Porous bovine bone mineral in healing of human extraction sockets. Part 1: histomorphometric evaluations at 9 months.
BACKGROUND
Extraction socket wound healing is characterized by resorption of the alveolar bone at the extraction site. This produces a decrease in ridge volume, deformations of ridge contours, and, thus, difficulties in delayed placement of root-form implants in an ideal position. Cancellous porous bovine bone mineral (PBBM) applied to fresh extraction sockets has recently been proposed to minimize the reduction in ridge volume. The aim of this study was to investigate the influence of PBBM grafted particles on the histopathologic pattern of the intrasocket regenerated bone and to evaluate histomorphometrically the healed PBBM grafted extraction socket site at 9 months' post-extraction.


METHODS
PBBM particles (250 to 1,000 microns in size) were grafted in 15 fresh human extraction sockets in 15 patients. Socket wall bone height was measured from the crestal ridge level before the mineral particles were inserted. Primary soft tissue closure was performed to protect the grafted particles via a pediculated split palatal flap. At 9 months, socket bone walls were remeasured and cylinder bone samples of the previously PBBM-grafted sites were obtained. Decalcified specimens were sectioned at a cross-horizontal plane and stained with hematoxylin and eosin for histopathologic and histomorphologic examination. Tissue area percentage of bone, PBBM, and connective tissue (CT) was calculated for each specimen from the crestal to the apical region and changes in values compared.


RESULTS
Average clinical overall bone fill of the augmented socket sites was 82.3%. Histologically, PBBM particles were observed in all specimens. Newly formed bone was characterized by abundance of cellular woven-type bone in the coronal area, while lamellar arrangements could be identified only in the more apical region. New osseous tissue adhered to the PBBM. Histomorphometric measurements showed an increase of mean bone tissue area along the histological sections from 15.9% in the coronal part to 63.9% apically (average 46.3%). CT fraction decreased from 52.4% to 9.5% (average 22.9%) from the crestal to the apical region. PBBM area fraction varied from 26.4% to 35.1% (average 30.8%). Statistical analysis of the comparison between areas of bone, CT, and PBBM was performed in different points along the coronal-apical axis. Differences were significant (P <0.01) at the most crestal, middle, and apical section cut areas, but not at the cervical section cuts. Bone area fraction increased in the apical direction as much as CT correlatively decreased. Unlike CT and bone, PBBM retained constant relative volume (approximately 30%), regardless of the depth of the specimen cores.


CONCLUSIONS
PBBM particles are an appropriate biocompatible bone derivative in fresh extraction sockets for ridge preservation. The resorbability of this xenograft could not be recognized in a 9-month period. Further investigation is needed to clarify the resorptive mechanisms of PBBM.
Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel. zviartzi@ccsg.tau.ac.il
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D000328:Adult; D000539:Alveolar Process / Q000473:pathology / Q000503:physiopathology; D000540:Alveolar Ridge Augmentation / Q000379:methods; D000704:Analysis of Variance; D000818:Animals; D001861:Bone Regeneration; D001862:Bone Resorption / Q000503:physiopathology; D018786:Bone Substitutes / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods*; D002417:Cattle; D004396:Coloring Agents; D003238:Connective Tissue / Q000473:pathology; D003758:Dental Implantation, Endosseous; D019250:Dental Implants, Single-Tooth; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D013524:Surgical Flaps; D014081:Tooth Extraction; D020390:Tooth Socket / Q000473:pathology / Q000503:physiopathology*; D014945:Wound Healing
D018786:Bone Substitutes; D004396:Coloring Agents