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López-Valverde N, Macedo de Sousa B, Blanco Rueda JA. Changes of the Alveolar Bone Ridge Using Bone Mineral Grafts and Collagen Membranes after Tooth Extraction: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2024; 11:565. [PMID: 38927801 PMCID: PMC11200736 DOI: 10.3390/bioengineering11060565] [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: 05/01/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Alveolar preservation techniques for esthetic or functional purposes, or both, are a frequently used alternative for the treatment of post-extraction sockets, the aim of which is the regeneration of the lesion and the preservation of the alveolar bone crest. METHODS Studies published in PubMed (Medline), Web of Science, Embase, and Cochrane Library databases up to January 2024 were consulted. Inclusion criteria were established as intervention studies, according to the PICOs strategy: adult subjects undergoing dental extractions (participants), with alveoli treated with bone mineral grafts and collagen membranes (intervention), compared to spontaneous healing (comparison), and observing the response to treatment in clinical and radiological measures of the alveolar bone crest (outcomes). RESULTS We obtained 561 results and selected 12 studies. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and methodological quality was assessed using the Joanna Briggs Institute. Due to the high heterogeneity of the studies (I2 > 75%), a random-effects meta-analysis was used. Despite the trend, no statistical significance (p > 0.05) was found in the experimental groups. CONCLUSIONS The use of bone mineral grafts in combination with resorbable collagen barriers provides greater preservation of the alveolar ridge, although more clinical studies are needed.
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Affiliation(s)
- Nansi López-Valverde
- Department of Surgery, Biomedical Research Institute of Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain;
| | - Bruno Macedo de Sousa
- Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal;
| | - José Antonio Blanco Rueda
- Department of Surgery, Biomedical Research Institute of Salamanca (IBSAL), University of Salamanca, 37008 Salamanca, Spain;
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Kim S, Kim SG. Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes. Maxillofac Plast Reconstr Surg 2024; 46:14. [PMID: 38625426 PMCID: PMC11021384 DOI: 10.1186/s40902-024-00425-w] [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: 10/30/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
This narrative review systematically explores the progression of materials and techniques in alveolar ridge preservation (ARP). We commence by delineating the evolution from traditional ARP methods to cutting-edge alternatives, including platelet-rich fibrin, injectable bone repair materials, and hydrogel systems. Critical examination of various studies reveals these innovative approaches not only accelerate bone healing but also significantly improve patient-reported outcomes, such as satisfaction, pain perception, and overall quality of life. Emphasis is placed on the correlation between advanced ARP techniques and enhanced patient comfort and clinical efficacy, underscoring their transformative potential in dental implantology. Highlighting the effectiveness of ARP, the implant survival rate over a span of 5 to 7 years was high, showcasing the reliability and success of these methods. Further, patients expressed high aesthetic satisfaction with the soft tissue outcome, evidenced by an average visual analog scale (VAS) score of 94. This positive aesthetic appraisal is linked to the clinical health of implants, potentially due to the employment of tooth-supported surgical guides. The economic analysis reveals a varied cost range for bone graft substitutes ($46.2 to $140) and socket sealing materials ($12 to $189), with a noteworthy correlation between the investment in barrier membranes and the diminished horizontal and vertical ridge resorption. This suggests that membrane usage significantly contributes to preserving ridge dimensions, offering a cost-effective strategy for enhancing ARP outcomes. In conclusion, this review illuminates the significant advancements in ARP, highlighting the shift towards innovative materials and techniques that not only promise enhanced bone regeneration and reduced healing times but also improve patient satisfaction and aesthetic outcomes. The documented high implant survival rate and the beneficial economic implications of membrane use further validate the effectiveness of contemporary ARP strategies, paving the way for their broader adoption in dental implantology.
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Affiliation(s)
- Suyoung Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457, Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, 25457, Republic of Korea.
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Fok MR, Pelekos G, Jin L. Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1198. [PMID: 38592010 PMCID: PMC10931845 DOI: 10.3390/jcm13051198] [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: 01/11/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
AIM To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites. METHODS An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates. RESULTS Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence. CONCLUSIONS Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.
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Affiliation(s)
- Melissa Rachel Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Khairallah CM, Ghosn N, Khairallah C, Makary C, Traini T, Younes R. Alveolar Ridge Preservation Using the One-Piece Autologous Tuberosity Graft: A Clinical, Radiological, and Histological Pilot Study. J Long Term Eff Med Implants 2024; 34:29-44. [PMID: 38305368 DOI: 10.1615/jlongtermeffmedimplants.2023046867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
This prospective study investigated clinically and radiologically the effectiveness of the use of a combined hard and soft tissue graft retrieved from the maxillary tuberosity and designed for alveolar ridge preservation following tooth extraction. Seven patients scheduled for a single mono-rooted tooth extraction were included in the study. After atraumatic extraction, sockets were filled with a "one-piece" dual tissue graft harvested from the tuberosity using an adjusted trephine. CBCTs were performed before the extraction and 4 months after ridge preservation, to analyze the vertical and horizontal alterations of the ridge, using ITK-Snap software. Clinical measurements of both soft and hard tissues were also assessed during the extraction and implant placement. All sites healed uneventfully. After 4 months, the 3D super-imposition of both CBCTs showed a mean bone volume resorption of 65 ± 76.7 mm3 (10.2 ± 10%). The mean horizontal reduction at 2, 4, and 6 mm from the top of the crest was respectively 1.5 ± 1.3 mm, 0.47 ± 1.4 mm and 0.57 ± 0.7 mm, while the mean vertical loss was 0.026 mm ± 2 mm. The mean soft tissue horizontal gain was 1.73 ± 1.12 mm. The "one-piece" autologous tuberosity graft was proven to be a safe and effective alveolar ridge preservation technique and may represent a feasible, user-friendly, time saving, low-cost solution for minimizing dimensional loss following tooth extraction.
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Affiliation(s)
- Carla Maria Khairallah
- Department of Oral Surgery, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Nabil Ghosn
- Department of Craniofacial Research Laboratory, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Carlos Khairallah
- Department of Aesthetic and Restorative Dentistry, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Christian Makary
- Department of Oral Surgery, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Tonino Traini
- Department of Innovative Technologies in Medicine and Dentistry, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Ronald Younes
- Department of Oral Surgery, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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Chou YH, Chen YJ, Pan CP, Yen WH, Liu PF, Feng IJ, Lin YC, Hu KF. Prevalence of peri-implantitis after alveolar ridge preservation at periodontitis and nonperiodontitis extraction sites: A retrospective cohort study. Clin Implant Dent Relat Res 2023; 25:1000-1007. [PMID: 37424382 DOI: 10.1111/cid.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/05/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Periodontitis is the main indication for dental extraction and often leads to peri-implantitis (PI). Alveolar ridge preservation (ARP) is an effective means of preserving ridge dimensions after extraction. However, whether PI prevalence is lower after ARP for extraction after periodontitis remains unclear. This study investigated PI after ARP in patients with periodontitis. MATERIALS AND METHODS This study explored the 138 dental implants of 113 patients. The reasons for extraction were categorized as periodontitis or nonperiodontitis. All implants were placed at sites treated using ARP. PI was diagnosed on the basis of radiographic bone loss of ≥3 mm, as determined through comparison of standardized bitewing radiographs obtained immediately after insertion with those obtained after at least 6 months. Chi-square and two-sample t testing and generalized estimating equations (GEE) logistic regression model were employed to identify risk factors for PI. Statistical significance was indicated by p < 0.05. RESULTS The overall PI prevalence was 24.6% (n = 34). The GEE univariate logistic regression demonstrated that implant sites and implant types were significantly associated with PI (premolar vs. molar: crude odds ratios [OR] = 5.27, 95% confidence intervals [CI] = 2.15-12.87, p = 0.0003; bone level vs. tissue level: crude OR = 5.08, 95% CI = 2.10-12.24; p = 0.003, respectively). After adjustment for confounding factors, the risks of PI were significantly associated with implant sites (premolar vs. molar: adjusted OR [AOR] = 4.62, 95% CI = 1.74-12.24; p = 0.002) and implant types (bone level vs. tissue level: AOR = 6.46, 95% CI = 1.67-25.02; p = 0.007). The reason for dental extraction-that is, periodontitis or nonperiodontitis-was not significantly associated with PI. CONCLUSION ARP reduces the incidence of periodontitis-related PI at extraction sites. To address the limitations of our study, consistent and prospective randomized controlled trials are warranted.
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Affiliation(s)
- Yu-Hsiang Chou
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Periodontics, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yan-Jun Chen
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Pin Pan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsi Yen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Feng Liu
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - I-Jung Feng
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ying-Chu Lin
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-Fang Hu
- Division of Periodontics, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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You S, Yu F, Fan Q, Xia T, Liang L, Yan Q, Zeng H, Shi B. Radiographic comparison of atelocollagen versus deproteinized bovine bone minerals covered with a collagen membrane in alveolar ridge preservation: a retrospective study. BMC Oral Health 2023; 23:901. [PMID: 37990178 PMCID: PMC10662564 DOI: 10.1186/s12903-023-03647-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Atelocollagen (AC) is a low-immunogenic collagen derivative with longer degradation time, which can be a suitable material for alveolar ridge preservation (ARP). However, there are few human studies on AC using for ARP. This research aims to radiographically evaluate the efficacy of AC in comparison to deproteinized bovine bone minerals covered with a collagen membrane (DBBM/CM) in ARP. METHODS Medical records in the Implantology Department of the Hospital of Stomatology of Wuhan University were screened for patients who received flapless ARP using either AC or DBBM/CM. A total of 58 patients were included in this retrospective study. 28 patients were treated with AC, while 30 patients were used DBBM/CM. Cone-beam computed tomography (CBCT) scans were taken before extraction and after 6 months of healing. To assess the dimensional change of the extraction sockets, the scanning data were output and transferred to the digital software to measure horizontal bone width change, vertical bone height change and bone volume change in region of interest. To evaluate the bone quality of healed sockets, the bone density of virtual implants was evaluated. RESULTS The horizontal bone width changes at all five different levels showed no significant difference between the two groups. The largest horizontal bone width decrement in both groups occurred at the crest of ridge, which decreased 3.71 ± 1.67 mm in AC group and 3.53 ± 1.51 mm in DBBM/CM group (p = 0.68). At the central buccal aspect, the ridge height reduced 0.10 ± 1.30 mm in AC group, while increased 0.77 ± 2.43 mm in DBBM/CM group (p = 0.10). The vertical bone height differences between two groups showed no statistical significance. The percentages of volume absorption in AC group and DBBM/CM group were 12.37%±6.09% and 14.54%±11.21%, respectively. No significant difference in volume absorption was found (p = 0.36). The average bone density around virtual implants in AC group (649.41 ± 184.71 HU) was significantly lower than that in DBBM/CM group (985.23 ± 207.85 HU) (p < 0.001). CONCLUSIONS ARP with AC had a similar effect on limiting the dimensional alteration of alveolar ridge, when radiographically compared with DBBM/CM.
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Affiliation(s)
- Sha You
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fan Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qihang Fan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Ting Xia
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Liang Liang
- Department of Oral Implantology, Jianli Stomatology Hospital, Dongguan, China
| | - Qi Yan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hao Zeng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
| | - Bin Shi
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Couso-Queiruga E, Weber HA, Garaicoa-Pazmino C, Barwacz C, Kalleme M, Galindo-Moreno P, Avila-Ortiz G. Influence of healing time on the outcomes of alveolar ridge preservation using a collagenated bovine bone xenograft: A randomized clinical trial. J Clin Periodontol 2023; 50:132-146. [PMID: 36345818 PMCID: PMC10100450 DOI: 10.1111/jcpe.13744] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
AIM To evaluate the healing outcomes in non-molar post-extraction sockets filled with deproteinized bovine bone mineral with collagen (DBBM-C) as a function of time. MATERIALS AND METHODS Patients in need of non-molar tooth extraction were randomly allocated into one of three groups according to the total healing time (A-3 months; B-6 months; C-9 months). The effect of alveolar ridge preservation (ARP) therapy via socket filling using DBBM-C and socket sealing with a porcine collagen matrix (CM) was assessed based on a panel of clinical, digital, histomorphometric, implant-related, and patient-reported outcomes. RESULTS A total of 42 patients completed the study (n = 14 in each group). Histomorphometric analysis of bone core biopsies obtained at the time of implant placement showed a continuous increase in the proportion of mineralized tissue with respect to non-mineralized tissue, and a decrease in the proportion of remaining xenograft material over time. All volumetric bone and soft tissue contour assessments revealed a dimensional reduction of the alveolar ridge overtime affecting mainly the facial aspect. Linear regression analyses indicated that baseline buccal bone thickness is a strong predictor of bone and soft tissue modelling. Ancillary bone augmentation at the time of implant placement was needed in 16.7% of the sites (A:2; B:1; C:4). Patient-reported discomfort and wound healing index scores progressively decreased over time and was similar across groups. CONCLUSIONS Healing time influences the proportion of tissue compartments in non-molar post-extraction sites filled with DBBM-C and sealed with a CM. A variable degree of alveolar ridge atrophy, affecting mainly the facial aspect, occurs even after performing ARP therapy. These changes are more pronounced in sites exhibiting thin facial bone (≤1 mm) at baseline (Clinicaltrials.gov NCT03659617).
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Affiliation(s)
- Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland.,Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Holly A Weber
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Carlos Garaicoa-Pazmino
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA.,Investigation Center, School of Dentistry, Espiritu Santo University, Samborondón, Ecuador
| | - Christopher Barwacz
- Department of Family Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Marisa Kalleme
- Division of Biostatistics and Computational Biology, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA.,Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA.,Private Practice, Atelier Dental Madrid, Madrid, Spain
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Raj SC, Pradhan SS, Mahapatra A, Katti N, Mohanty D, Rath R, Patnaik K, Agrawal P. Histomorphometric Analysis of Residual Alveolar Ridge Preserved using Collagen Cell Occlusive Membrane Alone and Along with Demineralized Bone Matrix Following Tooth Extraction: A Randomized Control Trial. Contemp Clin Dent 2022; 13:375-382. [PMID: 36686994 PMCID: PMC9855258 DOI: 10.4103/ccd.ccd_347_21] [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: 05/07/2021] [Revised: 10/19/2021] [Accepted: 12/26/2021] [Indexed: 11/09/2022] Open
Abstract
Context The changes in the volume and dimensions of the alveolar bone after tooth extraction often lead to challenges in prosthetic rehabilitation of the same necessitating ridge preservation procedures (RPP). Aim The aim of this randomized clinical trial was to evaluate and compare the dimensional and histomorphometric changes of the sites preserved using the collagen membrane with and without demineralized bone matrix (DMBM). Settings and Design Interventional, parallel-design, double blinded, randomized controlled trail. Materials and Methods A randomized controlled trial was designed with 45 participants having at least 2 teeth indicated for were enrolled in this study. The sites were randomly assigned to the control group (RPP using collagen membrane) and the test group (RPP using collagen membrane with DMBM). The clinical parameters assessed were alveolar bone width and alveolar bone height. Histomorphometric analysis was carried out on tissue trephined from the preserved sites to evaluate the percentage of bone and connective tissue (CT %) formed 8 months postRPP. Statistical Analysis Used Shapiro - Wilk test and paired and unpaired t-test. Results Horizontal resorption was significantly less in the test group (7.375 ± 1.64). Histomorphometry of these sites revealed a complete absence of residual graft particles, presence of trabecular bone, and a more mineralized matrix (63.256%) as compared to the control sites (46.833%). Conclusions The use of DMBM along with the collagen membrane for RPP yielded better results both clinically and histomorphometically.
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Affiliation(s)
- Subash Chandra Raj
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Shiba Shankar Pradhan
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Annuroopa Mahapatra
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Neelima Katti
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Devapratim Mohanty
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Rachna Rath
- Department of Oral Pathology, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Kaushik Patnaik
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
| | - Poonam Agrawal
- Department of Periodontics, S. C. B Dental College and Hospital, Cuttack, Odisha, India
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Di Stefano DA, Orlando F, Ottobelli M, Fiori D, Garagiola U. A comparison between anorganic bone and collagen-preserving bone xenografts for alveolar ridge preservation: systematic review and future perspectives. Maxillofac Plast Reconstr Surg 2022; 44:24. [PMID: 35821286 PMCID: PMC9276906 DOI: 10.1186/s40902-022-00349-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
After tooth extraction, dimensional changes affect the alveolar socket, leading to loss in alveolar bone height and width. Histological modifications also occur, with initial formation of a blood clot that is replaced with granulation tissue and subsequently with a provisional connective tissue matrix. Spontaneous healing ends with socket filling with woven bone, which is gradually replaced with lamellar bone and bone marrow. Adequate alveolar ridge dimensions and bone quality are required to assure optimal stability and osseointegration following dental implant placement. When a tooth is extracted, alveolar ridge preservation (ARP) procedures are an effective method to prevent collapse of the post-extraction socket. Heterologous bone is widely chosen by clinicians for ARP, and anorganic bone xenografts (ABXs) made bioinert by heat treatment represents the most used biomaterial in clinical applications. Collagen-preserving bone xenografts (CBXs) made of porcine or equine bone are fabricated by less invasive chemical or enzymatic treatments to remove xenogenic antigens, and these are also effective in preserving post-extraction sites. Clinical differences between anorganic bone substitutes and collagen-preserving materials are not well documented in the literature but understanding these differences could clarify how processing protocols influence biomaterial behavior in situ. This systematic review of the literature compares the dimensional changes and histological features of ABXs versus CBXs in ridge preservation procedures to promote awareness of different bone xenograft efficacies in stimulating the healing of post-extraction sockets.
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Affiliation(s)
- Danilo Alessio Di Stefano
- Private Practice, Centro Odontoiatrico e Protesico Civitali S.R.L., Milan, Italy.
- Department of Dentistry, Vita-Salute San Raffaele University Milan, Milan, Italy.
| | - Francesco Orlando
- Private Practice, Centro Odontoiatrico e Protesico Civitali S.R.L., Milan, Italy
- Dental School, Vita-Salute University IRCCS San Raffaele, Milan, Italy
| | - Marco Ottobelli
- Private Practice, Centro Odontoiatrico e Protesico Civitali S.R.L., Milan, Italy
| | - Davide Fiori
- Private Practice, Centro Odontoiatrico e Protesico Civitali S.R.L., Milan, Italy
| | - Umberto Garagiola
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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10
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Solakoğlu Ö, Ofluoğlu D, Schwarzenbach H, Heydecke G, Reißmann D, Ergun S, Götz W. A 3-year prospective randomized clinical trial of alveolar bone crest response and clinical parameters through 1, 2, and 3 years of clinical function of implants placed 4 months after alveolar ridge preservation using two different allogeneic bone-grafting materials. Int J Implant Dent 2022; 8:5. [PMID: 35102440 PMCID: PMC8804085 DOI: 10.1186/s40729-022-00402-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aim of this study was to longitudinally evaluate changes in alveolar bone crest (ABC) levels and differences in resorption rates (RR) between the tested grafting materials following alveolar ridge preservation (ARP) after tooth extraction after 1, 2, and 3 years (T1-T8) of clinical function. METHODS Patients were randomly assigned to two different bone allografts (group 1 maxgraft®, group 2 Puros®) for ARP. Non-restorable teeth were minimal traumatically extracted. Sockets were augmented with the tested materials and covered with a pericardium membrane. After 4 months of healing, 36 implants were placed and sites were clinically and radiographically monitored in the mesial (ABC-M), the distal (ABC-D, T1-T8), the bucco-lingual (ABC-BL), buccal (ABC-B) and oral (ABC-O) aspect (T1-T4). RESULTS Changes in (ABC-M), (ABC-D), (ABC-BL), (ABC-B), and (ABC-O) levels showed statistically highly significant differences between T1 and T2 for both bone allografts (p < 0.001). Changes at the ABC-M and ABC-BL levels between T2 and T3 of group 1 showed a statistically significant difference (p < 0.001). Both groups achieved and maintained increased ABC levels without statistically significant differences throughout the monitoring periods of 1-3 years (T6-T8) of clinical function. No failures or adverse events were observed. CONCLUSIONS To the best of our knowledge, this study is within its limitations the first study to directly compare ABC-changes and differences in RR of two different allogeneic grafting materials for a period of 3 years after ARP. It was demonstrated to be, despite significant differences in RR, a successful method of preserving increased ABC levels through 1, 2, and 3 years of clinical function. Trial registration DRKS00013010, registered 07/30/2018, http://apps.who.int/trialsearch.
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Affiliation(s)
- Önder Solakoğlu
- Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
- Specialty Dental Practice Limited to Periodontology and Implant Dentistry, Hamburg, Germany.
| | - Duygu Ofluoğlu
- Department of Oral Medicine and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Heidi Schwarzenbach
- Institute of Tumor Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthodontics Dental, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Reißmann
- Department of Prosthodontics Dental, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sertan Ergun
- Department of Oral Medicine and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Werner Götz
- Laboratory for Oral Biologic Basic Science, Department of Orthodontics, University of Bonn, Bonn, Germany
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Inchingolo F, Hazballa D, Inchingolo AD, Malcangi G, Marinelli G, Mancini A, Maggiore ME, Bordea IR, Scarano A, Farronato M, Tartaglia GM, Lorusso F, Inchingolo AM, Dipalma G. Innovative Concepts and Recent Breakthrough for Engineered Graft and Constructs for Bone Regeneration: A Literature Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:1120. [PMID: 35161065 PMCID: PMC8839672 DOI: 10.3390/ma15031120] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND For decades, regenerative medicine and dentistry have been improved with new therapies and innovative clinical protocols. The aim of the present investigation was to evaluate through a critical review the recent innovations in the field of bone regeneration with a focus on the healing potentials and clinical protocols of bone substitutes combined with engineered constructs, growth factors and photobiomodulation applications. METHODS A Boolean systematic search was conducted by PubMed/Medline, PubMed/Central, Web of Science and Google scholar databases according to the PRISMA guidelines. RESULTS After the initial screening, a total of 304 papers were considered eligible for the qualitative synthesis. The articles included were categorized according to the main topics: alloplastic bone substitutes, autologous teeth derived substitutes, xenografts, platelet-derived concentrates, laser therapy, microbiota and bone metabolism and mesenchymal cells construct. CONCLUSIONS The effectiveness of the present investigation showed that the use of biocompatible and bio-resorbable bone substitutes are related to the high-predictability of the bone regeneration protocols, while the oral microbiota and systemic health of the patient produce a clinical advantage for the long-term success of the regeneration procedures and implant-supported restorations. The use of growth factors is able to reduce the co-morbidity of the regenerative procedure ameliorating the post-operative healing phase. The LLLT is an adjuvant protocol to improve the soft and hard tissues response for bone regeneration treatment protocols.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Denisa Hazballa
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
- Kongresi Elbasanit, Rruga: Aqif Pasha, 3001 Elbasan, Albania
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Maria Elena Maggiore
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Marco Farronato
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (M.F.); (G.M.T.)
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (M.F.); (G.M.T.)
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
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12
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Canullo L, Del Fabbro M, Khijmatgar S, Panda S, Ravidà A, Tommasato G, Sculean A, Pesce P. Dimensional and histomorphometric evaluation of biomaterials used for alveolar ridge preservation: a systematic review and network meta-analysis. Clin Oral Investig 2021; 26:141-158. [PMID: 34826029 DOI: 10.1007/s00784-021-04248-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/23/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This systematic review and network meta-analysis aimed to answer to the following questions: (a) In patients undergoing alveolar ridge preservation after tooth extraction, which grafting material best attenuates horizontal and vertical ridge resorption, as compared to spontaneous healing?, and (b) which material(s) promotes bone formation in the extraction socket? MATERIALS AND METHODS The MEDLINE, SCOPUS, CENTRAL, and EMBASE databases were screened in duplicate for RCTs up to March 2021. Two independent authors extracted the data and assessed the risk of bias of the included studies. Primary outcomes were ridge horizontal and vertical dimension changes and new bone formation into the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes and compare different grafting materials. RESULTS Eighty-eight RCTs were included, with a total of 2805 patients and 3073 sockets. Overall, a total of 1740 sockets underwent alveolar ridge preservation with different materials (1432 were covered by a membrane). Pairwise meta-analysis showed that, as compared to spontaneous healing, all materials statistically significantly reduced horizontal and vertical shrinkage. According to the multidimensional scale ranking of the NMA, xenografts (XG) and allografts (AG), alone or combined with bioactive agents (Bio + AG), were the most predictable materials for horizontal and vertical ridge dimension preservation, while platelet concentrates performed best in the percentage of new bone formation. CONCLUSIONS Alveolar ridge preservation is effective in reducing both horizontal and vertical shrinkage, as compared to untreated sockets. NMA confirmed the consistency of XG for ridge dimension preservation, but several other materials and combinations like AG, Bio + AG, and AG + alloplasts, produced even better results than XG in clinical comparisons. Further evidence is needed to confirm the value of such alternatives to XG for alveolar ridge preservation. Bio + AG performed better than the other materials in preserving ridge dimension and platelet concentrates in new bone formation. However, alloplasts, xenografts, and AG + AP performed consistently good in majority of the clinical comparisons. CLINICAL RELEVANCE XG and Bio + AG demonstrated significantly better performance in minimizing post-extraction horizontal and vertical ridge dimension changes as compared with other grafting materials or with spontaneous healing, even if they presented the worst histological outcomes. Allografts and other materials or combinations (AG + AP) presented similar performances while spontaneous healing ranked last.
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Affiliation(s)
- L Canullo
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - M Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - S Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - S Panda
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Periodontics and Oral Implantology, Siksha 'O' Anusandhan University, Bhubaneswar, India
| | - A Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - G Tommasato
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - A Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - P Pesce
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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13
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Kim SY, Lee YJ, Cho WT, Hwang SH, Heo SC, Kim HJ, Huh JB. Preliminary Animal Study on Bone Formation Ability of Commercialized Particle-Type Bone Graft with Increased Operability by Hydrogel. MATERIALS 2021; 14:ma14164464. [PMID: 34442986 PMCID: PMC8399214 DOI: 10.3390/ma14164464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to evaluate the bone-generating ability of a new bovine-derived xenograft (S1-XB) containing hydrogel. For control purposes, we used Bio-Oss and Bone-XB bovine-derived xenografts. S1-XB was produced by mixing Bone-XB and hydrogel. Cell proliferation and differentiation studies were performed to assess cytotoxicities and cell responses. For in vivo study, 8 mm-sized cranial defects were formed in 16 rats, and then the bone substitutes were transplanted into defect sites in the four study groups, that is, a Bio-Oss group, a Bone-XB group, an S1-XB group, and a control (all n = 4); in the control group defects were left empty. Eight weeks after surgery, new bone formation areas were measured histomorphometrically. In the cell study, extracts of Bio-Oss, Bone-XB, and S1-XB showed good results in terms of the osteogenic differentiation of human mesenchymal stem cells (hMSCs) and no cytotoxic reaction was evident. No significant difference was observed between mean new bone areas in the Bio-Oss (36.93 ± 4.27%), Bone-XB (35.07 ± 3.23%), and S1-XB (30.80 ± 6.41%) groups, but new bone area was significantly smaller in the control group (18.73 ± 5.59%) (p < 0.05). Bovine-derived bone graft material containing hydrogel (S1-XB) had a better cellular response and an osteogenic effect similar to Bio-Oss.
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Affiliation(s)
- So-Yeun Kim
- Department of Prosthodontics, Kyungpook National University Dental Hospital, Daegu 41940, Korea;
| | - You-Jin Lee
- Department of Prosthodontics, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (Y.-J.L.); (W.-T.C.); (S.-H.H.)
| | - Won-Tak Cho
- Department of Prosthodontics, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (Y.-J.L.); (W.-T.C.); (S.-H.H.)
| | - Su-Hyun Hwang
- Department of Prosthodontics, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (Y.-J.L.); (W.-T.C.); (S.-H.H.)
| | - Soon-Chul Heo
- Department of Oral Physiology, Periodontal Diseases Signaling Network Research Center, Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan 50612, Korea;
| | - Hyung-Joon Kim
- Department of Oral Physiology, Periodontal Diseases Signaling Network Research Center, Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan 50612, Korea;
- Correspondence: (H.-J.K.); (J.-B.H.); Tel.: +82-10-6326-4189 (H.-J.K.); +82-10-8007-9099 (J.-B.H.); Fax: +82-55-510-8208 (H.-J.K.); +82-55-360-5134 (J.-B.H.)
| | - Jung-Bo Huh
- Department of Prosthodontics, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (Y.-J.L.); (W.-T.C.); (S.-H.H.)
- Correspondence: (H.-J.K.); (J.-B.H.); Tel.: +82-10-6326-4189 (H.-J.K.); +82-10-8007-9099 (J.-B.H.); Fax: +82-55-510-8208 (H.-J.K.); +82-55-360-5134 (J.-B.H.)
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14
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Jonker BP, Strauss FJ, Naenni N, Jung RE, Wolvius EB, Pijpe J. Early implant placement with or without alveolar ridge preservation in single tooth gaps renders similar esthetic, clinical and patient-reported outcome measures: One-year results of a randomized clinical trial. Clin Oral Implants Res 2021; 32:1041-1051. [PMID: 34129708 PMCID: PMC8457170 DOI: 10.1111/clr.13796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
Objectives To test whether early implant placement with alveolar ridge preservation (ARP) results in different esthetic, clinical and patient‐reported outcome measures (PROMs) compared with early implant placement without ARP. Material and methods Seventy‐five patients requiring single tooth extraction in the anterior maxilla were recruited. Following tooth extraction, the patients were randomly allocated to three groups: (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM‐C) covered by a collagen matrix (CM) (n = 25), (b) ARP using DBBM‐C covered with a palatal graft (PG) (n = 25) and (c) spontaneous healing (control) (n = 25). Eight weeks after tooth extraction, a CBCT was taken and early implant placement was performed in all patients. Esthetic, clinical and PROMs were evaluated one year post‐loading. Results A total of 70 patients were available for re‐examination at one year post‐loading. The median mid‐facial mucosal margin change amounted to −0.02 mm (IQR −0.27–0.46) in the CM group, −0.13 mm (IQR −0.44–0.25) in the PG group and −0.14 mm (IQR −0.29–0.07) in the control group, with no significant differences between the groups. Mean PES scores amounted to 7.0 ± 1.4 in the CM group, 7.1 ± 1.5 in the PG group and 7.3 ± 1.7 in the control group without significant differences between the groups. Plaque, bleeding on probing and probing depth did not differ between treatment groups. PROMs in general revealed no significant differences between the groups. Conclusion Early implant placement with ARP using either a collagen matrix or a palatal graft rendered similar esthetic, clinical and PROMs to early implant placement without ARP. When a failing tooth can be replaced with an implant within 2 months after tooth extraction, the added value of ARP might be clinically negligible.
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Affiliation(s)
- Brend P Jonker
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Justin Pijpe
- Department of Oral & Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Oral & Maxillofacial Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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15
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Atieh MA, Alsabeeha NH, Payne AG, Ali S, Faggion CMJ, Esposito M. Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. Cochrane Database Syst Rev 2021; 4:CD010176. [PMID: 33899930 PMCID: PMC8092674 DOI: 10.1002/14651858.cd010176.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. This is an update of the Cochrane Review first published in 2015. OBJECTIVES To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2021), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2021, Issue 2), MEDLINE Ovid (1946 to 19 March 2021), Embase Ovid (1980 to 19 March 2021), Latin American and Caribbean Health Science Information database (1982 to 19 March 2021), Web of Science Conference Proceedings (1990 to 19 March 2021), Scopus (1966 to 19 March 2021), ProQuest Dissertations and Theses (1861 to 19 March 2021), and OpenGrey (to 19 March 2021). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. A number of journals were also handsearched. SELECTION CRITERIA We included all randomised controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of alveolar ridge, changes in the vertical height of the alveolar ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. DATA COLLECTION AND ANALYSIS We selected trials, extracted data, and assessed risk of bias in duplicate. Corresponding authors were contacted to obtain missing information. We estimated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 16 RCTs conducted worldwide involving a total of 524 extraction sites in 426 adult participants. We assessed four trials as at overall high risk of bias and the remaining trials at unclear risk of bias. Nine new trials were included in this update with six new trials in the category of comparing ARP to extraction alone and three new trials in the category of comparing different grafting materials. ARP versus extraction: from the seven trials comparing xenografts with extraction alone, there is very low-certainty evidence of a reduction in loss of alveolar ridge width (MD -1.18 mm, 95% CI -1.82 to -0.54; P = 0.0003; 6 studies, 184 participants, 201 extraction sites), and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P < 0.0001; 6 studies, 184 participants, 201 extraction sites) in favour of xenografts, but we found no evidence of a significant difference for the need for additional augmentation (RR 0.68, 95% CI 0.29 to 1.62; P = 0.39; 4 studies, 154 participants, 156 extraction sites; very low-certainty evidence) or in implant failure rate (RR 1.00, 95% CI 0.07 to 14.90; 2 studies, 70 participants/extraction sites; very low-certainty evidence). From the one trial comparing alloplasts versus extraction, there is very low-certainty evidence of a reduction in loss of alveolar ridge height (MD -3.73 mm; 95% CI -4.05 to -3.41; 1 study, 15 participants, 60 extraction sites) in favour of alloplasts. This single trial did not report any other outcomes. Different grafting materials for ARP: three trials (87 participants/extraction sites) compared allograft versus xenograft, two trials (37 participants, 55 extraction sites) compared alloplast versus xenograft, one trial (20 participants/extraction sites) compared alloplast with and without membrane, one trial (18 participants, 36 extraction sites) compared allograft with and without synthetic cell-binding peptide P-15, and one trial (30 participants/extraction sites) compared alloplast with different particle sizes. The evidence was of very low certainty for most comparisons and insufficient to determine whether there are clinically significant differences between different ARP techniques based on changes in alveolar ridge width and height, the need for additional augmentation prior to implant placement, or implant failure. We found no trials which evaluated parameters relating to clinical attachment levels, specific aesthetic or prosthodontic outcomes for any of the comparisons. No serious adverse events were reported with most trials indicating that the procedure was uneventful. Among the complications reported were delayed healing with partial exposure of the buccal plate at suture removal, postoperative pain and swelling, moderate glazing, redness and oedema, membrane exposure and partial loss of grafting material, and fibrous adhesions at the cervical part of previously preserved sockets, for the comparisons xenografts versus extraction, allografts versus xenografts, alloplasts versus xenografts, and alloplasts with and without membrane. AUTHORS' CONCLUSIONS ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction but the evidence is very uncertain. There is lack of evidence of any differences in the need for additional augmentation at the time of implant placement, implant failure, aesthetic outcomes, or any other clinical parameters due to lack of information or long-term data. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long-term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.
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Affiliation(s)
- Momen A Atieh
- Mohammed bin Rashid University of Medicine and Health Sciences, Hamdan bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
| | - Nabeel Hm Alsabeeha
- RAK Dental Centre, Ministry of Health and Prevention, Ras Al-Khaimah, United Arab Emirates
| | - Alan Gt Payne
- Private practice, Northland Prosthodontics Ltd, c/o NorthShore Oral and Maxillofacial Surgeons, Auckland, New Zealand
| | - Sara Ali
- Mohammed bin Rashid University of Medicine and Health Sciences, Hamdan bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates
| | | | - Marco Esposito
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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de Oliveira Junior JM, Montagner PG, Carrijo RC, Martinez EF. Physical characterization of biphasic bioceramic materials with different granulation sizes and their influence on bone repair and inflammation in rat calvaria. Sci Rep 2021; 11:4484. [PMID: 33627770 PMCID: PMC7904940 DOI: 10.1038/s41598-021-84033-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Biphasic calcium phosphate bioceramics (BCP) consist of a mixture of hydroxyapatite (HA) and beta-tricalcium phosphate (β-TCP) within the same particle. Due to their osteoconductive properties, biocompatibility and resemblance to natural bone, these materials have become a promising and suitable alternative to autologous bone grafting. First, the topography characteristics, specific surface area, and total pore volume of BCP were evaluated using scanning electron microscopy and the BET and BJH methods. Next, this study aimed to evaluate the intensity of the inflammatory process and the bone neoformation capacity of various particle sizes of BCP in the repair of critical defects in the calvaria of rats. A xenogeneic biomaterial was used in the control group. After 30, 60, and 90 days, the animals were euthanized, followed by the processing of the samples to measure the intensity of inflammatory infiltrates and the areas of bone neoformation. Our results indicate that no considerable differences were observed in the inflammatory scores in sites treated with distinct BCP grain sizes. A greater area of bone neoformation was measured in the xenogeneic group at all analysis times, with no substantial differences in bone formation between the BCP particle size in the range of 250-500 µm and 500-1000 µm.
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Affiliation(s)
| | - Pedro Giorgetti Montagner
- Division of Cell Biology and Oral Pathology, São Leopoldo Mandic Research Institute, Campinas, SP, 13045-755, Brazil
| | - Rafael Coutinho Carrijo
- Division of Oral Implantology, São Leopoldo Mandic Research Institute, Campinas, SP, 13045-755, Brazil
| | - Elizabeth Ferreira Martinez
- Division of Cell Biology and Oral Pathology, São Leopoldo Mandic Research Institute, Campinas, SP, 13045-755, Brazil
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17
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da Costa DV, de Araújo VE, de Abreu FAM, Souto GR. Thrombocytopenia-Absent Radius (TAR): Case report of dental implant and surgical treatment. J Clin Exp Dent 2020; 12:e1196-e1200. [PMID: 33282142 PMCID: PMC7700778 DOI: 10.4317/jced.56642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Thrombocytopenia-absent radius (TAR) syndrome is a congenital malformation in which affected individuals present reductions in the number of platelets, hypoplasia, or absence of radial bone unilaterally or bilaterally. Hematologic, skeletal, cardiac (particularly tetralogy of Fallot and septal-atrial defects), and gastrointestinal anomalies are most commonly associated with TAR syndrome. Skeletal changes result in a higher risk of dental and craniofacial trauma in patients with the syndrome. Thus, it is important for the dentist to be aware of the characteristics of TAR syndrome and its clinical management for better care of these patients. The objective of this study is to describe a case report of a 26-year-old patient with TAR syndrome with a history of trauma and root fracture of tooth 11 and alveolar bone ridge. During anamnesis, root fractures requiring the extraction of the 11 tooth, alveolar bone ridge fracture in the adjacent region, and dental trauma were observed. A hematological evaluation and blood and radiological examinations were performed. Osseointegrated implant was performed using the guided surgery and flapless technique, as well as prosthetic rehabilitation in the affected region. This report discusses the importance of careful planning, such as the use of incisions and conservative surgery, techniques for alveolar ridge preservation, gingival manipulation, and prosthesis confection. The patient was attended by a hematologist throughout the treatment. Key words:TAR syndrome, absent radii and thrombocytopenia, dental implants, oral surgery.
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Affiliation(s)
- Danilo-Viegas da Costa
- DDS, MDSc student. Department of Dentistry. Pontifical Catholic University of Minas Gerais
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Sultan T, Cheah CW, Ibrahim NB, Asif MK, Vaithilingam RD. Three-dimensional assessment of the extraction sockets, augmented with platelet-rich fibrin and calcium sulfate: A clinical pilot study. J Dent 2020; 101:103455. [PMID: 32828845 DOI: 10.1016/j.jdent.2020.103455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This clinical study assessed and compared the linear and volumetric changes of extraction sockets grafted with a combination of Platelet-Rich Fibrin (PRF) and Calcium Sulfate (CS) (PRF-CS), and extraction sockets grafted with a combination of PRF and xenograft (X) (PRF-X). METHODS Five single maxillary premolar extraction sockets received PRF-CS grafts and five single maxillary premolar sockets received PRF-X grafts. Linear (horizontal and vertical) measurements were accomplished using Cone Beam Computed Tomography (CBCT) images and volumetric changes were assessed using MIMICS software. Soft tissue level changes were measured using Stonecast models. All measurements were recorded at baseline (before extraction) and at 5-months post-extraction. RESULTS Significant reduction in vertical and horizontal dimensions were observed in both groups except for distal bone height (DBH = 0.44 ± 0.45 mm, p = 0.09) and palatal bone height (PBH = 0.39 ± 0.34 mm, p = 0.06) in PRF-X group. PRF-CS group demonstrated mean horizontal shrinkage of 1.27 ± 0.82 mm (p = 0.02), when compared with PRF-X group (1.40 ± 0.85 mm, p = 0.02). Vertical resorption for mesial bone height (MBH = 0.56 ± 0.25 mm, p = 0.008), buccal bone height (BBH = 1.62 ± 0.91 mm, p = 0.01) and palatal bone height (PBH = 1.39 ± 0.87 mm, p = 0.02) in PRF-CS group was more than resorption in PRF-X group (MBH = 0.28 ± 0.14 mm, p = 0.01, BBH = 0.63 ± 0.39 mm, p = 0.02 and PBH = 0.39 ± 0.34 mm, p = 0.06). Volumetric bone resorption was significant within both groups (PRF-CS = 168.33 ± 63.68 mm3, p = 0.004; PRF-X = 102.88 ± 32.93 mm3, p = 0.002), though not significant (p = 0.08) when compared between groups. In PRF-X group, the distal soft tissue level (DSH = 1.00 ± 0.50 mm, p = 0.03) demonstrated almost 2 times more reduction when compared with PRF-CS group (DSH = 1.00 ± 1.00 mm, 0.08). The reduction of the buccal soft tissue level was pronounced in PRF-CS group (BSH = 2.00 ± 2.00 mm, p = 0.06) when compared with PRF-X group (BSH = 1.00 ± 1.50 mm, p = 0.05). CONCLUSIONS PRF-CS grafted sites showed no significant difference with PRF-X grafted sites in linear and volumetric dimensional changes and might show clinical benefits for socket augmentation. The study is officially registered with ClinicalTrials.gov Registration (NCT03851289).
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Affiliation(s)
- Tipu Sultan
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Chia Wei Cheah
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Norliza Binti Ibrahim
- Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Khan Asif
- Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Rathna Devi Vaithilingam
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603, Malaysia
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Avila-Ortiz G, Gubler M, Romero-Bustillos M, Nicholas C, Zimmerman M, Barwacz C. Efficacy of Alveolar Ridge Preservation: A Randomized Controlled Trial. J Dent Res 2020; 99:402-409. [DOI: 10.1177/0022034520905660] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alveolar ridge preservation (ARP) therapy is indicated to attenuate the physiologic resorptive events that occur as a consequence of tooth extraction with the purpose of facilitating tooth replacement therapy. This randomized controlled trial was primarily aimed at testing the efficacy of ARP as compared with unassisted socket healing. A secondary objective was to evaluate the effect that local phenotypic factors play in the volumetric reduction of the alveolar bone. A total of 53 subjects completed the study. Subjects were randomized into either the control group, which involved only tooth extraction (EXT n = 27), or the experimental group, which received ARP using a combination of socket grafting with a particulate bone allograft and socket sealing with a nonabsorbable membrane (dPTFE) following tooth extraction (ARP n = 26). A set of clinical, linear, volumetric, implant-related, and patient-reported outcomes were assessed during a 14-wk healing period. All linear bone assessments (horizontal, midbuccal, and midlingual reduction) revealed that ARP is superior to EXT. Likewise, volumetric bone resorption was significantly higher in the control group (mean ± SD: EXT = −15.83% ± 4.48%, ARP = −8.36% ± 3.81%, P < 0.0001). Linear regression analyses revealed that baseline buccal bone thickness is a strong predictor of alveolar bone resorption in both groups. Interestingly, no significant differences in terms of soft tissue contour change were observed between groups. Additional bone augmentation to facilitate implant placement in a prosthetically acceptable position was deemed necessary in 48.1% of the EXT sites and only 11.5% of the ARP sites ( P < 0.004). Assessment of perceived postoperative discomfort at each follow-up visit revealed a progressive decrease over time, which was comparable between groups. Although some extent of alveolar ridge remodeling occurred in both groups, ARP therapy was superior to EXT as it was more efficacious in the maintenance of alveolar bone and reduced the estimated need for additional bone augmentation at the time of implant placement (ClinicalTrials.gov NCT01794806).
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Affiliation(s)
- G. Avila-Ortiz
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - M. Gubler
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Private practice, Saint George, UT, USA
| | - M. Romero-Bustillos
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - C.L. Nicholas
- Department of Orthodontics, University of Illinois at Chicago, Chicago, IL, USA
| | - M.B. Zimmerman
- Biostatistics Consulting Center, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - C.A. Barwacz
- Department of Family Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
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Avila-Ortiz G, Chambrone L, Vignoletti F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:195-223. [PMID: 30623987 DOI: 10.1111/jcpe.13057] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 11/08/2018] [Indexed: 12/21/2022]
Abstract
AIM The aim of this systematic review was to critically analyse the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient-centred outcomes. MATERIAL AND METHODS A comprehensive search aimed at identifying pertinent literature for the purpose of this review was conducted by two independent examiners. Only randomized clinical trials (RCTs) that met the eligibility criteria were selected. Relevant data from these RCTs were collated into evidence tables. Endpoints of interest included clinical, radiographic and patient-reported outcome measures (PROMs). Interventions reported in the selected studies were clustered into ARP treatment modalities. All these different ARP modalities were compared to the control therapy (i.e. spontaneous socket healing) in each individual study after a 3- to 6-month healing period. Random-effects meta-analyses were conducted if at least two studies within the same ARP treatment modality reported on the same outcome of interest. RESULTS A combined database, grey literature and hand search identified 3,003 records, of which 1,789 were screened after removal of duplicates. Following the application of the eligibility criteria, 25 articles for a total of 22 RCTs were included in the final selection, from which nine different ARP treatment modalities were identified: (a) bovine bone particles (BBP) + socket sealing (SS), (b) construct made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, (c) cortico-cancellous porcine bone particles (CPBP) + SS, (d) allograft particles (AG) + SS, (e) alloplastic material (AP) with or without SS, (f) autologous blood-derived products (ABDP), (g) cell therapy (CTh), (h) recombinant morphogenic protein-2 (rhBMP-2) and (i) SS alone. Quantitative analyses for different ARP modalities, all of which involved socket grafting with a bone substitute, were feasible for a subset of clinical and radiographic outcomes. The results of a pooled quantitative analysis revealed that ARP via socket grafting (ARP-SG), as compared to tooth extraction alone, prevents horizontal (M = 1.99 mm; 95% CI 1.54-2.44; p < 0.00001), vertical mid-buccal (M = 1.72 mm; 95% CI 0.96-2.48; p < 0.00001) and vertical mid-lingual (M = 1.16 mm; 95% CI 0.81-1.52; p < 0.00001) bone resorption. Whether there is a superior ARP or SS approach could not be determined on the basis of the selected evidence. However, the application of particulate xenogenic or allogenic materials covered with an absorbable collagen membrane or a rapidly absorbable collagen sponge was associated with the most favourable outcomes in terms of horizontal ridge preservation. A specific quantitative analysis showed that sites presenting a buccal bone thickness >1.0 mm exhibited more favourable ridge preservation outcomes (difference between ARP [AG + SS] and control = 3.2 mm), as compared to sites with a thinner buccal wall (difference between ARP [AG + SS] and control = 1.29 mm). The effect of other local and systemic factors could not be assessed as part of the quantitative analyses. PROMs were comparable between the experimental and the control group in two studies involving the use of ABDP. The effect of other ARP modalities on PROMs could not be investigated, as these outcomes were not reported in any other clinical trial included in this study. CONCLUSION Alveolar ridge preservation is an effective therapy to attenuate the dimensional reduction of the alveolar ridge that normally takes place after tooth extraction.
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Affiliation(s)
| | - Leandro Chambrone
- Department of Periodontics, University of Iowa, Iowa City, Iowa.,School of Dentistry, Ibirapuera University, São Paulo, Brazil
| | - Fabio Vignoletti
- Department of Periodontology, Universidad Complutense de Madrid, Madrid, Spain
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21
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Troiano G, Zhurakivska K, Lo Muzio L, Laino L, Cicciù M, Lo Russo L. Combination of bone graft and resorbable membrane for alveolar ridge preservation: A systematic review, meta-analysis, and trial sequential analysis. J Periodontol 2019; 89:46-57. [PMID: 28895779 DOI: 10.1902/jop.2017.170241] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/15/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Alveolar ridge preservation (ARP) techniques aim to reduce resorption after tooth extraction. The combination of a graft material covered with a resorbable membrane represents one of the most common strategies performed in the clinical practice. The aim of this systematic review is to analyze evidence regarding potential benefits of ARP procedures performed with allogenic/xenogenic grafts in combination with a resorbable membrane coverage in comparison with spontaneous healing. METHODS Electronic databases were screened independently to select studies suitable for inclusion in this review. Horizontal ridge width reduction (HRWR) and vertical ridge height reduction (VRHR) were investigated as primary outcomes and volume changes (VC) as a secondary outcome. Meta-analysis was performed using the inverse of variance test with a random effect model. Adjustment for Type I and II errors and analysis of the power of evidence was performed with trial sequential analysis (TSA). RESULTS Seven studies met the inclusion criteria and were included in the quantitative synthesis. Meta-analysis revealed that the combination therapy resulted in a lower rate of resorption for both HRWR (-2.19 mm, 95% confidence interval [CI]: -2.67 to -1.71 mm) and VRHR (-1.72 mm, 95% CI: -2.14 to -1.30 mm). For VC no meta-analysis was performed due to insufficient data. Analysis of the power of the evidence performed with TSA showed that the number of both studies and sockets analyzed is sufficient to validate such findings, despite the high rate of heterogeneity. CONCLUSIONS Use of bone graft covered by a resorbable membrane can decrease the rate of alveolar ridge horizontal and vertical resorption after tooth extraction. The power and reliability of the evidence is strong enough to confirm the above-mentioned findings, despite the high rate of heterogeneity of included studies.
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Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Marco Cicciù
- Department of Human Pathology, School of Dentistry, University of Messina, Messina, Italy
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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22
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Canellas JVDS, Medeiros PJD, Figueredo CMDS, Fischer RG, Ritto FG. Which is the best choice after tooth extraction, immediate implant placement or delayed placement with alveolar ridge preservation? A systematic review and meta-analysis. J Craniomaxillofac Surg 2019; 47:1793-1802. [DOI: 10.1016/j.jcms.2019.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/26/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
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Ramanauskaite A, Borges T, Almeida BL, Correia A. Dental Implant Outcomes in Grafted Sockets: a Systematic Review and Meta-Analysis. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e8. [PMID: 31620270 PMCID: PMC6788428 DOI: 10.5037/jomr.2019.10308] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/05/2019] [Indexed: 12/28/2022]
Abstract
Objectives To assess the treatment outcomes of the dental implants placed in the grafted sockets. Material and Methods A search protocol was developed to evaluate the treatment outcomes of dental implants placed in the grafted sockets in terms of implant survival rates (primary outcome), marginal-bone-level (MBL) changes, clinical parameters (i.e., bleeding on probing, probing depth), occurrence of peri-implant diseases, and aesthetic outcomes (secondary outcomes). Randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective studies with at least 12 months of follow-up and a minimum of 10 patients having at least one dental implant inserted into the grafted socket were conducted. MEDLINE (PubMed) was searched for relevant articles published until 1st April 2019. A meta-analysis was performed using the random-effects model on the selected qualifying articles. Results The present analysis included 7 RCTs. The survival rate of the implants inserted into the grafted sockets ranged from 95 to 100% after 1 to 4 years of follow-up. MBL loss was found to be significantly greater for the implants placed in the non-grafted healed sites than for those placed in the previously grafted sockets (weighted mean difference = -1.961 mm, P < 0.0001). In terms of MBL changes, no difference was detected between immediately inserted implants versus implants placed in previously grafted sockets. None of the included studies reported on the clinical parameters or occurrence of peri-implant diseases Conclusions Implants inserted into the previously grafted sockets showed high survival rates and lower marginal-bone-level loss than the implants inserted into the non-grafted sites.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, FrankfurtGermany
| | - Tiago Borges
- Center for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, ViseuPortugal
| | - Bruno Leitão Almeida
- Center for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, ViseuPortugal
| | - Andre Correia
- Center for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, ViseuPortugal
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Majzoub J, Ravida A, Starch-Jensen T, Tattan M, Suárez-López Del Amo F. The Influence of Different Grafting Materials on Alveolar Ridge Preservation: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e6. [PMID: 31620268 PMCID: PMC6788425 DOI: 10.5037/jomr.2019.10306] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/05/2019] [Indexed: 11/22/2022]
Abstract
Objectives The purpose of the present review was to evaluate the effect of different bone substitutes used for alveolar ridge preservation on the post extraction dimensional changes. Material and Methods An electronic literature search in MEDLINE (PubMed), EMBASE (OVID) and Cochrane (CENTRAL) were performed, in addition to a manual search through all periodontics and implantology-related journals, up to December 2018. Inverse variance weighted means were calculated for all the treatment arms of the included trials for the quantitative analysis. Results Forty randomized controlled trials were included in the quantitative analysis. Dimensional changes were obtained from clinical measurements and three-dimensional imaging. The average amount of horizontal ridge resorption was 1.52 (SD 1.29) mm (allograft), 1.47 (SD 0.92) mm (xenograft), 2.31 (SD 1.19) mm (alloplast) and 3.1 (SD 1.07) mm for unassisted healing. Similarly, for all the evaluated parameters, the spontaneous healing of the socket led to higher bone loss rate than the use of a bone grafting material. Conclusions The utilization of a bone grafting material for alveolar ridge preservation reduces the resorption process occurring after tooth extraction. However, minimal differences in resorption rate were observed between allogeneic, xenogeneic and alloplastic grafting materials.
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Affiliation(s)
- Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MichiganUSA
| | - Andrea Ravida
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MichiganUSA
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IowaUSA
| | - Fernando Suárez-López Del Amo
- Department of Periodontics, University of Oklahoma Health Sciences Center - College of Dentistry, Oklahoma City, OklahomaUSA
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25
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Stumbras A, Kuliesius P, Januzis G, Juodzbalys G. Alveolar Ridge Preservation after Tooth Extraction Using Different Bone Graft Materials and Autologous Platelet Concentrates: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e2. [PMID: 31069040 PMCID: PMC6498816 DOI: 10.5037/jomr.2019.10102] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/12/2019] [Indexed: 12/25/2022]
Abstract
Objectives To review and assess the efficiency of different post extraction socket preservation techniques. Material and Methods An electronic literature search was performed on the MEDLINE and Embase databases. The review included human studies published between from January 1st, 2007 to January 1st, 2018, in English. Outcome measures included dimensional changes and/or histological evaluation of alveolar bone. Results Twenty-six full text articles were reviewed, 16 of which met the inclusion criteria and were selected for the study. Autogenous tooth graft prevented vertical resorption the most: -0.28 (SD 0.13) mm, observation period (OP): 4 months, while the least effective approach was beta tri-calcium phosphate (β-TCP): -1.72 (SD 0.56) mm, OP: 4 months. Estimating horizontal resorption, the most effective technique was biphasic calcium sulphate (BCS) with β-TCP and hydroxyapatite (HA) - BCS + TCP + HA: 0.03 (SD 2.32) mm, OP: 4 months, while β-TCP was the least efficient: -1.45 (SD 0.4) mm, OP: 4 months. Evaluating residual graft particles (RG) and newly formed bone (NFB) ratio the best results were achieved with demineralized freeze-dried bone allograft: RG: 8.88%, NFB: 38.42%, OP: 5 months, whereas magnesium-enriched hydroxyapatite was least effective: RG: 40.82%, NFB: 31.85%, OP: 4 months. Conclusions This review revealed that even though there are numerous types of biomaterials for socket preservation none of them can completely stop alveolar bone loss after tooth extraction. Furthermore, lack of information about qualitative evaluation of bone was noticed indicating that further studies regarding this topic are needed.
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Affiliation(s)
- Arturas Stumbras
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Povilas Kuliesius
- Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania
| | - Gintaras Januzis
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
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Vertical Bone Construction with Bone Marrow-Derived and Adipose Tissue-Derived Stem Cells. Symmetry (Basel) 2019. [DOI: 10.3390/sym11010059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The purpose of this study was to conduct a histomorphometric analysis of bone marrow-derived and adipose tissue-derived stem cells, associated with a xenograft block, in vertical bone constructions in rabbit calvaria. Ten rabbits received two xenograft blocks on the calvaria, after decortication of the parietal bone. The blocks were fixed with titanium screws. The blocks were combined with the bone marrow-derived mesenchymal stem cells in the bone marrow stem cell (BMSC) group (right side of the calvaria) or with the adipose tissue-derived mesenchymal stem cells in the adipose tissue stem cell (ATSC) group (left side of the calvaria). After 8 weeks, the animals were sacrificed and their parietal bones were fixed in 10% formalin for the histomorphometric analysis. The following parameters were evaluated—newly formed bone (NFB), xenogeneic residual particles (XRP), and non-mineralized tissue (NMT). The histomorphometric analysis revealed 11.9 ± 7.5% and 7.6 ± 5.6% for NFB, 22.14 ± 8.5% and 21.6 ± 8.5% for XRP, and 65.8 ± 10.4% and 70.8 ± 7.4% for NMT in groups BMSC and ATSC, respectively, with statistically significant differences in the NFB and the NMT between the groups, but no differences in the XRP. Therefore, it can be concluded that the bone marrow-derived stem cells seem to have more potential for the bone formation than do the adipose tissue-derived stem cells when used in combination with the xenogenous blocks in the vertical bone construction.
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Hong HR, Chen C, Kim DM, Machtei EE. Ridge preservation procedures revisited: A randomized controlled trial to evaluate dimensional changes with two different surgical protocols. J Periodontol 2018; 90:331-338. [DOI: 10.1002/jper.18-0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/18/2018] [Accepted: 09/23/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Heather R. Hong
- Department of Oral MedicineInfection, and ImmunityHarvard School of Dental Medicine Boston MA USA
| | - Chia‐Yu Chen
- Department of Oral MedicineInfection, and ImmunityHarvard School of Dental Medicine Boston MA USA
| | - David M. Kim
- Department of Oral MedicineInfection, and ImmunityHarvard School of Dental Medicine Boston MA USA
| | - Eli E. Machtei
- Department of Oral MedicineInfection, and ImmunityHarvard School of Dental Medicine Boston MA USA
- Department of PeriodontologySchool of Graduate DentistryRambam Health Care Campus & Faculty of MedicineTechnion, I.I.T. Haifa Israel
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Gavazzoni A, Filho LI, Hernandes L. Analysis of bone formation and membrane resorption in guided bone regeneration using deproteinized bovine bone mineral versus calcium sulfate. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:167. [PMID: 30392111 DOI: 10.1007/s10856-018-6167-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Guided Bone Regeneration (GBR) is a technique based on the use of a physical barrier that isolates the region of bone regeneration from adjacent tissues. The objective of this study was to compare GBR, adopting a critical-size defect model in rat calvaria and using collagen membrane separately combined with two filling materials, each having different resorption rates. A circular defect 8 mm in diameter was made in the calvaria of Wistar rats. The defects were then filled with calcium sulfate (CaS group) or deproteinized bovine bone mineral (DBBM group) and covered by resorbable collagen membrane. The animals were killed 15, 30, 45 and 60 days after the surgical procedure. Samples were collected, fixed in 4% paraformaldehyde and processed for paraffin embedding. The resultant sections were stained with H&E for histological and histomorphometric study. For the histomorphometric study, the area of membrane was quantified along with the amount of bone formed in the region of the membrane. Calcium sulfate was reabsorbed more rapidly compared to DBBM. The CaS group had the highest percentages of remaining membrane at 15, 30, 45 and 60 days, compared to the DBBM group. The DBBM group had the highest amount of new bone at 45 and 60 days compared to the CaS group. Based on these results, it was concluded that the type of filling material may influence both the resorption of collagen membrane and amount of bone formed.
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Affiliation(s)
| | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Luzmarina Hernandes
- Department of Morphological Sciences, State University of Maringá, Maringá, Paraná, Brazil.
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Bone Healing in Rabbit Calvaria Defects Using a Synthetic Bone Substitute: A Histological and Micro-CT Comparative Study. MATERIALS 2018; 11:ma11102004. [PMID: 30336544 PMCID: PMC6213059 DOI: 10.3390/ma11102004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/14/2018] [Accepted: 10/15/2018] [Indexed: 01/13/2023]
Abstract
Bioactive alloplastic materials, like beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), have been extensively researched and are currently used in orthopedic and dental bone regenerative procedures. The purpose of this study was to compare the performance of EthOss versus a bovine xenograft and spontaneous healing. The grafting materials were implanted in standardized 8 mm circular bicortical bone defects in rabbit calvariae. A third similar defect in each animal was left empty for natural healing. Six male rabbits were used. After eight weeks of healing, the animals were euthanized and the bone tissue was analyzed using histology and micro-computed tomography (micro-CT). Defects treated with β-TCP/CS showed the greatest bone regeneration and graft resorption, although differences between groups were not statistically significant. At sites that healed spontaneously, the trabecular number was lower (p < 0.05) and trabecular separation was higher (p < 0.05), compared to sites treated with β-TCP/CS or xenograft. Trabecular thickness was higher at sites treated with the bovine xenograft (p < 0.05) compared to sites filled with β-TCP/CS or sites that healed spontaneously. In conclusion, the novel β-TCP/CS grafting material performed well as a bioactive and biomimetic alloplastic bone substitute when used in cranial defects in this animal model.
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Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol. J Craniofac Surg 2018; 29:1037-1041. [PMID: 29489581 DOI: 10.1097/scs.0000000000004419] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this randomized controlled trial was to evaluate the survival rate, the marginal bone level, and the aesthetic outcome; at 3 years' follow-up, of dental implants placed into a high-esthetic aesthetic zone by comparing 2 techniques of postextraction implant with immediate loading: the socket shied technique and the conventional insertion technique.Several clinical studies suggested that the avulsion of a dental element causes dimensional alterations of both soft and hard tissues at the postextractive site. To increase the aesthetic outcomes, the "socket-shield technique" has been proposed. This method involves maintaining the vestibular root portion and immediate insertion of the dental implant in close proximity to the root.Patients enrolled in this study were randomized to receive a postextraction implant in the aesthetic zone, either with the socket shied technique or with the conventional insertion technique. Implant survival, marginal bone level, and the pink aesthetic score were the outcomes evaluated.Implant survival rate was 100% in both the groups at 3 years. Implants inserted with the socket shield technique showed better values of both marginal bone level and pink aesthetic score (P < 0.05).Although such preliminary results need to be further confirmed, the socket shield technique seems to be a safe surgical technique that allows an implant rehabilitation characterized by better aesthetic outcomes.
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ALCÂNTARA CEP, CASTRO MAA, NORONHA MSD, MARTINS-JUNIOR PA, MENDES RDM, CALIARI MV, MESQUITA RA, FERREIRA AJ. Hyaluronic acid accelerates bone repair in human dental sockets: a randomized triple-blind clinical trial. Braz Oral Res 2018; 32:e84. [DOI: 10.1590/1807-3107bor-2018.vol32.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022] Open
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Alternatives to Autologous Bone Graft in Alveolar Cleft Reconstruction: The State of Alveolar Tissue Engineering. J Craniofac Surg 2018; 29:584-593. [PMID: 29461365 DOI: 10.1097/scs.0000000000004300] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Alveolar cleft reconstruction has historically relied on autologous iliac crest bone grafting (ICBG), but donor site morbidity, pain, and prolonged hospitalization have prompted the search for bone graft substitutes. The authors evaluated bone graft substitutes with the highest levels of evidence, and highlight the products that show promise in alveolar cleft repair and in maxillary augmentation. This comprehensive review guides the craniofacial surgeon toward safe and informed utilization of biomaterials in the alveolar cleft.A literature search was performed to identify in vitro human studies that fulfilled the following criteria: Level I or Level II of evidence, ≥30 subjects, and a direct comparison between a autologous bone graft and a bone graft substitute. A second literature search was performed that captured all studies, regardless of level of evidence, which evaluated bone graft substitutes for alveolar cleft repair or alveolar augmentation for dental implants. Adverse events for each of these products were tabulated as well.Sixteen studies featuring 6 bone graft substitutes: hydroxyapatite, demineralized bone matrix (DBM), β-tricalcium phosphate (TCP), calcium phosphate, recombinant human bone morphogenic protein-2 (rhBMP-2), and rhBMP7 fit the inclusion criteria for the first search. Through our second search, the authors found that DBM, TCP, rhBMP-2, and rhBMP7 have been studied most extensively in the alveolar cleft literature, though frequently in studies using less rigorous methodology (Level III evidence or below). rhBMP-2 was the best studied and showed comparable efficacy to ICBG in terms of volume of bone regeneration, bone density, and capacity to accommodate tooth eruption within the graft site. Pricing for products ranged from $290 to $3110 per 5 mL.The balance between innovation and safety is a complex process requiring constant vigilance and evaluation. Here, the authors profile several bone graft substitutes that demonstrate the most promise in alveolar cleft reconstruction.
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Pelegrine AA, Romito G, Villar CC, Macedo LGSD, Teixeira ML, Aloise AC, Moy PK. Horizontal Bone Reconstruction on sites with different amounts of native bone: a retrospective study. Braz Oral Res 2018; 32:e21. [DOI: 10.1590/1807-3107bor-2018.vol32.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/15/2018] [Indexed: 01/21/2023] Open
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Saska S, Pigossi SC, Oliveira GJPL, Teixeira LN, Capela MV, Gonçalves A, de Oliveira PT, Messaddeq Y, Ribeiro SJL, Gaspar AMM, Marchetto R. Biopolymer-based membranes associated with osteogenic growth peptide for guided bone regeneration. ACTA ACUST UNITED AC 2018; 13:035009. [PMID: 29363620 DOI: 10.1088/1748-605x/aaaa2d] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Barrier membranes for guided bone regeneration (GBR) mainly promote mechanical maintenance of bone defect space and induce osteopromotion. Additionally, biopolymer-based membranes may provide greater bioactivity and biocompatibility due to their similarity to extracellular matrix (ECM). In this study, biopolymers-based membranes from bacterial cellulose (BC) and collagen (COL) associated with osteogenic growth peptide (OGP(10-14)) were evaluated to determine in vitro osteoinductive potential in early osteogenesis; moreover, histological study was performed to evaluate the BC-COL OGP(10-14) membranes on bone healing after GBR in noncritical defects in rat femur. The results showed that the BC-COL and BC-COL OGP(10-14) membranes promoted cell proliferation and alkaline phosphatase activity in osteoblastic cell cultures. However, ECM mineralization was similar between cultures grown on BC OGP(10-14) and BC-COL OGP(10-14) membranes. In vivo results showed that all the membranes tested, including the peptide-free BC membrane, promoted better bone regeneration than control group. Furthermore, the BC-COL OGP(10-14) membranes induced higher radiographic density in the repaired bone than the other groups at 1, 4 and 16 weeks. Histomorphometric analyses revealed that the BC-COL OGP(10-14) induced higher percentage of bone tissue in the repaired area at 2 and 4 weeks than others membranes. In general, these biopolymer-based membranes might be potential candidates for bone regeneration applications.
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Affiliation(s)
- Sybele Saska
- São Paulo State University-UNESP, Institute of Chemistry, Araraquara, SP, Brazil. São Paulo State University-UNESP, School of Dentistry, Araraquara, SP, Brazil
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Sbordone C, Toti P, Martuscelli R, Guidetti F, Porzio M, Sbordone L. Evaluation of volumetric dimensional changes in posterior extraction sites with and without ARP using a novel imaging device. Clin Implant Dent Relat Res 2017; 19:1044-1053. [PMID: 28905475 DOI: 10.1111/cid.12537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Alveolar ridge volume loss may be minimized when postextraction sockets are filled by bone substitutes. PURPOSE The aim of the study was to measure the effect of alveolar ridge preservation (ARP) in maintaining the external contour of the ridge after fresh socket grafting with or without particulate anorganic bovine bone mineral (BBM) and resorbable barrier covering. MATERIALS AND METHODS In the present controlled study, patients subjected to single-tooth extraction were allocated to 2 groups: postextraction sockets grafted with bovine bone mineral (bbm), and naturally healing sockets (nat). Before and at 5 months following tooth extraction, plaster cast contours of the sockets were acquired by means of an optical scanner; the 2 contours of each patient underwent voxelization and fusion using a matrix elaborator. Outcome variables at 5 months (volumetric, surface, and linear changes) were measured in digital fused plaster casts with a dental scan software analyzing a volume of interest ranging from residual papilla to 10 mm toward the apical point. Intra- and inter-group pair-wise variables' comparisons were conducted. Level of significance was set at 0.05. RESULTS Twenty-four sites were enrolled: 12 ARP and 12 naturally healed. Five-month percentage of volume loss of the bbm-group (21.7% ± 7.4%) was significantly lower (Ps < .0003) than that of the naturally healing group (38.8% ± 7.9%). When tooth position was investigated, volume loss in percentage registered a significantly better (P values ≤ .0485) behavior in molars (ΔV% = -19.1% ± 6.5% and ΔV% = -35.6% ± 7.6%, respectively, for bbm and nat) than that in premolars (ΔV% = -26.9% ± 7.2% and ΔV% = -45.1% ± 4.2%, respectively, for bbm and nat), in both the preserved and naturally healing groups. CONCLUSION The dimensional loss in postextraction sockets grafted with anorganic bovine bone substitute and covered by a resorbable collagen barrier was lower than that of the naturally healing sites. However, ridge preservation was able to maintain almost 80% of the pristine bone.
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Affiliation(s)
- Carolina Sbordone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80100 Naples, Italy.,Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", Doctorate School in Traslational and Clinical Medicine, University of Salerno, Via S. Allende, 84081 Baronissi (Salerno), Italy
| | - Paolo Toti
- Private Practice, Via Provinciale 87B, 55041 Camaiore (Lucca), Italy.,Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi (Salerno).,Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Ranieri Martuscelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80100 Naples, Italy
| | - Franco Guidetti
- Complex Operating Unit of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56100 Pisa, Italy
| | - Massimo Porzio
- Private Practice, Via Posillipo 181, 80123 Naples, Italy
| | - Ludovico Sbordone
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi (Salerno).,Head and Neck Clinical Department, Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggid'Aragona, Salerno, Italy.,Formerly Department of Surgery, University of Pisa, Pisa, Italy
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Barone A, Toti P, Menchini-Fabris GB, Derchi G, Marconcini S, Covani U. Extra oral digital scanning and imaging superimposition for volume analysis of bone remodeling after tooth extraction with and without 2 types of particulate porcine mineral insertion: A randomized controlled trial. Clin Implant Dent Relat Res 2017; 19:750-759. [PMID: 28508515 DOI: 10.1111/cid.12495] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/01/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Incorporation of bone substitute material into the extraction socket could minimize the edentulous ridge volume loss or maximize the bone formation within the healing area. PURPOSE The aim of the study was to test the effectiveness in maintaining the volumetric contour of fresh extraction sockets grafted with or without 2 types of porcine biomaterials and covered with a resorbable barrier. MATERIALS AND METHODS In the present multi-center single-blind randomized control trial, 55 patients underwent 1-tooth extraction, were surveyed, and randomly allocated to control- (25 sites, nat-group) or test groups (15 sites grafted with pre-hydrated collagenated cortico-cancellous porcine bone, coll-group, and 15 with cortical porcine bone, cort-group). Before extraction, and then 4 months later, contours of the sockets were acquired through a laser scanner, voxelized, and ghosts of each patient were superimposed with a matrix laboratory. Volumetric and area evaluations of the virtual superimposed models were performed with dentascan tools to create a volume of interest extending between the 2 residual teeth. Intra- and inter-group comparisons of the outcomes were performed. Non-parametric tests were applied with a level of significance set at P < .05. RESULTS Intergroup analysis at 4 months' survey revealed that percentage loss of alveolar ridge volume of the coll-group (28.8% ± 8.8%) and of the cort-group (30.2% ± 7.1%) was significantly lower (P < .0001) than that of the naturally-healing group (46.4% ± 4.1%). No statistically-significant differences in outcomes were observed between the 2 test groups at any of the observation periods. Moreover, tooth position (bicuspids vs molars) seemed to affect neither volume loss nor basal shrinkage. CONCLUSION At the 4-month analysis both test groups showed reduced bone loss when compared to naturally healing sockets. However, the 2 grafting materials were not able to preserve the alveolar crest, and a reduction close to 30% in the estimates was registered after healing.
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Affiliation(s)
- Antonio Barone
- Unit of Oral Surgery and Implantology, Department of Surgery, University of Geneva, Genève, Switzerland
| | - Paolo Toti
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Dental Institute, Fortis Dental Center, Forte dei Marmi, Italy
| | - Giovan-Battista Menchini-Fabris
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Dental Institute, Fortis Dental Center, Forte dei Marmi, Italy
| | - Giacomo Derchi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Dental Institute, Fortis Dental Center, Forte dei Marmi, Italy
| | - Simone Marconcini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Dental Institute, Fortis Dental Center, Forte dei Marmi, Italy
| | - Ugo Covani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Dental Institute, Fortis Dental Center, Forte dei Marmi, Italy
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Qiu ZY, Cui Y, Tao CS, Zhang ZQ, Tang PF, Mao KY, Wang XM, Cui FZ. Mineralized Collagen: Rationale, Current Status, and Clinical Applications. MATERIALS 2015; 8:4733-4750. [PMID: 28793468 PMCID: PMC5455477 DOI: 10.3390/ma8084733] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/29/2015] [Accepted: 07/13/2015] [Indexed: 01/19/2023]
Abstract
This paper presents a review of the rationale for the in vitro mineralization process, preparation methods, and clinical applications of mineralized collagen. The rationale for natural mineralized collagen and the related mineralization process has been investigated for decades. Based on the understanding of natural mineralized collagen and its formation process, many attempts have been made to prepare biomimetic materials that resemble natural mineralized collagen in both composition and structure. To date, a number of bone substitute materials have been developed based on the principles of mineralized collagen, and some of them have been commercialized and approved by regulatory agencies. The clinical outcomes of mineralized collagen are of significance to advance the evaluation and improvement of related medical device products. Some representative clinical cases have been reported, and there are more clinical applications and long-term follow-ups that currently being performed by many research groups.
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Affiliation(s)
- Zhi-Ye Qiu
- School of Materials Science and Engineering, Tsinghua University, Haidian District, Beijing 100084, China.
- Beijing Allgens Medical Science and Technology Co., Ltd., No.1 Disheng East Road, Yizhuang Economic and Technological Development Zone, Beijing 100176, China.
| | - Yun Cui
- Beijing Allgens Medical Science and Technology Co., Ltd., No.1 Disheng East Road, Yizhuang Economic and Technological Development Zone, Beijing 100176, China.
| | - Chun-Sheng Tao
- School of Materials Science and Engineering, Tsinghua University, Haidian District, Beijing 100084, China.
- The 401 Hospital of Chinese People's Liberation Army, No. 22 Minjiang Road, Qingdao 266071, China.
| | - Zi-Qiang Zhang
- Beijing Allgens Medical Science and Technology Co., Ltd., No.1 Disheng East Road, Yizhuang Economic and Technological Development Zone, Beijing 100176, China.
| | - Pei-Fu Tang
- The General Hospital of People's Liberation Army, No. 28 Fuxing Road, Beijing 100853, China.
| | - Ke-Ya Mao
- The General Hospital of People's Liberation Army, No. 28 Fuxing Road, Beijing 100853, China.
| | - Xiu-Mei Wang
- School of Materials Science and Engineering, Tsinghua University, Haidian District, Beijing 100084, China.
| | - Fu-Zhai Cui
- School of Materials Science and Engineering, Tsinghua University, Haidian District, Beijing 100084, China.
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Benic GI, Elmasry M, Hämmerle CHF. Novel digital imaging techniques to assess the outcome in oral rehabilitation with dental implants: a narrative review. Clin Oral Implants Res 2015; 26 Suppl 11:86-96. [DOI: 10.1111/clr.12616] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Moustafa Elmasry
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Barone A, Toti P, Quaranta A, Alfonsi F, Cucchi A, Calvo-Guirado JL, Negri B, Di Felice R, Covani U. Volumetric analysis of remodelling pattern after ridge preservation comparing use of two types of xenografts. A multicentre randomized clinical trial. Clin Oral Implants Res 2015; 27:e105-e115. [PMID: 25727443 DOI: 10.1111/clr.12572] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this randomized clinical trial was to analyse and compare the volumetric changes after ridge preservation procedures using two different biomaterials and to evaluate associations between outcome variables and pristine three-dimensional aspects of the ridges. MATERIALS AND METHODS Twenty-eight patients subjected to single-tooth alveolar ridge preservation were enrolled in the present multicentre, single-blind, prospective and randomized clinical trial. Fourteen sites were randomly allocated to each experimental group. The experimental sites were grafted with pre-hydrated collagenated cortico-cancellous porcine bone (coll group) or with a cortical porcine bone (cort group) and a collagen membrane; a secondary soft tissue healing was obtained for all experimental sites. Plaster casts were scanned (preoperative, at 1 and 3 months postoperative). Analysis of volumes and areas was performed, and all measured variables were statistically compared. RESULTS Intragroup analyses at 3 months revealed that when examining changes related to three-dimensional features of remodelling patterns (volume, surfaces, height and shape), the two biomaterials showed similar behaviours with a minor loss in volume and ridge surface. Intergroup analysis at 3-month survey revealed that volume resorption of the coll group (244 mm3 ) was significantly lower (P = 0.0140) than that of the cort group (349 mm3 ). The reduction for basal surface appeared significantly different between the two groups at 1-month survey only (P = 0.0137), while the final basal surface reduction was 4.9 and 12.2 mm2 for coll and cort group, respectively. The superior surface reduction was 40.8 mm2 for coll and 50.7 mm2 for cort group, with no significant difference between the two groups. CONCLUSION At the 3rd month analysis, coll group showed a significantly lower reduction of ridge volume and a significantly smaller shrinkage of the basal area when compared to the cort group; moreover, the coll group experienced a smaller superior surface shrinkage when compared to the cort group, even though no significance was evaluated.
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Affiliation(s)
- Antonio Barone
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy. .,Tuscan Stomatologic Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
| | - Paolo Toti
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Stomatologic Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy
| | - Alessandro Quaranta
- Department of Odontology and Specialized Clinical Sciences (DISCO), Marche Polytechnic University, Torrette di Ancona, Italy
| | - Fortunato Alfonsi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Stomatologic Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy
| | | | | | - Bruno Negri
- Department of Implantology, University of Murcia, Murcia, Spain
| | | | - Ugo Covani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.,Tuscan Stomatologic Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy
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