Pre-prosthetic Remodeling of Alveolar Ridge Using Calcium Phosphate

Biomaterials
M.C. Prez1,2, J.A. Delgado2, A. Alfonso2, R.M. Guerra2, J.A. Rodrguez1, L. Morejn2,
D.M. Mrquez1, A. Beltrn1, and A. Almirall2
1

Bauta Dental Teaching Clinic/Surgical Department, Artemisa, Cuba

2
Biomaterials Center, University of Havana, Havana, Cuba

Abstract Maxilla or mandible alveolar ridge defects are

commonly a sequel to dental extractions when preventive
treatment of atrophy of the maxillary bone (ABM) is not
performed. In order to achieve bone reconstruction of the
reabsorbed alveolar ridge, oral surgery is needed. The aim of
this paper is to study the combine application in the alveolar
ridge remodeling of dental biomaterials Biograft-G,
MEMBRACEL-O and Tisuacryl. Eleven patients affected
by maxillary alveolar bone atrophy were treated. The
evaluation was performed at 7 days and 6 months from
surgery. At seven days, no cases of infection were observed,
but the presence of edema was reported in two cases and
granules exfoliation in one of them. No ARs were observed. At
6 months, 100% of patients achieving a Success in the
reconstruction of atrophic alveolar ridge. It is concluded that
the combine application of dental biomaterials is effective and
safe for the pre-prosthetic alveolar ridge remodeling.
Keywords -tricalcium phosphate, Alveolar ridge
augmentation, Reconstruction of Atrophic Maxillary, collagen
membranes, synthetic biomaterials.
I. INTRODUCTION

The defects of the alveolar ridge in the maxilla or

mandible are a frequent sequel to dental extractions when
preventive treatment of atrophy of the maxillary bone
(AMB) is not performed [1, 2]. Different methodologies to
prevent reabsorption have been used, such as, postextraction filling, preservation of tooth roots, or the use of
metallic implants, bone grafts or recombinant human bone
morphogenetic protein [3-12]. However, when the
preventive methods have not been performed and AMB is
observed, a surgical reconstruction of the maxillary alveolar
ridges is needed, previous to the prosthetic rehabilitation
regardless the type of prosthesis to be used [13].
Among the materials used to carry out atrophic maxillary
alveolar ridge reconstruction, the -tricalcium phosphate (TCP) is a promissory candidate. The -TCP presents high
biocompatibility and biodegradability, providing a structure
for bone remodeling, which is gradually replaced by new
formed bone [8]. The aim of this paper is to study the
combine application in the alveolar ridge remodeling of
dental biomaterials BIOGRAFT-G, MEMBRACEL-O
and TISUACRYL.

II. MATERIALS AND METHODS

A. Materials
Tisuacryl is a N-butyl-2cyanoacrylate based tissue
adhesive used for wound closure in oral surgery,
commercialized by the Biomaterials Center (BIOMAT) of
the University of Havana [14].
Biograft-G is a synthetic dense ceramic granulate of
-TCP
for
bone
regeneration,
developed
and
commercialized by the Biomaterials Center (BIOMAT) of
the University of Havana. Biograft-G has proved to be
non-cytotoxic, bioactive and biocompatible, according to
preclinical and clinical assays results. In this study,
Biograft-G with a grain size of 0.1 mm to 0.4 mm was
used [15].
Membracel-O is a biocompatible and reabsorbable
collagen membrane for an odontological use of 3 x 3 cm.
provided by Laboratory Celina, Argentina. This biomaterial
is an ideal complement in oral surgery and implantology for
avoiding mucous cells to enter into the stratum, since those
cells grow more rapidly than the osseous cells affecting
bone remodeling [12].
B. Methods
Patients: Eleven patients diagnosed with AMB (Fig. 1),
of 50 to 79 years old, of both sexes, Cuban citizens, without
distinction of skin color and with health status that allowed
them the surgery, were included in the clinical investigation.
Patients with decompensate diabetes or malignancies,
mentally retarded, immunocompromised or under
immunosuppressive therapy, pregnant women, addicted to
smoking or alcohol, were excluded. Patients were given
detailed information about the nature and objectives of the
investigation, treatment and medical procedures, and written
informed consent was obtained.
Treatments: surgical bone remodeling of reabsorbed
alveolar ridge. The bone defects were exposed by a flap
technique after antiseptic treatment and anesthesia of the
affected area, then debridement of the damaged tissue and
irrigation with saline solution were carried out. Bone graft

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IFMBE Proceedings 49, DOI: 10.1007/978-3-319-13117-7_54

208

Pre-prosthetic Remodeling of Alveolar Ridge Using Calcium Phosphate Biomaterials

material Biograft-G was mixed with sterile water or the

patients blood before placing it and then covered with a
collagen membrane (Fig. 2) to prevent particle migration
[16]. After restoring the mucoperiosteum and the flap, the
surgical incision was closed with the tissue adhesive
Tisuacryl.

209

Finally, two assessment categories were established for

integral evaluation of efficacy and safety: Success, when the
remodeling of alveolar ridge was completed or partial and
ARs attributable to the product were not observed; Failure,
when the remodeling of alveolar ridge was incomplete or
ARs attributable to the product were observed.
The investigation was conducted according to Helsinki
Declaration [18] and Good Clinical Practices standards. The
study was approved by the Review and Ethics Committee of
the Bauta Dental Teaching Clinic, Havana, Cuba.
III. RESULTADOS Y DISCUSIN

Table 1 show the results obtained at seven day after the

implantation. There were no cases of infection but the
presence of edema was reported in two cases and granules
exfoliation in one of them. No ARs were observed.

Fig. 1 Atrophic maxillary alveolar ridge

Table 1 Evaluation at seven day after the implantation

Clinical evaluation

5064 years

6579 years

Total

Edema

Granule exfoliation

Infection

Total

Clinical outcomes after six month could be observed in

Table 2. In this evaluation 10 cases (90.9%) were assessed
as Satisfactory and one case as Improvement. It should be
noticed that no case of Failure was observed.

Fig. 2 Biograft-G covered with Membracel-O

After implantation, a soft diet for 72 hours and oral
rinsing with Colutol (Acrilet, Cuba) every 3 hours were
indicated to patients. Evaluations at 7 day and 34 weeks
after implantation were by means of clinical examination.
The clinical outcomes were categorized in three levels:
Success, Improvement or Failure.
Clinical evaluation at seven day after implantation
includes Absence or Occurrence of edema, granule
exfoliation and infection. The presence of edema was
qualified according to the increase of mucous volume
noticed. The presence of infection was evaluated in
accordance with the appearance or not of suppuration.
The safety was evaluated as Good (G) or Bad (B) in
accordance with the absence or not of adverse reaction (AR)
such as vomits, diarrheas, fever or migraine.
Clinical evaluation at 34 weeks after the implantation
was evaluated as Satisfactory, when the remodeling of
alveolar ridge was appropriated; Improvement, when more
than 50% of remodeling was achieved and Failure, when
remodeling of alveolar ridge was poor (less than 50%).

Table 2 Evaluation at 6 month after the implantation

Clinical evaluation

5064 years

6579 years

Total

Satisfactory

10

90,9

Improvement

9,1

Failure

Total

11

100

In the final evaluation at six months after surgery, all

cases were classified as Success (100%), observing the
presence of remodeled bone in the treated alveolar ridges
(Figure 3). In this study it was found that all materials were
well tolerated by the oral tissue, and no adverse reaction to
the implanted material was detected in any case.
The results prove to be as good as those obtained by Akif
et al. [17] using platelet rich plasma assisted guided bone
regeneration for ridge augmentation to increased horizontal
bone gain and percentage of vital bone. Similar results were
also obtained by Schwartz-Arad [13] in the construction of
the maxillary alveolar ridge with autogenous bone graft.

IFMBE Proceedings Vol. 49

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M.C. Prez et al.

6.

7.

8.

Fig. 3 Remodeling of alveolar ridge after 6 month of surgery

9.

IV. CONCLUSIONS

10.

Combine application of dental biomaterials Biograft-G ,

MEMBRACEL-O and Tisuacryl demonstrate to be
effective and safe for the pre-prosthetic alveolar ridge
remodeling.

11.
12.

ACKNOWLEDGMENT
The authors thank the Public Health Cuban Ministry for
supporting this work. We also thank the collaboration of the
Laboratory Celina, Argentina.

14.

CONFLICT OF INTEREST
The authors declare that they have no conflict of interest

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Author: Mayra de la Caridad Prez Alvarez

Institute:
Bauta Dental Teaching Clinic
Street: 251 St 13201, Bauta.
City:
Artemisa
Country: Cuba
Email: dntimefa@infomed.sld.cu mayra@biomat.uh.cu

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