Dental Asia March/April 2023

CLINICAL FEATURE
Next generation synthetic
graft materials: Clinical and
scientific review
Prof Dr Peter JM Fairbairn elaborates on the use of synthetic graft material in
dentoalveolar bone regeneration.
In the last 20 years, there has been a
dramatic increase in the use and research in
new synthetic or alloplastic particulate graft
materials (Fig. A) as seen in the author’s own 2
and other 1 research. Interest in synthetic
graft materials all started in 1892 when
Dreesman first used calcium sulphate (CS) in
femur fracture repair. This is where the bulk
of the work and research is still being done
today by our medical colleagues.
In this article, we will look at its dentoalveolar
use where the author has done over 7500
grafts in a 22-year period. There are many
different synthetic materials used as
particulates; initially CS was used but now
the most popular material is beta-tricalcium
phosphate (BTcP) with over 300 new papers
per annum in research. Whilst there are
many other materials such as hydroxyapatite
(HA), silicates and polylactides, most of the
work done by the author has been with the
first two materials i.e., CS and BTcP, which we
will concentrate on here.
effect. The CS then resorbs at three to four
weeks, and this creates space for further
neovascular ingrowth resulting in improved
angiogenesis. But the BTcP is the main
reason for the up-regulated host healing. The
shape size and porosity of the particles is of
great importance as seen in the work of De
Groot in 1985. This dramatic up-regulation
of host healing is noted by measuring
osteoprotegerin (OPG) in research 7 .
Our studies, both animal 5 and clinical 6 have
shown over 50% new bone at 10 weeks with
only 10-12% residual graft material. It is also
well documented that all calcium phosphate
materials have an osteoinductive potential
with BTcP showing greatest potential of
them all.
The stability given to the graft by the CS
element changing from a hemihydrate
to a dihydrate form enables it to be used
without membrane hence the term “true
bone regeneration”, optimising the immense
benefits of the periosteum, as well as the
blood supply it brings.
The next thing was to develop predictable
protocols for these materials to enable 99%
success in outcomes and to assess the longerterm
results which are again stable as the
material has been turned over to the host
bone. These materials are used in all aspects of
dentoalveolar surgery, socket grafting, buccal
defect repair, sinus augmentation, periodontal
bone repair, peri-implantitis bone repair, cyst
site repair and more.
In 2012, work was done on the development
of similar but improved material, EthOss
(65% BTcP and 35% CS) (EthOss Regeneration
Silsden, UK) which has better handling
properties. A 10-year study of 600 grafts
using these two materials was published in
2015 4 .
The key in both materials is the BTcP element
as the CS only provides a short transitory
role of stabilising the material and providing
the barrier function as well as improving the
soft tissue healing and having a bacteriostatic
Fig. A
26 DENTAL ASIA MARCH / APRIL 2023