Secondary Logo

Journal Logo

Book Review

Next-Generation Biomaterials for Bone and Periodontal Regeneration

Wallace, Stephen S. DDS

Author Information
doi: 10.1097/ID.0000000000000939
  • Free

About the Authors

Dr. Richard Miron, DDS, MSc, PhD, Dr. med dent

Dr. Richard Miron is currently an affiliated professor in the department of periodontology at the University of Bern, Switzerland, where he earned his PhD. He also serves as a visiting professor at Wuhan, China (oral implantology) and UIC in Barcelona, Spain (oral surgery). From 2015 to 2016, he served as the head of the oral biology laboratory at one of the highest-ranking dental schools in the world (University of Bern, Switzerland) under Chairs Professor Anton Sculean (periodontology) and Daniel Buser (oral surgery).

Dr. Miron and Dr. Joseph Choukroun recently edited a 15-chapter textbook titled: “Platelet Rich Fibrin in Regenerative Dentistry: Biological Background and Clinical Indications” with 20 coauthors from around the globe.

Dr. Yufeng Zhang, MD, DDS, PhD

Dr. Yufeng Zhang is currently a professor and chief physician at Wuhan University, Department of Implant Dentistry; The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine, Ministry of Education, School & Hospital of Stomatology. His research training was performed at the Queensland University of Technology, as a postdoctoral researcher and at the University of Bern as a research fellow. His research activities have often been in association with Dr. Richard Miron.

Three research projects they have collaborated on are discussed in detail in this textbook:

  1. An international research project to specifically improve the physiochemical properties of Emdogain for better protein (amelogenin) adsorption to bone biomaterials. A liquid-enamel matrix derivative (EMD) has recently been developed (Osteogain).
  2. Multiple studies conducted by Dr. Masako Fujioka-Kobayashi characterizing the superior osteoinductive potential of rhBMP9 in comparison with rhBMP2 in both in vitro and in vivo models.
  3. A 5-year study of further modifications to centrifugation speed and time having additionally improved PRF led to what is now known as the “low-speed centrifugation concept.” This introduced a new set of cells into platelet concentrates (namely leukocytes), which had a marked impact on tissue regeneration and wound healing.

This 370-page text with 23 chapters has Dr. Miron as one of its authors. This text is more-than-just edited by Dr. Miron but is guided by a philosophy of expanding the role of bioengineering in dental regenerative procedures.

The text begins with a comparison of the regenerative properties of the 4 families of bone grafts in (1). The text covers in sequential chapters our current utilization of regenerative materials, which include autografts. (2) 08 (autogenous bone, particulate dentin), allografts. (3) (FDBA, DFDBA, xenografts. (4) (BioOss), alloplasts 6. (Cerasorb, bi-phasic calcium phosphates, Perioglass, etc.). The positive and negative attributes of each group are well documented for use in periodontal regeneration and in bone augmentation/regeneration procedures. The chapters are well done starting with properties of each group, past and current literature/studies, and finishes with clinical case examples using these materials.

Not stopping with what is previously considered the standard grafting materials, there follow chapters on the “next generation” of many of these materials. Much comes from the research projects of Drs. Miron and Zhang. They include atelocollagen bovine bone material (5), osteoinductive calcium phosphates (Osopia) (7), osteoconductive bone adhesives (Tetranite) 09.

Chapters 10 and 11 discuss the value of 3D-printed scaffolds 10 and membranes 11 and 17.

Most of the later chapters involve tissue-engineered technologies along with potential improvements to outcomes that may be expected with ongoing research on these technologies.

Chapter 12 is devoted to discussions of autogenous blood-derived materials, from PRP to PRF. Research from the authors has led to a low-speed and low-time protocol for centrifugation. This change to existing protocols not only allows for the incorporation of a higher volume of the cells that are generally maximized in the fibrin fraction but also allows for the incorporation of leukocytes in the fibrin network.

The discussion continues with an evaluation of the data on BMP-2 in chapter 13. Research and clinical indications are presented. Chapter 18 presents ongoing research with BMP-9, which by far shows the greatest alkaline phosphatase activity of the 14 BMP's.

Discussed in great detail is the utilization of EMD-14–15. The amelogenins, which are the major component of enamel matrix proteins, have shown positive effects in the treatment of periodontal lesions. Research history and clinical cases are presented. The authors have conducted much research with a different delivery system for Emdogain. The product they are developing (Osteogain and Straumann) uses a liquid delivery system as opposed to the current gel-19. The liquid system allows for much better protein adsorption (amelogenin) and has demonstrated superior ability to promote new attachment and defect fill.

Chapter 16 discusses the research and proven efficacy of recombinant human PDGFββ and FGF-2 for periodontal regeneration. Not discussed in this chapter is the even more positive effect of rh-PDGFβ in maxillary sinus elevation, most likely due to the fact that this is an off-label use.

Chapters 20 to 22 present “next-generation uses of hyaluronic acid, ion incorporation, and gene therapy for growth factor delivery".

The plethora of information provided in this text may confound us as clinicians. The authors have therefore ended the volume with chapter 23 which gives their clinical guidelines for selecting biomaterials for bone and periodontal regeneration. Indications and contraindications are tabulated for specific grafting materials for use in extraction sockets, sinus augmentation, guided bone regeneration, guided bone regeneration with immediate implant placement, implant placement with contour augmentation, and periodontal regeneration. Clinical cases are presented to demonstrate correct utilization. Potential future uses for next-generation materials are also presented.

This text has a wealth of information pertaining to our existing regenerative therapeutic choices while also presenting future pathways for research to improve these regenerative materials and our clinical outcomes. It is uncommon to find one source that combines both research and clinical applications so as to make the clinician knowledgeable in the research background behind his therapeutic choices as well as presenting sound clinical cases as a guideline.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.