ArticleLiterature Review

A systematic review of post-extractional alveolar bone dimensional changes in humans

February 2012
Clinical Oral Implants Research 23 Suppl 5(5):1-21

DOI:10.1111/j.1600-0501.2011.02375.x

Source
PubMed

Authors:

May Chun Mei Wong

The University of Hong Kong

Niklaus P. Lang

Removal of teeth results in both horizontal and vertical changes of hard and soft tissue dimensions. The magnitude of these changes is important for decision-making and comprehensive treatment planning, with provisions for possible solutions to expected complications during prosthetic rehabilitation. To review all English dental literature to assess the magnitude of dimensional changes of both the hard and soft tissues of the alveolar ridge up to 12 months following tooth extraction in humans. An electronic MEDLINE and CENTRAL search complemented by manual searching was conducted to identify randomized controlled clinical trials and prospective cohort studies on hard and soft tissue dimensional changes after tooth extraction. Only studies reporting on undisturbed post-extraction dimensional changes relative to a fixed reference point over a clearly stated time period were included. Assessment of the identified studies and data extraction was performed independently by two reviewers. Data collected were reported by descriptive methods. Weighted means and percentages of the dimensional changes over time were calculated where appropriate. The search provided 3954 titles and 238 abstracts. Full text analysis was performed for 104 articles resulting in 20 studies that met the inclusion criteria. In human hard tissue, horizontal dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months. Percentage vertical dimensional change was 11-22% at 6 months. Percentage horizontal dimensional change was 32% at 3 months, and 29-63% at 6-7 months. Soft tissue changes demonstrated 0.4-0.5 mm gain of thickness at 6 months on the buccal and lingual aspects. Horizontal dimensional changes of hard and soft tissue (loss of 0.1-6.1 mm) was more substantial than vertical change (loss 0.9 mm to gain 0.4 mm) during observation periods of up to 12 months, when study casts were utilized as a means of documenting the changes. Human re-entry studies showed horizontal bone loss of 29-63% and vertical bone loss of 11-22% after 6 months following tooth extraction. These studies demonstrated rapid reductions in the first 3-6 months that was followed by gradual reductions in dimensions thereafter.

A Systematic Review and Meta-Analysis to Find Out the Efficacy of Socket Preservation Techniques in Adults in Split-Mouth Randomized Controlled Trials

Article

Mar 2025

Advancements in Hyaluronic Acid Effect in Alveolar Ridge Preservation: A Narrative Review

Article

Full-text available

Jan 2025

Background/Objectives: Tooth extraction induces significant alveolar ridge dimensional changes and soft tissue modifications, often leading to challenges in implant placement or conventional prosthetic rehabilitation. Alveolar Ridge Preservation (ARP) strategies aim to mitigate post-extraction resorption of the alveolar ridge, enhancing both the quality and quantity of bone and soft tissue during healing. Hyaluronic acid (HYA) has emerged as a promising biological agent for ARP due to its osteoinductive, antimicrobial, and anti-inflammatory properties. However, the effects of HYA in ARP remain inconsistently reported. This study aims to assess current clinical and preclinical evidence regarding the biological effects of HYA and its application in ARP. Additionally, it evaluates HYA’s impact—alone or in combination with other products—on hard and soft tissue dimensional changes, early wound healing, and implant success rates. Methods: A comprehensive electronic literature search was conducted, and studies meeting the inclusion criteria were critically evaluated. Relevant data were extracted from the final selection of articles. Results: Thirteen publications were evaluated. Some studies reported a significantly improved newly formed bone following ARP with intra-socket HYA application as a single approach (p = 0.004). Combining HYA with a bone graft and a free palatal graft resulted in significantly greater amounts of newly formed and mature bone, reduced clinical bone width changes, lower radiographic crestal bone loss (p < 0.01), and diminished radiological volumetric and linear bone resorption (p = 0.018). Short-term follow-up data indicated improved soft tissue healing associated with HYA-based ARP. While HYA appears to have a protective effect on ridge dimensional changes in ARP, other studies reported no significant differences in radiographic bone dimensional changes or soft tissue improvement. Conclusions: The addition of HYA to bone grafts may enhance some ARP outcomes. However, the variability in outcomes and methodologies across the evaluated studies precludes drawing definitive clinical conclusions. Further robust research is needed to clarify HYA’s role in ARP. With respect to clinical significance enhancing the understanding of ARP management strategies and their effects on post-extraction sockets empowers clinicians to make more informed decisions. The knowledge of HYA effects facilitates the selection of personalized ARP approaches tailored to optimize outcomes for subsequent interventions.

Eazygoma technique: a new approach for zygomatic implant placement aligned with maxillomalar anatomy

Article

Full-text available

Nov 2024
Periodontal and Implant Res.

This study focused on evaluating the novel Eazygoma method for zygomatic implant placement. This approach focuses on biomechanical principles, offering direct visualization that facilitates enhanced control during implant insertion. It helps prevent malpositioning, ensuring that the apical portion remains within the zygomatic body and achieves emergence in the alveolar crest through an inverted drilling sequence. The Eazygoma system enables improved control during drilling, starting in the zygomatic area and eliminating the need for osteotomies in the maxillary sinus. This not only simplifies the procedure but also significantly reduces the operative time, allowing it to be performed under local anesthesia and sedation in approximately one hour, according to the author’s experience. The study included 34 zygomatic implants placed in 11 patients with severe maxillary atrophy, treated between 2021 and 2023 at the Maxillofacial surgery Department of the private clinic “Clínica Colsanitas” in Bogotá, Colombia. To evaluate outcomes, intraoperative torque, surgical time, and whether alveolar emergence was achieved were measured for the implants. Patients were followed up at 12 months to assess implant survival. Results showed that the Eazygoma approach eliminated postoperative sinus injuries and implant malposition, ensuring alveolar emergence and achieving a torque greater than 50 Newtons in all cases, allowing for immediate implant loading.

Finite element analysis of a new alveolar bone splitting technique in the mandibular posterior region

Article

Full-text available

Mar 2025
BMC Oral Health

Background Finite element analysis was used to predict the risk of bone plate fracture and the expected bone augmentation effect of a new alveolar bone splitting technique in the mandibular posterior region for different alveolar crest widths, different alveolar bone densities, different root incision widths, and different insertion depths of bone expansion instrumentation. Methods The jaw models of the mandibular posterior region were constructed by computer-aided software and surgical incisions and bone expansion instruments were prepared on the models, after which the alveolar bone splitting procedure was simulated by finite element analysis software, and the equivalent stress-strain distribution characteristics of the jaw models of each group, as well as the maximal force and the maximal displacement of the bone plate when it was fractured, were recorded. Results The distribution of equivalent stress and strain was mainly concentrated in the cancellous bone area at the root incision and the lower 1/3 of the buccal cortical bone plate, and there was no significant difference in the stress-strain distribution characteristics of the jaw models of each group. The wider of the alveolar crest, the higher the force required to fracture the bone plate, but the smaller the maximum displacement; the plastic deformation capacity of type IV bone jaws was more excellent; the wider the width of the root incision, the shallower the depth of instrument insertion, and the larger the maximum displacement. Conclusion Finite element analysis can effectively simulate the surgical criticality index of the new alveolar bone splitting procedure. Alveolar crest width, alveolar bone density, root incision width, and instrument insertion depth had a clear correlation with the maximum displacement of the bone plate at fracture. The alveolar crest width and alveolar bone density also had a significant effect on the maximum force required to fracture the bone plate.

Orthodontic Extrusion: An Option to Improve the Peri-Implant Condition in Aesthetic Zone — Clinical Reports

Article

Full-text available

Jan 2025

The immediate implant with its installation followed by extraction dental is an available treatment option. The immediate implant procedures in the aesthetic zone require pre and/or trans-surgical procedures for a better aesthetic result. The literature that describes orthodontic extrusion as a reliable method to favor the pre-implant site. The objective of this article consists of a clinical cases series in which the orthodontic extrusion technique was applied before installation of implants in the aesthetic zone with satisfactory results.

Evaluation of Effectiveness of Nanocrystalline Hydroxyapatite and Demineralized Bone Matrix Combined with Titanium-platelet Rich Fibrin for Ridge Preservation: A Randomized Controlled Clinical Trial

Article

Full-text available

Jan 2025
J Contemp Dent Pract

Aim Preservation of ridge dimensions is the important aspect after tooth extraction for prosthetic and implant rehabilitation. Titanium-platelet rich fibrin (T-PRF) is an autologous biomaterial, and when used with bone graft it could enhance the bone regeneration. Hence, the aim of this study was to evaluate the combined effect of T-PRF with nanocrystalline hydroxyapatite (Nano-HA) and T-PRF with demineralized bone matrix (DMBM). Materials and methods Twenty systemically healthy patients were included in the study and were randomly assigned into two groups. Ten patients were treated with atraumatic extraction followed by ridge preservation using Nano-HA bone graft and T-PRF. In another group of ten patients, ridge preservation was done using a xenograft-DMBM. Preoperative cone beam computed tomography (CBCT) and postoperative CBCT after 3 months were evaluated for bone fill. The clinical parameters of ridge width (RW) and ridge height were measured clinically, with the help of UNC 15 probe, after 3 months. Results The treatment modality resulted in significant bone fill in CBCT and adequate RW clinically in both the groups. The mean bone density in the Nano-HA + T-PRF group was recorded as 776.72 ± 223.94, and 854.72 ± 183.57 was observed in the DMBM + T-PRF group, after 14−16 weeks. Conclusion The study's findings indicate that ridge preservation performed at the time of extraction is a reliable and predictable approach for minimizing alveolar bone resorption. Additionally, the combination of T-PRF with bone grafts yields effective results in a relatively short timeframe. Clinical significance This technique involves combining osteoconductive material from Nano-HA and DMBM and the growth factor-rich matrix of T PRF for quicker healing and better esthetic and functional results. It reduces morbidity in patients, does not require an autogenous graft, is biocompatible, and is economical; therefore, both clinical practice and regenerative research in the field of dentistry are advanced. Hence, it is one of the important evidences through this original study. How to cite this article Patil RT, Dhadse PV, Salian SS, et al. Evaluation of Effectiveness of Nanocrystalline Hydroxyapatite and Demineralized Bone Matrix Combined with Titanium-platelet Rich Fibrin for Ridge Preservation: A Randomized Controlled Clinical Trial. J Contemp Dent Pract 2024;25(11):1069–1076.

After Extraction, Upper Premolars Undergo Programmed Socket Collapse with Development of Cavitations Rather than Complete Socket Healing: A Radiological Study

Article

Full-text available

Jan 2025

The alveolar ridge undergoes a loss in volume and atrophy after tooth extraction. Understanding the wound healing and bone regeneration process after tooth extraction is a key factor in the insertion of dental implants. Therefore, the aim of the present study was to analyze the socket healing process after the extraction of upper premolars based on cone beam computed tomography (CBCT) over six months. Special focus was placed on the morphological changes in the alveolar crest and within the socket. A retrospective analysis of patients in need of tooth extraction in the upper premolar region was performed in this study. All patients received flapless tooth extraction under local anesthesia and CBCT immediately after tooth extraction. Further CBCT analysis was performed after three months for the first group (n = 18) and after six months for the second group (n = 18). The results showed that all sockets underwent an inward movement of the defect walls towards the defect center, resulting in reduced total alveolar ridge volume and defect volume. This result was observed after three months and persisted after six months. The inward movement was quantified as a vertical socket collapse of up to 30.1 ± 9.0% after three months and 34.3 ± 6.7% after six months. The horizontal inward movement was quantified as a buccal socket collapse of 47.7 ± 12.3% after three months and 55.7 ± 29.1% after six months. New bone formation within the socket was evident, especially in the occlusal part of the socket. Additionally, bone formation was primarily observed as bone apposition along the socket walls and did not reach the defect center in most cases. The combination of socket collapse and bone apposition led to the formation of cavitations inside the socket that were mostly localized under the occlusal part. These novel findings with respect to socket collapse and formation of cavitation represent a paradigm shift and call for reconsidering the current understanding of socket healing. Based on the data, socket healing should be understood as a patient-specific process that requires 3D radiographic analysis for planning dental implants.

Histological and histomorphometric evaluation of natural bovine bone substitute with hyaluronate in socket preservation—a report of three cases

Article

Full-text available

Jan 2025
J MATER SCI-MATER M

Tooth extraction is physiologically followed by resorption of alveolar bone. Surgical method which aims to minimise this reduction in alveolar bone with a goal to provide enough bone volume for dental implant insertion is called socket preservation. The purpose of this article was to asses clinical, histomorphometric and histological results of socket preservation conducted with natural bovine bone substitute with hyaluronate. Three patients with one or more hopeless teeth in posterior region planned for extraction and implant placement were included in these case reports. After atraumatic extractions, empty sockets were filled with the bovine xenograft with hyaluronate, and then covered with collagen sponge. After 4–7.5 months the samples for biopsy were taken and then implants were inserted. The augmented sites healed uneventfully and without any complications. The histological specimens demonstrated new bone formation and osteoclastic activity around the biomaterial, as well as blood vessels in soft tissue. Histomorphometrically, formation of new bone averaged 24.8% ± 4.7% (mean ± standard deviation) in bone biopsies taken from the center of the augmented site, while the residual biomaterial averaged 52.7% ± 4.9% and the soft tissue averaged 22.6% ± 4%. In conclusion, the natural bovine bone substitute with hyaluronate demonstrated excellent osteoconductive potential for bone regeneration. Graphical Abstract

Alveolar Ridge Preservation Comparing Allograft, Alloplast, and Autogenous Tooth Graft: A Randomized Clinical Trial

Article

Full-text available

Jan 2025

Pre-extraction alveolar buccal bone overbuilding: a preclinical investigation

Article

Full-text available

Dec 2024

Background The pre-extraction overbuilding procedure was designed aiming to mitigate buccal bone resorption following tooth extraction. The objective of this study was to compare the efficacy of pre-extraction and juxta-extraction buccal overbuilding treatments in preserving buccal bone volume following tooth extraction. Material and methods At the test sites (pre-extraction sites), an alveolar crest overbuilding was performed on the buccal aspect of the distal root of the fourth premolar using a xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both fourth premolars were extracted and the alveoli were filled with a collagenated xenograft. An overbuilt procedure was performed also at the control sites (juxta-extraction sites). After 3 months, biopsies were collected. Results Considering the initial height difference between the lingual and buccal bone plates at the time of extraction, histological evaluation revealed that the resorption of the buccal bone relative to the lingual bone wall was 3.2 mm at the pre-extraction sites and 3.3 mm at the juxta-extraction sites. New bone originated from the residual pre-existing bone crest in an attempt to restore the original dimension. Conclusion The buccal overbuilding procedures performed three months before tooth extraction did not contribute to preserve the buccal bone crest, despite necessitating an additional surgical procedure. Evidence of ongoing bone regeneration was observed within the augmented space maintained by the biomaterial, suggesting that a prolonged healing period, potentially exceeding six months as indicated by this study, might be required to achieve optimal outcomes.

Use of Deproteinized Bovine Bone in Association with Calcium Sulphate for Alveolar Socket Preservation

Article

Full-text available

Dec 2024

Background: The aim of this retrospective study was to compare the histomorphometry of post-extractive sites previously grafted with deproteinized bovine bone, with or without the association of a calcium sulphate preparation. Methods: The retrospective evaluation comprehended patients previously selected and treated for the extraction of one or more mono-radicular teeth, followed by an implant-prosthetic rehabilitation. Post-extractive sites had been randomly assigned to test or control group, respectively, if deproteinized bovine bone was used in association with a calcium sulphate preparation or alone. In both cases, a collagen membrane was employed to cover the grafted area. After four months, a biopsy of regenerated bone was taken from all grafted sites and then processed for histomorphometric analysis. Results: Of 24 samples analyzed 4 months after extraction, vital bone was present in 62.5% of cases for the test group and in 31.25% for the control group. Acellular bone was respectively found in 5% of cases for the test group and in 32.91% for the control group. Both these differences were statistically significant (p < 0.05) between groups. Conclusions: Calcium sulphate in association with deproteinized bovine bone seems to promote proper vital bone formation, with less acellular bone compared to deproteinized bovine bone used alone. Socket preservation procedures with the use of specific osteoconductive materials improve the maintenance of width and height of remaining bone. Findings of the present study offer clinicians a predictable protocol for preserving vital bone in early healing of post-extraction sites, slowing down the resorption process at the same time.

Radiographic Examination of Alveolar Ridge Resorption in Relation to Age in Kennedy Class II Edentulism

Article

Sep 2024

Purpose: After the loss of teeth, alveolar bone begins to resorb due to disappearance of the stimulus being applied by the teeth to the alveolar bone. This situation is termed as residual ridge resorption. The aim of this study is to determine the amount of alveolar bone resorption occured in the maxilla and mandible of the patients having Kennedy Class II edentulousness and the distribution of it according to age groups. Material and Methods: The study was carried out on the panoramic radiographs of 122 individuals (60 mandible, 62 maxilla). Vertical measurements were made at 10 sites (central incisors, first premolars and molars at the left and right of both jaws). The difference of the measurements according to the group and demographic variables was analyzed with the independent groups independent-t and one-way ANOVA tests. Also, dentate and edentulous measurements according to the group and demographic characteristics in the group interaction was analyzed with the repeated ANOVA test. Results: When the edentulous regions were considered, the vertical height values of the mandible were lower than maxilla. Also, statistically significant difference was detected in the maxillar premolar region of the edentulous regions. According to gender, womens’ vertical height results were found to be lower than men and the vertical heights of the 6-12 months group were higher than 12-24 months group. Conclusions: According to these results, we think that the patient should be directed to implant rehabilitation in order to prevent bone loss, especially in edentulous patients in the maxillary premolar region.

Featured Cover

Article

Dec 2024
CLIN IMPLANT DENT R

The cover image is based on the article 3D surface defect map for assessing buccolingual profile of single tooth gaps following alveolar ridge presrvation by Leonardo Mancini etal., https://doi.org/10.1111/cid.13377 . image

Influence of buccal bone lamella defects on hard and soft tissues with submerged and non-submerged healing in immediate implants - an experimental study in minipigs

Article

Full-text available

Mar 2025

Purpose This study assessed the impact of the buccal bone on hard and soft tissues in submerged and non-submerged immediate implants using a minipig model. Methods Sixty-five titanium implants (Camlog Progressive Line) were placed in four minipigs immediately after tooth extraction. All non-submerged (NSM) implants received a mechanically induced buccal bone defect (NSM-BD), whereas the submerged group (SM) was classified as defective (SM-BD) and intact (SM-BI). All bone defects underwent guided bone regeneration (GBR). After four months, the minipigs were sacrificed. Harvested specimens were analysed using histomorphometry and light and fluorescence microscopy. The evaluated parameters included the sulcus (S), implant epithelium (IE), connective tissue (CT), biological width (BW), highest soft tissue point (HSTP), and first hard tissue contact (FHTC). Results Of the 65 implants four (6%) were lost, while all remaining implants demonstrated clinical stability (Periotest). Despite GBR failures caused by the pigs’ hay consumption after one week, no significant differences ( p > 0.5) were observed between SM-BD and NSM-BD in buccal parameters (NSM-BD/SM-BD: S = 0.6 mm, IE = 2.9/2.4 mm, CT = 3.5/3.4 mm, BW = 5.9/5.8 mm). Compared to SM-BI soft-tissue parameters increased in length with reduced buccal bone lamella (SM-BI/SM-BD: S = 0.4/0,6 mm; p ≤ 0.04, SM-BI/NSM-BD: IE = 1.8/2.9 mm; p ≤ 0.007, SM-BI/SM-BD: CT = 2.5/3.4 mm; p ≤ 0.01, BW = 4.0/5.8 mm; p ≤ 0.007). The buccal HSTP remained unaffected ( p > 0.5; (NSM-BD = 1.8 mm, SM-BD = 1.0 mm, SM-BI = 2.0 mm; p > 0.5) for all groups. Conclusion A buccal bone defect resulted in prolonged S, IE, CT, and BW. However, the aesthetic parameter HSTP did not exhibit significant differences ( p > 0.5) at the buccal implant site when comparing the SM and NSM healing protocols. Graphical Abstract

Evaluation of Vestibular Socket Therapy Using Xenograft with and without Platelet Rich Fibrin for Managing Type II Extraction Sockets for Immediate Implant Placement in the Esthetic Zone

Article

Feb 2025

Heterotopically differentiated PDLSCs-laden 3D-bioprinted scaffolds for concurrent oral hard and soft tissue regeneration

Article

Full-text available

Oct 2024

Following dental extraction, the alveolar bone and gingival tissues could undergo varying degrees of resorption, which affects subsequent implant integration and aesthetic outcomes. Thus, having adequate volume of both hard and soft tissues for implantation or aesthetic restoration is essential for optimal results. Three-dimensional (3D) bioprinting technology offers the advantages of biomimicry, personalization, and precise spatial distribution, which are pivotal for enhancing the success and esthetics of dental restorations. In this study, we fabricated a construct with a natural transition and varying material concentrations by 3D bioprinting, comprising an upper layer of collagen/alginate/periodontal ligament stem cells (PDLSCs) and a lower layer of collagen/nano-hydroxyapatite (nHA)/alginate/PDLSCs. Characterization of the physicochemical properties revealed that the incorporation of nHA significantly enhanced the mechanical properties of both the bioink and the construct.Flow cytometry analysis confirmed the stemness of PDLSCs. Scanning electron microscopy (SEM) revealed that the construct possesses satisfactory pore density and a natural transition at the stratification point. The construct displayed good cell viability and proliferation, with the cellular movement observed at the stratification interface after bioprinting. Differentiation staining and quantitative reverse-transcription polymerase chain reaction (RT-qPCR) results demonstrated that PDLSCs within the 3D construct are capable of both osteogenic and fibroblastic differentiations. Ectopic transplantation in mice confirmed the biocompatibility of the construct. A rat tooth extraction model validated the construct’s effectiveness in the integrated regeneration of both hard and soft tissues in alveolar ridge preservation. In conclusion, this personalized, concentration-varied 3D construct exhibits excellent biocompatibility and tissue preservation effects, holding significant potential for clinical application.

L- shape symphyseal autogenous bone block for alveolar ridge augmentation in anterior maxilla and mandible, a prospective single arm clinical study

Article

Full-text available

Mar 2025
BMC Oral Health

Background Alveolar ridge augmentations are challenging procedures in dental implantology, especially in esthetic zone. 3D alveolar defects can be treated by guided bone regeneration (GBR), distraction osteogenesis, or bone blocks. This study introduces a new technique for 3D-alveolar ridge augmentation by using L-shape autogenous symphyseal bone block. Purpose This study aimed to assess both horizontal and vertical alveolar bone augmentation for severe atrophied anterior maxilla and mandible, using an L- shape autogenous bone block harvested from the symphysis. Patients and method elven partially edentulous patients who needed horizontal and vertical bone augmentation in the anterior maxilla or mandible before implant placement were selected for this study. For each patient, an autogenous bone block was harvested from the symphysis, trimmed to L-shape, and used to augment the anterior maxilla or mandible horizontally and vertically. Horizontal and vertical bone gain was measured by CBCT immediate postoperative and at 6months postoperatively. Results In this study, 14 L-shape bone blocks were grafted in 11 patients. The patients were 4males and 7females, with a mean age of 24.63years. Healing was uneventful for all patients with no sensory disturbance. The Mean of horizontal bone gain was 4.17 ± 0.77 mm immediate postoperative, and was 3.52 ± 0.75 after 6months. While, the mean of vertical bone gain was 6.51 ± 1.01 mm immediate postoperative, and was 4.74 ± 1.03after 6months. The mean of horizontal and vertical bone loss was 0.74 ± 0.24 mm and 1.62 ± 0.19 mm after 6 months, respectively. Conclusion Using L- shape autogenous bone block harvested from the symphysis for alveolar ridge augmentation is a safe, predictable and effective method for 3D ridge augmentation.

Socket Shield Technique of an Ailing Mandibular Molar With Customized Healing Abutment: Graftless Management of the Hard and Soft Tissue Foundation Around Immediate Dental Implants

Article

Full-text available

Feb 2025

Sanjay Sah

It is an established fact that postextraction ridge resorptive changes are inevitable and are very evident in the molar areas. Resorption in the molar sites can cause a reduction in the attached gingiva and affect the long‐term success of the osseointegrated implant. To prevent significant postextraction tissue alteration, the socket shield technique (SST) was developed to preserve the buccal plate, over a decade ago. Since then, various studies showcasing modifications of the technique have been published mainly focusing on SST in conjunction with immediate implants in the anterior esthetic zone. Gluckman gave a collective term called partial extraction therapy (PET) which includes SST, pontic shield technique, and root submergence technique. He suggested using a graft material in the gap between the shield and the implant. Later, Siormpas et al. advocated a root membrane technique (RMT) and suggested that it may not be necessary to use the graft material. With the evolution of the technique, the terms SST and RMT are more similar to each other now, with the only difference in the sequence of shield preparation and implant placement. The shield is prepared first, and osteotomy is done in the former and osteotomy is done before shield preparation in the latter. The SST technique is often ignored as a possibility in the molar sites. Though technique‐sensitive, SST with immediate implants in molars with a customized healing abutment ensures the maintenance of the original hard and soft tissue volumes in the most conservative way. The following case report showcases a stepwise, graftless management approach for a nonrestorable right mandibular molar with SST and immediate implant. Long‐term randomized controlled trials (RCTs) on molar SST are encouraged to make a recommendation for routine clinical practice.

Socket preservation utilizing polymeric bioresorbable membranes: a preclinical model

Article

Jan 2020

The Role of Hyaluronic Acid in Alveolar Ridge Preservation: A Systematic Review of Its Biological and Regenerative Potential According to PRISMA Guidelines and the Cochrane Handbook

Article

Full-text available

Feb 2025

Objectives: This systematic review evaluates the biological activity and regenerative potential of hyaluronic acid (HA) in alveolar ridge preservation (ARP) following tooth extraction, assessing its efficacy in reducing bone resorption and promoting bone regeneration when combined with xenografts. Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Lilacs databases, adhering to PRISMA guidelines. Studies from 2012 to December 2024 involving human participants were included based on a PECO framework. Four studies met the inclusion criteria, with data extracted and analyzed for clinical and histological outcomes. The risk of bias was assessed using the ROBINS-E tool. Results: The included studies demonstrated that HA combined with xenografts significantly reduced post-extraction bone resorption compared to controls. HA-enhanced grafts showed superior radiographic and histological outcomes, including increased bone density and reduced graft shrinkage. While one randomized controlled trial found no significant differences in wound healing or patient-reported outcomes between HA and control groups, other studies reported improved bone formation and graft stability with HA. Variability in study design and sample size was noted, with a generally moderate to high risk of bias in some studies. Conclusions: The evidence supports the beneficial role of HA as an adjuvant in ARP procedures, enhancing bone regeneration and limiting resorption. However, further research with larger samples and standardized methodologies is required to confirm these findings and optimize clinical protocols.

Clinical and histomorphometric comparison of autologous dentin graft versus a deproteinized bovine bone graft for Socket Preservation

Article

Full-text available

Oct 2024

Dentin has been a significant focus of research due to its potential as a bone substitute, owing to its higher mineral content than any material derived from bone. Additionally, dentin shares two key similarities with autologous bone: it is both osteocompatible and osteoconductive, providing a physical framework for the deposition of new bone. This comparative study assessed the osteoinductive and osteoconductive capabilities of various materials commonly used in “socket preservation” or alveolar ridge preservation. The results showed that the autologous dentin matrix and bovine-derived xenografts (Bio-oss) achieved superior bone regeneration, with a greater volume of newly formed bone (measured by the BV/TV parameter) and reduced fibrous bone, which has undesirable characteristics for implant biomechanics.

The Microbial Diversity and Biofilm Characteristics of d-PTFE Membranes Used for Socket Preservation: A Randomized Controlled Clinical Trial

Article

Full-text available

Jan 2025

Background: Understanding microbial colonization on different membranes is critical for guided bone regeneration procedures such as socket preservation, as biofilm formation may affect healing and clinical outcomes. This randomized controlled clinical trial (RCT) investigates, for the first time, the microbiome of two different high-density polytetrafluoroethylene (d-PTFE) membranes that are used in socket preservation on a highly molecular level and in vivo. Methods: This RCT enrolled 39 participants, with a total of 48 extraction sites, requiring subsequent implant placement. Sites were assigned to two groups, each receiving socket grafting with a composite bone graft (50% autogenous bone, 50% bovine xenograft) and covered by either a permamem® (group P) or a Cytoplast™ (group C). The membranes were removed after four weeks and analyzed using scanning electron microscopy (SEM) for bacterial adherence, qPCR for bacterial species quantification, and next-generation sequencing (NGS) for microbial diversity and composition assessment. Results: The four-week healing period was uneventful in both groups. The SEM analysis revealed multispecies biofilms on both membranes, with membranes from group C showing a denser extracellular matrix compared with membranes from group P. The qPCR analysis indicated a higher overall bacterial load on group C membranes. The NGS demonstrated significantly higher alpha diversity on group C membranes, while beta diversity indicated comparable microbiota compositions between the groups. Conclusion: This study highlights the distinct microbial profiles of two d-PTFE membranes during the four-week socket preservation period. Therefore, the membrane type and design do, indeed, influence the biofilm composition and microbial diversity. These findings may have implications for healing outcomes and the risk of infection in the dental implant bed and should therefore be further explored.

Clinical and histomorphometric comparison of autologous dentin graft versus a deproteinized bovine bone graft for Socket Preservation

Article

Full-text available

Oct 2024

Current Concepts in Alveolar Ridge Augmentation

Article

Full-text available

Jan 2025

Biologically‐oriented alveolar ridge preservation to correct bone dehiscence at immediate implant placement

Article

Full-text available

Jan 2025

Background The purpose of the present case study is to describe the application of a modification of the Biologically‐oriented Alveolar Ridge Preservation (BARP) principles in cases of peri‐implant bone dehiscence (PIBD) due to a compromised alveolus at immediate implant placement (IIP). Methods The technique is based on the stratification of three layers: a deep layer with a collagen sponge (CS) in the apical part of the alveolus (where the buccal bone plate was still present) to support the blood clot; a graft layer to correct the PIBD; and a superficial collagen layer to cover the graft thus providing space and enhancing clot/graft stability. Healing was obtained by primary closure. Results At the re‐entry procedure for implant uncovering, a complete PIBD correction with newly formed peri‐implant bone up to the level of the polished collar was observed in both cases. Conclusions These observations suggest that BARP based on the combined use of CS and deproteinized bovine bone mineral may be regarded as a simplified treatment option to correct a PIBD at IIP. Key points Why treat a Peri‐Implant Bone Dehiscence (PIBD)? PIBD should be treated to avoid biological and esthetic complications over time. What plays a key role in this case? The stability of both the graft and the cloth is essential for providing space for bone formation to correct the PIBD; the extraction socket supports angiogenic and osteogenic properties; Primary intention closure is crucial to prevent potential infection. Limitation: the efficacy of the technique must be assessed. Plain Language Summary This case study described the potential to correct a post‐extraction osseous defect associated with a substantial portion of a dental implant which resulted exposed and without bone support on its buccal aspect. The application of a novel bone augmentation technique, namely the biologically oriented Alveolar Ridge Preservation, has been described. This simplified procedure is based on the stratification of i) a deep collagen layer in the apical part of the socket to support the blood clot and spontaneous bone formation, ii) a graft of bone substitute to correct the missing bone, and iii) a superficial collagen layer to protect the graft and the wound. After 5 months, a complete correction of the osseous defect with newly formed bone up to the head of the implant was observed in both treated cases.

Socket Sealing Using Free Gingival Grafts: A Randomized Controlled Trial

Article

Full-text available

Jan 2025

Ralitsa Yotsova

Background: Post-extraction ridge resorption is an inevitable phenomenon that cannot be eliminated but is significantly reduced using additional surgical techniques known as socket preservation. They aim to create favorable conditions for implant placement and prosthetic restoration. This study aims to assess the effect of socket sealing (SS) with free gingival grafts on the vertical resorption of socket walls at the premolar and molar regions over 3 months. Methods: This randomized two-arm controlled trial with parallel groups (1:1 allocation) was conducted at the Department of Oral Surgery, Medical University-Varna, Bulgaria, from 27 June 2022 to 20 April 2023. Forty patients aged 30–65 were equally and randomly allocated to the SS or the control groups. Atraumatic tooth extraction was performed. In the control group, the socket was left on secondary wound healing. In the SS group, the socket orifice was “sealed” with an FGG harvested from the hard palate or maxillary tuberosity. Results: Data analysis demonstrated that SS with an FGG is a successful method for reducing the post-extraction resorption of the socket walls. In addition, this study confirms that the thickness of the buccal wall is a significant factor in its vertical resorption. Conclusions: Socket sealing with an FGG is a valuable method that eliminates the need for flap reflection and compensates for the soft tissue deficit when immediate implant placement or bone augmentation is required. Further research is necessary to determine the role of different factors influencing bone resorption and compare the effect of different socket preservation methods.

Alveolar Ridge Preservation

Chapter

Jan 2025

Managing Atrophic Thin Crest by Ridge Splitting Technique before Implant Placement

Article

Full-text available

Dec 2024

Critical alveolar ridge defects can result from several causes. Ridge expansion is a technique that aims to increase the width of the bone crest. A male patient presented an edentulous segment which leads to be careful concerning the adjacent teeth. Through this case report, the used technique was explained with all steps and was combined with guided bone regeneration (GBR). The particularity of this case was the membrane exposure during the healing period before placing the crowns, resulting in bone resorption. This resorption was stable after restauration and follow-up. Ridge split is indicated in cases where the width of the ridge is at least 3.5 mm. The procedure demonstrated a safe and predictable alternative for implant placement in a knife-edge ridge, with a high survival rate of ridge expansion. The patient presented good healing at the follow-up with a little resorption that remained stable in time after crown placing.

Alveolar ridge preservation in implant dentistry: A hype or buzz? – A review

Article

Full-text available

Dec 2024

Alveolar Ridge Preservation (ARP) in implant dentistry aims to preserve the existing soft and hard tissue envelope, further maintaining a stable alveolar ridge volume so as to simplify implant placement, improve functional, aesthetic outcomes, reducing need for further bone augmentation during implant placement, enhance survival and success rate, reduction of biological and technical complications associated with dental implants. Although literature suggests that application of ARP may reduce the need for further, simultaneous bone augmentation with respective to implant placement, this review article is an attempt to discuss various ARP techniques after tooth extraction.

Relationship between flap microcirculation and hard tissue changes following alveolar ridge augmentation: a prospective case series

Article

Dec 2024

Objectives: To assess blood flow alterations after horizontal Guided Bone Regeneration (GBR) and to evaluate correlations between blood flow and hard tissue changes. Method and materials: Twelve mandibular surgical sites were involved in the current case series. GBR was carried out using a split-thickness flap design. Blood circulation was assessed with Laser Speckle Contrast Imaging at baseline as well as 1, 4, 6, 11, 13, 20, 27, and 34 days after the surgery, subsequently on a monthly basis until 6 months. Hard tissue alterations were measured horizontally and vertically using linear measurements. The first measurement point was 2 mm distal to the distal surface of the last tooth; additional measurement points were placed every 3 mm up to the 15th mm. Volumetric hard tissue loss and gain were also assessed. Results: Baseline blood circulation was statistically significantly higher on the buccal side. On the first postoperative day, all regions presented a statistically significant decrease in blood flow circulation. The buccal-inner region presented significant ischemia on day 6. Mean volumetric hard tissue gain and loss were 712.62 ± 317.08 mm3 and 222.431 ± 103.19 mm3, respectively. Mean baseline alveolar ridge width was 4.82 ± 1.02 mm, 6 months ridge width averaged 7.21 ± 0.99 mm. Vertical resorption measured 1.24 ± 0.5 mm. Correlations between blood flow changes and hard tissue alterations were only found on Day 34 and Day 60. Conclusion: Laser Speckle Contrast Imaging is an efficient method to measure flap microcirculation. No correlation was found between flap microcirculation changes hard tissue and alterations.

Management of the Alveolar Ridge Preservation after Tooth Extraction: A Review

Article

Jun 2021

This review aims to evaluate the scientific evidence on the efficacy in the surgical protocols designed for preserving the alveolar ridge after tooth extraction and to evaluate how these techniques affect the placement of dental implants and the final implant supported restoration. Alveolar ridge preservation (ARP) procedures have become one of the most commonly performed surgical procedures in dentistry, due to increased demand for dental implant therapy. Previous studies have repeatedly shown a naturally healed socket could lose up to 50% of its buccolingual width, which in turn would negatively impact the future implant placement. ARP procedures have been shown to consistently reduce the amount of post-extraction horizontal and vertical bone loss; however, it is still not conclusive which biomaterial or technique is the most superior. The purpose of this article is to review current evidence on various ARP procedures.

Treatment Options for the Management of the Postextraction Socket: Report From the First Giuseppe Cardaropoli Foundation Consensus Conference

Article

Feb 2025
J PERIODONTAL RES

Aim Different approaches have been proposed for implant placement following tooth extraction. A Consensus conference was organised to provide expert‐based recommendations for the treatment of the postextraction site in the aesthetic zone in conjunction with implant therapy. Methods A panel of eight experts with a documented longstanding clinical and research experience in the field of implant therapy in the aesthetic zone were invited to participate in a structured survey. Participants were asked to select their preferred treatment approach for different clinical scenarios of the postextraction site from a list of different treatment options. Results were summarised and discussed in person at a 2 day consensus conference. Based on the outcome, treatment recommendations were phrased and are reported here. Results The group agreed that in case of an intact alveolus, immediate implant placement with immediate prosthetics represents the reference choice if proper primary stability can be achieved and the buccal bone plate is present. A bone‐to‐implant gap more than 2 mm should be seeked and grafted. Alveolar ridge preservation and early placement with contour augmentation may represent an alternative. If the alveolus is compromised, a staged approach (early or delayed placement) with bone augmentation may be preferred. Conclusions The characteristics of the site, in terms of the available bone volume, the integrity of the buccal bone plate and the periodontal phenotype are determining factors in the therapeutic choice. Therefore, case selection based on well‐defined selection criteria is extremely important and is the adequate way to guide the clinician in choosing the most appropriate approach to postextraction site management and timing for implant placement.

Ridge Augmentation Using a Self-Retaining Block Bone Material in Damaged Extraction Sockets: A Multi-Centre Randomized Controlled Clinical Trial

Article

Feb 2025
J CLIN PERIODONTOL

Aim To compare the dimensional stability of a self‐retaining synthetic block bone (srBB) and synthetic bone particles (SBP) for alveolar ridge augmentation (ARA) in damaged extraction sockets. Materials and Methods ARA was randomly performed in two centres on 57 participants presenting damaged extraction socket in a non‐molar tooth: (i) srBB and collagen membrane (srBB group, n = 29) or (ii) SBP and collagen membrane (SBP group, n = 28). Cone beam computed tomography (CBCT) was performed immediately after ARP (baseline, T0) and at 6 months (T1). T0 and T1 CBCTs were superimposed, and horizontal widths (H0–H5), vertical heights and volume changes were assessed using t ‐test. Results Due to wound dehiscence, srBB was removed in 10 patients. The change in horizontal width at the most coronal level (H0) was significantly lower for srBB compared to SBP (srBB: 0.8 ± 1.0 mm; SBP: 1.9 ± 2.2 mm, p < 0.05). Significantly less volume decrease was seen at the bucco‐coronal level for srBB (srBB: 3.2 ± 0.6 mm ³ ; SBP: 10.4 ± 2.3 mm ³ , p < 0.05). Conclusion Compared to synthetic bone particles, synthetic bone blocks have the potential to more effectively augment and maintain the coronal horizontal dimension and width of damaged extraction sockets for up to 6 months. However, this advantage is offset by their relatively high rates of early wound dehiscence. Trial Registration: Korean Clinical Research information service ( CRIS ) ( KCT0005462 )

Optimizing β-TCP with E-rhBMP-2-Infused Fibrin for Vertical Bone Regeneration in a Mouse Calvarium Model

Article

Feb 2025

Effective reconstruction of large bone defects, particularly in thickness, remains one of the major challenges in orthopedic and dental fields. We previously produced an E. coli-based industrial-scale GMP-grade recombinant human bone morphogenetic protein-2 (E-rhBMP-2) and showed that the combination of E-rhBMP-2 with beta-tricalcium phosphate (β-TCP/E-rhBMP-2) can effectively promote bone reconstruction. However, the limited mechanical strength and poor morphology retention of β-TCP granules are key points that need optimization to obtain more effective grafts and further expand its clinical applications. Therefore, we combined β-TCP/E-rhBMP-2 with fibrin gel to enhance its mechanical properties and usability for vertical bone regeneration. We investigated the mechanical properties and vertical bone regeneration effects of the materials, applied in conjunction with fibrin containing or not E-rhBMP-2 in a calvarial defect model in mice. Compression tests were conducted to assess the initial stability of the materials. Scanning electron microscope and Fourier transform infrared spectroscopy studies were conducted to characterize the presence of fibrin onto the scaffold. After 4 and 12 weeks of implantation, micro-computed tomography and histological and immunofluorescent analyses were performed to assess the morphology and volume of the newly formed bone. The fibrin-containing groups had significantly higher initial mechanical strength and higher ability to maintain their morphology in vivo compared to the counterparts without fibrin. However, fibrin gel alone suppressed the bone formation ability of β-TCP/E-rhBMP-2 whereas the presence of high doses of E-rhBMP-2 in fibrin gel resulted in material resorption and enhanced new bone formation. In conclusion, fibrin gel significantly improved the mechanical strength and surgical manageability of the β-TCP/E-rhBMP-2 scaffold, and the addition of E-rhBMP-2 to the fibrin gel further enhanced the vertical bone regeneration and initial structural integrity of the scaffold.

A Retrospective Case Series of Decoronation and Root Submergence With Long-Term Follow-Up: Trend Analysis of Provisional Restoration Survival and Marginal Bone Development

Article

Feb 2025
DENT TRAUMATOL

Background Dentoalveolar ankylosis posttrauma or external cervical resorption (ECR) post orthodontics might affect permanent teeth in growing individuals. Decoronation and root submergence attempt to minimize the impact of these sequelae. This is one of the few reports in which the survival of provisional restorations and preservation of the marginal bone post long‐term follow‐up of this treatment modality were evaluated for several cases. Materials and Methods Nine upper permanent incisors with ankylosis or ECR, treated using decoronation and root submergence were examined. The qualitative changes in the vertical dimension of the alveolar ridge were measured on periapical radiographs by means of a three‐point scoring system, and the time to moderate and considerable bone increase was assessed using Kaplan–Meier curves. The quantitative changes in vertical bone dimension were measured on the periapical radiographs and the inter‐rater reliability was assessed. The survival of the temporary restoration post decoronation and the presence of root remnants were evaluated. The mean age of the patients was 11 years at the time of trauma and 15.3 years when decoronated. The follow‐up period post decoronation was 1.5–8.5 years (mean 3.5 years). Post decoronation, quantitatively, 5 cases presented a slight bone increase (0.01–2 mm) and 4 unchanged or slightly decreased bone levels (0.2–1.3 mm). Qualitatively, 60% (95% CI; 15%–90%) of the female patients showed moderate bone increase and 40% (95% CI; 10%–70%) considerable, respectively, 1.7–8.3 and 2.5–8.3 years post decoronation. Age was inversely proportional with bone increase, independent of gender. At 1.5 years follow‐up, root remnants were present in all cases. The tooth shaped as a pontic failed the most as a temporary restoration. Conclusion Despite limitations, the following can be concluded: decoronation and root submergence of permanent incisors in growing individuals seem promising in terms of long‐term vertical alveolar ridge preservation. The restorative temporary replacement of decoronized teeth is challenging.

Effect of initial bone morphology on alveolar bone remodeling following molar extraction: A retrospective study

Article

Jan 2025
J PERIODONTOL

Background The clinical evidence about alveolar ridge changes following molar extraction and how the alveolar bone morphology influences the ridge dimensional changes remains limited. Methods A total of 192 patients with 199 molar extractions were included in this retrospective study. Cone‐beam computed tomography (CBCT) images of patients were obtained 0–3 months pre extraction and 6–12 months post extraction. Outcome variables included the change rate in ridge height and width. The effect of morphology on the outcomes was explored by single‐factor analysis, correlation analysis, and a multiple linear regression model. Results Significant resorption of alveolar bone occurred vertically and horizontally after molar extraction. Jaw, furcation involvement, number of roots, number of bone wall defects, extraction reasons, overall relative bone loss (RBL), bone height of the furcation region, thickness of the lingual/palatal wall, and height difference between buccal and lingual/palatal walls (|HB‐HL|) were significantly correlated with the change in the height of the central alveolar bone (HC). The number of bone wall defects, overall RBL, and |HB‐HL| were significantly correlated with horizontal width change. HC resorption was higher in sockets with |HB‐HL| > 2.5 mm and overall RBL > 50%. Conclusions The alveolar bone presented significant resorption after extraction. Anatomical characteristics affected the dimensions of the alveolar bone after molar extraction. When the initial overall RBL was severe or |HB‐HL| was larger, the loss of alveolar bone dimensions was even more. Plain Language Summary In recent years, it has been demonstrated that the local anatomical morphology of extraction sites may influence the process of alveolar bone remodeling. However, most studies have focused on the anterior teeth, with fewer investigations addressing molar extraction sites. Therefore, we aimed to describe ridge changes following molar extraction and investigate how alveolar bone morphology influences ridge dimensional changes. In this retrospective study, we included a total of 199 alveolar sockets from 192 patients with molar extractions and obtained the corresponding cone‐beam computed tomography (CBCT) images 0–3 months pre extraction and 6–12 months post extraction. The results showed significant resorption of the alveolar bone following molar extraction. We found that anatomical characteristics significantly affect the dimensions of the alveolar bone after molar extraction. Specifically, the loss of alveolar bone dimensions was greater when the initial overall relative bone loss (RBL) was severe or when the difference between buccal and lingual/palatal walls was greater.

Préparation orthodontique à l’implantologie

Article

Jan 2015

A. Costi

Implantologie dans le plan de traitement parodontal

Article

Jan 2017

Anatomie de l’édenté

Article

Nov 2022

Conception du traitement implantoprothétique : principes fondamentaux

Article

Dec 2024

R. Jaquet

Préparation orthodontique à l’implantologie

Article

Jan 2015

A. Costi

Préparation orthodontique à l’implantologie

Article

Jan 2015

A. Costi

Chirurgie pré-prothétique

Article

Jul 2021

Chirurgie pré-prothétique

Article

Sep 2020

Implantologie dans le plan de traitement parodontal

Article

Jan 2018

Characterization of craniofacial tissue aging in genetically diverse HET3 male mice with longevity treatment of 17-alpha estradiol

Article

Dec 2024
ARCH ORAL BIOL

Prospects for developing domestic instruments for dental implantation in various clinical conditions

Article

Jan 2024

Treatment Outcome of Using Guided Bone Regeneration for Bone Augmentation for the Placement of Dental Implants – A Systematic Review

Article

Dec 2024

A BSTRACT Aim The objective of this review is to evaluate the treatment outcome differences between guided bone regeneration (GBR) and other techniques of bone augmentation for the placement of dental implants. Materials and Methods This review was performed by two reviewers electronically on the PubMed and Cochrane database for articles published between 1990 and 2023. Only randomized clinical trials (RCTs) and prospective studies were included. Studies involved patients who have been treated with dental implants with simultaneous or previously performed GBR. Results and Discussion A total of 470 studies were identified after implementing the search strategy across the different databases. The results that have been reported may also be influenced by these factors. Conclusion After a careful evaluation of the limited evidence included in studies, it can be concluded that GBR is a stable and effective technique of bone augmentation when compared to block grafting and distraction osteogenesis.

Objectives of Preprosthetic Surgery

Chapter

Dec 2024

Surgical Guidelines for Dental Implant Placement

Chapter

Dec 2024

The goal of implant surgery is to provide reliable support for a restoration that can satisfy a patient’s functional and aesthetic expectations. To achieve this goal, interdisciplinary planning amongst restorative and surgical disciplines is required with a clear understanding of patient needs. Patient expectations should be carefully evaluated and at times adjusted to ensure a realistic outcome with presenting anatomical, systemic and local patient-specific risk factors. The term “restorative-driven” treatment planning is used to refer to interdisciplinary and patient-centred planning (Garber, Compend Contin Educ Dent 16:796–804, 1995). Such planning requires input form members of different disciplines such as restorative, surgical, orthodontic and endodontics to develop an interdisciplinary treatment plan. Treatment planning should include patient’s: Systemic and psychological fitness for treatment Diagnosis and classification of periodontal and dentoalveolar conditions Treatment needs and prognosis of remaining dentition The goal of such detailed planning is to align patient expectations with achievable treatment outcomes prior to initiating treatment based on patient-specific risk factors for implant therapy. Only when the goals have been defined can the sequence of therapy be established, and then patients can be informed about the extent of their treatment and the options available for their treatment (Zitzmann NU, Margolin MD, Filippi A, Weiger R, Krastl G. Patient assessment and diagnosis in implant treatment. Aust Dent J. 2008;53(Suppl 1):S3–10; Spear F. The challenges of presenting interdisciplinary treatment. Adv Esthet Interdiscip Dent. 2005;1:2).

A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots

Article

Full-text available

Feb 2006

The objective of this investigation was to determine the fate of thin buccal bone encasing the prominent roots of maxillary anterior teeth following extraction. Resorption of the buccal plate compromises the morphology of the localized edentulous ridge and makes it challenging to place an implant in the optimal position for prosthetic restoration. In addition, the use of Bio-Oss as a bone filler to maintain the form of the edentulous ridge was evaluated. Nine patients were selected for the extraction of 36 maxillary anterior teeth. Nineteen extraction sockets received Bio-Oss, and seventeen sockets received no osteogenic material. All sites were completely covered with soft tissue at the conclusion of surgery. Computerized tomographic scans were made immediately following extraction and then at 30 to 90 days after heating so as to assess the fate of the buccal plates and resultant form of the edentulous sites. The results were assessed by an independent radiologist, with a crest width of 6 mm regarded as sufficient to place an implant. Those sockets treated with Bio-Oss demonstrated a loss of less than 20% of the buccal plate in 15 of 19 test sites (79%). In contrast, 12 of 17 control sockets (71%) demonstrated a loss of more than 20% of the buccal plate. In conclusion, the Bio-Oss test sites outperformed the control sites by a significant margin. No investigator was able to predict which site would be successful without the grafting material even though all were experienced clinicians. This leads to the conclusion that a patient has a significant benefit from receiving grafting materials at the time of extraction.

Cola beverage consumption delays alveolar bone healing: A histometric study in rats

Article

Full-text available

Jun 2010
Braz Oral Res

Abstract: Epidemiological studies have suggested that cola beverage consumption may affect bone metabolism and increase bone fracture risk. Experimental evidence linking cola beverage consumption to deleterious effects on bone is lacking. Herein, we investigated whether cola beverage consumption from weaning to early puberty delays the rate of reparative bone formation inside the socket of an extracted tooth in rats. Twenty male Wistar rats received cola beverage (cola group) or tap water (control group) ad libitum from the age of 23 days until tooth extraction at 42 days and euthanasia 2 and 3 weeks later. The neoformed bone volume inside the alveolar socket was estimated in semi-serial longitudinal sections using a quantitative differential point-counting method. Histological examination suggested a decrease in the osteogenic process within the tooth sockets of rats from both cola groups, which had thinner and sparser new bone trabeculae. Histometric data confirmed that alveolar bone healing was significantly delayed in cola-fed rats at three weeks after tooth extraction (ANOVA, p = 0.0006, followed by Tukey’s test, p < 0.01). Although the results of studies in rats cannot be extrapolated directly to human clinical dentistry, the present study provides evidence that cola beverage consumption negatively affect maxillary bone formation.

Bone healing after dental extractions in irradiated patients: a pilot study on a novel technique for volume assessment of healing tooth sockets

Article

Full-text available

Sep 2008

The aim of this study was to evaluate longitudinally the bone-healing process by measuring volumetric changes of the extraction sockets in head and neck cancer patients undergoing radiotherapy after tooth extraction. A total group of 15 patients (nine males, six females) undergoing tooth extraction at the Department of Periodontology (University Hospital KULeuven) were enrolled after giving informed consent. In seven patients, teeth presenting a risk for complications and eventual radionecrosis were extracted prior to the radiotherapeutical procedure. Monitoring of bone healing was performed by evaluating the volumetric changes of the alveoli by cone beam CT scanning (CBCT) at extraction and after 3 and 6months. In parallel, a similar longitudinal evaluation of extraction sites was done in a control group of eight patients. Within this pilot-study, a total of 15 healing extraction sockets were evaluated and followed up. There was a significant difference in volumetric fill up of extraction sockets in test group vs. control group at three (37.1 ± 7.9%) vs. (54.6 ± 4.0%) and 6months (47.2 ± 8.8%) vs. (70.0 ± 7.3%), respectively. The present pilot study demonstrated the clinical usefulness of CBCT for evaluation of extraction socket healing. The study objectively demonstrates the delayed bone healing after tooth extraction in irradiated head and neck cancer patients. Considering the limitations of this pilot study, a potential effect of radiotherapy on further jaw bone healing after pre-therapeutic tooth extractions should be further explored.

The influence of platelet-rich plasma on the healing of extraction sockets: An explorative randomised clinical trial

Article

Full-text available

Jun 2010

To investigate the effect of platelet-rich plasma (PRP) on the healing of hard and soft tissues of extraction sockets with a pilot study. Patients undergoing tooth extraction under intravenous sedation were asked to participate in the trial. Autologous platelet concentrates were prepared from the patients' blood and autologous thrombin was produced. Outcome measures were: pain level, analgesic consumption, oral function (ability to eat food, swallowing, mouth opening and speech), general activity, swelling, bruising, bleeding, bad taste or halitosis, food stagnation, patient satisfaction, healing complications, soft tissue healing, trabecular pattern of newly formed bone in extraction sockets, trabecular bone volume, trabecular separation, trabecular length, trabecular width, and trabecular number. Patients were followed up to 3 months post-extraction. Twelve patients (15 sockets) were randomly allocated to the PRP group and 11 patients (14 sockets) to the control group. Two patients from the control group did not attend any of the scheduled appointments following tooth extraction, and were considered dropouts. Additionally, one more patient from the control group and four patients from the PRP group did not attend their 3-month radiographic assessment appointments. Statistically significantly more pain was recorded in the control group for the first (P=0.02), second (P=0.02) and third (P=0.04) post-operative days for Visual Analogue Scale scores, whereas no differences were observed for the fourth (P=0.17), fifth (P=0.38), sixth (P=0.75) and seventh (P=0.75) post-operative days. There was a statistically significantly higher analgesic consumption for the first (P=0.03) and second (P=0.02) post-operative days in the control group and no differences thereafter. Differences in patients' responses in the health-related quality of life questionnaire were statistically significant in favour of PRP treatment only for the presence of bad taste or bad smell in the mouth (P=0.03), and food stagnation in the operation area (P=0.03). The difference between groups was not statistically significant for patient satisfaction with the treatment (P=0.31). Regarding complications, two dry sockets and one acutely inflamed alveolus occurred in patients of the control group, which determined a borderline statistically significant difference in favour of the PRP group (P=0.06). Soft tissue healing was significantly better in patients treated with PRP (P=0.03). Radiographic evaluation carried out by the two blinded examiners revealed a statistically significant difference (P=0.01) for sockets with dense homogeneous trabecular pattern, a borderline statistically significant difference in the trabecular pattern for bone volume (P=0.06) favouring PRP use, and no significant differences for trabecular separation (P=0.66), trabecular length (P=0.16), trabecular width (P=0.16) and trabecular number (P=0.38). PRP may have some benefits in reducing complications such as alveolar osteitis and improving healing of soft tissue of extraction sockets. There were insufficient data to support the use of PRP to promote bone healing or to enhance the quality of life of patients following tooth extraction, although the sample size was too small to detect statistically significant differences.

Socket Grafting in the Posterior Maxilla Reduces the Need for Sinus Augmentation

Article

Full-text available

Jun 2010

This study compared the dimensional alterations, the need for sinus floor elevation, and the histologic wound healing of augmented and nonaugmented alveolar sockets. Sixteen human extraction sockets were either grafted or left untreated. At baseline and 3 and 6 months postextraction, alveolar ridge alterations were evaluated; at 3, 6, and 9 months, histologic analyses were conducted. Implant placement with or without sinus floor augmentation was decided at 6 months. Three of eight patients in the control group underwent sinus floor augmentation compared to one of six in the experimental group. The alveolar ridge augmentation procedure presented here increases the possibility of inserting implants without the need for a sinus augmentation procedure.

Histomorphometric analysis of rat alveolar wound healing with hydroxyapatite alone or associated to BMPs

Article

Full-text available

Jan 2002
Braz Dent J

Several materials and techniques have been proposed to improve alveolar wound healing and decrease loss of bone height and thickness that normally follow dental extraction. The objective of this research was the histologic analysis of bone morphogenetic proteins implanted into dental alveoli of rats after extraction. A total of 45 adult male Wistar rats were divided into three groups of 15 animals each: control (no treatment), implanted with pure hydroxyapatite (HA, 3 mg) and implanted with hydroxyapatite plus bone morphogenetic proteins (HA/BMPs, 3 mg). Five animals from each group were sacrificed at 7, 21 and 42 days after extraction for the histometric analyses of the osteoconductive potential of hydroxyapatite associated or not with BMPs. After dissection, fixation, decalcification and serial microtomy of 6-mm thick sections, the samples were stained with hematoxylin-eosin for histologic and histometric analyses. Both HA and HA/BMPs caused a delay in wound healing compared to control animals, evaluated by the percentage of bone tissue in the alveoli. The treatment with HA/BMPs had the greatest delay at 21 days, even though it produced values similar to the control group at 42 days. The materials did not improve alveolar repair in the normal period of wound healing and the association of HA/BMPs did not have osteoconductive properties with granulated hydroxyapatite as the vehicle.

Bone healing after dental extractions in irradiated patients: A pilot study on a novel technique for volume assessment of healing tooth sockets

Article

Full-text available

Dec 2008
CLIN ORAL INVEST

The aim of this study was to evaluate longitudinally the bone-healing process by measuring volumetric changes of the extraction sockets in head and neck cancer patients undergoing radiotherapy after tooth extraction. A total group of 15 patients (nine males, six females) undergoing tooth extraction at the Department of Periodontology (University Hospital KULeuven) were enrolled after giving informed consent. In seven patients, teeth presenting a risk for complications and eventual radionecrosis were extracted prior to the radiotherapeutical procedure. Monitoring of bone healing was performed by evaluating the volumetric changes of the alveoli by cone beam CT scanning (CBCT) at extraction and after 3 and 6 months. In parallel, a similar longitudinal evaluation of extraction sites was done in a control group of eight patients. Within this pilot-study, a total of 15 healing extraction sockets were evaluated and followed up. There was a significant difference in volumetric fill up of extraction sockets in test group vs. control group at three (37.1 +/- 7.9%) vs. (54.6 +/- 4.0%) and 6 months (47.2 +/- 8.8%) vs. (70.0 +/- 7.3%), respectively. The present pilot study demonstrated the clinical usefulness of CBCT for evaluation of extraction socket healing. The study objectively demonstrates the delayed bone healing after tooth extraction in irradiated head and neck cancer patients. Considering the limitations of this pilot study, a potential effect of radiotherapy on further jaw bone healing after pre-therapeutic tooth extractions should be further explored.

Xenograft Versus Extraction Alone for Ridge Preservation After Tooth Removal: A Clinical and Histomorphometric Study

Article

Full-text available

Sep 2008

The preservation of bone volume immediately after tooth removal might be necessary to optimize the success of implant placement in terms of esthetics and function. The objectives of this randomized clinical trial were two-fold: 1) to compare the bone dimensional changes following tooth extraction with extraction plus ridge preservation using corticocancellous porcine bone and a collagen membrane; and 2) to analyze and compare histologic and histomorphometric aspects of the extraction-alone sites to the grafted sites. Forty subjects who required tooth extraction and implant placement were enrolled in this study. Using a computer-generated randomization list, the subjects were randomly assigned to the control group (EXT; extraction alone) or to the test group (RP; ridge-preservation procedure with corticocancellous porcine bone and collagen membrane). The following parameters were assessed immediately after extraction and 7 months prior to implant placement: plaque index, gingival index, bleeding on probing, horizontal ridge width, and vertical ridge changes. A bone biopsy was taken from the control and test sites 7 months after the surgical treatment. Histologic and histomorphometric analyses were also performed. A significantly greater horizontal reabsorption was observed at EXT sites (4.3+/-0.8 mm) compared to RP sites (2.5+/-1.2 mm). The ridge height reduction at the buccal side was 3.6+/-1.5 mm for the extraction-alone group, whereas it was 0.7+/-1.4 mm for the ridge-preservation group. Moreover, the vertical change at the lingual sites was 0.4 mm in the ridge-preservation group and 3 mm in the extraction-alone group. Forty biopsies were harvested from the experimental sites (test and control sites). The biopsies harvested from the grafted sites revealed the presence of trabecular bone, which was highly mineralized and well structured. Particles of the grafted material could be identified in all samples. The bone formed in the control sites was also well structured with a minor percentage of mineralized bone. The amount of connective tissue was significantly higher in the extraction-alone group than in the ridge-preservation group. The ridge-preservation approach using porcine bone in combination with collagen membrane significantly limited the resorption of hard tissue ridge after tooth extraction compared to extraction alone. Furthermore, the histologic analysis showed a significantly higher percentage of trabecular bone and total mineralized tissue in ridge-preservation sites compared to extraction-alone sites 7 months after tooth removal.

Histomorphometric evaluation of the effect of bovine collagen granules on bone healing. An experimental study in rats.

Article

Jan 2004

Collagen materials have been utilized in medicine and dentistry because of their proven biocompatibility and capability of promoting wound healing. The aim of the present experimental study was to perform a histomorphometric evaluation of the effect of bovine collagen granules on post-extraction alveolar wound healing in rats. Twenty male Wistar rats were submitted to bilateral extraction of the first lower molars under ketamine/xylazine anesthesia according to the technique previously described by Guglielmotti and Cabrini. Sterile Bovine collagen granules of approximately 80 +/- 10 microm (Membracel G, Lab. Celina, Buenos Aires) were hydrated with saline solution and placed into the right mesial socket (experimental side) with gentle pressure, completely filling the site. The contralateral sockets were considered as the control side. Sutures were not performed. After surgery neither special diet nor antibiotics were given. The rats were fed rat chow and water ad libitum. All the animals were killed on the 30th day following surgery by ether overdose. The jaws were dissected, radiographed, decalcified, and embedded in paraffin. Sections were obtained at the level of the first molar mesial socket in a buccolingual orientation and stained with hematoxylin-eosin. The trabecular area and volume density of trabecular bone were measured histomorphometrically. The trabecular area was greater in alveoli treated with collagen granules than in control alveoli (P<0.05). Values of volume density of trabecular bone were greater in experimental than in control sockets (P<0.05). This experimental study provides evidence for the use of bovine collagen granules as bone grafting material, as a therapeutic alternative to fill postextraction sockets.

Variance of a Weighted Mean

Article

Mar 1953

Paul Meier

Alveolar wound healing under uranyl nitrate intoxication

Article

Aug 1985
J ORAL PATHOL MED

The deposit of uranium compounds in calcifying zones has been demonstrated in hone. Nevertheless, no studies on the effect of uranium on osteogenesis have been performed. A histologic and histometric study of the effect of a single intraperitoneal injection of 2 mg/kg of body weight of uranyl nitrate on bone formation is presented. It was performed on rats' healing sockets. 14 days after tooth extraction. The alveolar bone volume (15 × 105μm2 vs. 34 × 105μm2), total bone formation areas (4.85% vs. 19.55%). and volume density of bone in the alveolar apical third (0.26 vs. 0.40) were significantly lower in intoxicated animals than in the controls. These results indicate the inhibitory effect of uranyl nitrate on bone formation.

Alveolar ridge reconstruction and/or preservation using root form bioglass cones

Article

Oct 1998
J CLIN PERIODONTOL

Extraction of a tooth necessitated by factors such as developmental problems, trauma, severe periodontal disease and endodontic problems often causes deformities of the residual alveolar ridge in the maxillary anterior region. These cases are usually difficult to restore prosthetically and they result in poor esthetics and insufficient occlusal function. This study investigated the efficacy of root form bioactive glass cones implanted into (a) artificial sockets produced by bone splitting of previous extraction sites (group BS) and (b) fresh extraction sockets (group FES), We included conventional extraction sockets sutured without implanting the root form bioactive glass cones as a control (group C). A total of 16 patients were treated for whom extractions had been indicated due to severe periodontitis, 6 patients with 7 implant sites having Class II or III alveolar ridge deformities comprised the BS group. 5 patients with 10 implant sites comprised the FES group. Group C, comprised 5 patients with 10 extraction sites. Alveolar ridge width and height measurements were obtained using study casts preoperatively, immediately postoperatively. and at 3 and 12 months after operation. In the BS group, while the width of the alveolar ridge increased by 2.8 ± 1.18mm immediately after ridge augmentation procedure and by 2.4±0.93 mm at 1 year after operation (p<0.01), the height of the alveolar ridge increased by 1.8±1.99 mm and 1.4±1.74 mm respectively (p<0.05). In the FES group, the differences between preoperative original ridge height and width and postoperative measurements were not statistically significant, which demonstrated the efficiency of this method in preserving the alveolar ridge. In group C, while alveolar ridge width after 12 months had not Significantly changed, alveolar ridge height decreased significantly (1.35±1.05 mm. p<0.01). After 12 months, no dehiscences were detected and the differences in height between the groups remained significant. The results of this study indicate that this procedure is efficient in reconstructing alveolar ridges deformed as a result of extraction, particularly relevant in relation to preparation for subsequent restorative treatment.

Change in supporting tissue following loss of a permanent maxillary incisor in children

Article

Dec 2007
DENT TRAUMATOL

Abstract – Alveolar bone resorption is an inevitable consequence of tooth loss and may be detrimental to long-term dental aesthetics and function. The aim of the present study was to quantify the degree of tissue resorption following the loss of a permanent incisor in a young population. The study group comprised 11 boys and five girls who all required the extraction of a permanent maxillary central incisor due to trauma-related sequelae. Mean age at tooth loss was 10.8 years. Upper alginate impressions were taken at regular intervals following tooth loss and were cast in yellow dental stone. Study models were sectioned longitudinally through the mid-point of both the maxillary incisor socket and the contra-lateral incisor to provide a thin plaster section. Digital photographs were acquired of the edentulous (A1) and dentate (A2) surfaces of this section and image analysis software was employed to quantify the surface area of both A1 and A2. At 3 months postextraction, mean A1 was 15.7% less than mean A2. By 6 months mean A1 had further reduced and was 25.3% less than that of the corresponding dentate alveolus. However, at subsequent time intervals following tooth extraction (>6 months), tissue loss appeared to stabilise with an overall reduction in tissue area remaining at 22%. This reduction in supporting tissue area was found to be highly statistically significant (P = 0.002, anova). Furthermore, girls appeared to have an overall greater degree of tissue loss than boys (P = 0.015). Further research is indicated to explore factors influencing the degree of tissue loss following incisor extraction and the benefit of therapeutic interventions in limiting this resorption.

Ridge preservation following tooth extraction: A comparison between atraumatic extraction and socket seal surgery

Article

Jul 2010

To evaluate whether alveolar ridge resorption following tooth extraction could be prevented or reduced using absorbable collagen material impregnated with gentamicin and sealed with an autogenous soft tissue graft to stabilize the extraction clot, and to compare this with natural healing by clot formation using a classic extraction technique. A total of 125 patients providing 173 extraction sites were included in the study. Three extraction protocols were compared: atraumatic extraction (group A, n = 101 extraction sites), atraumatic extraction sealing the socket with autogenous soft tissue graft (group B, n = 39), and atraumatic extraction with socket seal surgery and collagen matrix impregnated with gentamicin (group C, n = 33). Silicone impressions were made before and 3 months after extraction. Casts were used to measure the width of the alveolar bone at the extraction area using the incisal edge of the adjacent teeth as a reference point. The clinical measurement 3 months after extraction revealed a loss of bone width of 0.3 +/- 0.5 mm in group A, 0.8 +/- 0.7 mm in group B, and 0.1 +/- 0.1 mm in group C. There was no significant difference in bone resorption in extraction sites among the groups (P > .05). However, the difference between group A and group C was borderline significant (P = .07). After 10 days, 31 grafts from group C and 30 grafts from group B remained vital. It seems that extraction technique affects alveolar bone resorption, regardless of whether the socket is treated with free gingival graft or bone graft. Further, the local application of gentamicin presented more vascular ingrowth in the blood clot and granulation tissue beneath the graft, thereby supplying better nourishment during the initial healing phase of the graft.

Clinical and histomorphometric evaluation of extraction sockets treated with an autologous bone marrow graft

Article

Mar 2010
CLIN ORAL IMPLAN RES

The aim of this study was to evaluate the potential of an autologous bone marrow graft in preserving the alveolar ridges following tooth extraction. Thirteen patients requiring extractions of 30 upper anterior teeth were enrolled in this study. They were randomized into two groups: seven patients with 15 teeth to be extracted in the test group and six patients with 15 teeth to be extracted in the control group. Hematologists collected 5 ml of bone marrow from the iliac crest of the patients in the test group immediately before the extractions. Following tooth extraction and elevation of a buccal full-thickness flap, titanium screws were positioned throughout the buccal to the lingual plate and were used as reference points for measurement purposes. The sockets were grafted with an autologous bone marrow in the test sites and nothing was grafted in the control sites. After 6 months, the sites were re-opened and bone loss measurements for thickness and height were taken. Additionally, before implant placement, bone cores were harvested and prepared for histologic and histomorphometric evaluation. The test group showed better results (P<0.05) in preserving alveolar ridges for thickness, with 1.14+/-0.87 mm (median 1) of bone loss, compared with the control group, which had 2.46+/-0.4 mm (median 2.5) of bone loss. The height of bone loss on the buccal plate was also greater in the control group than in the test group (P<0.05), 1.17+/-0.26 mm (median 1) and 0.62+0.51 (median 0.5), respectively. In five locations in the control group, expansion or bone grafting complementary procedures were required to install implants while these procedures were not required for any of the locations in the test group. The histomorphometric analysis showed similar amounts of mineralized bone in both the control and the test groups, 42.87+/-11.33% (median 43.75%) and 45.47+/-7.21% (median 45%), respectively. These findings suggest that the autologous bone marrow graft can contribute to alveolar bone repair after tooth extraction.

Dentoalveolar changes after unilateral extractions of mandibular first molars and their influence on third molar development and position

Article

Mar 2010

To investigate the spontaneous tooth position changes after unilateral extraction of mandibular first molars and the influence on third molar position. Panoramic radiographs of 111 individuals (mean age 19 years 8 months) in whom one mandibular first molar was extracted at least 5 years prior. Comparison of all measurements of the control and the affected side was performed by paired Student t test. The mandibular second molars tipped mesially, whereas the premolars, canines, and incisors moved distally toward the extraction space. Vertical alveolar resorption was significant, particularly in older patients. Mesial inclination of the third molar occurred in only subjects in whom this tooth was completely developed. No significant vertical change of the third molars was observed. Unilateral extraction of mandibular first molars causes a significant displacement of all teeth of the affected side toward the extraction site and a progressive vertical bone resorption of this area. The closer the teeth are to the extraction site, the more they are affected. No significant changes were observed on third molar vertical position.

Effects of platelet-rich plasma on healing of alveolar socket: Split-mouth histological and histometric evaluation in Cebus apella monkeys

Article

Oct 2009

The prediction of implant treatment is directly influenced by the quality of the remaining bone after tooth extraction. The purpose of this experimental study was to, histologically and histometrically, evaluate the bone repair process in the central areas of extraction sockets filled with platelet-rich plasma. Four young adult male Cebus apella monkeys were used. The extraction of both right and left inferior second premolars was accomplished. After extraction, in one of the extraction sockets, coagulum was maintained while in the other it was removed; the alveolus was dried with gauze compress and filled up with platelet concentrate. For PRP production, Sonnleitner's protocol was followed. The specimens for histological and histometric assessment were obtained in 30, 90, 120 and 180 days intervals. In 30 days new bone formation was intense in both experimental and control sockets and no significant differences were observed between the two groups. After 90 days of the extraction, while the control group showed signs of decrease in osteogenesis, in the experimental unit, the process of bone formation and fibroblast-like cell proliferation remained intense. After 120 days, the PRP treated socket was occupied by large trabeculae of bone. After 180 days, the control unit was occupied mostly with bone marrow. The experimental unit remained occupied with large amounts of bone tissue. It was possible to conclude that bone repair was enhanced by the use of platelet- rich plasma in alveolar sockets.

Measurement of ridge alterations following tooth removal: A radiographic study in humans

Article

Feb 2010
CLIN ORAL IMPLAN RES

The aim of this study was a radiographic mesiodistal analysis of the shape of the bone crest 3 months after tooth removal. One hundred single tooth extractions were performed on 100 patients because of orthodontic or prosthetic causes. Bite blocks were used for two radiographs: one on the day of extraction and the other after healing of the socket, 3 months later. These X-rays were used to determine: (1) the most apical distance of alveolar ridge resorption, with baseline as the line between bone-to-teeth contact (the greatest distance in bone resorption height) and (2) the mesiodistal distance (MDD) and mesial and distal angles arising after bone tissue modeling. Significant differences (P<0.05) emerged between the MDDs of multiple- [8 mm, 95% confidence interval (CI): 6.09, 9.90] and single-root teeth (5.60 mm, 95% CI: 4.80, 6.50). However, mesial or distal angles or the most apical distance of alveolar ridge resorption did not differ (mean distance in height=4.32 mm, 95% CI: 3.85, 4.78; mean angle=24 degrees ). In this study, the post-extraction mesiodistal bone distance between teeth adjacent to the edentulous ridge depends on the size of the edentulous space. Nevertheless, the distance does not affect the distance in bone loss height. The distance of bone resorption height reaches a balance at the midpoint, which we consider indicative of stable healing. This resorption process must be considered when placing dental implants in fresh extraction sockets, especially in aesthetic sites, because the implant surfaces could be exposed after 3 months.

Histomorphometric analysis and immunolocalization of RANKL and OPG during the alveolar healing process in female ovariectomized rats treated with oestrogen or raloxifene

Article

Nov 2009

To investigate the effects of bone-resorption inhibitors (oestrogen and raloxifene) on the RANKL/OPG balance during the chronology of the alveolar healing process in ovariectomized (OVX) rats by means of immunocolocalization and histomorphometric analysis. One hundred sixty female Wistar rats at 70 days of age were either OVX or sham-operated and divided into four groups: sham, OVX/Oil, OVX with E(2) replacement (17beta-estradiol, 400 microg/month), OVX with RLX treatment (1mg/kg bw/day). The 60-day treatment started 8 days after ovariectomy. The incisors were extracted to allow analysis of 7, 14, 21, 28 and 42 days of wound healing. After obtaining the histological samples, slides were stained with hematoxylin and eosin or subjected to immunocolocalization reaction for RANKL and OPG. Results were quantitatively evaluated. Histomorphometric analysis showed that the sham group presented the highest and OVX/Oil group the lowest mean bone formation value in the post-extraction period. The immunocolocalization analysis showed a larger increase in bone turnover at 7 postoperative days in OVX/Oil and sham groups and decreasing bone turnover in the other periods. The OVX/Oil group showed a large decrease in bone turnover at 14 postoperative days, a period demonstrated by mild cellular activity. OVX/E(2) and sham groups showed a decreased bone turnover at 28 postoperative days while OVX/RLX group showed a decreased bone turnover at 21 postoperative days. On the 42nd postoperative day, sham and OVX/RLX groups showed an established alveolar bone healing process. Ovariectomy delays the alveolar healing process and interferes with bone turnover through the balance between RANKL and OPG. Oestrogen replacement or raloxifene treatment did not totally recover the oestrogen-deficient state. However raloxifene treatment showed more satisfactory results than oestrogen replacement.

Alveolar bone dimensional changes of post-extraction sockets in humans: A systematic review

Article

Dec 2009
J CLIN PERIODONTOL

To review the literature to assess the amount of change in height and width of the residual ridge after tooth extraction. MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through up to March 2009. Appropriate studies which data reported concerning the dimensional changes in alveolar height and width after tooth extraction were included. Approximal height change, mid-buccal change, mid-crestal change, mid-lingual change, Alveolar width change and socket fill were selected as outcome variables. Mean values and if available standard deviations were extracted. Weighted mean changes were calculated. Independent screening of the titles and abstracts of 1244 MEDLINE-PubMed and 106 Cochrane papers resulted in 12 publications that met the eligibility criteria. The reduction in width of the alveolar ridges was 3.87 mm. The mean clinical mid-buccal height loss was 1.67 mm. The mean crestal height change as assessed on the radiographs was 1.53 mm. Socket fill in height as measured relative to the original socket floor was on an average 2.57 mm. During the post-extraction healing period, the weighted mean changes as based on the data derived from the individual selected studies show the clinical loss in width to be greater than the loss in height, assessed both clinically as well as radiographically.

Clinical and Histologic Healing of Human Extraction Sockets Filled with Calcium Sulfate

Article

Sep 2009

The aim of this investigation was to evaluate whether the placement of medical-grade calcium sulfate hemihydrate (MGCSH) in fresh extraction sockets might affect the quality of newly formed bone and influence crestal bone changes. Forty patients who needed maxillary single-tooth extraction followed by implant insertion were enrolled in the study. Alveoli were required to have four remaining intact walls. After tooth extraction, 22 patients received MGCSH in the extraction sockets (test group), and 18 received no grafting material (control group). At the time of extraction and 3 months later (at implant placement surgery), vertical and horizontal socket dimensions were measured. In addition, during implant placement, tissue specimens were harvested for histologic and immunohistochemical evaluations. Comparisons of test and control tissues were performed with the unpaired Student t test. Vertical resorption of the buccal socket walls and reduction of the buccopalatal width were more pronounced at control sites than at MGCSH sites (1.2 mm versus 0.5 mm, and 3.2 mm versus 2.0 mm, respectively). Formation of 100% living trabecular bone with woven and lamellar arrangements was found in both test and control sections. The average trabecular bone area fraction was greater in the grafted specimens than in control specimens (58.8% versus 47.2%). In the test group, the average percentage of lamellar bone increased from 16.4% to 43.6% from the crestal to the apical region and was greater than in unfilled specimens (11.1% coronally, 22.2% apically; P < .0001). MGCSH seems to be effective in accelerating the bone healing process and minimizing alveolar ridge resorption in intact fresh extraction sockets.

Ridge preservation with the use of Bio-Oss® Collagen

Article

Jun 2009
CLIN ORAL IMPLAN RES

In previous short-term studies, it was observed that while the placement of biomaterial in alveolar sockets may promote bone formation and ridge preservation, the graft may in fact also delay healing. The objective of the present experiment was to evaluate the more long-term effect on hard tissue formation and the amount of ridge augmentation that can occur by the placement of a xenogeneic graft in extraction sockets of dogs. Five beagle dogs were used. The third mandibular premolars were hemi-sected. The distal roots were carefully removed. A graft consisting of Bio-Oss collagen was placed in one socket while the contra-lateral site was left without grafting. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections - two from the mesial root and two from the healed socket - were prepared, stained and examined under a microscope. The placement of Bio-Oss collagen in the fresh extraction socket served as a scaffold for tissue modeling but did not enhance new bone formation. In comparison with the non-grafted sites, the dimension of the alveolar process as well as the profile of the ridge was better preserved in Bio-Oss-grafted sites. The placement of a biomaterial in an extraction socket may modify modeling and counteract marginal ridge contraction that occurs following tooth removal.

Ridge alterations following tooth extraction with and without flap elevation: An experimental study in the dog

Article

Jul 2009
CLIN ORAL IMPLAN RES

Different approaches were advocated to preserve or improve the dimension and contour of the ridge following tooth extraction. In some of studies, socket 'flapless extraction' apparently had a successful outcome. Aim: The objective of the present experiment was to compare hard tissue healing following tooth extraction with or without the prior elevation of mucosal full-thickness flaps. Five mongrel dogs were used. The two second mandibular premolars ((2)P(2)) were hemi-sected. The mesial roots were retained. By random selection the distal root in one side was removed after the elevation of full-thickness flaps while on the contralateral side, root extraction was performed in a flapless procedure. The soft tissue wound was closed with interrupted sutures. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections - two from the mesial root and two from the healed socket - were prepared, stained and examined in the microscope. The data showed that the removal of a single tooth (root) during healing caused a marked change in the edentulous ridge. In the apical and middle portions of the socket site minor dimensional alterations occurred while in the coronal portion of the ridge the reduction of the hard tissue volume was substantial. Similar amounts of hard tissue loss occurred during healing irrespective of the procedure used to remove the tooth was, i.e. flapless or following flap elevation. Tooth loss (extraction) resulted in marked alterations of the ridge. The size of the alveolar process was reduced. The procedure used for tooth extraction - flapless or following flap elevation - apparently did not influence the more long-term outcome of healing.

Human histologic evaluation of mineralized collagen bone substitute and recombinant platelet-derived growth factor-BB to create bone for implant placement in extraction socket defects at 4 and 6 months: a case series

Article

May 2009

The objective of this pilot study was to assess whether mineralized collagen bone substitute (MCBS) combined with recombinant human platelet-derived growth factor-BB (0.3 mg/mL) would generate adequate viable bone in buccal wall extraction defects to accommodate implant placement. The primary outcome variable was bone quality, as measured by microcomputed tomography and histologic evaluation. This was successfully accomplished in all eight specimens obtained from seven patients. The secondary outcome variables were bone quality and quantity as observed clinically, radiographically, and by the primary stability of implants at the time of placement. Soft tissue healing was excellent, and there were no unanticipated adverse events. Robust bone formation accompanied by MCBS resorption was evident in all 4- and 6-month specimens. This was accomplished without barrier membranes.

Effect of bismuth subgallate (a hemostatic agent) on bone repair; a histologic, radiographic and histomorphometric study in rats

Article

May 2009
INT J ORAL MAX SURG

Bismuth subgallate (BS) is a hemostatic agent used for soft tissue surgery in otorhinolaryngology and dermatology. Its effect on bone repair has not been studied. The present study undertook a quantitative and qualitative evaluation of post-extraction bone healing in the presence of BS. Under intraperitoneal anesthesia, forty male Wistar rats, 80+/-5g body weight, underwent the extraction of both lower first molars. BS was placed in the right post-extraction socket (group E) and the contralateral socket served as control (group C). The animals were killed in groups immediately, 7, 14 and 30 days post-extraction. The mandibles were resected, radiographed and processed for embedding in paraffin. The mesial socket was sectioned along the bucco-lingual axis and stained with hematoxylin-eosin. Total tissue volume and trabecular bone volume of the apical third of the sockets were determined histomorphometrically. At 14 and 30 days post-extraction, group E exhibited bone tissue that resembled that of group C. Histomorphometric analyses showed no statistically significant differences between groups C and E. Bismuth subgallate did not interfere with post-extraction bone healing. Further studies will analyze the effect of this hemostatic agent on bone repair in aniticoagulated rats.

Bone tissue formation in extraction sockets from sites with advanced periodontal disease: A histomorphometric study in humans

Article

Nov 2008

To investigate postextraction bone formation over time in both diseased and healthy sockets. Core specimens of healing tissues following tooth extraction were obtained at the time of implant placement in patients treated between October 2005 and December 2007. A disease group and a control group were classified according to socket examination at the time of extraction. The biopsy specimens were analyzed histomorphometrically to measure the dimensional changes among 3 tissue types: epithelial layer, connective tissue area, and new bone tissue area. Fifty-five specimens from sites of previously advanced periodontal disease from 45 patients were included in the disease group. Another 12 specimens of previously healthy extraction sockets were collected from 12 different patients as a control. The postextraction period of the disease group varied from 2 to 42 weeks. In the disease group, connective tissue occupied most of the socket during the first 4 weeks. New bone area progressively replaced the connective tissue area after the first 4 weeks. The area proportion of new bone tissue exceeded that of connective tissue by 14 weeks. After 20 weeks, most extraction sockets in the disease group demonstrated continuous new bone formation. The control group exhibited almost complete socket healing after 10 weeks, with no more new bone formation after 20 weeks. Osseous regeneration in the diseased sockets developed more slowly than in the disease-free sockets. After 16 weeks, new bone area exceeded 50% of the total newly regenerated tissue in the sockets with severe periodontal destruction. In the control group, after 8 weeks, new bone area exceeded 50% of the total tissue.

Magnesium-Enriched Hydroxyapatite Compared to Calcium Sulfate in the Healing of Human Extraction Sockets: Radiographic and Histomorphometric Evaluation at 3 Months

Article

Feb 2009

Reduction of alveolar height and width after tooth extraction may present problems for implant placement, especially in the anterior maxilla where bone volume is important for biologic and esthetic reasons. Different graft materials have been proposed to minimize the reduction in ridge volume. The aim of this study was to compare radiographic and histomorphometric results of magnesium-enriched hydroxyapatite (MHA) and calcium sulfate (CS) grafts in fresh sockets after tooth extractions. Forty-five fresh extraction sockets with three bone walls were selected in 15 patients. A split-mouth design was used: 15 sockets on the right side of the jaw received MHA, 15 sockets on the left side received CS, and 15 random unfilled sockets were considered the control (C) group. Intraoral digital radiographs were taken at baseline and at 3 months after graft material placement. At 3 months, cylinder bone samples were obtained for histology and histomorphometry analysis. The difference in mean radiographic vertical bone level from baseline to 3 months was -2.48 +/- 0.65 mm in the CS group, -0.48 +/- 0.21 mm in the MHA group, and -3.75 +/- 0.63 mm in the unfilled C group. Statistically significant differences (P <0.05) were found between CS and MHA groups and between MHA and C groups. Histologic examination revealed bone formation in all treated sites; trabecular bone assessment did not differ among apical, mesial, and coronal portions of the specimens. Mean vital bone measurements for CS, MHA, and C groups were 45.0% +/- 6.5%, 40.0% +/- 2.7%, and 32.8% +/- 5.8%, respectively. Statistically significant differences (P <0.05) were found among all groups. Connective tissue percentages averaged 41.5% +/- 6.7% for the CS group, 41.3% +/- 1.3% for the MHA group, and 64.6% +/- 6.8% for the C group. Statistically significant differences (P <0.05) were found between CS and C groups and between MHA and C groups. The CS-grafted sockets showed 13.9% +/- 3.4% residual implant material, whereas the MHA-treated sockets showed 20.2% +/- 3.2% residual material. The difference between the groups was statistically significant (P <0.05). Radiographs revealed a greater reduction of alveolar ridge in the CS group than in the MHA group. Histologic examination showed more bone formation and faster resorption in the CS group and more residual implant material in the MHA group.

Effects of Prostaglandin E1 Application on Rat Incisal Sockets

Article

Jan 2009

Atrophy of the alveolar ridge is a problem in prosthetic and esthetic treatment. In the present study, to examine effects of PGE1 on the alveolar bone after tooth extraction, PGE1 was applied to rat incisal sockets utilizing a slow drug release system using PLGA as the drug carrier. Thirty-six male Wistar rats, 10 weeks old, were divided into 3 groups. After all right mandibular incisors were extracted, the sockets were treated in the following manner. The first group was untreated (control group), the second group received a PLGA rod (PLGA group), and the third group was treated with a PLGA rod containing 0.5 mg PGE1 (PGE1 group). Six rats in each group were sacrificed at 4 weeks, and the remaining rats were sacrificed at 8 weeks. For fluorescence labeling, half of the animals were injected with calcein and tetracycline 8 days and 1 day before sacrifice, respectively. After sacrifice, the mandibles were radiologically and histologically examined. In the PGE1 group, the bone volume of the alveolar ridge including the socket was significantly (P < .05) greater than in the control and PLGA groups at 4 and 8 weeks. At 4 weeks in the PGE1 group, the mineral apposition rate and number of osteoclasts were higher than in the other groups, whereas these parameters were similar in all groups at 8 weeks. Based on this animal study, it appears that local application has the potential to preserve and/or augment the alveolar ridge after tooth extraction.

Hard tissue alterations after socket preservation: An experimental study in the beagle dog

Article

Dec 2008
CLIN ORAL IMPLAN RES

The aim of the following experimental study was to assess bone changes in the horizontal and vertical dimension when using different socket preservation procedures. In five beagle dogs the distal roots of the 3rd and 4th premolar were extracted without elevation of a mucoperiosteal flap and the following treatments were assigned: Tx 1: The extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and interrupted sutures were applied.: Tx 2: The extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and a free gingival graft was sutured to cover the socket.: Tx 3: The extraction socket was left with its blood clot and interrupted sututes were applied.: Four month after surgery the dogs were sacrificed and from each extraction site two histological sections were selected for histometric analysis. The following parameters were evaluated: (1) the vertical dimension was determined by placing a horizontal line on the lingual bone wall. Then, the distance from this line to the buccal bone wall was measured. (2) The horizontal dimension was assessed at three different areas measured from the top of the lingual crest: 1 mm (Value 1), 3 mm (Value 3) and 5 mm (Value 5). The mean vertical loss of the buccal bone plate for the Tx 1 group was 2.8+/-0.2 mm. The Tx 2 group showed vertical loss of 3.3+/-0.2 mm. The Tx 3 group demonstrated 3.2+/-0.2 mm of mean vertical loss. The horizontal dimension of the alveolar process was 4.4+/-0.3/6.1+/-0.2/7.2+/-0.1 mm at the three different levels for the Tx 1 group. The Tx 2 group depicted bone dimensions of 4.8+/-0.2/6.0+/-0.2/7.1+/-0.1 mm. The horizontal dimension of the Tx 3 group was 3.7+/-0.3/6.2+/-0.2/7.0+/-0.1 mm. When the results from the horizontal measurements were tested with the analysis of variance (ANOVA), a clear significance could be found in particular for Value 1 mm between the test groups Tx 1 and Tx 2 and the control group (Tx 3) (P<0.001). Furthermore the mean of treatment 1 (Tx 1) was slightly significantly lower than of treatment 2 (Tx 2) (P<0.05). The findings from the present study disclose that incorporation of BioOss Collagen into the extraction socket has only limited impact on the subsequent biologic process with particular respect to the buccal bone plate. The horizontal measurement of the alveolar ridge depicted that the loss of the buccal bone plate was replaced to a certain amount by newly generated bone guided by the BioOss Collagen scaffold. It seems that the mechanical stability provided by BioOss Collagen and furthermore by a free gingival graft could act as a placeholder preventing the soft tissue from collapsing.

Dimensional change of the alveolar ridge contour after different socket preservation techniques

Article

Aug 2008
J CLIN PERIODONTOL

The aim of the following study was to assess contour changes after socket preservation techniques. In five beagle dogs, the distal root of the third and fourth mandibular premolars was extracted. The following treatments (Tx) were randomly assigned for the extraction socket. Tx 1: BioOss Collagen. Tx 2: BioOss Collagen and a free soft tissue graft. Tx 3: No treatment. Tx 4: The internal buccal aspect was covered with an experimental collagen membrane, the extraction socket was filled with BioOss Collagen and the membrane folded on top of the graft. Impressions were obtained at baseline, 2 and 4 months after surgery. Bucco-lingual measurements were performed using digital imaging analysis. All groups displayed contour shrinkage at the buccal aspect. Only the differences between the two test groups (Tx 1, Tx 2) and the control group (Tx 3) were significant at the buccal aspect (p< or =0.001). No measurements of the Tx 4 group could be performed. Socket preservation techniques, used in the present experiment, were not able to entirely compensate for the alterations after tooth extraction. Yet, incorporation of BioOss Collagen seems to have the potential to limit but not avoid the post-operative contour shrinkage.

Effect of irradiation liming on the initial socket healing in rats

Article

Jan 1980
Int J Oral Surg

The effect of a single dose of 1500 R on early postextraction socket healing was studied in jaws of rats. A severe delay in healing was found in animals irradiated 2 weeks prior to extraction. Retardation of healing to a lesser degree was demonstrated in sockets irradiated immediately after exodontia.

Decrease and increase in residual ridges after extraction of teeth in monkeys (Part I)

Article

Oct 1976
Bull Tokyo Med Dent Univ

The purpose of this study is to prevent and control the reduction of residual ridges. The subjects used in this study consisted of 19 crab-eating monkeys which were divided into four groups according to the extraction area. These categories are 1U0L group (extracted on M1), 1U5L group (extracted on M1 and M3M2M1P2P1), 0U5L group (extracted on M3M2M1P2P1), and 5U1L group (extracted on M3M2M1P3P1 and M1). Impressions were taken before the extraction. Further impressions were taken at three week, six week, three month, six month, one year, and two year intervals after the extraction in order to observe morphological changes. Casts were made immediately thereafter and the cross-sectional areas of the residual ridges were measured by a standardized method with the aid of a Kubuskraniophor and a diagraph. The measurements taken of the right side, which was operated on, and the left side, which served as the control, were compared in order to observe changes in the form of the edentulous area. The results were as follows: 1) Increase in the Residual Ridge Areas: It is highly significant that the measurements of the M1 section of the 1U5L group and the M1 section of the 5U1L group gradually decreased until the sixth week, and then began to increase until the areas were approximately equivalent to the measurements of the areas before the extraction after a two-year period. This may be due to the fact that along with the elongation of the neighboring teeth, the alveolar bone grew to such an extent that the resorption rate was surpassed. 2) Decrease in the Residual Ridges Areas: With the exception of the above-mentioned sections, almost all of other sections responded in the expected manner, that is, there was a sharp decrease in the areas of these sections. The decrease took place rapidly. Seventy to 80% of the total loss occurring over the two-year period took place in the first three months. After a sharp decline in the initial three-month period, the process continued at a slow pace. This gradual decrease after a short period of rapid decrease typifies the standard pattern of the edentulous resorption process.

Comparing ridge resorption with various surgical techniques in immediate dentures

Article

Mar 1976
J PROSTHET DENT

The three surgical techniques of simple tooth extraction and labial plate and intraseptal alveoloplasty were compared. The results were confirmed by statistical analysis. The conclusion of this study clearly indicated that simple tooth extraction is the best surgical approach to be followed to preserve as much of the residual alveolar ridge as possible.

Effect of Salivary Gland Hypofunction on the Healing of Extraction Wounds: A Histomorphometric Study in Rats

Article

May 1992
J ORAL MAXIL SURG

The effect of salivary gland hypofunction (SGH) on oral wound healing is not well established. The present study evaluates the healing of extraction wounds in a SGH rat model. Experimental rats underwent removal of the submandibular and sublingual glands and ligation of the parotid ducts. Maxillary left first molars were extracted and healing was determined at 0, 1, 3, 5, 7, 10, 14, and 21 days after extraction. Salivary gland hypofunction caused a significant delay in socket healing. The inflammatory process was more intense and of longer duration. The formation of fibrous connective tissue and bone was relatively slow among the experimental rats. The results suggest that SGH patients undergoing oral surgery may have prolonged wound healing.

Alveolar bone remodeling after tooth extraction in normal and osteopetrotic rats

Article

May 1992

One of the osteopetrotic mutations in the rat, incisors-absent (ia), exhibits generalized skeletal sclerosis and failure or delay of tooth eruption, characteristics of other osteopetrotic mutations. Osteopetrosis in ia rats is known to be due to a reduction in bone resorption, the result of the inability of ia osteoclasts to elaborate a ruffled border. During healing of extraction wounds, especially the initial period, osteoclastic resorption of alveolar bone is considered to be a significant feature, followed by new bone formation. We have studied extraction wound healing in osteopetrotic (ia) rats histologically in order to determine if their systemic reduction in bone resorption changes the sequence or rate of alveolar bone healing within and outside the socket after tooth extraction, In ia rats, the healing process was delayed in comparison to that of normal rats. Many osteoclasts were observed on the surface of alveolar bone, but there was little evidence of resorption. Bone formation in the socket following bone resorption was reduced and the newly formed trabeculae were irregular. In contrast, the quantity of resorption-independent (periosteal) new bone formation outside the socket was exaggerated compared to normal animals. These data indicate that the disturbance of new bone formation in the socket is probably related to the reduction in osteoclastic bone resorption.

Effect of calcitonin on alveolar wound healing

Article

Sep 1991

The effect of calcitonin (CT) on alveolar wound healing was studied with histomorphometric methods. Wistar rats weighing 80-90 g were submitted to extraction of the three mandibular molars. Half of them were injected intraperitoneally with daily therapeutic doses of CT. The control group received no further treatment. All the rats were killed 14 days after the onset of the experiment. Bone healing was impaired in CT treated animals and involved a more intense bone remodeling activity. Bone resorptive areas were present both on the profiles of the newly formed bone and on the alveolar ridge surface. These results suggest that CT would accelerate the process of bone healing.

Application of propolis to dental sockets and skin wounds

Article

Apr 1990

The purpose of this study was to examine histologically the effects of propolis topical application to dental sockets and skin wounds. After topical application of either a 10% hydro-alcoholic solution of propolis or 10% hydro-alcoholic solution alone, cutaneous wound healing and the socket wound after tooth extraction were examined. The rats were sacrificed at 3, 6, 9, 15 and 21 days after the operation. The specimens were subjected to routine laboratory studies after staining with hematoxylin and eosin. It was concluded that topical application of propolis hydro-alcoholic solution accelerated epithelial repair after tooth extraction but had no effect on socket wound healing.

Tricalcium phosphate ceramic as immediate root implants for the maintenance of alveolar bone in partially edentulous mandibular jaws. A clinical study

Article

Nov 1989

This study was undertaken to probe the efficacy of tricalcium phosphate ceramic (TCP) as an immediate root implant in the maintenance of alveolar bone. Three patients had five TCP root implants placed in fresh extraction sockets with soft tissue closure. The control and implant areas were evaluated at the 20th and 78th week on the basis of radiographic and clinical measurements. Tricalcium phosphate ceramic root implants in extraction sockets produced a significant increase in height and width of alveolar bone compared with control sites. It is believed that this method is a more effective and efficient procedure to preserve alveolar bone for the retention of dentures than other methods.

Clinical evaluation of Durapatite submerged-root implants for alveolar bone preservation

Article

Mar 1986

A study was undertaken to evaluate the safety and efficacy of Durapatite cones as an immediate submerged-root implant in the mandibular symphysis region. The study involved 30 patients of which 15 received 96 implants and the other 15 served as controls. The clinical and radiographic results revealed the implants to be well-accepted by alveolar bone. No evidence of rejection or major complications were observed. The principal problem which occurred was dehiscence of mucosa over some implants. This problem was attributed to operative technique. There was significantly less vertical bone loss and contour change in the anterior part of mandible in the implant group than in the control group.

Maintenance of alveolar bone through implantation of graft substitutes in tooth extraction sockets

Article

Jun 1987
J AM DENT ASSOC

Effect of a topical drug combination on the early healing of extraction sockets in the vervet monkey

Article

May 1988

An animal trial was undertaken in 9 vervet monkeys to test the effect of a medicament combination on extraction socket healing. All 4 third molar teeth were extracted and 2 of the sockets in each animal were packed with Gelfoam sponge impregnated with a medicament containing a local anaesthetic, antiseptic, 2 potent antifibrinolytic agents and metronidazole. The remaining 2 sockets acted as controls: one of the sockets was packed with Gelfoam sponge alone and the other allowed to heal spontaneously with no implant. The healing of these sockets was evaluated histometrically in 4-, 6- and 8-day specimens, and from the results it was concluded that sockets containing the medicament compound showed enhanced early socket healing.

Preservation of alveolar ridge with hydroxyapatite-collagen implants in rats

Article

Jan 1989
J PROSTHET DENT

Dense hydroxyapatite root replica implantation: Measurement of mandibular ridge preservation

Article

Feb 1988

A clinical trial is reported in which the roots of extracted mandibular teeth were replaced by dense hydroxyapatite root replica implants (Calcitite®, Calcitek Inc, San Diego, Calif) prior to the insertion of immediate complete dentures. The degree of alveolar resorption that took place was compared in a test and control group. After a follow-up period of 1 year, patients provided with root replica implants were found to have significantly higher and wider residual ridges than control patients.

Prevention of alveolar bone loss postextraction with HTR polymer grafting material

Article

Feb 1987

Alveolar wound healing after X-irradiation: A histologic, radiographic, and histometric study

Article

Jan 1987
J ORAL MAXIL SURG

Healing of extraction wounds in rats following cephalic irradiation was studied by histologic, radiographic, and histometric methods 14 days after tooth extraction. Irradiation was given at 0, 3, and 7 days after surgery in doses of either 15, 20, or 30 Gy. No significant differences were seen with the different doses given seven days post-extraction. However, socket healing was delayed when irradiation was given immediately and three days after extraction. On the basis of these observations, it is recommended that radiation not begin until at least one week after the extraction of teeth.

Preservation of ridges utilizing hydroxyapatite

Article

Feb 1987

Alveolar wound healing and ridge remodeling after tooth extraction in the rat: A histologic, radiographic, and histometric study

Article

Jun 1985
J ORAL MAXIL SURG

Healing of extraction wounds in rats was analyzed by histologic, radiographic and histometric methods at 0, 7, 14, 30, 60 days after tooth removal. Total alveolar volume, volume density of bone, percentage of bone formation, bone resorption areas, and height of both vestibular and lingual crests were analyzed. Total alveolar bone volume and bone density in the apical third increased from 0 to 60 days. Maximum bone formation was observed at 14 days, whereas the greatest bone resorption was observed seven days after extraction. The height of the lingual crest was lowest 14 days postextraction and then increased progressively to day 60.

Preliminary study of mandibular shape after tooth loss

Article

Jun 1985
J PROSTHET DENT

C.L.B. Lavelle

Prevention of alveolar bone loss postextraction with HTR grafting material

Article

Sep 1985
Oral Surg Oral Med Oral Pathol

Alveolar wound healing alteration under uranyl nitrate intoxication

Article

Sep 1985
J Oral Pathol

The deposit of uranium compounds in calcifying zones has been demonstrated in bone. Nevertheless, no studies on the effect of uranium on osteogenesis have been performed. A histologic and histometric study of the effect of a single intraperitoneal injection of 2 mg/kg of body weight of uranyl nitrate on bone formation is presented. It was performed on rats' healing sockets, 14 days after tooth extraction. The alveolar bone volume (15 X 10(5) micron vs. 34 X 10(5) micron2), total bone formation areas (4.85% vs. 19.55%), and volume density of bone in the alveolar apical third (0.26 vs. 0.40) were significantly lower in intoxicated animals than in the controls. These results indicate the inhibitory effect of uranyl nitrate on bone formation.

A systematic review of post-extractional alveolar bone dimensional changes in humans

Abstract

No full-text available

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