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F. Secondo, C.F. Grottoli, I. Zolino, G. Perale, D. Lauritano
During a sinus lift procedure the main requirement in order to position an implant is to have a maxillary sinus floor cortical bone thick enough to guarantee a primary stability in the implant inserted. In this way, the healing process is facilitated and osseointegration of the titanium surface may occur simultaneously, thus reducing the waiting time for the engraftment of the implant into the body. Unfortunately, these conditions are not always present. Hence, the need of developing an alternative approach that could simultaneously allow to perform sinus floor elevation along with an implant placement.
Here we present the case of a 62-year-old patient that requires implant-prosthetic rehabilitation from 1.2 to 1.6 at diagnosis.
In this study, we reported a novel application derived from the use of a heterologous bone scaffold (SmartBone@) in a sinus lift procedure. We showed the successful implant along with sinus lift with SmartBone@, both at the time of the surgery and after follow-up of the patient at 10 months from the implant. The possibility to perform simultaneously the contextual implant along with sinus lift dramatically reduced the waiting time for the patient of minimum 5-6 months required for osseointegration of the grafted biomaterials, before performing the implant procedure. This surgery represents an advance both in terms of medical technique and as life-benefit for the patient.
Milazzo M., D’Alessandro D., Stefanini C., Pertici G., Perale G., Danti S.
L’ingegneria tissutale ha, tra i suoi obiettivi, quello di sviluppare nuovi biomateriali in grado di sostituire e/o rigenerare i tessuti ossei colpiti da patologie o rimossi tramite chirurgia.Questo studio si è proposto di analizzare l’efficacia di un nuovo biomateriale, Smartbone®, costituito da osso bovino spongioso deproteinizzato e funzionalizzato con biopolimeri e frammenti peptidici con sequenza RGD esposta, nella chirurgia maxillofacciale.
Milazzo Mario1, 2, D’Alessandro Delfo2, Stefanini Cesare1, Pertici Gianni3, Perale Giuseppe3, Danti Serena1,4
1 Istituto di Biorobotica, Scuola Superiore Sant’Anna, Pontedera (PI)
2 Dip. di Patologia Chirurgica, Medica, Molecolare e dell’Area Critica, Università di Pisa, Pisa
3 Industrie Biomediche Insubri S/A (IBI), Mezzovico-Vira, Svizzera
4 Dip. di Ingegneria Civile e Industriale, Università di Pisa, Pisa
Mahesh L., Aran Shetty D., Shukla S.
Soon after tooth extraction a cascade of bone remodeling starts which result in bone resorption. Procedures such Socket Seal Surgery can be employed to preserve future implant site. There are various grafts which can used for the same purpose. The best method to observe a graft’s healing is surgical re-entry and or histopathology. The aim of this Case Report is to document the use of Smartbone® xenograft for socket preservation. After 5 months of healing, histopathological core sampling revealed good osteoconduction of the graft.
Poonia N, Morales H, Mahesh L.
A patient with failed implant in relation to 44 was being referred to the dental office. Site 44 was reimplanted with AB Dent dental implants, and guided bone regeneration was done with Smartbone® bone graft and resorbable collagen membrane. Root submerged technique was followed in relation to 45. One year postoperative follow-up shows stable bone levels in relation to 44, 45, and 46.
Dr. Maurizio Martini, Dr. Anna Zazzetta (Macerata, Italy – Dubai, UAE)
Bone grafting has always been considered a challenge for dentists. Initially the diffusion of this procedure was conditioned by the need of invasive surgery, bone harvesting and the morbidity of the patient. Now its diffusion will be ever more necessary due to the spread of implantology. SmartBone allows dentists to reduce the patient’s morbidity, have an optimal osteointegration in order to achieve the best outcomes in implant surgery. In particular, the service “SmartBone on Demand” allows to obtain a custom-made graft to provide the exact required quantity of bone for the specific needs of the patient.
Delfo D’Alessandro, Giuseppe Perale, Mario Milazzo, Stefania Moscato, Cesare Stefanini, Gianni Pertici, Serena Danti
The ideal scaffold for bone regeneration is required to be highly porous, non-immunogenic, biostable until the new tissue formation, bioresorbable and osteoconductive. This study aimed at investigating the process of new bone formation in patients treated with granular SmartBone for sinus augmentation, providing an extensive histologic analysis. Five biopsies were collected at 4–9 months post SmartBone implantation and processed for histochemistry and immunohistochemistry. Histomorphometric analysis was performed. Bone-particle conductivity index (BPCi) was used to assess SmartBone osteoconductivity. At 4 months, SmartBone (12%) and new bone (43.9%) were both present and surrounded by vascularized connective tissue (37.2%). New bone was grown on SmartBone1 (BPCi = 0.22). At 6 months, SmartBone was almost completely resorbed (0.5%) and new bone was massively present (80.8%). At 7 and 9 months, new bone accounted for a large volume fraction (79.3% and 67.4%, respectively) and SmartBone1 was resorbed (0.5% and 0%, respectively). Well-oriented lamellae and bone scars, typical of mature bone, were observed. In all the biopsies, bone matrix biomolecules and active osteoblasts were visible. The absence of inflammatory cells confirmed SmartBone1 biocompatibility and nonimmunogenicity. These data indicate that SmartBone1 is osteoconductive, promotes fast bone regeneration, leading to mature bone formation in about 7 months.
E.C. Ekwueme, J.M. Patel, J.W. Freeman, S. Danti
The skeletal system provides structure, protection, and movement to the body through bones, cartilages, tendons, and ligaments. Many congenital, traumatic, and degenerative diseases may affect the function of skeletal tissues during the life span, leading to the necessity of very specific replacements and treatments. In the widespread and mechanically constraining scenario of skeletal pathologies, biodegradable polymers can play unique roles that should not only be confined to adjuvant bulk devices. Tissue engineering has recently renewed the attention towards this class of biomaterials, enchantingly exploiting their outstanding versatility to accomplish smart and biomimetic solutions to surgical and therapeutic needs. This chapter describes the most recent achievements in this field, focusing on tissue type- and subtype-specific replacements, while taking into account clinical applications and future trends.
Pertici G , Carinci F , Carusi G , Epistatus D , Villa T , Crivelli F , Rossi F , Perale G
Bovine bone xenografts, made of hydroxyapatite (HA), were coated with poly(L-lactide-co-ε-caprolactone) (PLCL) and RGD-containing collagen fragments in order to increase mechanical properties, hydrophilicity, cell adhesion and osteogenicity. In vitro the scaffold microstructure was investigated with Environmental Scanning Electronic Microscopy (ESEM) analysis and micro tomography, while mechanical properties were investigated by means compression tests. In addition, cell attachment and growth within the three-dimensional scaffold inner structure were validated using human osteosarcoma cell lines (SAOS-2 and MG-63). Standard ISO in vivo biocompatibility studies were carried out on model animals, while bone regenerations in humans were performed to assess the efficacy of the product. All results from in vitro to in vivo investigations are here reported, underlining that this scaffold promotes bone regeneration and has good clinical outcome.
Grecchi F, Perale G, Candotto V, Busato A, Pascali M, Carinci F
The repair of complex craniofacial bone defects is challenging and a successful result depends on the defect size, the quality of the soft tissue covering the defect and the choice of reconstructive method. Autologous bone grafts are the gold standard for bone replacement. Tissue engineered constructs are temporary substitutes developed to treat damaged or lost tissue. Recent advances in materials science have provided an abundance of innovations, underlining the increasing importance of polymer in this field. The Galeazzi Orthopedical institute of Milan received a Serbian soldier who reported a deep wound, due to the explosion of a grenade, during former-Yugoslavia’s war. His left cheekbone was completely lost, together with the floor of the left eye. SmartBone® technology allowed the realization of custom-made grafts which perfectly fitted the bone defect thanks to mechanical strength, also at small thicknesses, and the ability to be shaped without powder formation or unpredicted fractures. Tissue engineering approaches to regeneration utilize 3-dimensional (3D) biomaterial matrices that interact favorably with cells. The potential benefits of using a tissue engineering approach include reduced donor site morbidity, shortened operative time, decreased technical difficulty of the repair, ability to closely mimic the in vivo microenvironment in an attempt to recapitulate normal craniofacial development: this 36-month case study allowed to prove that SmartBone® custom-made bone grafts are an effective solution, gathering such benefits and being available now for daily routine.
Ilaria Zollino, Giorgio Carusi, Francesco Carinci, Giuseppe Perale
The present case reports the success rate after 8 months of follow-up in a sinus pneumatization case with maxillary sinus floor cortical bone loss due to 2.5 dental agenesis. Rehabilitation including the opportunity to insert a contextual implant during maxillary sinus lift surgery was planned, using SmartBone® Microchips heterologous bone inserted into the maxillary sinus. The newly developed bone substitute was designed starting from bovine bone derived mineral matrix, reinforced with bioresorbable aliphatic polymers and cell nutrients. SmartBone® Microchips showed a tight contact with the new bone and neither gaps nor fibrous tissues at the interface. No inflammation or foreign body reaction were observed, and these findings support the good biocompatibility of SmartBone® Microchips composite material. Moreover, new bone, thanks to its mechanical properties, consented to fix screw in combination with maxillary sinus floor elevation for a dental implant.
The newly developed bone substitute SmartBone® Microchips showed in a patient with jaw cortical pavement defect a tight contact with the new bone and neither gaps nor fibrous tissues at the interface. No inflammation or foreign body reaction were observed, and these findings support the good biocompatibility of SmartBone® Microchips composite material. Moreover, new bone, thanks to its mechanical properties, consented to fix one screw in combination with maxillary sinus floor elevation for the dental implant. All these statements showed the good suitability of SmartBone® Microchips for alveolar defect repair in sinus lift procedure
Ottardi C, Pertici G, Perale G, Vitta TMT
L. Laffranchi, B. Buffoli, R. Boninsegna, F. Zotti, F. Savoldi, P. Fontana, S. Bonetti, L. Visconti, L.F. Rodella, C. Paganelli
Purpose: Scaffolds play a critical role in tissue engineering, which aims to regenerate missing tissues or organs. For developing an effective bone regeneration strategy, we studied the efficacy of bone regeneration using the innovative bone scaffold “Reinforced Bioactive Bone Chip” (IBI SA-Mezzovico, Ticino-CH), which has been specifically developed for applications in regenerative medicine and therapy bone tissue engineering, on the calvarial defect of rats.
Methods and materials: A full-thickness defect (5mm×8mm) was created on each parietal region of Wistar rats (Harlan, Italy) by piezosurgery, a surgical technique that creates an effective osteotomy with no trauma to soft tissue and without causing bone necrosis. Bone scaffold was implanted in the right cranial defect whereas the left defect was used as control. Macroscopical evaluation of the surgical site and histological studies were performed to investigate the level of bone formation.
Results: The results confirmed that the treated defects with “Reinforced Bioactive Bone Chip” scaffold showed significant bone formation and maturation in comparison with the control group.
Conclusion: These results are promising and “Reinforced Bioactive Bone Chip” could be considered for future clinical use in human, mainly in the field of regeneration and/or replacement of bone tissue compartment of maxillofacial surgery.
G Pertici, F Rossi, T Casalini, G Perale
This study discusses composite polymer-coated mineral grafts for bone regeneration.
Bone xenografts are coated with degradable synthetic [poly(L-lactide-co-e-caprolactone)] and natural (polysaccharides) polymers in order to increase their mechanical properties, on one side, and to improve cell adhesion, on the other, with the purpose of developing a novel composite material for bone tissue engineering. In vitro assays help examine the microstructure of the scaffold by Fourier transform infrared and environmental scanning electron microscopy analyses and the porosity of the material by micro-computed tomography. The good adhesion property of polymer coated on to the mineral scaffold is deeply analysed and proved. The in vitro polymer degradation, in terms of time evolution of polymer-coating thickness, was rationalised with a mathematical model. The purpose of such modelling activity is to provide a simple but powerful tool to understand the influence of design parameters on coating behaviour.
The fabricated bone graft exhibited regular microstructure similar to healthy iliac bones with an average of 27% open porosity and an adequately rigid structure, which ensures a better osteointegration once implanted.
This approach avoids the use of trialand-error methods and consents a better a priori material design.
G. Pertici, F. Grecchi, G. Perale
Scaffolds for bone regeneration should ensure both mechanical stability and strength. Moreover, their intimate structure should have an adequate interconnected porous network for cell migration and proliferation, while also providing specific signals for bone regeneration. SmartBone® composite solution, based on a novel concept of biomaterial assembly, bearing cues from both mineral components and polymeric ones [1-3], was chosen to develop new patient-specific three-dimensional bone grafts. Indeed, thanks to mechanical performances and to full control over production, custom-made bone grafts can be produced according to the specific need of each single patient, via digital surgical planning, starting from CT scans.
Filippo Rossi, Marco Santoro, Giuseppe Perale
Although bone has a high potential to regenerate itself after damage and injury, the efficacious repair
of large bone defects resulting from resection, trauma or non-union fractures still requires the
implantation of bone grafts. Materials science, in conjunction with biotechnology, can satisfy these
needs by developing artificial bones, synthetic substitutes and organ implants. In particular, recent
advances in polymer science have provided several innovations, underlying the increasing importance
of macromolecules in this field. To address the increasing need for improved bone substitutes,
tissue engineering seeks to create synthetic, three-dimensional scaffolds made from polymeric materials,
incorporating stem cells and growth factors, to induce new bone tissue formation. Polymeric
materials have shown a great affinity for cell transplantation and differentiation and, moreover, their
structure can be tuned in order to maintain an adequate mechanical resistance and contemporarily
be fully bioresorbable. This review emphasizes recent progress in polymer science that allows relaible
polymeric scaffolds to be synthesized for stem cell growth in bone regeneration. Copyright © 2013
John Wiley & Sons, Ltd.