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Clinical Implant Dentistry and Related... Aug 2022An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The choice of the graft material and its properties...
BACKGROUND
An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The choice of the graft material and its properties also could have an impact on the results. To prevent alveolar ridge dimensional changes, since numerous graft materials have been suggested and in the past years, a growing interest in teeth material has been observed as a valuable alternative to synthetic biomaterials.
AIM
The aim of the study was to explore the histomorphometric outcomes of tooth derivative materials as used as bone substitute material in socket preservation procedure.
METHODS
After alveolar socket preservation (ASP) procedures using autologous demineralized tooth as graft material prepared by means of an innovative device, was evaluated. A total of 101 histological samples, from 96 subjects, were analyzed by evaluating the total amount of bone (BV), residual tooth material (residual graft, TT), and vital bone (VB). The section from each sample was then split in nine subsections, resulting in 909 subsections, to allow statistical comparison between the different areas.
RESULTS
It was not noticed a statistically significant difference between maxillary and mandibular sites, being the amount of VB in upper jaw sites 37.9 ± 21.9% and 38.0 ± 22.0% in lower jaw sites and the amount of TT was 7.7 ± 12.2% in maxilla and 7.0 ± 11.1% in mandibles. None of the other considered parameters, including defect type and section position, were statistically correlated to the results of the histomorphometric analysis.
CONCLUSIONS
ASP procedure using demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone potentially capable to support dental implant rehabilitation.
Topics: Alveolar Process; Alveolar Ridge Augmentation; Bone Substitutes; Bone Transplantation; Humans; Tooth Extraction; Tooth Socket
PubMed: 35507503
DOI: 10.1111/cid.13097 -
Journal of Long-term Effects of Medical... 2022Mini-implants were introduced as an alternative to standard implants for use in narrow alveolar ridges due to their smaller length and size. They are also used to... (Review)
Review
Mini-implants were introduced as an alternative to standard implants for use in narrow alveolar ridges due to their smaller length and size. They are also used to provide anchorage in orthodontic treatments. Mini-implants offer simplified treatment procedures with a flat learning curve, low cost, and a possible flapless surgical procedure that can decrease post-surgical morbidity. Before being implemented into clinical practice, they were subjected to in vivo testing using animal models as is with all implant research. The biomechanical properties of mini-implants have earned them a high rate of acceptance in treatment among patients. In this review, we focus on mini-implants, extrapolation from mini-implant testing on animal models, and their latest use in dentistry.
Topics: Alveolar Process; Animals; Dental Implants; Humans; Orthodontic Anchorage Procedures; Prostheses and Implants
PubMed: 35993987
DOI: 10.1615/JLongTermEffMedImplants.2022041814 -
Frontiers in Endocrinology 2023The aim of this clinical trial was to assess the impact of autologous concentrated growth factor (CGF) as a socket-filling material and its ridge preservation properties... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this clinical trial was to assess the impact of autologous concentrated growth factor (CGF) as a socket-filling material and its ridge preservation properties following the lower third molar extraction.
MATERIALS AND METHODS
A total of 60 sides of 30 participants who had completely symmetrical bilateral impacted lower third molars were enrolled. The primary outcome variables of the study were bone height and width, bone density, and socket surface area in the coronal section. Cone beam computed tomography images were obtained immediately after surgery and three months after surgery as a temporal measure. Follow-up data were compared to the baseline using paired and unpaired -tests.
RESULTS
CGF sites had higher values in height and width when compared to control sites (Buccal wall 32.9 ± 3.5 vs 29.4 ± 4.3 mm, Lingual wall 25.4 ± 3.5 vs 23.1 ± 4 mm, and Alveolar bone width 21.07 ± 1.55vs19.53 ± 1.90 mm, respectively). Bone density showed significantly higher values in CGF sites than in control sites (Coronal half 200 ± 127.3 vs -84.1 ± 121.3 and Apical half 406.5 ± 103 vs 64.2 ± 158.6, respectively). There was a significant difference between both sites in the reduction of the periodontal pockets.
CONCLUSION
CGF application following surgical extraction provides an easy, low-cost, and efficient option for alveolar ridge preservation. Thus, the use of CGF by dentists during dental extractions may be encouraged, particularly when alveolar ridge preservation is required.
CLINICAL TRIAL REGISTRATION
TCTR identification, TCTR20221028003.
Topics: Humans; Cone-Beam Computed Tomography; Tooth Extraction; Tooth Socket
PubMed: 37265705
DOI: 10.3389/fendo.2023.1163696 -
Journal of Clinical Periodontology Jan 2021To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing. (Meta-Analysis)
Meta-Analysis Review
AIM
To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing.
MATERIALS AND METHODS
The protocol of this PRISMA-compliant systematic review (SRs) was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random-effects meta-analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest.
RESULTS
Twenty-eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non-molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed clinically in non-molar sites was 2.73 mm (95% CI: 2.36-3.11), 1.71 mm (95% CI: 1.30-2.12) and 1.44 mm (95% CI: 0.78-2.10), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in non-molar sites was 2.54 mm (95% CI: 1.97-3.11), 1.65 mm (95% CI: 0.42-2.88) and 0.87 mm (95% CI: 0.36-1.38), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in molar sites was 3.61 mm (95% CI: 3.24-3.98), 1.46 mm (95% CI: 0.73-2.20) and 1.20 mm (95% CI: 0.56-1.83), respectively.
CONCLUSION
A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Humans; Tooth Extraction; Tooth Socket
PubMed: 33067890
DOI: 10.1111/jcpe.13390 -
The Journal of Contemporary Dental... Feb 2022Alveolar bone undergoes volumetric changes after extraction due to physiologic bone remodeling. The amount of alveolar bone available during prosthodontic treatment can... (Review)
Review
BACKGROUND
Alveolar bone undergoes volumetric changes after extraction due to physiologic bone remodeling. The amount of alveolar bone available during prosthodontic treatment can affect the esthetic outcome of the treatment and make implant placement challenging. Socket preservation techniques are advocated postextraction to maintain the bone's vertical and horizontal alveolar bone dimensions and prevent its atrophy.
AIM
This review is oriented toward a clinician, describing the different materials and techniques in practice today for socket preservation.
REVIEW RESULTS
A variety of methods have been studied as a means to stop alveolar ridge resorption. While immediate implant placement was recommended as a socket preservation technique, clinical trials have not demonstrated favorable results. The main techniques favored by clinicians today involve bone grafts, bone substitutes, barrier membranes, and combinations thereof. As with periodontal defects, these materials show favorable outcomes in alveolar bone regeneration and ridge preservation. Tooth bone grafts, both autogenous and allogenous, have been recommended recently for ridge preservation as they are chemically similar to bone and can induce osteogenesis. The use of autologous platelet concentrates has yielded contradictory results in studies. Cutting-edge approaches entail using growth factors and tissue engineering concepts. While these strategies are still in the development stages, it has peerless potential in preserving and regenerating alveolar bone.
CONCLUSION
Alveolar ridge resorption is an unavoidable physiological process after extraction and leads to severe bone deficiencies, affecting esthetics. These changes in alveolar ridge dimensions make implant placement difficult and affect the longevity of the implant. Clinical intervention can prevent alveolar bone resorption and preserve the ridge. Bone grafts and substitutes including concentrates remain the best choices in ride preservation. The use of growth factors and tissue engineering concepts requires further clinical trials before widespread use in clinical practice.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Esthetics, Dental; Humans; Tooth Extraction; Tooth Socket
PubMed: 35748457
DOI: No ID Found -
Annals of Anatomy = Anatomischer... Nov 2021Alveolar bone resorption after dental extraction frequently leads to situations in which long-term function and esthetic success of rehabilitations with dental implants... (Review)
Review
BACKGROUND AND PURPOSE
Alveolar bone resorption after dental extraction frequently leads to situations in which long-term function and esthetic success of rehabilitations with dental implants is a challenge. Socket shield has been described as an alternative technique to maintain the alveolar ridge when placing immediate implants. The aim of this review is to evaluate the medium- and long-term clinical outcomes of the socket shield technique in human studies.
MATERIAL AND METHODS
This review was conducted according to PRISMA guidelines. An electronic search was conducted in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL). The Cochrane Collaboration tool, the Newcastle-Ottawa Quality Assessment Scale and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed.
RESULTS
Six articles were included in this review. The studies analysed showed lower rates of horizontal and vertical alveolar bone resorption, better maintenance of the buccal plate, less marginal bone loss and better esthetic results than simple placement of immediate implants. However, a lack of homogeneity was found in evaluation methods of the different outcomes, surgical procedures and prosthetic management.
CONCLUSIONS
Based on the results of this review, it is possible to suggest that socket shield technique could be a good alternative in terms of alveolar bone maintenance, marginal bone stability and aesthetic outcomes in immediate implant treatment. However, it is not possible to recommend this technique as an alternative treatment with the same long-terms predictability as conventional immediate implants.
Topics: Alveolar Bone Loss; Alveolar Process; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Humans; Immediate Dental Implant Loading; Tooth Extraction; Tooth Socket
PubMed: 34087383
DOI: 10.1016/j.aanat.2021.151779 -
Journal of Long-term Effects of Medical... 2022The aim of this study was to assess the morphology and dimension of maxillary alveolar ridge at anterior and posterior regions using cone beam computed tomography (CBCT)...
The aim of this study was to assess the morphology and dimension of maxillary alveolar ridge at anterior and posterior regions using cone beam computed tomography (CBCT) prior to the placement of immediate implants. CBCT scans of 192 patients were evaluated. Measurements were taken at the cross sectional views in the maxillary central incisor, lateral incisor, canine incisor, first and second premolars and first and second molars regions. Alveolar ridge width and height, buccal plate thickness, buccal undercut, inter-root septum height, and root penetration to sinus floor were measured. Independent T-test was used for statistical analysis. The mean value of alveolar height in the maxillary incisors were higher than the posterior teeth with central incisors having the highest value of 19.23 ± 8.74 mm. At anterior maxilla, the lateral incisor with the mean value of 1.07 ± 0.64 mm exhibits the highest buccal undercut and the thinnest ridge width. At the site of posterior regions premolars had higher buccal undercut than molars. Canine with the mean value of 0.19 ± 0.31 mm thickness at the mid-alveolar of buccal plate, had the thinnest plate among other maxillary incisors. Sinus penetration and inter-root septum height were higher in premolar teeth than molars. The mean value of ridge width at all levels was significantly different between men and women, except at the level of crest in central incisor. CBCT evaluation presents accurate measurements for ridge assessment prior to immediate implant insertion. The recommended appropriate size of implant platform would be 5 mm in the incisor and almost 6 mm in premolar region.
Topics: Alveolar Process; Cone-Beam Computed Tomography; Cross-Sectional Studies; Female; Humans; Maxilla; Sinus Floor Augmentation; Spiral Cone-Beam Computed Tomography
PubMed: 35695628
DOI: 10.1615/JLongTermEffMedImplants.2022039223 -
Clinical Implant Dentistry and Related... Jun 2023Alveolar ridge preservation (ARP) is a well-defined treatment performed to reduce bone dimensional changes occurring during the healing of post-extraction sockets to... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Alveolar ridge preservation (ARP) is a well-defined treatment performed to reduce bone dimensional changes occurring during the healing of post-extraction sockets to allow for adequate implant placement. Leukocyte and platelet-rich fibrin (L-PRF) has been showing to potentially promote bone and tissue regeneration during wound healing. Therefore, the aim of this study is to evaluate its efficacy for ARP when applied to fresh extraction sockets, in comparison with spontaneous healing.
MATERIALS AND METHODS
Twenty-seven patients with hopeless non-molar teeth were treated. After randomization, fresh extraction sockets were either filled with L-PRF or allowed to heal spontaneously. CBCTs and intraoral scans were obtained immediately after extraction and at 4 months. Through superimposition of the obtained images, changes in the horizontal ridge width, height, buccal volume, and ridge contour changes were measured, as well as patient-reported outcome measures (PROM's).
RESULTS
The ridge dimensions changed similarly in both groups. Although less reduction occurred in the test group at 1 mm from the bone crest, differences were not statistically significant (p > 0.05). Application of L-PRF did not prevent reductions of ridge contours, neither in the linear vertical aspect nor in volumetric changes. There were no differences between groups in the need for bone regeneration when placing implants. Patients in both groups reported similar outcomes in terms of bleeding, pain, inflammation, and function at 1 and 4 weeks postoperatively.
CONCLUSION
Alveolar preservation with L-PRF neither minimized bone resorption occurring after tooth extraction in non-molar sites nor reduced the need for bone regeneration when placing implants. Furthermore, its use did not improve PROM's.
Topics: Humans; Alveolar Process; Tooth Socket; Platelet-Rich Fibrin; Alveolar Bone Loss; Tooth Extraction; Leukocytes; Alveolar Ridge Augmentation
PubMed: 37088697
DOI: 10.1111/cid.13208 -
International Journal of Environmental... Dec 2022Traumatic injuries to the permanent dentition are most common in children. In severe dentoalveolar injuries, especially avulsion and intrusion, dentoalveolar ankylosis...
Traumatic injuries to the permanent dentition are most common in children. In severe dentoalveolar injuries, especially avulsion and intrusion, dentoalveolar ankylosis is a common complication, leading to adverse effects on the developing alveolar bone and interfering with the eruption of the adjacent teeth. The decoronation procedure was suggested in 1984 to reduce these side effects related to ankylosis. The objective of the current publication is to describe a minimally invasive, flapless decoronation procedure aimed to minimize and simplify the surgical procedure of decoronation, and ease its clinical acceptance, particularly in young children. The technique is described in a detailed protocol and demonstrated in two cases. Under local anesthesia, the dental crown is removed, and the root is reduced by 1.5-2.0 mm apically to the marginal bone crest. The root canal content is then removed, allowing it to fill with blood. The socket is coronally sealed with a porcine-derived collagen matrix (PDCM) sutured using the "parachute" technique over the resected root, allowing close adaptation to the surrounding soft tissue. In conclusion, the presented technique of flapless decoronation is a modification of the classic decoronation procedure, which can be used as a minimally invasive technique to simplify the surgical procedure and the post-operative process.
Topics: Humans; Tooth Ankylosis; Tooth Crown; Alveolar Process; Tooth; Tooth Avulsion
PubMed: 36612921
DOI: 10.3390/ijerph20010603 -
Journal of Prosthodontic Research Jan 2023Tooth extraction is a last resort treatment for resolving pathological complications of dentition induced by infection and injury. Although the extraction wound... (Review)
Review
PURPOSE
Tooth extraction is a last resort treatment for resolving pathological complications of dentition induced by infection and injury. Although the extraction wound generally heals uneventfully, resulting in the formation of an edentulous residual ridge, some patients experience long-term and severe residual ridge reduction. The objective of this review was to provide a contemporary understanding of the molecular and cellular mechanisms that may potentially cause edentulous jawbone resorption.
STUDY SELECTION
Clinical, in vivo, and in vitro studies related to the characterization of and cellular and molecular mechanisms leading to residual ridge resorption.
RESULTS
The alveolar processes of the maxillary and mandibular bones uniquely juxtapose the gingival tissue. The gingival oral mucosa is an active barrier tissue that maintains homeostasis of the internal organs through its unique barrier immunity. Tooth extraction not only generates a bony socket but also injures oral barrier tissue. In response to wounding, the alveolar bone socket initiates regeneration and remodeling through coupled bone formation and osteoclastic resorption. Osteoclasts are also found on the external surface of the alveolar bone, interfacing the oral barrier tissue. Osteoclasts in the oral barrier region are not coupled with osteoblastic bone formation and often remain active long after the completion of wound healing, leading to a net decrease in the alveolar bone structure.
CONCLUSIONS
The novel concept of oral barrier osteoclasts may provide important clues for future clinical strategies to maintain residual ridges for successful prosthodontic and restorative therapies.
Topics: Humans; Osteoclasts; Bone Resorption; Alveolar Process; Mouth, Edentulous; Tooth Extraction; Tooth Socket; Alveolar Ridge Augmentation; Alveolar Bone Loss
PubMed: 35185111
DOI: 10.2186/jpr.JPR_D_21_00333