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BMC Oral Health Jun 2020The aim of this prospective clinical study was to investigate differences between virtually planned and clinically achieved implant positions in completely... (Clinical Trial)
Clinical Trial
BACKGROUND
The aim of this prospective clinical study was to investigate differences between virtually planned and clinically achieved implant positions in completely template-guided implant placements as a function of the tooth area, the use of alveolar ridge preservation, the implant length and diameter, and the primary implant stability.
METHODS
The accuracy of 48 implants was analyzed. The implants were placed in a completely template-guided manner. The data of the planned implant positions were superimposed on the actual clinical implant positions, followed by measurements of the 3D deviations in terms of the coronal (dc) and apical distance (da), height (h), angulation (ang), and statistical analysis.
RESULTS
The mean dc was 0.7 mm (SD: 0.3), the mean da was 1.4 mm (SD: 0.6), the mean h was 0.3 mm (SD: 0.3), and the mean ang was 4.1° (SD: 2.1). The tooth area and the use of alveolar ridge preservation had no significant effect on the results in terms of the implant positions. The implant length had a significant influence on da (p = 0.02). The implant diameter had a significant influence on ang (p = 0.04), and the primary stability had a significant influence on h (p = 0.02).
CONCLUSION
Template-guided implant placement offers a high degree of accuracy independent of the tooth area, the use of measures for alveolar ridge preservation or the implant configuration. A clinical benefit is therefore present, especially from a prosthetic point of view.
TRIAL REGISTRATION
German Clinical Trial Register and the International Clinical Trials Registry Platform of the WHO: DRKS00005978 ; date of registration: 11/09/2015.
Topics: Alveolar Process; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Female; Humans; Male; Prospective Studies; Tooth; Treatment Outcome
PubMed: 32600405
DOI: 10.1186/s12903-020-01155-x -
Clinical Implant Dentistry and Related... Jun 2022To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone... (Randomized Controlled Trial)
Randomized Controlled Trial
Histological and dimensional changes of the alveolar ridge following tooth extraction when using collagen matrix and collagen-embedded xenogenic bone substitute: A randomized clinical trial.
AIM
To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction.
METHODS
Patients that required extraction in non-molars areas were included. Test group-15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM-C), covered by a procaine collagen membrane (CMXs). Control group-15 sockets left for spontaneous healing. We used a custom-made acrylic stent as a reference for alveolar ridge measurements. Six-month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft.
RESULTS
Six months later, horizontal ridge width at -3 mm showed a significant (p < 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At -5 mm sub-crestally, statistically non-significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group.
CONCLUSION
Alveolar ridge preservation using DBBM-C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter-group differences might account for this phenomenon.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Animals; Bone Substitutes; Cattle; Collagen; Humans; Tooth Extraction; Tooth Socket
PubMed: 35298865
DOI: 10.1111/cid.13085 -
Clinical Oral Investigations Jan 2022Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature.
OBJECTIVE
To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance.
MATERIALS AND METHODS
The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow-up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed.
RESULTS
A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT).
CONCLUSIONS
NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage.
CLINICAL RELEVANCE
Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Biocompatible Materials; Collagen; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 34669038
DOI: 10.1007/s00784-021-04192-0 -
Swiss Dental Journal Apr 2022A 69-year-old woman consulted the Oral surgery and implantology unit of the Geneva University Hospitals with the chief complaint of chewing difficulties, aesthetic...
A 69-year-old woman consulted the Oral surgery and implantology unit of the Geneva University Hospitals with the chief complaint of chewing difficulties, aesthetic discomfort and dry mouth. The wish of the patient was to receive a reliable fixed solution in the long term. The patient had chronic nonspecific sialadenitis accompanied by xerostomia. She wore a total prosthesis stabilized on two inter-foraminal implants and had multiple cavities of the remaining maxillary teeth. The goals of treatment were to improve masticatory function with fixed prosthetic rehabilitation on upper and lower implants. With a post-extraction alveolar ridge preservation technique, the placement of Straumann® maxillary implants could be performed with a basic sequence without bone augmentation which reduced morbidity, treatment time and costs compared to reconstruction of the edentulous and atrophied mandible. The patient was very satisfied at the follow-up at 3 and 6 months as well as at 1 and 2 years, and the restorations were stable. In summary, the post-extraction preservation of the alveolar ridges is a predictable therapeutic option that can be considered in a context of multiple extraction in order to limit the complexity of the implant treatment.
Topics: Aged; Allografts; Alveolar Process; Dental Implantation, Endosseous; Dental Implants; Female; Humans; Tooth Extraction
PubMed: 35354240
DOI: No ID Found -
Archives of Oral Biology Dec 2018The alveolar bone has a unique capacity to follow the teeth's movements. It is formed around erupting teeth and their periodontal ligaments: the more the teeth have... (Review)
Review
The alveolar bone has a unique capacity to follow the teeth's movements. It is formed around erupting teeth and their periodontal ligaments: the more the teeth have erupted, the larger the alveolar process. Throughout life the teeth erupt and migrate in an occlusal and mesial direction to compensate for attrition, an evolutionary trait. After tooth extraction, the alveolar process is resorbed to varying degrees. The mandibular alveolar bone mirrors skeletal bone condition. Due to fast bone turnover (which is the fastest in the whole skeleton), low bone mass and increased fracture risk may first be seen here. If a periapical radiograph of the mandibular premolars shows a dense trabeculation with well-mineralized trabeculae and small intertrabecular spaces, it is a reliable sign of normal skeletal bone density (BMD) and low skeletal fracture risk, whereas a sparse trabecular pattern indicates osteopenia and high fracture risk. The bone turnover rate in the mandible is twice that of the maxilla, and may, hypothetically, play a role in the development of osteonecrosis of the jaw (ONJ), which has been found mainly in the mandibular alveolar process?
Topics: Alveolar Process; Animals; Biomarkers; Biomechanical Phenomena; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density; Bone Remodeling; Humans; Mandible; Osteoporosis; Tooth Eruption; Tooth Extraction; Tooth Movement Techniques
PubMed: 30292055
DOI: 10.1016/j.archoralbio.2018.09.016 -
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 -
AJNR. American Journal of Neuroradiology Apr 1997Congenital epulis of the newborn is a rare gingival tumor that occurs along the alveolar ridge. We report the prenatal sonographic and postnatal MR imaging findings in...
Congenital epulis of the newborn is a rare gingival tumor that occurs along the alveolar ridge. We report the prenatal sonographic and postnatal MR imaging findings in an infant with maxillary and mandibular congenital epulides.
Topics: Adult; Alveolar Process; Female; Fetal Diseases; Gingival Neoplasms; Humans; Infant, Newborn; Magnetic Resonance Imaging; Mandibular Neoplasms; Maxilla; Maxillary Neoplasms; Pregnancy; Ultrasonography, Prenatal
PubMed: 9127041
DOI: No ID Found -
Journal of Dental Research Jul 2020Tooth extraction results in alveolar bone resorption and is accompanied by postoperative swelling and pain. Maresin 1 (MaR1) is a proresolving lipid mediator produced by...
Tooth extraction results in alveolar bone resorption and is accompanied by postoperative swelling and pain. Maresin 1 (MaR1) is a proresolving lipid mediator produced by macrophages during the resolution phase of inflammation, bridging healing and tissue regeneration. The aim of this study was to examine the effects of MaR1 on tooth extraction socket wound healing in a preclinical rat model. The maxillary right first molars of Sprague-Dawley rats were extracted, and gelatin scaffolds were placed into the sockets with or without MaR1. Topical application was also given twice a week until complete socket wound closure up to 14 d. Immediate postoperative pain was assessed by 3 scores. Histology and microcomputed tomography were used to assess socket bone fill and alveolar ridge dimensional changes at selected dates. The assessments of coded specimens were performed by masked, calibrated examiners. Local application of MaR1 potently accelerated extraction socket healing. Macroscopic and histologic analysis revealed a reduced soft tissue wound opening and more rapid re-epithelialization with MaR1 delivery versus vehicle on socket healing. Under micro-computed tomography analysis, MaR1 (especially at 0.05 μg/μL) stimulated greater socket bone fill at day 10 as compared with the vehicle-treated animals, resulting in less buccal plate resorption and a wider alveolar ridge by day 21. Interestingly, an increased ratio of CD206:CD68 macrophages was identified in the sockets with MaR1 application under immunohistochemistry and immunofluorescence analysis. As compared with the vehicle therapy, local delivery of MaR1 reduced immediate postoperative surrogate pain score panels. In summary, MaR1 accelerated extraction wound healing, promoted socket bone fill, preserved alveolar ridge bone, and reduced postoperative pain in vivo with a rodent preclinical model. Local administration of MaR1 offers clinical potential to accelerate extraction socket wound healing for more predictable dental implant reconstruction.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Animals; Bone Regeneration; Docosahexaenoic Acids; Male; Rats; Rats, Sprague-Dawley; Tooth Extraction; Tooth Socket; Wound Healing; X-Ray Microtomography
PubMed: 32384864
DOI: 10.1177/0022034520917903 -
Alveolar ridge regeneration in two-wall-damaged extraction sockets of an in vivo experimental model.Clinical Oral Implants Research Aug 2021To determine the healing outcome following grafting with deproteinized porcine bone mineral (DPBM) with or without collagen membrane coverage in two-wall (both buccal...
AIM
To determine the healing outcome following grafting with deproteinized porcine bone mineral (DPBM) with or without collagen membrane coverage in two-wall (both buccal and lingual)-damaged extraction sockets.
MATERIALS AND METHODS
Distal roots of three mandibular premolars in six beagle dogs were extracted, and the whole buccal and lingual bony walls were surgically removed. Three treatment protocols were then applied according to the following group allocation: no graft (None), grafting DPBM (BG), and grafting DPBM with coverage by a collagen membrane (BG + M). Two observational periods (2 and 8 weeks) were used with the split-mouth design, and quantitative and qualitative analyses were performed by microcomputed tomography and histology.
RESULTS
The dimensions of the alveolar ridge at both grafted sites (BG and BG + M) remained similar to those of the pristine ridge in the histologic and radiographic analyses, whereas the ungrafted sites (None) collapsed both vertically and horizontally. Both grafting protocols produced substantial bony regeneration, but the addition of a covering membrane enhanced the proportion of mineralized tissue within the augmented area, and the BG + M group also showed a significantly larger area of regenerated ridge than the None group (p < .05).
CONCLUSIONS
Bone grafting with collagen membrane can maintain the alveolar ridge dimensions with substantial bone regeneration in a two-wall-damaged extraction socket.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Animals; Dogs; Models, Theoretical; Swine; Tooth Extraction; Tooth Socket; X-Ray Microtomography
PubMed: 34101908
DOI: 10.1111/clr.13791 -
International Journal of Environmental... Dec 2022Traumatic injuries to the permanent dentition are most common in children. In severe dentoalveolar injuries, especially avulsion and intrusion, dentoalveolar ankylosis...
Traumatic injuries to the permanent dentition are most common in children. In severe dentoalveolar injuries, especially avulsion and intrusion, dentoalveolar ankylosis is a common complication, leading to adverse effects on the developing alveolar bone and interfering with the eruption of the adjacent teeth. The decoronation procedure was suggested in 1984 to reduce these side effects related to ankylosis. The objective of the current publication is to describe a minimally invasive, flapless decoronation procedure aimed to minimize and simplify the surgical procedure of decoronation, and ease its clinical acceptance, particularly in young children. The technique is described in a detailed protocol and demonstrated in two cases. Under local anesthesia, the dental crown is removed, and the root is reduced by 1.5-2.0 mm apically to the marginal bone crest. The root canal content is then removed, allowing it to fill with blood. The socket is coronally sealed with a porcine-derived collagen matrix (PDCM) sutured using the "parachute" technique over the resected root, allowing close adaptation to the surrounding soft tissue. In conclusion, the presented technique of flapless decoronation is a modification of the classic decoronation procedure, which can be used as a minimally invasive technique to simplify the surgical procedure and the post-operative process.
Topics: Humans; Tooth Ankylosis; Tooth Crown; Alveolar Process; Tooth; Tooth Avulsion
PubMed: 36612921
DOI: 10.3390/ijerph20010603