• Journal of Periodontal and Implant Science
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• v.42 no.4
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• pp.127-135
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• 2012

Purpose: The aim of this study was to compare the clinical outcome of open flap debridement (OFD) with a biphasic calcium phosphate (BCP) graft to that of OFD without BCP graft for the treatment of intrabony periodontal defects (IBDs). Methods: The study included 25 subjects that had at least one intrabony defect of 2- or 3-wall morphology and an intrabony component ${\geq}4$ mm as detected radiographically. Subjects were randomly assigned to treatment with (BCP group, n=14) or without BCP (OFD group, n=11). Clinical parameters were recorded at baseline and 6 months after surgery and included the plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). A stringent plaque control regimen was enforced for all of the patients during the 6-month observation period. Results: In all of the treatment groups, significant PD reductions and CAL gains occurred during the study period (P<0.01). At 6 months, patients in the BCP group exhibited a mean PD reduction of $3.7{\pm}1.2$ mm and a mean CAL gain of $3.0{\pm}1.1$ mm compared to the baseline. Corresponding values for the patients treated with OFD were $2.5{\pm}0.8$ mm and $1.4{\pm}1.0$ mm, respectively. Compared to OFD group, the additional CAL gain was significantly greater in the patients in BCP group (P=0.028). The additional PD reduction was significant for the BCP group (P=0.048). The REC showed a significant increase in both groups, and the amount of recession was significantly smaller in the BCP group than OFD group (P=0.023). In radiographic evaluation, the height of the bone fill in the BCP group was significantly greater than OFD group. Conclusions: The clinical benefits of BCP found in this study indicate that BCP may be an appropriate alternative to conventional graft materials.

• Journal of Periodontal and Implant Science
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• v.27 no.1
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• pp.249-262
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• 1997

The present study investigates the effects of calcium sulfate graft on the periodontal healing in intrabony periodontal defects of dogs. Following the general anesthesia with 30mg/kg pentobarbital injected intravenously, the first premolar was extracted and full-thickness periodontal flap was elevated from the second premolar to the fourth premolar. The portion of premolars coronal to the alveolar crest was removed and mesial and distal roots were separated. Exposed root canals were sealed with Caviton and covered completely with flaps sutured. Following the healing period of 12 weeks, the surgical sited were uncovered and $4{\times}4mm$ intrabony defects were surgically created. Those defects with calcium sulfate graft following the root planing was designated as the test sites and those with flap surgery-only were designated as control sites. The animals were sacrificed after 8 weeks and the healing was histologically analyzed. The results were as follows. 1. No foreign body reaction or inflammation were observed in either groups. Calcium sulfate was completely resorbed in the test sites. 2. New cementum was observed coronal to the notch in both groups. Connective tissue fibers were oriented parallel to the root surface in the controls. Connective tissues were formed in large amount in the sites. 3. Test sites showed marked amount of new bone formation while the control sites showed minimal bone gain. 4. Root resorption was observed in coronal portions of th control Sites. The results suggest that calcium sulfate is a biocompatible graft material with a potential for new bone and cementum formation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.5
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• pp.405-418
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• 2007

Mesenchymal stem cells(MSCs) have been though to be multipotent cells that can replicate that have the potential to differentiate into lineages of mesenchymal tissue including the bone, cartilage, fat, tendon, muscle, and marrow stroma. Especially, scaffolds to support cell-based tissue engineering are critical determinants of clinical efforts to regenerate and repair the body. Selection of a matrix carrier imvolves consideration of the matrix's role as a scaffold for physical support and host tissue integration as well as its ability to support of synergize the osteoinductive program of the implanted mesenchymal stem cell. The aim of this study is to evaluate the effect of autobone and Bio-$Oss^{(R)}$ to adherent mesenchymal stem cells as scaffolds on sinus augmentation with fibrin glue mixture in a rabbit model. 16 New Zealand White rabbits were divided randomly into 4 groups based on their time of sacrifice(1, 2, 4 and 8 weeks). First, mesenchymal stem cells were isolated from iliac crest marrow of rabbits and expanded in vitro. Cell culture was performed in accordance with the technique described by Tsutsumi et al. In the present study, the animals were sacrificed at 1, 2, 4 and 8 weeks after transplantation, and the bone formation ability of each sides was evaluated clinically, radiologically, histologically and histomorphologically. According to the histological observations, autobone scaffolds group showed integrated graft bone with host bone from sinus wall. At 2 and 4 weeks, it showed active newly formed bone and neovascularization. At 8 weeks, lamellae bone was observed in sinus graft material area. Radiologically, autobone with stem cell showed more radiopaque than Bio-$Oss^{(R)}$ scaffolds group. there were significant differences in bone volume between 4 and 8 weeks(p<0.05).

• Journal of Veterinary Clinics
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• v.32 no.5
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• pp.410-416
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• 2015

Bone grafting is widely used to bridge major bone defects or to promote bone union. In the evaluation of bone defect regeneration, 5 mm-diameter defects were created in rabbit calvaria. Concerning biocompatibility, fibrous capsule thickness of CBHA (hydroxyapatite from cuttlebone) was significantly thinner than that of CB (cuttlebone) and CHA (hydroxyapatite from coral) (p < 0.05) at 2 and 4 weeks after implantation. Concerning 12-week total changes of radiologic gray-level histogram, CBHA was significantly higher than CHA (p < 0.05). In the evaluation of bone defect regeneration, bone formation of CHA was significantly higher than that of CB and CBHA (p < 0.05). Based on the clinical and histological results, CBHA would be a safe material for use inside the body and has more effective osteoconduction than CB. It is suggested that CBHA is a valuable bone graft material.

• Journal of Periodontal and Implant Science
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• v.50 no.1
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• pp.14-27
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• 2020

Purpose: To overcome several drawbacks of chemically-crosslinked collagen membranes, modification processes such as ultraviolet (UV) crosslinking and the addition of biphasic calcium phosphate (BCP) to collagen membranes have been introduced. This study evaluated the efficacy and biocompatibility of BCP-supplemented UV-crosslinked collagen membrane for guided bone regeneration (GBR) in a rabbit calvarial model. Methods: Four circular bone defects (diameter, 8 mm) were created in the calvarium of 10 rabbits. Each defect was randomly allocated to one of the following groups: 1) the sham control group (spontaneous healing); 2) the M group (defect coverage with a BCP-supplemented UV-crosslinked collagen membrane and no graft material); 3) the BG (defects filled with BCP particles without membrane coverage); and 4) the BG+M group (defects filled with BCP particles and covered with a BCP-supplemented UV-crosslinked collagen membrane in a conventional GBR procedure). At 2 and 8 weeks, rabbits were sacrificed, and experimental defects were investigated histologically and by micro-computed tomography (micro-CT). Results: In both micro-CT and histometric analyses, the BG and BG+M groups at both 2 and 8 weeks showed significantly higher new bone formation than the control group. On micro-CT, the new bone volume of the BG+M group (48.39±5.47 ㎣) was larger than that of the BG group (38.71±2.24 ㎣, P=0.032) at 8 weeks. Histologically, greater new bone area was observed in the BG+M group than in the BG or M groups. BCP-supplemented UV-crosslinked collagen membrane did not cause an abnormal cellular reaction and was stable until 8 weeks. Conclusions: Enhanced new bone formation in GBR can be achieved by simultaneously using bone graft material and a BCP-supplemented UV-crosslinked collagen membrane, which showed high biocompatibility and resistance to degradation, making it a biocompatible alternative to chemically-crosslinked collagen membranes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.5
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• pp.380-385
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• 2011

Introduction: Hydroxyapatite ($Ca_{10}(PO_4)_6(OH)_2$, HA) is the main inorganic phase of human hard tissue that is used widely as the repair material for bones. When HA is applied to a bony defect, however, it can be encapsulated with fibrous tissue and float in the implanted area due to a lack of consolidation. Bioceramics as allogenic graft materials are added to HA to improve the rate and bone healing capacity. Fluoridated hydroxyapatite ($Ca_{10}(PO_4)_6(OH,F)_2$, FHA), where F- partially replaces the OH- in hydroxyapatite, is considered a good alternative material for bone repair owing to its solubility and biocompatibility. Materials and Methods: This study was designed to determine the bone healing capacity of FHA newly produced as a nanoscale fiber in the laboratory. HA and FHA with bioglass was implanted in a rabbit cranium defect and the specimen was analysed histologically. Results: 1. At 4 weeks, fibrous connective tissue and little bone formation was observed around the materials of the experimental group I implanted HA and bioglass. Newly formed bone was observed around the materials in the experimental group II implanted FHA and bioglass. 2. At 8 weeks, the amount of newly formed and matured bone was higher in experimental group II than in experimental group I and the control group. Conclusion: These results suggest that FHA and bioglass is a relatively favorable bone substitute with biocompatibility and better bone healing capacity than pure HA and bioglass.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.2
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• pp.51-67
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• 2019

As dental implant surgery and bone grafts were widely operated in Korean dentist, many bone substitutes are commercially available, currently. For commercially used in Korea, all bone substitutes are firstly evaluated by the Ministry of Health and Welfare (MOHW) for safety and efficacy of the product. After being priced, classified, and registration by the Health Insurance Review and Assessment Service (HIRA), the post-application management is obligatory for the manufacturer (or representative importer) to receive a certificate of Good Manufacturing Practice by Ministry of Food and Drug Safety. Currently, bone substitutes are broadly classified into C group (bone union and fracture fixation), T group (human tissue), L group (general and dental material) and non-insurance material group in MOHW notification No. 2018-248. Among them, bone substitutes classified as dental materials (L7) are divided as xenograft and alloplastic bone graft. The purpose of this paper is to analyze alloplastic bone substitutes of 37 products in MOHW notification No. 2018-248 and to evaluate the reference level based on the ISI Web of Knowledge, PubMed, EMBASE (1980-2019), Cochrane Database, and Google Scholar using the criteria of registered or trademarked product name.

• Journal of Periodontal and Implant Science
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• v.38 no.sup2
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• pp.309-316
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• 2008

Purpose: The aim of this study was to determine the survival rates of implants placed in grafted maxillary sinuses and compare the results obtained with graft materials, implant surfaces and timing of implant placement. Materials and Methods: Between January 1996 and December 2005, 391 implants were placed in 161 patients who underwent sinus grafting treatment simultaneously or separately at Ewha Womans University Hospital. According to inclusion criteria, 272 implants were placed in 102 patients with 112 sinus grafts (30 females, 72 males), aged 26 to 88 years (mean age $49.0{\pm}9.7$). The follow-up period ranged from 12 to 134 months (mean F/U $47{\pm}32$). Survival rates were evaluated according to graft material, implant surface and timing of implant placement. The Kaplan-Meier procedure and the log rank (Mantel-Cox) test were used to estimate survival rates and test for equality of survival rates between different groups of patients. Results: Ten-year cumulative survival rate for implants placed in the grafted sinuses was 90.1%. The survival rates for autogenous bone, combination and bone substitutes were 94.6%, 85.9% and 100%, respectively (p > 0.05). According to implant surface, survival rates were 84.8% in machined group and 97.5% in rough group (p < 0.05). The survival rates were 92.9% in delayed group and 86.0% in simultaneous group (p > 0.05). Conclusion: Ten-year cumulative survival rate for implants placed in the grafted sinuses was 90.1%. Rough-surfaced implants have a higher survival rate than machined-surfaced implants when placed in grafted sinuses (p < 0.05).

• Journal of Periodontal and Implant Science
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• v.49 no.3
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• pp.171-184
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• 2019

Purpose: To evaluate the effects of intra-alveolar socket grafting, subepithelial connective tissue grafts, and individualized abutments on peri-implant hard and soft tissue outcomes following immediate implant placement. Methods: This randomized experimental study employed 5 mongrel dogs, with 4 sites per dog (total of 20 sites). The mesial roots of P3 and P4 were extracted in each hemimandible and immediate dental implants were placed. Each site was randomly assigned to 1 of 4 different treatment groups: standardized healing abutment (control group), alloplastic bone substitute material (BSS) + standardized healing abutment (SA group), BSS + individualized healing abutment (IA group), and BSS + individualized healing abutment + a subepithelial connective tissue graft (IAG group). Clinical, histological, and profilometric analyses were performed. The intergroup differences were calculated using the Bonferroni test, setting statistical significance at P<0.05. Results: Clinically, the control and SA groups demonstrated a coronal shift in the buccal height of the mucosa ($0.88{\pm}0.48mm$ and $0.37{\pm}1.1mm$, respectively). The IA and IAG groups exhibited an apical shift of the mucosa ($-0.7{\pm}1.15mm$ and $-1.1{\pm}0.96mm$, respectively). Histologically, the SA and control groups demonstrated marginal mucosa heights of $4.1{\pm}0.28mm$ and $4.0{\pm}0.53mm$ relative to the implant shoulder, respectively. The IA and IAG groups, in contrast, only showed a height of 2.6mm. In addition, the height of the mucosa in relation to the most coronal buccal bone crest or bone substitute particles was not significantly different among the groups. Volumetrically, the IA group ($-0.73{\pm}0.46mm$) lost less volume on the buccal side than the control ($-0.93{\pm}0.44mm$), SA ($-0.97{\pm}0.73mm$), and IAG ($-0.88{\pm}0.45mm$) groups. Conclusions: The control group demonstrated the most favorable change of height of the margo mucosae and the largest dimensions of the peri-implant soft tissues. However, the addition of a bone substitute material and an individualized healing abutment resulted in slightly better preservation of the peri-implant soft tissue contour.

• Journal of Veterinary Clinics
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• v.32 no.5
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• pp.417-421
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• 2015

Bone grafting is widely used to bridge major bone defects or to promote bone union. Natural calcium carbonate (CC) has been used as a bone substitute material and used to scaffold for bone morphogenetic protein (BMP). The aims of this study is to evaluate the biocompatibility of cuttlebone (CB) and hydroxyapatite from CB (CBHA). Each material was shaped into disks (5 mm in diameter and 2 mm in thickness). To test biocompatibility, the disks were implanted into the dorsal subcutaneous tissue in mice. Fibrous capsule thickness around each disk was evaluated histologically at 2 and 4 weeks after implantation. Concerning biocompatibility, fibrous capsule thickness of CBHA was significantly thinner than that of CB and CHA (p < 0.05) at 2 and 4 weeks after implantation. Based on the clinical and histological results, CBHA would be a safe material for use inside the body and has more effective osteoconduction than CB.