Ebenezer V, Balakrishnan K, Sargunar R. B, Senthilnadhan. Nano Hdroxyapatite Particulate Graft in Immediate Implant Placement - A Review Of 10 Cases. Biomed Pharmacol J 2015;8(October Spl Edition)

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Vijay Ebenezer¹, K. Balakrishnan²,  R Banu  Sargunar³, Senthilnadhan⁴

¹Hod and Professor, Department of Oral and Maxillofacial Surgery , Sree Balaji  Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100 ²Professor, Department of Oral and Maxillofacial Surgery , Sree Balaji  Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100 ³Senior Lecturer, Department of Oral and Maxillofacial Surgery , Sree Balaji  Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100 ⁴Reader, Department of Oral and Maxillofacial Surgery ,Sree Balaji  Dental College and Hospital, Bharath University, Pallikaranai, chennai, 600100

DOI : https://dx.doi.org/10.13005/bpj/715

Abstract

A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor. In addition to being stable in the physiological environment, titanium oxides increase calcium ion interactions, which are important for protein and subsequent osteoblast adhesion ^[1]. Enhanced bone bonding can be achieved with bioactive materials that form a stable unit with bone through a spontaneous formation of hydroxyapatite (HA) on their surface.

Keywords

Hydroxyapatite; Dental implant; Osseointegration

Introduction

The basis for modern dental implants is a biologic process called osseointegration where materials, such as titanium, form an intimate bond to bone. Titanium is widely used as material for permanent implants in dental applications. Nanosized hydroxyapatite (HA) is the main component of mineral bone .The biomineralized HA layer acts as a bonding layer to the bone and integration at the atomic/molecular scale can develop. For this reason HA is proposed as a suitable coating material to provide stronger early fixation of uncemented prosthesis. Although hydroxyapatite coatings on implants showed long-term survival ^[2], there are concerns about their reliability under loads. Hydroxyapatite  nano particles possesses exceptional biocompatibility and bioactivity properties with respect to bone cells and tissues, probably due to its similarity with the hard tissues of the body The HA naturally occurring in bone is a multi-substituted calcium phosphate, including traces of CO32- , F-, Mg2+, Sr2+, Si4+, Zn2+, Li+ etc ^{[3, 4].} These ionic substitutions are considered to play an important role for the formation and properties of bone. The basic building block of bone tissue is mineralized collagen fibrils approximately 100 nm in diameter ,These fibrils are made of collagen fibers 300 nm long and 1 – 1.5 nm thick. Within these fibrils are the hydroxyapatite crystals. They  usually form as thin flat plates parallel to the long axis of surrounding collagen fibers^[5]

Case Report

This case report gives study of  implants which was  placed immediately following  an extraction  , with placement of hydroxyapatite  nanoparticles (HA^NANO ). The use of this  hydroxyapatite  nanoparticles in this immediate implants provides more strength and stability to the implants , thus improvising the  bone formation . The mechanism of osseointegration with faster and stronger bone formation, for better stability during the healing process, thus allowing more rapid loading of the implant ^6,,7This study was done with  10 patients  whose age group varied from 24- 53 yrs , The patient fulfilled the following required criteria before undergoing treatment ,a through detailed history was taken for any systemic disorders and routine blood investigations were done .Patient had fractured  teeth in relation to 11 and 21(FIG 1). The  patient was informed about the procedure and placement of hydroxyapatite nanoparticles ( synthetic bone particles)  in detail and informed consent was taken. Pre operative OPG and IOPA (FIG 2) as taken and bone level  sinus  was noted   .The teeth was extracted with  care in preserving the buccal bones (FIG 3) , the implant was placed in the prepared  socket(FIG 4) and  hydroxyapatite  nano  particles are placed surrounding the implant (FIG 5) and packed gently  and suturing was done.  Immediate post operative radiograph of the implant reveals bone like mass surrounding the implant (FIG 6) ,

Figure 1: Pre Operative- Fractured Incisors Click here to view full figure

Figure 2: Pre Operativ Iopa Click here to view full figure

Figure 3: Atraumatic Extraction Click here to view full figure

Figure 4: Placement of Implants Click here to view full figure

Figure 5: Placement of Hydroxyapatite Nano Particles Click here to view full figure

Figure 6: Immediate Post Operative Iopa Click here to view full figure

Figure 7: Fifth Month Post Operative Opg Click here to view full figure

These  hydroxyapatite crystals get resorbed by four weeks  thus inducing the osteoblast  effect surrounding the  implant .These HA particles are three times more stronger than cortical bone hence gives good stability to implants and  immediate  post operative  radiograph taken( FIG 6) ,following  fifth month review was done ( FIG 7) and OPG reveals a definitive bone formation around the implant thus providing more stability and less  chances of  failures of the implant  less bone loss as noted comparatively to implants  without hydroxyapatite nano  particles.

Discussion

This study shows that immediate implants with hydroxyapatite nano particles  which is used to bridge the small gap between the implant a submerged surgical technique provides a clinically and radiographically  good result  of  stability and bone formation . The quality of implant surface influences wound healing at implantation site and subsequently  affects osseointegration^[6]. Hydroxyapatite nano particles increases the surface area of the implant , thus increasing the implant bone surface contact area and thereby implant stability. Synthetic hydroxyapatite is commercially available. Muller-Mai et al tested nanoapatite and nanoapatite/organic implants in vivo. From their results, it was seen that both materials were suitable for bone replacement and for drug release such as antibiotics, growth factors or other substances. In addition, the organic component can be used to control physical properties in the bone implantation ^[7]The production is usually based on aqueous precipitation or conversion from other calcium rich material. While these methods are common for supplying the material in a bulk form, coating hydroxyapatite onto other material is 20 also common^[8]. The aim  of this study was to  observe the bone formation and stability of implants with the hydroxyapatite nano particles which proved to have better results than immediate implants without any bone grafts .  Since hydroxyapatite is found in bone tissue and teeth, not only is it non-toxic but it would not be targeted by the immune system as foreign body. Therefore the local tissue inflammation and eventual scarring caused by an immunological response would not be an issue if hydroxyapatite were used.

Conclusion

Review of these cases were with one year  done and IOPA and OPG  revealed good density  of bone formation Thus in this study we conclude that use of hydroxyapatite  nanoparticles in  the placement of the immediate implants provides good result in stability , less complication  and perform comparatively well than without bone graft .

Reference

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