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Materials (Basel, Switzerland) Apr 2020Preservation of the alveolar bone is a determinant in the outcome of orthodontic treatment. Alveolar bone defects or a decrease of their height and width may occur due... (Review)
Review
Preservation of the alveolar bone is a determinant in the outcome of orthodontic treatment. Alveolar bone defects or a decrease of their height and width may occur due to common reasons such as inflammation, tooth extraction, or cleft lip and palate. The aim of this systematic review was to investigate and appraise the quality of the most up to date available evidence regarding the applications and effects of platelet-rich fibrin (PRF) in orthodontics. This study was carried out according to preferred reporting items for systematic reviews and meta-analyses guidelines using the following databases: Medline via PubMed, Cochrane Library, Web of Science Core Collection and EMBASE. The qualitative assessment of the included studies was performed using Cochrane Risk of Bias tool and ROBINS-I guidelines. Results: From a total of 489 studies, nine studies were selected. The majority of the included studies demonstrate that autogenous anterior iliac graft with PRF had a higher amount of newly formed bone. Furthermore, this review also suggests that the application of platelet derivatives in the extraction socket can accelerate orthodontic tooth movement. Despite the limitations in the included studies, this systematic review suggested that PRF can improve alveolar cleft reconstruction and orthodontic tooth movement.
PubMed: 32316144
DOI: 10.3390/ma13081866 -
Cureus Nov 2023Implant success is measured not only by implant survival but also by the long-term aesthetic and functional results. Implant placement should be prosthetically driven,... (Review)
Review
Implant success is measured not only by implant survival but also by the long-term aesthetic and functional results. Implant placement should be prosthetically driven, with proper three-dimensional positioning for optimal support and stability of the tissues. Several procedures could be performed to ensure this requirement. While socket preservation (SP) is performed at the stage of tooth extraction, guided bone regeneration (GBR) takes place before or simultaneous to implant placement. The current review aims to summarize and discuss the procedures used for the preparation of the implant site, the preservation of the existing tissues, and their augmentation in cases of deficiency. An electronic search using Google Scholar, PubMed, and Scopus was conducted up to October 2023, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review summarizes the current knowledge on SP and GBR as prerequisites for future implant placement. Their indications, advantages, and limitations have been thoroughly evaluated and some recommendations for further research have been suggested. Implant placement in sites with severe bone resorption is extremely challenging. It necessitates the application of different surgical techniques, especially augmentation procedures, including guided bone regeneration. The need for such procedures could be avoided or at least minimized by the execution of SP after tooth extraction or immediate/early implant placement.
PubMed: 38098920
DOI: 10.7759/cureus.48785 -
Journal of Indian Society of... 2020Dental implants require adequate bone, three dimensionally, for successful osseointegration. The extraction socket changes in the dimension had been described in several...
Dental implants require adequate bone, three dimensionally, for successful osseointegration. The extraction socket changes in the dimension had been described in several studies. Implant in extraction socket cannot prevent resorption of the surrounding tissues. The bony alterations make oral esthetic implant reconstruction difficult without hard- and soft-tissue augmentation. Placement of bone substitute material and immediate implant were not able to completely establish an esthetic outcome. A novel technique of retaining the buccal aspect of the tooth root during implant placement has shown preservation of esthetics. Hard and soft tissues were preserved in their original form around the replaced tooth. The retained root on the buccal aspect of an oral implant is observed to have formed cementum and to some aspects of osseointegration with the surrounding tissues. It is called socket-shield technique and if completed meticulously can be an alternative for regenerative materials and soft-tissue grafting. In our report, we completed 14 cases of the said technique with 5-year follow-up. The results looked promising as none of the cases required guided bone regeneration procedures. This may become the future noninvasive method for the preservation of hard and soft tissues around an oral implant in esthetic areas.
PubMed: 32773983
DOI: 10.4103/jisp.jisp_557_19 -
BioMed Research International 2020Replacing a single tooth in the anterior maxilla is one of the greatest challenges in dentistry. Both functional and aesthetic results are to be strictly pursued....
Replacing a single tooth in the anterior maxilla is one of the greatest challenges in dentistry. Both functional and aesthetic results are to be strictly pursued. Planning and executing such a case through a totally digital methodology eventually guarantee many advantages, above all patient's operative and postoperative comfort. To ascertain this, a BOP analysis was performed which allowed us to evaluate soft tissues health, and more; crestal bone resorption was measured to evaluate hard tissues stability. This assumption was studied through four cases in which patients were alternatively treated with analogic and digital techniques. Four homogeneous patients were recruited. They all needed to extract one of the upper incisors, due to different clinical reasons, and then to replace it with an implant. Each patient was treated with an immediate postextractive implant which was immediately loaded, and finally, analogical and digital techniques were compared. All patients underwent a preoperative CBCT examination. After surgery, patients were checked by the surgeon after 10 days and one month to evaluate the progress of healing and to exclude any prosthetic problem. At 6 months (T1), one year (T2), and three years (T3), intraoral x-rays were performed using customized centring devices, according to the parallel beam technique. All data have been collected in a table and statistically processed; mean and standard deviation were measured. All patients entered an oral hygiene program with six months recall. Dental hygienist checked the BOP at T1, T2, and T3. At every step, similar levels of BOP were recorded. About interproximal bone loss, all patients showed an initial moderate loss (between T1 and T2), followed by stable values between T2 and T3. Despite the important limitations of a study with few cases, these results show a similar outcome comparing digital and analogical methods.
Topics: Adult; Alveolar Bone Loss; Crowns; Dental Implants, Single-Tooth; Esthetics, Dental; Follow-Up Studies; Humans; Immediate Dental Implant Loading; Incisor; Maxilla; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 33150174
DOI: 10.1155/2020/4012127 -
PeerJ 2021Treatment of cleft lip and palate (CLP) requires a comprehensive interdisciplinary approach and long-term follow-up. Only a few studies are available that reported on...
BACKGROUND
Treatment of cleft lip and palate (CLP) requires a comprehensive interdisciplinary approach and long-term follow-up. Only a few studies are available that reported on changes after treatment, which showed that in particular the transverse dimension, in patients with CLP is prone to changes after treatment. However, those studies did not pay attention to concomitant changes in the mandibular arch that occur after treatment.
OBJECTIVES
To evaluate mandibular transverse dental arch dimensions and interarch transverse changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate (CUCLAP) up to five years after treatment.
MATERIAL AND METHODS
Retrospective longitudinal study in 75 consecutive patients with CUCLAP directly after comprehensive treatment (T0), two (T2), and 5 years after treatment (T5). Great Ormond Street, London and Oslo (GOSLON) scores were available for all patients. Three-dimensional scans of all dental casts were made. Inter premolar and intermolar distances between the mandibular contralateral teeth were measured. The modified Huddart Bodenham (MHB index) was applied to assess the transverse interarch relationship. Paired t-tests and ANOVA were used to analyze transverse and interarch transverse changes. Linear regression analysis was done to define contributing factors.
RESULTS
Paired t-tests showed a significant decrease of the mandibular inter first and second premolar distances ( < 0.05) and an increase of the inter second molar distance, whilst the MHB Index deteriorated at all time points for all segments and for the total arch score ( < 0.05). Linear regression showed no significant contributing factors on the decrease of the transverse distances. However, inter arch transverse relationship was significantly affected by age at the end of treatment, missing maxillary lateral incisor space closure, and the GOSLON Yardstick score at the end of treatment ( < 0.05), especially during the first two years after treatment.
CONCLUSIONS
Changes occurred in the mandibular arch expressed as changes in the transverse dimensions and interarch relationship measured by the MHB Index. A younger age at the end of treatment, space closure for a missing maxillary lateral incisor and a higher GOSLON score at the end of treatment negatively influence the interarch transverse deterioration especially in the first two years after treatment. For the transverse dimensional changes in the mandibular arch such influencing factors could not be determined.
PubMed: 35003933
DOI: 10.7717/peerj.12643 -
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 -
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 -
Journal of Prosthodontic Research Jan 2023Tooth extraction is a last resort treatment for resolving pathological complications of dentition induced by infection and injury. Although the extraction wound... (Review)
Review
PURPOSE
Tooth extraction is a last resort treatment for resolving pathological complications of dentition induced by infection and injury. Although the extraction wound generally heals uneventfully, resulting in the formation of an edentulous residual ridge, some patients experience long-term and severe residual ridge reduction. The objective of this review was to provide a contemporary understanding of the molecular and cellular mechanisms that may potentially cause edentulous jawbone resorption.
STUDY SELECTION
Clinical, in vivo, and in vitro studies related to the characterization of and cellular and molecular mechanisms leading to residual ridge resorption.
RESULTS
The alveolar processes of the maxillary and mandibular bones uniquely juxtapose the gingival tissue. The gingival oral mucosa is an active barrier tissue that maintains homeostasis of the internal organs through its unique barrier immunity. Tooth extraction not only generates a bony socket but also injures oral barrier tissue. In response to wounding, the alveolar bone socket initiates regeneration and remodeling through coupled bone formation and osteoclastic resorption. Osteoclasts are also found on the external surface of the alveolar bone, interfacing the oral barrier tissue. Osteoclasts in the oral barrier region are not coupled with osteoblastic bone formation and often remain active long after the completion of wound healing, leading to a net decrease in the alveolar bone structure.
CONCLUSIONS
The novel concept of oral barrier osteoclasts may provide important clues for future clinical strategies to maintain residual ridges for successful prosthodontic and restorative therapies.
Topics: Humans; Osteoclasts; Bone Resorption; Alveolar Process; Mouth, Edentulous; Tooth Extraction; Tooth Socket; Alveolar Ridge Augmentation; Alveolar Bone Loss
PubMed: 35185111
DOI: 10.2186/jpr.JPR_D_21_00333 -
Journal of Oral & Maxillofacial Research 2019To evaluate the reported literature on the use of stem cells or growth factors for post extraction treatment of the alveolar bone. (Review)
Review
OBJECTIVES
To evaluate the reported literature on the use of stem cells or growth factors for post extraction treatment of the alveolar bone.
MATERIAL AND METHODS
A NCBI PubMed and PubMed Central databases search was conducted between September 2010 and August 2018, to identify animal or clinical studies reporting the clinical, radiographical and/or histological outcomes of socket preservation techniques after applying mesenchymal stem cells or growth factors. Only studies published in English language in the last 10 years were included in the study.
RESULTS
Eleven studies were identified fulfilling the inclusion criteria. They evaluate a total of 386 post extraction sockets. The main tested materials identified in the current review were bone morphogenetic protein-2 - 3 studies and mesenchymal stem cells - 3 studies. Other comparators were bone morphogenetic protein-9, platelet-derived growth factor-BB homodimers and bone marrow. Overall evaluation indicate positive results for all test groups showing differences in final socket width between 0.64 and 1.28 mm favouring the test groups. Histologically, no particular differences are detected between test and control groups. Most of the studies present low risk of bias.
CONCLUSIONS
In general, the use of mesenchymal stem cells or bioactive osteogenic molecules favours bone regeneration after tooth extraction, as evaluated clinically, radiographically and histologically. However, specific differences that support particular recommendations are still unclear in light of the current published evidence. Future studies should include the standardization of the mesenchymal stem cells selection and purification as well as dosage and delivery methods of bioactive molecules.
PubMed: 31620269
DOI: 10.5037/jomr.2019.10307 -
Dentistry Journal Jul 2022Dry socket is one of the postoperative complications of tooth extraction. It is the partial or total loss of the post-extraction blood clot, resulting in severe pain... (Review)
Review
Dry socket is one of the postoperative complications of tooth extraction. It is the partial or total loss of the post-extraction blood clot, resulting in severe pain that usually starts one to five days postoperatively, with clinical evidence of exposed alveolar bone, necrotic debris, halitosis, and tenderness on examination. The purpose of our systematic review was to answer the question "Is there a relationship between smoking and dry socket?". After meeting the inclusion and exclusion criteria, eleven studies were included in this systematic review (according to the PRISMA statement guidelines). Based on a meta-analysis, tobacco smokers had a more than three-fold increase in the odds of dry socket after tooth extraction. Overall, the combined incidence of dry socket in smokers was found to be about 13.2% and in non-smokers about 3.8%. Despite the heterogeneity of the included studies (different types of teeth extracted, different age groups), cigarette smoking was related to an increased risk of dry socket after tooth extraction.
PubMed: 35877395
DOI: 10.3390/dj10070121