Histological and Histomorphometric Evaluation of a Silicate-Substituted β-Tricalcium Phosphate Putty in Alveolar Ridge Preservation: A Case Report With 3-Year Follow-Up
Abstract
Silicate-substituted calcium phosphates have emerged as a promising class of bone graft substitutes in hard tissue engineering, with preclinical studies demonstrating enhanced osteoconductive and osteoinductive properties. However, their biological performance and bone regenerative potential in oral surgery and implantology remain poorly documented, with quantitative histomorphometric data lacking. This case report describes the histological and histomorphometric outcomes after using a novel silicate-substituted β-tricalcium phosphate (β-TCP) putty alloplast for alveolar ridge preservation (ARP) after extraction of a mandibular first molar. Healing was uneventful, and at six months postoperatively, clinical and radiographic evaluation showed sufficient hard and soft tissue volume, allowing precise prosthetically driven implant placement without additional bone augmentation. We obtained a core bone biopsy at the time of implant placement. Histological findings demonstrated pronounced regeneration of vital bone and advanced graft resorption, while histomorphometric evaluation revealed 45.8% newly formed bone, 5.4% residual graft material, and the remaining fraction consisting of connective tissue. At 3-year follow-up, radiographic evaluation showed no apparent peri-implant bone loss, with radiographic changes consistent with ongoing bone remodeling around the loaded implant. To the authors’ knowledge, this is the first report providing human histological and histomorphometric evidence of a silicate-substituted β-TCP putty used for ARP in implant dentistry. Additionally, a customized anatomical healing abutment fitted at implant placement facilitated favorable peri-implant soft tissue conditioning. Within the limitations of a single case, this bone substitute showed promising bone-regenerative potential, supporting further investigation in oral surgery and implantology.