Autologous tooth bone graft block compared with advanced platelet-rich fibrin in alveolar ridge preservation: A clinico-radiographic study

Abstract

Objectives: To determine the clinico-radiographic efficiency of partially demineralized dentin matrix block (PDDM block), a mixture of PDDM with advanced-platelet-rich fibrin+ (A-PRF+) and injectable platelet-rich fibrin versus A-PRF+ alone in alveolar socket preservation.

Materials and methods: Sixteen molar teeth indicated for extraction were randomly assigned into two groups. For the test group, sockets were packed with PDDM block and control group, with A-PRF+ plug alone. Clinical and radiographic cone-beam computed tomography methods were used to assess the horizontal and vertical ridge dimensional changes at baseline and 4 months.

Results: Clinically, the mid buccal and palatal crestal height (10.25 ± 0.86 and 9.75 ± 0.28 mm) and alveolar ridge width (11.37 ± 0.25 mm) were significantly higher in the test group as compared to the control group, 4 months after tooth extraction (P < 0.01). Radiographically, there was improved apposition and nonsignificant resorption for the test group in ridge height and width, whereas statistically significant higher resorption was seen in the control group at 4 months.

Conclusion: The application of the PDDM block demonstrated efficacy in maintaining the dimensions of the extraction socket when compared to A-PRF+ alone. This autologous and immune-free regenerative biomaterial is widely obtainable, offering a glimpse into the potential of next-generation biofuels for regeneration.

Keywords: Advanced-platelet-rich fibrin+; alveolar ridge preservation; dentin graft; partially demineralized dentin matrix block.

Flowchart 1

Representing randomization of patients. N – Participants of the study, PDDM – Partially demineralized dentin matrix, A-PRF – Advanced platelet rich fibrin, i-PRF – injectable platelet rich fibrin

Figure 1

(a) Cleaning of tooth using airotor; (b) The cleaned tooth is placed in KometaBio^®; (c) Graft particle in collecting and waste drawer; (d) Particles immersed in dentin cleanser for 10 min; (e) Particles immersed in ethylenediamine tetraacetic acid for 2 min; (f) Particles washed twice with phosphate-buffered saline

Figure 2

(a) Partially demineralized dentin graft; (b) Collection of injectable platelet rich fibrin (i-PRF); (c) advanced-platelet-rich fibrin+ (A-PRF) + clot; (d) A-PRF+ membrane obtained using PRF xpression box; (e) partially demineralized dentin matrix was mixed with i-PRF and shredded A-PRF+; (f) Partially demineralized dentin bone matrix

Figure 3

(TEST GROUP): (a) Occlusal view at baseline; (b) Buccolingual width at baseline; (c) Mid lingual crestal height at baseline; (d) Mid buccal crestal height at baseline with University of North Carolina (UNC) 15 probe; (e) Extraction socket was filled with partially demineralized dentin matrix block; (f) Covered with advanced-platelet-rich fibrin+ membrane and sutured

Figure 4

(CONTROL GROUP): (a) Occlusal view at baseline; (b) Buccolingual width at baseline; (c) Mid lingual crestal height at baseline; (d) Mid buccal crestal height at baseline with University of North Carolina (UNC) 15 probe; (e) Advanced-platelet-rich fibrin+ (A-PRF+) plug; (f) A-PRF+ plug filled inside the socket covered with A-PRF+ membrane and sutured

Figure 5

TEST GROUP (cone-beam computed tomography); (a) Preoperative vertical dimensions; (b) Preoperative horizontal width; (c) Postoperative vertical dimensions; (d) Postoperative horizontal dimensions. mm – Millimeter

Figure 6

Vertical dimension was calculated from the coronal most part of the crestal bone till base of the socket, The Buccal and Lingual cortical heights were measured from the most crestal aspect of the socket on the buccal and lingual aspect to the apical most part of the socket on that aspect, HW-0, HW-2 mm, HW-4 mm: Horizontal width at 3 different levels – at crest, 2 mm below crest and 4 mm below crest extending from buccal cortical plate to lingual/palatal cortical plate. VD – Vertical dimension, BCH–LCH: Buccal cortical heights and Lingual cortical heights, PCH: Palatal cortical heights, HW – Horizontal width. mm – Millimeter

Figure 7

CONTROL GROUP (Cone-beam computed tomography) (a) Preoperative vertical dimensions; (b) Preoperative horizontal width; (c) Postoperative vertical dimensions; (d) Postoperative horizontal dimensions. mm – Millimeter