Comparison of bone grafting materials in human extraction sockets: Clinical, histologic, and histomorphometric evaluations

PURPOSE:: Although there are a number of bone replacement graft materials that are currently available for clinical use, there are few studies that directly compare efficacy among graft treatments before implant placement. The purpose of this report was to compare 3 bone replacement graft materials (PepGen P-15 228 FLOW [DENTSPLY Friadent CeraMed, Lakewood, CO], Puros® [Zimmer Dental, Carlsbad, CA], and C-Graft 228 [Clinicianĝ€™s Preference, Golden, CO]) for bone formation by clinical, histologic, and histomorphometric evaluation. MATERIALS AND METHODS:: In this prospective, intraoral pilot study, 13 maxillary sockets in 2 patients (both smokers) were grafted immediately after tooth extraction with C-Graft 228, Puros®, or PepGen P-15 228 FLOW (containing additional PepGen P-15 228 particles; FLOW PUTTY). After 4 months, bone cores were retrieved and analyzed histologically. RESULTS:: PepGen P-15 228 FLOW PUTTY produced a significantly (P <0.01) higher amount of vital bone than C-Graft 228 or Puros®. The amount of vital bone for FLOW PUTTY was 12-fold higher than for C-Graft 228 and 4-fold higher than Puros®. Of 7 FLOW PUTTY treated sites, 7 showed >14% vital bone versus 0 of 3 C-Graft 228 and 0 of 3 Puros® treated sites. FLOW PUTTY treated sites showed new vital bone between particles of residual graft. C-Graft 228 treated sites showed residual particles in a background of connective tissue with very little bone. Puros® treated sites showed nonvital bone particles in a background of connective tissue, with some new vital bone forming around the nonvital bone. CONCLUSION:: PepGen P-15 228 FLOW PUTTY produced significantly greater vital bone as compared to Puros® and C-Graft 228 after 4 months. A larger clinical study is required to confirm these results.