Search Results (43)

Background: Autologous dentin has emerged as a potential grafting material in regenerative oral surgery because of its structural and biological similarities to bone. This technical report describes a modified tooth-shell technique used for horizontal ridge reconstruction with simultaneous implant placement in two clinical cases involving the aesthetic zone. Case Presentation: The first case involved a 29-year-old female patient requiring extraction of a partially impacted, buccally positioned maxillary third molar (tooth 28). The extracted tooth was processed intraoperatively to obtain a dentin shell, which was fixed as a buccal plate during simultaneous implant placement. The remaining defect was filled with sticky bone prepared from biphasic calcium phosphate combined with platelet-rich fibrin. Radiographic evaluations performed at 4 and 6 months demonstrated stable ridge contours, while clinical follow-up continued for 2 years with maintenance of implant function and peri-implant tissue stability. The second case involved a 58-year-old female patient with a previous failure of immediate implantation in the anterior maxilla associated with implant overload, loss of implant stability, and buccal bone deficiency. After soft- and hard-tissue healing, ridge reconstruction was performed using a dentin shell prepared from tooth 18 together with simultaneous implant placement and immediate provisional restoration. Follow-up after 6 months revealed stable peri-implant tissues, a satisfactory aesthetic outcome, and successful prosthetic rehabilitation. Conclusions: The modified tooth-shell technique using autologous dentin provided satisfactory preliminary clinical and radiographic outcomes in both cases. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up periods. Full article

Background: The integrity of the alveolar ridge is compromised by tooth loss or trauma, initiating chronic resorption that alters bone morphology. Vertical bone augmentation (VBA) is a complex procedure required to rehabilitate severe atrophy. Currently, there is debate regarding the effectiveness of autologous bone versus xenografts and their combination to optimize bone regeneration and ensure dimensional stability. Objectives: To synthesize evidence on the efficacy of VBA by comparing autologous bone, xenografts, and their combination. Specifically, to evaluate vertical bone gain, volumetric stability and resorption, implant survival, complications, and whether combined grafts offer clinical advantages. Methods: A systematic review was conducted following PRISMA 2020 guidelines. MEDLINE, Scopus, SciELO, and Web of Science were searched up to January 2026. Risk of bias was assessed, using RoB 2 for randomized studies and ROBINS-I for non-randomized studies. Results: From 1517 initial records, 9 studies were included and 3 showed high risk of bias. Iliac crest grafts achieved the greatest vertical bone gain but also exhibited higher resorption compared to calvarial grafts. Xenografts (Bio-Oss) demonstrated superior volumetric stability, maintaining 10–13% more residual volume than autologous blocks. The most frequent complication was soft tissue dehiscence. Conclusions: VBA is an effective procedure. The combination of autologous bone and xenograft may represent a balanced approach, providing both biological potential and volumetric stability. Graft origin significantly influences outcomes and morbidity. However, current evidence is limited by methodological heterogeneity and small sample sizes, highlighting the need for well-designed clinical trials with standardized protocols and long-term follow-up. Full article

Autologous tooth-derived grafts are increasingly being investigated for bone regeneration, as dentin shares with bone a mineral phase and an organic matrix rich in type I collagen and non-collagenous proteins. Deciduous teeth are particularly attractive as biomaterials because they are easily obtained after physiological exfoliation, without additional surgical harvesting or donor-site morbidity and may expose a protein-rich matrix after processing. Whether deciduous teeth retain a biologic advantage after prolonged dry storage remains poorly documented. This proof-of-concept ex vivo and in vitro study compared pooled deciduous teeth from six different donors (exfoliated at least 10 years before the experiment and stored dry at room temperature conditions) with six freshly extracted third molars. The teeth were ground using a dedicated device, and conditioned supernatants were collected at 72 h (T1) and 28 days (T2). Osteocalcin, osteonectin, and BMP-2 were quantified by ELISA, and T1 supernatants were applied to human primary osteoblasts to assess the osteogenic response using qRT-PCR and immunofluorescence. Deciduous teeth-conditioned supernatants showed higher osteocalcin and osteonectin release than permanent teeth at both time points, whereas BMP-2 levels were comparable, though with higher values in deciduous samples. In osteoblasts, deciduous teeth-conditioned supernatants induced enhanced osteogenic responses, including greater activation of Collagen I, Osterix, RUNX-2, Osteocalcin, BMP-2 genes, and higher expression of bone-related proteins. Within the limits of this exploratory study, dry-stored deciduous teeth preserved a biologically active dentin matrix and showed a more favorable osteogenic profile than freshly extracted permanent teeth, supporting further investigation into standardized storage protocols and their potential use in regenerative applications. Full article

Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4–6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a “sticky bone” (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type. Full article

Background/Objectives: Autologous dentin matrix (ADM) has been suggested as a biologically plausible biomaterial for alveolar bone regeneration after tooth extraction. However, clinical evidence regarding its biological activity and early healing outcomes is limited. This exploratory, randomized controlled pilot study aimed to descriptively assess early alveolar healing patterns and bone morphogenetic protein 4 (BMP4) expression following tooth extraction using ADM compared with other grafting approaches. Methods: Patients requiring tooth extraction were allocated to one of four groups: ADM, xenograft, ADM combined with platelet-rich fibrin, and a graft-free control group. Histological and immunohistochemical analyses were performed four months after extraction to descriptively assess cellular features of healing and BMP4 expression. The trial was registered at the Brazilian Registry of Clinical Trials (ReBEC; RBR-24mdgrf) and conducted under prior ethics committee approval. Results: BMP4 expression was detected in 67.9% of the analyzed histological fields, predominantly localized in osteocytic, osteoblastic, and medullary areas. Although descriptive differences in BMP4-positive fields were observed among the groups, no statistically significant differences were identified between the groups. Histological evaluation revealed an active cellular environment across all treatment modalities, consistent with early post-extraction healing. No adverse events related to surgical procedures or grafting materials were reported during the study period. Conclusions: Within the limitations of this pilot randomized clinical trial, ADM exhibited consistent biological behavior during early post-extraction alveolar healing. The observed BMP4 expression likely reflects a general physiological healing response rather than a material-specific effect. This finding supports the biological plausibility of dentin-derived grafts as osteoconductive biomaterials. These findings are hypothesis-generating, and larger, adequately powered randomized clinical trials with standardized molecular and histological assessments are required to determine their clinical relevance. Full article

Objectives: This systematic review and meta-analysis aimed to evaluate histological outcomes of alveolar ridge preservation (ARP) compared to spontaneous healing after tooth extraction, focusing on the percentage of new bone formation and residual graft material. Materials and Methods: Randomized controlled trials (RCTs) assessing histomorphometric outcomes in humans were included. Eligible studies compared ARP using various graft materials to unassisted socket healing. Primary outcome was new bone formation (%); secondary outcome was residual graft material (%). Random-effects meta-analyses and subgroup analyses were conducted based on graft material type, membrane application, and healing duration. Risk of bias and certainty of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE, respectively. Results: Twenty-two RCTs (816 patients) met inclusion criteria. Overall, ARP did not result in significantly greater new bone formation compared to spontaneous healing (mean difference −5.86%, 95% CI: −13.84% to 2.11%, p = 0.15; I² = 98%), revealing a paradoxical trend: while ARP maintains ridge volume, histologically it may yield slightly lower proportions of vital bone compared to unassisted healing. However, autologous biomaterials (e.g., PRF/CGF) and xenografts with collagen membranes showed significantly new bone formation (mean differences +16.28% and −22.47%; p< 0.001 and p = 0.003, respectively). Residual graft content was highest in relation to xenografts and allografts, particularly without membranes. Long-term studies demonstrated a statistically significant benefit for ARP following excluding high-risk trials. Conclusions: Histological advantage of ARP is biomaterial-dependent. Autologous platelet concentrates and xenografts with membranes yielded the most consistent bone regeneration outcomes. Clinical Relevance: Although ARP preserves socket volume, its histological superiority over natural healing is not universal. Therefore, the selection of biomaterials and determination of and appropriate healing period are critical parameters. Full article

Background: Autologous tooth-derived grafts have recently gained attention as an innovative alternative to conventional biomaterials for alveolar ridge preservation (ARP) and augmentation (ARA). Their structural similarity to bone and osteoinductive potential support clinical use. Methods: This systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251108128). A comprehensive search was performed in PubMed, Scopus, and Web of Science (2010–2025). Randomized controlled trials (RCTs), split-mouth, and prospective clinical studies evaluating autologous dentin-derived grafts were included. Two reviewers independently extracted data and assessed risk of bias using Cochrane RoB 2.0 (for RCTs) and ROBINS-I (for non-randomized studies). Results: Nine studies involving 321 patients were included. Autologous dentin grafts effectively preserved ridge dimensions, with horizontal and vertical bone loss significantly reduced compared to controls. Histomorphometric analyses reported 42–56% new bone formation within 4–6 months, with minimal residual graft particles and favorable vascularization. Implant survival ranged from 96–100%, with stable marginal bone levels and no major complications. Conclusions: Autologous tooth-derived biomaterials represent a safe, biologically active, and cost-effective option for alveolar bone regeneration, showing comparable or superior results to xenografts and autologous bone. Further standardized, long-term RCTs are warranted to confirm their role in clinical practice. Full article

Background/Objectives: Vertical ridge augmentation remains a challenging procedure in alveolar bone reconstruction, with existing techniques often limited by surgical complexity, graft instability, and high resorption rates. This study evaluates the clinical and histological outcomes of a novel vertical ridge augmentation technique using a wide-head tenting pole screw (WHTPS) combined with sticky bone graft material. Methods: Five patients with vertical bone deficiencies (6–10 mm) in the maxilla or mandible underwent augmentation using a single WHTPS (rectangular or round wide-head type). Sticky bone was prepared using autologous tooth bone, allografts, or xenografts, combined with fibrin glue and covered with concentrated growth factor (CGF) membranes and/or resorbable collagen membranes. After 5–6 months of healing, the WHTPS was removed, and bone biopsies were taken for histological analysis. Results: Radiographic and histological evaluations confirmed successful ridge augmentation in all cases. Newly formed bone ranged from 21.2% to 57.5%. All patients proceeded to implant placement without complications. Radiographic, clinical, and histological assessments consistently showed that new bone formation extended up to the level of the screw head, indicating complete vertical fill of the augmented space. Histology showed well-integrated, mineralized bone with no signs of inflammation. The wide-head tenting pole screw was observed to support stable space maintenance and facilitate surgical handling and favorable outcomes in vertical ridge augmentation. Conclusions: In this case series, a single wide-head tenting pole screw appeared sufficient to maintain space and resist soft tissue pressure in wide alveolar bone defects during healing. This case series suggests that the wide-head tenting pole screw technique may be a feasible option for managing severe alveolar bone deficiencies. Full article

Aim: This retrospective observational clinical cohort study evaluated 84-month clinical and radiographic outcomes of a regenerative protocol combining autologous dentin grafts processed with the Tooth Transformer^® device and Concentrated Growth Factors (CGFs) in patients with severe maxillary atrophy undergoing sinus augmentation with simultaneous implant placement. Materials and Methods: Thirty-one patients (30–75 years) with residual crestal bone height ≥ 5 mm and requiring extraction of ≥2 molars were included. Extracted teeth were processed with the Tooth Transformer^® to obtain demineralized dentin granules (500–1000 µm), which were combined with CGFs prepared using the Medifuge MF200^® to form “sticky bone.” All patients underwent sinus lift via a lateral window approach (Hilt Tatum technique) with simultaneous placement of 98 implants (12–14 mm), which were loaded after six months. Results: At the 84-month follow-up, no implant failures or peri-implantitis were recorded. CBCT and clinical evaluations showed stable regenerated bone volume and absence of peri-implant bone resorption. All patients received fixed prostheses within six months without complications. Conclusions: The combined use of processed autologous dentin and CGFs proved to be a safe, predictable, and effective regenerative technique in cases of severe maxillary atrophy, with a 100% implant survival rate at five years. Full article

Background/Objectives: During alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g., intraoral bone, xenografts) are being tested. The aim of this study was to compare the efficacy of using an autologous tooth-derived graft material and iliac crest cancellous bone in the reconstruction of the alveolar cleft in patients with a unilateral cleft lip and palate. Methods: A total of 21 patients with a unilateral cleft lip and palate, who underwent alveolar bone grafting between 2020 and 2023 were included in the study. In 11 cases, the donor site was the iliac crest; in the rest of the cases, deciduous teeth were harvested, processed, and used as an autologous particulate graft material for alveolar reconstruction. The mean follow-up time was 30.0 months, CBCT scans were taken, and the results were compared based on the ranking system published by Stasiak et al. Results: The Wilcoxon signed-rank test showed that the amount of bone on the cleft side was significantly less than that on the contralateral non-cleft side (ATB: p = 0.002, iliac crest: p = 0.005). The Mann–Whitney U test showed that there were no significant differences in bone quantity on the cleft side between the two groups (U = 47.5, p = 0.617). Conclusions: The use of ATB might be a feasible alternative to autologous bone during alveolar cleft reconstruction. This type of graft shows long-term stability, which is comparable to the bone harvested from the iliac crest. Full article

Background: Bone resorption following tooth loss poses significant challenges for dental implant success. Guided bone regeneration (GBR) techniques, particularly in vertically deficient ridges, often require complex procedures and soft tissue management. This case report introduces a modified occlusive barrier with a window, combined with tricalcium phosphate, to address these challenges. Methods: A 26-year-old female with significant bone loss in the mandibular anterior region underwent GBR using a digitally designed titanium occlusive barrier. The barrier was fabricated using CAD/CAM technology and secured with screws. A blood clot mixed with tricalcium phosphate was used to promote bone regeneration. Postoperative care included regular irrigation, de-epithelialization, and follow-up over six months. Implant placement and histological analysis were performed to evaluate outcomes. Case Presentation: The patient achieved 8.8 mm of vertical and 7.6 mm of horizontal bone regeneration. Histological analysis confirmed the presence of mature, mineralized bone, and keratinized gingiva. The implant was successfully placed, and a fixed prosthesis was restored after four months, with stable results at a three-year follow-up. Conclusion: This technique demonstrates effective bone and soft tissue regeneration in a single procedure, eliminating the need for autologous bone grafts and secondary surgeries. The use of a digitally designed occlusive barrier offers precision, reduces morbidity, and simplifies the surgical process, suggesting a promising advancement in GBR. Further studies are needed to validate these findings. Full article

Purpose: To evaluate the clinical and histological outcomes of patients that receive implant-supported crowns after vacuum plasma surface treatment (VPST) of biomaterials used in socket preservation (SP) and guided bone regeneration (GBR). Materials and methods: This study was designed as a case series. Patients in need of tooth extraction and socket preservation or guided bone regeneration were enrolled. The socket preservation technique was performed after tooth extraction using a heterologous collagen bone graft and a collagen xenomatrix, both activated with vacuum plasma. Meanwhile, a two-stage horizontal ridge augmentation was performed using a customized titanium mesh and a mix of autologous (untreated) and heterologous (treated) bone grafts, along with a treated collagen membrane. ACTILINK Reborn with Universal Vortex Holder (Plasmapp Co., Ltd., Daejeon, Republic of Korea) was used to treat all biomaterials. The outcome measures were implant and prosthesis failures, complications, and histological examination. Soft and hard tissue samples were collected at the time of implant placement only in patients treated with SP. Results: A total of six patients were treated—three with socket preservation and delayed implant placement, and three with staged GBR. No implant or prosthesis failed. One customized titanium mesh broke after plasma treatment, requiring replacement with a pericardium membrane. No other complications occurred. Histological analysis at three months post-surgery revealed well-vascularized newly formed bone at different stages of maturation with integrated bone graft particles, while the soft tissue appeared to be physiologically structured. Conclusion: VPST may enhance the hydrophilicity of biomaterials, supporting favorable healing outcomes in SP and GBR. Further randomized controlled trials with appropriate sample size calculations are needed to confirm these preliminary results. Full article

Background: To reconstruct and maintain hard tissues over time, it is necessary to follow effective protocols and use appropriate materials. The selection of the graft material and its properties can also affect the final outcomes. For this purpose, numerous graft materials have been suggested. Among the valuable alternatives to these biomaterials, interest in using teeth as graft material has grown in recent years. Aim: The aim of the study was to investigate the histomorphometric outcomes of using tooth-derived materials when used as a bone substitute. Methods: We evaluated the histological results of autologous demineralized tooth graft material prepared using a Tooth Transformer device. A total of 187 histological samples from 186 subjects (52% male and 48% female, with an average age of 56.30 ± 12.97 years) were analyzed. The analysis focused on the total bone volume (BV%), residual tooth material (residual graft, TT%), and vital bone (VB%). The differences between the presence and absence of the resorbable membrane were also analyzed. Results: The amount of VB was 36.28 ± 19.09%, the residual graft TT was 9.6 ± 10.76%, and 46.96 ± 13.85% was the total bone volume (BV). The presence of membrane increased the amount of BV% and reduced the time to produce bone. Conclusions: The procedure using demineralized autologous tooth-derived biomaterial may be a predictable method for producing new vital bone capable of supporting dental implant rehabilitation and the use of membrane allow better results. Full article

Objectives: Recently, there has been great interest in teeth and their derivatives as suitable substrates for the treatment of alveolar bone defects. This retrospective study evaluates the clinical and radiographic outcomes of implants inserted in a site that underwent GBR procedure using a tooth derivate material. Materials and methods: A total of 21 patients received a GBR using an autologous extracted tooth. Four months after the GBR techniques, the implants were inserted and were followed for an average of 5.28 + −1.10 years after loading. The X-ray was analyzed after a period of 63.36 + −13.2 months for a total follow-up period. Results: A total of 28 implants were inserted. All the implants were clinically functional after the follow-up period. The average bone loss from the X-ray images was 0.1208 + −0.1307. Conclusion: Within the limitations of this study, the use of a tooth as a graft using a tooth transformer device guarantees the production of bone and maintenance over time. Full article

Following tooth extraction, the bone structure is prone to atrophic changes. Alveolar ridge resorption can compromise subsequent implant treatment not only at the extraction site itself but also by affecting the bone support of adjacent teeth. Various techniques, including the use of bone graft materials or autologous blood concentrates for ridge or socket preservation, aim to counteract this process. The efficacy of such methods can be evaluated non-invasively through radiological analysis of the treated region. However, existing radiological evaluation methods often focus only on isolated areas of the extraction socket, limiting their accuracy in assessing overall bone regeneration. This study introduces a novel, non-invasive, and semi-automated image-based analysis method that enables a more comprehensive evaluation of bone preservation using CBCT data. Developed with the open-source software “Fiji” (v2.15.0; based on ImageJ), the approach assesses bone changes at multiple horizontal and vertical positions, creating a near three-dimensional representation of the resorptive process. By analyzing the entire region around the extraction socket rather than selected regions, this method provides a more precise and reproducible assessment of alveolar ridge preservation. Although the approach requires some processing time and focuses exclusively on radiological evaluation, it offers greater accuracy than conventional methods. Its standardized and objective nature makes it a valuable tool for clinical research, facilitating more reliable comparisons of different socket preservation strategies. Full article