Comparative evaluation of the bone regeneration with and without use of 3d scaffold matrix in adult patients in defects following intra-alveolar extraction of mandibular molars – An Observer Blind Prospective Randomized Controlled Study

Alveolar Bone resorption is an inevitable consequence of tooth extraction. The basic premise of ridge healing mechanisms post extraction have clearly led to overall volumetric reduction in both horizontal (2.46 to 4.56mm) and vertical (0.8 to 1.5 mm) dimensions averaging up to 50% within 12 months, two thirds of which occurs within the first three months (Lang et al). Socket preservation techniques have always aimed to neutralize these early dimensional changes and maintain the ridge volumes within the envelope at the time of extraction. This is particularly relevant in cases where immediate or early implant placement as socket preservers is not feasible. Advances in biomaterials, and research unravelling the molecular mechanisms of alveolar bone resorption have led to the advent of multiple options ranging from autografts, xenografts, allografts and alloplastic bone substitutes. Factors which have been considered when selecting the appropriate choice have been the site and size of defect, healing time, evidence for safety and effectiveness, price of the graft, and availability of the graft material. The market demand for Alloplast is bound to grow rapidly over other modalities because of various advantages like no risk of transmission of infection, unlimited availability and avoidance of donor site morbidity and slower degradation. The alloplast is segmented into allograft & synthetic materials. The allografts segment includes demineralized bone matrix and others, whereas the synthetic segment is further broken down into ceramic, composite, polymers, and Bone Morphogenic Proteins (BMP). A good blend of osteoconductive, osteoinductive, osteopromotive and osteogenic properties have always governed the performance of these materials and outcomes. Alloplasts also may carry the advantage of being 3 D printable to match the defect in size, shape and volume for customization. While many materials and techniques have been studied to prevent post extraction resorption, none of the currently used techniques provides complete efficacy in terms of time required for regeneration, ridge preservation dimensionally and quality of regenerate. The use of growth factors and tissue engineering concepts is still in its nascent stage and, while promising, requires more clinical trials before we arrive at an economically viable, resorbable, biologically effective and an option amenable to 3 D printing as a one stop solution. Thus a novel three dimensional (3D) scaffold has been developed with the unique combination of nano hydroxyapatite/ gelatin/ carboxymethyl cellulose (nano Hydroxyapetite/ gelatin /Carboxy Methyl Cellulose) for bone tissue engineering by using the solvent-casting method combined with vapor-phase crosslinking and freeze-drying. The aim of this study is to evaluate the potential of absorbable nano Hydroxyapetite /gelatin/ Carboxy Methyl Cellulose as a scaffold to enhance bone formation in defects generated following a Mandibular Molar extraction in Human adults.