(85) The effect of autologous tooth structure biomaterials in the use of ridge preservation

Introduction: • The concept of using autologous tooth as grafting material is not novel, with reports dating back to the late 1960s. Bone grafts in modern implant dentistry may be autogenous, allogenic, xenogenic, and alloplastic in nature, all of which vary in their osteogenic, osteoinductive, and osteoconductive capabilities. Each bone substitute has unique physiochemical and biologic properties that dictate individual resorption rates and regeneration potential. To date, autogenous grafts are the only material to offer osteogenic potential thus offering a unique advantage to all other bone graft options. Platelet rich fibrin (PRF) is a recent generation of autologous biomaterial that represents a new opportunity for ridge preservation and augmentation. PRF works as a source of autologous biological mediators such as PDGF, TGF-B, EGF, IGF-I, and IGF-II. The aim of this case presentation is to report on the osteoconductive efficacy of autologous dentin, combined with PRF.

Methods: A 42 y/o African American patient presented to Penn Dental Medicine Periodontics Clinic with multiple crown-root fractures and non-restorable maxillary and mandibular molars. Surgical procedure: Atraumatic extractions were performed on #1-2-3-14-15-16-17-30-32, in an attempt to preserve the socket walls. Extracted teeth were used to obtain autologous dentinal tissue for graft material preparation. All restorative material was removed from teeth, as well as carious lesions, discolored dentin, periodontal ligament, and calculus using tungsten carbide burs. Teeth were then grinded in a sterile chamber, and processed into EDTA and sterile saline solution. Subsequently, sockets were thoroughly degranulated. Extraction sockets were then grafted with autologous dentin, combined with PRF. Additional PRF membranes were placed over the grafted sites, and secured with horizontal mattress sutures. Patient returned at 2 weeks, and at 4 months for evaluation and implant placement. Core biopsies were obtained during implant placement for histological evaluation.

Results: Uneventful wound healing was observed at 2 weeks. Patient was re-evaluated for implant placement at 4 months with a CBCT scan and clinical exam. Adequate ridge dimensions for implant placement were observed. Histological analysis revealed adequate bone formation and graft material remodeling.

Conclusions: This case presentation demonstrated that autologous dentin in combination with PRF can be successfully used for implant site development.

Lead Author's Contributions to the Research Project. : The lead author was responsible for the procedure performed, clinical photography, and composition of the abstract