Practical Application of the Newly Introduced Natural Bone Regeneration (NBR) Concept Utilizing Alloplastic Putty

Abstract

Background: The most frequent odontogenic cyst is the radicular or periapical cyst. Enucleation is the treatment of choice for radicular cysts that do not interfere with anatomical landmarks. Though large mandibular cysts exhibit spontaneous bone regeneration, the rate of bone in-growth is not adequate for a near-term implant placement. The case presented evaluates bone regeneration of a calcium phosphosilicate putty (NovaBone Dental Putty, NovaBone Products, Alachua, Florida) (NB Putty) when used to restore a large cystic defect in conjunction with platelet rich fibrin (PRF). Materials and methods: The patient, a 55-year-old patient presented with dull pain and tooth mobility in the mandibular right premolar area. Clinical examination of the area revealed attachment loss of 13 mm and 10 mm on the buccal and 11 mm and 10 mm on the lingual side of the right canine and first premolar respectively (Fig. 1). Grade 3 mobility was also recorded for the affected teeth. Preoperative Cone Beam CT (CBCT) revealed a large radiolucency in the apical area of the involved tooth indicative of a periapical cyst. The teeth were extracted and the large defect was restored with NB putty and covered with a PRF membrane that was created from patients serum. The area was evaluated at 3, 5, and 7 months postoperatively. Results: The healing proceeded uneventfully and the ridge width and height remained stabled during the evaluation period. Seven months CBCT showed good bone regeneration in the defect area. The buccal plate was completely regenerated while the crestal plate was still remodeling. The ridge was adequate enough to place a 4.3 mm × 11 mm implant. Conclusion: NB Putty in combination with PRF membrane can be recommended to regenerate cystic defects. However larger, longer term controlled studies are further suggested.