Bone regeneration and graft material resorption in extraction sockets grafted with bioactive silica-calcium phosphate composite (SCPC) versus non-grafted sockets: clinical, radiographic, and histological findings

Doaa Adel-Khattab, Nermeen S Afifi, Shaimaa M Abu El Sadat, Mona N Aboul-Fotouh, Karim Tarek, Robert A Horowitz, Doaa Adel-Khattab, Nermeen S Afifi, Shaimaa M Abu El Sadat, Mona N Aboul-Fotouh, Karim Tarek, Robert A Horowitz

Abstract

Purpose: The purpose of the present study was to evaluate the effect of silica-calcium phosphate composite (SCPC) granules on bone regeneration in extraction sockets.

Methods: Ten patients were selected for a split-model study. In each patient, bone healing in SCPC-grafted and control ungrafted sockets was analyzed through clinical, radiographic, histomorphometric, and immunohistochemical assessments 6 months postoperatively.

Results: A radiographic assessment using cone-beam computed tomography showed minimal ridge dimension changes in SCPC-grafted sockets, with 0.39 mm and 1.79 mm decreases in height and width, respectively. Core bone biopsy samples were obtained 6 months post-extraction during implant placement and analyzed. The average percent areas occupied by mature bone, woven bone, and remnant particles in the SCPC-grafted sockets were 41.3%±12%, 20.1%±9.5%, and 5.3%±4.4%, respectively. The percent areas of mature bone and woven bone formed in the control ungrafted sockets at the same time point were 31%±14% and 24.1%±9.4%, respectively. Histochemical and immunohistochemical analyses showed dense mineralized bundles of type I collagen with high osteopontin expression intensity in the grafted sockets. The newly formed bone was well vascularized, with numerous active osteoblasts, Haversian systems, and osteocytes indicating maturation. In contrast, the new bone in the control ungrafted sockets was immature, rich in type III collagen, and had a low osteocyte density.

Conclusions: The resorption of SCPC granules in 6 months was coordinated with better new bone formation than was observed in untreated sockets. SCPC is a resorbable bone graft material that enhances bone formation and maturation through its stimulatory effect on bone cell function.

Trial registration: ClinicalTrials.gov Identifier: NCT03897010.

Keywords: Alveolar ridge augmentation; Cone beam computed tomography; Histological techniques.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Copyright © 2020. Korean Academy of Periodontology.

Figures

Figure 1. Digital images of (A) teeth…
Figure 1. Digital images of (A) teeth before extraction, (B) atraumatic extraction of teeth 23 and 24, (C) extracted teeth, (D) the socket after grafting with SCPC granules, (E) 2 rectangular strips cut from a piece of the palate and used to seal the 2 grafted sockets, and (F) SCPC granules covered with the free gingival graft obtained from the palatal tissues and sutured with 4-0 polypropylene sutures.
SCPC: silica-calcium phosphate composite.
Figure 2. X-ray radiographs of (A) the…
Figure 2. X-ray radiographs of (A) the decayed teeth (number 23 and 24) prior to extraction, and (B) the extraction socket immediately after grafting with the SCPC granules. The SCPC particles were radiopaque and easily visualized inside the socket. (C) Six months postoperatively, new bone formation and graft material resorption were evident. The edges of the grafted sockets were no longer visible due to remodeling of the newly formed bone and graft material resorption. (D) Six months after implant placement in the newly formed bone.
SCPC: silica-calcium phosphate composite.
Figure 3. (A) Control decayed tooth 14…
Figure 3. (A) Control decayed tooth 14 preoperatively. The socket was left to heal for 6 months. (B) Periapical X-ray 6 months after implant placement.
Figure 4. (A) Control group before tooth…
Figure 4. (A) Control group before tooth extraction showing the measured buccolingual width and the measured height. (B) The buccolingual width and height 6 months after extraction.
Figure 5. (A) A bar graph showing…
Figure 5. (A) A bar graph showing the mean surface area percentages of newly formed mature bone, woven bone, and residual particles in the SCPC-grafted and control ungrafted sockets. (B) A bar graph showing the mean surface area percentages of new mature bone, woven bone tissue, and residual particles in the coronal and apical part of the SCPC graft.
SCPC: silica-calcium phosphate composite. a)P≤0.01; b)P≤0.001.
Figure 6. A bar graph showing gradual…
Figure 6. A bar graph showing gradual coronal-to-apical resorption and decrease in the surface area percentage occupied by SCPC granules in serial sections of a core bone biopsy obtained 6 months post-grafting in extraction sockets. A significant drop in the surface area percentage of the residual graft was observed, from 13%±6% within the first 0.2 mm of the coronal part to 1%±0.6% at the apical part of the sample.
SCPC: silica-calcium phosphate composite.
Figure 7. Photomicrographs of hematoxylin and eosin-stained…
Figure 7. Photomicrographs of hematoxylin and eosin-stained sections of core biopsy samples from sockets grafted with SCPC granules (A-D) and control ungrafted sockets (E, F) after 6 months, showing (A) bone regeneration and SCPC graft resorption. (B) The maturity of the newly formed bone was indicated by the presence of numerous osteocytes, osteoblasts, blood vessels, and Haversian systems. (C) Erosion of the surface of SCPC granules in the presence of osteoblasts attached at the material surface (black arrows), osteoblasts lining the mineralization front of the newly formed bone (white arrows). (D) New bone formation in the interspace between particles and with cracks inside the SCPC particles. (E) Thin bone spicules in newly formed bone in the control ungrafted extraction socket after 6 months. (F) Osteocytes in the newly formed bone surrounded by woven bone tissue in the control ungrafted defect. The darkly stained area indicates fibrous immature connective tissue.
SCPC: silica-calcium phosphate composite, H: Haversian systems, V: blood vessels.
Figure 8. (A, B) Polarized light microscopy…
Figure 8. (A, B) Polarized light microscopy of sirius red-stained sections, showing (A) a high density of red-stained newly formed bone and connective tissue, which is indicative of well-packed thick mineralized collagen type I in SCPC-grafted sockets. (B) The predominance of yellow-green is indicative of collagen type III and the limited red staining is indicative of low synthesis of collagen type I in the newly formed bone in the control ungrafted sockets. (C, D) Masson trichrome-stained sections, showing (C) a high density of red-stained newly formed bone, indicative of mature bone formation in the SCPC-grafted socket, and (D) predominance of blue-stained areas in the control ungrafted socket, which is indicative of immature woven bone. (E. F) Osteopontin immunohistochemical staining, showing (E) intense osteopontin immunoexpression by activated osteoblasts and along the incremental lines of the newly formed bone in SCPC-grafted sockets, and (F) weak osteopontin immunoexpression in the newly formed bone and osteoblasts in control ungrafted sockets.
SCPC: silica-calcium phosphate composite.

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