Effect of sandwich bone augmentation using hydroxyapatite and demineralized freeze- dried bone on infrabony pocket treatment


Eka Pramudita Ramadhany(1), Al Sri Koes Soesilowati(2), Sri Pramestri Lastianny(3*)

(1) School of Dentistry, Faculty of Medicine, Udayana University, Bali Periodontics Specialty Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(2) Departement of Periodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(3) Departement of Periodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author


Periodontitis is periodontal inflammation in response to plaque bacterial antigens, causing damage to periodontal ligament and alveolar bone resorption. Bone graft material combination i.e. demineralized freeze-dried bone allograft (DFDBA) and hydroxyapatite (HA) using sandwich bone augmentation (SBA) method will support each other and will be beneficial to be used as a scaffold. The body takes long time to resorb HA so this could complement DFDBA which is more easily dissolved. This study aimed to reveal the effect of bone graft addition using SBA method on the treatment of infrabony pocket with open flap debridement in terms of probing depth, relative attachment loss, alveolar bone height, and density. This study was carried out to 20 infrabony pockets, where 10 of them were treated using open flap debridement with HA addition, while the other 10 groups were treated using open flap debridement with DFDBA and HA using SBA method. Probing depth  and relative attachment loss were measured on days 0, 30 and 90. Bone height and density were measured using cone-beam computed tomography (images on day 0 and 90). The study showed that probing depth reduction on SBA group was greater than HA group. There were significant differences in probing depth and relative attachment loss examinations. However, bone height and bone density reduction did not show any significant difference. The conclusion from this study is open flap debridement using SBA method yields better regeneration in terms of probing depth and relative attachment loss than open flap debridement with HA addition. There is no difference in bone height and bone density between the two groups.


bone graft; infrabony pocket; sandwich bone augmentation

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1. Kesic L, Milasin J, Igic M, Obradovic R. Microbial etiology of periodontal disease – mini review. Medicine and Biology. 2018; 15(1): 1-6.

2. Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza’s clinical periodontology, 11th ed. St. Louis Missouri: Saunders Elsevier; 2012. 127-139.

3. Bartold PM, Gronthos S, Ivanovski S, Fisher A, Hutmacher DW. Tissue engineered periodontal products. J Periodont Res. 2016; 51(1): 1–15. doi: 10.1111/jre.12275

4. Urban IA, Lozada JL, Wessing B, SuarezLopez del Almo F, Wang HL. Vertical bone grafting and periosteal vertical mattress suture for the fixation of resorbable membranes and stabilization of particulate grafts in horizontal guided bone regeneration to achieve more predictable results: a technical report. Int J Periodontics Restorative Dent. 2016; 36(2): 152-159. doi:10.11607/prd.2627

5. Wang HL, Misch C, Neiva RF. “Sandwich” bone augmentation tehnique: rationale and report of pilot cases. Int J Periodontics Restorative Dent. 2004; 24(3): 233-245.

6. Pellegrini G, Pagni G, Rasperini G. Surgical approaches based on biological objective: GTR versus GBR techniques. Int J Dent. 2013; 521547:1-13. doi: 10.1155/2013/521547

7. Giele H, Cassel O. Plastic and reconstructive surgery. Spesialist handbook in surgery. Oxford; 2008.

8. Groeneveld EH, Burger EH. Bone morphogenetic proteins in human bone regeneration. Eur Journal of Endocrinology. 2000; 142(1): 9-21.

9. Dumitrescu AL. Bone grafts and bone graft substitutes in periodontal therapy. Chemicals in Surgical Periodontal Therapy; 2011. 73-144.

10. Bender SA, Rogalski JB, Mills MP, Arnold RM, Cochran DL, Mellonig JT. Evaluation of demineralized bone matrix paste and putty in periodontal intraosseous defects. J Periodontol. 2005; 76(5): 768–777. doi: 10.1902/jop.2005.76.5.768

11. Boyan BD, Ranly DM, Schwartz Z. Use of growth factors to modify osteoinductivity of demineralized bone allografts: lessons for tissue engineering of bone. Dent Clin North Am. 2006; 50(2): 217–228. doi: 10.1016/j.cden.2005.11.007

12. Smith PC, Cacares M, Martinez C, Oyazun A, Martinez J. Gingival wound healing: an essential response disturbed by aging. J Dent Res. 2015; 94(3): 395-402. doi: 10.1177/0022034514563750

13. Hallman M, Lundgren S, Seneby L. Histologic analysis of clinical biopsies taken 6 months and 3 years after maxillary sinus floor augmentation with 80% bovine hydroxyapatite and 20% autogenous bone mixed with fibrin glue. Clint Implant Dent Relat Res. 2001; 3(2): 87-96.

14. Reynolds MA, Aichelmann, Branch GL. Regeneration of periodontal tissue: bone replacement grafts. Dent Clin North Am. 2010; 54(1): 55-71. doi: 10.1016/j.cden.2009.09.003.

15. Wood RA, Mealey BL. Histologocal comparison id healing following tooth extraction with ridge preservation using mineralized vs demineralized freeze dried bone allograft. J Periodontol. 2012; 83(3): 329-336. doi: 10.1902/jop.2011.110270.

DOI: https://doi.org/10.22146/majkedgiind.37427

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