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Guruprasad Y, Dhurubatha J, Kumar S, Sultana R, Bakshi HT, Desai DT. A Comparative Study of the Flap and Flapless Techniques of Ridge Preservation: A Clinical Double-Blinded Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1065-S1068. [PMID: 37694067 PMCID: PMC10485448 DOI: 10.4103/jpbs.jpbs_220_23] [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: 03/07/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Extraction of the tooth often leads to crestal bone loss. It is difficult for clinicians to decide on the technique of extraction. Many studies on flap and flapless have led to confusion. Hence it becomes necessary to conduct this study to show the efficient ridge preservation technique. Materials and Methods Twenty patients were selected for this study. It was divided into the flap and flapless groups. In group A, the flap was elevated, tooth extraction was undertaken, the socket was cleaned, a graft was placed, a barrier was placed, and a suture was placed. In group B all the procedures were the same but without flap elevation. After surgery, clinical and radiographical parameters were recorded. Result Flapless technique showed a better result in bone preservation. There was a low vertical bone loss in the flapless technique. Conclusion Both techniques showed bone loss. But the flapless technique gave better results.
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Affiliation(s)
- Yadavalli Guruprasad
- Department of Dentistry, Vijaynagar Institute of Medical Sciences, VIMS Campus, Cantonment, Ballari, Karnataka, India
| | - J Dhurubatha
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Kadapa, Andhra Pradesh, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Rafat Sultana
- Department of Periodontology and Implantology, Design Private Practice, Lifeline Dental Care, Gaya, Bihar, India
| | - Heer T. Bakshi
- Department of Conservative and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Dhriti T. Desai
- Department of Conservative and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
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Liu Y, Li X, Jiang C, Guo H, Luo G, Huang Y, Yuan C. Clinical applications of concentrated growth factors membrane for sealing the socket in alveolar ridge preservation: a randomized controlled trial. Int J Implant Dent 2022; 8:46. [PMID: 36316617 PMCID: PMC9622971 DOI: 10.1186/s40729-022-00448-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to evaluate the efficacy of concentrated growth factor (CGF) membrane for the sealing of alveolar socket in alveolar ridge preservation (ARP). A total of 22 patients with 24 alveolar sockets were recruited and divided randomly into CGF group and Bio-Gide collagen membrane group. The soft tissue wound healing rate was calculated using intraoral scanner at 3, 7, and 14 days after ARP, and the bone resorption volume at 1, 3, and 5 mm below the alveolar ridge was measured by CBCT at 6 months postoperation. The keratinized gingival width was also measured before and 6 months after ridge preservation. In terms of soft tissue healing rate, the CGF group exhibited significant higher than that of Bio-Gide group at both 7 and 14 days after surgery (P < 0.05). However, there was no significantly different in bone resorption rate and the width of keratinized gingival after 6 months (P > 0.05). Therefore, the use of CGFs membranes for wound closure in ARP is a reliable method, but more clinical data are needed to prove it.
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Affiliation(s)
- Yumeng Liu
- grid.417303.20000 0000 9927 0537School of Stomatology, Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Xiaoming Li
- grid.417303.20000 0000 9927 0537Department of Oral Implantology, The Affiliated Stomatological Hospital of Xuzhou Medical University, 130 Huaihai West Road, Xuzhou, 221000 Jiangsu China
| | - Changwei Jiang
- grid.417303.20000 0000 9927 0537Department of Oral Implantology, The Affiliated Stomatological Hospital of Xuzhou Medical University, 130 Huaihai West Road, Xuzhou, 221000 Jiangsu China
| | - Huiying Guo
- grid.417303.20000 0000 9927 0537School of Stomatology, Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Guisheng Luo
- grid.417303.20000 0000 9927 0537School of Stomatology, Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Yangyang Huang
- grid.417303.20000 0000 9927 0537School of Stomatology, Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Changyong Yuan
- grid.417303.20000 0000 9927 0537Department of Oral Implantology, The Affiliated Stomatological Hospital of Xuzhou Medical University, 130 Huaihai West Road, Xuzhou, 221000 Jiangsu China
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Araújo MG, Hürzeler MB, Dias DR, Matarazzo F. Minimal invasiveness in the alveolar ridge preservation, with or without concomitant implant placement. Periodontol 2000 2022; 91:65-88. [PMID: 35913046 DOI: 10.1111/prd.12441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review was to evaluate the benefit of ridge preservation (RP) with minimally invasive (MI) approaches with or without concomitant implant placement on morbidity, esthetics, and patient-related outcomes. Three Internet sources were used to search for appropriate papers. The search strategy was designed to include any clinical study published on RP with MI approaches such as flapless surgery, socket shield and socket sealing techniques and, use of biological agents. Characteristics of the individual studies, regarding methodological aspects, quantitative and qualitative data were extracted. The potential risk of bias was estimated, and the acquired evidence was graded. Independent screening of 860 reports resulted in 26 included original articles. Nine publications evaluated MI approaches for RP without concomitant implant placement. Eleven studies evaluated interventions for RP with immediate implant placement (IIP). Six studies compared RP with IIP vs RP without IIP. This systematic review found that MI approaches in most of the studies failed to improve clinical variables regarding morbidity, esthetics, and patient-related outcomes. Based on the limited number of studies analyzed and the methodological discrepancies observed, it is not possible to confirm that MI approaches promote a significant benefit when applied to RP procedures.
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Affiliation(s)
- Maurício G Araújo
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Markus B Hürzeler
- Private Practice Hürzeler/Zuhr, Munich, Germany.,Department of Operative Dentistry and Periodontology, Albert Ludwigs University, Freiburg, Germany
| | - 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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Aladmawy MA, Natto ZS, Kreitzer M, Ogata Y, Hur Y. Histological and histomorphometric evaluation of alveolar ridge preservation using an allograft and nonresorbable membrane with and without primary closure: A pilot randomized controlled clinical trial. Medicine (Baltimore) 2022; 101:e29769. [PMID: 35777057 PMCID: PMC9239639 DOI: 10.1097/md.0000000000029769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The aim of this article is to assess the formation of new vital bone (VB) using histomorphometric analysis in alveolar ridge preservation (ARP), with and without primary closure. Eight patients needed bilateral tooth extraction and planned for ARP. All patients had a nonresorbable membrane with freeze-dried bone allograft after the extractions. Biopsies were obtained 6 months after ARP and were evaluated using histomorphometric analysis. The study included 6 males and 2 females, with an average age of 54.2 years (standard deviation, 9.7). The teeth requiring extraction included a bilateral canine (1 case), premolars (5 cases), and molars (2 cases). Histomorphometric values of new VB, residual bone (RB) substitute particles, and marrow tissue formation were 71.1 %, 16.2%, and 9.69% for closed flap and 50.9%, 15.3%, and 8.19 for open flap. P values were 0.066, 0.878, and 0.326, respectively. The present findings indicate that leaving the flap without primary closure did not have any effect on new VB, RB particles, and immature bone marrow compared with closed flap. However, the results favored the closed-flap technique.
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Affiliation(s)
- Majdi A. Aladmawy
- Department of Periodontology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA
- *Correspondence: Majdi A. Aladmawy, Department of Periodontology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia (e-mail: )
| | - Zuhair S. Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Yumi Ogata
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA
| | - Yong Hur
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA
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Buccal periosteal inversion (BUPI) for defect closure and keratinized gingiva width preservation after tooth extraction - technique modification. Saudi Dent J 2021; 33:1049-1054. [PMID: 34938049 PMCID: PMC8665163 DOI: 10.1016/j.sdentj.2021.05.004] [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: 09/28/2020] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Several techniques and methods have been proposed to cover alveolar bone after tooth extraction when soft tissue is lacking. Some authors recommend soft tissue flap techniques, and others advocate different types of materials for socket covering. In this article, the authors use a modified buccal inversion technique for adequate coverage of the alveolar ridge to ensure its preservation and to minimize soft tissue shrinkage and loss of keratinized gingiva after tooth extraction. This local mucogingival-periosteal plastic procedure was named by the authors the “Buccal Periosteal Inversion technique” or simply BUPI. Materials and Methods After extraction of a fractured, endodontically compromised lower right first molar, the BUPI technique was performed to cover the alveolus. After reflecting the two-sided full-thickness flap, the periosteum was split in the cranial direction. The inverted periosteum is used to provide tension-free defect closure of the postextractional defect. Detailed technique implementation and patient postoperative healing are presented here in detail. Results Postoperative evaluation at six weeks was presented with photos showing adequate surgical site healing, no signs of infection or dehiscence, and no crestal shift of the keratinized gingiva. Conclusion The buccal periosteal inversion (BUPI) technique is a modified technique that allows full socket coverage, avoiding a keratinized gingiva shift in the crestal direction using only the periosteum as a cover material. By inverting the buccal ridge periosteum alone from its normal position, the osteoclastic effect on the buccal bony wall will be eliminated, and this procedure abolishes the need for additional alveolar coverage materials.
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Atieh MA, Alfardan L, Alsabeeha NHM. Flapped versus flapless alveolar ridge preservation: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 51:133-142. [PMID: 34127352 DOI: 10.1016/j.ijom.2021.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/12/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022]
Abstract
Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. Flapped and flapless surgical approaches have been used for ARP; however, there is a lack of strong scientific evidence regarding their specific influences on the clinical outcomes of ARP. The aim of this systematic review and meta-analysis was to evaluate the effects of flapped and flapless surgical approaches on the dimensional changes of hard and soft tissues and patient-reported outcomes following ARP. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared flapped ARP by means of a coronally advanced flap to flapless ARP where barrier membranes were left exposed. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Data were analysed using a statistical software program. A total of 754 studies were identified, of which five studies with 149 extraction sockets in 128 participants were included. Overall, meta-analysis did not show any significant differences in the changes in ridge width or height between flapped and flapless ARP. The use of flapless ARP was associated with significantly less postoperative pain, thicker labial soft tissues, and marginally more favourable changes in width of the keratinized tissues compared to the flapped approach. The short-term hard tissue changes following ARP with a flapped or flapless approach are comparable. Postoperative pain and labial soft tissue changes are more favourable following ARP using a flapless approach. Further evidence from long-term RCTs is still required to substantiate the current findings.
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Affiliation(s)
- M A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates; Honorary Associate Professor, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
| | - L Alfardan
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - N H M Alsabeeha
- Ras Al-Khaimah Dental Center, Ministry of Health and Prevention, United Arab Emirates
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Natto ZS, Parashis AO, Jeong YN. Soft-Tissue Changes After Using Collagen Matrix Seal or Collagen Sponge With Allograft in Ridge Preservation: A Randomized Controlled Volumetric Study. J ORAL IMPLANTOL 2020; 46:588-593. [PMID: 32369569 DOI: 10.1563/aaid-joi-d-19-00080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study is to assess alterations in buccal soft-tissue contour after alveolar ridge preservation (ARP) using either a collagen matrix seal (CMS) or a collagen sponge (CS) as barriers with freeze-dried bone allograft (FDBA). Participants (28 total) were randomly assigned to the CMS group or CS group (14 participants each). The same clinical steps were used in both barriers. Cast models were taken at baseline and 4 months, and both models were then optically scanned and digitally superimposed. Volumetric, surface, and distance-adjusted measurements were calculated to assess buccal soft-tissue alterations. Surface area and volume loss in the CMS group were observed to be 71.44 ± 1189.09 mm2 and 239.58 ± 231.89 mm3, respectively. The CS group showed measurements of 139.56 ± 557.92 mm2 and 337.23 ± 310.18 mm3. Mean buccal soft-tissue loss and minimum-maximum distance loss were less in the CMS group (0.88 ± 0.52 mm and 0.2-2.15 mm, respectively) as compared with the CS group (1.63 ± 1.03 mm and 0.3-3.68 mm, respectively), with no statistically significant difference between the groups (P = .2742). Both alveolar ridge preservation barriers were unable to entirely prevent soft-tissue contour changes after extraction. However, collagen matrix seal application was slightly better in minimizing the amount of soft-tissue reduction compared with the CS.
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Affiliation(s)
- Zuhair S Natto
- Department of Dental Public Health, School of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Periodontology, School of Dental Medicine, Tufts University, Boston, Mass.,Department of Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University Boston, Mass
| | - Andreas O Parashis
- Department of Periodontology, School of Dental Medicine, Tufts University, Boston, Mass
| | - Y Natalie Jeong
- Department of Periodontology, School of Dental Medicine, Tufts University, Boston, Mass
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Omega-3 Fatty Acids Effects on Inflammatory Biomarkers and Lipid Profiles among Diabetic and Cardiovascular Disease Patients: A Systematic Review and Meta-Analysis. Sci Rep 2019; 9:18867. [PMID: 31827125 PMCID: PMC6906408 DOI: 10.1038/s41598-019-54535-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
The purpose of this systematic review and meta-analysis was to investigate omega-3 fatty acids’ influence on 12 inflammatory biomarkers—LDL, HDL, total cholesterol, TG, HbA1c, Apo AI, Apo AII, Apo B, CRP, TNF-α, glucose, and fasting blood glucose among diabetic and cardiovascular disease (CVD) patients. We searched articles in six database engines, and 16 of the 696 articles reviewed met the inclusion criteria. Among these, lipid and inflammatory biomarkers investigated commonly included total cholesterol (11 studies), LDL, and TG (10 studies each). Overall, omega-3 was associated with a significant reduction in Apo AII among diabetic patients, as compared to different controls (−8.0 mg/dL 95% CI: −12.71, −3.29, p = 0.0009), triglycerides (−44.88 mg/dL 95% CI: −82.6, −7.16, p < 0.0001), HDL (−2.27 mg/dL 95% CI: −3.72, −0.83, p = 0.002), and increased fasting blood glucose (16.14 mg/dL 95% CI: 6.25, 26.04, p = 0.001). Omega-3 also was associated with increased LDL among CVD patients (2.10 mg/dL 95% CI: 1.00, 3.20, p = 0.0002). We conclude that omega-3 fatty acids may be associated with lower inflammatory biomarkers among diabetic and cardiovascular patients. Clinicians should be aware of these potential benefits; however, it is essential to recommend that patients consult with clinicians before any omega-3 intake.
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Helmi MF, Huang H, Goodson JM, Hasturk H, Tavares M, Natto ZS. Prevalence of periodontitis and alveolar bone loss in a patient population at Harvard School of Dental Medicine. BMC Oral Health 2019; 19:254. [PMID: 31752793 PMCID: PMC6873420 DOI: 10.1186/s12903-019-0925-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/09/2019] [Indexed: 12/24/2022] Open
Abstract
Background Although several studies assessed the prevalence of alveolar bone loss, the association with several risk factors has not been fully investigated. The aim of this article is to measure the prevalence of periodontitis by calculating the mean alveolar bone loss/level of posterior teeth using bitewing radiographs among the patients enrolled in the clinics at Harvard School of Dental Medicine and address risk factors associated with the disease. Methods One thousand one hundred thirty-one patients were selected for radiographic analysis to calculate the mean alveolar bone loss/level by measuring the distance between the cementoenamel junction and the alveolar bone crest on the mesial and distal surfaces of posterior teeth. Linear regression with Multi-level mixed-effect model was used for statistical analysis adjusting for age, sex, race, median household income, and other variables. Results Mean alveolar bone level of the whole sample was 1.30 mm (±0.006). Overall periodontitis prevalence for the sample was 55.5% (±1.4%). Moderate periodontitis prevalence was 20.7% (±1.2%), while 2.8% (±0.5%) of the whole sample had severe periodontitis. Adjusted mean alveolar bone loss was higher in older age groups, males, Asian race group, ever smokers, and patients with low median household income. Conclusion The effect of high household income on the amount of bone loss can be powerful to the degree that high household income can influence outcomes even for individuals who had higher risks of developing the disease. Public health professionals and clinicians need to collaborate with policy makers to achieve and sustain high quality of healthcare for everyone.
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Affiliation(s)
- Mohammad F Helmi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Department of Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Hui Huang
- Pre-doc student, School of Dental Medicine, Harvard University, Boston, MA, USA
| | - J Max Goodson
- Department of Oral Medicine, Infection, and Immunity, School of Dental Medicine, Harvard University, Boston, MA, USA.,Department of Applied Oral Sciences, Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Hatice Hasturk
- Department of Applied Oral Sciences, Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Mary Tavares
- Department of Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Zuhair S Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
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