Volumetric, Radiographic, and Histologic Analyses of Demineralized Dentin Matrix Combined with Recombinant Human Bone Morphogenetic Protein-2 for Ridge Preservation: A Prospective Randomized Controlled Trial in Comparison with Xenograft

Influence of freeze-dried bone allograft on free gingival graft survival and alveolar ridge maintenance in socket seal procedures: a randomized controlled clinical trial

PURPOSE

This study aimed to investigate the viability of free gingival grafts (FGG) and assess clinical and radiographic changes in the alveolar ridge following socket seal surgery with or without freeze-dried bone allograft (FDBA).

MATERIALS AND METHODS

Twenty-eight anterior and premolar tooth extractions were randomly allocated to 2 groups: socket graft of FDBA sealed with FGG (n = 15) and control with empty sockets sealed solely with FGG (n = 13). Photographs taken at 3, 7, 14, and 30 days post-surgery assessed FGG viability. Alveolar ridge volume was clinically evaluated via intraoral scanners before surgery and at 1 and 3 months post-surgery. CBCT scans taken immediately post-surgery and 3 months later assessed alveolar ridge dimensions.

RESULTS

FGG viability in both groups increased from day 3 and reached the maximum score on day 14. Alveolar ridge volume reduction at 3 months in the FDBA group was comparable to the control group. Buccal alveolar bone height reduction was significantly higher in the FDBA group than the control group, while palatal alveolar bone height was comparable. Alveolar bone width reduction was evident but not statistically significant between the groups. The FDBA group exhibited a significant alteration in bone volume compared to the control group.

CONCLUSION

Viability of FGG was not affected by graft filling materials. Sealing the socket with FGG effectively preserved socket integrity and ridge volume in minor socket defects using either graft filling material or not. This study was registered on 4 January 2021 on Thai Clinical Trials Registry (TCTR20210104001).

Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures - a prospective clinical study

OBJECTIVES

To compare effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters.

MATERIALS AND METHODS

Thirty subjects with indication of mandibular posterior teeth extraction were randomly assigned to either test or control group. After atraumatic extraction, ridge preservation was performed using APD or DFDBA mixed with i-PRF in test and control groups respectively. Both groups had sockets sealed with A-PRF membrane. Clinical parameters (plaque, gingival and healing indices) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Statistical analysis was performed using an independent t-test to compare clinical and radiographic parameters between the groups.

RESULTS

Both groups had significant decreases in ridge dimensions over 6 months (p < 0.001). The test group showed less reduction in ridge dimensions than control group at 6 months (p < 0.001). Mean change in vertical height was not significant (1.37 ± 1.32, 1.7311 ± 0.563), but in horizontal ridge width (1.3120 ± 1.13, 1.8093 ± 1.16) was significantly different between test and control groups respectively. There was no statistical difference in clinical parameters between the groups at 6 months (p > 0.001).

CONCLUSIONS

APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to DFDBA group.

CLINICAL RELEVANCE

Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.

Competence of allogenic demineralized tooth matrix in socket seal surgery for alveolar ridge preservation: a randomized control clinical trial

OBJECTIVES

To assess and compare the clinical, radiological, and histological outcomes of socket seal surgery between two protocols: deproteinized demineralized tooth matrix (dpDTM) and freeze-dried bone allograft (FDBA) each covered with a free gingival graft.

MATERIALS AND METHODS

Twenty extraction sockets in the anterior or premolar region were randomly allocated to either the dpDTM or FDBA protocol (n = 10 per group). Measurements of the alveolar ridge changes were obtained using an intraoral scanner and cone-beam computed tomography at 3 months post-operation. Three-month post surgery, the dental implant was installed (n = 5 per group), bone biopsies were obtained for histomorphometrical and micro-computed tomography analyses. Implant stability quotients (ISQs) were determined and compared at 3 months post-implant.

RESULTS

Lower significant reductions in buccal alveolar ridge height and hard tissue volume were observed in dpDTM group compared to FDBA group at 3 months (0.25 ± 0.35 mm vs. 1.60 ± 0.66 mm [p = .000] and 9.64 ± 15.39% mm3 vs. 31.45 ± 18.11% mm3 [p = .010], respectively). At the same time, lower soft tissue volume reduction was detected in the dpDTM group compared to FDBA group (4.21 ± 5.25% mm3 vs. 5.25 ± 5.79% mm3). No statistically significant difference in the percentage of mineralized tissue formation was found between dpDTM group (53.39 ± 11.16%) and FDBA group (49.90 ± 3.27%). Even though the ISQ in the dpDTM group showed a higher value than the FDBA group at 3 months post-implant, the results were without statistical significance.

CONCLUSIONS

Alveolar ridge preservation using dpDTM is an efficacious procedure for providing the conditions for the development of functional and esthetic implants.

Dentin-derived alveolar bone graft for alveolar augmentation: A systematic review

Introduction

Application of alveolar bone graft (ABG) in alveolar augmentation is done to prevent excessive bone resorption due to tooth extraction, missing teeth, or other diseases/conditions affecting the alveolar bone. The use of autogenous dentin-derived ABG has been considered as the composition of dentin appears to be nearly analogous to that of bone.

Objective

This systematic review aims to assess the efficacy of dentin-derived ABG for alveolar augmentation of post-extraction sockets or other alveolar bone defects by evaluating volume gain and histomorphometric data.

Material and methods

A search of systematic literature was conducted in Pubmed, Scopus, Web of Science, and Embase from database inception to October 2023. The review included both randomized controlled trials (RCT), pilot studies, clinical trials, and retrospective studies reporting on dentin-derived ABG use for alveolar augmentation.

Results

Overall, 298 articles were obtained from the initial search. From these articles, 21 articles met the inclusion criteria and were included for descriptive analysis. All of the studies indicated low risk of bias. Studies of dentin-derived ABG, which used bone-derived grafts as the control group, have shown significantly higher percentages of new bone formation, gain in vertical and horizontal dimensions, and less reduction in dimensions.

Conclusions

Dentin-derived ABG was effective in volume maintenance, indicating promising results via histomorphometric and radiographic analysis.

Tooth Graft: An Umbrella Overview

This umbrella review aims to evaluate systematic/meta-analysis studies containing clinical evidence on tooth grafts as bone substitutes in the oral and maxillofacial regions. Using language restrictions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic database search of PubMed, MEDLINE, Embase, Cochrane library, and Google Scholar was conducted, featuring published studies up until August 2022. All systematic/meta-analysis review articles relating to tooth graft materials were matched against the inclusion criteria. Two qualified researchers independently assessed the studies' inclusion or exclusion criteria and risk of bias, and a third investigator assisted in resolving ambiguities. A total of 81 systematic/meta-analysis studies, comprising 21 animal-controlled trials, 23 randomized controlled human trials, 23 prospective studies, and 14 retrospective studies, were selected for this study. A small risk of bias was observed in systematic studies/meta-analyses. In addition, the clinical evidence from the analysis of these studies revealed a low incidence of side effects. According to the current review, two systematic reviews indicated that autogenous bone grafting of prepared teeth might be as effective as other bone grafting materials. Four studies also mentioned autologous grafts as potential alternatives to autologous grafts, autogenous demineralized dentin (ADDM), engineered grafts, root blocks, and dental matrix. On the other hand, three systematic studies stated that more long-term research is needed to confirm their findings. Finally, given the importance of standardization and homogeneity of studies for clinical cases, it is advised to be used cautiously due to the risks of transplant rejection.

Efficacy of Autogenous Dentin Biomaterial on Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial

Background

After tooth extraction, alveolar bone resorption is inevitable. This clinical phenomenon challenges dental surgeons aiming to restore esthetic and function. Alveolar ridge preservation can be applied to minimize dimensional changes with a new socket grafting material, an autogenous dentin graft, produced by mechanically and chemically processing natural teeth. This study assessed the safety and efficacy of using autogenous dentin biomaterial in alveolar ridge preservation.

Materials and Methods

Patients with nonrestorable maxillary anterior teeth bounded by natural sound teeth were included in this study. After a detailed clinical and tomographic examination, eligible participants were randomly allocated into two groups. The control group had spontaneous healing of extraction sockets. The study group had their extraction sockets filled with autogenous dentin biomaterial after processing their extracted retained roots with the KometaBio device. Standardized cone beam computed tomography (CBCT) scans were repeated four months later. A full-thickness mucoperiosteal flap reflection was achieved under local anesthesia to get core biopsies for histomorphometric analysis, and dental implants were placed at the same session.

Results

A total of 32 eligible patients were included in this study (n = 16 in each group). Both groups had significantly higher facial soft tissue thickness after four months than baseline (p < 0.05). However, the study group showed statistically significant lesser dimensional changes than the control group according to the standardized CBCT scans. Furthermore, core biopsies confirmed an excellent remodeling of the autogenous dentin biomaterial in the study group. In comparison, only new thin bone trabeculae-filled sockets were in the control group.

Conclusion

Autogenous dentin graft can be safely and successfully used for alveolar ridge preservation. Optimal graft remodeling histologically, better ridge dimensional stability, and uneventful wound healing support its clinical application. This trial is registered with TCTR20220615002.

Efficacy of autogenous particulated dentin graft for alveolar ridge preservation: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Autogenous particulate dentin (APD) has been used as a bone graft material for bone augmentation, but the specifics of its effect on alveolar ridge preservation (ARP) are uncertain. The aim of this study was to investigate the clinical and histomorphometric performance of APD compared with blood clot healing or other grafted materials in ARP.

METHODS

MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library and citation databases were searched until August 2, 2023 to identify randomized controlled trials that employed APD for ARP. Two independent meta-analyses were performed based on the different control groups (Group I: blood clot healing; Group II: other grafted materials). Weighted or mean differences (MDs) and corresponding 95% confidence intervals (CIs) were calculated. The protocol was prospectively registered with PROSPERO (CRD42023409339).

RESULTS

A total of 238 records were identified, of which ten studies with 182 participants were included. The meta-analysis indicated that APD resulted in fewer changes in horizontal ridge width (Group I: MD = 1.61, 95% CI 0.76-2.46; Group II: MD = 1.28, 95% CI 1.08-1.48) and labial bone height (Group I: MD = 1.75, 95% CI 0.56-2.94; Group II: P < .05) than the control treatments. Regarding histomorphometry, APD yielded a satisfactory proportion of vital bone area (MD = 10.51, 95% CI 4.70-16.32) and residual material area (MD = -8.76, 95% CI -12.81 to -4.71) in Group II, while there was no significant difference in Group I. Moreover, none of the secondary outcomes were significantly differed between groups.

CONCLUSION

Within this study limitations, APD effectively maintained the horizontal and vertical dimensions of the extraction sockets and exhibited favorable osteogenic properties and degradation capacity. Further well-designed randomized controlled trials with larger samples and longer follow-up periods are needed to evaluate whether APD is superior to other substitutes for ARP.

Cone-Beam Computed Tomography and Histological Findings for Socket Preservation Techniques Using Different Grafting Materials: A Systematic Review

OBJECTIVE

Socket preservation techniques have been used to maintain the ridge dimension following tooth extraction. The materials used influence the quality and quantity of newly formed bone. Therefore, the aim of this article was to systematically review the literature reporting both histological and radiographic outcomes of socket preservation techniques after tooth extraction in human subjects.

MATERIAL AND METHOD

A systematic electronic search was performed in the electronic databases. English language clinical studies that were published between 2017 and 2022 and included both histological and radiographic findings for the test and control groups. Our primary search produced 848 articles, and of these, 215 were duplicate studies. A total of 72 articles were then eligible for full-text reading.

RESULTS

The review included eight studies that met its inclusion criteria. Three outcomes were compared in the included studies. The percentage of newly formed bone ranged from 21.34 ± 9.14% to more than 50% of new bone formation. The materials that showed more than 50% of newly formed bone formation were demineralized dentin graft, platelet-rich fibrin, freeze-dried bone allograft, corticocancellous porcine, and autogenous bone. Four Studies did not report the percentage of the residual graft materials, while those who reported showed a variable range of a minimum 1.5% to more than 25%. One study did not report the changes in horizontal width at the follow-up period, while other studies ranged from 0.6 mm to 10 mm.

CONCLUSION

Socket preservation represents an efficient technique to preserve the ridge contour with satisfactory newly formed bone in the augmented site and maintaining the vertical and horizontal dimensions of the ridge.

Incorporating Moldable Demineralized Dentin Matrix into Treatment for a Jaw Cyst

The enucleation procedure is a standard treatment for jaw cysts; however, it often results in post-operative bony defects. These defects can lead to serious complications such as the risk of pathologic fracture and delayed wound healing, especially in the case of large cysts where there may be soft tissue dehiscence. Even in the case of smaller cysts, most cystic defects remain visible on postoperative radiographs and can be mistaken for cyst recurrence during follow-up periods. To avoid such complications, the use of bone graft materials should be considered. While autogenous bone is the most ideal graft material as it can be regenerated into functional bone, it has limitations due to the inevitable harvesting surgery. Many tissue engineering studies have been conducted to develop substitutes for autogenous bone. One such material is moldable-demineralized dentin matrix (M-DDM), which can aid in regeneration in cases of cystic defects. This case report highlights a patient who demonstrated the efficacy of M-DDM in bone healing for filling the cystic defect.

The use of autogenous tooth bone graft is an efficient method of alveolar ridge preservation - meta-analysis and systematic review

BACKGROUND

Ridge resorption following tooth extraction may be reduced by alveolar ridge preservation (ARP). Previous randomized clinical trials and systematic reviews have suggested that autogenous tooth bone graft (ATB) can be an effective alternative material for ARP. However, the results are heterogeneous. Therefore, our research aimed to evaluate the efficacy of ATB in ARP.

METHODS

A systematic search was conducted in Cochrane Library, Embase, MEDLINE and Scopus for studies published from inception to 31 November 2021. We searched searched for randomized, non-randomized controlled trials and case series reporting on ATB use for ARP. The primary outcome was the ridge width difference pre- and post-surgery, measured in millimetres (mm) measured on CBCT (cone beam computed tomography). The secondary outcomes were the histological results. We followed the PRISMA2020 recommendations for reporting our systematic review and meta-analysis.

RESULTS

The analysis included eight studies for the primary and six for the secondary outcomes. The meta-analysis revealed a positive ridge preservation effect with a pooled mean difference ridge width change of -0.72 mm. The pooled mean residual graft proportion was 11.61%, and the newly formed bone proportion was 40.23%. The pooled mean of newly formed bone proportion was higher in the group where ATB originated from both the root and crown of the tooth.

CONCLUSIONS

ATB is an effective particulate graft material in ARP. Complete demineralization of the ATB tends to decrease the proportion of newly formed bone. ATB can be an attractive option for ARP.

TRIAL REGISTRATION

The study protocol was registered on PROSPERO (CRD42021287890).

Autogenous particulated dentin for alveolar ridge preservation. A systematic review

PURPOSE

This review aimed to investigate the clinical outcomes of autogenous particulated dentin (APD) used for alveolar ridge preservation (ARP), evaluating volume gain, histologic/histomorphometric data, and associated complications.

MATERIAL AND METHODS

The review followed PRISMA guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was made in four databases (Medline/Pubmed, Scopus, Web of Science, and Cochrane Library) supplemented by a manual search for relevant clinical articles published before March 10th, 2022. The review included human studies of at least four patients in which extraction and subsequent ARP were performed in a single surgery. Both comparative studies and studies that assessed ARP with APD exclusively were admitted. The quality of evidence was assessed with the Cochrane bias assessment tool, the Newcastle-Ottawa Quality Assessment Scale, and the Joanna Briggs Institute Critical Appraisal tool.

RESULTS

Eleven studies fulfilled the inclusion criteria and were included for descriptive analysis, with a total of 215 patients, and 337 alveoli preserved by APD, spontaneous healing (blood clot), or other bone substitutes, obtaining comparatively less vertical and horizontal resorption when APD was used.

CONCLUSIONS

After dental extraction, autogenous dentin was effective in terms of volume maintenance, showing promising results in histologic/histomorphometric analysis, and a low complication rate. Nevertheless, few comparative studies with comparable parameters have been published and so more research providing long-term data is needed to confirm these findings.

Impact of Autogenous Demineralized Dentin Matrix on Mandibular Second Molar after Third Molar Extraction: Retrospective Study

The purpose of this retrospective study was to evaluate bone healing after autogenous demineralized dentin matrix (DDM) grafts, focusing on the distal root of the mandibular second molar after the extraction of the third. We included retrospective data from 20 patients who had undergone molar extractions (15 male, 41.9 ± 12.0 years) between January 2020 and September 2022 and had DDM grafts implanted on the extraction socket, immediately ("immediate graft") or 6 weeks ("delayed graft") after the first surgery without primary closure. Patients who underwent grafting on only one side were used as the control group (n = 4). Bone defects at the mandibular second molar were measured preoperatively and 4 months after the graft surgery using cone-beam computed tomography (CBCT). Improvement of bone defect (i.e., the change in the bony defect pre- vs. postoperatively) was compared between the control and graft groups using the Wilcoxon Signed Rank test, and the difference between immediate and delayed grafts was analyzed with the Mann-Whitney U test. Complications such as infections or graft failure did not occur. Although pre-operative defects were smaller in the control than in the graft group (2.98 ± 1.77 and 10.02 ± 3.22 mm, p = 0.001), post-operative defects were similar in both (2.12 ± 0.59 and 2.29 ± 1.67 mm, respectively). The improvement ratio was not statistically significant in the control group (22.68 ± 15.36%) but a difference was observed in the graft group (76.70 ± 15.36%, p = 0.001). The amount of improvement of bone defect was not affected by graft timing or patient sex. In conclusion, DDM can improve bone defect at the distal aspect of the mandibular second molar after third molar extraction.

Clinical Reference Strategy for the Selection of Treatment Materials for Maxillofacial Bone Transplantation: A Systematic Review and Network Meta-Analysis

Bone graft materials have mixed effects of bone repair in the field of oral maxillofacial surgery. The qualitative analyses performed by previous studies imply that autogenous odontogenic materials and autogenous bone have similar effects on bone repair in clinical jaw bone transplantation. This retrospective systematic assessment and network meta-analysis aimed to analyze the best effect of clinical application of autogenous odontogenic materials and autogenous, allogeneic, and xenogeneic bone grafts in bone defect repair. A systematic review was performed by searching the PubMed, Cochrane Library, and other journal databases using selected keywords and Medical Subject Headings search terms. 10 Papers (n = 466) that met the inclusion criteria were selected. The assessment of heterogeneity did not reveal any overall statistical difference or heterogeneity (P = 0.051 > 0.05), whereas the comparison between autogenous and allogeneic bone grafts revealed local heterogeneity (P = 0.071 < 0.1). Risk of bias revealed nine unclear studies and one high-risk study. The overall consistency was good (P = 0.065 > 0.05), and the local inconsistency test did not reveal any inconsistency. The publication bias was good. The confidence regarding the ranking of bone graft materials after GRADE classification was moderate. The effects on bone repair in the descending order were as follows: autogenous odontogenic materials, xenogeneic bone, autogenous bone, and allogeneic bone. This result indicates that the autogenous odontogenic materials displayed stronger effects on bone repair compared to other bone graft materials. Autogenous odontogenic materials have broad development prospects in oral maxillofacial surgery.

Autogenous tooth bone graft material prepared chairside and its clinical applications: a systematic review

This systematic review was conducted to evaluate the available literature on the clinical outcomes of the use of autogenous tooth bone graft prepared chairside, and its current applications. A literature search was done to answer the focused questions "In partially edentulous patients, what are the alveolar ridge volumetric changes, histological findings, and implant survival rates in sites augmented with autogenous tooth bone graft prepared chairside?" Twenty articles were included at the end of the database search. Reported alveolar bone dimension changes after ridge preservation ranged between - 0.64 mm and + 2.26 mm for height, and between - 1.21 mm and + 0.41 mm for width. Augmented sites showed a significant increase in their dimensions in all investigations. The implant survival rate was 98.8% for delayed placement and 97.4% for immediate placement. Additional reports were found on the percentage bone formation following the use of this graft at different postoperative time points, which showed a higher bone volume with time. Currently available studies have included small samples, with short follow-up periods, and most have lacked a control group. Within the limitations of this review, the available evidence suggests that the autogenous tooth bone graft prepared chairside is as effective as other bone grafting materials.

Demineralized human dentin matrix for alveolar ridge preservation using a volumetric and histologic analyses in rats

The aim of this study was to evaluate a Demineralized Human Dentine Matrix (DHDM) as viable biomaterial for alveolar ridge preservation in a rat model. Wistar rats were submitted to the extraction of maxillary first molars bilaterally. Sockets were filled with biomaterials and divided into 4 experimental groups (n=5): blood clot, autogenous bone, bovine-derived xenograft (BDX) and DHDM. Animals were sacrificed at 7, 14 e 28 days. Microtomography (uCT) volumetric evaluation and qualitative histological analyses were performed. Results obtained through the uCT showed similar values between the DHDM and the other experimental groups. The histological evaluation demonstrated DHDM with an unspecific inflammatory process and bone neoformation with slow reabsorption of the material. This result indicates that DHDM implanted in rat sockets is biocompatible and reduces the alveolar ridge volume loss after tooth extraction.

What grafting materials produce greater alveolar ridge preservation after tooth extraction? A systematic review and network meta-analysis

A systematic review and network meta-analysis was conducted to compare different bone-substitute materials used for alveolar ridge preservation after tooth extraction. The electronic search was carried out on Embase, PubMed, Cochrane Library, Web of Science, Scopus, LILACS, and grey literature up to March 22, 2020 (registration number INPLASY202030005). Only randomized controlled trials were included to answer the following PICOS question: 'What grafting materials produce greater alveolar ridge preservation after tooth extraction?' The primary outcomes were the alveolar width resorption 1 mm below the alveolar crest and buccal height resorption in millimeters. Of the 4379 studies initially identified, 31 studies involving 1088 patients were included in the quantitative analyses. Out of 25 revised biomaterials, eight showed a statistically significant difference compared with unassisted healing in both alveolar width and height measurements (mean width differences: ApatosⓇ, 2.27 [1.266-3.28]; Bio-OssⓇ, 0.88 [0.33-1.42]; Bio-Oss CollⓇ, 0.53 [0.04-1.01]; Bond-apatiteⓇ, 2.20 [1.30-3.11]; freeze-dried bone allograft, 1.35 [0.44-2.26]; Gen-OsⓇ, 1.90 [0.60-3.20]; platelet-rich fibrin, 1.66 [0.66-2.67]; and MP3Ⓡ, 2.67 [1.59-3.75]). Overall, xenograft materials should be considered as among the best of the available grafting materials for alveolar preservation after tooth extraction.

Comparison of Autogenous Tooth Materials and Other Bone Grafts

Autogenous odontogenic materials are a new, highly biocompatible option for jaw restoration. The inorganic component of autogenous teeth acts as a scaffold to maintain the volume and enable donor cell attachment and proliferation; the organic component contains various growth factors that promote bone reconstruction and repair. The composition of dentin is similar to that of bone, which can be a rationale for promoting bone reconstruction. Recent advances have been made in the field of autogenous odontogenic materials, and studies have confirmed their safety and feasibility after successful clinical application. Autogenous odontogenic materials have unique characteristics compared with other bone-repair materials, such as the conventional autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes. To encourage further research into odontogenic bone grafts, we compared the composition, osteogenesis, and development of autogenous odontogenic materials with those of other bone grafts. In conclusion, odontogenic bone grafts should be classified as a novel bone substitute.

Alveolar ridge preservation using autogenous whole-tooth versus demineralized dentin grafts: A randomized controlled clinical trial

OBJECTIVE

The objective of this randomized controlled trial was to evaluate the radiographic changes and histologic healing following alveolar ridge preservation (ARP) using autogenous whole tooth (AWTG), test group, versus autogenous demineralized dentin graft (ADDG), control group.

MATERIAL AND METHODS

Twenty non-molar teeth indicated for extraction were randomized into two groups (n = 10/group). Extracted teeth were prepared into AWTG or ADDG (0.6N HCl; 30 min), inserted into extraction sockets and covered by collagen membranes. Cone-beam computed tomography (CBCT) scans at baseline and six months were compared to assess ridge-dimensional changes. At six months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically.

RESULTS

All sites healed uneventfully. Reduction was 0.85 ± 0.38 mm and 1.02 ± 0.45 mm in ridge width, 0.61 ± 0.20 mm and 0.72 ± 0.27 mm in buccal and 0.66 ± 0.31 mm and 0.56 ± 0.24 mm in lingual ridge height for the AWTG and ADDG group, respectively (p > .05). Histologically, no inflammatory reactions were noticeable and all samples showed new bone formation. Qualitatively, graft-bone amalgamations were more pronounced in ADDG samples. Histomorphometrically, new bone, graft remnants and soft tissue occupied 37.55% ± 8.94%, 17.05% ± 5.58% and 45.4% ± 4.06% of the areas in the AWTG group and 48.4% ± 11.56%, 11.45% ± 4.13% and 40.15% ± 7.73% in the ADDG group of the examined areas, respectively (p > .05).

CONCLUSIONS

AWTG and ADDG are similarly effective in ARP. Yet, histologically ADDG seems to demonstrate better graft remodeling, integration and osteoinductive properties.

Allogeneic Demineralized Dentin Matrix Graft for Guided Bone Regeneration in Dental Implants

Autogenous and allogeneic demineralized dentin matrices (Auto-DDM and Allo-DDM, respectively) are currently used for guided bone regeneration (GBR). Buccal marginal bone (BMB) resorption is critical for successful implant integration. This study analyzed BMB resorption around dental implants for GBR between the control group (Auto-DDM graft) and experimental group (Allo-DDM graft). From 2014 to 2019, we enrolled 96 patients (59 males, 37 females, average 57.13 years) who received GBR (52 and 44 using Allo-DDM and Auto-DDM, respectively,) without a barrier membrane and a simultaneous single dental implantation (54 in the maxilla and 42 in the mandible). BMB height was measured immediately after GBR, at prosthetic loading, and 12 months after loading. BMB resorption was classified as initial resorption (between GBR and prosthetic loading) and functional resorption (during 12 months after prosthetic loading). The differences in the BMB levels of Auto-DDM and Allo-DDM were analyzed between the initial and functional resorption stages by independent sample t-test. Auto-DDM and Allo-DDM showed similar BMB changes in initial resorption (0.73 ± 0.97 and 0.72 ± 0.77 mm, respectively) and functional resorption (0.69 ± 0.81 and 0.48 ± 0.58 mm, respectively) without a significant difference between the maxilla and mandible. For GBR, Allo-DDM is comparable to Auto-DDM in terms of BMB resorption.

Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and PlateletRich Fibrin: A Retrospective Radiographic ConeBeam Computed Tomography Study

This study utilized radiographic comparative analysis in order to evaluate dimensional ridge changes four months after tooth extraction and immediate grafting with mineralized dentin particulate autograft and chopped platelet-rich fibrin. Fifty-eight extraction sockets with up to 2 mm of missing buccal bone in the coronal aspect compared to the lingual bone were included. Graft material was covered with either a platelet-rich fibrin membrane or collagen sponge with no effort to achieve primary closure. The dimensional changes of the ridge were assessed on cone-beam computed tomography (CBCT) images acquired prior to extraction and four months later. The reduction in the buccal bone plate thickness 1 mm, 3 mm, and 5 mm below the buccal crest was −0.87 ± 0.84 mm, −0.60 ± 0.70 mm, and −0.41 ± 0.55 mm, respectively. The mean ridge width changes 1 mm, 3 mm, and 5 mm below the crest were −1.38 ± 1.24 mm, −0.82 ± 1.13 mm, and −0.43 ± 0.89 mm, respectively. The average mid-buccal bone height gain was +1.1%, while the mid-lingual height gain was 5.6%. A mineralized dentin autograft with platelet-rich fibrin is effective in preserving post-extraction alveolar ridge dimensions.

Histological Review of Demineralized Dentin Matrix as a Carrier of rhBMP-2

In 2007, recombinant human bone morphogenetic protein-2 (rhBMP-2) was approved for use in humans at a concentration of 1.5 mg/mL with absorbable collagen sponges as an alternative to autogenous bone grafts for alveolar ridge augmentation, defects associated with extraction sockets, and sinus augmentation. However, the use of supraphysiological doses and the insufficient retention of rhBMP-2, when delivered through collagen sponge, result in dose-dependent side effects related to off-label use. Demineralized dentin matrix (DDM), an osteoinducing bone substrate, has been used as an rhBMP-2 carrier since 1998. In addition, DDM has both microparticle and nanoparticle structures, which do not undergo remodeling, unlike bone. In vitro, DDM is a suitable carrier for BMP-2, with the continued release over 30 days at concentrations sufficient to stimulate osteogenic differentiation. In this review, we discuss the histological outcomes of DDM loaded with rhBMP-2 to highlight the biological functions of exogenous rhBMP-2 associated with the DDM carrier in clinical applications in implant dentistry. Impact Statement Demineralized dentin matrix (DDM) has been used as an recombinant human bone morphogenetic protein (rhBMP-2) carrier and osteo-inducing bone substrate to facilitate continued release and stimulate osteogenic differentiation. In this review, we discuss the histological outcomes of DDM loaded with rhBMP-2 in order to highlight the biological functions of exogenous rhBMP-2 associated with the DDM carrier in clinical applications in implant dentistry.

Nano-Structured Demineralized Human Dentin Matrix to Enhance Bone and Dental Repair and Regeneration

Demineralized dentin matrix (DDM), derived from human teeth, is an excellent scaffold material with exciting bioactive properties to enhance bone and dental tissue engineering efficacy. In this article, first the nano-structure and bioactive components of the dentin matrix were reviewed. Then the preparation methods of DDM and the resulting properties were discussed. Next, the efficacy of DDM as a bone substitute with in vitro and in vivo properties were analyzed. In addition, the applications of DDM in tooth regeneration with promising results were described, and the drawbacks and future research needs were also discussed. With the extraction of growth factors from DDM and the nano-structural properties of DDM, previous studies also broadened the use of DDM as a bioactive carrier for growth factor delivery. In addition, due to its excellent physical and biological properties, DDM was also investigated for incorporation into other biomaterials design and fabrication, yielding great enhancements in hard tissue regeneration efficacy.