Demineralized Dentin Matrix for Dental and Alveolar Bone Tissues Regeneration: An Innovative Scope Review

Abstract

Background: Dentin is a permeable tubular composite and complex structure, and in weight, it is composed of 20% organic matrix, 10% water, and 70% hydroxyapatite crystalline matrix. Demineralization of dentin with gradient concentrations of ethylene diamine tetraacetic acid, 0.6 N hydrochloric acid, or 2% nitric acid removes a major part of the crystalline apatite and maintains a majority of collagen type I and non-collagenous proteins, which creates an osteoinductive scaffold containing numerous matrix elements and growth factors. Therefore, demineralized dentin should be considered as an excellent naturally-derived bioactive material to enhance dental and alveolar bone tissues regeneration.

Method: The PubMed and Midline databases were searched in October 2021 for the relevant articles on treated dentin matrix (TDM)/demineralized dentin matrix (DDM) and their potential roles in tissue regeneration.

Results: Several studies with different study designs evaluating the effect of TDM/DDM on dental and bone tissues regeneration were found. TDM/DDM was obtained from human or animal sources and processed in different forms (particles, liquid extract, hydrogel, and paste) and different shapes (sheets, slices, disc-shaped, root-shaped, and barrier membranes), with variable sizes measured in micrometers or millimeters, demineralized with different protocols regarding the concentration of demineralizing agents and exposure time, and then sterilized and preserved with different techniques. In the act of biomimetic acellular material, TDM/DDM was used for the regeneration of the dentin-pulp complex through direct pulp capping technique, and it was found to possess the ability to activate the odontogenic differentiation of stem cells resident in the pulp tissues and induce reparative dentin formation. TDM/DDM was also considered for alveolar ridge and maxillary sinus floor augmentations, socket preservation, furcation perforation repair, guided bone, and bioroot regenerations as well as bone and cartilage healing.

Conclusion: To our knowledge, there are no standard procedures to adopt a specific form for a specific purpose; therefore, future studies are required to come up with a well-characterized TDM/DDM for each specific application. Likely as decellularized dermal matrix and prospectively, if the TDM/DDM is supplied in proper consistency, forms, and in different sizes with good biological properties, it can be used efficiently instead of some widely-used regenerative biomaterials.

Keywords: Bone regeneration; Demineralized dentin matrix; Dental tissue regeneration; Dentin; Treated dentin matrix.

Fig. 1

Representative diagrams created with BioRender.com for the chemical composition of A dentin, B component parts of the tooth and C histological structure of dentin

Fig. 2

Flowchart for article selection according to preferred reporting items for systematic reviews and meta-analyses guidelines

Fig. 3

Exploded pie chart showing analytical data of the frequencies regarding source of teeth selected in study designs from the relevant articles

Fig. 4

Bar chart showing analytical data of the frequencies regarding tooth part selected in study designs from the relevant articles

Fig. 5

SEM images showing DDM particle size ranging from 350-500lm. Courtesy provided by the staff members of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt

Fig. 6

SEM images showing the basic dentin micro-texture after demineralization. Structurally, dentinal tubules are enlarged. Courtesy provided by the staff members of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.

Fig. 7

Decalcified sections of human pulp capped with A, B DDM hydrogel, C, D Biodentine, and E, F MTA after 2-mon examination period showing complete dentin bridge formation and absence of inflammatory pulp response. a, b, c × 40 and a1, b1, c1 are higher magnification of boxed areas × 200. Courtesy provided by the staff members of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt

Fig. 8

Exploded doughnut chart showing outcomes from the relevant articles