The case illustrated here presents the clinical, radiographic and histomorphometric results obtained by using an equinebone substitute, treated at high temperature, for performing an extensive ridge preservation procedure in the upper maxilla.
A 54-years-old patient came to our observation with all residual teeth of the upper maxilla compromised. After their extraction, the sockets were grafted with the slow resorption equine bone in order to prevent resorption of the alveolar process as much as possible. The graft was protected with a collagen membrane (sites in quandrant 1) or with an oxidized cellulose layer (sites in quadrant 2). After 8 months, five osseointegrated implants were placed. After another 6 months, the final prosthesis was fitted on. One year after fitting, the prosthesis is working perfectly. The comparison of the CBCT scans performed prior to the extractions and prior to implant placement indicates that the bone substitue has made it possible to decrease alveolar process bone resorption: the extent of the resorption in sites protected by membrane was, on average, 23%, lower than the approximately 40% resorption that was observed in the sites that were protected with oxidized cellulose. In both cases, histological observation highlighted that bone tissue quality in the grafted sites was satisfactory. The amount of newly formed bone tissue appeared to be greater in the sites protected by membrane compared to those where the hemostatic was present. However, further studies are required to verify this observation. The histological and histomorphometric analyses have also confirmed that the biomaterial used is biocompatible and slowly resorbable.
The slow resorption bone substitute of equine origin proved to be effective in the preservation of the alveolar process volume. Its ability to prevent ridge resorption, also in comparison with biomaterials with a longer application history, should undergo specific prospective studies, conducted on homogeneous patients by tissue biotype.