Biologic Therapy for Dental Treatments and Bone Grafting

1. Patient Selection Criteria

Ideal Candidates:

• Patients undergoing tooth extractions who require enhanced healing or preservation of bone and tissue structure.
• Individuals with periodontal defects or bone loss in need of regenerative support.
• Those undergoing dental implants or bone grafting procedures seeking improved outcomes.

Contraindications:

• Active oral infections or abscesses.
• Severe periodontal disease requiring extensive surgical intervention.
• Patients with systemic conditions contraindicating regenerative therapies, such as uncontrolled diabetes or severe autoimmune disorders.

2. Preparation

Clinic Preparation:

• Ensure a sterile environment with disinfected dental instruments and surfaces.
• Required equipment includes biologic product vials, sterile syringes, dental plugs (preloaded with ECM), bone graft material, and antiseptic solutions.

Patient Preparation:

• Informed Consent: Educate the patient about the procedure, expected benefits, and risks. Address any questions and set realistic expectations.
• Anesthesia Options: Apply local anesthetic (e.g., lidocaine) to the treatment area to minimize discomfort.
• Oral Preparation: Thoroughly rinse the oral cavity with an antiseptic solution (e.g., chlorhexidine) to reduce infection risk.

3. Dosage and Administration

Product:

• Extracellular Matrix: Designed for insertion into extraction sockets or periodontal defects to promote healing and tissue integration.
• Exosomes: Injectable biologics to support tissue repair and reduce inflammation in soft and hard tissues.

Dental Plugs in Extraction Sites:

• Tooth Extraction Sites: Insert ECM-loaded dental plugs directly into the extraction socket to promote healing and bone preservation. Apply gentle pressure to ensure the plug fits securely within the cavity.

Periodontal Defects:

• Option A: Injectable Biologics (e.g., Exosomes):
• Draw 0.1–0.2 mL of biologic solution per pocket into a sterile syringe with a 30-gauge needle.
• Use additional biologic material for larger or multiple pockets.
• Gently inject biologics into the periodontal pocket, ensuring delivery to the base of the pocket near the bone.
• Use a slow, controlled injection to avoid discomfort or leakage.
• Option B: Biologic-Enhanced Membranes or Gel:
• Mix biologics (e.g., ECM solution) with a resorbable collagen membrane or gel to enhance regeneration.
• Insert the biologic-enhanced membrane into the pocket to fill the defect.
• Secure with sutures if necessary to stabilize the material.
• Option C: Combination Treatment:
• Combine biologic injections into the pocket with the placement of biologic-enhanced membranes or bone graft material.
• Apply biologics into pockets or defects caused by periodontal disease to stimulate gum and bone regeneration.
• Secure the biologic material with sutures if necessary.

Bone Grafting and Implant Uses of Biologics:

• Injections Around the Bone Graft Site:
• Inject biologics such as exosomes or ECM solution into the periosteum (connective tissue surrounding the bone) or adjacent soft tissue.
• Typical volume: 0.5–1 mL per site, delivered using a 27–30 gauge needle at a depth of 1–3 mm.
• Distribute injections evenly around the graft area to enhance cellular communication and healing.
• Mixing Biologics with Bone Graft Material:
• Combine 1–2 mL of biologics with graft material (autograft, allograft, or synthetic).
• Mix thoroughly to ensure even distribution of biologics within the graft.
• Place the biologic-enhanced graft into the defect or void, packing it firmly but gently.
• Direct Application to the Surgical Site:
• Apply 1–2 mL of biologics directly to the bone graft or implant site to promote osseointegration.
• Cover with a resorbable membrane to stabilize the biologics and graft material.

4. Post-Treatment Care

• Advise patients to avoid eating or drinking for 2 hours post-treatment to allow proper integration of the biologic material.
• Refrain from using straws or performing vigorous rinsing for 24–48 hours to prevent dislodging the material.
• Mild swelling or tenderness at the site is normal and should subside within a few days.
• Recommend acetaminophen for pain relief; avoid NSAIDs to support the inflammatory phase of healing.
• Schedule a follow-up appointment within 1–2 weeks to assess the healing progress and integration of the biologic material.

5. Safety Precautions

• Observe the patient immediately post-procedure to ensure no adverse reactions, such as significant bleeding or infection.
• Keep emergency supplies, including epinephrine and antihistamines, on hand for rare allergic reactions.
• Maintain strict aseptic techniques throughout the procedure to minimize infection risks.

6. Follow-Up and Monitoring

• In the initial follow-up visit, assess the site for signs of healing, such as reduced inflammation and stable tissue integration.
• Document any adverse effects or signs of infection and address them promptly.
• For optimal results, encourage regular dental check-ups to monitor bone and tissue health, particularly for implant or graft sites.

Summary

Biologic therapy provides significant advancements in dental and bone grafting treatments. Whether applied as dental plugs for extraction sites or integrated into bone graft procedures, biologics can enhance tissue regeneration, reduce inflammation, and improve long-term outcomes. Following a structured protocol ensures safe, effective, and patient-centered care, promoting better oral health and functionality.