4. Discussion
periodontium, Tooth, tooth
PROLIFERATION, INFLAMMATORY RESPONSE
Tooth extraction triggers a series of biological reactions influenced by both the local inflammatory response that occurs after the surgery and the lack of masticatory stimulation on the periodontium. This leads to a disruption of the homeostasis and structure of the periodontal tissues. The extraction socket healing process begins with oral tissues' reorganization, followed by the proliferation and maturation of these tissues; this healing process ends with dimensional changes to the alveolar bone and gingival tissues [Following tooth extraction, the hard and soft tissues under dimensional change can significantly influence the esthetic and functional outcomes of the implant-supported prostheses, especially in the anterior maxillary area [Based on the systematic review findings, the ADB can be an alternative, cost-effective, and sustainable biomaterial for alveolar ridge preservation [Different graft materials are currently available for alveolar ridge preservation. However, ADB can eliminate the inherent risks associated with these materials, like heterogeneity, immunogenicity, and cross-infection, that may be associated with allografts and xenografts [This study proved the effectiveness of using ADB powder during ARP procedures. Clinical, tomographical, and histological data demonstrate favorable postextraction socket preservation utilizing an autogenous dentin grafting material.This study indicated that there was a significant increase in facial soft tissue thickness at 2 mm and 5 mm after 4 months compared to baseline (On a molecular level, eight weeks after tooth extraction, the soft tissue thickening is associated with increased endothelial cell density, bone morphogenetic protein-7, and osteocalcin expression [Despite multiple methods for measuring the alveolar ridge dimensions [The KometaBio device grinds, disinfects, and prepares extracted teeth to obtain ADB ready-to-use. ADB acts as a resorbable scaffold and space-maintaining device to facilitate healing in ARP procedures. This study showed that after 4 months of using ADB for ARP, ridge width was significantly decreased at 2 and 5 mm compared to baseline records, with a nonsignificant reduction in the buccal and palatal heights compared to the baseline records.These unavoidable changes in the alveolar bone dimensions occur primarily within the first two weeks of the healing process. Despite efforts, postextraction ridge resorption can only partially be prevented, as the literature states [In a meta-analysis assessing dimensional changes of alveolar sockets after tooth extraction without preservation, mean horizontal bone resorption of 3.87 mm was reported, along with mean buccal and lingual losses of 1.67 mm and 2.03 mm, respectively [However, the current study showed that ADB achieved statistically significant, much fewer dimensional changes in the alveolar bone dimensions (horizontal and vertical) than the control group. These results aligned with a meta-analysis that stated an alveolar ridge dimension decrease of 3.79 ± 0.23 mm horizontally and a reduction of 1.24 ± 0.11 mm on the buccal side six months after extraction [Bone histomorphometry remains the only method to analyze bone at the tissue and cell levels despite the development of noninvasive approaches [The histomorphometric analysis further revealed higher quantities of newly formed bone trabeculae and fewer graft remnants of ADB. The histomorphometric analysis reveals the following findings in core biopsy; the average amount of newly formed bone was significantly higher. Surface area of trabeculae bone in the study is compared to the control group, and there was a significantly lower surface area of bone marrow in the study compared to the control group. These results of the histological analysis were superior when compared with literature using different preservation procedures, with only restricted graft remodeling in newly formed hard tissues several months after ARP [Barone et al. utilized a combination corticocancellous porcine bone and collagen membrane for alveolar ridge preservation. After seven months, core biopsies showed that the connective tissue comprised about 36.6% of the specimen, with only 35,5% of the newly formed bone and 29.2% of the remaining graft materials [These findings suggest a faster and more efficient turnover of ADB graft particles in this study compared to literature reports on xenogeneic materials utilized in ARP.Histomorphometric analysis of this study proved that ADB has the ability to be osteoinductive and osteoconductive, with graft particles rapidly turning. Compared with other biomaterials, this novel graft material ADB is less costly [