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Magister Scientiae Dentium - MSc(Dent) / Autologous bone grafting in conjunction with dental implant therapy is a well-accepted procedure in oral and maxillofacial rehabilitation. A variety of intraoral donor sites, such as the mandibular symphysis, the mandibular ramus and the maxillary tuberosity have been used in oral and maxillofacial reconstruction. However these sites are associated with complications. In order to reduce these complications, the anterior palate has been proposed as a potential donor site. However, the scientific literature in this regard is sparse, and larger studies are required to investigate the clinical potential of this proposed site. Aim: To determine the volume and density of available bone in the anterior palate that may be used for bone harvesting using cone-beam computed tomography (CBCT) in a select South African population. Materials and methods: One hundred previously acquired CBCT scans taken at the Diagnostic and Radiology Department of Tygerberg Oral Health Centre were analyzed for the required data. These were all acquired from a single CBCT machine (Newtom VGI®, Verona, Italy). The study sample included 52 females and 48 males ranging from ages 20 years to 80 years. The CBCT scans were divided into 3 different age groups. The first age group was between the ages of 20 and 39 years, the second age group was from 40 to 59 years and the third age group was ≥ 60 years. The volume and density of the anterior palate of the different age groups were analyzed using specific criterion. CBCT specific software (Simplant Pro Crystal®) Dentsply implants, Mannheim, Germany was used to standardize the data collection. All data was stored in a Microsoft Excel spreadsheet (Microsoft Corporation, Washington, USA). Results: The mean volume of the anterior palate in this study was 2.11 ± 0.55 cm3, with a minimum volume of 1.04 cm3 and a maximum volume of 3.82 cm3. There was no significant difference in the volume and density of the anterior palate between different age groups and no significant difference in the volume between males and females (p value = 0.227). Conclusions: The anterior palate affords a considerable amount of bone volume which is similar or even more than other intraoral donor sites. The anterior palate is a potential donor site for bone harvesting and CBCT may be regarded as an ideal tool to analyze the amount of bone available for harvesting.

Syfte. Syftet med denna systematiska litteraturöversikt var att undersöka det vetenskapliga underlaget avseende långsiktig stabilitet hos olika typer av benersättningsmaterial i kombination med implantatinstallation.Material och metod. En elektronisk sökning gjordes med hjälp av PubMed och Web of Science. Block med sökord konstruerades och skrevs in i sökmotorerna för att hitta studier med implantatbehandling i kombination med benaugmentation, med en radiologisk uppföljning efter minst 2 år. Funna artiklar granskades i förhållande till förutbestämda inklusions- och exklusionskriterier. Data från inkluderade studier registrerades. Risken för bias i de inkluderade studierna bedömdes enligt modifierade protokoll.Resultat. Den elektroniska sökningen resulterade i 1183 studier, varav 14 studier med antingen autogent, allogent, xenogent eller alloplastiskt benersättningsmaterial inkluderades i denna litteraturöversikt. Resultatet från studierna visade en stor skillnad i både tekniker och material.Slutsats. Den generella slutsatsen i denna studie är att den marginella benförlusten vid dentala implantat som placerats i augmenterat ben inte överstiger 1 mm inom två år. En mer exakt slutsats om den marginella bennivåns stabilitet kunde inte dras på grund av de stora skillnaderna mellan de inkluderade studierna. Det finns ett behov av fler högkvalitativa studier med långtidsuppföljning som undersöker och jämför den marginella bennivåns stabilitet för olika benersättningsmaterial. / Aim. The purpose of this systematic review was to investigate the literature available regarding long-term stability of different bone augmentation materials in combination with dental implant treatment.Material and methods. An electronic search was done using PubMed and Web of Science. Blocks with keywords were constructed and inserted into the search engines to find studies involving implant treatment in combination with bone augmentation, with a radiographic follow-up of at least 2 years. Found articles were reviewed in relation to predetermined inclusion- and exclusion criteria. Data from included studies was extracted. Included studies were assessed of risk of bias according to modified protocols. Results. The electronic search yielded 1183 studies. 14 studies using either autogenous, allogeneic, xenogeneic or alloplastic augmentation materials was included in this review. The results from the data extraction process showed a wide variation in both materials and techniques used.Conclusion. The general conclusion drawn from this study is that marginal bone loss around dental implants placed in augmented bone does not exceed 1 mm within two years post-operatively. A more precise conclusion regarding marginal bone level stability could not be drawn due to the heterogeneity of the included studies. There is a need for additional high-quality studies with long-term follow-up, investigating and comparing marginal bone level stability for different bone augmentation materials.

This research project presents a study of the fixation of screws in augmented and non-augmented cancellous bone at a microscopic scale. It is estimated that somewhere close to one million screws are failing each year. Therefore, the aim is to identify the key parameters affecting screw pull-out in order to improve screw fixation in cancellous bone, and hence screw design. The background for this study comes from work by Stryker, comparing screw pull-out from augmented and non-augmented cancellous bone, where a few cases of screw pull-out gave better results without bone augmentation. This is contrary to most evidence and the hypothesis to explain these results is that the screw pull-out from cancellous bone could be strongly affected by the cancellous bone micro architecture. The effect of the influence of the screw’s initial position was first verified with 2D finite element (FE) models of screw pull-out from simplified cancellous bone models. The results showed a force reaction variation up to 28% with small change in position. The hypothesis was then tested with 3D FE models of screw pull-out from more complex cancellous bone models with different volume fractions. Three volume fractions were tested and again the effects were confirmed, but only in models with the lower volume fraction. A variation up to 30% of the force reaction was observed. The 3D simplified cancellous bone models with 5.3% volume fraction were also used to study the influence of augmentation using calcium phosphate cement. A significant improvement of the screw holding power (almost 2 times) as well as an important diminution of the variability of the pull-out force due to the screw initial position was found. Other augmentation geometries were used to model cement. They all showed an increase of the screw pull-out force reaction with an increase of the cement volume. Validation of FE results was achieved by comparing screw pull-out from a cadaver cancellous bone and the FE model constructed from the same bone sample. New studies were then carried out from the cadaver cancellous bone model. The first study examined the screw initial position influence with cancellous and cortical screws and again showed that there is a strong correlation between screw pull-out stiffness and bone volume fraction. The cortical screw showed improved performance over the cancellous screw. Augmentation cases were explored using three bone samples with a range of volume fractions obtained from different sites within the cadaver bone sample. The cancellous screw was tested with 3 types of augmentation and the cortical screw was tested with one augmentation in these 3 samples. The results showed each time a significant improvement of stiffness with augmentation but when compared with the effect of volume variation inside the bone sample, it appeared that the improvement of stiffness from augmentation might not cover the loss in stiffness from a small change in bone structure. Finally, screw design parameters were investigated, as cortical screws seemed to give as good or better stiffness results than cancellous screw. The thread pitch, the thread angle and the core diameter were analysed independently and it appeared that the most important parameter was the thread pitch with an improvement of the stiffness of +46% for cancellous screws with a smaller thread pitch. The two other factors studied (core diameter and thread angle) showed somewhat stiffer results but with a relatively small influence (less than 10%). From this study, the best screw for use in cancellous bone could be a cortical screw (diameter and pitch) with thread angles similar to a cancellous screw.

Introdução: A regeneração óssea guiada baseia-se no princípio de seletividade celular, utilizando membranas para impedir a migração de células indesejadas dos tecidos moles e guiar a proliferação de células osteogênicas. A MDA é um biomaterial que tem sido amplamente utilizado em procedimentos regenerativos periodontais, não somente por ser biocompatível, mas também pela sua capacidade reconstrutiva em proporcionar um aumento da faixa de tecido queratinizado. Em pesquisas recentes, foi demonstrado o envolvimento de uma cadeia de 15 aminoácidos do colágeno (P-15) na diferenciação celular de fibroblastos e osteoblastos. A associação de matriz óssea inorgânica bovina com o P-15 (MOI/P-15) tem apresentado bons resultados. O objetivo dessa pesquisa foi avaliar a eficácia da MDA associada à MOI/P-15 na preservação da crista alveolar após extração dentária em humanos. Metodologia: Foram selecionados 18 pacientes que necessitavam de exodontia de dentes anteriores da maxila com pelo menos dois dentes não contíguos. Foi adotado o modelo boca dividida. Após as extrações dentárias foram realizadas cirurgias regenerativas de preservação da crista alveolar utilizando MOI/P-15 (GT) em um alvéolo e o coágulo sanguíneo no outro alvéolo (GC). Após a inserção do substituto ósseo, a MDA foi posicionada e fixada com parafusos sobre os dois alvéolos para servir como membrana. O retalho foi suturado deixando 2 mm da MDA expostos na porção central. As medidas clínicas MVEP, MVEV e MAH foram registradas na primeira cirurgia e após 6 meses, na cirurgia de reentrada, tomando-se como pontos de referência os parafusos de titânio. Resultados Na análise intragrupos, após seis meses, houve redução estatisticamente significante nas medidas MVEP, MVEV e MAH para ambos os grupos. Para o grupo teste, houve redução na MVEP de 2,80 ± 1,61 para 1,97 ± 1,67 mm; na MVEV de 5,80 ± 1,74 para 4,60 ± 2,05 mm e na MAH de 7,40 ± 2,16 para 4,87 ± 1,51 mm. Para o grupo controle, a MVEP variou de 2,50 ± 1,24 para 1,63 ± 1,32 mm; a MVEV de 6,27 ± 1,75 para 4,77 ± 1,59 mm e MAH de 7,60 ± 1,18 para 4,20 ± 1,00 mm. Para a comparação entre os grupos, além das medidas iniciais e finais, foram calculadas as diferenças entre elas para cada grupo. No grupo teste, a diferença para MVEP foi de 0,83 ± 1,53 e no controle foi de 0,87 ± 1,13 mm; e para MVEV foi de 1,20 ± 2,02 e 1,50 ± 1,15 mm para os grupos teste e controle, respectivamente. Na medida horizontal (MAH) foi encontrada diferença estatística quando comparadas as diferenças no grupo teste e controle que foi de 2,53 ± 1,81 mm para o grupo teste e 3,40 ± 1,39 mm para o grupo controle (p<0,05). Conclusão: Os resultados deste estudo mostram que a MDA, associada ou não a MOIP-15, pode ser utilizada com sucesso como membrana para preservação do rebordo alveolar após extração dentária de dentes maxilares anteriores. A associação com o enxerto favorece de maneira significativa a manutenção da espessura no sentido horizontal da crista alveolar. / Background: Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several techniques are available to regenerative procedures and are used for socket preservation. The aim of this study was to analyze by clinical parameters the use of acellular dermal matrix (ADM) and anorganic bovine bone matrix (ABM) with a synthetic cell-binding peptide P-15 to preserve alveolar bone after tooth extraction. Methods: Eighteen patients in need of extraction of maxillary anterior teeth were selected and they were randomly assigned to the test (ADM plus ABM/P-15) or control (ADM only). Clinical measurements were recorded at initial and 6 months after ridge preservation procedures. Results: In the clinical measurements - External Vertical Palatal, External Vertical Buccal and Alveolar Horizontal (EVPM, EVBM and AHM) -, the statistical analysis showed no difference between test and control groups in the initial and at six months. The intragroup analysis, after six months, showed a statistically significant reduction in the measurements for both groups. In the comparison between the groups, the differences (mm), in the test group, were: EVLM=0.83±1.53, EVBM=1.20±2.02, AHM=2.53±1.81 and in the control were: EVLM=0.87±1.13, EVBM=1.50±1.15, AHM=3.40±1.39. The differences in EVLM and EVBM measurements were no statistically significant; however, in horizontal measurement (AHM), there was statistically difference (p<0.05). Conclusion: The results of this study show that ADM, with or without ABM/P-15, can be successfully when it is used as a membrane for preservation of alveolar ridge after tooth extraction of maxillary teeth earlier.

Introdução: A regeneração óssea guiada baseia-se no princípio de seletividade celular, utilizando membranas para impedir a migração de células indesejadas dos tecidos moles e guiar a proliferação de células osteogênicas. A MDA é um biomaterial que tem sido amplamente utilizado em procedimentos regenerativos periodontais, não somente por ser biocompatível, mas também pela sua capacidade reconstrutiva em proporcionar um aumento da faixa de tecido queratinizado. Em pesquisas recentes, foi demonstrado o envolvimento de uma cadeia de 15 aminoácidos do colágeno (P-15) na diferenciação celular de fibroblastos e osteoblastos. A associação de matriz óssea inorgânica bovina com o P-15 (MOI/P-15) tem apresentado bons resultados. O objetivo dessa pesquisa foi avaliar a eficácia da MDA associada à MOI/P-15 na preservação da crista alveolar após extração dentária em humanos. Metodologia: Foram selecionados 18 pacientes que necessitavam de exodontia de dentes anteriores da maxila com pelo menos dois dentes não contíguos. Foi adotado o modelo boca dividida. Após as extrações dentárias foram realizadas cirurgias regenerativas de preservação da crista alveolar utilizando MOI/P-15 (GT) em um alvéolo e o coágulo sanguíneo no outro alvéolo (GC). Após a inserção do substituto ósseo, a MDA foi posicionada e fixada com parafusos sobre os dois alvéolos para servir como membrana. O retalho foi suturado deixando 2 mm da MDA expostos na porção central. As medidas clínicas MVEP, MVEV e MAH foram registradas na primeira cirurgia e após 6 meses, na cirurgia de reentrada, tomando-se como pontos de referência os parafusos de titânio. Resultados Na análise intragrupos, após seis meses, houve redução estatisticamente significante nas medidas MVEP, MVEV e MAH para ambos os grupos. Para o grupo teste, houve redução na MVEP de 2,80 ± 1,61 para 1,97 ± 1,67 mm; na MVEV de 5,80 ± 1,74 para 4,60 ± 2,05 mm e na MAH de 7,40 ± 2,16 para 4,87 ± 1,51 mm. Para o grupo controle, a MVEP variou de 2,50 ± 1,24 para 1,63 ± 1,32 mm; a MVEV de 6,27 ± 1,75 para 4,77 ± 1,59 mm e MAH de 7,60 ± 1,18 para 4,20 ± 1,00 mm. Para a comparação entre os grupos, além das medidas iniciais e finais, foram calculadas as diferenças entre elas para cada grupo. No grupo teste, a diferença para MVEP foi de 0,83 ± 1,53 e no controle foi de 0,87 ± 1,13 mm; e para MVEV foi de 1,20 ± 2,02 e 1,50 ± 1,15 mm para os grupos teste e controle, respectivamente. Na medida horizontal (MAH) foi encontrada diferença estatística quando comparadas as diferenças no grupo teste e controle que foi de 2,53 ± 1,81 mm para o grupo teste e 3,40 ± 1,39 mm para o grupo controle (p<0,05). Conclusão: Os resultados deste estudo mostram que a MDA, associada ou não a MOIP-15, pode ser utilizada com sucesso como membrana para preservação do rebordo alveolar após extração dentária de dentes maxilares anteriores. A associação com o enxerto favorece de maneira significativa a manutenção da espessura no sentido horizontal da crista alveolar. / Background: Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several techniques are available to regenerative procedures and are used for socket preservation. The aim of this study was to analyze by clinical parameters the use of acellular dermal matrix (ADM) and anorganic bovine bone matrix (ABM) with a synthetic cell-binding peptide P-15 to preserve alveolar bone after tooth extraction. Methods: Eighteen patients in need of extraction of maxillary anterior teeth were selected and they were randomly assigned to the test (ADM plus ABM/P-15) or control (ADM only). Clinical measurements were recorded at initial and 6 months after ridge preservation procedures. Results: In the clinical measurements - External Vertical Palatal, External Vertical Buccal and Alveolar Horizontal (EVPM, EVBM and AHM) -, the statistical analysis showed no difference between test and control groups in the initial and at six months. The intragroup analysis, after six months, showed a statistically significant reduction in the measurements for both groups. In the comparison between the groups, the differences (mm), in the test group, were: EVLM=0.83±1.53, EVBM=1.20±2.02, AHM=2.53±1.81 and in the control were: EVLM=0.87±1.13, EVBM=1.50±1.15, AHM=3.40±1.39. The differences in EVLM and EVBM measurements were no statistically significant; however, in horizontal measurement (AHM), there was statistically difference (p<0.05). Conclusion: The results of this study show that ADM, with or without ABM/P-15, can be successfully when it is used as a membrane for preservation of alveolar ridge after tooth extraction of maxillary teeth earlier.

No description available.