Histological and Radiological Features of a Four-Phase Injectable Synthetic Bone Graft in Guided Bone Regeneration: A Case Report

Marija Čandrlić, Željka Perić Kačarević, Zrinka Ivanišević, Matej Tomas, Aleksandar Včev, Dario Faj, Marko Matijević, Marija Čandrlić, Željka Perić Kačarević, Zrinka Ivanišević, Matej Tomas, Aleksandar Včev, Dario Faj, Marko Matijević

Abstract

Background and objective: Injectable synthetic bone grafts (ISBG) are widely used biomaterials for regeneration purposes. The aim of this case report was to examine the efficacy of ISBG in the management of buccal fenestration in the case of a 25-year-old female.

Case report: After a traumatic tooth extraction, the defect was filled with ISBG and covered with a resorbable membrane. The ISBG showed easy handling and the patient had no complications during healing. Six months after augmentation, a bone biopsy was taken during implant bed preparation. The histological results showed good integration of ISBG into the newly formed bone and no signs of tissue inflammation. Additionally, a CBCT (cone beam computed tomography) analysis was performed to support the histological results.

Conclusion: The use of the examined ISBG led to successful treatment of the buccal fenestration defect.

Keywords: biomaterial; guided bone regeneration; injectable synthetic bone graft; tissue engineering.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The radiographic evaluation showed severe bone loss in the distal root area of the hopeless tooth #19.
Figure 2
Figure 2
(A) Occlusal aspect of hopeless tooth #19. (B,C) Exposure of buccal fenestration after flap elevation and curettage of the infected tissue. (D) Application of injectable synthetic bone graft (ISBG) into the extraction socket. (E,F) Coverage of the defect with resorbable membrane and final wound closure.
Figure 3
Figure 3
Histological examination of the bone biopsy taken six months post-implantation. (A) Longitudinal section of sample harvested from the augmented area. ISBG granules are completely consolidated with newly formed bone starting at the periphery border between the ISBG and pre-existing defect. The area of interest is marked by a square and shown in higher magnification (hematoxylin and eosin staining; magnification 10×). (B) Closer look at the area of interest. The residual ISBG is in close contact with a newly formed bone. There is no sign of inflammatory tissue response. Osteocytes are trapped into bone tissue, while active osteoblasts can be detected at the peripheral regions of residual ISBG and newly formed bone (hematoxylin and eosin staining; magnification 20×). (C) ISBG granules are integrated and in close contact with the newly formed bone six months post-implantation. Osteocytes and osteoblasts can be detected in the newly formed bone. Soft tissue area is rich with cells, mainly fibroblasts. Note the dark red areas that indicate new bone formation at the ISBG and bone contact. No signs of inflammatory tissue response towards the implanted ISBG. NB, newly formed bone; BM (biomaterial), residual ISBG; ST, soft tissue; black filled triangles: osteocytes; unfilled triangles: osteoblast; arrows: fibroblasts (Movat’s pentachrome staining, magnification 20×).
Figure 3
Figure 3
Histological examination of the bone biopsy taken six months post-implantation. (A) Longitudinal section of sample harvested from the augmented area. ISBG granules are completely consolidated with newly formed bone starting at the periphery border between the ISBG and pre-existing defect. The area of interest is marked by a square and shown in higher magnification (hematoxylin and eosin staining; magnification 10×). (B) Closer look at the area of interest. The residual ISBG is in close contact with a newly formed bone. There is no sign of inflammatory tissue response. Osteocytes are trapped into bone tissue, while active osteoblasts can be detected at the peripheral regions of residual ISBG and newly formed bone (hematoxylin and eosin staining; magnification 20×). (C) ISBG granules are integrated and in close contact with the newly formed bone six months post-implantation. Osteocytes and osteoblasts can be detected in the newly formed bone. Soft tissue area is rich with cells, mainly fibroblasts. Note the dark red areas that indicate new bone formation at the ISBG and bone contact. No signs of inflammatory tissue response towards the implanted ISBG. NB, newly formed bone; BM (biomaterial), residual ISBG; ST, soft tissue; black filled triangles: osteocytes; unfilled triangles: osteoblast; arrows: fibroblasts (Movat’s pentachrome staining, magnification 20×).
Figure 4
Figure 4
Grey levels in rectangular ROI at the site of augmentation. (A) CBCT scan ten days postoperatively. (B) Cone beam computed tomography (CBCT) scan 6 months post augmentation with ISBG. Pay attention to buccal bone plate regeneration at the site of augmentation (red arrows).

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