Guided Bone Regeneration in a Periodontally Compromised Individual with Autogenous Tooth Bone Graft: A Radiomics Analysis

Abstract

Background: Autogenous tooth bone graft material (AutoBT) has been advocated as a bone substitute when conducting alveolar ridge preservation. This study is aimed at using a radiomics approach in order to evaluate and testify whether AutoBT can stimulate bone growth during socket preservation in severe periodontal cases.

Materials and methods: For this study, 25 cases with severe periodontal diseases were selected. The patients' AutoBTs were inserted into the extraction sockets and covered with Bio-Gide^® collagen membranes. 3D CBCT scans and 2D X-rays were taken of the patients before surgery and after 6 months post-surgery. For the retrospective radiomics analysis, the maxillary and mandibular images were compared in different groups. Maxillary bone height was analyzed at the buccal, middle, and palatal crest sites, while the mandibular bone height was compared at the buccal, center, and lingual crest sites.

Results: In the maxilla, the alveolar height was increased by -2.15 ± 2.90 mm at the buccal crest; -2.45 ± 2.36 mm at the center of the socket, and -1.62 ± 3.19 mm at the palatal crest, while the height of the buccal crest was increased by 0.19 ± 3.52 mm, and the height at the center of the socket was increased by -0.70 ± 2.71 mm in the mandible. The three-dimensional radiomics analysis demonstrated significant bone growth in the local alveolar height and high density.

Conclusion: Based on clinical radiomics analysis, AutoBT could be used as an alternative bone material in socket preservation after tooth extraction in patients with severe periodontitis.

Keywords: CBCT scans; artificial bone grafting; autogenous tooth bone graft material (AutoBT); severe periodontitis; socket preservation.

Figure 1

Flow diagram of the patient demographics and tooth extraction sites showcasing the study’s procedural methods.

Figure 2

Photographs of a clinical case: (A) right mandibular first molar before extraction; (B) severe buccal bone defect and vertical release incision post-extraction; (C) mixture of AutoBT and the patient’s extracted tooth (particle size: 250 μm–1000 μm); (D) socket grafted with AutoBT; (E) graft site covered with a resorbable collagen membrane and non-absorbable sutures; (F) intraoral photograph of the clinical case 6 months post-surgery.

Figure 3

CBCT images of the (a,A) coronal; (b,B) sagittal; and (c,C) cross-sectional sections of the alveolar bone taken 6 months post-surgery. Red lines: Increased of the grafted site could be observed.

Figure 4

(a) Preoperative and postoperative comparison of the mandibular alveolar bone height. Table key: LH: height of the lingual crest; BH: height of the buccal crest; CH: height in the center of the socket; PH: height of the palatal crest. (b) Preoperative and postoperative comparison of the maxillary and mandibular alveolar bone height. Table key: BH: height of the buccal crest; CH: height in the center of the socket; LH: height of the lingual crest; PH: height of the palatal crest. * p < 0.05.

Figure 4

(a) Preoperative and postoperative comparison of the mandibular alveolar bone height. Table key: LH: height of the lingual crest; BH: height of the buccal crest; CH: height in the center of the socket; PH: height of the palatal crest. (b) Preoperative and postoperative comparison of the maxillary and mandibular alveolar bone height. Table key: BH: height of the buccal crest; CH: height in the center of the socket; LH: height of the lingual crest; PH: height of the palatal crest. * p < 0.05.

Figure 5

The treatment process of the case report. (a) Preoperative panoramic radiograph; (b) the panoramic radiograph 6 months after surgery; (c) Attaching abutments.

Figure 6

Histology of the grafted area for the AutoBT (H&E, magnification 200). The close contact of the newly formed bone with the bone substitute can be seen in the graft material.