# Clinical Case Employing Two Different Biomaterials in Bone Regeneration
## 2 Clinical Report
### Discussion  
Three-dimensional radiographic analysis during postoperative check-up showed both materials compacting correctly but behaving very differently under radiolucency. As can be seen in Figure 3, SB particulate mixed with CGF was quite highly radiotransparent, maintaining fair homogeneity with scarce vacuolar-compacting flaws. The zone to be reconstructed, where the vestibular cortical bone had been eroded by inflammatory episodes, seemed well-supported. The calcium phosphosilicate material seemed compact and homogeneous, almost simulating a cortical than a cancellous bone. Four months later, after a clinically asymptomatic period, we radiographically examined the evolution of the grafts (see Figure 4). Figure 4: Three-dimensional radiographic analysis (Acteon X-Mind Trium) done four months later, in (**A**) sagittal and (**B**) axial projection, and cross-sections of Regions (**C**) 35 and (**D**) 36. Figure 3: Postoperative 3D radiographic analysis (Acteon X-Mind Trium) in (**A**) sagittal and (**B**) axial projection, and cross-sections of Regions (**C**) 35 and (**D**) 36. In both surgical sites, we could see similar radiographic appearance, and both appeared morphologically suitable for implant surgery, as both materials seemed to have offered an effective structural support for bone regeneration on both lesions. No radiological evaluation was performed on the quality of bone density or on the level of bone growth during the healing process. The impossibility of performing reliable measurements was caused by difficulties in generating constant reference points though images captured during the different follow-ups. The only possible evaluations were conducted by comparing three-dimensional renderings with operative surgical feedback, and by evaluating what we saw in the implant-planning phase and the immediate postoperative period following the regenerative surgery compared to what was seen four months after the regenerative treatment. The three-dimensional rendering shown in Figure 5 demonstrates, beyond any objective measure, definite vestibular-cortical-bone loss at Region 35, while Region 36, where the peri-implantitis was, did not show the same morphology. Rendering in axial projection showed a regenerative material chromatically similar to the mandibular cortical bone already noticed in two-dimensional analysis. Four months later (right side of the image), good regeneration could be seen in the vestibular cortical bone, aided by the xenohybrid-bone particulate of SB mixed with CGF. Furthermore, the chromatic appearance of both regeneration materials was very similar, as if their morphogenetic structures were comparable to those of equal regenerative development. From a surgical point of view, bone quality surgically detected while working with bone drills proved excellent in both implant sites; despite that, the maxillary alveolar cortical bone was not yet well-consolidated, as seen in the three-dimensional rendering. Although we could not perform reliable measurements of loss or gain achieved through regenerative surgery, we could evaluate what we achieved by estimating what was seen during the postoperative check-up, what we expected, and what was achieved four months later. Figure 6A,B shows an implant simulation with two Immediateload Universe 4 \(\times\) 11.5 mm (IML SA, via Moree 16, 6850 Mendrisio, Switzerland) implants just after surgery. Figure 6C,D present a simulation of what could be seen four months later, while Figure 6E,F is the real outcome after implant insertion. All things considered, all images were similar, proving that regeneration was successful. Moreover, as presented in Figure 7A-D, the long-term follow-up after 37 months clearly demonstrated the results of regeneration for both biomaterials. Considering the two different sites, and hence the different anatomical needs to address, SB allowed for the regeneration of the cortical wall.