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Smart Grinder: Extracted Teeth as Autologous Transplants

With the Smart Grinder technique, Prof. Itzhak Binderman from Tel Aviv University, an international authority in the field of bone regeneration, has developed a concept in which the patient's own extracted teeth serve as autologous bone substitute material, preserving the alveolar bone similar to natural bone.

How did the idea of using a tooth as augmentation material come about?

The idea is not new. Dentists have been reimplanting and transplanting teeth for a long time, with evidence dating back to ancient Egypt. Before the advent of dental implants, such procedures were common. As augmentation material using the patient's own tooth, we have seen cases dating back to the 1930s, where teeth were crushed or shaped and used to fill alveolar defects. The composition of teeth and bone is remarkably similar. The fact that tooth material behaves like compact autologous bone, containing collagen and growth factors, and is known to integrate well with bone, makes it an optimal bioactive biomaterial. Autologous tooth graft regenerates osteoinductively, even in complex patient cases, resulting in a significant amount of newly formed bone. It is a slow-resorbing material that initially converts into newly formed bone and later into native lamellar bone, making it the ultimate framework.

Extracted teeth are often not healthy teeth. Does this not affect the material?

You are correct. We extract teeth for specific reasons, such as wisdom teeth, periodontally compromised teeth, and treated teeth. In Germany alone, there are more than 10 million extractions per year. Often, the extracted tooth may be abscessed, fractured, or decayed. However, these are topical infections that do not penetrate the tooth material itself. The protocol we use is highly effective in removing foreign bodies, bacteria, or infections. The process of converting these extracted teeth into bone grafts is as follows: First, the outer surface of the tooth is mechanically cleaned using a cooled high-speed milling tool. We ensure the removal of any restorative material, soft tissue, and caries. The tooth is then dried and placed in the grinding chamber. Within three seconds, the tooth is pulverized, and the resulting particles are sorted into two sizes and separated into two containers. They are then treated with a tooth material cleaning solution for five minutes, removing all organic substances, including caries, bacteria, and viruses. The dentin cleanser is suctioned using a sterile gauze. We then apply the dentin wash, which rinses out the dentin cleanser and lowers the pH of the particles to a biological pH of 7.2. The dentin wash is also absorbed using a sterile gauze. The entire process should not take longer than seven to eight minutes. At the end of the process, the tooth material particles can be used immediately or stored for later use. Our website features wonderful videos that demonstrate the described process. It is simple and can be performed entirely by dental assistants.

What are the advantages compared to other allograft or xenograft materials?

There are many advantages compared to other transplantation options. We use the patient's own tissue, avoiding the need to harvest bone from a secondary site as in autologous bone grafts. Autologous tissue is the gold standard for transplants because it is immediately recognized as such by the body, resulting in a faster and more predictable healing process. Autologous mineralized tooth material preserves the immunomodulators of bone formation, whereas bones or tooth materials from other individuals undergo chemical and thermal treatments that inactivate their biological organic matrix, rendering them only biocompatible scaffolds. Xenotransplants, bones, and teeth from animals, undergo even more extreme treatments. Thus, only the patient's own extracted teeth are truly bioactive. Mineralized tooth material naturally contains active growth factors such as BMP, which are slowly released during remodeling, stimulating local cells to become bone cells. In fact, all organic molecules retain their native biological activity, attracting precursor cells that accelerate osteoblastic activity. Tooth material is osteoinductive and promotes bone regeneration on its surface. This unique property provides the material with a significant advantage. Tooth material is a hard substance and therefore slowly resorbed and eventually converted. This is crucial, as slow resorption of the scaffold is important for providing sufficient support to newly formed bone, allowing it to become lamellar bone that can fill the defect morphology in the long term. Other advantages include ankylosis and inherent growth factors contributing to bone formation, healing, and stability. There is also the advantage of cost savings, as we use the patient's own tooth as biomaterial. It is increasingly common for patients to inquire about the materials used in their cases. Patients respond very positively to the idea of using their own extracted tooth for bone augmentation, as they immediately grasp the advantages of this approach.

Are there sufficient study results on the use of the Smart Grinder?

We are fortunate that many research centers worldwide have conducted studies using autologous tooth material and specifically our protocol. To date, I can refer to over 200 publications on the use of autologous tooth material for bone regeneration. The studies that utilize our protocol show remarkable and consistent results. Since 2015, most investigations have been conducted on human patients with 6, 12, and 18 months of follow-up. The quality and longevity of the bone over time are excellent. Additionally, many studies have measured additional factors such as implant stability.

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