Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures – A prospective clinical study

Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures – A prospective clinical study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures – A prospective clinical study Manisha Beldhi, Gautami S Penmetsa, Sruthima NVS Gottumukkala, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4507378/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Aug, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted 7 You are reading this latest preprint version Abstract Objectives To compare the effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters. Materials and Methods Thirty subjects with the indication of mandibular posterior teeth extraction were randomly assigned to either a test or control group. After atraumatic extraction, ridge preservation was performed using APD mixed with i-PRF in the test group and DFDBA mixed with i-PRF in the control group. Both groups had sockets sealed with an A-PRF membrane. Clinical parameters (plaque index, gingival index, healing index) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Results The test group exhibited a lesser reduction in ridge dimensions compared to the DFDBA group (p < 0.001). Both groups showed a significant decrease in ridge dimensions from baseline to 6 months (p 0.001). Conclusions APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to the DFDBA group. Clinical Relevance Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes. Alveolar ridge preservation Autologous particulate dentin Atraumatic extraction Demineralized freeze-dried bone allograft Figures Figure 1 Figure 2 Figure 3 INTRODUCTION The alveolar ridge is prone to major amount of resorption in both vertical and horizontal dimensions post-extraction with majority of alterations occurring in the first 3 months [ 1 , 2 ]. To reduce loss of alveolar bone to acceptable levels, several surgical techniques have been proposed. Ridge preservation is one such procedure, which was first described as ‘bone maintenance’ in 1982 and is synonymous with socket preservation, socket grafting and socket augmentation [ 3 ]. Ridge preservation is performed during extraction to minimize the resorption of the bone crest and buccal plate while maximizing bone formation in the alveoli. This principle behind ridge preservation is osteopromotion, which is considered to be very successful irrespective of the cause of tooth loss [ 4 ]. In instances where delayed prosthetic rehabilitation is required, ridge preservation is considered a reliable method of minimizing undesired ridge changes in both the horizontal and vertical dimensions after extraction[ 5 , 6 ]. A variety of graft materials have been utilized in an effort to preserve the alveolar ridge following extraction, including autogenous grafts, allografts, xenografts, and alloplasts [ 7 ]. Dentin has been studied as a biomaterial to promote bone growth since the 1960’s [ 8 ]. Several in vitro, in vivo, and clinical research have yielded positive findings, suggesting that dentin can serve as an appropriate bone graft replacement. The fact that dentin has the same embryologic origin as alveolar bone might explain its ability to form bone [ 9 , 10 , 11 ]. Furthermore, the organic composition of dentin and bone is relatively similar. Dentin's organic composition is mostly composed of collagen type-I (90%), and it contains numerous growth factors such as Bone Morphogenetic Proteins (BMP’s), which are known to stimulate bone development [ 12 ]. Additionally, it has the benefit of not causing host tissue reactivity or heterotopic bone development, which is an essential safety factor to consider when selecting a graft [ 13 ]. On the other hand allografts, such as Demineralized Freeze-dried Bone Allograft (DFDBA) and mineralized Freeze-Dried Bone Allograft (FDBA), are the widely used bone grafts [ 14 ]. DFDBA has dual properties of osteoconductivity and osteoinductivity. Various animal studies have demonstrated that DFDBA can stimulate new bone formation through osteoinduction. It encourages the differentiation of undifferentiated mesenchymal cells into osteoblasts, thereby promoting bone formation. Additionally, DFDBA serves as a scaffold that facilitates osteoconduction [ 15 ]. When these bone substitutes are placed in the socket, there's a potential for them to dislodge easily during the healing process. Thus, socket sealing also plays a crucial role as it provides the primary closure and helps in the success of ridge preservation technique [ 16 ]. Platelet Rich Fibrin (PRF) was pioneered by Joseph Choukroun and colleagues in France back in 2001. The concept emerged from the idea of harnessing human blood proteins, particularly growth factors, to facilitate angiogenesis. PRF is essentially a fibrin network enriched with platelets, white blood cells, serum and concentrated growth factors[ 17 ]. Recent advancements in PRF preparation methods have led to the discovery of Advanced PRF and Liquid PRF, also called as Injectable PRF (i-PRF). Injectable PRF offers a convenient liquid form of platelet concentrate that can be utilized independently or can be combined with various biomaterials. When combined with bone substitutes, Liquid PRF forms a cohesive mixture known as "sticky bone." This composite not only provides a scaffold for new bone formation but also releases bioactive compounds such as cytokines and growth factors (e.g., VEGF, PDGF, and TGF) to promote tissue regeneration. While, Advanced PRF (A-PRF) employs a low-speed centrifugation approach, resulting in higher growth factor release. Reducing the centrifugation speed during A-PRF preparation decreases the penetration of leukocytes into red blood cell fraction, leading to improved vascularization, accelerated soft tissue growth, increased cytokine production, and enhanced release of bone morphogenic proteins[ 18 ]. Although, the efficacy of autologous particulate dentin in bone regeneration is established,[ 19 ] there exists a paucity of research in the literature regarding its effectiveness in ridge preservation procedures. On the other hand, numerous studies have explored the use of DFDBA in such procedures, demonstrating favorable outcomes [ 20 ]. Therefore, the current study is undertaken to compare the clinical and radiographic outcomes of utilizing autologous particulate dentin versus DFDBA in ridge preservation procedures. MATERIALS AND METHODS Study design The present study is a randomized, controlled, single blind clinical trial at a single centre. Two treatment groups; APD + i PRF (test) and DFDBA + i PRF (control) were compared during a 6 month period. Figure 1 illustrates the flow chart of the current study. This study has been approved by the Institutional Ethics Committee, Vishnu dental college, Bhimavaram (Reference No: IECVDC/2022/PG01/PI/IVV/13). Prior to participation, all patients were thoroughly informed about the study's purpose and procedures. Those who agreed to participate provided written informed consent in compliance with the Declaration of Helsinki (1975, revised 2013). Study population A total of thirty patients with the indication of mandibular posterior teeth extraction were recruited from Vishnu dental college, Bhimavaram of November 2022 to June 2023. Subjects were enrolled in the study based on the following eligibility criteria; age 18–65, mandibular posterior teeth indicated for extraction, adequate restorative space for implant restoration. Exclusion criteria were chronic smoking, pregnancy or intent to become pregnant, history of bisphosphonate use, uncontrolled diabetes, autoimmune diseases, and periapical pathologies. Sample size The sample size was calculated with radiographical parameters (vertical ridge height and horizontal ridge width) as the primary outcome using sample size formula for difference in mean between the groups. The estimated sample size was thirty subjects. Thirty systemically healthy individuals were randomly assigned into test (autologous particulate dentin) and control (DFDBA) groups [ 21 ]. Pre-surgical intervention Each patient underwent a baseline periodontal examination, during which a detailed case history was recorded using a specially prepared form covering both clinical and radiographic parameters. Clinical Parameters including plaque index, gingival index, healing index were measured at baseline [ 23 , 24 ]. Cone Beam Computed Tomography (CBCT) was obtained before the extraction of the tooth and 6 months after extraction to assess the radiographical parameters. Surgical intervention Local anesthesia with 2% lignocaine containing adrenaline at a concentration of 1:200,000 was administered. Atraumatic extraction was done using periotomes. Periotomes were used to precisely severe the periodontal ligament apparatus between the tooth and bone. Once the tooth got luxated it was carefully removed using extraction forceps. Socket debridement was performed meticulously using a curette, followed by thorough saline irrigation. PRF preparation ` During or immediately following the extraction procedure, 20 ml of blood (10 ml for i-PRF and 10 ml for A-PRF) was drawn from the patient's antecubital vein and collected in two sterile glass test tubes. The i-PRF sample was centrifuged at 700 rpm for 3 minutes, whereas the A-PRF sample was centrifuged at 1400 rpm for 13 minutes[ 18 , 24 ]. Test group (Autologous particulate dentin) A surgical bur was used to clean the extracted teeth, removing the periodontal ligament, enamel and caries if present. The pulps of the tooth were extirpated using files. The clean and dry tooth, composed of primarily dentin, is promptly ground in the Smart Dentin Grinder (Kometa Bio, Creskill, NJ, USA). The resulted particles of dentin ranged in size from 300 to 1200 µm in diameter. The sorted particles of dentin was soaked in ethyl alcohol cleanser in a sterile container for 7 minutes to dissolve any organic debris and bacteria. The particles were then rinsed in sterile saline for 3 minutes. The obtained graft was mixed with i-PRF to form sticky bone. The sticky bone was placed in socket and the socket was sealed with the A-PRF membrane. Figure of 8 sutures were placed using 4 − 0 resorbable poly glycolic acid sutures. (fig-1) Fig − 2 CONTROL GROUP (DFDBA) – a. Pre-operative b. DFDBA mixed with i-PRF c. Sticky bone d. A-PRF membrane e. DFDBA placed in the socket f. A-PRF placed in the socket g. Figure of 8 suturing done Control group (DFDBA group) DFDBA was mixed with i-PRF, the obtained Sticky bone was placed in the socket and sealed with A-PRF membrane. Figure of 8 sutures were placed using 4 − 0 resorbable poly glycolic acid sutures. Postoperative care Patients were advised to abstain from brushing the surgical site. Antibiotics (Amoxicillin 500mg, three times daily for three days) and analgesics (Diclofenac 50mg, twice daily for three days) were prescribed. Patients were also advised to use a 0.2% chlorhexidine mouth rinse two times daily for seven days. Post-operative evaluation Following the surgical procedure, patients underwent a follow-up examination at the two-week mark for suture removal and assessment of the healing index. Subsequently, at the six-month interval, patients were reevaluated, with CBCT scans obtained for precise evaluation of radiographic parameters, specifically vertical ridge height and horizontal ridge width. STATISTICAL ANALYSIS: Data were analyzed using IBM SPSS version 2.0 software (IBM SPSS, IBM Corp., Armonk, NY, USA). Normality of the data was assessed using Kolmogorov Smirnov’s test and appropriate parametric / non-parametric tests were chosen depending on the distribution of the data. Independent samples t tests, Mann Whitney U tests, paired t tests, and Chi square test were done to analyze the study data. Bar charts and line diagrams were used for data presentation. Fig − 3 a,b - TEST GROUP(APD) a. Ridge dimensions measured at baseline in CBCT b. Ridge dimensions measured at 6 months in CBCT c,d – CONTROL GROUP (DFDBA) c. Ridge dimensions measured at baseline in CBCT d. Ridge dimensions measured at 6 months in CBCT RESULTS The intervention was done on 30 patients with no loss of follow up. Postoperative healing was uneventful in both groups, with no complications. Table 1 shows the clinical parameters at baseline and follow-up. No significant differences were observed between the groups at baseline (p > 0.05). The comparison of PI and GI values within and between the groups at any follow-up time point revealed no statistically significant differences (p > 0.05). On comparison of the healing index between the study groups, though no significant difference was observed between the groups, the test group had a higher incidence of Score 5 (excellent) compare to the control group(Table 2 ). Table 1 Intra and Inter group comparison of plaque and gingival indices between the study groups at baseline and 6 months PLAQUE INDEX Group Mean ± SD P Value Baseline 6 months Test 1.193 ± 0.41 0.707 ± 0.24 < 0.001* Control 1.100 ± 0.49 0.800 ± 0.26 0.003* P value 0.57 0.36 GINGIVAL INDEX Test 1.227 ± 0.36 0.807 ± 0.25 < 0.001* Control 1.107 ± 0.4 0.867 ± 0.30 < 0.001* P value 0.43 0.56 Indpendent samples t tests; *considered statistically significant Table 2 Comparison of healing index between the study groups Group Healing index Chi square value P value Score 3 n(%) Score 4 n(%) Score 5 n(%) Test 0 8(53.3) 7(46.7) 4.65 0.097 Control 3 (20) 9 (60) 3 (20) Chi square test; *considered statistically significant Table − 3 : Intra and Inter group comparison of vertical bone height and horizontal bone width between the study groups at baseline and 6 months Group Mean ± SD Mean difference VERTICAL RIDGE HEIGHT Baseline 6 months p Value Test 10.875 ± 1.5375 9.499 ± 1.2525 < 0.001* 1.3760 ± 1.32 Control 9.783 ± 1.4582 7.852 ± 1.3495 < 0.001* 1.7311 ± 0.563 P value 0.056 0.002* 0.056 HORIZONTAL RIDGE WIDTH Test 9.007 ± 1 7.695 ± 1.16 < 0.001* 1.3120 ± 1.13 Control 7.603 ± 1.9 5.793 ± 1.26 < 0.001* 1.8093 ± 1.16 P value 0.074 < 0.001* 0.002* Independent samples t tests; * denotes significance On intra-group comparisons, the test group showed a significant reduction in mean vertical ridge height from 10.87 ± 1.53 at baseline to 9.49 ± 1.25 at 6 months (p < 0.001*). The control group also showed a significant reduction from 9.78 ± 1.45 to 7.85 ± 1.34 (p < 0.001*) (Table 3). Intergroup comparisons revealed no significant difference in vertical ridge height at baseline (10.87 ± 1.53 vs. 9.78 ± 1.45, p = 0.0560), but the test group had a significantly higher vertical ridge height at 6 months (9.49 ± 1.25 vs. 7.85 ± 1.34, p = 0.002*) (Table 3). The mean change in vertical height was not significantly different between groups (1.37 ± 1.32 vs. 1.73 ± 0.32, p = 0.056) (Table 3). For horizontal ridge width, the test group decreased from 9.007 ± 1 to 7.60 ± 1.99 (p < 0.001*), and the control group from 7.60 ± 1.9 to 5.79 ± 1.26 (p < 0.001*) (Table 3). No significant difference was seen at baseline (9.00 ± 1.0 vs. 7.6 ± 1.99, p = 0.074), but the test group had a significantly higher width at 6 months (7.69 ± 1.16 vs. 5.79 ± 1.26, p < 0.001*) (Table 3). The control group showed a greater reduction in width (1.31 ± 1.13 vs. 1.8 ± 1.16, p = 0.002*) (Table 3). DISCUSSION 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. CONCLUSION The advantages of using autologous particulate dentin represents a pioneering approach in periodontal research providing clinicians with a versatile and effective substitute for regenerative procedures. While further research is necessary to fully elucidate its long-term efficacy and optimal application techniques, the current evidence underscores its potential as a valuable addition to the dentist's armamentarium, contributing to improved patient care and outcomes in the field of modern dentistry. Declarations Source of funding: There is no source of funding or grant from any of the organization or institute or individual towards this study. Conflict of interest: The other authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper Data availability statement: All the data related to the current research is available in the manuscript. No additional information is required to be available in other sources Ethics approval statement: The study was approved, and ethical clearance was obtained from the Institutional ethical committee with Ref No IECVDC/2022/PG01/PI/IVV/13 Patient consent statement: Before the start of research the study design was explained to all the participants and written informed consent was obtained from all the participants Permission to reproduce material from other sources: All the data provided in the article is original and not from any other sources. Author Contribution Manisha Beldhi: Surgical interventions, data interpretation and manuscript writing.Gautami S Penmetsa: study design, data interpretation and manuscript writing. NVS Sruthima G: Critical reading, study design. All authorshave read and approved the final version. References Kim S, Kim SG (2024) Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes. 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Med (Kaunas Lithuania) 58(1):56. https://doi.org/10.3390/medicina58010056 Jung GU, Jeon TH, Kang MH, Um IW, Song IS, Ryu JJ et al (2018) Volumetric, radiographic, and histologic analyses of demineralized dentin matrix combined with recombinant human bone morphogenetic protein-2 for ridge preservation: a prospective randomized controlled trial in comparison with xenograft. J Appl Sci 8(8):1288 Pohl S, Binderman I, Tomac J (2020) Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and PlateletRich Fibrin: A Retrospective Radiographic ConeBeam Computed Tomography Study. Mater (Basel Switzerland) 13(5):1083. https://doi.org/10.3390/ma13051083 Hussain AA, Al-Quisi AF, Abdulkareem AA (2023) Efficacy of Autogenous Dentin Biomaterial on Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. BioMed research international , 2023 , 7932432. https://doi.org/10.1155/2023/7932432 Yang F, Ruan Y, Bai X, Li Q, Tang X, Chen J, Chen Y, Wang L (2023) Alveolar ridge preservation in sockets with severe periodontal destruction using autogenous partially demineralized dentin matrix: A randomized controlled clinical trial. Clin Implant Dent Relat Res 25(6):1019–1032. https://doi.org/10.1111/cid.13247 Gowda TM, Jayashri M, Venkatesh, Usha Govindaroy2, Shah R, Amanna Kumar BT, Deepthi M Priya, Saloni. Autologous tooth bone graft block compared with advanced platelet-rich fibrin in alveolar ridge preservation: A clinico-radiographic study. J Indian Soc Periodontology 27(6):p 619–625, Nov–Dec 2023. https://10.4103/jisp.jisp_43_23 Qin C, Baba O, Butler WT (2004) Post-translational modifications of sibling proteins and their roles in osteogenesis and dentinogenesis. Crit reviews oral biology medicine: official publication Am Association Oral Biologists 15(3):126–136. https://doi.org/10.1177/154411130401500302 Reis-Filho CR, Silva ER, Martins AB, Pessoa FF, Gomes PV, de Araújo MS, Miziara MN, Alves JB (2012) Demineralised human dentine matrix stimulates the expression of VEGF and accelerates the bone repair in tooth sockets of rats. Arch Oral Biol 57(5):469–476. https://doi.org/10.1016/j.archoralbio.2011.10.011 de Oliveira GS, Miziara MN, Silva ER, Ferreira EL, Biulchi AP, Alves JB (2013) Enhanced bone formation during healing process of tooth sockets filled with demineralized human dentine matrix. Aust Dent J 58(3):326–332. https://doi.org/10.1111/adj.12088 Brunello G, Zanotti F, Scortecci G, Sapoznikov L, Sivolella S, Zavan B (2022) Dentin Particulate for Bone Regeneration: An In Vitro Study. Int J Mol Sci 23(16):9283. https://doi.org/10.3390/ijms23169283 Park M, Mah YJ, Kim DH, Kim ES, Park EJ (2015) Demineralized deciduous tooth as a source of bone graft material: its biological and physicochemical characteristics. Oral surgery, oral medicine, oral pathology and oral radiology , 120 (3), 307–314. https://doi.org/10.1016/j.oooo.2015.05.021 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Aug, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Revision requested 02 Jul, 2024 Reviews received at journal 02 Jul, 2024 Reviewers agreed at journal 01 Jul, 2024 Reviewers invited by journal 29 Jun, 2024 Submission checks completed at journal 04 Jun, 2024 Editor assigned by journal 04 Jun, 2024 First submitted to journal 31 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4507378","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":313403010,"identity":"76fea717-2eff-4a5e-a9e5-468e838e1141","order_by":0,"name":"Manisha Beldhi","email":"","orcid":"","institution":"Vishnu dental college","correspondingAuthor":false,"prefix":"","firstName":"Manisha","middleName":"","lastName":"Beldhi","suffix":""},{"id":313403013,"identity":"269889f7-5bbc-4130-9385-edbdac47e1cb","order_by":1,"name":"Gautami S Penmetsa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYPACCThLDkQceIBfOWMDXMsBBgZjMJ1AWAsDXEsimIdPi7z7GfMHP3Ms8viluxMff/hjlz4/7PBDoC12croN2LUYnskxbOzdJlEsOefsZoODbcm5G2+nGQC1JBubHcChpSHHsIF3m0Tihhu52yQONjDnbpydANJyIHEbLi39bwwb/wK17L+Ru/3HgT/16Yaz0z/g1SIvkWPYDLZFIncbwwG2wwny0jn4bTGQeFY4WxboF4kbuZslzrYdN9wgnVNwIMEAt1/k+5M3fHy7rS6Pf0buxg8Vf6rl5Wenb/7wocJODpcWA6h4ApqIAXblYFsa0LXAREbBKBgFo2AUwAAAPUZqtJ1yXVMAAAAASUVORK5CYII=","orcid":"","institution":"Vishnu dental college","correspondingAuthor":true,"prefix":"","firstName":"Gautami","middleName":"S","lastName":"Penmetsa","suffix":""},{"id":313403016,"identity":"555f3ffb-4b43-4160-9928-a89fba0b4cc4","order_by":2,"name":"Sruthima NVS Gottumukkala","email":"","orcid":"","institution":"Vishnu dental college","correspondingAuthor":false,"prefix":"","firstName":"Sruthima","middleName":"NVS","lastName":"Gottumukkala","suffix":""},{"id":313403019,"identity":"b37d9518-c9d5-415d-a615-458a51892982","order_by":3,"name":"Ramesh KSV","email":"","orcid":"","institution":"Vishnu dental college","correspondingAuthor":false,"prefix":"","firstName":"Ramesh","middleName":"","lastName":"KSV","suffix":""},{"id":313403022,"identity":"9297658a-6739-4848-9f20-d9cf6522ef8d","order_by":4,"name":"Mohan kumar P","email":"","orcid":"","institution":"Vishnu dental college","correspondingAuthor":false,"prefix":"","firstName":"Mohan","middleName":"kumar","lastName":"P","suffix":""},{"id":313403023,"identity":"35b93e44-67bd-4105-919e-2812ecdeb896","order_by":5,"name":"Bhavya Manchala","email":"","orcid":"","institution":"Vishnu dental college","correspondingAuthor":false,"prefix":"","firstName":"Bhavya","middleName":"","lastName":"Manchala","suffix":""}],"badges":[],"createdAt":"2024-05-31 08:25:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4507378/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4507378/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00784-024-05861-6","type":"published","date":"2024-08-21T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59033291,"identity":"14219990-dcf8-4728-9c5f-1d8bb693be15","added_by":"auto","created_at":"2024-06-25 14:34:00","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97944,"visible":true,"origin":"","legend":"\u003cp\u003eTEST GROUP(APD) – \u003cstrong\u003ea. \u003c/strong\u003ePre-operative \u003cstrong\u003eb. \u003c/strong\u003eExtracted tooth \u003cstrong\u003ec. \u003c/strong\u003eExtracted tooth placed in smart dentin grinder \u003cstrong\u003ed. \u003c/strong\u003eAutologous particulate dentin mixed with dentin cleanser \u003cstrong\u003ee. \u003c/strong\u003eAutologous particulate dentin mixed with saline \u003cstrong\u003ef. \u003c/strong\u003eAutologous particulate dentin mixed with i-PRF \u003cstrong\u003eg. \u003c/strong\u003eSticky bone \u003cstrong\u003eh. \u003c/strong\u003eA-PRF membrane \u003cstrong\u003ei.\u003c/strong\u003e Autologous particulate dentin placed in the socket \u003cstrong\u003ej. \u003c/strong\u003eA-PRF placed in the socket \u003cstrong\u003ek. \u003c/strong\u003eFigure of 8 suturing done\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4507378/v1/b66a73a7c943f49af13be868.jpeg"},{"id":59033288,"identity":"db97f345-348d-4b37-a72c-44ac3cf88092","added_by":"auto","created_at":"2024-06-25 14:34:00","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":247894,"visible":true,"origin":"","legend":"\u003cp\u003eCONTROL GROUP (DFDBA) – \u003cstrong\u003ea. \u003c/strong\u003ePre-operative \u003cstrong\u003eb. \u003c/strong\u003eDFDBA mixed with i-PRF \u003cstrong\u003ec. \u003c/strong\u003eSticky bone \u003cstrong\u003ed. \u003c/strong\u003eA-PRF membrane \u003cstrong\u003ee.\u003c/strong\u003e DFDBA placed in the socket \u003cstrong\u003ef. \u003c/strong\u003eA-PRF placed in the socket \u003cstrong\u003eg. \u003c/strong\u003eFigure of 8 suturing done\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4507378/v1/199c8a1a18313296667d12a4.jpeg"},{"id":59033290,"identity":"d5e7bc28-bd6d-4d34-9f62-c68d69813f97","added_by":"auto","created_at":"2024-06-25 14:34:00","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":117170,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea,b -\u003c/strong\u003eTEST GROUP(APD) \u0026nbsp;\u003cstrong\u003ea. \u003c/strong\u003eRidge dimensions measured at baseline in CBCT \u003cstrong\u003eb. \u003c/strong\u003eRidge dimensions measured at 6 months in CBCT \u003cstrong\u003ec,d –\u003c/strong\u003e CONTROL GROUP (DFDBA) \u0026nbsp;\u003cstrong\u003ec. \u003c/strong\u003eRidge dimensions measured at baseline in CBCT \u003cstrong\u003ed. \u003c/strong\u003eRidge dimensions measured at 6 months in CBCT\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4507378/v1/d391c8b110ac4ff72dfa6be4.jpeg"},{"id":63300127,"identity":"d987aa71-11b2-4c31-aba0-0c93e8d2c22b","added_by":"auto","created_at":"2024-08-26 16:11:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1059432,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4507378/v1/d4519474-0df5-4f15-b234-7688121342a2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures – A prospective clinical study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe alveolar ridge is prone to major amount of resorption in both vertical and horizontal dimensions post-extraction with majority of alterations occurring in the first 3 months [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. To reduce loss of alveolar bone to acceptable levels, several surgical techniques have been proposed. Ridge preservation is one such procedure, which was first described as \u0026lsquo;bone maintenance\u0026rsquo; in 1982 and is synonymous with socket preservation, socket grafting and socket augmentation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Ridge preservation is performed during extraction to minimize the resorption of the bone crest and buccal plate while maximizing bone formation in the alveoli. This principle behind ridge preservation is osteopromotion, which is considered to be very successful irrespective of the cause of tooth loss [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In instances where delayed prosthetic rehabilitation is required, ridge preservation is considered a reliable method of minimizing undesired ridge changes in both the horizontal and vertical dimensions after extraction[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA variety of graft materials have been utilized in an effort to preserve the alveolar ridge following extraction, including autogenous grafts, allografts, xenografts, and alloplasts [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Dentin has been studied as a biomaterial to promote bone growth since the 1960\u0026rsquo;s [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Several in vitro, in vivo, and clinical research have yielded positive findings, suggesting that dentin can serve as an appropriate bone graft replacement. The fact that dentin has the same embryologic origin as alveolar bone might explain its ability to form bone [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, the organic composition of dentin and bone is relatively similar. Dentin's organic composition is mostly composed of collagen type-I (90%), and it contains numerous growth factors such as Bone Morphogenetic Proteins (BMP\u0026rsquo;s), which are known to stimulate bone development [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, it has the benefit of not causing host tissue reactivity or heterotopic bone development, which is an essential safety factor to consider when selecting a graft [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand allografts, such as Demineralized Freeze-dried Bone Allograft (DFDBA) and mineralized Freeze-Dried Bone Allograft (FDBA), are the widely used bone grafts [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. DFDBA has dual properties of osteoconductivity and osteoinductivity. Various animal studies have demonstrated that DFDBA can stimulate new bone formation through osteoinduction. It encourages the differentiation of undifferentiated mesenchymal cells into osteoblasts, thereby promoting bone formation. Additionally, DFDBA serves as a scaffold that facilitates osteoconduction [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen these bone substitutes are placed in the socket, there's a potential for them to dislodge easily during the healing process. Thus, socket sealing also plays a crucial role as it provides the primary closure and helps in the success of ridge preservation technique [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Platelet Rich Fibrin (PRF) was pioneered by Joseph Choukroun and colleagues in France back in 2001. The concept emerged from the idea of harnessing human blood proteins, particularly growth factors, to facilitate angiogenesis. PRF is essentially a fibrin network enriched with platelets, white blood cells, serum and concentrated growth factors[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent advancements in PRF preparation methods have led to the discovery of Advanced PRF and Liquid PRF, also called as Injectable PRF (i-PRF). Injectable PRF offers a convenient liquid form of platelet concentrate that can be utilized independently or can be combined with various biomaterials. When combined with bone substitutes, Liquid PRF forms a cohesive mixture known as \"sticky bone.\" This composite not only provides a scaffold for new bone formation but also releases bioactive compounds such as cytokines and growth factors (e.g., VEGF, PDGF, and TGF) to promote tissue regeneration. While, Advanced PRF (A-PRF) employs a low-speed centrifugation approach, resulting in higher growth factor release. Reducing the centrifugation speed during A-PRF preparation decreases the penetration of leukocytes into red blood cell fraction, leading to improved vascularization, accelerated soft tissue growth, increased cytokine production, and enhanced release of bone morphogenic proteins[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough, the efficacy of autologous particulate dentin in bone regeneration is established,[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] there exists a paucity of research in the literature regarding its effectiveness in ridge preservation procedures. On the other hand, numerous studies have explored the use of DFDBA in such procedures, demonstrating favorable outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, the current study is undertaken to compare the clinical and radiographic outcomes of utilizing autologous particulate dentin versus DFDBA in ridge preservation procedures.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe present study is a randomized, controlled, single blind clinical trial at a single centre. Two treatment groups; APD\u0026thinsp;+\u0026thinsp;i PRF (test) and DFDBA\u0026thinsp;+\u0026thinsp;i PRF (control) were compared during a 6 month period. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the flow chart of the current study. This study has been approved by the Institutional Ethics Committee, Vishnu dental college, Bhimavaram (Reference No: IECVDC/2022/PG01/PI/IVV/13). Prior to participation, all patients were thoroughly informed about the study's purpose and procedures. Those who agreed to participate provided written informed consent in compliance with the Declaration of Helsinki (1975, revised 2013).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eA total of thirty patients with the indication of mandibular posterior teeth extraction were recruited from Vishnu dental college, Bhimavaram of November 2022 to June 2023. Subjects were enrolled in the study based on the following eligibility criteria; age 18\u0026ndash;65, mandibular posterior teeth indicated for extraction, adequate restorative space for implant restoration. Exclusion criteria were chronic smoking, pregnancy or intent to become pregnant, history of bisphosphonate use, uncontrolled diabetes, autoimmune diseases, and periapical pathologies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eThe sample size was calculated with radiographical parameters (vertical ridge height and horizontal ridge width) as the primary outcome using sample size formula for difference in mean between the groups. The estimated sample size was thirty subjects. Thirty systemically healthy individuals were randomly assigned into test (autologous particulate dentin) and control (DFDBA) groups [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePre-surgical intervention\u003c/h2\u003e \u003cp\u003eEach patient underwent a baseline periodontal examination, during which a detailed case history was recorded using a specially prepared form covering both clinical and radiographic parameters. Clinical Parameters including plaque index, gingival index, healing index were measured at baseline [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Cone Beam Computed Tomography (CBCT) was obtained before the extraction of the tooth and 6 months after extraction to assess the radiographical parameters.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSurgical intervention\u003c/h2\u003e \u003cp\u003eLocal anesthesia with 2% lignocaine containing adrenaline at a concentration of 1:200,000 was administered. Atraumatic extraction was done using periotomes. Periotomes were used to precisely severe the periodontal ligament apparatus between the tooth and bone. Once the tooth got luxated it was carefully removed using extraction forceps. Socket debridement was performed meticulously using a curette, followed by thorough saline irrigation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePRF preparation `\u003c/h2\u003e \u003cp\u003eDuring or immediately following the extraction procedure, 20 ml of blood (10 ml for i-PRF and 10 ml for A-PRF) was drawn from the patient's antecubital vein and collected in two sterile glass test tubes. The i-PRF sample was centrifuged at 700 rpm for 3 minutes, whereas the A-PRF sample was centrifuged at 1400 rpm for 13 minutes[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eTest group (Autologous particulate dentin)\u003c/h2\u003e \u003cp\u003e A surgical bur was used to clean the extracted teeth, removing the periodontal ligament, enamel and caries if present. The pulps of the tooth were extirpated using files. The clean and dry tooth, composed of primarily dentin, is promptly ground in the Smart Dentin Grinder (Kometa Bio, Creskill, NJ, USA). The resulted particles of dentin ranged in size from 300 to 1200 \u0026micro;m in diameter. The sorted particles of dentin was soaked in ethyl alcohol cleanser in a sterile container for 7 minutes to dissolve any organic debris and bacteria. The particles were then rinsed in sterile saline for 3 minutes. The obtained graft was mixed with i-PRF to form sticky bone. The sticky bone was placed in socket and the socket was sealed with the A-PRF membrane. Figure of 8 sutures were placed using 4\u0026thinsp;\u0026minus;\u0026thinsp;0 resorbable poly glycolic acid sutures. (fig-1)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFig \u0026minus;\u0026thinsp;2 CONTROL GROUP (DFDBA) \u0026ndash; \u003cb\u003ea.\u003c/b\u003e Pre-operative \u003cb\u003eb.\u003c/b\u003e DFDBA mixed with i-PRF \u003cb\u003ec.\u003c/b\u003e Sticky bone \u003cb\u003ed.\u003c/b\u003e A-PRF membrane \u003cb\u003ee.\u003c/b\u003e DFDBA placed in the socket \u003cb\u003ef.\u003c/b\u003e A-PRF placed in the socket \u003cb\u003eg.\u003c/b\u003e Figure of 8 suturing done\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eControl group (DFDBA group)\u003c/h2\u003e \u003cp\u003eDFDBA was mixed with i-PRF, the obtained Sticky bone was placed in the socket and sealed with A-PRF membrane. Figure of 8 sutures were placed using 4\u0026thinsp;\u0026minus;\u0026thinsp;0 resorbable poly glycolic acid sutures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative care\u003c/h2\u003e \u003cp\u003ePatients were advised to abstain from brushing the surgical site. Antibiotics (Amoxicillin 500mg, three times daily for three days) and analgesics (Diclofenac 50mg, twice daily for three days) were prescribed. Patients were also advised to use a 0.2% chlorhexidine mouth rinse two times daily for seven days.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePost-operative evaluation\u003c/h2\u003e \u003cp\u003eFollowing the surgical procedure, patients underwent a follow-up examination at the two-week mark for suture removal and assessment of the healing index. Subsequently, at the six-month interval, patients were reevaluated, with CBCT scans obtained for precise evaluation of radiographic parameters, specifically vertical ridge height and horizontal ridge width.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS:\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS version 2.0 software (IBM SPSS, IBM Corp., Armonk, NY, USA). Normality of the data was assessed using Kolmogorov Smirnov\u0026rsquo;s test and appropriate parametric / non-parametric tests were chosen depending on the distribution of the data. Independent samples t tests, Mann Whitney U tests, paired t tests, and Chi square test were done to analyze the study data. Bar charts and line diagrams were used for data presentation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFig \u0026minus;\u0026thinsp;3 \u003cb\u003ea,b -\u003c/b\u003e TEST GROUP(APD) \u003cb\u003ea.\u003c/b\u003e Ridge dimensions measured at baseline in CBCT \u003cb\u003eb.\u003c/b\u003e Ridge dimensions measured at 6 months in CBCT \u003cb\u003ec,d \u0026ndash;\u003c/b\u003e CONTROL GROUP (DFDBA) \u003cb\u003ec.\u003c/b\u003e Ridge dimensions measured at baseline in CBCT \u003cb\u003ed.\u003c/b\u003e Ridge dimensions measured at 6 months in CBCT\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe intervention was done on 30 patients with no loss of follow up. Postoperative healing was uneventful in both groups, with no complications. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the clinical parameters at baseline and follow-up. No significant differences were observed between the groups at baseline (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The comparison of PI and GI values within and between the groups at any follow-up time point revealed no statistically significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). On comparison of the healing index between the study groups, though no significant difference was observed between the groups, the test group had a higher incidence of Score 5 (excellent) compare to the control group(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra and Inter group comparison of plaque and gingival indices between the study groups at baseline and 6 months\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePLAQUE\u003c/p\u003e \u003cp\u003eINDEX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBaseline\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.193\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.707\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.100\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.800\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGINGIVAL\u003c/p\u003e \u003cp\u003eINDEX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.227\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.807\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.107\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.867\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIndpendent samples t tests; *considered statistically significant\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of healing index between the study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eHealing index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChi square value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore 3 n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore 4 n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eScore 5 n(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChi square test; *considered statistically significant\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable \u0026minus;\u0026thinsp;3 : Intra and Inter group comparison of vertical bone height and horizontal bone width between the study groups at baseline and 6 months\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eVERTICAL\u003c/p\u003e \u003cp\u003eRIDGE\u003c/p\u003e \u003cp\u003eHEIGHT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBaseline\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep Value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.875\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.499\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3760\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.783\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.852\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7311\u0026thinsp;\u0026plusmn;\u0026thinsp;0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHORIZONTAL\u003c/p\u003e \u003cp\u003eRIDGE\u003c/p\u003e \u003cp\u003eWIDTH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.007\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.695\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3120\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.603\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.793\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8093\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eIndependent samples t tests; * denotes significance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn intra-group comparisons, the test group showed a significant reduction in mean vertical ridge height from 10.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 at baseline to 9.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 at 6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*). The control group also showed a significant reduction from 9.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45 to 7.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*) (Table\u0026nbsp;3). Intergroup comparisons revealed no significant difference in vertical ridge height at baseline (10.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 vs. 9.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45, p\u0026thinsp;=\u0026thinsp;0.0560), but the test group had a significantly higher vertical ridge height at 6 months (9.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 vs. 7.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34, p\u0026thinsp;=\u0026thinsp;0.002*) (Table\u0026nbsp;3). The mean change in vertical height was not significantly different between groups (1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32 vs. 1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32, p\u0026thinsp;=\u0026thinsp;0.056) (Table\u0026nbsp;3). For horizontal ridge width, the test group decreased from 9.007\u0026thinsp;\u0026plusmn;\u0026thinsp;1 to 7.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*), and the control group from 7.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 to 5.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*) (Table\u0026nbsp;3). No significant difference was seen at baseline (9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 vs. 7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99, p\u0026thinsp;=\u0026thinsp;0.074), but the test group had a significantly higher width at 6 months (7.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 vs. 5.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*) (Table\u0026nbsp;3). The control group showed a greater reduction in width (1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 vs. 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16, p\u0026thinsp;=\u0026thinsp;0.002*) (Table\u0026nbsp;3).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAlveolar ridge preservation (ARP) is a procedure designed to mitigate post-extraction resorption, thereby optimizing conditions for successful functional and esthetic outcomes [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The primary rationale behind ARP is to maintain alveolar ridge dimensions, which is critical for preserving oral health and facilitating successful prosthetic replacement [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Considering the advantages and benefits of ARP, our present study employed an atraumatic technique of extraction using periotomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. 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 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Following an atraumatic tooth extraction, the socket is typically filled with bone graft material, a crucial component of the ARP procedure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. 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[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDentin 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 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUtilizing 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)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Andrade et al. (2019)[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Mailo et al. (2021)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] 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.\u003c/p\u003e \u003cp\u003eOver time, advancements in PRF technology led to the development of advanced platelet-rich fibrin (A-PRF) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and injectable platelet-rich fibrin (i-PRF)[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. i-PRF is the liquid state of PRF which due to its liquid state, can be combined with any particulate bone graft to form \u0026lsquo;Sticky bone\u0026rsquo;. Sticky bone is biologically solidified bone graft which is entrapped in fibrin network. The concept of sticky bone was first described by Sohn \u003cem\u003eet al\u003c/em\u003e 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\u0026thinsp;\u0026lt;\u0026thinsp;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.\u003c/p\u003e \u003cp\u003eThe 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 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 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 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. 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 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 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[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. 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\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04 mm and the mean decrease in the horizontal ridge width was 0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;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[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 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 [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. 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)[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, 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) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. 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 [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother 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 [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA 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.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe advantages of using autologous particulate dentin represents a pioneering approach in periodontal research providing clinicians with a versatile and effective substitute for regenerative procedures. While further research is necessary to fully elucidate its long-term efficacy and optimal application techniques, the current evidence underscores its potential as a valuable addition to the dentist's armamentarium, contributing to improved patient care and outcomes in the field of modern dentistry.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSource of funding:\u0026nbsp;\u003c/strong\u003eThere is no source of funding or grant from any of the organization or institute or individual towards this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe other authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eAll the data related to the current research is available in the manuscript. No additional information is required to be available in other sources\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval statement:\u0026nbsp;\u003c/strong\u003eThe study was approved, and ethical clearance was obtained from the Institutional ethical committee with Ref No IECVDC/2022/PG01/PI/IVV/13\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent statement:\u0026nbsp;\u003c/strong\u003eBefore the start of research the study design was explained to all the participants and written informed consent was obtained from all the participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePermission to reproduce material from other sources: \u0026nbsp;\u003c/strong\u003eAll the data provided in the article is original and not from any other sources.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAuthor Contribution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eManisha Beldhi: Surgical interventions, data interpretation and manuscript writing.Gautami S Penmetsa: study design, data interpretation and manuscript writing. 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Int J Mol Sci 23(16):9283. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijms23169283\u003c/span\u003e\u003cspan address=\"10.3390/ijms23169283\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark M, Mah YJ, Kim DH, Kim ES, Park EJ (2015) Demineralized deciduous tooth as a source of bone graft material: its biological and physicochemical characteristics. \u003cem\u003eOral surgery, oral medicine, oral pathology and oral radiology\u003c/em\u003e, \u003cem\u003e120\u003c/em\u003e(3), 307\u0026ndash;314. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.oooo.2015.05.021\u003c/span\u003e\u003cspan address=\"10.1016/j.oooo.2015.05.021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Alveolar ridge preservation, Autologous particulate dentin, Atraumatic extraction, Demineralized freeze-dried bone allograft","lastPublishedDoi":"10.21203/rs.3.rs-4507378/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4507378/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo compare the effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThirty subjects with the indication of mandibular posterior teeth extraction were randomly assigned to either a test or control group. After atraumatic extraction, ridge preservation was performed using APD mixed with i-PRF in the test group and DFDBA mixed with i-PRF in the control group. Both groups had sockets sealed with an A-PRF membrane. Clinical parameters (plaque index, gingival index, healing index) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe test group exhibited a lesser reduction in ridge dimensions compared to the DFDBA group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Both groups showed a significant decrease in ridge dimensions from baseline to 6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was no statistical difference in clinical parameters (plaque index, gingival index, healing index) between the groups at 6 months (p\u0026thinsp;\u0026gt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAPD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to the DFDBA group.\u003c/p\u003e\u003ch2\u003eClinical Relevance\u003c/h2\u003e \u003cp\u003eAutologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.\u003c/p\u003e","manuscriptTitle":"Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures – A prospective clinical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-25 14:33:55","doi":"10.21203/rs.3.rs-4507378/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-02T13:47:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-02T04:08:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29750776792546818689240428318130615611","date":"2024-07-02T03:09:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-29T23:27:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-04T04:56:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-04T04:56:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-05-31T08:24:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2a185332-7369-4abc-8c12-de1e6f0c2f29","owner":[],"postedDate":"June 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-26T16:01:10+00:00","versionOfRecord":{"articleIdentity":"rs-4507378","link":"https://doi.org/10.1007/s00784-024-05861-6","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2024-08-21 15:57:14","publishedOnDateReadable":"August 21st, 2024"},"versionCreatedAt":"2024-06-25 14:33:55","video":"","vorDoi":"10.1007/s00784-024-05861-6","vorDoiUrl":"https://doi.org/10.1007/s00784-024-05861-6","workflowStages":[]},"version":"v1","identity":"rs-4507378","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4507378","identity":"rs-4507378","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}