Autologous Deciduous Tooth-Derived Material for Alveolar Rid
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A 26-year-old woman, had referred pain and mobility in the area of 3.1 and 4.1. The radiographic and clinical examination revealed that the teeth (both) underwent nonsurgical endodontic treatment that was unsuccessful. It was evident the presence of a large bone loss area in the periapical region with partial preservation of the buccal bone. The teeth were both affected by mobility (more than 2 mm), suppuration, and spontaneous pain. Before surgery, as standard protocol, the patient received professional oral hygiene with supragingival scaling. After local anesthesia performed with articaine 4% and epinephrine 1:100.000 in the 3.1-4.1 position, the extraction of affected teeth was performed without flap elevation, preserving the buccal bone plate. A piezoelectric device was used to debride the alveolar socket, removing infected tissues.

In order to use deciduous teeth as bone substitute material, the following procedure was adopted: (1) the teeth were adequately selected avoiding teeth with caries and cleaned, (2) the teeth were cut in small portions, and (3) they were grinded, demineralized, and sterilized using a specific device (Tooth Transformer®, Milan, Italy), following a standard and automatic procedure. The so-obtained biomaterial, weighting approximately 1.5 grams, was placed and compacted in the alveolar sockets and the soft tissues were sutured with bioresorbable material. Standard postoperative instructions were provided, prescribing the use of 15 mL 0.2% chlorhexidine mouthwashes twice a day for seven days and nonsteroidal anti-inflammatory drug (ibuprofen 600 mg twice a day for three days).

After five months from the ARP intervention, performed a CBCT scan to evaluate the healing of the bone and to plan dental implant placement. The radiographic investigation revealed the presence of sufficient available bone to place two 3.5 × 13 mm implants. After local anesthesia, a full-thickness mucoperiosteal flap was raised in the 3.1-4.1 region, and it was possible to confirm the presence of available bone volume and quality to place two dental implants in that region, without needing further procedures for bone augmentation. While preparing the implant site, using a 3 mm trephine bur, a biopsy of the bone tissues was taken with the aim of analyzing the characteristics of the healed bone in the region of autogenous grafting. The surgical procedure ended after implant placement by suturing the repositioned flap. Healing was uneventful. Second stage surgery was performed after three months, and the metal-ceramic prosthesis was delivered after a total of nine months from the ARP procedure.

Source:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320275/
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