Buccal Plate Regeneration Using Particulate Allograft Materials in Implants Rehabilitation
This research review paper discusses use of bone regeneration techniques to treat jaw inadequacies caused by various factors such as tooth loss, infections, tissue damage, neoplasms, or local trauma. The paper highlights the need for long-lasting repair of the hard/soft tissue interface and the use of xenografts and alloplastic bone substitutes as a safe and practical alternative to autologous graft retrieval. The limitations of dental bone grafts availability in market and alternative materials are also discussed, along with potential future developments of workable replacements due to the recent discovery of synthetic bone substitutes. Additionally, the paper focuses on the importance of the buccal bone plate of the alveolar process and its remodeling process, which can impact the success of implant surgery. Various dental approaches for buccal plate regeneration, including GBR and autogenous bone grafts, are also discussed. In order to aid in the development of new bone substitute materials with more desirable biological and mechanical properties, the paper aims to highlight the differences between what is currently available on the market and what would be thought to be the ideal bone substitute material of choice in the future.
Buccal plate regeneration, Particulate allograft, Implant rehabilitation
GBR: Guided Bone Tissue Regeneration
Bone regeneration techniques have been developed to treat jaw inadequacies caused by tissue damage, neoplasms, tooth loss, infections, or local trauma. These techniques vary depending on the type of deficiency, the regional anatomy, the defect extension, and the anticipated rehabilitation . Xenografts and alloplastic bone substitutes are widely used because of their excellent manageability and effectiveness and have been evaluated in multiple studies. However, there are still issues with the materials being used, including minimal patient morbidity, low cost, low immunogenicity, ease of handling and angiogenic potential . The limitations of commercially available dental bone grafts and alternative materials are discussed in this literature review, along with any potential future developments of workable replacements due to the recent discovery of synthetic bone substitutes .
The buccal bone plate of the alveolar process is closely related to the tooth it supports and undergoes significant remodeling following tooth loss or extraction. Bone resorption is also seen after implant insertion and is thought to result from the surgical stress and the tissues' adaptation to the new foreign object. Planning an immediate implant requires a type 1 socket, and the thickness of the buccal alveolar bone wall experiences significant remodeling, impacting the implant's volume and how the soft and hard tissues interact with it .
Several surgical techniques may augment the bone volume of the horizontally deficient alveolar ridges and enable implant insertion in conjunction with a prosthodontic treatment plan. GBR has gotten much attention in the literature and is a well-respected method for enhancing hard tissue. Autogenous bone grafts are the gold standard for hard tissue augmentation surgeries, although using ABB and CS as allogeneic cancellous blocks has also been investigated .
In conclusion, bone regeneration techniques have become critical for restoring jaw inadequacies. However, the limitations of current materials have led to the development of new synthetic bone substitutes, which may offer more desirable biological and mechanical features. Dental professionals must be aware of the buccal plate's remodeling and plan accordingly to ensure the long-term biomechanical stability of the implant. Different surgical methods may increase the bone volume of horizontally deficient alveolar ridges, with GBR being a trusted technique for improving hard tissue .
The literature indicates that surgeons have developed various bone regeneration techniques to address jaw inadequacies resulting from infections, tissue damage, tooth loss, local trauma or neoplasms [7,8]. Strategies used for bone regeneration vary depending on the type of deficiency, the regional anatomy, the defect extension, and the anticipated rehabilitation [3,9].
Numerous studies, including in vivo studies on animal models, in vitro studies on cell cultures and human studies have been undertaken in numerous research institutes across the world to assess the efficacy of bone substitutes, such as xenografts and alloplastic bone substitutes [10-14].
According to recent data, up to 50% of dental implant operations may involve using bone grafts , and the number of procedures to treat bone anomalies is expected to increase by almost 13% annually worldwide . These operations are projected to cost US $664 million by 2021, and the dental bone substitutes market, worth over $493 million in 2018, is anticipated to reach approximately US $931 million by 2025, expanding at a collective annual growth rate of 9.5% .
Allografts and autografts, which do not meet the requirements for a bone substitute material, such as minimal patient morbidity, user-friendly, low immunogenicity, angiogenic potential and low cost are some of the limitations of the current bone graft and replacement materials available on the market . Therefore, innovative bone substitute materials with more appealing mechanical and biological properties are required.
Regarding buccal plate regeneration, the buccal bone plate of the alveolar process is a critical component closely related to the tooth it supports, and its remodeling can impair the cosmetic and functional success of implant surgery at the affected locations . Various surgical techniques can replace alveolar bone loss, distraction osteogenesis, and inlay and on lay grafting, including GBR, free vascularized auto grafts, and ridge splitting .
Hard tissue can be improved using the well-known GBR procedure, which can repair both horizontal and vertical flaws. Autogenous bone grafts are the gold standard for hard tissue augmentation treatments because they transmit vital minerals, proteins, and bone-related cells to the recipient location, encouraging bone regeneration and boosting bone augmentation success [2,4].
However, using autogenous bone may have dangerous side effects at the donor site. Other bone graft materials, such as ABB and CS, have also provided an effective scaffold for forming new bone and improving hard tissue . The literature also highlights that for the creation of new bone to be possible, there must be enough stability and minimal stress exposure because a new vascular system is vulnerable to degeneration brought on by mechanical conditions . Therefore, the choice of surgical technique, graft manipulation, and stabilization procedures are crucial in increasing the procedure's predictability.
In conclusion, the literature review highlights the various bone regeneration techniques available to address jaw inadequacies and the limitations of the current bone graft and replacement materials on the market. The review also emphasizes the importance of stability and minimal stress exposure in bone regeneration procedures, which could impact the predictability of the procedure's success. Further research is required to develop new bone alternative materials with more desirable mechanical and biological features to improve patient outcomes.
Based on the information provided in the literature review, the methodology for this study is a detailed analysis of the current state of bone regeneration techniques and bone graft materials used in dental implant surgery. The review follows a systematic approach to identifying relevant articles and studies exploring bone regeneration strategies' efficacy and limitations.
The methodology for this literature review involves searching electronic databases such as PubMed, ScienceDirect, and Google Scholar using relevant keywords, including "bone regeneration," "dental implants," "alveolar bone loss," "GBR," "autogenous bone grafts," and "bone substitute materials." The search is restricted to only English-language articles from the past 15 years.
The articles identified through the search are then screened based on their title and abstract to determine their relevance to the research question. Full-text articles that meet the inclusion criteria are then reviewed in detail. The review's inclusion criteria include articles exploring bone regeneration techniques and bone graft materials used in dental implant surgery, including in vivo , in vitro and human studies. The exclusion criteria include articles that do not meet the inclusion criteria, are not published in English, or are unavailable in full text.
The data from the selected articles are extracted and summarized to give an overview of the current state of bone regeneration techniques and bone graft materials used in dental implant surgery. The data are analyzed to identify common trends, limitations, and areas for future research. The review aims to provide an evidence-based evaluation of the efficacy and limitations of bone regeneration techniques and bone graft materials used in dental implant surgery and identify potential areas for future research to develop more effective and affordable bone substitute materials.
In summary, the methodology for this literature review involves a systematic search of relevant articles, screening for inclusion based on predetermined criteria, data extraction and analysis, and synthesis of findings to provide an evidence-based evaluation of bone regeneration techniques and bone graft materials used in dental implant surgery.
The review highlights several key findings regarding bone regeneration techniques and bone graft materials used in dental implant surgery: Bone regeneration techniques have been developed to treat jaw inadequacies brought on by tissue damage, tooth loss, infections, local trauma, or neoplasms. Diverse bone regeneration strategies have been employed depending on the type of deficiency, the defect extension, the regional anatomy, and the anticipated rehabilitation. After creating a blood clot, which encourages the local synthesis of new bone, xenografts and alloplastic bone replacements are feasible and safe techniques for long-lasting healing of the hard/soft tissue interface.
Multiple studies conducted in numerous research institutes worldwide have evaluated the effectiveness of bone substitute materials through in vivo studies on animal models, in vitro studies on cell cultures, and human studies to strengthen the 13 years of work experience in translational research activities. The dental bone substitutes market is expected to expand at a yearly growth rate of 9.5%. Currently available bone graft and replacement materials, including allografts and autografts, have limitations and do not meet the ideal bone substitute material criteria. The review discusses potential future developments of workable replacements due to the recent discovery of synthetic bone substitutes with more desirable biological and mechanical features (Table 1).
Additionally, the review provides information on the remodeling of the buccal bone plate of the alveolar process and the effects of tooth loss on alveolar bone loss. Various surgical methods may replace alveolar bone loss, including GBR, free vascularized auto grafts, inlay and on lay grafting, ridge splitting and distraction osteogenesis. The review highlights that GBR is a trusted technique for improving hard tissue and provides appropriate bone volume for dental implants to Osseo integrate, allowing for restoring both horizontal and vertical defects. However, using autogenous bone may have dangerous side effects at the donor site, such as added costs and time, postoperative pain, and an unpredictably high resorption rate.
This literature analysis concludes by thoroughly assessing the state of bone regeneration methods and bone graft materials currently employed in dental implant surgery. In order to encourage local bone production after the formation of a blood clot, the review emphasizes the significance of long-lasting healing of the hard/soft tissue interface. A donor site is not necessary for the recovery of autologous grafts when using xenografts and alloplastic bone replacements because of their superior manageability.
The review also identifies the limitations of currently available bone graft and replacement materials, including allografts and autografts, and the need for a bone substitute material that meets minimal patient morbidity, low immunogenicity, ease of handling, angiogenic potential and low cost. The dental bone substitutes market will likely increase at a combined annual growth rate of 9.5%, indicating the need for continued research and development of more effective and affordable bone substitute materials.
Furthermore, the review highlights the importance of remodeling the buccal bone plate of the alveolar process and the effects of tooth loss on alveolar bone loss. Several surgical methods can replace alveolar bone loss, including GBR, inlay and on lay grafting, free vascularized autografts, ridge splitting, and distraction osteogenesis.
Overall, this literature review provides valuable insights into the current state of bone regeneration techniques and bone graft materials used in dental implant surgery and identifies potential areas for future research and development of more effective and affordable bone substitute materials.
Ethical Approval and Consent to Participate
Informed consent was obtained from all subjects involved in the study Data Availability Statement.
Consent for Publication
Data Availability Statement
The data presented in this study are available on request from the corresponding authors. The data are not publicly available due to privacy reasons.
This research received no external funding.
- Bracey DN, Seyler TM, Jinnah A, et al. (2019) A porcine xenograft-derived bone scaffold is a biocompatible bone graft substitute: An assessment of cytocompatibility and the alpha-gal epitope. Xenotransplantation 26: e12534.
- Song YW, Bienz SP, Benic GI, et al. (2023) Soft-tissue dimensional change following guided bone regeneration on peri-implant defects using soft-type block or particulate bone substitutes: 1-year outcomes of a randomized controlled clinical trial. J Clin Periodontol 50: 147-157.
- Benic GI, Hämmerle CH (2014) Horizontal bone augmentation by means of guided bone regeneration. Periodontology 2000 66: 13-40.
- Cinar IC, Gultekin BA, Saglanmak, et al. (2022) Comparison of allogeneic bone plate and guided bone regeneration efficiency in horizontally deficient maxillary alveolar ridges. Applied Sciences 12: 10518.
- Döbelin N, Luginbühl R, Bohner M (2010) Synthetic calcium phosphate ceramics for treatment of bone fractures. Chimia 64 : 723-723.
- Hameed MH, Gul M, Ghafoor R, et al. (2019) Vertical ridge gain with various bone augmentation techniques: a systematic review and meta-analysis. J Prosthodont 28: 421-427.
- Jimi E, Hirata S, Osawa K, et al. (2012) The current and future therapies of bone regeneration to repair bone defects. Int J Dent 2012: 148261.
- Moslemi N, Mousavi Jazi M, Haghighati F, et al. (2011) Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: A 5-year randomized clinical study. J Clin Periodontol 38: 1122-1129.
- Faverani LP, Ramalho-Ferreira G, Santos PHD, et al. (2014) Surgical techniques for maxillary bone grafting-literature review. Rev Col Bras Cir 41: 61-67.
- Haggerty CJ, Vogel CT, Fisher GR (2015) Simple bone augmentation for alveolar ridge defects. Oral Maxillofac Surg Clin North Am 27: 203-226.
- Motamedian SR, Tabatabaei FS, Akhlaghi F, et al. (2017) Response of dental pulp stem cells to synthetic, allograft, and xenograft bone scaffolds. Int J Periodontics Restorative Dent 37: 49-59.
- Moy PK, Aghaloo T (2019) Risk factors in bone augmentation procedures. Periodontol 2000 81: 76-90.
- Yamada M, Egusa H (2018) Current bone substitutes for implant dentistry. J Prosthodont Res 62: 152-161.
- Omi M, Mishina Y (2022) Roles of osteoclasts in alveolar bone remodeling. Genesis 60: e23490.
- Sharif F, Rehman IU, Muhammad N, et al. (2016) Dental materials for cleft palate repair. Mater Sci Eng C Mater Biol Appl 61: 1018-1028.
- Manfio ASC, Suri S, Dupuis A, et al. (2022) Eruption path of permanent maxillary canines after secondary alveolar bone graft in patients with nonsyndromic complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 161: e416-e428.
- Zhao R, Yang R, Cooper PR, et al. (2021) Bone grafts and substitutes in dentistry: A review of current trends and developments. Molecules 26: 3007.
- Tahmasebi E, Alam M, Yazdanian M, et al. (2020) Current biocompatible materials in oral regeneration: A comprehensive overview of composite materials. Journal of Materials Research and Technology 9: 11731-11755.
Shohreh Ghasemi, DDS, Msc of Oral Surgery, Adjunct Faculty of OMFS Department of Augusta University, 1408 marsh trail circle, Atlanta, 3028 GA, USA.
© 2023 Ghasemi S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.