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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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Zhang H, Xu T, Wei Y, Wei N, Han Z, Hu W. Assessment of soft and hard tissue changes following micro crestal flap-Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage III/IV periodontitis: A randomized controlled trial. J Clin Periodontol 2024. [PMID: 39043452 DOI: 10.1111/jcpe.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
AIM This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy. MATERIALS AND METHODS Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery. RESULTS Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (p = .032) and greater augmentation in central bone height (p = .001) and ridge width (p = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (p = .010), 0.61 mm (p = .019) and 0.56 mm (p = .013) less than that in the NH group, respectively. There were significantly (p = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%). CONCLUSIONS Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy. TRIAL REGISTRATION Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.
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Affiliation(s)
- Haoyun Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Tao Xu
- Department of Emergency, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Yiping Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Ning Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Ziyao Han
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China
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Ko YC, Koo KT, Li L, Lee D, Lee YM, Seol YJ, Kim TH, Lee J. Clinical evaluation of implants placed within or beyond the boundaries of the alveolar ridge preservation: a retrospective case series with 10 weeks of observations in 28 patients. J Periodontal Implant Sci 2024; 54:54.e19. [PMID: 39058351 DOI: 10.5051/jpis.2400800040] [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: 01/29/2024] [Revised: 05/12/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE This study investigated the effect of implant vertical positioning within alveolar ridge preservation (ARP) sites on implant stability quotient (ISQ) values, which were measured 10 weeks post-implantation. METHODS Patients who underwent ARP using collagenized deproteinized bovine bone mineral, followed by implant placement in the posterior area, were divided into 2 groups: the within-ARP group and the beyond-ARP group. In the within-ARP group, osteotomy and implant placement occurred within the ARP boundary. In contrast, in the beyond-ARP group, these procedures were performed beyond the ARP boundary, incorporating 3 mm of pristine bone at the implant's apex. Bone quality was assessed by tactile sense, and both insertion torque during implant surgery and ISQ values at 10 weeks post-implant surgery were measured. Multiple linear regression analysis and Pearson correlation analysis were used to explore the relationship between insertion torque and ISQ values. RESULTS In total, 30 ARP sites in 28 patients were analyzed. There was no significant difference in bone quality, as determined by tactile sense, between the within-ARP and beyond-ARP groups. At the time of implant placement, the beyond-ARP group exhibited a higher insertion torque (33.33±13.39 Ncm) compared to the within-ARP group (17.08±11.17 Ncm). However, the ISQ values were similar between the 2 groups 10 weeks after implant placement. A positive correlation between insertion torque and ISQ values was confirmed at 10 weeks post-implant. CONCLUSIONS The engagement of pristine bone may facilitate high insertion torque during the placement of implants in ARP sites. Nevertheless, by 10 weeks post-implantation, the ISQ values were found to be comparable, irrespective of the implant's position.
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Affiliation(s)
- Young-Chang Ko
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Ling Li
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Dongseob Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul, Korea
| | - Yong-Moo Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Yang-Jo Seol
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Tae-Hyung Kim
- Private Practice, Kim & Lee Dental Clinic, Seoul, Korea.
| | - Jungwon Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, Korea.
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Dai A, Li HY, Kang S, Lin R, Huang JP, Mao F, Ding PH. Effect of alveolar ridge preservation at periodontally compromised molar extraction sockets: A retrospective cohort study. J Periodontol 2024. [PMID: 38884702 DOI: 10.1002/jper.24-0064] [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: 01/29/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND To date, the clinical evidence regarding the effectiveness of alveolar ridge preservation (ARP) in restricting alveolar bone height and width change after extraction at periodontally compromised molar extraction sockets still remains controversial. This retrospective cohort study aims to evaluate the effect of ARP in molars extracted for periodontal reasons. METHODS Retrospective data were collected from patient electronic records from January 2019 to December 2023. Patients with Stage III/IV periodontitis who underwent extraction of molars for periodontal reasons were screened for eligibility. The outcomes included the horizontal and vertical dimensions of alveolar bone. The need for additional augmentation procedure during implantation was also evaluated. A linear regression model was used to adjust for known confounders. RESULTS A total of 80 sockets were included in this study, of which 27 sockets received ARP therapy after extraction while 53 sockets experienced natural healing (NH). ARP resulted in significantly less bone height change in the periodontally compromised molar sites compared to the NH group (p < 0.001). In sockets displaying a height disparity of >2 mm between the buccal and palatal/lingual walls, the ARP group exhibited advantageous outcomes in terms of ridge width change, surpassing the NH group (p = 0.004). Moreover, the percentage for additional augmentation was significantly reduced in the ARP compared to the NH group (p = 0.006). Age, sex, smoking, jaw, location, and buccal wall thickness did not show any significant effect on bone height change. CONCLUSION ARP had benefits on limiting ridge resorption subsequent to molar extraction for periodontal reasons.
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Affiliation(s)
- Anna Dai
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
| | - Hao-Yu Li
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
| | - Sen Kang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
| | - Renjie Lin
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia-Ping Huang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
| | - Feifei Mao
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
| | - Pei-Hui Ding
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China
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Ko YC, Lee D, Kwon O, Seol YJ, Koo KT, Lee YM, Lee J. Preclinical comparison study of experimental peri-implantitis between alveolar ridge preservation and spontaneous healing sites in infected and noninfected tooth: a randomized blinded in vivo study. J Periodontol 2024. [PMID: 38865252 DOI: 10.1002/jper.23-0617] [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: 10/26/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND This study compared the progression of experimental peri-implantitis between alveolar ridge preservation (ARP) and spontaneous healing (SH) sites in infected (IT) and noninfected tooth (NIT). METHODS Bilateral mandibular third or fourth premolars of six beagle dogs were randomly assigned to IT and NIT groups. Before extraction, chronic dehiscence defects were created at the mesial root of mid-buccal area in IT group. Four weeks later, the mesial roots of the third and fourth premolars were extracted in all groups.ARP procedure was randomly conducted on one side of the extraction sockets using collagenated bovine bone substitutes and resorbable collagen membrane, and contralateral side was allowded spontaneous healing. After 12 weeks of healing, bone-level implants (ϕ 3.6 × 8.0 mm) were placed at the extraction sockets. Three months of ligature induced peri-implantitis and three months of spontaneous progression were allowed, with radiographs taken at each phase. Biopsies were retrieved at the implant site for histomorphometric, immunohistochemical, and polarized light-microscopic analyses. RESULTS Radiography demonstrated that the changes in the marginal bone level during the spontaneous progression period showed no significant differences between ARP and SH sites. Only small and/or nonsignificant differences in the progression of peri-implantitis were observed between ARP and SH sites in histomorphometric, immunohistochemical, and polarized light microscopic analyses. Additionally, the IT and NIT groups exhibited similar outcomes for most parameters. CONCLUSION ARP with xenogenic bone substitutes might provide similarly robust results as SH sites regarding the progression of experimental peri-implantitis, irrespective of the infected or noninfected nature of the site before tooth extraction.
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Affiliation(s)
- Young-Chang Ko
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Dongseob Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul, South Korea
| | - Obin Kwon
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Yang-Jo Seol
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Yong-Moo Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jungwon Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, South Korea
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Lin CY, Chiu MY, Kuo PY, Wang HL. Half- and full-grafting alveolar ridge preservation with different sealing materials: A three-arm randomized clinical trial. Clin Implant Dent Relat Res 2024; 26:651-662. [PMID: 38638057 DOI: 10.1111/cid.13327] [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: 12/01/2023] [Revised: 01/17/2024] [Accepted: 02/17/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The objective of this study is to investigate the effect of different alveolar ridge preservation (ARP) approaches on bone resorption and their potential for facilitating implant placement. MATERIALS AND METHODS Patients who underwent one or two tooth extractions with a desire for restoration were included in the study. The participants were randomly assigned to one of three groups for ARP. The groups were as follows: (1) Half grafting of bovine bone mineral (DBBM-C) covered with non-resorbable dense polytetrafluoroethylene (dPTFE) membrane (Test 1 group); (2) Half grafting of bovine bone mineral (DBBM-C) covered with collagen membrane (Test 2 group); and (3) Full grafting with collagen membrane (DBBM-C + Collagen membrane) as the Control group. After 6-month healing period, the evaluation encompassed clinical, radiographic, implant-related outcomes, and the factors contributing to hard and soft tissue alterations. RESULTS Enrollment in this study comprised 56 patients. At the 6-month follow-up, radiographic analysis in computed beam computed tomography images was conducted for 18, 19, and 19 patients with 18, 20, and 20 tooth sites in Test 1, Test 2, and Control groups, respectively. Additionally, a total of 15, 17, and 17 patients with 15, 18, and 17 implants were evaluated. Based on radiographic analysis, all groups showed limited ridge resorption at 1 mm from crest horizontally (Test 1: 1.29 ± 1.37; Test 2: 1.07 ± 1.07; Control: 1.54 ± 1.33 mm, p = 0.328), while the Control group showed greater radiographic bone height gain in mid-crestal part vertically (Test 1: 0.11 ± 1.02; Test 2: 0.29 ± 0.83; Control: -0.46 ± 0.95 mm, p = 0.032). There were no significant intergroup differences in terms of keratinized mucosal width, bone density, insertion torque, and the need of additional bone graft. However, the use of a dPTFE membrane resulted in a significantly higher vertical mucosal thickness (Test 1: 2.67 ± 0.90; Test 2: 3.89 ± 1.08; Control: 2.41 ± 0.51 mm, p < 0.001). CONCLUSIONS The study showed comparable dimensional preservation with limited vertical shrinkage, while thin buccal bone plate, non-molar sites, and large discrepancy between buccal and palatal/lingual height may contribute to greater shrinkage. Thicker mucosa with dPTFE membrane required further investigation for interpretation. CLINICAL TRIAL REGISTRATION NUMBER NCT06049823. This clinical trial was not registered prior to participant recruitment and randomization.
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Affiliation(s)
- Cho-Ying Lin
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan City, Taiwan
| | - Meng-Yao Chiu
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Pe-Yi Kuo
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Fok MR, Pelekos G, Jin L. Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1198. [PMID: 38592010 PMCID: PMC10931845 DOI: 10.3390/jcm13051198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
AIM To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites. METHODS An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates. RESULTS Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence. CONCLUSIONS Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.
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Affiliation(s)
- Melissa Rachel Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Han HS, Lee JT, Oh S, Cho YD, Kim S. Effectiveness of a collagen matrix seal and xenograft in alveolar ridge preservation: an experimental study in dogs. Sci Rep 2024; 14:163. [PMID: 38168516 PMCID: PMC10762190 DOI: 10.1038/s41598-023-50370-3] [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: 09/22/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
Majority of previous studies on alveolar ridge preservation (ARP) used collagen membranes as barrier membranes, and further evidence for ARP in dehiscent extraction sockets with a deproteinized bovine bone mineral (DBBM) and matrix is needed. The aim of this study is to assess the impact of non-cross linked collagen membranes (membrane) and crosslinked collagen matrices (matrix) on ARP using DBBM in extraction sockets with buccal dehiscence. In six mongrel dogs, the mesial roots of three mandibular premolars (P2, P3, and P4) were extracted 1 month after dehiscence defect induction. Two experimental groups were randomly assigned: (1) DBBM with a membrane (DBBM/membrane group) and (2) DBBM with a matrix (DBBM/matrix group). Three-dimensional (3D) volumetric, microcomputed tomography (μCT), and histologic analyses were performed to assess the ridge preservation. Both groups were effective to maintain the ridge width (p > 0.05), and the DBBM/matrix group showed more favorable soft tissue regeneration and bone quality in the histological analysis (p = 0.05). Based on these results, DBBM/matrix could be better choice for ARP in cases of buccal dehiscence defects.
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Affiliation(s)
- Hee-Seung Han
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101 Daehak-no, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jung-Tae Lee
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Seunghan Oh
- Department of Dental Biomaterials, The Institute of Biomaterial and Implant, School of Dentistry, Wonkwang University, Iksan, Republic of Korea
| | - Young-Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101 Daehak-no, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sungtae Kim
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101 Daehak-no, Jongno-gu, Seoul, 03080, Republic of Korea.
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Yang F, Ruan Y, Bai X, Li Q, Tang X, Chen J, Chen Y, Wang L. Alveolar ridge preservation in sockets with severe periodontal destruction using autogenous partially demineralized dentin matrix: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2023; 25:1019-1032. [PMID: 37455372 DOI: 10.1111/cid.13247] [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: 02/27/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The preservation and reconstruction of alveolar ridge volume in extraction sockets of molars affected by severe periodontitis is a critical challenge that requires clinical attention. PURPOSE This randomized controlled clinical trial was designed to evaluate the efficiency of autogenous partially demineralized dentin matrix (APDDM) for alveolar ridge preservation (ARP) in severely periodontally compromised sockets compared to spontaneous healing (SH) on radiographic and histomorphometric outcomes. MATERIALS AND METHODS Thirty-two patients with 32 periodontally compromised molars were randomized into either the test group, which received ARP using APDDM covered with a collagen sponge, or the control group, which underwent SH. Linear and volumetric changes were assessed using superimposed cone-beam computed tomography (CBCT) acquired pre-extraction and after a 4-month healing time. Histomorphometric evaluation was performed on trephine cores harvested during implant placement. RESULTS All sites healed uneventfully. The ridge width at 1 mm apical to the bone crest increased by 5.03, 4.50, and 5.20 mm in the mesial, middle, distal area in the APDDM group, while decreasing by -1.98, -2.19, and -1.98 mm in the SH group, respectively (p < 0.05). The height increase of the central bone was significantly higher in the APDDM group than in the SH group (p < 0.05). The height decrease of the buccal (mesial, middle, distal) bone plate was lower in the APDDM group than in the SH group (p < 0.05). After a 4-month healing time, bone volume increased by 37.07% in the APDDM group and by only 2.33% in the SH group (p < 0.05). Histomorphometric analysis revealed that APDDM particles were surrounded by newly formed bone, with partially absorbed residual APDDM materials observed. New bone, APDDM remnants, and connective tissue occupied 39.67 ± 8.28%, 23.66 ± 9.22%, and 36.67 ± 17.05% of the areas in the APDDM group, respectively. CONCLUSIONS ARP using APDDM was effective, resulting in a significant increase in both linear and volumetric changes in severely periodontally compromised extraction sockets compared to SH. These findings suggest that APDDM may serve as a promising new clinical option for the reconstruction of alveolar ridge dimensions.
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Affiliation(s)
- Fan Yang
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yan Ruan
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Amsterdam Movement Science (AMS), Vrije Universiteit Amsterdam (VU), Amsterdam, Netherlands
| | - Xiaolei Bai
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qi Li
- Department of Stomatology, Bengbu Medical College, Bengbu, China
| | - Xiaodong Tang
- Department of Stomatology, Tiantai Traditional Chinese Medicine Hospital, Taizhou, Zhejiang, China
| | - Jianping Chen
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yunfang Chen
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Linhong Wang
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Han HS, Lee JT, Oh S, Cho YD, Kim S. Evaluation of alveolar ridge preservation in sockets with buccal dehiscence defects using two types of xenogeneic biomaterials: An in vivo experimental study. Clin Oral Implants Res 2023; 34:1289-1298. [PMID: 37655673 DOI: 10.1111/clr.14169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/11/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Alveolar ridge preservation (ARP) has been extensively investigated in various preclinical and clinical studies, yielding favorable results. We aim to evaluate the effects of ARP using collagenated bovine bone mineral (CBBM) alone or particulated bovine bone mineral with a non-cross-linked collagen membrane (PBBM/NCLM) in tooth extraction sockets with buccal dehiscence in an experimental dog model. MATERIALS AND METHODS The mesial roots of three mandibular premolars (P2, P3, and P4) were extracted from six mongrel dogs 4 weeks after inducing dehiscence defects. ARP was randomly performed using two different protocols: 1) CBBM alone and 2) PBBM/NCLM. Three-dimensional (3D) volumetric, micro-computed tomography, and histological analyses were employed to determine changes over a span of 20 weeks. RESULTS In 3D volumetric and radiographic analyses, CBBM alone demonstrated similar effectiveness to PBBM/NCLM in ARP (p > .05). However, in the PBBM/NCLM group (3.05 ± 0.60 mm), the horizontal ridge width was well maintained 3 mm below the alveolar crest compared with the CBBM group (2.11 ± 1.01 mm, p = .002). CONCLUSION Although the radiographic changes in the quality and quantity of bone were not significant between the two groups, the use of PBBM/NCLM resulted in greater horizontal dimensions and more favorable maintenance of the ridge profile.
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Affiliation(s)
- Hee-Seung Han
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Jung-Tae Lee
- One-Stop Specialty Center, Seoul National University, Dental Hospital, Seoul, Republic of Korea
| | - Seunghan Oh
- Department of Dental Biomaterials, The Institute of Biomaterial and Implant, School of Dentistry, Wonkwang University, Iksan, Republic of Korea
| | - Young-Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Sungtae Kim
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, Seoul, Republic of Korea
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Park WB, Han JY, Kang P. The Bone Bridge Technique Utilizing Bone from the Lateral Wall of the Maxillary Sinus for Ridge Augmentation: Case Reports of a 1-7 Year Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1626. [PMID: 37763747 PMCID: PMC10536201 DOI: 10.3390/medicina59091626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
The post-extraction socket of a periodontally compromised tooth/implant is oftentimes accompanied by a very wide-deep alveolar ridge defect. The commonly utilized treatment is ridge preservation followed by delayed implant placement 4 to 6 months after extraction. In the four cases presented in this study, a novel technique of utilizing a bone block obtained from the lateral wall of the maxillary sinus is introduced. Due to the severe localized vertical ridge deficiency, an intraoral autogenous bone block was obtained from the ipsilateral sinus bony window. After the obtained bone block was properly trimmed, it was fixed in the form of a bridge over the vertical defect by the press-fit method. In two cases, the gap between the autogenous bone and defect was filled with a particulate synthetic bone graft, and in another two cases, the gap was left without grafting. All cases were covered with a resorbable collagen membrane. At the time of re-entry after 5 to 6 months, the bone bridge was well incorporated beside the adjacent native bone and helped by the implant placement. Uncovering was performed after 3 to 6 months, and prostheses were delivered after 2 months. Oral function was maintained without any change in the marginal bone level even after the 1- to 7-year post-prosthesis delivery. This case series showed that the bone bridge technique performed using an ipsilateral sinus bony window for a localized vertical deficiency of a post-extraction socket can be used for successful vertical ridge augmentation (VRA).
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea;
- Private Practice in Periodontics and Implant Dentistry, Seoul 02771, Republic of Korea
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Philip Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences Columbia University College of Dental Medicine, #PH7E-110, 630 W. 168 St., New York, NY 10032, USA
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12
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Zhang H, Wei Y, Xu T, Zhen M, Wang C, Han Z, Hu W, Chung KH. Assessment of soft and hard tissue characteristics of ridge preservation at molar extraction sites with severe periodontitis: a randomized controlled trial. BMC Oral Health 2022; 22:511. [DOI: 10.1186/s12903-022-02544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients.
Methods
This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation.
Discussion
This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets.
Trial registration
Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0.
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13
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Park WB, Ko JM, Han JY, Kang P. Flap Extension Technique Using Intrasocket Granulation Tissue in Peri-Implant Osseous Defect: Case Series. Medicina (B Aires) 2022; 58:medicina58111555. [PMID: 36363512 PMCID: PMC9698312 DOI: 10.3390/medicina58111555] [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: 08/19/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
A compromised extraction socket is characterized by severe bone resorption around neighboring teeth and is often occupied with thick intrasocket granulation tissue (IGT). Guided bone regeneration (GBR) is a procedure that can preserve the bone volume around extraction sockets, and it can also be combined with immediate implant placement. However, an early exposure of GBR sites is a possible complication because it increases the risk of infection and can inhibit successful bone regeneration. The purpose of these case series is to introduce a novel, surgical procedure that can prevent the exposure of GBR sites by using IGT for flap extension during immediate implant placement in compromised extraction sockets. The technique was successfully performed in six patients. For successful flap closure, the inner portion of the IGT was dissected so that the flap was properly extended with the base of IGT attached to the flap for blood supply. Periosteal releasing incisions were not performed. The IGT was first sutured to the palatal flap with resorbable sutures, and then the overlying flap was closed with additional sutures. There was no post-operative exposure of the surgical GBR site in any of the patients, and the location of the mucogingival junction remained unchanged. All grafted sites also achieved sufficient bone regeneration. Within the limitations, this case series demonstrates the potential use of IGT, a concept which was previously obsolete.
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Private Practice in Periodontics and Implant Dentistry, Seoul 02447, Korea
| | - Jung-Min Ko
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, NY 10032, USA
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Philip Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, NY 10032, USA
- Correspondence:
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Zhao L, Hu W, Liu Y, Chung KH. Evaluation of implant placement following ridge preservation in periodontally compromised molar extraction sockets: Three-year results of a prospective cohort study. Clin Oral Implants Res 2022; 33:735-744. [PMID: 35524437 DOI: 10.1111/clr.13949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 03/09/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the 3-year implant-related outcomes following alveolar ridge preservation in periodontally compromised molar sockets. MATERIAL AND METHODS Thirty implants were placed in 26 patients following either ridge preservation (test, n = 16) or natural healing (control, n = 14) at deficient molar extraction sites after a 6-month healing period. The need for additional augmentation procedures at implant placement was recorded. Patients were assessed for 3 years following a definitive restoration. Patient information being collected are modified plaque index, the modified sulcus bleeding index, the peri-implant probing depth clinically, and alterations of marginal bone level (MBL) radiographically. RESULTS There was a 100% survival rate of implants in both groups after 3-year follow-up. During implant placement operation, 35.7% in the control group and 6.3% in the test group required additional augmentation procedures. No statistically significant differences were determined for peri-implant parameters and marginal bone levels between the two groups. The overall mean difference of MBL was 0.072 mm (95% CI [-0.279, 0.423]) during the 3 years of follow-up. The success rate was 81.2% in the test and 78.6% in the control group. CONCLUSIONS Implants placed into periodontally compromised molar extracted sites after ridge augmentation resulted comparable outcomes to implants placement at naturally healed sites after 3-year functional loading.
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Affiliation(s)
- Liping Zhao
- Department of Emergency, 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 Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Wenjie Hu
- Department of Emergency, 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 Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Yunsong Liu
- Department of Prosthodontics, 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 Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Kwok-Hung Chung
- Department of Restorative Dentistry, University of Washington, Seattle, Washington, USA
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Lee JB, Chu S, Ben Amara H, Song HY, Son MJ, Lee J, Kim HY, Koo KT, Rhyu IC. Effects of hyaluronic acid and deproteinized bovine bone mineral with 10% collagen for ridge preservation in compromised extraction sockets. J Periodontol 2021; 92:1564-1575. [PMID: 33484160 DOI: 10.1002/jper.20-0832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of deproteinized bovine bone mineral with 10% collagen (DBBM-C) soaked with hyaluronic acid (HA) for ridge preservation in compromised extraction sockets. METHODS Bilateral third, fourth premolars and first molar were hemisected, distal roots were extracted, and then combined endodontic periodontal lesion was induced in the remaining mesial roots. After 4 months, the mesial roots were extracted and the following four treatments were randomly performed: Absorbable collagen sponge (ACS), ACS soaked with HA (ACS+HA), ridge preservation with DBBM-C covered with a collagen membrane (RP), ridge preservation with DBBM-C mixed with HA and covered with a collagen membrane (RP+HA). Animals were sacrificed at 1 and 3 months following treatment. Ridge dimensional changes and bone formation were examined using microcomputed tomography, histology, and histomorphometry. RESULTS At 1 month, ridge width was significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups, while the highest proportion of mineralized bone was observed in ACS+HA group. At 3 months, ridge width remained significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups. ACS+HA and RP+HA treatments featured the highest proportion of mineralized bone and bone volume density compared with the other groups. No statistical difference was observed between ACS+HA and RP+HA treatments. CONCLUSIONS Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.
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Affiliation(s)
- Jun-Beom Lee
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Seoyoon Chu
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Heithem Ben Amara
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Hyun-Young Song
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Jung Son
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jungwon Lee
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, College of Health Science & Department of Health Care Sciences, Graduate School & BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Ki-Tae Koo
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - In-Chul Rhyu
- Department of Periodontology and Dental research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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16
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Ridge preservation in maxillary molar extraction sites with severe periodontitis: a prospective observational clinical trial. Clin Oral Investig 2021; 26:2391-2399. [PMID: 34622309 DOI: 10.1007/s00784-021-04204-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess alveolar bone changes and treatment modality alterations after ridge preservation on maxillary molar extraction sockets with severe periodontitis, compared to natural healing. MATERIAL AND METHODS Thirty-six maxillary infected-molar teeth either receiving ridge preservation (RG group) or undergoing natural healing (NT group) were investigated. Cone-beam computed tomography (CBCT) scanning was performed immediately after surgery (the baseline) and repeated 6 months later to measure the linear and volumetric changes of the sockets. RESULTS Based on radiographic measurements, alveolar bone width decreased by 1.58 ± 4.61 mm in the NT group but increased by 3.74 ± 4.17 mm in the RG group (p < 0.05). Significant increases in ridge height at the center of both the NT (7.54 ± 4.54 mm) and RG (9.20 ± 3.26 mm) groups were observed. Mean sinus pneumatization was 0.19 ± 0.45 mm in the RG group and 0.59 ± 0.63 mm in the NT group (p < 0.05). The relative increase in total ridge volume was 8.0% and 35.5% in the NT and RG group, respectively (p < 0.05). Implant placement with additional sinus augmentation procedure was performed in 16.7% of the RG group cases, whereas 50% in the NT group cases. CONCLUSIONS Ridge preservation in the maxillary molar extraction sockets with severe periodontitis can improve alveolar ridge dimensions and decrease the necessity of advanced regenerative procedures at implant placement compared to natural healing. CLINICAL RELEVANCE Ridge preservation on maxillary molar extraction sockets with severe periodontitis maintained the vertical bone height more efficiently and resulted in less need for sinus augmentation procedures at 6 months compared to natural healing.
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17
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Tien HK, Lee WH, Kim CS, Choi SH, Gruber R, Lee JS. Alveolar ridge regeneration in two-wall-damaged extraction sockets of an in vivo experimental model. Clin Oral Implants Res 2021; 32:971-979. [PMID: 34101908 PMCID: PMC8453892 DOI: 10.1111/clr.13791] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/24/2021] [Accepted: 05/22/2021] [Indexed: 12/24/2022]
Abstract
Aim To determine the healing outcome following grafting with deproteinized porcine bone mineral (DPBM) with or without collagen membrane coverage in two‐wall (both buccal and lingual)‐damaged extraction sockets. Materials and methods Distal roots of three mandibular premolars in six beagle dogs were extracted, and the whole buccal and lingual bony walls were surgically removed. Three treatment protocols were then applied according to the following group allocation: no graft (None), grafting DPBM (BG), and grafting DPBM with coverage by a collagen membrane (BG + M). Two observational periods (2 and 8 weeks) were used with the split‐mouth design, and quantitative and qualitative analyses were performed by microcomputed tomography and histology. Results The dimensions of the alveolar ridge at both grafted sites (BG and BG + M) remained similar to those of the pristine ridge in the histologic and radiographic analyses, whereas the ungrafted sites (None) collapsed both vertically and horizontally. Both grafting protocols produced substantial bony regeneration, but the addition of a covering membrane enhanced the proportion of mineralized tissue within the augmented area, and the BG + M group also showed a significantly larger area of regenerated ridge than the None group (p < .05). Conclusions Bone grafting with collagen membrane can maintain the alveolar ridge dimensions with substantial bone regeneration in a two‐wall‐damaged extraction socket.
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Affiliation(s)
- Hsu Kuo Tien
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Won-Ho Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Chang-Sung Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Seong-Ho Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea.,Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Korea
| | - Reinhard Gruber
- Department of Oral Biology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea.,Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Korea.,Department of Oral Biology, School of Dentistry, Medical University of Vienna, Vienna, Austria
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18
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Lee J, Yun J, Kim JJ, Koo KT, Seol YJ, Lee YM. Retrospective study of alveolar ridge preservation compared with no alveolar ridge preservation in periodontally compromised extraction sockets. Int J Implant Dent 2021; 7:23. [PMID: 33768356 PMCID: PMC7994480 DOI: 10.1186/s40729-021-00305-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background To minimize alveolar bone resorption, alveolar ridge preservation (ARP) has been proposed. Recently, interest in improving the feasibility of implant placement has gradually increased, especially in situations of infection such as periodontal and/or endodontic lesions. The aim of this study was to investigate if ARP improves feasibility of implant placement compared with no ARP in periodontally compromised sites. Secondary endpoints were the necessity of bone graft at the time of implant placement and implant failure before loading at ARP compared with no ARP. Material and methods This retrospective study was performed using dental records and radiographs obtained from patients who underwent tooth extraction due to chronic periodontal pathology. Outcomes including the feasibility of implant placement, horizontal bone augmentation, vertical bone augmentation, sinus floor elevation, total bone augmentation at the time of implant placement, and implant failure before loading were investigated. Multivariable logistic regression analysis was performed to examine the influence of multiple variables on the clinical outcomes. Results In total, 418 extraction sites (171 without ARP and 247 with ARP) in 287 patients were included in this study. The ARP group (0.8%) shows significantly lower implant placement infeasibility than the no ARP group (4.7%). Horizontal and vertical bone augmentations were significantly influenced by location and no ARP. Total bone augmentation was significantly influenced by sex, location, and no ARP. Conclusion ARP in periodontally compromised sites may improve the feasibility of implant placement. In addition, ARP attenuate the severity of the bone augmentation procedure. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00305-2.
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Affiliation(s)
- Jungwon Lee
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, Republic of Korea.,Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Junseob Yun
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jung-Ju Kim
- 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
| | - 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.
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Ben Amara H, Kim JJ, Kim HY, Lee J, Song HY, Koo KT. Is ridge preservation effective in the extraction sockets of periodontally compromised teeth? A randomized controlled trial. J Clin Periodontol 2021; 48:464-477. [PMID: 33316099 DOI: 10.1111/jcpe.13412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/26/2020] [Accepted: 12/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To verify whether ridge preservation is effective in the reduction of dimensional loss and in bone formation compared to spontaneous healing in extraction sockets of periodontally compromised teeth. METHODS Twenty-six subjects requiring tooth extraction for stage III/IV periodontitis were randomly assigned to one of two interventions: alveolar ridge preservation using collagenated bovine bone mineral and a resorbable collagen membrane (test, RP) or spontaneous healing (control, SH). Six months later, postoperative cone-beam computed tomography (CBCT) was performed to measure the linear and volumetric changes of the sockets compared to baseline scans. Biopsies were retrieved at the implant site for histomorphometric calculations. Nonparametric tests were applied for statistical analysis. RESULTS Significantly less shrinkage occurred in RP compared to SH, mainly in the crestal zone. The width loss difference between groups was 3.3 mm and 2.2 mm at 1 mm and 3 mm below the crest, respectively (p < .05). RP yielded a gain in socket height of 0.25 mm, whereas a loss of -0.39 mm was observed in SH (p < .05). The percentage of volume loss recorded in RP was also less than that recorded in SH (-26.53% vs -50.34, p < .05). Significantly less bone proportion was detected in biopsies from RP (30.1%) compared with SH (53.9%). A positive association between baseline bone loss and ridge shrinkage was found in SH but not in RP. CONCLUSION Ridge preservation in extraction sockets of periodontally compromised teeth was effective in reducing the amount of ridge resorption.
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Affiliation(s)
- Heithem Ben Amara
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Jung-Ju Kim
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Hae-Young Kim
- Department of Health Policy and Management, Korea University, Seoul, Korea
| | - Jungwon Lee
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Hyun-Young Song
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), School of Dentistry, Seoul National University, Seoul, Korea
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20
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Kim JJ, Ben Amara H, Chung I, Koo KT. Compromised extraction sockets: a new classification and prevalence involving both soft and hard tissue loss. J Periodontal Implant Sci 2021; 51:100-113. [PMID: 33913633 PMCID: PMC8090797 DOI: 10.5051/jpis.2005120256] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/01/2020] [Accepted: 12/30/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Previous studies have solely focused on fresh extraction sockets, whereas in clinical settings, alveolar sockets are commonly associated with chronic inflammation. Because the extent of tissue destruction varies depending on the origin and the severity of inflammation, infected alveolar sockets may display various configurations of their remaining soft and hard tissues following tooth extraction. The aim of this study was to classify infected alveolar sockets and to provide the appropriate treatment approaches. METHODS A proposed classification of extraction sockets with chronic inflammation was developed based upon the morphology of the bone defect and soft tissue at the time of tooth extraction. The prevalence of each type of the suggested classification was determined retrospectively in a cohort of patients who underwent, between 2011 and 2015, immediate bone grafting procedures (ridge preservation/augmentation) after tooth extractions at Seoul National University Dental Hospital. RESULTS The extraction sockets were classified into 5 types: type I, type II, type III, type IV (A & B), and type V. In this system, the severity of bone and soft tissue breakdown increases from type I to type V, while the reconstruction potential and treatment predictability decrease according to the same sequence of socket types. The retrospective screening of the included extraction sites revealed that most of the sockets assigned to ridge preservation displayed features of type IV (86.87%). CONCLUSIONS The present article classified different types of commonly observed infected sockets based on diverse levels of ridge destruction. Type IV sockets, featuring an advanced breakdown of alveolar bone, appear to be more frequent than the other socket types.
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Affiliation(s)
- Jung Ju Kim
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | - Heithem Ben Amara
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | - Inna Chung
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | - Ki Tae Koo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea.
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Juodzbalys G, Stumbras A, Goyushov S, Duruel O, Tözüm TF. Morphological Classification of Extraction Sockets and Clinical Decision Tree for Socket Preservation/Augmentation after Tooth Extraction: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e3. [PMID: 31620265 PMCID: PMC6788426 DOI: 10.5037/jomr.2019.10303] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 01/19/2023]
Abstract
Objectives The aim of present study was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. Material and Methods The search protocol used the electronic MEDLINE (PubMed) and EMBASE databases for articles published between January 1 2009 and May 1 2019. The search included only human studies published in English. Outcomes were the indications and reasons for socket preservation/augmentation and classification of extraction sockets. Results Ten studies fulfilled the inclusion criteria and were selected for the study. Although there are various types of extraction socket classifications none of them could completely evaluate all morphological parameters of alveolar ridge. Furthermore, present study revealed that indications for extraction socket preservation/augmentation have wider spectrum than socket morphology and are related to surrounding tissue anatomy or dental implantation operation indications and timing. Based on currently proposed extraction socket classifications and rationales, a novel decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic area was suggested. Conclusions The need of extraction socket preservation/augmentation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint. A novel clinical decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic zones can be useful tool in socket preservation/augmentation procedures.
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Affiliation(s)
- Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania
| | - Arturas Stumbras
- Department of Oral and Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania
| | - Samir Goyushov
- Department of Periodontology, Faculty of Dentistry, Istanbul Aydin University, IstanbulTurkey
| | - Onurcem Duruel
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, AnkaraTurkey
| | - Tolga Fikret Tözüm
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IllinoisUSA
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Schwarz F, Sahin D, Becker K, Sader R, Becker J. Autogenous tooth roots for lateral extraction socket augmentation and staged implant placement. A prospective observational study. Clin Oral Implants Res 2019; 30:439-446. [DOI: 10.1111/clr.13429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 02/14/2019] [Accepted: 03/24/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum Goethe University Frankfurt Germany
- Department of Oral Surgery Universitätsklinikum Düsseldorf Düsseldorf Germany
| | - Didem Sahin
- Department of Oral Surgery Universitätsklinikum Düsseldorf Düsseldorf Germany
| | - Kathrin Becker
- Department of Oral Surgery Universitätsklinikum Düsseldorf Düsseldorf Germany
- Department of Orthodontics Universitätsklinikum Düsseldorf Düsseldorf Germany
| | - Robert Sader
- Department for Oral, Cranio‐Maxillofacial and Facial Plastic Surgery Medical Center of the Goethe University Frankfurt Frankfurt am Main Germany
| | - Jürgen Becker
- Department of Oral Surgery Universitätsklinikum Düsseldorf Düsseldorf Germany
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Zhao L, Xu T, Hu W, Chung KH. Preservation and augmentation of molar extraction sites affected by severe bone defect due to advanced periodontitis: A prospective clinical trial. Clin Implant Dent Relat Res 2018; 20:333-344. [PMID: 29377475 DOI: 10.1111/cid.12585] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies of the extracted infected-molar ridge preservation are limited. PURPOSE To compare alterations of hard and soft tissue in infected-molar sockets receiving ridge preservation compared with natural healing. MATERIALS AND METHODS Thirty-five infected-molar extraction sites either preserving with Bio-Gide membrane covered the Bio-Oss material or receiving natural healing procedure as controls. The soft tissue profile was evaluated before tooth extraction and after 6-month healing. Cone-beam computed tomography scans were taken immediately and 6 months after extraction. Vertical and horizontal bone changes were assessed radiographically. Data were analyzed with Mann-Whitney U test and α = 0.05. RESULTS No significant differences in soft tissue and vertical bone changes in the medium region of the sockets were found (P > .05). Buccal bone changes in the mesial and distal sites in the test group were significantly lower than the control group (P < .05). Ridge width increased from 0.21mm to 5.30mm at 1mm apical from the crest in the test and reduced from 0.12 mm to 1.00 mm in the control groups. CONCLUSION Ridge preservation at periodontally compromised molar extraction sites might compensate for ridge width and buccal bone resorption that occurs with natural healing alone.
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Affiliation(s)
- Liping Zhao
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, People's Republic of China
| | - Tao Xu
- Department of Emergency, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, People's Republic of China
| | - Wenjie Hu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, People's Republic of China
| | - Kwok-Hung Chung
- Department of Restorative Dentistry, University of Washington, Seattle, Washington, USA
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