Guided bone regeneration assisted by tooth roots with periodontal ligament: Case reports of immediate and staged approaches to implant therapy.

To potentially overcome current challenges in bone augmentation techniques and the limitations of bone graft materials, extracted tooth roots with periodontal ligament (TRPs) were strategically utilized to assist guided bone regeneration (GBR). This strategy sought to take advantage of the autologous and shapable nature of TRPs, along with their space-making and shielding ability, and the tissue conductivity/inductivity of the preserved periodontal ligament (PDL). The present article reports on three cases of TRP-assisted GBR as part of immediate and staged approaches to implant therapy. The first case involves immediate implant placement into the extraction socket of a maxillary central incisor, where a TRP veneer, shaped from the extracted central incisor, was used during simultaneous lateral augmentation. The second case describes a staged approach to lateral bone augmentation for a severe buccal bony defect at the maxillary lateral incisor site, where sectioned blocks/pieces of an extracted third molar TRP were used with other bone graft materials. The third case describes aggressive vertical and horizontal bone augmentation for staged implant placement, where an extracted third molar was sectioned and placed on the native alveolar bone as a buccal and lingual bracket, then filled with bone graft materials. All three cases received final restoration and were shown to be stable and functional at the 3-year follow-up. Osseointegration has been well maintained, and the transplanted TRPs seem to be integrated with the native or regenerated bone or remodeled and replaced by the native bone. Longer-term follow-up studies are required.