J Periodontal Implant Sci.  2019 Oct;49(5):330-343. 10.5051/jpis.2019.49.5.330.

Comparative preclinical assessment of the use of dehydrated human amnion/chorion membrane to repair perforated sinus membranes

• Chang YY
• Kim SH
• Goh MS
• Yun JH

• KMID: 2461023
• DOI: http://doi.org/10.5051/jpis.2019.49.5.330

Abstract

PURPOSE
The aim of this study was to evaluate the use of dehydrated human amnion/chorion membrane (dHACM) to repair perforated sinus membranes in rabbits.
METHODS
Bilateral surgical windows (7.5-mm diameter) were prepared on the nasal bones of 14 rabbits. Standardized circular perforations (5-mm diameter) were made in the sinus membrane by manipulating implant twist drills. The perforated sinus membranes were repaired using dHACM or a resorbable collagen membrane (CM). The negative control (NC) group did not undergo perforated sinus membrane repair, while the positive control (PC) group underwent sinus augmentation without perforations. The same amount of deproteinized porcine bone mineral was grafted in all 4 groups. After 6 weeks, micro-computed tomography (micro-CT) and histomorphometric evaluations were conducted.
RESULTS
The micro-CT analysis revealed that the total augmented volume was not significantly different among the groups. In the dHACM group, newly formed bone filled the augmented area with remaining biomaterials; however, non-ciliated flat epithelium and inflammatory cells were observed on the healed sinus membrane. Histometric analysis showed that the percentage of newly formed bone area in the dHACM group did not differ significantly from that in the CM group. The dHACM group showed a significantly higher percentage of newly formed bone area than the NC group, but there was no significant difference between the dHACM and PC groups.
CONCLUSIONS
dHACM could be a feasible solution for repairing sinus membrane perforations that occur during sinus floor augmentation.

Keyword

Amnion; Chorion; Histology; Rabbits; Sinus floor augmentation

MeSH Terms

Amnion
Biocompatible Materials
Chorion
Collagen
Epithelium
Humans*
Membranes*
Miners
Nasal Bone
Rabbits
Sinus Floor Augmentation
Transplants
Biocompatible Materials
Collagen

Figure

• 

  Figure 1 (A) Commercial dHACM. (B) Bilateral surgical areas (7-mm diameter) were prepared on the nasal bone, and the sinus membrane was elevated and perforated (5-mm diameter). The perforated sinus membrane on the left was untreated, whereas the perforated sinus membrane on the right was covered with dHACM. (C) Deproteinized porcine bone mineral was subsequently grafted on both elevated sinuses. (D) A metal pin (as a reference point) was fixed on the midline suture, and then the periosteum was sutured. (E, F) Field emission scanning electron microscope images of dHACM. dHACM: dehydrated human amnion/chorion membrane.

• 

  Figure 2 Cross-sectional and 3-dimensional reconstructed micro-computed tomography images of sinus floor augmentation. NC: negative control, dHACM: dehydrated human amnion/chorion membrane, PC: positive control, CM: collagen membrane.

• 

  Figure 3 Representative histologic views of the NC (A-C) and dHACM (D-F) groups 6 weeks after surgery. (A) Little NB was observed, and most RBs and fibrovascular tissue were in the augmented areas in the NC group. Discontinuous and perforated sinus membrane was observed. (B) Only RBs were deposited in the fibrovascular areas. (C) The lamina propria, containing a dense infiltration of inflammatory cells, was exposed to the sinus cavity. (D) Overall, the augmented areas in the dHACM group were embraced with the sinus membrane and densely packed with NB and RBs. (E) High-magnification view representing the center region of the augmented area. The NB was intimately connected to the RBs. (F) High-magnification view of the sinus membrane region. Pseudostratified ciliated columnar epithelium lined the augmented area, and a cluster of serous glands and small blood vessels were located in the lamina propria. An aggregation of inflammatory cells was also observed in the lamina propria (Masson's trichrome stain). Black arrow heads, asterisks, black arrows, empty black arrow are presented as the bony margin of the surgical window, perforated site, serous glands, and blood vessel, respectively. NC: negative control, dHACM: dehydrated human amnion/chorion membrane, NB: newly formed bone, RB: remaining biomaterial, PE: pseudostratified ciliated columnar epithelium.

• 

  Figure 4 Low- and high- magnification views of another specimen in the dHACM group. (A) NB had emerged from native bone and spread to the repaired sinus membrane regions. (B) Repaired sinus mucosa. The perforated, but repaired, sinus membrane adjacent to the ciliated columnar epithelium healed with non-ciliated, flat, and stratified epithelium. Inflammatory infiltration was also observed in the lamina propria, and serous glands were seldom observed (Masson's trichrome stain). Black arrow heads, black arrows, empty black arrow, and black dotted line are presented as the bony margin of the surgical window, pseudostratified ciliated columnar epithelium, healed and repaired non-ciliated stratified epithelium, and inferior border of lamina propria, respectively. RB: remaining biomaterial, dHACM: dehydrated human amnion/chorion membrane.

• 

  Figure 5 Representative histologic views of the CM (A-C) and PC (D-F) groups 6 weeks after surgery. (A) RBs were dispersed throughout the augmented areas, and the NB emerged from the native bone in the CM group. (B) High-magnification view showing new bone formation around native bone. (C) High-magnification view of the sinus membrane region. The lamina propria, including numerous serous glands and inflammatory cells, was relatively thick, similar to the dHACM group. (D, E) NB in direct contact with RBs was found at the bony margin of the surgical area and sinus membrane region in the PC group. (F) Ciliated columnar epithelium was well maintained, and abundant serous glands and small blood vessels were predominantly observed in the cell-rich lamina propria (Masson's trichrome stain). Black arrow heads, black arrows, and empty black arrows are presented as the bony margin of the surgical window, serous glands, and blood vessel, respectively. CM: collagen membrane, PC: positive control, dHACM: dehydrated human amnion/chorion membrane, NB: newly formed bone, RB: remaining biomaterial, PE: pseudostratified ciliated columnar epithelium.

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