Maxilo-facial surgery

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1
”P. L. Shupik” National Medical Academy of Postgraduate Education, Kiev, Ukraine
Corresponding author: kolenko@i.ua

$EVWUDFW implants should be installed in the places

Aim: To study the clinical and morphological
appropriate for assuring a proper functioning of
characteristics of Bio-Oss ® and Bio-Gate ® materials the orthopedic construction [1-3], which became
during bone-plastic operations, especially bone possible due to the development and introduction
regeneration after surgical interventiond. of directed tissue regeneration (DTR) as a new
0DWHULDOVDQGPHWKRG: The pathomorphological study
was performed with the intravital biopsy material of bone clinical technique, nowadays widely applied in
tissue from augmentation areas, obtained during implants implantology (plastic of alveolar bone, subantral
placement. Clinical studies included subjective and augmentation) and periodontology. The directed
objective methods, in particular X-ray analysis and photo
tissue regeneration method involves stimulation
documenting. Bio-Oss ®, Bio-Gide ®, Bio-Gide ® Perio
membranes, Resor-Pin pins, U-impl implant systems were of osteogenesis, membrane technique or, most
investigated and 231 operations were performed with Bio- important of all, combination of both techniques
Oss ® and Bio-Gate ®, of which 38 cases of sinus lifting, [4]. In order to understand the processes
145 of bone plasty with simultaneous implantation and 48
cases of periodontal surgery.
developed in the bone tissue during application
5HVXOWV Usage of bone-plastic Bio-OSS ® and Bio-Gate of the DTR method, it is necessary to know the
® materials during various bone-plastic and periodontal features of bone tissue regeneration, and also its
operations assures a high clinical effect (from 93 to 99%). physiological and reparative stages. Physiological
Morphologically, it has been observed that, after usage of
bone Bio-OSS ® and Bio-Gate ® materials, a new osteoid regeneration is a gradual and slow process of
tissue was formed, similar to the bone tissue of the alveolar restoring the healthy body tissues with affected
SURFHVVZLWKKLJKPLQHUDOL]DWLRQOHYHOVHVSHFLDOO\LQWKH vital activity, while reparative regeneration
ÀUVW  \HDUV GXH WR WKH VLPXOWDQHRXV UHVRUSWLRQ RI WKH
material. The newly-formed tissue has a classical design
involves restoration of the lost tissues due to
and can fully perform the functions of jaw bones, especially injuries. Bone tissue may involve several stages
for carrying loads transmitted with either teeth or implants. of repairing and restoration of its anatomical
.H\ZRUGV: reparative osteogenesis, bone substitutes, ǰio- structure and functional adaptability,
Oss®, subantral augmentation, Bio-Gide®, Bio-Gide Perio®,
U-Impl implants comparatively with the highly differentiated
tissues, which form paunch during their healing
,1752'8&7,21 process. The natural sources of bone regeneration
are proliferation of the cambium cell layer of the
periosteum, endosteum, insufficiently
5HOHYDQFH RI WKH VWXG\. Treatment and differentiated bone marrow cells, paraosal tissues
rehabilitation of patients with partial or complete metaplasia. Additional sources of stimulation of
loss of teeth using dental implants are largely bone regeneration refer to mechanical, physical,
applied nowadays. One of the most important medicinal and biological stimulations [5]. One of
conditions of implantation is the presence of a the biological stimulation techniques makes use
VXIÀFLHQWDPRXQWRIERQHDQGLWVTXDOLW\8QWLO of bone-plastic materials. The modern osteo-
recently, in many clinical situations, the SODVWLFPDWHULDOVDUHFODVVLÀHGDV
topographic-anatomical features of the jaws,
1. Autologous transplants – the tissue is
especially in the distal parts of the upper jaw,
transplanted from one organ to another within the
permitted no complete prosthetic treatment with
same individual. Such transplants are obtained from
implants. However, for a full rehabilitation,

International Journal of Medical Dentistry 23

Pavel SIDELNIKOV

extraoral (e.g., iliac crest) and intraoral (e.g., RVWHRFRQGXFWLYHHIIHFWDQGPPJUDLQVL]H

The Bio-Gide ® and Bio-Gide ® Perio bilayer
maxillary tuberosity or retromolar part of the lower
jaw) areas. UHVRUEHGPHPEUDQHVDUHPDGHRIKLJKO\SXULÀHG
type I and III collagen of porcine origin. The
2. Allogeneic transplants (allotransplants) – the
PHPEUDQHVDFWDVVLJQLÀFDQWEDUULHUVIRUVHYHUDO
tissues are transplanted within one species from one
genetically different individual to another. months [9].
3. Xenogeneic transplants (xenotransplants) – The principle of osteogenesis when using a
the tissue is obtained from individuals of another Bio-Oss ® osteoconductive material is the
species. following: the matrix is placed in the bone defect,
DQGLWVWDELOL]HVWKHEORRGFORW7KHQQHZEORRG
4. Alloplastic materials - synthetic or inorganic
materials, used as bone substitutes [6-8]. vessels grow into the defect and the process of
The currently used osteo-plastic materials are cell differentiation and bone formation begins on
“Collopan”, “KerGAP», «Riotec», HTR, Bio-Oss the solid matrix. Within approximately six
® and others. months, bone regeneration is completed, and
Regardless of the type and group of these bone remodeling occurs (Figs. 1,2). The intravital
materials, it is important to comply the bone biopsy material of bone tissue was obtained from
material with the surgery requirements of the patients subjected to subantral augmentation
clinician, namely the bone should be natural and before installing the implants.
safe to use for both doctor and patient. The bone The operations were carried out by the classical
replacer should be dissolved in a precisely method described by Boyne and James, and the
VSHFLÀHGSHULRGRIWLPHVRWKDWWKHGRFWRUFRXOG recommendations of Ole T. Jensen [10] on the
predict his future actions. Another important classical access to Caldwell-Luc.
property of the osteoplastic material is that of Bone biopsies were obtained at different times
treating various disorders of bone tissue, while (3-12 months) using 2 mm in diameter bone
also stimulating osteogenesis. No doubt, bone trephines. Morphological studies were carried
replacers should be easy to use. out in the Department of Pathological Anatomy
In the opinion of the author, Bio-Oss ® - AMS Institute of Oncology of Ukraine (head -
(“Geistlich Pharma AG”) meets almost fully all prof. Galakhin K.S.) [11]. The bone biopsy was
these requirements [5]. immersed into a fixing solution (20%
$LPStudy of the clinical and morphological formaldehyde) for minimum 48 hours.
characteristics of Bio-Oss ® and Bio-Gate ® 'HFDOFLÀFDWLRQ ZDV FDUULHG RXW LQ DQ DTXHRXV
materials during bone-plastic operations, solution of nitric acid (5-7.5%). The average
especially bone regeneration after surgical GXUDWLRQ RI GHFDOFLÀFDWLRQ ZDV RI  KRXUV
interventions. Further on, the preparation was placed for 24
hours in 96% alcohol and washed thoroughly
XQGHUÁRZLQJZDWHUIRUGD\V3UHSDUDWLRQRI
0$7(5,$/6$1'0(7+2'
the material for the study, carried out in an
AT-4M apparatus, involved treatments with
The material considered for the FKORURIRUPDQGSDUDIÀQ7KHPDWHULDOZDVSODFHG
pathomorphological study was the intravital LQ SDUDIÀQ EORFNV DQG VOLFHV SUHYLRXVO\ FRROHG
biopsy material of bone tissue from augmentation GRZQ LQ WKH IUHH]HU ZHUH REWDLQHG XVLQJ D
areas, obtained during implant placement microtome. The prepared slices were placed on
operations. Clinical studies involved both a glass slide and kept for 1 hour in a thermostate,
subjective and objective methods, in particular at 37°C. Hematoxylin-eosin staining was carried
X-ray analysis and photo documenting. The Bio- out according to the standard method (involving
Oss ® material, Bio-Gide ® membranes, Bio-Gide dewaxing and subsequent covering with balsam).
® Perio, Resor-Pin pins, U-impl implant system 7KHVDPSOHVZHUHVWXGLHGDW[PDJQLÀFDWLRQ
were investigated. Bio-Oss ®, used in its pure and photographed.
form in this study, is a naturally porous 231 operations were carried out with Bio-Oss
K\GUR[\DSDWKLWHRIEXOOLVKRULJLQZLWKVLJQLÀFDQW ®, Bio-Gate ® materials, among which 38 cases

24 9ROXPH‡,VVXH-DQXDU\0DUFK‡
 CLINICO-MORPHOLOGICAL RESEARCH OF BIO-OSS ® DURING BONE-PLASTIC OPERATIONS

of sinus lifting, 145 - bone plasty with - 8 months later, integration of the implant
simultaneous implantation and 48 cases of fragment (Bio-Oss ®) within the natural bone
periodontal surgery. RFFXUUHGDVLJQLÀFDQWERQHDFWLYLW\LQWKHDUHD
adjoining the Bio-Oss ® being revealed.
5(68/76$1'',6&866,21 - 10 months later, active biodegradation of
Bio-Oss ® particles and formation of a new bone
were observed (Fig. 4).
Study of the preparations evidenced the
- 12 months later, the full bone tissue was
following aspects:
formed, as evidenced by a uniform staining on
- 3 months after the introduction of the Bio-
KLVWRORJLFDOSUHSDUDWLRQÀOOLQJRIWKH+DYHUVLDQ
Oss ® implant in the augmentation area around
FDQDO ZLWK FDSLOODU\ DQG ZLWK LQVLJQLÀFDQW
WKHLPSODQWDQDFWLYHÀEUREODVWLFUHDFWLRQSDUWLDO
fragments of unresorbed Bio-Oss ® (Fig. 5).
biodegradation of material and formation of
The results of the clinical study are presented
young bone tissue were observed (Fig. 3).
in Table 1.
7DEHO5HVXOWVRIFOLQLFDODSSOLFDWLRQRI%LR2VVŠDQG%LR*DWHŠPDWHULDOV

1XPEHURI 1XPEHURI
7\SHRIVXUJHU\ &DXVHRIFRPSOLFDWLRQV
RSHUDWLRQV FRPSOLFDWLRQV

Early implantation (6 months

Sinus lifting 38 1
later)

Bone plasty with

simultaneous 145 2 Early load
implantation

)RUPDWLRQRIÀEURXV
Periodontal surgery 48 3
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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)LJ6FKHPHRIWKHUHSDUDWLYHRVWHRJHQHVLVSURFHVV GDUNWKHQHZO\IRUPHGERQHZKLFKJURZVDORQJ
ZLWK%LR2VVŠRVWHRFRQGXFWLYHPDWHULDO WKHSDUWLFOHOLJKWLQWKHPLGGOHERQHPDUURZ
´*HLVWOLFK3KDUPD$*µPDWHULDOV

International Journal of Medical Dentistry 25

Pavel SIDELNIKOV

&21&/86,216

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
Š XWLOL]DWLRQ D QHZ RVWHRLG WLVVXH ZDV IRUPHG
similar to the bone tissue of the alveolar process,
ZLWK KLJK OHYHOV RI PLQHUDOL]DWLRQ HVSHFLDOO\
)LJ+LVWRORJLFDOLPDJHPRQWKVODWHU 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.
5HIHUHQFHV
1. Zablotskiy Y.V. (2003) The new philosophy of orthopedic
WUHDWPHQWLQFOXGHGGHQWLWLRQGHIHFWV¿[HGSURVWKHVLVXVLQJ
implants. Modern Dentistry, 3, 85-95.
2. Paraskevich V.L. (2002) Methods of application
monocortical allotransplants bone in sinus lift operation.
)LJ+LVWRORJLFDOSLFWXUHPRQWKVODWHU
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.
)LJ+LVWRORJLFDOLPDJHPRQWKVODWHU 10. -HQVHQɈɌThe sinus bone graft, Quintessence
Publishing Co, Inc.
11. Galahin K.A., Sidel’nikov P.V. (2003) Application material
Bio-Oss ® with osteoplastic operations (clinico-
morphological study), Modern Dentistry, 4, 101-103.

26 9ROXPH‡,VVXH-DQXDU\0DUFK‡