The shift in therapeutic concepts from resection to regeneration has significantly changed the practice of periodontologly in recent years. Under the assumption that proper use and manipulation of bone replacement grafts can alter the biologic response from a regenerative to a reparative pattern, a robust interest and demand for bone replacement grafts with forementioned biologic potential have grown significantly. Also, the introduction and acceptance of dental implants as a predictable treatment modality has created new indications for the use of bone replacement grafts eventually resulting in increased demand and search for products with higher quality and superior biologic compatibility.

Various graft materials including autogenous, allogeneic, xenogeneic and alloplastic bone graft materials have been used in preserving the alveolar ridge following tooth extraction1). Autogenous bone, still considered the gold standard in bone grafting has been used with some success. Albeit the excellent biologic properties, limitations exist in availability, patient morbidity, increased chair time and irregular resorption rate. Allogeneic bone obtained from a different human source provides an alternative to autogenous bone, but the fear of disease transmission persists despite evidence to the contrary. This concern has driven the market to produce biocompatible alternatives to allogeneic bone.

In particular, a deprotenized bovine bone mineral has been extensively studied and is currently well accepted clinically by the majority of users involved in clinical dentistry2,3). However, despite heat treatment and prophylactic measures during processing to prevent disease transmission, safety concerns still remain especially with the discovery of bovine spongiform encephalopathy4). The controversy regarding this epidemic event remains unsolved though many attempts have been made to draw a definitive conclusion. A need for a complete disease transmission free donor has propagated research and development of a bone replacement graft from sources other than bovine origin. The objective of this clinical report was to observe both clinically and histologically, the biocompatibility and physical properties of a horse-derived bone biomaterial.

A horse-derived biomaterial was used in 8 patients admitted to Seoul National University, Department of Periodontology for different indications including socket preservation following tooth extraction, osseous bone grafting, and sinus augmentation procedure. Surgeries were performed by a well trained specialist. Clinical radiographs were obtained at different intervals while core biopsies of 2×8 mm were acquired prior to implant placement. This protocol was approved by the Institutional Review Board at Seoul National University Dental Hospital.(CDE 09002)

Eight patients with different indications were subjected to various procedures that involved the use of a horse derived bone substitue. Throughout the observation period of the successive surgeries that were performed, no signs of adverse effect or infection was obeserved both clinically and radiographically. Uneventful healing was observed in most of the cases except for one case with membrane exposure that eventually resulted with a positive outcome. Radiographic anlysis of the surgical sites showed increased radiopacity of granular nature as the healing time increased. Clinically, the biomaterial seemed well-tolerated with good intentional healing and harmony with the native surrounding tissues. Excellent ridge contour maintenance was observed both clinically and radiographically. The augmented sinuses healed uneventfully suggesting in part, good biocompatibility of the biomaterial. Dental implants placed following socket preservation were inserted with high initial torque suggesting good initial stability and bone quality. Histologic observations at 4-6 months healing intervals revealed new bone formation throughout the grafted defect. New bone formation extending to the coronal part of the defect showed appearance of mature bone with even continuity with the graft material. Also, appearance of full integration between the grafted bone and newly formed bone was observed.

Our results show that at least on a tentative level, a horse-derived biomaterial may be used clinically in socket preservation, sinus augmentation, bone grafting techniques with good intentional healing and positive results.