Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Received : 2018.01.02
  • Accepted : 2018.05.06
  • Published : 2019.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

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.

Keywords

References

  1. Thrivikraman G, Athirasala A, Twohig C, Boda SK, Bertassoni LE. Biomaterials for craniofacial bone regeneration. Dent Clin North Am 2017;61:835-56. https://doi.org/10.1016/j.cden.2017.06.003
  2. Gilbert Triplett R, Budinskaya O. New frontiers in biomaterials. Oral Maxillofac Surg Clin North Am 2017;29:105-15. https://doi.org/10.1016/j.coms.2016.08.011
  3. Adamopoulos O, Papadopoulos T. Nanostructured bioceramics for maxillofacial applications. J Mater Sci Mater Med 2007;18:1587-97. https://doi.org/10.1007/s10856-007-3041-6
  4. Kattimani VS, Chakravarthi PS, Prasad LK. Biograft block hydroxyapatite: a ray of hope in the reconstruction of maxillofacial defects. J Craniofac Surg 2016;27:247-52. https://doi.org/10.1097/SCS.0000000000002252
  5. Kattimani VS, Chakravarthi PS, Kanumuru NR, Subbarao VV, Sidharthan A, Kumar TS, et al. Eggshell derived hydroxyapatite as bone graft substitute in the healing of maxillary cystic bone defects: a preliminary report. J Int Oral Health 2014;6:15-9.
  6. Kattimani V, Lingamaneni KP, Chakravarthi PS, Kumar TS, Siddharthan A. Eggshell-derived hydroxyapatite: a new era in bone regeneration. J Craniofac Surg 2016;27:112-7. https://doi.org/10.1097/SCS.0000000000002288
  7. Siva Rama Krishna D, Siddharthan A, Seshadri SK, Sampath Kumar TS. A novel route for synthesis of nanocrystalline hydroxyapatite from eggshell waste. J Mater Sci Mater Med 2007;18:1735-43. https://doi.org/10.1007/s10856-007-3069-7
  8. Suresh Kumar G, Girija EK. Flower-like hydroxyapatite nanostructure obtained from eggshell: a candidate for biomedical applications. Ceram Int 2013;39:8293-9. https://doi.org/10.1016/j.ceramint.2013.03.099
  9. Kattimani VS, Bajantai NV, Sriram SK, Sriram RR, Rao VK, Desai PD. Observer strategy and radiographic classification of healing after grafting of cystic defects in maxilla: a radiological appraisal. J Contemp Dent Pract 2013;14:227-32. https://doi.org/10.5005/jp-journals-10024-1304
  10. Kattimani VS, Chakravarthi SP, Neelima Devi KN, Sridhar MS, Prasad LK. Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: a clinico-radiological study. Indian J Dent Res 2014;25:594-601. https://doi.org/10.4103/0970-9290.147100
  11. Dupoirieux L, Pourquier D, Souyris F. Powdered eggshell: a pilot study on a new bone substitute for use in maxillofacial surgery. J Craniomaxillofac Surg 1995;23:187-94. https://doi.org/10.1016/S1010-5182(05)80009-5
  12. Baliga M, Davies P, Dupoirieux L. [La poudre de coquille d'oeuf dans le comblement des cavitescystiques des maxillaires]. Rev Stomatol Chir Maxillofac 1998;99 Suppl 1:86-8. French.
  13. Dupoirieux L. Ostrich eggshell as a bone substitute: a preliminary report of its biological behaviour in animals--a possibility in facial reconstructive surgery. Br J Oral Maxillofac Surg 1999;37:467-71. https://doi.org/10.1054/bjom.1999.0041
  14. Dupoirieux L, Neves M, Pourquier D. Comparison of pericranium and eggshell as space fillers used in combination with guided bone regeneration: an experimental study. J Oral Maxillofac Surg 2000;58:40-6; discussion 47-8. https://doi.org/10.1016/S0278-2391(00)80013-0
  15. Park JW, Bae SR, Suh JY, Lee DH, Kim SH, Kim H, et al. Evaluation of bone healing with eggshell-derived bone graft substitutes in rat calvaria: a pilot study. J Biomed Mater Res A 2008;87:203-14.
  16. Kim SH, Kim W, Cho JH, Oh NS, Lee MH, Lee SJ. Comparison of bone formation in rabbits using hydroxyapatite and $\beta$-tricalcium phosphate scaffolds fabricated from egg shells. Adv Mater Res 2008;47-50:999-1002. https://doi.org/10.4028/www.scientific.net/AMR.47-50.999
  17. Lee SW, Kim SG, Balazsi C, Chae WS, Lee HO. Comparative study of hydroxyapatite from eggshells and synthetic hydroxyapatite for bone regeneration. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:348-55. https://doi.org/10.1016/j.tripleo.2011.03.033
  18. El-Ghannam A, Amin H, Nasr T, Shama A. Enhancement of bone regeneration and graft material resorption using surface-modified bioactive glass in cortical and human maxillary cystic bone defects. Int J Oral Maxillofac Implants 2004;19:184-91.
  19. Matsuoka H, Akiyama H, Okada Y, Ito H, Shigeno C, Konishi J, 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. J Biomed Mater Res 1999;47:176-88. https://doi.org/10.1002/(SICI)1097-4636(199911)47:2<176::AID-JBM7>3.0.CO;2-Z
  20. Yuan H, Fernandes H, Habibovic P, de Boer J, Barradas AM, de Ruiter A, et al. Osteoinductive ceramics as a synthetic alternative to autologous bone grafting. Proc Natl Acad Sci U S A 2010; 107:13614-9. https://doi.org/10.1073/pnas.1003600107
  21. Ripamonti U. Osteoinduction in porous hydroxyapatite implanted in heterotopic sites of different animal models. Biomaterials 1996;17:31-5. https://doi.org/10.1016/0142-9612(96)80752-6
  22. Gosain AK, Song L, Riordan P, Amarante MT, Nagy PG, Wilson CR, et al. A 1-year study of osteoinduction in hydroxyapatitederived biomaterials in an adult sheep model: part I. Plast Reconstr Surg 2002;109:619-30. https://doi.org/10.1097/00006534-200202000-00032
  23. Park JW, Jang JH, Bae SR, An CH, Suh JY. Bone formation with various bone graft substitutes in critical-sized rat calvarial defect. Clin Oral Implants Res 2009;20:372-8. https://doi.org/10.1111/j.1600-0501.2008.01602.x
  24. von Arx T, Alsaeed M. The use of regenerative techniques in apical surgery: a literature review. Saudi Dent J 2011;23:113-27. https://doi.org/10.1016/j.sdentj.2011.02.004
  25. Deng Y, Zhu X, Yang J, Jiang H, Yan P. The effect of regeneration techniques on periapical surgery with different protocols for different lesion types: a meta-analysis. J Oral Maxillofac Surg 2016;74:239-46. https://doi.org/10.1016/j.joms.2015.10.007
  26. Alnemer NA, Alquthami H, Alotaibi L. The use of bone graft in the treatment of periapical lesion. Saudi Endod J 2017;7:115-8.
  27. Sreedevi P, Varghese N, Varugheese JM. Prognosis of periapical surgery using bonegrafts: a clinical study. J Conserv Dent 2011;14:68-72. https://doi.org/10.4103/0972-0707.80743
  28. Taschieri S, Del Fabbro M, Testori T, Saita M, Weinstein R. Efficacy of guided tissue regeneration in the management of throughand-through lesions following surgical endodontics: a preliminary study. Int J Periodontics Restorative Dent 2008;28:265-71.
  29. Saad AY, Abdellatief EM. Healing assessment of osseous defects of periapical lesions associated with failed endodontically treated teeth with use of freeze-dried bone allograft. Oral Surg Oral Med Oral Pathol 1991;71:612-7. https://doi.org/10.1016/0030-4220(91)90372-J
  30. Gaviria L, Pearson JJ, Montelongo SA, Guda T, Ong JL. Threedimensional printing for craniomaxillofacial regeneration. J Korean Assoc Oral Maxillofac Surg 2017;43:288-98. https://doi.org/10.5125/jkaoms.2017.43.5.288

Cited by

  1. Use of eggshell-derived nano-hydroxyapatite as novel bone graft substitute-A randomized controlled clinical study vol.34, pp.4, 2019, https://doi.org/10.1177/0885328219863311
  2. State-of-the-Art of Eggshell Waste in Materials Science: Recent Advances in Catalysis, Pharmaceutical Applications, and Mechanochemistry vol.8, 2019, https://doi.org/10.3389/fbioe.2020.612567
  3. Potential Use of Eggshell as Bone Graft Compared with Bovine for Bone Defect: A Systematic Review Study vol.9, pp.6, 2019, https://doi.org/10.3889/oamjms.2021.7103
  4. Eggshell Microparticle Reinforced Scaffolds for Regeneration of Critical Sized Cranial Defects vol.13, pp.51, 2019, https://doi.org/10.1021/acsami.1c19884
  5. In vitro and mechanical characterization of PLA/egg shell biocomposite scaffold manufactured using fused deposition modeling technology for tissue engineering applications vol.43, pp.1, 2019, https://doi.org/10.1002/pc.26365