Immediate loading of implants installed in a healed alveolar bony ridge or immediately after tooth extraction: an experimental study in dogs

ObjectiveTo compare the sequential healing at immediately loaded implants installed in a healed alveolar bony ridge or immediately after tooth extraction.Material and methodsIn the mandible of 12 dogs, the second premolars were extracted. After 3months, the mesial roots of the third premolars were endodontically treated and the distal roots extracted. Implants were placed immediately into the extraction sockets (test) and in the second premolar region (control). Crowns were applied at the second and third maxillary premolars, and healing abutments of appropriate length were applied at both implants placed in the mandible and adapted to allow occlusal contacts with the crowns in the maxilla. The time of surgery and time of sacrifices were planned in such a way to obtain biopsies representing the healing after 1 and 2weeks and 1 and 3months. Ground sections were prepared for histological analyses.ResultsAt the control sites, a resorption of the buccal bone of 1mm was found after 1week and remained stable thereafter. At the test sites, the resorption was 0.4mm at 1-week period and further loss was observed after 1month. The height of the peri-implant soft tissue was 3.8mm both at test and control sites. Higher values of mineralized bone-to-implant contact and bone density were seen at the controls compared with the test sites. The differences, however, were not statistically significant.ConclusionsDifferent patterns of sequential early healing were found at implants installed in healed alveolar bone or in alveolar sockets immediately after tooth extractions. However, three months after implant installation, no statistically significant differences were found for the hard- and soft-tissue dimensions.

Buccal Bone Plate Remodeling After Immediate Implant Placement With and Without Synthetic Bone Grafting and Flapless Surgery: Radiographic Study in Dogs

Recent studies in animals have shown pronounced resorption of the buccal bone plate after immediate implantation. The use of flapless surgical procedures prior to the installation of immediate implants, as well as the use of synthetic bone graft in the gaps represent viable alternatives to minimize buccal bone resorption and to favor osseointegration. The aim of this study was to evaluate the healing of the buccal bone plate following immediate implantation using the flapless approach, and to compare this process with sites in which a synthetic bone graft was or was not inserted into the gap between the implant and the buccal bone plate. Lower bicuspids from 8 dogs were bilaterally extracted without the use of flaps, and 4 implants were installed in the alveoli in each side of the mandible and were positioned 2.0 mm from the buccal bone plate (gap). Four groups were devised: 2.0-mm subcrestal implants (3.3 x 8 mm) using bone grafts (SCTG), 2.0-mm subcrestal implants without bone grafts (SCCG), equicrestal implants (3.3 x 10 mm) with bone grafts (EGG), and equicrestal implants without bone grafts (ECCG). One week following the surgical procedures, metallic prostheses were installed, and within 12 weeks the dogs were sacrificed. The blocks containing the individual implants were turned sideways, and radiographic imaging was obtained to analyze the remodeling of the buccal bone plate. In the analysis of the resulting distance between the implant shoulder and the bone crest, statistically significant differences were found in the SCTG when compared to the ECTG (P = .02) and ECCG (P = .03). For mean value comparison of the resulting linear distance between the implant surface and the buccal plate, no statistically significant difference was found among all groups (P > .05). The same result was observed in the parameter for presence or absence of tissue formation between the implant surface and buccal plate. Equicrestally placed implants, in this methodology, presented little or no loss of the buccal bone. The subcrestally positioned implants presented loss of buccal bone, even though synthetic bone graft was used. The buccal bone, however, was always coronal to the implant shoulder.

Dental and skeletal pathology in lungfish jaws and tooth plates

Many lungfish of the tooth plated lineage, both fossil and living, are affected by dental and skeletal pathologies including dental caries, abscesses and cysts within the bone or tooth plate, osteopenia, bone hypertrophy, and malocclusion. These conditions, while influenced in part by structural relationships of soft and hard tissues in the tooth plates, jaw bones and surrounding oral tissues, can also be used as indicators of the kind of environment inhabited by the fish. The disease processes have specific structural consequences, related either to the pathology or to attempts to heal the damage, and usually alter the form and function of the tooth plate or bone. Consequently they can be distinguished from postmortem diagenetic or taphonomic effects, which alter the structure in less specific ways and show no sign of healing. Dental caries, the most common pathological condition in dipnoan dentitions, is recognisable in lungfish from the Devonian of Western Australia, the Tertiary of South Australia and the Northern Territory and from living lungfish in south east Queensland. Other pathologies have a more sporadic occurrence.

Early diagenesis of bone and tooth apatite in fluvial and marine settings: Constraints from combined oxygen isotope, nitrogen and REE analysis

Fossil bones and teeth of Late Pleistocene terrestrial mammals from Rhine River gravels (RS) and the North Sea (NS), that have been exposed to chemically and isotopically distinct diagenetic fluids (fresh water versus seawater), were investigated to study the effects of early diagenesis on biogenic apatite. Changes in phosphate oxygen isotopic composition (delta O-18(PO4)), nitrogen content (wt.% N) and rare earth element (REE) concentrations were measured along profiles within bones that have not been completely fossilized, and in skeletal tissues (bone, dentine, enamel) with different susceptibilities to diagenetic alteration. Early diagenetic changes of elemental and isotopic compositions of apatite in fossil bone are related to the loss of the stabilizing collagen matrix. The REE concentration is negatively correlated with the nitrogen content, and therefore the amount of collagen provides a sensitive proxy for early diagenetic alteration. REE patterns of RS and NS bones indicate initial fossilization in a fresh water fluid with similar REE compositions. Bones from both settings have nearly collagen-free, REE-, U-, F- and Sr-enriched altered outer rims, while the collagen-bearing bone compacta in the central part often display early diagenetic pyrite void-fillings. However, NS bones exposed to Holocene seawater have outer rim delta O-18(PO4) values that are 1.1 to 2.6 parts per thousand higher compared to the central part of the same bones (delta O-18(PO4) = 18.2 +/- 0.9 parts per thousand, n = 19). Surprisingly, even the collagen-rich bone compacta with low REE contents and apatite crystallinity seems altered, as NS tooth enamel (delta O-18(PO4) =15.0 +/- 0.3 parts per thousand, n=4) has about 3%. lower delta O-18(PO4) values, values that are also similar to those of enamel from RS teeth. Therefore, REE concentration, N content and apatite crystallinity are in this case only poor proxies for the alteration of delta O-18(PO4) values. Seawater exposure of a few years up to 8 kyr can change the delta O-18(PO4) values of the bone apatite by > 3 parts per thousand. Therefore, bones fossilized in marine settings must be treated with caution for palaeoclimatic reconstructions. However, enamel seems to preserve pristine delta O-18(PO4) values on this time scale. Using species-specific calibrations for modern mammals, a mean delta O-18(H2O) value can be reconstructed for Late Pleistocene mammalian drinking water of around -9.2 +/- 0.5 parts per thousand, which is similar to that of Late Pleistocene groundwater from central Europe. (c) 2008 Elsevier B.V. All rights reserved.

Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs

Objectives To evaluate the influence of implant size and configuration on osseointegration in implants immediately placed into extraction sockets. Material and methods Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, cylindrical transmucosal implants (3.3 mm diameter) were installed, while in the test sites, larger and conical (root formed, 5 mm diameter) implants were installed. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results With one exception, all implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test implants. This resorption was more pronounced at the buccal aspects and significantly greater at the test (2.7 +/- 0.4 mm) than at the control implants (1.5 +/- 0.6 mm). However, the control implants were associated with residual defects that were deeper at the lingual than at the buccal aspects, while these defects were virtually absent at test implants. Conclusions The installment of root formed wide implants immediately into extraction sockets will not prevent the resorption of the alveolar crest. In contrast, this resorption is more marked both at the buccal and lingual aspects of root formed wide than at standard cylindrical implants. To cite this article:Caneva M, Salata LA, de Souza SS, Bressan E, Botticelli D, Lang NP. Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs.Clin. Oral Impl. Res. 21, 2010; 885-895.doi: 10.1111/j.1600-0501.2010.01931.x.

A light and scanning electron microscopy study of bone healing following inferior alveolar nerve lateralization: An experimental study in rabbits

Purpose: The purpose of this study was to evaluate the bone healing kinetics around commercially pure titanium implants following inferior alveolar nerve (IAN) lateralization in a rabbit model. Materials and Methods: Inferior alveolar nerve lateralization was performed in 16 adult female rabbits (Oryctolagus cuniculus). During the nerve lateralization procedure, 1 implant was placed through the mandibular canal, and the IAN was replaced in direct contact with the implant. During the 8-week healing period, various bone labels were administered for fluorescent microscopy analysis. The animals were euthanized by anesthesia overdose, and the mandibular blocks were exposed by sharp dissection. Nondecalcified samples were prepared for optical light and scanning electron microscopy (SEM) evaluation. Results: SEM evaluation showed bone modeling/remodeling between the IAN and implant surface. Fluorochrome area fraction labeling at different times during the healing period showed that bone apposition mainly occurred during the first 2 weeks after implantation. Conclusions: The results obtained showed that bone healing/deposition occurred between the alveolar nerves in contact with a commercially pure titanium implant. No interaction between the nerve and the implant was detected after the 8-week healing period. Appositional bone healing occurred around the nerve bundle structure, restoring the mandibular canal integrity and morphology.

Influence of the ratio of particulate autogenous bone graft/platelet-rich plasma on bone healing in critical-size defects: a histologic and histometric study in rat calvaria

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Bone healing in critical-size defects treated with platelet-rich plasma activated by two different methods. A histologic and histometric study in rat calvaria

The purpose of this study was to analyze histologically the influence of platelet-rich plasma (PRP) coagulated with two different activators on bone healing in surgically created critical-size defects (CSD) in rat calvaria.Forty-eight rats were divided into three groups: C, PRP-C and PRP-T. An 8 mm diameter CSD was created in the calvarium of each animal. In group C, the defect was filled by a blood clot only. In groups PRP-C and PRP-T, the defect was filled with PRP activated with either calcium chloride or thromboplastin solution, respectively. Each group was divided into two subgroups (n = 8 per subgroup) and killed at either 4 or 12 weeks postoperatively. Histologic and histometric analyses were performed. The amount of new bone formed was calculated as a percentage of the total area of the original defect. Percentage data were transformed into arccosine for statistical analysis (analysis of variance, Tukey's post hoc test, p < 0.05).No defect completely regenerated with bone. Group PRP-C had a statistically greater amount of bone formation than groups C and PRP-T at both time points of analysis. No statistically significant differences were observed between groups C and PRP-T.It can be concluded that the type of activator used to initiate PRP clot formation influences its biological effect on bone healing in CSD in rat calvaria.

Influence of Bioactive Glass and/or Acellular Dermal Matrix on Bone Healing of Surgically Created Defects in Rat Tibiae: A Histological and Histometric Study

The purpose of this study was to histologically analyze the influence of bioactive glass and/or acellular dermal matrix on bone healing in surgically created defects in the tibiae of 64 rats (Rattus norvegicus, albinus, Wistar). Materials and Methods: A 4-mm X 3-mm unicortical defect was created on the anterolateral surface of the tibia. Animals were divided into 4 groups: C, control; BG, the defect was filled with bioactive glass; ADM, the defect was covered with acellular dermal matrix; and BG/ADM, the defect was filled with bioactive glass and covered with acellular dermal matrix. Animals were sacrificed at 10 or 30 days postoperatively, and the specimens were removed for histologic processing. The formation of new bone in the cortical area of the defect was evaluated histomorphometrically. Results: At 10 and 30 days postoperatively, groups C (39.65% +/- 5.63% / 63.34% +/- 5.22%) and ADM (38.12% +/- 5.53 / 58.96% +/- 7.05%) presented a larger amount of bone formation compared to the other groups (P<.05). In the same periods, groups BG (13.10% +/- 6.29% / 29.5% +/- 5.56%) and BG/ADM (20.72% +/- 8.31% / 24.19% +/- 6.69%) exhibited statistically similar new bone formation. However, unlike the other groups, group BG/ADM did not present a significant increase in bone formation between the 2 time points. Conclusion: Based on these results, it can be concluded that all of the materials used in this study delayed bone healing in non-critical-size defects. INT J ORAL MAXILLOFAC IMPLANTS 2008;23:811-817

Anterior Tooth Rehabilitation With Frozen Homogenous Bone Graft and Immediately Loaded Titanium Implant Using Computer-Guided Surgery

Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

Bone healing in critical-size defects treated with new bioactive glass/calcium sulfate: A histologic and histometric study in rat calvaria

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Bone healing in critical-size defects treated with platelet-rich plasma: a histologic and histometric study in the calvaria of diabetic rat

Objective. The objective of this study was to histologically analyze the influence of the platelet-rich plasma (PRP) on bone healing in surgically created critical-size defects (CSD) in the calvaria of diabetic rats.Study design. A total of 20 diabetic rats were divided into 2 groups: C (control) and PRP. A 5-mm diameter CSD was created in the calvarium of each animal. In Group C, the defect was filled by blood clot only. In Group PRP, 0.35 mL of PRP was placed in the defects. All animals were humanely killed 30 days postoperatively. Histometric and histologic analyses were performed. Data were statistically analyzed (t test, P < .05).Results. No defect completely regenerated with bone. Group PRP had a statistically greater amount of bone formation than Group C (37.22% +/- 6.00% and 21.68% +/- 11.35%, respectively).Conclusion. PRP placed in the defects significantly enhanced bone healing in CSD in the calvaria of diabetic rats both qualitatively and quantitatively. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 72-78)

Bone healing in critical-size defects treated with either bone graft, membrane, or a combination of both materials: a histological and histometric study in rat tibiae

Objectives: The aim of the present investigation was to histologically analyze the effect of using lyophilized bovine bone (GenOx (R) organic matrix) with (or without) guided tissue regeneration (using a decalcified cortical osseous membrane [GenDerm (R)]) on bone healing in surgically created critical-size defects created in rat tibia.Material and methods: Surgical critical-size bone defects were created in 64 animals that were randomly divided into four groups: group I (control); group II (defect filled with GenOx (R)); group III (defect covered by GenDerm (R)); group IV (defect filled with GenOx (R) and covered by GenDerm (R)). Animals were killed at 30 or 90 days post-surgery. The specimens were embedded in paraffin, serially cut, and stained with hematoxylin and eosin for analysis under light microscopy. The formation of new bone in the cortical area of the defect was histomorphometrically evaluated.Results: All experimental groups demonstrated superior bone healing compared with the control group. However, group IV samples showed evidence of more advanced healing at both 30 and 90 days post-surgery as compared with the other experimental groups.Conclusions: The bovine organic bone graft GenOx (R) associated with GenDerm (R) this produced the best treatment results in the case of critical-size defects in rat tibia.

PDGF-B gene therapy accelerates bone engineering and oral implant osseointegration

Platelet-derived growth factor-BB (PDGF-BB) stimulates repair of healing-impaired chronic wounds such as diabetic ulcers and periodontal lesions. However, limitations in predictability of tissue regeneration occur due, in part, to transient growth factor bioavailability in vivo. Here, we report that gene delivery of PDGF-B stimulates repair of oral implant extraction socket defects. Alveolar ridge defects were created in rats and were treated at the time of titanium implant installation with a collagen matrix containing an adenoviral (Ad) vector encoding PDGF-B (5.5 x 10(8) or 5.5 x 10(9) pfu ml (1)), Ad encoding luciferase (Ad-Luc; 5.5 x 10(9) pfu ml (1); control) or recombinant human PDGF-BB protein (rhPDGF-BB, 0.3 mg ml (1)). Bone repair and osseointegration were measured through backscattered scanning electron microscopy, histomorphometry, microcomputed tomography and biomechanical assessments. Furthermore, a panel of local and systemic safety assessments was performed. Results indicated that bone repair was accelerated by Ad-PDGF-B and rhPDGF-BB delivery compared with Ad-Luc, with the high dose of Ad-PDGF-B more effective than the low dose. No significant dissemination of the vector construct or alteration of systemic parameters was noted. In summary, gene delivery of Ad-PDGF-B shows regenerative and safety capabilities for bone tissue engineering and osseointegration in alveolar bone defects comparable with rhPDGF-BB protein delivery in vivo. Gene Therapy (2010) 17, 95-104; doi: 10.1038/gt.2009.117; published online 10 September 2009