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New Scientific Information Comparing Bio-Oss® to Allografts Just Published!
Comparative Histomorphometric Analysis of Extraction Sockets Healing with Bovine Xenografts, Irradiated Cancellous Allografts, and Solvent-Dehydrated Allografts in Humans.
Dong-Woon Lee, DDS, MS/Sung-Hee Pi, DDS, PhD/Suk-Kuen Lee, DDS, PhD/Eun-Cheol Kim, DDS, PhD. Int J Oral Maxillofac Implants 2009; 24:609-615.
Purpose
Various bone graft substitutes have been used for socket grafting immediately following tooth removal, including Bio-Oss® natural bone mineral, irradiated cancellous human allograft (ICA) and solvent-dehydrated allograft (Puros®). The purpose of the current prospective study was to compare the efficacy of each of these graft materials over a 4 to 6 month duration in regenerating vital healthy bone within extraction sockets compromised by severe periodontal disease.
Materials & Methods
Following atraumatic removal of periodontally hopeless teeth and thorough debridement of each socket, 20 patients were divided into three groups according to the following grafting material used for socket preservation:
- Bio-Oss® natural bone mineral (n = 7)
- ICA (n = 8)
- Puros® allograft (n = 5)
The bone graft substitutes were grafted to the alveolar crest and then covered with a Bio-Gide® resorbable membrane. (Figures 1a & 1b) Mucoperiosteal flaps were closed via multiple interrupted or figure-of-eight sutures. Four to six months later, following uneventful healing of all sites, implants were placed and bone cores from the central portion of each grafted socket were obtained for histologic and histomorphometric analysis. (Figure 2)
Figure 1a
Extraction sockets with severe palatal bone loss
Figure 1b
Extraction sockets were grafted to the alveolar crest with eas grafting material. Grafting with Bio-Oss® is shown in the image (left).
Figure 2
Bone cores were obtained at the time of implant placement. Note the high degree of bone regeneration in the Bio-Oss® grafted site (left).
Images Copyright 2009 Quintessence Publishing reproduced with permission from Int J Oral Maxillofac Implants 2009; 24:609-615.
Results
Investigators in this study examined both qualitative (histologic) and quantitative (histomorphometric) results.
Histologic Findings:
Bio-Oss® Grafted Sites
- The majority of Bio-Oss® particles were incorporated within newly regenerated, vital bone
- Residual Bio-Oss® particles were interconnected through formation of newly formed bone “bridges.”
- Only a few Bio-Oss® particles were in contact with adjacent stromal connective tissue.
- Inflammatory cell infiltration was rare in Bio-Oss® grafted sites.
- Bio-Oss® particles demonstrated evidence of slow resorption, with many residual particles remaining within a matrix of newly formed bone.
Irradiated Cancellous Allograft (ICA) Grafted Sites
- ICA particles showed active resorption, remnants of which were surrounded with irregularly deposited bone.
- Bridging with newly formed bone between particles occurred but with less frequency than seen in the Bio-Oss® grafted sites.
- Many residual ICA particles were surrounded by fibrous connective tissue.
- Focal areas of inflammatory cell infiltration were observed within the stromal connective tissue.
Puros® Allograft
- Puros® particles actively resorbed and remained as bony spicules partially incorporated with new bone.
- New bone formation on the surface of the graft particles was often irregular with little evidence of bone bridging between Puros® residual particles.
- Inflammatory cell infiltration was rare.
Histomorphometric Findings:
Quantitatively the Results after 4 –6 Months were as follows:
Conclusions
Preserving the anatomic integrity of extraction socket sites, with little to no loss of crestal bone, is the primary function of post-extraction socket grafting, especially in the esthetic zone of the maxilla. In order to achieve socket grafting success, grafting materials must be highly osteoconductive, slowly resorbable, and capable of supporting robust new vital bone growth. In this well-designed prospective study, Bio-Oss® natural grafting material exhibited greater osteoconductivity and new vital bone formation than either of the tested allograft materials. In addition, the long-term scaffold provided by Bio-Oss® particles may, according to the investigators, help maintain critical extraction socket volume during healing, a characteristic absent in the rapidly resorbing ICA and Puros® allografts.
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