Clinical Confidence with Biosynthetic Hydroxyapatite

Written by: Dr. Sneha Dhanke

A Closer Look at OSBONE^® in Dental Surgery

Introduction

OSBONE^®, a fully synthetic hydroxyapatite (HA) by curasan AG, delivers clear clinical advantages in modern dental regenerative procedures. With its controlled resorption rate, high biocompatibility, and predictable handling, OSBONE^® addresses the growing demand for safe and effective graft materials, particularly in complex or compromised cases.

Could the wrong Bone Graft be a hidden Cause of Peri-Implantitis?

Peri-implantitis is a progressive, plaque-associated inflammatory condition that affects both soft and hard peri-implant tissues, ultimately jeopardizing implant stability. While widely recognized risk factors include microbial biofilm, previous history of periodontitis, poor oral hygiene, smoking, and systemic diseases such as diabetes mellitus, one often overlooked yet critical factor is the choice of bone graft material.

Biomaterial-Driven Inflammation: An underestimated Risk ^{i, ii, iii}

Xenografts, typically sourced from bovine or porcine bone, undergo extensive sterilization processes, often involving high temperatures, to eliminate immunogenic components. While necessary for safety, these procedures denature native bone proteins and cellular structures, significantly reducing the graft’s regenerative potential.

The result is a biologically inert material that:

• maintains volume passively, without actively supporting bone regeneration
• lacks vascular supply, preventing angiogenesis and cell migration
• acts as a foreign body, risking prolonged low-grade inflammation
• may become encapsulated in fibrous tissue, delaying or preventing osseointegration

Over time, these conditions can foster a microenvironment prone to bacterial colonization, elevating the risk of secondary peri-implantitis.

Rethinking Graft Selection: The Clinical Perspective

Successful bone regeneration depends not just on volume maintenance, but on a graft’s ability to actively integrate with host tissues. Materials must support:

• Vascular invasion
• Cell adhesion and differentiation
• Controlled resorption and replacement with vital bone

Biosynthetic, biocompatible alternatives such as OSBONE^® offer a clear advantage in meeting these biological demands.

Clinical Validation of OSBONE^®

Multicenter Study: Real-World Outcomes ^iv

A prospective, open-label multicenter study across 32 dental clinics in Germany involving 190 patients evaluated OSBONE^® in various augmentation indications:

• 117 implants were placed simultaneously with OSBONE^®; 37 implants were placed in a delayed protocol (mean delay: 159 days)
• Clinical Indications: Alveolar ridge atrophy, sinus lifts, cystectomies, periodontal defects, and apical resections
• Healing Success: Primary wound closure with high integration even in challenging anatomical sites
• Radiologic Outcomes: Progressive radiopacity reduction indicated gradual resorption and bone substitution
• Soft Tissue Response: Rated “ideal” or “good” in over 80% of cases

OSBONE^® proved effective in single and multi-quadrant augmentation, with excellent compatibility with adjuncts like PRP, autologous bone, and resorbable membranes.

In Peri-Implantitis Management: Surgical Synergy with OSBONE^®

In a 2021 prospective case series (González Regueiro et al.)^v, OSBONE^® was used in a regenerative protocol addressing peri-implantitis, combined with:

• Implantoplasty
• Local antibiotic delivery (piperacillin/tazobactam)
• Collagen membrane coverage (OSGIDE^®)

Outcomes at 12 months:

• 86% disease resolution rate
• 2.6 mm mean defect fill (radiographic)
• PPD reduction: from 6.4 mm to 3.2 mm
• BoP reduction: from 100% to 14%
• Zero implant loss and no systemic antibiotics required

These results confirm OSBONE^®’s value in regenerative peri-implantitis surgery—offering both structural stability and biological safety.

Summary

Why OSBONE^® outperforms Biological HA Grafts?

The OSBONE^® Advantage:

• Fully inorganic composition
  Eliminates risks of immunogenicity or inflammation caused by residual proteins in xenografts
• 80% porosity with interconnected channels
  Promotes vascular infiltration and new bone formation while preserving mechanical integrity
• Superior cellular response
  OSBONE^® demonstrated significantly higher osteoblast adhesion and differentiation compared to bovine HA in a 28-day SaOS-2 cell culture model ^vi
• Batch-to-batch consistency and combination versatility
  Seamlessly integrates with regenerative protocols (e.g., GBR, PRP, local antibiotics) without variability

Clinical Takeaway

In complex, infected, or previously compromised sites, OSBONE^® provides a predictable, safe, and high-performance solution—offering:

• No biological risk
• Stable volumetric support
• Excellent radiologic and clinical outcomes
• Compatibility with modern regenerative techniques
• High patient acceptability

OSBONE^® is more than a graft – it is a next-generation regenerative strategy designed for long-term implant success.

[i] Rodriguez, A. E., & Nowzari, H. (2019). The long-term risks and complications of bovine-derived xenografts: A case series. Journal of Indian Society of Periodontology, 23(5), 487–492. https://doi.org/10.4103/jisp.jisp_656_18

[ii] Sato, R., Matsuura, T., Akizuki, T. et al. Influence of the bone graft materials used for guided bone regeneration on subsequent peri-implant inflammation: an experimental ligature-induced peri-implantitis model in Beagle dogs. Int J Implant Dent 8, 3 (2022). https://doi.org/10.1186/s40729-022-00403-9

[iii] Ivanovski, S., Bartold, P. M., & Huang, Y. S. (2022). The role of foreign body response in peri-implantitis: What is the evidence?. Periodontology 2000, 90(1), 176–185. https://doi.org/10.1111/prd.12456

[iv] Pehrsson, K. Application of a synthetic hydroxyapatite in dental surgery. Infection, 4(1), 2.

[v] González Regueiro, I., Martinez Rodriguez, N., Barona Dorado, C., Sanz‐Sánchez, I., Montero, E., Ata‐Ali, J., … & Martínez‐González, J. M. (2021). Surgical approach combining implantoplasty and reconstructive therapy with locally delivered antibiotic in the treatment of peri‐implantitis: A prospective clinical case series. Clinical implant dentistry and related research, 23(6), 864-873.

[vi] Bernhardt A, Lode A, Peters F, Gelinsky M. Novel ceramic bone replacement material Osbone® in a comparative in vitro study with osteoblasts. Clin Oral Implants Res. 2011 Jun;22(6):651-7. doi: 10.1111/j.1600-0501.2010.02015.x. Epub 2010 Oct 6. PMID: 21044164.