Innovative Alveolar Ridge Preservation Surgical Technique with Immediate Dental Implant Placement: A Retrospective Case Report of 1-Year Follow-Up.

Following tooth extraction, the alveolar ridge undergoes morphological and dimensional changes, including a clot formation that is gradually replaced by granulation tissue. Studies indicate that both horizontal and vertical ridge dimensions decrease after extraction; however, these changes can be mitigated through grafting with biomaterials and barrier membranes. Alveolar ridge preservation (ARP) techniques are employed to counteract bone resorption postextraction, encompassing periosteal inhibition and modified periosteal inhibition (MPI) techniques. The Degidi clot chamber technique offers a means to achieve biomaterial-free extraction sockets, promoting healing and osteointegration. This study aims to present the first rehabilitation of a postextraction dental implant in the maxilla using an innovative ARP procedure via a MPI technique. The technique does not involve autologous or heterologous grafting materials; instead, a cortical lamina and a customized screw are used in conjunction with the blood clot. The primary objective is to protect the vestibular cortical bone from preosteoclastic aggression, which can trigger bone resorption. The technique employs a 0.5-mm cortical lamina to mechanically shield the vestibular cortical bone, preventing vestibular cortical bone resorption and increasing its thickness without the need for biomaterial insertion, relying on the blood clot. The effectiveness of the technique was assessed through a 12-month postimplantation cone-beam computed tomography scan, revealing a 0.5-mm increase. Although based on a single case, the 1-year follow-up results are promising, and further studies are warranted to validate the technique's efficacy.

Biological Evaluation of the Osteoinductive Potential of Dry Teeth after Chemical Demineralization Treatment Using the Tooth Transformer Device.

Several studies have already demonstrated the biocompatibility of a tooth as a grafting material in the regeneration of bone tissue, showing its osteoconductive potential, while no studies have verified whether the osteoinductive potential of a tooth remains constant or is altered after its treatment with the Tooth Transformer (TT) device. The aim of the study was to demonstrate that the treatment with the TT device did not alter the osteoinductivity of an extracted tooth that was stored dry. Twelve extracted human teeth were collected from real patients. Caries, tartar and filling materials were removed from each tooth; each tooth was coarsely cut and stored at room temperature (RT) until use. Each sample was shredded, demineralized and disinfected, using the TT device. Protein extraction was carried out for each sample, and Western Blot analysis was performed to test the presence of mineralization protein LIM-1 and transforming growth factor-ß. The presence of the human Bone Morphogenetic Protein 2 (BMP-2) and human collagen Type I (COL-I) was found in dry tooth samples processed with the TT device and subjected to Enzyme-Linked Immunosorbent Assay (ELISA) testing. The treatment of chemical demineralization using the TT device does not alter the osteoinductive potential of a dry tooth.

Biomolecular Mechanisms and Case Series Study of Socket Preservation with Tooth Grafts.

The purpose of this research was to assess the effectiveness of an innovative medical device capable of extracting tooth graft materials directly from the patient's own teeth. Twenty consecutive tooth grafting procedures were conducted, with an average follow-up period of 18 months. METHODS: Twenty patients requiring tooth extraction underwent socket preservation utilizing the extracted tooth as the grafting material. RESULTS: After a 4-month healing period, the defects were significantly filled with newly formed hard tissue. Subsequently, bone biopsies were performed during dental implant placement to evaluate histological outcomes. The tissue exhibited a similar density to medium-density bone, displaying a homogeneous and uniform appearance without any visible signs of inflammation. The post-operative healing phase was free from infective complications or indications of graft particles within the regenerated bone structure. The histomorphometric analyses revealed the following results: bone total volume, BV% 52.6 ± 13.09, vital bone VB% 40.39 ± 15.86, residual graft % 12.20 ± 12.34. CONCLUSION: The study demonstrated positive bony healing in guided regenerative surgery procedures using autologous tooth grafts. However, further research with an extended follow-up period is necessary to thoroughly assess the potential of demineralized dentin autografts.

Comparison of Different Techniques in Post-Extractive Socket Regeneration Using Autologous Tooth Graft: Histological and Clinical Outcomes.

OBJECTIVE: Post-extractive socket grafting techniques reduce alveolar ridge dimensional changes. Numerous graft materials have been suggested and a growing interest in tooth material has been observed as a valuable alternative to synthetic biomaterials or xenografts. Furthermore, different clinical procedures have been proposed for the wound closure of the post-extractive site. This study aims to compare histological and clinical outcomes of two different surgical techniques to seal the post-extractive site with the use of autologous demineralized extracted tooth as graft material. MATERIALS AND METHODS: Sixteen post-extractive socket without buccal and/or palatal bone walls, in sixteen healthy patients, were grafted with the autologous tooth material treated by the new Tooth Transformer device (Tooth Transformer, Milan, Italy). Alveolar socket preservation procedures were performed without flap elevation. Patients were randomly subdivided into two equal groups according to the site closure technique. In group A, the pedunculate tissue was used, while in group B ice cone technique. A bone samples were collected in each site after 4 months for histological analysis. RESULTS: No significant clinical differences among the different sealing techniques were observed. In both groups, the site was filled by new bone formation after 4 months of healing. The histological analysis revealed 46.1 ± 8.07% of bone volume, 9.2 ± 9.46% of residual graft, and 35.2 ± 12.36% of vital bone in group A, while group B shows 41.22 ± 5.88% of bone volume, 7.94 ± 7.54% of residual graft, and 31.7 ± 7.52% new bone. No statistical differences were detected (p > 0.05). CONCLUSION: Further studies with a large number of patients, and different observation periods will be needed to confirm the results of this pilot study; however, the interesting data obtained have shown how these techniques, mixed with the autologous dentin derived graft material, seem to promote bone regeneration and reduce physiological bone resorption during alveolar socket preservation treatments.

Comportamiento del injerto autólogo de diente en preservación alveolar: evaluación clínica, radiográfica e histomorfométrica de un caso clínico tras un año de seguimiento / Behavior of the autologous tooth graft in alveolar preservation: clinical, radiographic and histomorphometric evaluation of a clinical case after one year of follow-up

Introducción: tras las extracciones, se producen una serie de cambios dimensio nales en sentido horizontal y vertical de la cresta alveolar, los cuales pueden ser minimizados mediante algunas técnicas quirúrgicas, como la preservación alveo lar, que utiliza diferentes sustitutos óseos, entre los que se encuentra actualmente el injerto autólogo de diente. Caso clínico: se presenta el caso clínico de una mujer de 61 años, que acudió a consulta presentando dolor intenso en la zona del segundo premolar superior de recho (1.5). Se realizó la exodoncia del 1.5, usándose como diente donante para realizar una preservación del alveolo tras la extracción. Cuatro meses tras el proce dimiento, se colocó un implante y se tomó una biopsia para realizar un análisis histo morfométrico. Un año tras la carga del im plante se observaron buenos resultados clínicos y radiográficos. Discusión: el diente y el tejido óseo tie nen similitudes en su composición quími ca, tanto en sus componentes inorgáni cos y orgánicos como en la cantidad de agua. En cuanto al contenido orgánico destacan los factores de crecimiento, la proteína morfogenética ósea 2 (BMP-2) y el colágeno tipo 1, dotando al diente como biomaterial de la propiedad de os teoinducción. El empleo del diente como sustituto en preservación alveolar consi gue porcentajes altos de hueso neofor mado, variando entre 37,55% cuando se usa el diente completo, al 48,40% usando dentina desmineralizada. Además de los buenos resultados histomorfométricos, goza de una buena aceptación por parte de los pacientes, fundamentalmente en determinadas ra zas o culturas, y consigue una reducción de las dimensio nes óseas evaluadas mediante escáner de haz cónico. Sin embargo, requiere un tiempo de preparación, que aumenta si el diente tiene restauraciones o tratamientos de conduc tos asociados (AU)

Introduction: following tooth extraction, horizontal and vertical resorption of bone volume occurs, but they can be reduced by many surgical procedures, such as alveolar ridge preservation, which uses different bone substitutes, being one of them autogenous tooth-graft. Clinical case: a 61-year-old woman is presented, who came to private dental clinic presenting intense pain in the area of an upper bicuspid of the first quadrant (1.5). Exodontia of the 1.5 was performed, using it as a donor tooth to obtain the biomaterial to preserve its alveolus. After 4 months re-entry was performed and an implant was placed, harvesting a bone biopsy for histomorphometric analysis. One year post-loading, good clinical and radiographic results were shown. Discussion: human bone and tooth have similarities in their chemical composition, both in their inorganic and organic components and in the amount of water. The organic content, growth factors, bone morphogenetic protein 2 (BMP-2) and type 1 collagen stand out, give the tooth the property of osteoinduction. The use of the tooth as a substitute in alveolar preservation achieves high percentages of neoformed bone, varying between 37.55% when the whole tooth is used, to 48.40% using demineralized dentin. In addition, it is well accepted by patients, especially in certain races or cultures, and achieves a reduction in bone dimensions evaluated by cone beam computed tomography. However, it has a drawback, requiring a long preparation time, which increases if the tooth has associated restorations or root canals. Conclusions: Autologous tooth-graft has a high biocompatibility, a low rate of intraoperative complications and good patient acceptance. It requires 25 minutes for preparation, which increases if there are restorations, root canals and caries. The percentage of vital bone obtained in the present clinical case shows new bone formation of 20% 4 months after alveolar ridge preservation (AU)

Socket Preservation Using Dentin Mixed with Xenograft Materials: A Pilot Study.

BACKGROUND: The use of human dentin matrix could serve as an alternative to autologous, allogenic, and xenogeneic bone grafts due to its osteoinductive characteristics. The limitations of its use is tooth availability and that it is often necessary to mix it with a biomaterial. AIM: The aim of this study was to analyze a mix of two different graft materials with different reabsorption ranges when the dentin graft material was not sufficient for full socket preservation. METHODS: Seven socket preservation surgeries were carried out employing a mixed graft material containing 50% dentin and 50% xenograft. After four months of recovery, the implants were positioned. At the time of the prosthesis placement and implant surgery, bone samples were collected. RESULTS: The histologic analysis revealed no inflammatory or infective reaction against the seven biopsies. The histomorphometric graft analysis revealed an amount of New Bone of 29.03 ± 6.57% after 4 months and 34.11 ± 5.02% after 8 months. CONCLUSIONS: The two graft materials had a different volume reabsorption rate: 71% after 4 months and 90% after 8 months for dentin, and 6% after 4 months and 26% after 8 months for the xenograft. The space created by the dentin reabsorption increased the quantity of new bone.

Maxillary Sinus Augmentation Using Autologous Platelet Concentrates (Platelet-Rich Plasma, Platelet-Rich Fibrin, and Concentrated Growth Factor) Combined with Bone Graft: A Systematic Review.

BACKGROUND: The current review aims to provide an overview of the most recent research on the potentials of concentrated growth factors used in the maxillary sinus lift technique. MATERIALS AND METHODS: "PRP", "PRF", "L-PRF", "CGF", "oral surgery", "sticky bone", "sinus lift" were the search terms utilized in the databases Scopus, Web of Science, and Pubmed, with the Boolean operator "AND" and "OR". RESULTS: Of these 1534 studies, 22 publications were included for this review. DISCUSSION: The autologous growth factors released from platelet concentrates can help to promote bone remodeling and cell proliferation, and the application of platelet concentrates appears to reduce the amount of autologous bone required during regenerative surgery. Many authors agree that growth factors considerably enhance early vascularization in bone grafts and have a significantly positive pro-angiogenic influence in vivo when combined with alloplastic and xenogeneic materials, reducing inflammation and postoperative pain and stimulating the regeneration of injured tissues and accelerating their healing. CONCLUSIONS: Even if further studies are still needed, the use of autologous platelet concentrates can improve clinical results where a large elevation of the sinus is needed by improving bone height, thickness and vascularization of surgical sites, and post-operative healing.

Effects of Elastodontic Appliance on the Pharyngeal Airway Space in Class II Malocclusion.

BACKGROUND: The present study analyzed the changes obtained on the upper airway and hyoid bone dimensions in a group of patients with skeletal Class II malocclusion treated with functional elastodontic devices compared to an untreated control group. METHODS: A group of 33 patients (19 females and 14 males) with Class II malocclusion treated with AMCOP® SC elastodontic device was compared with a control group of 35 subjects (17 females and 18 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start (T0) and end of treatment/period of observation (T1). Cephalometric analysis was performed and linear measurements to evaluate airway space and hyoid bone position were also obtained. A multivariate analysis of variance for repeated measures (MANOVA) was performed to determine the effects of interactions for the groups for time. RESULTS: Statistically significant differences were found in the study group from T0 and T1 with an improvement of superior upper airway (SPAS p < 0.0001), while in the control group it did not change in a statistically significant way from T0 to T1. The MANOVA test showed statistically significant differences between the two groups for the changes of SPAS (p = 0.003), IAS (p = 0.049), and H-C3 vertical (p = 0.038) values. CONCLUSIONS: Functional elastodontic therapy produced significant favorable airway changes in skeletal class II subjects.

Benefits of Natural Antioxidants on Oral Health.

In recent years, special attention has been paid to the correlation between oxidation-reduction mechanisms and human health. The free radicals produced via physiological cellular biochemical processes are major contributors to oxidation phenomena. Their instability is the major cause of cellular damage. Free radical reactive oxygen species containing oxygen are the best-known ones. The body neutralises the harmful effects of free radicals via the production of endogenous antioxidants (superoxide dismutase, catalase, glutathione, and melatonin). The field of study of nutraucetics has found antioxidant capacity in substances such as vitamins A, B, C, E, coenzyme Q-10, selenium, flavonoids, lipoic acid, carotenoids, and lycopene contained in some foods. There are several areas of investigation that aim to research the interaction between reactive oxygen species, exogenous antioxidants, and the microbiota to promote increased protection via the peroxidation of macromolecules (proteins, and lipids) by maintaining a dynamic balance among the species that make up the microbiota. In this scoping review, we aim to map the scientific literature on oxidative stress related to the oral microbiota, and the use of natural antioxidants to counteract it, to assess the volume, nature, characteristics, and type of studies available to date, and to suggest the possible gaps that will emerge from the analysis.

Dentin, Dentin Graft, and Bone Graft: Microscopic and Spectroscopic Analysis.

BACKGROUND: The use of the human dentin matrix could serve as an alternative to autologous, allogenic, and xenogeneic bone grafts. Since 1967, when the osteoinductive characteristics of autogenous demineralized dentin matrix were revealed, autologous tooth grafts have been advocated. The tooth is very similar to the bone and contains many growth factors. The purpose of the present study is to evaluate the similarities and differences between the three samples (dentin, demineralized dentin, and alveolar cortical bone) with the aim of demonstrating that the demineralized dentin can be considered in regenerative surgery as an alternative to the autologous bone. METHODS: This in vitro study analyzed the biochemical characterizations of 11 dentin granules (Group A), 11 demineralized using the Tooth Transformer (Group B), and dentin granules and 11 cortical bone granules (Group C) using scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) to evaluate mineral content. Atomic percentages of C (carbon), O (oxygen), Ca (calcium), and P (phosphorus) were individually analyzed and compared by the statistical t-test. RESULTS: The significant p-value (p < 0.05) between group A and group C indicated that these two groups were not significantly similar, while the non-significant result (p > 0.05) obtained between group B and group C indicated that these two groups are similar. CONCLUSIONS: The findings support that the hypothesis that the demineralization process can lead to the dentin being remarkably similar to the natural bone in terms of their surface chemical composition. The demineralized dentin can therefore be considered an alternative to the autologous bone in regenerative surgery.

Surface Coatings of Dental Implants: A Review.

Replacement of missing teeth is possible using biocompatible devices such as endosseous implants. This study aims to analyze and recognize the best characteristics of different implant surfaces that ensure good peri-implant tissue healing and thus clinical success over time. The present review was performed on the recent literature concerning endosseous implants made of titanium, a material most frequently used because of its mechanical, physical, and chemical characteristics. Thanks to its low bioactivity, titanium exhibits slow osseointegration. Implant surfaces are treated so that cells do not reject the surface as a foreign material and accept it as fully biocompatible. Analysis of different types of implant surface coatings was performed in order to identify ideal surfaces that improve osseointegration, epithelial attachment to the implant site, and overall peri-implant health. This study shows that the implant surface, with different adhesion, proliferation, and spreading capabilities of osteoblastic and epithelial cells, influences the cells involved in anchorage. Implant surfaces must have antibacterial capabilities to prevent peri-implant disease. Research still needs to improve implant material to minimize clinical failure.

Autologous Tooth Graft: Innovative Biomaterial for Bone Regeneration. Tooth Transformer® and the Role of Microbiota in Regenerative Dentistry. A Systematic Review.

Different biomaterials, from synthetic products to autologous or heterologous grafts, have been suggested for the preservation and regeneration of bone. The aim of this study is to evaluate the effectiveness of autologous tooth as a grafting material and examine the properties of this material and its interactions with bone metabolism. PubMed, Scopus, Cochrane Library, and Web of Science were searched to find articles addressing our topic published from 1 January 2012 up to 22 November 2022, and a total of 1516 studies were identified. Eighteen papers in all were considered in this review for qualitative analysis. Demineralized dentin can be used as a graft material, since it shows high cell compatibility and promotes rapid bone regeneration by striking an ideal balance between bone resorption and production; it also has several benefits, such as quick recovery times, high-quality newly formed bone, low costs, no risk of disease transmission, the ability to be performed as an outpatient procedure, and no donor-related postoperative complications. Demineralization is a crucial step in the tooth treatment process, which includes cleaning, grinding, and demineralization. Since the presence of hydroxyapatite crystals prevents the release of growth factors, demineralization is essential for effective regenerative surgery. Even though the relationship between the bone system and dysbiosis has not yet been fully explored, this study highlights an association between bone and gut microbes. The creation of additional scientific studies to build upon and enhance the findings of this study should be a future objective of scientific research.

Autogenous Dentin Particulate Graft for Alveolar Ridge Augmentation with and without Use of Collagen Membrane: Preliminary Histological Analysis on Humans.

(1) Background: The phenomenon of ankylosis of the dental elements has led clinicians to think that properly treated dentin and cement may be a potential graft for alveolar ridge augmentation. Currently, there are no studies in the literature able to histomorphometrically compare the healing patterns of an autogenous dentin particulate graft with the association, or not, of resorbable membranes. The aim of this pilot study is to histologically compare bone after an alveolar ridge augmentation using an autogenous dentin particulate graft with and without a resorbable collagen membrane. (2) Methods: this clinical trial enrolled six patients with defects requiring bone augmentation. Two procedures were performed in all six adult human patients in order to perform a study-control study: in Group 1, a ridge augmentation procedure with an autogenous dentin particulate graft and a resorbable collagen membrane was performed, and, in Group 2, an alveolar ridge preservation without a membrane was performed at the same time (T0). At 4 months, a biopsy of the bone tissues was performed using a 4 mm trephine bur in order to perform a histomorphometric analysis. (3) Results: The histomorphometric analysis demonstrated that Group 1 presented 45% of bone volume, 38% of vital bone, and 7% of residual graft. On the contrary, membrane-free regenerative procedures demonstrated 37% of bone volume, 9% of vital bone, and 27% of non-resorbed graft. In all cases, the regenerated bone allowed the insertion of implants with a standard platform, and no early failures were recorded. (4) Conclusions: Autogenous dentin particulate grafts seem to work best when paired with a membrane.

Tooth as graft material: Histologic study.

BACKGROUND: An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The choice of the graft material and its properties also could have an impact on the results. To prevent alveolar ridge dimensional changes, since numerous graft materials have been suggested and in the past years, a growing interest in teeth material has been observed as a valuable alternative to synthetic biomaterials. AIM: The aim of the study was to explore the histomorphometric outcomes of tooth derivative materials as used as bone substitute material in socket preservation procedure. METHODS: After alveolar socket preservation (ASP) procedures using autologous demineralized tooth as graft material prepared by means of an innovative device, was evaluated. A total of 101 histological samples, from 96 subjects, were analyzed by evaluating the total amount of bone (BV), residual tooth material (residual graft, TT), and vital bone (VB). The section from each sample was then split in nine subsections, resulting in 909 subsections, to allow statistical comparison between the different areas. RESULTS: It was not noticed a statistically significant difference between maxillary and mandibular sites, being the amount of VB in upper jaw sites 37.9 ± 21.9% and 38.0 ± 22.0% in lower jaw sites and the amount of TT was 7.7 ± 12.2% in maxilla and 7.0 ± 11.1% in mandibles. None of the other considered parameters, including defect type and section position, were statistically correlated to the results of the histomorphometric analysis. CONCLUSIONS: ASP procedure using demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone potentially capable to support dental implant rehabilitation.

Implants Survival Rate in Regenerated Sites with Innovative Graft Biomaterials: 1 Year Follow-Up.

In thirteen different dental clinics in Singapore, Spain, Czech Republic and Italy, 504 patients were selected, and 483 dental implants were placed in maxillary sites after alveolar socket preservation (ASP) procedures with an autologous demineralized tooth extracted as graft material from an innovative Tooth Transformer device was obtained. All procedures used were reported in n°638 Ethical Committee surgical protocol of University of Chieti and approved. After 4 months, at dental implant placing, bone biopsies were performed to evaluate the histologic outcomes, and 12 months after implant loading, global implant survival rate, failure percentage and peri-implant bone loss were detected. After ASP, only 27 post-operative complications were observed and after 4 months, bone biopsy histomorphometric analysis showed a high percentage of bone volume (BV) 43.58 (±12.09), and vital new bone (NB) 32.38 (±17.15) with an absence of inflammation or necrosis areas. Twelve months after loading, only 10 dental implants failed (2.3%), with a 98.2% overall implant survival rate, nine cases showed mucositis (1.8%) and eight showed peri-implantitis (1.6%). At mesial sites, 0.43 mm (±0.83) of bone loss around the implants was detected and 0.23 mm (±0.38) at the distal sites with an average value of 0.37 mm (±0.68) (p > 0.568). Several studies with a longer follow-up will be necessary to confirm the preliminary data observed. However, clinical results seem to suggest that the post-extraction socket preservation procedure using innovative demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone able to support dental implant rehabilitation of maxilla edentulous sites.

Autologous Deciduous Tooth-Derived Material for Alveolar Ridge Preservation: A Clinical and Histological Case Report.

The management of the alveolar socket is fundamental to create conditions that would allow the positioning of dental implants in the same site, when required. A number of biomaterials were described in scientific literature to be used for alveolar socket preservation immediately after tooth extraction: autogenous grafts, allograft (of various origin), and synthetic products. Among the autogenous biomaterials, some authors proposed the use of autogenous dentin and/or enamel, retrieved from teeth, adequately managed, and purified. The present case report with two-year follow-up shows one case of alveolar socket preservation by using tooth graft material that was subsequently treated with one implant-supported rehabilitation in the same site. The paper presents clinical and histological outcomes and confirms the feasibility of adopting such autogenous biomaterial in standard procedures.

Alveolar Socket Preservation with Different Autologous Graft Materials: Preliminary Results of a Multicenter Pilot Study in Human.

BACKGROUND: The histological and histomorphometrical results were evaluated between vital whole and non-vital endodontically treated teeth used as autologous grafts in post-extractive socket preservation procedures. METHODS: Twenty-eight patients (average age 51.79 ± 5.97 years) with post-extractive defects were enrolled in five dentistry centers. All patients were divided into two groups: with whole teeth (Group 1) and teeth with endodontical root canal therapy (Group 2). The extracted teeth were processed with the Tooth Transformer device to obtain a demineralized and granulated graft material used with a resorbable collagen membrane for socket preservation. After four months, 32 bone biopsies were obtained for histological, histomorphometric, and statistical analysis. RESULTS: During the bone healing period, no infection signs were observed. Nineteen biopsies in group 1 and 13 biopsies in group 2 were detected. The histological analysis showed neither inflammatory nor infective reaction in both groups. Autologous grafts surrounded by new bone were observed in all samples and, at high magnification, partially resorbed dentin and enamel structures were detected. No gutta-percha or cement was identified. Small non-statistically significant differences between the groups, in total bone volume (BV), autologous graft residual, and vital bone percentage were detected. CONCLUSIONS: The study showed that the TT Transformer grafts were capable of producing new vital bone in socket preservation procedures. The histomorphometric results showed no statistical differences comparing whole and endodontically treated teeth in bone regeneration. Further studies will be carried out in order to understand the advantages of the autologous graft materials obtained from the tooth compared with the current biomaterials in bone regeneration treatments.