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STUDY DESIGN: Systematic literature review. OBJECTIVES: To analyze the evidence available reporting complications in single or two-level anterior cervical discectomy and fusion (ACDF) using a demineralized bone matrix (DBM), hydroxyapatite (HA), or beta-tricalcium phosphate (ß-TCP). METHODS: A systematic review of the literature using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases was performed in August 2020 to identify studies reporting complications in one or two-level ACDF surgery using DBM, HA, or ß-TCP. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS: A total of 1857 patients were included, 981 male and 876 female, across 17 articles; 5 prospective, and 12 retrospectives. We noted heterogeneity among the included studies concerning the study design and combination of graft materials utilized in them. However, we noted a higher incidence of adjacent segment disease (17.7%) and pseudoarthrosis (9.3%) in fusion constructs using DBM. Studies using ß-TCP reported a higher incidence of pseudoarthrosis (28.2%) and implant failures (17.9%). CONCLUSIONS: Degenerative cervical conditions treated with one or two-level ACDF surgery using DBM, HA, or ß-TCP with or without cervical plating are associated with complications such as adjacent segment disease, dysphagia, and pseudarthrosis. However, consequent to the study designs and clinical heterogeneity of the studies, it is not possible to correlate these complications accurately with any specific graft material employed. Further well-designed prospective studies are needed to correctly know the related morbidity of each graft used for achieving fusion in ACDF.

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OBJECTIVE: To investigate the effects of stem cells from the pulp of human exfoliated deciduous teeth (SHED) on biphasic calcium phosphate granules (BCP) to repair rat calvarial defects as compared to autogenous bone grafting. MATERIALS AND METHODS: A defect with a 6-mm diameter was produced on the calvaria of 50 rats. BCP granules were incorporated into SHED cultures grown for 7 days in conventional (CM) or osteogenic (OM) culture media. The animals were allocated into 5 groups of 10, namely: clot, autogenous bone, BCP, BCP+SHED in CM (BCP-CM), and BCP+SHED in OM (BCP-OM). The presence of newly formed bone and residual biomaterial particles was assessed by histometric analysis after 4 and 8 weeks. RESULTS: The autogenous group showed the largest newly formed bone area at week 8 and in the entire experimental period, with a significant difference in relation to the other groups (P < 0.05). At week 8, BCP-CM and BCP-OM groups showed homogeneous new bone formation (P = 0.13). When considering the entire experimental period, the BCP group had the highest percentage of residual particle area, with no significant difference from the BCP-CM group (P = 0.06) and with a significant difference from the BCP-OM group (P = 0.01). BCP-CM and BCP-OM groups were homogeneous throughout the experimental period (P = 0.59). CONCLUSIONS: BCP incorporated into SHED cultures showed promising outcomes, albeit less pronounced than autogenous grafting, for the repair of rat calvarial defects. CLINICAL RELEVANCE: BCP incorporated into SHED cultures showed to be an alternative in view of the disadvantages to obtain autogenous bone graft.

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BACKGROUND: Synthetic biomaterials have played an increasingly prominent role in the substitution of naturally derived biomaterials in current surgery practice. In vitro and in vivo characterization studies of new synthetic biomaterials are essential to analyze their physicochemical properties and the underlying mechanisms associated with the modulation of the inflammatory process and bone healing. PURPOSE: This study compares the in vivo tissue behavior of a synthetic biomaterial nano-hydroxyapatite/beta-tricalcium phosphate (nano-HA/ß-TCP mixture) and deproteinized bovine bone mineral (DBBM) in a rat calvarial defect model. The innovation of this work is in the comparative analysis of the effect of new synthetic and commercially xenogenic biomaterials on the inflammatory response, bone matrix gain, and stimulation of osteoclastogenesis and osteoblastogenesis. METHODS: Both biomaterials were inserted in rat defects. The animals were divided into three groups, in which calvarial defects were filled with xenogenic biomaterials (group 1) and synthetic biomaterials (group 2), or left unfilled (group 3, controls). Sixty days after calvarial bone defects filled with biomaterials, periodic acid Schiff (PAS) and Masson's trichrome staining, immunohistochemistry tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase-9 (MMP-9), and electron microscopy analyses were conducted. RESULTS: Histomorphometric analysis revealed powerful effects such as a higher amount of proteinaceous matrix and higher levels of TNF-α and MMP-9 in bone defects treated with alloplastic nano-HA/ß-TCP mixture than xenogenicxenogic biomaterial, as well as collagen-proteinaceous material in association with hydroxyapatite crystalloids. CONCLUSION: These data indicate that the synthetic nano-HA/ß-TCP mixture enhanced bone formation/remodeling in rat calvarial bone defects. The nano-HA/ß-TCP did not present risks of cross-infection/disease transmission. The synthetic nano-hydroxyapatite/beta-tricalcium phosphate mixture presented adequate properties for guided bone regeneration and guided tissue regeneration for dental surgical procedures.

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OBJECTIVES: The objective of this cross-sectional study was to evaluate the vertical bone gain achieved after the sinus lift procedure with beta-tricalcium phosphate (ß-TCP) used as a bone substitute and simultaneous implant placement. METHODS: One hundred and twenty-eight sinus lift procedures (utilizing a synthetic ceramic containing 99.9% tricalcium phosphate as a bone substitute) and simultaneous implant placements were performed on 119 patients. The lateral window approach surgical protocol for maxillary sinus lift was performed on the patients. The implants were evaluated using cone-beam computed tomography (CBCT) at 6 months following placement. The vertical bone gain was considered a primary variable, while implant length, diameter, and location were considered secondary variables. RESULTS: The ANOVA results showed no statistical difference in vertical bone gain with implant parameters like implant length, width, and position. Pearsons correlation revealed a statistically significant positive correlation with vertical bone gain and implant length and diameter. A further multivariate linear regression analysis was performed and it observed statistically significant associations between the variables in the study after adjusting for confounding factors. CONCLUSIONS: This study concluded that there was vertical bone gain with the usage of ß-TCP in maxillary sinus lift surgical procedure with immediate implant placement and that implant variables like length and diameter had a significant influence on the average bone gain values. The implant position did not have a statistically significant influence but there was considerable variation in the bone gain between first, second premolar, and molar regions.

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Nowadays, we can observe a worldwide trend towards the development of synthetic biomaterials. Several studies have been conducted to better understand the cellular mechanisms involved in the processes of inflammation and bone healing related to living tissues. The aim of this study was to evaluate tissue behaviors of two different types of biomaterials: synthetic nano-hydroxyapatite/beta-tricalcium phosphate composite and bone xenograft in sub-critical bone defects in rat calvaria. Twenty-four rats underwent experimental surgery in which two 3 mm defects in each cavity were tested. Rats were divided into two groups: Group 1 used xenogen hydroxyapatite (Bio Oss™); Group 2 used synthetic nano-hydroxyapatite/beta-tricalcium phosphate (Blue Bone™). Sixty days after surgery, calvaria bone defects were filled with biomaterial, animals were euthanized, and tissues were stained with Masson's trichrome and periodic acid-Schiff (PAS) techniques, immune-labeled with anti-TNF-α and anti-MMP-9, and electron microscopy analyses were also performed. Histomorphometric analysis indicated a greater presence of protein matrix in Group 2, in addition to higher levels of TNF-α and MMP-9. Ultrastructural analysis showed that biomaterial fibroblasts were associated with the tissue regeneration stage. Paired statistical data indicated that Blue Bone™ can improve bone formation/remodeling when compared to biomaterials of xenogenous origin.

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RESUMO: As biocerâmicas microporosas de fosfatos de cálcio e bifásicas de hidroxiapatita e fosfato tricálcico beta (HA/TCP-β) na forma de biomateriais granulados microporosos, são temas de pesquisas e se destacam como substitutos ósseos em aplicações biomédicas. As biocerâmicas bifásicas são biocompatíveis, bioativas, osteoindutoras e promovem a osteointegração, quando aplicados in vivo ou em meio simulado. Outro ponto diferencial dessas biocerâmicas está associado à capacidade de solubilidade que esses biomateriais apresentam quando aplicados em meio biológico, permitindo a liberação gradual de íons cálcio e fosfatos para o meio biológico, estes são absorvíeis e promovem a neoformação de um novo tecido ósseo. As biocerâmicas bifásicas de fosfatos de cálcio também se apresentam promissores em aplicações traumatológicas na reparação do tecido ósseo traumatizado e na liberação controlada de medicamentos, em tratamentos da estrutura óssea. O desempenho desses biomateriais como substitutos ósseos e na liberação controlada de medicamentos, estão associados, as suas características físicas, químicas, morfológicas e de superfície. O objetivo desse estudo foi realizar a caracterização morfológica, microestrutural dos biomateriais pela técnica de microscopia eletrônica de varredura (MEV), física com difratometria de raios X (DRX) e método de Arthur para determinação da porosidade aberta. A densidade teórica dos biomateriais bifásicos foi determinada pelo método teórico das concentrações bifásicas. Por fim, se realizou avaliação do comportamento da neoformação óssea e osteointegração dos diferentes biomateriais de fosfatos de cálcio em testes in vivo em ovinos. Os testes in vivo foram realizados em tíbias de ovinos com tempo de implantação de 03 meses. Os biomateriais implantados foram hidroxiapatita (HA), fosfato tricálcico-β (TCP-β) e composições bifásicas HA/TCP-β nas proporções: 80/20, 20/80, 70/30 e 30/70. Foram utilizadas 08 ovelhas mestiças Texel, com 12 meses de idade e peso médio de 30 kg (±5 kg), nas quais foram produzidos três defeitos ósseos em cada tíbia, sendo que quatro desses defeitos foram preenchidos por biomateriais, e dois por fragmentos ósseos (autoenxerto), grupo controle. Os animais foram eutanasiados aos 03 meses após a implantação dos biomateriais. Após a eutanásia, foram coletadas as tíbias para avaliação com o uso da técnica de microscopia eletrônica de varredura (MEV). Os resultados encontrados mostram que os biomateriais granulados microporosos são formados por uma morfologia irregular com tamanho de grânulos entre 200 μm e 500μm, outra constatação foi microestrutura microporosa interconectada dos biomateriais. O resultado obtido da porosidade aberta mostrou que os biomateriais apresentam porosidade superior a 68%. A densidade teórica se apresentou semelhante entre os biomateriais granulados de fosfatos de cálcio e sugerem boa capacidade de neoformação óssea para todos os biomateriais, sendo que o bifásico 20/80 apresentou absorção do biomaterial e neoformação óssea mais rápida quando comparada com os outros biomateriais avaliados neste estudo.

ABSTRACT: Microporous bioceramics of calcium phosphate and biphasic hydroxyapatite and tricalcium phosphate beta (HA/TCP- β) in the form of microporous granules biomaterials are research subjects and stand out as bone substitutes in biomedical application. The biphasic bioceramics are biocompatible, bioactive, osteoinductive and promote osseointegration when applied in vivo or through simulated. Another aspect of such differential solubility bioceramics is associated with the capacity that these biomaterials exhibit when applied in biological environment, enabling the gradual release of calcium and phosphate ions to the biological environment they are absorbable and promote neogenesis of new bone tissue. The biphasic bioceramics of calcium phosphate also have promising applications in traumatology in the repair of injured bone and controlled release of drugs in the bone structure treatments. The performance of these biomaterials as bone substitutes and controlled release of drugs, are associated, their physical, chemical, morphological and surface. The aim of this study was to make morphological, microstructural of biomaterials by the technique of scanning electron microscopy (SEM), physics with X-ray diffraction (XRD) and Arthur method for determination of open porosity. The theoretical density of biphasic biomaterials was determined by theoretical method of biphasic concentrations. Finally, we conducted evaluation of osteogenesis and osseointegration behavior of different biomaterials of calcium phosphates in vivo tests on sheep. In vivo tests were performed on tibias of sheep up to of 03 months. The biomaterials implanted were hydroxyapatite (HA), tricalcium phosphate-β (β-TCP) and biphasic compositions as HA/TCP-β in rates: 80/20, 20/80, 70/30 and 30/70. Eight crossbred Texel sheep, with 12 months of age and average weight of 30 kg (±5 kg) were used, in which were produced three bone defects in the tibia, four of these defects were filled with biomaterials, and two by bone fragments (autograft), as control group. The animals were euthanized at 03 months after implantation of biomaterials. After euthanasia, the tibias were collected for evaluation using the scanning electron microscopy technique (SEM). The results show that the microporous biomaterial granules are formed by an irregular morphology with grain size between 200 μm and 500μm, another finding was microporous interconnected microstructure of biomaterials. The result showed that the open porosity of the biomaterials exhibit porosity greater than 68%. The theoretical density was relatively similar between the granulates biomaterials of calcium phosphates and suggest good capacity of osteogenesis for all biomaterials, with the biphasic absorption of the biomaterial introduced 20/80 and more rapid bone formation when compared with other biomaterials evaluated in study.

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As biocerâmicas microporosas de fosfatos de cálcio e bifásicas de hidroxiapatita e fosfato tricálcico beta (HA/TCP-β) na forma de biomateriais granulados microporosos, são temas de pesquisas e se destacam como substitutos ósseos em aplicações biomédicas. As biocerâmicas bifásicas são biocompatíveis, bioativas, osteoindutoras e promovem a osteointegração, quando aplicados in vivo ou em meio simulado. Outro ponto diferencial dessas biocerâmicas está associado à capacidade de solubilidade que esses biomateriais apresentam quando aplicados em meio biológico, permitindo a liberação gradual de íons cálcio e fosfatos para o meio biológico, estes são absorvíeis e promovem a neoformação de um novo tecido ósseo. As biocerâmicas bifásicas de fosfatos de cálcio também se apresentam promissores em aplicações traumatológicas na reparação do tecido ósseo traumatizado e na liberação controlada de medicamentos, em tratamentos da estrutura óssea. O desempenho desses biomateriais como substitutos ósseos e na liberação controlada de medicamentos, estão associados, as suas características físicas, químicas, morfológicas e de superfície. O objetivo desse estudo foi realizar a caracterização morfológica, microestrutural dos biomateriais pela técnica de microscopia eletrônica de varredura (MEV), física com difratometria de raios X (DRX) e método de Arthur para determinação da porosidade aberta. A densidade teórica dos biomateriais bifásicos foi determinada pelo método teórico das concentrações bifásicas. Por fim, se realizou avaliação do comportamento da neoformação óssea e osteointegração dos diferentes biomateriais de fosfatos de cálcio em testes in vivo em ovinos. Os testes in vivo foram realizados em tíbias de ovinos com tempo de implantação de 03 meses. Os biomateriais implantados foram hidroxiapatita...(AU)

Microporous bioceramics of calcium phosphate and biphasic hydroxyapatite and tricalcium phosphate beta (HA/TCP- β) in the form of microporous granules biomaterials are research subjects and stand out as bone substitutes in biomedical application. The biphasic bioceramics are biocompatible, bioactive, osteoinductive and promote osseointegration when applied in vivo or through simulated. Another aspect of such differential solubility bioceramics is associated with the capacity that these biomaterials exhibit when applied in biological environment, enabling the gradual release of calcium and phosphate ions to the biological environment they are absorbable and promote neogenesis of new bone tissue. The biphasic bioceramics of calcium phosphate also have promising applications in traumatology in the repair of injured bone and controlled release of drugs in the bone structure treatments. The performance of these biomaterials as bone substitutes and controlled release of drugs, are associated, their physical, chemical, morphological and surface. The aim of this study was to make morphological, microstructural of biomaterials by the technique of scanning electron microscopy (SEM), physics with X-ray diffraction (XRD) and Arthur method for determination of open porosity. The theoretical density of biphasic biomaterials was determined by theoretical method of biphasic concentrations. Finally, we conducted evaluation of osteogenesis and osseointegration behavior of different biomaterials of calcium phosphates in vivo tests on sheep. In vivo tests were performed on tibias of sheep up to of 03 months. The biomaterials implanted were hydroxyapatite (HA), tricalcium phosphate-β (β-TCP) and biphasic compositions as HA/TCP-β in rates: 80/20, 20/80, 70/30 and 30/70. Eight crossbred Texel sheep, with 12 months of age and average weight of 30 kg (±5 kg) were used...(AU)

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ABSTRACT: Microporous bioceramics of calcium phosphate and biphasic hydroxyapatite and tricalcium phosphate beta (HA/TCP- ) in the form of microporous granules biomaterials are research subjects and stand out as bone substitutes in biomedical application. The biphasic bioceramics are biocompatible, bioactive, osteoinductive and promote osseointegration when applied in vivo or through simulated. Another aspect of such differential solubility bioceramics is associated with the capacity that these biomaterials exhibit when applied in biological environment, enabling the gradual release of calcium and phosphate ions to the biological environment they are absorbable and promote neogenesis of new bone tissue. The biphasic bioceramics of calcium phosphate also have promising applications in traumatology in the repair of injured bone and controlled release of drugs in the bone structure treatments. The performance of these biomaterials as bone substitutes and controlled release of drugs, are associated, their physical, chemical, morphological and surface. The aim of this study was to make morphological, microstructural of biomaterials by the technique of scanning electron microscopy (SEM), physics with X-ray diffraction (XRD) and Arthur method for determination of open porosity. The theoretical density of biphasic biomaterials was determined by theoretical method of biphasic concentrations. Finally, we conducted evaluation of osteogenesis and osseointegration behavior of different biomaterials of calcium phosphates in vivo tests on sheep. In vivo tests were performed on tibias of sheep up to of 03 months. The biomaterials implanted were hydroxyapatite (HA), tricalcium phosphate- (-TCP) and biphasic compositions as HA/TCP- in rates: 80/20, 20/80, 70/30 and 30/70. Eight crossbred Texel sheep, with 12 months of age and average weight of 30 kg (±5 kg) were used, in which were produced three bone defects in the tibia, four of these defects were filled with biomaterials, and two by bone fragments (autograft), as control group. The animals were euthanized at 03 months after implantation of biomaterials. After euthanasia, the tibias were collected for evaluation using the scanning electron microscopy technique (SEM). The results show that the microporous biomaterial granules are formed by an irregular morphology with grain size between 200 m and 500m, another finding was microporous interconnected microstructure of biomaterials. The result showed that the open porosity of the biomaterials exhibit porosity greater than 68%. The theoretical density was relatively similar between the granulates biomaterials of calcium phosphates and suggest good capacity of osteogenesis for all biomaterials, with the biphasic absorption of the biomaterial introduced 20/80 and more rapid bone formation when compared with other biomaterials evaluated in study.

RESUMO: As biocerâmicas microporosas de fosfatos de cálcio e bifásicas de hidroxiapatita e fosfato tricálcico beta (HA/TCP-) na forma de biomateriais granulados microporosos, são temas de pesquisas e se destacam como substitutos ósseos em aplicações biomédicas. As biocerâmicas bifásicas são biocompatíveis, bioativas, osteoindutoras e promovem a osteointegração, quando aplicados in vivo ou em meio simulado. Outro ponto diferencial dessas biocerâmicas está associado à capacidade de solubilidade que esses biomateriais apresentam quando aplicados em meio biológico, permitindo a liberação gradual de íons cálcio e fosfatos para o meio biológico, estes são absorvíeis e promovem a neoformação de um novo tecido ósseo. As biocerâmicas bifásicas de fosfatos de cálcio também se apresentam promissores em aplicações traumatológicas na reparação do tecido ósseo traumatizado e na liberação controlada de medicamentos, em tratamentos da estrutura óssea. O desempenho desses biomateriais como substitutos ósseos e na liberação controlada de medicamentos, estão associados, as suas características físicas, químicas, morfológicas e de superfície. O objetivo desse estudo foi realizar a caracterização morfológica, microestrutural dos biomateriais pela técnica de microscopia eletrônica de varredura (MEV), física com difratometria de raios X (DRX) e método de Arthur para determinação da porosidade aberta. A densidade teórica dos biomateriais bifásicos foi determinada pelo método teórico das concentrações bifásicas. Por fim, se realizou avaliação do comportamento da neoformação óssea e osteointegração dos diferentes biomateriais de fosfatos de cálcio em testes in vivo em ovinos. Os testes in vivo foram realizados em tíbias de ovinos com tempo de implantação de 03 meses. Os biomateriais implantados foram hidroxiapatita (HA), fosfato tricálcico- (TCP-) e composições bifásicas HA/TCP- nas proporções: 80/20, 20/80, 70/30 e 30/70. Foram utilizadas 08 ovelhas mestiças Texel, com 12 meses de idade e peso médio de 30 kg (±5 kg), nas quais foram produzidos três defeitos ósseos em cada tíbia, sendo que quatro desses defeitos foram preenchidos por biomateriais, e dois por fragmentos ósseos (autoenxerto), grupo controle. Os animais foram eutanasiados aos 03 meses após a implantação dos biomateriais. Após a eutanásia, foram coletadas as tíbias para avaliação com o uso da técnica de microscopia eletrônica de varredura (MEV). Os resultados encontrados mostram que os biomateriais granulados microporosos são formados por uma morfologia irregular com tamanho de grânulos entre 200 m e 500m, outra constatação foi microestrutura microporosa interconectada dos biomateriais. O resultado obtido da porosidade aberta mostrou que os biomateriais apresentam porosidade superior a 68%. A densidade teórica se apresentou semelhante entre os biomateriais granulados de fosfatos de cálcio e sugerem boa capacidade de neoformação óssea para todos os biomateriais, sendo que o bifásico 20/80 apresentou absorção do biomaterial e neoformação óssea mais rápida quando comparada com os outros biomateriais avaliados neste estudo.

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BACKGROUND: The success of bone augmentation to a major degree depends on the biomechanics and biological conditions of the surrounding tissues. Therefore, an animal model is needed providing anatomical sites with similar mechanical pressures for comparing its influence on different biomaterials for bone regeneration. The present report describes the new bone formation associated to biomaterial in a bursa created in the epidural space, between dura mater and cranial calvaria, under the constant pressure of cerebrospinal fluid. METHODS: Five adult California rabbits were used for the trial. In each animal, two bursae were created in the epidural spaces, in the anterior part of the skull, below both sides of the interfrontal suture. The spaces between dura mater and cranial calvaria were filled with in-situ hardening biphasic calcium phosphate containing hydroxyapatite and beta tricalcium-phosphate (BCP), in-situ hardening phase-pure beta-tricalcium phosphate (ß-TCP) or without any biomaterials (sham). After 90 days, the animals were sacrificed, and the defect sites were extracted and processed for histomorphometric analysis by optical and backscattered electron microscopy. RESULTS: The cranial epidural spaces created (n = 10) could be preserved by the application both BCP (n = 3) and ß-TCP biomaterials (n = 3) in all experimental sites. The sites augmented with BCP showed less new bone formation but a trend to better volume preservation than the sites augmented with ß-TCP. However, the bone in the BCP sites seemed to be more mature as indicated by the higher percentage of lamellar bone in the sites. In contrast, the created space could not be preserved, and new bone formation was scarce in the sham-operated sites (n = 4). CONCLUSION: The experimental bursae created bilaterally in the epidural space allows comparing objectively bone formation in relation to biomaterials for bone regeneration under permanent physiological forces from cerebrospinal fluid pressure.

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El presente estudio evalúa los resultados de la utilización del fosfato tricálcico beta en la preservación de alvéolos postextracción al emplearlo solo o en conjunto con membranas no reabsorbibles. Se seleccionaron 18 dientes con indicación de extracción y con condiciones favorables para la preservación del alvéolo y posterior colocación de un implante oseointegrado. En 10 alvéolos se utilizó como relleno fosfato tricálcico beta en conjunto con membrana no reabsorbible, y 8 alvéolos fueron tratados solamente con fosfato tricálcico beta. Previo a la cirugía se evaluó el ancho y alto de cada alvéolo, mediante una tomografía computarizada de alta resolución, evaluación que fue repetida 6 meses después de realizada la intervención quirúrgica. Al momento de efectuar la técnica quirúrgica para la instalación de los implantes se tomaron muestras histológicas del sitio de colocación del implante para estudiar las características histológicas del sitio injertado después de 6 meses de realizada la cirugía de extracción dentaria y preservación de alvéolo. El uso de fosfato tricálcico beta, independiente o no del uso de membrana, mantuvo la altura del alvéolo transcurridos 6 meses desde su colocación, mientras que el ancho del alvéolo se mantuvo solo en el grupo sin membrana. Los resultados histológicos demostraron cantidades variables de regeneración ósea.

The present study evaluated the results of the post-extraction socket preservation technique using Beta-Tricalcium Phosphate with and without the use of a non-resorbable membrane. A total of 18 teeth with indication of extraction and socket preservation were selected, with 10 alveoli being treated with Beta-Tricalcium Phosphate combined with a non-resorbable membrane, and the other 8 with Beta-Tricalcium Phosphate only. The width and height of each socket was evaluated using computed tomography, prior to the extraction, and 6 months after the surgery. At the time of performing the surgical technique for installing the implants, histological specimens were taken from the implant site in order to study the graft site 6 months after the dental extraction surgery and alveoli preservation.The use of Beta-Tricalcium Phosphate, whether a membrane is used or not, maintained the alveolar height 6 months after the extraction, while the width of the alveolus only remained in the group without membrane. Histological results showed varying amounts of bone regeneration.

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Este relato de caso clínico descreveu o uso do beta-tricálcio fosfato para levantamento do seio maxilar e instalação do implante dentário. Uma paciente de 38 anos de idade apresentou-se com ausência dos elementos 26 e 27. Após a remoção da parede vestibular e levantamento do assoalho sinusal, uma membrana de colágeno foi interposta antes da deposição do biomaterial (granulação 1-2 mm). Oito meses depois, uma trefina foi usada para biopsia, e dois implantes dentários foram instalados. Os resultados histológicos mostraram a formação de tecido ósseo sadio. Mais tarde, as coroas defi nitivas foram confeccionadas e instaladas. O beta-tricálcio fosfato (Cerasorb) mostrou-se satisfatório como material para enxerto, mesmo sem o uso de osso autógeno concomitante

This case report describes the use of beta-tricalcium phosphate for maxillary sinus lifting and dental implant placement. A 38 years-old patient presented with the absence of the elements 26 and 27. After removing the buccal bone wall for sinus floor lifting, a collagen membrane was adapted before the biomaterial (1-2 mm granules) being inserted. Eight months later, a trephine bur was used for biopsy, and two dental implants were installed. Histological results showed the formation of healthy bone tissue. Later, the definitive crowns were made and installed. The betatricalcium phosphate (Cerasorb) was satisfactory as a biomaterial for grafting, even that no concomitant use of autogenous bone has been performed

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OBJECTIVE: This study aims to clinically evaluate the treatment of mandibular class II furcation defects with enamel matrix derivative (EMD) and/or a bone substitute graft made of ß-tricalcium phosphate/hydroxyapatite (ßTCP/HA). MATERIALS AND METHODS: Forty-one patients, presenting a mandibular class II buccal furcation defect, probing pocket depth (PPD) ≥4 mm and bleeding on probing, were included. They were randomly assigned to the groups: 1-EMD (n = 13); 2-ßTCP/HA (n = 14); 3-EMD + ßTCP/HA (n = 14). Plaque index (PI), gingival index (GI), relative gingival margin position (RGMP), relative vertical and horizontal attachment level (RVCAL and RHCAL), and PPD were evaluated at baseline and 6 and 12 months. The mean horizontal clinical attachment level gain was considered the primary outcome variable. RESULTS: No significant intragroup differences were observed for RGMP, but significant changes were observed for RVCAL, RHCAL, and PPD for all groups (p < 0.05). After 12 months, the mean horizontal clinical attachment level gain was 2.77 ± 0.93 mm for EMD, 2.64 ± 0.93 mm for ßTCP/HA, and 2.93 ± 0.83 mm for EMD + ßTCP/HA, with no significant differences among the groups. At the end of the study, 85.3 % of the sites were partially closed; however, no complete closure was observed. CONCLUSION: EMD + ßTCP/HA does not provide a significant advantage when compared to the isolated approaches. All three tested treatments promote significant improvements and partial closure of class II buccal furcation defects. Based on its potential to induce periodontal regeneration, EMD may be considered an attractive option for this type of defect, but complete closure remains an unrealistic goal. CLINICAL RELEVANCE: The partial closure of buccal furcation defects can be achieved after the three tested approaches. However, the combined treatment does not provide a significant benefit when compared to the isolated approaches.

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RESUMO

A substituição de parte do tecido ósseo se faz necessária muitas vezes na rotina cirúrgica, seja em função de fraturas, neoplasias ósseas ou enfermidades ortopédicas que acarretem em perda óssea. Neste sentido, têm se buscado biomateriais capazes de promover esta substituição, evitando o uso de enxertos ou transplantes ósseos. O objetivo deste trabalho foi avaliar a capacidade osteoregenerativa de biomateriais em diferentes composições, em tíbias de ovinos. Foram utilizadas oito ovelhas mestiças texel, com 12 meses de idade e peso médio de 28,5±7,4kg. Após adequada preparação anestésica e cirúrgica, foram produzidos três defeitos ósseos na diáfise das tíbias em sua face medial, totalizando seis defeitos de 6mm cada, sendo que quatro foram preenchidos por biomateriais, e dois por fragmentos ósseos retirados do próprio animal (autocontrole). Os materiais implantados foram: hidroxiapatita (HA), tricálcio fosfato-β (TCP-β), hidroxiapatita/tricálcio fosfato-b 60/40 (HA/TCP-b 60/40) e o nanocompósito hidroxiapatita/alumina a 5% (HA/Al2O3 a 5%). Os animais foram alocados em dois grupos: Grupo 60 (n=04), em que os animais foram eutanasiados após 60 dias da colocação dos implantes e Grupo 90 (n=04), em que a eutanásia ocorreu 90 dias após a colocação dos implantes. Foram realizadas radiografias nos períodos pré-operatório, imediatamente após o procedimento e aos 30, 60 e 90 dias de pós-operatório, a fim de excluir qualquer alteração prévia ou complicação pós-operatória, capaz de comprometer o estudo. Após a eutanásia, foram coletadas as tíbias para avaliação macro e microscópica, por meio de microscopia eletrônica de varredura (MEV) e microscopia óptica...

Bone replacement is often required in veterinary clinics and hospitals routine, even because fractures, bone tumors or any orthopedic disease that entail in bone loss. In this sense, biomaterials capable of promoting this substitution, avoiding the use of bone grafts or transplants have been searched. The aim of this study was evaluated the osteoregenerative capacity of biomaterials in different compositions, implanted in sheep's tibia. Eight female, mongrel sheeps, 12 months old, weighting 28,5±7,4kg were obtained for this study. Three bone defects, 6mm each, in both tibias, a total of six bone defects, were produced, being four of them treated with four different types of biomaterials and two with autogenous bone grafts, as a control group. The biomaterials implanted were: hydroxyapatite (HA), beta-tricalcium phosphate (TCP-β), hydroxyapatite/beta-tricalcium phosphate 60:40 (HA/TCP-β 60:40) and the nanocomposite hydroxyapatite and alumina (HA/Al2O3 5%). The animals were allocated in two groups: Group 60 (n=04), in which the animals were euthanized sixty days after the implantation of the biomaterials and Group 90 (n=04), in which the animals were euthanized ninety days after the procedure. Were performed radiograph images on the preoperative period, immediate postoperative and at 30, 60 and 90 days of postoperative period, to excluded any previously disease or postoperative complications that could compromise this research. After euthanasia, the tibias were collected for macro and microscopic evaluation, which was accessed by scanning electron microscopy (SEM) and optic microscopy...

Assuntos

RESUMO

A substituição de parte do tecido ósseo se faz necessária muitas vezes na rotina cirúrgica, seja em função de fraturas, neoplasias ósseas ou enfermidades ortopédicas que acarretem em perda óssea. Neste sentido, têm se buscado biomateriais capazes de promover esta substituição, evitando o uso de enxertos ou transplantes ósseos. O objetivo deste trabalho foi avaliar a capacidade osteoregenerativa de biomateriais em diferentes composições, em tíbias de ovinos. Foram utilizadas oito ovelhas mestiças texel, com 12 meses de idade e peso médio de 28,5±7,4kg. Após adequada preparação anestésica e cirúrgica, foram produzidos três defeitos ósseos na diáfise das tíbias em sua face medial, totalizando seis defeitos de 6mm cada, sendo que quatro foram preenchidos por biomateriais, e dois por fragmentos ósseos retirados do próprio animal (autocontrole). Os materiais implantados foram: hidroxiapatita (HA), tricálcio fosfato- (TCP-), hidroxiapatita/tricálcio fosfato-b 60/40 (HA/TCP-b 60/40) e o nanocompósito hidroxiapatita/alumina a 5% (HA/Al2O3 a 5%). Os animais foram alocados em dois grupos: Grupo 60 (n=04), em que os animais foram eutanasiados após 60 dias da colocação dos implantes e Grupo 90 (n=04), em que a eutanásia ocorreu 90 dias após a colocação dos implantes. Foram realizadas radiografias nos períodos pré-operatório, imediatamente após o procedimento e aos 30, 60 e 90 dias de pós-operatório, a fim de excluir qualquer alteração prévia ou complicação pós-operatória, capaz de comprometer o estudo. Após a eutanásia, foram coletadas as tíbias para avaliação macro e microscópica, por meio de microscopia eletrônica de varredura (MEV) e microscopia óptica. Os resultados encontrados mostraram uma boa capacidade de neoformação óssea e uma lenta absorção da HA. O TCP- foi rapidamente absorvido e apresentou boa capacidade osteoindutiva e osteocondutiva, sendo observada neoformação óssea no interior dos grânulos deste biomaterial. O composto bifásico HA/TCP- (60/40) apresentou o melhor resultado a longo prazo, devido ao melhor controle na solubilização e liberação dos íons cálcio e fosfatos para o meio biológico durante o processo de neoformação óssea. O biomaterial nanocompósito HA/Al2O3 a 5% não apresentou resultados promissores neste estudo, e sugerem-se novas pesquisas a fim de investigar melhor o potencial e aplicabilidade deste novo biomaterial. Conclui-se que a hidroxiapatita, o tricálcio fosfato- e a associação HA/TCP- (60/40) apresentam excelente capacidade de reparação óssea, podendo ser utilizados como substitutos ósseos, a associação HA/TCP- (60/40) é o melhor dentre os biomateriais estudados, pois apresenta velocidade de absorção intermediária em relação à HA e ao TCP- isolados, fornecendo ainda uma sustentação adequada ao tecido neoformado, o biomaterial HA/Al2O3 5% se mostrou incompatível, provocando reação de rejeição por parte do hospedeiro e com insignificante formação de tecido ósseo, sugerindo novas pesquisas acerca deste material.(AU)

Bone replacement is often required in veterinary clinics and hospitals routine, even because fractures, bone tumors or any orthopedic disease that entail in bone loss. In this sense, biomaterials capable of promoting this substitution, avoiding the use of bone grafts or transplants have been searched. The aim of this study was evaluated the osteoregenerative capacity of biomaterials in different compositions, implanted in sheep's tibia. Eight female, mongrel sheeps, 12 months old, weighting 28,5±7,4kg were obtained for this study. Three bone defects, 6mm each, in both tibias, a total of six bone defects, were produced, being four of them treated with four different types of biomaterials and two with autogenous bone grafts, as a control group. The biomaterials implanted were: hydroxyapatite (HA), beta-tricalcium phosphate (TCP-), hydroxyapatite/beta-tricalcium phosphate 60:40 (HA/TCP- 60:40) and the nanocomposite hydroxyapatite and alumina (HA/Al2O3 5%). The animals were allocated in two groups: Group 60 (n=04), in which the animals were euthanized sixty days after the implantation of the biomaterials and Group 90 (n=04), in which the animals were euthanized ninety days after the procedure. Were performed radiograph images on the preoperative period, immediate postoperative and at 30, 60 and 90 days of postoperative period, to excluded any previously disease or postoperative complications that could compromise this research. After euthanasia, the tibias were collected for macro and microscopic evaluation, which was accessed by scanning electron microscopy (SEM) and optic microscopy. The results suggest that HA, TCP- and HA/TCP- present a great osteoregenerative capacity. The last one seems to be better for a long-term outcome, due its best control in the solubilization and releasing of calcium and phosphates ions through the biological environment during bone formation. The nanocomposite HA/Al2O3 5% didn't show a good response on this study, and we suggest new researches to better evaluate the potential and applicability of this new biomaterial. We concluded that HA, TCP- and HA/TCP- 60:40 presented excellent capacity of bone repair, and could be used as bone substituts, the association HA/TCP- (60:40) is superior due his intermediary velocity of absortion comparing to HA and TCP- isolated, providing adequate supporting to the neoformed tissue, the HA/Al2O3 5% showed incompatibility, causing rejection reaction by the host and insignificant formation of bone tissue, suggesting further research on this material.(AU)

Assuntos