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The British Journal of Oral &... Feb 2022This study aimed to compare socket repair with Nylon 5-0 suture and closure using cyanoacrylate biological glue after tooth extraction. Twenty male Wistar rats, each...
This study aimed to compare socket repair with Nylon 5-0 suture and closure using cyanoacrylate biological glue after tooth extraction. Twenty male Wistar rats, each weighing approximately 200 g were submitted to the extraction of the right and left first molar teeth. On the right side, the alveolus was closed with 2 ethyl-cyanoacrylate glue, whereas on the left side closure was with a single interrupted Nylon 5-0 suture (Ethilon). The animals were sacrificed after 3, 7, 15, and 30 postoperative days, and images of histological sections of the alveolus were captured for analysis. Histomorphometry was performed using Image J software to quantify bone neoformation in the alveolus. The results showed that on the seventh postoperative day the side treated with 2-ethyl-cyanoacrylate presented a delay in relation to the sutured side. However, on days 15 and 30, the difference in bone neoformation between gradually decreased until the thirtieth postoperative day, with no significant difference in bone neoformation in the last period of analysis. There was no difference between neoformation in the two sides (p = 0.902) after statistical analysis of the histomorphometric results. In conclusion, socket repair after alveolus closure with 2-ethyl-cyanoacrylate allows complete bone neoformation after tooth extraction, and there is no significant difference when compared with closure with Nylon 5-0.
Topics: Animals; Cyanoacrylates; Humans; Male; Nylons; Rats; Rats, Wistar; Sutures; Tooth Socket
PubMed: 34953568
DOI: 10.1016/j.bjoms.2021.01.017 -
Biochemical and Biophysical Research... Jun 2022In this study, a tooth extraction socket model was established in vivo, and Lv-YAP1-GFP, Lv-GFP or saline was injected locally into the extraction socket. Expression of...
In this study, a tooth extraction socket model was established in vivo, and Lv-YAP1-GFP, Lv-GFP or saline was injected locally into the extraction socket. Expression of markers of osteogenesis, osteoclastogenesis, adipogenesis, proliferation and apoptosis explore whether YAP can promote bone formation in the process of tooth extraction socket healing. 66 BALB/c mice were divided into 3 groups and underwent left maxillary first molar extraction, Lv-YAP1-GFP, Lv-GFP or saline was injected into the tooth extraction socket. The maxilla was harvested 1, 3, 7, and 10 days after operation for subsequent analysis by Micro-CT and immunohistochemical analysis. Quantitative analysis of the expression of TRAP, ALP, BMP2, RUNX2, Osterix, OCN, RANKL, PPARγ, and PCNA was conducted. The results of immunofluorescence showed that the lentivirus was successfully transfected into the extraction socket. On the middle and last stage of tooth extraction healing, results of Micro-CT showed that the BV/TV, Tb.Th and Tb.N were significantly higher in the experimental group, results of immunohistochemistry showed that the overexpression of YAP increase in the expression of BMP2, ALP, RUNX2, Osterix, OCN, and PCNA. The expression of PPARγ and TUNEL staining results were significantly lower in the experimental group. The expression of TRAP and RANKL showed no significant differences among the 3 groups. We conclude that YAP could promote bone formation in the middle and late stages of tooth extraction socket healing. The overexpression of YAP increased bone formation and cell proliferation, decreased adipogenic differentiation and apoptosis.
Topics: Animals; Core Binding Factor Alpha 1 Subunit; Mice; Osteogenesis; PPAR gamma; Proliferating Cell Nuclear Antigen; Tooth Extraction; Tooth Socket; YAP-Signaling Proteins
PubMed: 35413538
DOI: 10.1016/j.bbrc.2022.03.116 -
Bone Oct 2019Within the dental alveolar socket, the sequence of events following tooth extraction involves deposition of a provisional connective tissue matrix that is later replaced...
Within the dental alveolar socket, the sequence of events following tooth extraction involves deposition of a provisional connective tissue matrix that is later replaced by woven bone and eventually by lamellar bone. Bone regeneration within the dental alveolar socket is unique since the space occupied by the root(s) of a tooth does not originally contain any bone. However, extracellular matrix composition of the healing alveolar socket has not previously been investigated. Here, alveolar bone biopsies representing early (7-46 months, < 4y) and late (48-60 months; 4-5y) healing periods were investigated using Raman spectroscopy, X-ray micro-computed tomography and backscattered electron scanning electron microscopy. Partially or completely edentulous individuals and those with a smoking habit were not excluded. Between < 4y and 4-5y, mineral crystallinity and bone mineral density increase, phenylalanine, proline/hydroxyproline, and bone surface-to-volume ratio decrease, while the carbonate-to-phosphate ratio, the mineral-to-matrix ratio, and the collagen crosslink ratio remain relatively unchanged. Observed exclusively at 4-5y, hypermineralised osteocyte lacunae contain spherical and rhomboidal mineral nodules. Spearman correlation analysis reveals several significant, high (ρ = 0.7-0.9; p ≤ 0.01) and moderate (ρ = 0.5-0.7; p ≤ 0.01) correlations. Mineral crystallinity and proline/hydroxyproline, the carbonate-to-phosphate ratio and phenylalanine, mineral crystallinity and bone surface-to-volume ratio, the carbonate-to-phosphate ratio and bone surface-to-volume ratio, proline/hydroxyproline and bone mineral density, and bone mineral density and bone surface-to-volume ratio are negatively correlated. Mineral crystallinity and bone mineral density, and proline/hydroxyproline and bone surface-to-volume ratio are positively correlated. Although bone regeneration in the dental alveolar socket follows typical bone healing patterns, the compositional and microstructural patterns reveal mature bone at <4y with indications of better mechanical competence at 4-5y.
Topics: Alveolar Process; Biopsy; Bone Density; Bone Regeneration; Child, Preschool; Crystallization; Extracellular Matrix; Humans; Minerals; Osteocytes; Spectrum Analysis, Raman; Statistics, Nonparametric; Tooth Socket; Wound Healing
PubMed: 31176735
DOI: 10.1016/j.bone.2019.06.003 -
Medical Hypotheses Sep 2020Bone change after tooth extraction has been well documented by different studies. Tooth extraction is followed by loss in height and width of the alveolar process. After...
Bone change after tooth extraction has been well documented by different studies. Tooth extraction is followed by loss in height and width of the alveolar process. After tooth loss, the natural healing process is governed by the formation of the blood clot, which is stabilized by a fibrin bridge, the starting structure for new bone apposition. The hematoma is then replaced by the granulation tissue which is rich in fibroblasts that synthesize the extra-cellular matrix. The adjoining of wound edges requires further contraction of the healing tissue which is exerted by myofibroblasts. Excessive myofibroblasts contraction at the early stage of healing might explain, in part, the pathophysiology of alveolar bone resorption. The authors advocate the use of collagen right after tooth extraction to sustain the soft tissue and releasing the tension at the most coronal portion of the wound, thus preventing excessive detrimental myofibroblasts contraction.
Topics: Alveolar Bone Loss; Alveolar Process; Humans; Periodontal Ligament; Tooth Extraction; Tooth Socket
PubMed: 32344287
DOI: 10.1016/j.mehy.2020.109746 -
The Journal of Prosthetic Dentistry Sep 2023Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome.
PURPOSE
The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets.
MATERIAL AND METHODS
An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference).
RESULTS
In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters.
CONCLUSIONS
Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.
Topics: Dental Implantation, Endosseous; Dental Implants; Tooth Socket; Esthetics, Dental; Immediate Dental Implant Loading
PubMed: 34772483
DOI: 10.1016/j.prosdent.2021.09.025 -
Clinical Oral Investigations Dec 2023To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.
MATERIALS AND METHODS
Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.
RESULTS
Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.
CONCLUSIONS
HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.
CLINICAL RELEVANCE
HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.
Topics: Humans; Animals; Tooth Socket; Hyaluronic Acid; Trismus; Dry Socket; Tooth Extraction; Molar, Third; Pain
PubMed: 37963982
DOI: 10.1007/s00784-023-05227-4 -
Evidence-based Dentistry Dec 2021Design Randomised, controlled, single-blind, single-centre clinical trial.Case selection Adult patients in need of a single tooth extraction in the anterior maxillary... (Review)
Review
Design Randomised, controlled, single-blind, single-centre clinical trial.Case selection Adult patients in need of a single tooth extraction in the anterior maxillary and premolar region. Full mouth plaque scores below 25% and bleeding scores below 10%, with no active periodontal disease. As assessed by cone beam computed tomography; intact buccal plate, adequate mesiodistal space and adequate quality of bone.Data analysis Patients had immediate implant placement following extraction, either with a flap with no vertical releasing incision (control group) or a minimal split-thickness envelope flap (test group). The trial compared clinical, radiographic, aesthetic and patient-reported outcomes of immediately placed implants. Primary outcomes were measured using the pink (PES) and white (WES) aesthetic score. JMP Pro 13 was the statistical software used. Statistical comparisons were conducted at a 0.05 level of significance.Results In total, 28 patients were enrolled in the study, after exclusions. The total PES and WES scores were similar in the control and test groups. Implant survival and success rate after 12 months was 100%. Buccal plate thickness at 12 months post-loading was 2.78 mm in the control group and 2.54 mm in the test group, so there was no statistically significant difference between them. The majority of patients in both groups responded as 'positive' in the patient satisfaction questionnaire and visual analogue scale.Conclusions When comparing PES/WES scores, success/modified success rate, survival, mean buccal plate resorption and patient satisfaction, there were no differences between immediate implants placed with a flap or with a minimal split-thickness envelope flap.
Topics: Adult; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Follow-Up Studies; Humans; Immediate Dental Implant Loading; Single-Blind Method; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 34916634
DOI: 10.1038/s41432-021-0215-x -
Journal of Periodontal Research Feb 2023Resorption of alveolar bone after tooth extraction is a common problem often requiring bone grafting. The success of the grafting procedures is dependent on multiple...
OBJECTIVE AND BACKGROUND
Resorption of alveolar bone after tooth extraction is a common problem often requiring bone grafting. The success of the grafting procedures is dependent on multiple factors including the presence of growth factors. This is the first in vivo study to investigate the role of the pleiotrophin family of cytokines in alveolar bone regeneration. This research investigated the role of the pleiotrophin-midkine (PTN-MDK) axis during osteogenesis, with and without a grafting material, after tooth extraction in a sheep model.
METHODS
Thirty Romney-cross ewes were anesthetized, and all premolar teeth on the right side were extracted. The sockets were randomized to controls sites with no treatment and test sites with Bio-Oss® graft material and Bio-Gide® membrane. Samples were harvested after sacrificing animals 4, 8, and 16 weeks post-grafting (n = 10 per time-point). Tissue for qRT -PCR gene analysis was recovered from the socket next to the first molar using a trephine (Ø = 2 mm). Each socket was fixed, decalcified, paraffin-embedded, and sectioned. Immunohistochemistry was conducted to localize both PTN and MDK along with their receptors, protein tyrosine phosphatase receptor type Z1 (PTPRZ1), ALK receptor tyrosine kinase (ALK), and notch receptor 2 (NOTCH2).
RESULTS
Within the healing sockets, high expression of genes for PTN, MDK, NOTCH2, and ALK was found at all time-points and in both grafted and non-grafted sites, while PTPRZ1 was only expressed at low levels. The relative gene expression of the PTN family of cytokines was not statistically different at the three time-points between test and control groups (p > .05). Immunohistochemistry found PTN and MDK in association with new bone, NOTCH2 in the connective tissue, and PTPRZ1 and ALK in association with cuboidal osteoblasts involved in bone formation.
CONCLUSIONS
The PTN-MDK axis was highly expressed in both non-grafted and grafted sockets during osteogenesis in a sheep model of alveolar bone regeneration with no evidence that grafting significantly affected expression. The activation of NOTCH2 and PTPRZ1 receptors may be important during bone regeneration in vivo. The discovery of the PTN-MDK axis as important during alveolar bone regeneration is novel and opens up new avenues of research into these stably expressed highly active cytokines. Growth factor supplementation with PTN and/or MDK during healing may be an approach for enhanced regeneration or to initiate healing where delayed.
Topics: Animals; Female; Cytokines; Intercellular Signaling Peptides and Proteins; Midkine; Receptor Protein-Tyrosine Kinases; Sheep; Tooth Extraction; Tooth Socket
PubMed: 36411509
DOI: 10.1111/jre.13073 -
Journal of Clinical Periodontology Oct 2022The present pilot RCT aimed to investigate the influence of a connective tissue graft (CTG) in combination with the immediate implant placement (IIP) on hard and soft... (Randomized Controlled Trial)
Randomized Controlled Trial
Soft and hard tissue changes after immediate implant placement with or without a sub-epithelial connective tissue graft: Results from a 6-month pilot randomized controlled clinical trial.
AIM
The present pilot RCT aimed to investigate the influence of a connective tissue graft (CTG) in combination with the immediate implant placement (IIP) on hard and soft tissue healing, without a bone replacement graft in the gap between the implant and the socket walls.
MATERIALS AND METHODS
Thirty patients requiring extraction of one anterior tooth (from premolar to premolar) were randomly assigned to one of the two treatment groups (test: IIP + CTG; control: IIP). Cone-beam computed tomography and optically scans were performed before tooth extraction and at 6-month follow-up. Then, DICOM files were superimposed in order to allow the evaluation of osseous ridge and buccal bone changes, while the superimposition of DICOM and Standard Tessellation Language files allowed for evaluating of soft tissue contour. For testing the differences between the two groups, the non-parametric test as Wilcoxon rank-sum test, was used.
RESULTS
Twenty-six of the 30 enrolled patients attended the 6-month follow-up visit. The four patients of the control group that were lost to follow-up were analysed under the intention-to-treat principle. No statistically significant differences between the groups were observed for the vertical buccal bone resorption (p = .90), as well as for the horizontal buccal bone resorption at all measured levels. Significant differences were found between the test and control groups in the horizontal dimensional changes of osseous ridge at the most coronal aspect (p = .0003 and p = .02). Changes in tissue contour were between -0.32 and -0.04 mm in the test group and between -1.94 and -1.08 mm in the control group, while changes in soft tissue thickness varied between 1.33 and 2.42 mm in the test group and between -0.16 and 0.88 mm in the control group, with statistically significant differences for both variables at all measured levels. At 6 months, the mean volume increase was 6.76 ± 8.94 mm and 0.16 ± 0.42 mm in the test and control groups, respectively, with a statistically significant difference.
CONCLUSIONS
The findings of the present study indicate that the adjunct of a CTG at the time of IIP, without bone grafting, does not influence vertical bone resorption. Within the limits of this study, it can be suggested that the adjunct of a CTG at the time of IIP, without bone grafting, reduces the horizontal changes of the alveolar ridge. Moreover, it allows maintenance of the tissue contour due to an increase in soft tissue thickness.
Topics: Alveolar Process; Bone Resorption; Connective Tissue; Dental Implants, Single-Tooth; Humans; Pilot Projects; Tooth Extraction; Tooth Socket
PubMed: 35713267
DOI: 10.1111/jcpe.13685 -
Journal of Esthetic and Restorative... Dec 2021Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST lack strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the effects of SST on dimensional changes of hard tissues, esthetic outcomes, implant stability, complication, and implant failure rates.
METHODS
Electronic databases were searched to identify randomized controlled trials (RCTs) that compared immediate implant placement with and without SST. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.
RESULTS
A total of 982 studies were identified, of which, seven RCTs with 206 immediately placed dental implants in 191 participants were included. Overall meta-analysis showed significant differences in the changes in buccal bone plate width (mean difference (MD) -0.22; 95% confidence interval (CI) -0.30 to -0.15; p < 0.0001) and height (MD -0.52; 95% CI -0.85 to -0.18; p = 0.002) in favor of SST. The use of SST was also associated with significantly less changes in peri-implant marginal bone levels and better pink esthetic score than immediately placing implants without SST. The differences in implant stability, complication and implant failure rates were not statistically significant between immediate implant placement with or without SST.
CONCLUSIONS
The short-term complication and implant failure rates following immediate implant placement with or without SST were comparable. The SST has short-term positive effects on the changes in width and height of buccal bone plate, peri-implant marginal bone levels and esthetic outcomes. Further evidence from long-term RCTs are still required to substantiate the current findings.
CLINICAL SIGNIFICANCE
SST can reduce changes in buccal plate width and height and improve the soft tissue profile following immediate implant placement in esthetic zone.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Tooth Extraction; Tooth Socket
PubMed: 34380176
DOI: 10.1111/jerd.12812