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Effectiveness of Two Differently Processed Bovine-Derived Xenografts for Alveolar Ridge Preservation with a Minimally Invasive Tooth Extraction Approach: A Feasibility Clinical Trial
Abstract
Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is an example of which is widely used and documented by many around the world. The present pilot clinical trial aimed at evaluating and comparing the clinical and morphological alterations of extraction sites after ARP, using two commercially available differently processed bovine bone grafts. Twenty adjacent extraction sites in ten patients were included. All sites received the exact same ARP therapy, except for the specific type of bovine bone graft which was randomly assigned between two adjacent extraction sockets in 10 patients (group A receiving Bio-Oss particles, and group B receiving Cerabone particles). The healing at all sites was monitored throughout the process at equal intervals, at time of surgery, 1 month, 2 months, 3 months and 4 months post operatively. All the augmented extraction sites successfully received implant therapy regardless of the type of bone graft material that was used for the ARP. And 6 weeks later, second stage/uncovery procedures were performed without complications. Inter-group comparisons of Crestal gingiva healing process (CGHP), Mean Transversal crestal ridge resorption (MTRR), and the Mean implant primary stability (MIPS) were in favor of site that were allocated to group A (treatment with Bio-Oss particles).
... (2) Ridge atrophy results from a substantial degree of physiologic remodeling that occurs in the alveolar socket following tooth extraction. (3) To minimize stress to the alveolus and accomplish minimal socket enlargement, atraumatic extraction must be carried out. Treatment options for ridge atrophy include several forms of bone and/or soft tissue augmentation; nevertheless, these methods are known to have varying degrees of success and predictability. ...
Background: Socket preservation is a pivotal procedure in modern dentistry, dedicated to the preservation of the alveolar ridge architecture after tooth extraction. The techniques vary from basic socket fillers such as blood clot preservation to more advanced techniques using barrier membranes and bone grafts such as autografts, allografts, xenografts, and synthetic materials. The aim of this study is to evaluate and compare the effectiveness of alveolar socket preservation with T-PRF (Titanium-Prepared Platelet-Rich Fibrin) and ADG (Autologous Dentin Graft) with T-PRF in socket preservation. This assessment will be carried out through comprehensive clinical, radiographic, and histomorphometric analysis. The objective is to determine the most efficient method for maintaining socket integrity after tooth extraction.
Method and Design: A total of 16 patients who match the specified criteria will be randomly assigned to one of two groups:(1) Socket preservation using DFDBA in combination with T-PRF and (2) Socket preservation performed using ADG with T-PRF. Following four months all the clinical variables will be assessed, a CBCT radiograph will be used to examine volumetric bone status, and biopsies will be analyzed histomorphometrically obtained during implant placement. Linear phenotypic dimensional changes will be assessed as secondary outcomes.
Discussion: The results obtained from this study will demonstrate if T-PRF along with ADG will lead to better radiographic bone fill and improved socket measurements compared to that of DFDBA with T-PRF. The results and patient-reported outcomes will be used to help choose the most effective type of therapy for socket preservation.
Trial registration: The registration number for this trial is CTRI/2024/05/068192.
... [46][47][48][49][50] Nevertheless, the debate regarding which graft material and/or membrane type would yield superior outcomes while causing fewer complications is ongoing. 51 Previously published systematic reviews on the use of titanium mesh in bone augmentation procedures focused mainly on complications, 52-57 but to the best of the present authors' knowledge, none have examined bone gain outcomes in a quantitative manner. As such, the present systematic review and meta-analysis aimed to analyse and report the outcomes of using titanium mesh in these procedures using the latest evidence available and compare this approach with GBR using collagen membranes. ...
Purpose:
To review and compare the available literature on bone regeneration using titanium mesh and map the current evidence on bone gain outcomes and complications while comparing this scaffold with collagen membranes.
Materials and methods:
A comprehensive electronic and manual search was performed to identify randomised and non-randomised prospective controlled clinical trials that involved the use of titanium mesh in at least one arm, with outcomes including complications and vertical and/or horizontal bone gain. The focused questions were defined as follows: What are the outcomes of using titanium mesh in ridge augmentation compared to other types of barrier membrane, and what is the complication rate (membrane exposure and infection) when titanium mesh is used in these procedures?
Results:
A total of 22 articles were included in the qualitative analysis. Overall, the studies that measured bone gain resulted in 3.36 mm vertical (196 subjects; 95% confidence interval 2.44 to 4.64 mm, range 1.4 to 5.7 mm) and 3.26 mm horizontal augmentation (81 subjects; 95% confidence interval 2.93 to 3.63 mm, range 2.6 to 3.7 mm), with variability among studies. The most commonly noted complication was mesh exposure, regardless of the type of mesh used, and the second most common was graft failure. The overall pooled complications rate reported in clinical trials was 10.8%. The meta-analysis comparing titanium mesh and collagen membranes, controlling for the type of bone regeneration (staged or simultaneous with implant placement), failed to show a significant difference in horizontal bone gain between the two techniques.
Conclusions:
Within the limitations of the present study and acknowledging the heterogeneity among the articles included, titanium mesh can serve as a feasible protective scaffold for bone regeneration with a relatively acceptable complication rate and in defects requiring around 4 mm 3D reconstruction. Data on patient-reported outcomes were scarce.
Conflict-of-interest statement:
None of the authors have any financial interests, either directly or indirectly, in the products or information mentioned in the present article.
... Successful implant therapy was achieved at all extraction sites, regardless of the BS. However, the Bio-Oss® group exhibited superior outcomes in terms of crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) [77]. In summary, the existing data do not suggest significant differences regarding the efficacy of different particulate bovine BS for ridge preservation. ...
Purpose
Particulate bovine bone substitutes (BS) are commonly used in oral regeneration. However, more literature is needed focusing on comparative analyses among various particulate bovine BS. This study evaluates pre-clinical and clinical data of different particulate bovine BS in oral regeneration.
Methods
A narrative review was conducted by screening the PubMed database Included in the review were pre-clinical and clinical studies until 2024 comparing a minimum of two distinct particulate bovine BS. In addition to examining general data concerning manufacturing and treatment processes, biological safety, physical and chemical characteristics, and graft resorption, particular emphasis was placed on assessing pre-clinical and clinical data related to ridge preservation, sinus floor elevation, peri-implant defects, and various forms of alveolar ridge augmentation utilizing particulate bovine BS.
Results
Various treatment temperatures ranging from 300 to 1,250 °C and the employment of chemical cleaning steps were identified for the manufacturing process of particulate bovine BS deemed to possess biosecurity. A notable heterogeneity was observed in the physical and chemical characteristics of particulate bovine BS, with minimal or negligible graft resorption. Variations were evident in particle and pore sizes and the porosity of particulate bovine BS. Pre-clinical assessments noted a marginal inclination towards favorable outcomes for particulate bovine BS subjected to higher treatment temperatures. However, clinical data are insufficient. No distinctions were observed regarding ridge preservation, while slight advantages were noted for high-temperature treated particulate bovine BS in sinus floor elevation.
Conclusions
Subtle variances in both pre-clinical and clinical outcomes were observed in across various particulate bovine BS. Due to inadequate data, numerous considerations related to diverse particulate bovine BS, including peri-implant defects, must be more conclusive. Additional clinical studies are imperative to address these knowledge gaps effectively.
Graphical abstract
Background
Three-dimensional (3D) alveolar ridge deficiencies necessitate horizontal and vertical bone reconstruction for optimal implant positioning. Despite several available techniques, achieving desired augmentation outcomes remains challenging. This case study aims to present a modified ridge split technique for bone reconstruction in both horizontal and vertical dimensions.
Methods and results
The proposed technique was used to reconstruct the horizontal and vertical ridge defect from removing a previously failed implant. This technique includes placing a cortical allograft plate as an internal tent in the split ridge. A portion of the plate was inserted into the ridge, while the other part was placed in the coronal of the vertical defect. Additional guided bone regeneration (GBR) was performed around the tented plate on both the buccal and lingual sides. After five months, cone beam computed tomography (CBCT) revealed sufficient bone formation in horizontal and vertical dimensions.
Conclusions
Within the limitations of the present case study, internal cortical tenting would be a reliable method for 3D bone reconstruction in cases where the ridge split is feasible.
Purpose:
To provide an up to date, contemporary and concise evidence-based review of peri-implant diseases and conditions and discuss the current therapeutic approaches to managing these diseases.
Materials and methods:
A literature review was conducted focusing on peri-implant health, peri-implant mucositis and peri-implantitis, as described according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions.
Results and conclusions:
Peri-implant health is described when there are no clinical signs of inflammation, and when no further bone loss after physiological remodelling or increase in probing depth can be observed. Peri-implant mucositis is a reversible inflammatory lesion that affects the soft tissues surrounding a dental implant in the absence of radiographic bone loss, whereas peri-implantitis is an irreversible pathological condition affecting the hard and soft tissues around an osseointegrated dental implant. Clinical diagnosis of peri-implant disease is in some ways similar to that of periodontitis, but their prevalence varies significantly due to many confounding variables. Different treatment modalities have been proposed and tested in the literature; as yet, however, no standard treatment protocol has been proven superior or completely effective. In future research, well-designed studies are required to assess treatment responses and evaluate additional approaches that may lead to improved outcomes. Conflict-of-interest statement: The authors do not have any financial interests, either direct or indirect, in the companies whose materials are mentioned in this study.
Implant-related esthetic demands have increased tremendously in recent years. The presence of shallow papillae or open interproximal spaces (black triangles) are some of the most troubling dilemmas in dentistry. Among the many factors associated with the presence of papilla or papilla height, the interproximal bone is one of the main factors dictating the presence of an adequate papilla between implants. The present case report describes a patient with severe hard and soft tissue deficiencies with a high smile line in the esthetic zone, requiring multiple implants. The step-by-step process of the utilized techniques for achieving inter-implant papilla reconstruction through a multidisciplinary approach using both hard and soft tissue augmentation procedures, as well as soft tissue conditioning with customized abutments, is delineated.
Objective
To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri‐implant referred to as the peri‐implant phenotype), in the context of peri‐implant esthetic complications.
Overview
The individual components of the peri‐implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri‐implant buccal bone) have been linked to different aspects of implant esthetics, as well as health‐related aspects. At the time of implant therapy, respecting the biology of the peri‐implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications.
Conclusions
While the current literature may not allow for a point‐by‐point evidence based‐recommendation for the required amount of each peri‐implant structure, bearing in mind the proposed values for the components of the peri‐implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications.
Clinical Significance
Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.
Aim: To analyze evidence pertaining to post-extraction dimensional changes of the alveolar ridge after unassisted socket healing.
Material and methods: The protocol of this PRISMA-compliant systematic review was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random effects meta-analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest.
Results: Twenty-eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non-molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed clinically in non-molar sites was 2.73mm (95% CI 2.36-3.11), 1.71mm (95% CI 1.30-2.12) and 1.44mm (95% CI 0.78-2.10), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in non-molar sites was 2.54mm (95% CI 1.97-3.11), 1.65mm (95% CI 0.42-2.88) and 0.87mm (95% CI 0.36-1.38), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in molar sites was 3.61mm (95% CI 3.24-3.98), 1.46mm (95% CI 0.73-2.20) and 1.20mm (95% CI 0.56-1.83), respectively.
Conclusion: A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.
Purpose:
To analyse and compare the dimensional changes of unassisted extraction sockets with alveolar ridge preservation (ARP) techniques and investigate any factors that impact the resorption of the alveolar bone.
Materials and methods:
A systematic search was conducted to identify randomised clinical trials (RCTs). All data were extracted, and a meta-analysis was performed for the changes in all buccolingual ridge width, midbuccal and midlingual ridge height, and mesial and distal ridge height, and horizontal width at reference points apical to the crestal area.
Results:
Based on 14 RCTs, the effectiveness of ARP in reducing the dimensions of the postextraction alveolar socket was confirmed. The clinical magnitude of this effect was 1.95 mm in the buccolingual ridge width, 1.62 mm in the midbuccal ridge height, and 1.26 mm on the midlingual ridge height. Additionally, 0.45 mm and 0.34 mm for mesial and distal ridge height, and 1.21 mm, and 0.76 mm for ridge width changes at points 3 and 5 mm apical to the crest were noted. Meta-regression analyses revealed that the reflection of flaps and primary wound coverage during ARP may have detrimental effects on bone remodelling, while no statistical significance was observed for any of the bone graft substitutes or the percentage of molar sockets.
Conclusions:
Regardless of the protocol, ARP can only minimise ridge resorption. ARP is most effective on horizontal ridge width, providing the most benefit coronally (approximating the crest), followed by the midbuccal ridge height.
Objectives: The purpose of the present review was to evaluate the effect of different bone substitutes used for alveolar ridge preservation on the post extraction dimensional changes.
Material and Methods: An electronic literature search in MEDLINE (PubMed), EMBASE (OVID) and Cochrane (CENTRAL) were performed, in addition to a manual search through all periodontics and implantology-related journals, up to December 2018. Inverse variance weighted means were calculated for all the treatment arms of the included trials for the quantitative analysis
Results: Forty randomized controlled trials were included in the quantitative analysis. The average amount of horizontal ridge resorption was 1.52 (SD 1.29) mm (allograft), 1.47 (SD 0.92) mm (xenograft), 2.31 (SD 1.19) mm (alloplast) and 3.1 (SD 1.07) mm for unassisted healing. Similarly, for all the evaluated parameters, the spontaneous healing of the socket led to higher bone loss rate than the use of a bone grafting material.
Conclusions: The utilization of a bone grafting material for alveolar ridge preservation reduces the resorption process occurring after tooth extraction. However, minimal differences in resorption rate were observed between allogeneic, xenogeneic and alloplastic grafting materials.
Introduction: The task of Group II was to review and update the existing data concerning extraction socket preservation with or without membranes and soft tissue influence on post-extraction alveolar ridge preservation; extraction socket preservation using different biomaterials as bone grafts, growth factors, and stem cells. Special interest was paid to the dental implant placement outcomes within grafted sockets.
Material and Methods: The main areas evaluated by this group were as follows: quantitative and qualitative assessment of the effect of different alveolar preservation techniques performed immediately after tooth extraction, with or without membranes and/or soft tissue grafting, and the use of different bone substitutes, stem cells or growth factors in the postextraction socket. Evaluation of the treatment outcomes of dental implants placed in the grafted sockets in terms of primary and secondary outcomes were assessed. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. TThe literature in the corresponding areas of interest was screened and reported following the PRISMA guidelines (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in the Preface chapter.
Results: The results and conclusions of the review process are presented in the respective papers. Three systematic reviews and one systematic review and meta-analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.
Aim:
The objective of this study was to histologically evaluate and compare vital bone formation, residual graft particles, and fraction of connective tissue (CT)/other tissues between 3 different time points at 2-month intervals after alveolar ridge preservation with a cancellous allograft and dense - polytetrafluoroethylene (d-PTFE) membrane.
Methods:
Ridge preservation with a cancellous allograft and d-PTFE membrane was performed at 49 extraction sockets (1 per patient). Volunteers were assigned to implant placement at three different time points of 2, 4, and 6 months, at which time core biopsies were obtained. Histomorphometric analysis were performed to determine the percentages of vital bone, residual graft particles, and connective tissue/other non-bone components, and subjected to statistical analyses.
Results:
There was a statistically significant difference in the amount of vital bone at every time point from 28.31% to 40.87% to 64.11% (at 2-, 4-, and 6-month groups, respectively) (p<0.05). The percentage of residual graft particles ranged from 44.57% to 36.16% to 14.86%, showing statistical significance between 4 to 6 months (21.29%, p<0.001), and 2 to 6 months (29.71%, p<0.001). While there were no significant differences for the amount of CT/other tissue among the different time points.
Conclusions:
This study provided the first histologic comparison of alveolar ridge preservation using a cancellous allograft and d-PTFE membrane at 3 different time points. Extraction sockets that healed for 6 months produced the highest amount of vital bone in combination with the least percentage of residual graft particles, while similar results were observed for the fraction of CT/other tissues between the 3 time points. This article is protected by copyright. All rights reserved.
Background:
The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations.
Methods:
Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool.
Results:
The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions.
Conclusions:
A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines.
Modifications of sintering temperature and treatment time of bovine‐derived bone grafts affect their physicochemical properties and further influence biological activity. Three different temperature sintered bovine‐derived bone grafts: group I (300 °C 3 h), group II (300 °C 3 h plus 530 °C 6 h), and group III (300 °C 3 h plus 1000 °C 2 h) and Bio‐Oss® were characterized and then compared in vitro for their effects on bone marrow stromal cells (BMSCs) migration, proliferation, and differentiation as estimated by cell migration assay, Alkaline phosphatase (ALP) activity assay, and Alizarin red staining. Further, the four bone grafts were implanted into the calvarial defects of rabbits to evaluate bone regeneration and graft degradation. The four deproteinized bovine‐derived bone grafts displayed different surface topography. Group II displayed the highest potential of attracting cells. Both groups I and II markedly promote BMSCs differentiation. After 6 and 12 weeks, defects grafted with groups I and II displayed a significant higher bone fraction than defects grafted with group III and Bio‐Oss®. Bone graft remnants remained in all four groups. Taken together, sintering at 300 °C for 3 h and sintering at 300 °C for 3 h with an addition of 530 °C for 6 h of bovine‐dervied bone grafts displayed potential use in bone regeneration. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019.
The purpose of this work was to evaluate the behavior of different membranes and bone filling materials used to fill critical defects in rabbit calvaria. Four defects were prepared in the cranial calvaria of female rabbits. They were randomly divided into three subgroups according to the type of barrier membrane to be used. Four animals carried cross-linked bovine collagen membranes (Mem-Lok, Bio-Horizons, Birmingham, AL, USA)), four human fascia lata membranes (Tissue, Inbiomed SA, Córdoba, Argentina) and four human chorioamniotic membranes (Tissue. Inbiomed SA, Córdoba, Argentina). The defects were filled with the deproteinized bovine bone particulate BioOss®(GeistlichPharma AG, Wolhusen, Switzerland), with particulate human hydroxyapatite MinerOss®(Bio-Horizons, Birmingham, AL, USA), with particulate dental material (Tissue Bank Foundation, Inbiomed S.A., Córdoba, Argentina), and the last one was left without the addition of filler material. In the first group of four specimens, a resorbable cross-linked bovine collagen membrane was placed over the skull and defects, without additional fixing. In the second group, a human fascia lata membrane was placed, without additional fixing. In the third group, a human chorioamniotic membrane was placed, without additional fixing. The animals were sacrificed at 4 and 8 weeks. The highest percentages of relative radiological density (average) were recorded considering the amnio-chorionic membranes (83.63%) followed by collagen (81.44%) and finally the fascia lata membranes (80.63%), but the differences were not statistically significant (p > 0.05). The sites grafted with a decellularized tooth (96.83%) and BioOss (88.42%), recorded the highest percentages of radiological density but did not differ significantly from each other (subset 2). The three membranes used did not show statistical differences between them, in any of the two time periods used. There were statistical differences between the filling materials evidencing the presence of a large quantity of calcified material in the defects treated with particulate tooth and deproteinized bovine bone and while smaller amounts of calcified material were registered in the case of defects treated with human hydroxyapatite and those that were not treated.
In this work, the physicochemical properties and in vitro bioactivity and cellular viability of two commercially available bovine bone blocks (allografts materials) with different fabrication processes (sintered and not) used for bone reconstruction were evaluated in order to study the effect of the microstructure in the in vitro behavior. Scanning electron microscopy, X-ray diffraction, Fourier transform infrared spectrometry, mechanical resistance of blocks, mercury porosimetry analysis, in vitro bioactivity, and cell viability and proliferation were performed to compare the characteristics of both allograft materials against a synthetic calcium phosphate block used as a negative control. The herein presented results revealed a very dense structure of the low-porosity bovine bone blocks, which conferred the materials’ high resistance. Moreover, relatively low gas, fluid intrusion, and cell adhesion were observed in both the tested materials. The structural characteristics and physicochemical properties of both ceramic blocks (sintered and not) were similar. Finally, the bioactivity, biodegradability, and also the viability and proliferation of the cells was directly related to the physicochemical properties of the scaffolds.
Purpose
The aim of this systematic review was to critically analyze the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient‐centered outcomes.
Material and Methods
A comprehensive search aimed at identifying pertinent literature for the purpose of this review was conducted by two independent examiners. Only randomized clinical trials (RCTs) that met the eligibility criteria were selected. Relevant data from these RCTs were collated into evidence tables. Endpoints of interest included clinical, radiographic, and patient‐reported outcome measures (PROMs). Interventions reported in the selected studies were clustered into ARP treatment modalities. All these different ARP modalities were compared to the control therapy (i.e. spontaneous socket healing) in each individual study after a 3‐ to 6‐month healing period. Random effects meta‐analyses were conducted if at least two studies within the same ARP treatment modality reported on the same outcome of interest.
Results
A combined database, grey literature and hand search identified 3,003 records of which 1,789 were screened after removal of duplicates. Following the application of the eligibility criteria, 25 articles for a total of 22 RCTs were included in the final selection, from which 9 different ARP treatment modalities were identified: 1. Bovine bone particles (BBP) + Socket sealing (SS), 2. Construct made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, 3. Cortico‐cancellous porcine bone particles (CPBP) + SS, 4. Allograft particles (AG) + SS, 5. Alloplastic material (AP) with or without SS, 6. Autologous blood‐derived products (ABDP), 7. Cell therapy (CTh), 8. Recombinant morphogenic protein‐2 (rh‐BMP2), and 9. SS alone. Quantitative analyses for different ARP modalities, all of which involved socket grafting with a bone substitute, were feasible for a subset of clinical and radiographic outcomes. The results of a pooled quantitative analysis revealed that ARP via socket grafting (ARP‐SG), as compared to tooth extraction alone, prevents horizontal (Mean = 1.99 mm; 95% CI 1.54 to 2.44; P < 0.00001), vertical mid‐buccal (Mean = 1.72 mm; 95% CI 0.96 to 2.48; P < 0.00001) and vertical mid‐lingual (Mean = 1.16 mm; 95% CI 0.81 to 1.52; P < 0.00001) bone resorption. Whether there is a superior ARP or SS approach could not be determined on the basis of the selected evidence. However, the application of particulate xenogenic or allogenic materials covered with an absorbable collagen membrane or a rapidly‐absorbable collagen sponge was associated with the most favorable outcomes in terms of horizontal ridge preservation. A specific quantitative analysis showed that sites presenting a buccal bone thickness > 1.0 mm exhibited more favorable ridge preservation outcomes (difference between ARP [AG+SS] and control = 3.2 mm), as compared to sites with a thinner buccal wall (difference between ARP [AG+SS] and control = 1.29 mm). The effect of other local and systemic factors could not be assessed as part of the quantitative analyses. PROMs were comparable between the experimental and the control group in two studies involving the use of ABDP. The effect of other ARP modalities on PROMs could not be investigated, as these outcomes were not reported in any other clinical trial included in this study.
Conclusion
ARP is an effective therapy to attenuate the dimensional reduction of the alveolar ridge that normally takes place after tooth extraction.
This article is protected by copyright. All rights reserved.
Objectives: The aim of present randomized controlled clinical trial was to clinically evaluate hard tissue changes after extraction socket preservation procedures compared to natural spontaneous healing.
Material and Methods: Thirty patients were enrolled in the present study and underwent single-tooth extraction in the premolar/molar areas. Ten sites were grafted with porcine-derived bone covered by collagen membrane, 10 covered by porcine-derived collagen membrane alone, and 10 underwent natural spontaneous healing. Vertical and horizontal bone changes after 3-month were evaluated at implant placement.
Results: The vertical and horizontal bone changes at the extraction sockets treated with collagen membrane alone (vertical: -0.55 [SD 0.11] mm, and horizontal: -1.21 [SD 0.69] mm) and collagen membrane plus porcine-derived bone (vertical: -0.37 [SD 0.7] mm, and horizontal: -0.91 [SD 0.53] mm) were found significantly lower (P < 0.001), when compared to non-grafted sockets (vertical: -2.09 [SD 0.19] mm, and horizontal: -3.96 [SD 0.87] mm).
In type 1 extraction sockets, in premolar sites, and in presence of vestibular bone thicknesses ≥ 1.5 mm, the use of collagen membrane alone revealed similar outcomes to those with additional graft material.
Conclusions: At the re-entry surgery, extraction sockets grafted with porcine-derived bone and covered by collagen membrane, and extraction sockets covered by porcine-derived collagen membrane alone, showed significantly lower vertical and horizontal bone changes, compared to extraction sockets sites underwent natural spontaneous healing. However, a complete prevention of remodelling is not achievable, irrespective of the technique used.
Objectives:
The aims of this randomized clinical trial were to compare the dimensional changes and the histological composition after using deproteinized bovine bone mineral (DBBM) or deproteinized bovine bone mineral with 10% collagen (DBBM-C) and a collagen membrane in ridge preservation procedures.
Material and methods:
Patients who required an extraction and a subsequent implant-supported rehabilitation at a non-molar site were recruited. After extraction, a cone beam computed tomography (CBCT) was performed and sites were randomly treated either with DBBM or DBBM-C plus a collagen membrane. At 5 months, before implant placement, a second CBCT was performed and a biopsy of the area was obtained. A blinded investigator superimposed the CBCTs and performed measurements to determine bone volume changes between the two time points. Additionally, a histomorphometric analysis of the biopsies was performed in a blinded manner.
Results:
Eleven sites belonged to the DBBM group and eleven to the DBBM-C group. All together, a significant reduction in height and width was observed at 5 months of healing, but no statistically significant differences were observed between the DBBM and the DBBM-C group. The histomorphometric analysis revealed a similar composition in terms of newly formed bone, connective tissue and residual graft particles in both groups.
Conclusions:
Deproteinized bovine bone mineral with 10% collagen showed a similar behaviour as DBBM not only in its capacity to minimize ridge contraction but also from a histological point of view. Thus, both graft materials seem to be suitable for ridge preservation procedures.
Tooth extraction is associated with loss of the alveolar bone and surrounding keratinised gingiva. The author illustrates a treatment protocol for the maximum and most predictable preservation outcome
Minimally invasive procedures are ubiquitous in medicine. They will also make an increasing mark in invasive disciplines of dentistry in the future. Therefore in implantology three-dimensional diagnostics, microsurgical instruments and suture materials, but
especially optical magnifi cation with axially aligned illumination are required. The operating microscope (OPMI) combines these last two requirements, which are essential for microsurgery, even at high magnification. Customised sterile draping sheets allow the
operating microscope to be used even under the aseptic conditions of implant surgery.
The advantages of the OPMI in implantology are numerous and are apparent especially in clinical assessment, diagnosis, management of the aesthetic zone, sinus lift, soft tissue management and photo and video documentation. Technical developments such as autofocus, xenon illumination, magnetic fixation, CCD and HD digital cameras enhance the precision of the OPMI, and at the same time improve ergonomy. The following overview article describes in detail the main indications for using the OPMI in minimally
invasive implantology
Objectives: To introduce an esthetic index for assessing the outcomes of Peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability.
Materials and methods: Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its 4 clinical variables.
Results: Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability), and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters.
Conclusion: The IDES showed persistent judgement among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.
Purpose:
Socket augmentation decreases the magnitude of alveolar ridge resorption, but the literature is limited in respect to quantifying soft tissue remodeling. The aim of this study was to determine the volumetric and linear dimensional changes at the buccal surface for both hard and soft tissues after socket augmentation treated with a xenogeneic collagen matrix in combination with bone grafting.
Materials and methods:
Twenty-four individuals indicated for tooth extraction were enrolled in this investigation. Each participant was randomly assigned to one of two groups: (1) deproteinized bovine bone + collagen plug, or (2) deproteinized bovine bone + xenogeneic collagen matrix. A cone beam computed tomography scan was taken prior to extraction and at 6 months postextraction. Intraoral scanning images were taken at baseline, 3 months, and 6 months postextraction. Hard and soft tissue analyses were performed to compare linear ridge remodeling and volumetric changes by noncontact reverse-engineering software.
Results:
Both groups showed bone and soft tissue remodeling. For hard tissue remodeling, there was no significant difference between the collagen plug and collagen matrix groups. For soft tissue remodeling, the collagen matrix group showed a reduced soft tissue loss compared with the collagen plug group. The volumetric analysis demonstrated that the mean buccal soft tissue volume loss for the collagen matrix group was 68.6 mm3 compared with 87.6 mm3 found in the collagen plug group (P = .009) over a 6-month period.
Conclusion:
This clinical investigation provides early evidence of using the total tissue volume to compare soft and hard tissue remodeling after socket augmentation. The results of this study demonstrated that the use of a xenogeneic collagen matrix reduced the buccal soft tissue loss after tooth extraction, but additional studies are necessary to evaluate the clinical significance of soft tissue augmentation after tooth extraction.
Background:
The periodontal phenotype consists of the bone morphotype, the keratinized tissue (KT) and gingival thickness (GT). The latter two components, overlying the bone, constitute the gingival phenotype (GP). Several techniques have been proposed for enhancing or augmenting KT or GT. However, how phenotype modification therapy (PMT) affects periodontal health and whether the obtained outcomes are maintained over time have not been elucidated.
Aim:
The aim of the present review was to summarize the available evidence in regard to the utilized approaches for gingival PMT and assess their comparative efficacy in augmenting KT, GT and in improving periodontal health using autogenous, allogeneic and xenogenic grafting approaches.
Materials and methods:
A detailed systematic search was performed to identify eligible randomized clinical trials (RCTs) reporting on the changes in GT and KT (primary outcomes). The selected articles were segregated into the type of approach based on having performed a root coverage, or non-root coverage procedure. A network meta-analysis was conducted for each approach to assess and compare the outcomes among different treatment arms for the primary outcomes.
Results:
A total of 105 eligible RCTs were included. 95 pertaining to root coverage (3,539 treated gingival recessions), and 10 for non-root coverage procedures (699 total treated sites). The analysis on root coverage procedures showed that all investigated techniques (the acellular dermal matrix (ADM), collagen matrix (CM), connective tissue graft (CTG)) are able to significantly increase the GT, compared to treatment with flap alone. However, KT was only significantly increased with the use of CTG or ADM. Early post-treatment GT was found to inversely predict future gingival recession. For non-root coverage procedures, only the changes in KT could be analyzed; all investigated treatment groups (ADM, CM, free gingival graft (FGG), living cellular constructs (LCC), in combination with an apically positioned flap (APF)), resulted in significantly more KT than treatment with APF alone. Additionally, the augmented GT was shown to be sustained, and KT displayed an incremental increase overtime.
Conclusions:
Within its limitations, it was observed that any graft material was able to significantly enhance GT, while KT in root coverage procedures was significantly enhanced with CTG and ADM, and in non-root coverage procedures, with ADM, CM, FGG and LCC compared to APF alone. The autogenous soft tissue graft (CTG/FGG) proved to be superior in all comparisons for both outcomes of GT and KT. This article is protected by copyright. All rights reserved.
Background:
To compare the histologic difference in healing between ridge preservation sites treated with a combination allograft of 70% mineralized and 30% demineralized freeze-dried bone allograft (FDBA) evaluated at 8 to 10 weeks versus 18 to 20 weeks post-extraction. Changes in morphological ridge dimensions were also evaluated.
Materials and methods:
Forty-four patients with a single-rooted tooth to be extracted and replaced by a dental implant were recruited for this study. At time of extraction, measurements were taken with a custom acrylic stent, and the extraction socket was grafted with the combination allograft and covered with a nonresorbable membrane. Patients were randomly assigned to the short-term (8 to 10 weeks) or long-term (18 to 20 weeks) healing group. Sites were re-entered for study measurements, a bone core sample, and implant placement. Bone cores obtained during implant placement were analyzed histologically to determine percentages of vital bone, residual graft, and CT/other.
Results:
Thirty-eight of the 44 patients completed the study, 19 in each group. There was a significant difference between the two groups for mean percent vital bone formation (short-term = 18.17%, long-term = 40.32%, p = <.0001) and percentage of residual graft (short-term = 41.54%, long-term = 23.59%, p = <.0001). There was no difference in morphological changes between the two groups.
Conclusion:
Ridge preservation using combination FDBA resulted in approximately twice as much vital bone and half as much residual graft material after 18 to 20 weeks of healing compared to only 8 to 10 weeks healing. This article is protected by copyright. All rights reserved.
Alveolar ridge preservation (ARP) therapy is indicated to attenuate the physiologic resorptive events that occur as a consequence of tooth extraction with the purpose of facilitating tooth replacement therapy. This randomized controlled trial was primarily aimed at testing the efficacy of ARP as compared with unassisted socket healing. A secondary objective was to evaluate the effect that local phenotypic factors play in the volumetric reduction of the alveolar bone. A total of 53 subjects completed the study. Subjects were randomized into either the control group, which involved only tooth extraction (EXT n = 27), or the experimental group, which received ARP using a combination of socket grafting with a particulate bone allograft and socket sealing with a nonabsorbable membrane (dPTFE) following tooth extraction (ARP n = 26). A set of clinical, linear, volumetric, implant-related, and patient-reported outcomes were assessed during a 14-wk healing period. All linear bone assessments (horizontal, midbuccal, and midlingual reduction) revealed that ARP is superior to EXT. Likewise, volumetric bone resorption was significantly higher in the control group (mean ± SD: EXT = −15.83% ± 4.48%, ARP = –8.36% ± 3.81%, P < 0.0001). Linear regression analyses revealed that baseline buccal bone thickness is a strong predictor of alveolar bone resorption in both groups. Interestingly, no significant differences in terms of soft tissue contour change were observed between groups. Additional bone augmentation to facilitate implant placement in a prosthetically acceptable position was deemed necessary in 48.1% of the EXT sites and only 11.5% of the ARP sites ( P < 0.004). Assessment of perceived postoperative discomfort at each follow-up visit revealed a progressive decrease over time, which was comparable between groups. Although some extent of alveolar ridge remodeling occurred in both groups, ARP therapy was superior to EXT as it was more efficacious in the maintenance of alveolar bone and reduced the estimated need for additional bone augmentation at the time of implant placement (ClinicalTrials.gov NCT01794806).
Purpose:
To compare the clinical and patient-reported outcomes of ≤6-mm implants with those of ≥10-mm implants placed after both lateral and transcrestal sinus floor elevation.
Materials and methods:
Using PubMed (MEDLINE), EMBASE, and Cochrane, a literature search for randomized controlled trials was performed. All the outcome variables were evaluated through a quantitative meta-analysis, and the influence of other clinical covariates were determined with a metaregression. For the survival outcomes, trial sequential analysis (TSA) was performed to adjust results for type I and II errors and to analyze the power of the available evidence.
Results:
After full-text reading, 12 studies were included in the analyses. No statistically significant difference was found after 3 years between the 2 study groups (P = 0.36). Short implants displayed fewer biological complications (P = 0.05), less marginal bone loss (MBL) from implant placement (P < 0.01), and reduced surgical time and treatment cost. However, long implants showed a statistically significant smaller number of prosthetic complications (P = 0.03). TSA confirmed the results of the meta-analysis, revealing that additional studies are needed due to low statistical power of the available evidence.
Conclusion:
The placement of short implants is a predictable option in treating patients with maxillary atrophy up to a 3-year follow-up. Studies with a longer observational period are needed to study the long-term performance of these implants.
Objective:
The aim of this study was to compare the influence of the physical-chemical properties of synthetic hydroxyapatite (HA) and biphasic commercial materials on the biological behavior of study materials through material characterization and SEM analysis before and after application in rabbit tibias.
Materials and methods:
Two defects were performed in each tibiae for a total of 180 defects: Group I HA granules (2000-4000 μm), Group II HA granules (1000-2000 μm), Group III HA granules (600-1000 μm), Group IV Ossceram(®) nano (Bredent medical GmbH & Co. KG, Senden, Germany), Group V 4Bone(®) granules (MIS Implants Technologies Ltd, Shlomi, Israel), and Group VI: empty defect acted as control. Comparison was performed by mean of material characterization, SEM, and EDX.
Results:
4Bone: Pores between 300 μm and 100 μm with intra- and interparticle spaces. Ossceram show also interparticle and intraparticle pores, between 100 μm and 26 μm, but the proportion of interparticles in the 4Bone is clearly minor than in the Ossceram. Related with pure HA, Group III has the greatest porosity (69.3%). For Group I, the intraparticle pores (0.71 μm) are about 8 times larger than those of the other two samples. The analysis of the images of in vivo SEM shown as biphasic groups has presented a more gradual resorption of the material.
Conclusion:
HA-based biomaterials, both pure and biphasic, are an effective means for bone regeneration processes; of these, materials with higher initial and secondary porosimetry allow greater cell colonization and therefore more effective substitution by new bone. The two-phase materials have a higher ion release to the environment in the early stages and thus allow greater colonization by collagen fibers that can be matured into new bone.
Objective:
The aim of this study was the synthesis and analysis of the tissue reaction to three different Hydroxyapatite (HA)-based bone substitute materials differing only in granule size, porosity, and crystallinity through an animal experimental model at 60 days.
Materials and methods:
Three different HA-based biomaterials were synthesized and characterized by X-ray diffraction, SEM, and EDS analysis, the resultant product was ground in three particle sizes: Group I (2000-4000 μm), Group II (1000-2000 μm), and Group III (600-1000 μm). Critical size defects were created in both tibias of 15 rabbits. Four defects per rabbit for a total of 60 defects were grafted with the synthesized materials as follows: Group I (15 defects), Group II (15 defects), Group III (15 defects), and empty (15 defects control). After animals sacrifice at 60 days samples were obtained and processed for SEM and EDS evaluation of Ca/P ratios, elemental mapping was performed to determine the chemical degradation process and changes to medullary composition in all the four study groups.
Results:
The tendency for the density was to increase with the increasing annealing temperature; in this way it was possible to observe that the sample that shows highest crystallinity and crystal size corresponding to that of group I. The SEM morphological examination showed that group III implant showed numerous resorption regions, group II implant presented an average resorption rate of all the implants. The group I displayed smoother surface features, in comparison with the other two implants.
Conclusion:
The data from this study show that changing the size, porosity, and crystallinity of one HA-based bone substitute material can influence the integration of the biomaterials within the implantation site and the new bone formation.
Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the socket wound and to restore tissue homeostasis, and are referred to as '"socket healing". The aims of the present report were twofold: first, to describe the socket-healing process; and, second, to discuss what can be learned from the temporal sequence of healing events, in order to improve treatment outcomes. The socket-healing process may be divided into three sequential, and frequently overlapping, phases: inflammatory; proliferative; and modeling/remodeling. Several clinical and experimental studies have demonstrated that the socket-healing process promotes up to 50% reduction of the original ridge width, greater bone resorption at the buccal aspect than at the lingual/palatal counterpart and a larger amount of alveolar bone reduction in the molar region. In conclusion, tooth extraction, once a simple and straightforward surgical procedure, should be performed in the knowledge that ridge reduction will follow and that further clinical steps should be considered to compensate for this, when considering future options for tooth replacement.
AimThe aim of this article was to systematically review histological and histomorphometrical data from literature that provide information regarding the effect of alveolar ridge preservation procedures on healing after tooth extraction in humans. Materials and methodsThe MEDLINE-PubMed and the Cochrane CENTRAL databases were searched up to September 2012; 38 papers were selected from 646 founded. A meta-analysis was performed regarding the variations in the mean percentage of Bone, Connective Tissue and Residual Graft Material between three different types of Procedures. ResultsThe highest value regarding bone percentages is produced at 3 months by Procedures with Allografts (54.4%), while the lowest is obtained, at 5 months, by those using Xenografts (23.6%). Referring to connective tissue, the highest and lowest values are shown at 7 months, with Allografts (67%) and Alloplasts (27.1%), respectively. Regarding residual graft material, the lowest rates are displayed by Procedures with Allografts (12.4–21.11%), while those using Xenografts and Alloplasts showed the best results at 7 months (37.14 and 37.23%). No statistical difference was found. Conclusions
With the limitations due to the features of the selected papers, no major histological and histomorphometrical differences arose among different procedures or when compared to spontaneous healing. Thus, it might be argued that in preserved sites it is unnecessary to wait over 3 to 4 months prior to implant insertion.
The aim of this study was to compare the effectiveness of two bone substitute materials for socket preservation after tooth extraction. Extraction sockets in 10 patients were filled with either inorganic bovine bone material (Bio-Oss) or with synthetic material consisting of hydroxyapatite and silicon dioxide (NanoBone). Extraction sockets without filling served as the control. The results demonstrate the effectiveness of the presented protocol for socket preservation and that the choice of a suitable bone substitute material is crucial. The dimensions of the alveolar ridge were significantly better preserved with Bio-Oss than with NanoBone or without treatment. Bio-Oss treatment resulted in better bone quality and quantity for successful implant placement.