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With aging populations and increasing oral rehabilitation, use of dental implants for oral reconstruction is increasing. Adequate hard/soft tissue are required to support use of titanium implants. Bone augmentation is sometimes a necessary procedure to supplement existing alveolar bone. With a wide variety of biomaterials available for clinical use, we focus on the enhancement of bone graft materials, targeting new technologies with potential clinical use. Clinical indications supported by research studies are provided for platelet-rich fibrin, various growth factors, and newly emerging scaffolds. Interestingly, modified biomaterials are being developed and have potential clinical use as more data become available., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Multiple bone augmentation techniques are available to allow implant placement in the atrophic maxilla. However, questions remain, regarding which methods are most predictable and have the best dental implant survival rate (SR) in grafted bone. The aim of this systematic review was to evaluate literature from the last 30 years to determine predictability of bone grafting of the edentulous maxilla for implant placement as well as for implant SR., Materials and Methods: A systematic review was performed of studies conducted during the period 1980 to 2014, specifically focusing on the edentulous maxilla and bone grafting. Surgical techniques discussed in the publications included were guided bone regeneration (GBR), sinus augmentation, onlay bone grafting, nasal floor grafting, and Le Fort I interpositional grafting. All identified articles were evaluated and screened to meet strict inclusion criteria of at least 10 patients, complete maxillary edentulism, 1-year follow-up, and information regarding implant SR. A total of 974 articles were identified with electronic and manual searches. On further evaluation of the titles and abstracts, 44 articles were excluded. Full texts of the articles that met the inclusion criteria were reviewed, of which 40 articles were included in the systematic review., Results: For onlay bone grafting, 16 studies were included and analyzed, and the weighted mean implant SR was 85.2%. For the GBR technique, two studies were included, with a reported SR ranging from 96.1% to 100%. For Le Fort I interpositional grafting, 11 studies were included, with a weighted mean SR of 89.6%. For the sinus augmentation technique, 12 studies were investigated and the weighted mean SR was 91.5%. For the combination technique, six studies were analyzed and the weighted mean SR was 93.6%., Conclusions: All five treatment modalities discussed-onlay bone grafting, GBR, Le Fort I interpositional grafting, maxillary sinus augmentation, and/or nasal floor inlay grafting or the combination approach-can be successfully used to augment edentulous maxillary ridge with high implant SRs.

Purpose: The collection of autologous platelet-rich plasma (PRP) has demonstrated favorable affects on wound healing in compromised patients. The purpose of this study was to evaluate the expression of PDGF, bFGF, and TGF-beta in irradiated and nonirradiated bone in a rabbit tibia model and the ability of PRP to increase growth factor expression when added to autogenous bone graft in a rabbit cranial defect model., Materials and Methods: Ten New Zealand White rabbit tibiae and calvariae were utilized for this study. Tibiae were irradiated at 60 to 70 cGy and evaluated for expression of PDGF, bFGF, and TGF-beta. Rabbit calvariae were also analyzed after grafting with autogenous bone and PRP for determination of growth factor expression., Results: Decreased expression of PDGF, bFGF, and TGF-beta was seen in cortical and cancellous bone samples when irradiated bone was compared to nonirradiated rabbit tibiae. An increase in PDGF, bFGF, and TGF-beta expression was detected in cortical autogenous bone grafts with PRP at 1 and 2 months compared to autogenous bone alone., Discussion: In this study, growth factors, which were decreased in irradiated cortical and cancellous bone, showed increased expression at 1 and 2 months when PRP was added to autogenous bone grafts. Thus, PRP may have potential therapeutic applications when bone grafting is required in patients with reduced bone vascularity, including patients with previous head and neck irradiation, diabetes, and smoking habits., Conclusions: Decreased expression of PDGF, bFGF, and TGF-beta was seen in radiated rabbit tibia as compared to nonirradiated controls, and increased expression of these growth factors was seen in PRP-containing autogenous bone grafts.

Platelet-rich plasma (PRP) offers a new and potentially useful adjunct to allograft materials in oral and maxillofacial bone and implant reconstructive surgery. This study compares bone healing in four cranial defects in the rabbit grafted with freeze-dried mineralized bone (FMB) alone, FMB+PRP, freeze-dried demineralized bone (FDDB) alone, and FDDB+PRP. Fifteen New Zealand white rabbits were included in this randomized, blind, prospective pilot study. Four equal 8 mm diameter defects were created in each rabbit cranium and immediately grafted with the above materials. Five rabbits were evaluated at 1, 2, and 4 months. Radiographically, FMB+PRP showed a tendency toward increased bone density over FMB alone, but was not statistically significant (P>0.05), and FDDB+PRP showed a tendency toward increased bone density over FDDB alone, but was not statistically significant (P>0.05). Histomorphometrically, FMB+PRP showed a tendency toward increased bone area over FMB alone at 1 and 4 months, but was not statistically significant (P>0.05), and FDDB+PRP showed a tendency toward increased bone area over FDDB alone, at 1 and 2 months, but was not statistically significant (P>0.05). This study failed to show a radiographic or histomorphometric increase in bone formation with the addition of PRP to either FMB or FDDB in non-critical-sized defects in the rabbit cranium.

Purpose: Platelet-rich plasma (PRP) is potentially useful as an adjunct to allograft and xenograft materials in oral and maxillofacial bone and implant reconstructive surgery. This study compares bone healing and formation in 4 cranial defects in rabbits grafted with autogenous bone, xenograft, and xenograft with PRP (with a no-graft group as a control)., Materials and Methods: Fifteen New Zealand white rabbits were included in this randomized, blind, prospective pilot study. Four identical 8-mm-diameter defects were created in each rabbit cranium and immediately grafted with the above materials. Five rabbits were evaluated at 1 month, 5 at 2 months, and 5 at 4 months. Radiographs were used to evaluate bone density., Results: Radiographically, sites at which Bio-Oss, autogenous bone, and Bio-Oss + PRP were grafted showed a significant increase in bone density at 1 month (P = .05 for Bio-Oss, P = .02 for autogenous bone, P = .008 for Bio-Oss + PRP) and at 4 months (P = .02 for Bio-Oss, P = .04 for autogenous bone, P = .05 for Bio-Oss + PRP). Autogenous bone sites (P < .001) and Bio-Oss + PRP sites (P < .001) also showed significant increases at 2 months. Histomorphometrically, autogenous bone sites showed a significantly greater increase than control sites (P = .08 at 1 month, P = .03 at 2 months, P = .01 at 4 months), Bio-Oss sites (P < .001 at all 3 evaluation points), or Bio-Oss + PRP sites (P = .009 at 1 month, P = .02 at 2 months, P = .01 at 4 months). Furthermore, Bio-Oss + PRP sites showed a significantly greater increase in bone area at 1, 2, and 4 months than Bio-Oss alone (P = .003 at 1 month, P = .02 at 2 months, P = .006 at 4 months)., Discussion: Radiographs showed significantly greater bone density at the Bio-Oss, autogenous bone, and Bio-Oss + PRP sites than at control sites at nearly every point in time evaluated; however, clinical significance is difficult to determine, since all materials appeared dense on the radiograph. Histomorphometry showed that the increase in bone area at autogenous sites was significantly greater than that seen with other grafting materials or at the control sites., Conclusion: This study showed a histomorphometric increase in bone formation with the addition of PRP to Bio-Oss in non-critical-sized defects in the rabbit cranium.