J Periodontal Implant Sci.  2017 Aug;47(4):194-210. 10.5051/jpis.2017.47.4.194.

Alveolar socket preservation with demineralised bovine bone mineral and a collagen matrix

• Maiorana C
• Poli PP
• Deflorian
• Testori T
• Mandelli F
• Nagursky H
• Vinci R

• KMID: 2388107
• DOI: http://doi.org/10.5051/jpis.2017.47.4.194

Abstract

PURPOSE
The aim of the present study was to evaluate the healing of post-extraction sockets following alveolar ridge preservation clinically, radiologically, and histologically.
METHODS
Overall, 7 extraction sockets in 7 patients were grafted with demineralised bovine bone mineral and covered with a porcine-derived non-crosslinked collagen matrix (CM). Soft tissue healing was clinically evaluated on the basis of a specific healing index. Horizontal and vertical ridge dimensional changes were assessed clinically and radiographically at baseline and 6 months after implant placement. For histological and histomorphometric analysis, bone biopsies were harvested from the augmented sites during implant surgery 6 months after the socket preservation procedure.
RESULTS
Clinically, healing proceeded uneventfully in all the sockets. A trend towards reduced horizontal and vertical socket dimensions was observed from baseline to the final examination. The mean width and height of resorption were 1.21 mm (P=0.005) and 0.46 mm (P=0.004), respectively. Histologically, residual xenograft particles (31.97%±3.52%) were surrounded by either newly formed bone (16.02%±7.06%) or connective tissue (50.67%±8.42%) without fibrous encapsulation. The CM underwent a physiological substitution process in favour of well-vascularised collagen-rich connective tissue.
CONCLUSIONS
Socket preservation using demineralised bovine bone mineral in combination with CM provided stable dimensional changes of the alveolar ridge associated with good re-epithelialisation of the soft tissues during a 6-month healing period.

Keyword

Bone regeneration; Bone substitutes; Histology; Tooth loss

MeSH Terms

Alveolar Process
Biopsy
Bone Regeneration
Bone Substitutes
Collagen*
Connective Tissue
Heterografts
Humans
Miners*
Tooth Loss
Transplants
Bone Substitutes
Collagen

Figure

• 

  Figure 1 (A) Minimally invasive surgical extraction of the upper right first premolar with preservation of the vestibular and palatal cortical bone. (B) Demineralised bovine bone mineral grafted in the post-extraction alveolar socket. (C) Porcine-derived CM stabilised at the top of the alveolar socket with 6-0 non-resorbable interrupted sutures. (D) Peri-apical radiograph of the grafted socket performed immediately after the socket preservation procedure. CM: collagen matrix.

• 

  Figure 2 (A) Healing of the soft tissues 1 week post-surgery. (B) Healing of the soft tissues 2 weeks post-surgery. (C) Suture removal 3 weeks post-surgery. (D) Healing of the soft tissues 4 weeks post-surgery. (E) Healing of the soft tissues 8 weeks post-surgery. (F) Healing of the soft tissues 10 weeks post-surgery.

• 

  Figure 3 (A) Maturation of the soft tissues after a 6-month healing period. (B) Peri-apical radiograph of the grafted socket performed 6 months after the socket preservation procedure. (C) Maturation of the bone tissue 6 months after the ASP procedure. (D) Implant placed in the preserved socket in a prosthetically guided position. ASP: alveolar socket preservation.

• 

  Figure 4 (A) Microphotograph showing a biopsy of the mucosa after a 6-month healing period from a premolar site. Complete re-epithelialisation of the defect is visible, with biomaterial granules surrounded by an uninflamed area of connective tissue with coarse collagen fibres. Azure II/pararosaniline stain; bar=500 μm. (B) Higher magnification of the mucosa biopsy showed in Figure 4A, illustrating a multi-layered epithelium comprising the stratum basale, stratum spinosum, and stratum corneum, typical for the keratinised mucosa. Rete ridges and connective tissue papillae are well developed. Azure II/pararosaniline stain; bar=100 μm. (C) Higher magnification illustrating membrane remnants covered by mucosa epithelium and biomaterial granules surrounded by uninflamed connective tissue with coarse collagen fibres. Azure II/pararosaniline stain; bar=100 μm. BO: biomaterial granules, E: epithelium, M: membrane remnants.

• 

  Figure 5 (A) Microphotograph illustrating biomaterial granules embedded in woven bone and in contact with well-vascularised, uninflamed, loose connective tissue. Biomaterials granules are connected via bony bridges. Azure II/pararosaniline stain; bar=100 μm. (B) Higher magnification of Figure 5A, illustrating seams of active osteoblasts forming dark-blue-stained osteoid. The biomaterial granule was in close contact with woven bone. No signs of acute inflammatory response were observed. Azure II/pararosaniline stain; bar=20 μm. (C) Microphotograph of the grafted site after 6 months of healing. The areas containing biomaterial show demineralised bovine bone granules in close contact with newly formed bone trabeculae. The loose connective tissue is well vascularised and free of inflammation. For histomorphometric purposes, biomaterial granules are labelled green and newly formed bone red. Azure II/pararosaniline stain; bar=500 μm. BO: biomaterial granules, NB: new bone, OB: osteoblasts, O: osteoid.

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