Evaluation of the osteoblastic activity and bone dimensional changes in patients receiving demineralized dentinal matrix autograft with varied particle size in immediate implant placement- a Randomized controlled clinical trial

Different biomaterials, ranging from synthetic products to autologous or heterologous grafts, have been suggested for bone preservation and regeneration during immediate implantology [1]. A jumping gap greater than 2 mm requires grafting with a bone substitute to regenerate hard tissue, which, in turn, helps maintain the soft tissue configuration [2]. This process enhances the thickness of the labial bone plate, showing superior outcomes compared to spontaneous healing through blood clot formation alone [3]. Use of autograft is found to be superior however, due to the additional invasive procedures and morbidity associated with autograft donor sites, special attention has been given to demineralised dentine autograft as a biomaterial for bone regeneration [4].

Demineralized dentin stimulates bone regeneration and has mechanisms similar to autologous bone grafts. It shows high biocompatibility and promotes rapid bone regeneration by maintaining an ideal balance between bone resorption and formation. Additionally, demineralized dentin has several advantages, such as faster recovery times, high-quality newly formed bone, low costs, no risk of disease transmission, the ability to be used in outpatient procedures, and no donor-related postoperative complications [1]. Autogenous DDM granules act as an excellent, readily available alternative to other bone graft materials in cases of immediate implant cases [7].

Studies have shown that there’s high resorption rate of demineralized dentinal autograft in around 3 months which replaces the bone without inflammation. [5]. However, higher resorption rate may be related to loss of bone volume. Studies conducted with allograft and xenograft showed that the particle size of grafts can also play a pivotal role in bone regeneration.  Smaller particles have a larger surface area relative to their volume, which makes them more accessible to osteoclasts, the cells responsible for bone resorption. This leads to faster degradation and remodelling of the graft material into new bone. In contrast, larger particles may resorb more slowly, providing prolonged structural support.[6]

By identifying the most effective particle size for specific graft materials, clinicians can improve the efficiency of bone regeneration procedures, minimizing complications and maximizing patient outcomes. Hence, the influence of particle size of DDM Autograft during immediate implant placement in promoting osseointegration is yet to be ascertained.