• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.28 no.6
• /
• pp.511-519
• /
• 2006

Autogenous bone grafts have been considered the gold standard for maxillofacial bony defects. However, this procedure could entail a complicated surgical procedure as well as potential donor site morbidity. Possibly the best solution for bone-defect regeneration is a tissue engineering approach, i.e. the use of a combination of a suitable scaffold with osteogenic cells. A major source of osteogenic cells is the bone marrow. Bone marrow-derived mesenchymal stem cells are multipotent and have the ability to differentiate into osteoblastic, chondrocytic, and adipocytic lineage cells. However, the isolation of cells from bone marrow has someproblems when used in clinical setting. Bone marrow aspiration is sometimes potentially more invasive and painful procedure and carries of a risk of morbidity and infection. A minimally invasive, easily accessible alternative would be cells derived from periosteum. The periosteum also contains multipotent cells that have the potential to differentiate into osteoblasts and chondrocytes. In the present study, we evaluated the osteogenic activity and mineralization of cultured human periosteal-derived cells. Periosteal explants were harvested from mandibule during surgical extraction of lower impacted third molar. The periosteal cells were cultured in the osteogenic inductive medium consisting of DMEM supplemented with 10% fetal calf serum, 50g/ml L-ascorbic acid 2-phosphate, 10 nmol dexamethasone and 10 mM -glycerophosphate for 42 days. Periosteal-derived cells showed positive alkaline phosphatase (ALP) staining during 42 days of culture period. The formation of ALP stain showed its maximal manifestation at day 14 of culture period, then decreased in intensity during the culture period. ALP mRNA expression increased up to day 14 with a decrease thereafter. Osteocalcin mRNA expression appeared at day 7 in culture, after that its expression continuously increased in a time-dependent manner up to the entire duration of culture. Von Kossa-positive mineralization nodules were first present at day 14 in culture followed by an increased number of positive nodules during the entire duration of the culture period. In conclusion, our study showed that cultured human periosteal-derived cells differentiated into active osteoblastic cells that were involved in synthesis of bone matrix and the subsequent mineralization of the matrix. As the periosteal-derived cells, easily harvested from intraoral procedure such as surgical extraction of impacted third molar, has the excellent potential of osteogenic capacity, tissue-engineered bone using periosteal-derived cells could be the best choice in reconstruction of maxillofacial bony defects.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.3
• /
• pp.257-265
• /
• 1999

To investigate the sequential changes in microvascular architecture and osseous regeneration during the bony healing after an application of the guided tissue regeneration method, we made artificial defects measuring $0.7cm{\times}0.3cm$ in size on femoral bones of rats measuring about 200gm and applied non-absorbable TEFE membrane at experimental sites but not at control sites. Then we observed the sequential changes and correlations between new vacuolation and bony regeneration using microvascular corrosion cast method and routine light microscopic observation at 1, 2 and 3 weeks after operation, respectively. The results showed that there were close relationships between regeneration of microvasculature and bone. In early phase, the invasion of granulation tissue at control sites delayed bony regeneration, however, in later phase, there was no remarkable differences in bony regeneration between control and experimental sites. The placement of barrier also affected in revascularization of regenerating bony defects. This is, the experimental sites showed parallel arranged nutritional vessels along long axis with well developed retiform plexus whereas the control revealed vertical invasion of microvasculature from outside of marrow space through bony defects which was also rearrange with time into parallel pattern with a vertical plexus but lesser organized than that of experimental sites. These findings suggest that the reconstruction of regenerating vasculature within the marrow cavity only may be sufficient and/or more be efficient in regeneration of bony defects.

• Journal of Periodontal and Implant Science
• /
• v.49 no.4
• /
• pp.258-267
• /
• 2019

Purpose: Increased bone regeneration has been achieved through the use of stem cells in combination with graft material. However, the survival of transplanted stem cells remains a major concern. The purpose of this study was to evaluate the viability of transplanted mesenchymal stem cells (MSCs) at an early time point (24 hours) based on the type and form of the scaffold used, including type I collagen membrane and synthetic bone. Methods: The stem cells were obtained from the periosteum of the otherwise healthy dental patients. Four symmetrical circular defects measuring 6 mm in diameter were made in New Zealand white rabbits using a trephine drill. The defects were grafted with 1) synthetic bone (${\beta}$-tricalcium phosphate/hydroxyapatite [${\beta}-TCP/HA$]) and $1{\times}10^5MSCs$, 2) collagen membrane and $1{\times}10^5MSCs$, 3) ${\beta}-TCP/HA+collagen$ membrane and $1{\times}10^5MSCs$, or 4) ${\beta}-TCP/HA$, a chipped collagen membrane and $1{\times}10^5MSCs$. Cellular viability and the cell migration rate were analyzed. Results: Cells were easily separated from the collagen membrane, but not from synthetic bone. The number of stem cells attached to synthetic bone in groups 1, 3, and 4 seemed to be similar. Cellular viability in group 2 was significantly higher than in the other groups (P<0.05). The cell migration rate was highest in group 2, but this difference was not statistically significant (P>0.05). Conclusions: This study showed that stem cells can be applied when a membrane is used as a scaffold under no or minimal pressure. When space maintenance is needed, stem cells can be loaded onto synthetic bone with a chipped membrane to enhance the survival rate.

• The Journal of Advanced Prosthodontics
• /
• v.2 no.1
• /
• pp.7-13
• /
• 2010

Although most researchers agree that platelet-rich plasma (PRP) is a good source of autogenous growth factors, its effect on bone regeneration is still controversial. The purpose of this study was to evaluate whether increasing angiogenic factors in the human PRP to enhance new bone formation through rapid angiogenesis. MATERIAL AND METHODS. In vitro, the human platelets were activated with application of shear stress, $20\;{\mu}g/ml$ collagen, 2 mM $CaCl_2$ and 10U thrombin/$1\;{\times}\;10^9$ platelets. Level of vascular endothelial growth factor (VEGF) and platelet microparticle (PMP) in the activated platelets were checked. In the animal study, human angiogenic factors-enriched PRP was tested in 28 athymic rat's cranial critical bone defects with $\beta$-TCP. Angiogenesis and osteogenesis were evaluated by laser Doppler perfusion imaging, histology, dual energy X-ray densinometry, and micro-computed tomography. RESULTS. In vitro, this human angiogenic factors-enriched PRP resulted in better cellular proliferation and osteogenic differentiation. In vivo, increasing angiogenic potential of the PRP showed significantly higher blood perfusion around the defect and enhanced new bone formation around acellular bone graft material. CONCLUSION. Angiogenic factor-enriched PRP leads to faster and more extensive new bone formation in the critical size bone defect. The results implicate that rapid angiogenesis in the initial healing period by PRP could be supposed as a way to overcome short term effect of the rapid angiogenesis.

• International Journal of Industrial Entomology and Biomaterials
• /
• v.39 no.1
• /
• pp.9-13
• /
• 2019

In this study, 4 different types of GBR membrane were undergone for bio-degradability test; Silk mat from silkworm cocoon (TDI), silk mat from flatwise-spun (FS), collagen membrane (OssGuide), and dPTFE membrane (Cytoplast). Each material was segmented in 10.00 mm length and 0.3 mm thickness. The samples were put into the normal saline at $37^{\circ}C$ for 2 weeks. After that, yield strength and tensile strain were measured and compared them with those of before treatment. The morphology of the membranes was observed by SEM. Tensile strain of FS was significantly increased at 2 weeks' normal saline treatment (P=0.018). When compared to OssGuide, TDI and FS showed significantly higher tensile strain at 2 weeks' normal saline treatment (P<0.05). In the SEM images, there were no significant changes in Cytoplast, TDI, and FS after 2 weeks' treatment. However, OssGuide showed damaged surface after 2 weeks' treatment. In conclusion, both TDI and FS did not have any evidence of biodegradability at 2 weeks' observation in normal saline treatment. However, OssGuide showed more than 20 % decrease in yield strength and tensile strain.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.26 no.1
• /
• pp.73-79
• /
• 2000

A material of 48 patients with 60 avulsed and replanted permanent teeth were followed retrospectively in the period of 1996. 1 to 1998. 12 (mean observation period=1year 7months). The age of the patients at the time of replantation ranged from 9 to 63 years (mean=24 years). Clinical records of patients were reviewed to obtain valid data concerning the extent of injury and treatment provided. Pulpal and periodontal healing states were examined with periapical x-rays and clinical examination procedures (i.e. percussion test and mobility test) at their recall visit. Root ankylosis was found in fifty-two teeth(87%) and root resorption in twenty-four(40%). Only two of the replanted teeth(3%) showed partial regeneration of the periodontal ligament. Six teeth(10%) resulted in tooth loss, but the remaining fifty-four were clinically well functioning. Most of teeth have mild marginal bone loss accompanied by gingival retraction without pathological periodontal pockets. The incidence of root resorption was much higher in younger age group. However, it was not affected by the interval between avulsion and replantation, the condition of supporting tissues, the degree of root formation and the type of splinting, indicating that multiple factors involved in determining the prognosis of replanted teeth. Based on these findings, avulsed teeth in unfavorable conditions (i.e. long extra-alveolar periods, etc.) should be preserved if possible.

• Journal of Periodontal and Implant Science
• /
• v.47 no.4
• /
• pp.194-210
• /
• 2017

Purpose: The aim of the present study was to evaluate the healing of post-extraction sockets following alveolar ridge preservation clinically, radiologically, and histologically. Methods: Overall, 7 extraction sockets in 7 patients were grafted with demineralised bovine bone mineral and covered with a porcine-derived non-crosslinked collagen matrix (CM). Soft tissue healing was clinically evaluated on the basis of a specific healing index. Horizontal and vertical ridge dimensional changes were assessed clinically and radiographically at baseline and 6 months after implant placement. For histological and histomorphometric analysis, bone biopsies were harvested from the augmented sites during implant surgery 6 months after the socket preservation procedure. Results: Clinically, healing proceeded uneventfully in all the sockets. A trend towards reduced horizontal and vertical socket dimensions was observed from baseline to the final examination. The mean width and height of resorption were 1.21 mm (P=0.005) and 0.46 mm (P=0.004), respectively. Histologically, residual xenograft particles ($31.97%{\pm}3.52%$) were surrounded by either newly formed bone ($16.02%{\pm}7.06%$) or connective tissue ($50.67%{\pm}8.42%$) without fibrous encapsulation. The CM underwent a physiological substitution process in favour of well-vascularised collagen-rich connective tissue. Conclusions: Socket preservation using demineralised bovine bone mineral in combination with CM provided stable dimensional changes of the alveolar ridge associated with good reepithelialisation of the soft tissues during a 6-month healing period.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.2
• /
• pp.131-138
• /
• 1999

The purpose of this study is to evaluate the effects of resorbable plate in the healing process of mandibular fracture. Reduction and rigid fixation was carried out on the artificial mandibular fracture site of the rabbits, using a resorbable screw, 1.5mm in diameter and 4.0mm in length, and an absorbable plate 1.5mm in thickness(Lactosorb$^{(R)}$). En block tissue specimens with plate were taken from the rabbits at 4, 6, 8, and 10 weeks intervals and specimen were observed with light microscope under the hematoxylin-eosin staining, to observe the inflammatory reaction and tissue healing process. The following conclusions were drawn: 1. The subject displayed good healing with no signs of detachment of the fixation plate. 2. At 4 weeks, the plate was covered by the connective tissue. Then at 6 weeks, bone regeneration was discovered around the plate. 3. During the period of healing, no inflammatory reaction or foreign body reaction, as a result of using resorbable plate, were observed. 4. At 8 weeks, the initial phase of the absorption of the plate was observed. Then at 10 weeks, macrophage were observed around the plate, indicating the absorption phase was in process. From the above results, it can be determined that when the resorbable plate is applied to rabbit, full recuperation occurs naturally in the absence of inflammatory reaction and foreign body reaction. The selected study is clinically valuable in proving this procedure.

• Journal of Periodontal and Implant Science
• /
• v.40 no.5
• /
• pp.220-226
• /
• 2010

Purpose: This study was performed to evaluate the periodontal wound healing effect of particulate equine bone mineral on canine alveolar bone defects. Methods: Twelve adult male beagle dogs were used as study subjects. The mandibular second and fourth premolars were extracted prior to the experimental surgery, and the extraction sites were allowed to heal for 8 weeks. After periodontal probing, two-walled defects were created at the mesial and distal sides of the mandibular third premolars bilaterally, and the defects were filled with equine particulate bone with collagen membrane or bovine particulate bone with collagen membrane, or collagen membrane alone. The defects without any treatment served as negative controls. After probing depth measurement, animals were sacrificed at 10, 16, and 24 post-surgery weeks for micro-computed tomographic and histomorphometric analysis. Results: The equine particulate bone-inserted group showed significantly decreased values of probing depth and first bone contact compared to the negative control and collagen membrane alone groups at weeks 10, 16, and 24 (P<0.05). There were no significant differences in the new cementum length, newly-formed bone area, or newly-formed bone volume between equine particulate bone- and bovine particulate bone-inserted groups, both of which showed significantly increased values compared to the negative control and collagen membrane alone groups (P<0.05). Conclusions: Equine particulate bone showed significant differences in probing depth, first bone contact, new cementum length, newly formed bone area, and bone volume fraction values when compared to the negative control and collagen membrane alone groups. There were no significant differences between equine and bovine particulate bone substitutes in these parameters; therefore, we can conclude that equine particulate bone is equivalent to bovine bone for periodontal regeneration.

• Journal of Periodontal and Implant Science
• /
• v.52 no.1
• /
• pp.3-27
• /
• 2022

Purpose: This study was conducted to evaluate and compare the effects of different graft materials used in alveolar ridge preservation on dimensional hard tissue changes of the alveolar ridge, assessed using cone-beam computed tomography (CBCT) scans. Methods: A systematic electronic search of MEDLINE and the Cochrane Central Register of Controlled Trials and a manual search were conducted from November 2019 until January 2020. Randomized controlled trials were included if they assessed at least 1 variable related to vertical or horizontal hard tissue changes measured using CBCT scans. After a qualitative analysis of the included studies, subgroups were formed according to the graft material used, and a quantitative analysis was performed for 5 outcome variables: changes in vertical alveolar bone height at 2 points (midbuccal and midpalatal/midlingual) and changes in horizontal (buccolingual) alveolar bone width at 3 different levels from the initial crest height (1, 3, and 5 mm). Results: The search resulted in 1,582 studies, and after an independent 3-stage screening, 16 studies were selected for qualitative analysis and 9 for quantitative analysis. The metaanalysis showed a significantly (P<0.05) lower reduction of alveolar ridge dimensions for the xenogenic subgroup than in the allogenic subgroup, both vertically at the midbuccal aspect (weighted mean difference [WMD]=-0.20; standard error [SE]=0.26 vs. WMD=-0.90; SE=0.22) as well as horizontally at 1 mm (WMD=-1.32; SE=0.07 vs. WMD=-2.99; SE=0.96) and 3 mm (WMD=-0.78; SE=0.11 vs. WMD=-1.63; SE=0.40) from the initial crest height. No statistical analysis could be performed for the autogenic subgroup because it was not reported in sufficient numbers. Conclusions: Less vertical and horizontal bone reduction was observed when xenogenic graft materials were used than when allogenic graft materials were used; however, the loss of alveolar ridge dimensions could not be completely prevented by any graft material.