Appliance of autologous dentine-graft for periodontally compromised teeth socket augmentation. First experience
DOI:
https://doi.org/10.11603/2311-9624.2021.4.12787Keywords:
autologous dentin-graft, alveolar process, platelet-rich fibrin, bone healingAbstract
Summary. Healing of the alveolar socket of the removed tooth is accompanied by significant spatial changes of the alveolar bone in the form of its resorption and deformation, which creates unfavorable conditions for future dental implantation and prosthetic rehabilitation. The combination of bone and plastic materials, in particular autologous dentin graft, with platelet-riched fibrin may be a promising therapeutic option to replace defects after tooth extraction due to acute or chronic periodontal pathology.
The aim of the study – to test and clinically evaluate the effectiveness of autologous dentin graft in combination with platelet-riched fibrin in the replacement of alveolar socket after tooth extraction with periapical pathology.
Materials and methods. Were examined and treated 12 patients (7 female and 5 male aged (28.23±7.78) years with exacerbation of chronic periodontitis, granulomatous apical periodontitis, radicular cysts, which could not undergo conservative treatment. The treatment plan included atraumatic tooth extraction and filling of the socket with a granular dentin composition prepared using a Smart dentin grinder (KometaBio, USA) in composition with platelet-riched fibrin. In none of the cases were other resorbable or non-resorbable factory-made membranes used for guided tissue regeneration. Follow-up clinical examinations were performed on days 1; 3; 10; 14. Cone-beam computed tomography was performed at 3rd and 6th months after surgery using a Veraviewepocs 3D R100 tomograph (J. Morita Manufacturing Corporation, Japan) to determine the amount of vertical bone loss by measuring the distance between the occlusal plane and the alveolar process) and horizontal (by measuring the width of the alveolar process at the middle level), determining the mineral bone density in the defect area using computed tomography viewer i-Dixel 2.1.
Results and Discussion. The period of complete epithelialization of alveolar socket was (13.2±0.84) days (p<0.001). In the study of vertical bone loss, it was found that before surgery, this figure averaged (8.49±0.67) mm, after 3 months post-op – (8.59±0.69) mm (p>0.05), and after 6 months – (10.52±0.75) mm (p<0.05). The width of the alveolar process at the middle of the defect was on average (7.38±0.36) mm before surgery, after 3 and 6 months – (7.13±0.40) mm and (6.98±0.44) mm respectively (p>0.05). The mineral bone density in the projection of the middle of alveolar sockets averaged (663.34±44.90) HU at the 3rd month of observation and (714.5±58.35) HU at the 6th month of observation (p<0.05), which indicates the formation of mature bone tissue in the area of defects. The clinical case of Pat. 38 years old is considered as an example of the successful appliance of a combination of autologous dentin graft and platelet-riched fibrin to replace a defect caused by tooth extraction and a large radicular cyst.
Conclusions. The composition of autologous dentin-graft with platelet-riched fibrin proves its effectiveness in the replacement of periodontally compromised teeth, peri-apical granulomas, radicular cysts.
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