Alloplastic Implants of Tricalcium Phosphate Ceramic in Human Periodontal Osseous Defects

Abstract

Initial pilot studies using tricalcium phosphate ceramic placed into human periodontal osseous defects demonstrated osseous repair. Therefore, further evaluation of this material was undertaken on 17 carefully selected patients with 1-wall, 2-wall, crestal and furcation defects using standardized preoperative and postoperative radiographs, clinical measurements and clinical photographs. Inverse bevel, full-thickness flaps were raised, the areas debrided, root surfaces planed with ultrasonic and hand instrumentation, osseous penetrations made with curet point and the flaps sutured after the defects were filled. Eighteen-month reentry surgical procedures were performed on 10 of the 17 patients, with a resultant average of 2.8 mm of new bone. Controls were not used in this study since a protocol describing a sham procedure with other than 3-wall osseous defects was not acceptable in 1973 to the Clinical Human Use Committee. Although the tricalcium phosphate ceramic material was not found to be totally predictable in this study, it may nevertheless become a useful graft material because of its potential for osseous repair in combination with its availability, host acceptability, ease of manipulation and storage advantages.

Comparison of Injectable Calcium Phosphate Bone Cement Grafting and Open Flap Debridement in Periodontal Intrabony Defects: A Randomized Clinical Trial

“…However, the CPC‐R group did not exhibit additional benefits in terms of PD reduction and CAL gain compared to the OFD group in accordance with other studies 8,9,14,15,26 evaluating alloplast materials. However, a number of studies 4‐7,10‐13,18 demonstrated a greater reduction in PD and a greater gain in CAL with grafting materials compared to OFD. This discrepancy in clinical outcomes, especially in the grafted group, might be explained by the different methods 27 used for comparisons between subjects and material selections, measurements, surgical techniques, 26–28 and defect characteristics 29,30 .…”

“…A variety of grafting materials have been used in bone grafting for the treatment of periodontal defects to obtain periodontal tissue regeneration 1–3 . Among grafting modalities, xenogenic or alloplastic osteoconductive materials, such as bovine bone‐derived mineral, 4,5 coralline calcium carbonate, 6,7 calcium‐layered composite of poly‐methyl‐methacrylate and poly‐hydroxyl‐ethyl‐methacrylate, 8,9 hydroxyapatite, 10–12 bioactive glass, 13–15 and tricalcium phosphate, 16–18 are options. This is because of their handling characteristics, their ready availability in various sizes, and the lack of morbidity that can result from harvesting autogenous bone.…”

“…This is because of their handling characteristics, their ready availability in various sizes, and the lack of morbidity that can result from harvesting autogenous bone. Overall, these alloplastic materials have resulted in positive clinical outcomes for probing depth (PD) reduction, favorable clinical attachment level (CAL) gain, and “fill” of the defects compared to open flap debridement (OFD) alone 4‐7,10‐13,18 …”

Clinical and Histologic Evaluation of Granular Beta‐Tricalcium Phosphate for the Treatment of Human Intrabony Periodontal Defects: A Report on Five Cases

“…Beta‐tricalcium phosphate (β‐TCP) (Ca 3 [PO 4 ] 2 ) belongs to the group of bioactive bioceramics of completely synthetic origin and has been used in periodontology as a bone graft substitute since the 1970s 23‐25 . Although acceptable clinical results were reported after treatment of intrabony periodontal defects involving surgical implantation of β‐TCP, 23‐29 contradictory information was provided in various publications from animal experimental studies 30,31 and human histologic cases, 24,32‐35 with the former mostly reporting about large amounts of periodontal regeneration after β‐TCP implantation in intrabony defects and the latter showing minimal bone formation, no periodontal regeneration, and rapid resorption or encapsulation of the β‐TCP particles by connective tissue.…”

New Composite Endpoints to Assess Efficacy in Periodontal Therapy Clinical Trials

“…The field of periodontics has witnessed some of the most significant growth related to the development of therapies for periodontal regeneration in the last 15 to 20 years. Treatments including use of growth factors or extracellular matrix proteins, “grafting” with bone or bone substitutes, 1‐17 cell occlusive barrier membranes for selective cell growth in periodontal defects, 18‐24 and modification of the tooth root surface 25‐30 have all been explored for their ability to predictably regenerate the periodontium.…”