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The International Journal of Oral &...This randomized clinical trial aimed to assess esthetic and soft and hard tissue outcomes 6 months after immediate implant placement using vestibular socket therapy... (Randomized Controlled Trial)
Randomized Controlled Trial
Immediate Implant Placement in Intact Fresh Extraction Sockets Using Vestibular Socket Therapy Versus Partial Extraction Therapy in the Esthetic Zone: A Randomized Clinical Trial.
PURPOSE
This randomized clinical trial aimed to assess esthetic and soft and hard tissue outcomes 6 months after immediate implant placement using vestibular socket therapy (VST) (test) versus partial extraction therapy (comparator) in intact thin-walled fresh extraction sockets in the esthetic zone.
MATERIALS AND METHODS
Twenty-four patients with hopeless maxillary anterior teeth requiring immediate implant placement were randomly assigned to two equal groups to receive either VST or partial extraction therapy. Definitive restorations were delivered after 3 months. Pink esthetic scores (PESs) and vertical soft tissue alterations in millimeters were measured 6 months after restoration using intraoral digital scans of the distal papilla, midfacial gingival margin, and mesial papilla. Facial bone thickness was measured using CBCT scans at baseline and after 6 months. Implant survival and peri-implant pocket depth were assessed.
RESULTS
Both groups showed 100% implant survival after 6 months. The overall PESs after 6 months were 12.67 (± 1.3) in the VST group, while the partial extraction therapy group score was 13.17 (± 1.19), with no significant difference between them ( = .02). The mean (± SD) vertical soft tissue measurements for the VST group were 0.08 (± 0.55), 0.01 (± 0.73), and -0.03 (± 0.52) mm, and for the partial extraction therapy group, they were -0.24 (± 0.25) mm, -0.20 (± 0.10) mm, and -0.34 (± 0.13) mm for the mesial papilla, midfacial gingival margin, and distal papilla, respectively. No significant differences were observed between the groups at any of the reference points ( ± .05). Both techniques demonstrated a significant gain in millimeters of labial bone thickness after 6 months compared to baseline (P ± .05). Regarding VST, the apical, middle, and crestal mean bone gain was 1.68 (±± 2.73), 1.62 (±± 1.35), and 1.33 (±± 1.22) mm, respectively, while partial extraction therapy showed 0.58 (± 0.62), 1.27 (± 1.22), and 1.53 (± 1.24) mm, respectively, with no significant difference detected between them ( ≥ .05). Additionally, the mean (± SD) peri-implant pocket depth after 6 months for VST was 2.16 (± 0.44) and 2.08 (± 1.02) mm for partial extraction therapy with no significant difference between them ( = .79).
CONCLUSION
This investigation suggests that both VST and partial extraction therapy preserved alveolar bone structure and peri-implant tissues following immediate implants. The novel VST might be considered a predictable alternative treatment approach for immediate implant placement in intact thin-walled fresh extraction sockets in the esthetic zone. Int J Oral Maxillofac Implants 2023;38:468-478. doi: 10.11607/jomi.9973.
Topics: Humans; Immediate Dental Implant Loading; Dental Implants; Treatment Outcome; Tooth Socket; Dental Implants, Single-Tooth; Esthetics, Dental; Maxilla; Tooth Extraction
PubMed: 37279214
DOI: 10.11607/jomi.9973 -
Journal of Dental Research Jul 2020The current study aimed at investigating the long-term biological mechanisms governing bone regeneration in osseous defects filled with bovine bone (BB). Tooth...
The current study aimed at investigating the long-term biological mechanisms governing bone regeneration in osseous defects filled with bovine bone (BB). Tooth extraction sockets were filled with BB or left unfilled for natural healing in a C57BL/6 mouse alveolar regeneration bone model ( = 12). Seven weeks later, the alveolar bone samples were analyzed histologically with hematoxylin/eosin and tartrate-resistant acid phosphatase staining. A separate group ( = 10) was used for RNA sequencing. Osteoclast inhibition was induced by zoledronic acid (ZA) administration at 2 wk postextraction in a third group ( = 28) for examination of osseous changes and cellular functions with micro-computed tomography and quantitative reverse transcription polymerase chain reaction, respectively. Histological and radiological osseous healing was observed in both BB-filled and normal-healing sockets. However, BB regenerated bone showed significant robust expression of genes associated with bone homeostasis and osteoclasts' function. Osteoclasts' inhibition in BB-filled sockets led to decreased bone resorption markers and reduced bone formation to a greater extent than that observed in osteoclasts' inhibition with natural healing. BB displays long-term biologically active properties, despite a naive osseous histological appearance. These include activation of osteoclasts, which in turn promotes osseous remodeling and maturation of ossified bone.
Topics: Animals; Bone and Bones; Cattle; Mice; Mice, Inbred C57BL; Osteoclasts; Tartrate-Resistant Acid Phosphatase; Tooth Socket; X-Ray Microtomography
PubMed: 32167856
DOI: 10.1177/0022034520911647 -
Journal of Stomatology, Oral and... Dec 2023The present study aims to assess and compare the clinical outcomes of immediate implant placement in the mandibular molar region with or without the presence of chronic...
INTRODUCTION
The present study aims to assess and compare the clinical outcomes of immediate implant placement in the mandibular molar region with or without the presence of chronic periapical periodontitis.
MATERIALS AND METHODS
Employing a case-control design, this study encompassed a cohort of patients necessitating implant surgery to supplant a single, failed mandibular molar. Participants exhibiting periapical lesions measuring between > 4 mm and < 8 mm were assigned to the test group, while those without periapical lesions to the control group. Subsequent to flap surgery and tooth extraction, extraction sockets were debrided thoroughly, and implants were immediately implanted (baseline). Permanent restorative procedures were carried out three months post-operation, with follow-up conducted one year post-surgery. During the study period, parameters including implant survival rate, Cone Beam Computer Tomography (CBCT) data, implant stability quotient (ISQ), insertional torque values (ITV), and potential complications were closely monitored.
RESULTS
Throughout the yearlong observation period subsequent to implant placement, both groups exhibited a 100% implant survival rate. None of the participants experienced any complications. Both groups demonstrated significant decreases in the height and width of the alveolar bone (P < 0.05). However, there were no statistically discernible differences between corresponding areas in the two groups (P > 0.05). The differences in ITV between the test group (37.94 ± 2.12 N•cm) and the control group (38.55 ± 2.71 N•cm) were not statistically significant at baseline (P > 0.05). A significant rise in ISQ was noted within the same group between baseline and three months post-operation (P < 0.05), while no significant variations in ISQ changes were noted between the two groups (P > 0.05).
CONCLUSION
Given the constraints of this investigation, the preliminary clinical outcomes of immediate implant placement in the mandibular molar region with chronic periapical periodontitis do not significantly differ from those observed in instances devoid of chronic periapical periodontitis.
Topics: Humans; Treatment Outcome; Tooth Socket; Dental Implantation, Endosseous; Periapical Periodontitis; Molar
PubMed: 37390904
DOI: 10.1016/j.jormas.2023.101545 -
Clinical Oral Investigations Jan 2022Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature.
OBJECTIVE
To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance.
MATERIALS AND METHODS
The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow-up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed.
RESULTS
A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT).
CONCLUSIONS
NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage.
CLINICAL RELEVANCE
Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Biocompatible Materials; Collagen; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 34669038
DOI: 10.1007/s00784-021-04192-0 -
Oral and Maxillofacial Surgery Jun 2022The replacement of teeth with osseointegrated implants is one of the significant advances in the field of restorative dentistry. The time interval between tooth... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND AIMS
The replacement of teeth with osseointegrated implants is one of the significant advances in the field of restorative dentistry. The time interval between tooth extraction and the implant can be very short or long. This systematic review and meta-analysis aimed to collect and evaluate articles related to determining the effect of instant loading of dental implants are placed in the fresh socket initial stability on the clinical success of the implant compared to delay loading dental implants.
MATERIALS AND METHODS
In this study, all the available articles indexed in leading databases, including PubMed, ISI Web of Science, Embase, PsycINFO, PROSPERO, and Scopus, were searched. The full text of the articles meeting the primary criteria to be included in this research was obtained and appraised. Data of studies were extracted if they were scored as a high or moderate level of evidence.
RESULTS
A total of 2258 published articles were found through electronic database searching. After screening the titles and abstracts, and full text of articles, 16 studies met the inclusion criteria and were included in the analysis. The results of this study revealed that regarding the success rate, although there was no significant difference between immediate and delayed of dental implants, immediate procedure showed a lower incidence of bone loss in single implants.
CONCLUSION
Based on the results of this study, immediate loading of dental implant, under certain conditions, is a successful treatment process and is effective in reducing treatment time. Thus, immediate loading represents a valid alternative to the traditional delayed loading rehabilitation.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Immediate Dental Implant Loading; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 34251545
DOI: 10.1007/s10006-021-00983-7 -
Clinical Implant Dentistry and Related... Feb 2023Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo- and dento-integration with partial preservation... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo- and dento-integration with partial preservation of the periodontal ligament (PDL) in humans. Strategic buccal root retention for PDL preservation is a biologically driven procedure that maintains alveolar ridge dimensions and esthetics, while allowing for implant placement. The aim of this study was to conduct a systematic review of longitudinal clinical outcomes of PDL-mediated ridge preservation in conjunction with implant placement in adults, compared with conventional immediate implant placement with total extractions. The primary outcome for this study was marginal bone level (MBL) changes after strategic buccal root retention implant placement techniques.
MATERIALS AND METHODS
To address a predefined PICOS question, a systematic search of randomized clinical trials and cohort studies with at least 10 participants per group and a minimum 12-month follow-up was conducted. A two-phase systematic selection strategy, data extraction, and risk of bias assessment, was performed independently and in duplicate. Randomized trials were quantitatively analyzed in a meta-analysis.
RESULTS
Ten human studies fulfilled the predefined criteria and were included; three clinical trials and seven cohort studies, for a total of 506 patients and 587 implants. PDL-mediated implant placement of single-rooted periodontally healthy teeth was found to reduce marginal peri-implant bone loss and buccal plate changes as compared to conventional immediate implants across studies, while implant survival and success rates were comparable between the two procedures. A meta-analysis found that bone changes were significantly less when retention of the buccal root section was performed as compared to total extractions (standardized mean difference: [-4.53, -0.11]); the three clinical trials were, however, largely heterogeneous (I : 93.1%; Q = 28.98, p < 0.001).
CONCLUSION
Strategic retention of the buccal root section has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases of single-rooted teeth.
Topics: Adult; Humans; Dental Implants; Immediate Dental Implant Loading; Tooth Socket; Dental Implants, Single-Tooth; Esthetics, Dental; Longitudinal Studies; Tooth Extraction; Treatment Outcome
PubMed: 36331494
DOI: 10.1111/cid.13150 -
BMC Oral Health Dec 2023In the period of the early implant placement, the socket is mainly occupied by provisional matrix (PM). Keratinized epithelium (KE) is critical for primary wound...
BACKGROUND
In the period of the early implant placement, the socket is mainly occupied by provisional matrix (PM). Keratinized epithelium (KE) is critical for primary wound closure. Although both KE and PM are important, the detailed relationship among migrating KE, PM formation and indication of the early implant placement is still unclear.
OBJECTIVE
This research aimed to locate a healing stage of KE with highest osteogenic PM formation after tooth extraction, which could be treated as the optimal time point for early implant placement.
MATERIAL AND METHODS
Mice were sacrificed on days 1, 2, 3, 4 and 6 after incisor extraction. Clinical, histological, and immunohistochemical evaluations of the extraction sockets were performed, and statistical analyses were conducted. We then inserted implants into the PM with the greatest bioactivity and observed its osseointegration pattern for 3, 10, 17 and 30 days.
RESULT
When KE fusion was reached, sockets were dominated by PM with the greatest expression of osteocalcin (OC, P < 0.05) and high levels of CD34 and Runx2. OC and Runx2 expression were positively correlated with KE coverage (P < 0.05). When the implant was inserted at 4 days' healing, the PM maintained its osteogenic ability, and osseointegration proceeded perfectly.
CONCLUSION
The migration of KE was correlated with the formation of highly osteogenic and angiogenic PM. And the fusion of KE could be treated as an indication for early implant placement.
Topics: Animals; Mice; Dental Implantation, Endosseous; Dental Implants; Core Binding Factor Alpha 1 Subunit; Tooth Socket; Esthetics, Dental; Osseointegration; Tooth Extraction
PubMed: 38115040
DOI: 10.1186/s12903-023-03755-9 -
Journal of Visualized Experiments : JoVE Jan 2023This study introduces the development of a molar extraction model in the murine mandible to provide a practicable model for studying alveolar bone regeneration and...
This study introduces the development of a molar extraction model in the murine mandible to provide a practicable model for studying alveolar bone regeneration and intramembranous ossification. C57/J6 mice were used to extract the mandibular first molar to establish this model. They were executed, and the bilateral mandibles harvested, at 1 week and 4 weeks post-surgery, respectively. Subsequent serial stereoscopic harvest, histological assessment, and immunofluorescence staining were performed to demonstrate successful surgery. Immediately after surgery, the stereoscopic images displayed an empty extraction socket. The hematoxylin and eosin (H&E) at 1 week and Masson staining at 4 weeks post-surgery showed that the area of the original root was partially and fully filled with bone trabeculae, respectively. The immunofluorescence staining showed that, compared with the homeostasis side, the Sp7 expression increased at 1 week post-surgery, suggesting vigorous osteogenesis in the alveolar fossa. All these results demonstrated a practicable murine tooth extraction socket healing model. Upcoming studies revealing the mechanisms of jawbone defect healing or socket healing could adopt this method.
Topics: Mice; Animals; Tooth Socket; Periodontal Ligament; Molar; Mandible; Tooth Extraction
PubMed: 36715407
DOI: 10.3791/64855 -
Journal of Esthetic and Restorative... Jan 2023Taxonomy and classification of a disease contributes to facilitating the diagnosis and treatment planning process and simplifies communication between clinicians. The... (Review)
Review
Taxonomy and classification of a disease contributes to facilitating the diagnosis and treatment planning process and simplifies communication between clinicians. The aim of this study was to provide a critical appraisal based on a systematic review of the single-rooted extraction socket (ES) classifications and subsequently, introduce a new classification system combining the cornerstones of the previously proposed systems and based on the latest consensus in implant dentistry. Following the systematic search process in PubMed, EMBASE, and SCOPUS databases 13 ES classifications were detected. The most repeated hard and soft tissue factors in the previous classifications were buccal bone dehiscence, interproximal bone, gingival recession, and soft tissue phenotype. However, there was minimal attention to patient-related factors such as systemic conditions and smoking. Therefore, a new classification system based on the combination of patient-related factors, clinical and radiographical parameters was proposed. This divides an ES into three types. Class I and II sockets are candidates for receiving immediate implant placement and conversely, a class III socket includes a compromised condition that requires multiple-stage reconstruction mostly suitable for standard delayed implant placement with alveolar ridge preservation. Within the limitations of this study, the new classification system not only provides comprehensive inclusion of various crucial parameters in implant placement (such as prediction of future implant position and osteotomy difficulty, etc.) but also, in contrast to the previously introduced systems, is able to classify the ES prior to extraction and also, takes into the account the patient-related factors as the class modifiers following the extraction.
Topics: Humans; Tooth Socket; Tooth Extraction; Gingival Recession; Immediate Dental Implant Loading; Dental Implants, Single-Tooth; Dental Implantation, Endosseous
PubMed: 36196906
DOI: 10.1111/jerd.12967 -
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