This article presents a comparison of bone replacement materials in terms of their ability to produce living bone image at the place of their implantation. Five bone replacement materials are compared (Osteovit—porous collagen, Cerasorb Foam—collagen scaffolding of synthetic β tricalcium phosphate, Osbone—synthetic hydroxyapatite, Endobone—deproteinized bovine-derived cancellous bone hydroxyapatite, and Cerasorb—synthetic β tricalcium phosphate). Intraoral radiographs are taken immediately after implantation and 12 months later. The texture analysis was performed to assess (texture index, TI) the level of structure chaos (entropy) in relation to the presence of longitudinal elements visible in radiographs (run length emphasis moment). The reference ratio of the chaotic trabecular pattern (Entropy) to the number of longitudinal structures, i.e., trabeculae (LngREmph), is 176:100 (i.e., 1.76 ± 0.28). Radiological homogeneity immediately after the implantation procedure is a result of the similar shape of its particles (Osbone, Endobone and Cerasorb) or radiolucency (Osteovit, Cerasorb Foam). The particles visible in radiographs were similar in the LngREmph parameters applied to the reference bone, but not in the co-occurrence matrix features. The TI for Osteovit during a 12-month follow-up period changed from 1.55 ± 0.26 to 1.48 ± 0.26 (p > 0.05), for Cerasorb Foam from 1.82 ± 0.27 to 1.63 ± 0.24 (p < 0.05), for Osbone from 1.97 ± 0.31 to 1.74 ± 0.30 (p < 0.01), and for Endobone from 1.86 ± 0.25 to 1.84 ± 0.25 (p > 0.05), The observed structure in the radiological image of bone substitute materials containing calcium phosphates obtains the characteristics of a living bone image after twelve months.

The development of oral surgery and implantology has led to the need for better and more predictable materials. Various substitute materials are now used for bone regeneration. The replacement of scaffolding material by new bone tissue is the most important condition. This study aimed to evaluate the effects of the resorbability of bone substitute materials during regeneration to the jawbone. The study included 88 patients during the 12-month follow-up. All the patients had undergone oral surgical procedures using two different substitute materials—Cerasorb (high-rate resorbable (β-tricalcium phosphate)) and Endobone (low-rate resorbable (hydroxyapatite)). Texture analysis was performed in intraoral radiographs, in which regions of interest were established for the bone substitute materials and reference bone. Five texture features were calculated, namely the sum average (SumAverg), entropy (Entropy), and three Harr discrete wavelet transform coefficients. This study revealed that all 5 features described the healing process well. Entropy was decreased in both cases with time; however, in Cerasorb cases, the texture feature values were very close to those of the reference bone after 12 months of healing (p < 0.05). The wavelet transform coefficient at scale 6 also showed that longitudinal objects appeared in implantation sites, similar to trabecular bone (p < 0.05) after 12 months of healing. The slow-resorbing material restored the structure of the alveolar crest better in terms of producing large objects similar to the components of a barrel bone image (wavelet coefficients), but required a longer time for reconstruction. The fast-resorbing material showed a texture image with a similar scattering of structures to that of the reference bone (entropy) after 12 months.

The local regeneration of bone defects is regulated by general hormone, enzyme, ion, and vitamin levels. General diseases and dysregulation of the human mineral system can impact this process, even in alveolar crest. The aim of this study is to investigate a relation between bone density, measured in two-dimensional X-rays, and general mineral condition of patients. The study included 42 patients on whom tooth extractions were performed. Data were divided into two groups: the region where collagen scaffold (BRM) was used and the reference region of intact normal bone (REF). Two-dimensional intraoral radiographs were taken in all cases just after the surgery (00 M) and 12 months later (12 M). Thyrotropin (TSH), parathormone (PTH), Ca2+ in serum, HbA1c, vitamin 25(OH)D3, and spine densitometry were checked. Digital texture analysis in MaZda 4.6 software was done. Texture Index (TI: BRM 1.66 ± 0.34 in 00 M, 1.51 ± 0.41 in 12 M, and REF 1.72 ± 0.28) and Bone Index (BI: BRM 0.73 ± 0.17 in 00 M, 0.65 ± 0.22 41 in 12 M, and REF 0.80 ± 0.14) were calculated to evaluate bone regeneration process after 12 months of healing (TI (p < 0.05) and BI (p < 0.01) are lower in BRM 12 M than in REF). This showed a relation between BI and TSH (R2 = 26%, p < 0.05), as well as a between BI and patient age (R2 = 65%, p < 0.001), and a weak relation between TI and TSH level (R2 = 10%, p < 0.05). This study proved that a collagen scaffold can be successfully used in alveolar crest regeneration, especially in patients with a high normal level of TSH in the middle-aged population.

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The phenomenon of peri-implant bone corticalization after functional loading does not yet have a definite clinical significance and impact on prognosis. An attempt was made to assess the clinical significance of this phenomenon. This prospective study included 554 patients. Standardized intraoral radiographs documenting the jawbone environment of 1556 implants were collected. The follow-up period was 10 years of functional loading. Marginal alveolar bone loss (MBL) and radiographic bone structure (bone index, BI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. After five years, bone structure abnormalities expressed by a reduction of BI to 0.47 ± 0.21 and MBL = 0.88 ± 1.27 mm were observed. Both values had an inverse relationship with each other (p < 0.0001). Reference cancellous bone showed BI = 0.85 ± 0.18. The same relationship was observed after ten years of functional loading: BI = 0.48 ± 0.21, MBL = 1.49 ± 1.94 mm, and again an inverse relationship (p < 0.0001). Increasing corticalization (lower BI) is strongly associated with increasing marginal bone loss and increasing corticalization precedes future marginal bone loss. Marginal bone loss will increase as corticalization progresses.

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Several measures describing the transformation of trabecular bone to cortical bone on the basis of analysis of intraoral radiographs are known (including bone index or corticalization index, CI). At the same time, it has been noted that after functional loading of dental implants such transformations occur in the bone directly adjacent to the fixture. Intuitively, it seems that this is a process conducive to the long-term maintenance of dental implants and certainly necessary when immediate loading is applied. The authors examined the relationship of implant design features to marginal bone loss (MBL) and the intensity of corticalization over a 10-year period of functional loading. This study is a general description of the phenomenon of peri-implant bone corticalization and an attempt to interpret this phenomenon to achieve success of implant treatment in the long term. Corticalization significantly increased over the first 5-year functional loading (CI from 200 ± 146 initially to 282 ± 182, p < 0.001) and maintained a high level (CI = 261 ± 168) in the 10-year study relative to the reference bone (149 ± 178). MBL significantly increased throughout the follow-up period—5 years: 0.83 ± 1.26 mm (p < 0.001), 10 years: 1.48 ± 2.01 mm (p < 0.001). MBL and radiographic bone structure (CI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. In the scope of the study, it can be concluded that the phenomenon of peri-implant jawbone corticalization seems an unfavorable condition for the future fate of bone-anchored implants, but it requires further research to fully explain the significance of this phenomenon.