Effectiveness of autogenous dentin graft along with amniotic membrane in post extraction wound healing

According to world health organization an impacted tooth, is the one that is unable to fully erupt in its normal functional occlusion/location by its expected age of eruption, because it is blocked by overlying soft tissue or bone or another tooth. Impacted third molars are classified by winters in 1926 according to the long axis of the second molar as mesioangular impaction, distoangular impaction, horizontal impaction, vertical impaction, transverse impaction and inverted impaction. In Impacted lower third molar extraction . Surgery, whether prophylactic or therapeutic, is a very common procedure in the field of oral and maxillofacial surgery. In case where the teeth are deeply impacted and covered by large quantity of bone. The frequency of impaction lies between 66% and 77% . In addition to its high prevalence, third molar extraction is a surgical procedure accompanied by complications that include periodontal problems characterized by bone loss on the distal aspect of the second molar. Post extraction socket healing is a coordinated, sequence of biochemical, physiological cellular response, aiming to restore tissue integrity and functional capacity. Over the years, surgical adjuvant, bone grafting have been used to improve periodontal status, regeneration, bone quality . Over the years, a lot of efforts have been made to improve the periodontal status of 2nd molar after surgical removal of third molar. Osborne et al showed only minimal reduction. of PD or induction of reattachment of gingival tissues achieved by root planning the distal aspect of second molar after extraction of an adjacent impacted third molar. Similarly, little or no benefit was found with different flap designs used in these situations. Guided tissue regeneration (GTR)-based procedures with or without bone grafting therapies provide some adjunctive clinical benefit compared to standard non-grafting procedures. Augmentation of the osseous defect with bone grafts has become one of the most common surgical techniques in recent years. Various bone-grafting materials have been used in post extraction site, include autogenous bone (harvested from the mandible during the rotatory osteotomy), allogenic bone, platelet rich plasma, plateletrich fibrin, synthetic bone graft substitutes (eg, Bio-oss, bioactive glass, and synthetic calcium hydroxyapatite) and a combination of these materials. Although different degrees of success were achieved, the autogenous bone. still proved to be the gold standard for bone regeneration, because of its osteoconductive and osteoinductive properties. The autotooth bone graft material is a system that treats patients by manufacturing bone graft material from their own extracted teeth. It has first been introduced by the Korea Tooth Bank R&D Center and has satisfied many clinicians and patients for its osteoconduction as well as osteoinduction capacity. Human dentin is composed of 70% organic content with four types of calcium phosphate (hydroxyapatite, tricalcium phosphate, octacalcium phosphate, and amorphous calcium phosphate), which provide dentin with its osteoconductive properties. However few studies are done where autogenous bone graft showed better results than other bone grafts, but relatively less studies have addressed combination of autogenous dentin graft with amniotic membrane in the extracted socket. Therefore, the purpose of the study is to evaluate effectiveness of autogenous dentin graft combined with amniotic membrane in wound healing after impacted third molar extraction.