Bone regeneration in implantology: tooth as a graft

Grafting materials must be safe, biocompatible and able to guarantee lasting results. Among the fundamental features of the ideal material is the ability to promote bone regeneration. The autologous tooth is a very promising candidate because it allows osteoinduction and its maintenance after the treatment. After examining the current scientific evidence and studies carried out at the Politecnico di Milano (Milan, Italy), The tooth as a graft provides an overview of all the aspects of bone regeneration and the various devices available on the market are presented and compared, their use explained step-by-step, from cleaning the tooth to the grinding, to the treatment of the material before grafting.

Author:

Flavio Pisani

DDS, PhD Spec in Oral Surgery, MSc in Periodontics, MSc in Implant Dentistry  Senior Clinical Lecturer in Periodontology Programme Lead MSc in Clinical Periodontology, University of Central Lancashire (UK) 

Elio Minetti 

Adjunct Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan

Chapter 1

Vascular anatomy of the maxillaries in relationship to bone regenerative procedures ................................................        1

S. Taschieri, S. Corbella

Introduction.................................................        1

Carotid artery ...............................................       2

Maxillary artery .............................................       2

Upper and lower jaw ........................................       4

Vascularization of the maxillary sinus . . . . . . . . . . . . . . . . . . . . . .        4

Vascularization of the anterior jaw........................      6

Chapter 2

Fundamentals of oral implantology . ........       9

S. Corbella, S. Taschieri

Introduction.................................................       9

Characteristics of the subject ...............................     10

Surgical procedure ..........................................     13

Timing of implant placement ...............................     14

General characteristics of the prosthesis and timing  of prosthetic loading......................................     15

Implant complications ......................................     15

Chapter 3

Guided bone regeneration: rationale and fundamental concepts.............     19

E. Minetti

Development and structure  of bone. Types of bone   and structural organization...............................     19

Composition of the bone ....................................    20

Bone matrix. Cortical bone, medullary bone,  lamellar bone, immature bone ...........................    22

Guided Bone Regeneration (GBR)...........................    24

Bone growth factors.........................................    26

Scaffold ......................................................     27

Dentin .......................................................     31

Chapter 4

The tooth as a source of bone graft ...........33

E. Minetti

Embryogenesis and tooth structure ........................    33

Tooth development ..........................................    36

Mineralization of dental tissues.............................    36

Enamel.......................................................    38

Dentin .......................................................    39

Cementum...................................................    40

History and literature review...............................    40

Chapter 5

In vitro studies with dental materials................................     61

E. Minetti

Analysis of the type of grinding.............................     61

Liquid evaluation............................................    62

Dentin treatment procedure chosen  after the tests carried out .................................     74

Bacterial load test ...........................................     75

Evaluation of the volume needed to completely remove active liquids (HCl and H2O2) ....................................     76

Deciduous tooth treatment .................................    78

Tooth weight ................................................     81

Chapter 6

Tools and procedures for processing bone substitute from dental origin.....................................    85

E. Minetti

Proposed procedures........................................    85

Devices on the market ......................................    87

Protein denaturation........................................    92

CE marking ..................................................    94

Chapter 7

Histological characteristics of the bone substitute of dental origin: scientific evidence ....................................     97

Biomedical aspects of cyto-histology of bone tissue ...     97

A. Casasco, M. CasascoHistology of the bone tissue.................................     97

Histological methods of studying bone tissue . . . . . . . . . . . . . .     98

Specific cells of bone tissue .................................    99

Composition of the fundamental substance of the bone ...  100

The bone lamella, an elementary structure of the bone tissue ......................................................   101

Histogenesis of bone tissue..................................   101

How bone mineralization occurs ...........................   103

The plasticity of bone tissue and its clinical implications...............................   104

Review of published articles with histological examples ....................................................   105

E. Minetti

Examples of histological material of dental origin......   105

P. Savadori

Preliminary data from ongoing studies..................    112

E. Minetti

Analysis over time (<4 months, 4-6 months, >6 months) . ....    112

Analysis by operator . .......................................    113

Analysis by surgical technique. Membranes and platelet derivatives . ................................................    113

Distribution of the results of histomorphometric analysis ...    113

Comparison of resorption with other materials mixed with the tooth ......................................   122

E. Minetti

Radiographic images . .......................................   124

Clinical cases . ...........................................    131

T. Beca Campoy, F. Bromuri, M. Contessi, U. Gambardella, E. Giacometti, H.K.L. Ho, M. Libertucci, E. Minetti, J. Santillana, J. Schmitz

Alveolar preservation......................................   132

Alveolar preservation with membrane . ....................   132

   Clinical case 1............................................   132

   Clinical case 2 ...........................................   135

Alveolar preservation with membrane,  platelet derivatives . .......................................   137

   Clinical case 3 . ..........................................   137

   Clinical case 4 ...........................................   140

Alveolar preservation without membrane . ................   143

   Clinical case 5  ...........................................   143

   Clinical case 6 ...........................................   145

Crest preservation . ........................................   148

Ridge preservation with membrane . .......................   148

   Clinical case 7  ...........................................   148

   Clinical case 8  ...........................................    151

   Clinical case 9  ...........................................   153

   Clinical case 10 ..........................................   155

   Clinical case 11  ..........................................   157

   Clinical case 12 . .........................................   159

Ridge preservation with membrane,  platelet derivatives . .......................................   162

   Clinical case 13 . .........................................   162

   Clinical case 14 . .........................................   164

   Clinical case 15 . .........................................  166

Sinus lift  ....................................................  169

   Clinical case 16  ..........................................  169

   Clinical case 17...........................................    171

Tunnel technique...........................................   173

   Clinical case 18 . .........................................   173

Periodontology.............................................   176

   Clinical case 19 ..........................................   176

Alveolar preservation with protective polypropylene support . ...................................   178

   Clinical case 20 . .........................................   178

Appendix . .................................................    181

Conclusions  ..............................................   187