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Yesbeck N, Huang D, Carrico C, Madurantakam P, Yang H. Antibiotic-Loaded Dendrimer Hydrogels in Periodontal Bone Regeneration: An In Vitro Release Feasibility Study. Gels 2024; 10:593. [PMID: 39330195 DOI: 10.3390/gels10090593] [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: 07/30/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
The prescription of a course of oral antibiotics following bone grafting procedures is a common practice in clinical periodontics to reduce surgical site infections. The goal of this study is to characterize the release profile of antibiotics via local delivery using dendrimer hydrogels (DH) and to analyze the effect of two different particulate bone allografts on the release of the antibiotics in vitro. DH were synthesized from polyamidoamine (PAMAM) dendrimer G5 and polyethylene glycol diacrylate, and cefazolin was chosen as the antibiotic. The antibiotic-loaded samples were bathed in PBS and incubated at 37 °C; aliquots were taken (1 h, 2 h, 3 h, 4 h, 5 h, 6 h, 12 h, 24 h, 48 h, 72 h) and analyzed using HPLC to determine the amounts of released cefazolin. In samples with DH, the estimated maximum concentration of cefazolin was 36.97 ± 2.39 μg/mL (95% CI: 34.58-39.36) with 50% released in 4.17 h (95%: 3.26-5.07) and an estimated growth rate of 0.27 (95% CI: 0.17-0.37). For samples without DH, the estimated maximum concentration of cefazolin was 167.4 ± 7.0 μg/mL (95% CI: 160.4-174.4) with 50% released in 2.36 h (95% CI: 2.05-2.67) and an estimated growth rate of 0.70 (95% CI: 0.54-0.87). We conclude that DH are a promising platform for sustained antibiotic release and that the presence of bone grafts did not significantly affect their release.
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Affiliation(s)
- Nicholas Yesbeck
- Department of Periodontics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Da Huang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou 350108, China
| | - Caroline Carrico
- Dental Public Health and Policy, Virginia Commonwealth University School of Dentistry, Richmond, VA 23298, USA
| | - Parthasarathy Madurantakam
- Department of General Practice, Virginia Commonwealth University School of Dentistry, Richmond, VA 23298, USA
| | - Hu Yang
- Linda and Bipin Doshi Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO 65401, USA
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Tonetti MS. Dental Pathophysiology of Odontogenic Sinusitis: Periodontitis. Otolaryngol Clin North Am 2024:S0030-6665(24)00117-8. [PMID: 39227245 DOI: 10.1016/j.otc.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Periodontitis is a highly prevalent oral microbial biofilm-driven chronic inflammatory disease. If unmanaged, periodontitis leads to progressive destruction of the ligamentous attachments of teeth to the alveolar bone and resorption of the alveolar bone. It eventually leads to tooth hypermobility and loss. Periodontitis commonly causes overlying maxillary sinus inflammation (mucositis), reflected on radiographic imaging as maxillary sinus mucosal thickening. While uncommon, advanced periodontitis (stage III/IV) or chronic perio-endo lesions can lead to purulent odontogenic sinusitis (ODS). This article describes periodontitis pathophysiology, diagnostic features, and its potential to cause ODS. Clinical practice guideline conform therapy is very successful in managing periodontitis and enabling long-term tooth retention. Localized tooth extration is reserved to end-stage disease.
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Affiliation(s)
- Maurizio S Tonetti
- Shanghai Perio-Implant Innovation Center, Institute for Integrated Oral-Craniofacial and Multisensory Research, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center of Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China; European Research Group on Periodontology, Genova, Italy.
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3
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Rodriguez Betancourt A, Kripfgans OD, Meneghetti PC, Mendonça G, Pereira R, Teixeira W, Zambrana N, Samal A, Chan HL. Intraoral ultrasonography image registration for evaluation of partial edentulous ridge: A methodology and validation study. J Dent 2024; 148:105136. [PMID: 38885734 DOI: 10.1016/j.jdent.2024.105136] [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: 11/23/2023] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Ultrasound (US) reveals details for diagnosing soft- and hard-tissue dimensions around teeth, implants, and the edentulous ridge, not seen in 2D radiographs. Co-registering free-hand US scans with other 3D modalities presents reliability challenges. This study first aims to develop and validate a registration method to longitudinally reproduce US images of the jawbone on a simulator. In addition, it also evaluates the degree of the anatomical match in humans between US images acquired by the proposed registration method and the commonly used freehand acquisitions in comparison to cone beam computed tomography (CBCT) and intra-oral optical scan (IOS), used as references. METHODS A previously introduced ultrasound phantom was employed as a CBCT-US hybrid, suitable for training and technique development of US guides in edentulous ridges. After establishing feasibility in the phantom, the methodology was validated in a cohort of 24 human subjects (26 cases). Soft tissues were delineated on US and IOS, and hard tissues on US and CBCT. US accuracy and repeatability from both guided and freehand scans (non-guided) was assessed as the average distance between US and the references. RESULTS Guided US images resembled the references more closely than freehand (non-guided) scans. Notably, delineation of soft and hard tissues was significantly more accurate when employing guides. In the phantom, guided scans exhibited an absolute mean deviation of 81.8 µm for gingiva and 90.4 µm for bone, whereas non-guided scans showed deviations of 150.4 µm and 177.2 µm, respectively. Similarly, in vivo, guided US outperformed non-guided US, with gingiva deviations of 125 µm and 196 µm, and bone deviations of 354 µm and 554 µm, respectively. CONCLUSIONS By using a registration method, guided US scans improved repeatability and accuracy of mapping hard and soft tissue of the edentulous ridge when compared to non-guided scans. CLINICAL RELEVANCE This guided US imaging method could lay the foundation for longitudinal evaluation of tissue behavior and dimensional changes with improved accuracy.
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Affiliation(s)
- Amanda Rodriguez Betancourt
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Department of Periodontics, University of Illinois Chicago, College of Dentistry, Chicago, IL, USA
| | - Oliver D Kripfgans
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Priscila Ceolin Meneghetti
- Department of Restorative Sciences, University of Alabama School of Dentistry, Birmingham, AL, USA; Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Gustavo Mendonça
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - Rafael Pereira
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Wendel Teixeira
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Nataly Zambrana
- Department of Biologic and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Ankita Samal
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Division of Periodontology, the Ohio State University, College of Dentistry, Columbus, OH, USA.
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Zhang Y, Du R, Yang B, Tao J, Jing W. Efficacy of autologous platelet concentrate products for alveolar preservation: A meta-analysis. Oral Dis 2024; 30:3658-3670. [PMID: 38297960 DOI: 10.1111/odi.14874] [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: 09/23/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE The purpose of the study was to systematically evaluate the efficacy of autologous platelet concentrate products in the preservation of the alveolar ridge after tooth extraction through meta-analysis and provide a theoretical basis for the clinical application of autologous platelet concentrates to reduce alveolar bone resorption. METHODS This study conducted a meta-analysis of clinical trials between 2013 and 2023, focusing on autologous platelet concentrate products (e.g., PRP, PRF, CGF, and PRCF) used for alveolar ridge preservation after tooth extraction. The analysis included 122 articles and 371 extraction sockets. All statistical analyses were performed using Review Manager version 5.4. RESULTS Results indicate that these platelet concentrates effectively reduced changes in horizontal width 1 mm below the alveolar crest and vertical socket height. They also promoted a higher percentage of new bone formation in extraction sockets compared with control groups. However, they did not significantly prevent horizontal bone resorption at 3 and 5 mm below the alveolar crest. CONCLUSION In conclusion, autologous platelet concentrates are useful for alveolar ridge preservation, but larger clinical studies are needed to confirm these findings due to the relatively small sample size in this study.
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Affiliation(s)
- Yi Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ruiyu Du
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Baohua Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Junming Tao
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Jing
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Engineering Research Center of Oral Translational Medicine, Ministry of Education & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Canullo L, Savadori P, Triestino A, Pesce P, Sora V, Caponio VCA, Mangano F, Menini M. Investigation of the extent of post-extraction bone contraction and remodeling after 4 months. A prospective pilot study. J Dent 2024; 150:105337. [PMID: 39222771 DOI: 10.1016/j.jdent.2024.105337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/11/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES To investigate the correlation between the serum levels of 25(OH)D and the resorption of the alveolar bone walls and regeneration of the alveolar space after tooth extraction. METHODS 14 adults in need of extraction of hopeless teeth were enrolled. An intraoral digital impression was performed, and each patient was tested to assess serum vitamin D levels. Subsequently, extraction of teeth and contextual guided bone regeneration was performed using porcine origin graft material and a resorbable collagen membrane to covert the defect. After 4 months, an impression was taken, and the model was scanned using a professional scanner for lab. At the same time, a cone beam computed tomography was performed to plan implant insertion through fully digital computer guided surgery. Bone was collected to perform histological and histomorphometric analysis. Pre and postoperative scans were compared using a specific software to estimate the volumetric changes. Tests were applied to investigate the relationship between the different predictor variables and the outcome variables. RESULTS 14 patients were divided in 3 groups depending on the serum Vit-D levels, identifying three ranges corresponding to low (lower than 20), medium (between 20 and 30), and optimal vitamin D levels (higher than 30). Volumetric contraction after extraction was observed for all patients, without any significant difference between the groups. Focusing on the post-extraction regeneration, patients belonging to the group with lower levels of Vit-D displayed lower and more disorganized levels of bone. Immunohistochemistry analysis showed that Col1A1 and Osteocalcin had no physiological alteration. Osteopontin could be identified near the external surface of bone tissue granules. Runx2 signals were detected near the margins of bone trabeculae. CONCLUSIONS Serum vit-D levels do not appear to influence the extent of post-extraction bone contraction; on the contrary, they seem to influence the post-extraction regeneration. CLINICAL SIGNIFICANCE Vit D serum levels may influence the regenerative aspect during post-extraction turn-over. This might suggest controlling and (in case of low levels) recommend Vit D supplement in the patient diet in case of extraction.
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Affiliation(s)
- Luigi Canullo
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy; Department of Periodontology, University of Bern, Bern, Switzerland.
| | - Paolo Savadori
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | - Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy.
| | - Valerio Sora
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | | | - Francesco Mangano
- Department of Pediatric, Preventive Dentistry and Orthodontics, I. M. Sechenov First State Medical University, Moscow, Russian Federation
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy.
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Sangkhamanee SS, Teparat-Burana T. Correction of Peri-Implant Soft Tissue Fenestration With Bony Dehiscence Associated With Intrabony Defect: A 2-Year Case Report. Case Rep Dent 2024; 2024:5895661. [PMID: 39166177 PMCID: PMC11335413 DOI: 10.1155/2024/5895661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/12/2024] [Accepted: 08/01/2024] [Indexed: 08/22/2024] Open
Abstract
Soft and hard tissue deficiencies around dental implants which can potentially compromise implant survival are commonly encountered. Complicated interventions are often required to address and resolve combinations of soft and hard tissue defects. This case report describes the management of peri-implant soft tissue fenestration accompanied by bony dehiscence associated with intrabony defect through soft tissue modification. A 51-year-old female was referred to the Periodontics and Oral Medicine Clinic with labial soft tissue fenestration at the maxillary left canine implant-supported crown. The patient complained of discomfort and malodor at the implant site. The implant showed mucosal fenestration and 6 mm probing depth (PD) with profuse bleeding at the distolabial site without mobility. A cone beam computed tomography (CBCT) demonstrated labial bony dehiscence associated with a 5.56-mm intrabony defect at mesial and distal surfaces. The implant was diagnosed as peri-implantitis with soft tissue deficiency. The treatment comprised oral hygiene instruction, debridement of the implant and all natural teeth, and mucogingival surgery with free connective tissue graft by the envelope technique. Two weeks after debridement, the mucosal margin of the implant disappeared, presenting soft tissue dehiscence of 4 × 4 mm. Mucogingival surgery was performed 3 weeks later. A 2-year follow-up revealed a stable mucosal margin with PD ranged 2-4 mm. In conclusion, modification of the soft tissue thickness around the implant together with excellent plaque control by the patient successfully maintained peri-implant health.
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Affiliation(s)
| | - Thitiwan Teparat-Burana
- Department of Oral Medicine and PeriodontologyFaculty of DentistryMahidol University, Bangkok 10400, Thailand
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Mahardawi B, Damrongsirirat N, Dhanesuan K, Subbalekha K, Mattheos N, Pimkhaokham A. Radiographic changes after alveolar ridge preservation using autogenous raw tooth particles versus xenograft: A prospective controlled clinical trial. Clin Oral Implants Res 2024. [PMID: 39132806 DOI: 10.1111/clr.14348] [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: 11/17/2023] [Revised: 07/06/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE The use of extracted teeth has been introduced as an option for bone grafting. However, the current method requires special machines and solutions, posing significant time and cost. The aim of this study was to evaluate the clinical performance of autogenous raw tooth particles (RTP), a grafting material made from a ground tooth using basic equipment, for alveolar ridge preservation. MATERIALS AND METHODS Twenty-three patients (12 study/11 control), having 14 and 13 sites were included for the study and control groups (commercially available xenograft), respectively. Radiographic measurements were taken at the baseline and the 4-month follow-up appointment. Furthermore, a questionnaire survey concerning the general preference of the type of graft to receive (if needed), before and after knowing the price, was distributed at the completion of the procedure for patients to answer. RESULTS Alveolar ridge width change was -1.03 ± 0.64 and -0.84 ± 0.35 for the study and the control groups, respectively. Regarding the height, the study group showed a buccal and lingual change of -0.66 ± 0.48 and -0.78 ± 0.81, respectively, while this was -0.78 ± 0.56 and -0.9 ± 0.41 for the xenograft group. There was no statistically significant difference between the groups. Patients preferred the raw tooth particles over other grafting materials (p = .01). CONCLUSION No core biopsies were taken to evaluate bone formation, which should be done in future studies. Within its limitations, the current study demonstrated that RTP graft could be an alternative graft for bone augmentation, offering a new cost-effective option for clinicians when available.
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Affiliation(s)
- Basel Mahardawi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Oral and Maxillofacial Surgery and Digital Implant Surgery Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Napat Damrongsirirat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Oral and Maxillofacial Surgery and Digital Implant Surgery Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Kanit Dhanesuan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Oral and Maxillofacial Surgery and Digital Implant Surgery Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Oral and Maxillofacial Surgery and Digital Implant Surgery Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Oral and Maxillofacial Surgery and Digital Implant Surgery Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Oral and Maxillofacial Surgery and Digital Implant Surgery Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Ko YC, Lee J, Urban I, Seol YJ, Lee YM, Koo KT. The adjunctive effect of polydeoxyribonucleotide on bone formation in alveolar ridge preservation: A pre-clinical in vivo study. J Clin Periodontol 2024; 51:1034-1043. [PMID: 38613334 DOI: 10.1111/jcpe.13988] [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: 08/27/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
AIM This study investigated the adjunctive effect of polydeoxyribonucleotide (PDRN) on bone formation in alveolar ridge preservation (ARP) sockets. MATERIALS AND METHODS Both mandibular second, third and fourth premolars of eight beagle dogs were randomly divided into ARP and ARP/PDRN groups. Following tooth extraction, ARP procedures were conducted using collagenized alloplastic graft material and bilayer collagen membrane soaked with normal saline (ARP group) or PDRN (ARP/PDRN group) for 10 min before application. Both groups were also randomly allocated to 2-, 4- or 12-week healing subgroups. The primary endpoint of this study was to compare histomorphometric differences between ARP and ARP/PDRN. The secondary endpoints of this study were to compare micro-CT analysis and three-dimensional volumetric measurement between the two groups. RESULTS In the histomorphometric analysis, the ARP/PDRN group exhibited greater new bone formation at coronal, middle and total position compared with the ARP group at 2-week healing. The number of newly formed blood vessels was higher in the ARP/PDRN group than in the ARP group at 2- and 4-week healing. In micro-CT analysis, the mean new bone volume/total bone volume between ARP and ARP/PDRN was statistically significant at 2-week healing. Ridge volume alterations were significantly decreased in the ARP/PDRN group during entire healing time compared with the ARP group, especially on the buccal side. CONCLUSIONS The application of PDRN in ARP might provide additional benefits for early bone regeneration and maintenance of buccal ridge volume.
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Affiliation(s)
- Young-Chang Ko
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jungwon Lee
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Istvan Urban
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Szeged, Szeged, Hungary
| | - Yang-Jo Seol
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Yong-Moo Lee
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ki-Tae Koo
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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Bighetti ACC, Cestari TM, Paini S, Pomini KT, Buchaim DV, Ortiz RC, Júnior RSF, Barraviera B, Bullen IRFR, Garlet GP, Buchaim RL, de Assis GF. Efficacy and safety of a new heterologous fibrin biopolymer on socket bone healing after tooth extraction: An experimental pre-clinical study. J Clin Periodontol 2024; 51:1017-1033. [PMID: 38685818 DOI: 10.1111/jcpe.13992] [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: 11/03/2023] [Revised: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
AIM To assess the efficacy of heterologous fibrin biopolymer (HFB) in promoting alveolar bone healing after tooth extraction in rats. MATERIALS AND METHODS The upper right incisors of 48 Wistar rats were extracted. Toothless sockets were filled with HFB (HFBG, n = 24) or blood clot (BCG, n = 24). The tooth extraction sites were subjected to micro-computed tomography (micro-CT), histological, histomorphometric and immunohistochemical (for Runt-related transcription factor 2/Runx2 and tartrate-resistant acid phosphatase/TRAP) analyses on days 0, 7, 14 and 42 after extraction. RESULTS Socket volume remained similar between days 0 and 14 (69 ± 5.4 mm3), except in the BCG on day 14, when it was 10% lower (p = .043). Although the number of Runx2+ osteoblasts was high and similar in both groups (34 × 102 cells/mm2), the HFBG showed lower inflammatory process and osteoclast activity than BCG at 7 days. On day 14, the number of Runx2+ osteoblasts remained high and similar to the previous period in both groups. However, osteoclast activity increased. This increase was 55% lower in the HFBG than BCG. In the BCG, the presence of an inflammatory process and larger and numerous osteoclasts on day 14 led to resorption of the alveolar bone ridge and newly formed bone. On day 42, numbers of Runx2+ osteoblast and TRAP+ osteoclasts decreased dramatically in both groups. Although the BCG exhibited a more mature cortical bone formation, it exhibited a higher socket reduction (28.3 ± 6.67%) and smaller bone volume (37 ± 5.8 mm3) compared with HFBG (socket reduction of 14.8 ± 7.14% and total bone volume of 46 ± 5.4 mm3). CONCLUSIONS HFB effectively suppresses osteoclast activity and reduces alveolar bone resorption compared with blood clot, thus preventing three-dimensional bone loss, particularly during the early healing period. HFB emerges as a promising biopharmaceutical material for enhancing healing processes after tooth extraction.
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Affiliation(s)
| | - Tania Mary Cestari
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Suelen Paini
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Karina T Pomini
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marilia, Brazil
| | - Daniela Vieira Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marilia, Brazil
- Teaching and Research Coordination of the Medical School, University Center of Adamantina (UNI-FAI), Adamantina, Brazil
| | - Rafael Carneiro Ortiz
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rui Seabra Ferreira Júnior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ Estadual Paulista, UNESP), Botucatu, São Paulo, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, São Paulo, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ Estadual Paulista, UNESP), Botucatu, São Paulo, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, São Paulo, Brazil
| | - Izabel R F R Bullen
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Gustavo Pompermaier Garlet
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rogério Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo, Brazil
| | - Gerson F de Assis
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
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Sivaraman K, Rajwar E, Chopra A, Cherukara G, Mehrotra S, Datta N, Koshy B. How effective is dentin autograft for socket preservation and implant site preparation: A systematic review protocol. F1000Res 2024; 13:204. [PMID: 39045172 PMCID: PMC11263907 DOI: 10.12688/f1000research.144522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 07/25/2024] Open
Abstract
Background Socket preservation is a surgical procedure aimed at preserving the dimensions of the alveolar bone following tooth extraction. It is performed by filling the extraction socket with bone graft material with or without a barrier membrane. Recently, dentine obtained from extracted teeth has been tried as an autograft for socket preservation. Studies have compared the use of dentin to other bone grafts, however, systematic reviews evaluating the efficacy of dentin for socket preservation are limited. Hence, this systematic review protocol is proposed to generate evidence on the efficacy of dentin as a viable alternative to other bone graft materials for socket preservation. Methods This systematic review protocol was prepared according to the Methodological Expectations of the Cochrane Intervention Reviews (MECIR) guidelines. It will be conducted using the Cochrane Handbook for Systematic Review of Interventions. PubMed, Scopus, Web of Science, EMBASE, Epistemonikos, Cochrane Central, and EBSCO databases and clinical trial registries, will be searched for all randomized controlled trials (RCTs) and non-randomized studies that have used autologous dentin graft (either in particulate/putty, or/matrix form) for socket preservation. The radiographic and clinical assessment of bone and soft tissue healing of the preserved sockets along with patient-related outcomes following surgery will be assessed. The risk of bias assessment of the RCTs and Non-RCTs will be assessed using the 'Cochrane Risk of Bias assessment tool (ROB II) and ROBINS-I respectively. The certainty of evidence will be assessed by the GRADE approach. Discussion This evidence is important for dental clinicians and the public to make an informed decision when choosing graft material for socket preservation. The extracted teeth are considered biological waste; however, this evidence provides scope for using a less invasive autograft for bone regenerative procedures. Systematic review registration PROSPERO: CRD42021201958 (Registered on 15/02/2021).
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Affiliation(s)
- Karthik Sivaraman
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Eti Rajwar
- The George Institute for Global Health India, New Delhi, Delhi, 110025, India
- Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Shubhankar Mehrotra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Namrata Datta
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Bindhu Koshy
- Specialist Referral Practice, Regents Street, BUPA Dental Care, Bristol, UK
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Kim YT, Lee JH. Profilometric, esthetic, and patient-reported outcomes of the L-shape technique combined with delayed connective tissue grafting in the maxillary anterior region: A 3-year case series study. J ESTHET RESTOR DENT 2024; 36:967-975. [PMID: 38534037 DOI: 10.1111/jerd.13229] [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: 02/11/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To evaluate the profilometric, esthetic, and patient-reported outcomes of peri-implant tissues in the maxillary anterior esthetic zone following guided bone regeneration (GBR) using the L-shape technique combined with delayed connective tissue grafting (CTG). MATERIALS AND METHODS Profilometric and pink esthetic score (PES) measurements were performed at the time of implant surgery with GBR (T0) and at the 1- (T1), 2- (T2), and 3-year (T3) follow-up. Patient-reported outcomes were also assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Statistical analysis over 3 years of follow-up assessed changes at time points (T0, T1, T2, and T3) and time periods (T0-T1, T0-T2, and T0-T3) using the Wilcoxon signed-rank test. RESULTS A total of 12 patients (57.5 ± 12.3 years) were included in this study. The mean profilometric change in peri-implant tissues over the 3-year follow-up period was 3.49 ± 1.11 mm, and the buccal contours were not significantly different between the comparison periods. The PES remained stable, while all OHIP-14 domain scores improved significantly. CONCLUSION Simultaneous implant placement and GBR using the L-shape technique combined with delayed CTG in the maxillary anterior region provides stable buccal profiles and consistent esthetics and improves patient-reported quality of life over a 3-year period. CLINICAL SIGNIFICANCE This study demonstrated that GBR using the L-shape technique combined with delayed CTG in the maxillary anterior region improved the buccal profile, esthetics, and patient-reported quality of life.
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Affiliation(s)
- Yeon-Tae Kim
- Department of Periodontology, Daejeon Dental Hospital, Institute of Wonkwang Dental Research, Wonkwang University College of Dentistry, Daejeon, South Korea
| | - Jae-Hong Lee
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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12
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Nagarajan M, Dayasekaran V, Jayavel K, Jayaraj M, Chellaswamy S, Ranganathan K, Kaliamoorthy S, Chellapandi S, Baskaran R, Elumalai A. Exploring Genetic Link of Residual Ridge Resorption in Completely Edentulous Individuals: A Prospective Case-Control Clinical Study. Cureus 2024; 16:e64039. [PMID: 39114253 PMCID: PMC11303737 DOI: 10.7759/cureus.64039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Residual ridge resorption presents obstacles in prosthodontic treatment, affecting denture stability and the success of dental implants. Genetic elements, specifically the single nucleotide polymorphism (SNP) 1772C>T variant within the hypoxia-inducible factor 1 subunit alpha (HIF-1α) gene, are hypothesized to contribute to residual ridge resorption progression. Nevertheless, its impact remains insufficiently investigated, especially within the context of South Indian populations. We sought to investigate the connection between SNP 1772C>T and residual ridge resorption (RRR) among fully edentulous individuals, considering demographic factors, genotyping methodologies, and statistical evaluations. METHODS In a prospective case-control study, we recruited 100 completely edentulous participants from South India. Participants were categorized based on alveolar ridge height. Saliva samples were non-invasively collected for DNA extraction, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was employed to determine genotype distribution using the HphI restriction enzyme. The statistical evaluations comprised the utilization of chi-square and Fisher's exact tests. RESULTS We observed no significant variations in genotype distributions between the case and control cohorts (CT: p=0.24; CC: p=0.65; TT: p=0.30). The heterozygous genotype CT was prevalent in both groups. CONCLUSIONS Although we did not observe significant associations between SNP 1772C>T and RRR, our findings imply a genetic predisposition to residual ridge resorption that warrants further exploration. Variations in genetic susceptibility across ethnicities and the influence of other genetic variants on residual ridge resorption require additional investigation. This study lays the groundwork for personalized prosthodontic care by highlighting the potential of genetic analysis in routine dental practice to improve treatment strategies.
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Affiliation(s)
- Mahendirakumar Nagarajan
- Department of Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Cuddalore, IND
| | - Vijitha Dayasekaran
- Department of Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Cuddalore, IND
| | - Kavitha Jayavel
- Department of Periodontics and Implantology, Government Dental College and Hospital, Cuddalore, IND
| | - Merlin Jayaraj
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, IND
| | - Sreeja Chellaswamy
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, IND
| | - Krishnaraj Ranganathan
- Department of Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Cuddalore, IND
| | - Sriram Kaliamoorthy
- Department of Dentistry, Vinayaka Mission's Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Karaikal, IND
| | - Sugirtha Chellapandi
- Department of Periodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Radhika Baskaran
- Department of Periodontics, Chettinad Dental College and Research Institute, Chennai, IND
| | - Agila Elumalai
- Department of Periodontics, Chettinad Dental College and Research Institute, Chennai, IND
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He G, Xian Y, Lin H, Yu C, Chen L, Chen Z, Hong Y, Zhang C, Wu D. An injectable and coagulation-independent Tetra-PEG hydrogel bioadhesive for post-extraction hemostasis and alveolar bone regeneration. Bioact Mater 2024; 37:106-118. [PMID: 39022616 PMCID: PMC11252469 DOI: 10.1016/j.bioactmat.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 07/20/2024] Open
Abstract
Effective control of post-extraction hemorrhage and alveolar bone resorption is critical for successful extraction socket treatment, which remains an unmet clinical challenge. Herein, an injectable Tetra-PEG hydrogel that possesses rapid gelation, firm tissue adhesion, high mechanical strength, suitable degradability, and excellent biocompatibility is developed as a sutureless and coagulation-independent bioadhesive for the management of extraction sockets. Our results demonstrate that the rapid and robust adhesive sealing of the extraction socket by the Tetra-PEG hydrogel can provide reliable protection for the underlying wound and stabilize blood clots to facilitate tissue healing. In vivo experiments using an anticoagulated rat tooth extraction model show that the hydrogel significantly outperformed clinically used cotton and gelatin sponge in hemostatic efficacy, wound closure, alveolar ridge preservation, and in situ alveolar bone regeneration. Histomorphological evaluations reveal the mechanisms for accelerated bone repair through suppressed long-term inflammation, elevated collagen deposition, higher osteoblast activity, and enhanced angiogenesis. Together, our study highlights the clinical potential of the developed injectable Tetra-PEG hydrogel for treating anticoagulant-related post-extraction hemorrhage and improving socket healing.
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Affiliation(s)
- Gang He
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China
| | - Yiwen Xian
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China
| | - Huajun Lin
- Department of Maxillofacial Surgery, Shenzhen Hospital, Southern Medical University, No. 1333 New Road, Baoan District, Shenzhen, Guangdong, 518101, China
| | - Chengcheng Yu
- Department of Maxillofacial Surgery, Shenzhen Hospital, Southern Medical University, No. 1333 New Road, Baoan District, Shenzhen, Guangdong, 518101, China
| | - Luyuan Chen
- Department of Maxillofacial Surgery, Shenzhen Hospital, Southern Medical University, No. 1333 New Road, Baoan District, Shenzhen, Guangdong, 518101, China
| | - Zhihui Chen
- Department of Maxillofacial Surgery, Shenzhen Hospital, Southern Medical University, No. 1333 New Road, Baoan District, Shenzhen, Guangdong, 518101, China
| | - Yonglong Hong
- Department of Maxillofacial Surgery, Shenzhen Hospital, Southern Medical University, No. 1333 New Road, Baoan District, Shenzhen, Guangdong, 518101, China
| | - Chong Zhang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China
| | - Decheng Wu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, No. 1088 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China
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14
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van Orten A, Goetz W, Bilhan H. Alveolar Ridge Preservation Using a Novel Species-Specific Collagen-Enriched Deproteinized Bovine Bone Mineral: Histological Evaluation of a Prospective Case Series. Bioengineering (Basel) 2024; 11:665. [PMID: 39061747 PMCID: PMC11273417 DOI: 10.3390/bioengineering11070665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/08/2024] [Accepted: 06/15/2024] [Indexed: 07/28/2024] Open
Abstract
In recent years, the significance of maintaining the alveolar ridge following tooth extractions has markedly increased. Alveolar ridge preservation (ARP) is a commonly utilized technique and a variety of bone substitute materials and biologics are applied in different combinations. For this purpose, a histological evaluation and the clinical necessity of subsequent guided bone regeneration (GBR) in delayed implantations were investigated in a prospective case series after ARP with a novel deproteinized bovine bone material (95%) in combination with a species-specific collagen (5%) (C-DBBM). Notably, block-form bone substitutes without porcine collagen are limited, and moreover, the availability of histological data on this material remains limited. Ten patients, each scheduled for tooth extraction and desiring future implantation, were included in this study. Following tooth extraction, ARP was performed using a block form of C-DBBM in conjunction with a double-folded bovine cross-linked collagen membrane (xCM). This membrane was openly exposed to the oral cavity and secured using a crisscross suture. After a healing period ranging from 130 to 319 days, guided trephine drilling was performed for implant insertion utilizing static computer-aided implant surgery (s-CAIS). Cores harvested from the area previously treated with ARP were histologically processed and examined. Guided bone regeneration (GBR) was not necessary for any of the implantations. Histological examination revealed the development of a lattice of cancellous bone trabeculae through appositional membranous osteogenesis at various stages surrounding C-DBBM granules as well as larger spongy or compact ossicles with minimal remnants. The clinical follow-up period ranged from 2.5 to 4.5 years, during which no biological or technical complications occurred. Within the limitations of this prospective case series, it can be concluded that ARP using this novel C-DBBM in combination with a bovine xCM could be a treatment option to avoid the need for subsequent GBR in delayed implantations with the opportunity of a bovine species-specific biomaterial chain.
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Affiliation(s)
- Andreas van Orten
- Private Dental Practice Do24, Dortmunder Str. 24–28, 45731 Waltrop, Germany;
| | - Werner Goetz
- Policlinic of Orthodontics, Centre for Dental Care, Basic Science Research in Oral Biology, Friedrich-Wilhelms University, Welschnonnenstr. 17, 53111 Bonn, Germany;
| | - Hakan Bilhan
- Department of Periodontology, School for Health Sciences, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, 58448 Witten, Germany
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15
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Garutti FCMB, Lehmann RB, Gialain IO, de Lima FFB. Analysis of the atrophic mandible rehabilitated with fixed total prosthesis on mono or bicortical implants. Braz Dent J 2024; 35:e245621. [PMID: 38922249 PMCID: PMC11196068 DOI: 10.1590/0103-6440202405621] [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: 06/29/2023] [Accepted: 03/11/2024] [Indexed: 06/27/2024] Open
Abstract
Rehabilitation of edentulous atrophic mandibles involves the placement of implants in the anterior segment of the mandible. The primary stability of these implants can be improved using the base of the mandible as complementary anchorage (bicorticalization). This study aimed to analyze the biomechanics of atrophic mandibles rehabilitated with monocortical or bicortical implants. Two three-dimensional virtual models of edentulous mandibles with severe atrophy were prepared. Four monocortical implants were placed in one model (McMM), and four bicortical implants were placed in the other (BcMM). An implant-supported total prosthesis was prepared for each model. Then, a total axial load of 600 N was applied to the posterior teeth, and its effects on the models were analyzed using finite element analysis. The highest compressive stresses were concentrated in the cervical region of the implants in the McMM (-32.562 Mpa); in the BcMM, compressive stresses were distributed in the upper and lower cortex of the mandible, with increased compressive stresses at the distal implants (-63.792 Mpa). Thus, we conclude that axial loading forces are more uniformly distributed in the peri-implant bone when using monocortical implants and concentrated in the apical and cervical regions of the peri-implant bone when using bicortical implants.
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Affiliation(s)
| | - Roberto Brunow Lehmann
- Mechanical Engineering Department, Volta Redonda School of Industrial Metallurgical Engineering, Federal Fluminense University, Volta Redonda/RJ- Brazil
| | - Ivan Onone Gialain
- Graduate Program in Integrated Dental SciencesUniversidade de Cuiabá, Cuiabá/MT- Brazil
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16
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Khaddour AS, Ghiță RE, Ionescu M, Rîcă RG, Mercuț V, Manolea HO, Camen A, Drăghici EC, Radu A, Popescu SM. Healing of Extraction Sites after Alveolar Ridge Preservation Using Advanced Platelet-Rich Fibrin: A Retrospective Study. Bioengineering (Basel) 2024; 11:566. [PMID: 38927802 PMCID: PMC11201034 DOI: 10.3390/bioengineering11060566] [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: 05/14/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Over time, numerous surgical procedures and biomaterials have been proposed for the reconstruction of post-extraction bone defects, each with their advantages and disadvantages. The main objective of this study was to evaluate dimensional changes in the alveolar bone 3 months after tooth extraction, before implant planning, comparing alveolar ridge preservation (ARP) with spontaneous healing. METHODS A total of 84 patients with non-restorable molars were included in the study. Forty-two patients received ARP with advanced platelet-rich fibrin (A-PRF) and spontaneous healing was evaluated in these patients. Cone beam computed tomography (CBCT) analysis performed before and after surgical intervention was used to determine the changes in vertical and horizontal bone dimensions produced after tooth extraction. RESULTS CBCT measurements showed reduction in both vertical and horizontal alveolar bone size in both groups. For the study group, the alveolar parameters (height, width) were higher compared to the control group. The percentage variations between dimensional differences from the two groups were 38.58% for height, and for width were 36.88% at 0 mm, 35.56% at 3 mm, 36.61% at 5 mm, and 38.73% at 7 mm. The differences were statistically significant (p ˂ 0.0005). CONCLUSIONS The results obtained after ARP with A-PRF showed a reduced loss of bone volume compared to spontaneous healing.
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Affiliation(s)
- Antonia Samia Khaddour
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Răzvan Eugen Ghiță
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu Gabriel Rîcă
- Department of Dental Technology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Veronica Mercuț
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Horia Octavian Manolea
- Department of Dental Materials, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Adrian Camen
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Emma Cristina Drăghici
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Andrei Radu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
| | - Sanda Mihaela Popescu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.S.K.); (E.C.D.); (A.R.); (S.M.P.)
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Fok MR, Jin L. Learn, unlearn, and relearn post-extraction alveolar socket healing: Evolving knowledge and practices. J Dent 2024; 145:104986. [PMID: 38574844 DOI: 10.1016/j.jdent.2024.104986] [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: 01/11/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular events during alveolar socket healing, ii) the dimensional ridge alterations after socket healing and controversies relating to sinus pneumatisation, iii) the patient-specific factors, procedural elements, and site-related variables influencing socket healing, iv) techniques and effectiveness of alveolar ridge preservation (ARP) procedure, and v) the philosophies and cost-effectiveness of ARP in clinical practice. SOURCES AND STUDY SELECTION To investigate the dimensional profiles of the alveolar ridge following unassisted healing, an overview of systematic reviews was conducted in February 2024 by two independent reviewers. Four electronic databases were searched in Pubmed, Embase, Web of science and Cochrane Library between 2004 and 2024 to identify all relevant systematic reviews on post-extraction healing. A further manual search of reviews was also conducted. The articles were further reviewed in full text for relevance. The AMSTAR-2 appraisal tool was adopted to assess methodological quality. Current research pertaining to other listed objectives was objectively analysed in narration. DATA 11 out of 459 retrieved studies were selected and ultimately covered in this review on the dimensional changes of alveolar ridge following natural healing: Seven systematic reviews and four systematic reviews with meta-analyses. The methodological quality of all included reviews was critically low. CONCLUSION This review thoroughly examines the healing profiles of post-extraction alveolar sockets and highlights the dynamic process with overlapping phases and the inter-individual variability in outcomes. ARP procedure is a potential strategy for facilitating prosthetic site development, while the current evidence is limited. Herein, an individualised and prosthetically driven approach is crucial. Further well sized and designed trials with novel biomaterials need to be undertaken, and the role of artificial intelligence in predicting healing and assisting clinical decision-making could be explored. CLINICAL SIGNIFICANCE By advancing our understanding of alveolar socket healing and its management strategies, clinicians can make more informed decisions regarding patient and site level assessment and selection, surgical techniques, and biomaterial choices, ultimately contributing to the enhanced healing process with reduced complications and improved quality of life for patients undergoing tooth extraction and dental implant treatments.
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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, PR China.
| | - Lijian Jin
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China
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Minetti E, Palermo A, Berardini M. Comparison of Different Techniques in Post-Extractive Socket Regeneration Using Autologous Tooth Graft: Histological and Clinical Outcomes. Eur J Dent 2024; 18:477-484. [PMID: 37729934 PMCID: PMC11132773 DOI: 10.1055/s-0043-1772251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE Post-extractive socket grafting techniques reduce alveolar ridge dimensional changes. Numerous graft materials have been suggested and a growing interest in tooth material has been observed as a valuable alternative to synthetic biomaterials or xenografts. Furthermore, different clinical procedures have been proposed for the wound closure of the post-extractive site. This study aims to compare histological and clinical outcomes of two different surgical techniques to seal the post-extractive site with the use of autologous demineralized extracted tooth as graft material. MATERIALS AND METHODS Sixteen post-extractive socket without buccal and/or palatal bone walls, in sixteen healthy patients, were grafted with the autologous tooth material treated by the new Tooth Transformer device (Tooth Transformer, Milan, Italy). Alveolar socket preservation procedures were performed without flap elevation. Patients were randomly subdivided into two equal groups according to the site closure technique. In group A, the pedunculate tissue was used, while in group B ice cone technique. A bone samples were collected in each site after 4 months for histological analysis. RESULTS No significant clinical differences among the different sealing techniques were observed. In both groups, the site was filled by new bone formation after 4 months of healing. The histological analysis revealed 46.1 ± 8.07% of bone volume, 9.2 ± 9.46% of residual graft, and 35.2 ± 12.36% of vital bone in group A, while group B shows 41.22 ± 5.88% of bone volume, 7.94 ± 7.54% of residual graft, and 31.7 ± 7.52% new bone. No statistical differences were detected (p > 0.05). CONCLUSION Further studies with a large number of patients, and different observation periods will be needed to confirm the results of this pilot study; however, the interesting data obtained have shown how these techniques, mixed with the autologous dentin derived graft material, seem to promote bone regeneration and reduce physiological bone resorption during alveolar socket preservation treatments.
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Affiliation(s)
- Elio Minetti
- Department of Biomedical, Surgical, Dental Science, University of Milan, Milan, Italy
| | - Andrea Palermo
- College of Medicine and Dentistry, University of Birmingham, Birmingham, United Kingdom
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Thomassen TMJA, Van der Weijden FA, Sälzer S, Slot DE. Cross-angled versus flat-trim bristle tuft configurations in manual toothbrushes: A systematic review. Int J Dent Hyg 2024. [PMID: 38590292 DOI: 10.1111/idh.12799] [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: 08/24/2023] [Revised: 02/14/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
AIM This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients. MATERIALS AND METHODS PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate. RESULTS Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group. CONCLUSION Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.
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Affiliation(s)
- Tim M J A Thomassen
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fridus A Van der Weijden
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sonja Sälzer
- Clinic for Conservative Dentistry and Periodontology, School for Dental Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Dagmar E Slot
- Department of Periodontology Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Shanmugam M, Balaji A, Valiathan M, Kannan R, Jeyaraj Samuel AF. Preserving Peri-Implant Soft Tissue Health: A Case Report on Immediate Implant Placement Using the Socket Shield Technique. Cureus 2024; 16:e57940. [PMID: 38738015 PMCID: PMC11082481 DOI: 10.7759/cureus.57940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Alveolar bone resorption is a natural occurrence following tooth extraction, complicating the process of prosthetic rehabilitation with implants. Techniques such as socket preservation, atraumatic extraction, and immediate implant placement are employed to reduce the dimensional changes associated with extraction. The socket shield technique (SST) is effective in preserving the alveolar ridge's contour, enhancing the aesthetic results of rehabilitation by maintaining the integrity of the bundle bone complex even when the buccal bone is less than 1mm. This case report presents a 23-year-old female patient with a fractured upper central incisor. The socket shield technique was chosen based on the clinical findings from the cone beam computed tomography (CBCT) scan. Immediate temporization was provided to preserve soft tissue integration. A comparison of the initial and subsequent cone beam computed tomography (CBCT) scans, along with clinical observations, suggests that the socket shield technique is a viable method for preserving both hard and soft tissue structures in the anterior dental region, thereby improving aesthetic outcomes.
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Affiliation(s)
| | - Anitha Balaji
- Periodontics, Sree Balaji Dental College and Hospital, Chennai, IND
| | - Mohan Valiathan
- Periodontics, Sree Balaji Dental College and Hospital, Chennai, IND
| | - Rudhra Kannan
- Periodontics, Sree Balaji Dental College and Hospital, Chennai, IND
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21
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Yi C, Jiang X, Di P, Ren S, Lin Y. The facial-coronal ridge crest alterations after single immediate implant placement and provisionalization with thin buccal plate phenotype in anterior maxilla: A radiographic case-series study. Clin Implant Dent Relat Res 2024; 26:317-326. [PMID: 37749868 DOI: 10.1111/cid.13280] [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: 05/29/2023] [Revised: 07/26/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
AIM To explore the features of and potential landmarks that predict crestal ridge remodeling after immediate implant placement and provisionalization (IIPP) with thin buccal plate phenotype in the anterior maxilla. MATERIALS AND METHODS Patients requiring IIPP of single maxillary incisor with thin buccal bone plate (<1 mm) were recruited. Cone-beam computed tomography (CBCT), performed before and 6 months after the intervention, were three-dimensionally superimposed. A virtual line connecting the bony emergence points of adjacent teeth was drawn as a reference. The facial-coronal alveolar crest of the extraction socket and healed ridge were located in mesial, middle and distal cross-sectional planes, and linear ridge reductions were measured. The correlation between ridge reduction and local factors was analyzed. RESULTS Fifty patients were included. From the extraction socket to healed ridge, the alveolar crest underwent linear bone reduction of 1.50 ± 0.50, 1.54 ± 0.66 and 1.65 ± 0.73 mm in the mesial, middle, and distal regions in an apical-palatal direction. The middle region had significantly higher horizontal (facial-palatal) but lower vertical (coronal-apical) bone reduction than the mesial and distal areas (P < 0.01). The facial-coronal ridge crest of the healed ridge located close to the reference line. Ridge reduction positively correlated with the distance between the initial facial-coronal crest of the extraction socket and the reference line (P < 0.01). CONCLUSIONS Alveolar crest of the socket lost its curvature and tended to attain a flat profile after IIPP due to inconsistent ridge reduction in middle, mesial and distal areas. The reference line may be a potential landmark for predicting the ridge crest after remodeling.
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Affiliation(s)
- Chun Yi
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xi Jiang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ping Di
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuxin Ren
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, China
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22
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Bhosale TN, Bhate K, Samuel S, Jacob G. Comparative evaluation of efficacy of physics forcep and conventional forceps for extraction of maxillary molars. Minerva Dent Oral Sci 2024; 73:75-80. [PMID: 37326503 DOI: 10.23736/s2724-6329.23.04740-x] [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: 06/17/2023]
Abstract
BACKGROUND Tooth extraction is one of the most commonly performed procedures in dentistry. It is usually a traumatic procedure often resulting in immediate destruction and loss of alveolar bone and surrounding soft tissues. It is the only dental procedure which was carried out by dentists in the previous centuries and various instruments have evolved for this procedure over time. Atraumatic extraction is one of the essential dental procedures, as atraumatic extraction leads to proper wound healing and appropriate bone healing. Physics forceps have got a new role in extraction technique, that it makes just one contact point with the tooth as a unique benefit. Physics forceps depends on the physics of rotational power, lever and torque much like a bottle top removal. A study was conducted to evaluate the efficacy of physics forceps and conventional forces in the extraction of maxillary molar. METHODS Eligible participants were adults aged 18-50 diagnosed with grossly decayed maxillary molars with poor endodontic prognosis and willing to participate in the study. Exclusion criteria were as follows: patients with dilacerate roots; patients with systemic diseases like hypertension, diabetes mellitus, thyroid, tuberculosis, epilepsy seizures, COVID-19 positive; patients' non-acceptance to voluntarily participate in research a refusal to sign the informed consent. Parameters such as a crown fracture or root fracture; buccal bone fracture; time taken for extraction and operator ease on the VAS scale are assessed. RESULTS Results showed that with the use of physics forces, there was very less incidence of crown fracture and no incidence of buccal bone fracture, whereas with the conventional forceps the result showed that in almost all the time taken for extraction was much more in conventional forcep and the operator ease rating was more with conventional forceps. CONCLUSIONS Hence, oral surgeons as well as general practitioner should adapt the use of physics forceps in routine extractions.
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Affiliation(s)
- Tushar N Bhosale
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr.D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Kalyani Bhate
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr.D. Y. Patil Vidyapeeth, Pimpri, Pune, India -
| | - Sherwin Samuel
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr.D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - George Jacob
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr.D. Y. Patil Vidyapeeth, Pimpri, Pune, India
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23
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Berberi A, Zoghbi AE, Aad G, Tehini G. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024; 25:213-220. [PMID: 38690692 DOI: 10.5005/jp-journals-10024-3659] [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] [Indexed: 05/02/2024]
Abstract
AIM The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. MATERIALS AND METHODS A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. RESULTS Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. CONCLUSION The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. CLINICAL SIGNIFICANCE Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.
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Affiliation(s)
- Antoine Berberi
- Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon, Phone: +961 37331173, e-mail: ;
| | - Amine El Zoghbi
- Department of Prosthodontics and Occlusion, Faculty of Dental Medicine Saint Joseph University, Beirut, Lebanon
| | - Georges Aad
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut Lebanon
| | - Georges Tehini
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Beirut Lebanon, and College of Healthcare Technology, American University of Baghdad
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24
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Mealey BL, Keeling F, Palaiologou AA. Histologic wound healing in studies using different ridge preservation protocols: A review. Clin Adv Periodontics 2024; 14:52-62. [PMID: 38450987 DOI: 10.1002/cap.10281] [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: 01/08/2024] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Alveolar ridge preservation (ARP) procedures are designed to lessen dimensional changes in the alveolar ridge after tooth extraction. Wound healing after ridge preservation involves the formation of new vital bone in the former socket, and this vital bone is important in the osseointegration of dental implants. METHODS A series of ARP studies have been performed to help clinicians better understand the wound-healing events that occur following tooth extraction and ridge preservation. Different protocols have been examined using various materials and periods of healing time prior to implant placement. The primary aim of these studies was to ascertain the relative percentage of vital bone formation, residual graft material, and connective tissue (CT)/other at the healing site using histomorphometric examination of bone core biopsies obtained during osteotomy preparation. RESULTS For allografts, the use of demineralized bone alone or in combination with mineralized is associated with more vital bone formation than the use of mineralized allograft alone. For mineralized allografts, the use of cortical versus cancellous bone has only minimal impact on new bone formation. Xenografts from bovine and porcine sources appear to have similar vital bone formation. Longer healing times prior to implant placement are associated with increased vital bone formation and decreased residual graft material. The most stable component in most studies is the percentage of CT/other. CONCLUSIONS The percentage of vital bone and residual graft at ARP sites is dependent on the materials used and the length of healing time prior to obtaining core biopsies. KEY POINTS What factors may affect the amount of new bone at the ARP site? At a time point about 4 months after ARP, the type of graft material used for ARP plays a large role in new bone formation. Studies focus on means and standard deviations, but patients often do not "follow the mean." Even if a single ARP protocol is used for all patients, there is great interindividual variability in new bone formation, and there is often variability between sites within a single patient. How long after ARP with an allograft should I wait to place an implant? Longer healing times such as 4-5 months generally provide higher amounts of vital bone formation than shorter healing times like 2-3 months. Differences in vital bone formation between ARP protocols tend to decrease with longer healing time. FDBA that contains demineralized bone, either alone or combined with mineralized FDBA, often provides higher amounts of new bone formation than 100% mineralized allograft, especially at shorter healing periods. Even a year after ARP with an allograft, residual graft material is often still present at the ARP site.
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Affiliation(s)
- Brian L Mealey
- Department of Periodontics, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - Francis Keeling
- Department of Periodontics, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - A Archontia Palaiologou
- Department of Periodontics, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
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25
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Chatzopoulos GS, Koidou VP, Sonnenberger M, Johnson D, Chu H, Wolff LF. Postextraction ridge preservation by using dense PTFE membranes: A systematic review and meta-analysis. J Prosthet Dent 2024; 131:410-419. [PMID: 35410705 DOI: 10.1016/j.prosdent.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/15/2022]
Abstract
STATEMENT OF PROBLEM The use of dense polytetrafluoroethylene (dPTFE) membranes in alveolar ridge preservation may help reduce the risk of bacterial contamination and infection, maintaining the soft-tissue anatomy. However, systematic reviews on their efficacy in postextraction sites are lacking. PURPOSE The purpose of this systematic review and meta-analysis was to assess the efficacy of alveolar ridge preservation with dPTFE membranes when used alone or in combination with bone grafting materials in postextraction sites. MATERIAL AND METHODS An electronic search up to February 2021 was conducted by using PubMed, Embase, and the Cochrane library to detect studies using dPTFE membranes in postextraction sites. An additional manual search was performed in relevant journals. Clinical and radiographic dimensional changes of the alveolar ridge, histomorphometric, microcomputed tomography, implant-related findings, and rate of complications were recorded. One-dimensional meta-analysis was performed to calculate the overall means and 95% confidence intervals (α=.05). RESULTS A total of 23 studies, 14 randomized controlled trials, 4 retrospective cohort studies, 3 case series, and 2 prospective nonrandomized clinical trials, met the inclusion criteria. Five studies were included in the quantitative analysis. The meta-analysis revealed that the use of dPTFE membranes resulted in a statistically significant (P=.042) increase in clinical keratinized tissue of 3.49 mm (95% confidence interval [CI]: 0.16, 6.83) when compared with extraction alone. Metaregression showed that the difference of 1.10 mm (95% CI: -0.14, 2.35) in the radiographic horizontal measurements was not significant (P=.082), but the difference of 1.06 mm (95% CI: 0.51, 1.62) in the radiographic vertical dimensional change between dPTFE membranes+allograft and extraction alone was statistically significant (P<.001). CONCLUSIONS The use of dPTFE membranes was better than extraction alone in terms of keratinized tissue width and radiographic vertical bone loss.
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Affiliation(s)
- Georgios S Chatzopoulos
- Diplomate of the American Board of Periodontology and Private practice Limited to Periodontics and Implant Dentistry, London, UK; Former Resident, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn.
| | - Vasiliki P Koidou
- PhD Candidate, Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University London (QMUL), London, UK; Diplomate of the American Board of Periodontology and Former Resident, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn
| | - Michelle Sonnenberger
- PhD Candidate, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minn
| | - Deborah Johnson
- Clinical Professor and Diplomate of the American Board of Periodontology, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn
| | - Haitao Chu
- Professor, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minn; Professor, Clinical Translational Science Institute (CTSI), University of Minnesota, Minneapolis, Minn
| | - Larry F Wolff
- Professor, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn
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26
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Ribes BL, Fernández-Baca I, Gil Mur J, López-Malla Matute J, Aragoneses Lamas JM. Autologous Tooth Granulometry and Specific Surface Area with Three Grinding Methods: An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2024; 17:773. [PMID: 38399026 PMCID: PMC10890256 DOI: 10.3390/ma17040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
A postextraction socket becomes a clinical challenge due to the fact that a series of changes associated with bone remodelling and resorption of the socket that occur after extraction, which limits the aesthetic and functional prognosis of implant-supported rehabilitations. It has been studied that the use of the autologous tooth-derived graft (ATDG) has regenerative properties and could therefore be useful for solving this type of problem. There is no consensus in the scientific literature on a standardized protocol for the use of the autologous tooth. Therefore, the aim of the present study was to evaluate the most relevant parameters to achieve the best properties of ground ATDG using three methods, namely Gouge forceps, electric grinder, and manual, that made up the study group (SG) and compared with the control group (CG) consisting of Bio-Oss®. The sample obtained by the electric grinder had the highest value of specific surface area (2.4025 ± 0.0218 m2/g), while the particle size as average diameter (751.9 µm) was the lowest and most homogeneous of the three groups. Therefore, the electric grinder allowed for obtaining ATDG with more regenerative properties due to its specific surface-area value and particle size in accordance with the xenograft with the greatest bibliographical support (Bio-Oss®). The higher specific surface increases the reaction with the physiological media, producing faster biological mechanisms.
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Affiliation(s)
- Berta Lavarias Ribes
- Bioengineering Institute of Technology, Faculty of Medicine and Health Sciences, International University of Catalonia, Sant Cugat del Vallés, 08195 Barcelona, Spain; (B.L.R.); (I.F.-B.); (J.G.M.)
- Faculty of Dentistry, Universidad Alfonso X El Sabio, 28037 Madrid, Spain;
| | - Ignacio Fernández-Baca
- Bioengineering Institute of Technology, Faculty of Medicine and Health Sciences, International University of Catalonia, Sant Cugat del Vallés, 08195 Barcelona, Spain; (B.L.R.); (I.F.-B.); (J.G.M.)
- Faculty of Dentistry, Universidad Alfonso X El Sabio, 28037 Madrid, Spain;
| | - Javier Gil Mur
- Bioengineering Institute of Technology, Faculty of Medicine and Health Sciences, International University of Catalonia, Sant Cugat del Vallés, 08195 Barcelona, Spain; (B.L.R.); (I.F.-B.); (J.G.M.)
| | | | - Juan Manuel Aragoneses Lamas
- Faculty of Dentistry, Universidad Alfonso X El Sabio, 28037 Madrid, Spain;
- Department of Dental Research, Federico Henriquez y Carvajal University, Santo Domingo 11005, Dominican Republic
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27
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Grassi A, Monica D, Minetti E, Ballini A, Gianfreda F, Bollero P, Cicciù M, Mastrangelo F. Innovative Alveolar Ridge Preservation Surgical Technique with Immediate Dental Implant Placement: A Retrospective Case Report of 1-Year Follow-Up. Eur J Dent 2024; 18:408-414. [PMID: 37995724 PMCID: PMC10959618 DOI: 10.1055/s-0043-1772676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Following tooth extraction, the alveolar ridge undergoes morphological and dimensional changes, including a clot formation that is gradually replaced by granulation tissue. Studies indicate that both horizontal and vertical ridge dimensions decrease after extraction; however, these changes can be mitigated through grafting with biomaterials and barrier membranes. Alveolar ridge preservation (ARP) techniques are employed to counteract bone resorption postextraction, encompassing periosteal inhibition and modified periosteal inhibition (MPI) techniques. The Degidi clot chamber technique offers a means to achieve biomaterial-free extraction sockets, promoting healing and osteointegration. This study aims to present the first rehabilitation of a postextraction dental implant in the maxilla using an innovative ARP procedure via a MPI technique. The technique does not involve autologous or heterologous grafting materials; instead, a cortical lamina and a customized screw are used in conjunction with the blood clot. The primary objective is to protect the vestibular cortical bone from preosteoclastic aggression, which can trigger bone resorption. The technique employs a 0.5-mm cortical lamina to mechanically shield the vestibular cortical bone, preventing vestibular cortical bone resorption and increasing its thickness without the need for biomaterial insertion, relying on the blood clot. The effectiveness of the technique was assessed through a 12-month postimplantation cone-beam computed tomography scan, revealing a 0.5-mm increase. Although based on a single case, the 1-year follow-up results are promising, and further studies are warranted to validate the technique's efficacy.
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Affiliation(s)
- Andrea Grassi
- Private Practice Dental Clinic, Reggio Emilia, Italy
| | - Daniele Monica
- Department of Clinical and Experimental Medicine, Dental School, University of Foggia, Foggia, Italy
| | - Elio Minetti
- Private Practice and Professor a c. University of Milan, Milan, Italy
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, Dental School, University of Foggia, Foggia, Italy
| | - Francesco Gianfreda
- Department of Industrial Engineering, University of Rome “Tor Vergata”, Rome, Italy
| | - Patrizio Bollero
- Department of System Medicine, Dental School, University of Rome “Tor Vergata”, Rome, Italy
| | - Marco Cicciù
- Department of General Surgery and Surgical-Medical Specialties, Dental School, University of Catania, Catania, Italy
| | - Filiberto Mastrangelo
- Department of Clinical and Experimental Medicine, Dental School, University of Foggia, Foggia, Italy
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Hussain AA, Al-Quisi AF, Abdulkareem AA. Efficacy of Autogenous Dentin Biomaterial on Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7932432. [PMID: 38179035 PMCID: PMC10764647 DOI: 10.1155/2023/7932432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
Background After tooth extraction, alveolar bone resorption is inevitable. This clinical phenomenon challenges dental surgeons aiming to restore esthetic and function. Alveolar ridge preservation can be applied to minimize dimensional changes with a new socket grafting material, an autogenous dentin graft, produced by mechanically and chemically processing natural teeth. This study assessed the safety and efficacy of using autogenous dentin biomaterial in alveolar ridge preservation. Materials and Methods Patients with nonrestorable maxillary anterior teeth bounded by natural sound teeth were included in this study. After a detailed clinical and tomographic examination, eligible participants were randomly allocated into two groups. The control group had spontaneous healing of extraction sockets. The study group had their extraction sockets filled with autogenous dentin biomaterial after processing their extracted retained roots with the KometaBio device. Standardized cone beam computed tomography (CBCT) scans were repeated four months later. A full-thickness mucoperiosteal flap reflection was achieved under local anesthesia to get core biopsies for histomorphometric analysis, and dental implants were placed at the same session. Results A total of 32 eligible patients were included in this study (n = 16 in each group). Both groups had significantly higher facial soft tissue thickness after four months than baseline (p < 0.05). However, the study group showed statistically significant lesser dimensional changes than the control group according to the standardized CBCT scans. Furthermore, core biopsies confirmed an excellent remodeling of the autogenous dentin biomaterial in the study group. In comparison, only new thin bone trabeculae-filled sockets were in the control group. Conclusion Autogenous dentin graft can be safely and successfully used for alveolar ridge preservation. Optimal graft remodeling histologically, better ridge dimensional stability, and uneventful wound healing support its clinical application. This trial is registered with TCTR20220615002.
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Affiliation(s)
| | - Ahmed Fadhel Al-Quisi
- Oral and Maxillofacial Surgery Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Ali A. Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
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29
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Tan S, Qiu Y, Xiong H, Wang C, Chen Y, Wu W, Yang Z, Zhao F. Mussel-inspired cortical bone-adherent bioactive composite hydrogels promote bone augmentation through sequential regulation of endochondral ossification. Mater Today Bio 2023; 23:100843. [PMID: 37942424 PMCID: PMC10628777 DOI: 10.1016/j.mtbio.2023.100843] [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: 07/09/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023] Open
Abstract
Endochondral ossification (ECO) plays an integral part in bone augmentation, which undergoes sequential processes including mesenchymal stem cells (MSC) condensation, chondrocyte differentiation, chondrocyte hypertrophy, and mineralized bone formation. Thus, accelerating these steps will speed up the osteogenesis process through ECO. Herein, inspired by the marine mussels' adhesive mechanism, a bioactive glass-dopamine (BG-Dopa) hydrogel was prepared by distributing the micro-nano BG to aldehyde modified hyaluronic acid with dopamine-modified gelatin. By in vitro and in vivo experiments, we confirm that after implanting in the bone augmentation position, the hydrogel can adhere to the cortical bone surface firmly without sliding. Moreover, the condensation and hypertrophy of stem cells were accelerated at the early stage of ECO. Whereafter, the osteogenic differentiation of the hypertrophic chondrocytes was promoted, which lead to accelerating the late stage of ECO process to achieve more bone augmentation. This experiment provides a new idea for the design of bone augmentation materials.
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Affiliation(s)
- Shuyi Tan
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Yonghao Qiu
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Huacui Xiong
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Chunhui Wang
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Yifan Chen
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Wangxi Wu
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Zhen Yang
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, China
| | - Fujian Zhao
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
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30
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Bhandari S, Prakash P. Functional and aesthetic rehabilitation using 'all on 4' treatment protocol with intraoral welding. Med J Armed Forces India 2023; 79:S365-S375. [PMID: 38144623 PMCID: PMC10746832 DOI: 10.1016/j.mjafi.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/03/2022] [Indexed: 11/29/2022] Open
Abstract
With the increasing life expectancy and improved quality of life, the conventional prosthodontic removable treatment modalities are being replaced with implant retained fixed prostheses. A full-arch conventional rehabilitation of edentulous ridges requires six to ten dental implants. However, some patients demand fixed implant-supported prostheses inspite of medical conditions and economic concerns. Also in completely edentulous cases, the insufficient bone morphology directs the treatment plan towards alternatives such as cantilever prostheses, short implants or ridge augmentation procedures. These clinical conditions have brought in a quantum shift in treatment planning towards the 'all on 4 protocol' providing immediately loaded fixed prosthesis supported by 4 implants thereby providing optimum and immediate restoration of function and esthetics.
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Affiliation(s)
- S.K. Bhandari
- Addl DGDS, O/o DGDS ‘L’ Block, AHQ, New Delhi, India
| | - Poonam Prakash
- Associate Professor (Prosthodontics), Command Hospital (Northern Command), Udhampur, India
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Salian SS, Durge KK, Dhadse PV. A Case Report of Atraumatic Tooth Extraction Followed by Ridge Preservation for Implant-Supported Prosthetic Rehabilitation Using an Alloplastic Bone Graft. Cureus 2023; 15:e50776. [PMID: 38239550 PMCID: PMC10795561 DOI: 10.7759/cureus.50776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
Exodontia is a painful treatment that frequently causes the alveolar bone and surrounding soft tissues to be immediately destroyed and lost. With regard to the amount of resorption taking place after extraction, various treatment protocols aimed at preventing or decreasing alveolar ridge collapse have been presented over the past three decades. Ridge preservation is a clinical technique used to prevent the socket walls' bone resorption after tooth extraction. A 43‑year‑old female patient with a non-significant medical history visited the Department of Periodontology and Implantology with a chief complaint of a decayed tooth in the upper left back region (26) for three years and wants to get it replaced. The treatment option that was given to the patient was atraumatic extraction, followed by ridge preservation. A cautious and conservative treatment strategy is necessary to preserve the oral structures as they currently exist and are intact for a successful outcome; careful case selection and thorough treatment planning are crucial. Atraumatic tooth extraction is a procedure used to delicately remove a tooth while upholding the fundamental principles of preserving the surrounding bone and gingival structure. This will ultimately maximize the success of implant placement in terms of appearance and functionality.
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Affiliation(s)
- Shrishti S Salian
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Khushboo K Durge
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad V Dhadse
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Rajamanickam P, Sundari SK. Mandibular Posterior Anatomic Limit for Distalization in Patients With Various Patterns of Third Molar Impactions: A Three-Dimensional Cone Beam CT (CBCT) Study. Cureus 2023; 15:e50165. [PMID: 38192921 PMCID: PMC10772357 DOI: 10.7759/cureus.50165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
AIM The aim was to compare and evaluate the variation in the mandible's posterior anatomic limits (MPAL) stratified by different third molar impaction patterns utilizing cone-beam CT (CBCT) in individuals with skeletal Class III malocclusion. METHODOLOGY The sample consisted of CBCT records of 80 samples of Class III patients categorized based on the pattern of their third molar impaction. The shortest linear distances from the distal root of the second mandibular molar to the inner cortex of the mandibular body were measured at the crown level, at the cementoenamel junction (CEJ), and at the depths of 4, 6, and 8mm from the CEJ, all parallel to the posterior occlusal line. The MPAL of the four groups were compared. The Shapiro-Wilk test for normality was performed. The Kruskal-Wallis test was performed to compare the MPAL distances between the groups. RESULTS Significant differences were noted between the four groups at every level. MPAL distances decreased towards apex in all the groups and was least at the 8mm root level. The greatest MPAL distances were noted in the no-impaction group followed by the horizontal. At 8mm, the MPAL were 4.2+/-1.3 in Group 3 (Control), 3.3+/-0.9 in Group 1 and 2.7+/-0.05 mm in Group 2. Though the amount of space available for distalization was greatest for the mesioangular group at the crown level, it was least at the 8mm level compared to other groups. CONCLUSION MPAL distances were shortest at the root level in Class III patients who had mesioangularly impacted third molars and care should be taken before attempting distalization in them.
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Affiliation(s)
- Preethi Rajamanickam
- Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Shantha K Sundari
- Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Franceschelli S, Lagioia R, De Cecco F, Minetti E, Ballini A, Panella V, Speranza L, Grilli A, Mastrangelo F. Biological Evaluation of the Osteoinductive Potential of Dry Teeth after Chemical Demineralization Treatment Using the Tooth Transformer Device. Biomolecules 2023; 13:1727. [PMID: 38136598 PMCID: PMC10741675 DOI: 10.3390/biom13121727] [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: 10/09/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Several studies have already demonstrated the biocompatibility of a tooth as a grafting material in the regeneration of bone tissue, showing its osteoconductive potential, while no studies have verified whether the osteoinductive potential of a tooth remains constant or is altered after its treatment with the Tooth Transformer (TT) device. The aim of the study was to demonstrate that the treatment with the TT device did not alter the osteoinductivity of an extracted tooth that was stored dry. Twelve extracted human teeth were collected from real patients. Caries, tartar and filling materials were removed from each tooth; each tooth was coarsely cut and stored at room temperature (RT) until use. Each sample was shredded, demineralized and disinfected, using the TT device. Protein extraction was carried out for each sample, and Western Blot analysis was performed to test the presence of mineralization protein LIM-1 and transforming growth factor-β. The presence of the human Bone Morphogenetic Protein 2 (BMP-2) and human collagen Type I (COL-I) was found in dry tooth samples processed with the TT device and subjected to Enzyme-Linked Immunosorbent Assay (ELISA) testing. The treatment of chemical demineralization using the TT device does not alter the osteoinductive potential of a dry tooth.
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Affiliation(s)
- Sara Franceschelli
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (S.F.); (F.D.C.); (V.P.); (L.S.); (A.G.)
- UdA-TechLab, Research Center, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Rosalba Lagioia
- Department of Clinical and Experimental Medicine, University of Foggia, Via L. Rovelli n°48, 71122 Foggia, Italy; (R.L.); (A.B.)
| | - Federica De Cecco
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (S.F.); (F.D.C.); (V.P.); (L.S.); (A.G.)
| | - Elio Minetti
- Department of Biomedical, Surgical, Dental Science, University of Milan, 20161 Milan, Italy;
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, Via L. Rovelli n°48, 71122 Foggia, Italy; (R.L.); (A.B.)
| | - Valeria Panella
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (S.F.); (F.D.C.); (V.P.); (L.S.); (A.G.)
| | - Lorenza Speranza
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (S.F.); (F.D.C.); (V.P.); (L.S.); (A.G.)
- UdA-TechLab, Research Center, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Alfredo Grilli
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (S.F.); (F.D.C.); (V.P.); (L.S.); (A.G.)
- UdA-TechLab, Research Center, University “G. d’Annunzio” Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Filiberto Mastrangelo
- Department of Clinical and Experimental Medicine, University of Foggia, Via L. Rovelli n°48, 71122 Foggia, Italy; (R.L.); (A.B.)
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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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Elbanna RM, Abdelaziz MS, Alameldeen HE. Augmentation of single tooth extraction socket with deficient buccal walls using bovine xenograft with platelet-rich fibrin membrane. BMC Oral Health 2023; 23:874. [PMID: 37978487 PMCID: PMC10657028 DOI: 10.1186/s12903-023-03554-2] [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: 04/01/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Different techniques and materials such as bone grafts and bioactive agents have been used for alveolar ridge augmentation in extraction sockets with a defective wall, there is not a specific material or technique that has resulted in superior outcomes or prevented total bone loss. OBJECTIVES This clinical study aims to evaluate radiographically the effectiveness of using bovine xenograft with platelet-rich fibrin (PRF) membrane on vertical and horizontal alveolar ridge dimensional changes following tooth extraction that are complicated by buccal bone loss. MATERIALS AND METHODS This study was conducted in Egypt on fourteen patients with a single posterior tooth indicated for extraction. A preoperative cone-beam computed tomography (CBCT) scan confirmed more than 50% loss in buccal bone in each tooth. Extraction sockets were packed with minced PRF clots mixed with a bovine xenograft. Each extraction socket was sealed by PRF membranes. CBCT scans, performed before tooth extraction and after 6 months, were used to assess alveolar ridge changes both vertically and horizontally. RESULTS There was a significant gain in the buccal and middle of the extraction socket bone height, recording 86.01% (6.33 mm) and 206.45% (9.6 mm), respectively. There was an insignificant bone loss in the lingual bone height and width, recording - 8.49% (-1.06 mm) and - 13.39% (1.05 mm), respectively. The results also showed a non-significant decrease in alveolar bone density (-14.06%) between pre-operative bone present apical to the extraction socket and newly formed bone inside the socket. CONCLUSIONS Ridge preservation/augmentation techniques using a bone graft mixed with PRF and covered by PRF membranes in fresh extraction sockets complicated by the loss of buccal bone result in buccal bone augmentation and a reduction in horizontal and vertical ridge collapse after tooth extraction. CLINICAL RELEVANCE The bovine xenograft in conjunction with PRF can be used immediately after extraction for ridge preservation, providing adequate bone width and height for implant placement.
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Affiliation(s)
| | - Medhat Sameh Abdelaziz
- Faculty of Oral and Dental Medicine, Prosthodontics department, Future University in Egypt, Cairo, Egypt.
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Seol J, Bayome M, Kook YA, Kang SJ, Oh J, Ham LK, Park JH. A 3-dimensional evaluation of available retromolar space for the application of ramal plates. Am J Orthod Dentofacial Orthop 2023; 164:628-635. [PMID: 37269257 DOI: 10.1016/j.ajodo.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study aimed to evaluate the available retromolar space for ramal plates in patients with Class I and III malocclusions and compare that space with and without third molars using cone-beam computed tomography. METHODS Cone-beam computed tomography images of 30 patients (17 males, 13 females; mean age, 22.2 ± 4.5 years) with Class III malocclusion and 29 subjects (18 males, 11 females; mean age, 24.3 ± 3.7 years) with Class I malocclusion were analyzed. Available retromolar space at 4 axial levels of the second molar root and the volume of the retromolar bone were evaluated. Two-way repeated measures analysis of covariance (repeated measures analysis of covariance) was applied to compare the variables between Class I and III malocclusions and the presence of third molars. RESULTS Patients with Class I and III relationships showed up to 12.7 mm of available retromolar space at 2 mm apical from the cementoenamel junction (CEJ). At 8 mm apical from CEJ, patients with Class III malocclusion had 11.1 mm of space, whereas those with a Class I relationship showed 9.8 mm of available space. When patients had third molars, the amount of available retromolar space was significantly greater in patients with a Class I and III relationship. However, patients with Class III malocclusion exhibited greater available retromolar space than those with a Class I relationship (P = 0.028). In addition, the bone volume was significantly greater in patients with Class III malocclusion than in patients with a Class I relationship and those with third molars than in those without them (P <0.001). CONCLUSIONS Class I and III groups showed the availability of at least 10.0 mm of retromolar space 2 mm apical to the CEJ for molar distalization. Based on this information, it is suggested that clinicians consider available retromolar space for molar distalization in diagnosing and planning treatment for patients with Class I and III malocclusion.
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Affiliation(s)
- Jungeun Seol
- Garak Samsung Dental Clinic, Seoul, South Korea; Department of Orthodontics, King Faisal University College of Dentistry, King Faisal University, Alhofof, Saudi Arabia
| | - Mohamed Bayome
- Department of Orthodontics, King Faisal University College of Dentistry, King Faisal University, Alhofof, Saudi Arabia; Department of Postgraduate Studies, Universidad Autonóma del Paraguay, Asunción, Paraguay
| | - Yoon-Ah Kook
- Dr. Kook's Hanmaum Bubu Dental Clinic, Seoul, South Korea.
| | | | - Jiyoung Oh
- Department of Orthodontics, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Lyun Kwang Ham
- Department of Orthodontics, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
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Araújo MG, Dias DR, Matarazzo F. Anatomical characteristics of the alveolar process and basal bone that have an effect on socket healing. Periodontol 2000 2023; 93:277-288. [PMID: 37533162 DOI: 10.1111/prd.12506] [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: 01/31/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 08/04/2023]
Abstract
Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing.
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Affiliation(s)
- Maurício G Araújo
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Flavia Matarazzo
- Department of Dentistry, State University of Maringá, Maringá, Brazil
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Mardas N, Macbeth N, Donos N, Jung RE, Zuercher AN. Is alveolar ridge preservation an overtreatment? Periodontol 2000 2023; 93:289-308. [PMID: 37622682 DOI: 10.1111/prd.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/24/2023] [Accepted: 05/19/2023] [Indexed: 08/26/2023]
Abstract
The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing.
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Affiliation(s)
- Nikos Mardas
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
| | - Neil Macbeth
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
- Defence Centre for Rehabilitative Dentistry, Defence Primary Health Care (DPHC), Dental Centre Aldershot, Guildford, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Anina Nives Zuercher
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Liñares A, Dopico J, Magrin G, Blanco J. Critical review on bone grafting during immediate implant placement. Periodontol 2000 2023; 93:309-326. [PMID: 37658586 DOI: 10.1111/prd.12516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 09/03/2023]
Abstract
In the last 20 years, immediate implant placement has been proposed as a predictable protocol to replace failing teeth. The research conducted in preclinical and clinical studies have focused on soft and hard tissue changes following tooth extraction and immediate implant placement. Different approaches for hard and soft tissue grafting together with provisional restorations have been proposed to compensate tissue alterations. This review analyzed some relevant clinical and preclinical literature focusing on the impact of bone grafting procedures on immediate implant placement in terms of hard and soft tissue changes, aesthetic results, and patient-related outcomes.
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Affiliation(s)
- Antonio Liñares
- Unit of Periodontology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Dopico
- Unit of Periodontology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Magrin
- Unit of Periodontology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Dentistry, Centre for Education and Research on Dental Implants (CEPID), Federal University of Santa Catarina, Florianopolis, Brazil
| | - Juan Blanco
- Unit of Periodontology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
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40
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M King E, Schofield J. Restoratively driven planning for implants in the posterior maxilla - Part 1: alveolar bone healing, bone assessment and clinical classifications. Br Dent J 2023; 235:585-592. [PMID: 37891288 PMCID: PMC10611561 DOI: 10.1038/s41415-023-6391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 10/29/2023]
Abstract
Sinus augmentation in conjunction with implant placement is widely considered to be a predictable and successful treatment option for the edentulous posterior maxilla. However, the anatomical changes of the posterior maxilla following tooth extraction (namely alveolar atrophy and pneumatisation of the maxillary sinus) creates unique challenges for implant and prosthodontic rehabilitation. A large volume of literature has been published regarding the surgical indications and treatment planning for implants in the posterior maxilla. In comparison, there is a relative paucity of literature regarding the prosthodontic challenges associated with implants placed in augmented maxillary sinuses. This article describes the scientific background of native and grafted alveolar bone healing in relation to implant rehabilitation. Furthermore, clinical classifications available to assist implant treatment planning are described.
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Affiliation(s)
- Elizabeth M King
- Consultant Senior Lecturer in Restorative Dentistry, University of Bristol, Bristol Dental School, UK.
| | - Jonathon Schofield
- Senior Clinical Lecturer, University of Bristol, Bristol Dental School, UK
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Mahardawi B, Kyaw TT, Mattheos N, Pimkhaokham A. The clinical efficacy of autogenous dentin blocks prepared chairside for alveolar ridge augmentation: A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34:1025-1037. [PMID: 37461220 DOI: 10.1111/clr.14131] [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: 02/04/2023] [Revised: 06/06/2023] [Accepted: 07/06/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES This systematic review aimed to evaluate the current evidence on the effectiveness of autogenous dentin block graft prepared chairside for alveolar ridge augmentation and compare its clinical outcomes to the main available grafting materials and techniques. MATERIALS AND METHODS Three databases were screened, including prospective clinical studies, utilizing autogenous dentin blocks for ridge augmentation, with at least 3 months of postoperative follow-up. RESULTS Eight articles were included, and four of them were meta-analyzed. Dentin blocks demonstrated similar vertical bone gain and significantly higher width gain, compared to bone blocks (WMD = 0.03, 95% CI -0.51 to 0.57, p = .92 and WMD = 1.34, 95% CI 0.57 to 2.12, p = .0007, respectively). Vertical and horizontal resorption were similar between the two groups (WMD = -0.36, 95% CI -0.91 to 0.18, p = .19, and WMD = -0.47, 95% CI -1.05 to 0.11, p = .11, respectively). Dentin blocks showed more incidences of postoperative complications, however, with no statistical significance (RR = 4.30, 95% CI 0.97 to 18.96, p = .054). The need for additional augmentation upon implant placement was also similar between both grafts (RR = 0.95, 95% CI 0.39 to 2.28, p = .90). Recorded incidences of graft exposure were low (2.27%), and no study stated surgical site infection. CONCLUSION Within its limitations, this study indicates that the autogenous dentin blocks prepared chairside could be a possible alternative to the other established bone augmentation techniques for staged ridge augmentation. Nevertheless, future studies are needed to confirm its efficacy and implant success/survival in sites grafted with this material.
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Affiliation(s)
- Basel Mahardawi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Thiha Tin Kyaw
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Atiphan Pimkhaokham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Urban IA, Montero E, Amerio E, Palombo D, Monje A. Techniques on vertical ridge augmentation: Indications and effectiveness. Periodontol 2000 2023; 93:153-182. [PMID: 36721380 DOI: 10.1111/prd.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness.
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Affiliation(s)
- Istvan A Urban
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eduardo Montero
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Ettore Amerio
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Palombo
- Department of Periodontics, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
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Udeabor SE, Heselich A, Al-Maawi S, Alqahtani AF, Sader R, Ghanaati S. Current Knowledge on the Healing of the Extraction Socket: A Narrative Review. Bioengineering (Basel) 2023; 10:1145. [PMID: 37892875 PMCID: PMC10604628 DOI: 10.3390/bioengineering10101145] [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: 07/28/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures performed in the dental clinic. Understanding this healing process is of utmost importance because the outcome has a direct bearing on future prosthetic rehabilitation and, by extension, on patients' esthetics and masticatory function, among others. This mini review, therefore, summarized the current knowledge on the different stages of socket healing, including the biologic and clinical events that occur following tooth extraction up until the complete closure of the socket. Additionally, the modeling of the alveolar bone/process post extraction, and the resultant dimensional changes that, altogether, shape the bone, were reviewed and documented. The effects of various socket preservation interventions to mitigate these dimensional changes, and therefore preserve the alveolar process in a condition suitable for future prosthetic rehabilitation, were highlighted. Finally, a review of some of the factors that influence the entire process was also carried out.
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Affiliation(s)
- Samuel E. Udeabor
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Anja Heselich
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Sarah Al-Maawi
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Ali F. Alqahtani
- Department of Periodontics and Community Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Shahram Ghanaati
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
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Abtahi S, Chen X, Shahabi S, Nasiri N. Resorbable Membranes for Guided Bone Regeneration: Critical Features, Potentials, and Limitations. ACS MATERIALS AU 2023; 3:394-417. [PMID: 38089090 PMCID: PMC10510521 DOI: 10.1021/acsmaterialsau.3c00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 03/22/2024]
Abstract
Lack of horizontal and vertical bone at the site of an implant can lead to significant clinical problems that need to be addressed before implant treatment can take place. Guided bone regeneration (GBR) is a commonly used surgical procedure that employs a barrier membrane to encourage the growth of new bone tissue in areas where bone has been lost due to injury or disease. It is a promising approach to achieve desired repair in bone tissue and is widely accepted and used in approximately 40% of patients with bone defects. In this Review, we provide a comprehensive examination of recent advances in resorbable membranes for GBR including natural materials such as chitosan, collagen, silk fibroin, along with synthetic materials such as polyglycolic acid (PGA), polycaprolactone (PCL), polyethylene glycol (PEG), and their copolymers. In addition, the properties of these materials including foreign body reaction, mechanical stability, antibacterial property, and growth factor delivery performance will be compared and discussed. Finally, future directions for resorbable membrane development and potential clinical applications will be highlighted.
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Affiliation(s)
- Sara Abtahi
- NanoTech
Laboratory, School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney 2109, Australia
- Department
of Dental Biomaterials, School of Dentistry, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Xiaohu Chen
- NanoTech
Laboratory, School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney 2109, Australia
| | - Sima Shahabi
- Department
of Dental Biomaterials, School of Dentistry, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Noushin Nasiri
- NanoTech
Laboratory, School of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney 2109, Australia
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Ghallab NA, Elaskary A, Elsabagh H, Toukhy AE, Abdelrahman H, El-Kimary G. A novel atraumatic extraction technique using vestibular socket therapy for immediate implant placement: a randomized controlled clinical trial. Oral Maxillofac Surg 2023; 27:497-505. [PMID: 35718834 PMCID: PMC10457233 DOI: 10.1007/s10006-022-01089-4] [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: 03/15/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This randomized controlled clinical trial compared soft tissue changes following a novel vestibular atraumatic extraction technique (test group) versus the conventional incisal atraumatic extraction approach (control group) while implementing the vestibular socket therapy for immediate implant placement. METHODS Thirty patients with hopeless maxillary anterior teeth requiring atraumatic extraction were randomly assigned into two equal groups to receive either test or control. Vertical soft tissue alterations in mm were measured at baseline and 12 months post-restoration using intraoral digital scans at three reference points, distal papilla, mid-facial gingival margin, and mesial papilla, as well as pink esthetic scores (PESs) after 12 months. RESULTS Vestibular extraction technique showed significant soft tissue improvement and creeping when compared to incisal extraction (P < 0.05). The test group showed soft tissue measurements with a mean (± SD) of 0.26 (± 0.58), 0.39 (± 0.64), and 0.05 (± 0.37) mm for the mesial papilla, mid-facial gingival margin, and distal papilla respectively. While the incisal extraction technique demonstrated gingival recession at the distal papilla, mid-facial gingival margin, and mesial papilla of - 0.37 (± 0.54) mm, - 0.32 (± 0.68) mm, and - 0.39 (± 0.59) mm respectively. The overall PESs after 12 months were 12.67 (± 1.59) in vestibular extraction group, while incisal extraction group was 11.40 (± 1.40), with significant difference between them (P = 0.03). CONCLUSION This investigation suggests that both studied techniques were successful in the atraumatic extraction of hopeless severely damaged teeth. The novel vestibular extraction technique might be considered an alternative reliable atraumatic extraction approach compared to the conventional incisal extraction when performing the vestibular socket protocol for immediate implant placement with soft tissue enhancement.
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Affiliation(s)
- Noha Ayman Ghallab
- Department of Oral Medicine & Periodontology, Faculty of Dentistry, Cairo University, 43 Zahraa Street, Giza, 12311, Dokki, Egypt.
| | | | - Hossam Elsabagh
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Hams Abdelrahman
- Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Gillan El-Kimary
- Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Wang XW, Yang HF, Wang EB, Cui XY, Zhao YJ, Jiang JH. Slim the face or not: 3D change of facial soft and hard tissues after third molars extraction: a pilot study. BMC Oral Health 2023; 23:508. [PMID: 37479973 PMCID: PMC10362706 DOI: 10.1186/s12903-023-03214-5] [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: 02/23/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Whether slim the face or not after removed third molars is the concern of some orthodontic treatment candidates. The aim of this article is to explore the volume changes of facial soft and hard tissues after third molars extraction, as well as develop a reproducible clinical protocol to precisely assess facial soft tissue volume change. METHODS A non-randomized, non-blind, self-controlled pilot study was conducted. 24 adults aged 18-30 had ipsilateral third molars extracted. The body weight change was controlled within 2 kg. Structured light scans were taken under a standardized procedure pre-extraction (T0), three (T1), and six (T2) months post-extraction; CBCTs were taken at T0 and T2. The projection method was proposed to measure the soft tissue volume (STV) and the soft tissue volume change (STVC) by the Geomagic software. The hard tissue volume change (HTVC) was measured in the Dragonfly software. RESULTS The final sample size is 23, including 5 males (age 26.6 ± 2.5 years) and 18 females (age 27.3 ± 2.5 years). The HTVC was - 2.33 ± 0.46ml on the extraction side. On the extraction side, the STV decreased by 1.396 (95% CI: 0.323-2.470) ml (P < 0.05) at T1, and increased by 1.753 (95% CI: -0.01-3.507) ml (P = 0.05) at T2. T2 and T0 had no difference (P > 0.05). The inter and intra-raters ICC of the projection method was 0.959 and 0.974. There was no correlation between the STVC and HTVC (P > 0.05). CONCLUSIONS After ipsilateral wisdom teeth extraction, the volume of hard tissue on the extraction side reduces, and the volume of facial soft tissue does not change evidently. However, further research with large sample size is still needed. The STV measurement has excellent repeatability. It can be extended to other interested areas, including forehead, nose, paranasal, upper lip, lower lip and chin, which is meaningful in the field of orthodontics and orthopedics. TRIAL REGISTRATION ChiCTR, ChiCTR1800018305 (11/09/2018), http://www.chictr.org.cn/showproj.aspx?proj=28868 .
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Affiliation(s)
- Xin-Wen Wang
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, CN, China
| | - Hui-Fang Yang
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, CN, China
| | - En-Bo Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, CN, China
| | - Xin-Yu Cui
- Department of Orthodontics, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Avenue, Haidian District, Beijing, CN, 100081, China
| | - Yi-Jiao Zhao
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, CN, China
| | - Jiu-Hui Jiang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Avenue, Haidian District, Beijing, CN, 100081, China.
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Minetti E, Palermo A, Savadori P, Patano A, Inchingolo AD, Rapone B, Malcangi G, Inchingolo F, Dipalma G, Tartaglia FC, Inchingolo AM. Socket Preservation Using Dentin Mixed with Xenograft Materials: A Pilot Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4945. [PMID: 37512221 PMCID: PMC10382043 DOI: 10.3390/ma16144945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The use of human dentin matrix could serve as an alternative to autologous, allogenic, and xenogeneic bone grafts due to its osteoinductive characteristics. The limitations of its use is tooth availability and that it is often necessary to mix it with a biomaterial. AIM The aim of this study was to analyze a mix of two different graft materials with different reabsorption ranges when the dentin graft material was not sufficient for full socket preservation. METHODS Seven socket preservation surgeries were carried out employing a mixed graft material containing 50% dentin and 50% xenograft. After four months of recovery, the implants were positioned. At the time of the prosthesis placement and implant surgery, bone samples were collected. RESULTS The histologic analysis revealed no inflammatory or infective reaction against the seven biopsies. The histomorphometric graft analysis revealed an amount of New Bone of 29.03 ± 6.57% after 4 months and 34.11 ± 5.02% after 8 months. CONCLUSIONS The two graft materials had a different volume reabsorption rate: 71% after 4 months and 90% after 8 months for dentin, and 6% after 4 months and 26% after 8 months for the xenograft. The space created by the dentin reabsorption increased the quantity of new bone.
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Affiliation(s)
- Elio Minetti
- Department of Biomedical, Surgical, and Dental Science, University of Milan, 20122 Milan, Italy
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Paolo Savadori
- Department of Biomedical, Surgical, and Dental Science, University of Milan, 20122 Milan, Italy
- Fondazione Ca'Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | | | - Biagio Rapone
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Carlo Tartaglia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
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Rando RG, Buchaim DV, Cola PC, Buchaim RL. Effects of Photobiomodulation Using Low-Level Laser Therapy on Alveolar Bone Repair. PHOTONICS 2023; 10:734. [DOI: 10.3390/photonics10070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Alveolar bone repair is a complex and extremely important process, so that functions such as the mastication, occlusion and osseointegration of implants can be properly reestablished. Therefore, in order to optimize this process, many procedures have been used, such as grafting with biomaterials and the application of platelet-rich fibrin (PRF). Another method that has been studied is the use of photobiomodulation (PBM) with the use of low-level laser therapy (LLLT), which, through the absorption of photons by the tissue, triggers photochemical mechanisms in the cells so that they start to act in the search for homeostasis of the affected region. Therefore, the objective of this review was to analyze the use of LLLT as a possible auxiliary tool in the alveolar bone repair process. A search was carried out in scientific databases (PubMed/MEDLINE, Web of Science, Scopus and Cochrane) regarding the following descriptors: “low-level laser therapy AND alveolar bone repair” and “photobiomodulation AND alveolar bone repair”. Eighteen studies were selected for detailed analysis, after excluding duplicates and articles that did not meet predetermined inclusion or non-inclusion criteria. According to the studies, it has been seen that LLLT promotes the acceleration of alveolar repair due to the stimulation of ATP production, activation of transcription and growth factors, attenuation of the inflammatory process and induction of angiogenesis. These factors depend on the laser application protocol, and the Gallium Aluminum Arsenide—GaAlAs laser, with a wavelength of 830 nm, was the most used and, when applications of different energy densities were compared, the highest dosages showed themselves to be more efficient. Thus, it was possible to conclude that PBM with LLLT has beneficial effects on the alveolar bone repair process due to its ability to reduce pain, the inflammatory process, induce vascular sprouting and, consequently, accelerate the formation of a new bone matrix, favoring the maintenance or increase in height and/or thickness of the alveolar bone ridge.
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Affiliation(s)
- Renata Gonçalves Rando
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo 05508-270, Brazil
| | - Paula Cristina Cola
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
- Speech Therapy Department, São Paulo State University (UNESP), Marilia 17525-900, Brazil
| | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo 05508-270, Brazil
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Lertwongpaisan T, Amornsettachai P, Panyayong W, Suphangul S. Soft tissue dimensional change using customized titanium healing abutment in immediate implant placement in posterior teeth. BMC Oral Health 2023; 23:384. [PMID: 37308877 PMCID: PMC10262413 DOI: 10.1186/s12903-023-03060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics. PURPOSE To evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth. METHOD Digital impressions using the intraoral scanner (MEDIT i500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test. RESULTS Customized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months. CONCLUSIONS Immediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management.
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Affiliation(s)
- Tanporn Lertwongpaisan
- Residency Training Program, Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Parinya Amornsettachai
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Woraphong Panyayong
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Suphachai Suphangul
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Dioguardi M, Spirito F, Alovisi M, Aiuto R, Garcovich D, Crincoli V, Ballini A, Caloro GA, Lo Muzio L. Location and Gender Differences in Osteonecrosis of the Jaws in Patients Treated with Antiresorptive and Antineoplastic Drugs Undergoing Dentoalveolar Surgical, Systematic Review with Meta-Analysis and Trial Sequential Analysis. J Clin Med 2023; 12:jcm12093299. [PMID: 37176741 PMCID: PMC10178920 DOI: 10.3390/jcm12093299] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
In the treatment and prevention of osteoporosis and more generally of neoplastic and metabolic pathologies affecting bone tissues, antiresorption drugs such as bisphosphonates and monoclonal antibody are used. Bisphosphonates have been linked to cases of osteonecrosis of the jaws since 2003 by Marx, with more and more evidence over the next two decades; together with bisphosphonate drugs, cases relating to the use of monoclonal drugs have been subsequently added. Among the main independent risk factors, we have extraction procedures in oral surgery that can affect both the mandible and the maxilla and the anterior or posterior sectors. The incidence of MRONJ treated with oral bisphosphonates ranges from 0.5% to 3% according to studies; this incidence would appear to be higher in patients treated with antiresorptive agents with neoplastic diseases. Many pathologies including those in which antiresorptive drugs are used show differences in prevalence in relation to sex; similarly, there could be differences in the incidence of cases of osteonecrosis based on gender in patients undergoing dentoalveolar surgery. Therefore, the objective of this systematic review and trial sequential analysis was to identify and quantify whether there is a proportionally greater risk of MRONJ in male or female subjects and whether there is evidence of greater involvement of osteonecrosis at several extraction sites, differentiating them into mandibular or maxilla and in the anterior or posterior sector. The revision protocol followed the indications of the Cochrane Handbook, and were recorded in Prospero, while the drafting of the manuscript was based on PRISMA. The results of the systematic review, after the study identification and selection process, included a total of 24 studies. The results of the meta-analysis reports: odds ratio (random effects model): 1.476 (0.684, 3.184) between male and female; odds ratio (random effects model): 1.390 (0.801, 2.412) between mandible and maxillary, and an odds ratio value of 0.730 (0.250, 2.137) between the anterior and posterior extraction sites. In conclusion, we can see that there was a trend in the onset of MRONJ as a complication of dentoalveolar surgical procedures, which proportionally mostly involved the male sex and the posterior mandibular sectors, however, this trend must be further confirmed by additional studies.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, University of Turin, 10127 Turin, Italy
| | - Riccardo Aiuto
- Department of Biomedical, Surgical, and Dental Science, University of Milan, 20122 Milan, Italy
| | - Daniele Garcovich
- Department of Dentistry, Universidad Europea de Valencia, Paseo de la Alameda 7, 46010 Valencia, Spain
| | - Vito Crincoli
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Division of Complex Operating Unit of Dentistry, "Aldo Moro" University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giorgia Apollonia Caloro
- Unità Operativa Nefrologia e Dialisi, Presidio Ospedaliero Scorrano, ASL (Azienda Sanitaria Locale) Lecce, Via Giuseppina Delli Ponti, 73020 Scorrano, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
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