**10.2 Surgical procedure 1**

X-ray photos were taken before surgery. Non-vital teeth with lesion (#14, 15, 34) were extracted, and the debris and foreign body were removed carefully. Two teeth were prepared for root-type DDM (**Figure 5b**). The roots were perforated by a round bur, using the medical device (FIX®, Tokyo Iken Co., Ltd), and demineralized in 2% HNO3 solution for 30 min. The other was crushed with saline ice by an electric mill

#### **Figure 5.**

*Case: 63-year-old woman, lateral augmentation (#35 and 36 regions) by DDM. (a) Initial X-ray view; (b) DDM materials (roots, granules); (c) immediate DDM graft; note, lateral augmentation; (d) view after placement of fixtures.* 

*Dentin Materials as Biological Scaffolds for Tissue Engineering DOI: http://dx.doi.org/10.5772/intechopen.85452* 

#### **Figure 6.**

*X-ray CT before and after augmentation by DDM in 63-year-old woman. (a) Initial X-ray CT (#35, 36 region); note, ridge of atrophic bone; (b) 3 months after DDM graft; note, DDM combined with original bone.* 

(Osteo-Mill®, Tokyo Iken Co., Ltd) at 12,000 rpm for 30 s (Japan Patent: 4,953,276; USA Patent: 8,752,777). Next, the crushed tooth granules were decalcified in 2% HNO3 for 20 min [55]. Two types of DDM were rinsed in cold distilled water. Perforations were performed into the atrophic bone (#35, 36) [43, 56]. DDM scaffolds were grafted for lateral augmentation (**Figure 5c**), covered by collagen membrane, and immediate implant placement (∅3.7 mm) was done into #34 socket under intravenous sedation.

#### **10.3 Surgical procedure 2**

X-ray CT was taken at 3 months after DDM graft. DDM residues did not get out during the drilling, and two fixtures (∅3.7 mm) were implanted into the augmented bone (#35, 36)(**Figure 5d**).

#### **10.4 Results and discussion**

 The CT images at 3 months showed remarkable lateral augmentation, compared with that of preoperation (**Figure 6**). Non-vital teeth-derived DDM scaffolds were received to host, and two fixtures (∅3.7 mm) were placed into the DDM-augmented bone. Partially demineralized dentin matrix from non-vital tooth is acellular composite of collagen and hydroxyapatite without BMP activity. As original bone contains BMP activity, bone managements such as ultrasonic scaler treatment and perforations into cortical bone must be essential.

This patient was successfully restored with her own teeth and implant surgery. This case was a unique DDM onlay graft, combined with two types of DDM (roots, granules) for lateral bone augmentation in 2015.

#### **11. Conclusion**

Vital- or non-vital tooth-derived DDM can be recycled as natural scaffolds for local bone engineering. DDM graft is a matrix-based therapy without cells. Doctors can use patient's own teeth as bone graft materials. Biomaterial science should

support and develop the advanced regenerative therapy using tooth-derived materials for patients in the near future.
