Minimally Invasive Alveolar Ridge Preservation Utilizing anIn SituHardeningβ-Tricalcium Phosphate Bone Substitute: A Multicenter Case Series

Abstract

Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (β-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that β-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques.

Sinus floor elevation using particulate PLGA‐coated biphasic calcium phosphate bone graft substitutes: A prospective histological and radiological study

“…On the other hand, higher osteoconductivity promotes quicker bone formation from all bony walls of the cavity, including the schneiderian's membrane, and therefore promotes space maintenance . In this sense, in terms of histological results, although clinical studies using β‐TCP are common, studies that use PLGA‐containing materials are limited and restricted to indications, such as the treatment of periodontal intrabony defects or ridge preservation . In this sense, 34%‐60% of vital bone formation has been reported with the use of PLGA in ridge preservation .…”

Randomized clinical trial for the biological evaluation of two nanostructured biphasic calcium phosphate biomaterials as a bone substitute

“…Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption . Human reentry studies recorded horizontal bone loss of 29% to 63% and vertical bone loss of 11% to 22% during the first 6 months after tooth removal .…”

“…Considering the difficulties related to obtaining autogenous grafts, as well as their unpredictability, experts have been using different resorbable osteoconductive biomaterials to fill postextraction sockets to maintain a more adequate bone volume and preserve an alveolar architecture that will favor dental implant installation . Hydroxyapatite (HA), the main constituent of the inorganic phase of bone, is employed in various areas of medicine and dentistry due to its chemical and structural characteristics.…”

Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study

“…The PLGA coating of the BCP granules provide additional initial in situ hardening properties and , therefore, allow stabilization of the bone graft substitute in the empty extraction socket without the use of a barrier membrane to stabilize the graft and to cover the defect without achieving primary wound closure [18]. …”