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

Abstract

Featured Application: Novel technology of bone regeneration.Abstract: The aim of this study was to evaluate the clinical, volumetric, radiographic, and histologic aspects of autogenous demineralized dentin matrix (DDM) combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) used for ridge preservation, compared to those of deproteinized bovine bone with collagen (DBBC). Following atraumatic extraction, the socket was filled with DBBC, DDM, or rhBMP-2/DDM. Scanned images of dental casts and cone beam computed tomographs (CBCT) were superimposed for the calculation of soft and hard tissue volume alteration. Preoperative and postoperative measurements of the height and width of the alveolar ridge were compared using CBCT images. After 4 months, bone specimens were harvested for histomorphometric assessment. Loss of hard and soft tissue volume occurred at 4 months after extraction and ridge preservation in all groups. No volumetric differences were detected among the three groups before and 4 months after ridge preservation. The reduction in the horizontal width at 5 mm was higher in the DBBC compared to the DDM. Histologically, approximately 40% newly formed bone was founded in rhBMP-2/DDM group. The autogenous dentin matrix used to fill the socket was as beneficial for ridge preservation as conventional xenografts. The combination of rhBMP-2 with dentin matrix also demonstrated appreciable volumetric stability and higher new bone formation compared to DDM alone and DBBC.

Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and Platelet-Rich fibrin: A Retrospective Radiographic Cone-Beam Computed Tomography Study

“…A ridge width reduction of −1.68 mm ± 1.11 mm for sockets grafted with BioOss Collagen, −1.54 mm for sockets grafted with recombinant human bone morphogenetic protein-2 and demineralized dentin particulate, and −0.78 ± 0.41 mm for the sockets grafted with demineralized dentin particulate measured 1 mm below the buccal bone crest was reported [26]. In the present study, the mean ridge width reduction 1 mm toward the apex from the ridge crest was 1.38 mm ± 1.24 mm.…”

“…A human pilot study showed a vertical height loss of −4.2% for six MPDA grafted sockets compared to −16.7% for non-grafted sockets [18]. A recently published study showed less vertical BPR for sites grafted with dentin compared to a xenograft: −1.14 mm ± 0.81 mm buccal bone height reduction for the sockets grafted with deproteinized bovine bone with collagen, −0.97 mm ± 0.37 mm reduction for a demineralized dentin graft, and −0.82 mm ± 0.36 mm reduction for sockets grafted with demineralized dentin with bone morphogenetic protein 2 [26]. In an animal experiment, it was shown that mineralized dentin particles present intra and extra pores up to 44.48%.…”

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

“…Two experimental studies were performed at skeletal sites, 27,28 and one was performed at both sites. 28 Among three clinical studies [29][30][31] comparing DDM/rhBMP-2 with DDM alone, one study 29 reported the histological features of the dentin matrix, and the other two studies 30,31 reported the total amount of bone formation and remaining dentin matrix. Histological comparisons between these materials in experimental and clinical studies are summarized in Table 2.…”

“…Consequently, less DDM remained in human studies of DDM/rhBMP-2. 31 Bone bridge, resorption, and remodeling 31 Autogenous 4 months Bone formation 30 Bone formation, resorption, and remodeling 30 Autogenous Don, donor; H, human; R, rat; Rab, rabbit; Rec, recipient; M, mouse; NB, new bone.…”

“…In clinical studies with 0.2 mg/mL rhBMP-2 DDM/ rhBMP-2, which is much lower than the conventional supraphysiological dosage described in previous reports, 1 the results showed almost similar osteoinductive bone formation. 14,17,[29][30][31][32][33][34] However, it was unclear why DDM favored osteoclast adhesion and resorption after the addition of rhBMP-2. In addition, the most physiological concentration of rhBMP-2 in terms of both direct osteoinduction activity and stimulation of ED-BMP release by osteoclastic resorption has still not been determined.…”