Usage of nanocrystalline
Hydroxylapatite in paste form to preserve post–extractive sites.
A one–case report. - Dr.Marco Iorio
Cure for the tooth ache -
Royal Gazatte & NewFoundland Adverise - Feb 14
The Series of the Best Papers Published in Dental Follicle Continues
with this issue too. In this Issue We Have selceted Dr. Marco
Iorio's Paper published Originally in June 2007 edition of Dental
Follicle. After Publishing so many cases and having had innumerable
discussions with Dr.Marco, I can surely say. Planet Earth is Blessed
to have an "Implantologist" called "Marco" from Italy.
The case report has not been added, rather linked to the original
paper at the end of the discussion.
ABSTRACT This article proposes a technique to
preserve post–extractive sites in order to simplify
prosthetically-guided insertion of osseointegrated dental
Nanocrystalline hydroxylapatite, dental implants, extraction
sockets, bone regeneration.
The healing process following tooth extraction often leads
to a partial filling of the empty socket1,2, together with
3–4mm ridge resorption both in transversal and vertical
direction1,3. The result of these processes is a narrow and
reduced ridge, with inadequate bone volume to support soft
tissue or to permit implant placement in an ideal position.
Applying GBR principles to post–extractive sockets
significantly reduces the amount of bone resorption3.
To make GBR effective, it is mandatory to obtain and
maintain soft tissue coverage over the augmented site4,5 by
elevating and advancing a wide mucoperiosteal flap. This
inevitably leads to a modification of normal mucoginigival
anatomy of the augmented site, with a subsequent esthetic
alteration. Full thickness flap elevation interrupts
periosteal vascularization of buccal bony plate, thus
inducing a partial resorption.
Recently a technique to preserve post–extractive site was
propose (Bio–Col technique, Sclar 20036). The tooth has to
be extracted without causing trauma to the neighboring
tissue, the empty socket has to be filled with bovine bone
mineral — a slow–resorbing osteconductive material — and the
site has to be sealed with resorbable collagen sponge and
This combination, according to the Author, leads to a good
re generation of alveolar bone, without the problems caused
by the need to obtain primary wound closure.
One big problem with this technique is the long resorbtion
time of bovine Hydroxylapatite.
Nanocrystalline hydroxylapatite in paste form (Ostim®,
Heraeus–Kulzer GmbH, Hanau, Germania) is a pure, unsintered
hydroxylapatite material, made of crystals of
hydroxylapatite (average dimension 18 μm) in 35% water
suspension. The nanocrystalline structure of the biomaterial
allows a quick vascularization of the graft, with a wide
contact surface between the graft and the osteoblasts (106
m2/g, vs 50–90 m2/g of bovine bone mineral). This
characteristic makes hydroxylapatite in paste form a very
quick resorbing biomaterial. A recent animal study reports a
53,9% average percentage of mineralization of a defect
filled with Ostim® at 12 weeks; this data is not
statistically different from the percentage of
mineralization of a similar defect filled with autogenous
Another characteristic of nanocrystalline hydroxylapatite in
paste form is its complete radiolucency, which allows for a
radiographical evaluation of bone regeneration process.