Allogeneic Dentin Graft: A Review on Its Osteoinductivity and Antigenicity
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
4.1. Osteoinductivity
4.2. Antigenicity
4.3. Demineralization of Dentin Matrix
4.4. Geometry of Allo-DDM
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Year (Author) [Ref.] | Theme | Donor (Tooth) | Geometry (Dentin) | Processing Method | Implant Site/Time | Key Findings |
---|---|---|---|---|---|---|
1967 (Bang & Urist) [23] | Osteoinduction | Rabbit (Mature molar) | Whole root dentin | Complete demineralization (0.6 N HCl) | Abdominis muscle/12 weeks | Demineralized dentin (DDM): Similar to the matrix of bone, induces bone formation at 4 weeks proportional to the volume of the original implant. |
Rat (Mature molar) | Un-demineralization | Abdominis muscle/12 weeks | Undemineralized dentin (MDM): Does not begin to be resorbed until 8–12 weeks later than demineralized dentine. | |||
1967 (Yeomans & Urist) [24] | Osteoinduction | Young New Zealand rabbit (Dentin) | Grinding dentin 1.0 mL | Complete demineralization (0.6 N HCl) | Rectus abdominis muscle/4, 8, 12 weeks | DDM: Rapidly resorbed more than bone, induces bone in 100% of implants within 4 weeks (3H-glycine autoradiograph: Positive evidence of translocation of 3H-glycine from the donor tissue to the cells of the host bed. Figure 2 in text) |
Un-demineralization | Rectus abdominis muscle/4, 8, 12 weeks | Undemineralized dentin (MDM) induces bone in 75% of implants, but only after a latent period of 8–12 weeks. | ||||
1968 (Urist et al.) [25] | Inductive substrate antigenicity (HCl vs. EDTA) | Rabbit (Dentin) | Grinding dentin 1.0 mL | Demineralization (0.6 N HCl) | Abdominis muscle/4–12 weeks | Inductive substrate such that new bone formation is the best at 0.6 N HCl and 150 mmol NaCl, and is derived from the extracellular and not cytoplasmic proteins. Antigenicity: The immune response is lowered, and the inductive activity appears earlier with lyophilized and irradiated 60Co at the dose of 0.2 Mrads or less. |
Rat (Dentin) | Demineralization (0.25 M EDTA) | EDTA: The inductive activity had been eliminated only from the exposed surface. Bone: The inductive activity was completely destroyed, Dentin: Persisted inductive activity for a longer time. | ||||
1970 (Huggins & Urist) [26] | ALP activity | Rat (Incisor) | Whole root dentin | Complete demineralization (0.5 N HCl, 1 mL/mg) | Rat abdominis muscle/1 year | Alkaline phosphatase activity (ALP) within 24 h: Reached maximum on day 7. Matrix transformation: Cartilage appeared within 5 days; bone and bone marrow formed within 14 days. The induced cartilage disappeared within 5 weeks. Transforming effects in postnatal life are comparable to embryonic induction because of highly cross-linked, exceptional resistance to the deleterious action of strong acid of dentin matrix. |
1970 (Huggins et al.) [27] | Transformation of fibroblasts | Rat (Incisor) Mice (Incisor) | Dentin powder (pooling) 200–400 µm (10–15 mg) | Complete demineralization (0.5 N HCl) | Subcutaneous pockets/9–21 days | DDM: Active transformation. An early and intense attraction for fibroblasts of the subcutaneous tissue. |
Un-demineralization | MDM: Does not induce ALP, cartilage, or bone. | |||||
Guinea pig (Incisor) | Dentin powder (Pooling) 200–400 µm (10–15 mg) | Complete demineralization (0.5 N HCl) | Subcutaneous pockets/9–21 days | DDM: No bone induction in guinea pig Transformation of fibroblast: Rat, mouse > guinea pig | ||
Un-demineralization | MDM: Does not induce alkaline phosphate, cartilage, or bone. | |||||
1972 (Bang) [28] | Antigenicity | Guinea pig (Incisor) | Root dentin pieces 2 × 2 × 1 mm | Demineralization (0.2 N HCl) | Abdominis muscle/4–12 weeks | Antigenicity: Histological examination 1. Demineralized and undemineralized dentin could evoke an immune reaction. 2. The first set of Allo-DDM induces bone formation in high percentages of cases. 3. Induction was reduced in 2nd set of grafts 4. No difference was observed in bone-inducing capacity between DDM and lyophilized DDM. |
Guinea pig (Molar) | Pieces 2 × 2 × 1 mm | Un-demineralization | Osteoinduction is prevented in the 2nd set of implants in MDM. | |||
1973 (Reddi & Huggins) [29] | Role of geometry | Rat (Incisor) | Whole tooth root | Demineralization (0.5 N HCl) | Subcutaneous tissue/7–35 days | Cartilage–chondrolysis–osteogenesis–ossicle with hemopoietic marrow. Figure 3a,b in Text |
Whole tooth root | Un-demineralization | Bone and cartilage: Not observed. Finding of fibrosis: Consistent with hypoxic environment of pulp chamber. Figure 3c in Text | ||||
1973 (Bang) [30] | Osteoinduction (HCl vs. EDTA) | Guinea pig (Molar) | Molar dentin 1/2 root 6–7 × 3 × 1.5 mm, 30 mm3, 30 mg | Demineralization (0.6 N HCl, 0.5 M EDTA) | Abdominis muscle/4–12 weeks | HCl, DDM: 13 out of 30 implants induce bone formation EDTA, DDM: 12 out of 30 implants induce bone formation |
Un-demineralization | MDM: Bone induction process is retarded, and the yield of new bone is low. | |||||
Rat (Molar, Incisor) | Whole molar tooth bud | Abdominis muscle/4–12 weeks | Tooth bud: No induction | |||
Incisor dentin 6–7 × 3 × 1.5 mm, 30 mm3, 30 mg | Demineralization (0.6 N HCl, 0.5 M EDTA) | HCl DDM: 1 out of 12 implants induce bone formation EDTA DDM: 3 out of 12 implants induce bone formation No distinct differences in the bone-inducing capacity of HCl and EDTA demineralization. | ||||
Incisor dentin 6–7 × 3 × 1.5 mm, 30 mm3, 30 mg | Un-demineralization | 3 out of 24 MDM: Osteoinduction after 12 weeks, bone induction process was retarded, and the yield of new bone was low | ||||
1975 (Linden) [31] | Osteoinduction cell sequences | Ash-Wistar rat (Incisor) | Whole root dentin block | Demineralization (0.6 N HCl) | Abdominis muscles/40 days | Cell Sequences in bone induction Qualitative trends may be listed as: (1) inflammation; (2) formation of vascularized connective tissue; (3) erosion; (4) recalcification; and (5) bone formation. |
1977 (Nilsen) [32] | Cell reaction | Guinea pig (Molar) | Root dentin Piece 6–7 × 3 × 1.5 mm | Demineralization (0.2 M HCl) | Abdominal muscles/22 days | Induce osteoid formation: Resorption of DDM is a prerequisite for osteoid formation (1) Matrix resorptive reaction mediated by monocytes, macrophages, and dentinoclasts. (2) Fibroblastic reaction as an unspecific capsulation process. (3) Osteoblastic reaction with osteoid matrix formation |
1986 (Inoue et al.) [33] | Chondrogenesis in the muscle, skin, periodontal ligament, and bone marrow | Wistar rat (Incisor) | Dentin rolls One incisor-one implant (not pool) | Demineralization (0.6 N HCl) | Abdominal muscles pouch/21 days | Cartilage is formed at 7 days Rectus abdominis muscle (cartilage induce) > Chest subcutaneous tissue (cartilage induce) > Periodontal ligament (deposits of cartilage were not seen) |
Subcutaneous pocket in the chest/21 days | Cartilage is first found at 10 days | |||||
Periodontal ligament of the first molar/21 days | Cartilage was not seen | |||||
Bone marrow in the femur/21 days | Woven bone is found at 10 days | |||||
1990 (Pinholt et al.) [34] | Osteoinduction | Male Wistar rat (Incisor) | 4 Granules1 × 1 × 1 mm | Demineralization (0.2 N HCl) | Abdominis muscle/4 weeks | Dentin induced new bone formation in 100% of implants No inflammatory or foreign body reactions were observed. |
Year [Author] | Theme | Donor (Tooth) | Geometry (Dentin) | Processing Method | Implant Site/Time | Key Findings |
---|---|---|---|---|---|---|
1967 (Yeomans & Urist) [24] | Osteoinduction | New Zealand rabbit | Grinding Dentin 1.0 mL | Complete demineralization (0.6 N HCl) | Mandibular drill hole (ø 5 mm)/4, 8, 12 weeks | DDM: Induce osteogenesis, not dentinogenesis. (1) Bone formed by extension of proliferating osteogenetic cells from the host bed and (2) bone formed by induction inside of dentine matrix are generally interwoven and continuous processes. The old DDM: Resorbed and partially refilled with new bone within 4 weeks, more slowly than bone; produced a separate and unattached ossicle inside the cavity. After 12 weeks, the end product is bone marrow and not solid bone tissue. |
Extraction socket/4, 8, 12 weeks | DDM: Induce osteogenesis and not dentinogenesis. The processes of (1) The regeneration from host bed and (2) the osteoinductive new bone formation from the dentin matrix generally progressed separately. Bone induction is the same as implants in the abdominal wall. | |||||
Un-demineralization | Mandibular drill hole (ø 5 mm)/4, 8, 12 weeks | MDM: New bone formation in 75% of implants only after a latent period of 8–12 weeks. Same results with (23, 24) in soft tissue | ||||
Extraction socket/4, 8, 12 weeks | MDM: New bone formation in 75% of implants only after a latent period of 8–12 weeks. Same results with (23, 24) in soft tissue | |||||
1990 (Pinholt et al.) [34] | Osteoinduction | Male Wistar rat (Incisor) | Granules 1 × 1 × 1 mm | Demineralization (0.2 N HCl) | Premaxilla, alveolar ridge (subperiosteal)/ 4 weeks | All 10 DDMs: Induced new bone formation Tissue response: No inflammatory or foreign body reactions were observed |
1972 (Bang et al.) [35] | Osteoinduction Osteoconduction | 16 Java monkeys | Root dentin pieces 4 × 1 × 1 mm, | Demineralization (0.2 N HCl) | Mandibular defect (ø 7 mm)/1 week–1 year | DDM: Osteoinduction and osteoconduction in histologic study |
2004 (Carvalho et al.) [36] | Osteopromotion | 36 adult rabbits (Central incisor) | Slices, 8 mm thick (Consisting of enamel, dentin, and cementum) | Complete demineralization (0.6 N HCl) | Mandibular defect (ø 5 mm and 2 mm in depth)/Approx. 13 weeks (90 days) | DDM slices: Biocompatible, stimulated newly formed bone until 30 days after implantation; resorbed during the bone remodeling process. The volume of the newly formed bone is significantly greater in the dentin graft than in ungrafted negative controls with low antigenicity during 13 weeks in a histologic study |
2007 (Gomes et al.) [37] | Osteopromotion | 48 New Zealand rabbits. Central incisors | Slices, 8 mm in thickness (Consisting of enamel, dentin, and cementum) | Complete demineralization (0.6 N HCl) | Parietal defect (ø 8 mm)/Approx. 13 weeks (90 days) | DDM: Significantly greater bone density than the ungrafted controls with low antigenicity for 13 weeks |
2008 (Gomes et al.) [38] | Osteopromotion Optical density | 48 New Zealand rabbits (Central incisor) | Slices, 8 mm in thickness (Consisting of enamel, dentin, and cementum) | Complete demineralization (0.6 HCl) | Parietal defect (ø 8 mm)/Approx. 13 weeks (90 days) | DDM: Dentin shows significantly greater radio-opacity and better trabecular bone arrangement than the empty negative controls during 13 weeks in a radiological study |
2010 (Al-Namnam et al.) [44] | Osteocompatibility Quantitative comparison of bone formation | 16 New Zealand white rabbits (Central incisor root) | Dentin particles 2–4 mm | Un-demineralization | Femoral defects (ø 5 mm)/12 weeks | MDM particle: No significant difference in new bone formation between autogenous bone graft, ungrafted sites, and MDM particles on histomorphometric analysis until 12 weeks. |
2012 (Bormann et al.) [39] | Inflammatory and neovascularization response | 24 isogenic mice (Mandibular central incisor) | Perforated (300 µm) dentin slices. 3 × 3 × 1 mm1 mm thick | Un-demineralization | Calvarial defect (36 mm2)/3 weeks (22 days) | Perforated MDM slice and ß-TCP scaffolds are similar to isogenic bone in terms of inflammatory and neovascularization response, highlighting their potential utility in the regeneration of bone defects. |
2013 (Bakhshalian et al.) [40] | Osteopromotion | 6 rabbits (Central incisor) | Dentin pieces 2 mm3 | Complete demineralization (0.6 N HCl) | Parietal defect (ø 8 mm, 0.5 mm in depth)/15–90 days | The amount of bone regeneration: Significantly higher in the DDM group than in the ungrafted group. |
2013 (Bakhshalian et al.) [41] | Osteopromotion Blood biomarkers | 24 New Zealand white rabbits (Mandibular incisor) | Powders 300 µm in pooling | Complete demineralization (0.6 N HCl) | Skull defect (ø 8 mm, 0.5 mm in depth)/15–90 days | DDM: Significantly increased bone mass and improved bone quality without causing an inflammatory reaction or infection. WBC count: Higher in the early stage, but lower in the later stage than that in the empty control. ALP: There was no difference in the plasma. |
2016 (Gomes et al.) [42] | Osteopromotion | 60 adult New Zealand rabbits (Central incisor) | Slices, 8 mm in thickness (Consisting of enamel, dentin, and cementum) | Complete demineralization (0.6 N HCl) | Parietal defect (ø 8 mm)/Approx. 13 weeks (90 days) | ALP: Significantly higher in the DDM group than in the empty control, empty diabetic, and DDM–PRP groups, confirming the findings of intense osteoblastic activity and increased bone mineralization. DDM promoted superior bone architectural microstructure in bone defects in diabetic rabbits because of its effective osteoinductive and osteoconductive activity, whereas PRP stimulated angiogenesis and red bone marrow formation. |
2018 (Um et al.) [43] | Osteopromotion | 6 rabbits (Dentin) | Powder 300–800 µm | Partial demineralization (0.6 N HCl) | Calvarial defect (ø 8 mm)/1–4 weeks | DDM: Osteoinductive and osteoconductive function in a histological study. |
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Um, I.-W.; Lee, J.-K.; Kim, J.-Y.; Kim, Y.-M.; Bakhshalian, N.; Jeong, Y.K.; Ku, J.-K. Allogeneic Dentin Graft: A Review on Its Osteoinductivity and Antigenicity. Materials 2021, 14, 1713. https://doi.org/10.3390/ma14071713
Um I-W, Lee J-K, Kim J-Y, Kim Y-M, Bakhshalian N, Jeong YK, Ku J-K. Allogeneic Dentin Graft: A Review on Its Osteoinductivity and Antigenicity. Materials. 2021; 14(7):1713. https://doi.org/10.3390/ma14071713
Chicago/Turabian StyleUm, In-Woong, Jeong-Keun Lee, Jun-Young Kim, Yu-Mi Kim, Neema Bakhshalian, Yeong Kon Jeong, and Jeong-Kui Ku. 2021. "Allogeneic Dentin Graft: A Review on Its Osteoinductivity and Antigenicity" Materials 14, no. 7: 1713. https://doi.org/10.3390/ma14071713