Early healing after elevation of the maxillary sinus floor applying a lateral access: a histological study in monkeys

AimTo describe the early healing within the void obtained after the elevation of the sinus mucosa and simultaneous implant installation without the use of any grafting material in monkeys.Material and methodsImplants were installed simultaneously with the elevation of the maxillary sinus using the lateral approach in eight monkeys without the use of grafting material. The healing after 4, 10, 20 and 30 days was evaluated in the area distal to the implants. Paraffin sections were prepared and analyzed using qualitative histological methods.ResultsThe healing process was initiated by the formation of a coagulum and followed by a provisional matrix and woven bone. Subsequently, a parallel-fiber bone replaced woven bone. The dimension of the elevated area shrank during the healing process. Sprouts of woven bone, present to a moderate extent after 4 days, were more numerous after 10 and 20 days. Newly formed bone originated from the sinus walls and septa, while there was no evidence of participation of the Schneiderian membrane in this process. After 30 days, the window access appeared to be closed by a layer of newly formed trabecular bone.ConclusionsThe coagulum that filled the void distal to the implant after simultaneous elevation of the sinus floor gave rise to newly formed bone. However, the void occupied by the coagulum shrank substantially. The Schneiderian membrane did not provide a basis for new bone formation in the early phase of healing.To cite this article:Scala A, Botticelli D, Rangel IG Jr, de Oliveira JA, Okamoto R, Lang NP. Early healing after elevation of the maxillary sinus floor applying a lateral access: a histological study in monkeys.Clin. Oral Impl. Res. 21, 2010; 1320-1326.doi: 10.1111/j.1600-0501.2009.01964.x.

Use of a titanium device in lateral sinus floor elevation: an experimental study in monkeys

Aim: To evaluate the effect of a space-maintaining device fixed to the lateral wall of the maxillary sinus after the elevation of the sinus mucosa on bone filling of the sinus cavity. Material and methods: Immediately after the elevation of the maxillary sinus Schneiderian membrane accomplished through lateral antrostomy in four monkeys, a titanium device was affixed to the lateral sinus wall protruding into the sinus cavity to maintain the mucosa elevated without the use of grafting material. The healing of the tissue around the implants was evaluated after 3 and 6 months. Ground sections were prepared and analyzed histologically. Results: The void under the elevated sinus membrane, originally filled with the blood clot, was reduced after 3 as well as after 6 months of healing of about 56% and 40.5%, respectively. In seven out of eight cases, the devices had perforated the sinus mucosa. The formation of mineralized bone and bone marrow amounted to about 42% and 69% after 3 and 6 months, respectively. The connective tissue represented about 53% and 23% of the newly formed tissue after 3 and 6 months, respectively. Conclusions: New bone formation was found below the devices. However, shrinkage of the newly formed tissue was observed both after 3 and 6 months of healing. Hence, the space-maintaining function of the devices used in the present study has to be questioned.

Effect of platelet-rich plasma on bone healing of autogenous bone grafts in critical-size defects

AimThis study histologically analysed the effect of autogenous platelet-rich plasma (PRP), prepared according to a new semiautomatic system, on healing of autogenous bone (AB) grafts placed in surgically created critical-size defects (CSD) in rabbit calvaria.Material and MethodsSixty rabbits were divided into three groups: C, AB and AB/PRP. A CSD was created in the calvarium of each animal. In Group C (control), the defect was filled by blood clot only. In Group AB (autogenous bone graft), the defect was filled with particulate autogenous bone. In Group AB/PRP (autogenous bone graft with platelet-rich plasma), it was filled with particulate autogenous bone combined with PRP. All groups were divided into subgroups (n=10) and euthanized at 4 or 12 weeks post-operatively. Histometric and histologic analyses were performed. Data were statistically analysed (anova, t-test, p < 0.05).ResultsGroup C presented significantly less bone formation compared with Group AB and AB/PRP in both periods of analysis (p < 0.001). At 4 weeks, Group AB/PRP showed a statistically greater amount of bone formation than Group AB (64.44 +/- 15.0% versus 46.88 +/- 14.15%; p=0.0181). At 12 weeks, no statistically significant differences were observed between Groups AB and AB/PRP (75.0 +/- 8.11% versus 77.90 +/- 8.13%; p > 0.05). It is notable that the amount of new bone formation in Group AB/PRP at 4 weeks was similar to that of Group AB at 12 weeks (p > 0.05).ConclusionWithin its limitation, the present study has indicated that (i) AB and AB/PRP significantly improved bone formation and (ii) a beneficial effect of PRP was limited to an initial healing period of 4 weeks.

Periapical tissue reactions to calcium hydroxide and MTA after external root resorption as a sequela of delayed tooth replantation

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

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

Repair process of surgical defects filled with autogenous bone grafts in tibiae of diabetic rats

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

Histometric Analysis of Bone Repair in Bone-Implant Interface Using a Polylactic/Polyglycolic Acid Copolymer Associated With Implants in Rabbit Tibia

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

Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs' teeth

Objective. The aim of this study was to evaluate the influence of apical foramen widening on the healing of chronic periapical lesions in dogs' teeth after root canal filling with Sealer 26 or Endomethasone.Study design. Forty root canals of dogs' teeth were used. After pulp extirpation, the canals were exposed to the oral cavity for 180 days for induction of periapical lesions, and then instrumented up to a size 55 K-file at the apical cemental barrier. In 20 roots, the cemental canal was penetrated and widened up to a size 25 K-file; in the other 20 roots, the cemental canal was preserved (no apical foramen widening). All canals received a calcium hydroxide intracanal dressing for 21 days and were filled with gutta-percha and 1 of the 2 sealers: group 1: Sealer 26/apical foramen widening; group 2: Sealer 26/no apical foramen widening; group 3: Endomethasone/apical foramen widening; group 4: Endomethasone/no apical foramen widening. The animals were killed after 180 days, and serial histologic sections from the roots were prepared for histomorphologic analysis. Scores were assigned according to preestablished histomorphologic parameters and analyzed statistically by Kruskal-Wallis and Mann-Whitney U tests.Results. Regarding new cementum formation, repair of cementum and bone resorption areas, presence of microorganisms, inflammatory cell infiltrate and periodontal ligament conditions, significantly better periapical healing was obtained when foramen widening was done and Sealer 26 was used.Conclusion. Apical foramen widening and calcium hydroxide-containing sealer were more favorable to the healing of chronic periapical lesions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:932-940)

Use of BioGran and Calcitite in bone defects: Histologic study in monkeys (Cebus apella)

The present study compares the biologic behavior of BioGran and Calcitite as fillers for surgical cavities in the mandibles of 4 adult monkeys (Cebus apella). The surgical cavities were prepared through both mandibular cortices, with a diameter of 5 mm, in the angle region. Two cavities were prepared on the right side and 1 on the left and divided into 3 groups: R-1 sites were filled with bioglass (BioGran), R, sites were not filled, and L sites were filled with hydroxyapatite (Calcitite). After 180 days the animals were sacrificed and the specimens were removed for histologic processing. Results showed no bone formation in group R, (empty cavities). BioGran-treated sites showed bone formation and total repair of the bone defect, and the bioglass particles were almost totally resorbed and substituted by bone. The few remaining crystals were in intimate contact with newly formed bone. Calcitite did not allow bone formation, and granules inside the cavities were involved by connective tissue. Based upon those results, the authors concluded that bioglass resulted in total obliteration of the surgical cavity with bone and hydroxyapatite was present in a large amount and involved by connective tissue, without bone formation.

Histological evaluation of chitosan-based biomaterials used for the correction of critical size defects in rat's calvaria

Chitosan, a biopolymer obtained from chitin, and its derivates, such as chitosan hydrochloride, has been reported as wound healing accelerators and as possible bone substitutes for tissue engineering, and therefore these Substances could be relevant in dentistry and periodontology. The purpose of this investigation was to make a histological evaluation of chitosan and chitosan hydrochloride biomaterials (gels) used in the correction of critical size bone defects made in rat's calvaria. Bone defects of 8 mm in diameter were surgically created in the calviria of 50 Holtzman (Rattus norvegicus) rats and filled with blood clot (control), low molecular weight chitosan, high molecular weight chitosan, low molecular weight chitosan hydrochloride, and high molecular weight chitosan hydrochloride, numbering 10 animals, divided into two experimental periods (15 and 60 days), for each biomaterial. The histological evaluation was made based on the morphology of the new-formed tissues in defect's region, and the results indicated that there was no statistical difference between the groups when the new bone formation in the entire defect's area were compared (p > 0.05) and, except in the control groups, assorted degrees of inflammation Could be Seen. In Conclusion, chitosan and chitosan hydrochloride biomaterials used in this study were not able to promote new bone formation in critical size defects made in rat's calvaria. (C) 2009 Wiley Periodicals, Inc. J Biomed Mater Res 93A: 107-114, 2016

Bioglass Associated With Leukocyte-Poor Platelet-Rich Plasma in the Rabbit Maxillary Sinus: Histomorphometric, Densitometric, and Fractal Analysis

The objective of the present study was to evaluate the outcomes of autogenous bone graft (AB) and bioglass (BG) associated or not with leukocyte-poor platelet-rich plasma (LP-PRP) in the rabbit maxillary sinus (MS) by histomorphometric and radiographic analysis. Twenty rabbits divided into 2 groups (G1, G2) were submitted to sinus lift surgery. In G1, 10 MS were grafted with AB and 10 MS were grafted with BG. In G2, 10 MS were grafted with AB + LP-PRP and 10 MS were grafted with BG + LP-PRP. After 90 days, the animals were killed and specimens were obtained, x-rayed, and submitted to histomorphometric, radiographic bone density (RD) and fractal dimension analysis. Radiographic bone density mean values (SD), expressed as aluminum equivalent in mm, of AB, BG, AB + LP-PRP, and BG + LP-PRP groups were 1.79 (0.31), 2.04 (0.39), 1.61 (0.28), and 1.53 (0.30), respectively. Significant differences (P < 0.05) were observed between BG and AB, and BG + PRP and BG. Fractal dimension mean values were 1.48 (0.04), 1.35 (0.08), 1.44 (0.04), and 1.44 (0.06), respectively. Significant differences were observed between BG and AB, and AB + LP-PRP and BG. Mean values for the percentage of bone inside MS were 63.30 (8.60), 52.65 (10.41), 55.25 (7.01), and 51.07 (10.25), respectively. No differences were found. No correlations were observed among percentage of bone, RD and FD. Histological analysis showed that MS treated with AB presented mature and new bone formation. The other groups showed minor bone formation. Within the limitations of this study, the results indicated that at a 90-day time end point, AB yielded better results than AB + LP-PRP, BG, and BG + LP-PRP and should be considered the primary material for MS augmentation.

Fixation of autogenous bone grafts with ethyl-cyanoacrylate glue or titanium screws in the calvaria of rabbits

This study compared the fixation of autogenous onlay bone grafts with cyanoacrylate glue (Super Bonder) and with titanium screws. Twenty rabbits underwent bilateral parietal ostectomies. Bone segments were fixed anteriorly to the resulting bone defect. In group I, the grafts were fixed with 4 min long, 1.5 mm diameter screws; in group II, adhesive was used. The animals were killed after 5, 15, 30, 60 and 120 days. Histomorphometric analysis was used to quantify the maintenance of the graft area. Discrete areas of inflammatory reaction were seen in both groups after 5 days and for group II after 15 days. After 30 days, new bone formation was seen at the interface of the grafts. After 120 days, the graft was incorporated into the host bed in group I and partially incorporated in group II. There was a significant statistical difference regarding the mean graft areas between 15 and 120 days (p < 0.001) and between fixation methods (p < 0.002). Fixation with adhesive promoted a significantly greater area of bone graft than screw fixation, independent of time period. The adhesive was biocompatible, presented similar stability to the screw and maintained the bone area, although there was a delay in graft incorporation.

Biological Response to Wollastonite Doped alpha-Tricalcium Phosphate Implants in Hard and Soft Tissues in Rats

The biological response following subcutaneous and bone implantation of beta-wollastonite(beta-W)-doped alpha-tricalcium phosphate bioceramics in rats was evaluated. Tested materials were: tricalciurn phosphate (TCP), consisting of a mixture of alpha- and beta-polymorphs; TCP doped with 5 wt. % of beta-W (TCP5W), composed of alpha-TCP as only crystalline phase; and TCP doped with 15 wt. % of beta-W (TCP15), containing crystalline alpha-TCP and beta-W. Cylinders of 2x1 mm were implanted in tibiae and backs of adult male Rattus norvegicus, Holtzman rats. After 7, 30 and 120 days, animals were sacrificed and the tissue blocks containing the implants were excised, fixed and processed for histological examination. TCP, TCP5W and TCP15W implants were biocompatible but neither bioactive nor biodegradable in rat subcutaneous tissue. They were not osteoinductive in connective tissue either. However, in rat bone tissue beta-W-doped alpha-TCP implants (TCP5W and TCP15W) were bioactive, biodegradable and osteoconductive. The rates of biodegradation and new bone formation observed for TCP5W and TCP15W implants in rat bone tissue were greater than for non-doped TCP.

Frontal sinus obliteration with heterogeneous corticocancellous bone versus spontaneous osteoneogenesis in monkeys (Cebus apella): Histologic analysis

Purpose: In this study, we evaluated the results of spontaneous osteoneogenesis of the frontal sinus with autogenous bone plug versus obliteration with heterogeneous (human) bone in monkeys (Cebus apella).Materials and Methods: Eight young adult male C apella monkeys underwent an ostectomy of the anterior wall of the frontal sinus, removal of the sinus mucosa, and inner decortication of the bony walls and then were divided into 2 groups of 4 each, as follows. Group I monkeys underwent obliteration of the nasofrontal ducts with a free segment of frontallis muscle and corticocancellous heterogeneous bone, followed by full obliteration of the sinus with corticocancellous heterogeneous bone (Dayton Regional Tissue Bank, Dayton, OH). Group II monkeys underwent obliteration of the nasofrontal ducts with a frontal muscle segment and tibial autogenous bone plug, without full obliteration of the frontal sinus. In all animals, the sinus anterior wall was repositioned and fixed with 1.0 plate and screws. The monkeys were killed after 180 days, and routine laboratory procedures were followed for hematoxylin-eosin staining and histologic evaluation of the specimens.Results: the 2 studied techniques were both effective in obliterating the frontal sinus with newly formed bone. The nasofrontal ducts were obliterated by new bone formation or fibrous tissue (1 animal only).Conclusions: Both methods used for frontal sinus obliteration were effective; the heterogeneous bone (human bone) was well tolerated and presented low antigenicity. The nasofrontal duct obliteration with autogenous muscle associated with autogenous tibial bone (group II) or with heterogeneous bone (group I) was effective, isolating the frontal sinus from the nasal cavity. The spontaneous obliteration resulted, in the period analyzed, in earlier bone maturation compared with the obliteration by heterogeneous bone. (C) 2003 American Association of Oral and Maxillofacial Surgeons.

Use of bovine bone graft and bone membrane in defects surgically created in the cranial vault of rabbits. Histologic comparative analysis

Purpose: This study was proposed to analyze histologically the process of repairing bone defects created surgically in the cranial vaults of rabbits. Materials and Methods: Thirty adult male rabbits (Oryctolagus cunilicus) received, under general anesthesia, bilateral parietal osteotomies by means of a 6mm-diameter trephine. The bony defects were divided into 4 groups. In group 1 the defect did not receive any treatment; in group 2 the defect was filled with lyophilized bovine bone (Biograft); in group 3 it was filled with bovine bone and covered with a bone matrix membrane (Bioplate); in group 4 it was covered with a bone matrix membrane. Animals were sacrificed in 3 equal groups at 15, 30, and 60 days. The specimens were subjected to routine laboratory procedures to evaluate the degree of bone repair. Results: After 60 days, new bone formation in group 2 was not satisfactory when compared to that of group 3. Large amounts of new bone formation in maturation were seen in group 3. In the defects covered with a membrane the results were similar to those of group 1 (ie, the cavity was filled with fibrous connective tissue). The implanted bone and membranes were totally resorbed. Discussion and Conclusions: the use of a membrane served as a barrier against the migration of cells from the adjacent tissue and the bone graft/membrane preserved the cavity space, resulting in an enhanced osteogenic effect.