Another Dentin Graft Case In Prep for Implants

How did you sterlize the dentin graft? Nice case...beautiful healing...

Dr Hertz, It seems like it is labor intensive and costly. Is there a benefit over any of the myriad of other grafting options?

To add to the comments made previously, I think the comparison to allografts or other 'off the shelf' grafts isn't the right comparison when you look at this technique. The comparison should be to autologous grafts. The technique offers a way to produce autologous graft within 15 minutes for a patient that would greatly appreciate you utilizing his or her own tissue. Can you compare that to scraping, suctioning, and surgically harvesting grafts from a secondary site? Now, the benefits of autologous grafts have been widely studied for many years and they still maintain their position as the GOLD standard of grafting. The problem is that up until this technique was introduced, getting autologous grafts was too long, too painful with high morbidity. So dentists reverted to the second best. We ask, why go for the second best when you can offer the best? Specifically in regards to dentin as a graft, the research that shows it as being extremely effective for the short and long term goes back over 35 years. All that we have done is provided an easy and simple device to produce the graft from an extracted tooth in an easy manner.

Incidentally, this whole discussion peaked my interest and I searched on PubMed and found this excellent article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858164/ (Tooth-derived bone graft material from the J Korean Assoc Oral Maxillofac Surg. 2013 Jun; 39(3): 103–111. ) Will have to read the article in full, though I think the title is misleading, tooth are not bones again, so they can't be considered a bone graft. Anyhow, cursory reading suggests that grafting with teeth is most similar to grafting with CS and hydroxyapatite, or even bTCP ("Dentin consists of 70% hydroxyapatite in its weight volume") Of course, this is a simplistic analysis, as it ignores the BMP component (controversial), so I'll stop there. Thanks for the great discussion. Definiately re-learning the biology of teeth.

Thanks Phil for pointing us to this great paper by Kim. There are many more papers that have looked at this topic and the success of using dentin graft. One of the key observations is how well it is accepted by the patient's own body, the fact that the fresh autologous dentin attracts progenitor cells at the site, the fact that inflammation and adverse reactions are rarely observed (due to it being autologous), the fact that the dentin graft undergoes immediate ankylosis with the opposed bone and therefore stabilizes the site and the fact that the histology shows a very fine cementum line and no granulation tissue - all results of utilizing an autologous graft vs grafts that are either synthetic or heavily processed from same species or other species that simply lost most of their biological properties and in some cases could introduce disease transmission. I agree that bone and tooth are not the same, but they are almost identical. It's like saying that a wood table and a wood chair are not the same, but when you grind them up, you end up with wood pulp. This is too simplistic - I know. So if we look at the makeup of cortical bone we get 60% of Crystalline Calcium Phosphate or HA, 30% Collagen Type I, and 10% water. Yes there's a little bit of BMP and even some stem cells. When you look at a tooth including all its components (dentin, enamel, pulp,...) we get approximately 70% Crystalline Calcium Phosphate or HA, 25% Collagen Type I, and 5% water, BMPs, and yes, even stem cells. In fact, there are more BMPs in a tooth than there are in bone - which is a very good thing if you're using it as a graft. So bone and tooth are not the same, but they are almost identical after they are grounded up. We have been using autologous dentin grafts for over 6 years now and the results are predictable - long lasting bone maintenance with very little recession if any. I'm glad that more and more dentists are taking to it for optimizing results for their patients.

Hi, What system or brand of machine are you using to grind and clean the teeth? And if you have multiple extractions is the machine able to grind two or three teeth at once? I assume teeth with fillings would require complete removal of fillings and endo treated teeth are contra indicated. Thanks! George

My only frame of reference is when I perform cornectomies or elective partial removal of impacted third molars near the nerve, if all enamel is removed then the bone heals really well and over time the roots seem to become incorporated into the bone. With leaving roots near implants not sure if there will be a future problem but sometimes that labial plate is so thin it causes so much damaging removing the roots. I'll be watching this technique for merit, thanks for posting!

Thanks to everyone for the discussion. I think it is true that time will tell. As with most things we do I am sure that some will go well and some won't. What happens if the tooth is not processed properly? Especially if this is delegated to an assistant?