Demineralized Freeze-Dried Bone and Modified Hydroxyapatite Granules in Patients Requiring Immediate Dental Implants: A Comparative Study.

Objectives: The objective is to compare demineralized freeze-dried bone and modified hydroxyapatite granules in patients requiring immediate dental implants. Materials and
Methods: Forty patients for immediate dental implants were divided into Group I (demineralized freeze-dried bone allograft) and Group II (modified hydroxyapatite) based on the type of graft used. Success of graft was evaluated based on modified plaque index, gingival index, and Periotest at 3, 6, and 12 months follow up.
Results: The mean modified plaque index, gingival index, peri-implant sulcular depth, and Periotest were recorded at baseline, 3, 6, and 12 months at implant site and full mouth in both groups found to be nonsignificant (P > 0.05).
Conclusion: Both demineralized freeze-dried bone allograft and modified hydroxyapatite grafts were equally efficient in immediate dental implant placement sites. Copyright:

INTRODUCTION

Preservation of alveolar bone is highly needed to ensure higher implant survival rates.[1] Numerous graft materials such as autogenous bone graft, xenograft, freeze-dried bone allograft, bioabsorbable membranes, etc., are available with more or less superior properties over each other.[2] Researches have demonstrated the use of various bone graft materials which have widened the selection criteria among clinicians.[3]

This study was done to compare demineralized freeze-dried bone and modified hydroxyapatite granules in patients requiring immediate dental implants.

MATERIALS AND METHODS

This in vivo study was commenced with approval from the Institutional Ethical Committee. A total of 40 patients were selected after considering inclusion and exclusion criteria.

Preoperative radiographs were obtained. Dental implant placement (root form threaded) was done following the standardized surgical procedure. Patients were divided into Group I (demineralized freeze-dried bone allograft) and Group II (modified hydroxyapatite) based on the type of graft used. Patients were evaluated for gingival index, modified plaque index, and peri-implant sulcular depth. All measurements were performed at mesial, distal lingual, and buccal sites using Williams graduated periodontal probe. Implant stability was assessed using Periotest. Digital intraoral periapical radiographs using paralleling technique were taken at baseline, 3, 6, and 12 months postoperatively. Comparison of parameters between implant sites with the full mouth was done. Data thus obtained were statistically analyzed. The level of significance was <0.05.

RESULTS

The mean plaque index recorded at baseline, 3, 6, and 12 months at implant site and full mouth in both groups found to be nonsignificant (P > 0.05) [Table 1]. The mean peri-implant sulcular depth recorded at 3, 6, and 12 months at distal side, lingual side, mesial, and mid-buccal side in both groups found to be nonsignificant (P > 0.05) [Table 2]. The mean gingival index recorded at 6 and 12 months at implant site and full mouth in both groups found to be nonsignificant (P > 0.05) [Table 3]. Table 4 shows that the value of Periotest at 3 months in Group I was −2.15 and in Group II was −2.24, at 6 months was −2.28 in Group I and −2.48 in Group II, at 12 months was −2.21 in Group I and −2.85 in Group II. A nonsignificant difference was observed (P > 0.05).

Table 1

Comparison of plaque index

Time interval	Groups	Implant		Full mouth
		Mean	P	Mean	P
Baseline	Group I	0.93	0.94	0.92	0.97
	Group II	0.96		0.91
3 months	Group I	0.94	0.95	0.92	0.17
	Group II	0.91		0.88
6 months	Group I	0.84	0.12	0.94	0.09
	Group II	0.94		0.87
12 months	Group I	0.85	1	0.87	1
	Group II	0.85		0.87

Intragroup (paired t-test), Intergroup (unpaired t-test), P<0.05, significance

Table 2

Comparison of peri-implant sulcular depth

Time interval	Groups	Distal		Lingual		Mesial		Mid-buccal
		Mean	P	Mean	P	Mean	P	Mean	P
3 months	Group I	1.41	0.07	1.59	0.81	2.19	0.82	1.85	0.84
	Group II	1.67		1.72		2.25		1.92
6 months	Group I	1.92	0.09	1.72	0.90	2.39	0.71	2.32	0.92
	Group II	1.79		1.59		2.59		2.45
12 months	Group I	2.0	0.13	2.32	0.95	2.79	0.74	2.0	0.96
	Group II	1.92		2.45		2.52		2.26

Intragroup (paired t-test), Intergroup (unpaired t-test), P<0.05, significance

Table 3

Comparison of gingival index

Time interval	Groups	Implant		Full mouth
		Mean	P	Mean	P
6 months	Group I	0.85	0.08	0.92	0.15
	Group II	0.94		0.87
12 months	Group I	0.83	0.17	0.90	0.81
	Group II	0.91		0.85

Intragroup (paired t-test), Intergroup (unpaired t-test), P<0.05, significance

Table 4

Comparison of Periotest

Time interval	Group I	Group II	P
3 months	−2.15	−2.24	0.91
6 months	−2.28	−2.48	0.82
12 months	−2.21	−2.85	0.75

Intergroup (unpaired t-test), P<0.05, significance

DISCUSSION

Delayed implant insertion is being replaced by immediate dental implant procedures.[4] Selection of graft in ridge preservation technique is a crucial step which determines the outcome of the treatment.

Viswambaran et al. revealed that there was 100% success rate with preservation of bone level in 1 year period.[5] Daniel et al. found good osseointegration around the immediate implant site with both Bio-Oss and PerioGlas graft in both groups.[6] Iasella et al. concluded that tetracycline hydrated freeze-dried bone allograft is a useful graft in preserving bone in immediate dental implants.[7]

The limitation of the present study is the small sample size and short follow-up. Large-scale studies using various grafts in immediate dental implant procedures are advisable.

CONCLUSION

Both demineralized freeze-dried bone allograft and modified hydroxyapatite grafts were equally efficient in immediate dental implant placement sites.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.