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Allogeneic bone block for challenging augmentation—a clinical, histological, and histomorphometrical investigation of tissue reaction and new bone formation

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Abstract

Objectives

The aim of the present study was the histological investigation of an allogeneic spongious bone block for horizontal and vertical ridge augmentation in humans. The amount of new bone, soft tissue, and residual bone substitute were histomorphometrically assessed after a mean healing period of 6 months.

Materials and methods

Fourteen patients received augmentation with an allogeneic spongious bone block (Tutobone®, Tutogen Medical, Neunkirchen, Germany). After 6 months of healing, 28 implants were placed with simultaneous harvesting of bone biopsies for histological and histomorphometrical analysis. Moreover, samples from the bone blocks were collected as blanks and analyzed histologically. The formation of new bone, connective tissue, and remaining bone substitute material as well as vascularization and formation of multinucleated giant cells (MNCGs) within the augmentation bed were analyzed.

Results

New bone formation could be observed primarily in close proximity to the bone block. Histomorphometrical analyses showed 18.65 ± 12.20% newly formed bone, 25.93 ± 12.36% allogeneic spongious bone block, and 53.45 ± 10.34% connective tissue. MNCGs were observed on the biomaterial surface. Furthermore, organic residues were evident, as donor-related cellular remnants within the osteocyte lacunae were found in the blank bone blocks and in the analyzed biopsies.

Conclusion

Despite the presence of donor-related organic remnants, the bone block shows the ability to serve as a scaffold for new bone formation. Within the limits of the present study, the detect organic remnants seemed not to affect the bone formation or influence the host in the long term.

Clinical relevance

Clinicians have to make a conscious choice of the applied biomaterials with regard to their components and structure to support tissue regeneration and maintain patient safety.

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Acknowledgments

The authors would like to thank Mrs. Verena Hoffmann and Mrs. Poju Chia for their excellent technical assistance.

Funding

The work was supported by the Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University in Frankfurt Am Main, Germany.

Author information

Author notes

  1. Markus Schlee and Shahram Ghanaati contributed equally to this work.

Authors and Affiliations

  1. FORM-Lab, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany

    Jonas Lorenz, Alica Kubesch, Sarah Al-Maawi, Robert A. Sader, Markus Schlee & Shahram Ghanaati

  2. Department of Oral Surgery, Medical Center of the Heinrich Heine University, Düsseldorf, Germany

    Frank Schwarz

  3. Private Practice for Implantology and Periodontology, Bayreuther Strasse 39, 91301, Forchheim, Germany

    Markus Schlee

Authors
  1. Jonas Lorenz
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  2. Alica Kubesch
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  3. Sarah Al-Maawi
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  4. Frank Schwarz
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  5. Robert A. Sader
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  6. Markus Schlee
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  7. Shahram Ghanaati
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Corresponding author

Correspondence to Shahram Ghanaati.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the present study involving human participants were in accordance with the ethical standards of the ethics commission of the University of Frankfurt (377/16) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Markus Schlee and Shahram Ghanaati have equal authorship.

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Lorenz, J., Kubesch, A., Al-Maawi, S. et al. Allogeneic bone block for challenging augmentation—a clinical, histological, and histomorphometrical investigation of tissue reaction and new bone formation. Clin Oral Invest 22, 3159–3169 (2018). https://doi.org/10.1007/s00784-018-2407-0

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  • DOI: https://doi.org/10.1007/s00784-018-2407-0

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