Comparable efficacy of autogenous tooth-derived grafts and xenografts in post-extraction osseous defects: a split-mouth randomized trial

Abstract

Objective: To evaluate the efficacy of autogenous tooth substitute graft (ATSG) prepared from autogenous third molars compared to xenograft in reducing osseous defects at the distal aspect of the second molars after impacted mandibular third molars removal. Materials and methods: A randomized, double-blind, split-mouth clinical trial was conducted with 14 patients (aged 20–30 years) with bilateral mesioangular or horizontal impacted mandibular third molars. Following extraction, one socket received autogenous tooth-derived graft material (experimental site) prepared using a dentine grinder while the contralateral socket received xenogenic bone substitute (control site). Clinical parameters (probing depth, mobility, pain score, healing) and radiographic outcomes (mean gray value, fractal dimension, bone integration, dimensional changes) were evaluated pre-operatively and at 2 weeks, 3 months, and 6 months post-operation. Results: Both groups showed similar clinical outcomes with no statistically significant differences in probing depth, mobility, pain scores, or healing. Radiographically, the mean gray value decreased by 4.62% in the autogenous group and 2.19% in the xenogeneic group at 6 months, though the differences were not statistically significant. Notably, by 6 months, total bone integration was observed in 64.29% of autogenous grafting sites compared to 57.14% of xenogeneic grafting sites. Fractal dimension analysis further suggested distinctive trabecular patterns between the two materials. Both materials demonstrated excellent biocompatibility with comparable dimensional stability; no significant differences were found in vertical or horizontal dimensional changes between the groups. Conclusions: Autogenous tooth-derived bone substitute demonstrates comparable clinical and radiographic outcomes to xenograft when used for alveolar ridge preservation following mandibular third molar extraction, suggesting it may be a viable alternative to conventional xenografts. Clinical relevance: ATSG offers a chairside-prepared autogenous grafting option that can be completely produced in under twenty minutes, eliminating the costly and time-consuming laboratory processing needed for other materials while maintaining comparable clinical efficacy to the commercial xenografts.