Magnesium-enriched hydroxyapatite compared to calcium sulfate in the healing of human extraction sockets: radiographic and histomorphometric evaluation at 3 months.
BACKGROUND
Reduction of alveolar height and width after tooth extraction may present problems for implant placement, especially in the anterior maxilla where bone volume is important for biologic and esthetic reasons. Different graft materials have been proposed to minimize the reduction in ridge volume. The aim of this study was to compare radiographic and histomorphometric results of magnesium-enriched hydroxyapatite (MHA) and calcium sulfate (CS) grafts in fresh sockets after tooth extractions.


METHODS
Forty-five fresh extraction sockets with three bone walls were selected in 15 patients. A split-mouth design was used: 15 sockets on the right side of the jaw received MHA, 15 sockets on the left side received CS, and 15 random unfilled sockets were considered the control (C) group. Intraoral digital radiographs were taken at baseline and at 3 months after graft material placement. At 3 months, cylinder bone samples were obtained for histology and histomorphometry analysis.


RESULTS
The difference in mean radiographic vertical bone level from baseline to 3 months was -2.48 +/- 0.65 mm in the CS group, -0.48 +/- 0.21 mm in the MHA group, and -3.75 +/- 0.63 mm in the unfilled C group. Statistically significant differences (P <0.05) were found between CS and MHA groups and between MHA and C groups. Histologic examination revealed bone formation in all treated sites; trabecular bone assessment did not differ among apical, mesial, and coronal portions of the specimens. Mean vital bone measurements for CS, MHA, and C groups were 45.0% +/- 6.5%, 40.0% +/- 2.7%, and 32.8% +/- 5.8%, respectively. Statistically significant differences (P <0.05) were found among all groups. Connective tissue percentages averaged 41.5% +/- 6.7% for the CS group, 41.3% +/- 1.3% for the MHA group, and 64.6% +/- 6.8% for the C group. Statistically significant differences (P <0.05) were found between CS and C groups and between MHA and C groups. The CS-grafted sockets showed 13.9% +/- 3.4% residual implant material, whereas the MHA-treated sockets showed 20.2% +/- 3.2% residual material. The difference between the groups was statistically significant (P <0.05).


CONCLUSIONS
Radiographs revealed a greater reduction of alveolar ridge in the CS group than in the MHA group. Histologic examination showed more bone formation and faster resorption in the CS group and more residual implant material in the MHA group.
Crespi
Roberto
R
Department of Dentistry, Vita Salute University, San Raffaele Hospital, Milan, Italy. robcresp@libero.it
Capparè
Paolo
P
Gherlone
Enrico
E
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology; D001861:Bone Regeneration; D018786:Bone Substitutes; D002133:Calcium Sulfate; D017886:Durapatite / Q000737:chemistry*; D005260:Female; D006801:Humans; D008274:Magnesium; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014081:Tooth Extraction / Q000009:adverse effects; D020390:Tooth Socket / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014945:Wound Healing
D018786:Bone Substitutes; D017886:Durapatite; D008274:Magnesium; D002133:Calcium Sulfate