Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
Indian Journal of Dental Research   Login   |  Users online: 2004

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         


Table of Contents   
Year : 2014  |  Volume : 25  |  Issue : 5  |  Page : 594-601
Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: A clinico-radiological study

Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Click here for correspondence address and email

Date of Submission06-Jan-2014
Date of Decision28-Mar-2014
Date of Acceptance06-Jun-2014
Date of Web Publication16-Dec-2014


Introduction: Bone grafts are frequently used in the treatment of bone defects. Bone harvesting can cause postoperative complications and sometimes does not provide a sufficient quantity of bone. Therefore, synthetic biomaterials have been investigated as an alternative to autogenous bone grafts.
Aim and Objectives: The aim of this study was to evaluate and compare bovine derived hydroxyapatite (BHA) and synthetic hydroxyapatite (SHA) graft material as bone graft substitute in maxillary cystic bony defects. Patients were analyzed by computerized densitometric study and digital radiography.
Materials and Methods: In this study, 12 patients in each group were included randomly after clinical and radiological evaluation. The integration of hydroxyapatite was assessed with mean bone density, surgical site margin, and radiological bone formation characteristics, of the successful graft cases using computer densitometry and radio-visiograph. Statistical analysis was carried out using Mann-Whitney U-test, Wilcoxon matched pairs test and paired t-test.
Results: By the end of 24 th week, the grafted defects radiologically and statistically showed similar volumes of bone formation. However, the significant changes observed in the formation of bone and merging of material and surgical site margin at 1 st week to 1 st month. The results were significant and correlating with all the parameters showing the necessity of the grafting for early bone formation. However, the bone formation pattern is different in both BHA and SHA group at 3 rd month interval with significant P value.
Conclusion: Both BHA and SHA graft materials are biocompatible for filling bone defects, showing less resorption and enhanced bone formation with similar efficacy. Our study showed maximum bone healing within 12 weeks of grafting of defects. The BHA is economical; however, price difference between the two is very nominal.

Keywords: bone graft, bone regeneration, bovine derived hydroxyapatite, densitometry, dental radio-visiography, observer strategy for bone healing, synthetic hydroxyapatite

How to cite this article:
Kattimani VS, Chakravarthi SP, Neelima Devi K N, Sridhar MS, Prasad L K. Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: A clinico-radiological study. Indian J Dent Res 2014;25:594-601

How to cite this URL:
Kattimani VS, Chakravarthi SP, Neelima Devi K N, Sridhar MS, Prasad L K. Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: A clinico-radiological study. Indian J Dent Res [serial online] 2014 [cited 2019 Oct 15];25:594-601. Available from:
Bone grafts are frequently used in the treatment of bone defects. [1],[2] Bone harvesting can cause postoperative complications and sometimes does not provide a sufficient quantity of bone. [2] Therefore, synthetic biomaterials have been investigated as an alternative to autogenous bone grafts.

Synthetic and bovine derived hydroxyapatite (BHA) grafts are commonly used in oral, maxillofacial, and orthopedic surgery for various indications, such as the filling of bone cavities, augmentation for dental implants, and reconstruction of the bone lost during tumor removal or trauma. [1],[2],[3] In particular, these form a quick bond with bone through a hydroxyapatite (HA) layer. [4] Fortunately, this bioactive HA layer can be formed on the bioactive graft surface even in acellular simulated body fluid with ion concentrations nearly equal to those of human blood plasma. Formation of the HA layer has been reported to be fastest for graft materials with the highest level of bioactivity. [4],[5],[6] A recent study by El-Ghannam et al. indicated that the greater bioactive effect of the HA ceramic was the result of the ability of the Hydroxycarbonate apatite layer to concentrate active fibronectin on its surface. [7]

In this study, bone regeneration and graft material resorption were compared in bony defects filled with BHA and synthetic hydroxyapatite (SHA). In addition, the effect of grafting on bone regeneration in human cystic bone defects was evaluated using computer densitometry and direct digital radiographic image technique.

   Materials and methods Top

Hydroxyapatite is apatite calcium phosphate (Ca 10 (PO 4 ) 6 (OH) 2 ). HA is being used in many disciplines of surgery. [2],[3],[4],[5] HA can be obtained for clinical use in block form or granules, in porous or dense form. Both BHA and SHA are commercially available in the market. These does not cause any foreign body reaction since it is an inorganic substance/ceramic. Hard tissue grows into the graft since it is porous and mingles with natural tissues. [2],[3],[4],[5],[6],[7],[8],[9]

Bovine derived hydroxyapatite

Derived from natural sources that is, bovine origin, it refills the gap in bone and aids in augmentation of bony structures.

Synthetic hydroxyapatite

The synthetic granules are obtained from synthetic calcium HA in low crystalline form. It is a mixture of HA, tri-calcium phosphate and other forms of calcium such as calcium carbonate and calcium phosphate. This polycrystalline structure is responsible for the strength of the substance.

Clinical study

The study was conducted in the Department of Oral and Maxillofacial Surgery in our institute. A total of 24 patients aged between l5 and 45 years [Table 1] and [Table 2] with periapical cyst/residual cyst of anterior maxilla, which required cystectomy were enrolled to reconstruct jaw bone defects after cystectomy and/or apicoectomy. The cyst sizes were ranged from 2 to 6 cm in diameter. Patients were divided randomly into two groups with 12 in each group. In Group-1, patients the cystic defects were filled with BHA, whereas in Group-2 patients filled with SHA. All the patients were followed for 1 st week, 1 st month, 3 rd month and 6 th month intervals postoperatively.
Table 1: Distribution of study subjects according to study groups and gender

Click here to view
Table 2: Mean and SD of age of study samples by groups and gender

Click here to view

Inclusion and exclusion criteria for patient selection

  • Patients with moderate sized periapical cystic lesion of anterior maxilla involving one or more teeth confirmed by clinical and radiological evaluation were included in the study
  • All cases were meticulously screened through routine blood and urine examination to rule out any systemic diseases such as diabetes, hypertension etc., and medically compromised patients were exempted from the study to eliminate bias
  • Patients with gross mobility of involved teeth due to moderate bone loss were not included in the study
  • Patients with frankly infected cysts were excluded in the study
  • Patients who are readily available for periodic recalls and reviews were included.

Operative procedures

An infraorbital nerve block and an incisive canal nerve block were induced by 2% lignocaine with adrenaline. After securing anesthesia, a mucoperiosteal flap was created and reflected under completely aseptic conditions. The underlying bone was removed and the apical lesion was curetted. The surgical site was irrigated with sterile saline and bleeding if present, was arrested by application of a gauze pack. In Groups 1 and 2 the graft material was packed inside the bony defect, with no over contouring. Care was taken to ensure that no graft particles were placed outside the cavity under the mucoperiosteal flap. The flap was repositioned and sutured. Gentle pressure with a sterile gauze pack was applied postoperatively to the surgical flap to facilitate reattachment of the flap to the underlying bone. In all cases, postoperative antibiotics and an antiinflammatory agent were prescribed.

Clinical evaluation

Follow-up examinations were conducted 1 st day, 7 th day (at the time of suture removal), and 4, 12, and 24 weeks postsurgery. Mucosal color and any postoperative pain or swellings were noted during clinical evaluations.

Intraoral digital radiographic imaging

At 1 st , 4 th , 12 th , and 24 th week postsurgery, the mean density of the image of the surgical defect was measured using a Digora unit. The mean density values and standard deviations were calculated using Quatro Pro software (Corel Corporation, Ottawa, Ontario, Canada).

Radiological examination carried out postoperatively by taking standard intra-oral periapical radio-visiograph, immediate postoperatively and at each follow-up visit to determine graft consolidation, graft resorption and new bone formation with radiographic parameters as:

Density of bone formation

Surgical site margin

Bone formation characteristics.

Both oral and maxillofacial surgeon and radiologist evaluated the radiological healing of bone. To avoid observer bias both examiners were blinded.

Postsurgical radiographic pattern of the surgical margins evaluated as

Unchanged - when the original radioopaque margin of the lesion was unaltered. Seen immediately in postoperative radiograph

Slightly changed - when the clarity and width of original margin were reduced that is, <1/4 th of the circumference of the lesion

Partly reduced - when the clarity of the original margin had partially disappeared or was partly displaced inward toward the center of the surgical area

Entirely absent - when the entire margin of the lesion was completely absent, indicating the merging of material margin and bony margin.

Postsurgical radiographic appearance of the internal portion of surgical site (bone formation) evaluated as

Changed - as the graft material placed in the surgical site that changes the internal portion. This immediate postoperative radiograph taken as standard for further bone formation characteristics

Ground glass - increase in radioopacity as noted with immediate grafting

Spicular - when bone spicules are visible from periphery to center of the surgical site

Trabecular - when radiating trabecule enclosing marrow spaces were observed uniformly.

Statistical analysis

Statistical comparison was made using Mann-Whitney U-test, Wilcoxon matched pairs test and paired t-test. The mean values and standard deviations of each parameter were calculated. The differences between means were evaluated using the Student's t-test; P < 0.05 was considered as significant. The kappa (κ) correlation taken in to consideration to assess the degree of observer agreement for radiological assessment.

   Results Top

0Clinical observation

First day postsurgery clinical examination showed similar edema among patients in both groups. The overlying mucosa had the same reddish color in all patients. At the time of suture removal, the mucosa of all patients had regained normal color and contour. Moreover, no flap dehiscence was observed. Except in one patient having >5 cm cystic defect and sinus tract in the flap in Group-2 required regular irrigation because of particle migration through existing sinus tract, which healed 2 weeks postoperatively with gingival dressing.

Digital radiographic observations

Surgical site out line [Figure 1]a and b evaluation at 3 rd month intervals in BHA is 156 and SHA 144, with P = 0.72 indicating both materials have similar margin blend with material margin, whereas similar results seen at 6 th month intervals also [Figure 2]. But, the sum of ranks of BHA is 113 and SHA is 187 at 3 rd month interval with significant P = 0.032 indicating bone formation pattern [Figure 3]a and b is different in both [Table 3].
Table 3: Comparison of groups (BHA and SHA) with radiological evaluation of bone formation at 1st week, 1st month, 3rd month and 6th months by Mann-Whitney U-test

Click here to view
Figure 1: (a) Schematic diagram showing radiological evaluation of surgical site outline (b) Intraoral periapiacal radiographs showing radiological evaluation of surgical site outline

Click here to view

The mean radiographic density of grafted cystic bone defects were continued to increase until it reached its maximum at week 24 [Figure 4] and [Table 4]. The mean density of BHA and SHA group at 3 rd month interval and at 6 months interval is statistically not significant suggesting both achieved similar density. Other characteristics like bone formation and blending of bone margin and material margin were well correlated with density of bone formation. The kappa correlation of observations of bone healing parameters by examiners was in very good agreement with each other (with κ - 0.81-0.92).
Table 4: Comparison of groups (BHA and SHA) with mean bone density at 1st week, 1st month, 3rd month and 6th month by t-test

Click here to view
Figure 2: Comparison of bovine derived hydroxyapatite and synthetic hydroxyapatite groups with radiological evaluation surgical site outline at 1st week, 1st month, 3rd month and 6th month

Click here to view
Figure 3: (a) Schematic diagram showing radiological evaluation of bone formation characteristics. (b) Intraoral periapiacal radiographs showing radiological evaluation of bone formation characteristics

Click here to view
Figure 4: Comparison of groups (bovine derived hydroxyapatite and synthetic hydroxyapatite) with mean bone density at 1st week, 1st month, 3rd month and 6th month

Click here to view

   Discussion Top

Hydroxyapatite is an osteoconductive material that is, it acts as a scaffold for bony ingrowth and gradually replaced by new bone. [1],[2],[3],[4],[5] HA is unique biocompatible ceramic substance that is beginning to find its rightful place as a useful and versatile biomaterial. This study showed that the biologic regeneration can be improved by grafting without any undue complications. Implantation promoted bone tissue regeneration and graft material resorption in bone defects of maxillary cystic cavities.

Density is the degree of darkening of exposed and processed X-ray film, expressed as the logarithm of the opacity of a given area of the film. Radio-visiography has a program to measure bone density. [10],[11],[12] In the present study, measurements of density of the grafted cystic cavities suggested that bone deposition continued to dominate inside the defect up to 24 weeks postsurgery. The mean density of BHA and SHA group at 3 rd month interval and at 6 months interval is statistically not significant suggesting both achieved similar density, which shows both are equally efficient in bone formation.

Surgical site out line [12],[13] is surgical margin after cystic enucleation. In the present study surgical site out line evaluation at 3 rd and 6 th month intervals with insignificant P value indicating both materials have similar margin blend with material margin. This indicates both materials are showing equal efficacy in surgical site margin blending with material margin.

The rapid bone regeneration associated with graft could be explained by the ability of the HA to enhance the selective adsorption of attachment proteins and growth factors which stimulate osteoblast adhesion and bone deposition. [7] Another mechanism by which the graft could enhance bone formation is through ion release, as supported by the work of Matsuoka and associates. [14] Results of the present study was associated with a significantly greater rate of bone regeneration both in BHA and SHA implantation sites.

The radiological evaluation of bone formation [12],[13],[14],[15] after grafting in cystic defects is the initiation of bone formation marked by radioopacity and pattern of bone formation. In our study sum of ranks of BHA is 113 and SHA is 187 at 3 rd month interval with significant P = 0.032 indicating bone formation pattern is different in both. This may be attributed to the material properties like early or late resorption of graft particles. However, at 6 th month interval it remains the same. Which indicates the pattern of bone formation is similar in both materials.

The grafting showed superior results over the traditional ungrafting, by accelerating bone tissue regeneration in cystic bone defects. [16],[17] The change in density measurements inside the cystic bone defects correlates well with bone regeneration and graft material resorption observed in vivo. [18],[19] . After 12 weeks, the density continued to increase until week 24, indicating new bone tissue formation. This healing phase is similar to the so-called "trabecular pattern," which occurs after 6 months with partial filling of the defect with bone. [20]

Use of HA in combination with platelet rich plasma, autogeneous bone, recombinant human bone morphogenic protein-2 (rhBMP-2) showed good results in bone formation. [21] The HA acts as a scaffold for bony ingrowth, even showed osteoinductive activity. [22],[23] But HA alone cannot be used in load bearing area for reconstruction. [21] It can be used with collagen matrix to have good strength. Recent advances in bone regeneration includes BMP, transforming growth factor-β, platelet derived growth factor, amino acids chain peptides-P-15 and OSA-117MV, stem cells. [21] While many of these particular concepts were regarded a visionary a few years ago, they have now reached clinical reality, in planned phased clinical trials. [24],[25],[26],[27],[28],[29] The reconstruction of atrophic alveolar ridges with allogenic bone graft, distraction and exotic autogenous bone graft for crater defects also showed good results. [30],[31],[32] Recently, demineralized bone matrix (DBM) incorporated into various carriers such as collagen or selected polymers for bone regeneration [33],[34],[35] The major disadvantage of this technique is the cost of the DBM material. [33],[34],[35]

Hydroxyapatite is a ceramic. HA can be divided into two groups depending upon its ability to resorb. [36],[37],[38],[39] Some refer to the internal pore size as a means of differentiating between various types of HA. [40],[41],[42] The porous form of HA allows rapid fibrovascular tissue ingrowth, which may stabilize the graft and help resist micromotion. [43],[44] HA can be machined to many shapes or consistencies. [45],[46],[47] HA has several potential clinical applications including the filling of bony defects, the retention of the alveolar ridge form following tooth extraction and as a bone expander when combined with autogenous bone during ridge augmentation and sinus grafting procedures. [48],[49],[50],[51],[52] One important advantage related to all xenogenic and allogenic materials is that they could potentially be used as bone graft expanders by mixing them with autogenous bone chips. This mixing could decrease the volume of autogenous bone graft needed, which in turn could convert an extra-oral harvesting procedure to an intra-oral harvesting procedure potentially reducing donor site morbidity. [53],[54] HA have been used to deliver BMP including other noncollagenous proteins, DBM, collagen, polylactic acid and or polyglycolic acid combinations, calcium carbonate, calcium sulphates and fibrin glue. [55],[56],[57],[58],[59],[60],[61],[62]

Many products are being marketed today as bone grafts. Several of these products capitalize on the necessities of an ideal substitute. As more materials are adapted and discovered, preexisting products are finding new applications and effectiveness in combination with newly emerging technology. In addition, further research is going on to use it in combination with collagen and others for bone repair. The very favorable results of our study warrant further multi-centric investigations as the study is limited to smaller sample size and moderate defects using only two types of materials.

   Conclusion Top

Hydroxyapatite is a versatile biocompatible graft substitute that does not cause any chronic inflammatory, allergic, or toxic reaction. It has been primarily used as ceramic formulation. The ideal graft material for reconstruction of bone defects should allow host bone formation in a relatively short span of time. HA provides a means of achieving this goal. Results of both densitometric and radiographic studies suggested that the use of HA graft material has the potential to accelerate bone formation. Both materials are equally efficient in bone regeneration.

   Acknowledgement Top

The study is registered in Clinical Trail Registry-India with registration no- CTRI/2014/05/004578.

   References Top

Damien CJ, Parsons JR. Bone graft and bone graft substitutes: A review of current technology and applications. J Appl Biomater 1991;2:187-208.  Back to cited text no. 1
Habal MB, Reddi AH. Different forms of bone grafts. In: Habal MB, Reddi AH, editors. Bone Grafts and Bone Substitutes. Philadelphia: Saunders; 1992. p. 6-8.  Back to cited text no. 2
Hench LL, Wilson J. An Introduction to Bioceramics. Singapore: World Scientific; 1993.  Back to cited text no. 3
Hench LL. Bio ceramics: From concept to clinic. J Am Ceram Soc 1991;74:1487-510.  Back to cited text no. 4
Greenwald AS, Boden SD, Goldberg VM, Khan Y, Laurencin CT, Rosier RN, et al. Bone-graft substitutes: Facts, fictions, and applications. J Bone Joint Surg Am 2001;83-A Suppl 2:98-103.  Back to cited text no. 5
Kasaj A, Willershausen B, Reichert C, Röhrig B, Smeets R, Schmidt M. Ability of nanocrystalline hydroxyapatite paste to promote human periodontal ligament cell proliferation. J Oral Sci 2008;50:279-85.  Back to cited text no. 6
El-Ghannam A, Amin H, Nasr T, Shama A. Enhancement of bone regeneration and graft material resorption using surface-modified bioactive glass in cortical and human maxillary cystic bone defects. Int J Oral Maxillofac Implants 2004;19:184-91.  Back to cited text no. 7
Eto AL, Joly JC, Jeffcoat M, de Araújo NS, de Araújo VC, Cury PR. Use of anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide (P-15) in the treatment of class II furcation defects: A clinical and radiographic study in humans. J Periodontol 2007;78:2277-83.  Back to cited text no. 8
Palmieri A, Pezzetti F, Spinelli G, Arlotti M, Avantaggiato A, Scarano A, et al. PerioGlas regulates osteoblast RNA interfering. J Prosthodont 2008;17:522-6.  Back to cited text no. 9
Bozzo Rde O, Rocha RG, Haiter Neto F, Paganini GA, Cavalcanti MG. Linear density analysis of bone repair in rats using digital direct radiograph. J Appl Oral Sci 2004;12:317-21.  Back to cited text no. 10
Oltramari PV, Navarro Rde L, Henriques JF, Taga R, Cestari TM, Janson G, et al. Evaluation of bone height and bone density after tooth extraction: An experimental study in minipigs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e9-16.  Back to cited text no. 11
Kattimani VS, Bajantai NV, Sriram SK, Sriram RR, Rao VK, Desai PD. Observer strategy and radiographic classification of healing after grafting of cystic defects in maxilla: A radiological appraisal. J Contemp Dent Pract 2013;14:227-32.  Back to cited text no. 12
Molven O, Halse A, Grung B. Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg 1987;16:432-9.  Back to cited text no. 13
Matsuoka H, Akiyama H, Okada Y, Ito H, Shigeno C, Konishi J, et al. In vitro analysis of the stimulation of bone formation by highly bioactive apatite-and wollastonite-containing glass-ceramic: Released calcium ions promote osteogenic differentiation in osteoblastic ROS17/2.8 cells. J Biomed Mater Res 1999;47:176-88.  Back to cited text no. 14
McAllister BS, Margolin MD, Cogan AG, Buck D, Hollinger JO, Lynch SE. Eighteen-month radiographic and histologic evaluation of sinus grafting with anorganic bovine bone in the chimpanzee. Int J Oral Maxillofac Implants 1999;14:361-8.  Back to cited text no. 15
Bezrukov VM, Grigor'iants LA, Zuev VP, Pankratov AS. The surgical treatment of jaw cysts using hydroxyapatite with an ultrahigh degree of dispersity. Stomatologiia (Mosk) 1998;77:31-5.  Back to cited text no. 16
Kandaswamy D, Ramachandran G, Maheshwari S, Mohan B. Bone regeneration using hydroxyapatite crystals for periapical lesions. Endodontology 2000;12:51-4.  Back to cited text no. 17
Mangano C, Scarano A, Perrotti V, Iezzi G, Piattelli A. Maxillary sinus augmentation with a porous synthetic hydroxyapatite and bovine-derived hydroxyapatite: A comparative clinical and histologic study. Int J Oral Maxillofac Implants 2007;22:980-6.  Back to cited text no. 18
Indovina A Jr, Block MS. Comparison of 3 bone substitutes in canine extraction sites. J Oral Maxillofac Surg 2002;60:53-8.  Back to cited text no. 19
Showkat M, Akhter M, Motiur Rahman M. Bone grafts in jaw cysts-hydroxyapatite and allogenic bone - A comparative study. Bangabandhu Sheikh Mujib Med Univ J 2009;2:25-30.  Back to cited text no. 20
Sandor GK, Lindholm TC, Clokie CM. Bone regeneration of the cranio-maxillofacial and dento-alveolar skeletons in the framework of tissue engineering. In: Ashammakhi N, Ferretti P, editors. Topics in Tissue Engineering. Finaland: University of Oulu; 2003. p. 1-46.  Back to cited text no. 21
Ripamonti U. Osteoinduction in porous hydroxyapatite implanted in heterotopic sites of different animal models. Biomaterials 1996;17:31-5.  Back to cited text no. 22
Gosain AK, Song L, Riordan P, Amarante MT, Nagy PG, Wilson CR, et al. A 1-year study of osteoinduction in hydroxyapatite-derived biomaterials in an adult sheep model: Part I. Plast Reconstr Surg 2002;109:619-30.  Back to cited text no. 23
Lindholm TC, Saf P, Clokie CM, Sàndor GK. Cortical bone grafts used to culture bone cells to be used for increasing efficacy of bone morphogenetic proteins in tissue engineered bone substitutes. J Oral Maxillofac Surg 2003;61 Suppl 1:74.  Back to cited text no. 24
Turhani D, Weissenböck M, Stein E, Wanschitz F, Ewers R. Exogenous recombinant human BMP-2 has little initial effects on human osteoblastic cells cultured on collagen type I coated/noncoated hydroxyapatite ceramic granules. J Oral Maxillofac Surg 2007;65:485-93.  Back to cited text no. 25
Schwarz F, Herten M, Ferrari D, Wieland M, Schmitz L, Engelhardt E, et al. Guided bone regeneration at dehiscence-type defects using biphasic hydroxyapatite+beta tricalcium phosphate (Bone Ceramic) or a collagen-coated natural bone mineral (BioOss Collagen): An immunohistochemical study in dogs. Int J Oral Maxillofac Surg 2007;36:1198-206.  Back to cited text no. 26
Hürzeler MB, Quiñones CR, Kirsch A, Schüpbach P, Krausse A, Strub JR, et al. Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part III. Evaluation of autogenous bone combined with porous hydroxyapatite. Clin Oral Implants Res 1997;8:401-11.  Back to cited text no. 27
Hürzeler MB, Quiñones CR, Kirsch A, Gloker C, Schüpbach P, Strub JR, et al. Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part I. Evaluation of anorganic bovine-derived bone matrix. Clin Oral Implants Res 1997;8:476-86.  Back to cited text no. 28
Heliotis M, Lavery KM, Ripamonti U, Tsiridis E, di Silvio L. Transformation of a prefabricated hydroxyapatite/osteogenic protein-1 implant into a vascularised pedicled bone flap in the human chest. Int J Oral Maxillofac Surg 2006;35:265-9.  Back to cited text no. 29
Lopes NM, Vajgel A, de Oliveira DM, de Santana Santos T, Wassall T. Use of rhBMP-2 to reconstruct a severely atrophic mandible: A modified approach. Int J Oral Maxillofac Surg 2012;41:1566-70.  Back to cited text no. 30
Ferraz EP, Rosa AL, de Oliveira PT, Santos TS, Pontes CD, Reino DM, et al. CLINICAL, histological and cellular evaluation of vertico-lateral maxillary reconstruction associating alveolar osteogenic distraction and fresh-frozen bone allograft. J Oral Implantol 2013;Oct 31:[Epub ahead of Print] PMID: 24175910.  Back to cited text no. 31
Puttaswamaiah RN, Galgali SR, Gowda VS. Exostosis: A donor site for autograft. Indian J Dent Res 2011;22:860-2.  Back to cited text no. 32
[PUBMED]  Medknow Journal  
Helm GA, Sheehan JM, Sheehan JP, Jane JA Jr, diPierro CG, Simmons NE, et al. Utilization of type I collagen gel, demineralized bone matrix, and bone morphogenetic protein-2 to enhance autologous bone lumbar spinal fusion. J Neurosurg 1997;86:93-100.  Back to cited text no. 33
Babbush CA. The use of a new allograft material for osseous reconstruction associated with dental implants. Implant Dent 1998;7:205-12.  Back to cited text no. 34
Morone MA, Boden SD. Experimental posterolateral lumbar spinal fusion with a demineralized bone matrix gel. Spine (Phila Pa 1976) 1998;23:159-67.  Back to cited text no. 35
Jarcho M. Biomaterial aspects of calcium phosphates. Properties and applications. Dent Clin North Am 1986;30:25-47.  Back to cited text no. 36
Alexander H, Parsons JR, Ricci J, Bajpai PK. Calcium-based ceramics and composites in bone reconstruction. CRC Crit Rev Biocompatiblity 1987;4:43-77.  Back to cited text no. 37
Ricci JL, Spivak JM, Alexander H, Blumenthal NC, Parsons JR. Hydroxyapatite ceramics and the nature of the bone-ceramic interface. Bull Hosp Jt Dis Orthop Inst 1989;49:178-91.  Back to cited text no. 38
Brown PW, Constantz B. Hydroxyapatite and related materials. CRC 1998;25:1036-40.  Back to cited text no. 39
Holmes RE. Bone regeneration within a coralline hydroxyapatite implant. Plast Reconstr Surg 1979;63:626-33.  Back to cited text no. 40
Guillemin G, Meunier A, Dallant P, Christel P, Pouliquen JC, Sedel L. Comparison of coral resorption and bone apposition with two natural corals of different porosities. J Biomed Mater Res 1989;23:765-79.  Back to cited text no. 41
Guillemin G, Patat JL, Meunier A. Natural corals as bone graft substitutes. Bull Inst Océanographique 1995;14:67-77.  Back to cited text no. 42
Kenney EB, Lekovic V, Carranza FA Jr, Dimitrijeric B, Han T, Takei H. A comparative clinical study of solid and granular porous hydroxylapatite implants in human periodontal osseous defects. J Biomed Mater Res 1988;22:1233-43.  Back to cited text no. 43
El Deeb M, Holmes RE. Tissue response to facial contour augmentation with dense and porous hydroxylapatite in rhesus monkeys. J Oral Maxillofac Surg 1989;47:1282-9.  Back to cited text no. 44
Schliephake H, Neukam FW. Bone replacement with porous hydroxyapatite blocks and titanium screw implants: An experimental study. J Oral Maxillofac Surg 1991;49:151-6.  Back to cited text no. 45
Frayssinet P, Hardy D, Rouquet N, Giammara B, Guilhem A, Hanker J. New observations on middle term hydroxyapatite-coated titanium alloy hip prostheses. Biomaterials 1992;13:668-74.  Back to cited text no. 46
Marchac D. Augmentation of the craniofacial skeleton with porous hydroxyapatite granules. Plast Reconstr Surg 1993;91:23-6.  Back to cited text no. 47
Stoelinga PJ, Blijdorp PA, Ross RR, De Koomen HA, Huybers TJ. Augmentation of the atrophic mandible with interposed bone grafts and particulate hydroxylapatite. J Oral Maxillofac Surg 1986;44:353-60.  Back to cited text no. 48
Bifano CA, Edgin WA, Colleton C, Bifano SL, Constantino PD. Preliminary evaluation of hydroxyapatite cement as an augmentation device in the edentulous atrophic canine mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:512-6.  Back to cited text no. 49
Haas R, Donath K, Födinger M, Watzek G. Bovine hydroxyapatite for maxillary sinus grafting: Comparative histomorphometric findings in sheep. Clin Oral Implants Res 1998;9:107-16.  Back to cited text no. 50
Haas R, Mailath G, Dörtbudak O, Watzek G. Bovine hydroxyapatite for maxillary sinus augmentation: Analysis of interfacial bond strength of dental implants using pull-out tests. Clin Oral Implants Res 1998;9:117-22.  Back to cited text no. 51
Simion M, Jovanovic SA, Trisi P, Scarano A, Piattelli A. Vertical ridge augmentation around dental implants using a membrane technique and autogenous bone or allografts in humans. Int J Periodontics Restorative Dent 1998;18:8-23.  Back to cited text no. 52
Kainulainen VT, Sàndor GK, Clokie CM, Oikarinen KS. Intraoral bone harvesting in oral and maxillofacial surgery. Suom Hammaslääkärilehti 2002;5:216-22.  Back to cited text no. 53
Hallman M, Lundgren S, Sennerby L. Histologic analysis of clinical biopsies taken 6 months and 3 years after maxillary sinus floor augmentation with 80% bovine hydroxyapatite and 20% autogenous bone mixed with fibrin glue. Clin Implant Dent Relat Res 2001;3:87-96.  Back to cited text no. 54
Harakas NK. Demineralized bone-matrix-induced osteogenesis. Clin Orthop Relat Res 1984 Sept; 188:239-51.  Back to cited text no. 55
Urist MR, Lietze A, Dawson E. Beta-tricalcium phosphate delivery system for bone morphogenetic protein. Clin Orthop Relat Res 1984;187:277-80.  Back to cited text no. 56
Urist MR. Experimental delivery systems for bone morphogenetic protein. In: Wise DL, Altobelli DE, Schwartz ER, Gresser JD, Trantolo DJ, Yaszemski M, editors. Handbook of Biomaterials and Applications, Section 3: Orthopaedic Biomaterials Applications. Boston: Mercel Dekker; 1995. p. 1093-133.  Back to cited text no. 57
Ono I, Gunji H, Kaneko F, Saito T, Kuboki Y. Efficacy of hydroxyapatite ceramic as a carrier for recombinant human bone morphogenetic protein. J Craniofac Surg 1995;6:238-44.  Back to cited text no. 58
Davis BR, Sándor GK. Use of fibrin glue in maxillofacial surgery. J Otolaryngol 1998;27:107-12.  Back to cited text no. 59
McAllister BS, Margolin MD, Cogan AG, Taylor M, Wollins J. Residual lateral wall defects following sinus grafting with recombinant human osteogenic protein-1 or Bio-Oss in the chimpanzee. Int J Periodontics Restorative Dent 1998;18:227-39.  Back to cited text no. 60
Si X, Jin Y, Yang L. Induction of new bone by ceramic bovine bone with recombinant human bone morphogenetic protein 2 and transforming growth factor beta. Int J Oral Maxillofac Surg 1998;27:310-4.  Back to cited text no. 61
Lindholm TS. BMPS delivered in skeletal reconstruction - A review. In: Lindholm TS, editor. Skeletal Reconstruction Using Bone Morphogenetic Proteins. Singapore: World Scientific Publishing Company; 2002. p. 353-84.  Back to cited text no. 62

Correspondence Address:
Vivekanand S Kattimani
Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9290.147100

Rights and Permissions


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  

    Materials and me...
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded122    
    Comments [Add]    

Recommend this journal