Autogenous Dentin Graft in Bone Defects after Lower Third Molar Extraction: A Split-Mouth Clinical Trial

Abstract

<jats:p>Various biomaterials are currently used for bone regeneration, with autogenous bone being considered the gold standard material because of its osteogenic, osteoconductive, and osteoinductive properties. In recent years, the use of autogenous dentin as a graft material has been described. This split-mouth clinical trial assesses the efficacy of autogenous dentin for the regeneration of periodontal defects caused by bone loss associated with impacted lower third molar extraction. Fifteen patients underwent bilateral extraction surgery (30 third molars) using dentin as a graft material on the test side, and leaving the control side to heal spontaneously, comparing the evolution of the defects by evaluating probing depth at three and six months post-operatively. Bone density and alveolar bone crest maintenance were also evaluated six months after surgery, and pain, inflammation, mouth opening capacity on the second and seventh days after surgery. Probing depth, radiographic bone density, and alveolar bone crest maintenance showed significant differences between the test and control sides. Autogenous dentin was found to be an effective biomaterial for bone regeneration after impacted lower third molar extraction.</jats:p>

The Use of Autogenous Teeth for Alveolar Ridge Preservation: A Literature Review

“…A similar result was found in a split-mouth clinical trial where the use of the lower third molar as a bone substitute resulted in a significant reduction of the pocket depth, mainly in the first 3 months [59]. After a 6-month-period, the bone density found in the test group was greater, with statistically significant difference (p < 0.001) [59].…”

“…As previously stated, the amount of biomaterial that the clinician can gather is dependent on the extension of carious lesions and filling materials [17,[44][45][46], nonetheless, one possible approach that can overcome this limitation is the extraction of impacted third molars, when it is required a larger amount of biomaterial [51,59].…”

“…Equivalently to the studies mentioned before, these clinical studies applied a similar protocol when preparing UDD. Generally speaking, after the teeth extraction, removal of crowns, fillings of any nature, pulp tissues and periodontal ligament, the biomaterial was grinded in order to generate particles with a diameter varying from 300 to 1200 μm [38,51,[54][55][56][57]59]. In most of the studies, a basic alcohol cleanser consisting of 0.5 M of NaOH and 30%/20% alcohol as well as a sterile phosphate buffered saline were applied to the samples gathered [38,55,56].…”

A Pilot Retrospective Study on the Effect of Bone Grafting after Wisdom Teeth Extraction

“…The continuous challenge for clinicians has always been to optimize patient comfort and outcomes after impacted mandibular M3 extraction [ 30 ]. The principal risk after surgical management of mandibular M3 is to develop or have a persistent periodontal pocket and bone loss on the distal aspect of the mandibular M2 [ 3 , 21 , 22 , 31 ].…”

“…Similarly, limited or no benefit was observed with different access flap designs used in the extraction procedure [ 18 , 19 , 20 ]. As of today, a clinically significant improvement in attachment levels has not been found in most of the randomized clinical trials evaluating various reconstructive techniques, such as autogenous bone, bone substitutes (i.e., demineralized bone powder (DBP)) [ 21 , 22 , 23 ], guided-tissue regeneration (GTR) [ 22 , 24 ], soft-tissue procedures, or platelet rich-plasm [ 25 ].…”