When a tooth is extracted and replaced with a dental implant, there may not be enough bone for supporting the implant, especially since the tooth has lost a substantial amount of supporting bone due to gum disease.
Fortunately, dental surgeons can help the body regenerate the bone volume surrounding the implant for stability and longevity by grafting. The technique of doing bone grafting and guided tissue regeneration has matured with much success for over 35 years. The materials used in bone graftings can be autogenous-from the same person, allogeneic-harvested from another person, and xenogeneic-obtained from other species like cattle or pigs. Surgeons can also use biosynthetic materials for bone grafting, and they are not made with animal tissues. An example of biosynthetic materials is Bioglass. It is composed of silicon dioxide, sodium oxide, calcium oxide, and phosphorous pentoxide.
An autogenous source is usually more desirable because it is from oneself. It is usually the gold standard in bone grafting. However, it is often difficult for a general dentist to harvest enough bone from other parts of the patient due to the lack of proper training and expertise. To gather enough bone, the surgeons also need to create an additional surgical wound to harvest the bone. A popular site to get extra bone is from the chin. The second wound will require more surgical time, more surgical procedures, increase the chance of surgical and post-operation complications like pain, swelling, bleeding, infection and nerve damage, etc. Besides, the bone harvest surgical procedure will incur additional costs to the patients.
Bone from a human cadaver is called allogeneic, and they generally provide good results as the autogenous bone. The bodies used in bone harvesting are screened for transmissible diseases first. The harvested bone was processed to remove any proteins and antigens to eliminate any immune response from the new host. The bone is also sterilized thoroughly to remove any potential pathogens before being used in grafting.
Some patients, however, do not feel comfortable having another person’s bone in their bodies.
Xenogeneic bone and biosynthetic bone are good options, but the materials often do not induce adequate new bone formation at the site by the body – less osteoinductive than the human bone graft. When there is not enough new bone formation at the graft site, the remaining unabsorbed xenographic or biosynthetic particles interspersing at the graft site will impair the area’s desired tensile and flexural strength.
I had the privilege of being introduced to using the extracted teeth from a patient as a graft material for the same patient. When the site of the extracted tooth is to have an implant, the extracted tooth can be processed, disinfected, and ready to be used in 15 minutes.
The prepared particles from the extracted tooth are packed into the sockets and other bony defects around the implant. The packed particles are then covered with a piece of collagen membrane. The site was then secured with sutures and left to heal over the next few months. During the few months, the majority of the graft particles will be resorbed by the body, and, simultaneously, new bone will form to replace the graft.
The benefits of using the extracted teeth for grafting have many benefits and advantages:
- Grafts are at low risk for infection.
- The graft site will heal faster with solid new bone formation because the graft has the growth factors like metalloproteinase, bone morphogenetic protein 7, etc., that are in teeth.
- Less costly than the allograft and biosynthetic materials.
- Better initial stability.
- No other surgical wound from bone harvesting can increase morbidities and complications.