Flapless alveolar ridge preservation utilizing the "socket-plug" technique: clinical technique and review of the literature

Efficacy of Platelet-Rich Fibrin in Preserving Alveolar Ridge Volume and Reducing Postoperative Pain in Site Preservation of Post-Extracted Sockets

Background and Objectives: In socket preservation, the goal is to minimize bone resorption after tooth extraction to maintain the volume and contour of the alveolar ridge. The use of PRF in post extraction sites may reduce ridge resorption by encouraging the growth of new bone and acting as a scaffold for tissue. In addition, PRF may enhance healing and minimize postoperative pain. The aim of this study was to evaluate the effectiveness of platelet-rich fibrin (PRF) in maintaining the ridges' dimensions at the extraction site, in the maxilla and mandible, as well as its impact on post-extraction discomfort. Methods: The study was conducted on 60 patients presenting for extraction of posterior teeth and was randomly divided into three groups: group I PRF (n = 20), group II PRF + collagen (n = 20), and group III control (n = 20). Sockets were filled with PRF (group I) and PRF + collagen (group II). At baseline and follow-up after 3 months, CBCT was used to assess the bone dimensions. The postoperative pain evaluations were performed at 24 h, 3 days, and 7 days after the tooth extraction. The pain rate was evaluated using a numerical rating scale from the British Pain Society. Results: The study examined the effects of platelet-rich fibrin (PRF) and PRF combined with collagen on the height and width of the ridges, as well as the pain experienced by the patients following alveolar ridge preservation surgery. ANOVA and t-tests were used to evaluate and compare the ridge dimensions. Comparing the results to the control group, there were no significant differences in the height or width of the ridges. However, both the PRF and PRF + Collaplug® treatments effectively reduced the short-term postoperative pain. Conclusions: The study findings suggest that platelet-rich fibrin (PRF) and PRF combined with collagen do not exert significant effects on ridge width and height compared to the standard treatment following alveolar ridge preservation. However, it is noteworthy that both the PRF and PRF + collagen treatments demonstrated efficacy in reducing postoperative pain in the short term, offering a potential advantage over standard treatment protocols.

A radiographic and histological study to compare red (650 nm) versus near infrared (810 nm) diode lasers photobiomodulation for alveolar socket preservation

Previous findings indicated that the laser photobiomodulation is more effective than the control or placebo in preserving the alveolar socket. This study aimed to compare two different lasers regarding their effectiveness in aiding alveolar socket preservation. Twenty extraction sockets were selected then divided into two equal groups. Group A was exposed to 650 nm Diode laser, and Group B to 810 nm Diode laser following the same protocol and parameters after a standard alveolar socket preservation procedure with collagen plug. Radiographic analysis with cone beam computed tomography was done to compare the alveolar bone surface area immediately after extraction and three months post-operatively, while bone samples collected before implant drilling were histologically examined for newly formed bone evaluation and histomorphometric analysis in terms of percentage of new bone surface area, percentage of unmineralized bone and finally, immunohistochemical analysis of Osteocalcin reaction surface area as well as optical density. Radiographically, infrared (810 nm) Diode effect on alveolar bone surface area has significantly exceeded the red laser, while histologically, red (650 nm) Diode has demonstrated statistical significance regarding all parameters; newly formed bone surface area percentage, unmineralized bone area percentage and finally Osteocalcin bone marker reaction surface area percentage and optical density. Under the specified conditions and laser parameters, photobiomodulation using the 810 nm Diode got the upper hand radiographically, yet histologically, the red 650 nm Diode managed to dominate all histological parameters when both employed as an adjunct to alveolar socket preservation procedures.

Use of Injectable Platelet-Rich Fibrin Accompanied by Bone Graft in Socket Endurance: A Radiographic and Histological Study

Background Ridge preservation became a crucial dental health issue and strategy to keep away from ridge defacement after post-tooth loss. The recent scientific evolution of platelet-rich fibrin (PRF) comprises a parenteral formulation of PRF. The combined allograft for socket preservation gives benefits. In this study, bone allografts, demineralized freeze-dried bone allografts (DFDBA) and freeze-dried bone allografts (FDBA) are used in a 30:70 ratio alone or in combination with injectable PRF (I-PRF) for socket preservation. Methods This study is a radiographic and histological examination conducted on 60 participants aged between 19-65 years. Participating patients agreed voluntarily that they would not bear any fixed prosthesis for the next nine months and plan for implanted teeth placement, including multi-rooted mandibular molars denticles. Both groups received atraumatic extraction; then, the socket was preserved with bone allograft alone in the control group and bone allograft mixed with I-PRF, forming sticky bone, in the experimental group. Clinical, radiological, and histological assessments were taken at the inception stage, three months, six months, and nine months. A multivariate regression model and a generalized estimating equation (GEE) model were used to analyse the effects of these changes on outcomes. Results In all the parameters, the test group indicated a good amount of bone growth with increasing intervals of time for bone height radiographically with statistically significant difference present (p<0.05) and histologically after nine months when socket site grafted with bone graft in combination with I-PRF. Conclusion This study's results demonstrated that I-PRF possesses the potential to regenerate and heal in the tooth-extracted socket. This study further recommends the implementation of I-PRF in safeguarding and conserving the raised rim of the tooth. Future research should take place on the osteogenic capability of I-PRF in more comprehensive ridge accession surgical procedures and additional expanding and improving capacities in periodontal reconstruction.

Influence of using collagen on the soft and hard tissue outcomes of immediate dental implant placement: A systematic review and meta-analysis

OBJECTIVE

To compare the effects of bone grafting materials, collagen-infused grafting materials, and no grafting materials on the soft and hard tissue outcomes when an immediate implant is placed.

MATERIALS AND METHODS

In addition to hand searching, electronic searches were performed in Pubmed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Only RCTs were included in our review. The Cochrane ROB 2.0 tool was used to assess the risk of bias (ROB). Two subgroups were used to evaluate implant failure rate, buccal bone resorption, soft tissue thickness, and esthetic scores. In the meta-analysis, both the fixed-effects model and the random-effects model were employed.

RESULT

7 RCTs were selected after screening 580 studies, and 205 patients were included in the review, with 279 implants. Two RCTs were at low bias of risk, three were at moderate bias, and two were deemed at high risk of bias. The failure rate (95% CI: 0.17 to 11.84) and soft tissue thickness were not significantly different between collagen with bone grafting materials and without bone grafting materials. On the basis of the failure rate and buccal bone thickness, there was no significant difference between collagen with bone grafting materials and bone grafting materials. While we found collagen with bone grafting materials could have a significant advantage on the buccal bone thickness (MD: -0.43,95% CI -0.72 to -0.41) and esthetic outcome (MD: -1.23,95% CI -1.90 to -0.55).

CONCLUSION

In the statement of immediate implant implantation, the thickness of the buccal bone and esthetic outcomes did significantly benefit from bone grafting materials with collagen inserted in the "jumping gap".

Clinical outcomes of retention of the buccal root section combined with immediate implant placement: A systematic review of longitudinal studies

INTRODUCTION

Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo- and dento-integration with partial preservation of the periodontal ligament (PDL) in humans. Strategic buccal root retention for PDL preservation is a biologically driven procedure that maintains alveolar ridge dimensions and esthetics, while allowing for implant placement. The aim of this study was to conduct a systematic review of longitudinal clinical outcomes of PDL-mediated ridge preservation in conjunction with implant placement in adults, compared with conventional immediate implant placement with total extractions. The primary outcome for this study was marginal bone level (MBL) changes after strategic buccal root retention implant placement techniques.

MATERIALS AND METHODS

To address a predefined PICOS question, a systematic search of randomized clinical trials and cohort studies with at least 10 participants per group and a minimum 12-month follow-up was conducted. A two-phase systematic selection strategy, data extraction, and risk of bias assessment, was performed independently and in duplicate. Randomized trials were quantitatively analyzed in a meta-analysis.

RESULTS

Ten human studies fulfilled the predefined criteria and were included; three clinical trials and seven cohort studies, for a total of 506 patients and 587 implants. PDL-mediated implant placement of single-rooted periodontally healthy teeth was found to reduce marginal peri-implant bone loss and buccal plate changes as compared to conventional immediate implants across studies, while implant survival and success rates were comparable between the two procedures. A meta-analysis found that bone changes were significantly less when retention of the buccal root section was performed as compared to total extractions (standardized mean difference: [-4.53, -0.11]); the three clinical trials were, however, largely heterogeneous (I2 : 93.1%; Q = 28.98, p < 0.001).

CONCLUSION

Strategic retention of the buccal root section has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases of single-rooted teeth.

Alveolar Bone Remodeling with or without Collagen Filling of the Extraction Socket: A High-Resolution X-ray Tomography Animal Study

The healing process of the tooth extraction socket often leads to significant resorption of the alveolar bone, eventually causing clinical difficulties for future implant-supported rehabilitations. The aim of the present animal study was to evaluate alveolar bone remodeling after tooth extraction in a rabbit model, either with or without the use of a plain collagen plug inside the socket, by means of micro-computed tomography. The study included the micro-tomography analysis of 36 rabbits’ incisor extraction sockets, either left empty or filled with a collagen plug. All animals were euthanized in a staggered manner, in order to address molecular, histologic, and radiographic analyses at different time-points, up to 90 days after surgery. The three-dimensional evaluation was carried out using micro-computed tomography technology on excised bone blocks including the alveolus and the contralateral bone. Both linear and volumetric measures were recorded: the percentage of bone volume change (ΔBV) within the region of interest was considered the primary endpoint of the study. The micro-CT analysis revealed mean volumetric changes of −58.1% ± from baseline to 3 months for the control group, and almost no bone loss for the test group, −4.6%. The sockets treated with the collagen plug showed significantly less dimensional resorption, while the natural-healing group showed an evident collapse of the alveolar bone three months after extraction surgery.

Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial

The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant placement using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted sites. We followed a parallel study design with patients divided into two groups: grafted group (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed up for 1-year post-loading. MBL after one year, in the control group, was −0.31 ± 0.11 mm (mesial) and −0.28 ± 0.09 mm (distal); and in the test group was −0.35 ± 0.11 mm (mesial) and −0.33 ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups after one year. ISR was similar between groups and the marginal bone changes were comparable one year after functional loading, without statistical significance, suggesting that bioactive glass permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants.

A Comparative Study of Two Bone Graft Substitutes–InterOss® Collagen and OCS-B Collagen®

Bone is a complex hierarchical tissue composed of organic and inorganic materials that provide structure, support, and protection to organs. However, there are some critical size defects that are unable to regenerate on their own and therefore require clinical repair. Bone graft substitutes allow repair by providing a temporary resorbable device. Among the common filler materials that aid in regeneration is hydroxyapatite particles of either animal or human origin which is used to fill or reconstruct periodontal and bony defects in the mouth. However, particulate graft substitutes suffer from localized migration away from the implantation site, necessitating the use of a barrier membrane. In this study, we designed InterOss Collagen, combining bovine hydroxyapatite granules with porcine-skin derived collagen to form a bone filler composite. Physiochemical properties of InterOss Collagen and a commercially available product, OsteoConductive Substitute-Bovine(OCS-B) Collagen, referred to as OCS-B Collagen, were examined. We found two bone graft substitutes to be mostly similar, though InterOss Collagen showed comparatively higher surface area and porosity. We conducted an in vivo study in rabbits to evaluate local tissue responses, percent material resorption and bone formation and showed that the two materials exhibited similar degradation profiles, inflammatory and healing responses following implantation. Based on these results, InterOss Collagen is a promising dental bone grafting material for periodontal and maxillofacial surgeries.

Open Healing: A Minimally Invasive Protocol with Flapless Ridge Preservation in Implant Patients

Simple Summary

We describe a minimally invasive technique for optimal preservation of post-extraction tooth socket, prior to implant insertion in over 100 patients (n = 104, with 0.55 sex ratio), with a follow-up period of up to five years. This “open healing” concept is a flapless protocol, using a collagen membrane and a bovine bone substitute that yielded an uneventful healing, with sufficient bone formation, checked periodically after one, two, and five years by calibrated computer tomography. Open-healing protocol led to alveolar ridge and height preservation that contributed to a 98.5% implant survival and 94.8% success rate at five-year follow-up.

Abstract

We aimed to validate the safety and efficacy of the minimally invasive “open healing” flapless technique for post-extraction socket and alveolar ridge preservation, while assessing the alveolar bone changes. The study enrolled (n = 104) patients (0.55 sex ratio), with atraumatic extraction of (N = 135) hopeless teeth, followed by either immediate placement of tissue level implants (N₁ = 26), or later stage implant insertion (N₂ = 109). No flap was raised in either situation. Post-extraction sockets were filled with deproteinized bovine bone granules and covered by collagen resorbable membrane—left purposely exposed during healing. This yielded an uneventful healing, with sufficient bone formation, while avoiding soft-tissue problems. The need for additional augmentation was assessed clinically and by calibrated CBCT scans at six months, before either loading (N₁) or implant insertion (N₂). Implant success and survival rate were evaluated at 12-, 24-, and 60-month follow-up control sessions. The inserted implants had a survival rate of 98.5% and a success rate of 94.8% at five-year follow-up. Open healing technique with flapless approach can be favorable for preserving the 3D architecture of the post-extraction socket, as well as the alveolar ridge width and height.

Could the socket shield technique be better than conventional immediate implantation? A meta-analysis

OBJECTIVES

The purpose of this study was to evaluate whether the clinical outcome of socket shield technique (SST) is superior to that of conventional immediate implantation (CII).

MATERIALS AND METHOD

Five electronic databases (PubMed, Cochrane, Web of Science, CNKI, and Google Scholar) were searched to identify randomized controlled trials up to June 31, 2021. Five evaluation indexes were extracted, namely, buccal bone resorption at the horizontal and vertical levels (BBH and BBV), the soft tissue recession assessed by pink evaluation scores (PES), patient satisfaction (PS), ISQ, and the success rate of implantation (SRI), to compare the superiority between SST and CII operations. All data analyses were performed using Review Manager (version 5.4).

RESULTS

Ten studies were included in this review. The sample included 388 implants, with 194 in the SST group and 194 in the CII group. Compared with the CII group, the SST group had a lower BBH and BBV (standardized mean difference (SMD), - 1.77; 95% CI, - 2.26 to - 1.28; P < 0.00001 and SMD, - 1.85; 95% CI, - 2.16 to 1.54; P < 0.00001), higher PES improvement (SMD, 2.27; 95% CI, 1.59 to 2.95; P < 0.00001), higher rate of PS (OR, 3.12; 95% CI, 1.08 to 9.04; P = 0.04), and slightly higher ISQ (SMD, 0.71; 95% CI, 0.28 to 1.15; P = 0.001).

CONCLUSIONS

Compared with CII, SST could be a better option for esthetic area implantation, but evaluation of its long-term success is still needed.

CLINICAL RELEVANCE

By comparing and analyzing the operations of immediate implant in esthetic zone, we could choose SST to effectively alleviate the absorption of bone tissue and improve the contouring of soft tissue after anterior teeth extraction, so as to achieve a more stable and superior clinical outcomes of implant in esthetic zone.

Bone remodeling around implants placed after socket preservation: a 10-year retrospective radiological study

BACKGROUND

To evaluate and compare the long-term clinical and radiological outcomes of post-extraction sockets after ridge preservation either with porcine xenograft or collagen alone. Patients underwent single-tooth extraction in the posterior mandible. Fresh extraction sockets were filled with pre-hydrated cortico-cancellous porcine bone or collagen sponge. Two or 3 months later, a ridge expansion technique with immediate implant positioning placement was performed. Primary (alveolar width changes) and secondary outcomes (adverse events and long-term maintenance of buccal plate covering the implant) were evaluated.

RESULTS

Thirty-four women and 20 men were selected: 30 implants (group A) placed into healed post-extraction sockets grafted with porcine bone and 24 (group B) into sockets filled with a collagen sponge. There was a significant loss in width in both groups from the first and second surgery (ranging between 2.7 mm and 4.5 mm). The ridge splitting with bone expansion resulted in significant long-term increases in width for both procedures and implant sites. Non-significant differences in alveolar width were registered between the groups at 10-year follow-up even if the analysis of the implant buccal bone coverage suggested that group A had significantly worst results.

CONCLUSIONS

Porcine bone group had significantly better short-term outcomes with lower long-term maintenance of the buccal plate.

Glass Ionomer Subgingival Matrix Technique to Restore a Tooth with Severe Root Resorption for Implant Site Development

Here, we present the multidisciplinary, patient-specific management of a patient with severe external root resorption and bone loss in a maxillary anterior tooth. The tooth was provisionally noninvasively restored with glass ionomer subgingival matrix in preparation for forced orthodontic extrusion, papillary preservation, and implant placement. This approach enables clinicians to control infection within and around the resorbed tooth and then to use it as an anchor for slow forced tooth eruption to correct bone and mucogingival deformities. Aesthetic and functional outcomes were clinically and radiographically satisfactory. The advantages and disadvantages of this technique are discussed.

Three-Dimensional Volumetric Changes After Socket Augmentation with Deproteinized Bovine Bone and Collagen Matrix

PURPOSE

Socket augmentation decreases the magnitude of alveolar ridge resorption, but the literature is limited in respect to quantifying soft tissue remodeling. The aim of this study was to determine the volumetric and linear dimensional changes at the buccal surface for both hard and soft tissues after socket augmentation treated with a xenogeneic collagen matrix in combination with bone grafting.

MATERIALS AND METHODS

Twenty-four individuals indicated for tooth extraction were enrolled in this investigation. Each participant was randomly assigned to one of two groups: (1) deproteinized bovine bone + collagen plug, or (2) deproteinized bovine bone + xenogeneic collagen matrix. A cone beam computed tomography scan was taken prior to extraction and at 6 months postextraction. Intraoral scanning images were taken at baseline, 3 months, and 6 months postextraction. Hard and soft tissue analyses were performed to compare linear ridge remodeling and volumetric changes by noncontact reverse-engineering software.

RESULTS

Both groups showed bone and soft tissue remodeling. For hard tissue remodeling, there was no significant difference between the collagen plug and collagen matrix groups. For soft tissue remodeling, the collagen matrix group showed a reduced soft tissue loss compared with the collagen plug group. The volumetric analysis demonstrated that the mean buccal soft tissue volume loss for the collagen matrix group was 68.6 mm³ compared with 87.6 mm³ found in the collagen plug group (P = .009) over a 6-month period.

CONCLUSION

This clinical investigation provides early evidence of using the total tissue volume to compare soft and hard tissue remodeling after socket augmentation. The results of this study demonstrated that the use of a xenogeneic collagen matrix reduced the buccal soft tissue loss after tooth extraction, but additional studies are necessary to evaluate the clinical significance of soft tissue augmentation after tooth extraction.

Extraction socket preservation using a collagen plug combined with platelet-rich plasma (PRP): A comparative clinico-radiographic study

Background. Alveolar bone remodeling after tooth loss results in reduced ridge dimensions in horizontal and vertical planes. To prevent this, various authors have proposed different ridge preservation techniques. A collagen plug is a novel material that has shown promising results in preserving the alveolar bone. PRP has also yielded favorable outcomes in wound healing and promoted osteoinduction and osteoconduction Methods. Thirty patients of both sexes with an age range of 30-18 years requiring bilateral extraction of teeth with similar tooth root anatomy in the maxilla or mandible were included in the study. The extraction of teeth was carried out atraumatically. The patients' arches were randomly divided and labeled as the test or control sides. Bone width was measured on both sides. A collagen plug, with PRP, was placed, and the extraction socket was sutured on the test side. The control side was just sutured. A baseline RVG was taken to record the apico-coronal height. The patients were recalled after 10 days for suture removal and evaluation of wound healing. Parameters were re-evaluated at three and six months postoperatively. The data were subjected to t-test and one-way ANOVA. Results. The height of the crestal bone on the grafted side was more when compared to the non-grafted side three and six months after tooth extractions, and the difference was statically significant (P<0.001). No statistically significant difference was seen in the width of the alveolar bone three and six months after tooth extraction (P>0.05). Conclusion. Collagen and PRP provided reasonable socket preservation as simple and inexpensive options as compared to other materials.

Combination of bone graft and resorbable membrane for alveolar ridge preservation: A systematic review, meta-analysis, and trial sequential analysis

INTRODUCTION

Alveolar ridge preservation (ARP) techniques aim to reduce resorption after tooth extraction. The combination of a graft material covered with a resorbable membrane represents one of the most common strategies performed in the clinical practice. The aim of this systematic review is to analyze evidence regarding potential benefits of ARP procedures performed with allogenic/xenogenic grafts in combination with a resorbable membrane coverage in comparison with spontaneous healing.

METHODS

Electronic databases were screened independently to select studies suitable for inclusion in this review. Horizontal ridge width reduction (HRWR) and vertical ridge height reduction (VRHR) were investigated as primary outcomes and volume changes (VC) as a secondary outcome. Meta-analysis was performed using the inverse of variance test with a random effect model. Adjustment for Type I and II errors and analysis of the power of evidence was performed with trial sequential analysis (TSA).

RESULTS

Seven studies met the inclusion criteria and were included in the quantitative synthesis. Meta-analysis revealed that the combination therapy resulted in a lower rate of resorption for both HRWR (-2.19 mm, 95% confidence interval [CI]: -2.67 to -1.71 mm) and VRHR (-1.72 mm, 95% CI: -2.14 to -1.30 mm). For VC no meta-analysis was performed due to insufficient data. Analysis of the power of the evidence performed with TSA showed that the number of both studies and sockets analyzed is sufficient to validate such findings, despite the high rate of heterogeneity.

CONCLUSIONS

Use of bone graft covered by a resorbable membrane can decrease the rate of alveolar ridge horizontal and vertical resorption after tooth extraction. The power and reliability of the evidence is strong enough to confirm the above-mentioned findings, despite the high rate of heterogeneity of included studies.

Ridge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue Regeneration

OBJECTIVE

To compare hard-tissue healing after 3 exodontia approaches.

MATERIALS AND METHODS

Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals were euthanized at 1 and 4 weeks. Amount of bone formation within socket and socket total area were measured.

RESULTS

Amount of bone formation revealed significant difference between 1 and 4 weeks; however, there was no differences among groups. Socket total area decreased after 4 weeks, and the flap + dPTFE group showed significantly higher socket total area. As a function of time and group, flap + dPTFE 4 weeks presented similar socket total area values relative to flap + dPTFE at 1 week, and significantly higher socket total area than flapless and flap. The histological sections revealed almost no bone formation within socket after 1 week, which increased for all groups at 4 weeks.

CONCLUSION

Socket coverage with polytetrafluoroethylene (dPTFE) membrane showed to effectively preserve bone architecture. Bone formation within sockets was not influenced by tooth extraction technique.

Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol

The aim of this randomized controlled trial was to evaluate the survival rate, the marginal bone level, and the aesthetic outcome; at 3 years' follow-up, of dental implants placed into a high-esthetic aesthetic zone by comparing 2 techniques of postextraction implant with immediate loading: the socket shied technique and the conventional insertion technique.Several clinical studies suggested that the avulsion of a dental element causes dimensional alterations of both soft and hard tissues at the postextractive site. To increase the aesthetic outcomes, the "socket-shield technique" has been proposed. This method involves maintaining the vestibular root portion and immediate insertion of the dental implant in close proximity to the root.Patients enrolled in this study were randomized to receive a postextraction implant in the aesthetic zone, either with the socket shied technique or with the conventional insertion technique. Implant survival, marginal bone level, and the pink aesthetic score were the outcomes evaluated.Implant survival rate was 100% in both the groups at 3 years. Implants inserted with the socket shield technique showed better values of both marginal bone level and pink aesthetic score (P < 0.05).Although such preliminary results need to be further confirmed, the socket shield technique seems to be a safe surgical technique that allows an implant rehabilitation characterized by better aesthetic outcomes.

Alveolar ridge preservation in the esthetic zone

In the esthetic zone, in the case of tooth extraction, the clinician is often confronted with a challenge regarding the optimal decision-making process for providing a solution using dental implants. This is because, after tooth extraction, alveolar bone loss and structural and compositional changes of the covering soft tissues, as well as morphological alterations, can be expected. Ideally, the therapeutic plan starts before tooth extraction and it offers three options: spontaneous healing of the extraction socket; immediate implant placement; and techniques for preserving the alveolar ridge at the site of tooth removal. The decision-making process mainly depends on: (i) the chosen time-point for implant placement and the ability to place a dental implant; (ii) the quality and quantity of soft tissue in the region of the extraction socket; (iii) the remaining height of the buccal bone plate; and (iv) the expected rates of implant survival and success. Based on scientific evidence, three time-periods for alveolar ridge preservation are described in the literature: (i) soft-tissue preservation with 6-8 weeks of healing after tooth extraction (for optimization of the soft tissues); (ii) hard- and soft-tissue preservation with 4-6 months of healing after tooth extraction (for optimization of the hard and soft tissues); and (iii) hard-tissue preservation with > 6 months of healing after tooth extraction (for optimization of the hard tissues).

The Root Membrane Technique: Human Histologic Evidence after Five Years of Function

Background

The "root membrane" (RM) is a technique that has become popular among implantologists for placement of immediate implants in the anterior maxilla.

Purpose

To present histologic evidence of an immediate implant placed in the human anterior maxilla, according to the RM technique, and retrieved after five years.

Methods

A fixture, along with the surrounding tissues, was retrieved from the anterior maxilla of a 68-year-old patient, who had been treated five years earlier with immediate implant placement and RM technique. The specimen was processed for histologic/histomorphometric evaluation.

Results

The buccal bone plate was maintained without any resorption; a healthy periodontal ligament was evidenced. The implant showed osseointegration, with a high percentage of bone-to-implant contact (BIC = 76.2%). With regard to the space between the RM and the implant, the apical and medial thirds were filled with compact, mature bone; the coronal third was colonized by noninfiltrated connective tissue.

Conclusions

The RM technique appears to be effective in preventing bone resorption of the buccal bone plate of the human anterior maxilla, five years after the placement of an immediate implant.

Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study

Aim

The aim of this study was to evaluate clinically and radiographically, extraction socket healing using autologous platelet rich fibrin (PRF).

Materials and methods

Twenty-four subjects needing single tooth simple extractions were selected. Twenty-four extraction sockets were divided into test group (PRF, n = 12) and control group (blood clot, n = 12). PRF was prepared with blood drawn from individuals after extraction using standard technique. PRF was placed in test group sockets followed by pressure application and figure 8 sutures. Sockets in control group were allowed to heal in the presence of blood clot and received a figure 8 suture. Ridge width was assessed using cast analysis with the help of acrylic stent and a pair of calipers. Radiographic analysis of socket surface area was performed using computer graphic software program. The clinical follow up assessments were performed at 1, 4 and 8 weeks. Collected data was assessed using ANOVA and multiple comparisons test.

Results

Subjects were aged between 25 and 50 (mean 37.8) years, including 15 females. The mean horizontal ridge width for sockets in the test group were 11.70 ± 2.37 mm, 11.33 ± 2.30 mm and 10.97 ± 2.33 mm at 1, 4 and 8 weeks respectively. Ridge width proportions were significantly higher among test group as compared to control group between baseline to 4 and 8 weeks respectively. The mean radiographic bone fill (RBF) percentage in the test group, was 74.05 ± 1.66%, 81.54 ± 3.33% and 88.81 ± 1.53% at 1, 4 and 8 weeks respectively. The mean RBF was significantly higher in the test group than control group at all time intervals.

Conclusion

The study outcomes demonstrate that the use of PRF accelerate socket wound healing after tooth extraction as noticed by increased bone fill and reduced alveolar bone width resorption using clinical and radiographic methods.

Quality assessment of systematic reviews on alveolar socket preservation

The aim of this overview was to evaluate and compare the quality of systematic reviews, with or without meta-analysis, that have evaluated studies on techniques or biomaterials used for the preservation of alveolar sockets post tooth extraction in humans. An electronic search was conducted without date restrictions using the Medline/PubMed, Cochrane Library, and Web of Science databases up to April 2015. Eligibility criteria included systematic reviews, with or without meta-analysis, focused on the preservation of post-extraction alveolar sockets in humans. Two independent authors assessed the quality of the included reviews using AMSTAR and the checklist proposed by Glenny et al. in 2003. After the selection process, 12 systematic reviews were included. None of these reviews obtained the maximum score using the quality assessment tools implemented, and the results of the analyses were highly variable. A significant statistical correlation was observed between the scores of the two checklists. A wide structural and methodological variability was observed between the systematic reviews published on the preservation of alveolar sockets post tooth extraction. None of the reviews evaluated obtained the maximum score using the two quality assessment tools implemented.

Extraction Socket Management Utilizing Platelet Rich Fibrin: A Proof-of-Principle Study of the "Accelerated-Early Implant Placement" Concept

Dental implants are widely accepted as the golden standard for the rehabilitation of an edentulous site following the extraction of a tooth. The ideal time for implant placement is dependent on the time required for partial or complete tissue healing and the adequacy of socket dimensions. The use of autologous growth factors is a promising new concept that aids clinicians in minimizing treatment time and increasing patient satisfaction. The purpose of this paper is to introduce a protocol for "accelerated-early" implant placement. In this protocol, platelet rich fibrin is employed to accelerate soft and hard tissue healing and to provide a better-healed recipient site for accelerated, early implant placement. Histological analysis revealed that at 6 weeks postextraction, the application of our approach resulted in delicate newly formed bone showing intense osteoblastic activity surrounded by connective tissue as well as areas of mineralized tissue. The present study is a proof-of-principle study of the acceleration of the physiologic postextraction healing sequelae with the use of autologous growth factors. The accelerated-early implant placement concept is a bioengineered protocol that may aid clinicians to achieve increased primary stability, by placing implants in ridges in an advanced stage of bone healing, while offering patients the benefits associated with early implant placement. Controlled studies are warranted to verify the reproducibility of this treatment concept and identify specific indications where the use of the presented technique can lead to significant clinical results.

Clinical Evaluation of 262 Osseointegrated Implants Placed in Sites Grafted With Calcium Phosphosilicate Putty: A Retrospective Study

Along with the widespread use of dental implants, regenerative procedures have become an indispensable tool for implant surgeons in managing residual ridges and the surrounding bone. Putty bone grafts have significantly superior handling characteristics in comparison to particulates. These include ease of placement, enhanced particle containment, and a viscous consistency that has allowed for unique delivery systems to be developed. The aim of this study was to report the clinical efficacy of calcium phosphosilicate (CPS) putty in a wide variety of indications related to implant reconstruction and to report the survival rate of implants placed in these grafted sites. The CPS putty was used as the graft material of choice. Treatments were categorized into following groups: extraction graft, extraction with immediate implant placement, all-on-four concept, peri-implantitis treatment, bone augmentation before implant placement, implant replacement graft, and grafting around implant placed in resorbed ridges. Included in the analysis were 65 patients (36 men, 29 women) with a mean age of 63 ± 12 years. In total, 262 implants were placed. Four implants were diagnosed with peri-implantitis and were treated as described in category 4, for a total of 266 grafted sites. Two implants from the extraction graft category and 3 implants from the all-on-four group were lost and replaced with successfully osseointegrated implants during a mean study follow-up period of 12.24 ± 2.32 months. The implant success rate at 1 year was 98.1% (257/262). Based on results of this large-scale, retrospective study we conclude that (1) the use of putty bone grafts can simplify bone-grafting procedures and reduce intraoperative time in various grafting indications, (2) this study verified the efficacy of a CPS putty bone graft biomaterial in a large array of implant-related surgical indications, and (3) implants placed in sites grafted with CPS putty yield very high survival rates.

A simplified approach to the minimally invasive antral membrane elevation technique utilizing a viscoelastic medium for hydraulic sinus floor elevation

PURPOSE

Maxillary sinus augmentation surgery is frequently employed to provide adequate vertical bony dimensions in posterior maxillary sites. When significant gain in bone height is sought for, an invasive lateral-window approach is routinely used to achieve sinus floor elevation. The minimally invasive antral membrane elevation technique was initially conceived as a surgical improvisation that has been shown to lead to up to, or exceeding, 10 mm of bone height, while enhancing the safety profile of the transalveolar sinus augmentation technique. This approach is based on the use of hydraulic pressure that is applied to the schneiderian membrane via a saline-inflatable balloon. Even though this technique has been shown to be a safe and efficacious treatment modality, the need for specialized equipment, training, and corresponding costs may hinder its widespread application. The purpose of this clinical paper is to introduce a simplified approach to the minimally invasive antral membrane elevation technique.

METHODS

The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure by a viscous bone graft that acts as an incompressible fluid. The specific clinical steps of this technique will be demonstrated to illustrate how grafting of the maxillary sinus is achieved simultaneously with the atraumatic elevation of the schneiderian membrane, thus resulting in even less operative time.

CONCLUSIONS

This simplified technique may make the minimally invasive antral membrane elevation technique more accessible to implant surgeons as it eliminates the need for purchase of specialized equipment and aids in further decrease of intra-operative time accomplished with the original technique.

Alveolar ridge preservation with the socket-plug technique utilizing an alloplastic putty bone substitute or a particulate xenograft: a histological pilot study

Following tooth extraction, ridge preservation procedures are employed to regenerate bone in the extraction socket, limit consequent ridge resorption, and provide a stable base for implant placement. The purpose of this study is to histologically evaluate and compare bone regeneration in extraction sockets grafted with either a putty alloplastic bone substitute or particulate anorganic bovine xenograft utilizing the socket-plug technique. Nineteen patients underwent 20 tooth extractions and ridge preservation following a standardized protocol. Ten sites were grafted with calcium phosphosilicate putty (CPS group) and the remaining 10 with anorganic bovine bone substitute (BO group). Patients were recalled after 4-6 months to evaluate the bone regeneration and to proceed with implant placement. A bone core was obtained during the implant procedure from each site and was used for histologic analysis. Histomorphometry revealed that residual graft values were significantly higher in the BO group (25.60% ± 5.89%) compared to the CPS group (17.40% ± 9.39%) (P < .05). The amount of new bone regenerated was also statistically significant higher in the alloplast group (47.15% ± 8.5%) as compared to the xenograft group (22.2% ± 3.5%) (P < .05). Results suggest that ridge preservation using a putty calcium phosphosilicate alloplastic bone substitute demonstrates more timely graft substitution and increased bone regeneration when compared to an anorganic bovine bone xenograft.