A purposive sampling method was employed to select ten patients who met the criteria for bilateral tooth extraction. Among these patients, one side served as the control group, undergoing no further intervention, while the contralateral side received an autogenous dental graft, constituting the experimental group. Additionally, an eleventh patient underwent a similar procedure, with one side filled with an autogenous dental graft and the other side augmented with an allogeneic dental graft obtained from the patient’s son. It is noteworthy that the patient’s son consented to the procedure after undergoing appropriate medical assessments to confirm their health status, coinciding with the father’s extraction appointment. All patients included in the study were non-smokers and abstained from alcohol consumption. Moreover, post-extraction examination revealed intact alveolar walls without any signs of inflammation. The study protocol received written approval, and all scheduled follow-up appointments were diligently attended, with follow-up assessments conducted over a period of four months. Table 1 provides an overview of the demographic characteristics of the research sample.

Data analysis was conducted utilizing R-4.4.1 software. The normal distribution of the data was verified using the Kolmogorov-Smirnov test, which indicated that all datasets adhered to a normal distribution (P > 0.05). Subsequently, the independent sample t-test was employed for further analysis.

The preparation of the autogenous tooth graft in vitro necessitated the utilization of the following items: 1.

Plastic canisters for the preservation of the extracted tooth, along with filter papers, distilled water, and a standard solution of hydrochloric acid.

Moreover, alongside anesthetic and extraction tools, Figure 1 depicts an image of the tooth grinder.

In this section, we delineate the protocol for preparing a tooth graft, the surgical procedure, and the radiographic examination. It is pertinent to note that our methodology adheres to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. ²⁹ This clinical trial is registered with the Brazilian Clinical Trials Registry (ReBEC) under the registration number RBR-65qchvs, Date: 28-05-2024. Detailed information regarding the clinical trial registration, including interventions, inclusion, and exclusion criteria, will be presented. The study in question was part of a larger, ongoing research initiative.

Initially, we aimed to gather preliminary data to better understand the scope and feasibility of the study before officially registering the trial. This preliminary phase was crucial to ensure that we were designing the study in the most effective way possible, taking into account any unforeseen challenges or necessary adjustments.

Initially, my research focused on autologous tooth-derived graft material in post-extraction dental socket preservation. While this study might have seemed repetitive, the occurrence of an allogeneic situation during the study had a significant impact on its publication and registration. On one hand, I obtained approval from the University Research Council and registered the study there. I wouldn’t have considered publishing the study if it weren’t for the presence of the allogeneic situation, which made the study a novel topic. The allogeneic case encouraged me to register and publish the study.

This is a two-arm, Single-blind, randomized controlled clinical study. In the experimental group, 11 patients requiring bilateral dental extractions were enrolled. Ten patients received autologous grafting on one side while leaving the other side untreated, and in the case of patient 11, one side received autogenous grafting while the other side was augmented with an allogeneic graft. Outcomes were monitored over a period of 4 months.

Patients of both genders; Individuals aged 18 to 64 years; non-smokers; non-alcoholics; medically fit patients (no previous medical conditions such as heart, diabetes, hypertension, etc.); with indication of extraction of symmetrical teeth; integrity of dental sockets after extraction; patients who signed Informed Consent and attended follow-up sessions

Smokers; alcoholics; patients with infections in the gums or alveoli.

Following tooth extraction, meticulous care was taken to remove all soft tissues adhering to the tooth surface and any potential contaminants. In cases where molars exhibited decay, thorough excavation was performed, ensuring complete removal of carious lesions and any restorative materials present, including layers of enamel. Subsequently, the crown was meticulously separated from the root to facilitate grinding using a manual bone mill. The tooth specimen was then immersed in a plastic canister containing 70% alcohol and rinsed with distilled water prior to the grinding process. Subsequent to grinding, the resultant graft granules underwent immersion in a chloric acid solution for twenty minutes, followed by thorough rinsing with distilled water to eliminate any residual acid traces. Finally, the granules were filtered using filter paper to achieve a clean, purified tooth graft product.

Prior to the operation, the patient receives a single dose of amoxicillin and clavulanic acid (1g) along with preoperative gargling using chlorhexidine or povidone. Local anesthesia is administered to the tooth slated for extraction. Subsequently, the periodontal ligament surrounding the tooth is incised, and straight elevators are employed to ensure gentle loosening, thereby facilitating a non-traumatic extraction. The tooth is then carefully removed using forceps, concomitant with the elevation of a full-thickness flap and contouring of the periosteum.

In the control group (comprising 10 patients), the wound is left to heal spontaneously post-extraction. Conversely, in the experimental group (also 10 patients), periosteum contouring is conducted at the base of the socket, aiming to extend it towards the lingual gum while preserving the alveolar bone, aligning with the research goal of alveolar preservation. As the socket chip develops to a suitable size for graft coverage, blood is drawn from the patient and combined with the autogenous graft material in a sterilized metal container. This mixture is then utilized to fill the socket adequately.

Following the complete filling of the socket with the autogenous graft material, the flap is sutured using Prolene 3-0 threads to ensure wound closure and facilitate healing. Post-surgery, the patient receives a prescription along with appropriate instructions for aftercare.

In the case of the eleventh patient, the procedure performed in the experimental group is replicated on one side of the extraction, while the other side is treated similarly but with allogeneic dental grafts. Figure 2 illustrates one of the 10 clinical cases, while Figure 3 depicts the eleventh clinical case.

Cone beam computed tomography (CBCT) is employed to conduct radiographic evaluations for both study groups comprising all 11 patients, both pre-extraction and four months post-surgery. The assessments include: •

Measurement of changes in alveolar height by determining the difference from the apex of the alveolar bone to its base across three regions: the vestibular, middle, and lingual aspects of the alveolus. Subsequently, the vertical distance between the alveolar ridge summit and a reference line is measured, comparing it to the control side, and recorded in the patient’s records.

Evaluating changes in vestibular plate bone dimensions

The discussion regarding the outcomes of autogenous tooth grafts in altering bone dimensions within the vestibular plate revealed noteworthy findings. Specifically, a significant variance in mean bone loss within the vestibular plate was observed, with the contralateral side experiencing four times greater loss compared to the side treated with autogenous tooth grafts. This discovery aligns closely with the findings of del Canto-Díaz et al. (2019), ³⁰ whose study also advocated for vestibular plate preservation through the utilization of autogenous grafts post-extraction. Similarly, the results of Horowitz et al. (2012) ³¹ support our findings, emphasizing the beneficial impact of autogenous grafts. Furthermore, Han et al. (2021) ¹⁶ emphasized the advantages of grafting, noting increased alveolar ridge dimensions, which further corroborates the efficacy of autogenous grafts.

Moreover, our study revealed a mean osseous absorption rate of 0.60 mm, contrasting with the 0.82 mm reported by Pan et al. (2019). ³² These findings underscore the effectiveness of autogenous grafts in mitigating osseous absorption. Similarly, Lai et al. (2020) ³³ demonstrated that Xenografts also contribute to reducing post-extraction absorption rates, thereby echoing the results of our study.

Conversely, the research conducted by Kumar et al. (2021), ³⁴ utilizing a TCB synthetic graft, found no significant differences in vestibular plate absorption. This variance in outcomes could potentially be attributed to variations in graft types used.

In summary, our study, complemented by prior research, highlights the importance of autogenous grafts in preserving the vestibular plate, reducing osseous absorption, and facilitating post-extraction healing processes.

Assessing changes in lingual/palatal plate bone dimensions

Our study elucidates significant statistical disparities in mean alveolar bone loss between the group receiving autogenous dental grafts and the control cohort. Notably, the control group exhibited approximately threefold greater mean alveolar bone loss, underscoring the efficacy of autogenous tooth grafts in mitigating bone resorption. This observation closely parallels the findings of del Canto-Díaz et al. (2019), who noted a twofold reduction in alveolar bone resorption following autogenous tooth graft application on the vestibular-lingual plate. ³⁰

Additionally, our results align with Vignoletti et al.’s research (2012), ³⁵ which documented vertical alveolar absorption ranging from 0.3 to 3.75 mm and horizontal absorption spanning from 0.16 to 4.5 mm within the experimental group. These findings underscore the extent of bone absorption possible without alveolar preservation techniques. In contrast, Morjaria et al. (2014) observed vertical alveolar absorption on the palate ranging from 0.51 to 1.17 mm in the control group and 0.02 to 1 mm in the experimental group. ¹² These outcomes indicate that techniques such as autogenous tooth grafting significantly reduce bone absorption compared to controls, albeit not entirely eliminating it. Our study reinforces this concept, consistent with Pan et al.’s findings (2019), where lingual/palatal plate bone absorption reached 1.07 mm in their study, compared to 0.83 mm in ours. ³² These results imply that while autogenous tooth grafts contribute to preserving the alveolar ridge’s height and width in the lingual and palatal plates, some degree of bone absorption persists.

Finally, our study’s outcomes corroborate Han et al.’s investigation (2021) ¹⁶ regarding the role of autogenous tooth grafts in preserving alveolar ridge dimensions in the lingual/palatal plate. Together, these findings validate the effectiveness of autogenous tooth grafts in reducing alveolar bone loss and maintaining the integrity of the alveolar ridge.

Examining changes in vestibular-lingual dimension of bon

The outcomes of our study unveiled noteworthy discrepancies in average bone loss between the site of autogenous tooth graft application and its counterpart on the opposing side, particularly evident in the lingual-palatal dimension. Notably, bone loss on the non-grafted side was approximately twice as pronounced as that observed on the grafted side, a finding consistent with previous investigations conducted by Morjaria et al. (2014) ¹² and Joshi et al. (2016). ³⁶ Echoing the observations of del Canto-Díaz et al. (2019), ³⁰ our results underscore a significant reduction in osseous loss on the grafted side compared to the control group, specifically within the lingual-palatal dimension. Likewise, our findings align with the conclusions drawn by Han et al. (2021) ¹⁶ and Joshi et al. (2016), ³⁶ supporting the notion of diminished bone loss in regions subjected to grafting procedures. Additionally, Horváth et al. (2013) ³⁷ have demonstrated that while measures can be taken to mitigate bone absorption, achieving complete prevention may prove elusive.

Our investigation unveiled a striking 82.91% elevation in bone density at the autogenous tooth graft site compared to its counterpart, aligning closely with the observations of del Canto-Díaz et al. (2019). ³⁰ Furthermore, our findings echo the work of Jun et al. (2014) ²⁶ and Zhang (2022), ³⁸ demonstrating comparable bone density levels in regions treated with autogenous tooth grafts, thus accentuating its regenerative prowess. The research conducted by Minetti et al. (2020) ³⁹ further corroborates our results, affirming the graft’s capacity to foster viable bone growth.

Moreover, our study resonates with the conclusions drawn by Castro et al. (2021) ⁴⁰ and Taşdemir et al. (2020), ⁴¹ highlighting the efficacy of autogenous tooth grafts in preserving alveolar structure and promoting enhanced bone formation. Collectively, these investigations underscore the affirmative impact of autogenous tooth grafting on bone regeneration.

In summary, our study, in harmony with existing literature, firmly establishes the superiority of autogenous tooth grafts in terms of bone density enhancement, regenerative potential, and alveolar preservation. This reiterates the significant role of autogenous tooth grafting in the domain of oral, facial, and maxillofacial surgery.

Contrary to our initial expectations, the results of allogeneic grafting diverged from previous findings, which typically favored autografting. The researcher postulates that one significant factor contributing to this outcome is the close kinship between the donor and the recipient, coupled with the age of the donor, who was 17 years old at the time of the surgery. This finding aligns with the notion that instead of discarding extracted human teeth as biomedical waste, a common practice, they can be harvested from suitable, systemically healthy donors. Through processing in a tissue bank, these teeth can be transformed into allografts, offering a compelling alternative to conventional allografts. ²⁸ Furthermore, we posit that utilizing teeth from relatives of the patient may further enhance the efficacy of such grafts.

This study reaffirms the significance of employing autogenous tooth grafts for preserving alveolar ridge dimensions, as highlighted in the introduction. It underscores the necessity for comparative investigations against other grafting modalities discussed earlier. Moreover, the intriguing discovery concerning allogeneic grafts prompts consideration for broader studies involving larger cohorts to yield more comprehensive insights. However, it is acknowledged that recruiting donors with familial ties to patients poses inherent challenges, albeit imperative for advancing research in this domain.