J Korean Assoc Oral Maxillofac Surg.  2019 Feb;45(1):34-42. 10.5125/jkaoms.2019.45.1.34.

Natural bioceramics: our experience with changing perspectives in the reconstruction of maxillofacial skeleton

• Kattimani
• Lingamaneni KP

• KMID: 2461490
• DOI: http://doi.org/10.5125/jkaoms.2019.45.1.34

Abstract

OBJECTIVES
Various bone graft substitute materials are used to enhance bone regeneration in the maxillofacial skeleton. In the recent past, synthetic graft materials have been produced using various synthetic and natural calcium precursors. Very recently, eggshell-derived hydroxyapatite (EHA) has been evaluated as a synthetic bone graft substitute. To assess bone regeneration using EHA in cystic and/or apicectomy defects of the jaws through clinical and radiographic evaluations.
MATERIALS AND METHODS
A total of 20 patients were enrolled in the study protocol (CTRI/2014/12/005340) and were followed up at 4, 8, 12, and 24 weeks to assess the amount of osseous fill through digital radiographs/cone-beam computed tomography along with clinical parameters and complications. Wilcoxon matched pairs test, means, percentages and standard deviations were used for the statistical analysis.
RESULTS
The sizes of the lesions in the study ranged from 1 to 4 cm and involved one to four teeth. The study showed significant changes in the formation of bone, the merging of material and the surgical site margins from the first week to the first month in all patients (age range, 15-50 years) irrespective of the size of the lesions and the number of teeth involved. Bone formation was statistically significant from the fourth to the eighth week, and the trabecular pattern was observed by the end of 12 weeks with uneventful wound healing.
CONCLUSION
EHA showed enhancement of bone regeneration, and healing was complete by the end of 12 weeks with a trabecular pattern in all patients irrespective of the size of the lesion involved. The study showed enhancement of bone regeneration in the early bone formative stage within 12 weeks after grafting. EHA is cost effective and production is environment friendly with no disease transfer risks. Thus, natural bioceramics will play an important role in the reduction of costs involved in grafting and reconstruction.

Keyword

Apicoectomy; Wound healing; Grafts; Osteoconduction

Figure

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  Fig. 1 A. Bony defect and loss of labial cortical plate. B. Bony defect filled with eggshell-derived hydroxyapatite. C. Wound closure. D. Well-healed wound with permanent crowns in place.

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  Fig. 2 Intraoral periapical radiographs showing radiological evaluations of lesion. A. Immediately after grafting. B. Four weeks postoperative. C. Eight weeks postoperative. D. Twelve weeks postoperative. E. Twenty-four weeks postoperative.

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  Fig. 3 Three-dimensional computed tomography of facial bone (frontal view) showing the complete bone formation after 24 weeks postoperative.

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  Fig. 4 Illustration showing the radiological evaluation of surgical site outline (A) and bone formation characteristics (B). Reproduced from the article of Kattimani et al. (Indian J Dent Res 2014;25:594-601)10 with original copyright holder's permission.

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