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PubMed2001

Treatment of a human transosseous mandibular defect by guided bone regeneration.

The treatment of through-and-through human periapical lesions by barrier membrane techniques has not been reported in the periodontal literature. However, periodontists frequently perform this treatment. The authors present a case that demonstrates radiopacity after regeneration surgery of a human periapical transosseous mandibular defect, suggesting local bone regeneration. The surgical technique performed in this case was based on the principles of guided bone regeneration using a demineralized freeze-dried bone membrane (DFDBM). The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissue. Radiographic findings demonstrated bone fill after 8 months.

Bone Regeneration↗
PubMed2002

[Bioresorbable barrier membranes for guided bone regeneration around dental implants].

The aim of this study was to evaluate the efficacy of two bioresorbable barriers especially produced for guided bone regeneration. Six beagle dogs were used in this investigation. At the beginning of the study, all mandibular premolars were extracted and after a healing period of three months three screw-type machined implants were inserted in each side of the mandible. At the buccal aspect of each implant bed a dehiscence type defect with a coronoapical and mesiodistal extension of 5 mm was created. Then, one of the following four methods for defect treatment was applied: 1) guided bone regeneration (GBR) with a bioresorbable barrier (poly-L/DL-lactide) (test group 1), 2) GBR with a bioresorbable composite barrier [poly-L/DL-lactide reinforced with tricalciumphosphate (TCP)] (test group 2), 3) GBR with an expanded polytetrafluoroethylene barrier (GTAM) (control group 1), and 4) no treatment (control group 2). The animals were sacrificed six months after implant installation. During the healing period the most common problems encountered in the test groups 1 and 2 were soft tissue dehiscences and bioresorbable membrane exposures. Retrieved tissue specimens were processed for histological and histometric evaluation. The mean amount of vertical bone regeneration at the defect areas was 1.75 mm for test group 1, 1.82 mm for the test group 2, 2.38 mm for control group 1, and 1.93 mm for control group 2. When the amount of bone regeneration in contact to the implant surface was evaluated, the regeneration result was 1.45 mm for test group 1, 1.49 mm for test group 2, 2.08 mm for control group 1, and 0.91 mm for control group 2. For both measurements, no statistically significant differences could be observed between the different groups. The present animal experiment showed that the treatment of dehiscence type defects around machined implants with the two bioresorbable barriers showed only slightly superior results compared to the treatment without barriers (control group 2). The best results--although not statistically significant different from the other treatment groups--were obtained when nonresorbable barriers were used.

Absorbable Implants↗
PubMed2006

Comparison of ready-made and self-setting alginate membranes used as a barrier membrane for guided bone regeneration.

In order to understand the requirements of guided bone regeneration (GBR) involving alginate base self-setting barrier membranes, GBR was performed in the case of bicortical bone defects formed at the tibiae of experimental animals employing self-setting and ready-made alginate membranes. Connective tissue ingress into the bone defects at the skin side of the tibia was observed when GBR was generated utilizing ready-made alginate membrane. In contrast, bone defects were reconstructed with bone tissue when GBR was generated with self-setting alginate membrane formed from aqueous 3% sodium alginate and 3% CaCl(2) solutions. The unreacted aqueous sodium alginate solution inherent to self-setting alginate membrane did not inhibit bone tissue regeneration. Rather, callus bone was formed using sodium alginate as the nucleus. However, when GBR was effected with self-setting alginate membrane formed from aqueous 10% CaCl(2) solution, membrane was too thick and thus regeneration of bone tissue in the bone cavity was prevented. Therefore, we concluded that self-setting alginate membrane is very useful as a barrier membrane for GBR upon appropriate adjustment of conditions with respect to preparation of alginate membrane.

Alginates↗
PubMedDate not supplied

The use of demineralized laminar bone sheets in guided bone regeneration procedures: report of three cases.

Demineralized laminar bone sheets were utilized as membranes to affect guided bone regeneration around five implants in two patients and to perform a ridge augmentation procedure in one patient. In all cases, significant regeneration of hard tissues occurred, and no complications were encountered. The regenerated hard tissues have been in function for up to 32 months with no clinical signs of breakdown.

Adult↗
PubMed2001

[Guided bone regeneration around dental implants using a bioabsorbable membrane. A pilot investigation in experimental animals].

The aim of this experimental investigation was to evaluate the effect of guided bone regeneration around immediately placed implants using different barrier membranes. Five adult fox hounds were used in this investigation. After extraction of all premolars in the lower jaw, implant osteotomies in the regions of the former premolars and additional buccal bone defects (5 mm x 5 mm) were created. Subsequently, the implants were placed. The defects were treated with one of the following three modalities: (a) guided bone regeneration, using a bioinert expanded polytetrafluoroethylene membrane, (b) no membrane application and (c) guided bone regeneration, using a bioabsorbable membrane made from a synthetic copolymer of lactide and glycolide. After a healing period of six months, the animals were sacrificed and the implants with the surrounding tissues processed for histologic evaluation. The clinical pretreatment defects between the different treatment groups were not statistically different (bioinert membrane group: 4.8 mm; control group: 4.3 mm; bioabsorbable membrane group: 4.9 mm). The remaining histological defects after a healing period of 6 months amounted to 3.2 mm for the nonresorbable group, to 5.6 mm for the control and to 6.3 mm for the bioabsorbable group. A significant difference was observed between the bioinert membrane group and the other two groups. The mineralized bone-to-implant contact in the bioinert membrane group was 52%, in the control group 47% and in the bioabsorbable membrane group 43.3%. The values were not statistically significant different. The results of this study indicate that a partial bone regeneration with bioinert e-PTFE membranes around immediately placed implants is possible. The utilized bioabsorbable polylactide/polyglycolide membrane did not show any bone regenerative effect, and the results did not differ from the control group without membrane application.

Absorbable Implants↗
PubMedDate not supplied

Influence of particle size of autogenous bone grafts on the early stages of bone regeneration: a histologic and stereologic study in rabbit calvarium.

PURPOSE: The aim of this study was to investigate the influence of particle size of autogenous bone grafts on the early stages of bone regeneration. MATERIALS AND METHODS: Bicortical skull bone defects were prepared in 15 rabbits (4 in each rabbit). Two defects were filled at random with either small (0.5 to 2 mm3) or large (10 mm3) autogenous bone particles. In addition, 1 defect was left unfilled (control defect). All defects were covered bicortically by expanded polytetrafluoroethylene membranes. The animals were divided randomly into 3 groups and sacrificed after 1, 2, and 4 weeks, respectively. Histologic and stereologic evaluations were performed after the sections were blinded. RESULTS: No significant differences in total vessel surface area could be identified among the 3 groups. The total volume of newly formed bone in defects with small particles was larger and more mature compared to defects with large particles after 2 and 4 weeks. Furthermore, the resorption of small particles was more pronounced after 4 weeks, documenting a higher level of bone substitution compared to large particles. DISCUSSION: The early stages of bone regeneration were influenced by the particle site of autogenous bone grafts. CONCLUSION: The present study indicated that particles of 0.5 to 2 mm3 in size should be preferred to particles of 10 mm3 in size for bone grafting.

Analysis of Variance↗
PubMed1999

Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges.

The aim of this study was to analyse the clinical outcome of two different surgical methods for the reconstruction of narrow edentulous ridges before implant installation: guided bone regeneration with e-PTFE membranes and autologous bone chips or grafting of autologous bone blocks without e-PTFE membranes. Thirty partially edentulous patients, presenting insufficient bone width (less than 4 mm) in the edentulous sites for installation of screw-type titanium implants, were selected and assigned to two different treatment modalities. Fifteen patients (group 1) were treated by means of guided bone regeneration with e-PTFE membranes supported by stainless steel screws and autologous bone chips taken from intraoral sites. Fifteen patients (group 2) were treated by means of autologous bone blocks taken from intraoral or extraoral sites (anterior iliac crest and calvaria) and stabilized with titanium microscrews. Six to 8 months later, during re-entry for implant insertion, the gain of ridge width obtained was measured. In group 1 the average amount of bone gain was 2.7 mm, whereas in group 2 the value was 4.0 mm. Five to 6 months after implant placement prosthetic rehabilitation was started. The mean follow-up after prosthetic load has been 22.4 months. Success rates of implants according to Albrektsson criteria has been 93.3% in group 1, and 90.9% in group 2. Although a statistical comparison between the two treatment modalities may not be feasible, due to the bias resulting from the choice of treatment by the clinician and from the differences in donor sites and defect extension, some considerations can be made: 1) both methods are a reliable means for the correction of narrow edentulous ridges; 2) both techniques necessitate overcorrection of the defect because of interposition of connective tissue beneath the membrane in the first group and bone resorption in the second one; 3) the use of semipermeable barriers increases the costs of the surgical procedure, as compared to bone grafting without membranes; 4) guided bone regeneration presents a higher risk of infection because of wound dehiscence and membrane exposure. Therefore, in case of wide edentulous areas, reconstruction of narrow ridges should be performed with bone blocks without membranes.

Adult↗
PubMed1999

[Guided bone regeneration for single tooth replacements by oral implants].

Single tooth replacement is a good indication for an oral implant. However, bone regeneration, is often required to improve the bone quantity and the contour of the overlying soft tissues. Guided Bone Regeneration (GBR) using membranes is a good technique to restore local bone defects within a six months period. With this technique it is crucial that a membrane properly separates the bony and soft tissues and creates a space around a bony defect for bone ingrowth. This article describes the indications and contra-indications for GBR, the technique and the possible complications.

Bone Regeneration↗
PubMed1987

Bone regeneration under the influence of a bone morphogenetic protein (BMP) beta tricalcium phosphate (TCP) composite in skull trephine defects in dogs.

Beta tricalcium phosphate (TCP) was employed as a nonimmunogenic biodegradable delivery system for bovine bone morphogenetic protein (BMP). A BMP/TCP composite was implanted in adult dogs with skull trephine defects of a critical size of 1.4 cm that would otherwise remain unhealed in the lifetime of the individual. BMP/TCP implants induced 91%-100% incorporation by deposits of new bone. In comparison, control implants of TCP impregnated with bovine serum albumin (BSA/TCP) induced 0%-8% incorporation, or only marginal host bed reactive bone formation. The retention of unabsorbed TCP in the host bone four months after implantation suggests that further research should be encouraged to obtain a formulation of sintered calcium phosphate that could be resorbed more rapidly and in the process more completely replaced by bone.

Animals↗
PubMed1994

The use of a new bioresorbable barrier for guided bone regeneration in connection with implant installation. Case reports.

This report presents 4 cases with 6 implant exposures after the installation of Brånemark System implants which called for treatment applying the guided bone regeneration technique. A bioresorbable barrier (GUIDOR Matrix Barrier) was used to cover the defects, 4 defects with and 2 without the support of autologous bone chips. Complete bone filling was found in 4 (2 without and 2 with bone chips) and partial filling in 2 (with bone chips) of the treated defects, as registered at the abutment connection 6-7 months after surgery. Besides its ability to serve as a barrier for guided bone regeneration, it was found that the matrix barrier had the following properties; biocompatibility observed as uneventful tissue healing, malleability facilitating the clinical handling and ability to be resorbed within 6 to 7 months, as evaluated by clinical inspection. The observations of the present case reports indicate that the tested barrier may be used for guided bone regeneration in connection with implant installation. It is advisable, however, to use a supporting material to prevent barrier collapse, although bone regeneration can be achieved in certain situations without such material if the defect morphology is favourable.

Aged↗
PubMedDate not supplied

Bone regeneration by basic fibroblast growth factor complexed with biodegradable hydrogels.

The objective of this study is to enhance the bone induction activity of basic fibroblast growth factor (bFGF) for reconstruction of skull bone defects which has been clinically recognized as almost impossible. For this purpose, we prepared biodegradable hydrogels from gelatin with an isoelectric point of 4.9 which is capable of polyionic complexing with basic bFGF. When implanted in rabbit skull defects of 6 mm in diameter (6 defects per experimental group), the gelatin hydrogels incorporating 100 microg of bFGF promoted bone regeneration at the defect in marked contrast to free bFGF of the same dose, finally closing the bone defects after 12 weeks of implantation as is apparent from histological examination. In dual energy X-ray absorptometry analysis, the bone mineral density at the skull defects enhanced by the hydrogels was significantly higher than that by free bFGF at doses ranging from 2 to 200 microg/defect (P < 0.05). The extent of bone regeneration induced by gelatin hydrogels incorporating 100 microg of bFGF increased with a decrease in their water content. Histological examination indicated that more slowly degrading hydrogels of lower water content prolonged the retention period of osteoblasts in the bone defects. This led to enhanced bone regeneration compared with faster degrading hydrogels of higher water content. It was concluded that this biodegradable hydrogel system was a promising surgical tool to assist self-reconstruction of the skull bone.

Animals↗
PubMed2004

Gene therapy platform for bone regeneration using an exogenously regulated, AAV-2-based gene expression system.

Viral delivery of the therapeutic gene bone morphogenetic protein-2 (BMP-2) is a promising approach for bone regeneration. The human parvovirus adeno-associated virus (AAV) type 2 is considered one of the most encouraging viral vector systems because of its high transduction rates and biosafety ratings. Bone morphogenetic protein-2 is a highly potent osteoinductive protein, which induces bone formation in vivo and osteogenic differentiation in vitro. The exogenous regulation of BMP-2 expression in bone-regenerating sites is required to control BMP-2 protein secretion, thus promoting safe and controlled bone formation and regeneration. We have therefore constructed a dual-construct vector for the recombinant AAV (rAAV)-based recombinant human BMP-2 (rhBMP-2) gene delivery system, which is regulated by the tetracycline-sensitive promoter (TetON). Each vector was encapsidated separately, yielding two recombinant viruses. We evaluated the efficiency of rAAV-hBMP-2 to induce bone formation in ectopic and orthotopic sites. Doxycycline (Dox), an analogue of tetracycline, was orally administered to mice via their drinking water to induce rhBMP-2 expression. Bone formation was measured using quantitative imaging-microcomputerized tomography and cooled charge-coupled device imaging-to detect osteogenic activity at the cellular level, detecting osteocalcin expression. The rAAV-hBMP-2-treated mice that were given Dox demonstrated bone formation in both in vivo models compared to none in mice prevented from receiving Dox. Thus, the Tet-regulated rAAV-hBMP-2 vector is an effective means of induction and regulation of bone regeneration and repair.

Animals↗
PubMed1988

Recurrent bone regeneration in titanium implants. Experimental model for determining the healing capacity of bone using quantitative microradiography.

An experimental technique for quantitative assessment of bone repair was tested. The recurrent regeneration capacity of cortical bone was analyzed in consecutive 3 wk periods, using an osseointegrated titanium implant, the Bone Harvest Chamber (BHC), in the proximal tibial metaphysis of the rabbit. The BHC is a divisible implant penetrated by a canal into which newly formed bone tissue will grow during a 3 wk healing period. The newly formed bone tissue may easily be collected (harvested) without the animal being killed. After 3 wk, bone tissue can again be harvested, in principle, indefinitely. Intact harvested specimens were quantified by microradiography-videodensitometry, yielding a total specimen mass in mg aluminium equivalent. This unit correlated very well to a specimen dry weight (r = 0.996) and an average mineralized bone density (r = 0.937). The specimens were also examined by correlative histology. Three weeks after implant insertion, the chambers had become integrated in the bone tissue but the average bone mass varied widely, influenced by the surgical insertion trauma. Six weeks after insertion, the greatest average bone mass was found, indicating an intense ongoing osseointegration. The amount of bone regenerated at later harvests was fairly equal, indicating a stabilization of the implant bed to the repeat stimulus, i.e. harvesting. Bone regeneration differed significantly between animals, but also intraindividual variations, i.e. different amounts of bone formed in the same chamber, were observed.

Animals↗
PubMedDate not supplied

Bone healing following the use of hydroxyapatite or ionomeric bone substitutes alone or combined with a guided bone regeneration technique: an animal study.

The healing of standardized bone defects grafted with either particulate ionomeric or hydroxyapatite bone substitutes was compared in the mandibular ramus of 30 Sprague-Dawley rats. The possible additional response achieved when combining these materials with a guided bone regeneration (GBR) technique was also evaluated. Three groups of 10 animals received either no implant material or ionomeric or hydroxyapatite bone substitute in defects in the right ramus. The left mandibular defects received the same treatment, except that the operation site was covered by a membrane (GBR technique). Half of the animals were sacrificed at 4 and 10 weeks following surgery, and the inflammatory response at the implant site and the amount of new bone formed in the defects were determined histomorphometrically. Defects implanted with ionomeric bone substitute exhibited more bone formation (4 weeks = 3.19 +/- 0.35 mm2, 10 weeks = 5.35 +/- 0.26 mm2) than both defects that received no treatment (4 weeks = 0.88 +/- 0.35 mm2, 10 weeks = 2.1 +/- 0.49 mm2), membrane alone (4 weeks = 1.21 +/- 0.05 mm2) or hydroxyapatite bone substitute (4 weeks = 1.41 +/- 0.46 mm2, 10 weeks = 3.34 +/- 0.41 mm2) at 4 weeks (P < or = .01) and at 10 weeks (P < or = .05). The use of a GBR technique did not increase the amount of bone formed, compared to the use of bone substitutes alone. Hydroxyapatite and ionomeric bone substitutes used alone were more effective in inducing repair of the defects than was GBR membrane alone. The use of hydroxyapatite was associated with a greater inflammatory reaction (P < or = .01) than was ionomer in this model.

Analysis of Variance↗
PubMed2006

Physiological bases of bone regeneration II. The remodeling process.

Bone remodeling is the restructuring process of existing bone, which is in constant resorption and formation. Under normal conditions, this balanced process allows the renewal of 5-10% of bone volume per year. At the microscopic level, bone remodeling is produced in basic multicellular units, where osteoclasts resorb a certain quantity of bone and osteoblasts form the osteoid matrix and mineralize it to fill the previously created cavity. These units contain osteoclasts, macrophages, preosteoblasts and osteoblasts, and are controlled by a series of factors, both general and local, allowing normal bone function and maintaining the bone mass. When this process becomes unbalanced then bone pathology appears, either in excess (osteopetrosis) or deficit (osteoporosis). The purpose of this study is to undertake a revision of current knowledge on the physiological and biological mechanisms of the bone remodeling process; highlighting the role played by the regulating factors, in particular that of the growth factors.

Biological Factors↗