Autologous Demineralized Tooth Matrix as Bone Grafting Material for Alveolar Ridge Preservation

Abstract

Background: During the healing phase following tooth extraction, dimensional loss of bone height and width is a natural occurrence. It's widely accepted that ridge preservation procedures following tooth extraction result in greater orofacial bone dimension than where no ridge preservation was performed. Numerous grafting materials have been used to facilitate the formation of new bone via osteoconduction that preserve the space and exclude unwanted cells from the wound. Although in almost the criterion standard is the autogenous bone graft, nevertheless, in socket preservation it may be considered an excessive or aggressive method to harvest autogenous bone for such small, contained defects. Studies have clearly proven the reliability and functionality of using either allografts or xenografts, which avoids the creation of an additional surgical site for bone harvesting. Dentin has been an area of interest for its potential use as a bone substitute since it has higher mineral content than any derived material. It's also a readily available graft. With the prospect of the possible use of autogenous matrix as a graft material comes the opportunity to utilize the patient's own dentin from their extracted tooth, Moreover, the osteoinductive property of demineralized dentin matrix is very valuable for bone healing defects. The aim of this study to determine the efficacy of autologous demineralized tooth matrix (auto-DTM) in the preservation of ridge shape after tooth extraction. Material and Methods: In this study, forty symmetrical premolar extraction sockets using split- mouth design were randomly filled with auto-DTM and sealed with PRF membrane (DTM group) or PRF membrane alone (control group). The healing of socket orifices, marginal bone resorption, and bone healing density were measured clinically and radiographically. Results: The study found that auto-DTM was well tolerated in all sites with no incidences of postoperative infection or graft rejection. At the 8th week, the mean horizontal width of the ridge at 3 mm apical to the cemento-enamel junction line in the DTM group (1.84±0.47mm) was significantly greater than that of the control group (2.26±0.59 mm). The overall radiographic resorption of marginal bone levels on the mesial side, the distal side, and at the center of the sockets in the DTM group were not significantly different from those of the control group. During the first 6 weeks, bone healing density of the DTM group was significantly higher than that of the control group. However, the density appeared more stable with no difference between the two groups at the 8 week. Conclusion: Auto-DTM can be a useful and safe alternative graft material for alveolar ridge preservation. Grafting extraction sockets with auto-DTM covered with PRF membrane can reduce buccal bone collapse and promote bone healing density as shown clinically and radiographically.