Zinc Incorporated Bovine Derived- Hydroxyappatite Xenograft in Immediately Placed Implant

Implant dentistry is a prosthetic effort via a surgical procedure. In order to achieve anideal prosthetic construct, precise plan should be taken into consideration prior to thebeginning of treatment. The position of implant requires protected prosthesis. It can beaffected by the implant size, volume, and the quantity and quality of bone provided atvarious sites.One pitfall of immediate implant use, however, is the inevitable residual space thatremains between the implant body and the socket wall, due to a discrepancy in sizebetween the implant and the socket wall. This space, which is located toward the coronalend of the implant, is called the jumping distance. Excessive jumping distance may leadto bone resorption and formation of a bony defect, decreasing the implant stability .One of the most extensively used methods for restoration of the lost attachment is theuse of bone grafts. bone grafting which is one of the methods used to address theseissues has experienced an increased level of demand.The problem of bone defects has also contributed to making bone autograft become the goldstandard for treating bone abnormalities, although it has its limitations which are graftquantity and donor site morbidity. Contributory,allografts have become popular forreplacing bone defects because the graft size can be easily adjusted but it also hasseveral drawbacks, including disease transfer, rejection reactions, non‐union, graftresorption, fracture, and donor restrictions A xenograft is one of the choices used toovercome these limitations since the raw material is plentiful, readily available, andinexpensive. Additionally, several previous studies showed that organic or inorganicmatrix derived from bovine bone is biocompatible, but this biomaterial requires properpreparation to avoid risks such as the transmission of zoonoses .Bovine hydroxyapatite is made up of materials which have biological properties that makesit biocompatible and osteoconductive. These important biological properties allow theapposition of newly formed bone by osteoprogenitor cells and the partial remodeling byosteoclast and osteoblast of the host . Hydroxyapatite is used as scaffolds to supportthe development of bone tissue from an osteoblast proliferation stage through toextracellular matrix (ECM) deposition and on to cell‐mediated early‐stage mineralization.The addition of small quantities of hydroxyapatite to the scaffolds considerablyincreases calcium deposition and has a mild osteogenic impact.One of the potential methods for producing anorganic xenograft with enhancedosteoconductivity is by substituting ions with the constituent elements of hydroxyapatitethat exist in bone mineral because this method has the potential to increasehydroxyapatite solubility by lowering its crystallinity and inducing a higher number ofstructural defects. For these reasons, the ionic activity product of apatite increases inbody fluid due to the released constituent elements of apatite and this will provoke theformation of low crystalline hydroxyl carbonate apatite (bioactivity) on ions substitutedhydroxyapatite surface, which enhances osteoconductivity. However, the effect of otherions in bone on the bioactivity and osteoconductivity of hydroxyapatite has not beenextensively investigated. The substitutions of sodium with calcium ions26‐38 and chlorinewith hydroxyl ions39‐50 in hydroxyapatite have been also reported, respectively, but theywere confined to synthetic procedures and structural analyses.Zinc is the most abundant trace metallic element found in the body with 85% present inmuscle and bone.Zinc has proven to possess a direct stimulatory effect on osteoblasticcells in vitro while bone resorption was inhibited . It also reduces bacterial load, thusproving its antimicrobial properties. Many studies have demonstrated that zincsignificantly improved the bioactivity of HA. Therefore, zinc‐HA can be a new generationof materials for bone tissue‐ engineering.In comparison with the pure HA group, Zn2+‐doped HA had more connective tissues replacedby rebuilt bones, confirming that Zn2+‐doped HA had a stronger osteo‐induction potential.In a word, Zn2+ ions act in promoting cell proliferation, increasing osteogenic activity,and inhibiting osteoclast bioactivity. Zn2+‐doped HA was considered as a suitablesubstitute for cancellous bone.To the best of our knowledge there are no studies conducted on zinc incorporation bovinederived hydroxyapatite xenograft (Zn‐BHA) on immediate implant so this study designed toevaluate the effect of bovine drived hydroxyapatite xenograft (BHA) alone and zincincorporated bovine drived hydroxyapatite xenograft clinically and radographically onimmediat implant.With the advancement of computer‐aided design and computer‐aided manufacturing (CAD‐CAM)technology, there are different approaches for implant prosthetics' digital workflow.Recent digital technology allowed the virtual extraction of unrestorable teeth, thedesign of a restoration with a perfect emergence profile that preserves soft tissuecontour, and finally the 3D printing of the interim restoration.The CAD‐CAM guided templates have many applications in dentistry such as implantplacement and endodontic access preparations, the guided implant osteotomy presents anaccurate protocol for implant placement in the preplanned position with less surgicaltime and few post‐surgical complications.The digitally designed surgical guides transfer the virtually planned implant angulation,width and length through the use of 3D printed transparent template.