GBR in Human Extraction Sockets and Ridge Defects Prior to Implant Placement: Clinical Results and Histologic Evidence of Osteoblastic and Osteoclastic Activities in DFDBA

This study evaluated new bone formation in 3 types of osseous defects following treatment with demineralized freeze-dried bone allografts (DFDBA) and cell-occlusive membranes. For 8 patients electing to receive implant treatment, a distinction was made among 3 clinical situations: (1) existing alveolar ridge defects; (2) extraction sockets with lost buccal plate; and (3) extraction sockets with an intact alveolus. Implants were placed a mean of 6 months after the regenerative procedure. Clinical examination of bone width and height at the time of implant placement showed sufficient augmentation or preservation, and implants were inserted without incident. Histologic examination of hard tissue biopsies obtained from the implant sites revealed no discernible differences among the 3 types of defects. Specifically, all sites demonstrated DFDBA particles surrounded by woven or lamellar bone. No fibrous encapsulation of DFDBA or inflammatory reaction was observed. Osteoblasts were found lining marrow spaces. Howeship's lacunae, with and without resident osteoclasts, were clearly seen in several DFDBA particles; this finding supports the belief that DFDBA undergoes osteoclasis in vivo. These results demonstrate that commercially available DFDBA has osteoconductive properties that lead to appositional new bone growth in both self-contained and non-self contained osseous defects.