Auto-dentin platelet-rich fibrin matrix is an alternative biomaterial for different augmentation procedures: A retrospective case series report

Abstract

Objectives: Autologous dentin grafts derived from extracted teeth have shown promise as bone graft materials for promoting bone regeneration. This retrospective case series aimed to evaluate clinical, radiographic, and histologic outcomes of using autologous dentin matrices in various bone regeneration procedures.

Materials and methods: This case series included 26 eligible patients and encompassed 4 socket preservation cases, 5 cases of guided tissue regeneration, 5 cases of guided bone regeneration (GBR), 10 cases of sinus augmentation procedures, 2 immediate placement implants, and 2 socket shields. Dentin grafts were prepared from extracted teeth, cleaned, and processed. These grafts were combined with platelet-rich fibrin (PRF) to create adhesive dentin matrices, then covered with collagen membranes for simultaneous guided bone augmentation cases. Cone beam computed tomography (CBCT) scans were conducted before surgery and 4 months postoperatively to assess ridge dimensions. Histologic evaluation was performed through bone core biopsies for socket preservation cases at the 4-month mark.

Results: A total of 42 implants were placed in 26 patients, with an average follow-up of 32 months. Notably, two implant failures occurred following lateral maxillary sinus augmentation. CBCT scans at the 4-month interval revealed bone coverage over implant platforms in the majority of cases. Histologic analysis from two cases of socket preservation demonstrated dentin granules enveloped by newly formed bone undergoing continuous remodeling. The quantitative histomorphometric assessment revealed a bone area of 42.8 ± 3.56%, a remaining graft area of 19.05 ± 4.58%, and a viable bone of 38.15 ± 7.84%.

Conclusions: The utilization of autologous dentin particles mixed with PRF proved effective as an alternative to conventional bone graft materials in GBR and maxillary sinus augmentation procedures. Larger controlled clinical trials are recommended to further substantiate these findings.

Keywords: autologous dentin graft; bone substitutes; platelet-rich fibrin; ridge augmentation.

Figure 1

Case of vertical sinus lifting performed simultaneously with implant placement (a, b) present formatted panoramic and coronal views of cone‐beam computed tomography, illustrating the impacted upper third molar and the dimensions of the ridge width and height, (c) displays a full‐thickness flap, revealing the impacted molar, (d) shows the extracted molar, while (e–g) illustrate the grinding process, and (h, i) demonstrate the platelet‐rich fibrin (PRF) and autogenous dentin combined to form a PRF matrix.

Figure 2

The following stages of the procedure: (a, b) The application of the autogenous dentin platelet‐rich fibrin matrix before and after implant placement. (c) The closure of the flap. (d) The healing process is 2 weeks postoperatively. (e) An apically displaced flap was performed during the second stage. (f, g) Cone beam computed tomography images were taken at 4 months. (h) Situation 4 weeks after placing the healing abutment. (i) 12‐month follow‐up.

Figure 3

Presents a case involving the surgical removal of a maxillary sinus mucocele carried out simultaneously with sinus lifting (a, b) display coronal and axial views of the cone‐beam computed tomography, highlighting the mucocele (indicated by white and red arrows), (c) a full‐thickness flap revealing the shadow of the sinus, (d) a small opening made to expose the mucocele, followed by the use of a disposable syringe to aspirate the cystic fluid (e). The sinus opening is then enlarged, and intentional perforation is performed (f). The cyst lining is held using small forceps (g), and the opening is further enlarged (h) to allow for the removal of the bone shell (i). Sinus lifting is initiated using various sinus elevators (j, k), leading to complete sinus lifting (l). Finally, two small holes are created to suture the perforated membrane with suture material (m).

Figure 4

Showcases the following steps of the procedure: (a) Extracted teeth are placed in the grinding machine. (b) The resulting dentin graft with particle sizes ranging from 250 to 1000 μm. (c) Platelet‐rich fibrin (PRF) was prepared. (d) The dentin graft is mixed with the liquid form of PRF. (e, f) PRF membrane was utilized to cover the sinus membrane before placing the dentin graft. (g, h) Collagen membrane employed for intra and extra‐sinus applications. (i) Flap closure. (j–m) Various cone beam computed tomography views captured after sinus augmentation.

Figure 5

Bone core obtained from an augmented socket using the autogenous dentin platelet‐rich fibrin matrix (a), new bone formation is observed, with cellular osseous tissue in direct contact with the dentin graft particles and (b) a higher magnification view of the marked area, revealing osteoblast‐enriched osseous tissue fused with the dentin graft particles. This fusion indicates replacement resorption of the grafted material. The images were obtained through hematoxylin and eosin staining at ×4 and ×20 magnifications, respectively.