## 3 Results and Discussion
### Bone Healing and Regeneration Characteristics of the Materials in the Clinical Application  
Figure 6 shows a panoramic image of the patient before and after obtaining a bone graft. A vertical bone loss in the posterior maxillary region (Figure 6a) caused the sinus lifting, and an additional bone graft was required to obtain adequate bone volume before implant placement [12; 15; 20]. The panoramic image immediately after sinus lifting and the implant of a bone graft material (Figure 6b) indicate that the bone graft material fills the space after sinus lifting. At the six months of follow-up after treatment, the bones in the implanted area were more radiopaque, and all of the bone graft material was absorbed. Figure 5: Histological images of \(\alpha\)-CSH bioceramic at day 3 and week 7 after implantation. (Critical size defect: CS, cortical bone: CB, trabecula bone: TB, immune cell: IC, testing article: TA, commercial product: CP, and soft tissue: ST). The cone-beam CT images before treatment also showed a vertical bone loss in the posterior maxillary region (Figure 7). In the jaw, the maxilla region is the most frequently experiencing vertical bone loss and the most difficult to treat [11; 12]. Therefore, both moderate and severe bone loss in this region require a bone graft to treat it [47]. The cone-beam CT images six months follow-up after treatment are presented in Figure 8, which exhibits the presence of ossification in the defect area. Figure 8a shows a cone-beam CT image representing a clinical case six months after bone graft placement in the left maxillary region, while Figure 8b,c represent bone graft placement in the right maxillary region. The presence of bone formation can also be seen in the area around the dental implant apex. Several studies have shown satisfactory results in the sinus lifting treatment accompanied by the placement of bone graft material, and this will affect the survival rate of the dental implant [21]. Figure 6: Panoramic images: (**a**) before treatment, (**b**) immediately after treatment, and (**c**) six months after treatment. Figure 7: Cone-beam computed tomography (CT) images before treatment. Figure 8: Cone-beam CT images after six months post-treatment in (**a**) the left maxillary region, (**b**) right maxillary molar, and (**c**) right maxillary premolar. In the clinical case presented in this study, a CGF membrane was used to cover the \(\alpha\)-CSH bioceramic bone graft. The use of bone graft following with the CGF membrane on dental implants has been widely reported [12; 48; 49]. The application of the CGF membrane is not only to accelerate bone formation but, also, to aid in soft tissue healing as a consequence of surgical procedures [12; 48; 49; 50; 51]. The CGF membrane is safe for clinical application due to, during the preparations, it does not require a chemical additive [12; 48; 49; 51]. The use of autologous bone graft and platelet-rich fibrin (PRF) as natural sources has also been reported to be successful in treating bone defects [52; 53]. Several harvesting methods such as a traditional (open) method or minimally invasive method can be used to harvest autologous bone grafts, although there have been several controversies in the literature both due to its complications and the need for the bone graft required [54; 55]. In general, traditional methods have been used to obtain more bone grafts. However, this method causes more complications than minimally invasive methods. Another study showed both the traditional and minimally invasive method that has no significant difference in morbidity rates [54]. Another issue of using a natural source bone graft is in the use of PRF for the treatment of bone defects. Although the use of PRF alone can be successful in bone formation, its osteogenic ability is still limited compared to using bone graft material due to a lack of rigidity and faster degradation [56]. To solve the issues of using natural sources, in this study, we used \(\alpha\)-CSH bioceramic as a synthetic bone graft substitute to treat bone defects.