-
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 -
British Dental Journal Aug 2019Alveolar ridge preservation (ARP) is a method of decreasing bone resorption following tooth extraction and facilitating prosthetically-driven implant placement. An...
Alveolar ridge preservation (ARP) is a method of decreasing bone resorption following tooth extraction and facilitating prosthetically-driven implant placement. An understanding of the physiological responses occurring after extraction and the effects of ARP are important in order to implement clinical procedures. ARP is a predictable way to reduce undesirable horizontal and vertical ridge reduction following extraction when dental implant treatment is to be delayed. Guided bone regeneration, socket fillers, socket sealers and growth factors have been used satisfactorily. However, there is currently no consensus on case selection, best clinical technique and material choice. Management of tooth extraction sockets is presented, with a focus on decision-making.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Dental Implants; Tooth Extraction; Tooth Socket
PubMed: 31444438
DOI: 10.1038/s41415-019-0647-2 -
Periodontology 2000 Jun 2023Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous... (Review)
Review
Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.
Topics: Humans; Alveolar Process; Tooth Socket; Cost-Benefit Analysis; Tooth Extraction; Alveolar Ridge Augmentation; Bone Transplantation; Alveolar Bone Loss
PubMed: 36580417
DOI: 10.1111/prd.12469 -
Clinical Oral Implants Research Jul 2022To compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket healing (Control).
MATERIAL AND METHODS
Patients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n= 14/). Cone Beam Computed Tomography (CBCT) images were recorded post-extraction and at 4 months, the mid-buccal and mid-palatal alveolar ridge heights (BARH/PARH) were measured. The alveolar ridge width, cross-sectional socket and alveolar-process area changes, implant placement feasibility, requirement for bone augmentation and post-surgical complications were also recorded.
RESULTS
BARH and PARH was found to increase with the SS (0.65 mm ± 1.1/0.65 mm ± 1.42) techniques, stabilise with GBR (0.07 mm ± 0.83/0.86 mm ±1.37) and decrease in the Control (-0.52 mm ± 0.8/-0.43 mm ± 0.83). Statistically significance was found when comparing the GBR and SS BARH (p = .04/.005) and GBR PARH (p = .02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (-2.17 mm ± 0.84), when compared to the Control (-2.3 mm ± 1.11) (p = .89). A mid-socket cross-sectional area reduction of 4% (-2.27 mm ± 11.89), 1% (-0.88 mm ± 15.48) and 13% (-6.93 mm ± 8.22) was found with GBR, SS and Control groups (GBR vs. Control p = .01). The equivalent alveolar process area reduction was 8% (-7.36 mm ± 10.45), 6% (-7 mm ± 18.97) and 11% (-11.32 mm ± 10.92). All groups supported implant placement, with bone dehiscence noted in 57% (n = 4), 64%(n = 7) and 85%(n = 12) of GBR, SS and Control cases (GBR vs. Control p = .03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown.
CONCLUSION
GBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Bone Regeneration; Humans; Single-Blind Method; Tooth Extraction; Tooth Socket
PubMed: 35488477
DOI: 10.1111/clr.13933 -
The Journal of Evidence-based Dental... Sep 2022This systematic review aimed to compare the clinical data including success rates, tissue preservation, esthetic results, and patient-reported outcomes between delayed... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review aimed to compare the clinical data including success rates, tissue preservation, esthetic results, and patient-reported outcomes between delayed implant placement after alveolar ridge preservation (ARP) and immediate implant placement (IIP).
MATERIAL AND METHODS
Both electronic and manual searches were performed for randomized controlled trials and cohort studies consisting of at least 10 cases per group and a follow-up of at least 1-year in duration. The primary outcome was the implant success rate and secondary outcomes were changes in marginal bone level (MBL), pink esthetic score (PES) and patient reported outcomes consisting of complications and satisfaction.
RESULTS
A total of 12 studies were included (8 randomized controlled trials and 4 cohort studies). This review contained 456 implants placed after ARP and 459 implants placed through IIP. The results from this meta-analysis showed that the success rates of implants placed through ARP protocol (98.68%) was significantly higher than that of implants placed through IIP protocol (95.21%) (RR = 1.03; 95% CI [1.01; 1.06]; P = .008; I = 0%).
CONCLUSION
The results from this meta-analysis and systematic review showed that implants placed through ARP protocol may demonstrate higher success rates compared to implants placed through IIP.
Topics: Alveolar Process; Alveolar Ridge Augmentation; Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 36162892
DOI: 10.1016/j.jebdp.2022.101734 -
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 -
Journal of Esthetic and Restorative... Jan 2021This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate...
This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.
Topics: Crowns; Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 33522700
DOI: 10.1111/jerd.12716 -
Clinical Oral Investigations Jan 2022This systematic review and network meta-analysis aimed to answer to the following questions: (a) In patients undergoing alveolar ridge preservation after tooth... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and network meta-analysis aimed to answer to the following questions: (a) In patients undergoing alveolar ridge preservation after tooth extraction, which grafting material best attenuates horizontal and vertical ridge resorption, as compared to spontaneous healing?, and (b) which material(s) promotes bone formation in the extraction socket?
MATERIALS AND METHODS
The MEDLINE, SCOPUS, CENTRAL, and EMBASE databases were screened in duplicate for RCTs up to March 2021. Two independent authors extracted the data and assessed the risk of bias of the included studies. Primary outcomes were ridge horizontal and vertical dimension changes and new bone formation into the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes and compare different grafting materials.
RESULTS
Eighty-eight RCTs were included, with a total of 2805 patients and 3073 sockets. Overall, a total of 1740 sockets underwent alveolar ridge preservation with different materials (1432 were covered by a membrane). Pairwise meta-analysis showed that, as compared to spontaneous healing, all materials statistically significantly reduced horizontal and vertical shrinkage. According to the multidimensional scale ranking of the NMA, xenografts (XG) and allografts (AG), alone or combined with bioactive agents (Bio + AG), were the most predictable materials for horizontal and vertical ridge dimension preservation, while platelet concentrates performed best in the percentage of new bone formation.
CONCLUSIONS
Alveolar ridge preservation is effective in reducing both horizontal and vertical shrinkage, as compared to untreated sockets. NMA confirmed the consistency of XG for ridge dimension preservation, but several other materials and combinations like AG, Bio + AG, and AG + alloplasts, produced even better results than XG in clinical comparisons. Further evidence is needed to confirm the value of such alternatives to XG for alveolar ridge preservation. Bio + AG performed better than the other materials in preserving ridge dimension and platelet concentrates in new bone formation. However, alloplasts, xenografts, and AG + AP performed consistently good in majority of the clinical comparisons.
CLINICAL RELEVANCE
XG and Bio + AG demonstrated significantly better performance in minimizing post-extraction horizontal and vertical ridge dimension changes as compared with other grafting materials or with spontaneous healing, even if they presented the worst histological outcomes. Allografts and other materials or combinations (AG + AP) presented similar performances while spontaneous healing ranked last.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Biocompatible Materials; Bone Transplantation; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 34826029
DOI: 10.1007/s00784-021-04248-1 -
Clinical Implant Dentistry and Related... Jun 2022To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant placement (IIP).
MATERIALS AND METHODS
Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to August 2021. Randomized controlled trials (RCTs) comparing IIP with and without SG were included for a qualitative analysis. Meta-analyses were performed when possible.
RESULTS
Out of 3627 records, 15 RCTs were selected and reported on 577 patients who received 604 single immediate implants (IIP + SG: 298 implants in 292 patients; IIP: 306 implants in 285 patients) with a mean follow-up ranging from 4 to 36 months. Two RCTs showed low risk of bias. Meta-analysis revealed 0.59 mm (95% CI [0.41; 0.78], p < 0.001) or 54% less horizontal buccal bone resorption following IIP + SG when compared to IIP alone. In addition, 0.58 mm (95% CI [0.28; 0.88], p < 0.001) less apical migration of the midfacial soft tissue level was found when immediate implants were installed with SG. A trend towards less distal papillary recession was found (MD 0.60 mm, 95% CI [-0.08; 1.28], p = 0.080) when SG was performed, while mesial papillae appeared not significantly affected by SG. Vertical buccal bone changes were also not significantly affected by SG. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes, pink esthetic score, marginal bone level changes, probing depth and bleeding on probing. Based on GRADE guidelines, a moderate recommendation for SG following IIP can be made.
CONCLUSION
SG may contribute to horizontal bone preservation and soft tissue stability at the midfacial aspect of immediate implants. Therefore, SG should be considered as an adjunct to IIP in clinical practice.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Tooth Socket
PubMed: 35313067
DOI: 10.1111/cid.13079 -
International Journal of Implant... Dec 2021To address the focused question: in patients with freshly extracted teeth, what is the efficacy of platelet-rich fibrin (PRF) in the prevention of pain and the... (Review)
Review
PURPOSE
To address the focused question: in patients with freshly extracted teeth, what is the efficacy of platelet-rich fibrin (PRF) in the prevention of pain and the regeneration of soft tissue and bone compared to the respective control without PRF treatment?
METHODS
After an electronic data search in PubMed database, the Web of Knowledge of Thomson Reuters and hand search in the relevant journals, a total of 20 randomized and/or controlled studies were included.
RESULTS
66.6% of the studies showed that PRF significantly reduced the postoperative pain, especially in the first 1-3 days after tooth extraction. Soft tissue healing was significantly improved in the group of PRF compared to the spontaneous wound healing after 1 week (75% of the evaluated studies). Dimensional bone loss was significantly lower in the PRF group compared to the spontaneous wound healing after 8-15 weeks but not after 6 months. Socket fill was in 85% of the studies significantly higher in the PRF group compared to the spontaneous wound healing.
CONCLUSIONS
Based on the analyzed studies, PRF is most effective in the early healing period of 2-3 months after tooth extraction. A longer healing period may not provide any benefits. The currently available data do not allow any statement regarding the long-term implant success in sockets treated with PRF or its combination with biomaterials. Due to the heterogeneity of the evaluated data no meta-analysis was performed.
Topics: Humans; Pain, Postoperative; Platelet-Rich Fibrin; Tooth Extraction; Tooth Socket; Wound Healing
PubMed: 34923613
DOI: 10.1186/s40729-021-00393-0