Alveolar ridge preservation using autogenous tooth graft versus beta-tricalcium phosphate alloplast: A randomized, controlled, prospective, clinical pilot study

Abstract

Background: A randomized, prospective clinical, radiographical, and histological study was conducted to evaluate healing after alveolar ridge preservation technique using two different graft materials, namely, a novel autogenous graft material i. e., autogenous tooth graft (ATG) and beta-tricalcium phosphate (β-TCP) alloplast.

Materials and methods: Fifteen patients undergoing extraction of at least three teeth were selected. Atraumatic extractions were performed. Of the three extraction sockets, one was grafted with ATG, other with β-TCP, and the third was left ungrafted. Cone-beam computed tomography scans were taken immediately after grafting and 4 months postoperatively to check the changes in alveolar crest height and width at all the sites. Three patients in whom implant placement was done after complete healing; bone samples were harvested using a 3 mm diameter trephine during osteotomy preparation from both the ridge preserved sites and studied histologically.

Results: There was a statistically significant difference when the changes in width and height of alveolar crest were compared within all the three groups (P < 0.05). Among three sites, ATG-grafted sites showed the most superior results with a minimal reduction in alveolar crest height and width. Histological analysis also showed the same trend with more new bone formation at ATG-grafted sites as compared to β-TCP-grafted sites.

Conclusion: Postextraction, ridge preservation leads to more predictable maintenance of alveolar ridge height and width. ATG as compared to β-TCP provided superior results. Based on this, we conclude that ATG material can serve as a better alternative to conventional bone graft materials.

Keywords: Bone graft(s); bone regeneration; imaging; ridge preservation.

Figure 1

Study flowchart

Figure 2

Preparatory steps of autogenous tooth graft. (a) Cleaned extracted teeth; (b) Conventional grinder; (c) Two autoclavable stainless steel sieves; (d) Prepared graft

Figure 3

Clinical postoperative comparison of alveolar ridge width shrinkage for grafted and ungrafted sites in a representative case

Figure 4

Four months postoperative radiographic images (cone-beam computed tomography images) comparing with baseline images. (a and c) Baseline radiographs; (b and d) Four months postoperative radiographs

Figure 5

Mean height change in millimeter

Figure 6

Mean width change in millimeter

Figure 7

Hematoxylin and eosin staining of biopsy tissue taken from (a) autogenous tooth grafted site after 4 months (×40); (b) Beta-tricalcium phosphate grafted site after 4 months (×40). ^*Indicates residual autogenous tooth graft particles; ^#Indicates residual beta-tricalcium phosphate particles; N.B. – New bone formation