Background: Extraction socket wound healing is characterized by resorption of the alveolar bone at the extraction site. This produces a decrease in ridge volume, deformations of ridge contours, and, thus, difficulties in delayed placement of root-form implants in an ideal position. Cancellous porous bovine bone mineral (PBBM) applied to fresh extraction sockets has recently been proposed to minimize the reduction in ridge volume. The aim of this study was to investigate the influence of PBBM grafted particles on the histopathologic pattern of the intrasocket regenerated bone and to evaluate histomorphometrically the healed PBBM grafted extraction socket site at 9 months' post-extraction. Methods: PBBM particles (250 to 1,000 µ in size) were grafted in 15 fresh human extraction sockets in 15 patients. Socket wall bone height was measured from the crestal ridge level before the mineral particles were inserted. Primary soft tissue closure was performed to protect the grafted particles via a pediculated split...

Porous bovine bone mineral in healing of human extraction sockets. Part 1: histomorphometric evaluations at 9 months.

Biopsies were taken from 16 out of 20 consecutive referral patients 6 to 8 months after maxillary sinus floor augmentation with a mixture of bovine hydroxyapatite (BH), autogenous bone particles and fibrin glue. Four days prior to biopsy retrieval the patients were given a single dose of tetracycline to label bone forming sites. Fluorescence microscopy of 100 microm thick sections revealed active bone formation in conjunction with the BH particles in 14 of 15 specimens analysed. Light microscopy and morphometry of ground sections from 16 patients showed various amounts of mineralised bone tissue in all except one specimen. In the latter case, the BH particles were encapsulated by a dense fibrous connective tissue. Sections from the augmented areas were occupied by non-mineralized tissue (54.1+12.6%), lamellar bone (21.2+24.5%), BH particles (14.5+10.3%) and woven bone (10.2+13.4%). The non-mineralized tissue seen in bone forming areas consisted of a loose connective tissue, rich of vessels and cells, and in the periphery of a more dense fibrous connective tissue. Woven bone with large and scattered osteocyte lacunae was bridging between the BH particles and the lamellar trabecular bone. There were no signs of resorption of the BH particles. The lamellar bone appeared to have originated from the recipient site and was seldom in contact with the BH particles. It is concluded that the tested implant material has bone conducting properties. The bone associated with the BH particles after 6 to 8 months of healing was mainly woven.

A clinical histologic study of bovine hydroxyapatite in combination with autogenous bone and fibrin glue for maxillary sinus floor augmentation. Results after 6 to 8 months of healing.

BACKGROUND: Bovine hydroxyapatite (Bio-Oss, Geistlich Pharmaceutical, Wollhausen, Switzerland) has been suggested to be used in maxillary sinus floor augmentation procedures prior to or in conjunct ...

Histologic analysis of clinical biopsies taken 6 months and 3 years after maxillary sinus floor augmentation with 80% bovine hydroxyapatite and 20% autogenous bone mixed with fibrin glue.

A prospective 1-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with bovine hydroxyapatite and autogenous bone.

Background: Porous bovine bone mineral (PBBM) has been used in ridge preservation procedures following tooth extractions. The aim of this study was to investigate histochemically tissue sockets grafted with PBBM at 9 months post-extraction. By using different histochemical stainings, characteristics of the newly formed bone; i.e., lamellar/woven ratio at different socket depths, were investigated and the arrangement of bone around the grafted material, as well as the nature of the amorphous organic material found in all specimens, were examined. Methods: After extraction of 15 single-rooted maxillary teeth from 15 patients, socket sites were grafted with PBBM particles (250 to 1000 µ). Primary soft tissue closure of the grafted site was established using the rotated split palatal pedicle flap technique. At 9 months, a cylindrical tissue specimen, 2.5 mm in diameter, was trephined from each previously grafted site followed by placement of a screw-shaped implant. Horizontal tissue section cuts, 5 µ wide, we...

Porous bovine bone mineral in healing of human extraction sockets: 2. Histochemical observations at 9 months.

To minimize potential infection following the transplantation of allogeneic bone, extremely rigorous selection of donors and careful processing and storage of samples are required. Other major problems related to allogeneic transplants, such as reduced osteogenic properties and immunological reactions, led to the development of demineralized bone matrix (DBM). This osteoinductive bone extract is largely free of antigens and is easy to produce. However, to eliminate the potential risk of infection, DBM should be sterilized prior to implantation. The purpose of this study was to investigate the influence of different sterilization techniques on the osteoinductive properties of DBM. A series of 76 cortical defects (drill holes) 0.6 cm in diameter in the tibiae of 11 Merino sheep were filled with DBM in addition to autogeneic and allogeneic cancellous bone. Prior to implantation DBM was sterilized by autoclaving, gamma irradiation, or application of ethylene oxide or ethyl alcohol. A further 12 drill holes were left empty as controls. The formation of new bone was examined 3 and 6 weeks postoperatively, using histological, fluorescent-optical and microradiographical techniques. The amount of newly formed bone was also quantified. Apart from autoclaved DBM all matrix grafts showed excellent new bone formation following sterilization, by far exceeding the formation with allogeneic cancellous bone.

The effect of various sterilization procedures on the osteoinductive properties of demineralized bone matrix

The aim of this study was to measure new bone formation after implantation of hydroxylapatite ceramic materials compared with autogenous and allogenous cancellous bone implantations. Eight standardised bore holes, each 6 mm in diameter, were drilled in the left medial tibia of each of seven merino sheep. Seven of these holes were filled with hydroxylapatite ceramic materials: Bio-Oss, Pyrost, autogenous and deep frozen allogenous spongiosa in various sequences. The empty hole was used for comparison. Results were evaluated after fluorescent marking with calcein green 6 weeks postoperatively. The extent of new bone formation was determined by means of fluorescence microscopy, microradiography and histological sections and quantified by means of an automatic surface-measuring programme. Whilst implantation of autogenous spongiosa resulted in almost complete slicing of the defect, the holes filled with hydroxylapatite ceramic materials showed no significant difference from the empty defect. We conclude that this purely inorganic material cannot stimulate new bone formation.

New bone formation following implantation of various hydroxyapatite ceramics. Animal experiment with bore hole models of the sheep tibia

The problems arising from the transplantation of autogenic and allogenic bone have significantly limited the use of these methods. Hence, there is an ever increasing demand for suitable transplant materials that could be readily available to orthopaedic surgeons throughout the country. Although the advantages of demineralized bone matrix over allogenic cancellous bone have been shown in numerous experimental studies, its broad clinical application has so far been limited. The purpose of this study was to investigate the osteogenic properties of partially demineralized bone matrix in clinically relevant and realistic conditions. Tibial defects 5 cm in length in 24 merino sheep were bridged by way of medullary nailing and filled with various preparations of bone matrix. Cortical bone displaying poor vascularization and rotation instability of the osteosynthesis ensured extremely difficult testing conditions for the transplant. Postoperatively, the extent of new bone formation was evaluated by means of regular X-ray examinations over a period of 12-20 weeks. In addition, histological, fluorescent-optical and microradiographic examinations of the final specimen were carried out. Good new bone formation regularly followed the transplantation of partially demineralized bone matrix with a particle size of 750 microns. Complete bridging of the defect was achieved when small amounts of bone marrow were added. The use of bone matrix with a smaller or larger particle size did not influence the rate of new bone formation perceptibly.

Bridging long tibial shaft defects by partially demineralized bone matrix

The transmission of infectious diseases by allografts from bone banks has led to considerable restrictions on bone transplantations. HIV and hepatitis are considered to be the most dangerous diseases transmitted in this way. To prevent the transmission of any infections, extensive precautions have to be applied when allografts are taken and during their storage. Donors have been checked for infectious diseases at the time of collection and 3 months later. In addition, the donated grafts must be cultured for aerobic and anaerobic bacteria. This elaborate series of tests can only be mastered if the bone bank is tightly organised. The number of available grafts also be increased by sterilisation and the use of demineralised bone matrix.

Organization of a bone bank

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The effect of various sterilization procedures on the osteoinductive properties of demineralized bone matrix

New bone formation following implantation of various hydroxyapatite ceramics. Animal experiment with bore hole models of the sheep tibia

Bridging long tibial shaft defects by partially demineralized bone matrix

Organization of a bone bank