Osteogen Plugs vs Other Plugs?

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Collagen plug and graft combination products are becoming quite popular in dentistry. These products aim to simplify socket preservation by interlacing a standard collagen plug with synthetic graft or xenograft material.

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The most popular product in this category continues to be the Osteogen Plug, which takes a collagen plug and fills it with OsteoGen non-ceramic crystals, a resorbable calcium apatite based graft (a non-ceramic production process yields a unique resorbable bone graft with a unique Ca:P ratio that is not a Ăź-TCP and not a non-resorbable dense ceramic HA). However, there are competing products to the Osteogen Plug, and very often we get questions about how the Osteogen Plug compares to similar collagen/graft combination products.

In this post, we will summarize all the alternative products and provide a brief summary of the differences between these products, and the Osteogen Plug, along with our final assessment.

Calcium Carbonate Plugs vs Osteogen Plugs

There are various collagen plugs that include calcium carbonate with the collagen plugs. Some brand names include: Osteoplug (Implant Direct), RegenerOss Plug ( Zimvie), and SocketPlug (Straumann). All of these plugs are exactly the same with just a difference in the packaging and name.

The difference between these plugs and Osteogen, is that Osteogen is a calcium-apatite based bone graft, while these other products are calcium-carbonate based grafts. Without getting too technical, the point is simply that the chemical nature of the synthetic grafting material used in these products is different, and this has a substantial effect on the clinical performance of the calcium carbonate plugs vs the Osteogen Plugs.

Specifically, with the calcium carbonate-based plugs, as opposed to the Osteogen Plug, there are two main issues. Firstly, calcium carbonate has a longer resorption time (9 to 12 months), as compared to Osteogen (resorbs in 4 to 6 months), and this has significant implications for healing time and future implant placement.

Secondly, for some reason, combining the calcium carbonate with collagen yields a lighter collagen, which causes poor handling during socket preservation. Very often the calcium carbonate plug will fall apart due to its soft consistency, and because of this a membrane will likely be required with the calcium carbonate plugs or there is a risk that the graft can ooze out of the socket. The Osteogen Plugs, however, have a stronger collagen structure and for most clinical situations you will not need a membrane (please see the IFU for specific considerations regarding a membrane).

Our conclusion: Osteogen Plugs are preferred over other synthetic collagen plugs, due to the inherent chemical properties of Osteogen, which ultimately produce a better plug.

Non-Resorbable Xenograft Plugs vs Osteogen Plugs

Another group of plugs uses xenograft as the graft material that is combined with collagen. These are sold under various brand names, like MinerOss X Plug (BioHorizons) or NuOss XC (Ace Surgical). The assessment of these plugs vs Osteogen Plugs is a bit less clear.

As opposed to calcium carbonate plugs mentioned above, the collagen structure of the xenograft-based plugs is good. The main issue, therefore, is that they are using a non-resorbable xenograft as the graft material as opposed to Osteogen, which is a resorbable synthetic graft. Xenografts leave behind dense particles,and are not ideal to drill through when placing an implant. So while some clinicians prefer xenograft materials, they are not necessarily the material of choice for socket preservation.

Our conclusion: If your preference, in general, is to use a xenograft for socket grafting, then you might prefer xenograft plugs over the Osteogen Plugs. However, if you are not a fan of xenografts or don’t use them, then Osteogen Plugs should be your choice.

Cross-Linked Atelo-Collagen Plugs vs Osteogen Plugs

There is a product called FOUNDATION which is marketed as a bone filling augmentation material. Foundation is made of absorbable atelo-collagen. The atelo-collagen has been cross-linked by heat treatment in order to achieve biocompatibility, and presumably to improve the resorption profile. Foundation is not a bone substitute, but rather a collagen plug that is supposed to stimulate new bone growth.

The difference between Osteogen Plugs and Foundation is that FOUNDATION does not include any graft material whatsoever. In fact, the marketing materials clearly state that it is not a bone substitute, as mentioned above. Osteogen Plugs, on the other hand does contain a proven graft material, Osteogen, along with the collagen plug.

Our conclusion: It is generally beneficial to deliver an actual graft material to the extraction site, and as such, we recommend Osteogen Plugs over Foundation when you are reaching for a combo collagen + grafting product. In cases, where you do not need or want a graft, or you plan to use standard grafting materials (like cortical cancellous bone mix) a standard non-cross linked Collagen Plug is probably your best option.

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in my practice. i do use osteoplug from implant direct, i would like to try the xeno plugs. but the wait time is 6 months compared to 4 months using allograft conventional technique. the plugs are definitely easier, faster and cheaper. which i pass along to the patient. If patient don’t mind the 6 months wait and the extraction socket calls for delayed implant placement instead of immediate implant placement. (sometimes patient just do not have the finances to do it all in one step). then the plug actually saves you chair time and saves patient money. I find the result similar, there is not much different between osteoplug and allograft particles. I wonder what other clinicians think?

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Thanks for the comment. Osteoplug from Implant Direct is calcium phosphate-based mineral with a synthetic carbonate apatite structure, i.e. it is calcium carbonate. Do you use a membrane with this product? Do you find that the collagen structure maintains its shape?

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i don’t use any membrane if using osteoplug. i would use a collagen plug on top if im using particulates. osteoplug maintain its shape when i place it. it also tolerates compression if i had to squeeze it into a smaller socket. for financially deficient patients. i usually recommend osteoplug over particulates. Also saves me time. compared to particulates which i need to hydrate, scoop and pack into socket and place a plug on top. the suture is the same. i usually use a PTFE suture.
In my practice, collagen/PTFE membranes are for buccal defects, ridge augmentation, and sinus lift. collagen membrane requires primary closure while PTFE membranes do not.

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Thanks for the feedback. In any case, the Osteogen Plugs behave more like traditional graft materials in terms of resorption profile, as Osteogen fully resorbs in 4 to 6 months, instead of 9 to 12 months for calcium carbonate plugs, like Implant Direct’s Osteoplug. So you can enter the site to place an implant a bit earlier than you would with Osteogen than the other plugs.

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Hi, I have been using Osteogen plugs or over 10 yrs, I absolutely love them. Have used many other products and this is by far my go to. The only limitation I encounter is where there is a large defect, especailly missing buccal wall, the graft is not dense enough and tends to resorb quickly, I would like it to be a little more consistent.
Stefano

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I have been a long time fan of the Osteogen Plug and about a year ago started using the ZCore Expand from Osteogenics. It is a collagen enriched Porcine xenograft and it seems to solve the issue that Stefano mentioned.

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is it fully resorbable?
thanks

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Zcore uses xenograft, and many studies have shown that xenografts do not typically fully resorb over time. Actually, they are sometimes called non-resorbable grafts, and possess the ability to remain within defect sites even years after their implantation. Some people prefer xenografts, though, for various reasons. But, the material is certainly not at all similar to Osteogen, in terms of resorption profile. That being said, if there is no buccall wall, I do not believe that Osteogen Plugs are a good indication. In that case, you are probably better off with the classic bone mix + membrane. Alternatively, we have a new 100% allograft call DALI One Graft Plug, that might help in these situations, if you are a fan of these kinds plugs.

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True except that Z Core is a porcine xenograft and not to be confused with the more traditional bovine products. The porcine is more pores on is said to resorb more like an allograft. I have never found either to be problematic and I have been placing fixtures into grafted sockets at 6-8 weeks post extraction/graft for the past 15 years with no issues. I have placed into xenograft, allograft, autogenous, and synthetic as well as the plugs using the same 6-8 week protocol. My thought process has always been that blood supply is the most important factor as it relates to surgical success and by going back in at 6-8 weeks to drill an osteotomy/place implant I am in a sense jumpstarting the blood supply and speeding up the turnover of the graft. Thi is just how my mechanic mind operates and it has worked well for a long time now…

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Thanks, I wasn’t aware that Z Core is porcine. So yes, it is true that porcine xenograft will act differently than bovine xenograft, but none of the xenografts resorb like an allograft, no matter what the manufacturer’s claim. Also, the resorption of a xenograft is also dependent on the specific heating (sintering) process used to produce the xenograft, so different porcine grafts will resorb at different rates. In any case, if it works for you, that’s all that matters, of course. Don’t fix what isn’t broken.

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Here’s a systematic review that talks about carbonate apatite and its proven applications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10892468/

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they all work to some degree. Something is better than nothing.