J Korean Assoc Oral Maxillofac Surg.  2019 Dec;45(6):332-342. 10.5125/jkaoms.2019.45.6.332.

Socket preservation using eggshell-derived nanohydroxyapatite with platelet-rich fibrin as a barrier membrane: a new technique

• Kattimani
• Lingamaneni KP
• Kreedapathi GE
• Kattappagari KK

• KMID: 2467185
• DOI: http://doi.org/10.5125/jkaoms.2019.45.6.332

Abstract

OBJECTIVES
Socket grafting is vital to prevent bone resorption after tooth extraction. Several techniques to prevent resorption have been described, and various bone graft substitutes have been developed and used with varying success. We conducted this pilot study to evaluate the performance of nanohydroxyapatite (nHA) derived from chicken eggshells in socket preservation.
MATERIALS AND METHODS
This was a prospective, single center, outcome assessor-blinded evaluation of 23 sockets (11 patients) grafted with nHA and covered with platelet-rich fibrin (PRF) membrane as a barrier. Bone width and radiographic bone density were measured using digital radiographs at 1, 12, and 24 weeks post-procedure. Postoperative histomorphometric and micro-computed tomography (CT) evaluation were performed. The study protocol was approved by the Institutional Ethics Committee.
RESULTS
All patients had uneventful wound healing without graft material displacement or leaching despite partial exposure of the grafted socket. Tissue re-epithelialized with thick gingival biotype (>3 mm). Width of the bone was maintained and radiographic density increased significantly with a trabecular pattern (73.91% of sockets) within 12 weeks. Histomorphometric analysis showed 56.52% Grade 3 bone formation and micro-CT analysis revealed newly formed bone with interconnecting trabeculae.
CONCLUSION
Use of a PRF membrane with nHA resulted in good bone regeneration in sockets. Use of a PRF membrane prevents periosteal-releasing incisions for primary closure, thereby facilitating the preservation of keratinized mucosa and gingival architecture. This technique, which uses eggshell-derived nHA and PRF membrane from the patient's own blood, is innovative and is free of disease transfer risks. nHA is a promising economic bone graft substitute for bone regeneration and reconstruction because of the abundant availability of eggshell waste as a raw material.

Keyword

Bone; Tooth extraction; Socket grafting; Wound healing; Bone regeneration

MeSH Terms

Bone Density
Bone Regeneration
Bone Resorption
Chickens
Ethics Committees
Fibrin*
Humans
Membranes*
Mucous Membrane
Osteogenesis
Pilot Projects
Prospective Studies
Tooth Extraction
Transplants
Wound Healing
Fibrin

Figure

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  Fig. 1 A. Bone defect immediately after extraction with curette in place. B. Bone graft material placed till crestal level in the mandibular left first molar socket. C. Wound closure using platelet-rich fibrin membrane and figure of eight suture. D. Well healed wound after two weeks. E. Well-formed bone observed during exposure for implant bed preparation. F. Cone-beam computed tomography pre-extraction view with roots and bone defect marked in red circles. G. Bone formation (red circles) assessed before implant placement.

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  Fig. 2 Intra-oral periapical radiographic images for assessment of bone formation and density using Digora software.

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  Fig. 3 A. Thick tissue biotype observed after removal of the screw-retained abutment of an immediate-loaded implant following suture removal after 1 week. B. Trephined bone (3×10 mm size) harvested from the left mandibular first molar site 24 weeks after grafting (during implant bed preparation) for micro-computed tomography (CT) and histomorphometric analysis. C, D. Micro-CT sections of trephine bone showing intervening trabeculae.

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  Fig. 4 A–C. Micro-computed tomography (CT) assessment of trephined bone using PhoenixV/tome/Xs machine image analyzing software. D. Schematic presentation of micro-CT image acquisition process for analysis using the PhoenixV/tome/Xs machine.

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  Fig. 5 A. Microphotograph of two (10 mm and 5 mm) trephine bone specimens showing intervening trabeculae with a rim of osteoblasts (arrows). B. Osteoid and fibrous connective tissue with plump lacunae with prominent osteocytes was visible (arrows). A, B. H&E staining (×10).

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  Fig. 6 Pattern of bone regeneration and distribution of these patterns.

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  Fig. 7 Histological grade of bone regeneration and distribution of these grades.

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