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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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Benalcázar Jalkh EB, Tovar N, Arbex L, Kurgansky G, Torroni A, Gil LF, Wall B, Kohanbash K, Bonfante EA, Coelho PG, Witek L. Effect of leukocyte-platelet-rich fibrin in bone healing around dental implants placed in conventional and wide osteotomy sites: A pre-clinical study. J Biomed Mater Res B Appl Biomater 2022; 110:2705-2713. [PMID: 35771197 DOI: 10.1002/jbm.b.35122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
Leukocyte-platelet-rich fibrin (L-PRF) has been suggested for gap management for immediate implant placement when the distance is greater than 2 mm. However, there remains a paucity in hierarchically designed research to support this application. The present study aimed to evaluate the effect of L-PRF on the osseointegration parameters of dental implants placed after conventional osteotomy of surgically created bone defects that simulate post extraction sockets in a canine model after 3, 6, and 12 weeks in vivo. Eighty dental implants (Intra-Lock, Boca Raton, FL) were placed in the radius of 13 beagle dogs. The experiment consisted of 4 groups (n = 20 implants/group): 1) Regular osteotomy (Reg n/L-PRF); 2) Regular osteotomy and implant placement with L-PRF membrane (Reg L-PRF); 3) Wide osteotomy with no gap management performed, where an osteotomy/bony defect (6 mm of diameter and ~5 mm deep) was created to simulate immediate implant placement in post-extraction sockets, and the gap was left for spontaneous healing (Wide nL-PRF); and 4) Wide osteotomy with L-PRF gap management (Wide L-PRF). L-PRF membranes were obtained by blood drawn from each subject and centrifuged at 2700 rpm (408 RCF-clot) for 12 min. In the experimental groups where L-PRF was utilized, the membrane was inserted into the osteotomy site prior to implant placement. Six dogs had implants placed in the radius for 3 weeks; and 7 dogs had implants placed in the left radius for 6 weeks and in the right radius for 12 weeks. At the corresponding experimental time points, samples were harvested, and subjected to histological processing for qualitative and quantitative analyses, via bone-to-implant contact (BIC) and bone-area-fraction occupancy (BAFO). Qualitative analysis demonstrated increased amounts of bone formation around the implant and within the healing chambers over time for all groups. While comparable histological features were observed for both Reg groups (L-PRF and nL-PRF), the gap management performed in Wide L-PRF group resulted in effective gap filling with improved bone growth in close proximity to the implant surface. Quantitative analyses of BIC and BAFO yielded higher values for both variables at 3 weeks for Wide L-PRF (~38% and ~56% respectively) compared to Wide nL-PRF (~20% for BIC and BAFO) (p < .03). No statistical differences were detected between Wide groups at 6 and 12 weeks, neither between Reg groups, independent of the association with or without the L-PRF membrane at all healing times. L-PRF placed within wide osteotomies, prior to implant placement, resulted in increased early bone formation compared to unfilled wide osteotomies at the early healing time (3 weeks in vivo).
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Affiliation(s)
- Ernesto B Benalcázar Jalkh
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Department of Prosthodontics and Periodontology, University of Sao Paulo, Bauru School of Dentistry, Bauru, Brazil
| | - Nick Tovar
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Department of Oral and Maxillofacial Surgery, New York University, Langone Medical Center and Bellevue Hospital Center, New York, New York, USA
| | - Leticia Arbex
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA
| | - Gregory Kurgansky
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA
| | - Andrea Torroni
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Luiz F Gil
- Department of Morphological Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Brittany Wall
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA
| | - Kimia Kohanbash
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of Sao Paulo, Bauru School of Dentistry, Bauru, Brazil
| | - Paulo G Coelho
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York, USA.,Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lukasz Witek
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York, USA
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Pesce P, Mijiritsky E, Canullo L, Menini M, Caponio VCA, Grassi A, Gobbato L, Baldi D. An Analysis of Different Techniques Used to Seal Post-Extractive Sites—A Preliminary Report. Dent J (Basel) 2022; 10:dj10100189. [PMID: 36285999 PMCID: PMC9600503 DOI: 10.3390/dj10100189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Bone grafting in post-extractive site improves tissue regeneration. Soft tissue sealing of the grafted post-extractive alveolus is supposed to limit microbiological contamination from the oral cavity and to stabilize the coagulum. Several techniques are presented in the literature to reach this goal using different heterologous matrices or autogenous grafts. In addition, recently, a technique based on the use of granulation tissue in the post-extractive alveolus has been proposed. Aim: To compare the effect of different graft sealing approaches in post-extractive sites by qualitatively evaluating their healing process. Materials and Methods: This retrospective investigation included 30 patients requiring post-extractive site regeneration in the aesthetic area. Post-extractive sites were regenerated using a bovine bone matrix and patients were divided into three groups (10 patients in each group) according to the material used to seal the alveolar socket. In the UD group, the granulation tissue was used to seal the defect; in the PC group, epithelial-connective soft tissue graft was used, and in the COLL group, a collagen-based membrane was employed. Images of the post-extractive sites at different follow-up periods (2 and 12 weeks) were taken and the healing process was blindly evaluated by two independent practitioners. The Healing Index (HI) by Landry, Turnbull and Howley was used to assess the quality of the healing process. The combination of presence/absence of five clinical criteria defines an HI ranging from 1 (very poor) to 5 (excellent). Patients’ clinical-pathological variables were recorded. One-way ANOVA was used to explore the dependence of HI on the different socket preservation protocols. Results: Based on clinical-pathological characteristics of the included patients, there were no statistically significant differences among the different sealing techniques. At the 2-week follow-up appointment, HI did not differ among the socket preservation protocols evaluated. Moreover, smoking status and reason for extraction did not influence the HI among the three groups (two-way ANOVA p-value = 0.686, p-value = 0.248 respectively). At the 2-week follow-up appointment, HI was significantly different among the socket preservation protocols investigated. Specifically, the group undergoing collagen-based socket preservation procedure reported the highest HI, compared to the other two techniques (COLL mean 4.60 ± 0.5; PC mean 3.5 ± 1.2; UD mean 3.4 ± 0.5, one-way ANOVA p-value 0.006). Conclusions: The use of collagen porcine membranes may represent a suitable option to improve the patient healing process in grafted post-extractive sites together with reducing the surgical intervention time compared to alternative sealing techniques.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
| | - Eitan Mijiritsky
- Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6139001, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luigi Canullo
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
| | - Maria Menini
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
| | | | | | | | - Domenico Baldi
- Department of Surgical Sciences, University of Genova, 16100 Genoa, Italy
- Correspondence:
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Ekhlasmandkermani M, Amid R, Kadkhodazadeh M, Hajizadeh F, Abed PF, Kheiri L, Kheiri A. Sinus floor elevation and simultaneous implant placement in fresh extraction sockets: a systematic review of clinical data. J Korean Assoc Oral Maxillofac Surg 2021; 47:411-426. [PMID: 34969014 PMCID: PMC8721410 DOI: 10.5125/jkaoms.2021.47.6.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 11/07/2022] Open
Abstract
Combining different procedures to reduce the number of surgical sessions and patient discomfort in implant placement and sinus floor elevation has been recommended, and evidence supports good outcomes. The aim of this study was to review the results of clinical studies on sinus floor elevation through extraction sockets and simultaneous immediate posterior implant placement. An electronic search was carried out in PubMed, Scopus, and Web of Science to find English articles published in or before August 2020. A manual search was also performed. Titles, abstracts, and the full-text of the retrieved articles were studied. Thirteen studies met our eligibility criteria: 6 retrospective case series, 3 case reports, 2 prospective cohort caseseries, 1 prospective case series, and 1 randomized controlled trial. Overall, 306 implants were placed; 2 studies reported implant survival rates of 91.7% and 98.57%. The others either did not report the survival rate or reported 100% survival. Sinus floor elevation through a fresh extraction socket and simultaneous immediate implant placement appears to be a predictable modality with a high success rate. However, proper case selection and the expertise of the clinician play fundamental roles in the success of such complex procedures.
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Affiliation(s)
- Mehdi Ekhlasmandkermani
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Amid
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Kadkhodazadeh
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hajizadeh
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooria Fallah Abed
- Department of Periodontology, Texas A and M College of Dentistry, Dallas, TX ,USA
| | - Lida Kheiri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Aida Kheiri
- Student Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vergara-Hernández CI, Martínez-Martínez AA, Díaz-Caballero AJ. Bone Regeneration in an Extreme Dental Clinical Condition. Contemp Clin Dent 2021; 12:184-186. [PMID: 34220161 PMCID: PMC8237808 DOI: 10.4103/ccd.ccd_283_20] [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: 04/13/2020] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 11/15/2022] Open
Abstract
Here, the authors present the clinical case of a 45-year-old woman with a diagnosis of a chronic periodontal abscess of the tooth #8. After atraumatic dental extraction and bone regeneration with the use of platelet-rich fibrin and bone graft, the area showed excellent bone regeneration with adequate stability of the soft tissue, even 4 months after the surgery.
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Lee W. Immediate implant placement in fresh extraction sockets. J Korean Assoc Oral Maxillofac Surg 2021; 47:57-61. [PMID: 33632979 PMCID: PMC7925164 DOI: 10.5125/jkaoms.2021.47.1.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
Immediate implant placement (IIP) in fresh extraction sockets exhibits similar survival and success rates to delayed implant placement in healed sockets. Several advantages of IIP involve shortened total treatment time, reduction of the number of invasive surgeries, and subsequent reduction of patient discomfort due to lack of additional surgeries. The major shortcomings in IIP, however, include the inability to obtain early bony support, presence of a gap between the extraction socket and fixture, and the inability to cover the fixture with soft tissue, leading to increased risk of infection and implant loss. When IIP is performed, atraumatic or minimally traumatic extractions, conservation of the septal bone in molars, minimal flap elevation or flapless surgery, bone grafting the gap between the fixture and the extraction socket, and coverage with soft tissue or a membrane must be considered.
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Affiliation(s)
- Won Lee
- Department of Dentistry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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The Effects of Leukocyte-Platelet Rich Fibrin (L-PRF) on Suppression of the Expressions of the Pro-Inflammatory Cytokines, and Proliferation of Schwann Cell, and Neurotrophic Factors. Sci Rep 2020; 10:2421. [PMID: 32051476 PMCID: PMC7016122 DOI: 10.1038/s41598-020-59319-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/27/2020] [Indexed: 11/21/2022] Open
Abstract
This study evaluates the use of L-PRF as an autologous scaffold in nerve regeneration, and Schwann cells (SCs) proliferation and secretion of neurotrophic factors and its anti-inflammatory effect on SC Porphyromonas Gingivalis-Lipopolysaccharide (PG-LPS)-induced inflammatory responses in vitro. SEM was done to investigate various features of L-PRF. L-PRF-extracts was used to investigate the release of growth factors and treatment of SCs line. ELISA was applied to examine the release of IGF-1. The proliferative effect of L-PRF on SCs was assessed with CCK-8 assay. The effect of L-PRF on the mRNA and protein expression of SC neurotrophic factors were analyzed by RT-qPCR and ELISA. CCK-8 assay and RT-qPCR were used to determine the required concentration and the action time of PG-LPS before the anti-inflammatory effect of L-PRF was determined by measuring the changes in IL-1β, IL-6, and TNF-a with RT-qPCR and ELISA. There are different features in L-PRF. Fourteen days was sufficient to release adequate GF. The mRNA expressions of the pro-inflammatory cytokines were notably raised by PG-LPS in 3-hours treatment. L-PRF can increase SC proliferation, neurotrophic factors secretion, and suppress SC PG-LPS-induced inflammatory responses in vitro. L-PRF has the potential as an autologous biological additive for peripheral nerve regeneration in the event of nerve inflammation and injuries.
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