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The International Journal of Oral &... 2021To evaluate and compare human chorionic amniotic membrane and platelet-rich fibrin on new bone formation and soft tissue healing in extraction sockets indicated for... (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation and Comparison of Human Chorionic Amniotic Membrane and Platelet-Rich Fibrin in Achieving Bone Formation and Soft Tissue Healing in Extraction Sockets Indicated for Rehabilitation with Implants: A Preliminary Study.
PURPOSE
To evaluate and compare human chorionic amniotic membrane and platelet-rich fibrin on new bone formation and soft tissue healing in extraction sockets indicated for rehabilitation with dental implants.
MATERIALS AND METHODS
A prospective, triple blind clinical study was conducted. The inclusion criteria were as follows: patient with two extraction sites each in the same arch, intact buccal bone and soft tissue around the socket, and recommended rehabilitation with dental implants. Postextraction, the sockets were randomly placed with human chorionic amniotic membrane in one site and platelet-rich fibrin in the other site. After 3 months, a trephine drill was used to take a biopsy of the respective sites for soft and hard tissue samples. The outcome parameters that were assessed histologically were percentage of new bone formation and lymphocyte density.
RESULTS
After screening 80 patients, eight participants were recruited for the study. The mean percentage of new bone formation in the human chorionic amniotic membrane group was 45.71% ± 4.82%, and for the plasma-rich fibrin group, it was 41.39% ± 6.29%, showing no statistically significant difference (z = 0.99, P = .31). In the human chorionic amniotic membrane group, six out of eight sites had mild lymphocyte density, while the plasmarich fibrin group had equal numbers of mild and moderate lymphocyte density. No statistically significant difference between the groups (Fischer test value = 0.60, P = .25) was noted.
CONCLUSION
Within the limitations of the study, the results showed that there is no difference in the efficiency of human chorionic amniotic membrane compared with platelet-rich fibrin in achieving new bone formation and soft tissue healing in the extraction socket.
Topics: Amnion; Dental Implants; Humans; Osteogenesis; Platelet-Rich Fibrin; Prospective Studies; Tooth Extraction; Tooth Socket
PubMed: 33909725
DOI: 10.11607/jomi.8344 -
Clinical Implant Dentistry and Related... Feb 2022There is no clear evidence that immediate implant placement can be applied to cases with dehiscence in the facial alveolar bone prior to extraction.
BACKGROUND
There is no clear evidence that immediate implant placement can be applied to cases with dehiscence in the facial alveolar bone prior to extraction.
PURPOSE
To evaluate the results of immediate implant placement in the anterior maxilla with facial alveolar bone dehiscence.
MATERIALS AND METHODS
We super positioned pre- and post-operative cone-beam computed tomography (CBCT) three-dimensional reconstruction images. A CBCT was taken before tooth extraction (T0), when the definitive restoration was placed (T1), and 1 year after placing the definitive restoration (T2). The depth and width of the dehiscence at T0, and the height and width of the facial hard and soft tissues are measured at the implant site at T1 and T2. We calculated the change in the amount of hard and soft tissues from T1 to T2 and determined the correlation between preoperative facial alveolar bone morphology and postoperative gingival recession.
RESULTS
13 women and 7 men were recruited. A total of 20 implants were evaluated. The implant survival rate was 100%. The mean facial alveolar bone dehiscence width was 3.9 ± 1.6 mm, and the mean depth from platform level was 2.9 ± 1.7 mm. The mean implant body exposure on the buccal was 4.8 ± 1.7 mm, and the mean socket width gap was 2.1 ± 0.8 mm. At T1, the mean facial hard tissue width was 2.1 ± 0.7 mm, and the mean height was 2.0 ± 0.7 mm. The mean change in vertical gingival recession from T1 to T2 was 0.5 ± 0.5 mm. We found a positive correlation between facial alveolar bone dehiscence width and gingival recession (r = 0.46, p-value = 0.04) and between dehiscence depth and gingival recession (r = 0.48, p-value = 0.03).
CONCLUSIONS
The results of our CBCT superposition method indicated that immediate implant placement can be considered in patients with facial alveolar bone dehiscence. However, there may be a higher risk of gingival recession with wide or deep dehiscence.
Topics: Cone-Beam Computed Tomography; Dental Implants; Dental Implants, Single-Tooth; Female; Gingival Recession; Humans; Male; Maxilla; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 34931737
DOI: 10.1111/cid.13059 -
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 -
International Journal of Environmental... Feb 2022Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar...
Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.
Topics: Alveolar Process; Humans; Immediate Dental Implant Loading; Maxilla; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 35270486
DOI: 10.3390/ijerph19052795 -
Oral and Maxillofacial Surgery Sep 2021To histologically analyze the effect of a curettage of the granulation tissue on healing at implants installed immediately after the extraction of teeth presenting...
OBJECTIVE
To histologically analyze the effect of a curettage of the granulation tissue on healing at implants installed immediately after the extraction of teeth presenting periapical lesions.
MATERIAL AND METHODS
In seven dogs, the dental pulp was removed from the pulp chamber and from the root canals of the right and left third and the fourth mandibular premolars and of the left second premolar. The chambers were left opened and, after 3 months, apical lesions were present, and the premolars were extracted. One alveolus each premolar was selected and, before implant installation, the apical lesions of two alveoli were curetted (curettage group) while the other three were not treated (no-treatment group). The second right premolar was also extracted (Negative control group). Six implants each dog were installed, and a fully submerged healing was allowed. Four months after, biopsies were collected, and histological analyses were performed.
RESULTS
The proportions of new bone at the entire body of the implant was 70.2 ± 10.7% at the no-treatment group, 72.1 ± 14.8% at the curettage group, and 69.6 ± 3.7% at the negative control group. The respective new bone proportion at the apical aspect of the implants was 68.4 ± 17.5%, 61.5 ± 27.3%, and 78.1 ± 5.7%. None of the differences among the various groups were statistically significant. No inflammatory infiltrates were seen in the apical region.
CONCLUSIONS
In this experimental study, it is concluded that the removal of the granulation tissue seems not to be necessary to obtain a proper osseointegration of implants installed immediately after the extraction of teeth presenting a periapical lesion.
Topics: Animals; Bicuspid; Dental Implantation, Endosseous; Dental Implants; Dogs; Osseointegration; Tooth Socket; Wound Healing
PubMed: 33219872
DOI: 10.1007/s10006-020-00926-8 -
Clinical Oral Implants Research May 2021The objective of this randomized controlled trial was to evaluate the radiographic changes and histologic healing following alveolar ridge preservation (ARP) using... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The objective of this randomized controlled trial was to evaluate the radiographic changes and histologic healing following alveolar ridge preservation (ARP) using autogenous whole tooth (AWTG), test group, versus autogenous demineralized dentin graft (ADDG), control group.
MATERIAL AND METHODS
Twenty non-molar teeth indicated for extraction were randomized into two groups (n = 10/group). Extracted teeth were prepared into AWTG or ADDG (0.6N HCl; 30 min), inserted into extraction sockets and covered by collagen membranes. Cone-beam computed tomography (CBCT) scans at baseline and six months were compared to assess ridge-dimensional changes. At six months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically.
RESULTS
All sites healed uneventfully. Reduction was 0.85 ± 0.38 mm and 1.02 ± 0.45 mm in ridge width, 0.61 ± 0.20 mm and 0.72 ± 0.27 mm in buccal and 0.66 ± 0.31 mm and 0.56 ± 0.24 mm in lingual ridge height for the AWTG and ADDG group, respectively (p > .05). Histologically, no inflammatory reactions were noticeable and all samples showed new bone formation. Qualitatively, graft-bone amalgamations were more pronounced in ADDG samples. Histomorphometrically, new bone, graft remnants and soft tissue occupied 37.55% ± 8.94%, 17.05% ± 5.58% and 45.4% ± 4.06% of the areas in the AWTG group and 48.4% ± 11.56%, 11.45% ± 4.13% and 40.15% ± 7.73% in the ADDG group of the examined areas, respectively (p > .05).
CONCLUSIONS
AWTG and ADDG are similarly effective in ARP. Yet, histologically ADDG seems to demonstrate better graft remodeling, integration and osteoinductive properties.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Dentin; Humans; Tooth Extraction; Tooth Socket
PubMed: 33565656
DOI: 10.1111/clr.13722 -
Odontology Jan 2023Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised...
Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.
Topics: Humans; Dental Implants; Treatment Outcome; Follow-Up Studies; Retrospective Studies; Lasers, Solid-State; Tooth Socket; Dental Implants, Single-Tooth; Immediate Dental Implant Loading; Tooth Extraction; Dental Prosthesis, Implant-Supported; Dental Restoration Failure
PubMed: 36074306
DOI: 10.1007/s10266-022-00734-4 -
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 -
British Dental Journal May 2022
Topics: Tooth Socket
PubMed: 35624262
DOI: 10.1038/s41415-022-4315-6 -
Odontology Oct 2023Bone metabolism and repair are directly regulated by arachidonic acid metabolites. At present, we analyzed the dose-response effects of a selective cysteinyl leukotriene...
Bone metabolism and repair are directly regulated by arachidonic acid metabolites. At present, we analyzed the dose-response effects of a selective cysteinyl leukotriene receptor type-1 antagonist during bone repair after tooth extraction and on non-injured skeleton. Sixty-three 129 Sv/Ev male mice composed the groups: C-Control (saline solution); MTK2-2 mg/Kg of Montelukast (MTK) and MTK4-4 mg/Kg of MTK, daily administered by mouth throughout all experimental periods set at 7, 14, and 21 days post-operative. Dental sockets were analyzed by computed microtomography (microCT), histopathology, and immunohistochemistry. Femurs, L5 vertebra and organs were also removed for observation. Blood was collected for plasma bone and liver markers. Histopathology and microCT analysis revealed early socket repair of MTK2 and MTK4 animals, with significant increased BV/TV at days 14 and 21 compared to C. Higher plasma calcium was detected at days 7 and 21 in MTK4 in comparison to C, while phosphate was significantly increased in MTK2 in the same periods in comparison to C and MTK4. No significant differences were found regarding plasma ALP and TRAP, neither for local TRAP and Runx2 immunolabeling at the healing sockets. Organs did not present histological abnormalities. Increased AST levels have been detected in distinct groups and periods. In general, femur phenotype was improved in MTK treated animals. Collectively, MTK promoted early bone formation after tooth extraction and increased bone quality of femurs and vertebra in a time-dose-dependent manner, and should be considered as an alternative therapy when improved post-extraction socket repair or skeleton preservation is required.
Topics: Male; Mice; Animals; Tooth Socket; Wound Healing; Tooth Extraction; Acetates
PubMed: 36920595
DOI: 10.1007/s10266-023-00800-5