Alveolar ridge preservation (ARP) is a procedure designed to mitigate post-extraction resorption, thereby optimizing conditions for successful functional and esthetic outcomes [25]. The primary rationale behind ARP is to maintain alveolar ridge dimensions, which is critical for preserving oral health and facilitating successful prosthetic replacement [26]. Considering the advantages and benefits of ARP, our present study employed an atraumatic technique of extraction using periotomes [3]. These instruments were utilized to delicately sever the periodontal ligament until the tooth was luxated, as opposed to the traditional bucco-lingual luxation method that may cause trauma to hard and soft tissues. Consequently, the use of periotomes minimizes tissue trauma and preserves the remaining bone around the teeth [27]. Following an atraumatic tooth extraction, the socket is typically filled with bone graft material, a crucial component of the ARP procedure [16]. The bone graft materials used can include hard tissue bone grafts (such as autografts, allografts, xenografts, or alloplastic materials), soft tissue grafts with resorbable or non-resorbable membranes, or a combination of these[16].
Dentin grafts have gained attention for their distinct ability to promote bone growth, making them a viable option for various bone augmentation procedures such as ridge preservation and sinus augmentation (Elio Minetti et al., 2020). Autologous dentin matrices contain bone morphogenetic proteins (BMPs) and fibroblast growth factors, which are crucial for bone repair and regeneration. The structural resemblance between dentin and autologous cortical bone underlines their analogous behavior, as demonstrated in comparative studies by Kim et al. (2014) with conventional grafting materials [28].
Utilizing autologous extracted teeth as block grafts or converting them into particulate dentin for ridge augmentation represents a promising strategy. Studies have illustrated that dentin grafts gradually resorb and are replaced by autogenous bone. The straightforward chair-side preparation protocol and cost-effectiveness make dentin grafts appealing for addressing various bone defects. Histomorphometric analyses by Ziv Mazor et al. (2019)[29], Andrade et al. (2019)[30], and Mailo et al. (2021)[31] confirm the resorption time for dentin grafts typically ranges between 10 to 12 months. Dentin grafts also offer additional benefits such as improved biocompatibility and a reduced risk of immune rejection.
Over time, advancements in PRF technology led to the development of advanced platelet-rich fibrin (A-PRF) [18] and injectable platelet-rich fibrin (i-PRF)[24]. i-PRF is the liquid state of PRF which due to its liquid state, can be combined with any particulate bone graft to form ‘Sticky bone’. Sticky bone is biologically solidified bone graft which is entrapped in fibrin network. The concept of sticky bone was first described by Sohn et al in 2010. The results of our study showed a statistically significant decrease in the ridge dimensions (vertical ridge height, horizontal ridge width) in both the groups from baseline to 6 months(p < 0.001). On comparison of study groups at 6 month time point the autologous particulate dentin group showed a statistically significant lesser decrease in ridge dimensions than that of control group.
The findings of the present study are in line with the study done by Jung et al in 2018 where they have compared the use of demineralized dentin matrix and recombinant human bone morphogenetic protein-2 (rhBMP-2), with deproteinized bovine bone with collagen (DBBC) in ridge preservation with a 4 month follow up. The results showed that demineralized dentin matrix showed a lesser reduction in both vertical ridge height and horizontal ridge width when compared to deproteinized bovine bone with collagen [32].
In a retrospective investigation undertaken by Pohl et al. in 2020, analogous outcomes were revealed. In their study, comparison was done with sockets augmented with a blend of autologous particulate dentin and chopped PRF against sockets subjected to spontaneous healing [33]. The results of their research concurred with the current study regarding alterations in mean alveolar ridge dimensions, encompassing both vertical and horizontal parameters. In a research undertaken by Hussain et al. in 2023, where autologous particulate dentin was utilized post-extraction of maxillary anterior teeth, their results were in accordance with the present study. Notably, there was a significant discrepancy observed in the mean reduction, with a more pronounced decrease noted in horizontal ridge dimensions compared to vertical ridge height, thereby highlighting a significant trend in the outcomes [34].
In another investigation by Fan Yung et al. in 2023, autologous particulate dentin was used in ridge preservation procedures among patients with severe periodontal destruction. Their findings correspond with those of the current study, indicating the effectiveness of alveolar ridge preservation. Specifically, significant increase was observed in both linear and volumetric changes within severely periodontally compromised extraction sockets, affirming effectiveness of the preservation technique in such cases[35]. Interestingly, in a study conducted by Gowda et al in 2023 where they compared autologous particulate dentin with A-PRF+, the mean decrease in the vertical ridge height was 0.55 ± 0.04 mm and the mean decrease in the horizontal ridge width was 0.29 ± 0.10 mm in autologous particulate dentin group, however the mean decrease in the vertical ridge height was greater than the mean decrease in the horizontal ridge width[36].
In the current study, a significant amount of bone formation was observed in the test group compared to the control group. This may be attributed to dentin's capacity to stimulate bone formation in the alveolar ridge, which can be elucidated by their shared embryological origin and similar composition. Both dentin and bone feature noncollagenous proteins from the SIBLING family, including dentin sialophosphoprotein (DSPP), dentin matrix protein 1 (DMP1), bone sialoprotein (BSP), and osteopontin (OPN). Moreover, dentin contains growth factors such as BMPs, transforming growth factor beta (TGF-β), insulin-like growth factor I (IGF-I), and IGF-II, all of which are recognized for their pivotal role in bone formation [37]. Research indicates that autologous particulate dentin increases the expression of vascular endothelial growth factor (VEGF), facilitating angiogenesis and promoting healing (Reis-Filho and co-workers, 2012)[38].
Moreover, it has been noted to boost the BMP-2 and BMP4 expression, which are crucial for osteoblast activity and bone repair (de Oliveira and co-workers, 2013) [39]. Dentin acts as an absorbable matrix with both osteoconductive and osteoinductive properties, gradually releasing BMPs as it degrades, thereby stimulating bone formation in a controlled manner [40].
Another advantage of utilizing dentin grafts is their prolonged resorption duration relative to alternative graft materials. In an animal study conducted by Guraido et al in 2019, it was demonstrated that mineralized dentin particles exhibit a significant presence of intra- and extra-pores, accounting for up to 44.48% of the material's composition.82 This inherent porosity was observed to enhance vascularization, thereby facilitating heightened blood perfusion to the graft site. Furthermore, the porous nature of the dentin particles supported a gradual and controlled resorption of the grafted material. This controlled degradation process was found to contribute to effective healing and replacement resorption, ultimately promoting the formation of lamellar bone, which is vital for successful bone regeneration [41].
A major drawback of the current study is the potential for improvement through the utilization of a larger sample size accompanied by long-term follow-ups. Additionally, the absence of histomorphometric analysis represents a notable limitation in enhancing the study's depth and insights.