Use of a xeno-hybrid bone graft and sticky bone preparation in mandibular regeneration complicated by Actinomyces infection: a case report

Abstract

Background: Bone regeneration is essential in oral surgery, particularly in advanced periodontal disease where teeth are no longer salvageable. Innovative biomaterials like SmartBone® combined with autologous platelet derivatives have shown promising regenerative potential. However, postoperative infections by Actinomyces israelii may compromise outcomes. Materials and Methods: A 52-year-old male with severe periodontal disease in the anterior mandible underwent extractions and grafting with SmartBone® mixed with autologous platelet derivatives using the Sticky Bone Preparation Device (SBPD). Three months post-surgery, localized inflammation occurred and was managed with antibiotics. Histopathological analysis identified A. israelii, prompting targeted antibiotic therapy. Results: Despite the infection, the graft maintained structural integrity, and the infection remained localized without fully compromising the regenerative site. After complete healing, four endosseous implants were successfully placed and restored with a fixed metal-ceramic prosthesis. Follow-ups at 8 and 30 months confirmed stable bone integration, healthy mucosa, and no recurrence. Conclusion: This case demonstrates the resilience of SmartBone® in maintaining regenerative function despite opportunistic infection. The xeno-hybrid graft and SBPD enabled successful implant-prosthetic rehabilitation. While the clinical outcome is encouraging, further microbiological studies are necessary to validate the protocol and explore any protective role of the graft material against infection.