Healing of extraction sockets filled with BoneCeramic® prior to implant placement: preliminary histological findings

Background: Various grafting materials have been designed to minimize edentulous ridge volume loss following tooth extraction by encouraging new bone formation in healing sockets. BoneCeramic(R) is a composite of hydroxyapatite and bèta-tricalcium phosphate with pores of 100-500 microns. Purposes: The aim of this study was to evaluate bone regeneration in healing sockets substituted with BoneCeramic(R) prior to implant procedures. Materials and Methods: Fifteen extraction sockets were substituted with BoneCeramic(R) and 14 sockets were left to heal naturally in 10 patients (mean age 59.6 years). Biopsies were collected only from the implant recipient sites during surgery after healing periods ranging from 6-74 weeks (mean 22). In total, 24 biopsies were available; 10 from substituted and 14 from naturally healed sites. In one site, the implant was not placed intentionally and, in four substituted sites, implant placement had to be postponed due to inappropriate healing, hence from five sites biopsies were not available. Histological sections were examined by transmitted light microscope. Results: At the time of implant surgery, bone at substituted sites was softer than in controls, compromising initial implant stability. New bone formation at substituted sites was consistently poorer than in controls, presenting predominantly loose connective tissue and less woven bone. Conclusion: The use of BoneCeramic(R) as a grafting material in fresh extraction sockets appears to interfere with normal healing processes of the alveolar bone. On the basis of the present preliminary findings, its indication as a material for bone augmentation when implant placement is considered within 6-38 weeks after extraction should be revised