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Periodontology 2000 Jun 2015Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the... (Review)
Review
Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the socket wound and to restore tissue homeostasis, and are referred to as '"socket healing". The aims of the present report were twofold: first, to describe the socket-healing process; and, second, to discuss what can be learned from the temporal sequence of healing events, in order to improve treatment outcomes. The socket-healing process may be divided into three sequential, and frequently overlapping, phases: inflammatory; proliferative; and modeling/remodeling. Several clinical and experimental studies have demonstrated that the socket-healing process promotes up to 50% reduction of the original ridge width, greater bone resorption at the buccal aspect than at the lingual/palatal counterpart and a larger amount of alveolar bone reduction in the molar region. In conclusion, tooth extraction, once a simple and straightforward surgical procedure, should be performed in the knowledge that ridge reduction will follow and that further clinical steps should be considered to compensate for this, when considering future options for tooth replacement.
Topics: Alveolar Process; Bone Remodeling; Humans; Regeneration; Tooth Extraction; Tooth Socket; Wound Healing
PubMed: 25867983
DOI: 10.1111/prd.12082 -
British Dental Journal May 2022
Topics: Tooth Socket
PubMed: 35624262
DOI: 10.1038/s41415-022-4315-6 -
Periodontology 2000 Oct 2023The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone... (Review)
Review
The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing.
Topics: Humans; Alveolar Ridge Augmentation; Tooth Extraction; Alveolar Process; Tooth Socket; Overtreatment; Alveolar Bone Loss
PubMed: 37622682
DOI: 10.1111/prd.12508 -
Journal of Clinical Periodontology Jul 2022To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB])... (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB]) during alveolar ridge preservation (ARP) in terms of horizontal ridge width resorption.
MATERIALS AND METHODS
Randomized trials of at least 2 months duration comparing at least two techniques to seal the alveolus against each other or against spontaneous healing (SH) were eligible. Searches were conducted in MEDLINE via PubMed, EMBASE, Scopus, and Cochrane Central. Conventional meta-analysis, meta-regression, and network meta-analysis (NMA) were conducted, with clinical and tomographic ridge width changes as outcomes. Predictive intervals (95% PI) were reported.
RESULTS
Twenty-two studies were included, accounting for 52 study arms. Meta-regression identified that the socket sealing technique and publication year explained the observed heterogeneity. NMA showed that FA and OHB led to significantly lower ridge resorption than SH, resulting in 1.18 mm (95% PI 0.21-2.13) and 1.10 mm (95% PI 0.49-1.69) wide alveolar ridges, respectively. No significant difference between OHNB and SH was found (0.46 mm, 95% PI -0.70 to 1.64). The treatment with the largest probability for ARP was FA (52.7%), followed by OHB (39.1%) and OHNB (8.2%).
CONCLUSIONS
FA and OHB are efficacious techniques to seal the alveolus during ARP.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 35451071
DOI: 10.1111/jcpe.13628 -
Periodontology 2000 Oct 2023Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of... (Review)
Review
Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing.
Topics: Humans; Tooth Socket; Alveolar Process; Tooth Extraction; Wound Healing; Alveolar Bone Loss; Alveolar Ridge Augmentation
PubMed: 37533162
DOI: 10.1111/prd.12506 -
International Journal of Implant... Dec 2021To address the focused question: in patients with freshly extracted teeth, what is the efficacy of platelet-rich fibrin (PRF) in the prevention of pain and the... (Review)
Review
PURPOSE
To address the focused question: in patients with freshly extracted teeth, what is the efficacy of platelet-rich fibrin (PRF) in the prevention of pain and the regeneration of soft tissue and bone compared to the respective control without PRF treatment?
METHODS
After an electronic data search in PubMed database, the Web of Knowledge of Thomson Reuters and hand search in the relevant journals, a total of 20 randomized and/or controlled studies were included.
RESULTS
66.6% of the studies showed that PRF significantly reduced the postoperative pain, especially in the first 1-3 days after tooth extraction. Soft tissue healing was significantly improved in the group of PRF compared to the spontaneous wound healing after 1 week (75% of the evaluated studies). Dimensional bone loss was significantly lower in the PRF group compared to the spontaneous wound healing after 8-15 weeks but not after 6 months. Socket fill was in 85% of the studies significantly higher in the PRF group compared to the spontaneous wound healing.
CONCLUSIONS
Based on the analyzed studies, PRF is most effective in the early healing period of 2-3 months after tooth extraction. A longer healing period may not provide any benefits. The currently available data do not allow any statement regarding the long-term implant success in sockets treated with PRF or its combination with biomaterials. Due to the heterogeneity of the evaluated data no meta-analysis was performed.
Topics: Humans; Pain, Postoperative; Platelet-Rich Fibrin; Tooth Extraction; Tooth Socket; Wound Healing
PubMed: 34923613
DOI: 10.1186/s40729-021-00393-0 -
Journal of Clinical Periodontology Dec 2009To review the literature to assess the amount of change in height and width of the residual ridge after tooth extraction. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review the literature to assess the amount of change in height and width of the residual ridge after tooth extraction.
MATERIAL AND METHODS
MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through up to March 2009. Appropriate studies which data reported concerning the dimensional changes in alveolar height and width after tooth extraction were included. Approximal height change, mid-buccal change, mid-crestal change, mid-lingual change, Alveolar width change and socket fill were selected as outcome variables. Mean values and if available standard deviations were extracted. Weighted mean changes were calculated.
RESULTS
Independent screening of the titles and abstracts of 1244 MEDLINE-PubMed and 106 Cochrane papers resulted in 12 publications that met the eligibility criteria. The reduction in width of the alveolar ridges was 3.87 mm. The mean clinical mid-buccal height loss was 1.67 mm. The mean crestal height change as assessed on the radiographs was 1.53 mm. Socket fill in height as measured relative to the original socket floor was on an average 2.57 mm.
CONCLUSION
During the post-extraction healing period, the weighted mean changes as based on the data derived from the individual selected studies show the clinical loss in width to be greater than the loss in height, assessed both clinically as well as radiographically.
Topics: Alveolar Bone Loss; Humans; Smoking; Tooth Extraction; Tooth Socket
PubMed: 19929956
DOI: 10.1111/j.1600-051X.2009.01482.x -
British Dental Journal Mar 2021
Topics: Dental Implants; Dental Implants, Single-Tooth; Immediate Dental Implant Loading; Tooth Socket
PubMed: 33772190
DOI: 10.1038/s41415-021-2851-0 -
Journal of Periodontology Dec 2021It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post-extraction sockets. The aim of this 5-year randomized controlled... (Randomized Controlled Trial)
Randomized Controlled Trial
Immediate single-tooth implant placement with simultaneous bone augmentation versus delayed implant placement after alveolar ridge preservation in bony defect sites in the esthetic region: A 5-year randomized controlled trial.
BACKGROUND
It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post-extraction sockets. The aim of this 5-year randomized controlled trial was therefore comparison of peri-implant soft and hard tissue parameters, esthetic ratings, and patient-reported satisfaction of immediate implant placement in post-extraction sockets with buccal bony defects of ≥ 5 mm in the esthetic zone, with delayed implant placement after ridge preservation.
METHODS
Patients presenting a failing tooth in the esthetic region and a buccal bony defect of ≥ 5 mm after extraction were randomly assigned to immediate (Immediate group, n = 20) or delayed (Delayed group, n = 20) implant placement. Second-stage surgery and placement of a provisional restoration occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. The follow-up was 5 years. Marginal bone level (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded.
RESULTS
Mean marginal bone level change was -0.71 ± 0.35 mm and -0.54 ± 0.41 mm in respectively the Immediate group and the Delayed group after 5 years (P = 0.202). This difference, and in other variables, was not significant.
CONCLUSIONS
Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in post-extraction sockets with buccal bony defects of ≥ 5 mm, were comparable to those following delayed implant placement after ridge preservation in the esthetic zone.
Topics: Alveolar Process; Alveolar Ridge Augmentation; Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 33724473
DOI: 10.1002/JPER.20-0845 -
Journal of Clinical Periodontology Sep 2003The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of...
OBJECTIVES
The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue.
MATERIAL AND METHODS
Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals.
RESULTS
During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180.
CONCLUSION
The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.
Topics: Animals; Biopsy; Blood Coagulation; Bone Marrow; Bone Matrix; Bone Remodeling; Calcification, Physiologic; Connective Tissue; Dogs; Osteogenesis; Time Factors; Tooth Extraction; Tooth Socket; Wound Healing
PubMed: 12956657
DOI: 10.1034/j.1600-051x.2003.00366.x