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Journal of Oral & Maxillofacial Research 2019The present manuscript aims to critically detail the physiologic process of socket healing, in the absence or presence of grafting materials or platelet concentrates,... (Review)
Review
OBJECTIVES
The present manuscript aims to critically detail the physiologic process of socket healing, in the absence or presence of grafting materials or platelet concentrates, addressing the associated molecular and cellular events that culminate in the restoration of the lost tissue architecture and functionality.
MATERIAL AND METHODS
An electronic search in the National Library of Medicine database MEDLINE through its online site PubMed and Web of Science from inception until May 2019 was conducted to identify articles concerning physiologic process of socket healing, in the absence or presence of grafting materials or platelet concentrates. The search was restricted to English language articles without time restriction. Additionally, a hand search was carried out in oral surgery, periodontology and dental implants related journals.
RESULTS
In total, 122 literature sources were obtained and reviewed. The detailed biological events, at the molecular and cellular level, that occur in the alveolus after tooth extraction and socket healing process modulated by grafting materials or autologous platelet concentrates were presented as two entities.
CONCLUSIONS
Tooth extraction initiates a convoluted set of orderly biological events in the alveolus, aiming wound closure and socket healing. The healing process comprises a wide range of events, regulated by the interplay of cytokines, chemokines and growth factors that determine cellular recruitment, proliferation and differentiation in the healing milieu, in a space- and time-dependent choreographic interplay. Additionally, the healing process may further be modulated by the implantation of grafting materials or autologous platelet concentrates within the tooth socket, aiming to enhance the regenerative outcome.
PubMed: 31620264
DOI: 10.5037/jomr.2019.10302 -
Journal of Oral & Maxillofacial Research 2019To assess the treatment outcomes of the dental implants placed in the grafted sockets. (Review)
Review
OBJECTIVES
To assess the treatment outcomes of the dental implants placed in the grafted sockets.
MATERIAL AND METHODS
A search protocol was developed to evaluate the treatment outcomes of dental implants placed in the grafted sockets in terms of implant survival rates (primary outcome), marginal-bone-level (MBL) changes, clinical parameters (i.e., bleeding on probing, probing depth), occurrence of peri-implant diseases, and aesthetic outcomes (secondary outcomes). Randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective studies with at least 12 months of follow-up and a minimum of 10 patients having at least one dental implant inserted into the grafted socket were conducted. MEDLINE (PubMed) was searched for relevant articles published until 1st April 2019. A meta-analysis was performed using the random-effects model on the selected qualifying articles.
RESULTS
The present analysis included 7 RCTs. The survival rate of the implants inserted into the grafted sockets ranged from 95 to 100% after 1 to 4 years of follow-up. MBL loss was found to be significantly greater for the implants placed in the non-grafted healed sites than for those placed in the previously grafted sockets (weighted mean difference = -1.961 mm, P < 0.0001). In terms of MBL changes, no difference was detected between immediately inserted implants versus implants placed in previously grafted sockets. None of the included studies reported on the clinical parameters or occurrence of peri-implant diseases.
CONCLUSIONS
Implants inserted into the previously grafted sockets showed high survival rates and lower marginal-bone-level loss than the implants inserted into the non-grafted sites.
PubMed: 31620270
DOI: 10.5037/jomr.2019.10308 -
Journal of Indian Society of... 2023To analyze through finite element analysis the stress distribution in peri-implant bone tissues, implants, and prosthetic components induced by the socket shield (SS)...
BACKGROUND
To analyze through finite element analysis the stress distribution in peri-implant bone tissues, implants, and prosthetic components induced by the socket shield (SS) technique in comparison to other techniques used to treat tooth loss.
MATERIALS AND METHODS
A three-dimensional model of a superior central incisor crown supported by implant was modeled and three different placement conditions were simulated: SS - 2.0-mm-thick root dentin fragment positioned between the alveolar buccal wall and implant; heterologous bone graft (HBG) - bovine bone graft positioned the alveolar buccal wall and implant; and control (C) - implant fully placed in bone tissue of a healed alveolus. The model was restricted at the lateral surfaces of the bone tissue and the following loads were simulated: Both oblique (45°) loads of 100 N on the lingual surface of the crown (maximal habitual intercuspation) and 25.5 N on the incisal edge of the crown (tooth contact during mandibular protrusion) were simultaneously applied. Tensile stress, shear stress, compression, and displacement were analyzed in the cortical bone, trabecular bone, dentin root fragment, and bone graft; while equivalent von Mises stresses were quantified in the implant and prosthetic components.
RESULTS
Stress values of SS and HBG in the bone tissues were higher than C, while slight differences within models were observed for dentin root fragment, bone graft, implant, and prosthetic components.
CONCLUSIONS
The SS technique presented the highest stress concentration in the peri-implant tissues.
PubMed: 37593548
DOI: 10.4103/jisp.jisp_356_22 -
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 -
Frontiers in Immunology 2024
Topics: Tooth Extraction; Bone and Bones
PubMed: 38545105
DOI: 10.3389/fimmu.2024.1394835 -
The Journal of Contemporary Dental... Apr 2022The aim of this study was to evaluate clinical features that might be related to success rates of autotransplantation of molars with complete root formation.
AIM
The aim of this study was to evaluate clinical features that might be related to success rates of autotransplantation of molars with complete root formation.
MATERIALS AND METHODS
A group of 60 patients with completely formed third molars autotransplanted to a different molar socket was followed for a medium period of 5 years and 5 months. Extreme care was used in order to preserve the vitality of the periodontal ligament cells. The same technique was applied for all teeth despite different anatomies. Descriptive statistics was performed. The association of the various factors with failures was assessed by using the Fisher's exact test and a -value of 0.05 was considered as significance threshold.
RESULTS
Autotransplantation was found to be a reliable method to replace extracted molar teeth with closed apices. The two major factors that positively influenced the outcomes were fixation with splint and a periodontal probing pocket depth less than 4 mm after the initial healing period. The technique resulted in a suitable well-conserved socket and donor tooth, after the extraction.
CONCLUSION
An accurate case evaluation was critically important in order to identify the risks prior to surgery and to select the right patients for this procedure. Autotransplantation of third molar teeth is a feasible approach to replace compromised mature molars. Proper stabilization of the transplanted tooth is strategical for the success of this procedure. A conservative approach to unerupted wisdom teeth is also recommended.
CLINICAL SIGNIFICANCE
Dental implants and fixed prostheses have been utilized to replace missing teeth, and orthodontic space closure can be sometimes an effective treatment option. Tooth autotransplantation can be a reliable and less invasive clinical alternative when an appropriate donor site is available.
Topics: Humans; Molar; Molar, Third; Periodontal Pocket; Tooth Extraction; Tooth Socket; Transplantation, Autologous
PubMed: 35945841
DOI: No ID Found -
Bioengineering (Basel, Switzerland) Sep 2023The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures... (Review)
Review
The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures performed in the dental clinic. Understanding this healing process is of utmost importance because the outcome has a direct bearing on future prosthetic rehabilitation and, by extension, on patients' esthetics and masticatory function, among others. This mini review, therefore, summarized the current knowledge on the different stages of socket healing, including the biologic and clinical events that occur following tooth extraction up until the complete closure of the socket. Additionally, the modeling of the alveolar bone/process post extraction, and the resultant dimensional changes that, altogether, shape the bone, were reviewed and documented. The effects of various socket preservation interventions to mitigate these dimensional changes, and therefore preserve the alveolar process in a condition suitable for future prosthetic rehabilitation, were highlighted. Finally, a review of some of the factors that influence the entire process was also carried out.
PubMed: 37892875
DOI: 10.3390/bioengineering10101145 -
Bioengineering (Basel, Switzerland) Sep 2023Dental autotransplantation is an effective alternative to conventional dental treatment, and it involves removing a tooth and repositioning it in a new position within...
Dental autotransplantation is an effective alternative to conventional dental treatment, and it involves removing a tooth and repositioning it in a new position within the same patient. Although this procedure might pose more intraoperative challenges, it provides a great solution for replacing missing teeth or aiding difficult eruption in young patients. This prospective method is also advocated as a use of treatment for unrestorable teeth. The success rates of autotransplantation cases with and without replicas were compared in a retrospective analysis of the data. By reducing donor tooth manipulation and ensuring a proper fit and positioning in the recipient socket, replicas significantly increased success rates of the procedure. CBCT scans were used to collect data. Data exported to the Mimics system were then processed in order to achieve a model of the donor tooth. Additive manufacturing technology was used to create the replicas. Specialized biocompatible material was used. Details of the replantation site and the donor tooth requirements were described, as well as the step-by-step surgical technique. For the best results, variables, like patient selection, surgical technique, and long-term monitoring, were found to be essential. The study highlights the significance of dental professionals and biomedical engineering staff working together to develop standard operating procedures and achieve predictable outcomes in autotransplantation procedures. The results suggest that 3D printed replicas could be a useful tool for improving the effectiveness and success of dental autotransplantation.
PubMed: 37760160
DOI: 10.3390/bioengineering10091058 -
BMC Oral Health Feb 2021The distribution of dental abnormalities among cleft patients concerning cleft type frequently poses ambiguity wherefore the aim of this study was to evaluate the...
BACKGROUND
The distribution of dental abnormalities among cleft patients concerning cleft type frequently poses ambiguity wherefore the aim of this study was to evaluate the prevalence of hypodontia and supernumerary teeth in an exemplary German cleft population dependent on the cleft type.
METHODS
Radiographs and dental records of cleft patients, which had been treated and followed up in the Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Campus, Dresden, Germany (investigation period of 22 years) were evaluated concerning hypodontia and supernumerary teeth dependent on the cleft type. Out of 386 records, 108 patients met the inclusion criteria: non-syndromic cleft of the alveolus with or without palate (CL/P), at least one clear panoramic x-ray, sufficient dental records. Statistical analysis was performed using x-square and binominal test (p ≤ 0.05).
RESULTS
Hypodontia was more frequent (54/50%) than supernumerary teeth (36/33.3%) and was more common in bilateral clefts of the lip and palate (BCLP) (70.1%) than in unilateral clefts of the lip and palate (UCLP) (51.6%) or clefts of the lip and alveolus (CLA) (34.5%) (p << 0.001). There was an average of 0.9 missing teeth per patient, thereof the upper lateral incisor was most often affected (23.2%). In contrast, supernumerary teeth were more frequent in CLA (51.7%; p = 0.014) than UCLP (29.0%) and BCLP patients (17.6%).
CONCLUSION
The prevalence for numerical dental anomalies was significantly different among the cleft types. Hypodontia significantly increased with the extend of the cleft, whereas the prevalence of supernumerary teeth decreased.
Topics: Anodontia; Cleft Lip; Cleft Palate; Germany; Humans; Palate; Prevalence; Tooth Abnormalities; Tooth, Supernumerary
PubMed: 33573652
DOI: 10.1186/s12903-021-01420-7 -
Clinical Oral Investigations Feb 2022By means of a systematic review and network meta-analysis, this study aims to answer the following questions: (a) does the placement of a biomaterial over an extraction... (Meta-Analysis)
Meta-Analysis Review
AIM
By means of a systematic review and network meta-analysis, this study aims to answer the following questions: (a) does the placement of a biomaterial over an extraction socket lead to better outcomes in terms of horizontal and vertical alveolar dimensional changes and percentage of new bone formation than healing without coverage? And (b) which biomaterial(s) provide(s) the better outcomes?
MATERIALS AND METHODS
Parallel and split-mouth randomized controlled trials treating ≥ 10 patients were included in this analysis. Studies were identified with MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials, and Scopus. Primary outcomes were preservation of horizontal and vertical alveolar dimension and new bone formation inside the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes. For NMA, prediction intervals were calculated to estimate clinical efficacy, and SUCRA was used to rank the materials based on their performance; multidimensional ranking was used to rank treatments based on dissimilarity. The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO).
RESULTS
Twelve trials were included in the qualitative and quantitative analysis: 312 sites were evaluated. Autologous soft tissue grafts were associated with better horizontal changes compared to resorbable membranes. A statistically significant difference in favor of resorbable membranes, when compared to no membrane, was found, with no statistically significant heterogeneity. For the comparison between crosslinked and non-crosslinked membranes, a statistically significant difference was found in favor of the latter and confirmed by histomorphometric NMA analysis. Given the relatively high heterogeneity detected in terms of treatment approaches, materials, and outcome assessment, the findings of the NMA must be interpreted cautiously.
CONCLUSIONS
Coverage of the healing site is associated with superior results compared to no coverage, but no specific sealing technique and/or biomaterial provides better results than others. RCTs with larger sample sizes are needed to better elucidate the trends emerged from the present analysis.
CLINICAL RELEVANCE
Autologous soft tissue grafts and membranes covering graft materials in post-extraction sites were proved to allow lower hard tissue shrinkage compared to the absence of coverage material with sealing effect. Histomorphometric analyses showed that non-crosslinked membranes provide improved hard tissue regeneration when compared to crosslinked ones.
Topics: Alveolar Ridge Augmentation; Biocompatible Materials; Dental Care; Humans; Network Meta-Analysis; Randomized Controlled Trials as Topic; Tooth Extraction; Tooth Socket; Treatment Outcome; Wound Healing
PubMed: 34825280
DOI: 10.1007/s00784-021-04262-3