Comparative alveolar ridge preservation using allogenous tooth graft versus free-dried bone allograft: A randomized, controlled, prospective, clinical pilot study

Abstract

Background:For the first time in India, allografts from human extracted teeth were prepared. A randomized, prospective, clinicoradiographical, histological study was conducted to evaluate their efficacy in comparison with freeze-dried bone allograft (FDBA) in alveolar ridge preservation.Materials and Methods:Graft preparation: with written consent, teeth were collected from three donors (full mouth extraction cases). Once donors’ serums were tested negative for HIV, HBV, HCV, and Venereal disease research laboratory (VDRL), mineralized whole tooth allograft (WTA) and dentin allograft (DA) were prepared using the standard protocol of Tissue Bank at Tata Memorial Hospital, Mumbai, India.Study Design:In this randomized controlled trial, 15 patients undergoing extraction of at least four teeth were selected. In each patient after atraumatic extractions, one socket was grafted with WTA, second with DA, third with FDBA, and fourth was left ungrafted (control site). All the sites were covered with chorion membrane. To estimate three-dimensional alveolar crest changes, cone beam computed tomography scans were taken immediately after grafting and 4 months postoperatively. Bone biopsies using 3 mm trephine bur were obtained from four patients at the time of implant placement and evaluated histologically.Results:Clinically uneventful healing was observed at all sites. Compared to other sites, WTA and DA consistently showed superior results demonstrating least reduction in alveolar crest height and width which was statistically significant (P < 0.05). Between WTA and DA sites, there was no statistically significant difference. Histological analysis also confirmed more new bone formation at WTA and DA sites.Conclusions:Rather than disposing extracted human teeth as a biomedical waste (common practice), they can be collected from suitable systemically healthy donors. With the help of tissue bank, they can be processed into an allograft, serving as an excellent alternative to conventional allografts.

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

“…The estimated effect size given for comparison of the groups was 2.049, based on a previous study [15]. It was determined that a sample set of nine participants per group would be required to recognize a significant difference regarding the ridge width of the CBCT, with 80% power and a 5% confidence level.…”

“…Several recent studies have demonstrated that DDM is well-tolerated when used to fill the ridge defects, indicating promising potential for bone regeneration [13][14][15]20]. Similarly, the effectiveness of DDM as a bone substitute has already been identified in various clinical circumstances such as the alveolar bone regeneration associated with dental implants, sinus augmentation, and preservation of extraction sockets [13][14][15]21,22]. In these studies, DDM completely fulfills the criteria for a bone regeneration material, possessing osteoinductive and osteoconductive properties [23].…”

“…A wide range of biomaterials, including autografts [9], allografts [10], xenografts [11], alloplastic materials such as bioactive glasses [12], autogenous tooth bone grafts [13][14][15], bioactive materials such as recombinant human bone morphogenetic protein-2 (rhBMP-2) [16], and platelet-rich fibrin (PRF) [17], has been shown to produce positive outcomes for ridge preservation. Autogenous bone is an ideal material for hard tissue defects because it has osteoinduction and osteoconduction and has no immune rejection.…”

“…In a previous study, a scanning electron microscopy (SEM) analysis of calcified dentin revealed dentinal tubules, which are thought to contribute to the diffusion of nutrients after grafting by acting as a network [19]. Several recent studies have demonstrated that DDM is well-tolerated when used to fill the ridge defects, indicating promising potential for bone regeneration [13][14][15]20]. Similarly, the effectiveness of DDM as a bone substitute has already been identified in various clinical circumstances such as the alveolar bone regeneration associated with dental implants, sinus augmentation, and preservation of extraction sockets [13][14][15]21,22].…”

Ridge augmentation using sticky bone: A combination of human tooth allograft and autologous fibrin glue

“…[6] Briefly, full-mouth extraction cases were screened to identify potential donors to collect extracted teeth. Four patients with nonreactive sera for HIV, hepatitis B virus, hepatitis C virus, and syphilis antigens donated their extracted teeth.…”