Some argument has been risen between clinical practitioners in the use of the extracted tooth to graft the socket. This procedure, from one side, appears to be accepted form the biologic point of view as you put an autogenic graft. on the other hand, it appears dangerous as the patient might have infection at the extraction site as well as the lack of the evidence-based to deal with such procedure.
Hi dear, in fact this step is still new, and lacks enough evidence. In my opinion, it should be tried first in animal models.
Article Use of extracted teeth in research
Dear Mohammed, After four years of experience in ridge preservation and other surgical procedures using autologous dentin graft as a biomaterial, I think it should be considered a real option for bone graft procedures. We are running several clinical and animal studies and so far the results are very promising. This is not really a new procedure, unfortunately, has not been used and promoted widely.
Dr Mohammed el material dental como relleno del alveolo una vez extraido el diente es algo que esta saliendo al mercado en los ultimos tiempos hay que ver el resultado no ha mediano plazo sino a largo plazo hay que llevar un control en los proximos 5 a 10 años a ver los verdaderos resultados , el injerto ose ya sea autologo como de banco ya tiene resultados y comprobados .
Dear Mohammed, I recommend reading the clasics works of Marshall:
Yeomans JD, Urist MR. Bone induction by decalcified dentine implanted into oral, osseous and muscle tissues.Arch Oral Biol. 1967 Aug;12(8):999-1008.
Urist MR. Bone: formation by autoinduction. Science. 1965 Nov 12;150(3698):893-9.
Q: Using the "extracted" tooth as a bone graft for soket preservation, Agree or Not?
More than 40 years ago, autogenous teeth were routinely transplanted into extraction sockets when possible. It is evident that transplanted teeth that are ankylosed in jaw bone undergo replacement resorption by bone in the span of 5-8 years. In addition, it is well documented that avulsed teeth that are implanted back into their sockets undergo firm reattachment by bone which is formed directly on root dentin or cementum, leading to ankylosis. An ankylosed root is continuously resorbed and replaced by bone, eventually resorbing the entire root, while the alveolar process is preserved during this period and later. After the initial inflammatory response following tooth replantation, mesenchymal cells surrounding the denuded root compete to repopulate its surface. Bone cells (osteoblasts and osteoclasts) come into direct contact with the root and initiate resorption of the dentin (osteoclasts) with a simultaneous formation of new bone (osteoblasts) in the affected area. The process leads to the replacement of the dental tissues by bone.
A root of a replanted tooth may continue to undergo replacement resorption until completely replaced by bone preserving the surrounding alveolar ridge volume. A resorptive process that results in ankylosis allows the clinician the freedom of choice as to the appropriate timing for tooth replacement and allows the postponement of the prosthetic rehabilitation to a convenient time. One of the negative sequels of tooth ankylosis is its infra-positioning, which occurs as the result of the local arrest of the surrounding alveolar bone growth concomitant to the continuous skeletal growth and development. Such infra-positioning results in an unesthetic dento-gingival complex and might complicate future prosthetic rehabilitation. Teeth and jawbone have a high level of affinity, having similar chemical structure and composition. Therefore, it has been proposed that extracted non-functional teeth or periodontally involved teeth should not be discarded anymore. Extracted teeth can become an autogenous dentin ready to be grafted within 15 minutes after extraction. Autogenous dentin has been considered as the gold standard graft for socket preservation, bone augmentation in sinuses or filling bone defects.
Teeth and bone have similar composition and dentin coul be used as bone regenaration material. When in an ankilosed tooth, we made a coronotomy of Malmgreem, we expect that the radicular part preserve the alveolar bone. So in the future autogenous dentin graft may be a good material for bone graft.
OK am I missing something? Have we used up all the cadaver bone, autonomous bone from host or synthetic bone? The use of a tooth, tooth root, or dentine (which by the way does not have any real similarity with bone but a partially calcified collagen matrix resembling skin more than bone) is at best a very poor substitute for a bony ridge preservation model. Because the tooth or tooth root maybe contaminated by way of the pulpal chamber and the fact that root fragments can not be systematically or reliably time lined for resorption makes for a very poor bone substitute. Titanium is a good framework for ridge augmentation when bone grafts are included. Why then pursue insanity of uncertainty when bone grafts produce a good reproducible matrix and tooth/tooth fragments are so unpredictable in resorption and reproducible results. Its reminds me of the want by certain "scientists" to grow teeth from tooth germs or implanting 3rd molars in place of anterior teeth. Unpredictable at best and in the terms of tooth germs, most patients I have had the pleasure to work on for over the last 40+ years of clinical, academic and research have voiced the opinion that they would rather have an implant with a 95% success rate for over 20 years than go through 2,3,or even 5+ years of eruption space with the hope that our bumbling scientific process gets it right and the central is really a central.
Since 1.5 years, our team at Nasik has been working on this project and even clinical cases have been done, and the results are awesome.
Tooth (whole/dentine only) can be used as autogenous bone graft with very high success rate, after grinding the particles need to be sterilized (chemically or with lasers) and grafted. Not a single patient reported with any infection or rejection. The 4 months post surgery resuts were far far better than conventional bone substitutes.
We are taking things further ahead in trying to make it like allograft that can be used in other patients mouth.
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