POST-EXTRACTION SOCKET PRESERVATION WITH AUTOGENOUS BONE GRAFT AND HYALURONIC ACID FOLLOWED BY DELAYED IMPLANT PLACEMENT

Taman, Rasha A.; Fahmy, Magued H.; Karam, Sahar Sh.; EL Ashwah, Adham A.

doi:10.21608/adjalexu.2017.57922

POST-EXTRACTION SOCKET PRESERVATION WITH AUTOGENOUS BONE GRAFT AND HYALURONIC ACID FOLLOWED BY DELAYED IMPLANT PLACEMENT

Document Type : Original Article

Authors

¹ Instructor at Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Pharos University, Alexandria Egypt.

² Professor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt.

³ Professor of Oral Biology, Department of Oral Biology, Faculty of Dentistry, Alexandria University, Egypt.

⁴ Assistant Professor of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt

10.21608/adjalexu.2017.57922

Abstract

INTRODUCTION: Alveolar ridge atrophy following tooth extraction remains a challenge for future implant placement. Post-extraction socket preservation and implant placement are two methods that are used to prevent significant post-extraction bone loss. OBJECTIVES: The aim of this study was to evaluate the role of hyaluronic acid when mixed with autogenous bone graft in alveolar socket preservation for future implant placement. MATERIALS AND METHODS: A split mouth randomized clinical trial was carried out in 10 patients, 20 mandibular extraction sockets of single rooted teeth with age ranged between 25-55 years, 10 sockets were grafted with autogenous bone graft only using Auto-MaxTM bone harvester and the other 10 sockets were grafted with autogenous bone graft mixed with hyaluronic acid (HyadentTM). All sockets were evaluated clinically, radiographically, and histologically (after 2 months, core biopsy was taken before implant placement) then histomophometric analysis and delayed implant insertion were done followed by implant stability assessment. After 4 months, final prosthesis was delivered. RESULTS: Histological evaluation revealed rapid thick bone deposition with many well organized osteocytes as well as osteoblast lining of the bone surfaces in the study group and increased mean area percent of formed bone. Radiographic bone density changes were found to be statistically significant between the two studied groups. (P2= <0.001). CONCLUSIONS: The use of autogenous bone graft with hyaluronic acid appears to be more efficient in osteoconduction when compared with autogenous bone graft alone and could be a promising strategy for preservation of alveolar sockets.

Keywords

Main Subjects

Oral and maxillofacial surgery

References

1. Quinn JH, Kent JN. Alveolar ridge maintenance with solid nonporous hydroxylapatite root implants. Oral Surg Oral Med Oral Pathol. 1984; 58:511-21.

2. Kentros GA, Filler SJ, Rothstein SS. Six-month evaluation of particulate Durapatite in extraction sockets for the preservation of the alveolar ridge. Implantologist. 1985; 3:53-62.

3. Hoexter DL. Osseous regeneration in compromised extraction sites: a ten-year case study. J Oral Implantol. 2002; 28:19–24.

4. Henkel KO, Gerber T, Lenz S, Gundlach KK, Bienengräber V. Macroscopical, histological, and morphometric studies of porous bone- replacement materials in minipigs 8 months after implantation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:606–13.

5. Ashman A. Postextraction ridge preservation using synthetic alloplast. Implant Dent. 2000; 9:168–76.

6. Marx RE. Clinical application of bone biology to mandibular and reconstruction. Clin Plast Surg. 1994; 21:377–84.

7. Urist MR. Bone: formation by autoinduction. Science. 1965; 150:893–9. “Quotation”

8. Widmark G, Ivanoff CJ. Augmentation of exposed implant threads with autogenous bone chips: prospective clinical study. Clin Implant Dent Relat Res. 2000; 2:178-83.

9. Zaffe D, D’Avenia F. A novel bone scraper for intraoral harversting:a device for filling small bone defects. Clin Oral Impl Res. 2007; 18:525-33.

10. Nandi A, Estess P,Siegelman MH. Hyaluronan Anchoring and Regulation on the Surface of Vascular Endothelial is Mediated through the Functionally Active Form of CD44. J Biol Chem 2000; 275: 14939–48.

11. Sasaki T, Watanabe C. Stimulation of osteoinduction in bone wound healing by high-molecular hyaluronic acid. Bone. 1995; 16:9–15.

12. McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. London: Mosby; 1993. p 16.

13. Glavind L, Loe H. Errors in the clinical assessment of periodontal destruction. J. of Period. Res. 1967; 2:180-184.

14. Steflik DE, Koth DL, Robinson FG, McKinney RV, Davis BC, Morris CF. et al. Prospective investigation of the single-crystal sapphire endosteal dental implant in humans: ten-year results. J Oral Implant. 1995; 21:8-18.

15. Orban B, Bhaskar S. Oral histology and embryology. 13th ed. St. Louis: Mosby Company; 2011. pp 410-6.

16. Kotz S, Balakrishnan N, Read CB, Vidakovic B. Encyclopedia of statistical sciences. 2nd ed. Hoboken, N.J.: Wiley-Interscience; 2006.

17. Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Student ed. Belmont, Calif.: Wadsworth, Cengage Learning; 2013.

18.Brkovic BM, Prasad HS, Konandreas G, Milan R, Antunovic D, Sándor GK, et al. Simple preservation of a maxillary extraction socket using beta-tricalcium phosphate with type I collagen: preliminary clinical and histomorphometric observations. J Can Dent Assoc. 2008; 74:523-8.

19. Kim CS, Choi SH, Cho KS, Chai JK, Wikesjö UM, Kim CK. Periodontal healing in one wall intra-bony defects in dogs following implantation of autogenous bone or a coralderived biomaterial. J Clin Periodontol. 2005; 32:583-9.

20. MacNeill SR, Cobb CM, Rapley JW, Glaros AG, Spencer P. In vivo comparison of synthetic osseous graft materials. A preliminary study. J Clin Periodontol. 1999; 26:239-45.

21. ELkarargy A. Alveolar Sockets Preservation Using Hydroxyapatite / Beta tricalcium Phosphate with Hyaluronic Acid (Histomorphometric study). J Am Sci. 2013; 9:556-63.

22.Ballini A, Cantore S, Capodiferro S, Grassi FR. Esterified hyaluronic acid and autologous bone in the surgical correction of the infra-bone defects. Int J Med Sci. 2009; 6:65–71.

23.Baldini A, Zaffe D, Nicolini G. Bone-defects healing by high-molecular hyaluronic acid: Preliminary results. Ann Stomatol (Roma) 2010; 1:2–7.

24. Strbac GD, Unger E, Donner R, Bijak M, Watzek G, Zechner W. Thermal effects of a combined irrigation method during implant site drilling. A standardized in vitro study using a bovine rib model. Clin Oral Implants Res. 2012; 25:665-74.

25. De Araújo Nobre M, Cintra N, Maló P. Peri-implant maintenance of immediate function implants: A pilot study comparing hyaluronic acid and chlorhexidine. Int J Dent Hyg. 2007; 5:87–94.

26. Wanden Bogaerde L.Treatment of infrabony periodontal defects with esterified hyaluronic acid: Clinical report of 19 consecutive lesions. Int J Periodontics Restorative Dent. 2009; 29:315-23.

27.Roos J, Sennerby L, Lekholm U, Jemt T, Grondahl K, Albrektsson T. A qualitative and quantitative method for evaluating implant success: a 5-year retrospective analysis of the Branemark implant. Int J Oral Maxillofac Implants. 1997; 12:504-14.

28. Lai HC, Zhuang LF, Zhang ZY. Stability of implants placed in different bone types. Zhonghua Kou Qiang Yi Xue Za Zhi. 2007; 42:292-3.

29. Petrie CS, Williams JL. Comparative evaluation of implant designs: influence of diameter, length, and taper on strains in the alveolar crest—a three-dimensional finite-element analysis. Clin Oral Implants Res. 2005; 16:486-94.

30. Meredith N. Assessment of implant stability as a prognostic determinant. Int J Prosthodont. 1998; 11:491–501.

31. Sennerby I, Meredith N. Resonance frequency analysis: measuring implant stability and osseointegration. Compend Contin Educ Dent. 1998; 19:493-8,500,502; quiz 504.

32. Huang HM, Lee SY, Yeh CY, Lin CT. Resonance frequency assessment of dental implant stability with various bone qualities: a numerical approach. Clin Oral Implants Res. 2002; 13:65-74.