Utilization of Demineralized Bone Matrix to Restore Missing Buccal Bone During Single Implant Placement: Clinical Report.

B ucco-lingual width is commonly a limitation when considering implant placement. Bone and soft tissue regeneration is often indicated to provide sufficient bucco-lingual width for the placement of dental implants. Simultaneous implant placement and bone grafting can be difficult due to availability of graft materials and whether primary closure is obtainable. When considering simultaneous implant placement and buccal bone augmentation, a bucco-lingual bone width of 3 mm or more remaining is required to have sufficient bone support to provide primary stability for the implant. Several techniques enable one to achieve this. For instance, a type of alveolar ridge augmentation, ridge splitting, is a viable procedure especially in the case of a long-span edentulous ridge. However, in the case of single tooth implant when there are adjacent teeth on each side of the implant site, ridge splitting can compromise the periodontal health of the adjacent teeth. Buccal bone grafting with single implant placement will be a more effective technique. Numerous types of grafting materials can be used to graft the buccal area of the implant. The ideal material would have properties similar to the patient’s bone. Autograph, a graft from the same patient, is considered a gold standard. However, it requires a donor site surgery, which is not always available or acceptable for the patient. Without autograft, commercially available bone grafting materials including xenograft, allograft, and synthetic materials can be used. A xenograft, a graft form of another species, could, in theory, eliminate transmission of human diseases. However, concerns have been raised on the process of elimination of animal-born disease agents such as prions. The major problem with the use of xenograft is antigenicity, as the body will recognize it as a foreign body. Many commercially available xenografts have often gone through heat treatments and or chemical processes that eliminate all organic materials and leave only inorganic materials behind. Depending on the graft preparation and treatments, xenograft materials range from scaffold osseous-like structure to glass-like materials. Xenografts retain only osteoconductive properties, not osteoinductive ones. An allograft, a graft from a human donor, is biocompatible and there are little to no problems with labeling the graft as a foreign body since it is from the same species. However, some major problems with the use of allografts are worries about infectious transmission, immune response problems, and there is a need to reduce antigenicity so that the patient does not reject the graft. At the same time, allografts have a potential of maintaining human biological factors allowing both osteoconduction and osteoinduction. Puros demineralized bone matrix (Puros DBM) is a type of allograft that maintains osteoinductive as well as osteoconductive properties, allowing the regeneration of bone. Puros DBM is easy to handle and contains scaffolding elements such as collagenous and noncollagenous proteins. Puros DBM is composed of 100% human DBM, active DBM (noncollagenous proteins), carrier DBM (collagenous protein matrix), cortico-cancellous bone (in some variations), and water. Puros DBM is made through several steps: screening, testing, and processing. First, the donor and all closebiological living relatives are screened and tested for potential hazards of infectious transmission of human immunodeficiency virus, hepatitis C virus, syphilis, and so on. The achieved bone is then ground down and demineralized into the resulting DBM powder. Stage 1 includes a 28-day rat assay that tests the osteoinductive potential of the DBM powder before it is mixed with the DBM carrier, sterile water, and cortico-cancellous chips. Stage 2 consists of a proprietary process to make the DBM Carrier, which allows easier handling and forming into the surgical site. Puros DBM has been shown to provide a successful delivery and containment at the surgical site. Here, we present the technique where we placed a single endosseous implant with simultaneous buccal bone grafting using allograft demineralized bone matrix to regenerate part of the buccal alveolar bone. Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC. Department of General Practice, School of Dentistry; and Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Va. * Corresponding author, e-mail: sbencharit@vcu.edu DOI: 10.1563/aaid-joi-D-16-00054