Immediate implant placement in extraction sockets with buccal bone dehiscence: A case study.

BACKGROUND: Immediate implant placement (IIP) has been associated with a higher risk of esthetic complications and particularly buccal mucosal recession, which can be more pronounced in non-intact sockets or in the presence of thin phenotype in the esthetic zone. Nevertheless, multiple techniques have been published to address IIP in non-intact alveolar sockets with favorable outcomes. The purpose of this study is to present an approach on IIP in sites with buccal bone dehiscence. METHODS: Three patients requiring extraction of one or multiple teeth in the presence of buccal bone dehiscence were treated with flapless extractions, IIP, guided bone regeneration (GBR), and connective tissue grafting (CTG) through a tunneling approach with a simultaneous use of custom healing abutments. RESULTS: All sites exhibited 1-2 mm of buccal bone thickness at the level of the implant platform, as well as significant buccal soft tissue thickness with no recession and a favorable development of the emergence profile at 4 months to a year post implant placement. CONCLUSIONS: IIP in sockets with buccal bone dehiscence can be managed by means of a flapless extraction, GBR and CTG through a tunneling approach exhibiting favorable hard and soft tissue responses. KEY POINTS: When placing immediate implants in non-intact sockets, simultaneous connective tissue grafting is recommended, especially in the esthetic zone. Bone grafting in immediate implants in sockets with buccal bone dehiscence can be performed through a tunneling approach without the need for open flap approaches. Placement of CHAs over immediate implants may help promote maintenance of the buccolingual ridge contours and overall hard and soft tissue responses. PLAIN LANGUAGE SUMMARY: Placing dental implants right after tooth extraction can lead to more visible aesthetic issues, especially gum recession. This is more common when the tooth socket is not intact or the gum tissue is thin. However, several techniques have shown good results even in these challenging situations. This study explores a method for implant placement right after tooth extraction in cases where there is bone missing on the socket. Three patients who needed teeth extracted and had bone loss on the outer side of their tooth sockets were treated. The treatment included: Extracting the teeth without cutting the gums, placing implants immediately, using GBR to help regrow bone, adding connective tissue grafts, and using custom healing cups to shape the gum tissue. After treatment, all the sites showed 1-2 mm of new bone on the outer side of the implants and thicker gum tissue without any recession. The gum and bone around the implants looked good 4 months to a year later. In conclusion, IIP in sockets with bone loss on the outer side can be effectively managed with this method, leading to good bone and gum tissue outcomes.

Bone Regeneration in Maxillary Sinus Augmentation Using Advanced Platelet-Rich Fibrin (A-PRF) and Plasma Rich in Growth Factors (PRGF): A Pilot Randomized Controlled Trial

The purpose of this pilot randomized controlled trial was to analyze and compare the effects of advanced platelet-rich fibrin (A-PRF) and plasma rich in growth factors (PRGF) combined with deproteinized bovine bone mineral (DBBM) on bone regeneration outcomes in maxillary sinus augmentation (MSA) procedures. A total of 15 patients in need of MSA were consecutively recruited. Maxillary sinuses were grafted with DBBM alone (control group), DBBM mixed with A-PRF (PRF group), or DBBM mixed with PRGF (PRGF group). After a 6-month healing period, bone core biopsy samples were collected prior to implant placement for histologic and histomorphometric analyses. The mean percentage of mineralized tissue (MT) was 20.33 ± 11.50 in the control group, 32.20 ± 7.29 for the PRF group, and 34.80 ± 6.83 for the PRGF group, with no statistically significant differences across the three groups (P > .05). The mean percentage of remaining bone grafting material (RBGM) was 24.00 ± 7.94 for the control group, 26.00 ± 7.78 for the PRF group, and 15.80 ± 8.23 for the PRGF group, with no statistically significant differences across the three groups (P > .05). Finally, the mean percentage of nonmineralized tissue (NMT) was 55.66 ± 7.77 for the control group, 41.40 ± 8.32 for the PRF group, and 49.60 ± 5.68 for the PRGF group, with no statistically signifcant differences across the three groups (P > .05). These findings suggest that the addition of A-PRF and PRGF to DBBM does not enhance new bone formation outcomes in maxillary sinus augmentation procedures. Neither of the two platelet concentrates were superior to the other in any of the variables assessed.

Osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures: A systematic review.

PURPOSE: The evidence pertaining to the contribution of the sinus membrane to new bone formation following maxillary sinus augmentation procedures is equivocal. The purpose of this study was to analyse the evidence currently available on the osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures, and the effect of local delivery of recombinant human bone morphogenic proteins (rhBMPs) on the bone-forming potential of the sinus membrane. MATERIALS AND METHODS: An electronic search was conducted using six different databases to identify controlled trials, prospective and retrospective cohort studies, case series and case reports, as well as preclinical (animal) studies reporting on new bone formation in close proximity with the sinus membrane after maxillary sinus augmentation procedures, assessed through histological and/or histomorphometrical evaluation, on the basis of pre-established eligibility criteria. RESULTS: No clinical studies were identified. Twenty-six preclinical studies were included in the review. Nine of them supported the osteogenic potential of the sinus membrane, while eight reported no evidence of osteogenicity from the sinus membrane. The nine remaining studies reported on the local effect of rhBMPs. The majority of these nine studies reported enhanced new bone formation in the sinus membrane region. CONCLUSIONS: The sinus membrane contains pluripotent mesenchymal cells with the capacity to differentiate and participate in the process of new bone formation. However, the findings from the studies selected in this systematic review do not consistently support that the sinus membrane significantly contributes to new bone formation following maxillary sinus augmentation procedures.

Association of Vitamin D With Periodontal Disease: A Narrative Review.

PURPOSE: To present a review of available literature on the association of vitamin D and periodontal disease. MATERIALS AND METHODS: A thorough search of articles was carried out on the databases PUBMED and MEDLINE regarding vitamin D and periodontal disease. The selected literature included cross-sectional, case-control and prospective and retrospective cohort studies. The main aspects of the association evaluated were a) the association of 25(OH)D and 1,25(OH)2D3 with periodontal disease severity, periodontal disease progression and tooth loss, b) the effect of vitamin D supplementation on periodontal health and c) the association of vitamin D receptor polymorphisms with periodontal disease. A brief overview of the biological mechanisms linking periodontal disease with vitamin D was also included. RESULTS AND CONCLUSIONS: There is conflicting evidence regarding the effects of 25(OH)D on periodontal disease severity, progression and tooth loss, with some studies reporting beneficial effects of higher 25(OH)D serum concentrations on periodontal health and tooth retention, whereas others could not find such an association. Limited evidence also supports a positive association between 1,25(OH)2D3 and periodontal health as well as a trend towards better periodontal health with vitamin D supplementation. Finally, various vitamin D polymorphisms were associated with chronic and aggressive periodontitis, with different outcomes reported for the various ethnic populations assessed.

Plasma rich in growth factors (PRGF) in intraoral bone grafting procedures: A systematic review.

PURPOSE: This systematic review aimed at assessing the effects of PRGF in new bone formation, soft tissue healing and post-operative pain and swelling in sites that underwent ridge preservation, ridge augmentation and maxillary sinus augmentation procedures. MATERIALS AND METHODS: A comprehensive literature search employing seven databases was conducted by two independent reviewers. Only randomized and non-randomized controlled clinical trials using PRGF alone or in combination with bone grafting materials were selected. RESULTS: Overall, 919 studies were identified, of which a total of 8 articles were included in the qualitative analysis. Two of the selected studies reported on ridge preservation, one on ridge augmentation and five on maxillary sinus augmentation. Positive results were recorded for soft tissue healing and post-operative pain and swelling following these procedures. However, outcomes of PRGF on new bone formation post extraction and on maxillary sinus augmentation when combined with other biomaterials were conflicting. Meta-analysis could not be conducted for any variables due to the heterogeneity of selected studies. CONCLUSION: Limited evidence exists on the effects of PRGF in different intraoral bone grafting procedures, with some benefit reported on soft tissue healing and post-operative symptomatology. As this platelet concentrate is commonly used in clinical practice, further research is needed to fully assess its clinical indications and effectiveness.

Vitamin D deficiency and periodontal clinical attachment loss in HIV-seropositive women: A secondary analysis conducted in the Women's Interagency HIV Study (WIHS).

OBJECTIVE: The aim of this study was to test a hypothesized positive association between low vitamin D (VitD) serum levels and the severity of periodontal disease in women with HIV infection. STUDY DESIGN: This was a cross-sectional secondary analysis of data from an oral substudy conducted within the Chicago site of the Women's Interagency HIV Study. Serum VitD levels and clinical attachment loss (CAL) measurements were available for 74 women with HIV infection. VitD levels were treated as both continuous and categorical variables in bivariate and multivariate analyses. Mean clinical attachment loss (mCAL) was determined for each subject by obtaining the averages of measurements taken at 4 sites in each measured tooth. RESULTS: Average age of study participants (n = 74) was 39.6 years (standard deviation 7.2), and the majority were African Americans (70.3%) with VitD deficiency (58.1%). VitD deficiency was positively associated with higher mCAL (P = .012). After adjustment for race, age, smoking, and HIV viral load, an association was found between VitD deficiency and mCAL (Beta 0.438; P = .036). CONCLUSIONS: We identified a previously unreported association between VitD deficiency and mCAL in women with HIV infection. Larger and more inclusive, multisite, longitudinal studies are warranted to investigate whether these findings can be generalized to all individuals with HIV infection in the current treatment era and to determine causality.

Complications Associated With the Use of Recombinant Human Bone Morphogenic Protein-2 in Ridge Augmentation: A Case Report.

This case report aims to describe in detail a complication associated with resorption of regenerated bone following implant placement and ridge augmentation using recombinant human bone morphogenic protein-2 (rhBMP-2) in combination with allograft and xenograft. Bilateral maxillary sinus and ridge augmentation procedures were completed using rhBMP-2 combined with allograft and xenograft. Five months later, significant bone augmentation was achieved, which allowed for the placement of 4 implants. Upon stage 2 surgery, significant dehiscence was noted in all implants. Treatment steps to address this complication included implant removal, guided bone regeneration with xenograft only, and placement of new implants followed by soft-tissue grafting. At the time of publication, this patient is status 1½ years post case completion with maintenance of therapy outcomes. Off-label use of rhBMP-2 has gained significant acceptance in implant dentistry. However, there is limited evidence regarding the bone maturation process when rhBMP-2 is combined with other biomaterials. More research may be needed regarding the timing and process of bone healing in the presence of rhBMP-2, in an effort to avoid surgical complications.