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Contour Augmentation after Guided Bone Regeneration with Porous Titanium Granules: A Clinical, Histologic and Histomorphometric Evaluation

Hadi Gholami, Gholamali Gholami, Dieter Bosshardt, Reza Amid, Mahdieh Mirakhori
Published: 13 April 2020
Modern Research in Dentistry , Volume 5, pp 453-461; doi:10.31031/mrd.2020.05.000603

Abstract: GholamAli Gholami1, Dieter Bosshardt2, Reza Amid3, Hadi Gholami4* and Mahdieh Mirakhori5 1Professor, Department of Periodontics, School of dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran 2Professor, Head of the Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Switzerland 3Associate Professor, Department of Periodontics, Research Institute for Dental Sciences, School of dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran 4Assistant Professor, Department of Prosthodontics, Tufts University, School of Dental Medicine, Boston, MA, USA 5Dental Research Center, Research Institute for Dental Sciences, School of dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran 6GPR Dental resident at West LA VA hospital, Los Angeles, CA, USA *Corresponding author: Hadi Gholami, Assistant Professor, Department of Prosthodontics, Tufts University, School of Dental Medicine, 1 Kneeland St 02111 Boston, MA, USA Submission: February 28, 2020;Published: April 13, 2020 DOI: 10.31031/MRD.2020.05.000603 ISSN:2637-7764Volume5 Issue1 Objectives: To determine clinical, histological, and histomorphometrial results following ridge preservation via contour augmentation with high resistance biomaterials. Material and Methods: A 54-year-old female was referred by her general dentist due to her crowded and periodontally hopeless maxillary right canine and premolar teeth. Two dental implants were surgically placed in palatal positions. The exposed implant surfaces were covered with a slowly-resorbable, synthetic, nanocrystalline hydroxyapatite bone substitute and overbuilding was done with porous titanium granules (PTGs) mixed with the patient’s blood. A long-lasting collagen membrane was fixed over the graft sites. Patient was recalled six months later for the second-phase surgery. At that time, a core biopsy from the augmentation site was taken. Result: The patient’s cone beam computed tomography scan showed that hard tissue width and height increased from 8.4 and 10.6mm to 9.2 and 12.3mm, respectively. The histological sections revealed that new bone was bridging between the PTGs and neighboring particles. The new bone matrix consisted of 12.41% mineralized bone matrix and 2.82% osteoid. Concerning the osteoconductivity of PTGs, 27.0% new mineralized bone, 10.2% osteoid, and 62.8% soft tissue were found covering the titanium particles. Conclusion: Overbuilding the ridge via contour augmentation with non-resorbable titanium granules could serve as a valid approach based on optimal clinical and biological results. Clinical Relevance: Immediate implant placement and use of PTGs and collagen membrane all at the same time can improve clinical periodontal parameters and implant stability in the short-term. Keywords: Guided Bone Regeneration; Contour Augmentation; Ridge preservation; Titanium Granules Tooth extraction causes inevitable changes in the supporting structures, which may lead to complications for dental implant placement [1]. Since the 1960s, many studies have been conducted to assess the loss of hard and soft tissues after tooth extraction, and innumerable efforts have been made to prevent or minimize bone loss [2]. Different methods have been suggested to preserve and reconstruct bone volume and prevent alveolar ridge resorption following traumatic events such as tooth extraction. The guided bone regeneration (GBR) technique has presented promising results in repairing bone defects. Autogenous bone grafts are considered the gold standard for GBR, due to their osteoconductive, osteoinductive, and osteogenic properties [3,4]. Despite their high efficacy for bone reconstruction, the need for a second surgical site, unpredictable remodeling rate and bone loss have been regarded as their main disadvantages. Thus, more recent studies have aimed to find a suitable alternative for autogenous bone grafts. Bone substitutes have found their niche within the field of dentistry and have shown promising results [5-7]. Hydroxyapatite-based materials are commonly used for this purpose. Rothamel et al. [8] evaluated the efficacy of nanocrystalline hydroxyapatite paste; however, he claimed that it is not efficient for ridge preservation due to its unpredictable resorption pattern. Since nonresorbable materials can withstand external loads and are resistant to deformation, they can be used with high success rate in bone defect reconstruction, especially for contour augmentation [5, 7,9-11]. The biocompatibility of titanium has been proven in the recent years, and its use in implant dentistry and orthopedics is widely growing. Titanium is highly resistant to corrosion in body fluids. Furthermore, it is considered a potentially appropriate bone substitute material due to its nonresorbable properties [10,11]. Titanium particles can stimulate the activation of complement system and platelets and can consequently increase the level of platelet-derived growth factor (PDGF). PDGF has been shown to promote bone growth, and this capability along with large surface area is advantageous for bone reconstruction [12]. Porous titanium granules (PTG) (Natix™, Tigran Technologies AB, Malmo, Sweden) possess these properties and contain 700-1000μm diameter granules. The porous nature of these granules enables bone infiltration between the particles. PTGs consist of irregular, highly porous, nonresorbable granules of commercially pure titanium; they were first introduced for treatment of peri-implant defects. When implanted, the granules are able to interlock with each other, providing a suitable environment for intra- and inter-granule osteogenesis. A stable porous structure is formed as such, which provides an optimal environment for bone ingrowth. Moreover, PTGs have been successfully used in different circumstances within the specialty of implant dentistry. They have also been suggested for management...
Keywords: optimal / Guided Bone / Nanocrystalline Hydroxyapatite / titanium particles / Contour Augmentation / Porous Titanium Granules

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