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A Step-by-Step Procedure for Bone Regeneration Using Calcium Phosphate Scaffolds

From Site Preparation to Graft Placement

Messina, Antonello Maria DDS*; Marini, Luca DDS; Oh, Daniel S. MS, PhD‡,§; Marini, Ettore MD, DDS*

doi: 10.1097/SCS.0000000000004996
Original Articles

Hydroxyapatite (HA) is the main mineral component of bone and teeth. HA is often used as a bone substitute and especially in its granular form it is osteoconductive and osseointegrating as shown by many investigations in animals and humans. HA granules are used for filling bone defects, but they have poor handling qualities and retention at the surgical site, leading to graft voids between the granules and bone tissue and resulting in mechanical instability. Furthermore HA implantation is not constantly followed by favorable results, especially when it is carried out for augmentation of the alveolar ridge. This article offers a protocol for bone reconstruction and predictable implant treatment outcomes. We provide a step-by-step description of both the recipient site and composite graft preparations using coralline HA granules (CHAG) and homologous fibrin glue (HFG). In the present study, 20 randomly selected patients (12 women and 8 men) underwent bone regeneration using CHAG-HFG before a dental implant procedure. Radiographic imaging, physical examination, and histological analysis were performed during a 2-year period. Biopsies were obtained at second-stage surgery before implant insertion using a 2.8-mm trephine bur. A morphological study of 20 bioptic human specimens was performed. Our results demonstrate that this surgical protocol for the preparation of the recipient site associated with a mixture of coralline HA granules with homologous fibrin glue provides reliable bone regeneration, thus reducing failures and minimizing risks of postoperative morbidity.

*Studio Medico Associato Marini Messina, via Salaria, Rome, Italy

University Vasile Goldis of Arad, Arad, Romania

Carroll Laboratory for Orthopedic Surgery, Columbia University

§DSO Bone Research Center, New York, NY.

Address correspondence and reprint requests to Antonello Maria Messina, DDS, Via Salaria 394/b, Rome 00199, Italy; E-mail:

Received 14 February, 2018

Accepted 27 July, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.