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Luigi C, Paolo S, Alessio T, Paolo P, Valerio S, Antonio CVC, Mangano F, Maria M. Investigation of the extent of post-extraction bone contraction and bone remodeling after 4 months. A prospective pilot study. J Dent 2024:105337. [PMID: 39222771 DOI: 10.1016/j.jdent.2024.105337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/11/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES Aim was to investigate a correlation between the serum levels of 25(OH)D and the resorption of the alveolar bone walls and regeneration of the alveolar space after tooth extractions. METHODS 14 adults in need of extraction of hopeless teeth were enrolled. An intraoral digital impression was performed using CS3600 scanner, and each patient was tested to assess serum vitamin D levels. Subsequently, extraction of teeth and contextual guided bone regeneration was performed using porcine origin graft material and a resorbable collagen membrane to covert the defect. After 4 months, an impression was taken, and the model was scanned using a professional scanner for lab. At the same time, a CBCT exam was performed to perform implant insertion through fully digital computer guided surgery. Bone was collected to perform histological and histomorphometric analysis. Pre and postoperative scans were compared using a specific software GOM Inspect, GOM GmbH, Germany) to estimate the volumetric changes. GLM tests were applied to investigate the relationship between the different predictor variables and the outcome variables. RESULTS 14 patients were divided in 3 groups depending on the serum Vit-D levels, identifying three ranges corresponding to low (lower than 20), medium (between 20-30), and optimal vitamin D levels (higher than 30). Volumetric contraction after extraction was observed for all patients without any significant difference. Focusing on the post-extraction regeneration, patients belonging to the group with lower levels of Vit-D displayed lower and more disorganized levels of bone. Immunohistochemistry analysis showed that Col1A1 and Osteocalcin had no physiological alteration. Osteopontin could be identified near the external surface of bone tissue granules. Runx2 signals were detected near the margins of bone trabeculae. CONCLUSIONS Serum vit-D levels do not appear to influence the extent of post-extraction bone contraction. On the contrary, it seems to significantly influence the post-extraction regeneration. CLINICAL SIGNIFICANCE Vit D serum levels may influence the regenerative aspect during post-extraction turn-over. This might suggest controlling and (in case of low levels) recommend Vit D supplement in the patient diet in case of extraction.
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Affiliation(s)
- Canullo Luigi
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy; Department of Periodontology, University of Bern, Bern, Switzerland.
| | - Savadori Paolo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | - Pesce Paolo
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy.
| | - Sora Valerio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | | | | | - Menini Maria
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy.
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Cervino G, Fiorillo L, Scotti N, Motta FA, Motta FM, Colombo J, Heboyan A, Baldi D. Magneto-dynamic tool for full arch immediate loading in post-traumatic restoration with narrow implants: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241241191. [PMID: 38559405 PMCID: PMC10981855 DOI: 10.1177/2050313x241241191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
New surgical techniques using narrow, tilted implants positioned through a magneto-dynamic tool in guided surgery for a Toronto restoration. A 69-year-old woman wanted fixed rehabilitation to replace her removable complete dentures. A cone-beam computed tomography showed significant bone resorption in both the maxillary and mandibular regions. The plan was to load the entire upper arch with six implants immediately, while removable partial dentures were recommended for the lower jaw. The guided surgery project was aligned with the new dentures, and the laboratory created a printed cast with dental implant analogues in planned positions. A metal-reinforced denture was constructed, and surgery was performed to place six narrow implants using the magneto-dynamic instrument. The denture was directly screwed onto multi-unit abutments. Final rehabilitation was completed after 6 months. Narrow implants can be a good option for fixed, full-arch rehabilitations. Further research is needed to confirm these findings on a larger scale.
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Affiliation(s)
- Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
- Department of Dental Cell Research, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Nicola Scotti
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Alessandro Motta
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Francesco Maria Motta
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Jacopo Colombo
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Domenico Baldi
- Division of Prosthetic Dentistry, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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Ucer C, Khan RS. Extraction Socket Augmentation with Autologous Platelet-Rich Fibrin (PRF): The Rationale for Socket Augmentation. Dent J (Basel) 2023; 11:196. [PMID: 37623292 PMCID: PMC10453157 DOI: 10.3390/dj11080196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/29/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
After tooth extraction, the alveolar ridge undergoes a physiological process of remodelling and disuse atrophy. Socket augmentation (SA) has been shown to preserve alveolar bone volume in order to facilitate implant placement and reduce the need for staged grafting at a later date. Although autogenic grafting has been shown to be the gold standard in bone regeneration, it has significant disadvantages. To prevent post-extraction volumetric alterations and alveolar bone resorption occurring, alternative grafting materials, including xenografts, alloplasts, and allografts, have been used successfully in fresh extraction sites. However, these materials act mostly as bio-scaffolds and require a slower integration period of 6-8 months prior to implant placement. Recently, the use of autologous platelet-rich fibrin (PRF) has been advocated alongside socket augmentation as a method of bio-enhancement of healing of soft and hard tissues. PRF contains platelet-derived growth factors, hormones, and bioactive components such as cytokines that have been shown to promote angiogenesis and tissue regeneration during wound healing. The aim of this article is to review the evidence base for the SA technique Clinical benefits of SA will be discussed with a reference to two cases. Therefore, this narrative review will discuss the post-extraction bone changes, the importance of SA, and the bio-enhancement role of PRF in the management of extraction site defects when the alternative technique of immediate implant placement is not possible or contraindicated.
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Affiliation(s)
| | - Rabia S. Khan
- I.C.E Postgraduate Dental Institute and Hospital, University of Salford, Salford M5 4WT, UK;
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De Angelis N, Bagnasco F, Amaroli A. Bone Regeneration: Overview and Future Trends. J Clin Med 2023; 12:4529. [PMID: 37445566 DOI: 10.3390/jcm12134529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
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Affiliation(s)
- Nicola De Angelis
- Unit of Implant and Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Faculty of Dentistry Department of Periodontology, Trisakti University, Jakarta 11440, Indonesia
- Faculty of Dentistry, Tunku Abdul Raman University (UTAR), Sungai Buloh 31900, Malaysia
| | - Francesco Bagnasco
- Unit of Implant and Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Andrea Amaroli
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, 16132 Genoa, Italy
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Pesce P, Mijiritsky E, Canullo L, Menini M, Caponio VCA, Grassi A, Gobbato L, Baldi D. An Analysis of Different Techniques Used to Seal Post-Extractive Sites—A Preliminary Report. Dent J (Basel) 2022; 10:dj10100189. [PMID: 36285999 PMCID: PMC9600503 DOI: 10.3390/dj10100189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Bone grafting in post-extractive site improves tissue regeneration. Soft tissue sealing of the grafted post-extractive alveolus is supposed to limit microbiological contamination from the oral cavity and to stabilize the coagulum. Several techniques are presented in the literature to reach this goal using different heterologous matrices or autogenous grafts. In addition, recently, a technique based on the use of granulation tissue in the post-extractive alveolus has been proposed. Aim: To compare the effect of different graft sealing approaches in post-extractive sites by qualitatively evaluating their healing process. Materials and Methods: This retrospective investigation included 30 patients requiring post-extractive site regeneration in the aesthetic area. Post-extractive sites were regenerated using a bovine bone matrix and patients were divided into three groups (10 patients in each group) according to the material used to seal the alveolar socket. In the UD group, the granulation tissue was used to seal the defect; in the PC group, epithelial-connective soft tissue graft was used, and in the COLL group, a collagen-based membrane was employed. Images of the post-extractive sites at different follow-up periods (2 and 12 weeks) were taken and the healing process was blindly evaluated by two independent practitioners. The Healing Index (HI) by Landry, Turnbull and Howley was used to assess the quality of the healing process. The combination of presence/absence of five clinical criteria defines an HI ranging from 1 (very poor) to 5 (excellent). Patients’ clinical-pathological variables were recorded. One-way ANOVA was used to explore the dependence of HI on the different socket preservation protocols. Results: Based on clinical-pathological characteristics of the included patients, there were no statistically significant differences among the different sealing techniques. At the 2-week follow-up appointment, HI did not differ among the socket preservation protocols evaluated. Moreover, smoking status and reason for extraction did not influence the HI among the three groups (two-way ANOVA p-value = 0.686, p-value = 0.248 respectively). At the 2-week follow-up appointment, HI was significantly different among the socket preservation protocols investigated. Specifically, the group undergoing collagen-based socket preservation procedure reported the highest HI, compared to the other two techniques (COLL mean 4.60 ± 0.5; PC mean 3.5 ± 1.2; UD mean 3.4 ± 0.5, one-way ANOVA p-value 0.006). Conclusions: The use of collagen porcine membranes may represent a suitable option to improve the patient healing process in grafted post-extractive sites together with reducing the surgical intervention time compared to alternative sealing techniques.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
| | - Eitan Mijiritsky
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6139001, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luigi Canullo
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
| | - Maria Menini
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
| | | | | | | | - Domenico Baldi
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
- Correspondence:
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Pesce P, Menini M, Canullo L, Khijmatgar S, Modenese L, Gallifante G, Del Fabbro M. Radiographic and Histomorphometric Evaluation of Biomaterials Used for Lateral Sinus Augmentation: A Systematic Review on the Effect of Residual Bone Height and Vertical Graft Size on New Bone Formation and Graft Shrinkage. J Clin Med 2021; 10:jcm10214996. [PMID: 34768518 PMCID: PMC8584826 DOI: 10.3390/jcm10214996] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to investigate the effect of residual bone height (RBH) and vertical bone gain on new bone formation (NBF) and graft shrinkage after lateral sinus lifts using different biomaterials. METHODS An electronic search was conducted on three databases to identify randomized controlled trials (RCTs) published until January 2021 with at least one follow-up at 6 months and at least five patients treated, comparing biomaterials used for maxillary sinus augmentation with a lateral approach. Graft volumetric changes, RBH, vertical bone gain, implant failure, and post-operative complications were evaluated. The risk of bias was assessed using the Cochrane tool. RESULTS We used 4010 identified studies, of which 21 were RCTs. Overall, 412 patients and 533 sinuses were evaluated. Only three publications had an overall low risk of bias. After 6 months, xenograft (XG) showed the least volume reduction (7.30 ± 15.49%), while autogenous graft (AU) was the most reabsorbed (41.71 ± 12.63%). NBF appeared to not be directly correlated with RBH; on the contrary, the overall linear regression analysis showed that NBF significantly decreased by 1.6% for each mm of postoperative vertical graft gain. This finding suggests that the greater the augmentation, the lower the NBF. A similar tendency, with a regression coefficient even higher than the overall one, was also observed with alloplast (AP) and XG. CONCLUSIONS The present results suggested that NBF was essentially independent of preoperative bone height. On the contrary, the smaller the volume was of the graft placed, the higher the amount of new bone formed, and the smaller the graft shrinkage was. Minimizing the augmentation volume might be beneficial to graft healing and stability especially when using AP and XG.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
- Correspondence:
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Luigi Canullo
- Department of Periodontology, University of Bern, 3012 Bern, Switzerland;
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
| | - Laura Modenese
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Gianmarco Gallifante
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
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Safi Y, Amid R, Kadkhodazadeh M, Mortazavi H, Sharifi MP, Gandomi S. Bone quality and quantity of the mandibular symphyseal region in autogenous bone grafting using cone-beam computed tomography: a cross-sectional study. Head Face Med 2021; 17:26. [PMID: 34253223 PMCID: PMC8273950 DOI: 10.1186/s13005-021-00282-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity and quality of bone in the mandibular symphysis for autogenous bone graft harvesting using cone-beam computed tomography (CBCT). METHODS This cross-sectional study evaluated the CBCT scans of 78 adults presenting to three oral and maxillofacial radiology centers. The vertical (VD) and horizontal (HD) alveolar bone dimensions, cortical thickness (CT), and cancellous to cortical bone ratio (C/C) were measured in the interforaminal region of the mandible at the sites of central incisor to first premolar teeth. The interforaminal distance (ID) and the anterior loop length were also measured. Nonparametric statistical tests were used to analyze the data with respect to sex, age, and tooth position. RESULTS The median VD, HD, and CT of the symphysis were 20.21 (3.26), 4.13 (0.37), and 2.25 (0.23) mm, respectively. The median C/C was 1.51 (0.11). The median ID was 52.24 (8.24) mm, and the median anterior loop length was 1.82 (1.06) mm. Significant differences were observed in all parameters among different teeth. Most of the measured parameters were greater in males compared with females. There were significant differences in ID, VD, and CT between different age groups. CONCLUSIONS The quantity and quality of the available bone in the mandibular symphysis for bone graft harvesting vary by gender, age, and harvesting site, necessitating careful preoperative evaluation.
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Affiliation(s)
- Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Amid
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Kadkhodazadeh
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shiva Gandomi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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