Assessment of changes in the outcome of autogenous tooth grafts over time. A clinical study evaluating periodontal healing in bone defects after lower third molar removal.

Background The removal of impacted lower third molars (ILTM) is associated with bone defects in the distal area of second molars. Different methods have been described to minimize these defects. Purpose The primary objective was to assess changes in probing depth (PD) over time (up to 36 months) between test (grafted) and control (ungrafted) groups; the graft was obtained from the extracted ILTM. Study design, setting, sample This split-mouth randomized clinical trial was conducted at the Postgraduate Course in Oral Surgery of the Faculty of Dentistry of the Complutense University of Madrid. Adult patients requiring bilateral ILTM extraction with adjacent second molars were recruited, excluding pregnant/lactating women, patients in treatment with nonsteroidal anti-inflammatory drugs and patients with periodontal diseases. Predictor/exposure/independent variable The predictor variable was the graft technique. The bone defect after ILTM removal was treated with autogenous tooth graft (ATG) in the test group, leaving the control group ungrafted. Main outcome variable PD on the distobuccal, distomedial and distolingual surfaces was recorded in both groups and averaged at baseline (T0), 3 (T1), 6 (T2) and 36 months (T3) postoperatively. Covariates Sex, age, surgical time, ILTM situation and position between groups were assessed. Analyses ANOVA repeated measures for comparisons between groups and the Friedman test for comparisons within the groups over time were applied. Statistical significance was established with a confidence interval (CI) of 95% (p<0.05). Results The sample comprised 22 patients (6 males, 16 females) with a mean age of 21.68±2.19 years; 44 ILTM extractions were performed. Statistically significant differences in PD average were found between groups (p<0.001, 95% CI) at 3 (1.63 ± 0.29), 6 (1.76 ± 0.3) and 36 months (1.74 ± 0.36). Reductions from T0 to T3 of 2.74±0.28 (p<0.001) and 0.54 ± 0.3 (p=0.43) were observed in test and control groups, respectively. Conclusions and relevance ATG placed on the distal surface of lower second molars and almost completely filling the extraction socket improved PD 3, 6 and 36 months after ILTM. Furthermore, no significant changes in PD were observed over time; no major complications occurred. ATG appears to be a viable alternative graft material for this procedure.