Evaluation Of Post Extraction Hard Tissue Alteration Following Ridge Preservation in The Esthetic Zone Using Allogeneic Dentin Matrix Versus Autogenous Partially Demineralized Dentine Matrix: A Randomized Controlled Clinical Trial
Research question: In patients with unrestorable anterior teeth, will the use of allogenic dentin matrix be more effective than autogenous partially demineralized dentine matrix (APDDM) in reducing hard tissue changes after post-extraction ridge preservation in the aesthetic zone? After enrolment, periodontal and radiographic examinations will be conducted, and patients with badly unrestorable teeth in the aesthetic zone will be identified. These patients will undergo measurements of mesio-distal distance between adjacent teeth, corono-apical height of bone, the presence of a labial undercut, dehiscence, or fenestration, and the relationship to adjacent teeth using the transgival probing technique and a preapical radiograph, or CBCT. In both groups, the desired tooth will be atraumatically extracted under local anaesthesia using peritomies and surgical forceps. In the intervention group: preparation of the allogenic dentin matrix. Steps of Allogenic Dentin Processing: Washing with distilled water for 30-120 minutes Ultrasonic cleaning cycles: 1st with distilled water for 5-10 minutes, 2nd with 5-7% hydrogen peroxide 10-30 minutes, then 3 minutes with distilled water for 5-10 minutes at 60-80 Defatting with Chloroform Methanol Solution 1:0.5 for 3-12 hours. Demineralization with 0.5% HCL for 10-60 min Dehydration with Neutral Ethyl Alcohol for 30 minutes, then defatting with Chloroform Methanol Solution 1:0.5 for 3-12 hours Washing with normal saline and freeze-drying, then sterilisation using ethylene oxide gas. After the recovery period of 6 months, a biopsy is taken for cases from the site of the operation for histological evaluation during implant placement. • In the control group, the teeth will be cleaned and dried, and then the dentin will be ground to obtain particles of a certain size, which will be partially demineralized by using a tooth transformer machine. In both groups, the dentin graft will be placed inside the socket, and then a 5/0 proline suture will be used to fix the collagen membranes to cover the graft. After the recovery period of 6 months, a biopsy is taken for cases from the site of the operation for histological evaluation during implant placement. Outcome: Radiographic bucco-lingual ridge width loss. Radiographic palatal vertical bone changes. Radiographic buccal vertical bone changes. Percentage of new vital bone formation. Percentage of residual bone graft. Implant Primary Stability.
• Patients with good health status (ASA-1, ASA-2).
• Adult patients over 18 years old.
• Patients with non-restorable teeth in the aesthetic zone for periodontal, carious, or traumatic reasons.
• Extraction socket with no more than 50% buccal bone loss.
• Patients accept a 6-month follow-up period (cooperative patients).
• Patients provide informed consent.