Novel Synthetic Carbonate Apatite as a Bone Substitute in Implant Treatments: Case Reports.

Bone graft materials are often used in implant treatment to optimize functional and esthetic outcomes. The requirements for bone grafting materials are the ability to maintain space for bone regeneration to occur and the capability of being resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are a chemically synthetic bone graft material similar to autogenous bone minerals and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments when used alone or in combination with autogenous bone. The clinical findings and the radiographic and histologic assessments in three cases of immediate implant placement and lateral and vertical guided bone regeneration are reported. Despite the short-term follow-ups, histologic findings showed that CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules maintained their morphology around the implant. This limited short-term case report suggests that this bone substitute is effective. However, further clinical studies and long-term reports of this new biomaterial are needed.

Novel Synthetic Carbonate Apatite as Bone Substitute in Implant Treatments: Case Reports.

Bone graft materials are often used in implant treatment for optimizing functional and esthetic outcomes. The requirements for bone grafting materials should be that they must be able to maintain space for bone regeneration to occur and must be resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are chemically synthetic bone graft material that are similar to autologous bone mineral and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments using CO3Ap granules in combination with autogenous bone or CO3Ap granules separately. This report will show the clinical findings as well as radiographic and histological assessments in three cases of immediate implant placement, lateral GBR and vertical GBR. These results demonstrated, although it was a short-term report, that in histological findings CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules contributed to maintaining their morphology tissue around the implant. In this limited short-term case report, it was suggested that this bone substitute was effective. However, further clinical studies and long-term reports of this new biomaterial are needed.

Guided bone regeneration assisted by tooth roots with periodontal ligament: Case reports of immediate and staged approaches to implant therapy.

To potentially overcome current challenges in bone augmentation techniques and the limitations of bone graft materials, extracted tooth roots with periodontal ligament (TRPs) were strategically utilized to assist guided bone regeneration (GBR). This strategy sought to take advantage of the autologous and shapable nature of TRPs, along with their space-making and shielding ability, and the tissue conductivity/inductivity of the preserved periodontal ligament (PDL). The present article reports on three cases of TRP-assisted GBR as part of immediate and staged approaches to implant therapy. The first case involves immediate implant placement into the extraction socket of a maxillary central incisor, where a TRP veneer, shaped from the extracted central incisor, was used during simultaneous lateral augmentation. The second case describes a staged approach to lateral bone augmentation for a severe buccal bony defect at the maxillary lateral incisor site, where sectioned blocks/pieces of an extracted third molar TRP were used with other bone graft materials. The third case describes aggressive vertical and horizontal bone augmentation for staged implant placement, where an extracted third molar was sectioned and placed on the native alveolar bone as a buccal and lingual bracket, then filled with bone graft materials. All three cases received final restoration and were shown to be stable and functional at the 3-year follow-up. Osseointegration has been well maintained, and the transplanted TRPs seem to be integrated with the native or regenerated bone or remodeled and replaced by the native bone. Longer-term follow-up studies are required.

Long-term alveolar ossification of connective tissue graft placed around natural teeth: a report of five cases.

Connective tissue graft (CTG) surgery has been performed since the 1980s with the principal aim of root coverage. Various types of CTG surgery have been reported, not only for root coverage but also as a preprosthetic treatment for the prevention of gingival recession and to alleviate gingival discoloration. Although there have been numerous reports on the prognosis of such treatment, few observational case reports of 10 years or more have been published. The present article reports on five patients who were monitored from between 13 to 23 years after CTG surgery through the use of intraoral findings, CBCT, and histologic evaluation. The hypothesis of the present authors is that growth factors are released gradually from connective tissue placed either above or below the periosteum. Furthermore, stimulated by the optimal occlusion of the natural teeth, osteoblasts present on the periosteum and/or alveolar bone surrounding the teeth are stimulated. Similarly, the connective tissue itself ensures that the soft tissue has a certain biologic width. At the same time, it acts as a scaffold, resulting in the tissue being replaced by bone.

Restoration of gingival and esthetic deformities following flap advancement: the physiologically pigmented gingival graft--a case report.

The coronal advancement of surgical flaps and subsequent shift of the mucogingival junction during bone augmentation procedures are common. These mucogingival alterations may become a challenge to manage in the maxillary anterior region among patients with a high lip line upon smiling or high esthetic demands. To further complicate matters, the presence of physiologic gingival pigmentation in the esthetic zone creates challenges of its own. In this case, a free gingival graft from the buccal gingiva of the maxillary molars was used to correct the mucogingival deformity created from a guided bone regeneration procedure.

A novel combined surgical approach to vertical alveolar ridge augmentation with titanium mesh, resorbable membrane, and rhPDGF-BB: a retrospective consecutive case series.

The purpose of this case series was to report the clinical outcomes and histologic findings of vertical ridge augmentation using a combination of titanium mesh, resorbable collagen membrane, and recombinant human platelet-derived growth factor BB (rhPDGF-BB). Nineteen patients were included, and autogenous bone and anorganic bovine bone particles were used. The bone graft was mixed with rhPDGF-BB and loaded onto the bony defect up to the level of the adjacent alveolar crest. A pre-adapted titanium mesh was placed over the grafted region and covered with a resorbable collagen membrane, leaving no areas of the grafted region exposed. Seventeen patients exhibited good soft tissue healing. Postoperative flap dehiscence occurred relatively early in the healing period in one patient, whereas the covering collagen membrane was exposed during the later phase of the healing period in another. During reentry surgery for removal of the titanium mesh, three patients with favorable soft and hard tissue healing underwent bone biopsies for histologic evaluation of the augmented tissue just below the titanium mesh. The mean vertical height of augmented bone was 8.6 ± 4.0 mm. This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh, resorbable collagen membrane, and rhPDGF for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely absorbed alveolar ridge.

Three-dimensional bone and soft tissue requirements for optimizing esthetic results in compromised cases with multiple implants.

Achieving an esthetic outcome in tooth replacement and implant treatment requires a proper tooth shape and stable surrounding soft tissue profiles. Bone augmentation is considered vital to support the esthetic soft tissue profile around definitive restorations. To prevent recession of the peri-implant soft tissue in cases with multiple implants, buccal bone augmentation of more than 2 mm from the implant platform is necessary to overcome the normal pattern of bone remodeling. Drawing an imaginary horizontal line spanning the space between the remaining healthy interproximal bone peaks is the most reliable vertical augmentation target to create esthetic papillae around an implant prosthesis. Provided that the adjacent bone peaks are at an ideal height and the bone is augmented vertically up to this line, the accepted general guideline of 2 to 3 mm of interproximal vertical bone augmentation from ideally placed implant platforms will invariably also be achieved. In addition, placing pontics in strategic positions to avoid consecutively placed implants has been suggested to facilitate vertical bone height preservation after bone augmentation. Even with esthetically successful results, there have been very few long-term studies on compromised cases with multiple implants. This will become more and more critical over time and must be remedied.