The Use of Autogenous Tooth Bone Graft Block (ABTB)

in Post-extraction Socket of Dental Implant Treatment Procedure: A

Literature Review

Bambang Tri Hartomo

1,2 a

, Ambar Delfi Mardiunti

1,2 b

, Dewi Sartieka Putri

1,2 c

Irma Khoerunisa

1,2 d

, and Pratitis Widi Seno

1,2 e

College of Dental Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia

Oral and Maxillofacial Dental Hospital, Universital Jenderal Soedirman, Purwokerto, Indonesia

Keywords: Bone graft, Dental implant; Autogenous Tooth Bone Graft Block.

Abstract: The success in making dentures was supported by adjustments to the anatomical condition of the oral cavity

and the prominent ridge that can be achieved after tooth extraction. Post-extraction conditions of the teeth

may cause inflammation, alveolar ridge resorption which becomes narrow and shortened, and the presence of

jaw bone atrophy. The use of implant dentures as a substitute for missing teeth serves to prevent or slow down

bone resorption that occurs by channeling the burden of chewing to the bone. A dental implant is an alternative

to artificial teeth that make patients comfortable because they last a long time. The ideal dental implant must

have strong alveolar bone support. Strong alveolar bone support can be obtained from using a bone graft. This

study shows the potential of Autogenous Tooth Bone Graft Block (ABTB) or teeth that have been extracted.

The use of Autogenous Tooth Bone Graft Block (ABTB) has the potential as an autograft biomaterial material

in the treatment of post-extraction sockets and bone regeneration processes as a foundation in implant

placement.

1 INTRODUCTION

Tooth loss is one of the problems that need to be

considered because it requires replacement, by using

the denture (Ananda et al., 2017). The condition of

tooth loss will affect the loss of bone tissue, nerves,

receptors, and muscles so that the orofacial function

will be reduced. Tooth loss will disturb the oral cavity

conditions such as reduced chewing, phonetic, and

aesthetic functions to restore the function it is

necessary (Mardiyantoro & Pratiwi, 2017).

Success in making the denture is supported by

adjusting the anatomical conditions of the oral cavity,

called prominent ridge that can be achieved after

tooth extraction. A prominent alveolar ridge is a

condition of protrusion of alveolar bone support that

is useful for achieving retention of dentures.

Post-

https://orcid.org/0000-0003-3902-7780

https://orcid.org/0000-0002-6237-4783

https://orcid.org/0000-0001-5330-2908

https://orcid.org/0000-0001-7685-9688

https://orcid.org/0000-0002-9957-501X

extraction conditions cause inflammation, resorption

of the alveolar ridge so that it becomes narrow and

shortened and there is jaw bone atrophy. Bone

resorption is influenced by the activation of cells of

osteoclasts. Osteoclasts and osteoblasts can regulate

the process of bone formation dynamically (Yustina

et al., 2012). If a tooth loss is not using the denture

immediately, it will affect the process of making the

denture, including the lack of retention of the denture

so that the denture is not fit when it is attached to the

patient (Lindhe et al., 2003).

Dental implants are an alternative surgical

treatment to replace dentures that are implanted into

the soft tissue or the jaw bone. The implant placement

procedure is recommended to be carried out as

quickly as possible to prevent serious bone resorption

(Kim et al., 2014). Dental implants can be a

comfortable treatment because it has well function

Hartomo, B., Mardiunti, A., Putri, D., Khoerunisa, I. and Seno, P.

The Use of Autogenous Tooth Bone Graft Block (ABTB) in Post-Extraction Socket of Dental Implant Treatment Procedure: A Literature Review.

DOI: 10.5220/0010489201430147

In Proceedings of the 1st Jenderal Soedirman International Medical Conference in conjunction with the 5th Annual Scientiﬁc Meeting (Temilnas) Consortium of Biomedical Science Indonesia

(JIMC 2020), pages 143-147

ISBN: 978-989-758-499-2

143

and long-lasting with the support of the condition of

the alveolar bone that serves as a buffer against the

implant. The stability of dental implants can be

disrupted due to a lack of alveolar bone support

(Saptaswari, 2017).

Alveolar bone support in the dental implant

placement process can be handled by using a

procedure for making the bone graft. Bone

regeneration is a process of regeneration or

reformation of bone to accelerate the recovery

process of bone damaged due to inflammation

(Ferdiansyah Mahyudin, 2018). Indications for the

use of bone regeneration are to form new bone around

the tooth socket that will be used as a location for

implant placement after tooth extraction.

A bone graft is a material that can function to

restore the function of a bone tissue that has been lost

or has been damaged. Osteoconduction and

osteoinduction properties in bone graft function to

support and stimulate new bone growth (Soepribadi,

2013). Important criteria that must be fulfilled by

bone graft are that it is well-accepted by the body

(biocompatible) and functions well in the process of

osteoconduction, osteoinduction, and bone

osteogenesis (Fauzia et al., 2019).

A bone graft is classified into four types, such as

autograft, allograft, xenograft, and alloplast.

Autograft is bone tissue material originating from the

same individual. An allograft is bone tissue material

originating from one individual to another individual

with different genetic construction but in one species.

A xenograft is bone tissue originating from one

individual to a different species. Alloplastic graft is

material derived from synthetic or artificial bone.

Autograft is the type of graft most often used (Smeets

et al., 2016). Autograft has become a gold standard

for good regenerative procedures because it can

support osteogenic, osteoconduction, and

osteoinduction properties associated with

prosteoblastic cells in the graft (Park et al., 2012).

Mesenchymal stem cells, osteogenic precursor cells,

and osteoblasts will stimulate the occurrence of

osteogenesis. These cells will synthesize new bone in

the recipient area where the bone graft is placed.

Osteoinductive is the ability of the bone graft to

help the process of proliferation and differentiation of

mesenchymal stem cells or progenitor cells into bone-

forming cells (osteoblasts) that produce bone

formation with normal mineralization.

Osteoconductive nature is the passive process of

bone-forming cells (osteoblasts) from recipients into

the bone graft and slowly replace it with new bone

(Ferdiansyah Mahyudin, 2018).

Autogenous Tooth Bone Graft Block (ABTB) is

one of the types of autograph which is derived from

extracted tooth bones (Smeets et al., 2016). The tooth

can be used as the material of bone graft because

dentin and cementum contain the same protein as

bone, such as osteocalcin, osteopontin, bone

sialoprotein, protein, matrix of dentin, and collagen

type I (Handschin et al., 2006). Based on weight and

volume, dentin and bone have the same percentage,

called collagen and hydroxyapatite, and contain some

growth factors, there are bone-morphogenetic protein

2 (BMP-2) and transformation growth factor (TGF)

which being an important role in bone tissue

regeneration (Kim et al., 2010). Disadvantages in

using ABTB are limited availability, requiring the

addition of surgical points, patient morbidity, and also

the patient’s clinical condition (Fauzia et al., 2019).

The dental implant placement must be

accompanied by strong bone support of the bone

graft. The use of Autogenous Tooth Bone Graft Block

(ABTB) as a material has not been well developed in

Indonesia. The ABTB method was first introduced by

the Korea Tooth Bank R&D Center and has been

shown good results (Kim et al., 2010). The purpose

of making this study is to further discuss the use of

ABTB as the bone-graft material to support bone

regeneration in the process of dental implant

placement.

2 MATERIALS AND METHODS

This research using PRISMA (Preferred Reporting

Items for Systematic Reviews and Meta-analysis)

methods. This PRISMA method doing systematically

following the correct stages or research protocols.

The procedure of this systematic review consists of

several steps, namely 1) Preparation of background

and purpose, 2) Formulation of problems, 3)

Searching for literature, 4) Selecting, 5) Collecting

Data, 6) Analysis, 7) Conclusions. This research was

conducted in March-June 2020. The search for

research articles relevant to this research was carried

out using keywords of implants, bone graft, ABTB,

and other types of various bone graft obtained from

national or international indexed and reputable

journals and also the google scholar.

JIMC 2020 - 1’s t Jenderal Soedirman International Medical Conference (JIMC) in conjunction with the Annual Scientiﬁc Meeting

(Temilnas) Consortium of Biomedical Science Indonesia (KIBI )

144

3 RESULTS

3.1 Dental Implant Treatment

Dental implants are an option for the treatment of

partial or complete tooth loss. Dental implant

treatment is useful to be able to restore the function

of mastication, aesthetics, and speech function

(Smeets et al., 2016; Tetelepta & Machmud, 2015).

The form of dental implants consists of various kinds

of boot form, blade form, ramus, and subperiosteal

implant. Dental implants that are often used are dental

implants in the form of root teeth. A root-form

implant shaped like a screw is used to replace the root

of a missing tooth. Dental implants in general are

mostly made of metal, titanium. Titanium metal can

be accepted by the body and can blend with the

patient's jawbone (Ramadhan, 2010).

Clinical dental implant treatment can be

successfully seen from the clinical function,

aesthetics, patient satisfaction, prosthetic stability,

peri-implant soft tissue infection, there are luctation

and no pain (Al-Sabbagh & Bhavsar, 2015). Dental

implants can function well if biologically suitable

placement. The 3-dimensional position of the implant

(fasiolingual, mesio-distal, apico-coronal) is essential

for successful treatment. The key factor for implant

placement is the availability of alveolar bone in the

area. The inadequate height, width, and quality of the

alveolar bone will determine the outcome of the

treatment received. Soft tissue profile is also

influenced by bone height and width. The ideal

implant placement must correct the placement

location and size of the implant, then it affects the

overall aesthetics.

The successful dental implant histologically is

characterized by new bone growth with the surface of

the implant called osseointegration (Utami et al.,

2019). Alveolar bone serves as a buffer for the dental

implant. The dimension of alveolar bone that

decreases both vertically and horizontally will affect

the stability and comfort retention of the denture. The

risk of a fail dental implant under conditions of less

alveolar bone support (Kamadjaja, 2016)

3.2 Bone Graft

Bone grafting is a surgical procedure to replace the

bone loss with bone material that comes from the

patient's own body, artificially or naturally. Bone

tissue can regenerate properly if space is provided for

the bone to grow. Natural bone that grows generally

replaces the graft material and produces a new fully

integrated bone region. A bone graft consists of

autograft, allograft, xenograft, and alloplast. a.

autograft, bone material from the same individual; b.

allograft, bone material from one individual to

another different from the genetic constitution but in

one species c. xenograft, bone material from one

individual to a different species, for example from

animals to humans. d. alloplastic grafts, bone material

that uses bone synthesis, such as hydroxylapatite,

phosphoric calcium ceramics, and oily calcium

hydroxide in a cream form (Smeets et al., 2016).

The most commonly used type of graft is the free

autogenus bone graft. Free autogenus bone graft is

bone material originating from the same patient so

that it may not be able to bring a rejection response

from the patient's immune system. This graft is

usually obtained from the maxilla, mandible,

cranium, tibia bone, iliac crest, and ribs. The bone

graft serves for the reformation of the jawbone, the

transfer of tissue free from microvascular, and the re-

formation of alveolar cleft (Smeets et al., 2016). An

ideal bone graft must have the potential to keep cells

alive, not cause an immunological reaction, be easily

obtained and provide strength to the area around the

bone and not spread disease (Purnomo & Adji, 2012).

In general, the greater the genetic difference between

the graft and its receptors, the greater the rejection

reaction which arises. The material that is often used

in biomedical applications as bone graft material is

hydroxyapatite. Hydroxyapatite (HA) with the

chemical formula Ca10(PO4)6(OH)2 is an inorganic

compound that makes up hard human tissues such as

bones and teeth.

4 DISCUSSION

The success of implant treatment is reviewed based

on the ability of the graft material to integrate well in

the surrounding environment. Successful transplants

must meet basic requirements, namely, the size of the

recipient area must be as strong as the support of a

good alveolar process. The recipient area can easily

receive transplants by directly being carried out into

the former tooth extraction chamber. In patients with

the early loss of molar teeth or premolar different

conditions can be found which are characterized by

the alveolar process atrophy. These conditions require

additional surgical procedures to obtain a recipient

area that is as bone autograft or splitting osteotomy of

the alveolar process. The ideal bone graft material

must have the potential point to keep cells alive, not

cause an immunological reaction, be easily obtained

and provide strength to the area around the bone and

not spread disease (Purnomo & Adji, 2012).

The Use of Autogenous Tooth Bone Graft Block (ABTB) in Post-Extraction Socket of Dental Implant Treatment Procedure: A Literature

Review

145

In general, the genetic difference between the

graft and its recipient, so then the greater reaction

rejection arising. The three case reports that have

been reported that the treatment plan is to use

postextraction dental treatment by implanting the

dental implant accompanied by an autograft type

bone graft. The selection of material, in this case, uses

Autogenous Tooth Bone Graft Block (ABTB) which

is bone graft material derived from extracted teeth.

The extracted tooth root has been used as a block for

alveolar bone augmentation. The tooth has the

potential to be an alternative autograft and functions

structurally and biologically to be used as a

foundation for implant placement (implant

osseointegration). The rejection response of the

patient's immune system is unlikely to arise if using a

graft that comes from the same patient (Smeets et al.,

2016).

An evaluation of the clinical condition showed

that the bones formed to the new bone regeneration at

the post-extraction socket. Bone volume is

maintained which is then successfully used for

implant placement. Soft tissue also undergoes healing

without any signs of inflammation. Dentin is a

graphite material that can maintain the structure of

collagen. It shows that dentin and cementum particles

(ABTB) can be used as an autogenous biomaterial for

socket treatment and new bone regeneration

(Cardaropoli et al., 2019).

The advantage of using ABTB as a bone graft

material is because of its similarity to human bones

and the use of this autograft source has been tried by

many researchers around the world. Similarities

between bones and teeth show a similar biochemical

composition consisting mainly of organic and

inorganic. Alveolar bone consists of 65% inorganic

and 35% organic with a percentage comparable to

dentin (inorganic 65-70% and organic 30-35%) and

cementum (inorganic 45-50% and organic 50-55%)

(Kim et al., 2013).

Dentin and cementum have collagen type I,

collagen type III and several growth factors including

bone morphogenic protein (BMP), growth factors

such as insulin-II (IGF-II), and growth factor-β (TGF)

-β) as the role major in bone remodeling. The

majority of proteins found such as osteopontin

(OPN), osteocalcin (OC), sialoprotein (BSP), osterix,

collagen type I, and Cbfa1 (Runx2) are also found in

dentin, which can be used for materials used for bone

material available (Khanijou et al., 2019). Previous

studies by Kim et al. performed to compare the

traditional implantation materials and autogenous

teeth which showed using XRD the crystal structure

of autogenous teeth had a pattern similar to the

autogenous bone. SEM tests have also proven that

after the use of autogenous teeth, dentine tubules and

solid collagen matrix are mostly homogeneous and

well-formed (Kim et al., 2014). Previous studies have

shown that material converted into bone grafting

material is quite efficient requiring a long process

because of wasting time in demineralization

technique (Um et al., 2017). Many dentists and

researchers around the world who use this ABTB

material because it only becomes dental fuel have

been used as an affordable autogenous alternative as

several commercially available graft materials.

Some deficiencies in the use of Autogenous

Tooth Bone Graft Block (ABTB) are deficiencies in

its form ingredients (Khanijou et al., 2019). Another

disadvantage is that the indications are limited and

also related to the manufacturing process which is

quite complicated and more wasting time.

Several

studies have begun to find various alternative sources

such as allograft teeth, but the risk of disease

development cannot be ignored so the use of autograft

is more recommended (Khanijou et al., 2019).

5 CONCLUSIONS

The success of implant treatment is reviewed based

on the ability of the graft material to integrate well in

the surrounding environment. The use of Autogenous

Tooth Bone Graft Block (ABTB) has the potential as

an autograft biomaterial material in the treatment of

post-extraction sockets and bone regeneration

processes. Artificial dentin material derived from

extracted teeth is successfully used for bone

regeneration and the gradual placement of the

osseointegration implant. The ideal bone graft

material must have the potential to keep cells alive,

not cause an immunological reaction, be easily

obtained and provide strength to the area around the

bone and not spread disease. Future technological

advances make the use of ABTB recommended as an

effective bone graft material that can be more easily

accessed and successfully developed further.

ACKNOWLEDGEMENTS

Our sincere gratitude and appreciation to the head of

College of Dental Medicine and Dean of Faculty of

Medicine UNSOED for the opportunity given in the

preparation of this manuscript. We also express our

gratitude to the UPIPM FK UNSOED unit which

provided support for this activity and LPPM

JIMC 2020 - 1’s t Jenderal Soedirman International Medical Conference (JIMC) in conjunction with the Annual Scientiﬁc Meeting

(Temilnas) Consortium of Biomedical Science Indonesia (KIBI )

146

UNSOED who had helped in drafting the script. Our

gratitude also goes to the DRPM of the Ministry of

Research and Technology / the National Innovation

Research Agency (KEMENRISTEK BRIN) for

supporting the preparation of this manuscript.

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