Alveolar ridge preservation with autologous particulated dentin-a case series

Abstract

Introduction: Ridge preservation can be performed with autologous bone, alloplastic bone substitute material or a combination of both. Dentin is similar to bone in its chemical composition. In its use as bone substitute material, it undergoes a remodelling process and transforms to bone. The presented case report introduces a technique in which the extraction socket is augmented with autologous, particulated dentin.

Material and methods: The fractured, non-savable mesial incisor of the upper jaw was carefully extracted in axial direction. After the extraction, the tooth was cleared from remaining periodontal tissue. The vital pulp tissue or a root canal filling, enamel and cementum were also removed. Following the particulation of the remaining dentin in a bone mill, the dentin particles were immediately filled orthotope into the alveolar socket. The soft tissue closure was performed with a free gingival graft of the palate.

Results: After an observation period of 4 months, an implant was placed in the augmented area, which osseointegrated successfully and could be restored prosthodontically in the following. The results of this method showed a functional and aesthetic success.

Conclusion: The pre-implantological, autologous ridge preservation with dentin could be performed successfully. For the establishment of dentin as augmentation material for jaw augmentation procedures, a prospective, clinical trial is now necessary.

Keywords: Alveolar ridge preservation; Autologous augmentation; Bone augmentation; Bone substitute; Particulated dentin.

Figures

Fig. 1

Extraction with the benex system

Fig. 2

The remaining root of tooth 11

Fig. 3

Removal of the pulp

Fig. 4

Removal of enamel and the cementum

Fig. 5

Autologous dentin in a bone mill

Fig. 6

Autologous dentin with the desired particle size

Fig. 7

Autologous, particulated dentin mixed with blood from the operating site

Fig. 8

Autologous, particulated dentin in the alveolar socket

Fig. 9

Soft tissue punch

Fig. 10

Soft tissue graft placed on the recipient site

Fig. 11

Sagittal view

Fig. 12

Axial view

Fig. 13

a, b Clinical situation prior to implant placement

Fig. 14

Single tooth X-ray immediately after the augmentation using autogenous dentin

Fig. 15

Single tooth X-ray, showing a constant bone level 7 months after implant placement

Fig. 16

Single tooth X-ray, 1 year post-implantation, showing the finalized crown

Fig. 17

Histology of dentin augmentation. aAsterisk denotes incorporated dentin particle, surrounded by vital woven bone. Triangle shows reactive process in the bone marrow lacunae with osteoblast rimming. No signs of necrosis or infection (H&E stain, ×100 magnification). b Larger magnification at ×200. c EvG (Elastica van Gieson) stain, ×200

Fig. 18

Finalized prosthetic restoration after 1 year

Fig. 19

Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration

Fig. 20

Colour-coded superimposition of intraoral scans before extraction and after definitive prosthetic restoration