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Clinical Oral Investigations Aug 2023To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.
MATERIALS AND METHODS
A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.
RESULTS
Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).
CONCLUSION
The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.
CLINICAL RELEVANCE
When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.
Topics: Humans; Tooth Socket; Alveolar Process; Osteogenesis; Tooth; Platelet-Rich Plasma; Tooth Extraction; Fibrin; Alveolar Ridge Augmentation
PubMed: 37439800
DOI: 10.1007/s00784-023-05126-8 -
The Angle Orthodontist Jul 2008To determine the effectiveness of orthodontic extrusion of nonrestorable teeth prior to implant placement for improving the alveolar bone and gingival characteristics of... (Review)
Review
OBJECTIVE
To determine the effectiveness of orthodontic extrusion of nonrestorable teeth prior to implant placement for improving the alveolar bone and gingival characteristics of implant recipient sites.
MATERIALS AND METHODS
Electronic database searches of the following databases were conducted with the help of a senior health sciences librarian: Medline, PubMed, EMBASE, Scopus, Web of Science, and CINAHL Plus. Hand searches of the reference lists of selected articles were also conducted. Abstracts that appeared to fulfill the initial selection criteria were selected for full article retrieval. Retrieved articles were then carefully evaluated, and more specific selection criteria were applied. The authors conducted the selection processes independently, and any differences were resolved through discussion. An analysis of timing, type, and magnitude of forces applied was sought.
RESULTS
Eighteen articles were considered for review. Most of the selected articles were case reports or case series describing orthodontic extrusion of periodontally hopeless maxillary anterior teeth. The results of the reported cases were evaluated individually and collectively with regard to various hard and soft tissue implant site characteristics. Clinically significant gains in alveolar bone and gingival tissue were reported in all cases, resulting in significant quantitative and qualitative improvements in the implant sites.
CONCLUSIONS
Based on the available literature, orthodontic extrusion of nonrestorable teeth prior to implant placement appears to be a viable alternative to conventional surgical augmentative procedures in implant site development. No direct comparison to any other method was found, and therefore no conclusion could be made about its relative efficacy.
Topics: Alveolar Bone Loss; Dental Implantation, Endosseous; Humans; Orthodontic Extrusion; Tooth Extraction; Tooth Socket
PubMed: 18302478
DOI: 10.2319/0003-3219(2008)078[0752:ISDBOE]2.0.CO;2 -
Biomedical Engineering Online Aug 2015Both maxillary protraction and rapid expansion are recommended for patients with cleft palate and alveolus. The aim of the study is to establish a three-dimensional...
Displacements prediction from 3D finite element model of maxillary protraction with and without rapid maxillary expansion in a patient with unilateral cleft palate and alveolus.
BACKGROUND
Both maxillary protraction and rapid expansion are recommended for patients with cleft palate and alveolus. The aim of the study is to establish a three-dimensional finite element model of the craniomaxillary complex with unilateral cleft palate and alveolus to simulate maxillary protraction with and without rapid maxillary expansion. The study also investigates the deformation of the craniomaxillary complex after applied orthopaedic forces in different directions.
METHODS
A three dimensional finite element model of 1,277,568 hexahedral elements (C3D8) and 1,801,945 nodes was established based upon CT scan of a patient with unilateral cleft palate and alveolus on the right side in this study. A force of 4.9 N per side was directed on the anatomic height of contour on the buccal side of the first molar. The angles between the force vector and occlusal plane were -30°, -20°, -10°, 0°, 10°, 20°, and 30°. A force of 2.45 N on each loading point was directed on the anatomic height of contour on the lingual side of the first premolar and the first molar to simulate the expansion of the palate.
RESULTS
The craniomaxillary complex displaced forward under any of the loading conditions. The sagittal and vertical displacement of the craniomaxillary complex reached their peak at the protraction degree of -10° forward and downward to the occlusal plane. There were larger sagittal displacements when the maxilla was protracted forward with maxillary expansion. The palatal plane rotated counterclockwise under any of the loading conditions. Being protracted without expansion, the dental arch was constricted. When supplemented with maxillary expansion, the width of the dental arch increased. Transverse deformation of the dental arch on affected side was different from that on unaffected side.
CONCLUSIONS
Protraction force alone led the craniomaxillary complex moved forward and counterclockwise, accompanied with lateral constrain on the dental arch. Additional rapid maxillary expansion resulted in a more positive reaction including both larger sagittal displacement and the width of the dental arch increase.
Topics: Adolescent; Cleft Palate; Dental Arch; Finite Element Analysis; Humans; Male; Maxilla; Palatal Expansion Technique; Rotation; Tomography, X-Ray Computed; Tooth Socket
PubMed: 26285822
DOI: 10.1186/s12938-015-0074-9 -
Journal of Periodontal Research Feb 2023Resorption of alveolar bone after tooth extraction is a common problem often requiring bone grafting. The success of the grafting procedures is dependent on multiple...
OBJECTIVE AND BACKGROUND
Resorption of alveolar bone after tooth extraction is a common problem often requiring bone grafting. The success of the grafting procedures is dependent on multiple factors including the presence of growth factors. This is the first in vivo study to investigate the role of the pleiotrophin family of cytokines in alveolar bone regeneration. This research investigated the role of the pleiotrophin-midkine (PTN-MDK) axis during osteogenesis, with and without a grafting material, after tooth extraction in a sheep model.
METHODS
Thirty Romney-cross ewes were anesthetized, and all premolar teeth on the right side were extracted. The sockets were randomized to controls sites with no treatment and test sites with Bio-Oss® graft material and Bio-Gide® membrane. Samples were harvested after sacrificing animals 4, 8, and 16 weeks post-grafting (n = 10 per time-point). Tissue for qRT -PCR gene analysis was recovered from the socket next to the first molar using a trephine (Ø = 2 mm). Each socket was fixed, decalcified, paraffin-embedded, and sectioned. Immunohistochemistry was conducted to localize both PTN and MDK along with their receptors, protein tyrosine phosphatase receptor type Z1 (PTPRZ1), ALK receptor tyrosine kinase (ALK), and notch receptor 2 (NOTCH2).
RESULTS
Within the healing sockets, high expression of genes for PTN, MDK, NOTCH2, and ALK was found at all time-points and in both grafted and non-grafted sites, while PTPRZ1 was only expressed at low levels. The relative gene expression of the PTN family of cytokines was not statistically different at the three time-points between test and control groups (p > .05). Immunohistochemistry found PTN and MDK in association with new bone, NOTCH2 in the connective tissue, and PTPRZ1 and ALK in association with cuboidal osteoblasts involved in bone formation.
CONCLUSIONS
The PTN-MDK axis was highly expressed in both non-grafted and grafted sockets during osteogenesis in a sheep model of alveolar bone regeneration with no evidence that grafting significantly affected expression. The activation of NOTCH2 and PTPRZ1 receptors may be important during bone regeneration in vivo. The discovery of the PTN-MDK axis as important during alveolar bone regeneration is novel and opens up new avenues of research into these stably expressed highly active cytokines. Growth factor supplementation with PTN and/or MDK during healing may be an approach for enhanced regeneration or to initiate healing where delayed.
Topics: Animals; Female; Cytokines; Intercellular Signaling Peptides and Proteins; Midkine; Receptor Protein-Tyrosine Kinases; Sheep; Tooth Extraction; Tooth Socket
PubMed: 36411509
DOI: 10.1111/jre.13073 -
Journal of Clinical Periodontology Feb 2023To evaluate the healing outcomes in non-molar post-extraction sockets filled with deproteinized bovine bone mineral with collagen (DBBM-C) as a function of time. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To evaluate the healing outcomes in non-molar post-extraction sockets filled with deproteinized bovine bone mineral with collagen (DBBM-C) as a function of time.
MATERIALS AND METHODS
Patients in need of non-molar tooth extraction were randomly allocated into one of three groups according to the total healing time (A-3 months; B-6 months; C-9 months). The effect of alveolar ridge preservation (ARP) therapy via socket filling using DBBM-C and socket sealing with a porcine collagen matrix (CM) was assessed based on a panel of clinical, digital, histomorphometric, implant-related, and patient-reported outcomes.
RESULTS
A total of 42 patients completed the study (n = 14 in each group). Histomorphometric analysis of bone core biopsies obtained at the time of implant placement showed a continuous increase in the proportion of mineralized tissue with respect to non-mineralized tissue, and a decrease in the proportion of remaining xenograft material over time. All volumetric bone and soft tissue contour assessments revealed a dimensional reduction of the alveolar ridge overtime affecting mainly the facial aspect. Linear regression analyses indicated that baseline buccal bone thickness is a strong predictor of bone and soft tissue modelling. Ancillary bone augmentation at the time of implant placement was needed in 16.7% of the sites (A:2; B:1; C:4). Patient-reported discomfort and wound healing index scores progressively decreased over time and was similar across groups.
CONCLUSIONS
Healing time influences the proportion of tissue compartments in non-molar post-extraction sites filled with DBBM-C and sealed with a CM. A variable degree of alveolar ridge atrophy, affecting mainly the facial aspect, occurs even after performing ARP therapy. These changes are more pronounced in sites exhibiting thin facial bone (≤1 mm) at baseline (Clinicaltrials.gov NCT03659617).
Topics: Swine; Humans; Animals; Cattle; Tooth Socket; Alveolar Bone Loss; Heterografts; Alveolar Process; Wound Healing; Collagen; Tooth Extraction; Alveolar Ridge Augmentation
PubMed: 36345818
DOI: 10.1111/jcpe.13744 -
International Journal of Environmental... Feb 2022Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar...
Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.
Topics: Alveolar Process; Humans; Immediate Dental Implant Loading; Maxilla; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 35270486
DOI: 10.3390/ijerph19052795 -
Stomatologija 2018The purpose of the present study is to provide the efficacy of autologous platelet rich fibrin in bone augmentation and bone regeneration procedures in regard of soft... (Review)
Review
OBJECTIVE
The purpose of the present study is to provide the efficacy of autologous platelet rich fibrin in bone augmentation and bone regeneration procedures in regard of soft and hard tissue healing in oral surgery treatment.
MATERIAL AND METHODS
An electronic search on PubMed database was performed regarding the placement of autologous platelet rich fibrin at tooth extraction sockets, bone and soft tissue augmentation procedures associated with implant placement and infrabony defects. The search was constrained to English language articles published during last five years and includes only clinical trials.
RESULTS
In total, 25 articles were included in this literature review. The studies were divided into five main groups, depending on the application: 1) utilization of autologous platelet rich fibrin at 3rd molar extraction sockets preservation, 2) any extraction socket preservation, 3) bone augmentation/sinus lift procedures with implant placement, 4) augmentation of peri-implant tissues, and 5) treatment of infrabony defects.
CONCLUSIONS
The application of autologous platelet rich fibrin (PRF) show benefits in promoting soft tissue healing and bone regeneration in different surgical procedures. Furthermore, it is an autologous biomaterial which has low cost and does not need administration of any additives. Nevertheless, further studies with a bigger sample size and longer follow up duration are necessary to facilitate more substantial evidence of the efficacy of PRF in promotion of soft and hard tissue healing.
Topics: Bone Regeneration; Bone Transplantation; Humans; Platelet-Rich Fibrin; Tooth Extraction; Tooth Socket
PubMed: 31074457
DOI: No ID Found -
Archives of Oral Biology May 2021This systematic review aimed to address whether the alveolar socket repair after a tooth extraction is impacted by an osteoporotic phenotype and propose methodological... (Review)
Review
OBJECTIVE
This systematic review aimed to address whether the alveolar socket repair after a tooth extraction is impacted by an osteoporotic phenotype and propose methodological observations.
DESIGN
A search strategy in MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases was performed. Quality assessment was carried out through the SYRCLE Risk of Bias tool.
RESULTS
Out of the 1147 potentially relevant records, 25 met the inclusion criteria. Most of the studies were performed in rats, and ovariectomy (OVX) was the most frequent osteoporosis induction method. Histomorphometry, micro-computed tomography (microCT), and immunohistochemistry were the main bone repair evaluation methods. Most of the included studies (88 %) presented negative impacts of osteoporosis on the alveolar socket repair. Only three studies (12 %) showed no statistical differences among groups. Overall, most of the quality assessment categories presented a high percentage of unclear risk of bias due to insufficient information in the studies.
CONCLUSIONS
The results indicated that an osteoporotic phenotype seems to impair alveolar socket repair after tooth extraction. However, there is still a lack of information and standardization. Therefore, further studies should consider the proposed methodological aspects regarding animal characteristics, OVX associated with a low calcium diet, waiting 8 weeks to osteoporosis induction, maxillary molars as the best option for tooth extraction, confirming and reporting OVX and osteoporosis success, and an appropriate method of repair analysis.
Topics: Animals; Female; Humans; Osteoporosis; Ovariectomy; Rats; Tooth Extraction; Tooth Socket; Tooth, Impacted; X-Ray Microtomography
PubMed: 33667958
DOI: 10.1016/j.archoralbio.2021.105054 -
The American Journal of Pathology Feb 2023This study explored the role of transient receptor potential channel melastatin 2 (TRPM2)-mediated activation of NOD-, LRR-, and pyrin domain-containing protein 3...
Suppression of the NLRP3 Inflammasome through Activation of the Transient Receptor Potential Channel Melastatin 2 Promotes Osteogenesis in Tooth Extraction Sockets of Periodontitis.
This study explored the role of transient receptor potential channel melastatin 2 (TRPM2)-mediated activation of NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome in osteogenesis during healing of tooth extraction sockets. Tooth extraction socket tissue samples were collected from patients with or without periodontitis. In a TRPM2 knockout mouse model of socket healing, mice with or without periodontitis and their wild-type littermates were used for comparing the socket healing phenotypes. Micro-computed tomography imaging, three-dimensional reconstruction of the sockets, and hematoxylin and eosin staining for histopathologic analysis were performed. Immunofluorescence, immunohistochemistry, and Western blot analysis were used for evaluation of protein expression; the mRNA levels were evaluated by quantitative RT-PCR. Osteogenic, chondrogenic, and adipogenic differentiation potential of human bone marrow mesenchymal stem cells (BMMSCs) was evaluated. Calcium deposition was evaluated using Alizarin Red S staining. NLRP3 and CASP1 were up-regulated in tooth sockets of periodontitis patients. NLRP3 knockdown promoted the osteogenic differentiation of maxillary BMMSCs under inflammatory conditions. TRPM2 was up-regulated in the tooth extraction socket tissue of periodontitis. Inhibiting TRPM2 expression mitigated the NLRP3 inflammasome and its deleterious effect on osteogenesis. Activation of the TRPM2 ion channel regulated osteogenesis of BMMSCs under inflammatory conditions via Ca influx, the mitochondrial dynamics, and pyroptosis. Targeting the TRPM2/Ca/NLRP3 axis could be beneficial in the healing process of the tooth extraction sockets of patients with periodontitis.
Topics: Humans; Mice; Animals; Inflammasomes; Osteogenesis; Tooth Socket; NLR Family, Pyrin Domain-Containing 3 Protein; TRPM Cation Channels; Transient Receptor Potential Channels; X-Ray Microtomography; Mice, Inbred NOD; Periodontitis; Tooth Extraction
PubMed: 36410421
DOI: 10.1016/j.ajpath.2022.10.009 -
Ear, Nose, & Throat Journal 2016We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate...
We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate and/or maxillary alveolus after surgical excision of the primary tumor. We also sought to identify any risk factors for recurrence. Our study population was made up of 20 patients-9 men and 11 women, aged 46 to 88 years (mean: 72.6)-who had undergone excision of an SCC of the hard palate and/or maxillary alveolus at a tertiary care cancer center over a 7-year period. Half of all patients were former tobacco users. Of the 20 tumors, 10 involved the maxillary alveolus, 4 involved the hard palate, and 6 involved both sites. Three patients were clinically categorized as T1, 9 as T2, 6 as T3, and 2 as T4; pathologically, 8 tumors were categorized as T4a. In addition to maxillectomy, a neck dissection was performed in 7 patients-4 therapeutically and 3 electively. Eight of 20 patients experienced a recurrence: 4 local, 6 regional, and 2 distant (several patients had a recurrence at more than one site). Univariate analysis identified perineural invasion (p = 0.04) as a statistically significant risk factor for recurrence. Of 14 patients with a clinicopathologically negative neck, 5 (36%) developed a cervical recurrence, and 4 of them died of their disease. An advanced stage (T4 vs.
alveolus. Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Incidence; Male; Maxillary Neoplasms; Middle Aged; Neck Dissection; Neoplasm Recurrence, Local; Palatal Neoplasms; Palate, Hard; Retrospective Studies; Tooth Socket; Treatment Outcome
PubMed: 27792826
DOI: 10.1177/014556131609510-1103