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Oral and Maxillofacial Surgery Clinics... Nov 2020Extensive reviews have concluded that grafting of the socket reduces bone loss regardless of product or method. However, nothing has been shown to reliably and... (Review)
Review
Extensive reviews have concluded that grafting of the socket reduces bone loss regardless of product or method. However, nothing has been shown to reliably and completely maintain alveolar dimensions. We advocate a biologically driven and anatomically based approach for reconstruction of the socket. There are various socket manipulations that we have found to predictably prepare a site for dental implant. The combination of graft construct design and socket management maximizes graft success for any practitioner. Each socket should be treated individually, and products or methods used that are coincident with the complexity of the defect in question.
Topics: Alveolar Ridge Augmentation; Humans; Tooth Extraction; Tooth Socket
PubMed: 33004150
DOI: 10.1016/j.coms.2020.07.010 -
Journal of Oral and Maxillofacial... Apr 2024Patients may need removal of their teeth with placement of implants for rehabilitation. The clinical problem is the status of the remaining teeth and how this affects... (Review)
Review
PURPOSE
Patients may need removal of their teeth with placement of implants for rehabilitation. The clinical problem is the status of the remaining teeth and how this affects the timing for implant placement and the method for provisionalization. The importance of this review is to document the different strategies including sequential tooth removal and grafting and the use of teeth to provide a fixed provisional rather than a removable provisional, to provide surgeons with a reference to maintain patient function during their rehabilitation.
METHODS
Pubmed.gov was the information source. Years reviewed included 1990 to 2022. Inclusion criteria included only articles in peer-reviewed journals. Variables evaluated included the success for placing implants immediately into extraction sites, and the methods to transition between steps in their rehabilitation. Data collected were results of systematic reviews and independent clinical series, as well as case reports of prosthetic methods for transitioning.
RESULTS
The search used terms which included implants in extraction sites (n = 205) and transitioning teeth to implants (n = 153). Twenty-one articles were reviewed involving extraction sites and 19 articles reviewed concerning transitioning from teeth to implants. The placement of implants immediately into excretion sites did have a relative risk for failure compared to implant placement in healed sites. The use of non-restorable teeth to support a fixed provisional prosthesis was successful; however, variability in reporting prevented a statistical analysis.
CONCLUSION
The surgeon needs to utilize teeth to provide support during treatment phases in order to provide the patient with a fixed provisional prosthesis to allow for implant integration and to provide time for graft healing. Specific methods used for transitioning do not have a significant evidence base to recommend one method but routine prosthetic techniques have been used and are reported in case reports.
Topics: Humans; Dental Implants; Tooth Socket; Systematic Reviews as Topic; Tooth Extraction; Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Treatment Outcome
PubMed: 38336353
DOI: 10.1016/j.joms.2024.01.012 -
Journal of Dental Research Jan 2022Osseointegration is the key issue for implant success. The in vivo properties of cell populations driving the osseointegration process have remained largely unknown. In...
Osseointegration is the key issue for implant success. The in vivo properties of cell populations driving the osseointegration process have remained largely unknown. In the current study, using tissue clearing-based 3-dimensional imaging and transgenic mouse model-based lineage tracing methods, we identified Gli1+ cells within alveolar bone marrow and their progeny as the cell population participating in extraction socket healing and implant osseointegration. These Gli1 cells are surrounding blood vessels and do not express lineage differentiation markers. After tooth extraction and delayed placement of a dental implant, Gli1 cells were activated into proliferation, and their descendants contributed significantly to new bone formation. Ablation of Gli1 cells severely compromised the healing and osseointegration processes. Blockage of canonical Wnt signaling resulted in impaired recruitment of Gli1 cells and compromised bone healing surrounding implants. Collectively, these findings demonstrate that Gli1 cells surrounding alveolar bone marrow vasculature are stem cells supporting dental implant osseointegration. Canonical Wnt signal plays critical roles in regulating Gli1 stem cells.
Topics: Animals; Bone Marrow; Dental Implantation, Endosseous; Dental Implants; Mice; Osseointegration; Stem Cells; Tooth Extraction; Tooth Socket; Zinc Finger Protein GLI1
PubMed: 34009063
DOI: 10.1177/00220345211013722 -
The International Journal of... 2021Clinical evidence suggests using lateral and vertical ridge preservation procedures to make dental implant placement possible. This study evaluates and compares the... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical evidence suggests using lateral and vertical ridge preservation procedures to make dental implant placement possible. This study evaluates and compares the radiographic and volumetric changes following ridge preservation procedures using either mineralized plasmatic matrix grafts (MPM) or bone grafts alone (non-MPM) in the existing crestal ridges of sockets in maxillary and mandibular regions using CBCT scans. Healthy volunteers (n = 26) were recruited and randomized into MPM and non-MPM groups (n = 13 patients per group). Ridge preservation (RP) was performed in sockets after extraction. Preoperative baseline vertical measurements (V1) were made from the existing highest level of the socket crestal ridges to a reference point in an apicocoronal direction. Similarly, baseline horizontal measurements (H1) were made in a buccolingual direction on CBCT scans. The measurements were repeated after 3 months (V2 and H2) and 6 months (V3 and H3) using the same reference points. Difference between V3 and V1 as well as H3 and H1 was used to assess the gains in height and width of the sockets after RP. No significant difference was found in the initial baseline V1 and H1 values in MPM and non-MPM groups. Median (Mdn) V2 and H2 scores were significantly different between MPM (Mdn = 18.91) and non-MPM groups (Mdn = 27.81) after 3 months of RP (U = 37, z = -6.302, P < .001.) However, after 6 months of treatment, V3 and H3 scores were significantly different between the MPM (Mdn = 27.19) and the non-MPM group (Mdn = 37.81). MPM can be used as a valuable and predictable technique in obtaining bone fill in the maxillary and mandibular sockets with residual crestal ridges deemed necessary for RP in implant therapy.
Topics: Alveolar Bone Loss; Alveolar Ridge Augmentation; Bone Transplantation; Humans; Maxilla; Tooth Extraction; Tooth Socket
PubMed: 34076644
DOI: 10.11607/prd.4972 -
BioMed Research International 2023After tooth extraction, alveolar bone resorption is inevitable. This clinical phenomenon challenges dental surgeons aiming to restore esthetic and function. Alveolar... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
After tooth extraction, alveolar bone resorption is inevitable. This clinical phenomenon challenges dental surgeons aiming to restore esthetic and function. Alveolar ridge preservation can be applied to minimize dimensional changes with a new socket grafting material, an autogenous dentin graft, produced by mechanically and chemically processing natural teeth. This study assessed the safety and efficacy of using autogenous dentin biomaterial in alveolar ridge preservation.
MATERIALS AND METHODS
Patients with nonrestorable maxillary anterior teeth bounded by natural sound teeth were included in this study. After a detailed clinical and tomographic examination, eligible participants were randomly allocated into two groups. The control group had spontaneous healing of extraction sockets. The study group had their extraction sockets filled with autogenous dentin biomaterial after processing their extracted retained roots with the KometaBio device. Standardized cone beam computed tomography (CBCT) scans were repeated four months later. A full-thickness mucoperiosteal flap reflection was achieved under local anesthesia to get core biopsies for histomorphometric analysis, and dental implants were placed at the same session.
RESULTS
A total of 32 eligible patients were included in this study ( = 16 in each group). Both groups had significantly higher facial soft tissue thickness after four months than baseline ( < 0.05). However, the study group showed statistically significant lesser dimensional changes than the control group according to the standardized CBCT scans. Furthermore, core biopsies confirmed an excellent remodeling of the autogenous dentin biomaterial in the study group. In comparison, only new thin bone trabeculae-filled sockets were in the control group.
CONCLUSION
Autogenous dentin graft can be safely and successfully used for alveolar ridge preservation. Optimal graft remodeling histologically, better ridge dimensional stability, and uneventful wound healing support its clinical application. This trial is registered with TCTR20220615002.
Topics: Humans; Tooth Socket; Biocompatible Materials; Alveolar Process; Alveolar Bone Loss; Tooth Extraction; Mouth, Edentulous; Dentin; Alveolar Ridge Augmentation
PubMed: 38179035
DOI: 10.1155/2023/7932432 -
International Journal of Oral and... Jan 2022Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. Flapped and flapless surgical approaches have been used for ARP; however,... (Meta-Analysis)
Meta-Analysis Review
Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. Flapped and flapless surgical approaches have been used for ARP; however, there is a lack of strong scientific evidence regarding their specific influences on the clinical outcomes of ARP. The aim of this systematic review and meta-analysis was to evaluate the effects of flapped and flapless surgical approaches on the dimensional changes of hard and soft tissues and patient-reported outcomes following ARP. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared flapped ARP by means of a coronally advanced flap to flapless ARP where barrier membranes were left exposed. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Data were analysed using a statistical software program. A total of 754 studies were identified, of which five studies with 149 extraction sockets in 128 participants were included. Overall, meta-analysis did not show any significant differences in the changes in ridge width or height between flapped and flapless ARP. The use of flapless ARP was associated with significantly less postoperative pain, thicker labial soft tissues, and marginally more favourable changes in width of the keratinized tissues compared to the flapped approach. The short-term hard tissue changes following ARP with a flapped or flapless approach are comparable. Postoperative pain and labial soft tissue changes are more favourable following ARP using a flapless approach. Further evidence from long-term RCTs is still required to substantiate the current findings.
Topics: Alveolar Process; Alveolar Ridge Augmentation; Humans; Surgical Flaps; Tooth Extraction; Tooth Socket
PubMed: 34127352
DOI: 10.1016/j.ijom.2021.05.023 -
Journal of Clinical Periodontology Jul 2022To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB])... (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB]) during alveolar ridge preservation (ARP) in terms of horizontal ridge width resorption.
MATERIALS AND METHODS
Randomized trials of at least 2 months duration comparing at least two techniques to seal the alveolus against each other or against spontaneous healing (SH) were eligible. Searches were conducted in MEDLINE via PubMed, EMBASE, Scopus, and Cochrane Central. Conventional meta-analysis, meta-regression, and network meta-analysis (NMA) were conducted, with clinical and tomographic ridge width changes as outcomes. Predictive intervals (95% PI) were reported.
RESULTS
Twenty-two studies were included, accounting for 52 study arms. Meta-regression identified that the socket sealing technique and publication year explained the observed heterogeneity. NMA showed that FA and OHB led to significantly lower ridge resorption than SH, resulting in 1.18 mm (95% PI 0.21-2.13) and 1.10 mm (95% PI 0.49-1.69) wide alveolar ridges, respectively. No significant difference between OHNB and SH was found (0.46 mm, 95% PI -0.70 to 1.64). The treatment with the largest probability for ARP was FA (52.7%), followed by OHB (39.1%) and OHNB (8.2%).
CONCLUSIONS
FA and OHB are efficacious techniques to seal the alveolus during ARP.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 35451071
DOI: 10.1111/jcpe.13628 -
Journal of Dentistry Jun 2024This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular... (Review)
Review
OBJECTIVE
This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular events during alveolar socket healing, ii) the dimensional ridge alterations after socket healing and controversies relating to sinus pneumatisation, iii) the patient-specific factors, procedural elements, and site-related variables influencing socket healing, iv) techniques and effectiveness of alveolar ridge preservation (ARP) procedure, and v) the philosophies and cost-effectiveness of ARP in clinical practice.
SOURCES AND STUDY SELECTION
To investigate the dimensional profiles of the alveolar ridge following unassisted healing, an overview of systematic reviews was conducted in February 2024 by two independent reviewers. Four electronic databases were searched in Pubmed, Embase, Web of science and Cochrane Library between 2004 and 2024 to identify all relevant systematic reviews on post-extraction healing. A further manual search of reviews was also conducted. The articles were further reviewed in full text for relevance. The AMSTAR-2 appraisal tool was adopted to assess methodological quality. Current research pertaining to other listed objectives was objectively analysed in narration.
DATA
11 out of 459 retrieved studies were selected and ultimately covered in this review on the dimensional changes of alveolar ridge following natural healing: Seven systematic reviews and four systematic reviews with meta-analyses. The methodological quality of all included reviews was critically low.
CONCLUSION
This review thoroughly examines the healing profiles of post-extraction alveolar sockets and highlights the dynamic process with overlapping phases and the inter-individual variability in outcomes. ARP procedure is a potential strategy for facilitating prosthetic site development, while the current evidence is limited. Herein, an individualised and prosthetically driven approach is crucial. Further well sized and designed trials with novel biomaterials need to be undertaken, and the role of artificial intelligence in predicting healing and assisting clinical decision-making could be explored.
CLINICAL SIGNIFICANCE
By advancing our understanding of alveolar socket healing and its management strategies, clinicians can make more informed decisions regarding patient and site level assessment and selection, surgical techniques, and biomaterial choices, ultimately contributing to the enhanced healing process with reduced complications and improved quality of life for patients undergoing tooth extraction and dental implant treatments.
Topics: Humans; Tooth Socket; Tooth Extraction; Wound Healing; Alveolar Process; Alveolar Ridge Augmentation; Alveolar Bone Loss
PubMed: 38574844
DOI: 10.1016/j.jdent.2024.104986 -
The Pan African Medical Journal 2022
Topics: Infant; Humans; Cleft Lip; Pulmonary Alveoli; Tooth Socket; Gastrointestinal Diseases; Palate
PubMed: 36451981
DOI: 10.11604/pamj.2022.42.316.33040 -
Oral Surgery, Oral Medicine, Oral... Mar 2023
Topics: Humans; Alveolar Process; Tooth Extraction; Alveolar Ridge Augmentation; Alveolar Bone Loss; Tooth Socket
PubMed: 36153300
DOI: 10.1016/j.oooo.2022.08.003