Bone block from lateral window-correcting vertical and horizontal bone deficiency in maxilla posterior site:A case report

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.

3D-printed bioactive ceramic scaffolds with biomimetic micro/nano-HAp surfaces mediated cell fate and promoted bone augmentation of the bone-implant interface in vivo

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.

Gene-activated matrix harboring a miR20a-expressing plasmid promotes rat cranial bone augmentation

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.

Design,fabrication,and structural safety validation of 3D-printable biporous bone augments

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.

Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease:A case report and review of literature

BACKGROUND In the clinical scenario,adult patients with periodontal diseases and dental malformation,characterized by dental crowding in lower anterior teeth with the thin biotype,often require orthodontic treatment.This case report aimed to evaluate the clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics(PAOO)combined with autologous platelet-rich fibrin(PRF)in an adult patient with class I malocclusion along with dental crowding,a thin periodontal biotype,and buccal plate deficiency.CASE SUMMARY A 32-year-old female complaining of dental crowding and gingival bleeding was referred to the orthodontic clinic.The patient underwent periodontal risk assessment prior to orthodontic treatment.She was diagnosed with a high risk of gingival recession due to dental crowding,root prominence,loss of buccal plates,and a thin gingival tissue biotype.The treatment regimen included PAOO combined with autologous PRF for alveolar augmentation and interproximal enamel reduction for moderate dental crowding.Clinically,PAOO-assisted orthodontic tooth movement in this case showed enhanced periodontium remodeling.Radiographic outcomes also showed statistically significant improvements(P<0.01)in the mandibular buccal alveolar bone.CONCLUSION This case report suggests the combination of autologous PRF with PAOO to enhance bone augmentation and long-term tissue support in adult orthodontic patients with periodontal disease.

Implant site development using titanium plate and platelet-rich fibrin for congenitally missed maxillary lateral incisors:A case report

BACKGROUND Bone deficiency and soft tissue atrophy in the absence of maxillary lateral incisors are among the most challenging problems for implant clinicians.Autologous bone grafting is the gold standard for bone augmentation,but not without limitations.Platelet-rich fibrin(PRF),a biodegradable autologous biomaterial,has been widely used for bone and soft tissue management.Moreover,titanium plate is an advantageous barrier due to its good space-maintaining ability.However,there is a lack of literature on implant site development using titanium plate and PRF for congenitally missing maxillary lateral incisors.CASE SUMMARY The patient was a 19-year-old girl with a congenitally missing tooth(#12).She underwent implant placement and simultaneous autologous bone grafting with titanium plate and PRF.At the follow-up visit 15 d post-procedure,the vascularization of soft tissue was visible.There was no swelling or pain after the surgery.Six months postoperatively,bone regeneration was evident.Subsequently,the definitive restoration was placed,and the patient was satisfied with the esthetic outcomes.CONCLUSION Implant site development using titanium plate and PRF for congenitally missing maxillary lateral incisors is a feasible procedure.In this case,the labial bone plate was displaced but remained connected to the base bone,ensuring blood supply.The titanium plate fixed the labial bone plate and maintained the osteogenic space,while the PRF provided growth factors and leukocytes for bone and soft tissue regeneration.Furthermore,the procedure reduced the surgical complexity and adverse reactions,displaying outstanding esthetic outcomes.

Efficacy of concentrated growth factors combined with mineralized collagen on quality of life and bone reconstruction of guided bone regeneration

To evaluate the clinical efficacy of concentrated growth factors(CGFs)combined with mineralized collagen(MC)in guided bone regeneration(GBR).A retrospective study involving 29 patients treated with GBR technique,which was performed either CGF and MC complexes or MC alone.Implants were inserted simultaneously and cone-beam computed tomography was taken immediately,at 3 and 6 months postoperation.Questionnaires were completed by all patients so as to evaluate the main symptoms and daily activities during the first week after surgery.The outcomes of the two groups were statistically compared.All implants healed uneventfully.Patients in both groups suffered from different levels of discomfort for the reason of swelling,pain and chewing impairment on 1-2 days.Meanwhile,swelling of the Trial group was weaker than the Control group.When compared with the Control group,pain levels in Trial group were more rapidly reduced and patients took fewer analgesics from Day 3.Furthermore,the reconstitution mean value of the graft was thicker at 3 and 6 months in Trial group.CGFs complex with MC were beneficial to relieve the clinical symptoms,promote the peri-implant bone regeneration and shorten the healing time.

Hard and soft tissue augmentation with occlusive titanium barriers in jaw vertical defects:a novel approach

Aim:The aim of this study was to evaluate hard and soft tissue changes following guided bone regeneration(GBR),with occlusive titanium barriers(OTB),in the rehabilitation of partially edentulous atrophic jaws.Vertical bone gain(VBG),horizontal bone width(HBW),and flap thickness(FT)changes,observed between the first and the second surgical stages,were evaluated.Methods:The study included 35 patients(9 men and 26 women;mean age 60±10.53 years)in need of vertical bone augmentation for implant placement.Seventy implants were placed,44 with a one-stage approach(Group A)and 26 with a two-stage approach(Group B).VBG,HBW,and FT were measured and statistically compared.Results:VBG for implants placed in Group B was significantly higher than those placed in Group A(P=0.006).The increased HBW in Group B was highly significant compared to that exhibited in Group A(P=0.000).A highly significant difference was found in FT before and after the GBR in the two groups considered together,for both the upper and lower jaws(P=0.000 for both).Conclusions:OTBs are reliable devices in GBR,yielding predictable results in terms of bone augmentation.In almost all cases(94.3%),a spontaneous increase of the FT,at the second surgical phase,was observed.This could be due to the titanium surface features which increases spontaneously the thickness of soft tissues over the OTB.