Harmony with natureon 28th July 2019
Lloyd Pope discusses the role of resorbable structural fillers in guided bone regeneration
While browsing Facebook recently, I came across a comment from a well-respected implant dentist discussing bone regeneration techniques.
They wrote: ‘I often hear that you need a filler like a xenograft to maintain long-term stability (although humans seem to be able to stand up okay without fillers in our skeleton). But the originators of the myth merely do not understand true host regeneration: bone is living tissue and needs to turnover and respond to function.’
While I agree with this individual when it comes to the issue of xenographic permanent non-resorbable fillers, I disagree regarding the need for fillers in general because the comment confuses the role of a ‘filler’ in bone substitutes and healthy functional bone.
In truth, all bone substitutes are fillers of defects. Ideally, to generate new bone, a bone graft should maintain shape and volume, but be fully resorbed and replaced by the patient’s own bone during the natural period of healing and remodelling. Logically, that period should coincide with the time that nature would dictate if the patient’s own bone had been used.
Many bone grafts or fillers are fully resorbable, but the type of filler this individual was referring to is a non-resorbable mineral derived from high temperature processing of bone, usually bovine, that burns away the protein, but leaves the bone mineral so hard that it cannot be resorbed. Bio-oss from Geistlich is a typical example.
There are low-temperature xenografts and allografts, which are more gently processed and act and render results almost indistinguishable from the results obtained using the patient’s own bone.
Structural versus permanent fillers
While it is true that the body does not require permanent residual fillers, it does need structural fillers initially to act as a framework until the body’s intrinsic bone regeneration process converts them all to natural bone.
In fact, even the patient’s own bone can be considered a filler when used as an autogenous bone graft.
However, not all materials are the same because they all have different filler resorption times. It is a case of finding the material with the optimum resorption time, not too fast and not too slow, one most in harmony with nature.
Even synthetic materials, such as Ethoss, contain TCP and calcium sulphate, which function as temporary fillers, but can be quickly resorbed.
Some argue this is too quick and happens faster than with a natural graft and before the body has had chance to create stable new bone. They argue that a slower resorbing filler is more considerate of the natural course of events.
Other synthetic materials, such as Maxresorb and Reprobone, contain fillers that fully resorb, but over a much longer period of time; though, like Ethoss, they do not contain any intrinsic protein (collagen). Collagen has been proven to have beneficial properties.
Tecnoss’ Osteobiol range contains collagen fibres that remain naturally intertwined with the bone mineral, even after processing that eliminates reactive proteins. The result is a graft very similar to and which works like human bone. Similarly, Rocky Mountain allograft, which is gamma-irradiated human donor bone.
Osteobiol, from Tecnoss, is produced using a patented process that removes all the potentially dangerous allergenic protein components from the animal bone (pig or horse), but preserves both the collagen and resorbable bone mineral in a useable structural format.
This outstanding material, that literally expands as it absorbs blood to provide extra volume, produces remarkable results. This is because it contains a biocompatible ‘magic matrix’ that human bodies can deal with in a naturally harmonious way.
Timing is critical
Bone grafting at its best works in harmony with nature’s clock. Not too fast, as is sometimes associated with synthetic materials when volume and even the whole graft can disappear, and not too slow, when unresorbable ‘filler debris’ remains indefinitely and could be considered to be detrimental to the long-term post-surgical blood supply, and hence the health of the bone around the implant.
Tecnoss’ Osteobiol grafts are synchronised and in harmony with nature. In the short term, they provide a filler (scaffold) on which new bone is formed and encouraged, but after stabilisation they are steadily resorbed transitioning to healthy patient’s own bone.
To begin with, the granules act as a filler, while the highly vascularised soft tissue matrix starts to mature and form new bone around them. Then the granules start to resorb until eventually they disappear entirely to be replaced by 100% patient’s bone.
Even at the recommended re-entry time of four to five months, Osteobiol grafts exhibit a visibly much higher percentage of new bone formation, which is typically 90% complete within just one year.
This process is enhanced by their active collagen content, which functions to stimulate new bone formation and act as a matrix, just like the patient’s own collagen during the bone regeneration process.
Surgeons need to feel confident they have given their patients the best chance of success and a result like nature intended.
If they use the patient’s own bone this should be the healthiest solution, but if this isn’t available, then the operator should look for the nearest alternative that best matches nature. A profile that is as similar to nature as possible because you cannot hurry nature.
Though I am a qualified dentist, I am not an opinion leader and I do not work in practice. However, I have a huge army of successful Osteobiol users, including Tiziano Testori, Roberto Rossi and Patrick Palacci and researchers, such as Ulf Nannmark, and the Bone, Biomaterials and Beyond Academy behind me.
In addition, more than 172 papers from reputable sources have been published on Osteobiol materials. For example, one from the University of Marseilles showed Osteobiol endothelial cell proliferation in comparison to bovine high temperature bone.
Lloyd Pope BDS is marketing manager at Trycare.