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Periodontology 2000 Oct 2023The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone... (Review)
Review
The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing.
Topics: Humans; Alveolar Ridge Augmentation; Tooth Extraction; Alveolar Process; Tooth Socket; Overtreatment; Alveolar Bone Loss
PubMed: 37622682
DOI: 10.1111/prd.12508 -
Periodontology 2000 Oct 2023Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of... (Review)
Review
Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing.
Topics: Humans; Tooth Socket; Alveolar Process; Tooth Extraction; Wound Healing; Alveolar Bone Loss; Alveolar Ridge Augmentation
PubMed: 37533162
DOI: 10.1111/prd.12506 -
International Journal of Oral and... Jan 2024Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A... (Meta-Analysis)
Meta-Analysis Review
Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A systematic review of randomised clinical trials was conducted to compare the risk of dry socket and surgical site infection after the removal of lower third molars with different prophylactic antibiotics. The occurrence of any antibiotic-related adverse event was also analysed. A pairwise and network meta-analysis was performed to establish direct and indirect comparisons of each outcome variable. Sixteen articles involving 2158 patients (2428 lower third molars) were included, and the following antibiotics were analysed: amoxicillin (with and without clavulanic acid), metronidazole, azithromycin, and clindamycin. Pooled results favoured the use of antibiotics to reduce dry socket and surgical site infection after the removal of a lower third molar, with a number needed to treat of 25 and 18, respectively. Although antibiotic prophylaxis was found to significantly reduce the risk of dry socket and surgical site infection in patients undergoing lower third molar extraction, the number of patients needed to treat was high. Thus, clinicians should evaluate the need to prescribe antibiotics taking into consideration the patient's systemic status and the individual risk of developing a postoperative infection.
Topics: Humans; Dry Socket; Antibiotic Prophylaxis; Surgical Wound Infection; Molar, Third; Network Meta-Analysis; Anti-Bacterial Agents; Tooth Extraction
PubMed: 37612199
DOI: 10.1016/j.ijom.2023.08.001 -
Periodontology 2000 Oct 2023Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth... (Review)
Review
Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in alveolar ridge deficiencies. Although RAP-related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post-surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post-surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.
Topics: Humans; Alveolar Ridge Augmentation; Dental Implantation, Endosseous; Quality of Life; Bone Transplantation; Alveolar Process; Bone Substitutes; Biocompatible Materials; Tooth Extraction; Tooth Socket; Dental Implants
PubMed: 37489632
DOI: 10.1111/prd.12509 -
Periodontology 2000 Oct 2023In the last 20 years, immediate implant placement has been proposed as a predictable protocol to replace failing teeth. The research conducted in preclinical and... (Review)
Review
In the last 20 years, immediate implant placement has been proposed as a predictable protocol to replace failing teeth. The research conducted in preclinical and clinical studies have focused on soft and hard tissue changes following tooth extraction and immediate implant placement. Different approaches for hard and soft tissue grafting together with provisional restorations have been proposed to compensate tissue alterations. This review analyzed some relevant clinical and preclinical literature focusing on the impact of bone grafting procedures on immediate implant placement in terms of hard and soft tissue changes, aesthetic results, and patient-related outcomes.
Topics: Humans; Immediate Dental Implant Loading; Bone Transplantation; Tooth Socket; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Tooth Extraction; Esthetics, Dental; Treatment Outcome
PubMed: 37658586
DOI: 10.1111/prd.12516 -
Clinical Oral Investigations Aug 2023The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements.
BACKGROUND
Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures, a bone grafting material is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane, and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness.
MATERIALS AND METHODS
Forty-one patients were randomly assigned in four treatment groups: (A) freeze-dried bone allograft (FDBA) covered with collagen sponge (CS), (B) FDBA covered with free gingival graft (FGG), (C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG, and (D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss.
RESULTS
Overall, groups A, B, and C presented significantly less vertical and horizontal bone resorption compared to group D. No statistically significant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically significantly reduced bone loss compared to allograft (group C vs group B: adjusted β coef: 1.07 mm; 95%CI: 0.01, 2.10; p = 0.05). No significant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA.
CONCLUSIONS
No differences between FDBA and DBBM could practically be confirmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and the effect of CS and FGG on soft tissue dimensional changes.
CLINICAL RELEVANCE
Xenograft and allograft were equally efficient in ARP 4 months after tooth extraction in horizontal level. Xenograft maintained the mid-buccal site of the socket marginally better than the allograft, in vertical level. FGG and CS were equally efficient as SS materials regarding the hard tissue dimensional alterations.
TRIAL REGISTRATION
Clinical trial registration Number: NCT04934813 (clinicaltrials.gov).
Topics: Humans; Animals; Cattle; Tooth Socket; Alveolar Process; Alveolar Bone Loss; Collagen; Tooth Extraction; Alveolar Ridge Augmentation
PubMed: 37227497
DOI: 10.1007/s00784-023-05068-1 -
Journal of Dental Research Mar 2024Periodontal mesenchymal stem cells (MSCs) play a crucial role in maintaining periodontium homeostasis and in tissue repair. However, little is known about how...
Periodontal mesenchymal stem cells (MSCs) play a crucial role in maintaining periodontium homeostasis and in tissue repair. However, little is known about how periodontal MSCs in vivo respond under periodontal disease conditions, posing a challenge for periodontium tissue regeneration. In this study, Gli1 was used as a periodontal MSC marker and combined with a Gli1-cre ERT2 mouse model for lineage tracing to investigate periodontal MSC fate in an induced periodontitis model. Our findings show significant changes in the number and contribution of Gli1 MSCs within the inflamed periodontium. The number of Gli1 MSCs that contributed to periodontal ligament homeostasis decreased in the periodontitis-induced teeth. While the proliferation of Gli1 MSCs had no significant difference between the periodontitis and the control groups, more Gli1 MSCs underwent apoptosis in diseased teeth. In addition, the number of Gli1 MSCs for osteogenic differentiation decreased during the progression of periodontitis. Following tooth extraction, the contribution of Gli1 MSCs to the tooth socket repair was significantly reduced in the periodontitis-induced teeth. Collectively, these findings indicate that the function of Gli1 MSCs in periodontitis was compromised, including reduced contribution to periodontium homeostasis and impaired injury response.
Topics: Mice; Animals; Zinc Finger Protein GLI1; Osteogenesis; Periodontitis; Periodontium; Mesenchymal Stem Cells; Periodontal Ligament
PubMed: 38284236
DOI: 10.1177/00220345231220915