Synthetic Material for Bone, Periodontal, and Dental Tissue Regeneration: Where Are We Now, and Where Are We Heading Next?

Abstract

Alloplasts are synthetic, inorganic, biocompatible bone substitutes that function as defect fillers to repair skeletal defects. The acceptance of these substitutes by host tissues is determined by the pore diameter and the porosity and inter-connectivity. This narrative review appraises recent developments, characterization, and biological performance of different synthetic materials for bone, periodontal, and dental tissue regeneration. They include calcium phosphate cements and their variants β-tricalcium phosphate (β-TCP) ceramics and biphasic calcium phosphates (hydroxyapatite (HA) and β-TCP ceramics), calcium sulfate, bioactive glasses and polymer-based bone substitutes which include variants of polycaprolactone. In summary, the search for synthetic bone substitutes remains elusive with calcium compounds providing the best synthetic substitute. The combination of calcium sulphate and β-TCP provides improved handling of the materials, dispensing with the need for a traditional membrane in guided bone regeneration. Evidence is supportive of improved angiogenesis at the recipient sites. One such product, (EthOss® Regeneration, Silesden UK) has won numerous awards internationally as a commercial success. Bioglasses and polymers, which have been used as medical devices, are still in the experimental stage for dental application. Polycaprolactone-TCP, one of the products in this category is currently undergoing further randomized clinical trials as a 3D socket preservation filler. These aforementioned products may have vast potential for substituting human/animal-based bone grafts.

Osteoconductive Silk Fibroin Binders for Bone Repair in Alveolar Cleft Palate: Fabrication, Structure, Properties, and In Vitro Testing

“…In particular, a bone-defect area requires biomaterials when grafting. Some biomaterials for bone grafting include hydroxyapatite, β-tricalcium phosphate, biphasic calcium phosphate, and calcium sulphate [ 4 ]. These materials show good performance to promote new tissue formation.…”

The Application of Beta-Tricalcium Phosphate in Implant Dentistry: A Systematic Evaluation of Clinical Studies

“…The main disadvantage of this graft material is its poor mechanical strength [17], which is why it tends to be more often used in contained defects than in areas subject to load. For this reason, in the last years, biphasic calcium phosphates with different HA/β-TCP ratios have been developed, improving its mechanical properties and maintaining a good reabsorption capacity.…”

“…HA grafts have slow and limited resorptive potential, so they cannot be replaced entirely by new bone, but can act as volumetric fillers [5,9,11]. In contrast, β-TCP is easily resorbable, and together with its interconnected porous structure, it is rapidly replaced by new bone [5,8,11,17].…”

Calcium Phosphate-Based Biomaterials for Bone Repair

“…In the presence of Ca 2+ and PO 4 3− ions, the surface of HAP can act as a nucleation site for the initiation of biomineralization [ 75 ]. Therefore, HAP is used widely for dental surgery, long bone defects, bone nonunion, vertebral fusion operation and maxillofacial repair [ 76 ]. The biocompatibility, osseointegration, and bioactivity of metal implants are improved by coating their surfaces with HAP, which enhances the bone contact area and cell adhesion properties of the implants [ 30 ].…”