CC BY 4.0 · Eur J Dent 2023; 17(03): 727-734
DOI: 10.1055/s-0042-1753453
Original Article

Prospective Clinical Study with New Materials for Tissue Regeneration: A Study in Humans

1   Department of Implant Dentistry, International Dental Research Institute, Catholic University San Antonio of Murcia (UCAM), Murcia, Spain
,
2   Department of Integrated Clinic for Adults, International Dental Research Institute, Catholic University San Antonio of Murcia, Murcia, Spain
,
José Manuel Granero Marín
3   Department of Restorative Dentistry, International Dental Research Institute, Catholic University San Antonio of Murcia (UCAM), Murcia, Spain
,
4   Department of Implant Dentistry and Periodontology, International Dental Research Institute, Catholic University San Antonio of Murcia, Murcia, Spain
5   Department of Materials Science and Engineering, International Research Institute for Biomaterials, Catholic University San Antonio of Murcia, Murcia, Spain
› Institutsangaben

Abstract

Objective This study was performed to evaluate the clinical, radiographic, and histomorphometric outcomes of novel bone grafting materials and dental membranes and to compare the results with current data from the literature.

Materials and Methods New synthetic bone substitutes, consisting of biphasic calcium phosphate in the ratio of 60% hydroxyapatite and 40% β-tricalcium phosphate, were applied in bony defects and covered by either a novel synthetic poly(lactic-co-glycolic) acid (PLGA) or porcine collagen membrane. A sample of 51 biomaterials was placed in a total of 20 patients during different surgical protocols. Implants were simultaneously inserted, and in the case of sinus floor elevations 6 months later. Pre- and postoperative cone-beam computed tomographies were taken. Bone biopsies were harvested from augmented sides and processed for histomorphometric evaluation.

Statistical Analysis Averages and ranges were calculated for the percentage of newly formed bone, residual biomaterial, and connective tissue. Data were submitted to analyze the radiological mean differences in length, width, and density. Paired t-tests were deployed for the analysis of differences within each group between the baseline (preoperative) and the final (postoperative) measurements.

Results The mean bone gain in length and width were 0.96 ± 3.33 mm (+27.59%) and 1.22 ± 1.87 mm (+30.48%), respectively. The bone density was increased by a factor of 4, reaching an average of 387.47 ± 328.86 HU. Histomorphometric evaluations revealed new bone formation of 41.44 ± 5.37%, residual biomaterial of 24.91 ± 7.31%, and connective tissue of 33.64 ± 4.81%. The mean healing period was 8.32 ± 3.00 months.

Conclusions Data from this study confirmed the suitability of the tested materials in dental surgery. The biomaterials may be recommended for various clinical procedures. A satisfactory level of increase of new bone was reported in augmented sides. No significant differences were observed between the tested membranes. PLGA membranes might be superior to collagen membranes for their easier handling.

Ethical Approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Catholic University San Antonio of Murcia (protocol code CE061912 and date of approval: 07.06.2019).


Authors' Contributions

All authors gave their final approval and agreed to be accountable for all aspects of the work.




Publikationsverlauf

Artikel online veröffentlicht:
04. Oktober 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Caldwell CS. Particulate membrane grafting/guided bone regeneration. In: Resnik RR. ed. Misch's Contemporary Implant Dentistry. 4th ed.. St. Louis, MO: Mosby; 2020: 933-986
  • 2 Tadic D, Epple M. A thorough physicochemical characterisation of 14 calcium phosphate-based bone substitution materials in comparison to natural bone. Biomaterials 2004; 25 (06) 987-994
  • 3 Conz MB, Granjeiro JM, Soares GdeA. Physicochemical characterization of six commercial hydroxyapatites for medical-dental applicatons as bone graft. J Appl Oral Sci 2005; 13 (02) 136-140
  • 4 LeGeros RZ. Properties of osteoconductive biomaterials: calcium phosphates. Clin Orthop Relat Res 2002; (395) 81-98
  • 5 Zhao R, Yang R, Cooper PR, Khurshid Z, Shavandi A, Ratnayake J. Bone grafts and substitutes in dentistry: a review of current trends and developments. Molecules 2021; 26 (10) 3007
  • 6 Wenisch S, Stahl JP, Horas U. et al. In vivo mechanisms of hydroxyapatite ceramic degradation by osteoclasts: fine structural microscopy. J Biomed Mater Res A 2003; 67 (03) 713-718
  • 7 Carotenuto G, Spagnuolo G, Ambrosio L, Nicolais L. Macroporous hydroxyapatite as alloplastic material for dental applications. J Mater Sci Mater Med 1999; 10 (10/11) 671-676
  • 8 Suneelkumar C, Datta K, Srinivasan MR, Kumar ST. Biphasic calcium phosphate in periapical surgery. J Conserv Dent 2008; 11 (02) 92-96
  • 9 Maté Sánchez de Val JE, Calvo-Guirado JL, Gómez-Moreno G, Pérez-Albacete Martínez C, Mazón P, De Aza PN. Influence of hydroxyapatite granule size, porosity, and crystallinity on tissue reaction in vivo. Part A: synthesis, characterization of the materials, and SEM analysis. Clin Oral Implants Res 2016; 27 (11) 1331-1338
  • 10 Kim SE, Park K. Recent advances of biphasic calcium phosphate bioceramics for bone tissue regeneration. Adv Exp Med Biol 2020; 1250: 177-188
  • 11 Kini V, Nayak DG, Uppoor AS. A clinical evaluation of biphasic calcium phosphate alloplast with and without a flowable bioabsorbable guided tissue regeneration barrier in the treatment of mandibular molar class II furcation defects. J Contemp Dent Pract 2016; 17 (02) 143-148
  • 12 Mkukuma LD, Skakle JM, Gibson IR, Imrie CT, Aspden RM, Hukins DW. Effect of the proportion of organic material in bone on thermal decomposition of bone mineral: an investigation of a variety of bones from different species using thermogravimetric analysis coupled to mass spectrometry, high-temperature X-ray diffraction, and Fourier transform infrared spectroscopy. Calcif Tissue Int 2004; 75 (04) 321-328
  • 13 Goto T, Kojima T, Iijima T. et al. Resorption of synthetic porous hydroxyapatite and replacement by newly formed bone. J Orthop Sci 2001; 6 (05) 444-447
  • 14 Miron RJ, Zhang Q, Sculean A. et al. Osteoinductive potential of 4 commonly employed bone grafts. Clin Oral Investig 2016; 20 (08) 2259-2265
  • 15 Werner J, Linner-Krcmar B, Friess W, Greil P. Mechanical properties and in vitro cell compatibility of hydroxyapatite ceramics with graded pore structure. Biomaterials 2002; 23 (21) 4285-4294
  • 16 Bouler JM, Pilet P, Gauthier O, Verron E. Biphasic calcium phosphate ceramics for bone reconstruction: a review of biological response. Acta Biomater 2017; 53: 1-12
  • 17 Bucchi C, Del Fabbro M, Arias A. et al. Multicenter study of patients' preferences and concerns regarding the origin of bone grafts utilized in dentistry. Patient Prefer Adherence 2019; 13: 179-185
  • 18 Maté Sánchez de Val JE, de Aza Moya PN. Comparative Analysis of Three Different Reports (OssCeram/Keramat/Bredent) (unpublished work). Murcia, Spain: Catholic University of San Antonio of Murcia (UCAM); 2020
  • 19 Gentile P, Chiono V, Carmagnola I, Hatton PV. An overview of poly(lactic-co-glycolic) acid (PLGA)-based biomaterials for bone tissue engineering. Int J Mol Sci 2014; 15 (03) 3640-3659
  • 20 Daculsi G, Passuti N, Martin S, Deudon C, Legeros RZ, Raher S. Macroporous calcium phosphate ceramic for long bone surgery in humans and dogs. Clinical and histological study. J Biomed Mater Res 1990; 24 (03) 379-396
  • 21 Yamada S, Heymann D, Bouler JM, Daculsi G. Osteoclastic resorption of calcium phosphate ceramics with different hydroxyapatite/beta-tricalcium phosphate ratios. Biomaterials 1997; 18 (15) 1037-1041
  • 22 Lee J, Lee YM, Lim YJ, Kim B. Ridge augmentation using β-tricalcium phosphate and biphasic calcium phosphate sphere with collagen membrane in chronic pathologic extraction sockets with dehiscence defect: a pilot study in beagle dogs. Materials (Basel) 2020; 13 (06) E1452
  • 23 Ransford AO, Morley T, Edgar MA. et al. Synthetic porous ceramic compared with autograft in scoliosis surgery. A prospective, randomized study of 341 patients. J Bone Joint Surg Br 1998; 80 (01) 13-18
  • 24 Friedmann A, Dard M, Kleber BM, Bernimoulin JP, Bosshardt DD. Ridge augmentation and maxillary sinus grafting with a biphasic calcium phosphate: histologic and histomorphometric observations. Clin Oral Implants Res 2009; 20 (07) 708-714
  • 25 Mangano C, Perrotti V, Shibli JA. et al. Maxillary sinus grafting with biphasic calcium phosphate ceramics: clinical and histologic evaluation in man. Int J Oral Maxillofac Implants 2013; 28 (01) 51-56
  • 26 Danesh-Sani SA, Engebretson SP, Janal MN. 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 2017; 52 (03) 301-312
  • 27 Schmitt CM, Doering H, Schmidt T, Lutz R, Neukam FW, Schlegel KA. Histological results after maxillary sinus augmentation with Straumann® BoneCeramic, Bio-Oss®, Puros®, and autologous bone. A randomized controlled clinical trial. Clin Oral Implants Res 2013; 24 (05) 576-585
  • 28 Tosta M, Cortes AR, Corrêa L, Pinto Jr DdosS, Tumenas I, Katchburian E. Histologic and histomorphometric evaluation of a synthetic bone substitute for maxillary sinus grafting in humans. Clin Oral Implants Res 2013; 24 (08) 866-870
  • 29 Danesh-Sani SA, Wallace SS, Movahed A. et al. Maxillary sinus grafting with biphasic bone ceramic or autogenous bone: clinical, histologic, and histomorphometric results from a randomized controlled clinical trial. Implant Dent 2016; 25 (05) 588-593
  • 30 Jensen SS, Bornstein MM, Dard M, Bosshardt DD, Buser D. Comparative study of biphasic calcium phosphates with different HA/TCP ratios in mandibular bone defects. A long-term histomorphometric study in minipigs. J Biomed Mater Res B Appl Biomater 2009; 90 (01) 171-181
  • 31 Troeltzsch M, Troeltzsch M, Kauffmann P. et al. Clinical efficacy of grafting materials in alveolar ridge augmentation: a systematic review. J Craniomaxillofac Surg 2016; 44 (10) 1618-1629
  • 32 Al-Qutub MN, Al-Omar NA, Ramalingam S. et al. Guided bone regeneration using biphasic calcium phosphate with adjunct recombinant human bone morphogenetic protein-2 with and without collagen membrane in standardized calvarial defects in rats: a histologic and biomechanical analysis. Int J Periodontics Restorative Dent 2016; 36 (Suppl): s11-s20
  • 33 Batas L, Stavropoulos A, Papadimitriou S, Nyengaard JR, Konstantinidis A. Evaluation of autogenous PRGF+β-TCP with or without a collagen membrane on bone formation and implant osseointegration in large size bone defects. A preclinical in vivo study. Clin Oral Implants Res 2016; 27 (08) 981-987
  • 34 Ramachandran C, Sangwan VS, Ortega I. et al. Synthetic biodegradable alternatives to the use of the amniotic membrane for corneal regeneration: assessment of local and systemic toxicity in rabbits. Br J Ophthalmol 2019; 103 (02) 286-292
  • 35 Alpar B, Leyhausen G, Günay H, Geurtsen W. Compatibility of resorbable and nonresorbable guided tissue regeneration membranes in cultures of primary human periodontal ligament fibroblasts and human osteoblast-like cells. Clin Oral Investig 2000; 4 (04) 219-225
  • 36 Hoornaert A, d'Arros C, Heymann MF, Layrolle P. Biocompatibility, resorption and biofunctionality of a new synthetic biodegradable membrane for guided bone regeneration. Biomed Mater 2016; 11 (04) 045012
  • 37 Won JY, Park CY, Bae JH. et al. Evaluation of 3D printed PCL/PLGA/β-TCP versus collagen membranes for guided bone regeneration in a beagle implant model. Biomed Mater 2016; 11 (05) 055013
  • 38 Selvido DI, Bhattarai BP, Riddhabhaya A, Vongsawan K, Arunpraphan S, Wongsirichat N. A review on the application of silver nanoparticles in oral and maxillofacial surgery. Eur J Dent 2021; 15 (04) 782-787
  • 39 Caruana A, Savina D, Macedo JP, Soares SC. From platelet-rich plasma to advanced platelet-rich fibrin: biological achievements and clinical advances in modern surgery. Eur J Dent 2019; 13 (02) 280-286
  • 40 Hendrijantini N, Hartono P, Ari MDA, Rantan FA. Human umbilical cord mesenchymal stem-cell therapy to increase the density of osteoporotic mandibular bone. Eur J Dent 2019; 13 (01) 58-63