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

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.

[1]  J. Ong,et al.  Three-dimensional printing for craniomaxillofacial regeneration , 2017, Journal of the Korean Association of Oral and Maxillofacial Surgeons.

[2]  L. Bertassoni,et al.  Biomaterials for Craniofacial Bone Regeneration. , 2017, Dental clinics of North America.

[3]  Lubna Alotaibi,et al.  The use of bone graft in the treatment of periapical lesion , 2017 .

[4]  R. Gilbert Triplett,et al.  New Frontiers in Biomaterials. , 2017, Oral and maxillofacial surgery clinics of North America.

[5]  Jun Yang,et al.  The Effect of Regeneration Techniques on Periapical Surgery With Different Protocols for Different Lesion Types: A Meta-Analysis. , 2016, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[6]  V. Kattimani,et al.  Biograft Block Hydroxyapatite: A Ray of Hope in the Reconstruction of Maxillofacial Defects , 2016, The Journal of craniofacial surgery.

[7]  T. Kumar,et al.  Eggshell-Derived Hydroxyapatite: A New Era in Bone Regeneration , 2016, The Journal of craniofacial surgery.

[8]  M. Sridhar,et al.  Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: a clinico-radiological study. , 2014, Indian journal of dental research : official publication of Indian Society for Dental Research.

[9]  T. Kumar,et al.  Eggshell derived hydroxyapatite as bone graft substitute in the healing of maxillary cystic bone defects: a preliminary report. , 2014, Journal of international oral health : JIOH.

[10]  G. S. Kumar,et al.  Flower-like hydroxyapatite nanostructure obtained from eggshell: A candidate for biomedical applications , 2013 .

[11]  V. Kattimani,et al.  Observer strategy and radiographic classification of healing after grafting of cystic defects in maxilla: a radiological appraisal. , 2013, The journal of contemporary dental practice.

[12]  C. Balázsi,et al.  Comparative study of hydroxyapatite from eggshells and synthetic hydroxyapatite for bone regeneration. , 2012, Oral surgery, oral medicine, oral pathology and oral radiology.

[13]  T. von Arx,et al.  The use of regenerative techniques in apical surgery: A literature review. , 2011, The Saudi dental journal.

[14]  P. Sreedevi,et al.  Prognosis of periapical surgery using bonegrafts: A clinical study , 2011, Journal of conservative dentistry : JCD.

[15]  Huipin Yuan,et al.  Osteoinductive ceramics as a synthetic alternative to autologous bone grafting , 2010, Proceedings of the National Academy of Sciences.

[16]  Jin-Woo Park,et al.  Bone formation with various bone graft substitutes in critical-sized rat calvarial defect. , 2009, Clinical oral implants research.

[17]  Sang-Hyun Kim,et al.  Evaluation of bone healing with eggshell-derived bone graft substitutes in rat calvaria: a pilot study. , 2008, Journal of biomedical materials research. Part A.

[18]  Myung-Hyun Lee,et al.  Comparison of Bone Formation in Rabbits Using Hydroxyapatite and β-Tricalcium Phosphate Scaffolds Fabricated From Egg Shells , 2008 .

[19]  S. Taschieri,et al.  Efficacy of guided tissue regeneration in the management of through-and-through lesions following surgical endodontics: a preliminary study. , 2008, The International journal of periodontics & restorative dentistry.

[20]  A. Siddharthan,et al.  A novel route for synthesis of nanocrystalline hydroxyapatite from eggshell waste , 2007, Journal of materials science. Materials in medicine.

[21]  Triantafillos Papadopoulos,et al.  Nanostructured bioceramics for maxillofacial applications , 2007, Journal of materials science. Materials in medicine.

[22]  A. el-Ghannam,et al.  Enhancement of bone regeneration and graft material resorption using surface-modified bioactive glass in cortical and human maxillary cystic bone defects. , 2004, The International journal of oral & maxillofacial implants.

[23]  Arun K Gosain,et al.  A 1-year study of osteoinduction in hydroxyapatite-derived biomaterials in an adult sheep model: part I. , 2002, Plastic and reconstructive surgery.

[24]  M. Neves,et al.  Comparison of pericranium and eggshell as space fillers used in combination with guided bone regeneration: an experimental study. , 2000, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[25]  L. Dupoirieux.  Ostrich eggshell as a bone substitute: a preliminary report of its biological behaviour in animals--a possibility in facial reconstructive surgery. , 1999, The British journal of oral & maxillofacial surgery.

[26]  T. Kokubo,et al.  In vitro analysis of the stimulation of bone formation by highly bioactive apatite- and wollastonite-containing glass-ceramic: released calcium ions promote osteogenic differentiation in osteoblastic ROS17/2.8 cells. , 1999, Journal of biomedical materials research.

[27]  U. Ripamonti.  Osteoinduction in porous hydroxyapatite implanted in heterotopic sites of different animal models. , 1996, Biomaterials.

[28]  D. Pourquier,et al.  Powdered eggshell: a pilot study on a new bone substitute for use in maxillofacial surgery. , 1995, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[29]  A. Saad,et al.  Healing assessment of osseous defects of periapical lesions associated with failed endodontically treated teeth with use of freeze-dried bone allograft. , 1991, Oral surgery, oral medicine, and oral pathology.