Search Results (37)

Background/Objective: Advanced peri-implantitis presents a significant challenge in contemporary implant dentistry and sometimes necessitates implant removal when regenerative therapies are no longer reliable. Protocols for staged bone reconstruction, re-implantation, and definitive prosthetic rehabilitation following peri-implantitis continue to evolve. This study aims to present a clinical case of advanced peri-implantitis with vertical interproximal bone loss managed with a staged surgical and prosthetic approach and review current concepts in implant removal, bone regeneration, re-implantation, and soft-tissue management. Methods: A patient with peri-implantitis affecting two maxillary implants underwent treatment over one year. The initial surgical stage included removal of the failing implants and reconstruction of the defects using guided bone regeneration with a composite graft of 50% xenogeneic bone substitute and 50% autogenous bone, covered by a barrier membrane. After six months of healing, a second surgical stage was performed, involving placement of two new implants in positions 2.2 and 2.4, additional bone augmentation, and soft tissue grafting to enhance soft tissue volume and the width of keratinized gingiva following mucogingival line rebounce. After an additional six months of osseointegration, full maxillary prosthetic rehabilitation was completed in August 2025. Results: Clinical and radiographic assessments demonstrated successful bone regeneration, stable implant integration, adequate peri-implant soft-tissue conditions, and favorable functional and esthetic outcomes at follow-up. The case is discussed in the context of current evidence regarding indications for implant removal, regenerative strategies after explantation, timing of re-implantation, and the importance of keratinized gingiva and prosthetic design in long-term peri-implant health. Conclusions: Staged explantation, guided bone regeneration, delayed re-implantation, and comprehensive soft-tissue and prosthetic management may represent a viable treatment strategy in selected cases of advanced peri-implantitis. Full article

Research in implant dentistry has predominantly focused on bone regeneration, osseous volume maintenance, and successful osseointegration. However, soft tissue healing, which influences implant functional sealing, long-term stability, and esthetic integration, remains underexplored. This study investigated the effects of three xenogenic bone substitutes on gingival healing in vitro. Three experimental groups were established using extracts from bone substitutes diffusing through the OsteoBiol^® Evolution collagen membrane: two collagenated substitutes, OsteoBiol^® Gen-Os^® (Gen-Os) and OsteoBiol^® GTO^® (GTO), and one inorganic substitute, Bio-Oss^® (Bio-Oss). The substitutes were prepared in test tubes, and the extracts diffusing through the collagen membrane were used to evaluate human gingival cell (hGC) proliferation (MTT assay), migration (scratch assay), and growth factor release (ELISA). Angiogenic potential was assessed by endothelial cell proliferation, recruitment (Boyden chambers), and organization (Matrigel^® assays). The indirect interaction between stimulated gingival cells and human bone marrow mesenchymal stem cells (hMSC) was investigated by analyzing hMSC recruitment and osteogenic BMP-2 secretion. Collagenated GTO and Gen-Os significantly enhanced hGC proliferation and migration in the scratch assay, with 1.8-fold and 1.6-fold increases, respectively, compared to control. All three substitutes enhanced neoangiogenesis in vitro. VEGF and FGF-2 secretion was significantly higher with GTO, showing 5-fold and 5.7-fold increases, respectively, resulting in a 3.7-fold increase in tube formation compared to control. Collagenated materials promoted hMSC recruitment, whereas BMP-2 secretion was not affected by any material. The observed effects were higher with the collagenated Gen-Os and GTO, with 2.5-fold and 2.8-fold increases, respectively, than with the non-collagenated Bio-Oss, which showed a 1.5-fold increase. These findings demonstrate that collagenated bone substitutes enhance gingival healing and angiogenic potential through barrier membranes and confirm that stimulated gingival cells indirectly promote hMSC recruitment, indicating that bone substitute effects extend beyond bone regeneration to include soft tissue healing and inter-tissue communication. Full article

Regeneration of jawbone defects poses major challenges. The combination of dental pulp stem cells (DPSCs) or DPSC-derived extracellular vesicles (EVs) with bone substitute materials shows promising potential for bone tissue engineering in vitro. This study evaluated the in vivo bone regeneration potential of DPSCs and EVs with bone graft substitutes in a novel intrabony defect model. DPSCs were isolated from 35 male Sprague–Dawley rat incisors, and EVs were collected from the cell culture medium. DPSCs were seeded onto alloplastic and xenogeneic bone graft materials and implanted into bone defects. Control groups received bone substitutes without DPSCs or EVs. Micro-computed tomography (µCT) was performed at 12 and 24 weeks post-implantation to assess bone volume (BV), bone density (BD), trabecular thickness (Tr.Th), bone growth rate (BGR), and bone-to-mineral ratio (BMR). Both graft types increased BV and BD, with no significant differences between them. Tr.Th increased across all treatments after 24 weeks, indicating ongoing bone remodeling. Notably, xenogeneic grafts combined with DPSCs and EVs significantly improved BGR (p = 0.034) and BMR (p = 0.021) compared to alloplastic grafts with DPSCs. Xenogeneic bone grafts combined with DPSCs and EVs appear to be a promising approach for bone regeneration of alveolar bone defects. Full article

Background: In atrophic posterior maxillary regions, sub-antral surgery is often used for rehabilitation with implants. In order to stimulate bone regeneration, autogenous, xenogenic, alloplastic and platelet-rich fibrin (PRF) grafts are commonly used. Aim: To assess the effectiveness of PRF alone or combination with synthetic bone substitutes on bone formation, implant stability, and survival in sub-antral surgery. Materials and Methods: A literature review was carried out from September 2024 to April 2025, according to PRISMA guidelines using the PubMed, Cochrane Library, Wiley, ScienceDirect, and Web of Science databases. From a total of 601 articles identified, 11 met the inclusion criteria and were selected for analysis. Results: PRF in combination with synthetic materials has shown potential benefits, especially in increasing biomechanical stability and bone formation. Although, most studies have not reported statistically significant differences when comparing the use of synthetic material alone against its combination with PRF. Discussion: The use of synthetic grafts in combination with PRF has become increasingly common in sub-antral implant procedures. PRF promotes angiogenesis, osteoprogenitor cell differentiation and bone regeneration, favouring the healing and remodelling process of the tissues, as well as greater stability and longevity of the implant. Conclusions: The combination of PRF with synthetic bone grafting shows promising results; however, further studies are needed to confirm the efficacy of PRF in maxillary sinus grafts in conjunction with the use of biomaterials. Full article

Background: Bone regeneration is a key therapeutic objective in periodontology, particularly in the treatment of alveolar defects caused by periodontal disease, dentoalveolar trauma, or surgical interventions. Among current regenerative strategies, collagen-enriched biomaterials have demonstrated an active role in modulating cellular behavior during bone repair. However, the specific effects of different collagen formulations on human dental pulp stem cells (hDPSCs) have not yet been fully characterized. Objective: To evaluate the impact of xenogeneic bone grafts with and without collagen—OsteoBiol^® Gen-Os^® (GO), OsteoBiol^® GTO^® (GTO), and Geistlich Bio-Oss^® (BO)—on cell viability, adhesion, migration, osteogenic differentiation, and mineralization potential of hDPSCs, and to explore the molecular mechanisms underlying their effects. Methods: In vitro assays were conducted to assess viability (MTT and fluorescence staining), adhesion (SEM), migration (wound healing assay), and mineralization (Alizarin Red S staining). Gene expression analyses (RT-qPCR) were performed for adhesion/migration markers (FN, SDF-1, COL1A1), angiogenic/proliferation markers (VEGF, FGF2), and osteogenic differentiation markers (RUNX2, ALP, COL1A1). Results: GO showed a higher early expression of genes associated with adhesion, migration, angiogenesis (FN, SDF-1, VEGF and FGF2: p < 0.05; COL1A1: p < 0.01), and osteogenic differentiation (7 days: COL1A1 and ALP (p < 0.001)); (14 days: RUNX2, ALP: p < 0.001; COL1A1: p < 0.05), indicating a sequential activation of molecular pathways and mineralization capacity comparable to the control group. GTO demonstrated the best biocompatibility, with significantly higher cell viability (p < 0.05), strong adhesion, and markedly increased mineralization at 21 days (p < 0.001), despite moderate early gene expression. BO showed reduced cell viability at 10 mg/mL (p < 0.05) and 20 mg/mL (p < 0.001), with mineralization levels similar to the control group. Conclusion: Collagen-based xenografts demonstrate favorable interactions with hDPSCs, enhancing viability and promoting osteogenic differentiation. Our findings suggest that beyond the presence of collagen, the specific formulation of these biomaterials may modulate their biological performance, highlighting the importance of material design in optimizing regenerative outcomes. Clinical Significance: The formulation of collagen in xenogeneic bone substitutes may be a determining factor in enhancing periodontal regenerative outcomes by modulating the early cellular response and osteogenic activity in stem cell-based tissue engineering. Full article

Background: The growing demand for effective methods of bone tissue regeneration highlights the relevance of studying modern bone substitutes and their applications in regenerative medicine. The aim of this work was to conduct a comprehensive analysis of the biological, mechanical, and clinical characteristics of various types of bone substitutes to determine their potential in regenerative medicine. Methods: The study was performed as a systematic literature review in accordance with PRISMA guidelines, analyzing 68 high-quality scientific sources from 2019 to May 2025, using the PubMed, Scopus, Web of Science, and Google Scholar databases. Results: It was established that autogenous grafts exhibit the highest osteogenic properties due to the presence of growth factors BMP-2, BMP-7, and concentrated growth factors; however, their use is limited by donor site morbidity in 20–30% of patients and the requirement to treat 6% of fractures complicated by non-union. Allogeneic and xenogeneic substitutes provide structural support for large defects but require intensive processing in accordance with European Directives 2004/23/EC and 2006/86/EC to minimize the risk of infection transmission. Synthetic substitutes based on calcium phosphate ceramics with pore sizes ranging from 23 to 210 micrometres demonstrate excellent biocompatibility and controlled degradation, with β-tricalcium phosphate exhibiting optimal characteristics for long-term applications compared to calcium sulphate. Conclusions: The findings of the study highlight the necessity of a personalized approach in selecting bone substitutes, considering the specific requirements of medical specialities, and support the development of hybrid biomaterials to combine structural strength with biological activity. Full article

Background: The combination of polynucleotides and hyaluronic acid with bovine bone grafts in maxillary sinus lift procedures appears to be a promising strategy to enhance bone regeneration. This study aimed to analyze implant osseointegration, bone repair and sinus mucosa integrity using Bio-Oss^® and Hyaluronic Acid-Polynucleotide Gel (Regenfast^®) in maxillary sinus augmentation in rabbits. Methods: Sinus floor elevation was performed in 12 rabbits, with one implant placed per sinus simultaneously. In the control group, sinuses were grafted with deproteinized bovine bone mineral (Bio-Oss^®) alone; in the test group, Bio-Oss^® was combined with Regenfast^®. Two histological slides were obtained per sinus after 2 weeks (six animals) and 10 weeks (six animals): one from the grafted area alone (non-implant sites), and one from the implant site. Primary outcome variables included the percentage of newly formed bone, the extent of implant osseointegration, and the number of sinus mucosa perforations caused by contact with graft granules. Results: After 10 weeks of healing, the test group showed a significantly higher percentage of new bone formation (37.2 ± 6.7%) compared to the control group (26.8 ± 10.0%; p = 0.031); osseointegration extended to the implant apex in both groups; fewer sinus mucosa perforations were observed in the test group (n = 5) than in the control group (n = 14). Conclusions: The addition of Regenfast^® to Bio-Oss^® granules promoted enhanced bone regeneration within the elevated sinus area and was associated with a lower incidence of sinus membrane perforations compared to the use of Bio-Oss^® alone. Full article

Background: The socket preservation technique involves filling the bone defect created after tooth extraction with a bone substitute material. This helps to reduce bone resorption of the post-extraction alveolar ridge. Various types of bone substitute biomaterials are used as augmentation materials, including autogeneic, allogeneic, and xenogeneic materials. The purpose of this study was to evaluate changes in alveolar ridge dimensions and alterations of optical bone density in sockets grafted with two different biomaterials. Additionally, bone biopsies taken from the grafted sites underwent histological evaluation. Methods: This study enrolled 10 generally healthy patients, who were divided into two equal groups. Patients in the first group were treated with an allogeneic material (BIOBank^®, Biobank, Paris, France), while patients in the second group were treated with an xenogeneic material (Geistlich Bio-Oss^®, Geistlich Pharma AG, Wolhusen, Switzerland). Tooth extraction was performed, following which the appropriate material was placed into the debrided socket. The material was secured with a collagen membrane (Geistlich Bio-Gide^®, Geistlich Pharma AG, Wolhusen, Switzerland) and sutures, which were removed 7 to 10 days after the procedure. Micro-CBCT examinations were performed, for the evaluation of alveolar ridge dimensions and bone optical density, at 7–10 days and six months after the procedure. Bone trepanbiopsy was performed simultaneously to the implant placement, six months after socket preservation. The retrieved biopsy was subjected to histological examination via hematoxylin and eosin (H&E) staining and Masson’s trichrome staining. Results: The results showed that the allogeneic material was more effective in preserving alveolar buccal height and was probably more rapidly transformed into the patient’s own bone. Sockets grafted with the xenogeneic material presented higher optical bone density after six months. Both materials presented similar effectiveness in alveolar width preservation. Conclusions: Based on the outcomes of this study, it can be concluded that both materials are suitable for the socket preservation technique. However, the dimensional changes in the alveolar ridge and the quality of the newly formed bone may vary depending on the type of biomaterial used. Full article

In recent years, the management of bone defects in regenerative medicine and orthopedic surgery has been the subject of extensive research efforts. The complexity of fractures and bone loss arising from trauma, degenerative conditions, or congenital disorders necessitates innovative therapeutic strategies to promote effective healing. Although bone tissue exhibits an intrinsic regenerative capacity, extensive fractures and critical-sized defects can severely compromise this process, often requiring bone grafts or substitutes. Tissue engineering approaches within regenerative medicine have introduced novel possibilities for addressing nonunions and challenging bone defects refractory to conventional treatment methods. Key components in this field include stem cells, bioactive growth factors, and biocompatible scaffolds, with a strong focus on advancements in bone substitute materials. Both natural and synthetic substitutes present distinct characteristics and applications. Natural grafts—comprising autologous, allogeneic, and xenogeneic materials—offer biological advantages, while synthetic alternatives, including biodegradable and non-biodegradable biomaterials, provide structural versatility and reduced immunogenicity. This review provides a comprehensive analysis of the diverse bone grafting alternatives utilized in orthopedic surgery, emphasizing recent advancements and persistent challenges. By exploring both natural and synthetic bone substitutes, this work offers an in-depth examination of cutting-edge solutions, fostering further research and innovation in the treatment of complex bone defects. Full article

Bone regeneration has emerged as a critical research and clinical advancement field, fueled by the growing demand for effective treatments in orthopedics and oncology. Over the past two decades, significant progress in biomaterials and surgical techniques has led to the development of novel solutions for treating bone defects, surpassing the use of traditional autologous grafts. This review aims to assess the latest approaches in bone regeneration, including autologous, allogenic, and xenogenic grafts, naturally derived biomaterials, and innovative synthetic substitutes such as bioceramics, bioactive glasses, metals, polymers, composite materials, and other specialized applications. A comprehensive literature search was conducted on PubMed, focusing on studies published between 2019 and 2024, including meta-analyses, reviews, and systematic reviews. The review evaluated a range of bone regeneration strategies, examining the clinical outcomes, materials used, surgical techniques, and the effectiveness of various approaches in treating bone defects. The search identified numerous studies, with the inclusion criteria focused on those exploring innovative bone regeneration strategies. These studies provided valuable insights into the clinical and biological outcomes of different biomaterials and graft types. Results indicated that while advancements in synthetic and naturally derived biomaterials show promising potential, challenges remain in optimizing therapeutic strategies across diverse patient populations and clinical settings. The findings emphasize the need for an integrated approach that combines scientific research, clinical practice, and technological innovation to improve bone regeneration therapies. Further research is required to establish standardized protocols and determine the optimal application of various materials and techniques to enhance patient outcomes and the quality of care. Full article

Objective: Bone augmentation has become a significant practice in various areas of bone regeneration dentistry. This systematic review analyzes the research focused on evaluating bone substitute materials for the presence of contaminants. Methods: In June 2024, an extensive electronic search was conducted using renowned databases such as PubMed, Web of Science, and Scopus. Specific keywords employed in the search included ((bone AND (substitute) AND (remnants OR (purity)) OR ((graft AND tooth) AND (remnants OR purity)) OR ((graft AND dentin) AND (remnants OR purity)). The search adhered to the PRISMA protocol and the PICO framework. The review concentrated on the origin of bone substitute materials, the processing methods used for these materials, techniques for assessing purity, and types of contamination identified. A total of 594 articles were identified of which 22 met the criteria and were incorporated into the review. Results: Investigations into allogeneic and xenogeneic bone substitute materials have revealed that, despite manufacturers’ assurances of purity, some materials still contain contaminants. Sample analyses demonstrated the presence of donor cellular remains, cellular debris, intertrabecular fat, connective tissue, and collagen. Similarly, synthetically produced bone substitute materials (alloplastic materials) contained various impurities, such as polyvinyl alcohol (PVA), CaO phases, calcium-deficient HAp phases, oily substances containing carbon and silicone, cellulose derivatives, alpha-tricalcium phosphate (α-TCP), and heavy metals. Conclusions: Bone-derived and bone-like graft materials can contain various organic and inorganic impurities. Full article

Background: A patient had lost the first left maxillary incisor in the esthetic zone. Methods: The defect in the alveolar ridge was reconstructed for an implant-supported restoration using a new xenogeneic bone substitute containing hyaluronate, which was used in combination with allogeneic bone granules. Results: After three years of follow-up, the dental implant was stable and showed no signs of infection. Conclusions: This is the first case report with a long-term follow-up time of three years of a successful clinical application of a xenograft–allograft combination (cerabone^® plus combined with maxgraft^®) for alveolar ridge augmentation before dental implantation. Cerabone^® plus offers volume stability, provides reliable and efficient structural support of the oral soft tissues in the augmented region (particularly crucial in the aesthetic zone), and preserves the alveolar ridge shape. Full article

Background: Bone defect therapy is a common clinical challenge for orthopedic and clinical physicians worldwide, and the therapeutic effect affects the physiological function and healthy life quality of millions of patients. Compared with traditional autogenous bone transplants, bone xenografts are attracting attention due to their advantages of unlimited availability and avoidance of secondary damage. However, there is currently a lack of bibliometric analysis on bone xenograft. This study aimed to use bibliometric methods to analyze the literature on bone xenograft from 2013 to 2023, to explore the current status, hotspots, and future trends of research in this field, and to promote its development and progress. Methods: Using the Web of Science Core Collection database, we retrieved and collected publication data related to xenogeneic bone grafting materials worldwide from January 2013 to March 2023. Origin (2021), CiteSpace (6.2.R2 standard), and an online bibliometric platform were used for bibliometric analysis and data visualization. Results: A total of 3395 documents were retrieved, and 686 eligible papers were selected. The country and institutions with the highest number of publications and centrality were the United States (125 papers, centrality = 0.44) and the University of Zurich (29 papers, centrality = 0.28), respectively. The most cited author was Araujo MG (163 times), and the author with the most significant centrality was Froum SJ (centrality = 0.09). The main keyword clusters were “tissue engineering”, “sinus floor elevation”, “dental implants”, “tooth extraction”, and “bone substitutes”. The most significant bursting keywords in the last three years were “platelet rich fibrin”. Conclusions: Research on bone xenograft is steadily growing and will continue to rise. Currently, research hotspots and directions are mainly focused on dental implants related to bone-augmentation techniques and bone tissue engineering. In the future, research hotspots and directions may focus on decellularization technology and investigations involving platelet-rich fibrin. Full article

To date, bone regeneration techniques use many biomaterials for bone grafting with limited efficiencies. For this purpose, tissue engineering combining biomaterials and stem cells is an important avenue of development to improve bone regeneration. Among potentially usable non-toxic and bioresorbable scaffolds, porous silicon (pSi) is an interesting biomaterial for bone engineering. The possibility of modifying its surface can allow a better cellular adhesion as well as a control of its rate of resorption. Moreover, release of silicic acid upon resorption of its nanostructure has been previously proved to enhance stem cell osteodifferentiation by inducing calcium phosphate formation. In the present study, we used a rat tail model to experiment bone tissue engineering with a critical size defect. Two groups with five rats per group of male Wistar rats were used. In each rat, four vertebrae were used for biomaterial implantation. Randomized bone defects were filled with pSi particles alone or pSi particles carrying dental pulp stem cells (DPSC). Regeneration was evaluated in comparison to empty defect and defects filled with xenogenic bone substitute (Bio-Oss^®). Fluorescence microscopy and SEM evaluations showed adhesion of DPSCs on pSi particles with cells exhibiting distribution throughout the biomaterial. Histological analyzes revealed the formation of a collagen network when the defects were filled with pSi, unlike the positive control using Bio-Oss^®. Overall bone formation was objectivated with µCT analysis and showed a higher bone mineral density with pSi particles combining DPSC. Immunohistochemical assays confirmed the increased expression of bone markers (osteocalcin) when pSi particles carried DPSC. Surprisingly, no grafted cells remained in the regenerated area after one month of healing, even though the grafting of DPSC clearly increased bone regeneration for both bone marker expression and overall bone formation objectivated with µCT. In conclusion, our results show that the association of pSi with DPSCs in vivo leads to greater bone formation, compared to a pSi graft without DPSCs. Our results highlight the paracrine role of grafted stem cells by recruitment and stimulation of endogenous cells. Full article