Article

Tissue alterations after tooth extraction with and without surgical trauma: A volumetric study in the beagle dog

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Abstract

The aim of this study is to evaluate whether tooth extraction without the elevation of a muco-periosteal flap has advantageous effects on the resorption rate after tooth extraction. In five beagle dogs polyether impressions were taken before the surgery. The roots of the first and second pre-molars (P(1) and P(2)) were extracted and the sites were assigned to one of the following treatments: treatment group (Tx) 1, no treatment; Tx 2, surgical trauma (flap elevation and repositioning); Tx 3, the extraction socket was filled with BioOss Collagen and closed with a free soft-tissue graft; Tx 4, after flap elevation and repositioning, the extraction socket was treated with BioOss Collagen and a free soft-tissue graft. Impressions were taken 2 and 4 months after surgery. The casts were scanned, matched together with baseline casts and evaluated with digital image analysis. The "flapless groups" demonstrated significant lower resorption rates both when using socket-preservation techniques and without. Furthermore, socket-preservation techniques yielded better results compared with not treating the socket. The results demonstrate that leaving the periosteum in place decreases the resorption rate of the extraction socket. Furthermore, the treatment of the extraction socket with BioOss Collagen and a free gingival graft seems beneficial in limiting the resorption process after tooth extraction.

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... 9 Atraumatic Tooth Extraction Tooth extraction should involve as little injury as possible to the surrounding bone and soft tissue. 10,11 Damage to the labial plate can exacerbate horizontal and vertical resorption, while damage to the interproximal bone can result in loss of papilla. ...
... Unnecessary flap elevation should be avoided to minimize devascularization of the labial plate that would exacerbate labial bone loss. 11,12 Flap elevation during tooth removal has been reported to increase bone resorption by 16%. 11 Sectioning of teeth and the judicious use of peritomes, proximators, and luxators will aid in expanding the PDL space and tooth removal while limiting trauma to the surrounding alveolus. ...
... 11,12 Flap elevation during tooth removal has been reported to increase bone resorption by 16%. 11 Sectioning of teeth and the judicious use of peritomes, proximators, and luxators will aid in expanding the PDL space and tooth removal while limiting trauma to the surrounding alveolus. After the tooth is removed, the socket should be inspected in all dimensions for surrounding bone integrity. ...
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Technical Report
Tooth extraction is a common procedure in the field of dentistry. Although atraumatic extraction is always preferred, it is not always accomplished. In this course, we will cover topics such as how normal healing occurs and why atraumatic tooth extraction is desired, as well as how best to achieve this result. We will also discuss various techniques for socket augmentation and preservation, as well as when a particular technique is indicated. After taking this course, participants will be versed in the various grafting options available to practitioners and be able to discern what option may be most suitable for their clinical needs. The authors will also discuss the role of immediate implants in dentistry and how they can effect extraction sites.
... Initially, it was thought that it was necessary not to open gingival flaps, to allow the least traumatic healing of the postextraction site. 15,17 Afterward, it was thought that the immediate insertion of a dental implant could prevent the alveolar resorption in the first 90 days after surgery. 15,[17][18][19][20][21][22] However, the advent of three-dimensional radiological analysis methods has shown that fenestrations, or even bone resorption on the buccal cortical bone, are often present. ...
... 15,17 Afterward, it was thought that the immediate insertion of a dental implant could prevent the alveolar resorption in the first 90 days after surgery. 15,[17][18][19][20][21][22] However, the advent of three-dimensional radiological analysis methods has shown that fenestrations, or even bone resorption on the buccal cortical bone, are often present. ...
Article
Background: Tooth loss reduces crestal bone with important resorption of alveolar dimensions, reducing the possibility of placing implants after wounds healing. Objective: The goal of this pilot experience was to consider, in alveolar ridge preservation, the regenerative and decontaminating potential of oxygen high-level laser therapy (OHLLT), a high-frequency and high-power diode laser combined with hydrogen peroxide 10 volumes 3%, and to evaluate wound closure during the 14-21 days after surgery. Methods: For this study we selected 15 patients (age range from 30 to 70 years old) who underwent alveolar ridge preservation (three patients were treated in the anterior maxilla, 12 in the mandibular jaw, with molars and premolars involved). A clinical and radiographic examination was performed at baseline. In this pilot experience, after the extractions, the sockets were treated with photodynamic therapy without dye (OHLLT/SiOxyL+ protocol) to decontaminate the area that was treated, combined with allografts, Osteobiol, granulometry 25, Platelet-Rich Fibrin and collagen membranes, Biogide/Geistlich. Photobiomodulation (PBM) sessions with ATP38 were made for the first 4 months every 2 weeks. Clinical evaluations were performed at 14, 21, 90, and 240 days. Radiographic evaluations with cone beam computed tomography (CBCT) were performed at 240 days, before the second surgery. Two hundred seventy days after the first surgery, a new surgical treatment was made with the same concepts adopted in the first surgery, to place implants. Results: All alveolar ridge preservation surgeries were successful, with minimal bone resorption after 9 months. Closure of gingival tissue healed by secondary intention was achieved after 14 days for all patients, except one, who showed wound closure after 21 days. Conclusions: This pilot experience showed that this technique allowed to obtain new bone and wound healing by secondary intention in treated sites and to place implants in all patients, without other bone augmentation techniques, thanks to extracellular matrix induced by photodynamic laser therapy on grafts materials and to PBM made each 2 weeks for the first 4 months postsurgery. The study was conducted according to the guidelines of the Ethics Committee of the School of Medicine and Surgery at the Milano Bicocca University (protocol n. 11/17), and derived from the approval of Italian National Institute of Health (ISS), protocol 30 July 2007-0040488.
... The performance of flapless surgery in immediate implant placement has recently been studied to address the negative results from some studies on flap immediate implants in the anterior region. Pertinently, several authors suggest that this approach causes less trauma to the peri-implant tissues by not having to separate the periosteum from the underlying bone, which causes vascular disruption and consequent bone resorption or gingival recession [28][29][30][31][32]. However, this technique is not free of disadvantages; for example, the surgeon works blindly when placing implants with a flapless procedure, and bone dehiscence or fenestration is more likely [33,34]. ...
... Whether or not to elevate the flap is an issue in implant therapy that has always been the subject of debate and controversy. Authors who advocate flapless surgery defend the approach because it causes less trauma to the peri-implant tissues by not having to separate the periosteum from the underlying bone, which causes vascular disruption and consequent bone resorption or gingival recession [6,[28][29][30]97]. However, when placing implants with a flapless procedure, the surgeon works blindly, and bone dehiscence or fenestration is more likely [33,34]. ...
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Article
IntroductionPreserving peri-implant tissues after immediate implant placement (IIP), especially in aesthetic zones, is a topic of interest.Objectives This systematic review investigated the effects of currently available surgical procedures for preserving peri-implant tissue or ensuring dimensional stability following immediate implant placement.Materials and methodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement’s guidelines were followed, and articles were sought on the PubMed and Cochrane databases with no date restrictions. Only randomised clinical trials that evaluated changes in soft and hard tissues around immediately placed implants were included. Statistical analyses were performed, and the studies´ quality was assessed using the Cochrane Collaboration tool. The agreement between reviewers was assessed based on Cohen’s kappa statistics.ResultsOf the 14 studies that met the inclusion criteria, 11 were analysed in the meta-analysis (kappa = 0.814; almost perfect agreement). The use of connective tissue grafts resulted in a significantly greater improvement of the facial gingival level (MD = −0.51; 95% CI: −0.76 to −0.31; p = < .001), and the placement of bone grafts significantly reduced the horizontal resorption of the buccal bone (MD = −0.59; 95% CI: −0.78 to −0.39; p < .001).Conclusion Connective tissue grafts and bone grafts positively influence tissue preservation around immediately placed implants. Neither the flapless technique nor palatal implant positioning resulted in significant improvements to any of the investigated parameters. Additional longitudinal studies are required.Clinical relevanceThis meta-analysis is useful for discerning the effects of soft tissue augmentation, bone grafting, the flapless technique, and palatal implant positioning on preserving peri-implant tissues after immediate implant placement.
... Sealing techniques have further been developed to close the alveolar socket, to protect the bone substitute, and to avoid a mucoperiosteal flap [20,21]. Free gingival grafts were shown for instance to exert beneficial effects on minimizing the soft tissue shrinkage [22]. ...
... The main limitations of this clinical trial are the small sample size of patients included (21), the absence of incisors, and the use of a conventional impression method. The location of tooth extraction which may have an impact on the alveolar shrinkage (distinct bone wall and/or soft tissue thickness, presence of bone septum) is another limitation on the present work. ...
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Article
Objectives This pilot study aimed to assess dimensional changes following two different alveolar socket sealing techniques.Material and methodsTwenty-one patients requiring tooth extraction and implant placement were randomly allocated to two different alveolar ridge preservation techniques. In the control group, demineralized bovine bone mineral (DBBM) and a gingival soft tissue punch were used to fill and seal the socket, whereas in the test group, the extraction socket was filled with DBBM and sealed with a hemostatic gelatin sponge. Digitalized impressions were taken before and 6 months after tooth extraction. The comparison was made on horizontal and vertical dimensional changes.ResultsThe mean vertical loss was 0.8 ± 0.6 mm for the control group and 0.7 ± 0.5 mm for the test one. No statistical difference was found between groups for the vertical shrinkage. The horizontal dimensional narrowing of the alveolar socket was respectively 7.1/4.0/2.5 mm at levels 1, 3, and 5 mm from a coronal reference level for the control group. The test group showed dimensional changes of 4.8/2.3/1.3 mm at the three different levels, respectively. A significant difference was found at levels 3 and 5 mm. Referring to a visual analog pain scale, patients reported more severe pain in the control group (5.7/10) when compared with the test group (2.8/10). The difference was statistically highly significant (P ≤ 0.001).ConclusionsA significant difference was found between control and test groups regarding the horizontal dimensional changes and the post-operative pain.Clinical relevanceRegarding this primary result, the socket sealing technique with a hemostatic sponge provides an effective and inexpensive protocol with less post-operative pain.
... Radiograficamente, foram observadas perdas dentárias (dentes 16,18,25,28,35,36, 45 e 48), implante dentário (dente 11), perda óssea nas cristas alveolares generalizadas e imagens radiopacas sugestivas de cálculos dentários nos dentes 31 e 41 (Figuras 2 e 3, respectivamente). ...
... Busca-se a formação fisiológica da rede de fibrina, com quimiotaxia de células responsáveis pela angiogênese, migração de células indiferenciadas que competirão para ocupar seu sítio proliferativo, promovendo mudanças secretórias originando os tecidos de granulação, cuja diferenciação e síntese de matriz extracelular, passível de mineralização e maturação, desenvolver-se-ão até os tecidos ósseos maduros [16][17][18][19][20] . Nesta perspectiva, foram utilizadas telas de ouro, mamona e politetrafluoretileno [21][22][23][24][25][26] , não atingindo plenamente as seguintes características, consideradas ideais para o uso promissor e seguro de uma membrana: impermeabilidade; resistência; possibilidade de ser recortada com tesoura; apresentar maleabilidade; ter baixo custo; não necessitar de parafusos, telas compressivas ou tachas para fixação; podendo ser exposta ao meio bucal; favorecer contato passivo das bordas do retalho; ser conservadora por não necessitar do emprego de incisões relaxantes; assentar passivamente; podendo ser removida com facilidade, caso necessário; e, atender as necessidades da técnica de regeneração óssea guiada, para preservação e funcionalidade do osso alveolar para posterior reabilitação oral [26][27][28][29] . ...
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Article
Introdução: A evolução dos materiais e técnicas restauradoras trouxe avanços técnico-científicos inimagináveis. A agilidade no tratamento, maior conforto, redução de custos e satisfação de pacientes e profissionais constituem uma realidade premente na prática odontológica. O atual conhecimento da previsibilidade do comportamento ósseo após a execução de uma exodontia, sugere alguns cuidados que podem minimizar a perda óssea em altura e largura, que comprometem a reabilitação estética e funcional dos ossos maxilares. A dependência do coágulo na constituição do arcabouço demanda intervenção sistematizada na sua imobilidade, a qual, potencializará a resposta biológica do tecido duro. Objetivo: O escopo desse trabalho é apresentar o caso do emprego da membrana de polipropileno após exodontia, com vistas à futura instalação de implante. Descrição do caso: foi realizada a exodontia dos dentes 31 e 41 e utilizada a membrana de polipropileno, que permaneceu intencionalmente exposta durante 10 dias. A permanência da membrana favoreceu a manutenção do coágulo sanguíneo que serviu como arcabouço para a remodelação óssea, interferindo o mínimo possível na reabsorção das paredes remanescentes do alvéolo, favorecendo a futura instalação de implante e reabilitação implanto-protética. Conclusões: A Regeneração Óssea Guiada alcançada pela osteopromoção, por meio do através da utilização de membrana de polipropileno demonstra ser uma técnica promissora na Odontologia contemporânea. O baixo custo, a facilidade de acesso e manipulação por parte do cirurgião-dentista e o controle participativo na fisiologia tecidual foram fatores para que a técnica seja uma alternativa potencial na minimização da reabsorção óssea ou mesmo na imobilização do coágulo.
... Flapless tooth extraction has been shown to reduce the amount of bone loss in the early healing phase 4-8 weeks post-extraction compared with full-thickness flap elevations [28] , whereas after a healing period of 6 months, no differences were observed regarding bone loss with or without flap elevation. Therefore, a flapless low-trauma tooth extraction approach is recommended in cases of immediate implant placement in sockets with thick facial bone wall phenotypes and when using early implant placement protocols (Type 2, 3) in order to avoid additional bone loss at the superficial bone wall. ...
Book
Atraumatic tooth extraction is very important requirement for soft and hard post-extraction site tissues preservation. Augmentation of tooth alveoli after tooth removal is more often applied in recent practice and is effective when applying to limited post-extraction osseous and soft tissue defects. More and more surgical procedures are presented, as they are evolving. There are no enough studies to determine the best method, or the most appropriate materials, and yet there are no special techniques of long-term results and assessment of the outcome of dental implantation after such augmentations. No clarification to the impact of augmentation effectiveness has former pathology of augmented area, because of which tooth had been removed. Socket preservation procedures, as they can limit bone changes of the alveolar process; the use of grafts and barrier membrane or collagen membrane, both together and alone, might help to interfere in the normal sequence of biological events leading to resorption in wound healing.
... 4 Generally, the amount of bone loss varies among different individuals and its mechanism is not clear yet. Some studies [5][6][7][8] have shown that the absorption of alveolar bone may be related to anatomical features, surgical procedures, and implant timing. The width and height of alveolar ridges can be lost by 50% within 6 months aer tooth extraction, 9 and these changes in tissue contours at the extraction site would increase the difficulty of implant restoration. ...
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Article
Post-extraction, preventing the absorption of alveolar ridge to retain the supporting construction for implanted teeth is still a challenge. Herein, we developed modified chitosan (CS)-based hydrogel using N-hydroxysuccinimide-terminated 4-arm poly (ethylene glycol) (4-arm-PEG-NHS) as the crosslinking agent, after introducing it to the polyhexamethyleneguanidine hydrochloride (PHMB) solution, CS/PEG/PHMB hydrogel with the enhanced antibacterial properties was obtained. The CS/PEG hydrogel and CS/PEG/PHMB hydrogel prepared here showed excellent mechanical strength and their compressive strength could reach 440 kPa and 450 kPa, respectively. The composite hydrogel was designed to be directional porous, low cytotoxic, pH-sensitive, and degradable. The weight of the hydrogel was reduced by ∼30% after 28 days of incubation, and it swelled significantly in the acidic condition while it did not swell in the neutral and weakly alkaline environments, indicating an excellent biodegradability in the inflammation site. In vitro antibacterial experiments showed that the bacteriostatic rate of the CS/PEG/PHMB hydrogel against S. aureus was above 90%, which could effectively inhibit the spread of the bacteria and inflammation in the alveolar ridge. Additionally, the hybrid hydrogels demonstrated good biocompatibility with the NIH 3T3 fibroblast cells. Overall, the CS/PEG/PHMB hydrogel is a promising biological scaffold for maintaining the alveolar ridge and subsequently improving the success rate of the dental implant.
... 11 In contrast, in a human study by Barone et al. and a canine model by Fickl et al., it was shown that more bone resorption occurred with a full thickness flap in post-extraction sockets. 12,13 As indicated by the recent systematic reviews, there is a need for clinical studies investigating ARP that allow for direct comparison between surgical variables, such as flap reflection among others. 3,14 Hence, the primary aim of this randomized controlled single-blinded clinical trial was to compare a flapless technique of ARP versus a conventional flap technique. ...
Article
Background: The aim of this randomized clinical trial was to compare a flapless technique of alveolar ridge preservation (ARP) to a flap technique, to determine if preserving the periosteal blood supply would limit loss of crestal ridge width and height. Materials and methods: Twenty-four patients were randomly assigned to receive ARP using either a flapless or flap technique. Sockets were grafted with demineralized bone matrix and mineralized particulate allograft then covered with a barrier. Re-entry was performed at 4 months to obtain samples for histological analysis and subsequent implant placement. Results: Ridge width of the flapless group at the crest decreased from 8.3 ± 1.3 mm to 7.0 ± 1.9 mm for a mean loss of 1.3 ± 0.9 mm (p < 0.05), whereas the flap group decreased from 8.5 ± 1.5 mm to 7.5 ± 1.5 mm for a mean loss of 1.0 ± 1.1 mm (p < 0.05). The mean mid-buccal vertical change for the flap group was a loss of 0.9 ± 1.3 mm (p < 0.05) versus 0.5 ± 0.9 mm (p < 0.05) for the flapless group. There was no statistically significant difference between the groups. Histologically, flapless ARP revealed more vital mineralized tissue (44 ± 10%) compared to the flap group (p>0.05). In the flapless group, the occlusal soft tissue was significantly thicker than the flap group at the 4-month reentry (p< 0.05). Conclusions: Crestal ridge width, height, and percentage of vital mineralized bone following treatment with a flapless ARP technique was not significantly different from a flap technique. This article is protected by copyright. All rights reserved.
... Advances in biomaterials and research unraveling the molecular mechanisms of alveolar bone changes have led to the exploration of new avenues to achieve the optimal treatment result. Alveolar ridge preservation techniques encompass procedures such as the flapless extraction technique recommended by Fickl et al. 9 to the cutting-edge treatments using autologous stem cells and growth factors. 10 ...
Article
Background: Alveolar bone undergoes volumetric changes after extraction due to physiologic bone remodeling. The amount of alveolar bone available during prosthodontic treatment can affect the esthetic outcome of the treatment and make implant placement challenging. Socket preservation techniques are advocated postextraction to maintain the bone's vertical and horizontal alveolar bone dimensions and prevent its atrophy. Aim: This review is oriented toward a clinician, describing the different materials and techniques in practice today for socket preservation. Review results: A variety of methods have been studied as a means to stop alveolar ridge resorption. While immediate implant placement was recommended as a socket preservation technique, clinical trials have not demonstrated favorable results. The main techniques favored by clinicians today involve bone grafts, bone substitutes, barrier membranes, and combinations thereof. As with periodontal defects, these materials show favorable outcomes in alveolar bone regeneration and ridge preservation. Tooth bone grafts, both autogenous and allogenous, have been recommended recently for ridge preservation as they are chemically similar to bone and can induce osteogenesis. The use of autologous platelet concentrates has yielded contradictory results in studies. Cutting-edge approaches entail using growth factors and tissue engineering concepts. While these strategies are still in the development stages, it has peerless potential in preserving and regenerating alveolar bone. Conclusion: Alveolar ridge resorption is an unavoidable physiological process after extraction and leads to severe bone deficiencies, affecting esthetics. These changes in alveolar ridge dimensions make implant placement difficult and affect the longevity of the implant. Clinical intervention can prevent alveolar bone resorption and preserve the ridge. Bone grafts and substitutes including concentrates remain the best choices in ride preservation. The use of growth factors and tissue engineering concepts requires further clinical trials before widespread use in clinical practice.
... Although the vertical resorption of lingual/palatal bone displayed no signi cance between groups, but the test groups presented less resorption than that of the control group which was comparable with previous studies [14,23,39,40]. Vertical bone resorption in this study was partially in line with a previous study which observing a mean resorption of − 1.94 ± 1.73 mm, − 1.30 ± 1.47 mm in the test group c ombined with-3.02 ...
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Preprint
Objective: This randomized controlled trial was primarily aimed at evaluating the volumetric changes of the alveolar bone after alveolar ridge reconstruction (ARR)in molar sites with severe bone resorption as compared with unassisted socket healing by means of three dimensional and linear analyses. Material and methods: A total of 31 patients (15 males, 16 females) with more than 50% of hard tissue loss in one or more socket walls were recruited and randomized into either the test group(ARR after extraction using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and platelet-rich fibrin (PRF) with a resorbable collagen membrane) or the control group (natural healing after extraction).The clinical, linear, volumetric implant-related and patient-reported outcomes were analyzed following a 4-months healing process. This single blinded randomized clinical trial was approved by Chinese Clinical Trial Registry (Identifier: ChiCTR2100047321). Results: Linear bone assessments presented significantly more gains of ridge width presented at 25% level in mesial, mid-facial and distal aspects in the test group and less reduction of vertical bone ridge than in the control group from (P<0.05).Similarly, volumetric bone remodeling was significant higher in the test group (ARR=35.1±34.9%, control=14.2±12.8%, P<0.05). Assessment of patient-reported discomfort and keratinized mucosa changes were comparable between groups Conclusion: Alveolar ridge reconstruction with DBBM-C in combination with PRF and resorbable membrane in posterior sites with severe socket walls deficiency (>50% bone loss) is a safe and more capable method when compared with natural healing unassisted socket. Clinical Relevance: The presented study have demonstrated that alveolar ridge reconstruction could be an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defect during 4 months of healing.
... higher than whole bovine bone (Shah, 2020). (Fickl et al., 2008), or any particular advantage between the two techniques (Araújo & Lindhe, 2009). More recently, an active role of GBR membranes has been demonstrated in promoting regeneration within an osseous defect, rather than functioning simply as a passive barrier (Elgali et al., 2017). ...
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Article
Objectives: When teeth are lost, dental implants contribute to improved oral function and quality of life. Limitations in dental implant placement arising from poor bone anatomy may be circumvented via alveolar ridge preservation (ARP). The aim is to evaluate the long-term impact of ARP on peri-implant health and the relationship with common risk indicators such as smoking and history of periodontitis. Materials and methods: One hundred and eight patients were enrolled in this retrospective cohort study with 308 implants. Of these, ∼41% were placed in bone sites that had previously received ARP with deproteinized bovine bone mineral xenograft. Association between baseline variables: ARP, age, gender, number of implants per patient, anatomical site, smoking, and previous history of grade III/IV periodontitis, and outcome variables: mucositis, peri-implantitis, implant loss, full-mouth plaque score (FMPS), full-mouth bleeding score, and marginal bone loss (MBL) was evaluated using both univariate and multivariate models. Results: After 5 years, the overall survival rate was 93.7%. The occurrence of peri-implantitis was 21.3% and the extent of MBL was ~2.2 mm. Both peri-implantitis occurrence and MBL were comparable between ARP+ and ARP- . Smoking is associated with higher FMPS and MBL. Conclusions: The findings indicate that peri-implant health can be maintained around dental implants for up to 5 years in ARP+ sites using Bio-Oss®. Smoking is a major risk indicator for peri-implantitis, whereas the association between history of periodontitis and the risk of peri-implantitis, based on this specific, well-maintained cohort and the specific implants used, remains inconclusive.
... This study used an innovative combination of optical scans, superimposed CBCT radiographs and overlaid mesh images to undertake comparative analysis of dimensional changes following two different ARP techniques and unassisted healing. Whilst the use of superimposed or fused images (Fickl et al., 2008a) has been documented, the accuracy of recorded measurements is influenced by the quality of the CBCT scans and their ability to display anatomical features. The image display is affected by the field of view, tube voltage and amperage, partial volume averaging, the presence of noise or artefacts on the image (Molen, 2010), soft tissue factors, voxel size and spatial resolution (Molen, 2010;Patcas et al., 2012). ...
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Article
Objectives: To compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a socket seal (SS) technique, or unassisted socket healing (Control). Material and methods: Patients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n=14/). Cone Beam Computed Tomography (CBCT) images were recorded post-extraction and at 4-months, the mid-buccal and mid-palatal alveolar ridge height (BARH/PARH) was measured. The alveolar ridge width, cross-sectional socket and alveolar-process area changes, implant placement feasibility, requirement for bone augmentation and post-surgical complications were recorded. Results: BARH and PARH was found to increase with the SS (0.65mm±1.1/0.65mm±1.42) techniques, stabilise with GBR (0.07mm±0.83/0.86mm±1.37) and decrease in the Control (-0.52mm±0.8/-0.43mm±0.83). Statistically significance was found when comparing the GBR and SS BARH (p=0.04/0.005) and GBR PARH (p= 0.02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (-2.17mm±0.84), when compared to the Control (-2.3mm±1.11) (p=0.89). A mid-socket cross-sectional area reduction of 4% (-2.27mm2 ±11.89), 1% (-0.88mm2 ±15.48) and 13% (-6.93mm2 ±8.22) was found with GBR, SS and Control groups (GBR vs. Control p=0.01). The equivalent alveolar process area reduction was 8% (-7.36mm2 ±10.45), 6% (-7mm2 ±18.97) and 11% (-11.32mm2 ±10.92). All groups supported implant placement, with bone dehiscence noted in 57%(n=4), 64%(n=7) and 85%(n=12) of GBR, SS and control cases (GBR Vs. Control p=0.03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown. Conclusion: GBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.
... Minimizing damage to the underlying alveolar bone can serve to enhance the success and survival rate of dental implants. Several strategies are used to prevent alveolar bone resorption, including atraumatic flapless tooth extraction [24], bone grafts, membranes, and additional surgical procedures [25]. This study assessed the implant survival rate (ISR) and marginal bone loss (MBL) in mesial and distal sites of dental implants placed with guided implant surgical protocol (GIS) in sockets with bioactive glass grafts compared to non-grafted sites after one year of functional loading. ...
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Article
The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant placement using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted sites. We followed a parallel study design with patients divided into two groups: grafted group (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed up for 1-year post-loading. MBL after one year, in the control group, was −0.31 mm ± 0.11 mm (me-sial) and −0.28 mm ± 0.09 mm (distal); and in the test group was −0.35 mm ± 0.11 mm (mesial) and −0.33 mm ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups after one year. ISR was similar between groups and the marginal bone changes were comparable one year after functional loading, without statistical significance, suggesting that bioactive glass permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants.
... . In contrast, Barone et al., with their human study and Fickl et al., in a canine study, showed that more bone resorption occurred with a full thickness flap in post extractive sockets37,38 . However, whether the magnitude of the loss is clinically meaningful or not, the evidence remains inconclusive39 . ...
Article
Background: Full thickness mucoperiosteal flap (FTF) elevation could potentially affect the periodontium of the involved teeth; it is not clear if the periodontal phenotype of teeth involved in a FTF may influence these changes. The aim of this study was to evaluate the impact of FTF on teeth periodontium, as well as assessing the impact of periodontal phenotype on bone remodeling. Methods: In this single arm prospective clinical trial, 26 subjects and a total of 52 adjacent teeth were included. Patients receiving implant surgery in the posterior area, at the time of implant site preparation, an FTF was extended one tooth mesial and distal to the planned site, and the flap was elevated both facially and lingually. Vertical and horizontal bone linear changes were measured on both adjacent teeth, using superimposed cone-beam computerized tomography (CBCT) images taken prior to implant placement (T0) and at 12 months (T1). Baseline digital scans of models and DICOM files were superimposed to assess the periodontal phenotype. Results: Vertical bone changes from T0 to T1 were statistically significant (p=0.013), with changes were significantly higher at the mesial (-0.31± 0.30 mm) and facial (p<0.05) sites. Horizontal dimensional changes 5 mm subcrestally were similar among different locations (p=0.086) and the bone width loss was higher closest to the crest (p=0.001). No correlation was found between soft tissue thickness and bone changes. However, bone thickness at baseline appears to influence the extent of horizontal bone remodeling. Overall, the magnitude of bone loss either vertically or horizontally was clinically insignificant (≤0.4 mm). Conclusion(s): Marginal bone changes in maxillary and mandibular posterior teeth following FTF at 12 months are very minimal, and mainly influenced by bone rather than soft tissue thickness. Overall, FTF does not seem to have deleterious effects on adjacent teeth periodontium.
... . In contrast, Barone et al., with their human study and Fickl et al., in a canine study, showed that more bone resorption occurred with a full thickness flap in post extractive sockets37,38 . However, whether the magnitude of the loss is clinically meaningful or not, the evidence remains inconclusive39 . ...
Article
Background: Full thickness mucoperiosteal flap (FTF) elevation could potentially affect the periodontium of the involved teeth; it is not clear if the periodontal phenotype of teeth involved in a FTF may influence these changes. The aim of this study was to evaluate the impact of FTF on teeth periodontium, as well as assessing the impact of periodontal phenotype on bone remodeling. Methods: In this single arm prospective clinical trial, 26 subjects and a total of 52 adjacent teeth were included. Patients receiving implant surgery in the posterior area, at the time of implant site preparation, an FTF was extended one tooth mesial and distal to the planned site, and the flap was elevated both facially and lingually. Vertical and horizontal bone linear changes were measured on both adjacent teeth, using superimposed cone-beam computerized tomography (CBCT) images taken prior to implant placement (T0) and at 12 months (T1). Baseline digital scans of models and DICOM files were superimposed to assess the periodontal phenotype. Results: Vertical bone changes from T0 to T1 were statistically significant (p = 0.013), with changes were significantly higher at the mesial (-0.31± 0.30 mm) and facial (p<0.05) sites. Horizontal dimensional changes 5 mm subcrestally were similar among different locations (p = 0.086) and the bone width loss was higher closest to the crest (p = 0.001). No correlation was found between soft tissue thickness and bone changes. However, bone thickness at baseline appears to influence the extent of horizontal bone remodeling. Overall, the magnitude of bone loss either vertically or horizontally was clinically insignificant (≤0.4 mm). Conclusion(s): Marginal bone changes in maxillary and mandibular posterior teeth following FTF at 12 months are very minimal, and mainly influenced by bone rather than soft tissue thickness. Overall, FTF does not seem to have deleterious effects on adjacent teeth periodontium. This article is protected by copyright. All rights reserved.
... Biologically, the act of raising a mucoperiosteal flap implies a temporary interruption of the vascular supply between the gum-periosteum and the bone, as well as being the trigger for an inflammatory reaction in this bone. These inflammatory phenomena have been described in experimental research (Staffileno et al. 1966), and in some cases it has been observed that this temporary vascular interruption caused by the raising of a flap in a tooth extraction can result in about 14% greater dimensional reduction that when it is carried out without flap raising (Fickl et al. 2008). The effect of raising a mucoperiosteal flap or not when placing an immediate implant has been studied in various preclinical investigations. ...
Article
Many different delayed and immediate implantation techniques have been researched for tooth replacement in the upper anterior jaw. Although good esthetic results can be expected, the treatment duration as well as patient morbidity is still high owing to prolonged treatment times and multiple surgeries or surgical sites. By leaving the buccal piece of the root of the failing tooth in place, the otherwise expected post-extractional resorption and remodeling processes are not initiated. The socket shield technique has consequentially shown to completely prevent soft and hard tissue alterations after immediate implantation with open healing. At the same time, it reduces treatment time and patient morbidity to one single surgery and one surgical site.
... Fickl et al. observed that, on a canine model, Open Flap Treatment group had a less bone loss compared with the Close Flap Treatment. 20 Conversely, Araujo and Lindhe 21 reported that raising a flap during extraction may had an effect on the short-term only. However, the difference between the two techniques was insignificant after 6 months. ...
Article
Primary closure is the most important step following tooth extraction. Primary closure using cut back incision technique helps in preserving the bone graft in socket and to preserve it in their desired position. To assess the healing outcome with and without cut back incision technique in adult population for the purpose of socket preservation at baseline, 1 week and 4 weeks. In this single blinded randomized controlled trial forty-two sites were planned for extraction with bone augmentation and were randomly divided. In group 1 sockets were preserved using cutback incision technique and in group 2 sockets were grafted without cutback incision technique. Clinical standardized measurements were used to assess the dimensional alterations of the extraction socket. Various non-parametric tests have been used for comparisons. Intergroup comparison showed statistical higher difference on Pain on VAS (p >0.00 6) and KGW (p 0.039) at 1 week and primary healing showed no significant results at all time intervals. The present finding concluded that use of cutback incision technique enhances primary closure and the socket seal of the extraction site with minimal pain, morbidity and low cost.
... Also, recent systematic reviews implement that thin soft tissues possible induced bone remodeling (Suarez-Lopez Del Amo et al., 2016;Thoma et al., 2018). On the other hand, flap elevation-either full-thickness or partial thickness-might induce bone remodeling (Fickl et al.,2008(Fickl et al., , 2011. ...
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Article
Objectives This systematic review assessed the influence of soft tissue augmentation procedures on marginal bone level changes in partial or fully edentulous patients. Material and Methods We identified three relevant PICO questions related to soft tissue augmentation procedures and conducted a systematic search of four major electronic databases for clinical studies in systemically healthy patients receiving at least one dental implant and a minimum follow-up of one year after implant placement. The primary outcome was mean difference in marginal bone levels, and secondary outcomes were clinical and patient-related outcomes such as thickness of peri-implant mucosa, bleeding indices, and Pink Esthetic Score. Results We identified 20 publications reporting on 16 relevant comparisons. Studies varied considerably and thus only two meta-analyses could be performed. This systematic review showed that: Soft tissue augmentation either for augmentation of keratinized mucosa or soft tissue volume inconsistently had an effect on marginal bone level changes when compared to no soft tissue augmentation, but consistently improved secondary outcomes. The combination soft and hard tissue augmentation showed no statistically significant difference in terms of marginal bone level changes when compared to hard tissue augmentation alone, but resulted in less marginal soft tissue recession as shown by a meta-analysis. Soft or hard tissue augmentation performed as contour augmentations resulted in comparable marginal bone level changes. Conclusions Peri-implant soft and hard tissues seem to have a bidirectional relationship: “Bone stands hard, but soft tissue is the guard”.
... As far as bone remodeling is concerned, the type of surgical procedure (traumatic/atraumatic) is one of the most active factors: the architecture of the tissues around the surgical site (hard and soft tissues) and dynamic of the healing process (wound closure and blood clot stabilization) were key drivers for success [20]. Among the several strategies used to prevent alveolar bone resorption, different methods of ridge preservation had been proposed, that range from atraumatic flapless tooth extraction aiming for undisturbed extraction wounds [21] to more complex and demanding socketplug technique in combination with different grafting materials, barrier membranes, and additional surgical procedures [22]. ...
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Article
Background To evaluate and compare the long-term clinical and radiological outcomes of post-extraction sockets after ridge preservation either with porcine xenograft or collagen alone. Patients underwent single-tooth extraction in the posterior mandible. Fresh extraction sockets were filled with pre-hydrated cortico-cancellous porcine bone or collagen sponge. Two or 3 months later, a ridge expansion technique with immediate implant positioning placement was performed. Primary (alveolar width changes) and secondary outcomes (adverse events and long-term maintenance of buccal plate covering the implant) were evaluated. Results Thirty-four women and 20 men were selected: 30 implants (group A) placed into healed post-extraction sockets grafted with porcine bone and 24 (group B) into sockets filled with a collagen sponge. There was a significant loss in width in both groups from the first and second surgery (ranging between 2.7 mm and 4.5 mm). The ridge splitting with bone expansion resulted in significant long-term increases in width for both procedures and implant sites. Non-significant differences in alveolar width were registered between the groups at 10-year follow-up even if the analysis of the implant buccal bone coverage suggested that group A had significantly worst results. Conclusions Porcine bone group had significantly better short-term outcomes with lower long-term maintenance of the buccal plate.
... Soft and hard tissue alteration always happens following tooth extraction. The amount of tissue loss depends on the buccal alveolar bone wall thickness [1], prominent roots [2] and surgical trauma [3][4][5]. Fifty percent of bone width loss happens in the first year after tooth extraction [6]. Different approaches to minimize the dimensional ridge alteration following tooth extraction have been described [7][8][9][10], but they were not capable to avoid bone loss even though high cost techniques have been applied [11,12]. ...
Article
For a long time, different approaches to minimize the dimensional ridge alteration following tooth extraction have been described even though none of them was capable to avoid alveolar bone loss. The Socket-Shield Technique (SST) seems to be an alternative for alveolar bone preservation in dental extraction planning. This technique conventionally uses a flapless approach and the buccal root portion retention to prevent bone loss. This case report describes the SST with an early implant placement in a patient who presented the nonrestorable tooth # 15 due to the extensive cavity. After six months of the implant placement a porcelain-fused-to-metal crown was fabricated and screwed into the implant with a satisfactory esthetic and functional result. The SST is a non-invasive and effective approach to tooth extraction and rehabilitation, especially in the aesthetic zone. Approximately two-year follow-up shows a satisfactory aesthetic maintenance.
... Jeong et al. [17] compared the flapless and flap groups and examined the effect of the surgical approach on crestal bone level and osseointegration and found that the mean peri-implant bone height was greater at the flapless sites compared to the sites with flaps. Barros et al. [18] and Fickl et al. [19] observed a loss of bone height at least two times more pronounced in the group where immediate implants were installed after the elevation of mucoperiosteal flap than in the group without flap elevation. ...
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Article
Background: The aim of this study is to clinically evaluate and compare the clinical success and the relative bone healing of the implants which are placed using a flapless procedure and compare it to those placed by the conventional flap technique. Materials and Methods: This study was conducted with ten patients that were randomly divided into two groups. Group A included patients with immediately placed implants after extraction with flap elevation. Group B included patients with immediately placed implants after extraction without any flap elevation. The clinical parameters recorded were Plaque index, Modified Gingival Index, Early Wound Healing Index, Buser's criteria, Distance between implant shoulder and the crestal bone (DIB), and Radiographic Examination in a standardized manner to evaluate changes for the DIB values. Results: There was an improvement in Plaque Score from baseline to 1 month and baseline to abutment placement (6 months), which was statistically significant, but the plaque score from 3 months to abutment placement (6 months) was statistically nonsignificant in both the group. There was an increase in modified gingival score from baseline to 3 months, baseline to abutment placement (6 months), and 3 months to abutment placement (6 months), which was statistically significant in both the groups. The DIB scores in Group A recorded at baseline to 6 months were 2.80 ± 0.57 and 1.90 ± 0.42, respectively, showing a mean difference of −0.90 and P = 0.001 in comparison. Whereas, the DIB scores in Group B at baseline to 6 months were 3.20 ± 0.57 and 2.50 ± 0.50, respectively, showing a mean difference of −0.70 and P = 0.001 in comparison. The DIC scores in Group A at baseline to 6 months were 1.60 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.60 and P = 0.003 in comparison, Whereas the DIC scores in Group B at baseline to 6 months were 1.40 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.40 and P = 0.005 in comparison. Conclusion: Implants placed in fresh extraction sockets with and without mucoperiosteal flap elevation can be successfully done with augmentation procedures. Short-term survival rates and clinical outcomes of both groups were similar and appeared to be predictable treatment modalities.
... Jeong et al. [17] compared the flapless and flap groups and examined the effect of the surgical approach on crestal bone level and osseointegration and found that the mean peri-implant bone height was greater at the flapless sites compared to the sites with flaps. Barros et al. [18] and Fickl et al. [19] observed a loss of bone height at least two times more pronounced in the group where immediate implants were installed after the elevation of mucoperiosteal flap than in the group without flap elevation. ...
Article
Background: The aim of this study is to clinically evaluate and compare the clinical success and the relative bone healing of the implants which are placed using a flapless procedure and compare it to those placed by the conventional flap technique. Materials and methods: This study was conducted with ten patients that were randomly divided into two groups. Group A included patients with immediately placed implants after extraction with flap elevation. Group B included patients with immediately placed implants after extraction without any flap elevation. The clinical parameters recorded were Plaque index, Modified Gingival Index, Early Wound Healing Index, Buser's criteria, Distance between implant shoulder and the crestal bone (DIB), and Radiographic Examination in a standardized manner to evaluate changes for the DIB values. Results: There was an improvement in Plaque Score from baseline to 1 month and baseline to abutment placement (6 months), which was statistically significant, but the plaque score from 3 months to abutment placement (6 months) was statistically nonsignificant in both the group. There was an increase in modified gingival score from baseline to 3 months, baseline to abutment placement (6 months), and 3 months to abutment placement (6 months), which was statistically significant in both the groups. The DIB scores in Group A recorded at baseline to 6 months were 2.80 ± 0.57 and 1.90 ± 0.42, respectively, showing a mean difference of -0.90 and P = 0.001 in comparison. Whereas, the DIB scores in Group B at baseline to 6 months were 3.20 ± 0.57 and 2.50 ± 0.50, respectively, showing a mean difference of -0.70 and P = 0.001 in comparison. The DIC scores in Group A at baseline to 6 months were 1.60 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of -1.60 and P = 0.003 in comparison, Whereas the DIC scores in Group B at baseline to 6 months were 1.40 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of -1.40 and P = 0.005 in comparison. Conclusion: Implants placed in fresh extraction sockets with and without mucoperiosteal flap elevation can be successfully done with augmentation procedures. Short-term survival rates and clinical outcomes of both groups were similar and appeared to be predictable treatment modalities.
... This process results in an increased resorption rate of the extraction socket after flap elevation. (Fickl et al., 2008) A study by Tiyapatanaputi et al. (2004) concluded that the absence of the periosteum on transplanted bone blocks resulted in a 75% reduction in osteoclast numbers on bone grafts, which correlated with poor remodeling activity. Nguyen et al. (2019) showed that the inhibition of osteoclast migration from the periosteum to the bone surface can be used for alveolar ridge preservation. ...
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Article
Introduction Several techniques and methods have been proposed to cover alveolar bone after tooth extraction when soft tissue is lacking. Some authors recommend soft tissue flap techniques, and others advocate different types of materials for socket covering. In this article, the authors use a modified buccal inversion technique for adequate coverage of the alveolar ridge to ensure its preservation and to minimize soft tissue shrinkage and loss of keratinized gingiva after tooth extraction. This local mucogingival-periosteal plastic procedure was named by the authors the “Buccal Periosteal Inversion technique” or simply BUPI. Materials and Methods After extraction of a fractured, endodontically compromised lower right first molar, the BUPI technique was performed to cover the alveolus. After reflecting the two-sided full-thickness flap, the periosteum was split in the cranial direction. The inverted periosteum is used to provide tension-free defect closure of the postextractional defect. Detailed technique implementation and patient postoperative healing are presented here in detail. Results Postoperative evaluation at six weeks was presented with photos showing adequate surgical site healing, no signs of infection or dehiscence, and no crestal shift of the keratinized gingiva. Conclusion The buccal periosteal inversion (BUPI) technique is a modified technique that allows full socket coverage, avoiding a keratinized gingiva shift in the crestal direction using only the periosteum as a cover material. By inverting the buccal ridge periosteum alone from its normal position, the osteoclastic effect on the buccal bony wall will be eliminated, and this procedure abolishes the need for additional alveolar coverage materials.
... In the case of a thin vestibular wall consisting only of cortical bone, blood flow coming from the periosteum is not sufficient to fully preserve this structure. The dimensional variations were analyzed both in animal and human models, using various methods ranging from the radiographic evaluation to clinical assessment of post-extraction sockets to analysis of pre-op and postop scans of plaster models [4][5][6][7]. From a clinical standpoint, the average resorption of post-extraction sockets is around 50% of the vestibular-palatal-lingual width and mostly occurs within the first three months following tooth extraction [8,9]. Such volume loss may cause problems to dental implant placement [8,9]. ...
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Article
Analysis of short-term results regarding dimensional stability of post-extraction sockets managed via a preservation protocol using deproteinized bovine bone matrix and a xenogeneic collagen matrix. Materials and methods Fifteen patients needing extraction of one single-rooted premolar tooth were treated in a pilot study. Five patients were treated in each centre. After tooth extraction, sockets were filled with anorganic bovine bone matrix and covered with a xenogeneic collagen matrix. Six months later, implants were placed. Dimensional changes in the treated sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Results After six months of healing, the vertical reduction of the grafted sites was 0.31 ± 0.24 mm (p < 0.001). Volumetric analysis of superimposed models showed an average palatal-lingual contraction of 0.33 ± 0.51 mm3 (p = 0.02). At the vestibular level, the average contraction was found to be 0.8 ± 0.3 mm3 (p < 0.001). Finally, the analysis of linear variations in the treated sites on a single sagittal section at the crystal level, and at 3 and 7 mm apically respect to the crest, both towards the vestibule and palate, generally showed more marked resorption at the crestal level compared to apical measurements. Conclusion: The clinical protocol herein employed for socket preservation showed a positive effect in preventing the physiological post-extraction remodeling.
... Guided bone regeneration performed to preserve the alveolar ridge usually requires a primary closure of the wound to promote proper regeneration and avoid contamination of the grafts [6,7]. It involves making incisions and lifting a flap that may reduce the blood supply, and cause a marginal recession at the adjacent teeth, defective papillae, loss of keratinized mucosa, increased postoperative pain, and swelling in patients [7][8][9]. These may have more impact on the anterior maxilla, where the anatomic features such as the labial plate are usually thinner and the esthetic outcomes are challenging. ...
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Article
Background The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation. Objective To learn about the effect of different SSS techniques on alveolar ridge preservation Material and methods Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at − 1, − 3, and − 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA). Results A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (− 1.42 mm in the experimental group versus − 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at − 1, − 3, and − 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences. Conclusions There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.
... There is no significant histological difference between flapped and flapless groups; thus, the percentage of new bone, connective tissue, and residual bone graft is similar between these two groups [10]. However, more buccal bone resorption is found in extraction sockets with full-thickness flap elevation, which would disturb the surrounding periosteum [9,[11][12][13]. The flapless procedure is less traumatic and results in more keratinized tissue than the flap procedure [8,9,14]. ...
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Article
This retrospective study compared the effects of different extraction sockets when using flapless ridge preservation during dental implant therapy. The extraction sockets were divided into four groups: Class I, intact soft tissue wall and bone walls; Class II, intact soft tissue wall with the destruction of at least one bone wall; Class III, the recession of all soft tissue walls by ≤5 mm; and Class IV, the recession of at least one soft tissue wall by >5 mm. We compared clinical parameters of dental implant therapy using flapless ridge preservation among these groups. Seventy patients with 92 dental implants, including 53 maxillary and 39 mandibular implants, involving flapless ridge preservation were enrolled. The implant survival rate was not affected by socket morphology. Total treatment time from extraction to final prosthesis placement was significantly longer in Class II and III than in Class I, among the maxillary sockets. However, there was no significant difference in the total treatment time among the different groups in the mandible. Therefore, implant survival rates did not differ according to socket morphology; however, total treatment time was significantly affected by socket morphology in the maxilla and was longer in socket classes associated with periodontitis.
... Prognostic factors are dependent on the thickness of the patient's buccal bone wall and soft tissue phenotype [9][10][11]. It has been clearly revealed that the buccal plate, especially in the coronal part, usually is composed solely of bundle bone, which is resorbed after the tooth extraction [12,13]. Since the normal amount of the covering soft tissue varies from 2.8 mm to 3.8 mm, the bone resorption can cause various degrees of soft tissue shrinkage in the midfacial area [14,15]. ...
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Article
The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment ( P > 0.05 ), while the NG group presented a significant difference ( P < 0.05 ). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group ( P < 0.05 ). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.
... Primary outcomes were BCPF and GL, selected as these outcomes are most likely to represent an objective measure of dental extraction trauma and can occur simultaneously. [23][24][25][26] Secondary outcomes were determined as tooth fracture, operating time, ease of technique, bleeding, pain, postoperative infection, and healing. Secondary outcomes were not part of the inclusion criteria; nonetheless, they were analyzed as a result of their potential impact on rehabilitation and to give the reader an additional insight into the performance and safety of the physics forceps. ...
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Article
Purpose The aim of this study was to systematically review the literature to investigate the efficacy of physics forceps compared to conventional forceps for simple exodontia. Methods A systematic review was conducted using Embase, Medline, PubMed, Scopus, Web of Science, Dentistry and Oral Sciences Source, Cochrane databases and Google Scholar. Primary outcomes investigated were buccal cortical plate fracture (BCPF) and gingival laceration (GL) and secondary outcomes included bleeding, delayed healing, ease of technique, pain, tooth fracture, operating time and postoperative infection. Results Eight randomized controlled trials were included in the review. One study identified a significant difference in BCPF (P=0.001) and 3 studies reported a significant reduction in GL (all P≤0.032) from using physics forceps, compared to conventional forceps. Secondary outcomes of bleeding (K=2) and pain (K=3), on day 1, was significantly reduced when utilizing the physics forceps (P≤0.001) and (P≤0.03), respectively. There were no significant differences or inconclusive results found for tooth fracture, operating time, ease of technique, postoperative infection and delayed healing. Conclusion The review identified that only a limited number of included studies were reported to provide a more atraumatic approach for simple exodontia in terms of BCPF, GL, postoperative pain and bleeding, when compared to conventional forceps. The majority of studies reported no significant differences. However, studies were associated with a high risk of bias and selective outcome reporting.
... These could involve trauma to the surrounding hard and soft tissues during tooth removal [14] or a reduction in alveolar bone because of periodontal or peri-apical pathology. Soft tissue elevation could also have a negative impact on bone preservation, and it is suggested that a flapless surgical approach could reduce the amount of bone loss [15][16][17][18]. It is assumed that alveolar bone remodeling is thus affected by various simultaneous factors, and its magnitude is patient, site and time dependent [19]. ...
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Article
The aim was to evaluate ridge reduction and mucosal recession following immediate placement of ultra-wide implants in molar sockets, without bone grafting. Impressions were taken prior to tooth extraction, 4 months and 1 year after implant placement. The casts were digitized and compared. Mucosal recessions and horizontal ridge reduction were measured. A total of 16 implants were in the maxilla and 11 in the mandible. At the buccal aspect, there was a mean reduction of 0.94 mm after 4 months and 0.89 mm after one year (p = 0.933). At the palatal/lingual aspect, this was 1.09 mm after 4 months and 0.69 mm after 1 year (p = 0.001). After 1 year, a recession of 0.59 mm was measured at the zenith, 1.04 mm at the mesial and 0.98 mm at the distal papilla. The mean midfacial horizontal ridge reduction was 1.23 mm after 4 months and 1.45 mm after 1 year. At the midpalatal/midlingual aspect, the mean horizontal reduction was 1.43 mm after 4 months and 1.16 mm after 1 year. Immediate implant placement without bone grafting in the posterior jaw yields a significant horizontal ridge reduction and minor mucosal recession. Clinicians should anticipate the amount of ridge reduction and consider augmentation at the time of implant placement.
... 2,3,18,33 Experimental studies suggest that a flapless approach to tooth extractions and immediate implant placement results in better preservation of the soft tissue contour. 34,35 Nevertheless, the flapless approach entails some inconveniences, including the difficulties in appraising the size and shape of the crest and the soft tissue thickness; the clinician must rely on indirect evaluation by means of probing and palpation. Flapless atraumatic extraction, immediate implant insertion in the fresh socket, and immediate incorporation of a provisional crown are associated with minimal facial recessions (0.45 ± 0.25 mm) 1 year after implant insertion. ...
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Article
Purpose: A prospective cohort multicenter study was undertaken to identify risk factors for implant survival, complications, and patient-centered outcomes following single-tooth immediate implant placement and loading in esthetic areas. Materials and methods: Consecutive immediate implants placed in incisors, canines, and premolar sites were included. Variables recorded as possible risk factors included smoking habit, systemic conditions or therapies, previous assumption of bisphosphonates, inability to take amoxicillin, untreated periodontitis, thin periodontium, parafunctional habits, suppuration, bone dehiscences, and buccal bone fracture during implant insertion. Outcome variables included implant survival, recession, other complications, and patient satisfaction. Results: Data of 215 implants in 215 patients were collected in 15 centers in 2 years. One implant was seated with a torque < 30 Ncm and was not immediately loaded. It was successfully loaded 10 weeks after placement and was healthy 2 years later. This implant was excluded from subsequent analysis. Potential risk factors were identified in 116 patients (54.21%). There were 11 dropouts after 1 year and 37 after 2 years. Failures were relatively frequent (14.6%) before the delivery of the definitive prosthesis. No significant association was observed between early failures and risk factors. One failure and six recessions were observed after the definitive prosthesis. High satisfaction scores (mean score of 9.47/10 and 9.55/10 for esthetics and function, respectively) were recorded at 2 years. No recession occurred in the no-risk group. Five mucositis cases and one peri-implantitis case were observed in the 2-year follow-up. Conclusion: Failures were frequent before the definitive restoration and could not be explained by specific risk factors. Tissues appeared stable after the definitive restoration. Patients were very satisfied during the follow-up.
... While minimal bone resorption at 3 months with use of atraumatic extraction technique was reported, post-extraction buccal plate fracture (9%) and dehiscence (28%) could also occur [18,19]. In animal studies, the benefit of flapless technique appeared to be short term (3 months postoperative) because the difference became negligible at longer follow-up visits [20,21]. Based on 34 consecutive subjects requiring single implant restoration, Chen and Darby reported that the dimensional changes were most pronounced at sites with fenestrations and dehiscence at extraction [22]. ...
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Article
Purpose of Review 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. Recent Findings The electronic database search was limited to the past 3 years (publication dates between January 1, 2017, and February 29, 2020) and to human clinical studies (including controlled clinical trials and randomized controlled trials) investigating dimensional changes in alveolar sockets after various ARP techniques with outcomes measured from 3 to 6 months postoperatively. A total of 31 articles were reviewed, with approximately half of the selected studies using bovine (14) bone substitutes. Other biomaterials used in the studies included porcine bone substitutes, allografts (both freeze-dried and solvent-dehydrated), alloplasts (biphasic calcium phosphate, β-tricalcium phosphate, and hydroxyapatite), biologics (platelet-rich fibrin and recombinant bone morphogenetic protein-2), collagen and high-density polytetrafluoroethylene membranes, and micro-titanium stent. Summary Collagenated deproteinized bovine bone matrix (DBBM-C) was the most studied biomaterial in the past 3 years. Most studies showed DBBM-C plus barrier membranes resulted in comparable clinical and radiographic outcomes with DBBM and allografts. Consistent with previous studies, most of the ARP procedures reviewed in this article demonstrated effective reduction of alveolar ridge dimensional changes. Based on the selected articles and recent systematic reviews and meta-analysis, ARP procedure using bovine and porcine xenografts, as well as allografts, in conjunction with either collagen membranes or high-density polytetrafluoroethylene membranes gives similar results and should be considered when indicated.
... The fate of the buccal bone is unpredictable, and the bone resorption relies on many different factors. It has been shown that both the buccal bone thickness (Chappuis et al., 2013) and the extraction technique (Fickl, Zuhr, Wachtel, Bolz, & Huerzeler, 2008) have an effect on the postextraction remodelling of the buccal bone. ...
Article
Aim To systematically review buccal bone thickness (BBT) in the anterior maxilla in different teeth, age groups and genders. Materials and Methods PubMed, EMBASE and Cochrane databases were searched up to April 2020. Clinical and radiographic studies reporting on BBT of maxillary anterior teeth, with at least 10 patients were included. A meta‐analysis was performed using random effect models to report differences of BBT. Results 50 studies were included. Using bone crest (BC) as a reference point, no significant differences were found in BBT between different tooth types, except for 0.16 mm (95%‐CI:0.02‐0.30) increased mid‐root thickness of premolars compared to canines. Using the CEJ as a reference point, canines presented with a significantly increased thickness of 0.32 mm (95%‐CI:0.11‐0.54) coronally compared to laterals. When BC was used as reference, males demonstrated a significantly increased thickness of 0.21 mm (95%‐CI:0.15‐0.27) apically, while middle‐aged adults showed a 0.06 mm (95%‐CI:‐0.12,‐0.01) statistically significant increase in the coronal level compared to older adults. Conclusions Few maxillary anterior teeth have BBT greater than 1mm. Buccal bone tends to get thicker from a coronal to apical position along the root surface and from an anterior to posterior position in the arch.
... The sub epithelial connective graft removed from the palate can be largely used in the anterior area of the maxilla, increasing the soft tissue volume and creating a favorable phenotype [3]. The immediate temporization of the implant supported prosthesis can preserve the natural architecture of the socket and is the best technique to maintain the papillae high [7]. ...
... [3][4][5][6] Minimizing extraction trauma and limiting flap elevation are among these procedures. 7 The usage of bone fillers in socket augmentation also assists in preserving the remaining hard and soft tissues after tooth extractions and assists in decreasing additional bone grafting procedures for future implant placement. 3,8,9 However, the literature is limited in quantifying soft tissue healing after socket augmentation protocols. ...
Article
Purpose: Socket augmentation decreases the magnitude of alveolar ridge resorption, but the literature is limited in respect to quantifying soft tissue remodeling. The aim of this study was to determine the volumetric and linear dimensional changes at the buccal surface for both hard and soft tissues after socket augmentation treated with a xenogeneic collagen matrix in combination with bone grafting. Materials and methods: Twenty-four individuals indicated for tooth extraction were enrolled in this investigation. Each participant was randomly assigned to one of two groups: (1) deproteinized bovine bone + collagen plug, or (2) deproteinized bovine bone + xenogeneic collagen matrix. A cone beam computed tomography scan was taken prior to extraction and at 6 months postextraction. Intraoral scanning images were taken at baseline, 3 months, and 6 months postextraction. Hard and soft tissue analyses were performed to compare linear ridge remodeling and volumetric changes by noncontact reverse-engineering software. Results: Both groups showed bone and soft tissue remodeling. For hard tissue remodeling, there was no significant difference between the collagen plug and collagen matrix groups. For soft tissue remodeling, the collagen matrix group showed a reduced soft tissue loss compared with the collagen plug group. The volumetric analysis demonstrated that the mean buccal soft tissue volume loss for the collagen matrix group was 68.6 mm3 compared with 87.6 mm3 found in the collagen plug group (P = .009) over a 6-month period. Conclusion: This clinical investigation provides early evidence of using the total tissue volume to compare soft and hard tissue remodeling after socket augmentation. The results of this study demonstrated that the use of a xenogeneic collagen matrix reduced the buccal soft tissue loss after tooth extraction, but additional studies are necessary to evaluate the clinical significance of soft tissue augmentation after tooth extraction.
... As a conclusion, most studies demonstrated that ridge preservation techniques are beneficial in maintaining the hard tissue volume to a certain extent. However, a complete preservation and regeneration of the bone volume after tooth extraction has not been reported, especially in compromised sites with partial or complete loss of the buccal bone plate, despite these deficient sockets (Carmagnola et al., 2003;Fickl et al., 2008a;Nevins et al., 2006). There is no evidence to support the superiority of one technique over another. ...
Article
Objectives To explore whether placement of a soft cortical membrane can restore and regenerate the original alveolar ridge contour in deficient sockets. Materials and Methods One Beagle dog was used in this proof-of-principle evaluation. In a first intervention, a standardized buccal dehiscence defect was artificially created at the distal roots of the 3rd and 4th mandibular premolars. Four weeks later, following endodontic treatment of the mesial roots, teeth were hemisected and the distal roots were extracted without raising a flap. A cortical membrane (Lamina®, Osteobiol) was placed outside of the bony envelope of the extraction socket to rebuild the buccal bone contour. Afterwards, sockets were filled with a collagen-modified porcine bone graft material (Gen-Os®, Osteobiol) to the level of the surrounding bone height. The socket orifice was closed with a porcine dermal matrix (Derma®). After four months, block specimens containing the socket-sites and remaining roots were retrieved, histologically processed and analyzed. Results Surgery and post-operative healing were uneventful. Histologically, bone formation under the membrane was found, i.e. bony protrusions and ossicles by osteoblasts could be identified. Concomitantly, the membrane showed clear signs of degradation. Bone substitute was well integrated in newly formed bone and resorption of particles was found. Conclusion Three major observations were made in the present proof-of-principle study: i) regeneration of a compromised socket seems possible when applying the presented approach, ii) the soft cortical membrane was sufficiently stable to allow for the establishment of the contour and to inhibit soft tissue invasion and iii) the applied xenogenic graft material was undergoing remodelling processes while allowing adequate bone regeneration.
... The amount of bone resorption occurring after flapped or flapless tooth extraction remains controversial. Flapless surgery in dogs reduced the volumetric alterations on the buccal aspect irrespective of whether a grafting material was used (22) . In the present study preoperative at mesial, distal and middle surface; there was a non-statistically significant difference between the width of alveolar ridge measurements in the two groups. ...
... Thus, PRF membranes or collagen sponges can be utilized to cover and protect the graft. Primary wound closure may lead to muco-gingival junction repositioning, keratinized mucosa displacement, and additional ridge resorption due to flap elevation [29,30]. All sockets were grafted with a mixture of particulate dentin autograft (2/3) and chopped PRF membranes (1/3). ...
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Article
This study utilized radiographic comparative analysis in order to evaluate dimensional ridge changes four months after tooth extraction and immediate grafting with mineralized dentin particulate autograft and chopped platelet-rich fibrin. Fifty-eight extraction sockets with up to 2 mm of missing buccal bone in the coronal aspect compared to the lingual bone were included. Graft material was covered with either a platelet-rich fibrin membrane or collagen sponge with no effort to achieve primary closure. The dimensional changes of the ridge were assessed on cone-beam computed tomography (CBCT) images acquired prior to extraction and four months later. The reduction in the buccal bone plate thickness 1 mm, 3 mm, and 5 mm below the buccal crest was −0.87 ± 0.84 mm, −0.60 ± 0.70 mm, and −0.41 ± 0.55 mm, respectively. The mean ridge width changes 1 mm, 3 mm, and 5 mm below the crest were −1.38 ± 1.24 mm, −0.82 ± 1.13 mm, and −0.43 ± 0.89 mm, respectively. The average mid-buccal bone height gain was +1.1%, while the mid-lingual height gain was 5.6%. A mineralized dentin autograft with platelet-rich fibrin is effective in preserving post-extraction alveolar ridge dimensions.
Chapter
The healing events following tooth extraction are well‐studied and described in animals and in humans. Knowledge of the sequence and histology of these events and the alterations of the edentulous alveolar ridge are essential not only for the appropriate prosthodontically driven implant planning but also for the timing of implant placement. This chapter provides an overview of the anatomy of the alveolar bone, the histologic healing of the extraction socket, the grafting procedures to preserve the alveolar ridge, and the rationale for the timing of implant placement.
Chapter
Adjunctive procedures in implant dentistry are on both the surgical and restorative sides. Dental implants have provided a profession with many functional and aesthetic options for replacing missing teeth. The options depend on the number of teeth missing, bone, patient preference and cost. It has been well established that careful treatment planning to identify risk factors and establish ideal conditions for implant placement is critical to success for dental implant therapy. Bone replacement grafts are used throughout implant dentistry to serve as a scaffold and allow new bone formation at a desired site. Hygienists play the key role to clearly define the patient's wants, needs, and expectations. The hygienist can discuss with the patient all restorative and adjunctive procedure options if they feel comfortable or schedule an implant consultation appointment with office implant coordinator and/or doctor.
Chapter
The replacement of an anterior tooth with an implant is one of the most difficult challenges for the implant surgeon. Changes to the hard and soft tissues of the alveolar ridge following tooth extraction result in loss of buccal lingual width, loss of bone height, loss of height of the interdental papilla, and flattening of the arch. While placing a dental implant can restore the function of the arch, restoring the aesthetic form can be significantly more challenging, particularly in patients with a high smile line. This chapter discusses the socket shield technique, an alternative to total tooth extraction in which a thin “shield” of dentin is left in the socket to prevent resorption of bone, resulting in preservation of hard and soft tissue contours and superior aesthetic results.
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Article
Objective: The objective of the present study was to compare the effect of mixing simvastatin with Nanobone graft on the healing process of extraction sockets regarding to the histological parameter. Materials and Methods: In a prospective randomized clinical study, ten patients (study group, Group II) treated by simvastatin mixed with Nanobone after tooth extraction. The other ten patients (Control group, Group I) received Nanobone only. Three months after tooth extraction and socket preservation, histological biopsies were taken at the time of implant placement. The biopsies were evaluated in the terms of the histological parameter for the identification of vascularization and bone metabolism factors. Results: The use of simvastatin combination results in slightly higher values of mineralized area of newly formed bone andnumerous well differentiated capillary vascularization. Conclusion: Simvastatin and Nanobone combination showed improvement in socket preservation.
Article
Background Alveolar ridge preservation can effectively decrease alveolar ridge resorption following tooth extraction, but it can be limited by reducing new bone formation and residual bone graft material. Efforts to develop more efficacious approaches are thus an area of active research. Purpose To assess the impact of autologous concentrated growth factors (CGF) on alveolar ridge absorption and osteogenesis following posterior tooth extraction. Materials and methods Fifty patients were randomly assigned to have extraction sockets treated with CGF or no treatment. At 10 days, 1 month, and 3 months postextraction, soft tissue color and texture were examined and evaluated with healing score. Cone-beam computed tomography (CBCT) scans were performed before and 3 months after extraction, while radiographic analyses were used to assess vertical and horizontal bone changes. Bone samples were collected from the extraction sockets during implant placement, and micro-computed tomography (micro-CT) scans and histological analysis were performed to evaluate new bone formation. t-Test or Mann–Whitney U test was used to compare data and the level of statistical significance was set at 0.05 for all analyses. Results Forty-six patients completed the trial. Sockets in the experimental group exhibited significantly better healing score on Day 10 postextraction relative to the control group, whereas comparable healing was observed in both groups at 1 and 3 months postextraction. Experimental group exhibited reduced vertical bone changes relative to the control (p < 0.05). Significant reductions were observed in ridge width changes at 1 and 2 mm apical to the crest (p < 0.05), although differences at 3 and 5 mm apical to the crest were not significant. Significant differences of bone mineral density (BMD) and microarchitecture of trabecular bone were observed via micro-CT analyses, and the experimental group had better results. Conclusion CGF application following posterior tooth extraction may reduce vertical and horizontal bone resorption and promote new bone formation.
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Article
Background/purpose Laser technology and minimally invasive therapy has gained attention in many dentistry fields. Er,Cr:YSGG laser is the latest laser type that can be applied on both soft tissue and hard tissue. This study presents periodontal outcome of Er,Cr:YSGG laser flapless crown lengthening procedure compared with traditional technique. Materials and methods Twenty-five participants were divided into two groups: 13 patients were treated with the traditional method of crown lengthening and 12 patients were treated using a flapless Er,Cr:YSGG laser. Their periodontal status were measured and compared at baseline, immediately, one month, and three months after surgery. Results The results showed a significant increase in clinical crown length immediately after surgery in both groups. After a three-month follow-up, the gingival margin of the laser group remained at stable height with 0.17 ± 0.31 mm increase after surgery, while the gingival margin of traditional group showed both recession and rebounding by −0.13 ± 0.63 mm (p > 0.05) average. Conclusion The flapless Er,Cr:YSGG laser crown lengthening with its minimally invasive approach without flap reflection may be an alternative treatment for providing an adequate height of tooth for restoration.
Thesis
Zahnverlust geht bekannter Weise mit einem Verlust von Hart- und Weichgewebe einher. Mit der relativ neuen Tent-Pole Technik könnte der Volumenverlust durch den Wundverschluss bei Knochenaugmentation nach der GBR-Methode geringer ausfallen. In 10 Schweineunterkiefern wurden mit beiden Methoden augmentiert und mithilfe von Cerec- und DVT-Scans das Volumen vor und nach dem Wundverschluss verglichen. Dabei konnte festgestellt werden, dass bei Verwendung einer Tenting Screw signifikant weniger Volumenverlust als bei Augmentation mit der GBR-Technik resultierte. Ein zusätzlicher Vergleich von zwei Kollagenmembranen, OssixPlus und BioGide, im Hinblick auf den Widerstand gegen den Nahtverschluss zeigte im Signifikanztest keinen Vorteil der ribosekreuzvernetzten und steiferen OssixPlus Membran. Zahlreiche klinische Untersuchungen berichten im Zusammenhang mit der Tent Pole-Technik von komplikationslosem Einheilen, suffizientem Knochenaufbau und erfolgreicher Implantation. So könnte sich die Tenting Screw nach weiteren Untersuchungen im in vivo Modell zu einer eventuell ebenbürtigen Alternative zum bisherigen Goldstandard, dem Knochenblock entwickeln. Dieser stellt sich im Vergleich als technikintensivere und, gerade bei autologem Material, als für den Patienten weniger komfortable Maßnahme dar.
Article
Background Customized sealing socket abutment (SSA) has been claimed to optimize the peri‐implant hard and soft tissues in type 1 implant placement. However, the evidence to claim the benefits of this technique over the use a conventional healing abutment remains weak. Purpose The aim of this retrospective study was to provide a 3D‐radiographic evaluation of hard tissues changes following immediate implant placement in molar sites combined to ARP technique and installation of SSA. Materials and Methods Baseline and follow‐up (FU) CBCTs (from 1 to 5 years) of 26 patients were collected and included in the study. Baseline and FU CBCTs were superimposed and horizontal and vertical bone changes were assessed. Results A total of 26 patients and 27 implants were included. Horizontal bone remodeling was not significant in any of the measured areas except in the most cervical level, where a mean bone remodeling of 0.73 mm was found. Proximal and buccal vertical bone changes were not significant. Conclusions Within the limits of a retrospective study, dimensional alveolar ridge changes 1 to 5 years after immediate implant placement in molar sites with simultaneous ARP technique and installation of SSA seem to be very limited.
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Article
The existence of alveolar processes and the integrity of the maxillae outside of a specific pathological process are linked to the presence of teeth. The aging process is most often accompanied, at the buccal level, by a narrowing of the prosthetic corridor in relation to the importance of bone resorption and the invasion of peripheral elements. Thus, we are and will be confronted more and more with complete edentulous patients, presenting a very strong resorption of the alveolar processes, even of the osseous bases, which will increase proportionally the difficulties of obtaining a good retention and good stability of the prostheses.Our work aims to review the various means available to us to prevent bone resorption, throughout the stages of prosthetic and post-prosthetic realization.
Article
Objectives: To compare two ridge preservation techniques and spontaneous healing in terms of soft tissue thickness, contour changes and soft tissue handling two months after tooth extraction. Methods: Thirty-six patients were included with buccal bone plate dehiscences of up to 50% after single-tooth extraction in the esthetic zone. They were randomly assigned to receive one of three procedures: a deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered with a collagen matrix (DBBM-C/CM), DBBM-C alone or spontaneous healing (SH). Two months later, the status of soft tissue healing was assessed, and the thickness of the mucosa was measured at the center of the site. Thereafter, implants were placed and the need for further guided bone regeneration (GBR) to cover exposed implant surfaces assessed. Results: Thirty-six patients were evaluated at the day of implant placement. An invagination of the soft tissues was recorded in 41.7% (n=12), 53.8% (n=13) and 90.9% (n=11) of the sites in groups DBBM-C/CM, DBBM-C and SH respectively. The median thickness of the mucosa measured 3.0mm in group DBBM-C/CM, 2.1mm in group DBBM-C and 1.5mm in the SH group. Additional GBR was necessary in 66.7% (n=12), 53.8% (n=13) and 90.9% (n=11) of the sites in groups DBBM-C/CM, DBBM-C and SH respectively. Conclusions: The present explorative study revealed slight tendencies for more favorable soft tissue conditions with less invaginations as well as increased soft tissue volume and thickness in groups having received an alveolar ridge preservation procedure compared to spontaneously healed sites at 8 weeks of healing.
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Article
Optimal implant placement can be achieved only if the ridge maintains its dimensions and the quality of bone. To prevent the resorption of the ridge and to enhance the quality of regenerated bone, two main approaches have been suggested. Part I of this article presents a modified regenerative technique-the "socket seal surgery" (SSS). Part II will present a modified prosthetic technique--the "cervical contouring concept" (CCC)--and it will be published in the May, 1994, issue of PP&A. The learning objective of this article is to supplement reader knowledge of methods and techniques for prevention of ridge resorption and enhancement of bone regeneration.
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Article
TEN PATIENTS WHO REQUIRED two or more anterior teeth extractions were utilized in this study. Extraction procedures were carried out with a full thickness surgical flap approach. After flap reflection, teeth were removed with a minimum of trauma to the surrounding bone. Following extraction silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions. One socket was covered with an expanded polytetrafluoroethylene (ePTFE) barrier membrane (experimental site); the other socket was a conventional control. The soft tissue flaps were then mobilized using periosteal releasing incision and the wound closed with ePTFE mattress sutures. Six months following extraction, patients were treated with flap surgery to expose both extractions sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points. Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control (P < or = 0.05). Three patients with exposed membranes had similar dimensional changes as controls. Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry.
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Article
For the clinical performance of new dental restorative materials to be accurately assessed, the three-dimensional anatomical changes of the functional surfaces of the restoration must be elucidated over time. To this end, a highly accurate 3-D optical scanner has been developed that utilizes the principles of triangulation and a reference-free automated 3-D superimposition software. The aim of this study was to assess the accuracy and the precision of the new system with and without referenced positioning. Additionally, the ability of the system to determine wear of posterior fillings three-dimensionally has been shown. Gypsum replicas of restored teeth were evaluated. The tooth surfaces were scanned with a resolution of 250,000 surface points within a measuring time of 20 to 40 sec. The results show that the precision and accuracy of 3-D data acquisition depend on the surface inclination. Up to an angle of 60 degrees, the precision is better than 3 microns, and the accuracy is better than 6 microns. If exact repositioning of the object before and after occlusal loading is possible, e.g., with in vitro studies, differences on the surface can be determined with a precision of 2.2 microns. In reference-free measurements, which are a necessity in clinical studies, the 3-D data acquisition in combination with the automatic matching program can detect wear with an accuracy of 10 microns. The application of this measuring device for the detection of wear of a composite filling functioning in the mouth has been shown. Since this measuring technique is automated, and measurements of high accuracy can be attained in a short period of time, this system offers the possibility for complex analyses of three-dimensional wear to be conducted on a large number of samples in clinical studies.
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Article
Preservation of alveolar bone volume following tooth extraction facilitates subsequent placement of dental implants and leads to an improved esthetic and functional prosthodontic result. The aim of the present study was to assess bone formation in the alveolus and the contour changes of the alveolar process following tooth extraction. The tissue changes after removal of a premolar or molar in 46 patients were evaluated in a 12-month period by means of measurements on study casts, linear radiographic analyses, and subtraction radiography. The results demonstrated that major changes of an extraction site occurred during 1 year after tooth extraction.
Article
Restoring the dentofacial harmony after tooth loss in the esthetic zone has become one of the major challenges in modern dentistry. The long-term stable reconstruction of esthetics and function can be achieved either with tooth-supported or - preferably - with implant-supported restorations. Both treatment modes depend on the proper surgical and prosthetic management of the extraction sockets. For implant-supported restorations, immediate implant placement has become an integral part of a treatment protocol that was inaugurated to preserve a harmonious curvature of the gingival margins around the restoration relative to the adjacent dentition. Practical experience has shown, however, that the concept of immediate implant placement is highly technique-dependent and will only yield esthetically satisfactory results in carefully selected patients and under consideration of important requirements. Traditional treatment concepts such as implant placement in healed ridges or tooth-supported bridge restorations therefore continue to play a major clinical role. This article intends to explain the therapeutic problems related to extraction sockets and to present a number of clinical concepts for their solution, especially from the point of view of the prosthodontics.
Article
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.
Article
The purposes of this study were to evaluate digitized images from standardized radiographs for quantitative changes in alveolar bone density following periodontal surgical procedures, and to correlate these changes to the changes in the clinical parameters P1I, GI, PD, AL. 14 crown-lengthening procedures for restorative purposes were performed in 13 patients and 15 modified Widman flaps were performed in 15 patients, providing 61 surgical interdental test sites and 61 matching controls. Standardized radiographs were obtained immediately post-operatively, and at 1 and 6 months postsurgically. Digitized images were obtained from the radiographs by means of a video camera linked to an image processor and a computer. Quantitative information regarding density changes within windows covering the interdental alveolar crest was obtained after superimposition and grey-level correction of images to be compared. The results indicated statistically significantly more density loss 4 to 6 weeks postsurgically at test sites treated by periodontal surgical procedures compared to corresponding controls. Significant differences in the remodelling activity between the patients exposed to crown lengthening procedures for restorative purposes and the periodontitis patients in the period 1 to 6 months postsurgically were evident. CADIA assessed differences in the tissue changes in the healing phase following periodontal surgical procedures, which were not detected by the clinical variables applied.
Article
https://deepblue.lib.umich.edu/bitstream/2027.42/141755/1/jper0127.pdf
Article
This study evaluated bone regeneration and osseointegration of hydroxyapatite (HA) coated and titanium plasma sprayed (TPS) implants placed in sockets immediately after extraction in 36 adults, mean age 55.2 years (range 26 to 81 years). Twelve TPS and 10 HA-coated implants in 20 patients were grafted with demineralized freeze-dried bone allograft (DFDBA), covered with a barrier material, and the facial flap coronally positioned to attain primary closure (experimental). The remaining 11 TPS and 10 HA-coated implants were placed similarly, except that no DFDBA was used (control). Osseous structures were measured at the initial placement and 6-month re-entry surgeries. At the 6-month re-entry, all implants placed were clinically osseointegrated. Bone resorption at the most coronal socket crest was -1.53 mm for the grafted group and -1.59 mm for the control group. Crestal bone apposition of 1.39 mm was noted at the most apical socket crest (ASC) for the grafted group, whereas crestal resorption of -0.11 mm was noted in the ungrafted control group (P < 0.02). Bone fill from the base of the deepest osseous defect was 5.68 mm for the grafted group and 3.18 mm for the control group (P < 0.04). Complete resolution of osseous defects occurred at 15 of 22 sites in the grafted group and at 9 of 21 sites in the control group. Clinical exposure of the barrier material and a subsequent inflammatory response at 27 of 43 sites, requires removal of the material prior to the 6-month re-entry and was associated with significantly more bone loss at the ASC sites (P < 0.01). There was no significant difference for any of the parameters when comparing the TPS with the HA-coated implants.
Article
Alveolar ridge preservation following tooth extraction is important when implant-supported oral rehabilitation is considered. The ability to maintain the ridge allows implant placement in an ideal position, fulfilling both functional and esthetic demands. A deproteinized bovine bone mineral (DBBM) was used as a socket site filler material to maintain ridge configuration, without applying an occlusive membrane. The material was grafted and packed onto the socket sites immediately after extractions, and subsequently primary soft tissue closure was attempted. The ridge healed for 9 months before the second surgical procedure, in which the implant was placed. New bone formation was observed in all histological specimens. DBBM particles adhered to a highly osteocyte-rich woven and lamellar-type bone. Clinically and histologically, this report demonstrated DBBM particles to be an effective biocompatible filler agent in extraction sockets for ridge preservation prior to titanium fixture implantation. Randomized controlled clinical trials are needed to fully evaluate the usefulness of this material in ridge preservation after tooth extraction.
Article
The purpose of this study was to evaluate the clinical effectiveness of a bioabsorbable membrane made of glycolide and lactide polymers in preserving alveolar ridges following tooth extraction using a surgical technique based on the principles of guided bone regeneration. Sixteen patients requiring extractions of 2 anterior teeth or bicuspids participated in the study (split-mouth design). Following elevation of buccal and lingual full-thickness flaps and extraction of teeth, experimental sites were covered with bioabsorbable membranes; control sites did not receive any membrane. Titanium pins served as fixed reference points for measurements. Flaps were advanced in order to achieve primary closure of the surgical wound. No membrane became exposed in the course of healing. Reentry surgeries were performed at 6 months. Results showed that experimental sites presented with significantly less loss of alveolar bone height, more internal socket bone fill, and less horizontal resorption of the alveolar bone ridge. This study suggests that treatment of extraction sockets with membranes made of glycolide and lactide polymers is valuable in preserving alveolar bone in extraction sockets and preventing alveolar ridge defects.
Article
Extraction socket wound healing is characterized by resorption of the alveolar bone at the extraction site. This produces a decrease in ridge volume, deformations of ridge contours, and, thus, difficulties in delayed placement of root-form implants in an ideal position. Cancellous porous bovine bone mineral (PBBM) applied to fresh extraction sockets has recently been proposed to minimize the reduction in ridge volume. The aim of this study was to investigate the influence of PBBM grafted particles on the histopathologic pattern of the intrasocket regenerated bone and to evaluate histomorphometrically the healed PBBM grafted extraction socket site at 9 months' post-extraction. PBBM particles (250 to 1,000 microns in size) were grafted in 15 fresh human extraction sockets in 15 patients. Socket wall bone height was measured from the crestal ridge level before the mineral particles were inserted. Primary soft tissue closure was performed to protect the grafted particles via a pediculated split palatal flap. At 9 months, socket bone walls were remeasured and cylinder bone samples of the previously PBBM-grafted sites were obtained. Decalcified specimens were sectioned at a cross-horizontal plane and stained with hematoxylin and eosin for histopathologic and histomorphologic examination. Tissue area percentage of bone, PBBM, and connective tissue (CT) was calculated for each specimen from the crestal to the apical region and changes in values compared. Average clinical overall bone fill of the augmented socket sites was 82.3%. Histologically, PBBM particles were observed in all specimens. Newly formed bone was characterized by abundance of cellular woven-type bone in the coronal area, while lamellar arrangements could be identified only in the more apical region. New osseous tissue adhered to the PBBM. Histomorphometric measurements showed an increase of mean bone tissue area along the histological sections from 15.9% in the coronal part to 63.9% apically (average 46.3%). CT fraction decreased from 52.4% to 9.5% (average 22.9%) from the crestal to the apical region. PBBM area fraction varied from 26.4% to 35.1% (average 30.8%). Statistical analysis of the comparison between areas of bone, CT, and PBBM was performed in different points along the coronal-apical axis. Differences were significant (P <0.01) at the most crestal, middle, and apical section cut areas, but not at the cervical section cuts. Bone area fraction increased in the apical direction as much as CT correlatively decreased. Unlike CT and bone, PBBM retained constant relative volume (approximately 30%), regardless of the depth of the specimen cores. PBBM particles are an appropriate biocompatible bone derivative in fresh extraction sockets for ridge preservation. The resorbability of this xenograft could not be recognized in a 9-month period. Further investigation is needed to clarify the resorptive mechanisms of PBBM.
Article
The aim of this study was to investigate the healing of human extraction sockets filled with Bio-Oss particles (Geistlich Pharma AG, Wolhusen, Switzerland). In 21 subjects, providing a total of 31 healing sites, at least one tooth was scheduled for extraction and the extraction sites for implant therapy. The dimensions of the alveolar ridge at the extraction sites were considered insufficient and required augmentation concomitant with tooth extraction. There were three treatment groups. In group A, the extraction sockets were covered with a Bio-Gide membrane (Geistlich Pharma AG) and in group B the extraction sockets were filled with Bio-Oss. The extraction sockets in group C were left to heal spontaneously. Biopsies from the extraction sites were collected at the time of implant installation. Samples from group A showed large amounts of lamellar bone and bone marrow and small proportions of woven bone. Sites grafted with Bio-Oss (group B) were comprised of connective tissue and small amounts of newly formed bone surrounding the graft particles. Only 40% of the circumference of the Bio-Oss particles was in contact with woven bone. Sites from group C were characterized by the presence of mineralized bone and bone marrow.
Article
The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.
Article
The aim of this prospective clinical study was to analyze graft-enhanced soft tissue healing during the initial phases after tooth extraction. Twenty patients in need of tooth extraction (incisors, canines, and premolars) and implant replacement were included. In patients with multiple extractions, one tooth was randomly selected for treatment. After administration of antibiotics, the selected tooth was gently removed. The socket was completely filled with deproteinized bovine bone mineral integrated in a 10% collagen matrix to fill out the space of the alveolus and support the soft tissue. A biopsy punch with a diameter corresponding to the socket orifice was chosen to harvest a free gingival graft of 2- to 3-mm thickness from the palate. The punched graft was carefully sutured to the deepithelialized soft tissue margins of the socket. One week after graft insertion, 64.3% of the mean graft area was fully integrated, 35.6% was fibrinoid, and 0.1% showed necrotic parts. Three and 6 weeks postsurgery, the mean integrated graft surface increased to 92.3% and 99.7%, respectively. After 6 weeks, a mean of 0.3% of the surface in four grafts showed incomplete wound closure, and no fibrin or necrosis was present. Colorimetry of the graft and adjacent tissue revealed a mean color match of deltaE = 2.91, lower than the critical threshold of 3.7 for intraoral visibility of different colors. This soft tissue punch technique led to successful biologic and esthetic integration of the transplanted graft into the local host tissues.
Article
To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change. Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope. It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall. The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood.
Article
The current experiments had three aims (i) to determine whether the absence of the periodontal ligament (PDL) may alter features of the healing of an extraction socket, (ii) to examine if there were differences in the proportion of different tissues in resolved extraction sockets and surgically produced defects after 3 months of healing, (iii) to study the influence of different biomaterials on the healing of surgically produced bone defects. Extraction sites: In five dogs, the 4th mandibular pre-molars were hemi-sected and the distal roots were removed. The extraction socket of one of the pre-molars was instrumented to eliminate all remnants of the PDL tissue. The socket of the contra-lateral pre-molar was left without instrumentation. The dogs were sacrificed after 3 months of healing. Defect sites: In five dogs, the pre-molars and 1st molars on both sides of the mandible were first removed and 3 months of healing allowed. After this interval three standardized cylindrical defects were prepared in each side of the mandible. The defects were 3.5 mm in diameter and 8 mm deep. In each quadrant one defect was grafted with Bio-Oss Collagen, one with Collagen Sponge and one defect was left non-grafted. The dogs were sacrificed 3 months after the grafting procedure. Extraction sites: The two categories of extraction sockets did not differ with respect to gross morphological features. The tissue of the extraction sites, apical of a newly formed bone bridge, was dominated by bone marrow. Few trabeculae of lamellar bone were also present. Defect sites: The non-augmented defect was sealed by a hard-tissue bridge. In the central and apical portions of the defect bone marrow made up about 61%, and mineralized bone 39% of the tissues. The invagination of the surface of this crestal bone was 0.8+/-0.3 mm. The defect augmented with Collagen Sponge was covered by a hard-tissue bridge 38% of the tissue within the defect was made up of bone marrow while the remaining 62% was occupied by mineralized bone. The invagination of the hard-tissue bridge was on the average 0.6+/-0.1 mm. In defects augmented with Bio-Oss Collagen the biomaterial occupied a substantial portion of the tissue volume. Eighty-five percent of the periphery of the Bio-Oss particles were found to be in direct contact with newly formed mineralized bone. Woven bone and bone marrow made up 47% and 26% of the newly formed tissue. The invagination of the most coronal part of the bone defect was 0.1+/-0.1 mm. Sockets that following tooth removal had their PDL tissue removed exhibited similar features of healing after 3 months as sockets which had the PDL retained. The tissues present in an extraction site appeared to be more mature than those present in a surgically produced defect of similar dimension. The Bio-Oss Collagen augmented defect exhibited less wound shrinkage than the non-augmented defect.
Article
To study dimensional alterations of the alveolar ridge that occurred following implant placement in fresh extraction sockets. Five beagle dogs were included in the study. In both quadrants of the mandible, incisions were made in the crevice region of the third and fourth pre-molars. Buccal and minute lingual full-thickness flaps were elevated. The mesial root of the four pre-molars root was filled and the teeth were hemi-sected. Following flap elevation in (3)P(3) and (4)P(4) regions, the distal roots were removed. In the right jaw quadrants, implants with a sand blasted and acid etched (SLA) surface were placed in the fresh extraction sockets, while in the left jaws the corresponding sockets were left for spontaneous healing. The mesial roots were retained as surgical control teeth. After 3 months, the animals were examined clinically, sacrificed and tissue blocks containing the implant sites, the adjacent tooth sites (mesial root) and the edentulous socket sites were dissected, prepared for ground sectioning and examined in the microscope. At implant sites, the level of bone-to-implant contact (BC) was located 2.6+/-0.4 mm (buccal aspect) and 0.2+/-0.5 mm (lingual aspect) apical of the SLA level. At the edentulous sites, the mean vertical distance (V) between the marginal termination of the buccal and lingual bone walls was 2.2+/-0.9 mm. At the surgically treated tooth sites, the mean amount of attachment loss was 0.5+/-0.5 mm (buccal) and 0.2+/-0.3 mm (lingual). Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars. The placement of an implant in the fresh extraction site obviously failed to prevent the re-modelling that occurred in the walls of the socket. The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites and vertical bone loss was more pronounced at the buccal than at the lingual aspect of the ridge. It is suggested that the resorption of the socket walls that occurs following tooth removal must be considered in conjunction with implant placement in fresh extraction sockets.
Die Versorgung der Extraktionsalveole aus prothetischer Sicht. Detailaspekte für klinisch relevante Situationen
  • O Zuhr
  • S Fickl
  • H C Wachtel
  • W Bolz
  • M B Hürzeler
Zuhr, O., Fickl, S., Wachtel, H. C., Bolz, W. & Hürzeler, M. B. (2006) Die Versorgung der Extraktionsalveole aus prothetischer Sicht. Detailaspekte für klinisch relevante Situationen. Implantologie 14, 339-353. Address: Dr. Stefan Fickl Private Institute for Periodontology and Implantology Rosenkavalierplatz 18 Munich 81925