Estudio comparativo entre fosfato cálcico vs. hueso bovino en el relleno alveolar postextracción

Abstract

After tooth extraction, the alveolar bone undergoes an irreversible physiological resorption in the vertical and horizontal dimensions. The clinical consequences of these changes can affect the outcome of treatments aimed at restoring lost dentition, either by limiting bone availability for implant placement or by compromising the aesthetic result of prosthetic restorations. To minimize this loss, different bone graft materials have been used in the alveolar ridge preservation technique, without currently existing sufficient scientific evidence to determine which biomaterial is superior to the others. The general objective of this study is to determine the amount of newly formed bone obtained by both biomaterials. On the other hand, the specific objectives are to determine radiologically the mineral bone density, the presence of residual biomaterial, the degree of alveolar corticalization, analyze the vertical and horizontal bone loss of the alveoli and to determine histomorphometrically the amount of lamellar bone, residual biomaterial and connective tissue obtained by both materials. Randomized, longitudinal and prospective controlled clinical study. Alveolar ridge preservation was performed in 30 alveoli establishing two groups: a test group in which after dental extraction the alveoli was filled with calcium phosphate modified with silicon and a control group in which it was filled with hydroxyapatite of bovine origin. The variables that were analyzed were bone density, radiographic presence of residual biomaterial, degree of alveolar crest corticalization, vertical and horizontal bone loss, amount of neoformed bone, lamellar bone, residual biomaterial and connective tissue 3 months after extraction. No statistically significant differences were found between the groups in bone density, radiographic presence of residual biomaterial, degree of alveolar crest corticalization and vertical bone loss. On the other hand, the alveoli of the test group showed less horizontal bone loss compared to the alveoli of the control group (0.92 ± 0.20 mm vs. 1.22 ± 0.29 mm) with a statistically significant difference (p = 0.004). The histomorphometric results revealed greater new bone formation in the test group than in the control group (23.14 ± 14.66% vs. 11.04 ± 6.80%) (p = 0.039) and a lower amount of residual biomaterial (5.14 ± 10.04% vs. 17.41 ± 13.38%) (p = 0.043) with statistically significant differences. No differences were found in the amount of lamellar bone and connective tissue between the groups. Both materials have a similar behavior in terms of densitometric results, finding graft particles three months after alveolar ridge preservation. Corticalization at the crestal level, in the period of 90 days after tooth extraction, was incomplete in both groups. The dimensional changes produced after dental extraction in the vertical dimension were similar in both groups, on the other hand, the horizontal changes were smaller in the test group. The histomorphometric results showed greater bone formation and less residual biomaterial in the test group than in the control group, noticing that a 90-day period of healing of the socket after tooth extraction turns out to be insufficient time for a complete replacement of both biomaterials by newly formed bone. The amount of lamellar bone and connective tissue was similar between both groups. Therefore, the test group obtained better results than the control group in the alveolar ridge preservation technique, showing itself as an alternative biomaterial in guided bone regeneration techniques.