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Gong Z, Gao G, Shi M, Gan X, Cai G, Chen H, Li C, Chen Z, Chen D, Chen Z. Integrated correlation analysis of the thickness of buccal bone and gingiva of maxillary incisors. J Appl Oral Sci 2024; 32:e20240018. [PMID: 38896641 PMCID: PMC11178351 DOI: 10.1590/1678-7757-2024-0018] [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: 01/18/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE This study aimed to validate the integrated correlation between the buccal bone and gingival thickness of the anterior maxilla, and to gain insight into the reference plane selection when measuring these two tissues before treatment with implants. METHODOLOGY Cone beam computed tomography (CBCT) and model scans of 350 human subjects were registered in the coDiagnostiX software to obtain sagittal maxillary incisor sections. The buccal bone thickness was measured at the coronal (2, 4, and 6 mm apical to the cementoenamel junction [CEJ]) and apical (0, 2, and 4 mm coronal to the apex plane) regions. The buccal gingival thickness was measured at the supra-CEJ (0, 1mm coronal to the CEJ) and sub-CEJ regions (1, 2, 4, and 6 mm apical to the CEJ). Canonical correlation analysis was performed for intergroup correlation analysis and investigation of key parameters. RESULTS The mean thicknesses of the buccal bone and gingiva at different levels were 0.64~1.88 mm and 0.66~1.37 mm, respectively. There was a strong intergroup canonical correlation between the thickness of the buccal bone and that of the gingiva (r=0.837). The thickness of the buccal bone and gingiva at 2 mm apical to the CEJ are the most important indices with the highest canonical correlation coefficient and loadings. The most and least prevalent subgroups were the thin bone and thick gingiva group (accounting for 47.6%) and the thick bone and thick gingiva group (accounting for 8.6%). CONCLUSION Within the limitations of this retrospective study, the thickness of the buccal bone is significantly correlated with that of the buccal gingiva, and the 2 mm region apical to the CEJ is a vital plane for quantifying the thickness of these two tissues.
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Affiliation(s)
- Zhuohong Gong
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
| | - Guangqi Gao
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
| | - Mengru Shi
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
| | - Xuejing Gan
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
| | - Gengbin Cai
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
| | - Hongcheng Chen
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
| | - Cuijun Li
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Department of Oral Implantology, Guangzhou , China
| | - Zhuofan Chen
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Zhujiang New Town Dental Clinic, Guangzhou , China
| | - Danying Chen
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Zhujiang New Town Dental Clinic, Guangzhou , China
| | - Zetao Chen
- Sun Yat-sen University , Guanghua School of Stomatology , Hospital of Stomatology , Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China
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Saiter Assis Beltrame L, Delatorre Bronzato J, Jacy da Silva Almeida T, Batista Gagno Intra J, Carneiro Nunes F, de Freitas Britto C, Barcellos de Freitas Coutinho N, Rangel Zanetti G, Frozoni M. Evaluation of Bone Growth around Autotransplanted Teeth Using Cone-Beam Computed Tomographic Images. J Endod 2024; 50:590-595. [PMID: 38428806 DOI: 10.1016/j.joen.2024.02.016] [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: 10/10/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The aim of this observational study was to evaluate bone growth at the recipient site of autotransplanted teeth using cone-beam computed tomography (CBCT) images and to compare it to the control tooth. METHODS Bone growth was measured on CBCT images obtained from the anterior region of the maxilla, which received a single transplant of immature premolars due to early loss of the central incisor. The results were compared to the bone growth of contralateral central incisor that served as control. The sample consisted of 13 autotransplanted teeth and 13 control teeth. It was determined the thickness of the buccal bone of the marginal ridge, the thickness of the palatal bone of the marginal ridge, the height of the maxillary bone, and the thickness of the maxillary bone at its mid-height. The measurements were analyzed statistically, adopting a significance level of 5%. RESULTS The mean interval between the dental autotransplantation surgery and the CBCT scan was 16.2 years. The mean thickness of the buccal bone of the marginal ridge, thickness of the palatal bone of the marginal ridge, height of the maxillary bone, and thickness of the maxillary bone at its mid-height were, respectively, 0.85, 0.94, 19.6, and 8.85 mm for autotransplanted teeth and 0.79, 1.09, 18.88, and 8.5 mm for control teeth. There were no significant differences in the bone measurements between autotransplanted and control teeth (P > .05). CONCLUSIONS The growth of maxillary bone in the region that received the autotransplanted tooth was proportional to that of maxillary bone that supports the contralateral tooth. Thus, autogenous transplantation is efficient in maintaining the bone architecture at the recipient site.
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Affiliation(s)
| | - Juliana Delatorre Bronzato
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.
| | | | - João Batista Gagno Intra
- Department of Endodontics, Brazilian Dental Association of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Fernanda Carneiro Nunes
- Department of Endodontics, Brazilian Dental Association of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Cleber de Freitas Britto
- Department of Orthodontics, Brazilian Dental Association of Espirito Santo, Vitória, Espirito Santo, Brazil
| | | | - Glauco Rangel Zanetti
- Department of Endodontics, Brazilian Dental Association of Espirito Santo, Vitória, Espirito Santo, Brazil; Department of Restorative Dentistry, Federal University of Espirito Santo, Vitória, Espirito Santo, Brazil
| | - Marcos Frozoni
- Department of Endodontics, São Leopoldo Mandic School of Dentistry, Campinas, São Paulo, Brazil
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Janda M, Mattheos N. Prosthetic design and choice of components for maintenance of optimal peri-implant health: a comprehensive review. Br Dent J 2024; 236:765-771. [PMID: 38789753 DOI: 10.1038/s41415-024-7357-0] [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: 10/29/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 05/26/2024]
Abstract
Current research has identified features of the prosthetic design with potential to significantly impact the long-term health of peri-implant tissues, while the choice of prosthetic components is also shown to be critical in an effort to reduce long-term complications of implant therapy. Overcontouring of the prosthesis emergence profile has been associated with marginal bone loss, recession and peri-implantitis, while the mucosal emergence angle is shown to have a strong association with peri-implant tissue inflammation. Further elements of interest include convexity/concavity of the restoration, the prosthetic connection and the different geometric configurations of junctions, as well as the peri-implant tissue dimensions. With regards to implant components, the choice between original and third-party-manufactured components might come with implications, as differences in material and microgeometry might impact precision of fit and overall performance, potentially leading to complications. Scrutiny of the specifications and manufacturing is essential when third-party-manufactured components are considered.The aim of this narrative review was to summarise the current evidence with regards to the restorative features of the implant prosthesis and also the selection of prosthetic components which can have implications for the long-term success of the implant therapy. Furthermore, the review aimed at interpretating current scientific evidence into meaningful strategies and recommendations to implement in clinical practice of implant dentistry.
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Affiliation(s)
- Martin Janda
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Sweden.
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Thailand; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Naiem SN, Al-Nawas B, Tawfik OK, El-Nahass H. Jumping gap in immediate implant placement in the esthetic zone: A virtual implant planning using cone-beam computed tomography. J Prosthodont Res 2024; 68:347-353. [PMID: 37574277 DOI: 10.2186/jpr.jpr_d_23_00033] [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: 08/15/2023]
Abstract
PURPOSE A jumping gap (JG) refers to the implant's future buccal wall; this study aims to estimate the jumping gap dimension in relation to virtual implant placement and subsequently link the implant diameter and implant position with the anatomical site. METHODS This observational study was conducted to analyze the maxillary teeth in the esthetic zone from cone-beam computed tomography (CBCT) scans using OnDemand software. The horizontal jumping gap dimension of each tooth was assessed by subtracting the calculated virtual implant diameter from the socket dimensions. RESULTS A total of 253 anterior and premolar maxillary teeth were analyzed from 52 CBCT scans. The estimated JG dimensions were 1.23 ± 0.59 mm, 1.80 ± 0.64 mm, 3.02 ± 0.69 mm, for central incisors, lateral incisors and canines respectively, 3.70 ± 0.68 mm for the first premolars showing the highest horizontal gap and 3.19 ± 0.88 mm for second premolars. The incisors showed the smallest horizontal gap compared to the canines and premolars. CONCLUSIONS In terms of JG, immediate implant placement is more favorable at the canine and premolar sites. By contrast, the incisors sites should be handled with extreme caution, where the use of narrower implants is advisable when necessary.
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Affiliation(s)
- Suzy Nabil Naiem
- Department of Oral Medicine and Periodontology, Faculty of Dentistry Cairo University, Egypt
| | - Bilal Al-Nawas
- Oral and Maxillofacial Surgery, Plastic surgery department, Mainz University, Germany
| | - Omnia Khaled Tawfik
- Department of Oral Medicine and Periodontology, Faculty of Dentistry Cairo University, Egypt
| | - Hani El-Nahass
- Department of Oral Medicine and Periodontology, Faculty of Dentistry Cairo University, Egypt
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Musskopf ML, Finger Stadler A, Fiorini T, Ramos UD, de Sousa Rabelo M, de Castro Pinto RN, Susin C. Performance of a new implant system and drilling protocol-A minipig intraoral dental implant model study. Clin Oral Implants Res 2024; 35:40-51. [PMID: 37855174 DOI: 10.1111/clr.14194] [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: 10/18/2022] [Revised: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
AIM A new implant system encompassing implants with a tri-oval cross-sectional design and a simplified site preparation protocol at low speed and no irrigation has been developed. The objective of this study was to assess the safety and efficacy of the new implant system using the minipig intraoral dental implant model. METHODS Eight Yucatan minipigs were included. Twelve weeks after extractions, four implants per animal were randomly placed and allowed to heal transmucosal for 13 weeks: two Ø3.5 × 10 mm implants with a back-tapered collar and circular cross-section (control) and two Ø3.5 × 11 mm implants with tri-oval collar and cross-section (test). MicroCT and histological analysis was performed. RESULTS Thirty-two implants were placed; one implant for the control group was lost. Histologically, BIC was higher in the test compared with the control group (74.1% vs. 60.9%, p < .001). At the platform level, inflammation was statistically significantly higher albeit mild in the test compared with the control group. No other significant differences were observed between groups. MicroCT analysis showed that bone-to-implant-contact (BIC) and trabecular thickness were statistically significantly higher for the test than the control group. Test group had significantly higher first BIC distance than controls on lingual sites. CONCLUSIONS The present study results support the safety and efficacy of the new dental implant system and simplified site preparation protocol; human studies should be carried out to confirm these findings.
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Affiliation(s)
- Marta Liliana Musskopf
- Laboratory for Applied Periodontal & Craniofacial Research, Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda Finger Stadler
- Laboratory for Applied Periodontal & Craniofacial Research, Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tiago Fiorini
- Department of Conservative Dentistry - Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Research, Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Rodrigues DM, Petersen RL, Montez C, de Moraes JR, Ferreira V, Barboza EP. The relationship between tomographic sagittal root position of maxillary anterior teeth and the bone housing. J Prosthet Dent 2023; 130:705-714. [PMID: 35012769 DOI: 10.1016/j.prosdent.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 01/10/2023]
Abstract
STATEMENT OF PROBLEM In a prosthetically driven treatment plan, the tomographic sagittal root position in relation to the bone housing is an important factor in the decision-making process for immediate implant placement. However, other important parameters must be considered in the bone housing of each tooth, including the alveolar ridge dimensions, the buccal and the palatal bone thickness, and the root dimensions. PURPOSE The purpose of this clinical study was to evaluate the relationship between the sagittal root position of maxillary anterior teeth and the bone housing. MATERIALS AND METHODS A total of 420 maxillary anterior teeth were analyzed in 70 participants. The tomographic scans were classified as sagittal root position classes I, II, III, and IV. Measurements included buccal and palatal bone thickness, alveolar ridge height, alveolar ridge width, apical bone height, root length, and root width. The Pearson correlation, ANOVA, and Tukey post hoc tests were used to determine statistically significant differences (α=0.05). RESULTS The sagittal root position distribution was 65.2%, 9.3%, 0.7%, and 24.8% for classes I, II, III, and IV, respectively. Bone housing measurements were significantly different in relation to the 4 sagittal root position classes (P<.05), except for alveolar ridge height. Post hoc analysis showed that, in class I, buccal bone thickness and alveolar bone height were significantly low, whereas root length and palatal bone thickness were high. The higher buccal bone thickness was found in class II, and lower alveolar ridge width and palatal bone thickness in class IV. These measurements in tooth groups were also significantly different over the sagittal root position classes (P<.05). The buccal bone thickness, palatal bone thickness, and alveolar ridge width presented different levels of correlation with alveolar ridge width over the sagittal root position classes. The buccal bone thickness and palatal bone thickness were weakly correlated in class I (r=0.163) and IV (r=0.222). CONCLUSIONS Bone housing measurements were significantly different in relation to the sagittal root position of maxillary anterior teeth.
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Affiliation(s)
| | - Rodrigo L Petersen
- Radiologist, Petersen Diagnostic Imaging Center, Niterói, Rio de Janeiro, Brazil
| | - Caroline Montez
- Student, Graduate Program, School of Dentistry, Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil
| | - José R de Moraes
- Professor, Department of Statistics, Institute of Statistics and Mathematics, Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Vinicius Ferreira
- Student, Post Graduate Program, School of Dentistry, Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Eliane Porto Barboza
- Professor of Periodontology, Department of Dental Clinic, School of Dentistry, Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil.
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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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Schulze R. The problem in visualization and measuring tiny structures on CBCT-images. J Orofac Orthop 2023; 84:340-341. [PMID: 37353684 DOI: 10.1007/s00056-023-00477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Affiliation(s)
- R Schulze
- Head Division of Oral Diagnostic Sciences, School of Dental Medicine, University of Bern, Freiburgstr. 7, 3010, Bern, Switzerland.
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Couso-Queiruga E, Barboza EP, Avila-Ortiz G, Gonzalez-Martin O, Chambrone L, Rodrigues DM. Relationship between supracrestal soft tissue dimensions and other periodontal phenotypic features: A cross-sectional study. J Periodontol 2023; 94:944-955. [PMID: 36797817 DOI: 10.1002/jper.22-0434] [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: 07/20/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The purpose of this study was to determine the association between periodontal supracrestal soft tissue dimensions (PSSTDs) and other phenotypic features in non-molar maxillary teeth. MATERIALS AND METHODS Adult subjects in need of comprehensive dental treatment were recruited. Periodontal phenotypic variables (i.e., facial and palatal gingival thickness [GT], alveolar bone thickness [BT], and PSSTDs, namely distance from the gingival margin to the bone crest defined as periodontal supracrestal tissue height [PSTH] and distance from the cementoenamel junction to the bone crest [CEJ-BC]) were recorded using cone-beam computed tomography scans. Standardized intraoral photographs were obtained to assess facial keratinized tissue width (KTW) and other anatomical parameters (i.e., tooth type, gingival architecture, and interproximal papilla height). RESULTS The study sample was constituted of 87 participants that contributed with a total of 522 maxillary anterior teeth. Differences in mean values of PSSTDs, KTW, GT, and BT were observed between tooth types and sex. Males exhibited a thicker GT and BT, and taller PSTH and KTW compared to females. Shorter CEJ-BC was associated with shorter PSTH, wider KTW, and thicker GT and BT. Shorter PSTH was associated with thicker facial BT. Notably, BT and GT were positively correlated at both facial and palatal sites, meaning that the thicker the gingival phenotype, the thicker the bone morphotype. Facial BT and facial GT were positively correlated with KTW. A flat gingival architecture was associated with the thick periodontal phenotype. Square teeth had shorter CEJ-BC, wider KTW, and thicker GT. CONCLUSIONS Periodontal phenotypic features vary across and within subjects, between facial and palatal sites at different apico-coronal levels, and as a function of sex and tooth type. The shorter the PSSTDs, the wider the KTW and the thicker the GT and BT. PSSTDs, particularly PSTH, should be considered an integral component of the periodontal phenotype.
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Affiliation(s)
- Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eliane Porto Barboza
- Department of Dental Clinic, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Gustavo Avila-Ortiz
- Private Practice, Atelier Dental Madrid, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Oscar Gonzalez-Martin
- Private Practice, Atelier Dental Madrid, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
- Department of Periodontology, Complutense University of Madrid, Madrid, Spain
| | - Leandro Chambrone
- Evidence-Based Hub, Interdisciplinary Research Center Egas Moniz (CiiEM), Egas Moniz-Cooperative of Higher Education, Caparica, Almada, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Diogo Moreira Rodrigues
- Department of Periodontology, National Institute of Dental Sciences (INCO 25), Niterói, Rio de Janeiro, Brazil
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Stefanini M, Rendón A, Zucchelli A, Sangiorgi M, Zucchelli G. Avoiding errors and complications related to immediate implant placement in the esthetic area with a mucogingival approach. Periodontol 2000 2023; 92:362-372. [PMID: 37365042 DOI: 10.1111/prd.12491] [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: 03/26/2023] [Accepted: 04/07/2023] [Indexed: 06/28/2023]
Abstract
Immediate implant placement is considered the treatment of choice for single tooth replacement in the esthetic area. However, this treatment is associated with several critical drawbacks related to the inadequate assessment/management of the soft and hard peri-implant tissues and their subsequent remodeling, resulting in peri-implant soft-tissue defects that can lead to impaired esthetic outcomes in time. We describe in detail how the mucogingival approach to immediate implant placement ensures a standard result regardless of the baseline soft-hard tissue situation. Fully guided implant placement guarantees an adequate three-dimensional implant placement, the flap design makes it possible to perform bone augmentation with complete visibility of the area being treated, allows soft tissue augmentation with proper fixation of the connective tissue graft, and the placement of an immediate provisional ensures stabilization of the peri-implant tissues throughout the healing period.
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Affiliation(s)
- Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, Periodontology Unit, Bologna University, Bologna, Italy
| | - Alexandra Rendón
- Department of Biomedical and Neuromotor Sciences, Periodontology Unit, Bologna University, Bologna, Italy
| | | | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences, Periodontology Unit, Bologna University, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, Periodontology Unit, Bologna University, Bologna, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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13
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Aljabr AA, Almas K, Aljofi FE, Aljabr AA, Alzaben B, Alqanas S. A CBCT Study of Labial Alveolar Bone Thickness in the Maxillary Anterior Region in a Teaching Hospital Population in the Eastern Province of Saudi Arabia. Biomedicines 2023; 11:1571. [PMID: 37371666 DOI: 10.3390/biomedicines11061571] [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: 04/01/2023] [Revised: 05/19/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Labial alveolar bone thickness in the maxillary anterior region is the key factor in the placement of implants. Differences in the thickness of the bone are reported among different ethnic groups. Thus, the present study was aimed at assessing labial alveolar bone thickness in the maxillary anterior region in the population of the eastern province of Saudi Arabia. MATERIALS AND METHODS The six anterior teeth in each of the 186 CBCT sagittal images were analyzed at three points: Point A from the facial plate at the level of the bone crest to the coronal root third, Point B to the mid-root surface, and Point C to the apical third. Crest height (Point D) was measured as the distance from the CEJ to the alveolar bone crest. The analysis was done using SPSS version 20. A p-value of <0.05 was considered statistically significant. RESULTS The bone thickness at any given point (Point A, Point B, or Point C) was less than the preferred bone thickness of 2 mm in all six teeth. The thickness was minimum at Point B, maximum at Point C, and intermediate at Point A. This difference was found to be statistically significant (p-value < 0.05). The crestal height (Point D) was less than 3 mm, and it was not statistically significant. Comparison of bone thickness on the right and left sides for any given point was not statistically significant except at Point A in the central incisor, where it was statistically significant (p-value = 0.035). Gender comparison of bone thickness showed no difference at Point A; however, at Points B and C, it showed statistical significance (p-value < 0.05). CONCLUSIONS The alveolar bone thickness being <2 mm in the labial anterior region warns of the importance of the proper assessment of bone during implant placement to have a predictable outcome.
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Affiliation(s)
- Abdulmajeed A Aljabr
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Khalid Almas
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Faisal E Aljofi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Abdullah A Aljabr
- Department of Medical Education, College of Dentistry, Majmaah University, P.O. Box 1712, Al Majma'ah 15341, Saudi Arabia
| | - Bader Alzaben
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Sarah Alqanas
- College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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14
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AlAli F, Atieh MA, Hannawi H, Jamal M, Harbi NA, Alsabeeha NHM, Shah M. Anterior Maxillary Labial Bone Thickness on Cone Beam Computed Tomography. Int Dent J 2023; 73:219-227. [PMID: 35527034 PMCID: PMC10023538 DOI: 10.1016/j.identj.2022.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
AIM The objective of this research was to measure the labial bone thickness (LBT) in relation to the 6 anterior maxillary teeth at different levels along the long axis and the distance between cementoenamel junction and bone crest (CEJ-BC) based on cone beam computed tomography (CBCT) scans retrieved from patients of Arab ethnicity and identify any association with patients' characteristics. MATERIALS AND METHODS A total of 100 CBCT scans were evaluated by one calibrated examiner. The thickness of the labial bone was measured perpendicular to the long axis of the tooth at 1, 3, and 5 mm from the alveolar crest (LBT-1, LBT-3, and LBT-5, respectively) and CEJ-BC using a medical imaging viewer. RESULTS CBCT scans of 58 female patients and 42 male patients with a mean age of 39.7 ± 9.5 years were included. A high variation of CEJ-BC was observed (range, 0.55-3.90 mm). Statistically significant higher CEJ-BC values were associated with men and increased age (>50 years). The overall means of LBT-1 were 0.76 ± 0.26, 0.79 ± 0.26, and 0.83 ± 0.37 mm; LBT-3: 0.92 ± 0.36, 1.05 ± 0.46, and 1.03 ± 0.48 mm; LBT-5: 1.17 ± 0.52, 0.80 ± 0.45, and 0.81 ± 0.40 mm for central incisors, lateral incisors, and canines, respectively. The LBT was <1 mm in 74.2% of all maxillary anterior teeth, with central incisors showing the highest predilection (85% with LBT <1 mm). No significant association between LBT and patient characteristics was observed. CONCLUSIONS The CEJ-BC distance is greater in men and increases with age, particularly in those aged 50 years and older. The LBT in the 6 maxillary anterior teeth is predominantly thin (<1 mm) and has no correlation to age or sex. An increased LBT was observed at a 3-mm level when compared with LBT-1 and LBT-5. Such variability should be taken into consideration when planning for implant placement.
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Affiliation(s)
- Fawaghi AlAli
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Momen A Atieh
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates; Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Haifa Hannawi
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates; Emirates Health Services, Dubai, United Arab Emirates
| | - Mohamad Jamal
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | | | | | - Maanas Shah
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates.
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15
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Todorovic VS, Postma TC, Hoffman J, van Zyl AW. Buccal and palatal alveolar bone dimensions in the anterior maxilla: A micro-CT study. Clin Implant Dent Relat Res 2023; 25:261-270. [PMID: 36596566 DOI: 10.1111/cid.13175] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Anterior maxillary immediate implant placement has become a popular procedure. It has aesthetic and functional risks. A prerequisite for success is sufficient alveolar bone for primary stability. Many cone-beam computed tomography (CBCT) studies have assessed alveolar bone dimensions in the anterior maxilla, with varying results. More accurate information on the alveolar bone dimensions in the anterior maxilla is required. The objective of the present study was to evaluate bone dimensions in the anterior maxilla using micro-CT, a high-resolution imaging tool. MATERIALS AND METHODS Seventy-two human skulls were scanned using micro-CT at the South African Nuclear Energy Corporation. Specialized software was used for 3-D rendering, segmentation, and visualization of the reconstructed volume data. Axial planes were created over each alveolus/tooth from canine to canine. Buccal and palatal bone dimensions were measured at crestal, 3 mm, 6 mm, and 9 mm levels. RESULTS Buccal bone rarely exceeded 0.5 mm, consisting of bundle bone only for all investigated teeth at all levels. Up to a third of teeth showed buccal fenestrations. Alveolar bone on the palatal side was thicker than buccal and increased from <1 mm at crestal level up to 3.77 mm, 4.56 mm, and 5.43 mm for centrals, laterals, and canines at the 9 mm level, respectively. CONCLUSIONS Immediate implants in the anterior maxillae has anatomical risks. Alveolar bone on the buccal aspect is very thin, with fenestrations in certain positions. Therefore, a thorough planning and individual approach are needed to avoid possible complications and achieve stable aesthetic and functional results in the long-term.
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Affiliation(s)
- Vladimir S Todorovic
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Thomas C Postma
- Department of Dental Management Sciences, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Jakobus Hoffman
- Necsa (The South African Nuclear Energy Corporation), Pretoria, South Africa
| | - Andre W van Zyl
- Private Practice, Western Cape, South Africa.,Department of Oral Medicine and Periodontology, University of Pretoria, Pretoria, South Africa
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16
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Othman B, Zahid T, Khalifa H, Afandi A, Alshehri NA, Sait A, Abdoun S. Measuring the Facial Plate of Bone in the Upper Anterior Teeth Utilizing Cone Beam Computed Tomography at King Abdulaziz University, Jeddah, Saudi Arabia. Cureus 2022; 14:e29453. [PMID: 36159355 PMCID: PMC9497454 DOI: 10.7759/cureus.29453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aim Radiographic assessment is an important diagnostic tool in dental practice.Cone beam computed tomography (CBCT) is among the most important imaging examinations. By providing multiplanar visualization of the maxillofacial region, CBCT enables practitioners to assess various conditions three-dimensionally. CBCT is utilized in different fields within dentistry, including oral and maxillofacial surgery, endodontics, orthodontics, periodontics, implant dentistry, and others. Having access to accurate 3D images is crucial in implant dentistry. This study aimed to measure the crestal bone height loss and facial alveolar bone thickness in the maxillary anterior teeth using CBCT to investigate its effect on surgical planning for dental implant placement in adult patients. Material and methods CBCT scans (N = 119) of adults, aged 18-65 years, with bilateral permanent maxillary anterior teeth present were included in this retrospective study. The mean alveolar bone plate thickness and crest bone height loss adjacent to the maxillary anterior teeth were measured and differences were examined. Results The results suggest that additional care and assessment of dental implant placement should be considered when replacing the permanent lateral incisors and canines. The frequency of fenestrations and dehiscence is higher in older adults. Possible management includes guided bone regeneration or “pink restorative solutions.” Conclusion CBCT analysis to assess the bone morphology surrounding “hopeless” maxillary anterior teeth is important to ensure proper diagnosis and management, including the use of dental implants.
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17
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Incidence and clinical risk factors associated with the development of labial protuberances after orthodontic treatment. Am J Orthod Dentofacial Orthop 2022; 162:890-897. [PMID: 36117032 DOI: 10.1016/j.ajodo.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Distinct, irregular, and hard, nodular labial protuberances (LPs) that were due to differential alveolar bone modeling can be noted on the labial gingival surface of the incisors after orthodontic treatment. Clinically, LPs cause patient discomfort and esthetic issues, but information on this phenomenon is limited. This study aimed to evaluate the incidence of LPs and demonstrate the etiology and clinical risk factors associated with this phenomenon. METHODS Differential alveolar bone modeling was defined as present (+) when ≥1 distinct LPs (diameter >1 mm) developed after orthodontic treatment by comparing pretreatment and posttreatment intraoral photographs and casts of an orthodontic patient cohort treated with fixed appliances (n = 872). The incidence rate, affected sites, and their association with age, sex, and orthodontic treatment modalities were evaluated. RESULTS The incidence rate of differential alveolar bone modeling among orthodontic patients was 3.2% (28 out of 872). The maxillary lateral incisor region was the most frequently affected site. Males (vs females) (odds ratio, 2.56 [95% confidence interval, 1.155-5.604]), adults (aged ≥ 20 years) (vs teens) (12.84 [3.003-54.866]), and those who had orthodontic extraction (vs nonextraction) (11.60 [3.434-39.156]) demonstrated significantly higher odds of developing LPs after orthodontic treatment (P <0.05). CONCLUSIONS The incidence rate of the development of notable LPs after orthodontic treatment was 3.2%. Adult males and those who undergo orthodontic extraction have a higher risk of developing LPs. Clinicians should be aware that distinct LPs may develop when large amounts of incisal retraction are planned in adults.
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18
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Naghibi N, Fatemi K, Hoseini‐Zarch S, Sadeghi B, Fasihi Ramandi M. CBCT evaluation of buccal bone thickness in the aesthetic zone of menopausal women: A cross‐sectional study. Clin Exp Dent Res 2022; 8:1076-1081. [PMID: 35796053 PMCID: PMC9562795 DOI: 10.1002/cre2.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nava Naghibi
- School of Dentistry, Dental Research Center, Mashhad University of Medical Science Mashhad Iran
| | - Kazem Fatemi
- School of Dentistry, Dental Research Center, Mashhad University of Medical Science Mashhad Iran
| | - Seyed‐Hosein Hoseini‐Zarch
- Oral and Maxillofacial Radiology, Dental Materials Research Center, Mashhad University of Medical Sciences Mashhad Iran
| | - Bijan Sadeghi
- School of Dentistry, Mashhad University of Medical Sciences Mashhad Iran
| | - Mahdiye Fasihi Ramandi
- Department of Periodontics School of Dentistry, Mashhad University of Medical Sciences Mashhad Iran
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19
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Rodrigues DM, Barreto LSDC, Petersen RL, Ferreira V, Cavalcante DM, Barboza EDSP. Relationship between smile type and periodontal phenotype: a clinical and tomographic cross-sectional study. J Dent 2022; 122:104160. [PMID: 35550399 DOI: 10.1016/j.jdent.2022.104160] [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: 02/04/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To evaluate the correlation between smile type (ST) and the periodontal phenotype (PP). MATERIAL AND METHODS Clinical and photographic examinations of 164 participants (48 men and 116 women, mean age 22.9 ± 4.6 years) were performed, including an evaluation of ST (high, average, and low), gingival phenotype (GP) by transparency of the periodontal probe (TRAN), keratinized tissue width (KTW), gingival architecture (GA), tooth shape (TS), and papilla height (PH). A subgroup of 70 participants underwent soft-tissue cone-beam tomographic examinations (ST-CBCT), in which GP, gingival thickness (GT), buccal bone thickness (BBT), and the distances from the gingival margin and cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC) were evaluated. The data were analyzed using one-way ANOVA, Student's t-test, and chi-square tests, with the level of significance set at 0.05. RESULTS High, average, and low STs were found in 31.7%, 56.7%, and 11.6% of the participants, respectively. Sex (p=0.001), GP evaluated using TRAN (p=0.021) and ST-CBCT scans (p=0.009), GA (p<0.001), and TS (p=0.001), were associated with STs. The prevalence of thin GP was: 63% in low, 50% in average, and 38% in high smile types. KTW (p=0.004), PH (p<0.001), GT at different landmarks (p<0.05), CEJ-BBC (p=0.017), and GM-BBC (p=0.001) were significantly different among STs. The highest GT and KTW were found in the high-smile group, average-smile presented the higher CEJ-BBC while GM-BBC and PH, were higher in low-smile group. CONCLUSION Periodontal phenotype components presented important difference over the smile types. CLINICAL RELEVANCE A detailed examination of smile types is an essential part of treatment planning, especially when the patient has high esthetic demands. Clinical and tomographic individual analysis of periodontal phenotypes over the smile types may be helpful for a case-by-case approach, and for the development of well-defined treatment protocols.
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Affiliation(s)
| | | | | | - Vinicius Ferreira
- Post Graduate Program, Department of Dental Clinic, Federal Fluminense University School of Dentistry, Niterói, Brazil
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20
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MacBeth N, Donos N, Mardas N. Alveolar Ridge Preservation with Guided Bone Regeneration or Socket Seal Technique. A Randomised, Single-Blind Controlled Clinical Trial. Clin Oral Implants Res 2022; 33:681-699. [PMID: 35488477 PMCID: PMC9541021 DOI: 10.1111/clr.13933] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/27/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
Objectives To compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket healing (Control). Material and methods Patients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n= 14/). Cone Beam Computed Tomography (CBCT) images were recorded post‐extraction and at 4 months, the mid‐buccal and mid‐palatal alveolar ridge heights (BARH/PARH) were measured. The alveolar ridge width, cross‐sectional socket and alveolar‐process area changes, implant placement feasibility, requirement for bone augmentation and post‐surgical complications were also recorded. Results BARH and PARH was found to increase with the SS (0.65 mm ± 1.1/0.65 mm ± 1.42) techniques, stabilise with GBR (0.07 mm ± 0.83/0.86 mm ±1.37) and decrease in the Control (−0.52 mm ± 0.8/−0.43 mm ± 0.83). Statistically significance was found when comparing the GBR and SS BARH (p = .04/.005) and GBR PARH (p = .02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (−2.17 mm ± 0.84), when compared to the Control (−2.3 mm ± 1.11) (p = .89). A mid‐socket cross‐sectional area reduction of 4% (−2.27 mm2 ± 11.89), 1% (−0.88 mm2 ± 15.48) and 13% (−6.93 mm2 ± 8.22) was found with GBR, SS and Control groups (GBR vs. Control p = .01). The equivalent alveolar process area reduction was 8% (−7.36 mm2 ± 10.45), 6% (−7 mm2 ± 18.97) and 11% (−11.32 mm2 ± 10.92). All groups supported implant placement, with bone dehiscence noted in 57% (n = 4), 64%(n = 7) and 85%(n = 12) of GBR, SS and Control cases (GBR vs. Control p = .03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown. Conclusion GBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.
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Affiliation(s)
- 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, Guilford, Surry, 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
| | - 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
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21
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Relationship between anterior maxillary tooth sagittal root position and periodontal phenotype: a clinical and tomographic study. Clin Oral Investig 2021; 26:1309-1321. [PMID: 34529147 DOI: 10.1007/s00784-021-04105-1] [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: 04/07/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the relationship between the tomographic sagittal root position (SRP) of maxillary anterior teeth and periodontal phenotype (PP). MATERIAL AND METHODS Seventy volunteers (420 teeth) were evaluated. Clinical and photographic exams included the evaluation of gingival phenotype (GP) by transparency of the periodontal probe, keratinized tissue width (KTW), gingival architecture, tooth shape, and papilla height (PH). Soft tissue tomographic scan (ST-CBCT) measurements included the SRP classification, GP, gingival thickness in the tissue zone (GT-TZ) and in the bone zone (GT-BZ), buccal bone thickness (BBT), and the distances from the gingival margin and from cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC). Kruskal-Wallis test and a linear regression analysis model were used. RESULTS The frequency of SRP over the 420 teeth was 65.2% (class I), 9.3% (class II), 0.7% (class III), and 24.8% (class IV). Linear regression analysis showed that SRP is related to PP (p < 0.05). Significantly different measurements of PP parameters were found in SRP classes. The higher and lower GT and BBT were found in classes II and I, respectively. Class IV presented the highest KTW, PH, CEJ-BBC, and GM-BBC. Central incisors (CI) classes I and II were most frequently square-shaped, while 89% of CI Class IV were triangular-shaped. CONCLUSION The SRP of maxillary anterior teeth is related to periodontal phenotype. CLINICAL RELEVANCE Clinical and ST-CBCT individual analysis of PP and SRP may be helpful for an esthetic and functional treatment plan based on soft and hard tissue thickness and tooth positioning.
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22
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Zaki J, Yusuf N, El‐Khadem A, Scholten RJPM, Jenniskens K. Efficacy of bone-substitute materials use in immediate dental implant placement: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2021; 23:506-519. [PMID: 34118175 PMCID: PMC8453723 DOI: 10.1111/cid.13014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/25/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the efficacy of using a bone substitute material (BSM) in the fixture-socket gap in patients undergoing tooth extraction and immediate implant placement. MATERIALS AND METHODS MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs). RCTs were screened for eligibility, and data were extracted by two authors independently. Risk of bias (ROB) was assessed using Cochrane's ROB tool 2.0. Primary outcomes were implant failure, overall complications, and soft-tissue esthetics. Secondary outcomes were vertical buccal bone resorption, vertical interproximal bone resorption, horizontal buccal bone resorption, and mid-buccal mucosal recession. Meta-analysis was performed using random-effects model with generic inverse variance weighing. GRADE was used to grade the certainty of the evidence. RESULTS After screening 19 544 potentially eligible references, 20 RCTs were included in this review, with a total of 848 patients (916 sites). Most included RCTs were deemed of some concerns (53%) or at low (38%) risk of bias, except for overall complications (high ROB). Implant failure did not differ significantly RR = 0.92 (confidence intervals [CI] 0.34 to 2.46) between using a BSM compared with not using a BSM (NoBSM). BSM use resulted in less horizontal buccal bone resorption (MD = -0.52 mm [95% CI -0.74 to -0.30]), a higher esthetic score (MD = 1.49 [95% CI 0.46 to 2.53]), but also more complications (RR = 3.50 [95% CI 1.11 to 11.1] compared with NoBSM. Too few trials compared types of BSMs against each other to allow for pooled analyses. The certainty of the evidence was considered moderate for all outcomes except implant failure (low), overall complications (very low), and vertical interproximal bone resorption (very low). CONCLUSION BSM use during immediate implant placement reduces horizontal buccal bone resorption and improves the periimplant soft-tissue esthetics. Although BSM use increases the risk of predominantly minor complications.
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Affiliation(s)
- John Zaki
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Maidan Dental ClinicKuwait
| | - Nermin Yusuf
- Department of Periodontology, Faculty of DentistryCairo UniversityGizaEgypt
| | - Ahmed El‐Khadem
- The Centre for Evidence‐Based Dentistry, Faculty of DentistryCairo UniversityGizaEgypt
- Department of Pediatric Dentistry, Faculty of DentistryCairo UniversityGizaEgypt
| | - Rob J. P. M. Scholten
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Kevin Jenniskens
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
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23
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Ulm C, Strbac GD, Stavropoulos A, Esfandeyari A, Dobsak T, Bertl K. Improved access to the bone marrow space by multiple perforations of the alveolar bundle bone after tooth extraction-A case report. Clin Exp Dent Res 2021; 8:3-8. [PMID: 34296542 PMCID: PMC8874110 DOI: 10.1002/cre2.474] [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: 01/10/2021] [Revised: 05/16/2021] [Accepted: 06/30/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives The dental alveolus is lined by a thin cortical layer (“bundle bone”, “alveolar bone proper”, “cribriform plate”, “lamina dura”), that can impede access to the bone marrow and its vasculature. During unassisted socket healing, the alveolar bundle bone is gradually resorbed allowing tissue resources from the bone marrow to enter into the socket space. An optimized wound healing process, either during unassisted socket healing or during ridge preservation procedures, with autogenous bone and/or any bone/collagen substitute material, depends at least partly on an adequate vascularization of the socket space. This ensures sufficient recruitment of osteoblast and osteoclast precursor cells and facilitates fast bone regeneration and/or uneventful integration of the augmentation material. Methods The present technical note describes an easy treatment step after tooth extraction aiming to improve socket healing with or without any ridge preservation procedure, by facilitating an increased blood inflow into the dental alveolus. Specifically, after tooth extraction the alveolar bundle bone is perforated several times – mainly in a palatally/lingually – by a small round bur (diameter < 1 mm) extending into the trabecular bone. Results and conclusions By means of this relatively simple treatment step, an increased blood inflow into the alveolus is achieved after tooth extraction, which might enhance socket healing and corticalization of the entrance, and in turn result in a lower complication rate (e.g., dry socket), in an enhanced graft incorporation, and/or in a reduced loss of alveolar ridge volume.
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Affiliation(s)
- Christian Ulm
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Georg D Strbac
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Azadeh Esfandeyari
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Toni Dobsak
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Kristina Bertl
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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Velasco Bohórquez P, Rucco R, Zubizarreta-Macho Á, Montiel-Company JM, de la Vega Buró S, Madroño EC, Marín LSH, Hernández Montero S. Failure Rate, Marginal Bone Loss, and Pink Esthetic with Socket-Shield Technique for Immediate Dental Implant Placement in the Esthetic Zone. A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10060549. [PMID: 34207379 PMCID: PMC8235067 DOI: 10.3390/biology10060549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
Aim: To compare the failure rate, marginal bone loss, and pink esthetic for the socket-shield technique and the conventional technique for immediate dental implant placement in the esthetic zone. Material and methods: A systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the failure rate, marginal bone loss, and pink esthetic with the socket-shield technique for immediate dental implant placement in the esthetic zone was performed. A total of 4 databases were consulted in the literature search: PubMed-MEDLINE, Scopus, Embase, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, 16 articles were selected for the qualitative and quantitative analysis. Results: Four randomized controlled trials, five prospective clinical studies, four retrospective studies, and three case series were included in the meta-analysis. The dental implant failure rate for the socket-shield technique for immediate dental implant placement was 1.37% (95% CI, 0.21-2.54%); however, no statistically significant differences between the conventional and socket-shield technique were found. The estimated mean difference in the marginal bone loss for the socket-shield technique was -0.5 mm (95% CI, -0.82 to -0.18) and statistically significant (p < 0.01), with a high heterogeneity (I2 = 99%). The mean pink esthetic score was 12.27 (Q test = 4.47; p-value = 0.61; I2 = 0%). The difference in pink esthetic between the conventional (n = 55) and socket-shield techniques (n = 55) for immediate dental implant placement was 1.15 (95% CI, 0.73-1.58; Q test = 8.88; p value = 0.11; I2 = 44%). The follow-up time was found to be significant (beta coefficient = 0.023; R2 = 85.6%; QM = 3.82; p = 0.049) for the PES for the socket-shield technique. Conclusions: Within the limitations of this systematic review with meta-analysis, the dental implant failure rate did not differ between the socket-shield technique and conventional technique for immediate implant placement in the esthetic zone. However, a lower marginal bone loss and higher pink esthetic scores were found for the socket-shield technique compared to the conventional technique.
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Affiliation(s)
- Pilar Velasco Bohórquez
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
| | - Roberta Rucco
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
- Correspondence:
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - Susana de la Vega Buró
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
| | - Esther Cáceres Madroño
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
| | - Lara San Hipólito Marín
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
| | - Sofía Hernández Montero
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (P.V.B.); (R.R.); (S.d.l.V.B.); (E.C.M.); (L.S.H.M.); (S.H.M.)
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Shemtov-Yona K. Quantitative assessment of the jawbone quality classification: A meta-analysis study. PLoS One 2021; 16:e0253283. [PMID: 34133463 PMCID: PMC8208540 DOI: 10.1371/journal.pone.0253283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/02/2021] [Indexed: 12/26/2022] Open
Abstract
AIM Bone quality is evaluated using bone density for qualitative classification, a characteristic that may be delicate to evaluate. Contemporary implantology that relies on modern measurement techniques, needs a more quantitative estimate of the bone quality. MATERIALS AND METHODS PubMed and EMBASE databases were searched with no time restriction. Clinical and radiographic studies reporting on alveolar ridge dimensions and its parameters in different areas of the dentate and edentulous jaws were included. A meta-analysis was performed using random effect models to report a combined mean for alveolar ridge and its parameters. Meta regression statistical tests were performed in order to identify differences in those outcome parameters. RESULTS 30 studies were included. The majority of the selected studies (total of 27) used live human subjects and CBCT to analyze alveolar ridge dimensions and its parameters. Using the combined mean obtained from the meta-analysis, a typical portrait of the alveolar ridge was constructed, and a geometrically based quantitative bone classification proposed. The quantitative classification was found to match the existing qualitative classification. CONCLUSION A geometry-based analysis was constructed that yields valuable insights on the bone type based on its components and on the dynamics of the dentate / edentulous states.
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Affiliation(s)
- Keren Shemtov-Yona
- Faculty of Mechanical Engineering, Technion, Haifa, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Department of Oral Biology, Tel Aviv University, Tel Aviv, Israel
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