Eggshell derived hydroxyapatite as bone graft substitute in the healing of maxillary cystic bone defects: a preliminary report

Abstract

Background: Since ancient times, use of graft materials to promote healing of defects of bone is wellknown. Traditionally, missing bone is replaced with material from either patient or donor. Multiple sources of bone grafts have been used to graft bone defects to stimulate bone healing. Hydroxyapatite is naturally occurring mineral component of bone, which is osteoconductive. This versatile biomaterial is derived from many sources. The aim of this study is to evaluate the efficacy of eggshell derived hydroxyapatite (EHA) in the bone regeneration of human maxillary cystic bone defects secondary to cystic removal/apicoectomy and compare the material properties of EHA in vitro.

Materials and methods: A total of eight maxillary bone defects were grafted after cystic enucleation and/or apicoectomy in the year 2008 and completed the study at 1 year. The patients were followed-up 2 weeks after surgery for signs and symptoms of infection or any other complications that may have been related to surgical procedure. Follow-up radiographs were obtained immediately after surgery followed by 1, 2, and 3 months to assess the efficacy of EHA in bone healing. Physicochemical characterization of the EHA was carried out in comparison with synthetic hydroxyapatite (SHA), also compared the biocompatibility of EHA using in vitro cytotoxicity test.

Results: By the end of the 8(th) week, the defects grafted with EHA showed complete bone formation. However, bone formation in non-grafted sites was insignificant. The values of density measurements were equal or more than that of surrounding normal bone. These results indicate that the osseous regeneration of the bone defect filled with EHA is significant. EHA showed the superior material properties in comparison with SHA.

Conclusion: EHA is a versatile novel bone graft substitute that yielded promising results. Because of its biocompatibility, lack of disease transfer risks, ease of use and unlimited availability, EHA remains a viable choice as regenerative material. EHA is very cost-effective, efficient bone graft substitute, which can be prepared in a very economical way. It is a worthwhile bone substitute because it is safe and easily available material. How to cite the article: Kattimani VS, Chakravarthi PS, Kanumuru NR, Subbarao VV, Sidharthan A, Kumar TS, Prasad LK. Eggshell derived hydroxyapatite as bone graft substitute in the healing of maxillary cystic bone defects: A preliminary report. J Int Oral Health 2014;6(3):15-9.

Keywords: Bone regeneration; bone substitute; eggshell derived hydroxyapatite; hen's eggshell; hydroxyapatite; osteoconductivity; synthetic hydroxyapatite.

Figure 1: Schematic diagram showing radiological evaluation of surgical site outline.

Figure 2: Schematic diagram showing radiological evaluation of bone formation characteristics.

Figure 3: Graph showing measurements of mean bone density at 1st week, 1st month, 2nd month, and 3rd month.

Figure 4: Intraoral periapiacal radiographs showing radiological evaluation of surgical site outline and bone formation characteristics