Bovine xenograft pericardial patch use for definitive single stage repair of a large esophageal defect: a case report

Background Large esophageal perforations are challenging and often treated with exclusion or resection. This case demonstrates the feasibility of definitive surgical repair of a large esophageal perforation using large bovine pericardial patch. Case A patient with missed Boerhaave Syndrome underwent transesophageal echocardiography causing worsening perforation and sepsis. At thoracotomy and faced with a large esophageal defect, a large Bovine pericardial patch was used for repair with omentopexy. The patient recovered promptly and at 8 months was asymptomatic with satisfactory studies. Conclusion Xenograft pericardium is available and widely used for vascular reconstructions. It’s use for primary repair of large esophageal perforations should be considered.

In vitro resorbability and granular characteristics of 3D-printed hydroxyapatite granules versus allograft, xenograft, and alloplast for alveolar cleft surgery applications

Three-dimensionally printed hydroxyapatite (3DP HA) was investigated in regards to its functional properties supporting bone regeneration and tooth movement in alveolar cleft applications. Commercially available bovine xenograft (BXG), biphasic calcium phosphate alloplast (BCP), and two types of freeze-dried bone allograft granules (FDBA and FDBA-CMC) were employed as control samples. Degradability was studied by submerging the samples in pH 7.4 buffered solution at 37°C for 28 days and determining subsequent weight loss percentage. The wicking property and granular agglomeration were evaluated by putting the granules in contact with deionized water, blood, and phosphate-buffered saline (PBS). Both of FDBA and FDBA-CMC showed the greatest weight loss at 28 days followed by 3DP HA. In contrast, 3DP HA showed significantly greater wicking ability than other samples for all liquid types. FDBA-CMC exhibited the greatest granular agglomeration for all liquid types followed by 3DP HA. 3DP HA was found to be a favorable candidate for bone grafting in alveolar cleft treatment.

In vitro resorbability and granular characteristics of 3D-printed hydroxyapatite granules versus allograft, xenograft, and alloplast

BackgroundThree-dimensionally printed hydroxyapatite (3DP HA) was investigated in regards to its functional properties supporting bone regeneration and tooth movement. The material’s high porosity and nanocrystal structure were investigated in terms of degradability, wicking property, and granular agglomeration in order to identify its potential for use as bone graft in alveolar cleft applications. Materials and methodsCommercially available bovine xenograft (Bio-Oss), biphasic calcium phosphate alloplast (BoneCeramic), and two types of freeze-dried bone allograft granules (SureOss Plus and RegenOss) were employed as control samples for comparison. In vitro degradability was studied by submerging the samples in pH 7.4 buffered solution at 37 o C for 28 days and determining subsequent weight loss percentage. The wicking property and granular agglomeration were evaluated by putting the granules in contact with deionized water, whole blood, and phosphate-buffered saline (PBS).ResultSureOss Plus and RegenOss showed the greatest weight loss at 28 days (6.64 and 8.91%, respectively) followed by 3DP HA (2.82%), Bio-Oss (0.21%), and BoneCeramic (0.20%). In contrast, 3DP HA showed significantly greater wicking ability than other samples for all types of tested liquids. SureOss Plus exhibited the greatest granular agglomeration for all liquid types followed by 3DP HA and Bio-Oss, Regenoss, and BoneCeramic, respectively.Conclusion3DP HA was found to be a favorable candidate for bone grafting in alveolar cleft treatment. Its resorption ability and exceptionally high wicking ability would be beneficial in bone healing and tooth movement. In addition, its moderate granular agglomeration capacity would help in graft handling and manipulation.

Peri-implantitis: risk factors and outcome of reconstructive therapy

This thesis is focused on (I) the outcome of reconstructive treatment of peri-implant defects and (II) risk factors for the development of peri-implantitis. Background An increasing number of individuals have dental implant-supported reconstructions. The long-time survival rate of dental implants is good, but complications do occur. Accumulation of bacteria on oral implants and the development of a pathogenic biofilm at the mucosal margin will result in inflammatory responses diagnosed as peri-implant mucositis(PiM). Furthermore, PiM may progress to peri-implantitis (Pi) involving the implant-supporting bone and potentially result in a severe inflammatory process resulting in alveolar bone destruction and consequently implantloss. Currently, Pi is a common clinical complication following implant therapy.The prevalence of peri-implantitis has been reported to be around 20 %. Susceptibility to infections and a history of periodontitis are considered as important risk indicators for peri-implantitis. It seems logical that a past history of periodontitis is linked to an increased risk of peri-implantitis. It is possible that other patient-associated factors such as a smoking habit, and presence of general diseases may also be linked to a higher risk for developing peri-implantitis.Treatment of peri-implantitis is difficult. Non-surgical treatment modalities may not be sufficient to resolve the inflammatory process to obtain healthy conditions.Surgical treatment of peri-implantitis has commonly been employed in clinical practice to obtain access to the implant surface thereby increasing the possibility to effectively decontaminate the implant surfaces.The effectiveness and long-term outcomes of reconstructive surgical treatments of peri-implantitis has been debated. The scientific evidence suggests that regular supportive care is an essential component in order to maintain and secure long-term results following treatment of peri-implantitis. Aims 1. To assess the short-term efficacy of reconstructive surgical treatmentof peri-implantitis (Study I). 2. To analyse risk factors related to the occurrence of peri-implantitis(Study II). 3. To assess the importance of defect configuration on the healing response after reconstructive surgical therapy of peri-implantitis (Study III). 4. To assess the long-term efficacy of reconstructive surgical treatmentof peri-implantitis (Study IV). MethodsFour studies were designed to fulfil the aims: - A single-blinded prospective randomised controlled longitudinal human clinical trial evaluating the clinical and radiographic results of reconstructive surgical treatment of peri-implantitis defects usingeither AB or BDX. - A retrospective analysis of individuals with either peri-implantitis, or presenting with either peri-implant health, or peri-implant mucositis assessing the likelihood that peri-implantitis was associated with a history of systemic disease, a history of periodontitis, and smoking. - A prospective study evaluating if the alveolar bone defect configuration at dental implants diagnosed with peri-implantitisis related to clinical parameters at the time of surgical intervention and if the short- and long-term outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment. - A prospective 5-year follow-up of patients treated either with AB or BDX. Results - The success for both surgical reconstructive procedures was limited. Nevertheless, bovine xenograft provided evidence of more radiographic bone fill than AB. Improvements in PD, BOP, and SUP were observed for both treatment modalities -In relation to a diagnosis of peri-implantitis, a high likelihood of comorbidity was expressed in the presence of a history of periodontitis and a medical history of cardiovascular disease - The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration - 4-wall defects and deeper defects demonstrated more radiographic evidence of defect fill - Reconstructive surgical treatment of peri-implant defects may result in successful clinical outcomes, that can be maintained over at least five years - The use of BDX is more predictable than use of harvested bone from the patient (AB) Conclusions The study results suggest that a bovine xenograft provides better radiographic evidence of defect fill than the use of autogenous bone harvested from cortical autologous bone grafts.Treatment with bone grafts to obtain radiographic evidence of defect fill is more predictable at 3- and 4-wall defects than at peri-implantitis bone defects with fewer bone walls.In relation to a diagnosis of peri-implantitis, a high likelihood of comorbidity was found for a history of periodontitis and a history of cardiovascular disease.

Minimally Invasive Transcrestal Sinus Floor Elevation Procedure in Severely Atrophic Ridge – A Case Report.

Typically, the greater the atrophy of the process the more extensive and invasive is the sinus floor elevation procedure. A case of a 39 - year - old man demonstrates a minimally invasive hydrokinetic sinus lift from 1.7 mm height process in the site of lost tooth no. 16. Using small flap, safe drills for crestal approach diameter 2.8mm, 2ml of saline solution under pressure of syringe plunger and 1g of particulated bovine xenograft a 14mm height and 12mm width sinus floor elevation was obtained. Implant was placed with torque 30 Ncm, and healing cap was attached. Despite the very difficult conditions presented method obtain not only a very good therapeutic effect, but also reduce the number of procedures and time necessary for the full rehabilitation of the patient. Total treatment time to final crown delivery was 6 months.

Comparison of osteopromoting ability of human tooth powder with the demineralized freeze-dried bone allograft, a bovine xenograft, and a synthetic graft: An in vitro study

Background. The present study aimed to evaluate the osteopromoting ability of human tooth powder and compare it to a bovine xenograft, a synthetic material, and the DFDBA allograft. Methods. In this in vitro study, 30 teeth without caries, inflammation, and infection, which had been extracted for orthodontic reasons, were collected. The crowns were removed, pulpectomy was carried out, and the samples were ground to a powder with particles <500 µm. Osteoblast-like cells of MG-63 were cultured with the tooth powder, Cerabone, DFDBA, and Osteon II. Cell proliferation was assessed by the MTT assay at 24- and 72-hour intervals. The alizarin red test was carried out after three and five days. The alkaline phosphatase level was measured after 24, 48, and 72 hours to assess the osteoblastic activity. The results were analyzed with one-way ANOVA. Results. According to the MTT assay, all the materials exhibited a higher proliferation rate than the control group in 24 hours. In 72 hours, DFDBA had the lowest cell proliferation rate at concentrations of 40 and 80 mg/mL. DFDBA and the positive control group were able to create calcified nodules by the alizarin red test. At the 48- and 72-hour intervals, DFDBA had the lowest alkaline phosphatase activity at a concentration of 40 mg/mL. At the 72-hour interval, bovine xenograft had the highest alkaline phosphatase level, followed by the synthetic material and tooth powder. Conclusion. The tooth powder was able to increase cell proliferation in comparison with the bovine xenograft, the synthetic graft, and the DFDBA. However, its osteopromoting ability was less than that of the osteogenic materials.