Search Results (66)

The reconstruction of a severely resorbed alveolar bone is a significant challenge in dental implantology and maxillofacial surgery. Traditional bone grafting materials, including autogenous, allogeneic, xenogeneic, and alloplastic materials, have limitations such as donor site morbidity, limited availability, and prolonged maturation periods. To address these challenges, recombinant human bone morphogenetic protein-2 (rhBMP-2) has emerged as a potent osteoinductive factor that facilitates bone regeneration without the need for additional donor site surgery. This study introduces a box technique which combines rhBMP-2 (CowellBMP^®, Cowellmedi, Busan, Republic of Korea) with a 3D-preformed titanium mesh (3D-PFTM), utilizing a mixture of allografts and xenografts for horizontal and vertical alveolar ridge augmentation. The technique leverages the structural stability provided by the OssBuilder^® (Osstem, Seoul, Republic of Korea), a preformed titanium mesh, that allows for simultaneous implant placement and vertical ridge augmentation. This technique not only reduces the treatment time compared to traditional methods but also minimizes post-operative discomfort by eliminating the need for autogenous bone harvesting. Clinical outcomes from this technique demonstrate successful bone regeneration within a shorter period than previously reported techniques, with excellent bone quality and implant stability being observed just four months after vertical augmentation. In conclusion, the so called BOXAM (BMP-2, Oss-builder, Xenograft, Allograft, Maintenance) technique presents a promising therapeutic strategy for alveolar bone reconstruction, particularly in cases of severe bone resorption. Further studies are needed to evaluate the long-term outcomes and potential limitations of this approach, especially in scenarios where the inferior alveolar nerve proximity poses challenges for fixture placement. Full article

Background: Bone resorption following tooth loss poses significant challenges for dental implant success. Guided bone regeneration (GBR) techniques, particularly in vertically deficient ridges, often require complex procedures and soft tissue management. This case report introduces a modified occlusive barrier with a window, combined with tricalcium phosphate, to address these challenges. Methods: A 26-year-old female with significant bone loss in the mandibular anterior region underwent GBR using a digitally designed titanium occlusive barrier. The barrier was fabricated using CAD/CAM technology and secured with screws. A blood clot mixed with tricalcium phosphate was used to promote bone regeneration. Postoperative care included regular irrigation, de-epithelialization, and follow-up over six months. Implant placement and histological analysis were performed to evaluate outcomes. Case Presentation: The patient achieved 8.8 mm of vertical and 7.6 mm of horizontal bone regeneration. Histological analysis confirmed the presence of mature, mineralized bone, and keratinized gingiva. The implant was successfully placed, and a fixed prosthesis was restored after four months, with stable results at a three-year follow-up. Conclusion: This technique demonstrates effective bone and soft tissue regeneration in a single procedure, eliminating the need for autologous bone grafts and secondary surgeries. The use of a digitally designed occlusive barrier offers precision, reduces morbidity, and simplifies the surgical process, suggesting a promising advancement in GBR. Further studies are needed to validate these findings. Full article

Aim: to evaluate the bone regeneration capacity of two alloplastic biomaterials in a critical-size rat calvarial defect model. Methods: A total of 80 rats were randomized into 8 groups of 10 animals each. An Ø8 mm, critical-size calvarial defect was created, and the following treatments were randomly allocated: sham surgery, deproteinized bovine bone mineral (DBBM) + collagen membrane (CM), poly-(lactic-co-glycolic-acid) (PLGA)-coated pure phase β-tricalcium phosphate (β-TCP), or PLGA-coated 60% hydroxyapatite (HA):40%β-TCP. Animals were allowed to heal for 2 and 6 weeks. Microcomputed tomography (μCT) was used to evaluate mineralized tissue and biomaterial displacement. Histological samples were used to evaluate new bone formation. Results: μCT analysis showed no significant differences among groups for total volume of mineralized tissue or residual biomaterials. DBBM + CM showed significantly increased horizontal biomaterial displacement at 2 weeks but not at 6 weeks. Histological analysis showed that sham surgery had a significantly higher percentage of bone area fraction than the DBBM + CM and PLGA + β-TCP at 2 weeks, but not at 6 weeks. Residual biomaterial area fraction showed no significant differences among experimental groups at any healing time. Conclusions: The alloplastic biomaterials showed suitable construct integrity and retention in the defect. All biomaterials were associated with limited new bone formation comparable to the sham surgery control. Full article

Purpose: To evaluate the clinical and histological outcomes of patients that receive implant-supported crowns after vacuum plasma surface treatment (VPST) of biomaterials used in socket preservation (SP) and guided bone regeneration (GBR). Materials and methods: This study was designed as a case series. Patients in need of tooth extraction and socket preservation or guided bone regeneration were enrolled. The socket preservation technique was performed after tooth extraction using a heterologous collagen bone graft and a collagen xenomatrix, both activated with vacuum plasma. Meanwhile, a two-stage horizontal ridge augmentation was performed using a customized titanium mesh and a mix of autologous (untreated) and heterologous (treated) bone grafts, along with a treated collagen membrane. ACTILINK Reborn with Universal Vortex Holder (Plasmapp Co., Ltd., Daejeon, Republic of Korea) was used to treat all biomaterials. The outcome measures were implant and prosthesis failures, complications, and histological examination. Soft and hard tissue samples were collected at the time of implant placement only in patients treated with SP. Results: A total of six patients were treated—three with socket preservation and delayed implant placement, and three with staged GBR. No implant or prosthesis failed. One customized titanium mesh broke after plasma treatment, requiring replacement with a pericardium membrane. No other complications occurred. Histological analysis at three months post-surgery revealed well-vascularized newly formed bone at different stages of maturation with integrated bone graft particles, while the soft tissue appeared to be physiologically structured. Conclusion: VPST may enhance the hydrophilicity of biomaterials, supporting favorable healing outcomes in SP and GBR. Further randomized controlled trials with appropriate sample size calculations are needed to confirm these preliminary results. Full article

Background/Objectives: Guided bone regeneration (GBR) is a regenerative technique used to treat maxillary osseous defects to enable implant placement for prosthetic rehabilitation. It is generally performed with the use of barrier membranes and bone substitute materials of human or animal origin. Here, we report the clinical and histological outcomes of a horizontal GBR, treated using only synthetic biomaterials. Methods: A graft of nanocrystalline hydroxyapatite (NH) embedded in a silica gel matrix was used to fill a horizontal bone defect. The graft was covered with a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane, and primary closure was completed and maintained for 10 months. Then, the site was re-opened for membrane removal and implant insertion. During implant bed preparation, a bone biopsy was obtained for histological evaluation. A metal–ceramic crown was fitted, and the 5-year follow-up after prosthetic loading showed clinical and radiographically healthy tissues. Results: Histological examination revealed good integration of the biomaterial into the surrounding tissues, which were composed of lamellar bone trabeculae and connective tissue. New bone formation occurred not only around the NH granules but even inside the porous amorphous particles. Conclusions: The combination of NH and the TR-dPTFE membrane produced good clinical and histological results, which remained stable for 5 years. Full article

Background: Alveolar ridge preservation (ARP) is widely used in clinical practice to prevent horizontal and vertical bone loss following tooth extraction. Conventional ARP uses a single coverage material with bone graft materials on a simple tooth extraction site. The objective of this study was to evaluate the clinical efficacy of a new double-layer ARP technique that additionally covers a collagen matrix at the top position, especially on the periodontally collapsed region following tooth extraction. Methods: In a clinical study process comparing our newly attempted ARP with the widely used conventional ARP, we discovered the clinical efficacy of our new ARP for specially selected cases. Because the extraction socket wall had collapsed and the entire ridge needed to be reconstructed, this procedure should be described as alveolar ridge augmentation. Results: Additional coverage of the collagen matrix protected the internal bone grafting and promoted external soft tissue regeneration and healing in sample cases. Conclusions: In conclusion, our procedure promotes the new generation of hard and soft tissues. It is particularly effective in regions requiring flapped surgery, such as areas with periodontal disease, long-span areas requiring multiple tooth extractions, and areas in which there is wide destruction of hard and soft tissues. Through this proof-of-concept case study, we aimed to standardize and evaluate this unprecedented surgical technique. Full article

Background and Objectives: Periodontal regeneration involves techniques intended at restoring the lost supporting tissue around a periodontally weakened tooth. These regenerative methods frequently utilize periosteal grafts to stimulate the evolvement of vital adjacent tissues. This paper intended to evaluate the use of autogenous periosteal grafts in treating grade II furcation defects (Glickman Classification 1953) in patients with chronic periodontitis. Materials and Methods: The databases MEDLINE (via PubMed), Cochrane, EBSCO, and Google Scholar were searched for papers published in English from January 1991 till December 2022. Three individuals examined the reclaimed articles according to the inclusion norms. Randomized controlled trials (RCTs) assessing the efficacy of autogenous periosteal grafts for treating Grade II furcation defects in chronic periodontitis patients were involved. Only four related studies were identified for data extraction, involving 80 patients aged 18 to 52 years. Outcome variables measured included horizontal bone loss (HD), vertical bone loss (VD), pocket depth (PD), clinical attachment level (CAL), bone height (BH), gingival recession (GR), plaque index (PI), and gingival index (GI). Data were examined using RevMan 5.4.1 software. Mean differences and 95% confidence intervals were employed to estimate effect sizes. Results: Both groups showed similar results for reductions in PI, GI, and BOP. However, The periosteal graft also yielded better outcomes for CAL gain, BH, and GR. The meta-analysis showed a significant overall effect of Periosteal Barrier Membrane (PBM) on horizontal and vertical bony change levels, but subgroup differences between unilateral and bilateral applications were not statistically significant due to high heterogeneity. Although the bilateral subgroup demonstrated significant benefits of PBM treatment, the overall findings across the clinical attachment level group remain inconclusive. Conclusion: Current evidence suggests that while PBM may benefit bilateral mandibular sites, and autogenous periosteal grafts offer no added advantage over OFD alone in Grade II furcation defects, the overall findings remain inconclusive. Full article

Background: Advanced platelet-rich fibrin + (A-PRF+) represents a third generation of autologous platelet derivatives. Appropriate centrifugation conditions cause the formation of a clot containing platelets, which slowly release growth factors that influence healing. The objective of this article was to undertake a review of the available literature on the effectiveness of A-PRF+ use in hard tissue procedures. Materials and methods: In order to ensure the most accurate and relevant results, only randomized clinical trials regarding bone regeneration techniques/bone healing that compared the effect of the A-PRF+ addition in dentistry were included in this study. Articles taken into consideration for the review were published between the beginning of 2014 and 31 December 2024. The search of manuscripts for the review was conducted using the PubMed, Scopus, Google Scholar, and Cochrane databases. For this study, 10 articles focusing on A-PRF+ were qualified. Results: A-PRF+ was found to increase the post-surgical vertical and horizontal alveolar ridge dimensions. The bone formed in the surgical site presented a higher volume of vital and non-vital bone and a more optimal bone composition, at the same time providing a lower percentage of connective tissue inclusions. When combined with other grafting biomaterials, A-PRF+ enhanced their performance and integration. A-PRF+ did not have any significant effect on the mineral bone density compared with other grafting materials. Compared with PRF and other blood derived plasmas rich in growth factors, the performance of A-PRF+ was generally better, but often with no statistical significance. The treatment of periodontal defects measured by the reduction in pocket depth and clinical attachment level also fared better with the A-PRF+ addition, although there was no differences noted between A-PRF+ and biphasic calcium phosphate and xenograft. Finally, the A-PRF+ addition improved the primary implant stability in the evaluated studies. Conclusions: The A-PRF+ addition to the surgical protocols significantly enhanced the healing of the bone and when combined with biomaterials improved their integration and increased the implant insertion torque, improving the primary and secondary stability. It may be a viable alternative for patients that express their concern towards human- and animal-derived biomaterials. Full article

The patient-specific treatment of bone fractures using porous osteoconductive scaffolds has faced significant clinical challenges due to insufficient mechanical strength and bioactivity. These properties are essential for osteogenesis, bone bridging, and bone regeneration. Therefore, it is crucial to develop and characterize biocompatible, biodegradable, and mechanically robust scaffolds for effective bone regeneration. The objective of this study is to systematically investigate the mechanical performance of SimuBone, a medical-grade biocompatible and biodegradable material, using 10 distinct triply periodic minimal surface (TPMS) designs with various internal structures. To assess the material’s tensile properties, tensile structures based on ASTM D638-14 (Design IV) were fabricated, while standard torsion structures were designed and fabricated to evaluate torsional properties. Additionally, this work examined the compressive properties of the 10 TPMS scaffold designs, parametrically designed in the Rhinoceros 3D environment and subsequently fabricated using fused deposition modeling (FDM) additive manufacturing. The FDM fabrication process utilized a microcapillary nozzle (heated to 240 °C) with a diameter of 400 µm and a print speed of 10 mm/s, depositing material on a heated surface maintained at 60 °C. It was observed that SimuBone had a shear modulus of 714.79 ± 11.97 MPa as well as an average yield strength of 44 ± 1.31 MPa. Scaffolds fabricated with horizontal material deposition exhibited the highest tensile modulus (5404.20 ± 192.30 MPa), making them ideal for load-bearing applications. Also, scaffolds with large voids required thicker walls to prevent collapse. The P.W. Hybrid scaffold design demonstrated high vertical stiffness but moderate horizontal stiffness, indicating anisotropic mechanical behavior. The Neovius scaffold design balanced mechanical stiffness and porosity, making it a promising candidate for bone tissue engineering. Overall, the outcomes of this study pave the way for the design and fabrication of scaffolds with optimal properties for the treatment of bone fractures. Full article

Guided bone regeneration (GBR) has represented a challenge for clinicians in the past 30 years, and the literature has well described many different surgical options such as d-PTFE membranes, titanium grids, or autogenous bone harvested from the posterior mandible. All of the previously mentioned techniques have shown a high rate of complications but, in the last decade, a new membrane made of xenogenic bone was introduced. Most of the publications regarding its application report very few and mild complications. In this article we will suggest a new application using segmented xenogenic bone sheets instead of autogenous bone to correct severe ridge deformity. Background and Objectives: Xenogenic bone sheets have been studied extensively over the past decade and have proven effective, with a very low rate of complications when used to reconstruct bone atrophies. The technique presented in this paper aims to reduce morbidity, avoid the need for intra-oral graft harvesting, and minimize both surgical time and post-operative discomfort. Materials and Methods: Xenogenic bone sheets of equine origin were used to reconstruct severe 3D bone defects in five patients requiring dental implants. The segmentation of the sheet allowed the operator to rebuild the missing bone walls and achieve optimal anatomy without compromise. Furthermore, using different sizes and thicknesses of the bone sheets allowed safe procedures preventing early exposure of the membranes. CBCT of the defects before and after 8 months of healing were measured with Exocad software to assess the volumetric gain. Histological analysis performed on one site showed integration of the bone lamina and live bone underneath. Results: In all five cases evaluated the ridge deformities were successfully corrected and all patients’ implants have functioned for more than two years to date. The average horizontal bone gain in these five cases was 6.18 mm (±1.19 mm) while the vertical gain was 9.70 mm (±2.39 mm). Conclusions: This new application of flex cortical sheets simplifies the surgical procedure for both operator and patient, reduces morbidity and post-operative complications, and shows promising signs for resolving complex 3D bone reconstructions. Full article

Following tooth extraction, the bone structure is prone to atrophic changes. Alveolar ridge resorption can compromise subsequent implant treatment not only at the extraction site itself but also by affecting the bone support of adjacent teeth. Various techniques, including the use of bone graft materials or autologous blood concentrates for ridge or socket preservation, aim to counteract this process. The efficacy of such methods can be evaluated non-invasively through radiological analysis of the treated region. However, existing radiological evaluation methods often focus only on isolated areas of the extraction socket, limiting their accuracy in assessing overall bone regeneration. This study introduces a novel, non-invasive, and semi-automated image-based analysis method that enables a more comprehensive evaluation of bone preservation using CBCT data. Developed with the open-source software “Fiji” (v2.15.0; based on ImageJ), the approach assesses bone changes at multiple horizontal and vertical positions, creating a near three-dimensional representation of the resorptive process. By analyzing the entire region around the extraction socket rather than selected regions, this method provides a more precise and reproducible assessment of alveolar ridge preservation. Although the approach requires some processing time and focuses exclusively on radiological evaluation, it offers greater accuracy than conventional methods. Its standardized and objective nature makes it a valuable tool for clinical research, facilitating more reliable comparisons of different socket preservation strategies. Full article

Background: Guided bone regeneration (GBR) is a widely used technique in oral and maxillofacial surgery to restore lost bone. The aim of this study is to evaluate the effectiveness of titanium occlusive barriers in GBR for increasing bone volume in both vertical and horizontal dimensions. Methods: A prospective analysis was conducted on 11 patients (15 cases) undergoing bone augmentation with titanium barriers combined with bone graft biomaterials for dental implant placement. Bone gain was assessed using pre- and postoperative low-dose cone beam computed tomography (CBCT) measurements in vertical and horizontal planes. Histological analyses evaluated the quality and vascularization of the regenerated bone. Results: Significant bone volume increases were observed, with a mean vertical gain of 7.60 mm (SD 0.23) and a horizontal gain of 5.44 mm (SD 0.39). Histological examination confirmed well-vascularized regenerated bone with minimal residual graft material, effective integration, and the formation of keratinized gingiva. Conclusions: Titanium occlusive barriers in GBR provide a reliable and minimally invasive method for substantial bone regeneration, showing advantages such as ease of handling and reduced invasiveness. Additional studies are recommended to validate these findings and evaluate long-term outcomes. Full article

Background: Immediate post-extraction dental implants are increasingly popular, but ensuring primary stability and managing peri-implant tissues remain challenging. Implant macro-design significantly impacts stability and osseointegration. This study used Cone-beam Computed Tomography (CBCT) to evaluate changes in alveolar bone following immediate placement of two implant designs, System 2P and Dura-Vit 3P, which feature semi-conical microgeometry and apical self-tapping portions for improved stability and bone regeneration. Methods: With a 1:1 allocation ratio, the current investigation was a two-arm parallel group randomized clinical trial. Patients qualified if they required immediate dental replacements with adequate buccal bone support. Two types of implants were placed: System 2P (cylindrical shape) and Dura-Vit 3P (more conical shape, with a particular architecture of threads). Following the intervention, CBCT was performed both immediately (T1) and six months later (T2). Measurements of CBCT horizontal bone level at apical, medial, and bevel height on the palatal/lingual and vestibular sides as well as the buccal vertical gap were the primary results. Complications, implant stability quotient (ISQ), and torque insertion were evaluated. The Mann–Whitney test was used to determine time-based differences within each group, while the Wilcoxon test was used to estimate differences between groups. The impact of baseline marginal gap dimension and gingival biotype was estimated using multiple regressions. Results: Thirty patients were recruited and randomized to treatments, with two lost to follow-up. One System 2P implant failed and two patients of the Dura-Vit 3P group dropped out. At T1, the Dura-Vit 3P group exhibited a lower mean insertion torque and a higher ISQ than the System 2P group. Furthermore, the Dura-Vit 3P group showed lower bone reduction compared to System 2P at horizontal and vertical measurements with significant differences for the vestibular and palatal base and medial level (p-values < 0.05). Regression models indicated a positive effect of thick biotypes on gap filling and dimensional bone reduction. No complications were observed in both groups. Conclusions: The Dura-Vit 3P implant exhibits high primary stability when inserted in post-extraction sites. Furthermore, this kind of implant stimulates higher bone stability on both the palatal and buccal side when compared to the System 2P implant. The present findings support the evidence that the macro-design of the Dura-Vit 3P implant promotes increased primary stability and reduces bone loss. Full article

The alveolar ridge undergoes a loss in volume and atrophy after tooth extraction. Understanding the wound healing and bone regeneration process after tooth extraction is a key factor in the insertion of dental implants. Therefore, the aim of the present study was to analyze the socket healing process after the extraction of upper premolars based on cone beam computed tomography (CBCT) over six months. Special focus was placed on the morphological changes in the alveolar crest and within the socket. A retrospective analysis of patients in need of tooth extraction in the upper premolar region was performed in this study. All patients received flapless tooth extraction under local anesthesia and CBCT immediately after tooth extraction. Further CBCT analysis was performed after three months for the first group (n = 18) and after six months for the second group (n = 18). The results showed that all sockets underwent an inward movement of the defect walls towards the defect center, resulting in reduced total alveolar ridge volume and defect volume. This result was observed after three months and persisted after six months. The inward movement was quantified as a vertical socket collapse of up to 30.1 ± 9.0% after three months and 34.3 ± 6.7% after six months. The horizontal inward movement was quantified as a buccal socket collapse of 47.7 ± 12.3% after three months and 55.7 ± 29.1% after six months. New bone formation within the socket was evident, especially in the occlusal part of the socket. Additionally, bone formation was primarily observed as bone apposition along the socket walls and did not reach the defect center in most cases. The combination of socket collapse and bone apposition led to the formation of cavitations inside the socket that were mostly localized under the occlusal part. These novel findings with respect to socket collapse and formation of cavitation represent a paradigm shift and call for reconsidering the current understanding of socket healing. Based on the data, socket healing should be understood as a patient-specific process that requires 3D radiographic analysis for planning dental implants. Full article

Background: Alveolar ridge resorption following tooth loss poses a significant challenge for successful dental implant placement. In cases of severe atrophy, bone augmentation is required to restore sufficient bone volume. This technical note outlines a detailed, stepwise surgical protocol for horizontal and vertical alveolar ridge augmentation using customized titanium mesh. Materials and Methods: The procedure includes precise mesh fitting, autologous bone grafting, and the application of bioactive agents to promote bone regeneration. Emphasis is placed on the technique’s feasibility, predictability, and the critical steps necessary for preventing complications. Results: The use of customized mesh ensures stability and improved bone regeneration outcomes, enabling clinicians to achieve successful implant placement even in severely atrophic ridges. Conclusions: The described protocol has demonstrated predictable results in both clinical and radiographic evaluations, offering an effective solution for complex bone augmentation cases. Full article