortical part also correlated with each other (0.477; P = .035). Conclusion: While differences may exist between bone regenerated using different biomaterials with respect to biologic behavior, differences in the mechanical properties determining primary implant stability seem to be minor. Implant insertion torque measurements appear to be a reliable tool for determining bone quality if only one specific implant type is considered. [ABSTRACT FROM AUTHOR]

Background: This study aimed to equate implants placed using a traditional flap elevation technique with implants placed using a flapless process regarding bone healing and success in clinical conditions. Materials and Methods: Sixty subjects were included in this research work. The participants were randomly divided into two groups. Patients in group A underwent implant placement with the flap elevation technique. Similarly, group B patients underwent implant placement without flap reflection. Parameters such as plaque index, wound healing index, crestal bone loss, and radiograph were considered to estimate the effectiveness of the two techniques. Results: Plaque indexes were improved in both groups. The modified gingival index also improved in all the phases of healing. The flapless method showed a better crestal bone. Conclusion: It can be concluded that this study showed that with the right augmentation techniques, implants could be successfully performed immediate extraction sockets, both with and without elevation of the mucoperiosteal flap. [ABSTRACT FROM AUTHOR]

Background: The application of blood concentrates has gained popularity in dentistry in recent years. Platelet-rich fibrin (PRF) has been discussed frequently due to a high content of growth factors and the option of chair-side manufacturing in a simple centrifugation process. PRF is free from adjuvants and inexpensive to produce. The number of studies reporting beneficial effects of PRF in various clinical applications such as alveolar ridge preservation, sinus floor elevation, management and prevention of medical-related osteonecrosis of the jaw, third molar extractions, and guided bone regeneration in dentistry has increased recently. However, to date, neither clinical recommendations nor guidelines are available. The present narrative review aims to summarize the level of evidence on the clinical application of PRF within the field of oral surgery and implantology. Summary: A literature search in Pubmed and Medline has identified 34 articles as a basis for this narrative review. The effectiveness of the clinical application of PRF has been analyzed for five indications within dentistry: medical-related osteonecrosis of the jaw, wisdom tooth extraction, guided bone regeneration, sinus floor elevation, and alveolar ridge preservation. The amount of data for third molar extractions, socket preservation, and guided bone regeneration is extensive. Less data were available for the use of PRF in combination with sinus floor elevations. There is a lack of studies with scientific evidence on PRF and medical-related osteonecrosis of the jaw; however, studies positively impact patient-related outcome measures. Most studies report on beneficial effects when PRF is additionally applied in intrabony defects. There is no evidence of the positive effects of PRF combined with bone graft materials during sinus floor elevation. However, some benefits are reported with PRF as a sole filling material. Key Messages: Many recently published studies show the positive clinical impact of PRF. Yet, further research is needed to ensure the validity of the evidence. [ABSTRACT FROM AUTHOR]

Objective: Guided bone regeneration with titanium mesh is a commonly used bone augmentation technique. However, deformation and sliding may occur during the installation of titanium mesh, which may lead to poor accuracy of bone augmentation. This article presented three cases, which describe a tooth‐supported titanium mesh bending and positioning module aiming to improve the precision of bone augmentation. Clinical Considerations: After designing the ideal bone increment volume digitally, print out the difference bone module between the ideal and existing bone mass and one or two wings. The wings are supported by the adjacent teeth to show the ideal bone mass in the patients' mouth. Finally, the titanium mesh is bent and installed in the ideal position by the module. Conclusions: A favorable outcome has been preliminarily confirmed in these cases, the average vertical bone gain was 4.16 mm and the average horizontal gain was 7.48 mm after 6 months. Using the module in the treatment of patients with bone augmentation can effectively improve the accuracy, the maximum deviation was 1.5 mm and the mean was 0.6 mm. Clinical Significance: This study improves the bone augmentation technology with titanium mesh. The titanium mesh is fixed in the ideal position, which facilitates subsequent implantation and denture repair. [ABSTRACT FROM AUTHOR]

Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re‐entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented. [ABSTRACT FROM AUTHOR]

Background: This study aimed to equate implants placed using a traditional flap elevation technique with implants placed using a flapless process regarding bone healing and success in clinical conditions. Materials and Methods: Sixty subjects were included in this research work. The participants were randomly divided into two groups. Patients in group A underwent implant placement with the flap elevation technique. Similarly, group B patients underwent implant placement without flap reflection. Parameters such as plaque index, wound healing index, crestal bone loss, and radiograph were considered to estimate the effectiveness of the two techniques. Results: Plaque indexes were improved in both groups. The modified gingival index also improved in all the phases of healing. The flapless method showed a better crestal bone. Conclusion: It can be concluded that this study showed that with the right augmentation techniques, implants could be successfully performed immediate extraction sockets, both with and without elevation of the mucoperiosteal flap.

Aim: Alveolar ridge resorption following tooth extraction often renders a lateral bone augmentation inevitable. Some patients, however, suffer from severe early (during graft healing, Eres) and/or late (during follow‐up, Lres) graft resorption. We explored the hypothesis that the "individual phenotypic dimensions" may partially explain the degree of such resorptions. Materials and Methods: Patients who underwent a guided bone regeneration (GBR) procedure were screened for inclusion according to the following criteria: (1) a relatively symmetrical maxillary arch; (2) an intact contra‐lateral alveolar bone dimension; (3) the availability of a pre‐operative cone‐beam CT (CBCT); (4) a CBCT taken immediately after GBR, and (5) at least one CBCT scan ≥6 months after surgery. CBCT scans from different timepoints were registered and imported into the Mimics software (Materialise, Leuven, Belgium). Bone dimensions of the contra‐lateral site of the augmentation, representing the "individual phenotypical dimension (IPD) of the alveolar crest", were superimposed on the augmented site and registered accordingly. As such, Eres and Lres could be measured over time, in relation to the IPD (in two dimensions; per millimetre apically from the alveolar crest, in the centre of the GBR), as well as in three dimensions (the entire GBR, 2 mm away from the mesial, distal, and apical border for standardization). Results: A total of 17 patients (23 augmented sites) were included. After Eres, the outline of the augmentation was in general located ±1 mm outside the IPD, but ≥1.5 years after GBR, it further moved towards the IPD (85% within 0.5 mm distance). Conclusions: Within the limitations of this study, the results indicate that the dimensions of a lateral bone augmentation are defined by the "individual phenotypic bone boundaries" of the patient. [ABSTRACT FROM AUTHOR]

The need to obtain adequate bone volumes for prosthetic rehabilitation supported by implants, using different techniques and materials, represents an urgent need in modern dentistry. We report a case regarding the management of implant-prosthetic rehabilitation of the first and second upper right molars, in which no less than 4 mm of crestal bone remained to insert two implants. Regeneration of the residual bone was previously performed using a customized titanium barrier and a filler of a blood clot with tricalcium beta phosphate. The bone gain (3 mm) was evaluated by comparing CBCT images, while the implant stability (mean 70) was assessed with the ISQ measurement. A regenerated bone sample was taken for histological analysis. Guided bone regeneration obtained with a titanium barrier and blood clot allowed for the insertion of stable implants in a mature bone without heterologous material. [ABSTRACT FROM AUTHOR]

Sinus augmentation has become an integrated surgical phase in posterior maxillary implant prosthesis reconstruction. Since the residual alveolar bony height usually requires additional volume particularly at this anatomical region, sinus floor augmentation is advocated routinely. Over the years, Implant success rate is proved to be comparable to the one in the pristine bone, which is well documented in the literature. Anatomical aspects as well as surgeon skills are at most importance to achieve predictable outcome. In this narrative review, the different osteotomy techniques, the indications toward 1 or 2‐stage approaches, the control of the Schneiderian membrane integrity as well as the management of intra‐ and post‐operative complications are thoroughly discussed according the current data. In light of the excellent long‐term implant success rate concurrent with the application of contemporary advanced techniques of the sinus augmentation via the lateral wall osteotomy approach, reduce invasiveness and less complication occurrences are well documented. A well‐codified patient selection involving the rhinologist as an integral medical team would be significantly beneficial toward early diagnosis. In‐depth knowledge of the anatomy, execution of a well standardized surgical technique, and understanding the complication etiology and their management are prerequisites for reducing patient morbidity to minimal discomfort and predictable successful outcome. [ABSTRACT FROM AUTHOR]

Purpose: Intermittent parathyroid hormone (PTH) is the commonly used therapeutic approach for patients with severe osteoporosis. The goal of this study was to elucidate the effect of the intermittent PTH treatment on guided bone augmentation (GBA) in the calvarium of ovariectomized (OVX) rats. Materials and Methods: Surgical ovariectomy on 14 rats and sham surgery on 7 rats were conducted on all rats as the first surgery. GBA surgery was conducted 8 weeks following the first surgery in the rat calvarium by placing 5-mm-diameter cylindrical plastic caps. Following surgery, rats were treated with 40 µg/kg PTH (OVX-PTH) or saline (Sham-Saline, OVX-Saline) via intraperitoneal injection three times per week during the all-observational period. Longitudinal microcomputed tomography (micro-CT) imaging was performed every 2 weeks following the GBA surgery without euthanasia, and the amount of newly generated bone volume (BV) was calculated. All rats were euthanized 12 weeks after GBA surgery, and histology was obtained. Sections stained with hematoxylin and eosin were used for the quantitative analysis of newly generated tissue, and immunohistology was used to visualize Runx2-positive cells and TRAP-positive cells. Results: Throughout the monitoring period, the BVs of OVX rats without PTH treatment (OVX-Saline) were significantly lower than that of the other two groups at weeks 8 and 12 in micro-CT analysis. During all experimental periods, the BV was highest in the OVX rats that were treated with PTH (OVX-PTH). Histologic analysis confirmed the result of micro-CT, and determined that the OVX-PTH presented a greater number of Runx2-positive cells. The number of TRAP-positive multinucleated osteoclasts was highest in OVX-PTH rats; there were no significant differences between the other two groups. Conclusion: The results of this study suggest that treatment with intermittent PTH was associated with increased newly regenerated bone volume in ovariectomized rat calvarial bone augmentation, which may have important clinical implications. [ABSTRACT FROM AUTHOR]

Alloplastic and xenogeneic bone grafting materials are frequently used for bone augmentation. The effect of these materials on precursor cells for bone augmentation is yet to be determined. The aim of this study was to ascertain, in vitro, how augmentation materials influence the growth rates and viability of human unrestricted somatic stem cells. The biocompatibility of two xenogeneic and one alloplastic bone graft was tested using human unrestricted somatic stem cells (USSCs). Proliferation, growth, survival and attachment of unrestricted somatic stem cells were monitored after 24 h, 48 h and 7 days. Furthermore, cell shape and morphology were evaluated by SEM. Scaffolds were assessed for their physical properties by Micro-CT imaging. USSCs showed distinct proliferation on the different carriers. Greatest proliferation was observed on the xenogeneic carriers along with improved viability of the cells. Pore sizes of the scaffolds varied significantly, with the xenogeneic materials providing greater pore sizes than the synthetic inorganic material. Unrestricted somatic stem cells in combination with a bovine collagenous bone block seem to be very compatible. A scaffold's surface morphology, pore size and bioactive characteristics influence the proliferation, attachment and viability of USSCs. [ABSTRACT FROM AUTHOR]

Autogenous dentin is a promising biological material that can be used as a substitute for autologous bone. It has been used in postextraction site preservation, maxillary sinus floor elevation, and alveolar ridge augmentation. The clinical application methods of autologous dentin have showed great diversity without uniform standard. The present article reviewed the clinical application of autogenous dentin to provide new ideas for its future development. The literature review results show that dentin materials require several preparations before transplantation, among which the demineralization is a common chemical processing method. Demineralization can enhance the osteoconductive and osteoinductive properties of dentin, but the complex and time-consuming operation process has limited its application to a certain extent. Partial demineralization may be a more appropriate choice. During transplantation, the morphology of dentin depends on the condition of the bone defect and the surgical method. Granular materials with different diameters are convenient for filling irregular defects. Block materials are conducive to maintaining the space of the reconstruction site. Hollow frame materials are slightly more complicated to process but can combine the advantages of granular and block grafts. In addition to being used alone, dentin can also be transplanted in combination with multiple biological materials. Platelet-rich plasma combined with dentin materials has shown ideal results in clinical studies. Plaster of paris and calcium phosphate ceramics have also been combined with dentin materials in animal experiments. But since they have not been applied in humans, their clinical effects require further research.

Multiple bone augmentation techniques are available to allow implant placement in the atrophic maxilla. However, questions remain, regarding which methods are most predictable and have the best dental implant survival rate (SR) in grafted bone. The aim of this systematic review was to evaluate literature from the last 30 years to determine predictability of bone grafting of the edentulous maxilla for implant placement as well as for implant SR. Materials and Methods: A systematic review was performed of studies conducted during the period 1980 to 2014, specifically focusing on the edentulous maxilla and bone grafting. Surgical techniques discussed in the publications included were guided bone regeneration (GBR), sinus augmentation, onlay bone grafting, nasal floor grafting, and Le Fort I interpositional grafting. All identified articles were evaluated and screened to meet strict inclusion criteria of at least 10 patients, complete maxillary edentulism, 1-year follow-up, and information regarding implant SR. A total of 974 articles were identified with electronic and manual searches. On further evaluation of the titles and abstracts, 44 articles were excluded. Full texts of the articles that met the inclusion criteria were reviewed, of which 40 articles were included in the systematic review. Results: For onlay bone grafting, 16 studies were included and analyzed, and the weighted mean implant SR was 85.2%. For the GBR technique, two studies were included, with a reported SR ranging from 96.1% to 100%. For Le Fort I interpositional grafting, 11 studies were included, with a weighted mean SR of 89.6%. For the sinus augmentation technique, 12 studies were investigated and the weighted mean SR was 91.5%. For the combination technique, six studies were analyzed and the weighted mean SR was 93.6%. Conclusions: All five treatment modalities discussed--onlay bone grafting, GBR, Le Fort I interpositional grafting, maxillary sinus augmentation, and/or nasal floor inlay grafting or the combination approach--can be successfully used to augment edentulous maxillary ridge with high implant SRs. [ABSTRACT FROM AUTHOR]

Achieving predictable guided bone regeneration in critical size defects for future endosseous dental implant therapy poses a great challenge to clinicians. A novel technique utilizing autogenous osteogenic progenitor cells, calcium sulfate activated platelet-rich plasma in addition to particulate allograft was successfully used to augment a severely deficient maxillary anterior edentulous ridge. After 6 months of healing, satisfactory radiographic and clinical bone gain was noted with significant increase in alveolar ridge width. Endosseous implants were placed and restored successfully. The techniques with underlying clinical and biologic rationales are presented and discussed in this report. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate whether photofunctionalization of titanium mesh enhances its osteoconductive capability. Materials and Methods: The titanium mesh (0.2 mm thickness) used in this study was made of commercially pure grade-2 titanium and had hexagonal apertures (2 mm width). Photofunctionalization was performed by treating titanium mesh with UV light for 12 minutes using a photo device immediately before use. Untreated or photofunctionalized titanium mesh was placed into rat femurs, and bone generation around titanium mesh was profiled using three-dimensional (3D) microcomputed tomography (micro-CT). A set of in vitro experiments was conducted using bone marrow-derived osteoblasts. Results: Photofunctionalized titanium mesh surfaces were characterized by the regenerated hydrophilicity and significantly reduced surface carbon. Bone generation profiling at week 3 of healing showed that the hexagonal apertures in photofunctionalized mesh were 95% filled, but they were only 57% filled in untreated mesh, particularly with the center zone remaining as a gap. Bone profiling in slices parallel to the titanium surface showed that photofunctionalized titanium mesh achieved 90% bone occupancy 0 to 400 μm from the surface, compared with only 35% for untreated mesh. Bone occupancy remained as high as 55% 800 to 1,200 μm from photofunctionalized titanium mesh surfaces, compared with less than 20% for untreated mesh. In vitro, photofunctionalized titanium mesh expedited and enhanced attachment and spread of osteoblasts, and increased ALP activity and the rate of mineralization. Conclusion: This study may provide novel and advanced metrics describing the osteoconductive property of photofunctionalized titanium mesh. Specifically, photofunctionalization not only increased the breadth, but also the 3D range, of osteoconductivity of titanium mesh, enabling space-filling and far-reaching osteoconductivity. Further translational and clinical studies are warranted to establish photofunctionalized titanium mesh as a novel clinical tool for better bone regeneration and augmentation. [ABSTRACT FROM AUTHOR]

Concomitant to the increased use of dental implants to replace lost dentition, there is a growing need to regenerate atrophic jaw bone to allow dental implant placement. Current surgical techniques for jaw bone augmentation share several limitations, such as operator sensitivity and relatively low predictability and high morbidity rates. Therefore, alternative treatment approaches have been developed in the field of tissue engineering. Bone tissue engineering integrates the use of different scaffolds, growth factors, and stem cells. This method aims to induce bone augmentation of large bone defects by mimicking biologic processes that occur during embryogen esis. This review will present available sources for adult stem cells, the rationale for using stem cells for bone regeneration, and recent studies that use mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) to induce bone augmentatio [ABSTRACT FROM AUTHOR]

BACKGROUND: With the introduction and application of guided bone regeneration technology, bone augmentation technology has been rapidly developed, and the indications for implantation have been continuously expanded. In the pilot studies, small animal models of craniofacial critical bone defects were used for evaluation of implantable materials, providing guidance for subsequent research. OBJECTIVE: To summarize and discuss the small animal models of critical size craniofacial bone defects used in guided bone regeneration studies. METHODS: CNKI, WanFang, and PubMed databases were searched for the articles regarding the guided bone regeneration studies in the small animal models of critical size craniofacial bone defect. The keywords used were “guided bone regeneration, alveolar ridge augmentation, critical size defects” in Chinese and English, respectively. Included articles were summarized. RESULTS AND CONCLUSION: The critical size bone defect model has the advantages of strong operability and controllability, which can be used to initially simulate clinical conditions and evaluate new materials in guided bone regeneration. With the introduction of guided bone regeneration technology, bone regeneration can be achieved in various types of craniofacial bone defects in mall animals. The jaw and cranial bones are mainly used as modeling sites. For the jaw model, except for cases involving special anatomical structures such as the maxillary sinus, most studies are conducted in the mandible. By choosing a reasonable modeling method, the small animal model of critical size craniofacial bone defects can be also applied in some special situations. Researchers should choose appropriate models according to their research purposes and actual conditions. [ABSTRACT FROM AUTHOR]

Objectives: Biphasic calcium phosphate (BCP) is a bioceramic material successfully used in alloplastic bone augmentation. Despite many advantages, a disadvantage of BCP seems to be a difficult application and position instability. The aim of this study was to determine how different carrier materials influence BCP-induced quantitative and qualitative bone regeneration. Materials and methods: A total of 70 critical size defects were set in the frontal bone of 14 domestic pigs (5 each) and filled randomly with either BCP alone (BCP), BCP in combination with nano-hydroxyapatite (BCP + NHA), BCP embedded in native porcine type I/III collagen blocks (BCP + C), autologous bone (AB), or were left empty (ED). Specimens were harvested after 4 and 8 weeks and were evaluated histologically as well as histomorphometrically. Results: Significantly lowest rate of new bone formation was found in ED (p = < 0.001) and BCP + NHA groups (p = 0.05). After 8 weeks, the highest percentage of new bone formation was observed in the BCP + C group. Fibrous matrix was detected highest in BCP alone. The lowest residual bone substitute material was found in BCP + C after 8 weeks. Conclusions: BCP-induced bone regeneration is indeed affected by different carrier types. Surface morphology and bioactive characteristics influence osseointegration and new bone formation in vivo. The combination of type I/III collagen seems most suitable for qualitative and quantitative bone regeneration. Clinical relevance: Stabilization of granular bone substitutes using type I/III collagen might be an alternative to granulates alone, indicating excellent volume stability, satisfactory plasticity, and easy application. [ABSTRACT FROM AUTHOR]

Alloplastic and xenogeneic bone grafting materials are frequently used for bone augmentation. The effect of these materials on precursor cells for bone augmentation is yet to be determined. The aim of this study was to ascertain, in vitro, how augmentation materials influence the growth rates and viability of human unrestricted somatic stem cells. The biocompatibility of two xenogeneic and one alloplastic bone graft was tested using human unrestricted somatic stem cells (USSCs). Proliferation, growth, survival and attachment of unrestricted somatic stem cells were monitored after 24 h, 48 h and 7 days. Furthermore, cell shape and morphology were evaluated by SEM. Scaffolds were assessed for their physical properties by Micro-CT imaging. USSCs showed distinct proliferation on the different carriers. Greatest proliferation was observed on the xenogeneic carriers along with improved viability of the cells. Pore sizes of the scaffolds varied significantly, with the xenogeneic materials providing greater pore sizes than the synthetic inorganic material. Unrestricted somatic stem cells in combination with a bovine collagenous bone block seem to be very compatible. A scaffold’s surface morphology, pore size and bioactive characteristics influence the proliferation, attachment and viability of USSCs.

Introduction: Dental implant placement can be challenging when insufficient bone volume is present and bone augmentation procedures are indicated. The purpose was to assess clinically and histologically a specimen of 30%HA-60%β-TCP BCP 3D-printed scaffold, after 7-years.Case Description: The patient underwent bone regeneration of maxillary buccal plate with 3D-printed biphasic-HA block in 2013. After 7-years, a specimen of the regenerated bone was harvested and processed to perform microCT and histomorphometrical analyses.Results: The microarchitecture study performed by microCT in the test-biopsy showed that biomaterial volume decreased more than 23% and that newly-formed bone volume represented more than 57% of the overall mineralized tissue. Comparing with unloaded controls or peri-dental bone, Test-sample appeared much more mineralized and bulky. Histological evaluation showed complete integration of the scaffold and signs of particles degradation. The percentage of bone, biomaterials and soft tissues was, respectively, 59.2, 25.6, and 15.2%. Under polarized light microscopy, the biomaterial was surrounded by lamellar bone. These results indicate that, while unloaded jaws mimicked the typical osteoporotic microarchitecture after 1-year without loading, the BCP helped to preserve a correct microarchitecture after 7-years.Conclusions: BCP 3D-printed scaffolds represent a suitable solution for bone regeneration: they can lead to straightforward and less time-consuming surgery, and to bone preservation.

Purpose: The aim of this paper is to present a large-scale long-term follow-up of dental implants placed simultaneously with nasal floor augmentation using osteoconductive bovine bone substitutes. Materials and Methods: Patients who received dental implants combined with nasal floor elevation in three dental centers between 2006 and 2012 were included in this report. Preoperative available bone height was measured on computed tomographic scans. Implant parameters as well as implant survival rates were recorded. The cohort consisted of long-term follow-up of this previously reported cohort, combined with a cohort of newly treated patients. Results: Overall, 67 patients were included in this study. Cigarette smoking was reported by 16 patients. Two hundred three implants were inserted in combination with nasal floor elevation. No nasal mucosa perforations were observed. The mean follow-up periods were 65.93 ± 13.2 months (range, 33 to 86 months) for the original cohort and 23.14 ± 9.4 months (range, 7 to 44 months) for the newly treated patients. The available bone height prior to bone augmentation was 8.89 ± 1.1 mm (range, 5 to 11.2 mm) and a mean of 3.65 ± 0.9 mm (range, 1.1 to 7 mm) of additional height was achieved with nasal floor elevation. During the follow-up period, no implants were lost, resulting in a 100% survival rate. Conclusion: Nasal floor augmentation, as shown in this report, might serve as a reliable method for reconstruction of the anterior atrophic maxilla when residual height is insufficient. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the feasibility of application of thermoplastic poly-Llactic acid (PLLA) membranes for guided bone regeneration in rabbit parietal bone. Materials and Methods: PLLA membranes with a molecular weight of 100,000 (PLLA-100,000) and a molecular weight of 380,000 (PLLA-380,000) were dissolved in chloroform to prepare concentrations of 8% by weight and 4% by weight, respectively. The compression strength, temperature, and time to prepare each formulation were measured. Moreover, the pH was noted and cytotoxicity of the membrane was determined by monotetrazolium assay. In vivo experiments were performed to measure the volume of newly formed bone tissue in hematoxylin and eosin-stained tissue sections 4 and 12 weeks after implantation. Results: The membrane prepared from PLLA-380,000 showed excellent thermoplasticity at 75°C to 80°C and the compressive strength was equal to that of titanium mesh, in contrast to that of PLLA-100,000 and poly(lactic acid-co-glycolic acid). There was a significant change in the pH of an aqueous solution in which the PLLA-380,000 membrane was placed, but there was no cytotoxic activity. The membrane made of PLLA-380,000 induced new bone formation in a dome shape without any membrane deformation. Conclusion: Thermoplastic PLLA membrane shows promise for guided bone regeneration in vertical bone augmentation [ABSTRACT FROM AUTHOR]

Even though conventionally prepared octacalcium phosphate and collagen composite (OCP/Col) has exhibited excellent bone regeneration and has recently been commercialized for treating bone defects, reproducible appositional bone formation with OCP/Col has never been achieved. The present study investigated whether appositional bone formation could be achieved by altering the density of OCP/Col and applying liquid nitrogen during the preparation of OCP/Col. The prepared OCP/Col disks had eight variations and were divided into categories according to four different type of densities (1.0, 1.3, 1.7, and 2.0) of OCP/Col and two different pre‐freezing conditions of gas phase (G group: −80°C) and liquid phase (L group: −196°C). These disks were implanted into subperiosteal pockets in rodent calvaria, five samples per each eight variations. Radiomorphometric analysis was conducted at 4 and 12 weeks after implantation, and histological analysis was conducted at 12 weeks after implantation. OCP/Col samples in the L group tended to retain their height and shape and had enhanced appositional bone formation, whereas OCP/Col samples in the G group tended to lose their height and shape and had limited appositional bone formation. The appositional bone formation increased along with growing density of OCP/Col, and L2.0 demonstrated higher appositional bone formation than other samples. These results suggest that the pre‐freezing conditions and densities of OCP/Col affect the appositional bone formation. [ABSTRACT FROM AUTHOR]