Evaluation of different grafting materials in three-wall intra-bony defects around dental implants in beagle dogs

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1 Current Applied Physics 5 (2005) Evaluation of different grafting materials in three-wall intra-bony defects around dental implants in beagle dogs Ui-Won Jung a, Hee-Il Moon a, Chang-sung Kim a, Yong-Keun Lee b, Chong-Kwan Kim a, Seong-Ho Choi a, * a Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Brain Korea 21 Project for Medical Science, 134 Shinchon-Dong, Seodaemun-gu, Yonsei University, Seoul, Republic of Korea b Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, Seoul, Republic of Korea Received 18 October 2004; received in revised form 5 November 2004 Available online 19 February 2005 Abstract The purpose of this study was to evaluate histologically and compare the healing of three-wall defects using xenogeneic demineralized bone matrix putty (xdbm putty), porous b-tricalcium phosphate (b-tcp), or newly developed non-crystalline calcium phosphate glass around submerged SLA (Sand blasted with Large-grit and Acid Etched) surface dental implants in dogs. All of the treatment groups in this study showed no histologic evidence of new bone formation around implants or of bone to implant contact originating from grafted material. No beneficial effects on osseointegration in intrabony defects around implants was attributed to the use of these grafting materials. Ó 2005 Elsevier B.V. All rights reserved. PACS: 85 Keywords: Xenogeneic demineralized bone matrix putty; Porous b-tricalcium phosphate; Non-crystalline calcium phosphate glass; SLA surface dental implant; Intrabony defect 1. Introduction Dental implants have been used for many years to treat completely and partially edentulous patients with good long term predictability. However, the problem of insufficient bone volume is encountered during implant placement. Consequently, clinicians are faced with problems associated with the management of these complicated cases. Many graft materials and techniques have been examined for the repair of osseous defects around implants [1 7]. One of the most common methods involves * Corresponding author. Tel.: ; fax: address: shchoi726@yumc.yonsei.ac.kr (S.-H. Choi). harvesting and implanting fresh autogenous bone. Guided bone regeneration (GBR) with mechanical barriers, has been shown to be effective in the treatment of bone defects around dental implants [3]. Demineralized bone matrix (DBM) is considered a transplantable tissue, and recently several authors have evaluated the usage of DBM putty. Alloplasts, such as the bioactive glass, may be an effective alternative to DFDB. Commonly used ceramic bioactive alloplastic bone grafting materials include hydroxyapatite and b-tricalcium phosphate, which have been reported to form a chemical bond with bone tissue [4]. Recently Lee et al. newly fabricated a calcium phosphate glass with Ca/P ratio of 0.6 using the CaO CaF 2 P 2 O 5 MgO ZnO system. This material is expected to extend the application field to biomaterials for hard tissue repair, because of their /$ - see front matter Ó 2005 Elsevier B.V. All rights reserved. doi: /j.cap

2 508 U.-W. Jung et al. / Current Applied Physics 5 (2005) non-crystalline structure and their low Ca/P ratio [5,6]. The purpose of this study was to histologically evaluate and compare the healing of three-wall defects using xenogeneic DBM putty, porous b-tricalcium phosphate (b-tcp), and the newly developed non-crystalline calcium phosphate glass around submerged SLA surface dental implants in beagle dogs. Histologic analysis was included to provide clinicians with a better understanding of process of selecting the most suitable graft material. 2. Methods Five male, beagle dogs were used. Teeth were extracted under general anesthesia. The SLA surface dental implants (6 mm in length, 3.4 mm in diameter, Implantium Ò, Dentium) were placed after a healing period of 8 weeks. Mucoperiosteal flaps were carefully reflected on the buccal and lingual aspects.two implants were placed on each side of the mandible. Before placement, a standardized three-wall intrabony defect (3 mm buccolingual 3 mm apicocoronal 5 mm mesiodistal) was created at the mesial of the each implant.countersinking was done, and placement was made without tapping. The implants were positioned such that the most coronal portion of the implant body was level with the osseous crest and centered in a buccal-lingual position. Graft materials were then inserted into the three-wall defect sites. The defects were grafted with either b-tcp, xdbm putty, non-crystalline calcium phosphate glass, or left unfilled (control). Flaps were closed with 5-0 resorbable sutures. Sutures were removed after 10 days. Dogs were sacrificed 8 weeks after graft material placement. Block sections including segments with implants were preserved and fixed in 10% neutral buffered formalin for histologic preparation and analysis. Blocks were reduced with a grinding unit to a thickness of approximately 40 lm. Sections were analyzed under an optical microscope for new bone formation, bone to implant contact, and residual graft particle content. Sites from the top of the implant to the base of the defect created, originally 3 mm and 2.5 mm (half of original defect M-D length), respectively, mesial of the defect were observed along the side of the implant. 3. Results 3.1. Clinical findings During the postoperative period, no tissue exposure and imflammation was observed clinically Histologic findings Evaluation of the histologic sections revealed similar findings in all treatment groups. There was no evidence of acute inflammatory reaction around any of the dental implants. Retentive grafted particles adjacent to the implant could be seen regardless of graft type. The treatment groups in this study showed histologic evidence of slight new bone formation from the base of the bone defects Non-crystalline calcium phosphate glass Large amounts of grafted particles were visible in histologic sections. Grafted particles were surrounded with connective tissue. Minimal newly formed bone originating from existing bone was found only in the proximity of the bases of bone defects. In contrast, grafted particles were located at the upper portions of defects. Histologic sections demonstrate grafted particles throughout the field. No new bone-to-implant surface contact was observed (Fig. 1) Porous b-phase tricalcium phosphate Most of the b-tcp granules in the infrabony defects were surrounded with connective tissue. There was a large amount of newly formed bone among the b-tcp granules, and an apparent bone scaffolding effect was observed. Ingrowth of new bonefrom the lateral wall was observed in the b-tcp specimen. A small amount of new bone formation originating from bone defect bases was observed at the surface of dental implants. No new bone-to-implant surface contact was observed (Fig. 2) xdbm putty Biopsies from these sites consisted of grafted bone particles enmeshed inconnective tissue. Most of the xdbm putty was observed at the upper portions of defects. Two distinct parts were observed between newly formed bone and xdbm putty scattered in the connective tissue. New bone formation around graft materials was absent. A small amount of newly formed bone adjacent to the surface of implants was observed, which originated from the bases of bone defects. These findings were similar to those of the control. No new bone-toimplant surface contact was observed (Fig. 3) The control (no treatment) The upper regions of bone defects were completely filled with connective tissue, which consisted of fiber, blood vessels, and inflammatory cells. Collapsed defect space was observed in these specimens. However, there

3 U.-W. Jung et al. / Current Applied Physics 5 (2005) Fig. 1. A: Photomicrograph of non crystalline calcium phosphate glass ( 20). B: Higher magnification of A ( 100). Fig. 2. A: Photomicrograph of b-tcp ( 20). B: Higher magnification of A ( 100). was a small amount of newly formed bone adjacent to implants near the bone, originating from the bone defect bases. No new bone-to-implant contact was observed (Fig. 4). 4. Discussion and conclusion Recently, several authors have reported on the use of b-tcp with dental implant placement [4]. In fact, the present experimental design was a modification of a previous study, and the defect size used was smaller than that used by Hall et al. [2]. New bone formation probably occurs from the apical and lateral wound margin in three-wall defects. Therefore, we expected an evaluation of rapid bone healing could be made after an 8-week healing period for three-wall defects in beagle dogs. In the present study, most b-tcp granules in the intrabony defects were surrounded with connective tissue, and significant amounts of newly formed bone tissue were observed at the base of bone defects, i.e., originating from pre-existing bone. However, large amounts of newly formed bone were observed among b-tcp granules despite most granules being circumscribed by connective tissue. Ingrowth of new bonefrom the lateral wall was observed in b-tcp

4 510 U.-W. Jung et al. / Current Applied Physics 5 (2005) Fig. 3. A: Photomicrograph of xdbm putty ( 20). B: Higher magnification of A ( 100). Fig. 4. A: Photomicrograph of the control ( 20). B: Higher magnification of A ( 100). specimens. Therefore, we feel that the difference between b-tcp and non-crystalline calcium phosphate glass may have been due to its porosity. There was apparently no evidence that xdbm putty induced significant bone formation at the surface of the implant in the present study, although a significant amount of newly formed bone originating from the bases of bone defects. Furthermore, most xdbm unresorbed putty was observed in upper defect regions. The use of xdbm did not appear to provide more bone to implant contact and new bone formation than synthetic materials. In the present study, xdbm putty and calcium phosphate glass were considered inert and well tolerated. We found that only b-tcp showed evidence of new bone formation. Sections were also analyzed concerning bone and non-bone contact areas in the grafted area. To determine the amount of new bone formation adjacent to an implant, bone-to-implant contact and bone height fill were examined as described previously. In our study, all

5 U.-W. Jung et al. / Current Applied Physics 5 (2005) grafted sites showed no bone-to-implant contact. Takeshita et al. reported that the grafting of dense HA into bone defects surrounding implants will result in fibrous healing during the early healing stage (28 days after surgery) [7]. Our histologic findings are similar to theirs despite out use of a different type graft. Non-crystalline calcium phosphate glass might not promote active bone formation in bone defects. Moreover, there is a possibility that the presence of non-crystalline calcium phosphate glass arrests bone formation, as was observed for dense HA in a study by Takeshita et al. Moreover, the graft materials used failed to induce new bone formation (osseoinduction) adjacent to the implant surface, though there was some difference with respect to the amount of new bone formation between non-crystalline calcium phosphate glass and b-tcp. There is a possibility that differences between synthetic materials, e.g., dense or porous, might influence bone formation in bone defects surrounding implants. Cho et al. reported that xdbm apparently delayed bone formation, because they found that bone activity peaked at week 8, but peaked at 4 weeks in membrane alone defects. This study was designed to observe relatively short term healing. Different studies have indicated that the quality of new tissue is time dependent. We suggest that additional studies should be undertaken to examine the long term use of the grafting materials examined in the present study adjacent to the implant surface. Until longer term data on the stability of regenerated periimplant bone using our experimental grafting materials are available, it seems reasonable to suggest that exposed implants be treated by the membrane technique with or without autogenous bone. Acknowledgment This study was supported by a grant from the Korean Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (03-PJ1-PG1-CH ). References [1] J.C. Vicente et al., Int. J. Periodontics Restorative Dent. 20 (2000) 41. [2] E.E. Hall et al., J. Periodontol. 70 (1999) 526. [3] W. Becker et al., Int. J. Oral Maxillofac. Implants 10 (1995) 143. [4] H.A. Merten et al., J. Craniofac. Surg. 12 (1) (2001) 59. [5] K.S. Cho et al., Clin. Oral impl. Res. 9 (1989) 419. [6] Y.K. Lee et al., Key Eng. Mater (2003) 391. [7] F. Takeshita et al., J. Periodontol. 68 (1997) 924.

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