Overaugmentation to compensate for postextraction ridge atrophy using a putty-type porcine bone substitute material with recombinant bone morphogenetic protein-2: 4 weeks of healing in a canine model

Abstract

OBJECTIVES The aims of the present study were (i) to determine the short-term effects of putty-type porcine bone substitute material (PB) with recombinant bone morphogenetic protein-2 (rhBMP-2) for alveolar ridge preservation (ARP) and (ii) evaluate the early healing of labial overaugmentation. MATERIALS AND METHODS Two groups were randomly assigned to the extraction sockets in mandibular incisors of eight dogs: labial overaugmentation with (i) PB (control) or (ii) rhBMP-2-loaded PB (BMP). Microcomputed tomography (micro-CT), and histologic and histomorphometric analyses were performed after 4 weeks. RESULTS Micro-CT revealed that some of the overaugmented PB was dispersed in both groups. The new bone volume was significantly larger in the BMP group than in the control group (18.4 ± 3.3 vs. 15.5 ± 3.0 mm, mean ± SD, P < 0.05). Labial bone resorption was generally found histologically. No signs of mineralization were observed in the overaugmented area despite significantly increased ridge width, as compared to the adjacent tooth area. The area of new bone formation was larger in the BMP group than in the control group overall (23.7 ± 18.8 vs. 18.3 ± 21.2 mm) and in three parts (apical, middle, and coronal), although the difference was statistically significant only in the coronal part (7.7 ± 7.9 vs. 4.6 ± 6.4 mm, P < 0.05). CONCLUSIONS The addition of rhBMP-2 enhanced ossification in the coronal part of the extraction socket relative to using PB alone. Overaugmentation increased the ridge dimension with no evidence of ossification in situ at 4 weeks. CLINICAL RELEVANCE In early healing following ARP, rhBMP-2 enhances bone formation within the socket, but ossification in the overaugmented area needs to be studied further. , Ui-Won (2019). Overaugmentation to compensate for postextraction ridge atrophy using a putty-type porcine bone substitute material with recombinant bone morphogenetic protein-2: 4 weeks of healing in a canine model. Clinical Oral Investigations, 23(5):2465-2474. AbstractObjectives: (i) to determine the short-term effects of putty-type porcine bone substitute material (PB) with recombinant bone morphogenetic protein-2 (rhBMP-2) for alveolar ridge preservation (ARP) and (ii) evaluate the early healing of labial overaugmentation. Materials and Methods: Two groups were randomly assigned to the extraction sockets in mandibular incisors of eight dogs: labial overaugmentation with (i) PB (control) or (ii) rhBMP-2-loaded PB (BMP). Microcomputed tomography (micro-CT), and histologic and histomorphometric analyses were performed after 4 weeks. Results: Micro-CT revealed that some of the overaugmented PB was dispersed in both groups. The new bone volume was significant larger in the BMP group than control group (18.4±3.3 vs. 15.5±3.0 mm 3 , mean±SD, P<0.05). Labial bone resorption was generally found histologically. No signs of mineralization were observed in the overaugmented area despite significantly increased ridge width, as compared to the adjacent tooth area. The area of new bone formation was larger...

Primary flap closure in alveolar ridge preservation for periodontally damaged extraction socket: A randomized clinical trial

“…14,15 Third, when applying ARP to damaged sockets, ridge contours are inevitably recreated along the imaginary pre-existing contour 16,17 or are over-contoured relative to the adjacent ridge. 18 The above observations suggest that ARP requires the healing of periodontally damaged sockets to take place in a fully closed environment, such as in GBR. 4,19 There is also evidence of inferior bone formation at GBR sites with wound dehiscence compared with uneventfully healed sites.…”

“…This might cause unwanted pressure to the overaugmented area during the healing period and a subsequent significant amount of shrinkage. 18,40 The positive effect of ARP in maintaining the alveolus dimensions is well-documented. Methodologically, this effect was manifested by comparing sockets that received ARP and naturally healed sockets in systematic reviews.…”

“…Second, post‐extraction bone remodeling was delayed in damaged sockets in terms of bone‐forming rate and cortication 14,15 . Third, when applying ARP to damaged sockets, ridge contours are inevitably recreated along the imaginary pre‐existing contour 16,17 or are over‐contoured relative to the adjacent ridge 18 . The above observations suggest that ARP requires the healing of periodontally damaged sockets to take place in a fully closed environment, such as in GBR 4,19 .…”

Enamel matrix derivative promotes new bone formation in xenograft assisted maxillary anterior ridge preservation—A randomized controlled clinical trial

“…Hence, biologically active materials, such as platelet-rich plasma (Cheah et al 2014;Strauss et al 2018), platelet-rich fibrin (Marenzi et al 2015) and recombinant bone morphogenic protein-2 (Lim et al 2018), have been utilized to improve the performance of osteoconductive materials with mixed results.…”

“…However, these slowly resorbing materials also interfere with new bone formation in the healing socket (Araujo et al 2009), which may compromise the osseointegration of implants subsequently placed in these sites. Hence, biologically active materials, such as platelet-rich plasma (Strauss et al 2018, Cheah et al 2014, platelet-rich fibrin (Marenzi et al 2015) and recombinant bone morphogenic protein-2 (Lim et al 2018) have been utilized to improve the performance of osteoconductive materials with mixed results.…”