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The Journal of Contemporary Dental... Mar 2024The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly...
Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.
AIM
The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment.
MATERIALS AND METHODS
A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading.
RESULTS
Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years.
CONCLUSION
The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level.
CLINICAL SIGNIFICANCE
Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, . Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.
Topics: Humans; Male; Dental Implants, Single-Tooth; Female; Prospective Studies; Maxilla; Adult; Immediate Dental Implant Loading; Tooth Socket; Computer-Aided Design; Crowns; Alveolar Bone Loss; Dental Abutments; Esthetics, Dental; Tooth Extraction; Dental Prosthesis, Implant-Supported; Dental Prosthesis Design; Dental Implant-Abutment Design; Young Adult
PubMed: 38690692
DOI: 10.5005/jp-journals-10024-3659 -
Journal of Clinical Periodontology Apr 2024To assess the efficacy of heterologous fibrin biopolymer (HFB) in promoting alveolar bone healing after tooth extraction in rats.
AIM
To assess the efficacy of heterologous fibrin biopolymer (HFB) in promoting alveolar bone healing after tooth extraction in rats.
MATERIALS AND METHODS
The upper right incisors of 48 Wistar rats were extracted. Toothless sockets were filled with HFB (HFBG, n = 24) or blood clot (BCG, n = 24). The tooth extraction sites were subjected to micro-computed tomography (micro-CT), histological, histomorphometric and immunohistochemical (for Runt-related transcription factor 2/Runx2 and tartrate-resistant acid phosphatase/TRAP) analyses on days 0, 7, 14 and 42 after extraction.
RESULTS
Socket volume remained similar between days 0 and 14 (69 ± 5.4 mm), except in the BCG on day 14, when it was 10% lower (p = .043). Although the number of Runx2+ osteoblasts was high and similar in both groups (34 × 10 cells/mm), the HFBG showed lower inflammatory process and osteoclast activity than BCG at 7 days. On day 14, the number of Runx2+ osteoblasts remained high and similar to the previous period in both groups. However, osteoclast activity increased. This increase was 55% lower in the HFBG than BCG. In the BCG, the presence of an inflammatory process and larger and numerous osteoclasts on day 14 led to resorption of the alveolar bone ridge and newly formed bone. On day 42, numbers of Runx2+ osteoblast and TRAP+ osteoclasts decreased dramatically in both groups. Although the BCG exhibited a more mature cortical bone formation, it exhibited a higher socket reduction (28.3 ± 6.67%) and smaller bone volume (37 ± 5.8 mm) compared with HFBG (socket reduction of 14.8 ± 7.14% and total bone volume of 46 ± 5.4 mm).
CONCLUSIONS
HFB effectively suppresses osteoclast activity and reduces alveolar bone resorption compared with blood clot, thus preventing three-dimensional bone loss, particularly during the early healing period. HFB emerges as a promising biopharmaceutical material for enhancing healing processes after tooth extraction.
PubMed: 38685818
DOI: 10.1111/jcpe.13992 -
International Journal of Molecular... Apr 2024In addition to post-extraction bleeding, pronounced alveolar bone resorption is a very common complication after tooth extraction in patients undergoing anticoagulation...
In addition to post-extraction bleeding, pronounced alveolar bone resorption is a very common complication after tooth extraction in patients undergoing anticoagulation therapy. The novel, biodegenerative, polyurethane adhesive VIVO has shown a positive effect on soft tissue regeneration and hemostasis. However, the regenerative potential of VIVO in terms of bone regeneration has not yet been explored. The present rodent study compared the post-extraction bone healing of a collagen sponge (COSP) and VIVO in the context of ongoing anticoagulation therapy. According to a split-mouth design, a total of 178 extraction sockets were generated under rivaroxaban treatment, of which 89 extraction sockets were treated with VIVO and 89 with COSP. Post-extraction bone analysis was conducted via in vivo micro-computed tomography (µCT), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX) after 5, 10, and 90 days. During the observation time of 90 days, µCT analysis revealed that VIVO and COSP led to significant increases in both bone volume and bone density ( ≤ 0.001). SEM images of the extraction sockets treated with either VIVO or COSP showed bone regeneration in the form of lamellar bone mass. Ratios of Ca/C and Ca/P observed via EDX indicated newly formed bone matrixes in both treatments after 90 days. There were no statistical differences between treatment with VIVO or COSP. The hemostatic agents VIVO and COSP were both able to prevent pronounced bone loss, and both demonstrated a strong positive influence on the bone regeneration of the alveolar ridge post-extraction.
Topics: Animals; Bone Regeneration; Tooth Extraction; Rats; X-Ray Microtomography; Male; Anticoagulants; Tissue Adhesives; Alveolar Bone Loss; Collagen
PubMed: 38673796
DOI: 10.3390/ijms25084210 -
Journal of Clinical Medicine Apr 2024(1) This study aimed to compare a collagen matrix to a hemostatic gelatin sponge as a socket seal in alveolar ridge preservation (ARP). (2) Systemically healthy...
(1) This study aimed to compare a collagen matrix to a hemostatic gelatin sponge as a socket seal in alveolar ridge preservation (ARP). (2) Systemically healthy patients planned for ARP at two sites with more than 50% of the buccal bone wall remaining after tooth extraction were eligible for inclusion. ARP involved socket grafting using collagen-enriched deproteinized bovine bone mineral. Sites were then randomly assigned to the test group (collagen matrix) or the control group (hemostatic gelatin sponge). The primary outcome was soft tissue thickness in the center of the site at 4 months, analyzed on cone-beam computed tomography. Secondary outcomes included the buccal and lingual soft tissue heights, horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and Socket Wound Healing Score (SWHS). (3) In total, 18 patients (12 females, 6 males) with a mean age of 57.3 years (SD 11.1) were included. Four months after ARP, the soft tissue thickness in the center of the site amounted to 2.48 mm (SD 0.70) in the test group and 1.81 mm (SD 0.69) in the control group. The difference of 0.67 mm (95% CI: 0.20-1.14) in favor of the collagen matrix was statistically significant ( < 0.009). The buccal soft tissue height was also statistically significantly higher for the collagen matrix (0.72 mm; 95% CI: 0.06-1.38; = 0.034). A trend favoring the collagen matrix was found for the lingual soft tissue height ( = 0.066). No significant differences between the groups in terms of horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and the SWHS were found. (4) The absence of significant differences in hard tissue outcomes suggests that both the collagen matrix and hemostatic gelatin sponge effectively sealed the extraction socket and supported bone preservation. However, the collagen matrix better maintained soft tissue dimensions. The clinical relevance of this finding with respect to the necessity for adjunctive soft tissue augmentation at the time of implant placement is yet to be studied.
PubMed: 38673566
DOI: 10.3390/jcm13082293 -
Gels (Basel, Switzerland) Mar 2024Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a...
BACKGROUND/AIM
Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel's potential to promote regeneration and inhibit complications associated with the replantation process.
MATERIALS AND METHODS
Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically.
RESULTS
The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF.
CONCLUSIONS
Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.
PubMed: 38667632
DOI: 10.3390/gels10040213 -
The Journal of Oral Implantology Jun 2024To compare histologically the percentage of bone formation 12-20 weeks after ridge augmentation using 2 different techniques. Tooth loss is associated with 3-dimensional... (Comparative Study)
Comparative Study
To compare histologically the percentage of bone formation 12-20 weeks after ridge augmentation using 2 different techniques. Tooth loss is associated with 3-dimensional bone remodeling and ridge atrophy. Ridge preservation procedures can prevent alveolar bone volume loss. Different techniques and materials are used to preserve the alveolar ridge. Computer-generated randomization software was used to assign 2 ridge preservation techniques for 11 extraction sites. In group I, type I bovine Achilles tendon collagen plugs with bioactive resorbable calcium apatite crystals (CPCAC) were placed, and in group II, cortico-cancellous bone chips (CCBC) mix and an expanded polytetrafluoroethylene (ePTFE) barrier membrane were placed. The histomorphometric studies were performed using a computer-based image analysis system (ImageJ 1.4, National Institute of Health, Bethesda, Md) to calculate the pixel area of bone tissue and the remaining bone graft material. The histomorphometric data were analyzed using a Student t test to compare the measurements between the 2 experimental groups. This parametric statistical test was employed to determine if there were any statistically significant differences in the quantitative histological parameters between the groups. The sockets that received CPCAC showed a lower (31.89%) percentage of native bone surface area compared with the CCBC group (43.87%). However, the difference was not statistically significant (P < .05). In addition, the CPCAC group showed evidence of foreign-body reaction. The CCBC graft covered with an ePTFE barrier may induce more bone formation with minimal inflammation in an extraction socket compared with a collagen plug with calcium apatite crystals. In addition, histological analysis of the CPCAC graft showed evidence of foreign-body reaction, which indicates a negative clinical impact.
Topics: Bone Transplantation; Alveolar Ridge Augmentation; Humans; Polytetrafluoroethylene; Alveolar Bone Loss; Male; Animals; Middle Aged; Alveolar Process; Female; Collagen; Tooth Socket; Osteogenesis
PubMed: 38660739
DOI: 10.1563/aaid-joi-D-23-00060 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2024The machairodontine felid Homotherium achieved a global geographic distribution throughout much of the Pleistocene. Accordingly, that large carnivore is important for...
The machairodontine felid Homotherium achieved a global geographic distribution throughout much of the Pleistocene. Accordingly, that large carnivore is important for understanding patterns of community composition. We report on a new record of Homotherium based on a fragmentary premaxilla-maxilla discovered on McFaddin Beach, Texas, along the Gulf of Mexico. Skeletal remains of extinct, Pleistocene vertebrates accumulate on McFaddin Beach. Those fossils appear to originate from submerged deposits on the continental shelf in the Gulf of Mexico, an area that was subaerially exposed in the Late Pleistocene during glacial intervals. Marine erosion and transport altered the externally visible morphology of the current specimen, obscuring and/or damaging taxonomically informative details of the preserved dentition. However, high-resolution X-ray computed tomography revealed diagnostic portions of the unerupted crown of an upper canine within its alveolus. The serrated edges of the canine combined with the position of the incisors demonstrate that the specimen from McFaddin Beach represents a species of Homotherium. That specimen is the latest in a larger sample of Homotherium in Texas that spans most of the Pliocene-Pleistocene. This is the first occurrence of Homotherium from the continental shelf of the Gulf Coast. That landscape may have formed a broad subtropical Gulf Coast corridor that facilitated the dispersal of Neotropical taxa along the coast between Texas and Florida. The associated fauna from McFaddin Beach contains Neotropical mammals common to southern Texas and Florida and indicates that Homotherium was a member of the fauna inhabiting the Gulf Coast corridor during the Late Pleistocene.
PubMed: 38654480
DOI: 10.1002/ar.25461 -
Annals of Surgery Apr 2024We propose the first classification scheme for macroglossia in patients with Beckwith-Wiedemann Syndrome (BWS), the BWS Index of macroGlossia (BIG).
OBJECTIVE/ SUMMARY BACKGROUND DATA
We propose the first classification scheme for macroglossia in patients with Beckwith-Wiedemann Syndrome (BWS), the BWS Index of macroGlossia (BIG).
METHODS
Patients with molecularly confirmed BWS seen from 2004-2023 were included to develop this system. Relationships among BIG scores, tongue reduction surgery, BWS clinical score, percent mosaicism, and polysomnography findings were examined.
RESULTS
Patients were classified from BIG0 to BIG3. BIG0 includes those without macroglossia; BIG1 includes those with macroglossia not protruding beyond the teeth/alveolus; BIG2 includes those with tongue protrusion past the teeth/alveolus to the lips but that can be contained within the mouth; and BIG3 includes those with tongues that protrude beyond the teeth/alveolus and lips but that cannot be closed within the mouth. Of the 459 patients with molecularly confirmed BWS, 266 (58.0%) patients were scored. One hundred and eleven (41.7%) were BIG0, 44 (16.5%) were BIG1, 90 (33.8%) were BIG2, and 21 (7.9%) were BIG3. As scores increased, patients had an increased incidence of tongue reduction surgery (BIG0: 0% versus BIG1: 20.5% versus BIG2: 51.1% versus BIG3: 100%; r=0.66, P <0.01). Higher BIG scores were associated with elevated BWS clinical scores (r=0.68, P <0.01) and increased tissue mosaicism (r=0.50, P <0.01) as well as trends towards worse obstructive apnea-hypopnea indices (r=0.29, P =0.02) and lower SpO 2 nadirs (r=-0.29, P =0.02).
CONCLUSION
In this large series of patients with Beckwith-Wiedemann Syndrome, increased BIG score correlates with undergoing tongue reduction surgery and increased phenotypic severity. Adoption of the BIG scoring system may facilitate communication and risk stratification across institutions.
PubMed: 38647147
DOI: 10.1097/SLA.0000000000006301 -
Clinical Advances in Periodontics Apr 2024The socket-shield (SS) technique results in long-term functional osseo- and dento-integration, preserving the dimensional stability of hard and soft tissues over time....
BACKGROUND
The socket-shield (SS) technique results in long-term functional osseo- and dento-integration, preserving the dimensional stability of hard and soft tissues over time. This study aimed to describe the successful implementation of a surgical technique to facilitate "SS" cases.
METHODS
The cases included males and females aged 32-81 years consecutively treated between 2020 and 2023 (longest follow-up, 3.5 years). For each case, pre- and post-operative cone-beam computed tomography (Digital Imaging and Communications in Medicine files) and intraoral optical scans (IOS; STL files) were performed. Digital immediate implant placement and simultaneous tooth extraction and SS production were planned using an implant planning software. Implants were planned considering sagittal-ridge and tooth-root angular-configuration. Surgical guides were used to perform the digitally-supported SS technique. All cases were planned and surgically performed by one operator (Pedro M. Trejo). Preoperative digital IOS-models were superimposed to post-operative models to assess soft-tissue changes. Pre and post sagittal views were used to assess the radiographic buccal-plate thickness at various healing times. An investigator not involved with case planning or treatment performed measurements.
RESULTS
Results reflected soft-tissue stability with minimal mean thickness change at 0-, 1-, 2-, and 3-mm measurement levels of 0.03, -0.2, 0.14, -0.07, and 0.04 mm, respectively, with a mean gingival-margin change of 0.04 mm. The free gingival-margin change ranged from a 0.58-mm gain in height to a -0.57-mm loss. The mean radiographic buccal-plate thickness post-operatively was 2.04 mm (range, 0.7-2.9 mm).
CONCLUSION
The digitally-supported guided SS technique enables predictable immediate implant-placement positions and stable buccal peri-implant soft and hard tissues over time.
KEY POINTS
Why are these cases new information? The uniqueness of the surgical technique described herein is that it results in favorable positions of immediate, socket-shielded (SSed), implant placements, with soft- and hard-tissue stability as the byproduct. What are the keys to successful management of these cases? Digitally, plan for the best possible implant position within the alveolar housing to satisfy prosthetic requirements, and then adjust this position to accommodate the socket shield dimensions. Digitally, provide a space/gap between the future dentinal shield and the implant. Clinically, allow for time to carve the final position and dimensions of the shield. Plan ahead the extent of the apical third of the SS, and the removal of the apex, if dealing with a long root. What are the primary limitations to success in these cases? Inadequate use of digital technology; case-sensitive technique requires proper execution of each digital and technical clinical step.
PubMed: 38646865
DOI: 10.1002/cap.10290 -
Frontiers in Bioengineering and... 2024Several diseases affect the alveoli, and the efficacy of medical treatments and pharmaceutical therapies is hampered by the lack of pre-clinical models able to recreate...
Several diseases affect the alveoli, and the efficacy of medical treatments and pharmaceutical therapies is hampered by the lack of pre-clinical models able to recreate the diseases. Microfluidic devices, mimicking the key structural and compositional features of the alveoli, offer several advantages to medium and high-throughput analysis of new candidate therapies. Here, we developed an alveolus-on-a-chip recapitulating the microanatomy of the physiological tissue by including the epithelium, the fibrous interstitial layer and the capillary endothelium. A PDMS device was obtained assembling a top layer and a bottom layer obtained by replica molding. A polycaprolactone/gelatin (PCL-Gel) electrospun membrane was included within the two layers supporting the seeding of 3 cell phenotypes. Epithelial cells were grown on a fibroblast-laden collagen hydrogel located on the top side of the PCL-Gel mats while endothelial cells were seeded on the basolateral side of the membrane. The innovative design of the microfluidic device allows to replicate both cell-cell and cell-extracellular matrix interactions according to the cell arrangement along with the establishment of physiologically relevant air-liquid interface conditions. Indeed, high cell viability was confirmed for up to 10 days and the formation of a tight endothelial and epithelial barrier was assessed by immunofluorescence assays.
PubMed: 38646009
DOI: 10.3389/fbioe.2024.1346660