Volume No:

8, Issue No: 1

ISSN No: 2582-0559

ALLOPLASTIC PUTTY BONE GRAFT- A SHORT REVIEW

Dr. Nisha Mary Jose, Dr. Ashok Kumar. S, Dr. Jaideep Mahendra, Dr. Abirami Nayaki Rao.P

Department of Periodontology, Faculty of Dentistry

Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research,

Alapakkam Main Road, Chennai, Tamilnadu, India

Address for Correspondence:

Dr. S. Ashok Kumar, MDS.,

Associate Professor, Department of Periodontology,

Faculty of Dentistry, Meenakshi Ammal Dental College

and Hospital,

Meenakshi Academy of Higher Education and Research,

Alapakkam Main Road, Chennai, Tamilnadu, India

Email id: drashok.perio@madch.edu.in

ABSTRACT

The shift in therapeutic concepts from resection to

regeneration has influenced the advancement in grafting materials.
The enormous progress in the field of biomaterial science, the risk
of infectious diseases transmission and finally, efforts to reduce
morbidity and cost has led research into the development of a
variety of synthetic graft materials as alternatives. Synthetic bone
grafts have been shown to produce greater clinical bone defect fill
as a bone graft substitute.

KEYWORDS:

Alloplastic Bone graft, Guided bone regeneration

Received:

16.02.2021 First Published

15.03.2021

Accepted:

14.03.2021

Published:

27.03.2021

SHORT COMMUNICATION

DOI:1.37841/jidam_2021_V8_I1_08

Nisha et al: Alloplastic Putty Bone Graft

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

INTRODUCTION:

  Healing  of  bone  is  a  multifactorial  and  complex
process. With the current revolution in biotechnology and
tissue engineering, the number of options for bone grafting
have continued to grow. Factors such as type of graft, site
of  preparation,  mechanical  strength,  vascularity  and  pore
size  of  the  material  are  involved  in  the  successful
incorporation of a grafted material. New developments in
material  science  offers  a  range  of  synthetic  replacements
for natural grafts.

BONE GRAFT CHARACTERISTICS:



Osteoinduction - ability of the graft to recruit and
induce mesenchymal stem cells to differentiate
into mature bone-forming cells.



Osteoconduction - cellular invasion of the graft.



Osteointegration - functional integration of the
graft with the host tissue through new bone
formation.



Osteogenesis

recruitment

osteoblast

precursors and growth factors at sites of
augmentation.

  Synthetic grafting materials or alloplastic materials are
shown to possess characteristics such as osteoconduction
and  osteointegration.  The  ideal  synthetic  graft  material
should  be  biocompatible,  support  new  bone  growth  and
undergo  remodelling.  Modulus  of  elasticity,  toughness,
and  compressive  strength  compared  with  host  cortical  or
cancellous bone are the other features of a bone graft. The
most  common  alloplastic  materials  are  tricalcium
phosphates(TCP),  bioactive  glass,  hydroxyapatite(HA)
and dicalcium phosphates.

PUTTY BONE GRAFT:

Various

studies

have

reported

the

superior

manageability, hemostatic and osteoconductive properties
of bioactive glass and may act to retard epithelial down-
growth. NovaBone

Dental Putty in Syringe* is a new,

next  generation  calcium-phosphosilicate  (CPS)  bone
graft material based on NB’s bioengineered technology
platform  that  offers  enhanced  handling  characteristics
with  unparalleled  performance.

CPS bone graft material

is  built  from  a  bioactive  glass  with  additives  like
polyethylene  glycol  (PEG)  and  glycerin  to  improve
handling  and  efficacy.  The  particulate  and  binder  are
provided  premixed  as  a  pliable  cohesive  material.  On
implantation,  the  binder  is  absorbed  to  permit  tissue
infiltration between the bioglass particles. The particles are
slowly  absorbed  and  replaced  by  new  bone  tissue  during
the  healing  process.  This  osteostimulation  results  in  new

bone formation throughout the grafted site at rates faster
than those seen with other synthetics.

*NovaBone

Dental Putty in Syringe (NovaBone

Products, LLC)

Built on a CPS platform, NB putty demonstrates
superior performance characteristics that are a result of
multiple

physical

and

chemical

interactions:

Osteostimulation is an active process, and CPS dental putty
acts as a bone matrix and encourages differentiation of new
bone cells at the site.

Putty has been approved by Food and Drug

Administration and CE dental indications in 2007. It was
the first synthetic putty that required no handling or
manipulation and the first to be available in a significantly
simplified

cartridge

delivery

system.

Calcium

phosphosilicate putty minimizes graft wastage and reduces
chair-side  time.  Unlike  other  synthetic  grafts  that  are
bioinert,  CPS  putty  belongs  to  the  class  of  bioactive
regenerative  materials  that  not  only  act  as  an
osteoconductive  scaffold  but  also  interacts  with  the
surrounding tissues and imparts an osteostimulatory effect.
The viability and proliferation potential of osteoblasts has
been  shown  to  be  exemplified  in  the  presence  of  CPS
particles.  These  CPS  particles  contain  an  increased
osteocalcin  and  alkaline  phosphatase  levels  providing  a
favourable site for bone formation

(Figure 1 and 2).

Figure 1: Novabone putty bone graft in syringe

Nisha et al: Alloplastic Putty Bone Graft

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

Figure 2: Easy adaptation of bone graft into the defect
site

COMPOSITION:

The CPS putty is composed of a bimodal particle

distribution  of  CPS  (active  ingredient),  with  PEG  as  an
additive  and  glycerine  as  the  binder.  The  volume  of  the
active ingredient is approximately 70%. The components
are premixed, and the putty is delivered in a ready-to-use
state.  Both  PEG  and  glycerin  are  water  soluble  and  are
engineered to be absorbed from the site in 3 to 5 days. The
putty is tan in colour after sterilization.

ADVANTAGES OF THE CPS PUTTY:



Ideal for minimally invasive surgeries, hard to
access defects, immediate implant surgeries,
osteotome sinus surgeries, etc.



Unique to CPS putty, osteostimulation increases
the rate of bone formation.



Putty will not washout from the graft site during
irrigation and suction.



During manipulation CPS putty does not adhere
to surgical gloves or instruments.



CPS putty has no risk of antigenic response or
disease transmission.



CPS putty appears radiodense on the radiograph.



It is stable at room temperatures (25°C) and does
not require any refrigeration.

APPLICATION IN PERIODONTICS:



Immediate implant surgeries



Ridge augmentation



Sinus elevation



Cystic defect



Fenestration and dehiscence defect

FATE OF CPS PUTTY GRAFT:

Upon implantation, clinically the binder gets absorbed

within 24 to 72 hours creating a three-dimensional porous
scaffold  that  facilitates  active  movement  of  blood  and
tissue fluids through the matrix. There is an initial burst of
calcium  and  phosphate  ions,  which  is  provided  by  the
interaction  of  small  CPS  particles  with  blood.  Numerous
calcium  phosphate  nodules  are  formed  due  to  this
interaction  that  mature  individually  to  form  bone
throughout  the  defect.  Subsequently,  the  larger  particles
react and continue the process of bone regeneration. Bone
density analysis suggests that there is a steady increase in
bone density for 6 months.

CONCLUSION:

Modalities of treatment that involve less invasive,

more reproducible and less technique sensitive procedures
and biomaterials are needed. New developments towards a
more individualized and personalized bone regeneration
therapy are being evolved.

FINANCIAL SUPPORT AND SPONSORSHIP

Nil

CONFLICTS OF INTEREST

There are no conflicts of interest.

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