Background: The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs. Material and Methods: Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and se...
Background: The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs. Material and Methods: Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge $3.0{\times}10mm$ fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation. Result: NBF were $48.15{\pm}18.02%$, $45.50{\pm}28.37%$, and $77.13{\pm}15.30%$ in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed $37.00{\pm}11.53%$, $32.25{\pm}26.99%$, and $1.33{\pm}2.31%$ in 4,8,12 weeks, respectively. BIC ratio were $53.08{\pm}19.82%$, $45.00{\pm}28.37%$, and $75.13{\pm}16.55%$ in 4,8,12 weeks, respectively. Those for the control groups were $38.33{\pm}6.43%$, $33.50{\pm}29.51%$, and $1.33{\pm}2.31%$ in 4, 8, 12 weeks, respectively. Conclusion: Autogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.
Background: The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs. Material and Methods: Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge $3.0{\times}10mm$ fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation. Result: NBF were $48.15{\pm}18.02%$, $45.50{\pm}28.37%$, and $77.13{\pm}15.30%$ in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed $37.00{\pm}11.53%$, $32.25{\pm}26.99%$, and $1.33{\pm}2.31%$ in 4,8,12 weeks, respectively. BIC ratio were $53.08{\pm}19.82%$, $45.00{\pm}28.37%$, and $75.13{\pm}16.55%$ in 4,8,12 weeks, respectively. Those for the control groups were $38.33{\pm}6.43%$, $33.50{\pm}29.51%$, and $1.33{\pm}2.31%$ in 4, 8, 12 weeks, respectively. Conclusion: Autogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.
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가설 설정
5. Based on the above results, autogenous tooth bone graft materials are thought to be good graft materials that can substitute for existing autogenous bone graft materials.
Villanueva osteochrome bone stain. C. Histopathologic findings in 12 weeks, Lt: Low power view showed little new bone formation (open asterisks) around the implant (asterisk). Rt: Higher power view of the right midportion of the left figure showed absence of new bone formation around the implant (asterisk).
제안 방법
A healing group provided with no treatment so that artificial bone defects would be naturally healed was selected as a control group to experiment on the effects of autogenous tooth bone blocks. Although there is a time difference of 10 days, this experiment minimized the fabrication period to differentiate the experimental group and the control group in the shortest possible period, and these authors are confident that this is the most accurate experiment on the effects of autogenous tooth bone. Given that this was not an experiment to form bone defects, wait until the wounds are healed, and graft bones onto chronic bony defects, this experiment has a limitation in that it could not consider the characteristics of existing chronic diseases such as periodontal diseases.
The panorama photos, digitized as DICOM files, were converted into JPEG graphic files, and the JPEGs were stored. From the stored files, bone densities were measured in the area around each implant ranging from 2 mm in front of the implant boundary to 2 mm in the rear of the implant boundary and to 2 mm downward from the upper bone boundary considering the size of the autogenous tooth bone graft material using the average value of the 255 tonality grayscale using the gray-level histogram of the Adobe Photoshop CS3 program. The peri-implant bone densities were measured in panoramas using the Adobe Photoshop CS3 program.
Although there is a time difference of 10 days, this experiment minimized the fabrication period to differentiate the experimental group and the control group in the shortest possible period, and these authors are confident that this is the most accurate experiment on the effects of autogenous tooth bone. Given that this was not an experiment to form bone defects, wait until the wounds are healed, and graft bones onto chronic bony defects, this experiment has a limitation in that it could not consider the characteristics of existing chronic diseases such as periodontal diseases. However, bearing this situation in mind, the fact that if some time is allowed to pass after extraction, experiments cannot be standardized as the shapes of vertical bone defects cannot be controlled was considered.
Images magnified by factors of 12.5 and 40 were obtained using an optical microscope (Axioscop, Carl Zeiss, Jena, Germany) and the images were reconstructed to photos of the entire tissues using the Photoshop program. From these photos, the ratio of newly formed mineralized bones (NBF, new bone formation) to the entire bone defect was calculated using an image analyzer (iMTechnology, Korea).
, Seoul, Korea). Infiltration anesthesia was conducted on the surgical site using lidocaine (2% lidocaine hydrochloride - epinephrine, 1.8 ml, Yuhan Co., Seoul, Korea) for anesthesia and hemostasis. Four molar teeth on the right side of the lower jar were extracted and processed into autogenous tooth bone.
데이터처리
As a statistical method, the non-parametric Wilcoxon test of the SPSS 12.0 program (SPSS Inc. Chicago, USA) was used, and the statistical significance level was set to P < 0.05.
The nonparametric Mann–Whitney test of the SPSS 12.0 program (SPSS Inc. Chicago, USA) was used and the statistical significance level was set to P < 0.05.
성능/효과
1. At all of weeks four, eight, and 12, the experimental group grafted with autogenous tooth graft materials showed higher BIC and NBF compared to the control group. However, the differences at weeks four and eight were not statistically significant.
2. At week 12 after implant placement, the experimental group grafted with autogenous tooth graft materials showed statistically significantly higher BIC and NBF compared to the control group (p < 0.05).
3. In a comparison of bone densities in panoramas at weeks four and 12, although the experimental group showed more increases in bone densities, both the experimental group and the control group showed significant increases over time (p < 0.05).
4. In CT findings, the experimental group showed higher bone densities compared to the control group at week 12 and the difference was significant (p < 0.05).
Figure 3 Microphotographs of experimental group. A. Histopathologic findings in 4 weeks, Lt: Low power view showed increased new bone formation (open asterisks) and bone-implant contact(BIC) ratio around the implant (asterisk). Rt: Higher power view of the left lower half of the left figure showed higher new bone formation (open asterisks) and BIC around the implant (asterisk).
According to the results of comparison of changes in periimplant bone densities of the control group and the experimental group in panorama photos at weeks four and 12 after implant placement, the control group showed average 7 gray-level scale increases, while the experimental group showed average 10 gray-level scale increases, which were larger than those of the control group, but the bone density increases over time in both the control group and the experimental group were significant (p < 0.05) (Figure 2, Table 5).
As a statistical method, independent sample t-tests were conducted using SSPS ver.17.0 (SPSS, Chicago, IL, USA) and cases where the P value was smaller than 0.05 were regarded as being statistically significant.
Villanueva osteochrome bone stain. C. Histopathologic findings in 12 weeks, Lt: Low power view showed significantly increased new bone formation (open asterisks) and bone-implant contact(BIC) ratio around the implant(asterisk). Rt: Higher power view of the right upper half of the left figure showed higher new bone formation (open asterisks) and BIC around the implant (asterisk).
From the CT images taken from the implants of minipigs sacrificed at week 12 for comparison of bone densities, the average value of the control group was measured as 87 gray level scale on average and that of the experimental group was measured as 128 gray level scale on average, which was higher by 41 gray-level scale levels on average than that of the control group. The bone densities of the experimental group in CT images were shown to be higher compared to the control group, and the differences were statistically significant (p < 0.
The newly formed bone area ratios of the experimental group at weeks four, eight, and 12 (Figure 3) were 48.15 ± 18.02%, 45.50 ± 28.37%, and 77.13 ± 15.30%, respectively, which were higher than those of the control group (Figure 4), which were 37.00 ± 11.53%, 32.25 ± 26.99%, and 1.33 ±2.31%, respectively, (Table 1) and the difference between the week 12 groups was statistically significant (Table 2).
The newly formed bone area ratios of the experimental group at weeks four, eight, and 12 were 53.08 ± 19.82%, 45.00 ±28.37%, and 75.13 ± 16.55%, respectively, which were larger than those of the control group, which were 38.33 ±6.43%, 33.50 ± 29.51%, and 1.33 ± 2.31%, respectively (Table 3).
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