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Zhang H, Xu T, Wei Y, Wei N, Han Z, Hu W. Assessment of soft and hard tissue changes following micro crestal flap-Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage III/IV periodontitis: A randomized controlled trial. J Clin Periodontol 2024. [PMID: 39043452 DOI: 10.1111/jcpe.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
AIM This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy. MATERIALS AND METHODS Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery. RESULTS Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (p = .032) and greater augmentation in central bone height (p = .001) and ridge width (p = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (p = .010), 0.61 mm (p = .019) and 0.56 mm (p = .013) less than that in the NH group, respectively. There were significantly (p = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%). CONCLUSIONS Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy. TRIAL REGISTRATION Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.
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Affiliation(s)
- Haoyun Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Tao Xu
- Department of Emergency, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Yiping Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Ning Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Ziyao Han
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
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A Retrospective Digital Analysis of Contour Changing after Tooth Extraction with or without Using Less Traumatic Surgical Procedures. J Clin Med 2022; 11:jcm11040922. [PMID: 35207192 PMCID: PMC8875248 DOI: 10.3390/jcm11040922] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The present retrospective analysis aimed to compare two different single tooth extraction surgical approaches in both premolar and molar areas: less traumatic magneto-electrical versus conventional tooth extraction in minimizing the edentulous ridge volume loss. METHODS In the present retrospective control trial, 48 patients who underwent one-tooth extraction, were allocated either to control (28 sites treated with conventional tooth extraction procedures) or test group (20 subjects treated with less traumatic tooth extraction procedures by tooth sectioning and magnetoelectric roots subluxation). Intraoperatively (during tooth extraction surgery just after the subsequent filling of the alveolar socket with the sterile fast re-absorbable gelatin sponge), and then four months later, contours of the sockets were acquired through a laser intra-oral scanner. The digitally superimposed models were converted to dicom (Digital Imaging and Communications in Medicine) format first, then volumetric and area evaluations were performed with a DentaScan tool package. Non-parametric tests were applied with a level of significance set at p < 0.01. RESULTS significant reductions of anatomical features were observed four months later in all the groups (p-values < 0.001) with volume losses leading to a final alveolar ridge volume of 0.87 ± 0.34 cm3 for atraumatic extractions and 0.66 ± 0.19 cm3 for conventional extractions. No significant differences were registered for outcomes related to the basal surface variables. When just molar tooth were considered, the outcomes relating to volume loss between baseline and four months (ΔV) and its percentage (ΔV%) showed a better behavior in the less traumatic procedure (ΔV = -0.30 ± 0.10 cm3 and ΔV% = -22.3 ± 8.4%) compared to the conventional extractions (ΔV = -0.59 ± 0.10 cm3 and ΔV% = -44.3 ± 5.8%) with p-values < 0.0001. CONCLUSIONS at four months, the less traumatic tooth extraction procedures by tooth sectioning and magnetoelectric root subluxation seemed to be able to better preserve the volume of the alveolar crest (reduction close to 22% with less traumatic extraction in molar sites) when compared to subjects treated with the conventional tooth extraction techniques.
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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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Couso-Queiruga E, Stuhr S, Tattan M, Chambrone L, Avila-Ortiz G. Post-extraction dimensional changes: A systematic review and meta-analysis. J Clin Periodontol 2020; 48:126-144. [PMID: 33067890 DOI: 10.1111/jcpe.13390] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022]
Abstract
AIM To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing. MATERIALS AND METHODS The protocol of this PRISMA-compliant systematic review (SRs) was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random-effects meta-analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest. RESULTS Twenty-eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non-molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed clinically in non-molar sites was 2.73 mm (95% CI: 2.36-3.11), 1.71 mm (95% CI: 1.30-2.12) and 1.44 mm (95% CI: 0.78-2.10), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in non-molar sites was 2.54 mm (95% CI: 1.97-3.11), 1.65 mm (95% CI: 0.42-2.88) and 0.87 mm (95% CI: 0.36-1.38), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in molar sites was 3.61 mm (95% CI: 3.24-3.98), 1.46 mm (95% CI: 0.73-2.20) and 1.20 mm (95% CI: 0.56-1.83), respectively. CONCLUSION A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.
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Affiliation(s)
- Emilio Couso-Queiruga
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Sandra Stuhr
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Leandro Chambrone
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA.,Graduate Dentistry Program, Ibirapuera University, São Paulo, Brazil.,Unit of Basic Oral Investigations, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
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Menchini-Fabris GB, Toti P, Crespi G, Covani U, Crespi R. Distal Displacement of Maxillary Sinus Anterior Wall Versus Conventional Sinus Lift with Lateral Access: A 3-Year Retrospective Computerized Tomography Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197199. [PMID: 33019711 PMCID: PMC7579181 DOI: 10.3390/ijerph17197199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Background: The present study is designed to compare the outcomes of two sinus augmentation procedures: distal displacement of the anterior wall versus standard sinus lifting and grafting with a lateral window approach. Methods: In the displacement group, a localized surgical fracture of the sinus floor achieved through an electromagnetic device results in the distal displacement of the anterior wall. In the filling group, sinus lifting (with lateral access) and grafting with particulate xenogeneic bone substitute was performed. Bone volume beneath the maxillary sinus was investigated with computerized tomography after baseline and postoperative data superimposition. Clinical and radiological outcomes over three years had been evaluated. Results: Forty-three dental implants were selected. The two sinus lift procedures significantly increased the bone volume (p-value ≤ 0.0017) in the displacement group from 1.17 ± 0.34 to 1.53 ± 0.39 cc, with a final bone gain of +0.36 ± 0.17 cc, and in the filling group from 1.24 ± 0.41 to 1.94 ± 0.68 cc, with a bone augmentation of +0.71 ± 0.31 cc. No events of dental implant bulging into the maxillary sinus occurred. Two implants failed early on in the filling group, attesting the 3-year survival rate of 92.6% (CI95%: 82.7–100%). Marginal bone loss at the distal aspect was 1.66 ± 0.72 and 1.25 ± 0.78 mm, respectively, for the displacement and filling groups, with a significant difference (p-value = 0.0497). Conclusion: Results showed a significant and effective bone gain around dental implants at a 3-year survey for both sinus augmented by backward displacement of the anterior wall (+34%) and sinus lifting and grafting with a lateral window approach (+57%).
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Affiliation(s)
- Giovanni Battista Menchini-Fabris
- Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Via Vittoria Colonna, 11, 00193 Rome, Italy; (G.B.M.-F.); (R.C.)
- San Rossore Dental Unit, Viale delle Cascine 152 San Rossore, 56122 Pisa, Italy
| | - Paolo Toti
- Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Via Vittoria Colonna, 11, 00193 Rome, Italy; (G.B.M.-F.); (R.C.)
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.)
- Correspondence: ; Tel.: +39-3345640252; Fax: +39-0584-752105
| | - Giovanni Crespi
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.)
| | - Ugo Covani
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.)
| | - Roberto Crespi
- Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Via Vittoria Colonna, 11, 00193 Rome, Italy; (G.B.M.-F.); (R.C.)
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Menchini-Fabris GB, Toti P, Crespi G, Covani U, Furlotti L, Crespi R. Effect of Different Timings of Implant Insertion on the Bone Remodeling Volume around Patients' Maxillary Single Implants: A 2-3 Years Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186790. [PMID: 32957683 PMCID: PMC7557473 DOI: 10.3390/ijerph17186790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022]
Abstract
Background: To investigate the middle-term effect on bone remodeling of different timings for different implant placement (immediate versus delayed). Methods: Patients with an anterior maxillary failing tooth were treated by single-crown supported by dental implant. Subjects were retrospectively analyzed for 3 years and assigned to one of two predictor groups: nine immediate versus 10 delayed implant placement (1-2 months after tooth extraction). The crestal bone loss around dental implants was measured with the cone beam computerized tomography by fusing pre-operative and post-operative data. Results: The percentage of volume loss registered at 1-year follow-up (%ΔV) was of 7.5% for the immediate group, which was significantly lower (p-values ≤ 0.0002) than the loss of 24.2% for the delayed group. At 3 years, there was a significant difference (p-values = 0.0291) between the two groups, respectively, with a volume loss of 14.6% and 27.1%. When different times were compared, the percentage of the volume loss for the immediate group was different (p-value = 0.0366) between the first and third year (7.5% and 14.6%, respectively). For the delayed group, no significant difference was registered between the 1- and 3-year follow-up. Conclusions: The bone loss around dental implant-supported single-crown with different timing of insertion appeared higher for the delayed group than the immediate group.
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Affiliation(s)
- Giovanni Battista Menchini-Fabris
- Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Via Vittoria Colonna, 11, 00193 Rome, Italy; (G.B.M.-F.); (R.C.)
- San Rossore Dental Unit, Viale delle Cascine 152 San Rossore, 56122 Pisa, Italy
| | - Paolo Toti
- Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Via Vittoria Colonna, 11, 00193 Rome, Italy; (G.B.M.-F.); (R.C.)
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.); (L.F.)
- Correspondence: ; Tel.: +39-334-5640252; Fax: +39-0584-752105
| | - Giovanni Crespi
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.); (L.F.)
| | - Ugo Covani
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.); (L.F.)
| | - Luca Furlotti
- Department of Stomatology, Tuscan Stomatological Institute, Foundation for Dental Clinic, Research and Continuing Education, Via Padre Ignazio da Carrara 39, 55042 Forte Dei Marmi, Italy; (G.C.); (U.C.); (L.F.)
| | - Roberto Crespi
- Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Via Vittoria Colonna, 11, 00193 Rome, Italy; (G.B.M.-F.); (R.C.)
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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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Sapata VM, Llanos AH, Cesar Neto JB, Jung RE, Thoma DS, Hämmerle CHF, Pannuti CM, Romito GA. Deproteinized bovine bone mineral is non-inferior to deproteinized bovine bone mineral with 10% collagen in maintaining the soft tissue contour post-extraction: A randomized trial. Clin Oral Implants Res 2020; 31:294-301. [PMID: 31886909 DOI: 10.1111/clr.13570] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to demineralized bovine bone mineral with 10% collagen (DBBM-C) for the maintenance of the soft tissue contour after tooth extraction in the esthetic zone. MATERIAL AND METHODS Sixty-five patients randomly received ridge preservation at a single site in the anterior maxilla with DBBM or DBBM-C. Both, DBBM and DBBM-C, were covered with a collagen matrix. Profilometric analyses were performed at baseline (BL), immediately after treatment (PO), and at 4 months (FU; day of implant placement). The main outcome was the horizontal mean change (HC) at the buccal aspect. The measurements also included changes of the estimated soft tissue thickness (eTT) at 1, 3, and 5 mm below the buccal gingival margin. Descriptive analysis was performed, and differences between groups were analyzed using independent samples t test. The non-inferiority test was performed for HC. RESULTS At 4 months, the horizontal mean change (HC) was -1.43 mm (±0.53 mm) (DBBM-C) and -1.32 mm (±0.53 mm) (DBBM). Change of the estimated soft tissue thickness (eTT) between baseline (BL) and four months of follow-up (FU) at 1, 3, and 5 mm amounted to -4.58 mm (±2.02 mm), -2.40 mm (±0.97 mm), and -1.37 mm (±0.78 mm) for DBBM-C and to -4.12 mm (±1.80 mm), -2.09 mm (±0.91 mm), and -1.23 mm (±0.72 mm) for DBBM. The differences between the groups were not statistically significantly for any of the outcome measures (p > .05). CONCLUSIONS DBBM is non-inferior to DBBM-C for the maintenance of the soft tissue contour 4 months after tooth extraction.
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Affiliation(s)
- Vítor M Sapata
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Alexandre H Llanos
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - João B Cesar Neto
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Cláudio M Pannuti
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Giuseppe A Romito
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Ramaglia L, Di Spirito F, Sirignano M, La Rocca M, Esposito U, Sbordone L. A 5-year longitudinal cohort study on crown to implant ratio effect on marginal bone level in single implants. Clin Implant Dent Relat Res 2019; 21:916-922. [PMID: 30907504 DOI: 10.1111/cid.12757] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/06/2019] [Accepted: 03/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND A 5-year longitudinal cohort study was carried out to evaluate the influence of anatomical crown to implant ratio (CIR) on peri-implant marginal bone level (MBL) in single implants. MATERIALS AND METHODS The longest possible implants, according to the availability of pristine bone, were inserted, one per patient, among periodontally healthy teeth in consecutively recruited subjects. CIR and MBL changes were measured on standardized radiographs. The relationship between MBL and multiple predictors was investigated. A statistical analysis suitable for mixed type distributions was conducted: for the discrete component a logistic regression model was used and for the continuous component the impact of the variables on MBL was examined by using robust nonparametric comparison tests. RESULTS Seventy-eight dental implants were inserted in 34 mandibles and 44 maxillae, with one stage procedure in 40 cases and two stage in 38 cases. Thirty-five implants were <10 mm, while 43 were ≥ 10 mm long; 28 implants had a CIR ≤1 and 50 had a CIR >1. No drop-outs or implant loss were observed. Bone loss occurred only in a few cases, measuring less than 0.5 mm and being significantly more pronounced for implant length ≥10 mm, for lower CIR values and for the two stage procedure. CONCLUSION Higher CIR values were not related to increased peri-implant bone loss; a <10 mm long implant insertion may be safely considered for reduced bone heights.
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Affiliation(s)
- Luca Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.,Clinical Department of Head and Neck, University of Naples "Federico II", Naples, Italy
| | - Federica Di Spirito
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Massimiliano Sirignano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Michele La Rocca
- Department of Economics and Statistics, University of Salerno, Fisciano (Salerno), Italy
| | | | - Ludovico Sbordone
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Salerno, Italy
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Sbordone C, Toti P, Brevi B, Martuscelli R, Sbordone L, Di Spirito F. Computed tomography-aided descriptive analysis of maxillary and mandibular atrophies. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:99-105. [PMID: 30562623 DOI: 10.1016/j.jormas.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/05/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of the present retrospective chart review was to analyze by Computed Tomography (CT) scan technique the degree of maxillomandibular atrophies, searching for differences between totally- and partially-edentulous subjects, and possibly identify and classify maxillomandibular atrophy staged patterns for implant planning in both totally- and partially- edentulous jaws. MATERIAL AND METHODS CT scans of 89 mandibles and 77 maxillae from 111 patients were classified according to six different patterns of residual ridge resorption and to two different groups of edentulism (totally- and partially-edentulous). Maxillomandibular absolute linear dimensions were calculated and results compared for statistically significant differences by Wilcoxon tests. RESULTS Maxillomandibular CT cross-section interpretation showed different patterns of linear bone remodelling (height values) between the two groups of edentulism joined with specific positions in the maxilla or mandible. The judgment of the investigator was uncertain in the analysis of the mandibular posterior areas with similar percentages for both totally- and partially-edentulous groups (12.5% and 11.5%, respectively). DISCUSSION The 3D analysis is self-explanatory and easy to apply, aided by CT scans. The measurements between the referring planes and inviolable anatomical structures (nasal floor NFD, lower border of mandible LBD, inferior alveolar nerve AND, and sinus floor SFD), showed that class III may not guarantee an optimal implant placement, especially in the totally-edentulous group, due to a major degree of pneumatisation.
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Affiliation(s)
- Carolina Sbordone
- Department of Radiology, School of Medicine, University of Molise, Via Giovanni Paolo II, Contrada "Tappino" 86100, Campobasso, Italy.
| | - Paolo Toti
- Private Practice, Via Provinciale 87B, 55041, Camaiore (Lucca), Italy; Department of Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
| | - Bruno Brevi
- Complex Operating Unit of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56100 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, 80131, Naples, Italy.
| | - Ludovico Sbordone
- Dept. of Medicine, Surgery and Dentistry "Schola Medica Salernitana" School of Dentistry, University of Salerno, and Complex Operating Unit of Odontostomatology, Head and Neck Clinical Department, Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggi d'Aragona, Via S. Allende, 84081, Baronissi (Salerno), Italy; Department of Surgery, University of Pisa, Complex Operating Unit of Odontostomatology and Implantology, Head and Neck Clinical Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Federica Di Spirito
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana" School of Dentistry, University of Salerno and Complex Operating Unit of Odontostomatology, Head and Neck Clinical Department, Azienda Ospedaliero-Universitaria San Giovanni di Dio e Ruggid'Aragona, Via S. Allende, 84081, Baronissi (Salerno), Italy.
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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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