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Clinical Implant Dentistry and Related... Feb 2023The objective of this study is to retrospectively evaluate the clinical outcomes of alveolar ridge preservation (ARP) in the compromised extraction sockets using...
OBJECTIVE
The objective of this study is to retrospectively evaluate the clinical outcomes of alveolar ridge preservation (ARP) in the compromised extraction sockets using autogenous cortical-lamina anchoring technique (CAT).
MATERIAL AND METHODS
Twenty patients were treated with ARP in the compromised extraction sockets by applying CAT. Then implant placement and crown delivery was performed. A planned follow-up was performed by analyzing various outcome measures to evaluate the clinical outcomes, including primary outcome measures [radiographic assessment of residual alveolar ridge height (RARH) and residual alveolar ridge width (RARW)] and secondary outcome measures [clinical assessment of the healing of the soft and hard tissue, survival rates of implants, marginal bone loss (MBL) evaluation of implants, buccal bone thickness (BBT), and esthetic treatment outcomes].
RESULTS
Among the 20 patients, 17 were consecutively treated and 3 dropped out after implant crown delivery because of loss to follow-up. After the ARP, the initial RARH (12.37 mm) significantly increased to 19.29 mm (P < .05). No significant difference was detected in the RARW before (7.92 ± 1.18 mm) and after (7.92 ± 1.18 mm) the ARP, but reduce to 6.99 ± 1.18 mm at the implant placement and 6.64 ± 0.77 mm at the 3-year follow-up (P < .05). The MBL at the implant crown delivery (0.13 ± 0.12 mm) significantly increased to 0.31 ± 0.14 mm at 1-year follow-up and 0.56 ± 0.23 mm at 3-year follow-up, respectively. The bone loss was limited (<1 mm) but statistically significant (P < .05). The BBT at the implant placement (2.53 ± 0.56 mm) significantly reduced to 2.23 ± 0.44 mm at implant crown delivery and 2.14 ± 0.40 mm at 3-year follow-up, respectively. The bone loss was also limited (<0.5 mm) but statistically significant (P < .05). Each implant site showed acceptable aesthetic outcome and the average score was 16.4. The incisions healed uneventful in all patients and the implant survival rate was 100% during the 3-year follow-up.
CONCLUSION
Autogenous CAT was successfully applied to preserve the height and width of alveolar ridge in the compromised extraction sockets.
Topics: Humans; Tooth Socket; Retrospective Studies; Tooth Extraction; Esthetics, Dental; Alveolar Process; Alveolar Ridge Augmentation; Alveolar Bone Loss
PubMed: 36222202
DOI: 10.1111/cid.13141 -
Clinical Implant Dentistry and Related... Oct 2019Preclinical studies have hypothesized a possible immunological reponse to allogeneic materials due to detection of remnants of potential immunogenic molecules. However,... (Randomized Controlled Trial)
Randomized Controlled Trial
Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans.
BACKGROUND
Preclinical studies have hypothesized a possible immunological reponse to allogeneic materials due to detection of remnants of potential immunogenic molecules. However, their impact on integration, bone remodeling and immunological reaction after the augmentation procedure is largely unknown and a direct correlation of analytical data and evaluation of human biopsies is missing.
PURPOSE
The present study aimed to compare two commercially available allogeneic materials regarding their content of cellular remnants as well as the bone remodeling, and integration and potential immunologic reactions on a histological and immunohistochemical level, integrating also in vitro analytical evaluation of the specific batches that were used clinically.
MATERIALS AND METHODS
Twenty patients were randomly assigned to treatment with Maxgraft or Puros for lateral ridge augmentation in a two-stage surgery. After a mean healing period of 5 months, implants were placed and biopsies were taken for histological, immunhistochemical, and histomorphometrical evaluation regarding bone remodeling and inflammation, protein concentrations in vitro and the presence of MHC molecules of the same batches used clinically.
RESULTS
No differences in clinical outcome, histological, immunohistochemical, and in vitro protein analysis between the two bone grafting materials were observed. Active bone remodeling, amount of newly formed bone, and residual grafting material was independent of the materials used, but varied between subjects. MHC1 residues were not detected in any sample.
CONCLUSIONS
Within the limitations of this study, both tested materials yielded equivalent results in terms of clinical outcome, new bone formation, and lack of immunological potential on a histological and immunohistochemical level.
Topics: Alveolar Process; Alveolar Ridge Augmentation; Bone Substitutes; Bone Transplantation; Dental Implantation, Endosseous; Hematopoietic Stem Cell Transplantation; Humans; Prospective Studies
PubMed: 31424173
DOI: 10.1111/cid.12824 -
International Journal of Implant... Feb 2021The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation.
OBJECTIVE
To learn about the effect of different SSS techniques on alveolar ridge preservation MATERIAL AND METHODS: Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at - 1, - 3, and - 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA).
RESULTS
A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (- 1.42 mm in the experimental group versus - 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at - 1, - 3, and - 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences.
CONCLUSIONS
There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.
Topics: Alveolar Process; Alveolar Ridge Augmentation; Esthetics; Humans; Randomized Controlled Trials as Topic; Tooth Socket
PubMed: 33615421
DOI: 10.1186/s40729-021-00294-2 -
The Journal of Contemporary Dental... Jan 2020Alveolar split crest is an established surgical technique to enable implant insertion into narrow and atrophic alveolar crest. This surgical technique is adopted to...
INTRODUCTION
Alveolar split crest is an established surgical technique to enable implant insertion into narrow and atrophic alveolar crest. This surgical technique is adopted to position standard or large implants so that postextractive anatomy compromises with this attempt. The aim of this study was to evaluate the horizontal alveolar bone augmentation and its stability along time with a minimally invasive flapless technique.
MATERIALS AND METHODS
Twenty-four implants were inserted in 10 patients during a 15-month period. Clinical parameters such as horizontal bone augmentation, intrasurgical complications, patient morbidity, implant loss, and vertical bone loss (VBL) were recorded in the first 3 years after surgery. Using cone-beam computed tomography (CBCT), alveolar bone width was measured for both implants position and bone reconstructions. 6 months later, at the time of implant integration, a new low-dose CBCT was performed. Implant survival (IS) and VBL were evaluated radiographically for 3 years.
RESULTS
The initial bone thickness measured on the ridge is between 0.82 mm and 5.40 mm (average 2.43 mm), after the split crest the bone width is between 4.65 mm and 8.09 mm (average 6.39 mm). This leads to an increase in the alveolar bone width of between 0.80 mm and 6.01 mm (average 3.71 mm) on the ridge. No implant was lost at 3 years, and all implants are stable at the end of the study. Three years after the surgery, controls showed a VBL of between 0.0 mm and 1.2 mm (average 0.63 mm) around the inserted implants. These parameters suggest using a flapless technique to reduce bone resorption around the implant neck.
CONCLUSION
A minimally invasive approach allows to reduce the surgical trauma and postsurgical discomfort. The complete vascular supply is maintained, the bone resorption is reduced, and the connective epithelium does not undergo postsurgical retraction, achieving the full maintenance of the residual keratinized gingiva.
CLINICAL SIGNIFICANCE
A technique such as split crest can be a valid option to avoid autologous or heterologous bone grafts.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Bone Transplantation; Dental Implants; Humans
PubMed: 32381797
DOI: No ID Found -
Tissue Engineering. Part B, Reviews Jun 2020In 2007, recombinant human bone morphogenetic protein-2 (rhBMP-2) was approved for use in humans at a concentration of 1.5 mg/mL with absorbable collagen sponges as an... (Review)
Review
In 2007, recombinant human bone morphogenetic protein-2 (rhBMP-2) was approved for use in humans at a concentration of 1.5 mg/mL with absorbable collagen sponges as an alternative to autogenous bone grafts for alveolar ridge augmentation, defects associated with extraction sockets, and sinus augmentation. However, the use of supraphysiological doses and the insufficient retention of rhBMP-2, when delivered through collagen sponge, result in dose-dependent side effects related to off-label use. Demineralized dentin matrix (DDM), an osteoinducing bone substrate, has been used as an rhBMP-2 carrier since 1998. In addition, DDM has both microparticle and nanoparticle structures, which do not undergo remodeling, unlike bone. , DDM is a suitable carrier for BMP-2, with the continued release over 30 days at concentrations sufficient to stimulate osteogenic differentiation. In this review, we discuss the histological outcomes of DDM loaded with rhBMP-2 to highlight the biological functions of exogenous rhBMP-2 associated with the DDM carrier in clinical applications in implant dentistry. Impact Statement Demineralized dentin matrix (DDM) has been used as an recombinant human bone morphogenetic protein (rhBMP-2) carrier and osteo-inducing bone substrate to facilitate continued release and stimulate osteogenic differentiation. In this review, we discuss the histological outcomes of DDM loaded with rhBMP-2 in order to highlight the biological functions of exogenous rhBMP-2 associated with the DDM carrier in clinical applications in implant dentistry.
Topics: Alveolar Process; Animals; Bone Morphogenetic Protein 2; Dentin; Humans; Prostheses and Implants; Recombinant Proteins; Transforming Growth Factor beta
PubMed: 31928139
DOI: 10.1089/ten.TEB.2019.0291 -
Journal of Clinical Periodontology Apr 2013To investigate and compare outcomes following alveolar ridge preservation (ARP) in posterior maxilla and mandible.
AIM
To investigate and compare outcomes following alveolar ridge preservation (ARP) in posterior maxilla and mandible.
METHODS
Twenty-four patients (54 ± 3 years) with single posterior tooth extraction were included. ARP was performed with freeze-dried bone allograft and collagen membrane. Clinical parameters were recorded at extraction and re-entry. Harvested bone cores were analysed by microcomputed tomography (micro-CT), histomorphometry and immunohistochemistry.
RESULTS
In both jaws, ARP prevented ridge height loss, but ridge width was significantly reduced by approximately 2.5 mm. Healing time, initial clinical attachment loss and amount of keratinized tissue at extraction site were identified as determinants of ridge height outcome. Buccal plate thickness and tooth root length were identified as determinants of ridge width outcome. In addition, initial ridge width was positively correlated with ridge width loss. Micro-CT revealed greater mineralization per unit volume in new bone compared with existing bone in mandible (p < 0.001). Distributions of residual graft, new cellular bone and immature tissue were similar in both jaws.
CONCLUSION
Within the limitations of this study, the results indicate that in different anatomic locations different factors may determine ARP outcomes. Further studies are needed to better understand determinants of ARP outcomes.
Topics: Adult; Aged; Aged, 80 and over; Alveolar Bone Loss; Alveolar Process; Bone Regeneration; Bone Transplantation; Chi-Square Distribution; Collagen; Dental Implantation, Endosseous; Female; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Middle Aged; Prospective Studies; Regression Analysis; Statistics, Nonparametric; Tooth Extraction; Tooth Socket; Treatment Outcome; X-Ray Microtomography; Young Adult
PubMed: 23432761
DOI: 10.1111/jcpe.12065 -
Journal of Oral Science Jan 2024After tooth extraction, preservation of the alveolar ridge by socket grafting attenuates bone resorption. Runt-related transcription factor 2 (RUNX2) and SP7/Osterix...
PURPOSE
After tooth extraction, preservation of the alveolar ridge by socket grafting attenuates bone resorption. Runt-related transcription factor 2 (RUNX2) and SP7/Osterix (OSX) are transcription factors playing an important role in osteoblast differentiation. The purpose of this study was to evaluate the effects of carbonate apatite (COAp) on osteoblast-related gene and protein expression after socket grafting.
METHODS
Alveolar bone and new bone after COAp grafting were collected at the time of implant placement. Levels of mRNA for RUNX2, SP7/OSX, bone morphogenetic protein 2 (BMP2), BMP7 and platelet derived growth factor B were determined by real-time PCR. Immunostaining was performed using antibodies against RUNX2, SP7/OSX, vimentin and cytokeratin. To evaluate bone resorption rates, cone-beam CT (CBCT) imaging was performed after socket grafting and before implant placement.
RESULTS
CBCT imaging showed that the average degree of bone resorption at the COAp graft site was 7.15 ± 3.79%. At the graft sites, levels of SP7/OSX and BMP2 mRNA were significantly increased. Replacement of COAp with osteoid was evident histologically, and in the osteoid osteoblast-like cells were stained for SP7/OSX and vimentin.
CONCLUSION
These results show that gene expression of both SP7/OSX and BMP2 can be induced by COAp, suggesting that increased expression of SP7/OSX and vimentin may be involved in the BMP pathway.
Topics: Humans; Bone Morphogenetic Protein 2; Core Binding Factor Alpha 1 Subunit; Vimentin; Cell Differentiation; Osteoblasts; Alveolar Process; RNA, Messenger; Bone Resorption; Gene Expression; Sp7 Transcription Factor; Apatites
PubMed: 38008425
DOI: 10.2334/josnusd.23-0220 -
Journal of Medicine and Life 2009In the genesis of dental-maxillary anomalies both morphologic factors (of proven genetic origin) and functional factors (as added ethio-pathogenic elements) are... (Review)
Review
In the genesis of dental-maxillary anomalies both morphologic factors (of proven genetic origin) and functional factors (as added ethio-pathogenic elements) are incriminated. From this point of view, Class II/2 malocclusion, presents two morphologic factors whose genetic origin is certain and upon which functional factors have minor influence. These are: the morphology of the teeth and alveolar process in the anterior region of the maxilla and the type of rotation. The combination of the two generates a broad range of deep bite case variants.
Topics: Alveolar Process; Humans; Malocclusion, Angle Class II; Maxilla; Models, Dental; Tooth
PubMed: 20108495
DOI: No ID Found -
Head & Face Medicine Apr 2013Alveolar ridge keratosis (ARK) is a distinct, benign clinicopathological entity, characterized by a hyperkeratotic plaque or patch that occurs on the alveolar edentulous...
BACKGROUND
Alveolar ridge keratosis (ARK) is a distinct, benign clinicopathological entity, characterized by a hyperkeratotic plaque or patch that occurs on the alveolar edentulous ridge or on the retromolar trigone, considered to be caused by chronic frictional trauma. The aim of this retrospective study is to present the clinicopathological features of 23 consecutive cases of ARK.
MATERIAL AND METHODS
The 23 biopsy samples of ARK were selected and pathological features were revised (keratosis, acanthosis, surface architecture, and inflammation). Factors such as the patient's gender, age, anatomical location, tobacco and alcohol use were analyzed.
RESULTS
Sixteen out of the 23 cases studied were men and 7 women with a mean age of 55.05 (age ranged from 17 to 88 years). Thirteen cases had a history of tobacco habit, amongst whom, 4 also presented alcohol consumption. All the cases presented only unilateral lesions. Nineteen cases involved the retromolar trigone while 4 cases involved edentulous alveolar ridges. When observed microscopically, the lesions were mainly characterized by moderate to important hyperorthokeratosis. Inflammation was scanty or absent. In four of the cases, the presence of melanin pigment in the superficial corium or in the cytoplasm of macrophages was detected. None of the cases showed any features of dysplasia.
CONCLUSION
Our results reveal that ARK is a benign lesion. However, the high prevalence of smokers amongst the patients might suggest that some potentially malignant disorders such as tobacco associated leukoplakia may clinically mimic ARK.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alveolar Process; Biopsy; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Follow-Up Studies; Gingival Neoplasms; Humans; Keratosis; Male; Middle Aged; Precancerous Conditions; Retrospective Studies; Young Adult
PubMed: 23587097
DOI: 10.1186/1746-160X-9-12 -
BMC Oral Health Nov 2022The aim of this study was to evaluate the effects of membrane exposure during vertical ridge augmentation (VRA) utilizing guided bone regeneration with a dense...
Reconstruction of vertical alveolar ridge deficiencies utilizing a high-density polytetrafluoroethylene membrane /clinical impact of flap dehiscence on treatment outcomes: case series/.
OBJECTIVES
The aim of this study was to evaluate the effects of membrane exposure during vertical ridge augmentation (VRA) utilizing guided bone regeneration with a dense polytetrafluoroethylene (d-PTFE) membrane and a tent-pole space maintaining approach by registering radiographic volumetric, linear and morphological changes.
METHODS
In 8 cases alveolar ridge defects were accessed utilizing a split-thickness flap design. Following flap elevation VRA was performed with tent-pole space maintaining approach utilizing the combination of a non-reinforced d-PTFE membrane and a composite graft (1:1 ratio of autogenous bone chips and bovine derived xenografts). Three-dimensional radiographic evaluation of hard tissue changes was carried out with the sequence of cone-beam computed tomography (CBCT) image segmentation, spatial registration and 3D subtraction analysis.
RESULTS
Class I or class II membrane exposure was observed in four cases. Average hard tissue gain was found to be 0.70 cm ± 0.31 cm and 0.82 cm ± 0.40 cm with and without membrane exposure resulting in a 17% difference. Vertical hard tissue gain averaged 4.06 mm ± 0.56 mm and 3.55 mm ± 0.43 mm in case of submerged and open healing, respectively. Difference in this regard was 14% between the two groups. Horizontal ridge width at 9-month follow-up was 5.89 mm ± 0.51 mm and 5.61 mm ± 1.21 mm with and without a membrane exposure respectively, resulting in a 5% difference.
CONCLUSIONS
With the help of the currently reported 3D radiographic evaluation method, it can be concluded that exposure of the new-generation d-PTFE membrane had less negative impact on clinical results compared to literature data reporting on expanded polytetrafluoroethylene membranes.
Topics: Humans; Cattle; Animals; Alveolar Ridge Augmentation; Polytetrafluoroethylene; Guided Tissue Regeneration, Periodontal; Membranes, Artificial; Alveolar Bone Loss; Alveolar Process; Bone Transplantation; Dental Implantation, Endosseous
PubMed: 36376891
DOI: 10.1186/s12903-022-02513-7