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Clinical Application of Autogenous Grinded Tooth Graft in Immediate Implant Placement Procedures: Case Series



Authors:

Melike Aytekin, DDS – PhD Student, Istanbul University

Alper Gültekin, DDS – Research Assistant, Istanbul University

Serdar Yalçın, DDS – Full Professor, Istanbul University

Abstract:

Purpose of the Study: Alveolar ridge resorption following tooth extraction may considerably affect favorable implant positioning and prosthetic outcomes. Immediate implant placement along with the use of bone grafting materials inside the extraction socket is the most applied treatment protocol to minimize buccal bone collapse and achieve good levels of osseointegration. Variety of bone substitutes are available for grafting procedures, however, there are some concerns regarding these materials’ unpredictable healing patterns, foreing body reactions, inflammation and infection risks and high costs. Extracted and grinded autogenous teeth set an effective alternative with high potential of bone regeneration, less foreign body reaction and cost reduction. The purpose of this case series is to evaluate the effectiveness of autogenous grinded tooth application in immediate implant placement procedures.

Methods: In this case series, seven patients were examined through clinical and radiographical parameters. Patients with hopeless natural teeth showed no restrictions for further surgical  operations. Under local anesthesia, all remaining teeth were extracted, present fillings and decays were removed then teeth were grinded(The Smart Dentin Grinder, KometaBio Inc., New Jersey, USA). Dental implants were placed in the extraction sockets and the gaps between implant and the buccal bone were filled with grinded teeth particulates. Prior to primary closure L-PRF membranes were placed onto the surgical site for an optimal soft tissue healing. Implants were then allowed to acquire secondary stability for the next 3 months before prosthodontic rehabilitation(Figures 1-27). Post-surgical repetitive radiological measurements were performed via Cone Beam Computed Tomography (CBCT) to evaluate volumetric changes in the grafted sites. Images were taken immediately after implant placement, at 3 months after healing and at final follow-up after six months of loading. The data obtained from the CBCT images were transferred to a network computer workstation, where the volumetric changes of the graft were analyzed using MIMICS 14.0 software (Materialise Europe, World Headquarters, Leuven, Belgium) Stabilization of implants, complications during and after surgery, and the presence of any adverse tissue response were also investigated. 

Results: Seven patients were selected to be eligible for inclusion in this study. Totally, 61 sites and implants were evaluated clinically and radiographically. All dental implants were placed in the extracted sites successfully. None of the patients had any surgical complications during the study period. All implants showed satisfactory clinical stability and osseointegration, with a 1-year cumulative survival rate of 100%. All patients experienced uneventful healing without complications associated with the healing of grafted sites. The average percentage of grafted site resorption was found 5.4 ±1.28 % regarding the comparative post-operative CBCT analyses.

Conclusion: The volume of grafted sites were maintained with the autogenous teeth graft material during follow-up. It may be a viable option to fill the buccal gap in immediate implant placement procedures. 

Articles: 1-)Gultekin BA, Cansiz E, Borahan MO. Clinical and 3-Dimensional Radiographic Evaluation of Autogenous Iliac Block Bone Grafting and Guided Bone Regeneration in Patients With Atrophic Maxilla. J Oral Maxillofac Surg. 2016 Nov 26. pii: S0278-2391(16)31186-7. 2-) Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone. Clin Oral Implants Res. 2016 Jun 8. doi: 10.1111/clr.12885.

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