Insufficient alveolar bone thickness increases the risk of periodontal dehiscence and fenestration,especially in orthodontic tooth movement.Abaloparatide(ABL),a synthetic analog of human PTHr P(1–34)and a clinical me...Insufficient alveolar bone thickness increases the risk of periodontal dehiscence and fenestration,especially in orthodontic tooth movement.Abaloparatide(ABL),a synthetic analog of human PTHr P(1–34)and a clinical medication for treating osteoporosis,has recently demonstrated its potential in enhancing craniofacial bone formation.Herein,we show that intraoral submucosal injection of ABL,when combined with mechanical force,promotes in situ alveolar bone thickening.The newly formed bone is primarily located outside the original compact bone,implying its origin from the periosteum.RNA sequencing of the alveolar bone tissue revealed that the focal adhesion(FA)pathway potentially mediates this bioprocess.Local injection of ABL alone enhances cell proliferation,collagen synthesis,and phosphorylation of focal adhesion kinase(FAK)in the alveolar periosteum;when ABL is combined with mechanical force,the FAK expression is upregulated,in line with the accomplishment of the ossification.In vitro,ABL enhances proliferation,migration,and FAK phosphorylation in periosteal stem cells.Furthermore,the pro-osteogenic effects of ABL on alveolar bone are entirely blocked when FAK activity is inhibited by a specific inhibitor.In summary,abaloparatide combined with mechanical force promotes alveolar bone formation via FAK-mediated periosteal osteogenesis.Thus,we have introduced a promising therapeutic approach for drug-induced in situ alveolar bone augmentation,which may prevent or repair the detrimental periodontal dehiscence,holding significant potential in dentistry.展开更多
The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure.In these patients the cup alone cannot cover the bone defect,an...The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure.In these patients the cup alone cannot cover the bone defect,and thus,an additional augment or cage is required.In this study,we designed three-dimensional(3D)printable bone augments as an alternative to surgeries using reinforcement cages.Thirty-five sharp-edged bone augments of various sizes were 3D printed.A biporous structure was designed to reduce the weight of the augment and to facilitate bone ingrowth.Two types of frames were used to prevent damage to the augment’s porous structure and maintain its stability during printing.Furthermore,two types of holes were provided for easy augment fixation at various angles.Fatigue tests were performed on a combination of worst-case sizes derived using finite element analysis.The test results confirmed the structural stability of the specimens at a load of 5340 N.Although the porosity of the specimens was measured to be 63.70%,it cannot be said that the porous nature was uniformly distributed because porosity tests were performed locally and randomly.In summary,3D-printable biporous bone augments capable of bonding from various angles and bidirectionally through angulation and bottom-plane screw holes are proposed.The mechanical results with bone augments indicate good structural safety in patients.However,further research is necessary to study the clinical applications of the proposed bone augment.展开更多
Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrop...Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrophic segments, extraoral donor sites may be mandatory. The aim of this report is to introduce the Fares Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Methods: This report includes patients with moderate to severe ridge atrophy in different regions of the both jaws who were treated over 6-years period (2009-215) with wedge Technique (WT). Patients received panorex immediately after the surgery, and they were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. At this stage specimens for histologic examination were also obtained. Results: 39 augmentation sites in 22 patients (15 women, 7 men: mean age 47 years) were followed 12 to 52 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, and the bone gain average was 3 - 6 mm vertically and 3 - 9 mm horizontally. In two patients the graft was partially exposed and treated with shaving and rounding the exposed wedges, but the augmentations were saved. In one case the majority of the bone graft was lost. At 38 sites the patients had successfully received 114 implants. Conclusions: wedge technique can augment multiple segments of atrophic ridges with small amount of autogenic graft. The bone volume that achieved was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.展开更多
Calcium phosphate bio-ceramics are osteo-conductive,but it remains a challenge to promote the induction of bone augmentation and capillary formation.The surface micro/nano-topography of materials can be recognized by ...Calcium phosphate bio-ceramics are osteo-conductive,but it remains a challenge to promote the induction of bone augmentation and capillary formation.The surface micro/nano-topography of materials can be recognized by cells and then the cell fate are mediated.Traditional regulation methods of carving surface structures on bio-ceramics employ mineral reagents and organic additives,which might introduce impurity phases and affect the biological results.In a previous study,a facile and novel method was utilized with ultrapure water as the unique reagent for hydrothermal treatment,and a uniform hydroxyapatite(HAp)surface layer was constructed on composite ceramics(β-TCP/CaSiO_(3))in situ.Further combined with 3D printing technology,biomimetic hierarchical structure scaffolds were fabricated with interconnected porous composite ceramic scaffolds as the architecture and micro/nano-rod hybrid HAp as the surface layer.The obtained HAp surface layer favoured cell adhesion,alleviated the cytotoxicity of precursor scaffolds,and upregulated the cellular differentiation of mBMSCs and gene expression of HUVECs in vitro.In vivo studies showed that capillary formation,bone augmentation and new bone matrix formation were upregulated after the HAp surface layer was obtained,and the results confirmed that the fabricated biomimetic hierarchical structure scaffold could be an effective candidate for bone regeneration.展开更多
Gene-activated matrix(GAM)has a potential usefulness in bone engineering as an alternate strategy for the lasting release of osteogenic proteins but efficient methods to generate non-viral GAM remain to be established...Gene-activated matrix(GAM)has a potential usefulness in bone engineering as an alternate strategy for the lasting release of osteogenic proteins but efficient methods to generate non-viral GAM remain to be established.In this study,we investigated whether an atelocollagen-based GAM containing naked-plasmid(p)DNAs encoding microRNA(miR)20a,which may promote osteogenesis in vivo via multiple pathways associated with the osteogenic differentiation of mesenchymal stem/progenitor cells(MSCs),facilitates rat cranial bone augmentation.First,we confirmed the osteoblastic differentiation functions of generated pDNA encoding miR20a(pmiR20a)in vitro,and its transfection regulated the expression of several of target genes,such as Bambi1 and PPARc,in rat bone marrow MSCs and induced the increased expression of BMP4.Then,when GAMs fabricated by mixing 100 ll of 2%bovine atelocollagen,20mg b-TCP granules and 0.5mg(3.3 lg/ll)AcGFP plasmid-vectors encoding miR20a were transplanted to rat cranial bone surface,the promoted vertical bone augmentation was clearly recognized up to 8 weeks after transplantation,as were upregulation of VEGFs and BMP4 expressions at the early stages of transplantation.Thus,GAM-based miR delivery may provide an alternative non-viral approach by improving transgene efficacy via a small sequence that can regulate the multiple pathways.展开更多
In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and t...In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.展开更多
BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm.However,managing cases becomes more challenging when a m...BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm.However,managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width.In this case,we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation.This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst.CASE SUMMARY A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth.Intraoral examination showed a horizontal deficiency of the alveolar ridge contour.The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography(CBCT).And a typical well-defined'dome-shaped'lesion in maxillary sinus was observed on CBCT imaging.The lateral bony window was prepared using a piezo-ultrasonic device,then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm.The space between the bony window and the alveolar ridge was filled with Bio-Oss,covered with a Bio-Gide collagen membrane,and subsequently sutured.Nine months later,the patient’s bone width increased from 4.8 to 10.5 mm,and the bone height increased from 3.6 to 15.6 mm.Subsequently,a Straumann^(■)4.1 mm×10 mm implant was placed.The final all-ceramic crown restoration was completed four months later,and both clinical and radiographic examinations showed that the implant was successful,and the patient was satisfied with the results.CONCLUSION The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.展开更多
Objective: To evaluate the feasibility and effectiveness of a new approach for craniofacial augmentation by a minimally-invasive subpericranial injection. Three commercially available semi-liquid bioceramic bone-graft...Objective: To evaluate the feasibility and effectiveness of a new approach for craniofacial augmentation by a minimally-invasive subpericranial injection. Three commercially available semi-liquid bioceramic bone-grafting materials were examined for this application in a rat model. Material and Methods: Twenty-four adult male rats were randomly assigned to undergo onlay calvarial grafting by subpericranial injection of three semi-liquid bone void fillers: Norian SRS(calcium phosphate), ChronOs InjectTM (porous beta-tricalcium phosphate), or BonePlastharvested after 24 hours to serve as controls. The rest were studied after 16 weeks. The volume fraction of the following parameters was morphometrically measured: new bone, blood vessels, residual bone filler and inflammation. Results: In all study groups (including controls), histological examination demonstrated that bone fillers were successfully delivered to the desired subpericranial space by the percutaneous injection method. New bone formation was evidenced adjacent to the cranial bone in all the study groups. The Norian filler material survived in a significantly higher volume fraction (38.4% ± 6.5%) than the ChronOs filler (18.8% ± 1.6%;P 0.0001) and the BonePlast filler (17.8% ± 1.5%;P 0.0001). New bone was formed in all groups, particularly adjacent to the interface of graft material with native bone but only to minimal extent. Conclusion: This new approach for craniomaxillofacial augmentation was successfully demonstrated in a rat model. The Norian filler (calcium phosphate) demonstrated superior space preservation abilities. This model may be further applied to test new injectable bone substitutes in the craniomaxillofacial area.展开更多
AIM: To investigate the effectiveness of mesenchymal stem cells(MSCs) in maxillary sinus augmentation(MSA), with various scaffold materials.METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinu...AIM: To investigate the effectiveness of mesenchymal stem cells(MSCs) in maxillary sinus augmentation(MSA), with various scaffold materials.METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinus graft, MSA, maxillary sinus lift, sinus floor elevation, MSC and cellbased, in different combinations. The searches included full text articles written in English, published over a 10-year period(2004-2014). Inclusion criteria were clinical/radiographic and histologic/ histomorphometric studies in humans and animals, on the use of MSCs in MSA. Meta-analysis was performed only for experimental studies(randomized controlled trials and controlled trials) involving MSA, with an outcome measurement of histologic evaluation with histomorphometric analysis reported. Mean and standard deviation values of newly formed bone from each study were used, and weighted mean values were assessed to account for the difference in the number of subjects among the different studies. To compare the results between the test and the control groups, the differences of regenerated bone in mean and 95% confidence intervals were calculated.RESULTS: Thirty-nine studies(18 animal studies and 21 human studies) published over a 10-year period(between 2004 and 2014) were considered to be eligible for inclusion in the present literature review. These studies demonstrated considerable variation with respect to study type, study design, follow-up, and results. Metaanalysis was performed on 9 studies(7 animal studies and 2 human studies). The weighted mean difference estimate from a random-effect model was 9.5%(95%CI: 3.6%-15.4%), suggesting a positive effect of stem cells on bone regeneration. Heterogeneity was measured by the I2 index. The formal test confirmed the presence of substantial heterogeneity(I2 = 83%, P < 0.0001). In attempt to explain the substantial heterogeneity observed, we considered a meta-regression model with publication year, support type(animal vs humans) andfollow-up length(8 or 12 wk) as covariates. After adding publication year, support type and follow-up length to the meta-regression model, heterogeneity was no longer significant(I2 = 33%, P = 0.25).CONCLUSION: Several studies have demonstrated the potential for cell-based approaches in MSA; further clinical trials are needed to confirm these results.展开更多
充足的骨组织是保证种植体长期稳定性的先决条件。Urban教授提出了基于引导骨再生(guided bone regeneration,GBR)原理的“香肠技术”。研究显示,该技术在牙槽骨水平向增量方面达(5.3±2.3)mm,垂直向增量为(4.2±1.9)mm,显著优...充足的骨组织是保证种植体长期稳定性的先决条件。Urban教授提出了基于引导骨再生(guided bone regeneration,GBR)原理的“香肠技术”。研究显示,该技术在牙槽骨水平向增量方面达(5.3±2.3)mm,垂直向增量为(4.2±1.9)mm,显著优于传统GBR方法。香肠技术利用生物膜的弹性与韧性,结合膜钉固定,将自体骨与骨移植材料稳定在植骨区域,有效防止移位并增强空间稳定性。骨替代材料和自体骨的使用兼顾了自体骨的成骨活性和骨替代材料的低吸收速率;在受区的皮质骨使用球钻进行滋养孔的制备,为间充质干细胞和骨祖细胞向骨再生区域迁移提供了通路,同时也可以加速创口愈合早期新生血管生成;充分减张缝合,以确保在缝合时不对愈合区域施加过大的压力。这有效提高了香肠技术的可预测性。尽管该技术疗效显著,但潜在的软硬组织并发症可能影响患者恢复及手术结果。因此,深入探讨其并发症及诱因,对于提升香肠技术的临床安全性和有效性具有重要意义。本文总结了香肠技术的应用原理、临床效果、屏障膜的应用、骨移植材料的选择及并发症防治,旨在为其在口腔种植领域的广泛应用提供参考。展开更多
基金supported by the National Natural Science Foundation of China(NSFC)(82371003)the Elite Research Grant of the International Orthodontics Foundation 2022。
文摘Insufficient alveolar bone thickness increases the risk of periodontal dehiscence and fenestration,especially in orthodontic tooth movement.Abaloparatide(ABL),a synthetic analog of human PTHr P(1–34)and a clinical medication for treating osteoporosis,has recently demonstrated its potential in enhancing craniofacial bone formation.Herein,we show that intraoral submucosal injection of ABL,when combined with mechanical force,promotes in situ alveolar bone thickening.The newly formed bone is primarily located outside the original compact bone,implying its origin from the periosteum.RNA sequencing of the alveolar bone tissue revealed that the focal adhesion(FA)pathway potentially mediates this bioprocess.Local injection of ABL alone enhances cell proliferation,collagen synthesis,and phosphorylation of focal adhesion kinase(FAK)in the alveolar periosteum;when ABL is combined with mechanical force,the FAK expression is upregulated,in line with the accomplishment of the ossification.In vitro,ABL enhances proliferation,migration,and FAK phosphorylation in periosteal stem cells.Furthermore,the pro-osteogenic effects of ABL on alveolar bone are entirely blocked when FAK activity is inhibited by a specific inhibitor.In summary,abaloparatide combined with mechanical force promotes alveolar bone formation via FAK-mediated periosteal osteogenesis.Thus,we have introduced a promising therapeutic approach for drug-induced in situ alveolar bone augmentation,which may prevent or repair the detrimental periodontal dehiscence,holding significant potential in dentistry.
基金supported by the Technology Development Program(P0011350)funded by the Ministry of SMEs and Startups(MSS,Korea)。
文摘The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure.In these patients the cup alone cannot cover the bone defect,and thus,an additional augment or cage is required.In this study,we designed three-dimensional(3D)printable bone augments as an alternative to surgeries using reinforcement cages.Thirty-five sharp-edged bone augments of various sizes were 3D printed.A biporous structure was designed to reduce the weight of the augment and to facilitate bone ingrowth.Two types of frames were used to prevent damage to the augment’s porous structure and maintain its stability during printing.Furthermore,two types of holes were provided for easy augment fixation at various angles.Fatigue tests were performed on a combination of worst-case sizes derived using finite element analysis.The test results confirmed the structural stability of the specimens at a load of 5340 N.Although the porosity of the specimens was measured to be 63.70%,it cannot be said that the porous nature was uniformly distributed because porosity tests were performed locally and randomly.In summary,3D-printable biporous bone augments capable of bonding from various angles and bidirectionally through angulation and bottom-plane screw holes are proposed.The mechanical results with bone augments indicate good structural safety in patients.However,further research is necessary to study the clinical applications of the proposed bone augment.
文摘Purpose: Autogenous bone was still considered as the gold standard in bone augmentations prior to implants insertion at the atrophic ridges. However if large bone grafts are needed to augment multiple edentulous atrophic segments, extraoral donor sites may be mandatory. The aim of this report is to introduce the Fares Wedge Technique, as a new bone augmentation method that can augment multiple edentulous ridges with intraoral cortical bone grafts. Methods: This report includes patients with moderate to severe ridge atrophy in different regions of the both jaws who were treated over 6-years period (2009-215) with wedge Technique (WT). Patients received panorex immediately after the surgery, and they were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the new bone volume and quality and to insert implants. At this stage specimens for histologic examination were also obtained. Results: 39 augmentation sites in 22 patients (15 women, 7 men: mean age 47 years) were followed 12 to 52 months. The healing process was uneventful, with minimal morbidity. The success rate was 95%, and the bone gain average was 3 - 6 mm vertically and 3 - 9 mm horizontally. In two patients the graft was partially exposed and treated with shaving and rounding the exposed wedges, but the augmentations were saved. In one case the majority of the bone graft was lost. At 38 sites the patients had successfully received 114 implants. Conclusions: wedge technique can augment multiple segments of atrophic ridges with small amount of autogenic graft. The bone volume that achieved was satisfying, especially that the majority of the augmented areas were at posterior mandibular defects.
基金financially supported by the National key research and development plan(Grant No.2017YFC1105000,Grant No.2017YFA0205600)Outstanding Scholar Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory(2018GZR110102001)+4 种基金the Science and Technology Program of Guangdong Province(Grant No.2019B010941002)the Science and Technology Program of Guangzhou(Grant No.201804020060,Grant No.202007020002)Natural Science Foundation of Guangdong Province(Grant No.2021A1515011741,2020A1515011354)the National Nature Science Foundation of China(Grants U1801252),National Natural Science Foundation of China(31700823)Guangzhou Science and Technology Planning Project(202102020005).
文摘Calcium phosphate bio-ceramics are osteo-conductive,but it remains a challenge to promote the induction of bone augmentation and capillary formation.The surface micro/nano-topography of materials can be recognized by cells and then the cell fate are mediated.Traditional regulation methods of carving surface structures on bio-ceramics employ mineral reagents and organic additives,which might introduce impurity phases and affect the biological results.In a previous study,a facile and novel method was utilized with ultrapure water as the unique reagent for hydrothermal treatment,and a uniform hydroxyapatite(HAp)surface layer was constructed on composite ceramics(β-TCP/CaSiO_(3))in situ.Further combined with 3D printing technology,biomimetic hierarchical structure scaffolds were fabricated with interconnected porous composite ceramic scaffolds as the architecture and micro/nano-rod hybrid HAp as the surface layer.The obtained HAp surface layer favoured cell adhesion,alleviated the cytotoxicity of precursor scaffolds,and upregulated the cellular differentiation of mBMSCs and gene expression of HUVECs in vitro.In vivo studies showed that capillary formation,bone augmentation and new bone matrix formation were upregulated after the HAp surface layer was obtained,and the results confirmed that the fabricated biomimetic hierarchical structure scaffold could be an effective candidate for bone regeneration.
基金This work was supported by Grants-in-Aid for Scientific Research(15H05044,17H01604 and 19K21349)from the Japan Society for the Promotion of Science.
文摘Gene-activated matrix(GAM)has a potential usefulness in bone engineering as an alternate strategy for the lasting release of osteogenic proteins but efficient methods to generate non-viral GAM remain to be established.In this study,we investigated whether an atelocollagen-based GAM containing naked-plasmid(p)DNAs encoding microRNA(miR)20a,which may promote osteogenesis in vivo via multiple pathways associated with the osteogenic differentiation of mesenchymal stem/progenitor cells(MSCs),facilitates rat cranial bone augmentation.First,we confirmed the osteoblastic differentiation functions of generated pDNA encoding miR20a(pmiR20a)in vitro,and its transfection regulated the expression of several of target genes,such as Bambi1 and PPARc,in rat bone marrow MSCs and induced the increased expression of BMP4.Then,when GAMs fabricated by mixing 100 ll of 2%bovine atelocollagen,20mg b-TCP granules and 0.5mg(3.3 lg/ll)AcGFP plasmid-vectors encoding miR20a were transplanted to rat cranial bone surface,the promoted vertical bone augmentation was clearly recognized up to 8 weeks after transplantation,as were upregulation of VEGFs and BMP4 expressions at the early stages of transplantation.Thus,GAM-based miR delivery may provide an alternative non-viral approach by improving transgene efficacy via a small sequence that can regulate the multiple pathways.
文摘In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.
文摘BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm.However,managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width.In this case,we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation.This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst.CASE SUMMARY A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth.Intraoral examination showed a horizontal deficiency of the alveolar ridge contour.The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography(CBCT).And a typical well-defined'dome-shaped'lesion in maxillary sinus was observed on CBCT imaging.The lateral bony window was prepared using a piezo-ultrasonic device,then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm.The space between the bony window and the alveolar ridge was filled with Bio-Oss,covered with a Bio-Gide collagen membrane,and subsequently sutured.Nine months later,the patient’s bone width increased from 4.8 to 10.5 mm,and the bone height increased from 3.6 to 15.6 mm.Subsequently,a Straumann^(■)4.1 mm×10 mm implant was placed.The final all-ceramic crown restoration was completed four months later,and both clinical and radiographic examinations showed that the implant was successful,and the patient was satisfied with the results.CONCLUSION The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.
文摘Objective: To evaluate the feasibility and effectiveness of a new approach for craniofacial augmentation by a minimally-invasive subpericranial injection. Three commercially available semi-liquid bioceramic bone-grafting materials were examined for this application in a rat model. Material and Methods: Twenty-four adult male rats were randomly assigned to undergo onlay calvarial grafting by subpericranial injection of three semi-liquid bone void fillers: Norian SRS(calcium phosphate), ChronOs InjectTM (porous beta-tricalcium phosphate), or BonePlastharvested after 24 hours to serve as controls. The rest were studied after 16 weeks. The volume fraction of the following parameters was morphometrically measured: new bone, blood vessels, residual bone filler and inflammation. Results: In all study groups (including controls), histological examination demonstrated that bone fillers were successfully delivered to the desired subpericranial space by the percutaneous injection method. New bone formation was evidenced adjacent to the cranial bone in all the study groups. The Norian filler material survived in a significantly higher volume fraction (38.4% ± 6.5%) than the ChronOs filler (18.8% ± 1.6%;P 0.0001) and the BonePlast filler (17.8% ± 1.5%;P 0.0001). New bone was formed in all groups, particularly adjacent to the interface of graft material with native bone but only to minimal extent. Conclusion: This new approach for craniomaxillofacial augmentation was successfully demonstrated in a rat model. The Norian filler (calcium phosphate) demonstrated superior space preservation abilities. This model may be further applied to test new injectable bone substitutes in the craniomaxillofacial area.
文摘AIM: To investigate the effectiveness of mesenchymal stem cells(MSCs) in maxillary sinus augmentation(MSA), with various scaffold materials.METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinus graft, MSA, maxillary sinus lift, sinus floor elevation, MSC and cellbased, in different combinations. The searches included full text articles written in English, published over a 10-year period(2004-2014). Inclusion criteria were clinical/radiographic and histologic/ histomorphometric studies in humans and animals, on the use of MSCs in MSA. Meta-analysis was performed only for experimental studies(randomized controlled trials and controlled trials) involving MSA, with an outcome measurement of histologic evaluation with histomorphometric analysis reported. Mean and standard deviation values of newly formed bone from each study were used, and weighted mean values were assessed to account for the difference in the number of subjects among the different studies. To compare the results between the test and the control groups, the differences of regenerated bone in mean and 95% confidence intervals were calculated.RESULTS: Thirty-nine studies(18 animal studies and 21 human studies) published over a 10-year period(between 2004 and 2014) were considered to be eligible for inclusion in the present literature review. These studies demonstrated considerable variation with respect to study type, study design, follow-up, and results. Metaanalysis was performed on 9 studies(7 animal studies and 2 human studies). The weighted mean difference estimate from a random-effect model was 9.5%(95%CI: 3.6%-15.4%), suggesting a positive effect of stem cells on bone regeneration. Heterogeneity was measured by the I2 index. The formal test confirmed the presence of substantial heterogeneity(I2 = 83%, P < 0.0001). In attempt to explain the substantial heterogeneity observed, we considered a meta-regression model with publication year, support type(animal vs humans) andfollow-up length(8 or 12 wk) as covariates. After adding publication year, support type and follow-up length to the meta-regression model, heterogeneity was no longer significant(I2 = 33%, P = 0.25).CONCLUSION: Several studies have demonstrated the potential for cell-based approaches in MSA; further clinical trials are needed to confirm these results.
文摘充足的骨组织是保证种植体长期稳定性的先决条件。Urban教授提出了基于引导骨再生(guided bone regeneration,GBR)原理的“香肠技术”。研究显示,该技术在牙槽骨水平向增量方面达(5.3±2.3)mm,垂直向增量为(4.2±1.9)mm,显著优于传统GBR方法。香肠技术利用生物膜的弹性与韧性,结合膜钉固定,将自体骨与骨移植材料稳定在植骨区域,有效防止移位并增强空间稳定性。骨替代材料和自体骨的使用兼顾了自体骨的成骨活性和骨替代材料的低吸收速率;在受区的皮质骨使用球钻进行滋养孔的制备,为间充质干细胞和骨祖细胞向骨再生区域迁移提供了通路,同时也可以加速创口愈合早期新生血管生成;充分减张缝合,以确保在缝合时不对愈合区域施加过大的压力。这有效提高了香肠技术的可预测性。尽管该技术疗效显著,但潜在的软硬组织并发症可能影响患者恢复及手术结果。因此,深入探讨其并发症及诱因,对于提升香肠技术的临床安全性和有效性具有重要意义。本文总结了香肠技术的应用原理、临床效果、屏障膜的应用、骨移植材料的选择及并发症防治,旨在为其在口腔种植领域的广泛应用提供参考。
