IMPLANT ESSENTIALS

Autologous bone grafting using extraded teeth Armin Nedjat explains how using the patient's own extracted teeth can provide a readily-available and effective grafting material

Figures 1·3: The extracted teeth are cleaned. Amalgam, composites, and endodontic filling material afe removed from the teeth with it diamond, under water cooling, and with a turbine. The tooth fragments are then thoroughly dried and placed In the chamber

Figures 4-6: The chamber is tightly closed. The 'grind' setting is adjusted to three se<onds and 'SOrt' to 20 seconds before the grinding process begins. The unit sorts the granules Into two filtration chambers

In Germany alone, morc than aboUl nine million adult teeth are extracted every year, which all need replacing.

When socket preservation is not performed after extraction, the hard and soft tissues can lose up to 50% of their volume. Consequently, de layed implantation is often aSSOCiated with bone grafts.

For decades, bone gra ft s have been SCientificall y documented to achieve good results. A variety of graft materials, from aUlologous bone (derived from the chin, the

Dr Armin Nedjat is founder and managing director of Champions Implants. He " also the developN of the MIMI (,minimally invasive method of implantation') procedure. For more information, visit www.gbr.champlomimplantHom.

figure 7 and B: The ground and filtered material Is immersed in a cleanser solution for 10 minutes. The cleanser, which is bactericidal, consists of sodium hydroxide with 20% ethanol

ramus, or from the hip of the patient) or synthetiC bone (Beta-TCP), to xenogenous bone have all seen some. measure of success.

A new techn ique has been developed that allows the clinician to transfonn extr3cted teeth into aULOlogous bone graft material ,

which when used correc tly will ankylose and undergo a direct attachment with bone.

A win-win situation For some lime, th is author has incorporated this concept in his practice. The concept, ..

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Effectiveness of dentin-cleanser

FigurtS 9·11: The resulting particulate is carefully dried, before being neutralised In a buffering solution for three minutes and then again dried with sterile swabs. A third optional stage, Involving the use of £OTA solution for one minute, can be added between cleansing and neutrallsing if so desired. After the tooth has been ground and processed, the resulting 'sticky bone' can be used as graft in the alveolus. In practice, the graft does not crumble and exhibits a capadty to bond. A membrane and sutures do not seem to be necessary when the patient Is advised not to drink. rinse, or brush their teeth for twO and a half hours after the procedure

which originates from the USA and Israel, is deceptively simple: tostead of discarding extracted teeth , the latter are bio-recycled allhe chairside and cleaned directly after extr3Clion in order La use them as osteoinductive aULa logous bone graft.

The LOath fragments contain important bone growth factors. Many studies have confirmed the benefits of the natural leeth material as bone graft, and the Cost-efficient restora tion for the patient can be easily and quickly fiLted in any dental office.

Socket preservation techmques, as an ahernative to immediate implant placement, are also suitable for use with this technique. In socket preservallon procedures a graft is placed at the time of extraction bUl Lhe implant is typically nOI placed for anoLher three to four months.

It is the belief of this author that lhe Champions Smart Grinder Concept (CSGC) has the potent ial to be a win-win situation fo r patients and dentists.

Discussion In immediate placement cases, the graft can be prepared while the implant is placed.

It is recommended that the implant be placed first (ideally, at a primary Sfability of 30Ncm), and then the graft added to nil the bone-implant cavity. A prospective study by Barone documented stable soft tissue with a success rate of 95 % after seven years following an immediate implantation and immediate restora tion (Barone et al 2016).

The palatinalllingual pOSition of the implant in the 'b io logical envelope' seems to comribute to success.

For aboUl l 5 years. as has been said in clinical sLUdies, this author has postulated that it is paramount to prevent the graft and/or the implant from applying pressure on the buccal bone lamella (even if it .

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Another mndornised study showed there was not a diITerence between the peri-implant soft l!ssue volume increase in the: group with xenogenous collagen mamx and the group with a connect ive tissue graft (Thoma et al 20J 6).

In a study conducted by Kim el al (2016) wi th 30 palients, it was shown that demineralized and ground autologous teeth, in combin::llion wi th PRp, were suitable (or sinus lift.

Figul'tS 12 ,nd 13: The resuh ing 'sticky bone' can be used as a grafting material

A study conducted by Pohl et .1 in Austria (2016) also demonstrated the use of ground third molars in sinus lift procedures.

is very thin . with an intact periosteum) (S lagter et.1 2016.; Slagter et al 2016b; Cochlidakls 2016; Khoury 2016).

The buccal resorption is independent of the biOlype. With a mlOimally invasive method of implantation (ie, without raising flaps), there is likely to be resorption of only 0.3mm (Merhab et al 2016), which is a sa tisfactory and even long-tenn aesthetic clinical result!

In add ition, a Significant correlation of lasting aesthetic results with the vestibular bone thickness has not been found.

A prospective study found that for immediate implantation, it was not Significant whether the vestibular bone wall measured O.4mm or 1.2rnm (Arora and Ivanovskl 2016).

If a graft is placed in the cavi ty between the bone and the implant . the buccal lamella can be stabilised (Arora and lvanovski 2016). A meta-analysis has shown that a connect ive tissue graft for immediate implantation is nOt more aesthetic in the long term and is therefore questioned (de Olivwa-Neto et aI2016).

In the author's experience, the Sman Dentine Gri nder has been very successful, providing 100% physiologicallylbiologic.lly compat ible material. wilhout incidence of dehlscences and clinical complica tions. Psychologically, patients do not need lO be informed about foreign material anymore -since their own teeth can be reused .

Conclusion and economical considerations The general dentist, during the treatment o f hislher patients. willlypically extract teeth that cannOt be preserved and go on

50 May 2017 lOT

Figures 14-17: The tooth at UR6 could not be preserved (Figure 14). After antibiotic treatment, It was extracted. During Immediate Implant placement of a Champions {R)evolution , Ox4mm implant. the tooth was cleaned and prepared. After placing the implant at a primary stability of 30Nan (Figure 13), the particulate was placed In the alveolus (figure 141. After only 10 weeks. very satisfactory results were achieved (Figure 1 S) with the autologous graft using the Champions Smart Grinder Concept, also in combInation with immediate Implantation or during an efficient and cost-efficient socket preservation. Additionally, the distal bone at URS seemed to regenerate well.

lOT May201) 51

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LO fit a prosthesis of some description. As clinicians we know that tackling an

alveolar resorption rate of around 50% after extraction requires an efficient. non-traumatic treatment that can be carried out at the chairside and wi lhout a big investment in laboraLOfY material.

In the author's opinion , the Smarl Dentine Grinder device, which has been va lidated by the EC and approved by FDA 510 (K) in the United States, fits this bill.

References

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Cone bt:lm computed lomogl'llphy In Implant dentistry: II

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52 May 2017 IDT

In Europe the machine is distributed by Champions Implams. a company whose philosophy is lhal non-lraumatic, reliable treatment, requiring rewer surgery sessions should be a priority.

With a Smart Dentine Grinder, graft ing treatment is qUick. erncient, reliable - and also affordable.

From an economical poim of view, compared to 'classical' socket preservation that uses bovine or alloplastic material.

Du Toit], Gluckman II, Gamll R, Renton T (2015) Implant Injury Ube Series Ilnd Review Qfthe Uterntuu p. ... rt I: Inrerior Alveolar Net\'t Injury. The Journal of oral implantalogy 41(-1); e144-51

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the COSt of a chairside procedure using the patients own teeth is significantly lower.

Tbis author suggests that all clinical colleagues should look at the potential affo rded by no longer disca rding extracted teeth from the patient.

Instead , implant dentists can reuse them as bone graft material, inrorm their palients about iI. and Simplify their socket preservalion techniques. IDT

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