Background: Although Urist and many other investigators have reported a bone regeneration capacity of demineralized tooth since 1967, cumbersome procedures including long demineralization time limit their clinical use. An ultrasonic device operating under periodic negative pressure and a bioreactor tube system can ensure rapid and aseptic preparation of partially demineralized dentin for alveolar bone grafting immediately after extraction in clinic. Using this approach, it took us 2 hrs (block type) or less (powder type) to prepare the graft material.

Aim/Hypothesis: This study shows that preparation of partially demineralized autogenous dentin in clinic is a safe and useful method for immediate reconstruction of alveolar bone defects and can be a good alternative to the use of autogenous bone.

Methods: This clinical trial was performed at two centers in Korea. Consecutive 149 patients who needed both extraction of teeth (for endodontic or periodontal reasons or pericoronitis of third molar) and alveolar bone regeneration were included in this study. The reasons for bone grafting were vertical or horizontal alveolar bone deficiency for dental implant restoration or pre-existing periodontal defect on the distal aspect of the lower second molar (LM2) due to the impacted third molar. Two hours or less after tooth extraction, patients were prepared for bone grafting. Bony defects were restored just after extraction with the teeth from the original sites (113 cases) or third molars of other site (36 cases). 

Results: There were no significant differences among the cases in relation to age and gender. All cases showed an uneventful healing process. No significant complications such as compromised wound healing including uncontrolled dehiscence, local wound infection, graft failure or dental implant failure were observed. A few cases (n= 4) showed minor wound dehiscence in early stage of soft tissue healing, but they were healed completely by secondary intention within 4 weeks. All culture tests showed no bacterial growth.

Conclusions: 
Bone graft material prepared as partially demineralized autogenous dentin on the day of extraction would be convenient for both patients and clinicians. We conclude that availability of instant partially demineralized dentin after extraction would have a strong positive effect on clinical use of tooth as bone graft material, although further studies should be performed to confirm its osteogenic effect and biological safety.

Clinical application of partially demineralized autogenous dentin prepared at chairside for alveolar bone regeneration- 149 human cases