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Abstract Regeneration and preservation of bone after the extraction of a tooth is necessary for the placement of a dental implant. The goal is to regenerate alveolar bone with minimal postoperative pain. Medical grade calcium sulfate hemihydrate (MGCSH) can be used alone or in combination with other bone grafts; it improves graft handling character...
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Background:
A common sequel of tooth extraction is alveolar bone resorption. It makes the placement of dental implants difficult and creates an esthetic problem for the fabrication of conventional prostheses. Therefore, alveolar bone following tooth extraction should be preserved.
Aims and objectives:
The present prospective study was conducted...
Citations
... The growing demand for materials for bone reconstruction has stimulated research in the area of biomaterials, in order to supply the scarce source of autogenous and allogeneic bone available [14]. Several bioceramic materials have been developed as an alternative, and several studies-both experimental and clinical-have demonstrated the osteoconductive properties (materials that facilitate infiltration through the bone surrounding the defect) of these materials when used for medium and small bone defects, increasing the bone crest for implant placement, bone defects due to periodontal disease, and maxillary sinus elevation [43,[50][51][52][53]. Within the group of ceramics, materials based on calcium phosphate are extensively studied and frequently used as bone grafts due to their compositional similarity with natural bone, with their HA demonstrating excellent biocompatibility. ...
This review provides an overview of various materials used in dentistry and oral and maxillofacial surgeries to replace or repair bone defects. The choice of material depends on factors such as tissue viability, size, shape, and defect volume. While small bone defects can regenerate naturally, extensive defects or loss or pathological fractures require surgical intervention and the use of substitute bones. Autologous bone, taken from the patient’s own body, is the gold standard for bone grafting but has drawbacks such as uncertain prognosis, surgery at the donor site, and limited availability. Other alternatives for medium and small-sized defects include allografts (from human donors), xenografts (from animals), and synthetic materials with osteoconductive properties. Allografts are carefully selected and processed human bone materials, while xenografts are derived from animals and possess similar chemical composition to human bone. Synthetic materials such as ceramics and bioactive glasses are used for small defects but may lack osteoinductivity and moldability. Calcium-phosphate-based ceramics, particularly hydroxyapatite, are extensively studied and commonly used due to their compositional similarity to natural bone. Additional components, such as growth factors, autogenous bone, and therapeutic elements, can be incorporated into synthetic or xenogeneic scaffolds to enhance their osteogenic properties. This review aims to provide a comprehensive analysis of grafting materials in dentistry, discussing their properties, advantages, and disadvantages. It also highlights the challenges of analyzing in vivo and clinical studies to select the most suitable option for specific situations.
... It is biocompatible, bioresorbable, and osteoconductive. It undergoes complete and rapid resorption without eliciting any inflammatory-tissue response [138]. Generally, it is found in three distinct forms: CS dihydrate, CS hemihydrate, and CS anhydrite. ...
In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area.
... Some studies have verified that calcium sulfate hemihydrate promotes bone regeneration by generating bioactive and osteoconductive bone scaffolds [44,45]. As the calcium sulfate is resorbed, it acts as a main calcium source which is crucial throughout mineralization in progressive bone remodeling [17,25]. Local bone mineralization is related to the osteoinductive property of calcium sulfate [45], while the bone mineralization results from a local pH reduction which subsequently renders the release of osteoinductive molecules in the bone matrix inducing the healing process [45,46]. ...
This study aimed to elucidate the local effect and micro-computed tomographic (μ-CT) assessment following bone implantation of an innovative bioceramic (α-calcium sulfate hemihydrate; α-CSH) on femur lateral condyle cortical bone of rabbit models. The innovative α-CSH bioceramic was synthesized through a green processing technology (microwave irradiation treatment). The bilateral implantation model was performed among 24 New Zealand White rabbits which were divided into three groups based on the type of filling materials: α-CSH, control, and blank. Treatments were performed in defects with 6 mm diameter and 7 mm depth and observed after 2, 4, 8, and 12 weeks. Material reaction and bone formation after implantation were evaluated radiographically and histopathologically. The μ-CT analysis results showed that the degradation of α-CSH and control material was similar at 4 and 8 weeks. The bone volume in the defects indicated the α-CSH increased most in 8 weeks. In histopathological evaluation, the α-CSH group was repaired with lamellar bone and well-grown bone marrow infiltration similar to the control material. Moreover, the α-CSH revealed a faster degradation rate and better healing progress than the control material under the same conditions. Therefore, the α-CSH was confirmed to be useful in promoting osteoconduction and in controlling the resorption rate in bone defects. Further, the innovative α-CSH could be considered as a promising bone substitute for utilization in bone reconstructive therapy in dental and orthopedic fields.
... The presence of such defects may encompass adverse outcomes ranging from losing a tooth to the more extreme situation of losing part of the jaw or face. In recent years investigations in repairing or replacing defective hard tissue has led to rapid development in the fields of bone grafting and augmentation through the surgical implantation of autogeneous bone or artificial bone implants for repairing defects and for regeneration of bone volume (Tadic and Epple, 2004;Bagoff et al., 2013). Autogeneous bone is bone material which is surgically taken from another part of a patients' body and still represents the most effective bone graft (golden standard) in terms of outcome. ...
... Clinically, CS are usually used as bone grafts after mixing with saline or saliva (Ahmet et al., 2016;Bagoff et al., 2013;Damien and Parsons, 1991;Harris, 2004;Jinno et al., 2019;Lombardo et al., 2015;Machtei et al., 2013;Mayer et al., 2016;Turri and Dahlin, 2015). This setting allows the in-situ formation of a rigid structure which is highly T. Grego, et al. ...
Calcium sulfate (CS) is a reasonable alternative to autogenous dental bone graft and is used as a bone filler or for the treatment of bone defects. Medical grade CS must be sterilized, usually by gamma-irradiation. In this study the structures of CS polymorphs, calcium sulfate dihydrate and calcium sulfate hemihydrate, have been investigated with electron paramagnetic resonance (EPR) spectroscopy, X-ray diffraction, thermogravimetric analyses and infrared spectroscopy. The influences of saline and artificial saliva on gamma-induced radical concentrations have been monitored.
... Calcium sulfate bioresorption studies and clinical experience have shown consistent osteoconduction and complete resorption, replaced by newly formed bone that is ultimately remodeled. 20 Calcium ions activate platelets to release bone morphogenetic proteins and platelet-derived growth factors that stimulate proliferation and osteogenic differentiation of mesenchymal stem cells. 21,22 This makes this osseous graft material well tolerated and nonimmunogenic, with no adverse reactions or failure to heal being reported in the literature. ...
Dental treatment may require osseous grafting. Pathologic voids may require grafting to restore osseous anatomy. Various osseous grafting materials have been used and reported. These include autografts, allografts, xenografts, and nonbiological products. Osseous grafts act as a scaffold, maintaining volume while allowing bone formation. Calcium sulfate has been used as an osseous void filler, binder, and grafting material. It possesses many characteristics of an ideal material for bone regeneration. It provides an effective cement for maxillofacial and dental augmentation that is easy to use and cost effective, while not requiring complete soft tissue coverage or a membrane at placement.
... In the natural healing process, the socket is first occupied by a coagulum, which is successively replaced by granulation tissue, provisional connective tissue and woven bone, and finally lamellar bone and marrow [30]. The first signs of remodeling are seen with a vascular network and osteoid within a week, and even after 2 months, bone formation is incomplete and remodeling is in progress [31]. However, the CPC material-grafted sites exhibit a delayed healing pattern. ...
Background. The healing process following tooth extraction results in alveolar ridge resorption. The dimensional changes may complicate the subsequent implant procedure. Socket preservation using absorbable collagen membranes or a combination of membranes with calcium phosphate cement (CPC) particles might ensure that the alveolar ridge retains a suitable morphology for implant placement. Objective. To evaluate the quality and quantity of new bone regenerated after application of either collagen membranes alone covering the sockets or a combination of membranes with CPC particles added into the sockets in dogs. Materials and Methods. Six dogs were included in this study. The mandibular premolars were extracted. For each hemimandible, three premolar extraction sites were randomly assigned to one of the following treatments: a covering collagen membrane, CPC with a covering collagen membrane, and a socket left empty. Cone-beam computed tomography (CBCT) measurements, polyfluorochrome sequential labeling, and histological assessments were performed to investigate the healing ability and repair processes within a 6-month observation period. Results. Buccal bone height in the membrane group was significantly higher than that in the membrane+CPC and blank groups at 4 and 6 months after extraction. The mineral apposition rate over 2-4 months and the alizarin red-stained area in the membrane group were significantly higher than those in the other two groups. Histological analysis after 6 months of healing showed significantly higher amounts of newly formed bone in the membrane group than in the other groups. Conclusion. Extraction sites treated with collagen barrier membranes showed better protection than sites not covered with membranes. And the buccal bone wall of the socket was well preserved by collagen membrane without extra CPC materials. Socket preservation using absorbable membranes alone yielded better quality and quantity of regenerated bone inside the socket site.
1. Introduction
Dental implants supported prostheses represent one of the most optimal methods for oral rehabilitation because of their significantly ideal aesthetics, low failure rates, high masticatory efficiency, etc. [1]. Ideal functional and aesthetic prosthetic reconstruction following implant therapy requires sufficient alveolar bone volume in both vertical and horizontal dimensions [2]. However, physiological atrophy of the alveolar ridge occurs rapidly after tooth extraction and is primarily noted in the first 6 months postextraction [3]. The morphological changes in the extraction socket can be observed in the apical-coronal (vertical) and buccal-lingual (horizontal) dimensions [4]. In addition, during the process of recovery, food debris and the rapidly growing connective tissue can enter into the deep open wound and disturb bone regeneration [5]. Furthermore, the bundle bone of the buccal bone wall, which is a part of the periodontium, loses its function after tooth removal and starts undergoing resorption. Thus, buccal bone loss is more obvious than lingual bone loss, making it more difficult to achieve the aesthetic standards expected of dental implants [6]. The loss of alveolar bone volume also complicates implantation surgery by necessitating additional augmentative therapy or even making the placement of the implant impossible [7].
Socket preservation after tooth extraction has been regarded as an important step to ensure that the alveolar ridge retains a suitable morphology for an implant site. Bone substitute materials implanted into fresh sockets with a barrier membrane covering them could interfere with the bone resorption process and limit the atrophy of the alveolar ridge [8]. However, conflicting data have been reported regarding the outcome of using bone substitutes for preserving the extraction socket. Some reports have demonstrated that they cannot prevent resorption and that they lead to a reduction in the height of the buccal bone crest [9]. There is also a controversy regarding the quality of the bone augmented in the extraction socket. Histological observations have shown that the augmented bone mainly contains connective tissue and material particles after 6 to 9 months [10].
Barrier membranes have been shown to preserve alveolar ridges and provide beneficial results following tooth extraction in clinical trials [11]. The artificial membrane could seal off the socket for a healing period of up to several weeks. Extraction sockets covered by porcine-derived collagen membrane alone showed significantly lower vertical and horizontal bone changes, compared to spontaneous healing [12]. Moreover, calcium phosphate cement (CPC) may also be useful for increasing the height of the alveolar ridge [13]. However, the differences in socket preservation achieved by using the barrier membrane alone and the barrier membrane in combination with additional grafting material have not been fully investigated. Studies have also not clarified which approach provides regenerated bone with better quality and is more suitable for dental implants. In this study, we evaluated the effects of socket preservation using collagen membrane alone or in combination with CPC particles. Cone-beam computed tomography (CBCT) measurements, polyfluorochrome sequential labeling, and histological observations were used to assess the healing ability and repair processes associated with these two methods.
2. Materials and Methods
2.1. Animals
The animal selection, management, and experimental protocols were approved by the Animal Care and Experiment Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (Animal Welfare Ethics acceptance number: No.DWLL2017-0316) and complied with the ARRIVE guidelines [14]. A total of six healthy adult male beagles aged 18 months, each weighing 15.0 to 20.0 kg, were used in the study. All animals had a healthy, fully erupted permanent dentition. The dogs received standard food and water ad libitum.
2.2. Surgical Procedure
All animals were fasted for 48 hours before surgery but were allowed water ad libitum. General anesthesia was achieved by intravenous administration of pentobarbital sodium (30 mg/kg). After orotracheal intubation, the animals were monitored by a heart monitor during the entire course of the surgery.
Buccal and lingual full-thickness flaps were made to expose the alveolar crests of the mandibular premolar regions on both sides. Three premolars (P2, P3, and P4) were hemisected on both sides using fissure burs (Figure 1(a)). The canals of all mesial roots were cleaned and filled with gutta-percha. The coronal parts of the pulp chambers were sealed with resin (Clearfil Core; Kuraray, Tokyo, Japan). The distal roots were carefully extracted using elevators and forceps (Figures 1(a) and 1(b)).
(a)
... Patients are subjected to additional X-ray exposure, and clinical methods are more time-consuming and are prone to more measurement errors [16,17]. The use of various radiographic methods, including CBCT for the assessment of post-extraction resorption of the alveolar bone, is used by many authors [18][19][20]. The clinical findings from the CBCT in our pilot study are comparable to the results from socket preservation therapies presented in the literature [19,21]. ...
The aim of this study was to compare two different methods for evaluation of alveolar bone resorption after the socket preservation procedure. In the current study, 9 patients with a total of nine teeth indicated for extraction were included. Patients received alveolar ridge preservation with allograft (BoneAlbumin™, OrthoSera Dental, Gyor, Hungary) or Platelet-Rich fibrin (PRF). CBCT (Planmeca ProMax 3D, Helsinki, Finland), was taken at 1 week and 4 months after the socket preservation procedure. A 3D scan, obtained with Trios (3Shape, Copenhagen, Denmark) of the alveolar bone of the surgical site and the adjacent teeth at the place of extraction was performed during the surgical procedure, immediately after the graft placement in the alveolar socket, and after 4 months. Virtual study models were generated using the three-dimensional file processing software “Meshlab” (ISTI—CNR Rome Italy). The changes of alveolar height and width were measured and analyzed. Results were taken from both methods. Radiographic examination revealed that the average value of horizontal resorption is 0.6–2.4 mm, and vertical resorption is 0.46–2.8 mm. On virtual models, the average value for horizontal resorption is 1.92–3.64 mm, the vertical resorption value is 0.95–2.10 mm. The Trios intraoral scan can provide non-invasive and more accurate quantitative insights into the dimensional changes in the alveolar ridge after the bone remodeling process. More research is needed for verification of these results.
... 10,11 In addition, calcium sulfate is also used to preserve the alveolar ridge following tooth extraction, 12 applied to socket preservation, and sinus augmentation procedures. 13,14 In addition, the bone graft substitutes can serve as a carrier for different drugs. For example, calcium sulfate impregnated with gentamicin and vancomycin was used to treat deep diabetic foot infections. ...
Patients with inadequate volume of alveolar processes or bone defects commonly require graft substitutes in oral, maxillofacial or orthopedic surgery. Ridge augmentation and reconstruction of facial bony defects with bone graft materials achieve better outcomes in functional and aesthetic rehabilitation. The injectable calcium sulfate filler is used widely in intra-operative applications. Calcium sulfate bone filler has been shown to upregulate bone formation-related mRNA genes in vitro and improve osseointegration in vivo. In addition, the bone graft substitute can be used as a drug delivery system for antibiotics to treat or prevent infections based on the clinical experiences. However, the influences of antibiotics addition on the calcium sulfate are not fully understood. In this study, calcium sulfate impregnated with gentamycin in different weight ratios was characterized. The results showed that gentamycin prolonged the hydration process and extended initial/final setting times of calcium sulfate. The addition of gentamycin slowed the conversion from calcium sulfate hemihydrate to dihydrate and changed the crystalline phase and microstructure. Higher amounts of gentamycin added resulted in faster degradation and lower mechanical strength of calcium sulfate. This study reveals that the extended setting time, decreased compressive strength, and the accelerated degradation of the gentamycin-impregnated calcium sulfate bone graft substitutes should be considered during intra-operative applications. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2016.
Objectives:
To assess dimensional changes and histologic/histomorphometric aspects of grafted sockets using either calcium sulfate-platelet-rich plasma (CS-PRP) or CS alone in socket preservation procedure.
Study design:
Twelve subjects with single nonmolar teeth underwent atraumatic extraction. Six sockets received CS grafts and 6 sockets received CS-PRP grafts. Cone-beam computerized tomography scans taken immediately after extraction and 4 months after surgery were used to measure vertical and horizontal dimensional changes. Histologic and histomorphometric analyses of grafted sites were performed at 4 months after surgery. Intergroup changes were compared using Mann-Whitney U test.
Results:
CS group demonstrated 18.6% horizontal resorption as compared with 9.2% in CS-PRP group. Resorption for buccal height (BH) (14%) and palatal/lingual height (PH) (13.7%) in CS group was nearly 3 times more than resorption in BH (5%) and PH (4.6%) for CS-PRP group. Mineralized bone component in CS-PRP group (11.19% ± 6.59%) was significantly more than CS group (1.51% ± 2.86%) (P = 0.01).
Conclusion:
CS-PRP-grafted sites demonstrated higher mineralized bone content than CS-grafted sites.
