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Journal of Dentistry Mar 2023The primary aim of this in vitro study was to evaluate the influence of alveolar ridge morphologies on the accuracy of static Computer-Assisted Implant Surgery (sCAIS)....
Influence of alveolar ridge morphology and guide-hole design on the accuracy of static Computer-Assisted Implant Surgery with two implant macro-designs: An in vitro study.
OBJECTIVES
The primary aim of this in vitro study was to evaluate the influence of alveolar ridge morphologies on the accuracy of static Computer-Assisted Implant Surgery (sCAIS). The secondary aims were to evaluate the influence of guide-hole design and implant macro-design on the accuracy of the final implant position.
METHODS
Eighteen standardized partially edentulous maxillary models with two different types of alveolar ridge morphologies were used. Each model was scanned via cone beam computer tomography prior to implant placement and scanned with a laboratory scanner prior to and following implant placement using sCAIS. The postsurgical scans were superimposed on the initial treatment planning position to measure the deviations between planned and postsurgical implant positions.
RESULTS
Seventy-two implants were equally distributed to the study groups. Implants placed in healed alveolar ridges showed significantly lower mean deviations at the crest (0.36 ± 0.17 mm), apex (0.69 ± 0.36 mm), and angular deviation (1.86 ± 0.99°), compared to implants placed in fresh extraction sites (0.80 ± 0.29 mm, 1.61 ± 0.59 mm, and 4.33 ± 1.87°; all p<0.0001). Implants placed with a sleeveless guide-hole design demonstrated significantly lower apical (1.02 ± 0.66 mm) and angular (2.72 ± 1.93°) deviations compared to those placed with manufacturer's sleeves (1.27 ± 0.67 mm; p = 0.01, and 3.46 ± 1.9°; p = 0.02). Deep-threaded tapered bone level implants exhibited significantly lower deviations at the crest (0.49 ± 0.28 mm), apex (0.97 ± 0.63 mm), and angular deviations (2.63 ± 1.85°) compared to shallow-threaded parallel-walled bone level implants (0.67 ± 0.34 mm; p = 0.0005, 1.32 ± 0.67 mm; p = 0.003, and 3.56 ± 1.93°; p = 0.01).
CONCLUSIONS
The accuracy of the final implant position with sCAIS is determined by the morphology of the alveolar ridge, the design of the guide holes, and the macrodesign of the implant.
CLINICAL SIGNIFICANCE
Higher accuracy in the final implant position was observed with implants placed in healed alveolar ridge morphologies, in implants with deep-threaded tapered macro-design, and when sleeveless surgical guide holes were used.
Topics: Dental Implants; Dental Implantation, Endosseous; Computer-Aided Design; Alveolar Process; Cone-Beam Computed Tomography; Computers; Imaging, Three-Dimensional
PubMed: 36652971
DOI: 10.1016/j.jdent.2023.104426 -
Clinical Oral Investigations Aug 2023To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.
MATERIALS AND METHODS
A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.
RESULTS
Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).
CONCLUSION
The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.
CLINICAL RELEVANCE
When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.
Topics: Humans; Tooth Socket; Alveolar Process; Osteogenesis; Tooth; Platelet-Rich Plasma; Tooth Extraction; Fibrin; Alveolar Ridge Augmentation
PubMed: 37439800
DOI: 10.1007/s00784-023-05126-8 -
BMC Oral Health Nov 2022Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients.
METHODS
This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation.
DISCUSSION
This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets.
TRIAL REGISTRATION
Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0.
Topics: Humans; Alveolar Bone Loss; Alveolar Ridge Augmentation; Molar; Periodontitis; Tooth Socket; Tooth Extraction
PubMed: 36397049
DOI: 10.1186/s12903-022-02544-0 -
PloS One 2021Bone quality is evaluated using bone density for qualitative classification, a characteristic that may be delicate to evaluate. Contemporary implantology that relies on... (Meta-Analysis)
Meta-Analysis
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.
Topics: Alveolar Process; Cone-Beam Computed Tomography; Humans; Jaw; Jaw, Edentulous; Mandible; Maxilla
PubMed: 34133463
DOI: 10.1371/journal.pone.0253283 -
Head and Neck Pathology Dec 2020Benign alveolar ridge keratosis (BARK), the intraoral counterpart of cutaneous lichen simplex chronicus, is a reactive hyperkeratosis caused by trauma or friction that...
Benign alveolar ridge keratosis (BARK), the intraoral counterpart of cutaneous lichen simplex chronicus, is a reactive hyperkeratosis caused by trauma or friction that presents as a poorly demarcated white papule or plaque on the keratinized mucosa of the retromolar pad or alveolar ridge mucosa (often edentulous). This is a clinical and histopathologic analysis of BARK including evaluation of p53 expression in selected cases. One hundred and sixty-seven cases of BARK were identified from 2016 to 2017 and 112 (67.1%) occurred in males with a median age of 56 years (range 15-86). The retromolar pad was affected in 107 (64.1%) cases and the edentulous alveolar mucosa in 60 (35.9%) cases, with 17.4% of the cases presenting bilaterally. BARK showed hyperkeratosis often with wedge-shaped hypergranulosis and occasional focal parakeratosis. The epithelium exhibited acanthosis and surface corrugation with tapered rete ridges often interconnected at the tips. The study for p53 performed in 12 cases showed less than 25% nuclear positivity. BARK is a distinct benign clinicopathologic entity caused by friction, which should be clearly distinguished from true leukoplakia, a potentially malignant disorder.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alveolar Process; Biomarkers; Female; Humans; Jaw Diseases; Keratosis; Male; Middle Aged; Tumor Suppressor Protein p53; Young Adult
PubMed: 32180128
DOI: 10.1007/s12105-020-01151-1 -
Clinical Oral Investigations Jan 2022Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature.
OBJECTIVE
To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance.
MATERIALS AND METHODS
The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow-up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed.
RESULTS
A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT).
CONCLUSIONS
NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage.
CLINICAL RELEVANCE
Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Biocompatible Materials; Collagen; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 34669038
DOI: 10.1007/s00784-021-04192-0 -
Journal of Immunology Research 2021Periodontitis is an oral chronic inflammatory disease that is initiated by periodontal microbial communities and requires disruption of the homeostatic responses. The... (Review)
Review
Periodontitis is an oral chronic inflammatory disease that is initiated by periodontal microbial communities and requires disruption of the homeostatic responses. The prevalence of periodontal disease increases with age; more than 70% of adults 65 years and older have periodontal disease. A pathogenic microbial community is required for initiating periodontal disease. Dysbiotic immune-inflammatory response and bone remodeling are characteristics of periodontitis. The transcription factor forkhead box protein O1 (FOXO1) is a key regulator of a number of cellular processes, including cell survival and differentiation, immune status, reactive oxygen species (ROS) scavenging, and apoptosis. Although accumulating evidence indicates that FOXO1 activity can be induced by periodontal pathogens, the roles of FOXO1 in periodontal homeostasis and disease have not been well documented. The present review summarizes how the FOXO1 signaling axis can regulate periodontal bacteria-epithelial interactions, immune-inflammatory response, bone remodeling, and wound healing.
Topics: Alveolar Process; Animals; Bone Remodeling; Dysbiosis; Epithelial Attachment; Forkhead Box Protein O1; Gene Expression Regulation; Gene Knockdown Techniques; Host Microbial Interactions; Humans; Macrophages; Mice; Microbiota; Mouth Mucosa; Periodontitis; Reactive Oxygen Species; Signal Transduction; Wound Healing
PubMed: 33860060
DOI: 10.1155/2021/5557095 -
TheScientificWorldJournal 2015Orthodontic force-induced stresses cause dynamic alterations within the extracellular matrix and within the cytoskeleton of cells in the periodontal ligament and... (Review)
Review
Orthodontic force-induced stresses cause dynamic alterations within the extracellular matrix and within the cytoskeleton of cells in the periodontal ligament and alveolar bone, mediating bone remodelling, ultimately enabling orthodontic tooth movement. In the periodontal ligament and alveolar bone, the mechanically induced tensile strains upregulate the expression of osteogenic genes resulting in bone formation, while mechanically induced compressive strains mediate predominantly catabolic tissue changes and bone resorption. In this review article we summarize some of the currently known biological events occurring in the periodontal ligament and in the alveolar bone in response to application of orthodontic forces and how these facilitate tooth movement.
Topics: Alveolar Process; Bone Remodeling; Bone Resorption; Gene Expression Regulation; Humans; Orthodontic Wires; Osteoclasts; Osteogenesis; Periodontal Ligament; Signal Transduction; Stress, Mechanical; Tensile Strength; Tooth Movement Techniques; Wnt Proteins; beta Catenin
PubMed: 26421314
DOI: 10.1155/2015/876509 -
European Review For Medical and... Aug 2022An adequate alveolar facial bone thickness (FBT) and facial bone height (FBH) in the mandibular anterior region is essential for implant placement. However, the diabetic...
OBJECTIVE
An adequate alveolar facial bone thickness (FBT) and facial bone height (FBH) in the mandibular anterior region is essential for implant placement. However, the diabetic condition may affect FBT and FBH. The aim of the study is to compare the alveolar FBT and FBH in the anterior mandibular region of diabetic and non-diabetic individuals utilizing Cone Beam Computed Tomography (CBCT) images.
MATERIALS AND METHODS
This cross-sectional study was conducted in dental clinics of Riyadh Elm University, Riyadh, Saudi Arabia. A total of 46 CBCT images belonging to the diabetic (n=23) and non-diabetic (n=23) individuals were obtained from the radiographic image database of the hospital. The alveolar FBT and FBH in the anterior mandibular region were measured directly on CBCT images using Galileos 3D Digital Imaging System in Sagittal and cross-sectional view.
RESULTS
The comparison of mean FBT between non-diabetic and diabetic individuals in central incisors (0.96±0.25 vs. 0.79±0.24, p=0.025) and lateral incisors (1.00±0.23 vs. 0.78±0.17, p=0.001) showed a statistically significant difference. Similarly, the mean FBH between non-diabetic and diabetic individuals differed significantly in central (31.37.96±2.98 vs. 26.07±6.58, p=0.001) and lateral incisor (31.20±3.05 vs. 26.79±6.83, p=0.008) regions.
CONCLUSIONS
Based on our study, non-diabetic individuals showed higher alveolar FBT and FBH levels than diabetic individuals. Hence, diabetic condition affects the alveolar FBT and FBH around the central and lateral incisor regions.
Topics: Alveolar Process; Cone-Beam Computed Tomography; Cross-Sectional Studies; Diabetes Mellitus; Humans; Incisor; Mandible
PubMed: 35993643
DOI: 10.26355/eurrev_202208_29416 -
International Journal of Implant... Dec 2022The remodeling process following tooth extraction can be observed as horizontal and vertical bone reduction of the alveolar ridge. Preservation procedures such as...
PURPOSE
The remodeling process following tooth extraction can be observed as horizontal and vertical bone reduction of the alveolar ridge. Preservation procedures such as alveolar ridge preservation (ARP) aim to maintain the 3D volume of the extraction site. This retrospective study analyzed differences in the hard and soft tissue changes in patients treated with either spontaneous healing or ARP.
METHODS
After tooth extraction, the patients were treated either by spontaneous socket healing (SH group) or with ARP using a xenograft and a resorbable membrane (ARP group). One week before and 6 months after extraction, the patients underwent cone beam computed tomography. A volumetric analysis was performed by superimposing the digital models of the two time points. Intraoral radiography was performed after implant placement, upon prosthesis delivery, and at 1-year post-treatment. An esthetic assessment was conducted using the Pink Esthetic Score (PES). The patients' overall satisfaction with the implant restoration was investigated at 12 months.
RESULTS
Intragroup comparisons revealed significant differences between baseline and the 6-month follow-up in both groups at the measured locations (1 mm, 3 mm, and 5 mm below the most coronal aspect of the alveolar ridge) showing a reduction of the horizontal width (P < 0.05). Additionally, after treatment, the horizontal width at 1 mm was significantly different in the SH and ARP groups (P < 0.001), with mean changes of 2.03 ± 0.54 mm and 0.86 ± 0.49 mm, respectively. ARP was associated with an increased PES (11.6 ± 2.2) and a reduction in patients requiring additional grafting procedures in subsequent treatment phases (9% vs 26%; P = 0.11).
CONCLUSIONS
In both groups, significant horizontal and vertical bone loss was observed after the extraction. ARP can reduce linear and volumetric shrinkage of the alveolar ridge, leading to improved outcomes. It can also simplify implant restoration.
Topics: Humans; Retrospective Studies; Alveolar Process
PubMed: 36480055
DOI: 10.1186/s40729-022-00456-w