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PubMed1994

A comparison of demineralized freeze-dried bone and autologous bone to induce bone formation in human extraction sockets.

The purpose of this study was to test the bone-forming capacity of demineralized freeze-dried bone (DFDBA) and autologous bone grafts in extraction sockets. Seven paired sites were grafted with either DFDBA or autologous bone. The sites were reentered between 3 and 13 months for the purposes of obtaining biopsies of the grafted sites and to place endosseous implants. Biopsies from 6 of the 7 grafted sites were evaluated for new bone formation. DFDBA sites revealed the presence of dead particles of DFDBA with no evidence of bone formation on the surfaces of the implanted particles and no evidence of osteoclastic resorption of the bone particles. Biopsies from the 6 autologous sites revealed vascular channels with woven and lamellar bone. Some specimens had retained cortical, non-vital bone chips. These bone chips were undergoing active osteoclastic resorption. The results of this study questions the use of DFDBA as a bone inductive graft material.

Alveolar Process↗
PubMed2003

Effect of dexamethasone on root resorption after delayed replantation of rat tooth.

The purpose of this study was to evaluate the effect of dexamethasone after delayed tooth replantation with specific regard to root resorption and ankylosis. In addition, the study was planned to elucidate further the usefulness of the model. Fifty-two maxillary first molar teeth were extracted from 26 Sprague-Dawley white female rats fed 0.4% beta-aminoproprionitrile for 3 days to facilitate the extraction. After extraction, the mesiobuccal root canals were endodontically treated under a microscope to prevent subsequent inflammatory resorption of pulpal origin and were assigned to three groups. Teeth in group 1, the dexamethasone group (n = 22), were demineralized in citric acid (1 min), washed, soaked in 1000 nM dexamethasone solution (3 min), air-dried, and replanted in the original sockets. Total extraoral treatment time for each tooth was controlled to 30 min. Teeth in group 2, the dried-only group (n = 22), were air-dried for 30 min after obturation without any surface treatment and replanted. Teeth in group 3, the immediate group (n = 8), were extracted, not root-filled and replanted immediately into their sockets. All experimental animals were killed at 3 weeks after replantation and evaluated histologically. Forty-three of the 52 teeth were available for histological interpretation. They consisted of six immediate, 18 dried-only, and 19 dexamethasone-treated teeth. The degree of progressive root resorption was significantly less in the dexamethasone-treated group than in the dried-only group (p < 0.05). The dexamethasone-treated group exhibited significantly more bone ankylosis than the dried-only group (p < 0.05). These results indicate that the topical use of dexamethasone may be of value in reducing the degree or rate of progressive root resorption secondary to traumatic avulsion and that the rat is a reasonable model for tooth replantation.

Administration, Topical↗
PubMed1991

Factors related to failure of structural bone grafts in acetabular reconstruction of total hip arthroplasty.

Structural bone grafts in acetabular reconstruction of total hip arthroplasty have come into more common usage with the increasing number of revision arthroplasties. The authors present the outcome of 40 bone grafts with follow-up periods of 2-8 years. Primary and revision arthroplasties with both cemented and noncemented fixation are included. Factors that had a statistically significant relationship to failure of the bone graft included fit and fixation of bone graft to host, fit and fixation of prosthesis to host, union of bone graft to host, and the presence or absence of the confluence of the anterior and posterior columns of the acetabulum. Other findings of interest were a higher failure rate of multiple grafts as compared to a single graft and freeze-dried femoral heads. Migration of the socket of more than 3 mm is statistically related to failure of the socket.

Acetabulum↗
PubMed1975

The bony residual ridge in man.

The bone which fills in the socket after tooth extractions was investigated in 120 dry skull specimens and 100 radiographs in which one or more teeth had been missing for at least three months. The bony content of the socket was of the trabecular type. This trabecular bone was well differentiated from the adjacent cortical bony plates. In buccolingual sections, the residual crest was formed by dense trabecular bone, clearly differentiated from the cortical plates as well as from the less dense trabecular bone that was deeper within the former sockets. From the occlusal aspect, the crest of the edentulous surface had shifted lingually when compared to the original position of the teeth before extractions. From the lateral aspect, the residual ridge formed a concavity or went straight between the alveolar crests of the adjacent remaining teeth. When several teeth were missing, the concavity was more pronounced than when a single tooth was missing.

Adult↗
PubMed1992

Bone regeneration and tissue acceptance of human fascia lata grafts adjacent to dental implants: a preliminary case report.

The biologic principle of guided tissue regeneration (GTR) has been studied extensively in hopes of regenerating alveolar bone. Various materials have been utilized as regenerative membranes; however, all materials have disadvantages, and the ideal membrane material is yet to be identified. In this case report, human freeze-dried fascia lata strips were used as a regenerative barrier membrane in conjunction with the placement of endosseous root implants and demineralized, freeze-dried bone allograft. The major advantage in the use of human fascia lata for guided tissue regeneration is that a second procedure to remove the material is not necessary, and the fascia is accepted by the surrounding tissues without complication. There is acceptance of four endosseous root-form dental implants that were immediately placed into fresh extraction sockets and covered with demineralized freeze-dried bone allograft (DFDBA), with human freeze-dried fascia lata used to serve as a biocompatible, collagenous, regenerative augmentation membrane over the dental implants. The biologic concept of GTR is clinically applied to increase the dimensions of the edentulous, maxillary alveolar ridge with use of human freeze-dried fascia lata barrier membranes.

Adolescent↗
PubMed2002

Reduction in the incidence of alveolar osteitis in patients treated with the SaliCept patch, containing Acemannan hydrogel.

PURPOSE: In the present study, we compared the incidence of alveolar osteitis (AO) in patients treated with either clindamycin-soaked Gelfoam (Pharmacia and Upjohn Co, Kalamazoo, MI) or SaliCept Patches (Carrington Laboratories, Inc, Irving, TX). The SaliCept Patch is a freeze-dried pledget that contains Acemannan Hydrogel (Carrington Laboratories) obtained from the clear inner gel of Aloe vera L. PATIENTS AND METHODS: A retrospective evaluation was performed of the records of 587 patients (1,031 sockets) whose extraction sites had been treated with clindamycin-soaked Gelfoam. A prospective trial was conducted in which 607 patients (1,064 sockets) had 2 SaliCept Patches placed immediately after extraction. The same surgeon treated all patients. RESULTS: Analysis restricted to mandibular third molar sites showed that 78 of 975 sites (8.0%) in the Gelfoam group developed AO, whereas only 11 of 958 sites (1.1%) in the SaliCept group developed AO (P <.0001). Further analysis of all extraction sites revealed that the incidence of AO in the Gelfoam group was 7.6% compared with 1.1% in the SaliCept-treated group (P <.0001). CONCLUSIONS: The study results suggest that the SaliCept Patch significantly reduces the incidence of AO compared with clindamycin-soaked Gelfoam.

Adolescent↗
PubMed2001

Effect of contact stress on friction and wear of ultra-high molecular weight polyethylene in total hip replacement.

This paper studies the effect of contact stress on friction and wear of ultra-high molecular weight polyethylene (UHMWPE) acetabular cups by means of friction and wear joint simulator testing under serum lubrication. For a given applied load, increasing the contact stress by increasing the ball/socket radial clearance decreased both the coefficient of friction and the wear rate. Friction and wear were highly correlated. The dependence of friction on contact stress for the UHMWPE socket under serum lubrication was similar to that of semi-crystalline polymers under dry sliding. This finding indicates the occurrence of partial dry contact at asperity levels for the metal-polyethylene ball-in-socket joint under serum lubrication.

Arthroplasty, Replacement, Hip↗
PubMed1989

Effect of tetracycline and SnF2 on root resorption in replanted incisors in dogs.

The present study was made to assess the effect of applying SnF2, tetracycline, or both, to root surfaces of extracted teeth prior to replantation. In five young adult beagles, a total of 18 mandibular incisors were extracted, bench dried for 45 min, and reimplanted in their respective sockets either after no further treatment or following treatment with 1% doxycycline HCl for 5 min, 1% SnF2 for 5 min, or 1% SnF2 followed by 1% doxycycline HCl. After 4 wk of healing, the relative frequency of root resorption (surface resorption, inflammatory resorption and replacement resorption) was approximately 27% of the root surface in bench-dried as well as in doxycycline-treated specimens. By contrast, SnF2-treated and SnF2 + doxycycline-treated teeth showed less than 1% resorption. In the latter two specimen groups an inflammatory reaction in the periodontal ligament without resorption occurred with a frequency of 38.3% and 11.1%, respectively. The results indicate that application of SnF2 to the root surface prior to replantation effectively reduces resorptive processes during the first postoperative weeks. By subsequently treating the root surface with tetracycline, the adverse effect of SnF2 on periodontal connective tissue repair may be reduced.

Animals↗
PubMedDate not supplied

Histomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allograft and barrier membrane: a pilot study.

The aim of the study was to determine the fate of demineralized freeze-dried bone allograft (DFDBA) used in conjunction with a barrier membrane in the management of extraction sockets and deficient alveolar ridges, and to compare the amount of bone formed with that found in untreated sites. Ten biopsies were obtained from 8 grafted patients. Five biopsies were harvested from untreated sites during routine implant placement and analyzed for comparison. In the socket management procedure, DFDBA was packed tightly into the socket and covered with an expanded polytetrafluoroethylene (e-PTFE) membrane. Primary closure was achieved in all cases. In the ridge regeneration procedure, cortical columns were placed in the ridge projecting outward approximately 3 mm to create and maintain space for DFDBA particles packed between them; the columns were then covered by an e-PTFE membrane. Healing time ranged from 8 to 23 months. At the time of implant placement, bone cores (7 mm x 2 mm) were harvested, fixed in 10% formalin solution, and prepared for histologic examination. At the light microscopic level, no inflammation or fibrous encapsulation was observed. New bone formation on and around DFDBA particles was widespread. Histomorphometric analysis of the grafted specimens and untreated sites was carried out using the trabecular bone volume (TBV) index. The TBV in the maxillary test specimens was 55.03%, as compared to 57.33% of control cores. Unaltered DFDBA made up 8.7% of the test specimens. In the mandibular biopsies, the TBV was 56.6%, while for the controls it was 40.9%. The volume of DFDBA still present was 2.45%. The results tended to indicate that treatment with DFDBA in conjunction with cell occlusive membranes will result in new bone formation, predominantly by the process of conduction, which appears to be similar in amount and nature to that found in cores harvested from healed nonfunctional edentulous areas.

Adult↗
PubMed2002

Consequences of deltoid muscle elongation on deltoid muscle performance: a computerised study.

BACKGROUND: The deltoid muscle plays an important role in normal shoulder function. Knowledge of the position of the glenohumeral rotational centre and of the deltoid muscle length is essential to understand optimal placement of a total shoulder prosthesis. OBJECTIVE: This study is designed to analyse the effect of deltoid muscle elongation on shoulder joint function. DESIGN: A three-dimensional model of the glenohumeral joint with deltoid muscle analysis in the scapular plane. METHODS: A geometrical three-dimensional ball-and-socket model of the shoulder joint was developed. From dry bones, the position of the origins and insertions of the three parts of the deltoid muscle relative to the calculated centre of rotation of the humeral head was defined. The position and the direction of the muscle force working lines relative to this humeral centre were calculated using former measurements and CT-data of the deltoid. Muscle length-tension data were applied to obtain angle-force relationships. The model was used to calculate the angle-force relationships, the moment arm and the moment of the deltoid muscle components for successive arm elevation angles in the scapular plane. These data were compared to those of a theoretical situation assuming a 10% elongation of the muscle. RESULTS: Muscle angle-force curves show a more favourable slope after moderate (10%) deltoid muscle elongation. Elongating the muscle by changing the distance between the humeral rotation point and the deltoid insertion along the humeral axis does not affect moment arms. The moments of the deltoid muscle forces themselves, however, seem more adapted to elevation in the scapular plane. The deltoid maximal moment exceeds the arm-weight moment by about 40% instead of being approximately equal, and that the maximum is situated around 100 degrees of elevation. CONCLUSIONS: From a biomechanical point of view, stretching the deltoid muscle by 10% seems to result in a significantly more favourable position in case of shoulder elevation at 90 degrees of abduction in the scapular plane in a centred glenohumeral joint. RELEVANCE: This model suggests that a 10% elongation of the deltoid muscle, the most important shoulder abductor, improves its ability to elevate the arm. If properly implemented, this observation can be very important in the treatment and early rehabilitation of rotator-cuff-insufficient shoulders treated by a specific total shoulder replacement design.

Adult↗
PubMed2006

Preserving pulpal health of a geminated maxillary lateral incisor through multidisciplinary care.

AIM: To report the multidisciplinary care of an unaesthetic geminated maxillary lateral incisor tooth, which allowed its preservation in the mouth. SUMMARY: Preoperative examination of an unsightly geminated maxillary lateral incisor (tooth 22) demonstrated two pulp chambers and open apices, with normal pulp sensitivity responses. At surgery, a periodontal mucoperiosteal flap was reflected and the distal part of the geminated tooth was removed. The exposed root canal of the preserved tooth was sealed with mineral trioxide aggregate (MTA). The extraction socket and osseous defect was grafted with decalcified freeze-dried bone allograft (DFDBA) before flap closure. During follow-up, distal caries in tooth 22 and a diastema between tooth 22 and 23 were managed with composite resin restorations. Forty-two months postoperatively, normal thermal and electrical pulp sensitivity tests confirmed pulp health. Convincing apexogenesis and dentinogenesis of the developing root was confirmed by radiographic examination. Acceptable periodontal health including 3-4 mm clinical probing depths was achieved. Optimizing aesthetics and occlusion was accomplished without orthodontic treatment.

Aluminum Compounds↗
PubMed2001

A model to evaluate bone substitutes for immediate implant placement.

A calcified alloplast was evaluated as a gap-filling material around implants placed immediately into fresh extraction sockets. Periodontal measurements and computed tomography scans were obtained to evaluate the clinical effectiveness of the alloplast when compared with demineralized freeze-dried bone. To determine whether this alloplast would be a suitable grafting material, 14 patients were selected to evaluate the extraction socket as a model for routine histologic confirmation of the efficacy and biocompatibility of bone substitutes. The results of this study showed the following: (1) human extraction sockets can be models for the study of bone/implant interaction; (2) the alloplast was well tolerated and demonstrated no inflammation through histologic evaluation of core biopsies; (3) the alloplast was a suitable material when used as a gap-filling graft in sockets around immediately placed implants; and (4) dental computed tomography scans and periodontal measurements around grafted implants 6 months after the procedure provide valuable clinical information about graft healing and osteointegration.

Alveolar Bone Loss↗
PubMed2006

Evaluation of an integrated orbital tissue expander in an anophthalmic feline model.

PURPOSE: To evaluate the anatomical effects and tissue biocompatibility in a feline model of an integrated orbital tissue expander (OTE) designed to stimulate bone growth in an anophthalmic socket. DESIGN: An animal study was performed in cats to assess orbital bone growth with and without an OTE. METHODS: The OTE is an inflatable (0.5 to >6.0 cm(3)) polymeric globe sliding on a titanium T plate secured to the lateral orbital rim with screws. Eight cats had left eye enucleation at age two weeks, with five orbits receiving an OTE and the remaining three serving as nonimplanted controls. Serial transconjunctival implant inflation was performed by injecting normal saline solution into the OTE to a final volume of 3.5 ml. Serial computed tomographic scans were obtained to assess socket growth. All eight cats were euthanized at 18 weeks and dry skulls prepared. The effective orbital volume was measured by inflating an OTE in the orbit of a dry skull until it filled the cavity completely. RESULTS: Three cats periodically scratched open the tarsorrhaphy and conjunctiva to rupture the OTE, which resulted in implant exchanges. At 18 weeks, the OTE expanded orbital volume was approximately 18% smaller than the normal contralateral side. In the control animals, the anophthalmic orbital volume was approximately 66% smaller than the contralateral orbit. Histopathology of orbital tissues showed no evidence of foreign body reaction. CONCLUSIONS: This proof-of-concept pilot study demonstrated implant efficacy in cats, and no implant-related adverse effects were observed. OTE has the potential to stimulate bone growth in human anophthalmic orbits.

Animals↗
PubMed2004

The effect of basic fibroblast growth factor on delayed-replanted monkey teeth.

BACKGROUND: Basic fibroblast growth factor (bFGF; FGF-2) has been reported to facilitate wound healing and periodontal regeneration in experimental alveolar bone defects. The purpose of this study was to evaluate histologically the effect of topically applied bFGF with or without fibrin glue on delayed-replanted monkey teeth prone to replacement resorption. METHODS: Forty-five roots from five monkeys were endodontically treated aseptically and then extracted as atraumatically as possible. Ten negative control roots were replanted immediately, while 12 positive control roots were allowed to bench dry for 1 hour prior to replantation, both without further treatment. Roots in the two experimental groups were bench dried for 1 hour, rinsed with saline, and then replanted into sockets filled with bFGF with (11 roots) or without (12 roots) fibrin glue. After 12 weeks, histological sections were prepared and evaluated according to morphometric analysis as complete healing or unfavorable healing composed of inflammatory resorption and replacement resorption. RESULTS: Kruskal-Wallis and Mann-Whitney U tests showed teeth in the negative control group to have significantly higher complete healing (98.88% +/- 2.30%) and significantly lower unfavorable healing (1.12% +/- 2.30%) than the positive control group and the experimental groups. bFGF/fibrin glue group showed higher occurrence of complete healing (39.06% +/- 41.62%) compared to the bFGF group (25.28% +/- 28.85%) and the positive control group (16.58% +/- 19.60%), although the differences were not significant. Comparing the complete and unfavorable healing, there was no significant difference in the bFGF/fibrin glue group (P = 0.47), but the differences were significant in the other groups (P < 0.05). CONCLUSION: Topical application of bFGF with fibrin glue showed an insignificantly higher occurrence of complete healing in delayed-replanted monkey teeth.

Animals↗
PubMed1995

Clinical management of the avulsed tooth.

Treatment outside the dental office: Replant immediately after gentle washing if practical. If replantation is not practical, store the tooth in the best medium available. Storage media in order of preference are Hank's Balanced Salt Solution (HBSS), milk, saline, and saliva (buccal vestibule). Water is the least desirable storage medium. Treatment in the office: Emergency visit; Place tooth in HBSS while exam is conducted and history is taken. Prepare socket for gentle repositioning of the tooth. Prepare the root. Extraoral dry time < 20 minutes: Closed apex--replant immediately after gentle washing. Open apex--soak in 1 mg doxycycline in 20 mg saline for 5 minutes. Extraoral dry time 20 to 60 minutes: Soak in HBSS for 30 minutes and replant. Extraoral dry time > 60 minutes: soak in citric acid, 2% stannous fluoride, and doxycycline and replant. Endodontics can be done extraorally. Semirigid splint for 7 to 10 days. (If alveolar fracture is present, rigid splint for 4 to 8 weeks). Suture soft-tissue lacerations, particularly in the cervical area. Administer systemic antibiotics (penicillin V potassium if possible) Chlorhexidine rinses and stringent oral hygiene while the splint is in place (7 to 10 days). Analgesics as required. Second visit after 7 to 10 days: Endodontic treatment: Tooth with open apex and extraoral dry time of < 60 minutes: No endodontic treatment initially. Recall every 3 to 4 weeks to examine for evidence of pathosis. If pathosis is noted, disinfect the pulp space and start apexification procedure. Tooth with open apex and extraoral dry time > 60 minutes: If endodontics was not completed in the emergency visit, start endodontics and follow apexification procedure. Tooth with closed apex: Endodontics should be initiated after 7 to 10 days. Careful chemomechanical instrumentation under strict asepsis. Splint removed at end of visit. Obturation visit: If endodontics was initiated 7 to 10 days after the avulsion, obturation can take place after short-term calcium hydroxide treatment. If endodontics was initiated more than 14 days after the avulsion or inflammatory resorption, long-term calcium hydroxide for 6 to 24 months, obturated when an intact lamina dura is traced. Restorations: Temporary restorations: Should be 4 mm deep. Reinforced zinc-oxide-eugenol, acid-etch composite resin, glass-ionomer cement. Permanent restoration: Placed immediately after obturation. Acid-etch resin and dentin bonding agents. Follow-up care: Twice per year for 3 years and yearly for as long as possible. Late complications are common.

Dental Restoration, Permanent↗
PubMed1999

[Experimental study of osseointegrated dental implants placed into fresh extraction sockets in dogs].

OBJECTIVE: To investigate the better way in treating bone defects around implants. METHODS: 12 mongrel dogs, pure titanium implants were immediately inserted in the mesial roots of the second, third and fourth mandibular premolar sockets. The defects around implants were separately filled with demineralized freeze-dried bone allograft (DFDBA), demineralized freeze-dried allocancellous in combination with bBMP (bBMP compound bone) and nothing. RESULTS: Histologic observation showed that bone defects around implants were substituted by new bone in DFDBA group at 12 weeks and in bBMP compound bone group at 8 weeks, and also the osseointegration were obtained between implants and bone, but bone defects were only filled about 3/5 in no graft group at 12 weeks. CONCLUSION: Immediate implants could obtain good osseointegration if the defects around implants were treated properly and the right technique was used, and also the use of bBMP compound bone could promote obviously bone formation in defects around implants.

Animals↗
PubMed1998

Histologic findings after implantation and evaluation of different grafting materials and titanium micro screws into extraction sockets: case reports.

The purpose of this study was to compare extraction socket healing in 8 patients after implantation with either xenogenic bovine bone (n=5 sites), demineralized freeze-dried bone (DFDBA) (n=3 sites), autologous bone (n=3 sites), or human bone morphogenetic proteins in an osteocalcein/osteonectin carrier (hBMP/NCP) (n=2 sites). Three of the patients received 6 commercially pure micro screws which were fixed into extraction sockets, after which the sockets were implanted with either bovine bone (n=3 sites), DFDBA (n=2 sites) or intraoral autologous bone (n=1 site). Biopsies of the extraction sockets were taken from 3 to 6 months after treatment (average, 4.6 months). For comparison of healing between the implanted materials, histologic evaluation and bone scores were determined. Bone scores of 0 indicated an absence of new bone, with dead implanted bone particles entrapped within connective tissue, while a score of 3 indicated the entire field consisted of vital bone. Biopsies from bovine bone sockets revealed dead implanted particles surrounded by connective tissue. Isolated sections showed host bone in contact with the bovine bone particles. Bone scores ranged from 0 to 3. Biopsies from DFDBA-implanted sites revealed dead particles entrapped with dense connective tissue. The bone scores ranged from 0 to 1. Biopsies from sites implanted with hBMP/NCP revealed a combination of woven and lamellar bone with bone scores of 3. Five of the 6 micro screws were processed and evaluated. One screw was mobile at the time of removal and was not evaluated. Bone scores were used to compare new bone formation adjacent to the micro screws. Bone scores ranged from 0 to 2. A score of 0 indicated non-vital implant material in contact with host bone and connective tissue in contact with implant; 2 indicated vital bone in contact with the majority of the implant surface. Retrieved sockets with micro screws implanted with bovine bone (n=2) demonstrated a connective tissue interface between the screws and the surrounding tissues (bone score 0). The adjacent tissues showed dead bovine particles entrapped within fibrous tissue. Retrieved screws implanted with DFDBA (n=2) were surrounded by connective tissue, with dead bone particles enmeshed within fibrous tissue (bone score 0). The screw implanted with intra-oral autologous bone was primarily surrounded by vital bone with a connective tissue interface (bone score 1). Three implant threads were in contact with bone. The results of this study indicate that bovine bone, DFDBA, and intraoral autologous bone do not promote extraction socket healing. Sockets implanted with hBMP/NCP contained vital woven and lamellar bone. Xenogenic bovine bone and DFDBA did not contribute to bone to micro screw contacts and are not recommended for enhancement of vital bone to implant contacts. Intraoral autogenous bone also does not appear to significantly contribute to bone to implant contacts. Intraoral autologous bone, xenogenic bone, and DFDBA appear to interfere with normal extraction socket healing.

Aged↗
PubMed1999

Localized ridge maintenance using bone membrane.

The immediate placement of a dental implant into a fresh extraction socket has been limited in many instances by the quantity of bone that remains after the extraction. This article presents two clinical cases that demonstrate successful regeneration of alveolar ridges in which there was extensive loss of the buccal plate of bone. This lack of alveolar process impeded the immediate placement of dental implants into fresh extraction sockets. The surgical technique performed in these cases was based on the principles of guided bone regeneration using a demineralized freeze-dried bone membrane. The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissues. Bone formation took place for the placement of endosseous dental implants 8 months after the procedures were initiated. These human clinical cases confirm positive results of previous animal findings.

Adult↗