Search Results (51)

Background/Objectives: Alveolar ridge atrophy following tooth extraction complicates subsequent prosthetic rehabilitation and implant placement. This systematic review seeks to provide a comprehensive evaluation of existing evidence regarding the effectiveness of xenogeneic bone graft materials in socket preservation, particularly emphasizing their influence on the adjacent soft tissues. Methods: A systematic literature search was carried out across the CENTRAL, Embase, MEDLINE, PubMed, and Scopus databases. The search targeted randomized controlled trials (RCTs) published in English between January 2015 and September 2025 that examined xenogenic bone grafts used for ridge preservation in comparison either to spontaneous socket healing or to other types of grafting materials. The primary outcomes of interest were bone regeneration and alterations in soft tissues. Multiple independent reviewers performed study screening, data extraction, and risk of bias evaluation using the RoB 2 tool. Results: From 2242 initial records, 4 RCTs (138 patients) met the inclusion criteria. Studies compared xenografts (deproteinized bovine bone mineral with/without collagen), often combined with membranes, to unassisted healing. Augmentation techniques consistently showed a trend toward reduced horizontal and vertical ridge contraction compared to controls, though differences often lacked statistical significance (p > 0.05). Histological analysis revealed significantly less vital bone formation and residual graft particles in xenograft sites versus controls, suggesting volume maintenance is largely graft-dependent. Soft tissue contour changes were evaluated using 3D model scanning. Risk of bias varied, with concerns regarding randomization and reported outcomes in some studies. Conclusions: Xenogenic materials demonstrate comparable clinical effectiveness in preserving alveolar ridge dimensions, though radiographic volume stability may be partially attributed to the slow resorption of the graft material itself rather than new bone formation. Full article

Objectives: Autologous bone grafting remains the gold standard for maxillofacial reconstruction but is limited by tissue scarcity and donor-site morbidity. Consequently, substitutes like bioactive glass (BG), beta-tricalcium phosphate (β-TCP), and deproteinized bovine bone (DBB) are widely used. However, comprehensive mechanistic comparisons among them remain scarce. Materials and Methods: We systematically evaluated these substitutes under standardized in vitro conditions to compare their physicochemical transformations, degradation profiles, biological performances, and underlying osteogenic molecular pathways. Results: In simulated body fluid, BG underwent rapid hydroxyapatite mineralization, whereas the highly porous DBB and dense β-TCP remained structurally inert. Degradation assays revealed BG exhibited the fastest mass loss and ion release, β-TCP showed intermediate degradation, and DBB maintained high in vitro structural stability. Biologically, all materials showed favorable cytocompatibility and comparable angiogenic potential. However, BG demonstrated significant antibacterial activity (E. coli, S. aureus) and a strong potential to enhance osteogenic differentiation, significantly upregulating the protein-level expression of RUNX2 and OCN, alongside the transcriptional upregulation of Bmp2, Runx2, and Ocn. Transcriptomic profiling and pharmacological validation suggest that the enhanced osteogenic performance of BG might be associated with specific regulatory pathways, supporting the hypothesis that the suppression of NF-κB-mediated inflammation and the activation of the ECM-Integrin-FAK mechanotransduction axis play potential roles. Conclusions: BG offers high bioactivity and notable potential to enhance osteogenic differentiation in vitro but degrades rapidly. DBB ensures structural durability without intrinsic osteoinductivity, and β-TCP provides a balanced, intermediate profile. These in vitro mechanistic insights provide a theoretical foundation for future in vivo evaluations and designing next-generation bone scaffolds. Full article

Alveolar ridge preservation (ARP) aims to reduce post-extraction bone resorption and facilitate implant placement. Among alloplastic grafts, β-tricalcium phosphate (β-TCP) is widely used due to its osteoconductive properties and complete resorbability. This systematic review evaluated the clinical effectiveness of β-TCP for ARP, focusing on ridge dimensional changes assessed by cone–beam computed tomography (CBCT). Electronic searches were performed in major scientific databases up to April 2026. Randomized controlled trials (RCTs) reporting CBCT-based dimensional outcomes after at least 4 months were included. Five RCTs met the inclusion criteria. Considerable heterogeneity was observed in biomaterial formulations, socket management, and outcome assessment. When used alone, β-TCP showed variable results, ranging from greater ridge resorption compared with xenograft to outcomes comparable with those of freeze-dried bone allograft. More consistent findings were reported when β-TCP was used in combination with other biomaterials, with outcomes generally comparable to those of deproteinized bovine bone mineral (DBBM). Overall, β-TCP may have a potential role in alveolar ridge preservation; however, evidence remains limited and heterogeneous. Differences between β-TCP alone and composite formulations should be carefully considered, and no definitive conclusions can be drawn regarding its comparative predictability versus xenografts. Further RCTs are needed to clarify its clinical effectiveness and identify optimal applications. Full article

Background: To investigate whether coating xenogeneic bone grafts with hyaluronic acid influences early osteogenic and fibrotic marker expression in vitro. Methods: Three xenograft materials were evaluated, including one hyaluronic acid-coated product and two uncoated deproteinized bovine bone mineral products, all commercially available. Human osteoblast-like cells (U2OS) and bone marrow stromal cells (HS5) were cultured with material extracts. Proliferation was assessed using XTT assay at 24 and 48 h. Cell adhesion was evaluated through fluorescence microscopy. Osteogenic markers (RUNX2, COL1A1) and fibrotic markers (COL3A1, TGF-β3) were quantified using quantitative real-time PCR. Statistical analysis employed one-way ANOVA with Benjamini–Krieger–Yekutieli (BKY) two-stage FDR correction for datasets that met the normality assumption, and the Kruskal–Wallis test with Dunn’s post hoc test for non-normally distributed data (HS5 XTT assay). Pairwise comparisons were restricted to each xenograft group versus the untreated control; an adjusted p-value < 0.05 was considered statistically significant. Results: At 48 h, the HA-coated xenograft (Xeno1) showed the highest mean metabolic activity in U2OS cells (0.538 ± 0.056) compared with the uncoated Xeno2 (0.450 ± 0.120) and Xeno3 (0.439 ± 0.073); however, after FDR correction no statistically significant differences were observed between groups. The coated material was associated with upregulation of early osteogenic markers, 2.61-fold RUNX2 upregulation (p = 0.01) compared to untreated cells. Both coated and uncoated xenografts demonstrated equivalent suppression of fibrotic markers in HS5 cells, reducing COL3A1 by 92.7% (p = 0.001) and TGF-β3 by 92.1% (p = 0.001). Conclusions: These exploratory in vitro findings suggest that HA coating may enhance early osteogenic marker expression. The observed effects on stromal markers warrant further investigation using primary cells, additional fibrotic endpoints (e.g., TGF-β1, ACTA2), and in vivo models before translational conclusions can be drawn. Full article

This split-mouth pilot study evaluated implant stability using resonance frequency analysis (ISQ), Periotest measurements (PTV), and CBCT imaging as a supportive descriptive modality. Twenty patients requiring implant placement in the anterior maxilla underwent bilateral augmentation with deproteinized bovine bone mineral, with an adjunctive polynucleotide–hyaluronic acid complex applied at one site and the contralateral site serving as control. Implants were placed after a standardized 6-month healing period. Implant stability was recorded at placement and during follow-up. Test sites showed slightly higher ISQ values and more negative PTV values at placement, followed by progressive stabilization in both groups during healing. Parallel trends of increasing ISQ and decreasing PTV values were observed over time. CBCT was used exclusively for intra-patient comparative and morphologic assessment. Within the limitations of this pilot design, implant stability measurements should be interpreted as functional indicators of the implant–bone complex during early healing. The combined use of ISQ and Periotest measurements may support longitudinal monitoring of implant stability in routine clinical practice. Further studies with larger cohorts and extended follow-up are warranted. Full article

Objectives: Horizontal ridge augmentation remains a clinical challenge due to limitations in terms of spatial maintenance, graft stability and predictability of new bone formation. The umbrella-screw tent technique provides mechanical stability for particulate grafts, while adjuvants such as hyaluronic acid (HA) and polynucleotides (PN) may enhance biological remodeling. Evidence for this compound in implant-related bone augmentation is still scarce. Material and methods: In a single patient with a knife-edge alveolar ridge, augmentation was performed in regions 34 to 36 using the umbrella-screw tent technique. The defect was grafted with deproteinized bovine bone mineral (DBBM) mixed with hyaluronic acid (HA) and polynucleotides (PN), supplemented with platelet-rich fibrin (PFR) and covered with a resorbable collagen membrane. After six months, two implants were installed, and a biopsy was obtained by trepanation for histological and histomorphometric analysis. Results: Healing occurred without compromise, with no signs of infection or graft exposure. Horizontal bone gain averaged 4.5 mm, corresponding to a relative Target Performance Index (TPI-h) of 75%. Histomorphometric analysis revealed a total mineralized fraction of 76.4%, consisting of 36.1% newly formed bone and 40.3% residual DBBM particles. The xenogeneic granules were completely integrated into mature bone, with no signs of inflammation or foreign body reaction. Conclusion: The case report illustrates that the combination of DBBM with HA and PN, stabilized by the umbrella-screw tent technique, can lead to significant new bone formation and favorable graft integration. Although limited by its single-case design, the case report provides preliminary insights into the synergistic potential of HA and PN as biological enhancers in bone augmentation, warranting further controlled studies. Full article

Maxillary sinus augmentation is a key procedure for rehabilitating the atrophic posterior maxilla and enabling predictable implant-supported restorations. Although autogenous bone remains the biological gold standard due to its osteogenic potential, its clinical use has declined because of donor-site morbidity, limited availability, and increased surgical burden. Deproteinized bovine bone mineral (DBBM) is currently the most widely used substitute, providing excellent biocompatibility and long-term volumetric stability. However, its inert nature, limited bioactivity, and slow resorption have driven the development of next-generation graft materials. Recent biomaterial innovations aim to enhance vascularization, accelerate osteogenesis, modulate immune responses, and achieve controlled resorption while maintaining favorable handling properties. These include ion-releasing bioactive ceramics, growth factor-enhanced allografts, polysaccharide–hydroxyapatite composites, smart hydrogels, and synthetic scaffolds with tunable degradation profiles. Given the complexity of bone regeneration, effective clinical translation requires an integrated framework combining in vitro assays, animal models, and human clinical studies. This review synthesizes evidence published since 2018 on emerging biomaterials for sinus floor elevation, critically evaluating their potential to overcome the limitations of DBBM and highlighting the importance of a coordinated preclinical-to-clinical research continuum. Full article

Background and Objectives: Adequate buccal bone thickness is critical for long-term peri-implant health and stability. When residual alveolar bone volume is insufficient, guided bone regeneration (GBR) is a widely adopted technique. While non-resorbable membranes provide structural support, they carry a higher risk of complications and require secondary surgery. Resorbable collagen membranes, offer promising biological properties and easier clinical handling, yet clinical data remain limited. This prospective cohort study aimed to evaluate the clinical and radiographic outcomes of horizontal GBR using a native, non–cross-linked resorbable porcine pericardium membrane fixed with titanium pins, in conjunction with simultaneous implant placement. Materials and Methods: Eighteen patients (26 implants) with horizontal alveolar defects (<6 mm) underwent implant placement and GBR with deproteinized bovine bone mineral and a porcine pericardium collagen membrane. Horizontal bone gain and buccal bone thickness were measured at baseline and 6 months post-operatively. Post-operative complications, patient-reported outcomes (PROMs), and peri-implant tissue health were assessed up to 1 year post-loading. Results: Mean bone gain was 2.95 ± 0.95 mm, and all sites achieved a buccal bone thickness ≥ 1.5 mm. No membrane-related complications occurred. PROMs revealed low morbidity. At 1-year follow-up, marginal bone loss averaged 0.54 ± 0.7 mm, mean probing depth was 2.79 ± 0.78 mm, 92% of sites exhibited keratinized mucosa ≥ 2 mm. Conclusions: Native resorbable porcine pericardium membranes, when combined with DBBM and mechanical stabilization, seem to be effective for horizontal bone regeneration. Full article

Background: The combination of polynucleotides and hyaluronic acid with bovine bone grafts in maxillary sinus lift procedures appears to be a promising strategy to enhance bone regeneration. This study aimed to analyze implant osseointegration, bone repair and sinus mucosa integrity using Bio-Oss^® and Hyaluronic Acid-Polynucleotide Gel (Regenfast^®) in maxillary sinus augmentation in rabbits. Methods: Sinus floor elevation was performed in 12 rabbits, with one implant placed per sinus simultaneously. In the control group, sinuses were grafted with deproteinized bovine bone mineral (Bio-Oss^®) alone; in the test group, Bio-Oss^® was combined with Regenfast^®. Two histological slides were obtained per sinus after 2 weeks (six animals) and 10 weeks (six animals): one from the grafted area alone (non-implant sites), and one from the implant site. Primary outcome variables included the percentage of newly formed bone, the extent of implant osseointegration, and the number of sinus mucosa perforations caused by contact with graft granules. Results: After 10 weeks of healing, the test group showed a significantly higher percentage of new bone formation (37.2 ± 6.7%) compared to the control group (26.8 ± 10.0%; p = 0.031); osseointegration extended to the implant apex in both groups; fewer sinus mucosa perforations were observed in the test group (n = 5) than in the control group (n = 14). Conclusions: The addition of Regenfast^® to Bio-Oss^® granules promoted enhanced bone regeneration within the elevated sinus area and was associated with a lower incidence of sinus membrane perforations compared to the use of Bio-Oss^® alone. Full article

Aim: to evaluate the bone regeneration capacity of two alloplastic biomaterials in a critical-size rat calvarial defect model. Methods: A total of 80 rats were randomized into 8 groups of 10 animals each. An Ø8 mm, critical-size calvarial defect was created, and the following treatments were randomly allocated: sham surgery, deproteinized bovine bone mineral (DBBM) + collagen membrane (CM), poly-(lactic-co-glycolic-acid) (PLGA)-coated pure phase β-tricalcium phosphate (β-TCP), or PLGA-coated 60% hydroxyapatite (HA):40%β-TCP. Animals were allowed to heal for 2 and 6 weeks. Microcomputed tomography (μCT) was used to evaluate mineralized tissue and biomaterial displacement. Histological samples were used to evaluate new bone formation. Results: μCT analysis showed no significant differences among groups for total volume of mineralized tissue or residual biomaterials. DBBM + CM showed significantly increased horizontal biomaterial displacement at 2 weeks but not at 6 weeks. Histological analysis showed that sham surgery had a significantly higher percentage of bone area fraction than the DBBM + CM and PLGA + β-TCP at 2 weeks, but not at 6 weeks. Residual biomaterial area fraction showed no significant differences among experimental groups at any healing time. Conclusions: The alloplastic biomaterials showed suitable construct integrity and retention in the defect. All biomaterials were associated with limited new bone formation comparable to the sham surgery control. Full article

Background: Alveolar ridge preservation (ARP) following tooth extraction plays a vital role in maintaining ridge dimensions and supporting subsequent implant therapy. Objectives: This study histologically and radiographically evaluates the efficacy of techBiomat bone^®—a deproteinized bovine bone mineral (DBBM)—for alveolar ridge preservation (ARP), comparing the results of bone formation, residual graft particles, and nonmineralized tissue to those of spontaneous healing in human tooth sockets. Methods: A split-mouth study was conducted to evaluate the radiographic and histologic outcomes in human sockets with and without ARP. Results: A significant improvement in bone fill was observed compared to untreated sockets. Radiographically, 87% of the treated sockets demonstrated more than 75% bone fill, whereas only 7% of the untreated sockets did. Histologically, the percentage of new bone formation was greater in treated sockets (42%) than in untreated sockets (25%). The findings also highlighted a lower proportion of nonmineralized tissue in grafted sites, suggesting improved healing over spontaneous healing. The residual graft material in the treated sockets had a moderate resorption rate, with almost complete replacement by the host bone after six months. The use of techBiomat bone^® demonstrated promising results, with a resorption rate conducive to optimal bone regeneration, with less than 9% residual graft material remaining after six months. Conclusions: This study supports the efficacy of techBiomat bone^® graft material for ARP, highlighting its potential in maintaining ridge volume. Further studies with larger sample sizes are needed to confirm these findings. Full article

Current treatment methods for critical bone defects involve the implantation of large bone grafts, which are limited by tissue availability and failure to heal correctly with high complication rates. Bioengineered scaffolds have emerged, which deploy biodegradable, highly osteoconductive materials in porous structures to accommodate the high mass transport requirements of large bone defects. Ideal scaffold biomaterials require a balance between strength, composition, and osteoconduction, a balance which has yet to be discovered. Naturally derived materials like deproteinized bovine bone mineral (DBBM) have seen successful clinical use for decades as bone void fillers, but their granular or putty form lacks the interconnected porosity required to treat large defects. Leveraging the clinical success of DBBM, this paper presents the first fabrication of highly porous scaffolds composed of naturally derived, deproteinized bone mineral, for potential use in large bone defects. Ovine bone mineral powder was prepared from fresh ovine bone, fabricated into a photopolymeric slurry and 3D-printed using a photocasting process into 67% porous gyroid scaffolds. Ovine bone mineral composition, surface microstructure, compressive properties, and failure probability were evaluated and compared to gyroid scaffolds composed of tricalcium phosphate. Both scaffold types were similar, with characteristics in the low range of human cancellous bone. Full article

Platelet-rich fibrin (PRF) membranes are a biomaterial derived from the patient’s own blood, used in different medical and dental areas for their ability to promote healing, tissue regeneration, and reduce inflammation. They are obtained by centrifuging the blood, which separates the components and concentrates the platelets and growth factors in a fibrin matrix. This material is then moulded into a membrane that can be applied directly to tissues. The use of these PRF membranes is often associated with the use of different biomimetic materials such as deproteinized bovine bone mineral (DBBM), β-tricalcium phosphate (β-TCP), enamel matrix derivative (EMD), and hydroxyapatite (HA). Different indications of PRF membranes have been proposed, like alveolar ridge preservation, alveolar ridge augmentation, guided tissue regeneration (GTR), and sinus floor augmentation. The aim of this narrative review is to check the state-of-the-art and to analyze the existing gaps in the use of PRF membranes in combination with biomimetic materials in alveolar ridge preservation, alveolar ridge augmentation, guided tissue regeneration (GTR), and sinus floor augmentation. Full article

The aim of this study was to compare the efficacy of the guided tissue regeneration (GTR) of periodontal infrabony defects using the frozen radiation-sterilized allogenic bone graft (FRSABG) versus deproteinized bovine bone mineral (DBBM) 5 years after treatment. The association between patients’ compliance and periodontitis recurrence with 5-year outcomes was also evaluated. Thirty infrabony defects in 15 stage III/IV periodontitis patients were randomly allocated to the FRSBAG group (tests) or the DBBM group (controls). Between 1 and 5 years, one patient was lost to follow-up and one tooth was extracted due to root fracture. No tooth was extracted for periodontal reasons. Consequently, 13 teeth in test sites and 14 teeth in control sites were available for the 5-year analysis. The clinical attachment level gain (CAL-G, primary outcome), probing pocket depth (PPD), radiographic defect depth (DD), and linear defect fill (LDF) were examined at baseline and 5 years post-surgically. Both groups showed statistically significant improvements in all evaluated clinical and radiographic parameters at 5 years, with insignificant intergroup differences. CAL-Gs were 4.46 ± 2.07 mm in the FRSBAG group, and 3.86 ± 1.88 mm in the DBBM group (p = 0.5442). In six (43%) patients, we observed periodontitis recurrence, among whom two (33.33%) participated regularly in supportive periodontal care (SPC) and the other four (66.7%) did not take part in SPC. A regression analysis revealed that periodontitis recurrence was a significant predictor of CAL loss and DD increase. FRSBAG and DBBM were both equally effective 5 years after the GTR of infrabony defects. Within the limitations of the present study, its outcomes advocate that both grafts may be considered as a viable option based on patient preferences and clinical considerations. Full article

This study evaluated the clinical and tomographic outcomes of socket healing. Immediate implants were placed in the molar area, and the gap was filled with either deproteinized bovine bone mineral (B) or collagen matrix (BM), n = 14/group. Scores of epithelization healing, immunoassay for VEGF, IL-1β, and FGF from wound exudate, keratinized mucosa variation (ΔKM), and bone levels were evaluated. The B group had slower tissue maturation than BM (p < 0.05), but gingival epithelialization was similar (p > 0.05). At the restorative phase, the B group exhibited greater ΔKM at prosthesis installation—1 to 2 months of postoperative (increase of 0.29 mm) compared to the BM group (reduction of −1.5 mm) (p < 0.05). Inflammatory tissue responses as well as vertical and horizontal bone remodeling were similar (p > 0.05). Crestal bone remodeling was limited to less than 0.8 mm for both groups. Taken together, the B and BM groups behaved similarly and promoted stable conditions for biomaterial incorporation in the socket healing after immediate implant placement in molar areas. Full article