Impact of diabetes mellitus and metabolic control on bone healing around osseointegrated implants: Removal torque and histomorphometric analysis in rats

Objectives: To evaluate bone healing around dental implants with established osseointegration in experimental diabetes mellitus (DM) and insulin therapy by histomorphometric and removal torque analysis in a rat model. Materials and methods: A total of 80 male Wistar rats received a titanium implant in the tibiae proximal methaphysis. After a healing period of 60 days, the rats were divided into four groups of 20 animals each: a 2-month control group, sacrificed at time (group A), a diabetic group (group D), an insulin group (group I), and a 4-month control group (group C), subdivided half for removal torque and half for histomorphometric analysis. In the D and I groups the DM was induced by a single injection of 40 mg/kg body weight streptozotocin (STZ). Two days after DM induction, group I received subcutaneous doses of insulin twice a day, during 2 months. Groups C and D received only saline. Two months after induction of DM, the animals of groups D, C and I were sacrificed. The plasmatic levels of glucose (GPL) were monitored throughout the experiment. Evaluation of the percentages of bone-to-implant contact and bone area within the limits of the implant threads was done by histomorphometric and mechanical torque analysis. Data were analyzed by anova at significant level of 5%. Results: The GPL were within normal range for groups A, C and I and higher for group D. The means and standard deviations (SD) for histomorphometric bone area showed significant difference between group D (69.34 ± 5.00%) and groups C (78.20 ± 4.88%) and I (79.63 ± 4.97%). Related to bone-to-implant contact there were no significant difference between the groups D (60.81 + 6.83%), C (63.37 + 5.88%) and I (66.97 + 4.13%). The means and SD for removal torque showed that group D (12.91 ± 2.51 Ncm) was statistically lower than group I (17.10 ± 3.06 Ncm) and C (16.95 ± 5.39 Ncm). Conclusions: Diabetes mellitus impaired the bone healing around dental implants with established osseointegration because the results presented a lower percentage of bone area in group D in relation to groups C and I resulting in a lowest torque values for implant removal. Moreover, insulin therapy prevents the occurrence of bone abnormalities found in diabetic animals and osseointegration was not compromised. © 2012 John Wiley & Sons A/S.

Dynamics of bone healing after osteotomy with piezosurgery or conventional drilling - histomorphometrical, immunohistochemical, and molecular analysis

Background: Piezosurgery is an osteotomy system used in medical and dental surgery. Many studies have proven clinical advantages of piezosurgery in terms of quality of cut, maneuverability, ease of use, and safety. However, few investigations have tested its superiority over the traditional osteotomy systems in terms of dynamics of bone healing. Therefore, the aim of this study was to evaluate the dynamics of bone healing after osteotomies with piezosurgery and to compare them with those associated to traditional bone drilling.Methods: One hundred and ten rats were divided into two groups with 55 animals each. The animals were anesthetized and the tibiae were surgically exposed to create defects 2 mm in diameter by using piezosurgery (Piezo group) and conventional drilling (Drill group). Animals were sacrificed at 3, 7, 14, 30 and 60 days post-surgery. Bone samples were collected and processed for histological, histomorphometrical, immunohistochemical, and molecular analysis. The histological analysis was performed at all time points (n = 8) whereas the histomorphometrical analysis was performed at 7, 14, 30 and 60 days post-surgery (n = 8). The immunolabeling was performed to detect Vascular Endothelial Growth Factor (VEGF), Caspase-3 (CAS-3), Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor kappa-B Ligand (RANKL), and Osteocalcin (OC) at 3, 7, and 14 days (n = 3). For the molecular analysis, animals were sacrificed at 3, 7 and 14 days, total RNA was collected, and quantification of the expression of 21 genes related to BMP signaling, Wnt signaling, inflammation, osteogenenic and apoptotic pathways was performed by qRT-PCR (n = 5).Results: Histologically and histomorphometrically, bone healing was similar in both groups with the exception of a slightly higher amount of newly formed bone observed at 30 days after piezosurgery (p < 0.05). Immunohistochemical and qRT-PCR analyses didn't detect significant differences in expression of all the proteins and most of the genes tested.Conclusions: Based on the results of our study we conclude that in a rat tibial bone defect model the bone healing dynamics after piezosurgery are comparable to those observed with conventional drilling. © 2013 Esteves et al.; licensee BioMed Central Ltd.

Sequential healing of open extraction sockets. An experimental study in monkeys

AimTo describe the sequential healing of open extraction sockets at which no attempts to obtain a primary closure of the coronal access to the alveolus have been made.Material and methodsThe third mandibular premolar was extracted bilaterally in 12 monkeys, and no sutures were applied to close the wound. The healing after 4, 10, 20, 30, 90 and 180days was morphometrically studied.ResultsAfter 4days of healing, a blood clot mainly occupied the extraction sockets, with the presence of an inflammatory cells' infiltrate. A void was confined in the central zones of the coronal and middle regions, in continuity with the entrance of the alveoli. At 10days, the alveolus was occupied by a provisional matrix, with new bone formation lining the socket bony walls. At 20days, the amount of woven bone was sensibly increasing. At 30days, the alveolar socket was mainly occupied by mineralized immature bone at different stages of healing. At 90 and 180days, the amount of mineralized bone decreased and substituted by trabecular bone and bone marrow. Bundle bone decreased from 95.5% at 4days to 7.6% at 180days, of the whole length of the inner alveolar surface.ConclusionsModeling processes start from the lateral and apical walls of the alveolus, leading to the closure of the socket with newly formed bone within a month from extraction. Remodeling processes will follow the previous stages, resulting in trabecular and bone marrow formation and in a corticalization of the socket access.

Obtention and characterization of collagen and chitosan based cements for bone regerneration. Part 1: extraction and characterization of collagen

Several cements are used as biomaterials. Biopolymers such as chitosan and collagen exhibit excellent biocompatibility and can be used in the remodeling of bone tissue. The cement must have high mechanical strength and compatibility with original tissue. In this context, the objective of this study was to extract, characterize and cross-link collagen from bovine tendon, forlater associate it with chitosan and calcium phosphate to obtain cements for bone regeneration. Glutaraldehyde was used as cross-linker in 0.1, 0.5, 1.0 and 10% concentration. Infrared analysis confirmed the presence of functional groups characteristic of collagen, whereas the capacity of water absorption decreased with the increasing of cross-linking degree. Denaturation temperatures of collagen samples were obtained by Differential Scanning Calorimetry and Scanning Electron Microscopy showed the fiber structure characteristics of collagen, which were more organized for high degree of cross-linking samples.

Effect of platele-rich plasma on healing of class III furcation defects treated with autogenous bone grafting and guided tissue regeneration: a histomorphometric sutdy in dogs

Objective: The purpose of this study was to evaluate the effects of the platelet-rich plasma (PRP) when used in combination with autogenous bone graft and bioabsorbable membrane (Resolut® ) in the treatment of Class  III furcation defects in dogs. Material and method: Class III furcation defects (5 mm in height and in depth) were surgically created in the mandibular third premolars of five mongrel dogs. After nine weeks, the lesions were treated with scaling and root planning and each defect received one of the following treatments: autogenous bone graft + membrane (group C) or PRP + autogenous bone graft + membrane (group T). After a healing period of 90 days, the animals were sacrificed. Routine histological processing and staining with hematoxilyn and eosin and Masson trichrome were performed and a histomorphometric analysis determined the effect of the treatments on periodontal tissue regereneration. Data were analyzed by Hotelling’s T-squared (p < 0.05). Result: No statistically significant difference between C and T groups was observed by the histomorphometric analysis of the furcation area. Both treatment groups demonstrated similar regenerative results with the furcation defects partially filled and periodontal regeneration limited to the experimental notches of the lesions. (p > 0.05). Conclusion: According to the present results, PRP does not enhance the periodontal regeneration in class III furcation defects treated with autogenous bone graft and bioabsorbable membrane.

Deproteinized Bovine Bone Mineral or Autologous Bone at Dehiscence Type Defects at Implants Installed Immediately into Extraction Sockets: An Experimental Study in Dogs

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

Lack of bone healing: an unusual complication following surgically assisted rapid palatal expansion

Bone defects at interdental osteotomy sites are as a complication of surgi-cally assisted rapid palatal expansion (SARPE). The replacement of osseoustissue by fibrous connective tissue impairs the spontaneous closure of adiastema between central incisors, and orthodontic tooth movementthrough the defect area may lead to root resorption. Treatment of such asituation requires an orthodontic-surgical approach. In this report, wedescribe the lack of bone healing at the midline osteotomy site after SARPE,which was treated by autogenous bone grafting as assessed by cone beamcomputed tomography. In addition, we discuss factors related to the aetiol-ogy and treatment of a bone defect after SARPE.

Effect of platelet-rich plasma on healing of class III furcation defects treated with autogenous bone grafting and guided tissue regeneration: a histomorphometric study in dogs

The purpose of this study was to evaluate the effects of the platelet-rich plasma (PRP) when used in combination with autogenous bone graft and bioabsorbable membrane (Resolut® ) in the treatment of Class  III furcation defects in dogs. Material and method: Class III furcation defects (5 mm in height and in depth) were surgically created in the mandibular third premolars of five mongrel dogs. After nine weeks, the lesions were treated with scaling and root planning and each defect received one of the following treatments: autogenous bone graft + membrane (group C) or PRP + autogenous bone graft + membrane (group T). After a healing period of 90 days, the animals were sacrificed. Routine histological processing and staining with hematoxilyn and eosin and Masson trichrome were performed and a histomorphometric analysis determined the effect of the treatments on periodontal tissue regereneration. Data were analyzed by Hotelling’s T-squared (p < 0.05). Result: No statistically significant difference between C and T groups was observed by the histomorphometric analysis of the furcation area. Both treatment groups demonstrated similar regenerative results with the furcation defects partially filled and periodontal regeneration limited to the experimental notches of the lesions. (p > 0.05). Conclusion: According to the present results, PRP does not enhance the periodontal regeneration in class III furcation defects treated with autogenous bone graft and bioabsorbable membrane.

New LLLT protocol to speed up the bone healing process-histometric and immunohistochemical analysis in rat calvarial bone defect

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effects of oestrogen deficiency and 17 beta-estradiol therapy on bone healing in calvarial critical size defects treated with bovine bone graft

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

Bone morphogenetic proteins: promising molecules for bone healing, bioengineering, and regenerative medicine

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

Bone Ceramic® at implants installed immediately into extraction sockets in the molar region: an experimental study in dogs

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

Retrospective Clinical Study of 988 Dual Acid-Etched Implants Placed in Grafted and Native Bone for Single-Tooth Replacement

Purpose: To evaluate the influence of sex, implant characteristics, and bone grafting on the survival rate of dual acid-etched (DAE) implants. Materials and Methods: Patients treated with internal-hex DAE implants for single-tooth replacement in a military dental clinic between January 2005 and December 2010 were included in this study. Clinical data related to implant characteristics, implant location, presence of grafted bone, and implant failures were collected. The primary outcome was implant loss. The survival rate was analyzed using the Kaplan-Meier method. Cox regression modeling was used to determine which factors would predict implant failure. Results: DAE implants were evaluated in a total of 988 patients (80.3% men). Twenty-four (2.4%) implants failed, most were cylindric (54.2%) with regular platforms (70.8%) and were 10 mm long (58.3%). The failure rate was 2.4% for the anterior maxilla, 3.3% for the posterior maxilla, 1.6% for the anterior mandible, and 2.0% for posterior mandible. The cumulative survival rate was 97.6%. The failure rate was 8.8% in implants placed after sinus augmentation, 7.3% in bone block-grafted areas, and 1.6% in native bone. Based on multivariable analysis (Cox regression), sinus augmentation and bone block grafting had a statistically significant effect on implant failure; the hazard ratios were 5.5 and 4.6, respectively. Conclusion: The results revealed that DAE implants had high survival rates, and no influence of sex, location, shape, diameter, or length on failure rates could be observed. However, a significant association was observed between failure and presence of bone graft in the implant area. Int J Oral Maxillofac Implants 2012;27:1243-1248

A Comparative Analysis between Ultrasonometry and Computer-Aided Tomography to Evaluate Bone Healing

An ultrasonometric and computed-tomographic study of bone healing was undertaken using a model of a transverse mid-shaft osteotomy of sheep tibiae fixed with a semi-flexible external fixator. Fourteen sheep were operated and divided into two groups of seven according to osteotomy type, either regular or by segmental resection. The animals were killed on the 90th postoperative day and the tibiae resected for the in vitro direct contact transverse and axial measurement of ultrasound propagation velocity (UV) followed by quantitative computer-aided tomography (callus density and volume) through the osteotomy site. The intact left tibiae were used for control, being examined in a symmetrical diaphyseal segment. Regular osteotomies healed with a smaller and more mature callus than resection osteotomies. Axial UV was consistently and significantly higher (p?=?0.01) than transverse UV and both transverse and axial UV were significantly higher for the regular than for the segmental resection osteotomy. Transverse UV did not differ significantly between the intact and operated tibiae (p?=?0.20 for regular osteotomy; p?=?0.02 for resection osteotomy), but axial UV was significantly higher for the intact tibiae. Tomographic callus density was significantly higher for the regular than for the resection osteotomy and higher than both for the intact tibiae, presenting a strong positive correlation with UV. Callus volume presented an opposite behavior, with a negative correlation with UV. We conclude that UV is at least as precise as quantitative tomography for providing information about the healing state of both regular and resection osteotomy. (C) 2011 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:10761082, 2012

Long-term stability of contour augmentation with early implant placement following single tooth extraction in the esthetic zone: a prospective, cross-sectional study in 41 patients with a 5- to 9-year follow-up

BACKGROUND Early implant placement with simultaneous contour augmentation is documented with short- and medium-term studies. The long-term stability of contour augmentation is uncertain. METHODS In this prospective, cross-sectional study, 41 patients with an implant-borne single crown were examined twice, in 2006 and 2010. Clinical, radiologic, and esthetic parameters were assessed at both examinations. In addition, a cone beam computed tomographic (CBCT) image was obtained during the second examination to assess the dimensions of the facial bone wall. RESULTS All 41 implants demonstrated ankylotic stability without signs of peri-implant infection at both examinations. The clinical parameters remained stable over time. Satisfactory esthetic outcomes were noted, as assessed by the pink and white esthetic score (PES/WES) indices. Overall, the PES scores were slightly higher than the WES scores. None of the implants developed mucosal recession over time, as confirmed by values of the distance between implant shoulder and mucosal margin and cast measurements. The periapical radiographs yielded stable peri-implant bone levels, with a mean distance between implant shoulder and first visible bone-implant contact value of 2.18 mm. The CBCT analysis demonstrated a mean thickness of the facial bone wall ≈2.2 mm. In two implants (4.9%) no facial bone wall was detectable radiographically. CONCLUSIONS This prospective cross-sectional study demonstrates stable peri-implant hard and soft tissues for all 41 implants examined and satisfactory esthetic outcomes overall. The follow-up of 5 to 9 years confirmed again that the risk for mucosal recession is low with early implant placement. In addition, contour augmentation with guided bone regeneration was able to establish and maintain a facial bone wall in 95% of patients.