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BMC Oral Health Sep 2023Platelet-rich fibrin (PRF) is commonly used for ridge preservation following tooth extraction. However, its effectiveness diminishes over a period of two weeks as it is... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Platelet-rich fibrin (PRF) is commonly used for ridge preservation following tooth extraction. However, its effectiveness diminishes over a period of two weeks as it is resorbed and loses its biological activities. Therefore, this clinical study aims to evaluate the effect of recurrent application of concentrated PRF (C-PRF) inside the extraction socket on the hard and soft tissue alterations.
METHODS
Twenty patients requiring single tooth extraction and replacement with a dental implant were randomized into one of two ridge preservation approaches: Advanced PRF plus alone (Control group) or advanced PRF plus with the recurrent application of a C-PRF inside the socket every two weeks for 2 months (four times). The ridge width, the ridge height, and the soft tissue thickness were assessed clinically at the baseline and reassessed after 3 months from tooth extraction during implant surgery. Then the amount of hard tissue loss and soft tissue alterations were calculated.
RESULTS
There was a statistically significant difference in the amount of hard tissue loss between groups in the third month. The amount of horizontal ridge loss for the control and test groups were 2.9 ± 0.7 mm and 1.9 ± 0.5 mm, respectively (p-value < 0.05). The vertical bone loss for control and test groups were 1.8 ± 0.5 mm and 1.0 ± 0.3 mm, respectively (p-value < 0.05). Additionally, for the soft tissue thickness, there was no statistical difference between the groups (p-value > 0.05).
CONCLUSION
Within the limitations of this study, the recurrent application of C-PRF in the extraction socket could decrease the amount of ridge alteration following tooth extraction and may play a role in the bone regeneration procedures.
TRIAL REGISTRATION
Registered on ClinicalTrials.gov (ID: NCT05492357, on 08/08/2022).
Topics: Humans; Platelet-Rich Fibrin; Dental Care; Tooth Extraction; Bone Regeneration
PubMed: 37726689
DOI: 10.1186/s12903-023-03400-5 -
Clinical Implant Dentistry and Related... Feb 2024The present systematic review aimed to identify and summarize the clinical, radiographic, and histological outcomes of alveolar ridge preservation using bone xenografts... (Meta-Analysis)
Meta-Analysis Review
AIM
The present systematic review aimed to identify and summarize the clinical, radiographic, and histological outcomes of alveolar ridge preservation using bone xenografts and absorbable sealing materials compared with spontaneous healing in the esthetic zone.
MATERIALS AND METHODS
Randomized clinical trials (RCTs) fulfilling specific eligibility criteria were included. Two review authors independently searched for eligible studies, extracted data from the published reports and performed the risk of bias assessment (RoB 2 tool). Study results were summarized using random effects meta-analyses.
RESULTS
Thirteen articles concerning 10 RCTs were included, involving a total of 357 participants. Most of studies were considered as "low" risk of bias. Meta-analyses indicated less horizontal (difference in means-MD = 1.88 mm; p < 0.001), vertical mid-buccal (MD = 1.84 mm; p < 0.001) and vertical mid-lingual (MD = 2.27 mm; p < 0.001) bone resorption in alveolar ridge preservation compared to spontaneous healing as assessed clinically. Bone changes assessed radiographically showed consistent results in terms of horizontal (at 1 mm: MD = 1.84 mm, p < 0.001), vertical mid-buccal (MD = 0.95 mm; p < 0.001) and mid-lingual (MD = 0.62 mm; p = 0.05) resorption. Part of the bone resorption in the spontaneous healing group was compensated by soft-tissues, since the observed differences between groups in linear ridge reduction evaluated through cast models superimposition were smaller (MD = 0.52 mm; p < 0.001).
CONCLUSIONS
Alveolar ridge preservation with xenogeneic bone substitutes and non-autogenous resorbable socket sealing materials is efficacious in reducing post-extraction bone and ridge changes in the esthetic region.
Topics: Humans; Alveolar Process; Tooth Socket; Alveolar Ridge Augmentation; Alveolar Bone Loss; Heterografts; Remission, Spontaneous; Tooth Extraction; Esthetics, Dental
PubMed: 37674334
DOI: 10.1111/cid.13257 -
Clinical Advances in Periodontics Mar 2024Alveolar ridge preservation (ARP) procedures are designed to lessen dimensional changes in the alveolar ridge after tooth extraction. Wound healing after ridge... (Review)
Review
BACKGROUND
Alveolar ridge preservation (ARP) procedures are designed to lessen dimensional changes in the alveolar ridge after tooth extraction. Wound healing after ridge preservation involves the formation of new vital bone in the former socket, and this vital bone is important in the osseointegration of dental implants.
METHODS
A series of ARP studies have been performed to help clinicians better understand the wound-healing events that occur following tooth extraction and ridge preservation. Different protocols have been examined using various materials and periods of healing time prior to implant placement. The primary aim of these studies was to ascertain the relative percentage of vital bone formation, residual graft material, and connective tissue (CT)/other at the healing site using histomorphometric examination of bone core biopsies obtained during osteotomy preparation.
RESULTS
For allografts, the use of demineralized bone alone or in combination with mineralized is associated with more vital bone formation than the use of mineralized allograft alone. For mineralized allografts, the use of cortical versus cancellous bone has only minimal impact on new bone formation. Xenografts from bovine and porcine sources appear to have similar vital bone formation. Longer healing times prior to implant placement are associated with increased vital bone formation and decreased residual graft material. The most stable component in most studies is the percentage of CT/other.
CONCLUSIONS
The percentage of vital bone and residual graft at ARP sites is dependent on the materials used and the length of healing time prior to obtaining core biopsies.
KEY POINTS
What factors may affect the amount of new bone at the ARP site? At a time point about 4 months after ARP, the type of graft material used for ARP plays a large role in new bone formation. Studies focus on means and standard deviations, but patients often do not "follow the mean." Even if a single ARP protocol is used for all patients, there is great interindividual variability in new bone formation, and there is often variability between sites within a single patient. How long after ARP with an allograft should I wait to place an implant? Longer healing times such as 4-5 months generally provide higher amounts of vital bone formation than shorter healing times like 2-3 months. Differences in vital bone formation between ARP protocols tend to decrease with longer healing time. FDBA that contains demineralized bone, either alone or combined with mineralized FDBA, often provides higher amounts of new bone formation than 100% mineralized allograft, especially at shorter healing periods. Even a year after ARP with an allograft, residual graft material is often still present at the ARP site.
Topics: Humans; Animals; Cattle; Swine; Tooth Socket; Alveolar Ridge Augmentation; Alveolar Process; Wound Healing; Preservation, Biological
PubMed: 38450987
DOI: 10.1002/cap.10281 -
Cureus Jul 2023Objective Dry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the...
Objective Dry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the extraction. Despite several risk factors, the exact cause and underlying mechanisms of dry sockets remain unclear. This study aims to propose a novel pathogenesis and management approach for dry sockets based on an infectious process. Methods The study was conducted by reviewing medical records, at a private dental clinic, of patients who fit the inclusion criteria; these patients appeared to have come between April 2022 and April 2023. The study included all patients with age ≥17 years diagnosed with dry socket that was resistant to conventional topical treatment, and who received treatment with ciprofloxacin 500 mg three times per day during the study period. Results Out of 15 patients who received treatment with ciprofloxacin 500 mg three times per day during the study period, 11 patients (73.3%) were completely relieved of symptoms within 24 hours, with no need for additional painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, two patients (13.3%) had a partial response after 48 hours, where their pain was ameliorated from severe to moderate with the use of conventional painkillers (including paracetamol and NSAIDs) and steroidal anti-inflammatory drugs such as dexamethasone (8 mg IM daily) to have total relief. On the other hand, the other two patients (13.3%) had a negative response to the treatment and were out of reach for follow-up. Conclusion These clinical outcomes, coupled with previous laboratory data, could explain all clinical aspects of dry sockets and provide substantial support for the hypothesis that an infectious mechanism plays the principal role in the pathophysiology of dry sockets.
PubMed: 37546073
DOI: 10.7759/cureus.41347 -
Dental Research Journal 2023The healing process after dental extraction is influenced by various factors, and finding effective strategies for promoting wound healing and reducing postoperative...
BACKGROUND
The healing process after dental extraction is influenced by various factors, and finding effective strategies for promoting wound healing and reducing postoperative discomfort remains a challenge. This study aimed to evaluate the effectiveness of topical gel in reducing pain and promoting wound healing after dental extraction, with the secondary objective of assessing the occurrence of dry sockets. The study was a split-mouth randomized controlled trial conducted at the oral and maxillofacial surgery department over 3 months.
MATERIALS AND METHODS
This split-mouth randomized controlled trial consisted of a total of 21 patients undergoing bilateral extractions. One extraction socket was randomly assigned to the test group, where . gel was applied, while the contralateral socket served as the control group, receiving a placebo. Pain and wound healing were evaluated using standardized scales on the 3 and 7 days postextraction. Descriptive statistics, paired -tests, and unpaired -tests were performed using the SPSS software version 19. The statistical significance was fixed at ≤ 0.05.
RESULTS
The test group showed significantly higher mean healing scores on the 3 and 7 days compared to the control group. On the 7 day, the test group had significantly lower mean pain scores than the control group. No cases of dry sockets were observed in either group.
CONCLUSION
Topical Curcuma longa gel demonstrated positive effects in promoting wound healing and reducing pain after dental extraction. Clinicians should consider the use of Curcuma longa gel as a post-extraction medicament, particularly in cases involving multiple or traumatic extractions.
PubMed: 38020260
DOI: No ID Found -
Medicina (Kaunas, Lithuania) May 2024: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets... (Meta-Analysis)
Meta-Analysis Comparative Study Review
: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets with and without periapical pathology. : After the search and review of the literature in the electronic databases, 109 publications were achieved. The titles and abstracts of 66 publications were screened. After the evaluation of the full text of 22 publications, based on the inclusion criteria, six controlled clinical studies were included in this systematic review and meta-analysis. The statistical calculation showed no heterogeneity among the studies included. The implant survival was 99.6% in the test (socket with periapical pathology) and control (socket without periapical pathology) groups of all the clinical trials. The results of the meta-analysis showed no statistically significant difference between test and control groups regarding the marginal bone level and the width of keratinized mucosa in all the studies. Other parameters indicating plaque level, bleeding on probing, and gingival recession also did not differ between test and control groups at the final follow-up in nearly all studies. : Within the limitation of this systemic review and meta-analysis, the obtained data suggest that implants immediately placed into the extraction sockets of teeth exhibiting periapical pathology can be successfully osseointegrated for an extended period.
Topics: Humans; Tooth Socket; Dental Implantation, Endosseous; Dental Implants; Immediate Dental Implant Loading
PubMed: 38929509
DOI: 10.3390/medicina60060893 -
Evidence-based Dentistry Dec 2023A systematic review and meta-analysis of observational studies. (Meta-Analysis)
Meta-Analysis
DESIGN
A systematic review and meta-analysis of observational studies.
DATA SOURCES
Electronic search included PubMed, Scopus, and Web of Science databases up to March 2022 using appropriate keywords.
SELECTION CRITERIA
The review included all observational studies (case-control, cohort and cross-sectional studies) published in English after 2000, comparing the prevalence of dry socket between smokers and non-smokers after simple or surgical tooth extraction. Exclusion criteria included patients with other post-extraction complications, prevalence of different risk factors, and unrelated study designs (literature reviews, case reports, expert opinion, and conference reports).
DATA EXTRACTION AND SYNTHESIS
Two independent investigators screened the records (by title, abstract, and full text), and selected the eligible studies according to the predefined criteria. Collected data from each study included author name and country, year of publication, gender and age of patients, smoking status, inclusion and exclusion criteria, medical history and oral hygiene, prevalence of dry socket, type of tooth and extraction technique, symptoms and treatment. Risk of bias was assessed according to the (NHLBI, NIH) Quality Assessment Tool For Observational Cohort and Cross-Sectional Studies, while the level of evidence was assessed using the classification of the Oxford Centre for Evidence-Based Medicine levels for diagnosis. Two independent reviewers conducted the assessments, and any disagreements were addressed through discussion.
RESULTS
Eleven studies from ten different countries representing a total of 10,195 patients (3007 smokers and 7188 non-smokers) were included in the final analysis. Nine studies were classified as having "good" quality and two as "intermediate," while all of the studies have the third or fourth level of evidence (through 5-graded scale). The prevalence of dry socket in smokers was about 13.2% (95% CI: 5.8-23.1%) and in non-smokers about 3.8% (95% CI: 2.1-6.0%). Meta-analysis showed that regular tobacco smoking was associated a more than 3-fold increase in the odds of dry socket after tooth extraction.
CONCLUSION
Despite heterogeneity among the included studies (different age groups and types of teeth extracted), there was a consistent association between cigarette smoking and an elevated risk of developing dry socket post tooth extraction.
Topics: Humans; Cigarette Smoking; Cross-Sectional Studies; Dry Socket; Prevalence; Tobacco Use Cessation; Observational Studies as Topic
PubMed: 37814003
DOI: 10.1038/s41432-023-00938-9 -
PeerJ 2023An incomplete, yet remarkably-sized dentated rostrum and associated partial cervical vertebrae of a pterosaur (ML 2554) were recently discovered from the Late Jurassic...
An incomplete, yet remarkably-sized dentated rostrum and associated partial cervical vertebrae of a pterosaur (ML 2554) were recently discovered from the Late Jurassic (Late Kimmeridgian-Early Tithonian) Lourinhã Formation of Praia do Caniçal, of central west Portugal. This specimen exhibits features such as a spatulated anterior expansion of the rostrum, robust comb-like dentition, and pronounced rims of the tooth alveoli, indicating gnathosaurine affinities. Based on its further unique tooth and dentary morphology, a new genus and species, gen. et spec. nov., is proposed, making this the first named pterosaur species found within Portugal. The presence of this taxon adds yet another element to the fluvio-deltaic lagoonal environment that has been suggested as representative of the Lourinhã Formation in the Late Jurassic, further contributing to the diversity and distribution of gnathosaurines worldwide.
Topics: Portugal; Cervical Vertebrae; Tooth Socket
PubMed: 37744218
DOI: 10.7717/peerj.16048 -
The Journal of Histochemistry and... Dec 2023This study investigated whether osteocalcin (OCN) is present in osteoblast precursors and its relationship with initial phases of alveolar process formation. Samples of...
This study investigated whether osteocalcin (OCN) is present in osteoblast precursors and its relationship with initial phases of alveolar process formation. Samples of maxillae of 16-, 18-, and 20-day-old rat embryos (E16, E18, and E20, respectively), and 05-, 10-, and 15-day-old postnatal rats (P05, P10, and P15, respectively) were fixed and embedded in paraffin or araldite. Immunohistochemistry for osterix (Osx), alkaline phosphatase (ALP), and OCN detection was performed and the number of immunolabelled cells was computed. Non-decalcified sections were subjected to the von Kossa method combined with immunohistochemistry for Osx or OCN detection. For OCN immunolocalization, samples were fixed in 0.5% glutaraldehyde/2% formaldehyde and embedded in LR White resin. The highest number of ALP- and OCN-immunolabelled cells was observed in dental follicle of E16 specimens, mainly in basal portions of dental alveolus. In corresponding regions, osteoblasts in differentiation adjacent to von Kossa-positive bone matrix exhibited Osx and OCN immunoreactivity. Ultrastructural analysis revealed OCN immunoreactive particles inside osteoblast in differentiation, and in bone matrix associated with collagen fibrils and within matrix vesicles, at early stages of alveolar process formation. Our results indicate that OCN plays a role in osteoblast differentiation and may regulate calcium/phosphate precipitation during early mineralization of the alveolar process.
Topics: Rats; Animals; Osteocalcin; Cell Differentiation; Osteogenesis; Alkaline Phosphatase; Osteoblasts; Alveolar Process
PubMed: 37953508
DOI: 10.1369/00221554231211630 -
Clinical Oral Investigations Mar 2024to compare the parameters of pain, oedema, temperature, and soft tissue closure in dental sockets that received two different photobiomodulation (PBM) protocols... (Comparative Study)
Comparative Study Randomized Controlled Trial
Clinical and thermographic evaluation after lower third molar extractions and the application of different photobiomodulation protocols: double-blind randomised clinical trial.
OBJECTIVES
to compare the parameters of pain, oedema, temperature, and soft tissue closure in dental sockets that received two different photobiomodulation (PBM) protocols following extractions.
MATERIALS AND METHODS
Thirty-one participants had their teeth 38 and 48 extracted. Subsequently, one of the dental sockets received PBM at a wavelength (WL) of 808 nanometers (808 group- nm) and the other dental socket received the PBM at WLs of 808 nm and 660 nm, simultaneously (808 + 660 group). The PBM was applied immediately after the surgical procedure and on the 3rd and 7th days.
RESULTS
The mean of Visual Analogue Scale (VAS) values for pain were 1.45 for the 3rd day and 0.52 for the 7th day in the 808 + 660 and 808 group, respectively. The mean the pogonion-tragus measurement, used to assess facial oedema on the 3rd day, was 15.38 cm (range 13.5-17.5) in the 808 + 660 group and 15.48 cm (range 14.0-17.5) in the 808 group. The mean facial temperatures in the 808 + 660 group were 34.9 degrees Celsius (ºC) (range 33.5-36.4) on the 3rd day and 35 ºC (range 33.4-36.4) on the 7th day. In the 808 group, the mean temperatures were 34.9 ºC (range 33.9-36.2) on the 3rd day and 34.9 ºC (33.7-36.2) on the 7th day. Regarding the dimensions of the dental socket, the mean were similar for both groups. Significant differences between the groups were only observed in the pain parameter and only on the 7th day, being greater for the 808 + 660 group (p = 0.031).
CONCLUSIONS
The association of the 660 nm with 808 nm, and the increase in energy did not showed more benefits in pain reduction oedema, or acceleration of the closure of the soft tissues of the dental sockets of lower third molars, in the protocols used here.
CLINICAL RELEVANCE
There is no need to combine lasers at wavelengths of 660 and 808 nm to reduce oedema, pain and repair of soft tissues after extraction of lower third molars.
CLINICAL TRIAL REGISTRATION
This trial was registered in the Brazilian Registry of Clinical Trials (ReBEC) with the following code: RBR-66pyrh8, on 29th December, 2022.
Topics: Humans; Edema; Low-Level Light Therapy; Molar, Third; Pain; Pain, Postoperative; Tooth Extraction
PubMed: 38453808
DOI: 10.1007/s00784-024-05594-6