Filling bone defects with β-TCP in maxillofacial surgery: A review

doi:10.1016/j.morpho.2017.05.002

Morphologie

Volume 101, Issue 334, September 2017, Pages 113-119

https://doi.org/10.1016/j.morpho.2017.05.002 Get rights and content

Summary

Reconstruction of bone defects prior to implant placement now involves synthetic substitutes such as β-TCP because of its ability to promote bone remodeling. Its capacity to be progressively substituted by the patient's bone allows to regenerate a dense bone volume. In addition, its availability in large quantities, avoiding the morbidity observed with harvesting autogenous bone, widens the operative indications. In this paper, the main indications of β-TCP in maxillofacial surgery (dentistry, parodontology and dental implant surgery) are reviewed. They include periodontal bone disease, bone disjunction, pre-implant surgery (sinus floor elevation and lateralization of the inferior alveolar nerve).

Résumé

La reconstruction des déficits osseux avant la pose d’implant fait appel désormais à des matériaux de substitution synthétique comme le β-TCP de par ses capacités à favoriser le remodelage osseux. Il est progressivement substitué par l’os du patient permettant de régénérer un volume osseux dense. Enfin, sa disponibilité en grande quantité, évitant la morbidité liée à un site de prélèvement d’autogreffe, élargit les indications opératoires. Dans ce travail, les principales indications d’utilisation du β-TCP en chirurgie maxillofaciale (chirurgie dentaire, parodontologie et implantation dentaire) sont revues. Elles comprennent la maladie osseuse parodontale, la disjonction osseuse, la chirurgie pré-implantaire (élévation de sinus et latéralisation du nerf alvéolaire inférieur).

Introduction

In dental and maxillofacial surgery, the repair of bone defects aims at recreating a bony site that is suitable for morphological, prosthetic or implant-prosthetic rehabilitation [1], [2]. Causes of bone deficiency are numerous: genetic, post-traumatic, secondary to tooth removal, infectious or iatrogenic. The volume of bone to reconstruct varies according to the anatomical situation. The characteristics of the graft depend on the volumes to be filled (alveolar area) or to be restored (vertical or horizontal ridge insufficiency, bone cyst or sinus lifting). The volume and form of the defect influence the choice of the grafting material. A considerable number of possibilities are available: e.g., harvesting autologous bone particles to fill a post-extraction socket [3], thickening of a thin ridge caused by hypodontia [4], bone disjunction [5], sinus lifting [6] or lateralization of the inferior alveolar nerve [7]. Surgical techniques also use various surgical protocols with a local or a general anesthesia; it should be noticed that local anesthesia is being practiced more and more frequently. Although autologous bone grafts and allografts have been a recognized surgical modality for several decades, the use of synthetic biomaterials has continued to develop as substitute products, especially in the context of pre-implant surgery.

Section snippets

Definitions of graft-related criteria

A bone substitute must be biocompatible and fill several criteria: bio-inertia is defined as the absence of physicochemical reaction of the product in direct contact with bone. Bioactivity is the capacity to develop reactions favoring osseointegration of the product and the adaptation of the receiving tissue. Osteoinduction is defined as the ability to induce bone formation in an extra-skeletal area. Osteoconduction is the ability of the recipient bone cells to colonize the graft. An evolution

Characteristics of β-TCP

β-TCP - Ca₃(POH₄)₂ - belongs to the family of tricalcium phosphates in the beta phase. Being considerably much more resorbable than hydroxyapatite, this biomaterial is highly biocompatible when implanted in bone; it is resorbable within 6 to 9 months as shown in animal and human histological studies [10]. One of the main characteristics of the biomaterial is to be commercially available as scaffolds with a macroporosity of 100 to 600 μm that ensures osteoconduction and can reach 85% of the total

Periodontal bone disease

It has been proposed for more than 15 years to fill periodontal pockets with biomaterial granules. Loss of the peri-radicular bone tissue induces mobility of the dental root and can cause loss of the tooth. Under local anesthesia, the procedure consists in detaching the full thickness of the gingiva to scrap the inflammatory tissues and cementum along the root and to fill the defect. β-TCP is available in various granule sizes varying from 550–1000 μm to 1000–2000 μm. The characteristics of β-TCP

Conclusion

Bone remodeling is an essential step in the healing process of a grafted area. The contribution of synthetic biomaterials is now confirmed and guarantees an optimal reconstruction that allows implant placement in a second step. The availability of β-TCP in the form of granules or compact slabs offers new therapeutic perspectives in maxillofacial and pre-implant surgery.

Disclosure of interest

The author declares that he has no competing interest.

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General reviewFilling bone defects with β-TCP in maxillofacial surgery: A reviewComblement osseux par β-TCP en chirurgie maxillofaciale : revue des indications

Summary

Résumé

Introduction

Section snippets

Definitions of graft-related criteria

Characteristics of β-TCP

Periodontal bone disease

Conclusion

Disclosure of interest

Int J Oral Maxillofac Surg

Morphologie

Rev Stomatol Chir Maxillofac

Int J Oral Maxillofac Surg

Micron

Dent Clin North Am

Acta Biomater

Biomaterials

Int J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

A new technique for reconstruction of the atrophied narrow alveolar crest in the maxilla using morselized impacted bone allograft and later placement of dental implants

Clin Implant Dent Relat Res

Tooth agenesis: from molecular genetics to molecular dentistry

J Dent Res

New palatal distraction device by both bone-borne and tooth-borne force application in a paramedian bone anchorage site: surgical and occlusal considerations on clinical cases

J Craniofac Surg

A literature review on biomaterials in sinus augmentation procedures

Clin Implant Dent Relat Res

General review
Filling bone defects with β-TCP in maxillofacial surgery: A reviewComblement osseux par β-TCP en chirurgie maxillofaciale : revue des indications