Histologic analyses of flapless ridge preservation in sockets with buccal dehiscence defects using two alloplastic bone graft substitutes
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To investigate whether one of two synthetic bone substitute materials used for ridge preservation in the extraction sockets with buccal dehiscence defects was superior regarding new bone formation and ridge preservation and to compare it to sites left for spontaneous healing.
Materials and methods
In sixteen dogs, P3 and P4 were hemi-sectioned and the respective distal roots were extracted. Following the preparation of a mucoperiosteal flap without vertical releasing incisions, 50% of the buccal bone was carefully removed. The extraction sites were randomly assigned either to a ridge preservation procedure (alloplastic bone substitute material (two test groups)) or to spontaneous healing (control group). Descriptive histology and histomorphometric analyses were performed at healing times of 4, 8, and 16 weeks. In case of homogeneous variances, the results were analyzed by one-way ANOVA, followed by Tukey’s post-hoc test. If inhomogeneous, the data was analyzed using Welch-type ANOVA, followed by the Games–Howell post-hoc test.
The use of bone substitute material led to significantly greater horizontal dimensions amounting to 3.3 mm (SD = 0.67; test 1) and 3.5 mm (SD = 0.72; test 2) compared to spontaneous healing (1.7 mm, SD = 0.23) at 16 weeks of healing (p < 0.0001). A significant difference was observed between spontaneous healing and the test groups in terms of newly formed bone tissue at 4, 8, and 16 weeks (p = 0.001), with values reaching 7.9, 21.8, and 36.8% (test 1), 5.0, 10.4, and 29% (test 2), and 26.2, 43.5, and 56.4% (control), but there were no significant differences between the test groups (p > 0.05). The final ridge profile was more favorable after ridge preservation (p < 0.001) as demonstrated by a loss of 28.8% (spontaneous healing) and an increase in both test groups at 16 weeks (test 1 = 60.5% and test 2 = 31.2%).
The use of alloplastic materials rendered greater horizontal dimensions and a more favorable maintenance of the ridge profile.
Alloplastic bone substitute materials can successfully be used for ridge preservation procedures.
KeywordsRidge preservation Alveolar ridge augmentation Alloplastic bone substitute
The authors would like to acknowledge the animal care team at the NAMSA, Lyon, France, for assistance during surgery. The support and expertise of Dr. Lorenz Uebersax, Sunstar Suisse SA, Etoy, Switzerland, is highly appreciated. The statistical analysis performed by Prof. Juerg Huesler, University, of Zurich, Zurich, Switzerland is very much appreciated.
This study was funded by Sunstar Suisse SA, Etoy, Switzerland, and the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
For this type of study, formal consent is not required.
- 1.Al Salamah L, Babay N, Anil S, Al Rasheed A, Bukhary M (2012) Guided bone regeneration using resorbable and non-resorbable membranes: a histological study in dogs. Odonto-Stomatol Trop 35:43–50Google Scholar
- 7.Atieh MA, Alsabeeha NH, Payne AG, Duncan W, Faggion CM, Esposito M (2015) Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. Cochrane Database Syst Rev:CD010176. https://doi.org/10.1002/14651858.CD010176.pub2
- 9.Cardaropoli G, Araujo M, Hayacibara R, Sukekava F, Lindhe J (2005) Healing of extraction sockets and surgically produced—augmented and non-augmented—defects in the alveolar ridge. An experimental study in the dog. J Clin Periodontol 32:435–440. https://doi.org/10.1111/j.1600-051X.2005.00692.x CrossRefPubMedGoogle Scholar
- 10.Danesh-Sani SA, Engebretson SP, Janal MN (2017) Histomorphometric results of different grafting materials and effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res 52:301–312. https://doi.org/10.1111/jre.12402 CrossRefPubMedGoogle Scholar
- 11.de Barros RRM, Novaes AB Jr, de Carvalho JP, de Almeida ALG (2017) The effect of a flapless alveolar ridge preservation procedure with or without a xenograft on buccal bone crest remodeling compared by histomorphometric and microcomputed tomographic analysis. Clin Oral Implants Res 28:938–945. https://doi.org/10.1111/clr.12900 CrossRefPubMedGoogle Scholar
- 13.Gholami GA, Najafi B, Mashhadiabbas F, Goetz W, Najafi S (2012) Clinical, histologic and histomorphometric evaluation of socket preservation using a synthetic nanocrystalline hydroxyapatite in comparison with a bovine xenograft: a randomized clinical trial. Clin Oral Implants Res 23:1198–1204. https://doi.org/10.1111/j.1600-0501.2011.02288.x CrossRefPubMedGoogle Scholar
- 15.Jung RE, Sapata VM, Hämmerle CHF, Wu H, Hu XL, Lin Y (2018) Combined use of xenogeneic bone substitute material covered with a native bilayer collagen membrane for alveolar ridge preservation: a randomized controlled clinical trial. Clin Oral Implants Res 29(5):522–529. https://doi.org/10.1111/clr.13149
- 16.Kakar A, Rao BHS, Hegde S, Deshpande N, Lindner A, Nagursky H, Patney A, Mahajan H (2017) Ridge preservation using an in situ hardening biphasic calcium phosphate (beta-TCP/HA) bone graft substitute—a clinical, radiological, and histological study. Int J Implant Dent 3:25. https://doi.org/10.1186/s40729-017-0086-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Mardas N, Chadha V, Donos N (2010) Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clin Oral Implants Res 21:688–698. https://doi.org/10.1111/j.1600-0501.2010.01918.x CrossRefPubMedGoogle Scholar
- 21.Naenni N, Sapata V, Bienz SP, Leventis M, Jung RE, Hammerle CH, Thoma DS (2017) Effect of flapless ridge preservation with two different alloplastic materials in sockets with buccal dehiscence defects—volumetric and linear changes. Clin Oral Inv. https://doi.org/10.1007/s00784-017-2309-6
- 22.Papageorgiou SN, Papageorgiou PN, Deschner J, Gotz W (2016) Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: systematic review and network meta-analysis of parallel and cluster randomized controlled trials. J Dent 48:1–8. https://doi.org/10.1016/j.jdent.2016.03.010 CrossRefPubMedGoogle Scholar
- 23.Rolvien T, Barbeck M, Wenisch S, Amling M, Krause M (2018) Cellular mechanisms responsible for success and failure of bone substitute materials. Int J Mol Sci 19. https://doi.org/10.3390/ijms19102893
- 25.Thoma DS, Jung RE, Schneider D, Cochran DL, Ender A, Jones AA, Gorlach C, Uebersax L, Graf-Hausner U, Hammerle CH (2010) Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis. J Clin Periodontol 37:659–666. https://doi.org/10.1111/j.1600-051X.2010.01581.x CrossRefPubMedGoogle Scholar
- 26.Valdivia-Gandur I, Engelke W, Beltran V, Borie E, Fuentes R, Manzanares-Cespedes MC (2016) Novel use of cranial epidural space in rabbits as an animal model to investigate bone volume augmentation potential of different bone graft substitutes. Head Face Med 12:35. https://doi.org/10.1186/s13005-016-0131-z CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Wildburger A, Bubalo V, Magyar M, Nagursky H, Jakse N, Schmelzeisen R, Sauerbier S (2017) Sinus floor augmentation comparing an in situ hardening biphasic calcium phosphate (hydroxyapatite/beta-tricalcium phosphate) bone graft substitute with a particulate biphasic calcium phosphate (hydroxyapatite/beta-tricalcium phosphate) bone graft substitute: an experimental study in sheep. Tissue Eng Part C Methods 23:404–411. https://doi.org/10.1089/ten.TEC.2016.0549 CrossRefPubMedGoogle Scholar