CBCT analysis of bone density in bicortical defects after augmentation with alloplastic and xenogeneic bone substitutes – A study on domestic pigs

Filip Djordjević; Branko Mihailović; Raša Mladenović; Dejan Dubovina; Mirjana Kostić; Jelena Stanišić; Zoran Vlahović

doi:10.2298/VSP190731040D

Filip Djordjević University of Priština/Kosovska Mitrovica, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia
Branko Mihailović University of Priština/Kosovska Mitrovica, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia
Raša Mladenović University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
Dejan Dubovina University of Priština/Kosovska Mitrovica, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia
Mirjana Kostić University of Priština/Kosovska Mitrovica, Faculty of Medicine, Institute of Preventive Medicine, Kosovska Mitrovica, Serbia
Jelena Stanišić University of Priština/Kosovska Mitrovica, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia
Zoran Vlahović University of Priština/Kosovska Mitrovica, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia

DOI: https://doi.org/10.2298/VSP190731040D

Keywords: alveolar ridge augmentation, bone density, bone regeneration, bone transplantation, cone-beam computed tomography, dental implants, oral surgical procedures, swine

Abstract

Background/Aim. A significant benefit in bicortical defects healing can be achieved by guided tissue and guided bone regeneration. The aim of this study was a cone-beam computed tomography (CBCT) radiographic bone density analysis of bicortical defects healing when treated with guided bone regeneration and two bone substitutes – bovine xenograft and alloplastic bone substitute. Methods. The research was performed on domestic pigs in two phases. In the first phase, extraction of all teeth in the intercanine sector was performed in the lower jaw and postextraction wounds were sutured. In the second phase, after the period required for healing, bicortical defects were formed – following the elevation of mucoperiosteal flaps from the vestibular and lingual side in the area of the previously extracted teeth, surgical removal of the cambium layer of periosteum was performed in the area of future defects with sharp surgical scissors and curette. Two defects, 10 mm in diameter, on the left and right side of the medial line were formed and filled with alloplastic bone substitute on the left and xenograft on the right side afterward. After augmentation, the defects were covered by a collagen resorptive membrane on both sides, and the flap was repositioned and sutured. After 12 weeks, experimental animals were sacrificed. The surrounding native bone was used as a control. Results. Analysis of bone tissue density showed a statistically significant difference between the examined bone substitutes (p < 0.01), with a better effect achieved by the use of alloplastic bone substitute. After applying Bonferroni correction, the difference was still statistically significant. Conclusion. Both bone substitutes used in the study showed good osteoconductive properties in the treatment of bicortical defects. Bone tissue density in defects filled with alloplastic bone graft was statistically significantly higher than that in the defects filled with xenograft.

References

von Arx T, AlSaeed M. The use of regenerative techniques in apical surgery: a literature review. Saudi Dent J 2011; 23(3): 113‒

Taschieri S, Del Fabbro M, Testori T, Saita M, Weinstein R. Efficacy of guided tissue regeneration in the management of through-and-through lesions following surgical endodontics: a preliminary study. Int J Periodont Restorative Dent 2008; 28(3): 265‒

Taschieri S, Del Fabbro M, Testori T, Weinstein R. Efficacy of Xenogeneic Bone Grafting With Guided Tissue Regeneration in the Management of Bone Defects After Surgical Endodontics. J Oral Maxillofac Surg 2007; 65(6): 1121‒

Dahlin C, Gottlow J, Linde A, Nyman S. Healing of Maxillary and Mandibular Bone Defects Using a Membrane Technique: An Experimental Study in Monkeys. Scand J Plast Reconstr Surg Hand Surg 1990; 24(1): 13‒

Hämmerle C, Schmid J, Lang N, Olah A. Temporal dynamics of healing in rabbit cranial defects using guided bone regeneration. J Oral Maxillofac Surg 1995; 53(2): 167‒

Hammerle C, Jung R. Bone augmentation by means of barrier membranes. Periodontology 2000 2003; 33(1): 36‒

Eppley BL, Pietrzak WS, Blanton MW. Allograft and alloplastic bone substitutes: a review of science and technology for the craniomaxillofacial surgeon. J Craniofac Surg 2005; 16(6): 981‒

Giannoudis PV, Dinopoulos H, Tsiridis E. Bone substitutes: an update. Injury 2005; 36 (Suppl 3): S20‒

Flautre B, Hardouin P. Microradiography in the study of trabecular parameters. Acta Orthop Belg 1992; 58(3): 287‒ (French)

Altındağ A, Avsever H, Borahan O, Akyol M, Orhan K. Incidental Findings in Cone-Beam Computed Tomographic Images: Calcifications in Head and Neck Region. Balk J Dent Med 2017; 21(2): 100‒

Soardi C, Zaffe D, Motroni A, Wang H. Quantitative Comparison of Cone Beam Computed Tomography and Microradiography in the Evaluation of Bone Density after Maxillary Sinus Augmentation: A Preliminary Study. Clin Implant Dent Relat Res 2012; 16(4): 557‒

Oltramari PV, Navarro Rde L, Henriques JF, Taga R, Cestari TM, Janson G, et al. Evaluation of bone height and bone density after tooth extraction: an experimental study in minipigs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104(5): e9‒

Lindhe J, Karring T, Lang NP. Clinical Periodontology and Implant Dentistry. 4th ed. Oxford, UK: Blackwell Munksgaard; 2003.

Pecora G, De Leonardis D, Ibrahim N, Bovi M, Cornelini R. The use of calcium sulphate in the surgical treatment of a 'through and through' periradicular lesion. Int Endod J 2001; 34(3): 189‒

Gottlow J, Nyman S, Karring T, Lindhe J. New attachment formation as the result of controlled tissue regeneration. J Clin Periodontol 1984; 11(8): 494‒

Zitzmann NU, Naef R, Schärer P. Resorbable versus nonresorbable membranes in combination with Bio-Oss for guided bone regeneration. Int J Oral Maxillofac Implants 1997; 12(6): 844‒

Tatakis D, Promsudthi A, Wikesjö U. Devices for periodontal regeneration. Periodontol 2000 1999; 19(1): 59‒

Demers C, Hamdy CR, Corsi K, Chellat F, Tabrizian M, Yahia L. Natural coral exoskeleton as a bone graft substitute: a review. Biomed Mater Eng 2002; 12(1): 15‒

Turhani D, Cvikl B, Watzinger E, Weißenböck M, Yerit K, Thurnher D, et al. In Vitro Growth and Differentiation of Osteoblast-Like Cells on Hydroxyapatite Ceramic Granule Calcified From Red Algae. J Oral Maxillofac Surg 2005; 63(6): 793‒

Baldini N, De Sanctis M, Ferrari M. Deproteinized bovine bone in periodontal and implant surgery. Dent Mat 2011; 27(1): 61‒

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(1): 171‒

Buser D, Hoffmann B, Bernard JP, Lussi A, Mettler D, Schenk RK. Evaluation of filling materials in membrane-protected bone defects. A comparative histomorphometric study in the mandible of miniature pigs. Clin Oral Implants Res 1998; 9(3): 137‒

Fujita R, Yokoyama A, Nodasaka Y, Kohgo T, Kawasaki T. Ultrastructure of ceramic-bone interface using hydroxyapatite and β-tricalcium phosphate ceramics and replacement mechanism of β-tricalcium phosphate in bone. Tissue Cell 2003; 35(6): 427‒

LeGeros RZ. Calcium Phosphate-Based Osteoinductive Materials. Chem Rev 2008; 108(11): 4742‒

Lee J, Ryu M, Baek H, Lee K, Seo J, Lee H. Fabrication and Evaluation of Porous Beta-Tricalcium Phosphate/Hydroxyapatite (60/40) Composite as a Bone Graft Extender Using Rat Calvarial Bone Defect Model. ScientificWorldJournal 2013; 2013: 481789.

Walsh WR, Vizesi F, Michael D, Auld J, Langdown A, Oliver R, et al. β-TCP bone graft substitutes in a bilateral rabbit tibial defect model. Biomaterials 2008; 29(3): 266‒

Shiwaku Y, Neff L, Nagano K, Takeyama K, de Bruijn J, Dard M, et al. The Crosstalk between Osteoclasts and Osteoblasts is Dependent upon the Composition and Structure of Biphasic Calcium Phosphates. PLoS One 2015; 10(7): e0132903.

Jensen S, Broggini N, Hjorting-Hansen E, Schenk R, Buser D. Bone healing and graft resorption of autograft, anorganic bovine bone and beta-tricalcium phosphate. A histologic and histomorphometric study in the mandibles of minipigs. Clin Oral Implants Res 2006; 17(3): 237‒

Jensen SS, Yeo A, Dard M, Hunziker E, Schenk R, Buser D. Evaluation of a novel biphasic calcium phosphate in standardized bone defects. A histologic and histomorphometric study in the mandibles of minipigs. Clin Oral Implants Res 2007; 18(6): 752‒

Miron R, Sculean A, Shuang Y, Bosshardt D, Gruber R, Buser D, et al. Osteoinductive potential of a novel biphasic calcium phosphate bone graft in comparison with autographs, xenografts, and DFDBA. Clin Oral Implants Res 2015; 27(6): 668‒

Kim Y, Nowzari H, Rich SK. Risk of prion disease transmission through bovine-derived bone substitutes: a systematic review. Clin Implant Dent Relat Res 2013; 15(5): 645‒

Kim Y, Rodriguez AE, Nowzari H. The Risk of Prion Infection through Bovine Grafting Materials. Clin Implant Dent Relat Res 2016; 18(6): 1095‒

Misch CE. Contemporary implant dentistry. 3rd ed. St. Louis: Mosby/Elsevier; 2008.

Gulsahi A. Bone quality assessment for dental implants. In: Turkyilmaz I, editor. Implant dentistry - the most promising discipline of dentistry. Rijeka: Intech; 2011; p. 437‒

Misch C, Qu Z, Bidez M. Mechanical properties of trabecular bone in the human mandible: Implications for dental implant treatment planning and surgical placement. J Oral Maxillofac Surg 1999; 57(6): 700‒6; discussion 706‒8.