The effects of sodium alendronate on socket healing after tooth extraction: a systematic review of animal studies.

The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE's RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.

Dental implants placed buccally to the mandibular canal in molar regions with severe vertical bone loss: case reports

Introduction: Alveolar bone loss in posterior regions of the mandible is a serious limiting factor for the installation of osseointegrated dental implants. New surgical procedures are needed to circumvent the lack of vertical bone. Objective: The objective of this study was to present an alternative technique for dental implants in the lateral posterior region of the mandible in patients with severe vertical ridge atrophy Case Reports: Four patients with the specific anatomical characteristics that met the requirements of the technique were selected. Six implants were inserted buccally to the mandibular canal and were restored after at least two months of healing time. The mean follow up period of the implants was 3 years. No implant was lost during this time. All of them remained in excellent clinical condition and met the aesthetic criteria and functional demands of occlusion. Conclusion: The technique presented here proved to be minimally invasive, safe, conservative and effective as an alternative treatment option for dental rehabilitation in mandibular posterior regions with severe bone atrophy. However, it requires experience, preparation and skill of the professional in order not to damage the inferior alveolar nerve and at the same time install the implant in the correct position, thus allowing its functional and aesthetic rehabilitation.

Introdução: A perda óssea alveolar severa em região posterior de mandíbula é um sério fator limitante para instalação de implantes dentários osseointegráveis. Novas técnicas cirúrgicas são necessárias visando contornar a falta de osso vertical. Objetivo: O objetivo deste estudo foi apresentar uma técnica alternativa de inserção de implante dentário na região posterior lateral da mandíbula em pacientes com atrofia vertical severa de rebordo alveolar. Relatos de casos : Foram selecionados 4 pacientes com características anatômicas específicas que atendiam aos requisitos da técnica. Seis implantes foram instalados lateralmente ao canal mandibular por vestibular e foram restaurados após o tempo de cicatrização de pelo menos dois meses. A média da avaliação de seguimento do implante foi de 3 anos. Nenhum implante foi perdido e todos eles atenderam às exigências estéticas e funcionais da oclusão, estando em ótimas condições clínicas. Conclusão: A técnica mostrou-se minimamente invasiva, segura, conservadora e eficaz como alternativa de tratamento para reabilitação dentária em regiões posteriores de mandíbula com atrofia óssea severa. Entretanto, ela requer experiência, preparo e habilidade do profissional que visa não lesionar o nervo alveolar inferior e, ao mesmo tempo, instalar corretamente o implante em uma posição que permita sua restauração funcional e estética.

Alendronate improves bone density and type I collagen accumulation but increases the amount of pentosidine in the healing dental alveolus of ovariectomized rabbits.

BACKGROUND: It has been shown that the oral aminobisphosphonate sodium alendronate (ALN) therapy reduces the risk of main fractures in osteoporotic women, but its effect on the jaw bones is poorly known. Here, we hypothesized that ALN affects the newly formed alveolar bone, particularly the quality of the type I collagen cross-linking. METHODS: Osteoporosis was induced by ovariectomy (OVX) in 6-month old rabbits. Six weeks following surgery, eight animals were treated by oral gavage with ALN (OVX + ALN) and ten received placebo (OVX + Pbo). Another six rabbits which were sham operated also received placebo (SHAM + Pbo). One month following the beginning of treatment, the upper and lower left first premolars were removed. Six weeks later, the upper and the lower right first premolars were also extracted. One month after the second extraction, biopsies were collected from the maxillary extraction sites and collagen crosslinks were analyzed in the newly formed bone tissue by HPLC. Also, at this time, mandibular bone segments were subjected to µCT. RESULTS: Animals treated with ALN achieved a roughly 2-time greater bone volume fraction value at a late healing period than animals in the other groups (p < 0.05). Collagen mean results were 2- to 4-times superior in the OVX + ALN group than in the control groups (p < 0.05). ALN-treated animals presented higher amounts of the non-enzymatic collagen cross-link pentosidine (PEN) than the sham-operated rabbits (p < 0.05), whereas the OVX + Pbo group presented the highest amount of PEN (p < 0.05). CONCLUSION: Alendronate increases bone volume and collagen accumulation, but does not fully rescue the non-osteoporotic alveolar tissue quality as is evident from the increased quantity of pentosidine.

Efeito do alendronato de sódio na cicatrização óssea alveolar pós-extração dentária em coelhas osteoporóticas / Effect of alendronate sodium on post-extraction alveolar bone healing in osteoporotic rabbits

Objetivo: Tem sido mostrado que o aminobisfosfonato oral alendronato de sodio (AL) reduz o risco de fraturas em mulheres osteoporóticas, mas o efeito desta terapia nos ossos maxilares ainda é controverso. O objetivo foi testar a hipótese de que a terapia anti-osteoporótica com AL afeta a qualidade do osso alveolar neoformado após extração dentária, em especial o padrão de reticulação do colágeno tipo I. Métodos: Osteoporose foi induzida por ovariectomia (OV) em coelhas com 6 meses de idade (Oryctolagos cuniculus). Seis semanas após a cirurgia, oito animais foram tratados por gavagem com AL (OV+AL) e dez receberam placebo (OV+PL). Seis coelhas que foram submetidas a operação de simulação (SH) também receberam placebo (SH+PL). Um mês após o início do tratamento, os dentes #34 e #24 foram removidos. Seis semanas mais tarde, os dentes #14 e #44 foram extraídos. Um mês após a segunda extração, biópsias foram coletadas com uma trefina dos sítios em reparo do dente #34 (cicatrização inicial) e do #14 (cicatrização tardia) e submetidas a cromatografia líquida de alta eficiência para quantificação do "crosslink" pentosidina. Parte das biópsias foram submetidas a quantificação do colágeno tipo I por espectrofotometria. Nesse mesmo tempo, segmentos ósseos mandibulares bilaterais, englobando os sítios de extração dos dentes #34 e #44 foram submetidos a microtomografia computadorizada para comparação de volume ósseo entre os grupos. Valores médios foram comparados com ANOVA para medidas repetidas, seguida de teste post-hoc de Tukey. Resultados: Animais tratados com AL alcançaram o maior volume médio de osso neoformado no período de cicatrização tardia (2 vezes OV+PL, p<0,05). Colágeno se acumulou mais no grupo OV+AL em comparação com os grupos controle, tanto na fase inicial quanto na tardia de cicatrização (2-4 vezes, p<0,05). Entretanto, os animais dos grupos OV+PL e OV+AL apresentaram quantidades maiores de pentosidina do que os do grupo SH+PL (p<0,05). Conclusão: A terapia anti-osteoporótica com alendronato de sódio proporciona aumento no volume ósseo e no acúmulo de colágeno tipo I, mas não resgata totalmente a qualidade do tecido alveolar não-osteoporótico, evidenciado pela quantidade aumentada de reticulação colágena não enzimática. (AU)

Objective: It has been shown that the oral aminobisphosphonate sodium alendronate (AL) reduces the risk of main fractures in osteoporotic women, but the effects of this therapy on the jaw bones is still controversial. Our goal was to test the hypothesis that the anti-osteoporotic therapy with AL affects the quality of the post-extraction neoformed alveolar bone, particularly type I collagen crosslinking. Methods: Osteoporosis was induced by ovariectomy (OV) in 6-month old white rabbits (Oryctolagos cuniculus). Six weeks following surgery, eight animals were treated by oral gavage with AL (OV+AL) and ten received placebo (OV+PL). Six rabbits which were sham operated (SH) also received placebo (SH+PL). One month following the beginning of treatment, teeth #34 and #24 were removed. Six weeks later, teeth #14 and #44 were also extracted. One month after the second extraction procedure biopsies were collected with a trephine from the extraction sites of teeth #34 (initial healing) and #14 (late healing), and subjected to High Performance Liquid Chromatography for the quantification of crosslink pentosidine and to spectrophotometer for quantification of type I collagen. Also at this time, bilateral bone segments of the mandible, encompassing the extraction sites of teeth #34 and #44, were subjected to microComputed Tomography for the comparison of bone volume among groups. Mean values were compared with one-way repeated measures ANOVA followed by post-hoc Tukey's test. Results: Animals treated with AL achieved the greatest mean volume of new formed bone at the late healing period (2-times OV+PL, p<0.05). Collagen accumulated significantly more in the OX+AL group compared with the control groups, at both initial and late healing phase (2-4-times, p<0.05). However, OV+PL and OV+AL animals presented higher amounts of the crosslink pentosidine than the SH+PL group (p<0.05). Conclusion: Anti-osteoporotic therapy with sodium alendronate increases bone volume and type I collagen accumulation, but does not fully rescue the nonosteoporotic alveolar tissue quality as is evident from the increased quantity of non-enzymatic collagen crosslink. (AU)

The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis.

PURPOSE: The aim of this study was to systematically review the studies on the association between diabetes mellitus (DM) and destructive periodontal disease. METHODS: The methods applied include a literature search strategy, inclusion and exclusion criteria for selecting the studies, characteristics of the studies, quality assessment and meta-analysis. Data sources included PubMed, EMBASE, SciELO and LILACS. Selected papers were articles relating to human studies investigating whether or not diabetes is a risk factor for periodontitis and if it influences the response to periodontal therapy. Those papers that were published between January 1980 and June 2007 were retrieved. RESULTS: Of the 2440 identified studies, 49 cross-sectional and eight longitudinal studies met the inclusion criteria. Twenty-seven of the 49 cross-sectional studies that are included in this review detected more periodontal disease in diabetic subjects compared with non-diabetic subjects. The greater risk of periodontal disease progression was associated with type 2 DM, and one study associated DM with response to periodontal therapy. Methodological flaws of most of the studies included inadequate control for confounders, insufficient statistical analysis and lack of information about sampling design. Random effect model showed a significant association with clinical attachment level (mean difference = 1.00 [CI 95% = 0.15 to 1.84]) and periodontal pocket depth (mean difference = 0.46 [CI 95% = 0.01 to 0.91]) between type 2 diabetics and non-diabetics. CONCLUSIONS: Type 2 DM can be considered a risk factor for periodontitis. More studies are needed to confirm the harmful effects of type 1 DM on periodontal disease.

A guia anterior no estudo da oclusão / Anterior guidance in the study of occlusion

A guia anterior é a relação dinâmica do contorno lingual dos seis dentes antero-superiores sobre as bordas dos seis antero-inferiores quando estes se tocam na oclusão cêntrica e durante os movimentos protusivos, laterais ou látero-protrusivos normalmente observada na dentição natural. As quatro funções da guia anterior são a incisão de alimentos, fonética, estética, e proteger os dentes posteriores pela desoclusão posterior que realiza durante a mastigação. Dada a sua importância, os autores apresentam vários aspectos importantes da guia anterior no estudo da oclusão, justificando porque ela seja talvez o fator mais importante na reconstrução total ou parcial do sistema estomatognático

A guia anterior no estudo da oclusäo / Anterior guidance in the study of occlusion

A guia anterior é a relaçäo dinâmica do contorno lingual dos seis dentes antero-superiores sobre as bordas dos seis antero-inferiores quando estes se tocam na oclusäo cêntrica e durante os movimentos protrusivos, laterais ou látero-protrusivos normalemnte observada na dentiçäo natural. As quatro funçöes da guia anterior säo a incisäo de alimentos, fonética, estética e proteger os dentes posteriores pela desoclusão posterior que realiza durante a mastigaçäo. Dada a sua importância, os autores apresentam vários aspectos importantes da guia anterior no estudo da oclusäo, justificando porque ela seja talvez o fator mais importante na reconstruçäo total ou parcial do sistema estomatognático