CLINICO-MORPHOLOGICAL RESEARCH OF BIO-OSS ® DURING BONE-PLASTIC OPERATIONS

International Journal of Medical Dentistry 23

Maxilo-facial surgery

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1 _{”P. L. Shupik” National Medical Academy of Postgraduate Education, Kiev, Ukraine}

Corresponding author: kolenko@i.ua

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Aim_{: To study the clinical and morphological} characteristics of Bio-Oss ® and Bio-Gate ® materials during bone-plastic operations, especially bone regeneration after surgical interventiond.

0DWHULDOVDQGPHWKRG: The pathomorphological study was performed with the intravital biopsy material of bone tissue from augmentation areas, obtained during implants placement. Clinical studies included subjective and objective methods, in particular X-ray analysis and photo documenting. Bio-Oss ®, Bio-Gide ®, Bio-Gide ® Perio membranes, Resor-Pin pins, U-impl implant systems were investigated and 231 operations were performed with Bio-Oss ® and Bio-Gate ®, of which 38 cases of sinus lifting, 145 of bone plasty with simultaneous implantation and 48 cases of periodontal surgery.

5HVXOWV Usage of bone-plastic Bio-OSS ® and Bio-Gate ® materials during various bone-plastic and periodontal operations assures a high clinical effect (from 93 to 99%). Morphologically, it has been observed that, after usage of bone Bio-OSS ® and Bio-Gate ® materials, a new osteoid tissue was formed, similar to the bone tissue of the alveolar

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material. The newly-formed tissue has a classical design and can fully perform the functions of jaw bones, especially for carrying loads transmitted with either teeth or implants. .H\ZRUGV: reparative osteogenesis, bone substitutes, ǰ io-Oss®, subantral augmentation, Bio-Gide®, Bio-Gide Perio®, U-Impl implants

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5HOHYDQFH RI WKH VWXG\. Treatment and rehabilitation of patients with partial or complete loss of teeth using dental implants are largely applied nowadays. One of the most important conditions of implantation is the presence of a VXIÀFLHQWDPRXQWRIERQHDQGLWVTXDOLW\8QWLO recently, in many clinical situations, the topographic-anatomical features of the jaws, especially in the distal parts of the upper jaw, permitted no complete prosthetic treatment with implants. However, for a full rehabilitation,

implants should be installed in the places appropriate for assuring a proper functioning of the orthopedic construction [1-3], which became possible due to the development and introduction of directed tissue regeneration (DTR) as a new clinical technique, nowadays widely applied in implantology (plastic of alveolar bone, subantral augmentation) and periodontology. The directed tissue regeneration method involves stimulation of osteogenesis, membrane technique or, most important of all, combination of both techniques [4]. In order to understand the processes developed in the bone tissue during application of the DTR method, it is necessary to know the features of bone tissue regeneration, and also its physiological and reparative stages. Physiological regeneration is a gradual and slow process of restoring the healthy body tissues with affected vital activity, while reparative regeneration involves restoration of the lost tissues due to injuries. Bone tissue may involve several stages of repairing and restoration of its anatomical structure and functional adaptability, comparatively with the highly differentiated tissues, which form paunch during their healing process. The natural sources of bone regeneration are proliferation of the cambium cell layer of the periosteum, endosteum, insufficiently differentiated bone marrow cells, paraosal tissues metaplasia. Additional sources of stimulation of bone regeneration refer to mechanical, physical, medicinal and biological stimulations [5]. One of the biological stimulation techniques makes use of bone-plastic materials. The modern osteo-SODVWLFPDWHULDOVDUHFODVVLÀHGDV

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Pavel SIDELNIKOV

extraoral (e.g., iliac crest) and intraoral (e.g., maxillary tuberosity or retromolar part of the lower jaw) areas.

2. Allogeneic transplants (allotransplants) – the tissues are transplanted within one species from one genetically different individual to another.

3. Xenogeneic transplants (xenotransplants) – the tissue is obtained from individuals of another species.

4. Alloplastic materials - synthetic or inorganic materials, used as bone substitutes [6-8].

The currently used osteo-plastic materials are “Collopan”, “KerGAP», «Riotec», HTR, Bio-Oss ® and others.

Regardless of the type and group of these materials, it is important to comply the bone material with the surgery requirements of the clinician, namely the bone should be natural and safe to use for both doctor and patient. The bone replacer should be dissolved in a precisely VSHFLÀHGSHULRGRIWLPHVRWKDWWKHGRFWRUFRXOG predict his future actions. Another important property of the osteoplastic material is that of treating various disorders of bone tissue, while also stimulating osteogenesis. No doubt, bone replacers should be easy to use.

In the opinion of the author, Bio-Oss ® (“Geistlich Pharma AG”) meets almost fully all these requirements [5].

$LPStudy of the clinical and morphological characteristics of Bio-Oss ® and Bio-Gate ® materials during bone-plastic operations, especially bone regeneration after surgical interventions.

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The material considered for the pathomorphological study was the intravital biopsy material of bone tissue from augmentation areas, obtained during implant placement operations. Clinical studies involved both subjective and objective methods, in particular X-ray analysis and photo documenting. The Bio-Oss ® material, Bio-Gide ® membranes, Bio-Gide ® Perio, Resor-Pin pins, U-impl implant system were investigated. Bio-Oss ®, used in its pure form in this study, is a naturally porous K\GUR[\DSDWKLWHRIEXOOLVKRULJLQZLWKVLJQLÀFDQW

RVWHRFRQGXFWLYHHIIHFWDQGPPJUDLQVL]H The Bio-Gide ® and Bio-Gide ® Perio bilayer UHVRUEHGPHPEUDQHVDUHPDGHRIKLJKO\SXULÀHG type I and III collagen of porcine origin. The PHPEUDQHVDFWDVVLJQLÀFDQWEDUULHUVIRUVHYHUDO months [9].

The principle of osteogenesis when using a Bio-Oss ® osteoconductive material is the following: the matrix is placed in the bone defect, DQGLWVWDELOL]HVWKHEORRGFORW7KHQQHZEORRG vessels grow into the defect and the process of cell differentiation and bone formation begins on the solid matrix. Within approximately six months, bone regeneration is completed, and bone remodeling occurs (Figs. 1,2). The intravital biopsy material of bone tissue was obtained from patients subjected to subantral augmentation before installing the implants.

The operations were carried out by the classical method described by Boyne and James, and the recommendations of Ole T. Jensen [10] on the classical access to Caldwell-Luc.

Bone biopsies were obtained at different times (3-12 months) using 2 mm in diameter bone trephines. Morphological studies were carried out in the Department of Pathological Anatomy - AMS Institute of Oncology of Ukraine (head - prof. Galakhin K.S.) [11]. The bone biopsy was immersed into a fixing solution (20% formaldehyde) for minimum 48 hours. 'HFDOFLÀFDWLRQ ZDV FDUULHG RXW LQ DQ DTXHRXV solution of nitric acid (5-7.5%). The average GXUDWLRQ RI GHFDOFLÀFDWLRQ ZDV RI KRXUV Further on, the preparation was placed for 24 hours in 96% alcohol and washed thoroughly XQGHUÁRZLQJZDWHUIRUGD\V3UHSDUDWLRQRI the material for the study, carried out in an AT-4M apparatus, involved treatments with FKORURIRUPDQGSDUDIÀQ7KHPDWHULDOZDVSODFHG LQSDUDIÀQEORFNVDQGVOLFHVSUHYLRXVO\FRROHG GRZQ LQ WKH IUHH]HU ZHUH REWDLQHG XVLQJ D microtome. The prepared slices were placed on a glass slide and kept for 1 hour in a thermostate, at 37°C. Hematoxylin-eosin staining was carried out according to the standard method (involving dewaxing and subsequent covering with balsam). 7KHVDPSOHVZHUHVWXGLHGDW[PDJQLÀFDWLRQ and photographed.

International Journal of Medical Dentistry 25

CLINICO-MORPHOLOGICAL RESEARCH OF BIO-OSS ® DURING BONE-PLASTIC OPERATIONS

of sinus lifting, 145 - bone plasty with simultaneous implantation and 48 cases of periodontal surgery.

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Study of the preparations evidenced the following aspects:

- 3 months after the introduction of the Bio-Oss ® implant in the augmentation area around WKHLPSODQWDQDFWLYHÀEUREODVWLFUHDFWLRQSDUWLDO biodegradation of material and formation of young bone tissue were observed (Fig. 3).

- 8 months later, integration of the implant fragment (Bio-Oss ®) within the natural bone RFFXUUHGDVLJQLÀFDQWERQHDFWLYLW\LQWKHDUHD adjoining the Bio-Oss ® being revealed.

- 10 months later, active biodegradation of Bio-Oss ® particles and formation of a new bone were observed (Fig. 4).

- 12 months later, the full bone tissue was formed, as evidenced by a uniform staining on KLVWRORJLFDOSUHSDUDWLRQÀOOLQJRIWKH+DYHUVLDQ FDQDO ZLWK FDSLOODU\ DQG ZLWK LQVLJQLÀFDQW fragments of unresorbed Bio-Oss ® (Fig. 5).

The results of the clinical study are presented in Table 1.

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Sinus lifting 38 1 Early implantation (6 months

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Bone plasty with simultaneous implantation

145 2 Early load

Periodontal surgery 48 3 )RUPDWLRQRIÀEURXV

capsules

Thus, in all three groups of patients, a highly positive clinical result was noticed: during sinus lifting in 97.4% of cases, with osteoplastic operations and simultaneous implantation in 99% of cases, with plastic of alveolar bone during the treatment of generalized periodontitis - in 93.75% of cases.

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Usage of bone-plastic Bio-Oss ® and Bio-Gate ® materials for various bone-plastic and periodontal operations provides a high clinical effect (from 93% to 99%). Morphologically, it has been found out that, after Bio-Oss ® and Bio-Gate ŠXWLOL]DWLRQDQHZRVWHRLGWLVVXHZDVIRUPHG similar to the bone tissue of the alveolar process, ZLWK KLJK OHYHOV RI PLQHUDOL]DWLRQ HVSHFLDOO\ ZLWKLQWKHÀUVW\HDUVGXHWRWKHVLPXOWDQHRXV resorption of the material. The newly formed tissue has a classical design and can fully perform the functions of the jaw bones, particularly favorable for carrying loads transmitted with teeth or implants.

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1. Zablotskiy Y.V. (2003) The new philosophy of orthopedic

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implants. Modern Dentistry, 3, 85-95.

2. Paraskevich V.L. (2002) Methods of application monocortical allotransplants bone in sinus lift operation. Dentistry News, 2, 4-17.

3. Uhryn M. (2001) ([SHULHQFHZLWKWKHWHFKQLTXHRIUDLVLQJ

WKHÀRRURIWKHPD[LOODU\VLQXVGXULQJGHQWDOLPSODQWDWLRQ.

News of dentistry. 4, 6-9.

4. Ackerman K.L., Kirsch A. (2003) Improving prediction of bone regeneration using barrier membranes Bio-Gide ®. Dentistry News, 4, 34-39.

5. Olexa A.P. Traumatology. – Playbill, 1996.

6. Opanasiuk I.V., Opanasiuk Yu.V. (2002) Osteo-plastic materials in modern dentistry. Alloplastic materials. Modern Dentistry, 3, 101-105.

7. Skulan A. Jensen S. (2005) Biomaterials for the reconstructive treatment of intraosseous periodontal defects. Part I. Bone and bone substitute materials. Perio IQ, 1, 21-31.

8. Skulan A. Jensen S. (2005) Biomaterials for the reconstructive treatment of intraosseous periodontal defects. Part II. Guided tissue regeneration. Biological agents and combination therapy. Perio IQ, 2, 9-22.

9. 0DLRUDQDɋ6LPLRQ0$GYDQFHGWHFKQLTXHVIRU

bone regeneration with Bio-Oss and Bio-Gide, RC Libri S.r.I, 89-101.

10. -HQVHQɈɌThe sinus bone graft, Quintessence Publishing Co, Inc.