Histological observation of excellent bony remodeling in xenogenic bone graft for dental implant

김연숙,이석근 대한구강악안면병리학회 2017 대한구강악안면병리학회지 Vol.41 No.1

With the multiple practices of bone graft using different artificial bone regenerative substitutes, the bone graft procedures have been widely performed to increase the bony stabilization of dental implant. Xenogenic bone graft materials have been well developed because of their good biocompatibility and abundant source of bone materials. The present study demonstrated the histological findings from excellent bony remodeling in xenogenic bone graft biopsies compared to those findings in autogenous bone graft. For the graft bone biopsies which were usually done in 5-9 months after graft bone insertion, five types of histological grades including excellent, favorable, partial, degenerative, and poor bony remodeling could be assessed to give prognostic information for dental implant. However, recently the xenograft bone materials have been much improved and produced strong osteogenic effect. Among 239 cases of trephine bur-supported core bone biopsy the excellent bony remodeling was found in 20 cases (13.1%) out of 153 xenogenic bone grafts and in 13 cases (43.3%) out of 30 autogenous bone grafts. They produced abundant new bones on the surface of the graft bones in 5–9 months, and the graft bones were partly resorbed and also surrounded by the repetitive deposition of new bone. The osteophytic new bones showed strong birefringence under polarizing microscope, and were gradually elongated and anastomosed with each other to form trabecular bony networks which became proper stress-baring structures for dental implant. Their marrow stromal tissues were composed of loose connective tissue which was well vascularized but rarely infiltrated with inflammatory cells. The present study compared the histological features of excellent bony remodeling between xenogenic and autogenous bone grafts. Although the ratio of excellent bony remodeling in xenogenic bone graft was still low, 13.1%, the recent advance of xenogeic bone products was remarkable in biological aspect and almost comparable to the autogenous bones. Therefore, it was suggested that the xenogenic bone graft will be applicable to the bone regeneration procedures for dental implant with beneficial output in the near future.

개의 비유합(非癒合) 골절(骨折) model에 있어서 동결건조골이식(凍結乾燥骨移植)의 효과(效果)

최인혁,김현경,김남수,사사키 노부오,Choi, In-hyuk,Kim, Hyeon-gyeong,Kim, Nam-soo,Sasaki, Nobuo 대한수의학회 1996 大韓獸醫學會誌 Vol.36 No.2

To investigate the effectiveness of the freeze-dried allografts and fibrin glue in bone grafts, the status of new bone formation and union of the grafted bone were observed in three types of grafting bones; autogenic bone(AT), allogenic bone(AL), and allogenic bone particles mixed with fibrin glue(FG). These were transplanted into non-union fracture model of 7 adult dogs with 2cm defect made in the proximal metaphysis of both fibulae. The autogenic and allogenic grafting bones had been treated by a modified freeze-dried method. The serial radiogram were observed the repair process of grafted bones biweekly until 17 or 21 weeks after transplantation and the observation of histological aspects, tetracycline double labeling and microradiography in the grafted bones were undertaken at 17 or 21 weeks after transplantation. The incorporation of bone minerals to the non-union fracture models were accomplished in 4 of 5 cases grafted with AL and in 2 of 4 cases grafted with AT. None of 5 cases grafted with FG were incorporated. The process of new bone formation and resorption in the grafted bones were observed three types; resorption of the grafted bones after newbone formation(type A) in 4 cases, new bone formation after resorption(type B) in 2 cases and complete or incomplete resorption without new bone formation(type C) in 8 cases. The modified freeze-dried method used in this study contributed to inhibite the rejection in allogenic grafts but the union period of the grafted freeze-dried bone was more prolonged than that of fresh autografts. Fibrin glue did not contribute to induce a new bone formation ofbone grafts.

Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes

( Jae Hwi Han ),( Hyun Jung Kim ),( Jae Gwang Song ),( Jae Hyuk Yang ),( Nikhl N Bhandare ),( Aldrich Raymund Fernandez ),( Hyung Jun Park ),( Kyung Wook Nha ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.4

Purpose: Bone grafting in opening wedge high tibial osteotomy (OWHTO) is still controversial. The purpose of this study is to compare the radiological outcomes of OWHTO with bone graft (autogenous, allogenous, and synthetic bone graft) and those without bone graft. Materials and Methods: PubMed, MEDLINE, EMBASE and Cochrane Register of Studies databases were searched using specific inclusion and exclusion criteria for radiological studies involving OWHTO with bone graft and without bone graft groups. All reported delayed union, nonunion and correction loss were analyzed. Data were searched from the time period of January 2000 through July 2014. In addition, a modified Coleman methodology score (CMS) system was used to assess the methodological quality of the included studies. Results: Twenty-five studies with a mean CMS value of 77 (range, 61 to 85 score) were included. In total, 1,841 patients underwent OWHTO using 4 different procedures for bone graft: autobone graft (n=352), allobone graft (n=547), synthetic bone graft (n=541) and no bone graft (n=401). There was a similar tendency for delayed union, nonunion and correction loss rate among the osteotomy space filling methods. Conclusions: The meta-analysis showed there was a similar tendency for radiological union and correction maintenance among patients undergoing OWHTO regardless of the type of bone in all of the studies. However, the currently available evidence is not sufficient to strongly support the superiority of OWHTO with bone graft to OWHTO without bone graft.

치과용 임플란트를 위한 이종골 이식에서 보이는 우수한 골재건의 조직학적 관찰

Yeon Sook Kim,Suk Keun Lee 대한구강악안면병리학회 2017 대한구강악안면병리학회지 Vol.41 No.1

With the multiple practices of bone graft using different artificial bone regenerative substitutes, the bone graft procedures have been widely performed to increase the bony stabilization of dental implant. Xenogenic bone graft materials have been well developed because of their good biocompatibility and abundant source of bone materials. The present study demonstrated the histological findings from excellent bony remodeling in xenogenic bone graft biopsies compared to those findings in autogenous bone graft. For the graft bone biopsies which were usually done in 5-9 months after graft bone insertion, five types of histological grades including excellent, favorable, partial, degenerative, and poor bony remodeling could be assessed to give prognostic information for dental implant. However, recently the xenograft bone materials have been much improved and produced strong osteogenic effect. Among 239 cases of trephine bur-supported core bone biopsy the excellent bony remodeling was found in 20 cases (13.1%) out of 153 xenogenic bone grafts and in 13 cases (43.3%) out of 30 autogenous bone grafts. They produced abundant new bones on the surface of the graft bones in 5–9 months, and the graft bones were partly resorbed and also surrounded by the repetitive deposition of new bone. The osteophytic new bones showed strong birefringence under polarizing microscope, and were gradually elongated and anastomosed with each other to form trabecular bony networks which became proper stress-baring structures for dental implant. Their marrow stromal tissues were composed of loose connective tissue which was well vascularized but rarely infiltrated with inflammatory cells. The present study compared the histological features of excellent bony remodeling between xenogenic and autogenous bone grafts. Although the ratio of excellent bony remodeling in xenogenic bone graft was still low, 13.1%, the recent advance of xenogeic bone products was remarkable in biological aspect and almost comparable to the autogenous bones. Therefore, it was suggested that the xenogenic bone graft will be applicable to the bone regeneration procedures for dental implant with beneficial output in the near future.

가토의 두개골에서 티타늄 반구를 이용한 다양한 onlay bone graft시 골형성 능력

박영준,최근호,장정록,정승곤,한만승,유민기,국민석,박홍주,유선열,오희균,Park, Young-Jun,Choi, Guen-Ho,Jang, Jung-Rok,Jung, Seung-Gon,Han, Man-Seung,Yu, Min-Gi,Kook, Min-Suk,Park, Hong-Ju,Ryu, Sun-Youl,Oh, Hee-Kyun 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.6

육안적 검사결과 실험군과 대조군 모두에서 특별한 염증 소견이나 창상 이개 없이 반원 모양의 골형성이 관찰되었다. 조직학적으로 3주째에 대조군, 실험 1군, 실험2군, 실험 3군 모두 이식골 주위 및 티타늄 반구 내면을 따라 신생 골형성이 관찰되었다. 조직학적으로 6주째에 모든 군에서 3주째에 비하여 신생골 면적의 증가 및 성숙 소견이 관찰되었고, 실험2군에서는 부분적으로 이식골이 흡수되면서 신생골이 형성되는 것이 관찰된 반면, 실험 3군에서는 이식골의 흡수 소견이 관찰되지 않았다. 조직형태계측학적으로 3주, 6주 모두 자가골에서 가장 많은 신생골 형성이 나타났고, 신생골 면적 비교시 자가골, 이종골, 합성골 순으로 크게 나타났고, 각 군간의 통계학적으로 유의한 차이는 없었다(p>0.05). 본 연구결과 골유도 재생술시 골형성 능력은 자가골이 가장 좋지만, 자가골 채취가 불가능할 경우, 적절한 차폐막을 사용한 합성골과 이종골 복합 이식방식도 좋은 대체제가 될 것으로 생각된다. Purpose: This study was performed to evaluate the effect of various graft materials used with a titanium cap on the ability of new bone formation in the rabbit calvarium. Materials and Methods: A total of 32 sites of artificial bony defects were prepared on the calvaria of sixteen rabbits by using a trephine bur 8 mm in diameter. Each rabbit had two defect sites. 0.2 mm deep grooves were formed on the calvaria of sixteen rabbits by using a trephine bur 8 mm in diameter for the fixation of a titanium cap. The treatments were performed respectively as follows: without any graft for the control group (n=8), autogenous iliac bone graft for experimental group 1 (n=8), alloplastic bone graft ($SynthoGraft^{(R)}$, USA) for experimental group 2 (n=8), and xenogenic bone graft ($NuOss^{(R)}$, USA) for experimental group 3 (n=8). After the treatments, a titanium cap (8 mm in diameter, 4 mm high, and 0.2 mm thick) was fixed into the groove. At the third and sixth postoperative weeks, rabbits in each group were sacrificed for histological analysis. Results: 1. In gross examination, the surgical sites showed no signs of inflammation or wound dehiscence, and semicircular-shaped bone remodeling was shown both in the experimental and control groups. 2. In histological analysis, the control group at the third week showed bone remodeling along the inner surface of the cap and at the contact region of the calvarium without any specific infiltration of inflammation tissue. Also, there was no soft tissue infiltration. Bone remodeling was observed around the grafted bone and along the inner surface of the titanium cap in experimental group 1, 2, and 3. 3. Histologically, all groups at the sixth week showed the increased area of bone remodeling and maturation compared to those at the third week. In experimental group 2, the grafted bone was partially absorbed by multi nucleated giant cells and new bone was formed by osteoblasts. In group 3, however, resorption of the grafted bone was not observed. 4. Autogenous bone at the third and sixth week showed the most powerful ability of new bone formation. The size of newly formed bone was in decreasing order by autogenous, alloplastic, and heterogenous bone graft. There was no statistically significant difference among autogenous, alloplastic, and heterogenous bones(p>0.05). Summary: This result suggests that autogenous bone is the best choice for new bone formation, but when autogenous bone graft is in limited availability, alloplastic and xenogenic bone graft also can be an alternative bone graft material to use with a suitably guided membrane.

치조열에서 재 시행한 골이식의 분석

고경석,이성욱,최종우,이영규,권순만 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.3

Purpose: The most widely accepted protocol for alveolar cleft reconstruction is to repair it during the mixed dentition stage. There were lower resorption rate (about 88%) at this stage. However we found some cases that need repeated bone grafting. Therefore we sought to analyze the cause of repeated alveolar bone grafting in connection with other factors. Methods: From January 2000 to January 2006, thirty-nine secondary alveolar bone grafts with iliac crest spongiosa were carried out. In 39 patients, 5 patients who had significant bone graft resorption received repeated alveolar bone graft. In all the cases, the causes of repeated bone grafts were dental root exposure(angulation), and the deficiency of the bony support for lateral incisor or canine eruption. In 3 cases, there was deficiency of the alveolar bone at the cleft side. There was the need of repeated bone grafts for orthodontic treatment in 2 cases and for application of dental implants in 1 case. Results: During the follow-up period, the clinical and radiologic examinations showed that repeated alveolar bone grafts were maintained successfully without any complications. The volume of the repeated bone graft was sufficient for orthodontic treatment and implantation. Conclusion: The essential conditions for successful alveolar bone grafting includes the status of cleft sided teeth, further treatment and planed schedule, as well as canine eruption. Alveolar bone grafting has to be performed with difference of each case in mind.

Use of mandibular chin bone for alveolar bone grafting in cleft patients

Park, Young-Wook,Lee, Jang-Ha Korean Association of Maxillofacial Plastic and Re 2016 Maxillofacial Plastic Reconstructive Surgery Vol.38 No.-

Background: We evaluated and compared the outcomes of different ossification processes in patients with alveolar cleft in whom correction was performed using endochondral bone graft or intramembranous bone graft. Methods: The patients were divided into two groups: the endochondral bone (iliac bone or rib bone) graft group and the intramembranous bone (mandibular bone) graft group. Medical records and radiologic images of patients who underwent alveolar bone grafting due to alveolar cleft were analyzed retrospectively. Through postoperative and follow-up radiologic images, the height of the interdental bone septum was classified into four types based on the highest point of alveolar ridge. Then, the height of the interdental bone septum and the area of the bone graft were evaluated according to the type of bone graft. In addition, the occurrence of complications and the need for an additional bone graft, the result of postoperative orthodontic treatment, and the eruption of impacted teeth were investigated. Results: Thirty patients were included in this study. There was no significant difference in the change of the interdental bone height and the area of the bone graft according to the type of bone. There was no significant difference in the success rate of the surgery according to the type of bone. One patient underwent an additional bone graft surgery during the follow-up period. Conclusions: The outcomes of alveolar bone grafting were not significantly different according to the type of bone graft. If appropriate to the size of the recipient site, the chin bone is a useful graft material in alveolar cleft, as is the iliac bone.

혈행차단에 따른 두개골외판 이식의 생존 차이

박관규,박성근,한기환,강진성 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.1

Difficulties arise in prediction of maintenance of the graft volume and viability of graft over time when a bone graft used for facial reconstruction. A bone-to-bone contact between the graft and the recipient bone is imporant for creeping substitution and survial of the recipient bone is important for creeping substitution and of the grafted bone. An adequate blood supply is also essential to ensure the survival of any live cells of the surface of the graft. Our study was designed to determine which one is an important factor viability of the grafted bone in Korean adult dogs : a bone-to-bone contact or overlying soft tissue. Blocks of outer table of the parietal bone were placed at the maxillae subperiostially in 4 different ways : bone-to-bone contact groups(groups Ⅰand Ⅱ)with placing a silicone membrane over the grafted bone and soft tissue contact groups(groups Ⅲand Ⅳ)with placing a silicone sheet between the grafted bone and the recipient. In groups Ⅰand Ⅲ, the cancellous surfaces of the parietal bone was placed on the recipient and the cortical surfaces were placed on the recipient in groups Ⅱ and Ⅳ. Caliper techniques were used to study the rates of volume maintenance of the grafts at 6, 12, and 20 weeks after bone grafting. The volumes of the living bone were quantified microscopically using a modified point-countiong technique. The volume is reduced in a similar rate with time in all groups. At 6 week, living bone cells increased in soft tissue contact groups Ⅲ and Ⅳ however, and increased in bone to bone contact groups Ⅰand Ⅱ at 12 and 20 weeks. there were osteoblastic proliferation and laminated mature bones in group Ⅰand Ⅱ. But osteoclasts and their associated osteolytic changes were still seen near the silicone membrane in group Ⅲ and Ⅳ, which may imply a continuing resorptive process with time. In summary, revascularization from the overlying soft tissue is important for the graft survival in early stage of the bone grafting while bone-to-bone contact may be essential in a later stage.

두개안면골격에 중첩이식된 골이식편의 운명에 영향을 미치는 요인

김준형,박관규,강진성 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

The superior volume maintenance of membranous over endochondral bone grafts, which was shown in several studies has provided the basis for its preferred clinical use as an onlay grafting material on the craniofacial skeleton. The scientific rationale for this seeming embryological advantage, however, has never been proven, Since the cortical component of membranous bone is proportionally greater than that of endochondral bone, it follows that membranous grafts would show greater volume maintenance over time. Our hypothesis is that the pattern of onlay bone graft resorption is primarily determined by a graft's micro-architecture (relative cortical and cancellous composition) rather than its embryololgical origin(membranous versus endochondral). Fourty adult New Zealand white rabbits were used for this study. There were 8 animals in each of 4 groups. The rabbits of each group were sacrificed at 3, 8, and 16 weeks. Four types of grafts were placed subperosteally, onto each rabbit's cranium: a hydroxyapatite, a cortical bone graft of membranous origin, a cortical bone graft of endochondral origin and a cancellous bone graft of endochondral origin. Membranous bone grafts were obtained from the lateral mandible and endochondral bone grafts were obtained from the ileum. In order to determine post-sacrifice volume and density of the bone grafts, a caliper technique and bone densitometry(bone densitometer: LUNAR, DPX-L, U.S.A.) were performed on all of the bone grafts. Bone graft specimens were histologically examined at 3, 8, and 16 weeks. The measurement of volume and density show that there is a statistically greater resumption in the cancellous endochondral bone grafts for all parameter, compared to either the endochondral or membranous cortical bone grafts or hydroxyapatite at all time points(p< 0.05). In addition, there is no significant difference in the resorption rates between the endochondral and membranous cortical bone grafts for all parameters at all time points. By placing cortical bone grafts and cancellous bone grafts on the recipient sites separately, we have shown that the former grafts maintain their volumes, widths and projections significantly better than the latter grafts. Futhermore, we found no statistical difference in resorption rates between the two cortical bone grafts of different embryologic origins, a finding which has never been previously shown. Bone volume fraction, measured with bone densitometry, was shown to be higher in cortical bone than in cancellous bone at all time points, further illustrating the differences between cortical and cancellous bone. From our results, we believe cortical bone to be a superior onlay-graftiong material, independent of its embryololgic origin.

난소 제거된 쥐의 두개골 결손에서 bisphosphonate와 parathyroid hormone 전신 투여 후 골 재생 평가

임지영,박경미 대한통합치과학회 2023 대한통합치과학회지 Vol.12 No.3

Although there are many studies comparing the individual effects of zoledronic acid and teriparatide in bone grafting in an osteoporotic environment, the combined effect is not well known. The purpose of this study was to compare the effects of systemic administration of zoledronic acid and teriparatide on bone regeneration at the bone graft site after bone grafting to the cranium defect in rats with osteoporosis induced by ovariectomy. Thirty-nine rats were randomly divided into 8 groups (sham ovariectomy group [sOVX, n=4]; Control group [CONT, n=5]; sham zoledronic acid group [sZA, n=5]; sham teriparatide group [sTPD, n=5]; sham zoledronic acid and sham teriparatide group [sZATPD, n=5]; zoledronic acid group [ZA, n=5]; teriparatide group [TPD, n=5]; zoledronic acid and sham teriparatide group [ZA-TPD, n=5]). A critical size defect with a diameter of 5 mm was formed on both craniums of osteoporosisinduced rats, and bone grafting was performed on only one side. The defect on both sides was covered with a collagen membrane. After bone grafting, zoledronic acid and teriparatide were administered, and all animals were sacrificed 6 weeks after bone grafting. Specimens were subjected to micro-computed tomography and histological analysis. As a result of micro-computed tomography analysis, bone mineral density in the tibia was the highest in the ZA-TPD group, followed by the zoledronic acid and teriparatide groups. Residual graft material at the site where bone grafting was performed was the highest in the TPD group, and new bone increased in the order of CONT, ZA, TPD, and ZATPD groups. The TPD group had the most new bone in the area where bone grafting was not performed, and the CONT group had the biggest BS/BV, but there was no statistically significant difference. As a result of histological morphological analysis, the remaining graft material in the bone graft site decreased in the order of CONT, ZA, TPD, and ZA-TPD groups, and the new bone increased in the order of ZA, ZA-TPD, CONT, and TPD groups. The amount of new bone in the areas where bone grafting was not performed increased in the order of ZA, CONT, TPD, and ZA-TPD groups, and the CONT and TPD groups showed a statistically significant difference from the ZA-TPD group. Zoledronic acid and teriparatide showed differences in bone regeneration at the parietal bone graft site, and the combination of the two drugs was more effective in bone regeneration.