The Role of Blood Clot in Guided Bone Regeneration: Biological Considerations and Clinical Applications with Titanium Foil

In Guided Bone Regeneration (GBR) materials and techniques are essential to achieve the expected results. Thanks to their properties, blood clots induce bone healing, maturation, differentiation and organization. The preferred material to protect the clot in Guided Bone Regeneration is the titanium foil, as it can be shaped according to the bone defect. Furthermore, its exposition in the oral cavity does not impair the procedure. We report on five clinical cases in order to explain the management of blood clots in combination with titanium foil barriers in different clinical settings. Besides being the best choice to protect the clot, the titanium foil represents an excellent barrier that is useful in GBR due to its biocompatibility, handling, and mechanical strength properties. The clot alone is the best natural scaffold to obtain the ideal bone quality and avoid the persistence of not-resorbed granules of filler materials in the newly regenerated bone. Even though clot contraction still needs to be improved, as it impacts the volume of the regenerated bone, future studies in GBR should be inspired by the clot and its fundamental properties.

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The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

BMC Medicine ◽

10.1186/1741-7015-10-81 ◽

2012 ◽

Vol 10 (1) ◽

Cited By ~ 142

Author(s):

Rozalia Dimitriou ◽

George I Mataliotakis ◽

Giorgio Maria Calori ◽

Peter V Giannoudis

Keyword(s):

Bone Regeneration ◽

Clinical Evidence ◽

Bone Defects ◽

Guided Bone Regeneration ◽

Barrier Membranes ◽

Large Bone ◽

Large Bone Defects

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The Role of Bone Decortication in Enhancing the Results of Guided Bone Regeneration: A Literature Review

Journal of Periodontology ◽

10.1902/jop.2009.080309 ◽

2009 ◽

Vol 80 (2) ◽

pp. 175-189 ◽

Cited By ~ 37

Author(s):

G. Greenstein ◽

B. Greenstein ◽

J. Cavallaro ◽

D. Tarnow

Keyword(s):

Literature Review ◽

Bone Regeneration ◽

Guided Bone Regeneration

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Improvement of the Physical Properties of Guided Bone Regeneration Membrane from Porcine Pericardium by Polyphenols-Rich Pomace Extract

Materials ◽

10.3390/ma12162564 ◽

2019 ◽

Vol 12 (16) ◽

pp. 2564 ◽

Cited By ~ 5

Author(s):

Nazario Russo ◽

Clara Cassinelli ◽

Elisa Torre ◽

Marco Morra ◽

Giorgio Iviglia

Keyword(s):

Physical Properties ◽

Bone Regeneration ◽

Enzymatic Degradation ◽

Guided Bone Regeneration ◽

Mechanical Stiffness ◽

Infra Red ◽

Space Maintenance ◽

The One ◽

Porcine Pericardium

To achieve optimal performances, guided bone regeneration membranes should have several properties, in particular, proper stiffness and tear resistance for space maintenance, appropriate resorption time, and non-cytotoxic effect. In this work, polyphenol-rich pomace extract (PRPE), from a selected grape variety (Nebbiolo), rich in proanthocyanidins and flavonols (e.g., quercetin), was used as a rich source of polyphenols, natural collagen crosslinkers, to improve the physical properties of the porcine pericardium membrane. The incorporation of polyphenols in the collagen network of the membrane was clearly identified by infra-red spectroscopy through the presence of a specific peak between 1360–1380 cm−1. Polyphenols incorporated into the pericardium membrane bind to collagen with high affinity and reduce enzymatic degradation by 20% compared to the native pericardium. The release study shows a release of active molecules from the membrane, suggesting a possible use in patients affected by periodontitis, considering the role of polyphenols in the control of this pathology. Mechanical stiffness is increased making the membrane easier to handle. Young’s modulus of pericardium treated with PRPE was three-fold higher than the one measured on native pericardium. Tear and suture retention strength measurement suggest favorable properties in the light of clinical practice requirements.

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Comparison of Autologous Blood Clots with Fibrin Sealant as Scaffolds for Promoting Human Muscle-Derived Stem Cell-Mediated Bone Regeneration

Biomedicines ◽

10.3390/biomedicines9080983 ◽

2021 ◽

Vol 9 (8) ◽

pp. 983

Author(s):

Xueqin Gao ◽

Haizi Cheng ◽

Xuying Sun ◽

Aiping Lu ◽

Joseph J. Ruzbarsky ◽

...

Keyword(s):

Stem Cells ◽

Bone Regeneration ◽

Osteogenic Differentiation ◽

Fibrin Sealant ◽

Blood Clot ◽

Autologous Blood ◽

Human Muscle ◽

Blood Clots ◽

Autologous Blood Clot

Background. Fibrin sealant has been used as a scaffold to deliver genetically modified human muscle-derived stem cells (hMDSCs) for bone regeneration. Alternatively, autologous blood clots are safe, economic scaffolds. This study compared autologous blood clot (BC) with fibrin sealant (FS) as a scaffold to deliver lenti-BMP2/GFP-transduced hMDSCs for bone regeneration. Methods. In vitro osteogenic differentiation was performed using 3D pellet culture and evaluated using microCT and Von Kossa staining. The lenti-GFP transduced cells were then mixed with human blood for evaluation of osteogenic differentiation. Furthermore, a murine critical- sized calvarial defect model was utilized to compare BC and FS scaffolds for lenti-BMP2/GFP-transduced hMDSCs mediated bone regeneration and evaluated with micro-CT and histology. Results. Lenti-BMP2/GFP transduced hMDSCs formed significantly larger mineralized pellets than non-transduced hMDSCs. hMDSCs within the human blood clot migrated out and differentiated into ALP+ osteoblasts. In vivo, BC resulted in significantly less new bone formation within a critical-sized calvarial bone defect than FS scaffold, despite no difference observed for GFP+ donor cells, osteoclasts, and osteoblasts in the newly formed bone. Conclusions. Human lenti-BMP2/GFP-transduced hMDSCs can efficiently undergo osteogenic differentiation in vitro. Unexpectedly, the newly regenerated bone in BC group was significantly less than the FS group. The autologous blood clot scaffold is less efficacious for delivering stem cells for bone regeneration than fibrin sealant.

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Role of the blood clot stabilization in early bone regeneration and osseointegration

10.5353/th_b4696039 ◽

2011 ◽

Author(s):

Hamza Mohammad Khaleel Alnsour

Keyword(s):

Bone Regeneration ◽

Blood Clot

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The Role of Two Different Collagen Membranes for Dehiscence Defect Around Implants in Humans

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-13-00214 ◽

2015 ◽

Vol 41 (4) ◽

pp. 445-448 ◽

Cited By ~ 3

Author(s):

Dong-Woon Lee ◽

Kyeong-Taek Kim ◽

Yon-Soo Joo ◽

Mi-Kyung Yoo ◽

Jeoung-A Yu ◽

...

Keyword(s):

Bone Regeneration ◽

Guided Bone Regeneration ◽

Allogenic Bone ◽

The Mean ◽

Collagen Membranes ◽

Dehiscence Defect ◽

Result Analysis ◽

Bone Particles

The aim of this study was to elucidate the role of 2 types of collagen membranes (cross-linked vs noncross-linked) used in conjunction with autogenous or allogenic bone followed by xenogeneic bone particles for dehiscence defect around implants in humans. Experimental groups were divided into 2 groups: Group CL (cross-linked, Ossix Plus, n = 24 implants, 16 patients) and Group NCL (noncross-linked, Bio-Gide, n = 25 implants, 18 patients). At the time of implant insertion and uncovery surgery, measurements of the dehiscence bony height, width, and surface area were made. Before applying the membrane to defects, guided bone regeneration was performed. Because it is difficult to measure the degree of exposure, early exposed cases were excluded from the result analysis. The mean percentage gain of the dehiscence defect and the mean marginal bone reduction value of follow-up radiograph did not show statistically significant differences between the 2 groups. Both membranes exhibited satisfactory results on dehiscence defects. As a result, our authors concluded the success of guided bone regeneration was performed simultaneously for dehiscence defects around the implant, regardless whether collagen membranes were cross-linked or noncross-linked.

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A Critical Review on the Production of Electrospun Nanofibres for Guided Bone Regeneration in Oral Surgery

Nanomaterials ◽

10.3390/nano10010016 ◽

2019 ◽

Vol 10 (1) ◽

pp. 16 ◽

Cited By ~ 7

Author(s):

Federico Berton ◽

Davide Porrelli ◽

Roberto Di Lenarda ◽

Gianluca Turco

Keyword(s):

Bone Regeneration ◽

Antimicrobial Agents ◽

Soft Tissues ◽

Oral Surgery ◽

Blood Clot ◽

High Surface ◽

Bone Matrix ◽

Guided Bone Regeneration ◽

Electrospinning Technique

Nanofibre-based membranes or scaffolds exhibit high surface-to-volume ratio, which allows an improved cell adhesion, representing an attractive subgroup of biomaterials due to their unique properties. Among several techniques of nanofiber production, electrospinning is a cost-effective technique that has been, to date, attractive for several medical applications. Among these, guided bone regeneration is a surgical procedure in which bone regeneration, due to bone atrophy following tooth loss, is “guided” by an occlusive barrier. The membrane should protect the initial blood clot from any compression, shielding the bone matrix during maturation from infiltration of soft tissues cells. This review will focus its attention on the application of electrospinning (ELS) in oral surgery bone regeneration. Despite the abundance of published papers related to the electrospinning technique applied in the field of bone regeneration of the jaws, to the authors’ knowledge, no articles report clinical application of these structures. Moreover, only a few records can be found with in vivo application. Therefore, no human studies have to date been detectable. New approaches such as multifunctional multilayering and coupling with bone promoting factors or antimicrobial agents, makes this technology very attractive. However, greater efforts should be made by researchers and companies to turn these results into clinical practice.

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