Immediate Dentoalveolar Restoration Technique (IDR). Autograft characterization and a case report

Case report We present a case of implant rehabilitation using the immediate dentoalveolar restoration (IDR) technique where the bone walls are reconstructed by a bone graft harvested from the maxillary tuberosity. In addition, we performed cellular and molecular evaluations of osteoblastic cells harvested from maxillary tuberosity as: cell proliferation, alkaline phosphatase activity, extracellular matrix mineralization and gene expression of osteoblastic markers. Three maxillary tuberosities were reconstructed using microtomography and qualitative-quantitative analyses were performed. Clinical and tomographic evidences showed that IDR is a feasible technique that allows in only one session the full reconstruction of alveolar socket, placement of dental implant and provisionalization. Cell proliferation increased over time and cell displayed alkaline phosphatase (ALP) activity, extracellular mineralized matrix and gene expression of all evaluated bone markers (ALP, RUNX2, bone sialoprotein, osteopontin, osteocalcin and distal-less homeobox 5), ratifying the osteogenic potential of the tuberosity cells. Micro-CT analysis showed the maxillary tuberosity as a highly porous structure surrounded by a thin cortical that resembles a mechanical barrier. These cellular, molecular and tomographic features indicate that the maxillary tuberosity is a source of osteoblastic cells and acts as a natural scaffold, supporting the excellent functional and aesthetic results of IDR technique.