Migration of alloplastic bone graft material in infected conditions: a case study and animal experiment.
OBJECTIVE
Distant migration associated with sinus lifting procedures has not been investigated. In the present study, a case of distant migration of graft material was observed, and the potential mechanisms of migration were analyzed using material analysis and in vivo experiments.


METHODS
The migrated graft material was biphasic calcium phosphate-based alloplastic material (BCP), and its physical properties were compared with those of xenogenic material (Bio-Oss). The comparisons of the physical properties were performed using scanning electronic microscopic, x-ray diffraction, and Fourier-transform infrared absorbance spectra analysis. The comparative graft migration study was performed using the subcutaneous pocket model in rats (n = 10). The clinical case was analyzed by histologic section and energy dispersive x-ray (EDX) microanalysis.


RESULTS
The observed diffraction patterns from the Bio-Oss revealed characteristic diffractions for the hydroxyapatite phase, and those from the BCP revealed additional diffractions that could be assigned to the tricalcium phosphate phase. In the animal model, the graft migration distances observed in the BCP group were significantly greater than those observed in the Bio-Oss group (P = .012). In the clinical case, the lymphatic vessels of the submandibular gland contained foreign materials that were morphologically similar to those of the maxillary sinus. EDX microanalysis revealed that the particles in the lymphatic vessels exhibited calcium concentrations that were approximately 200 times greater than those in the adjacent glandular tissue.


CONCLUSIONS
In the present study, BCP-based sinus grafts had migrated into the submandibular glandular area by way of the lymphatic chain in the presented clinical case.
Resident, Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea.
Hyun
H
Seok
Professor, Department of Oral and Maxillofacial Pathology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea.
Seuk-Keun
SK
Lee
Associate Professor and Chairman, Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. Electronic address: kimsg@gwnu.ac.kr.
Seong-Gon
SG
Kim
Researcher, Gangneung Center, Korea Basic Science Institute, Gangneung, Korea.
Tae-Yeon
TY
Kang
Researcher, Gangneung Center, Korea Basic Science Institute, Gangneung, Korea.
Myung-Jin
MJ
Lee
Researcher, Gangneung Center, Korea Basic Science Institute, Gangneung, Korea.
Weon-Sik
WS
Chae
D000818:Animals; D018786:Bone Substitutes / Q000009:adverse effects*; D055598:Chemical Phenomena; D003238:Connective Tissue / Q000473:pathology; D004195:Disease Models, Animal; D004577:Electron Probe Microanalysis; D005547:Foreign Bodies / Q000473:pathology; D005548:Foreign-Body Migration / Q000209:etiology*; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D006882:Hydroxyapatites / Q000009:adverse effects / Q000737:chemistry; D008199:Lymphadenitis / Q000209:etiology; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D008903:Minerals / Q000009:adverse effects / Q000737:chemistry; D010316:Particle Size; D051381:Rats; D059546:Sinus Floor Augmentation / Q000009:adverse effects*; D017550:Spectroscopy, Fourier Transform Infrared; D013203:Staphylococcal Infections / Q000382:microbiology; D040521:Subcutaneous Tissue / Q000382:microbiology / Q000601:surgery; D013363:Submandibular Gland / Q000473:pathology; D014961:X-Ray Diffraction
C077540:Bio-Oss; D018786:Bone Substitutes; D006882:Hydroxyapatites; D008903:Minerals; C074950:hydroxyapatite-beta tricalcium phosphate