Competence of allogenic demineralized tooth matrix in socket seal surgery for alveolar ridge preservation: a randomized control clinical trial.

OBJECTIVES: To assess and compare the clinical, radiological, and histological outcomes of socket seal surgery between two protocols: deproteinized demineralized tooth matrix (dpDTM) and freeze-dried bone allograft (FDBA) each covered with a free gingival graft. MATERIALS AND METHODS: Twenty extraction sockets in the anterior or premolar region were randomly allocated to either the dpDTM or FDBA protocol (n = 10 per group). Measurements of the alveolar ridge changes were obtained using an intraoral scanner and cone-beam computed tomography at 3 months post-operation. Three-month post surgery, the dental implant was installed (n = 5 per group), bone biopsies were obtained for histomorphometrical and micro-computed tomography analyses. Implant stability quotients (ISQs) were determined and compared at 3 months post-implant. RESULTS: Lower significant reductions in buccal alveolar ridge height and hard tissue volume were observed in dpDTM group compared to FDBA group at 3 months (0.25 ± 0.35 mm vs. 1.60 ± 0.66 mm [p = .000] and 9.64 ± 15.39% mm3 vs. 31.45 ± 18.11% mm3 [p = .010], respectively). At the same time, lower soft tissue volume reduction was detected in the dpDTM group compared to FDBA group (4.21 ± 5.25% mm3 vs. 5.25 ± 5.79% mm3). No statistically significant difference in the percentage of mineralized tissue formation was found between dpDTM group (53.39 ± 11.16%) and FDBA group (49.90 ± 3.27%). Even though the ISQ in the dpDTM group showed a higher value than the FDBA group at 3 months post-implant, the results were without statistical significance. CONCLUSIONS: Alveolar ridge preservation using dpDTM is an efficacious procedure for providing the conditions for the development of functional and esthetic implants.

Reconstruction of Sockets and Associated Maxillary Ridge Defect Using Suture Tenting, Synthetic Bone Graft, and Unique Macro Morphology Implants With an Immediately Loaded Provisional Bridge.

Immediate implant placement in the anterior maxilla remains complex, particularly when the labial cortical plate of the socket is deficient and there is an associated class IV ridge defect with both hard- and soft-tissue deficiencies. This case report describes a novel combination of polydioxanone (PDS) suture tenting to support a synthetic bone graft with simultaneous implant placement with implants featuring a body-shift design and subcrestal internal angle correction. In addition, the implants were immediately loaded with a four-unit provisional bridge at the time of surgery, thus reducing morbidity, costs, and total treatment time.

Effect of Dental Implant System-Assisted Tooth Intentional Replantation in the Treatment of Anterior Teeth with Pathological Tooth Flaring, Drifting and Elongation in Patients with Stage III/IV Periodontitis: a Case Series.

OBJECTIVE: To investigate the clinical effect of implant-assisted dental intentional replantation (IR) for the treatment of "drifted" anterior periodontally hopeless teeth (PHT). METHODS: The present authors recruited 22 patients with stage III/IV periodontitis who suffered drifting of the maxillary anterior teeth, with a total of 25 teeth. The PHT were extracted for in vitro root canal treatment (RCT). The root surface was smoothed and the shape was trimmed, and the alveolar socket was scratched. The dental implant system was used to prepare the alveolar socket according to the direction, depth and shape of the tooth implantation. The PHT were reimplanted into the prepared alveolar socket. The periodontal indicators were analysed statistically before and after surgery. RESULT: Twenty-two patients who completed the full course of treatment, with a total of 25 PHT, had a successful retention rate of 88%. Mean periodontal probing depth (PPD) decreased by 2.880 ± 0.556 mm and 3.390 ± 0.634 mm at 6 months and 1 year, respectively, and clinical attachment loss (CAL) decreased by 2.600 ± 0.622 mm and 2.959 ± 0.731 mm at the same time points, respectively, showing significant improvement (P < 0.05). CONCLUSION: Dental implant system-assisted IR can effectively preserve "drifted" natural PHT in patients with stage III/IV periodontitis.

Concentrated growth factor and collagen as barrier materials in alveolar ridge preservation for posterior teeth: a prospective cohort study with one-year follow-up.

OBJECTIVES: This study aims to evaluate the efficacy of concentrated growth factor (CGF) membrane and collagen as barrier materials in sealing the alveolar socket in alveolar ridge preservation (ARP) in the posterior region during a one-year follow-up. METHODS: A total of 24 patients who underwent ARP in the posterior region were selected for inclusion and randomly assigned to the CGF group (12 cases) and Collagen group (12 cases). The patients in both groups underwent extraction of posterior teeth. The extraction sockets were filled with a bone substitute to the level of the pre-extraction buccal and lingual or palatal alveolar bone plates. The wounds in the CGF group were closed with a fabricated CGF overlaying the upper edge of the bone substitute material, whereas those in the Collagen group were closed with Bio-Oss Collagen. The implants were placed after 6 months. The evaluation was based on implant retention, re-grafting rate, and vertical and horizontal alveolar ridge bone volume changes measured by cone beam computed tomography (CBCT). Data were statistically analyzed using SPSS 28.0 software. RESULTS: No patient withdrew throughout the follow-up period. No implant failure and no severe peri-implant or mucosal soft tissue complications were observed. Six months after the operation, the degree of vertical alveolar ridge height resorption in the CGF group was lower than that in the Collagen group (P<0.05). There were no statistically difference between the groups at 1 year after the operation (P>0.05). The amount of bone reduction in horizontal alveolar ridge width showed no difference between the groups at 6 months and 1 year after surgery (P>0.05). CONCLUSIONS: CGF membrane and Bio-Oss Collagen as barrier materials for posterior ARP inhibited reduction in alveolar ridge bone mass.

Efficacy of Platelet-Rich Fibrin in Preserving Alveolar Ridge Volume and Reducing Postoperative Pain in Site Preservation of Post-Extracted Sockets.

Background and Objectives: In socket preservation, the goal is to minimize bone resorption after tooth extraction to maintain the volume and contour of the alveolar ridge. The use of PRF in post extraction sites may reduce ridge resorption by encouraging the growth of new bone and acting as a scaffold for tissue. In addition, PRF may enhance healing and minimize postoperative pain. The aim of this study was to evaluate the effectiveness of platelet-rich fibrin (PRF) in maintaining the ridges' dimensions at the extraction site, in the maxilla and mandible, as well as its impact on post-extraction discomfort. Methods: The study was conducted on 60 patients presenting for extraction of posterior teeth and was randomly divided into three groups: group I PRF (n = 20), group II PRF + collagen (n = 20), and group III control (n = 20). Sockets were filled with PRF (group I) and PRF + collagen (group II). At baseline and follow-up after 3 months, CBCT was used to assess the bone dimensions. The postoperative pain evaluations were performed at 24 h, 3 days, and 7 days after the tooth extraction. The pain rate was evaluated using a numerical rating scale from the British Pain Society. Results: The study examined the effects of platelet-rich fibrin (PRF) and PRF combined with collagen on the height and width of the ridges, as well as the pain experienced by the patients following alveolar ridge preservation surgery. ANOVA and t-tests were used to evaluate and compare the ridge dimensions. Comparing the results to the control group, there were no significant differences in the height or width of the ridges. However, both the PRF and PRF + Collaplug® treatments effectively reduced the short-term postoperative pain. Conclusions: The study findings suggest that platelet-rich fibrin (PRF) and PRF combined with collagen do not exert significant effects on ridge width and height compared to the standard treatment following alveolar ridge preservation. However, it is noteworthy that both the PRF and PRF + collagen treatments demonstrated efficacy in reducing postoperative pain in the short term, offering a potential advantage over standard treatment protocols.

Ridge Preservation Combined With Open Barrier Membrane Technique in Case of Postextractive Oroantral Communication: A Case Series Retrospective Study.

After dental extraction, a physiological phenomenon of reabsorption of the dentoalveolar process is triggered, especially if periradicular lesions are present, which can sometimes be associated with oroantral communication in the upper posterior maxilla. To investigate a minimally invasive approach, 19 patients undergoing tooth extraction in the posterosuperior maxilla were recruited. All cases presented an oroantral communication with a diameter of 2-5 mm after tooth extraction and the alveolar process and, in some cases, with a partial defect of 1 or more bony walls. In these cases, a single surgical procedure was used to preserve the alveolar ridge using an open barrier technique with an exposed dense polytetrafluoroethylene membrane. The bottom of the extraction socket was filled with a collagen fleece. The residual bone process was reconstructed using a biomaterial based on carbonate-apatite derived from porcine cancellous bone. After 6 months, all patients were recalled and subjected to radiographic control associated with an implant-prosthetic rehabilitation plan. Data relating to the sinus health status and the average height and thickness of the regenerated bone were collected. Radiographic evaluation verified the integrity of the maxillary sinus floor with new bone formation, detecting a vertical bone dimension between 3.1 mm and 7.4 mm (average 5.13 ± 1.15 mm) and a horizontal thickness between 4.2 mm and 9.6 mm (average 6.86 ± 1.55 mm). The goal of this study was to highlight the advantage of managing an oroantral communication and, simultaneously, obtain the preservation and regeneration of the alveolar bone crest. The open barrier technique appears to be effective for the minimally invasive management of oroantral communication up to 5 mm in diameter in postextraction sites, with a good regeneration of hard and soft tissue.

Influence of freeze-dried bone allograft on free gingival graft survival and alveolar ridge maintenance in socket seal procedures: a randomized controlled clinical trial.

PURPOSE: This study aimed to investigate the viability of free gingival grafts (FGG) and assess clinical and radiographic changes in the alveolar ridge following socket seal surgery with or without freeze-dried bone allograft (FDBA). MATERIALS AND METHODS: Twenty-eight anterior and premolar tooth extractions were randomly allocated to 2 groups: socket graft of FDBA sealed with FGG (n = 15) and control with empty sockets sealed solely with FGG (n = 13). Photographs taken at 3, 7, 14, and 30 days post-surgery assessed FGG viability. Alveolar ridge volume was clinically evaluated via intraoral scanners before surgery and at 1 and 3 months post-surgery. CBCT scans taken immediately post-surgery and 3 months later assessed alveolar ridge dimensions. RESULTS: FGG viability in both groups increased from day 3 and reached the maximum score on day 14. Alveolar ridge volume reduction at 3 months in the FDBA group was comparable to the control group. Buccal alveolar bone height reduction was significantly higher in the FDBA group than the control group, while palatal alveolar bone height was comparable. Alveolar bone width reduction was evident but not statistically significant between the groups. The FDBA group exhibited a significant alteration in bone volume compared to the control group. CONCLUSION: Viability of FGG was not affected by graft filling materials. Sealing the socket with FGG effectively preserved socket integrity and ridge volume in minor socket defects using either graft filling material or not. This study was registered on 4 January 2021 on Thai Clinical Trials Registry (TCTR20210104001).

Comparing the modified socket-shield technique with the conventional immediate implantation technique in the anterior dentition: A 5-year retrospective clinical study.

AIMS: The aim of this retrospective clinical study was to compare the 5-year radiological and clinical outcomes of patients undergoing immediate implantation with or without the modified socket-shield technique. MATERIALS AND METHODS: Patients who underwent anterior tooth replacement via the modified socket-shield technique (MSST) or the conventional immediate implantation technique (CIIT) between 2016 and 2017 were included. The labial bone thickness was assessed at different measurement levels (0, 2, 4 and 6 mm apical to the implant shoulder (IS)) postoperatively (T1), 6 months postoperatively (T2) and 5 years postoperatively (T3). The pink aesthetic score (PES) was evaluated before surgery (T0) and at T2 and T3. Implant success, complications and patient satisfaction were evaluated at every visit. RESULTS: Thirty-six patients (18 in the MSST group) underwent follow-up for 5 years, with no cases of implant failure. Two cases of exposure were detected in the MSST group, but there were no significant effects on hard or soft tissue. Patients in the MSST group showed less and more stable bone resorption than did those in the CIIT group at any measurement level and any time. A higher PES was achieved in the MSST group. Patient satisfaction was similar in both groups. CONCLUSIONS: The MSST is a reliable immediate implantation method because of its ability to preserve the alveolar bone and provide superior recovery of aesthetics.

NF-κB Decoy Oligodeoxynucleotide-Loaded Poly Lactic-co-glycolic Acid Nanospheres Facilitate Socket Healing in Orthodontic Tooth Movement.

Orthodontic space closure following tooth extraction is often hindered by alveolar bone deficiency. This study investigates the therapeutic use of nuclear factor-kappa B (NF-κB) decoy oligodeoxynucleotides loaded with polylactic-co-glycolic acid nanospheres (PLGA-NfDs) to mitigate alveolar bone loss during orthodontic tooth movement (OTM) following the bilateral extraction of maxillary first molars in a controlled experiment involving forty rats of OTM model with ethics approved. The decreased tendency of the OTM distance and inclination angle with increased bone volume and improved trabecular bone structure indicated minimized alveolar bone destruction. Reverse transcription-quantitative polymerase chain reaction and histomorphometric analysis demonstrated the suppression of inflammation and bone resorption by downregulating the expression of tartrate-resistant acid phosphatase, tumor necrosis factor-α, interleukin-1ß, cathepsin K, NF-κB p65, and receptor activator of NF-κB ligand while provoking periodontal regeneration by upregulating the expression of alkaline phosphatase, transforming growth factor-ß1, osteopontin, and fibroblast growth factor-2. Importantly, relative gene expression over the maxillary second molar compression side in proximity to the alveolus highlighted the pharmacological effect of intra-socket PLGA-NfD administration, as evidenced by elevated osteocalcin expression, indicative of enhanced osteocytogenesis. These findings emphasize that locally administered PLGA-NfD serves as an effective inflammatory suppressor and yields periodontal regenerative responses following tooth extraction.

RNA Technology to Regenerate and Repair Alveolar Bone Defects.

microRNA-200a (miR-200a) targets multiple signaling pathways that are involved in osteogenic differentiation and bone development. However, its therapeutic function in osteogenesis and bone regeneration remains unknown. In this study, we use in vitro and in vivo models to investigate the molecular function of miR-200a overexpression and miR-200a inhibition using a plasmid-based miR inhibitor system (PMIS) on osteogenic differentiation and bone regeneration. Inhibition of miR-200a using PMIS-miR-200a significantly increased osteogenic biomarkers of human embryonic palatal mesenchyme cells and promoted bone regeneration in rat tooth socket defects. In rat maxillary M1 molar extractions, the supporting tooth structures were removed with an implant drill to yield a 3-mm defect in the alveolar bone. A collagen sponge was inserted into the open alveolar defect and PMIS-miR-200a plasmid DNA was added to the sponge and the wound sutured to protect the sponge and close the defect. It was important to remove the existing tooth supporting structure, which can influence alveolar bone regeneration. The alveolar bone was regenerated in 4 wk. The collagen sponge acts to stabilize and deliver the PMIS-miR-200a DNA to cells entering the sponge in the bone defect. We show that mesenchymal stem cells expressing CD90 and Stro-1 enter the sponges, take up the DNA, and express PMIS-miR-200a. PMIS-miR-200a initiates a bone regeneration program in transformed cells in vivo. In vitro inhibition of miR-200a was found to upregulate Wnt and BMP signaling activity as well as Runx2, OCN, Lef-1, Msx2, and Dlx5 associated with osteogenesis. Liver and blood toxicity testing of PMIS-miR-200a-treated rats showed no increase in several biomarkers of liver disease. These results demonstrate the therapeutic function of PMIS-miR-200a for rapid bone regeneration. Furthermore, the studies were designed to demonstrate the ease of use of PMIS-miR-200a in solution and applied using a syringe in the clinic through a simple one-time application.

Synchrotron Analysis of Damaged Extraction Sockets Augmented Using a Synthetic Bone Block: A Pilot Study.

This study aimed to investigate the dimensional stability and quality of the alveolar ridge augmented using a synthetic bone block (SBB) at damaged extraction sockets. Four participants were included, and socket augmentation was performed using SBB and a collagen membrane. Intraoral and CBCT scans were performed before extraction (baseline), immediately postoperative (IP), and at 6 months postoperative (6M). At 6M, a trephine biopsy sample was obtained during implant placement, and the sample was observed using synchrotron. Soft tissue profile changes were assessed using profilometric analysis of the intraoral scan data, while dimensional changes in hard tissue were evaluated based on CBCT measurements. Bone quality was analyzed using synchrotron imaging. There were minimal changes in the soft tissue profile between baseline and IP, baseline and 6M, and IP and 6M (0.11 ± 1.08 mm3, 0.02 ± 0.8 mm3, and -0.65 ± 0.82 mm3, respectively). Horizontal bone width was measured at 1-mm increments from the augmented bone crest to 5 mm apically and revealed only a slight reduction (< 1 mm) at all levels between IP and 6M. The augmented bone height was well maintained from IP until 6M (-0.21 ± 0.53 mm). Synchrotron analysis revealed low to moderate bone quality after 6M (percentage of new bone: 16.49% ± 4.91%). Socket augmentation using SBB appears to be a viable technique for regenerating damaged extraction sockets, with the augmented ridge dimensions maintained up to 6M. Further long-term randomized clinical trials are needed.

Bone-Level Tapered Implants for Single Tooth Replacement: Immediate vs Delayed Placement-A Multicenter Randomized Controlled, 1-Year, Non-inferiority Clinical Study.

PURPOSE: To compare the outcomes of immediate and delayed implant placement with bone-level tapered implants. MATERIALS AND METHODS: In this post-market, multicenter prospective randomized controlled study with a primary endpoint of 1 year, 53 patients were randomized to receive either immediate implant placement (test group) or delayed implant placement (control group). The mean crestal bone level changes from implant loading to 12 months postloading were measured using standardized digital periapical radiographs. Changes in facial plate thickness (as measured on CBCT images), implant success and survival, implant stability, soft tissue changes, patient-centered outcomes, and adverse events were measured to assess outcomes between the test and control treatments at 12 months postloading. RESULTS: Of the original 53 patients, 46 patients completed the study (23 in each group). Mean bone changes from loading to the 12-month follow-up were recorded with no statistically significant difference (P = .950) between the groups. The hypothesis was confirmed that immediate implant placement (test) in extraction sockets produces in similar outcomes as delayed placement (control). The test group was found to be similar to the control group (P = .022) in terms of mean changes in facial plate thickness. Implant survival and success were 95.8% in the test group and 92% in the control group. Stability in the control group was superior at the time of surgery, but there was no difference between the groups at implant loading, producing a nonsignificant P value of .563). CONCLUSIONS: This randomized controlled multicenter study showed comparable outcomes 1 year after prosthetic loading in the immediate and delayed implant placement groups.

Accuracy of open-sleeved vs. closed-sleeved static computer-assisted implant systems in immediate maxillary molar implant placement: An in vitro study.

OBJECTIVES: The objective of this study is (1) to compare the accuracy of an open-sleeved static computer-assisted implant system (sCAIS) with a closed-sleeve sCAIS and free-hand approach in immediate implant placement (IIP) of maxillary molar sites and (2) to investigate the influence of socket morphology on these approaches. MATERIALS AND METHODS: Ninety partially edentulous duplicated maxillary models simulating three different molar sockets (type A, B, and C based on Smith and Tarnow's classification) were investigated. Three modalities, including sCAIS with open-sleeves, sCAIS with closed-sleeves, and free-hand approach, were applied separately to 30 models with 120 sockets. A customized Python script automatically measured the deviations between the virtual and actual implant positions for all 360 implants. RESULTS: The 3D deviations of sCAIS were significantly influenced by the socket and sleeve types. Both guided groups exhibited significantly less deviation than the free-hand approach. Type A and C sockets resulted in better implant positions than type B socket sites. In type B sockets, the open-sleeve group achieved significantly less deviation compared to the closed-sleeve group, with respect to apical global (1.34 ± 0.53 vs. 1.84 ± 0.59 mm), coronal horizontal (0.68 ± 0.36 vs. 0.93 ± 0.34 mm), apical horizontal (1.21 ± 0.59 vs. 1.74 ± 0.63 mm), and angular (3.30 ± 1.41 vs. 4.41 ± 1.96°) deviations. CONCLUSIONS: Guided implant surgery significantly reduces deviations during molar IIP compared to free-hand procedures. Furthermore, the use of open-sleeve sCAIS appears to be more effective in minimizing deviations in type B sockets when compared with the closed-sleeve guided system.

Effect of radiation cross-linked collagen scaffold in alveolar ridge preservation of extraction socket.

This study aimed to evaluate the properties of radiation cross-linked collagen scaffold (RCS) and its efficacy for alveolar ridge preservation (ARP). RCS was prepared from collagen dispersion by electron beam irradiation and freeze-drying. The microstructure, swelling ratio, area alteration and mechanical properties of RCS were characterized. Fifty-four New Zealand rabbits performing incisor extraction on maxilla and mandible were randomly assigned into positive, sham operation or treatment groups. Micro-computed tomography (micro-CT) scans, performed after 1, 4, and 12 weeks of surgery, were to assess changes in ridge height at buccal and palatal side, in ridge width and in micromorphological parameters. Histological analysis accessed socket microarchitecture. The results showed that RCS had stable mechanical properties and morphologic features that provided a reliable physical support for ARP. Dimensional changes in treatment group revealed significantly greater vertical height at buccal (5.32 [3.37, 7.26] mm, p < .0001) and palatal (4.37 [2.66, 6.09] mm, p < .0001) side, and horizontal width at the maxilla (0.16 [0.04, 0.28] mm, p < .01) and mandible (0.33 [0.11, 0.54] mm, p < .01) than those in sham operation group after 12 weeks. The treatment group had advantage than positive group in vertical height preservation, quantitatively. The order and density of bone trabeculae were improved in treatment group. These findings indicated that RCS had the potential to serve as an effective scaffold for ARP.

Immediately placed implants using simvastatin and autogenous tooth graft combination in periodontally compromised sites: a randomized controlled clinical trial.

OBJECTIVES: The present study aimed to assess clinically and radiographically the usage of autogenous tooth bone graft (ATBG) combined with and without Simvastatin (SMV) around immediately placed dental implants in periodontally compromised sites. METHODS: Thirty-nine patients required a single extraction of periodontally compromised tooth were divided into three groups (13 patients each). Group I received immediate implant placement (IIP) without grafting. Group II received IIP with ATBG filling the gap around IIP. Group III received SMV gel mixed with ATBG around IIP. Radiographic changes were reported at the baseline, 6-, and 12-months post-surgery. RESULTS: All implants achieved the success criteria with no complications. At 6- and 12-months post-surgery, group III showed a statistically lower mean ridge width loss compared to Group I and Group II (P < .001). Group II revealed less reduction in the mean alveolar ridge width compared to group I (P < .001). Group III showed a statistically significantly less MBL loss than group I and group II (P < .001). All groups showed a statistically significant increase in BD gain compared to baseline (P < .001). Group III showed statistically significant high BD compared to group II (P < .001). Group II showed statistically significantly higher mean BD gain than that of group I (P < .001). CONCLUSION: SMV combined with ATBG boosts the hard tissue parameters around dental implants over ATBG alone. Clinical trial registration was on August 1, 2021 (NCT04992416). CLINICAL RELEVANCE: ATBG with SMV in periodontally compromised sites could improve implant osseointegration and promote favorable changes in peri-implant tissues.

Comparing Bone Alteration and Esthetic Recovery Between the Socket-Shield Technique and the Conventional Immediate Implant Technique: A Retrospective Study.

PURPOSE: To evaluate bone preservation and esthetic recovery between the socket-shield technique (SST) with different labial bone plate thicknesses and the conventional immediate implant technique (CIIT). MATERIALS AND METHODS: Patients who underwent immediate implant placement in the anterior region were divided into three groups: the SST with a thickwall phenotype (> 1 mm; SSTA group), the SST with a thin-wall phenotype (< 1 mm; SSTB group), and the CIIT with a thickwall phenotype (> 1 mm; CIIT group). Radiologic images and clinical photos were collected before surgery, immediately postoperatively, and 6 months postoperatively. The labial bone width, labial bone width change (BWC), labial bone volume change (BVC), pink esthetic score (PES), and complication rate were evaluated among the three groups. Statistical analysis was performed using SPSS software. RESULTS: A total of 60 patients (n = 20/group) were enrolled in this 6-month retrospective study. The BWC in the SSTA group (0.22 to 0.30 mm) and the SSTB group (0.18 to 0.33 mm) was less than that in the CIIT group (0.61 to 0.80 mm; P < .004). The SSTA group and the SSTB group had a lower BVC (24.08 vs 21.14 vs 54.81, respectively; P = .004) and greater PES (11.75 vs 11.65 vs 10.65, respectively; P = .009) than the CIIT group. No complications occurred among these patients. CONCLUSIONS: With the limitations of this study, it can be concluded that the SST is a reliable method for preserving bone and achieving satisfactory esthetic outcomes. The labial bone plate phenotype associated with the SST has minimal impact on both clinical and radiologic outcomes.

Flapless early implant placement into the uncalcified provisional matrix-Does it lead to osseointegration of the implant? A preclinical study.

AIM: To test whether early implant placement into the extraction socket containing an uncalcified provisional matrix leads to successful osseointegration and stable marginal bone levels. MATERIALS AND METHODS: In six mongrel dogs, the mandibular molars were extracted. Three weeks later, early implant placement was performed according to three experimental protocols: (i) flapless implant placement with preservation of the provisional matrix; (ii) flap elevation, socket debridement and implant placement; and (iii) flap elevation, socket debridement, implant placement and guided bone regeneration (GBR). One untreated extraction socket served as a control group. Data analyses were based on histologic slides 3 months after implant placement. RESULTS: There were no differences in bone-to-implant contact between the three experimental groups (66.97%, 58.89% and 60.89%, respectively) (inter-group comparison p = .42). Marginal bone levels, first bone-to-implant contact as well as the thickness of the connective tissue did not reveal any significant differences between the groups (p = .85, .60 and .65, respectively). CONCLUSIONS: Flapless early implant placement into posterior extraction sockets was as effective as an open flap approach in conjunction with GBR. Mineralization of the socket seems to occur irrespective of the presence of dental implants or biomaterials.

Pre-surgical socket analysis for immediate implant placement.

BACKGROUND: Traditional protocols for implant surgery suggest a healing period of 2-3 months from dental extraction to implant placement. Based on all the volumetric modifications produced by that approach, there are authors who advocate for immediate implantology. The aim of the present study was to determine the prevalence of different sockets, and the dimensions of the bone around the upper anterior incisors and canines, to determine the predictability of immediate implants in our population. MATERIAL AND METHODS: This is an observational, cross-sectional study based on cone-beam computed tomography images of the anterior maxila of patients attending the Odontological Hospital of the University of Barcelona (OHUB) and requesting for implant treatment. Different measurements were performed on every analyzed tooth, and also they were categorized by using the main dental sockets classifications. RESULTS: Bone attachment levels and cortical thickness are lower in women compared to men in all three types of teeth (the difference in the bone attachment levels ranges from 4.68%-8.63% and in the bone thickness goes from 0.02-0.58mm). Bone attachment level gradually reduces with age. The reductions observed in all the measurements are higher in the case of canines, compared with the other teeth. The differences from patients <45 years old and patients between 55-64 years old are 13.58±14.55mm in the case of central incisors, 10.04±5.52 in the case of lateral incisors and 22.39±13.65mm in the case of canines. CONCLUSIONS: According to our results, the canines are the teeth with the greatest complexity when it comes to immediate implantology treatments. Furthermore, that kind of treatment is more complex as age increases, since we observed a gradual percentage of unfavourable sockets in older patients.

Transitioning From Teeth to Implants: A Narrative Review.

PURPOSE: Patients may need removal of their teeth with placement of implants for rehabilitation. The clinical problem is the status of the remaining teeth and how this affects the timing for implant placement and the method for provisionalization. The importance of this review is to document the different strategies including sequential tooth removal and grafting and the use of teeth to provide a fixed provisional rather than a removable provisional, to provide surgeons with a reference to maintain patient function during their rehabilitation. METHODS: Pubmed.gov was the information source. Years reviewed included 1990 to 2022. Inclusion criteria included only articles in peer-reviewed journals. Variables evaluated included the success for placing implants immediately into extraction sites, and the methods to transition between steps in their rehabilitation. Data collected were results of systematic reviews and independent clinical series, as well as case reports of prosthetic methods for transitioning. RESULTS: The search used terms which included implants in extraction sites (n = 205) and transitioning teeth to implants (n = 153). Twenty-one articles were reviewed involving extraction sites and 19 articles reviewed concerning transitioning from teeth to implants. The placement of implants immediately into excretion sites did have a relative risk for failure compared to implant placement in healed sites. The use of non-restorable teeth to support a fixed provisional prosthesis was successful; however, variability in reporting prevented a statistical analysis. CONCLUSION: The surgeon needs to utilize teeth to provide support during treatment phases in order to provide the patient with a fixed provisional prosthesis to allow for implant integration and to provide time for graft healing. Specific methods used for transitioning do not have a significant evidence base to recommend one method but routine prosthetic techniques have been used and are reported in case reports.

Alveolar ridge preservation of two-wall bone defects using mineralized dentin matrix: An experimental pre-clinical study.

OBJECTIVES: To study bone healing of two-wall bone defects after alveolar ridge preservation using mineralized dentin matrix. MATERIALS AND METHODS: After distal roots extraction of second and fourth premolars (P2, P4) on one lateral mandible in 12 beagles, two-wall bone defects (5 × 5 × 5 mm) were surgically created distally to the remaining mesial roots of P2 and P4. A total of 24 sites were randomly allocated to three groups (implant material- time of execution): mineralized dentin matrix (MDM)-3 m (MDM + collagen membrane; 3 months), MDM-6 m (MDM particles + collagen membrane; 6 months), and C-6 m (collagen membrane only; 6 months). Clinical, radiographic, digital, and histological examinations were performed 3 and 6 months after surgery. RESULTS: The bone healing in MDM groups were better compared to Control group (volume of bone regenerated in total: 25.12 mm3 vs. 13.30 mm3, p = .046; trabecular volume/total volume: 58.84% vs. 39.18%, p = .001; new bone formation rate: 44.13% vs. 31.88%, p = .047). Vertically, the radiological bone level of bone defect in MDM-6 m group was higher than that in C-6 m group (vertical height of bone defect: 1.55 mm vs. 2.74 mm, p = .018). Horizontally, no significant differences in buccolingual bone width were found between MDM and C groups at any time or at any level below the alveolar ridge. The percentages of remaining MDM were <1% in both MDM-3 m and MDM-6 m groups. CONCLUSIONS: MDM improved bone healing of two-wall bone defects and might be considered as a socket fill material used following tooth extraction.