Hindawi Publishing Corporation

BioMed Research International

Volume 2014, Article ID 320790, 9 pages
http://dx.doi.org/10.1155/2014/320790

Research Article
Physicochemical Characteristics of Bone Substitutes Used in
Oral Surgery in Comparison to Autogenous Bone

Antoine Berberi,1 Antoine Samarani,2 Nabih Nader,1 Ziad Noujeim,1

Maroun Dagher,3 Wasfi Kanj,1 Rita Mearawi,1 Ziad Salemeh,1 and Bassam Badran2
1
School of Dentistry, Lebanese University, P.O. Box 4, Hadath, Lebanon
2
Ecole Doctorale, PRASE, Lebanese University, P.O. Box 4, Hadath, Lebanon
3
Faculty of Dental Medicine, Saint Joseph University, P.O. Box 17-5208, Beirut, Lebanon

Correspondence should be addressed to Antoine Berberi; [email protected]

Received 11 May 2014; Accepted 8 June 2014; Published 8 July 2014

Academic Editor: David M. Dohan Ehrenfest

Copyright © 2014 Antoine Berberi et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bone substitutes used in oral surgery include allografts, xenografts, and synthetic materials that are frequently used to compensate
bone loss or to reinforce repaired bone, but little is currently known about their physicochemical characteristics. The aim of
this study was to evaluate a number of physical and chemical properties in a variety of granulated mineral-based biomaterials
used in dentistry and to compare them with those of autogenous bone. Autogenous bone and eight commercial biomaterials of
human, bovine, and synthetic origins were studied by high-resolution X-ray diffraction, atomic absorption spectrometry, and
laser diffraction to determine their chemical composition, calcium release concentration, crystallinity, and granulation size. The
highest calcium release concentration was 24. 94 mg/g for Puros and the lowest one was 2.83 mg/g for Ingenios 𝛽-TCP compared
to 20.15 mg/g for natural bone. The range of particles sizes, in terms of median size D50, varied between 1.32 𝜇m for BioOss and
902.41 𝜇m for OsteoSponge, compared to 282.1 𝜇m for natural bone. All samples displayed a similar hexagonal shape as bone,
except Ingenios 𝛽-TCP, Macrobone, and OsteoSponge, which showed rhomboid and triclinic shapes, respectively. Commercial
bone substitutes significantly differ in terms of calcium concentration, particle size, and crystallinity, which may affect their in vivo
performance.

1. Introduction Autogenous bone is osteogenic (cells within a donor graft

synthesize new bone at implantation sites), osteoinductive
Bone is a living tissue that serves for structural support and (new bone is formed by active recruitment of host mesenchy-
calcium metabolism. Bone matrix is organic and consists of a mal stem cells from surrounding tissue, which differentiate
network of collagen protein fibers impregnated with mineral into bone-forming osteoblasts), osteoconductive (vascular-
salts (85% of calcium phosphate, 10% of calcium carbonate,
ization and new bone formation into the transplant), and
and 5% of calcium fluoride and magnesium fluoride). The
highly biocompatible [3, 4]. These characteristics should be
mineral compartment of bone is predominantly present in
present in an ideal substitute and all bone grafting materials
the form of calcium hydroxyapatites (Ca10 [PO4 ]6 [OH]2 ).
Bone tissue also contains negligible quantities of noncollagen can be classified according to these characteristics [5].
proteins, including the family of bone morphogenetic pro- Bone substitutes (BS) are frequently used in oral and
teins (BMPs) [1]. maxillofacial surgery, periodontics, and orthopedics. They
Calcium (Ca) plays an important role in osteoconductiv- include inorganic or organic, natural or synthetic materials to
ity and may enhance bone tissue integration by entrapping compensate for bone loss or to reinforce new bone ingrowth
and concentrating circulating bone growth factors (BMPs) into defect sites [6–17]. This second option is, in fact, the role
and osteoprogenitor cells, thus imparting osteoinductive played by calcium phosphate and constitutes materials that
properties to calcium-based bone graft materials [2, 3]. show the closet similarity to the mineral component of bone
2 BioMed Research International

[14]. The greatest success in bone grafting has been achieved used for dental applications as bone substitutes and to
with autogenous bone (gold standard), which fulfills all compare them with autogenous bone.
essential physicochemical and biological properties needed
in a bone graft material, despite its inherent limitations in 2. Materials and Methods
availability and postoperative pain at donor sites [6, 8, 10, 11,
13, 18–20]. This study evaluated the physicochemical characteristics of
Numerous BS biomaterials have been successfully used, the eight commercially available bone substitutes of human,
such as allografts (human), xenografts (porcine, equine, bovine, and synthetic origins. Each material was used in
or bovine, and synthetic calcium-based materials (cal- its lowest available particle size range, and all samples were
cium phosphates [𝛽-tricalcium phosphate/𝛽-TCP, hydrox- obtained directly from their manufacturers in sealed vials and
yapatite/HA], bioactive glasses), calcium sulfate, calcium evaluated without alteration.
hydroxide), and a combination of these with or without the
use of membrane and screws [6–23]. (i) DynaBlast (Keystone Dental, Inc., Burlington, MA) is
a combination of mineralized and demineralized allo-
Allografts do not have the drawbacks of autografts but are
genic bone that is mixed with a proprietary poloxamer
less successful in clinical practice. They also display several
reverse-phase resorbable medium and processed into
other disadvantages: risk of disease transmission or infec-
a paste or puttylike form [28, 36].
tion, difficulties in obtaining and processing, possible rapid
resorption, [8–10, 24], and partial loss of mechanical strength (ii) Puros bone allograft (Zimmer Dental, Inc., Carls-
after sterilization [25, 26]. Xenogenic bone substitutes of bad, CA) is an allogenic graft material treated by a
porcine, bovine, or, more recently, equine origin are used proprietary process (Tutoplast, RTI Biologics, Inc.,
because of their chemical and structural composition simi- Alachua, FL) designed to inactivate pathogens and
larity when compared to human bone [27]. They represent remove fat, cells, and antigens, while preserving the
an unlimited supply of available material and may reduce minerals and collagen matrix of the native bone
morbidity by eliminating the donor site [5, 10, 22, 23]. Heat or tissue. After processing, the material is preserved by
other treatments are used to deproteinate bone particles and solvent dehydration, which can also help to ensure
eliminate immunogenicity risks [25, 28]. Synthetic calcium pathogen inactivation [13]. It is available in cortical,
phosphate ceramics with their excellent biocompatibility are cancellous, and a cortical-cancellous mix in particle
common alternatives to autogenous bone [15]. sizes ranging from 0.25 to 2 mm [26, 37].
Ideally, a BS should have specific biological and clinical (iii) OsteoSponge allograft (Bacterin International, Inc.,
particularities. Biologically, it should mediate recruitment of Belgrade, MT) consists of 100% of demineralized
mesenchymal cells derived from host site and have bioactive human cancellous bone, with no additional carrier
effects on ossification (osteoinduction). Furthermore, it must materials. It is prepared using undisclosed methods
be osteoconductive, providing three-dimensional scaffolds that reportedly preserve native growth factors [25].
for the ingrowth of vessels and osteoprogenitor cells. Finally, The granule size varies from 1 to 4 mm.
it should be resorbable. Clinically, a BS should be easy to (iv) BioOss (Geistlich Pharma AG, Wolhusen, Switzer-
use, cost effective, and with adequate density to allow easy land) xenogenic spongiosa granules are reported to
radiographic recognition during the entire healing process be a natural bone mineral derived from bovine bone
[27, 29]. This feature is particularly important to radiograph- which contain carbonate apatite. Granules are ren-
ically follow the rate of resorption/substitution [30, 31]. dered nonorganic through a proprietary extraction
Regarding material structure, particle size affects not only process that involves treatment with strong alkalis and
contact area but also the packing characteristics of the mate- organic solvents under high-temperature processing
rials, which ultimately determines the macroporosity of a up to 300∘ C, which allegedly renders the substrate
particulate graft [32, 33]. It is also known that pore size exerts antigenic and protein-free [37]. The material was used
a major influence over the interaction of osteogenic cells in granules of 0.25–1 mm.
with the biomaterial surface [34, 35]. Biological integration
requires pores that are greater than 100–150 mm in diameter (v) Cerabone (AAP Biomaterials GmbH, Berlin, Ger-
to provide a blood supply to the tissues [27]. A BS should many) xenogenic granulate is a bovine bone material
gradually degrade with time until it is completely replaced sintered at high temperature (>1200∘ C), which retains
with vital new bone tissue. Moreover, a material’s resorption the inorganic part of bone (hydroxyapatite) [38]. The
rate should match the formation rate of the new bone tissue material used was granulate of 0.5–1.0 mm in size.
[29]. Biomaterial degradation that occurs too rapidly can (vi) Macrobone (Euroteknika Groupe, Sallanches,
exert a negative effect on bone regeneration processes, [24] France) is a high-porosity (90%), synthetic bone sub-
and the presence of residual BS graft particles after bone stitute made of pure 𝛽-TCP that is completely and
healing may lead to composite tissue repair rather than to rapidly resorbable [39]. Particle size varies between
bone tissue regeneration [27]. 0.15 mm and 2 mm.
The aim of this study was to evaluate some of physical (vii) IngeniOs 𝛽-TCP (Zimmer Dental, Inc.) is a bioactive
and chemical properties in a variety of commercially available material made of silicated 𝛽-TCP of non-biologic ori-
granulated mineral-based biomaterials that are frequently gin. The structure is a porous biocompatible synthetic
BioMed Research International 3

scaffold of ceramic material [40]. The size of the par- orthogonal direction to the crystal plane according to the
ticles is 0.25–1 mm. following formula:
(viii) IngeniOs HA (Zimmer Dental Inc.) is a synthetic
spongious bone substitute. The structure is a porous 0.9𝜆
𝑋𝑠 = , (1)
scaffold that resembles cancellous bone. Particles (FWHM × cos 𝜃)
are biocompatible and made of 100% hydroxyapatite
ceramic with a putty phase of ≥95%, and granules where 𝑋𝑠 is the crystallite size in nanometer, 𝜆 is the
range 1-2 mm in size [41]. wavelength of X-ray beam in nanometer (𝜆 = 0.15406 nm in
our case), and FWHM is the full width at half maximum for
(ix) Autogenous bone samples were collected during
the diffraction angle at 2𝜃 = 25.9∘ that was selected according
mandibular third-molar surgery, rinsed with ethanol,
to (002) Miller’s plane family [47].
dried in vacuum at room temperature, ground in
an agate mortar, and sterilized by gamma irradiation
[42, 43]. 3. Results
Atomic Absorption Spectroscopy (AAS) (WFX-210, Ray- AAS results of calcium concentration over the observation
Leigh, BRAIC, China) was used to determine the concentra- period are summarized in Table 1. Cerabone showed less
tion of calcium ions in the bone substitutes by quantifying the calcium release than BioOss. In the synthetic xenograft
release of calcium and phosphorous from the graft material category, Macrobone displayed a high calcium release
in demineralized water. For this aim, standards for calcium concentration (17.30 mg/g), compared to IngeniOs HA
and phosphorous within the range between 0.5 and 10 𝜇g/L (2.92 mg/g) and IngeniOs 𝛽-TCP (2.83 mg/g). In the allograft
were prepared, and 0.4 mg of each biomaterial (all nine group, OsteoSponge revealed the lowest calcium release
samples) was immersed in 100 mL of 0.9% NaCl and the pH concentration (4.05 mg/g). The calcium concentration of
was adjusted at 7 by using hydrochloric acid (0.1 N). The Puros (24.94 mg/g) was comparable to autogenous bone
variation of Ca concentration was determined at D0 (day 0), (20.15 mg/g).
D2 (day two), and each week after, until the sixth week. The The particles median size D50 (in volume percentages),
concentration was calculated based on the Beer-Lambert law the particle size range expressed by the 10% and 90% per-
[44]. centiles (D10 and D90 ), and the particles size ranges reported
LASER Diffraction (LD) was used to determine particle by the manufacturers as determined by the LD measurements
size by evaluating the distribution of the granules using a laser are all presented in Table 2.
scattering particle size analyzer (Patrica LA-950 V2 Horiba Results showed that BioOss had the lowest median
Instruments, Japan). The measurement method relied on the particle size (1.32 𝜇m) followed by Ingenios 𝛽-TCP (6.72 𝜇m),
Mie scattering theory [45]. Using an ultrasonic probe with while OsteoSponge had the highest one (902.41 𝜇m).
measuring time of 20 s at a frequency of 20 kHz, the unit’s The median size of Macrobone (262.37 𝜇m) was close to
measuring range varied between 0.01 and 3.00 𝜇m. The devise autogenous bone (282.1 𝜇m). The narrowest size distribution
was equipped with an optical system of two light sources, was observed with BioOss (0.26–8.92 𝜇m), followed by Inge-
a laser diode of approximately 1.6 mW with 𝜆 = 650 nm, nios 𝛽-TCP (3.90–15.18 𝜇m). The widest size distribution was
and a 405 nm light emitting diode of approximately 0.3 mW. observed with OsteoSponge (174.62–2301.84 𝜇m) followed by
Large particles scatter light at small angles relative to the DynaBlast (39.24–1754.62 𝜇m).
laser beam and small particles scatter light at large angles. X-ray diffractograms for all bone substitutes are shown
The particle size is reported as a volume equivalent sphere in Figure 1. They represent the intensity of X-ray (cps) as a
diameter [43, 46]. Samples were well mixed and homogenized function of the diffraction angles (2 theta, 𝜃).
in their powder state prior to their analysis. Average particle Results of the XRD experiments that are indicative for
size and distribution were calculated for all nine biomaterials the chemical composition of the BS are shown in Table 3
and autogenous bone. except for DynaBlast, as the puttylike material was not
X-ray Diffraction (XRD) (D8 Advance, Bruker Corpora- granular in form. All study materials showed small amounts
tion, Billerica, MA) was used to identify phase and composi- of impurities. These materials diffract more and less the X-
tion features and qualitatively evaluate the crystallinity of all ray, which means diverse degrees of crystallinity, as indicated
study materials. Homogenized powder samples (1-2 g) were in the different peaks widths.
compressed in polyvinyl chloride lenses (diameter 2.5 cm, The common crystal phase was calcium phosphate silicate
thickness 2 mm) and measured using a diffract meter (copper hydroxide (Ca5 (PO4 )2.85 (SiO4 )0.15 (OH)) in BioOss, Ingenios
anticathode 𝜆K𝛼 = 0.154060 nm). A range of 2𝜃 between 𝑥∘ HA, Puros, OsteoSponge, and autogenous bone. Macrobone
and 𝑦∘ was chosen to obtain maximum information about was composed from calcium phosphate (Ca3 (PO4 )2 ). Cer-
crystal phases. Collected diffract grams were analyzed by abone and Ingenios 𝛽-TCP were composed, respectively,
software EVA (EVA, Bruker Corporation) based on powder of calcium gadolinium oxide phosphate (Ca8 Gd2 (PO4 )6O2 )
diffraction files provided by the International Center for and sodium calcium iron phosphate (Na2 Ca19 Fe0.667 (PO4 )14 )
Diffraction Data (Newtown Square, PA). Crystallite size as the main crystal phases. Except for Ingenios 𝛽-TCP,
analysis was calculated using the peak broadening of XRD Macrobone, and Osteosponge, all samples were crystallized
reflection that is used to estimate the crystallite size in an at different levels of crystallinity in hexagonal systems.
 4

Table 1: The calcium concentration as derived from AAS experiments by brand names and time period.
Ca (mg/g) BioOss Cerabone Macrobone Ingenios B-TCP Ingenios HA Puros OsteoSponge Dyna Blast Autogenous bone
Day 0 1.977 0.98 1.4485 0.892 0.7485 2.104 1.521 2.768 3.77
Day 2 2.643 1.061 3.0735 1.276 2.3862 3.613 1.723 3.7132 4.2
Week 1 7.849 2.605 10.9865 1.663 2.5515 6.99 1.859 4.871 6.73
Week 3 8.79 3.308 15.301 2.306 2.7427 15.1535 2.018 5.6507 16.4
Week 4 9.451 3.445 16.081 2.682 2.7502 18.879 2.18 5.8985 17.96
Week 5 10.205 4.023 16.11 2.834 2.8282 23.11 2.493 6.0485 19.64
Week 6 11.8 4.194 17.308 2.835 2.9275 24.942 4.051 6.2 20.15
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Table 2: Particle size parameters in volume percentage of the samples.

Median size Size range Size range reported

Sample
(D50 𝜇m) (D10 –D90 𝜇m) By producers (𝜇m)
Bio-Oss 1.32 0.26–8.92 250–1000
Cerabone 663.31 174.62–1337.48 500–1000
Macrobone 262.37 22.79–517.2 150–500
Ingenios B-TCP 6.72 3.90–15.18 250–1000
Ingenios HA 592.39 8.82–1337.48 1000–2000
Puros 630.47 174.62–1167.72 250–2000
OsteoSponge 902.41 152.45–2301.84 1000–4000
Dyna Blast 777.14 39.24–1754.62 Nonindicated
Autogenous bone 282.1 90.5–465.15

Ingenious-HA Ingenious 𝛽-TCP Macrobone

700 280 260
260 240
600 240 220
220 200
500

Lin (Cps)
Lin (Cps)

Lin (Cps)

200 180
180 160
400 160 140
140 120
300 120 100
100 80
200 80 60
60
100 40 40
20 20
0 0 0
3 10 20 30 40 50 60 70 80 3 10 20 30 40 50 60 70 80 5 10 20 30 40 50 60 70 80
2-theta-scale 2-theta-scale 2-theta-scale

Cerabone BioOss
200
180
90
160 80
70
Lin (Cps)

140
60
Lin (Cps)

120
100 50
80 40
60 30
40 20
20 10
0 0
3 10 20 30 40 50 60 70 80 3 10 20 30 40 50 60 70 80
2-theta-scale 2-theta-scale
(a)
OsteoSponge Puros Autogeneous bone
400 70 110
100
60 90
300
Lin (Cps)

50 80
Lin (Cps)

Lin (Cps)

70
200 40 60
30 50
40
100 20 30
10 20
10
0 0 0
3 10 20 30 40 50 60 70 80 3 10 20 30 40 50 60 70 80 3 10 20 30 40 50 60 70 80
2-theta-scale 2-theta-scale 2-theta-scale
(b)

Figure 1: X-ray diffraction data for all investigated samples. (a) Ingenios HA, Ingenios 𝛽-TCP, Marrowbone, Cerabone, and BioOss have well
defined peaks, which reflects their well-crystallized components. (b) OsteoSponge, Puros, and autogenous bone have noisy diffractograms
revealing less crystallinity.

The 𝑎/𝑐 or 𝑏/𝑐 ratios (9.42/6.89) indicated a flat structure other bones crystallized in hexagonal system. Nevertheless,
parallel to 𝐴 6 axis. Such geometry may enhance the settle- 𝑐 length (37.3 Å) in Ingenios 𝛽-TCP and Macrobone was
ment properties of these particles. For Ingenios 𝛽-TCP and 5.4 times greater than 𝑐 (6.89 Å) length in the other bones.
Macrobone, 𝑎 and 𝑏 crystal dimensions in the rhombohedra Hence, settlement may be oriented preferably orthogonal to
system were relatively too close to 𝑎 and 𝑏 dimensions of the 𝐴 3 axis. In Ingenios 𝛽-TCP and Macrobone, crystal size was
 6

Table 3: Chemical compositions and shapes of samples, except for Dyna Blast due to its puttylike form, as derived from X-ray diffraction.
Product Compound name Formula System 𝑎 (Å) 𝑏 (Å) 𝑐 (Å) Alpha (∘ ) Beta (∘ ) Gamma (∘ )
Bio-Oss Calcium phosphate silicate hydroxide Ca5 (PO4 )2.85 (SiO4 )0.15 (OH) Hexagonal 9.42 9.42 6.89 90 90 120
Cerabone Calcium gadolinium oxide phosphate Ca8 Gd2 (PO4 )6 O2 Hexagonal 9.39 9.39 6.89 90 90 120
Macrobone Calcium phosphate Ca3 (PO4 )2 Rhomboid 10.4 10.4 37.4 90 90 120
Ingenios B-TCP Sodium calcium iron phosphate Na2 Ca19 Fe0.667 (PO4 )14 Rhomboid 10.4 10.4 37.3 90 90 120
Ingenios HA Calcium phosphate silicate hydroxide Ca5 (PO4 )2.85 (SiO4 )0.15 (OH) Hexagonal 9.42 9.42 6.89 90 90 120
Puros Calcium phosphate silicate hydroxide Ca5 (PO4 )2.85 (SiO4 )0.15 (OH) Hexagonal 9.42 9.42 6.89 90 90 120
OsteoSponge Calcium phosphate silicate hydroxide Ca5 (PO4 )2.85 (SiO4 )0.15 (OH) Triclinic 6.25 11.9 5.6 97 114 93
Dyna Blast
Autogenous Bone Calcium phosphate silicate hydroxide Ca5 (PO4 )2.85 (SiO4 )0.15 (OH) Hexagonal 9.42 9.42 6.89 90 90 120
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BioMed Research International 7

30 between the sizes of particles and calcium concentration with

the time (Figure 2).
X-ray diffractograms give a clear idea about the crys-
25
tallinity of the analyzed materials and their crystal phases.
HA, Ingenios 𝛽-TCP, Macrobone, Cerabone, and BioOss
have well-defined peaks which reflects their well-crystallized
Calcium release concentration

20
components; OsteoSponge, Puros, and autogenous bone have
noisy diffractograms revealing the presence of amorphous
15 structure or at least noncrystallized faces of the materials.
All bone substitutes show a typical and most intense
diffraction at 2𝜃 of 32∘ since phosphate is the common com-
10 ponent in all used materials. Crystal phases were identified
using the powder diffraction files, provided by the Interactive
Center for Diffraction Data.
5
XRD diffractograms of various materials, including
human bone, were quite similar to common crystal phase
0 calcium phosphate silicate hydroxide (Ca5 (PO4 )2.85 ⋅
0 5 10 15 20 25 30 35 40 45 (SiO4 )0.15 (OH)) except for Cerabone, which showed the
Number of days presence of gadolinium in its composition, and Ingenios
𝛽-TCP, which showed the presence of iron. However,
BioOss Puros silicates, when they are present, are not major components
Cerabone OsteoSponge
of the crystal phases, since their stoichiometry compared to
Macrobone Dyna blast
Ingenios B-TCP Autogenous bone
phosphate (2.85) were considerably negligible (0.15). Iron and
Ingenios HA sodium are also negligible compared to calcium in Ingenios
𝛽-TCP. Along with calcium, they help to compensate the
Figure 2: AAS results from calcium concentration over the obser- negative charges of phosphate. It must be highlighted that,
vation period of all tested bone substitutes. 𝑌-axes represent calcium in bone and all bone substitutes, Ca to P ratios fluctuated
release in mg/g and 𝑋 axes represent day’s number. between 1.75 and 1.33. This could mean that calcium was the
major element that compensated phosphate charges.
It is not clear why gadolinium was present in the crystal
greater than that of the other bones. OsteoSponge was the phase of Cerabone. One possible explanation could be the
only sample crystallized in the triclinic system. iron oxidized at high temperature since the product was
subjected to high-temperature calcination ±1200∘ C [55].
Another explanation could be that it was used for its property
4. Discussion to enhance the resistance of alloys against oxidation. It
should be noted that natural gadolinium occurs in monazite
The higher the calcium concentration in a biomaterial, the mineral (rare earth phosphate) and gadolinium salt has an
more prone it will be to degradation [3, 42, 43]. The acidic exceptionally high absorption of neutrons and therefore is
buffer, to some extent, mimics the acidic environment during used for shielding in radiography as a contrast agent [56].
osteoclastic activity or bone resorption [3, 42, 43]. In our Nevertheless, we could not assert if gadolinium in those
study, different biomaterials had different calcium releasing studied samples naturally occurred or was purposely added.
characteristics. This could be explained by the fact that the XRD diffractograms showed that all samples, including
speed of BS biodegradability in vivo or in vitro depends on the natural bone, proved to have the same anisotropic crystal
material’s composition, particle size, crystallinity, porosity, size (9.42 Å in 𝑎- and 𝑏-directions and 6.89 Å in 𝑐-direction
and preparation [3, 38, 42, 43, 48]. with alpha and beta 90∘ and gamma 120∘ ); Ingenios 𝛽-TCP
From the particle size data, it can be concluded that, and Macrobone showed different anisotropic size 10.4 Å in
in general, size ranges measured for tested materials were 𝑎- and 𝑏-directions and 37,3 Å in 𝑐-direction with alpha
different from those reported by manufacturers who do and beta 90∘ and gamma 120∘ , 6.25 Å in 𝑎-direction, 11.9 Å
not specify the technique used in the crystalline material’s in 𝑏-direction, and 5.6 Å in 𝑐-direction with alpha 97 and
characterization and could explain the noticed differences beta 114∘ and gamma 93∘ , respectively. These results demon-
[49–54]. However, it should be kept in mind that the granules strated that crystal shapes of the BS and autogenous bone
under analysis differed not only in their size but also in their had a similar, hexagonal shape; only Ingenios 𝛽-TCP and
physicochemical properties. Macrobone showed a rhomboid design and OsteoSponge a
The influence of properties and characteristics of BS triclinic shape. This structure is the poorest system in the
on biological response cannot be easily predicted as the symmetric properties [57].
published studies involve different types of BS in different Eight different bone-grafting materials were herein inves-
particle size ranges. Regarding the ranges of particle size that tigated, and the results were compared to autogenous bone.
were tested in the present investigation, there was no relation Even when similar chemical characteristics were found,
8 BioMed Research International

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formance of three ceramic bone graft substitutes,” The Spine
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or information listed in this paper. The authors declare that
[16] D. M. Dohan Ehrenfest, B. S. Kang, G. Sammartino et al.,
they have no conflict of interests. “Guidelines for the publication of articles related to implant
surfaces and design from the POSEIDO: a standard for surface
Acknowledgments characterization,” POSEIDO, vol. 1, no. 1, p. 15, 2013.
[17] J. P. Davidas, “Looking for a new international standard for
The authors would like to thank Manal Houhou, Sarah characterization, classification and identification of surfaces in
Hadda, Sahar Rihan, and Hussein Bassal for their excellent implantable materilals: the long march for the evaluation of
technical assistance. This project was supported by a grant dental implant surfaces has just began,” POSEIDO, vol. 2, no.
from the Ecole Doctorale, Lebanese University. 1, pp. 1–5, 2014.
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