J Periodontal Implant Sci.  2016 Oct;46(5):291-302. 10.5051/jpis.2016.46.5.291.

Benefits of mineralized bone cortical allograft for immediate implant placement in extraction sites: an in vivo study in dogs

• Orti V
• Bousquet P
• Tramini P
• Gaitan C
• Mertens B
• Cuisinier

• KMID: 2354928
• DOI: http://doi.org/10.5051/jpis.2016.46.5.291

Abstract

PURPOSE
The aim of the present study was to evaluate the effectiveness of using a mineralized bone cortical allograft (MBCA), with or without a resorbable collagenous membrane derived from bovine pericardium, on alveolar bone remodeling after immediate implant placement in a dog model.
METHODS
Six mongrel dogs were included. The test and control sites were randomly selected. Four biradicular premolars were extracted from the mandible. In control sites, implants without an allograft or membrane were placed immediately in the fresh extraction sockets. In the test sites, an MBCA was placed to fill the gap between the bone socket wall and implant, with or without a resorbable collagenous membrane. Specimens were collected after 1 and 3 months. The amount of residual particles and new bone quality were evaluated by histomorphometry.
RESULTS
Few residual graft particles were observed to be closely embedded in the new bone without any contact with the implant surface. The allograft combined with a resorbable collagen membrane limited the resorption of the buccal wall in height and width. The histological quality of the new bone was equivalent to that of the original bone. The MBCA improved the quality of new bone formation, with few residual particles observed at 3 months.
CONCLUSIONS
The preliminary results of this animal study indicate a real benefit in obtaining new bone as well as in enhancing osseointegration due to the high resorbability of cortical allograft particles, in comparison to the results of xenografts or other biomaterials (mineralized or demineralized cancellous allografts) that have been presented in the literature. Furthermore, the use of an MBCA combined with a collagen membrane in extraction and immediate implant placement limited the extent of post-extraction resorption.

Keyword

Allografts; Alveolar bone loss; Bone regeneration; Dental implants; Tooth extraction

MeSH Terms

Allografts*
Alveolar Bone Loss
Animals
Bicuspid
Biocompatible Materials
Bone Regeneration
Bone Remodeling
Collagen
Dental Implants
Dogs*
Heterografts
Mandible
Membranes
Miners*
Osseointegration
Osteogenesis
Pericardium
Tooth Extraction
Transplants
Biocompatible Materials
Collagen
Dental Implants

Figure

• 

  Figure 1 The 2 types of sockets. (A) Intact sockets (S100%) with 3 implants. The middle implant was placed with cortical Puros® chips (black arrow) in the socket. (B) Sockets with the buccal wall height reduced to 50% (S50%). The implant on the right was cover with mineralized bone cortical allograft (black arrow).

• 

  Figure 2 The interface between bone and the implant surface. (A) An implant alone placed into the fresh extraction socket (Goldner trichrome stain). (B) An implant with mineralized bone cortical allograft (Goldner trichrome stain). (C) An implant with a mineralized bone cortical allograft combined with a collagen membrane (Goldner trichrome stain).

• 

  Figure 3 Interface bone-implant surface with mineralized bone cortical allograft particles without a membrane 3 months after implantation. (A) Mineralized bone cortical allograft (A) and new bone (NB) (Goldner trichrome stain). (B) The black arrow indicates a layer of newly formed bone (B) between the dental implant (Ti) and mineralized bone cortical allograft particles (Goldner trichrome stain).

• 

  Figure 4 Histological view of a titanium implant 1 month after of implantation. The space between the implant and the alveolar socket was filled with mineralized bone cortical allograft and a membrane was placed in the buccal side. (A) Mineralized bone cortical allograft particles (Goldner trichrome stain). (B, C) Enlarged views of mineralized bone cortical allograft particles. The green layer surrounding the mineralized bone cortical allograft corresponds to newly formed bone. In both cases, contact between newly formed bone and the implant surface was established (black arrows). The newly formed bone layer is continuous around the mineralized bone cortical allograft particles in contrast to the titanium (Goldner trichrome stain).

• 

  Figure 5 Bone-implant interface with mineralized bone cortical allograft particles and a membrane 3 months after implantation. (A) General view with mineralized bone cortical allograft particles (Goldner trichrome stain). (B) The black arrow indicates a layer of newly formed bone between the dental implant (Ti) and particles of mineralized bone cortical allograft (A) (Goldner trichrome stain).

• 

  Figure 6 X-ray tomography at 1 month (S100%, intact socket). (A) Mesio-distal view of 3 implants. (B) Linguo-vestibular view of an implant with mineralized bone cortical allograft particles and a membrane. The blue arrow indicates the buccal wall with limited height and widthwise bone resorption.

• 

  Figure 7 X-ray tomography at 3 months (S100%, intact socket). (A) Mesio-distal view of 4 implants. (B) Linguo-vestibular view of implant B with mineralized bone cortical allograft particles and a membrane. The blue arrow indicates the buccal wall with limited resorption.

• 

  Figure 8 X-ray tomography at 3 months (S100%, intact socket). (A) Longitudinal view of 4 implants. (B) Coronal view of implant C with mineralized bone cortical allograft particles. The blue arrow indicates the buccal wall with post-extraction resorption. S100%, intact socket.

• 

  Figure 9 X-ray tomography at 3 months with 50% of the buccal wall (BW) removed (S50%, buccal wall socket height reduced by 50%). (A) Longitudinal view of 4 implants. (B) Coronal view of implant C with mineralized bone cortical allograft particles and a membrane. The blue arrow indicates the BW with limited resorption.

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