Clinical, radiographical and histological evaluation of alveolar ridge preservation with an autogenous tooth derived particulate graft in EDS class 3-4 defects

Abstract

Background: The shrinkage of alveolar bone dimensions after tooth extraction is a well-known issue. This clinical phenomenon poses a challenge for clinicians aiming at implant-prosthetic treatment. BonMaker^® ATB is a novel autogenous bone grafting material, produced by the mechanical and chemical processing of natural teeth. This pilot case report aims at providing a clinical, radiographical, and histological evaluation of the safety and efficacy of Bonmaker ATB powder in the treatment of EDS class 3-4 postextraction sockets with alveolar ridge preservation.

Methods: A total of 9 teeth were extracted from 5 patients. The extracted teeth were prepared immediately with the Bonmaker^® device. The extraction sockets were filled up with ATB powder. Six months after extraction, standardized intraoral x-rays and CBCT scans were performed. Re-entry was performed under local anaesthesia. Core biopsies were harvested for histological analysis and implants were placed.

Results: Horizontal alveolar dimension loss occurred, even though ARP was performed, but the horizontal shrinkage was moderate. Vertical dimensions did not show loss of volume, but increased defect fill. Core biopsies showed ATB particles surrounded by newly formed bone and connective tissue. According to histomorphometric analysis, the harvested samples contained 56% of newly formed bone on average, and only a mean of 7% of non-remodelled ATB material was observed.

Conclusion: The preliminary clinical, radiographical, and histological results of Bonmaker^® autogenous tooth graft therapy indicate that ATB may be safely and successfully used as a grafting material for ARP. Optimal graft incorporation and histologically proven effective remodelling, as well as uneventful wound healing support the clinical application of ATB to minimize post-extraction hard tissue loss. Further research is needed to exploit the full potential of ATB and to evaluate the long-term peri-implant hard and soft tissue stability of ATB-treated post-extraction sites.

Fig. 1

Baseline clinical view: middle incisors with periodontally hopeless prognosis

Fig. 2

Baseline intraoral X-ray

Fig. 3

Baseline CBCT scan of upper middle incisors, (a) upper right first incisor, (b) upper left first incisor

Fig. 4

(a) Alveolar ridge preservation was carried out with the disinfected auto-tooth bone graft (BonMaker^®, Korea Dental Solutions Co. Ltd., South Korea), (b) Post extraction sockets covered with FGG transplants

Fig. 5.

6-month postoperative view, before re-entry

Fig. 6.

6-month postoperative CBCT scan before re-entry, (a) upper right first incisor, (b) upper left first incisor

Fig. 7

(a) Intraoperative picture before histological sample harvesting, (b) Histological sample harvesting with trephine burs

Fig. 8

(a) Implant placement (ICX, Medentis Medical GmbH, Germany) after the histological sample harvesting, (b) Implants in final position

Fig. 9

(a) Temporary restorations, (b) Final restorations

Fig. 10

(a) Intraoral X-ray at delivery of final restorations, (b) 12 months after delivery

Fig. 11

Histological overview, × 100 magnification, Haematoxylin–eosin staining

Fig. 12

(a) Histological view, × 200 magnification, Haematoxylin–eosin staining, (b) Histological view, × 400 magnification, Haematoxylin–eosin staining