A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Management Comparing a Wound Dressing and a Soft Tissue Substitute.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial.

BACKGROUND: The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation. METHODS: A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient-reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6-month end point results were followed for 1 year. RESULTS: Thirty patients received control and test therapies, and all patients were available for follow-up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87% versus 70.7% ± 28.26% for VCMX+CAF, P <0.0001. Both therapies produced significant soft tissue volume increases (84.8 ± 47.43 mm3 control versus 48.90 ± 35.58 mm3 test, P = 0.0006). The test, harvest graft substitute produced less postoperative pain and was preferred by patients at the 6-month end point. All other end point measures were not significantly different. CONCLUSIONS: VCMX+CAF root coverage was inferior to CTG+CAF but produced less morbidity and was preferred by patients. Case/patient selection and surgical technique appear key to achieving successful results with the harvest graft alternative.

Retrospective Study to Determine Patient Satisfaction of Immediately Placed and Provisionalized Implants in the Esthetic Zone From a US Private-Practice Research Network.

BACKGROUND: Immediately placed/immediately restored dental implants in the esthetic zone are judged by not only their functional success but also the appearance and acceptance of the restorative outcome. The purpose of this study was to retrospectively evaluate in a private-practice setting the satisfaction of both patients and doctors regarding immediately placed/immediately restored implants in the esthetic zone. METHODS: The author group consists of nine board-certified periodontists. Each private practice contributed to the patient population of this study through a primarily referral-based source. In a 6-month period, practices evaluated patients who were candidates for dental implant replacement with teeth Nos. 5 through 12 scheduled for extraction. All patients received informed consent and were asked if their data could be used with a visual analog scale (VAS) they graded. Pretreatment and 6-month post-final restoration loading was compared for statistically significant changes in reference to crestal bone changes, papilla index score (PIS), facial gingival margin stability (FGMS), and investigator/patient esthetic evaluations using a VAS. RESULTS: Thirty-five patients were included in the study with a total of 35 implants placed and 32 restored with a final restoration. Implants were followed for an average of 15.4 months prior to reporting. A total of three failures were encountered. The PIS resulted in an average score of 2.7. VAS resulted in an average score of 9.3 by the surgeons and 9.5 by the patients. The FGMS accounted for 76% of the implants with no change, 15% demonstrating recession, and 9% demonstrating coronal migration. CONCLUSIONS: Immediately placed and immediately temporized implants in the esthetic zone demonstrated a successful outcome that was highly acceptable to patients in private-practice settings from a diverse group of private periodontal practices.

A randomized, controlled, multicentre clinical trial of post-extraction alveolar ridge preservation.

AIM: To compare the effectiveness of two-ridge preservation treatments. MATERIALS AND METHODS: Forty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross-linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post-operatively, and biopsies were retrieved for histomorphometric analysis at 6 months. RESULTS: Primary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty-seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites. CONCLUSION: DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.

Complete transition from failing restorations to implant-supported fixed prostheses in a patient with scleroderma.

In a case involving a patient with scleroderma, the authors demonstrate how to treatment plan and sequence the transition from a failing restored dentition to complete implant-supported fixed prostheses with sequential extractions and implant placements. The article also presents surgical and prosthodontic considerations for a complete-mouth implant-supported fixed rehabilitation while achieving optimal esthetics without compromising function in patients with this condition. Sequential treatment provided the patient with fixed provisional restorations during treatment in multiple, short surgical appointments with less psychosocial trauma. This case posed treatment challenges due to limited oral access, unpredictable disease progression, and limited data on the success of treatment with endosseous dental implants in these patients.

Effect of implant surface and grafting on implants placed into simulated extraction sockets: a histologic study in dogs.

PURPOSE: To study bone healing at implant sites in simulated extraction sockets with 1-mm marginal defects and compare healing around a turned surface (T) to that around a porous oxide surface prepared by anodic oxidation (AO) with or without the use of an autogenous bone graft. MATERIALS AND METHODS: All mandibular premolars and first molars were extracted from 10 mongrel dogs. After 9 weeks, four sites were prepared on both sides of all mandibles. Each osteotomy was widened in the coronal 5 mm to create a marginal defect of 1 mm around the implants. Autogenous bone was collected during the drilling procedure. The sites were randomized to receive implants with a T or an AO surface, with or without bone grafting. The animals were sacrificed 4 months after implant placement for histologic analysis. RESULTS: Clinically, all sites healed with complete bone fill. The combination of an AO implant and a bone graft resulted in a significantly greater percentage of bone-to-implant contact (BIC) (P < .05) versus all other groups. The highest point of BIC was achieved with the AO group, which was significantly greater than the lowest group (T). No significant differences between groups were found when the apical 4 mm (non-gap areas) were compared (P = .65). CONCLUSIONS: Studies have demonstrated that bone can fill in a marginal defect around a titanium implant with varied histologic BIC, depending on implant surface type and defect dimensions. Based upon this animal study using 10 mongrel dogs, marginal circumferential defects of 1 mm showed significantly higher BIC values for implants that were prepared by AO compared to implants with a turned surface. The addition of autogenous bone grafts further enhanced the degree of BIC.

Sequencing patients to implant-supported, full-mouth reconstructions: a case report.

UNLABELLED: Patients presenting with debilitated dentitions are often excellent candidates for implant-supported reconstructions. Their existing teeth, even if compromised structurally, help preserve the ridge anatomy and can be used to support fixed, interim prostheses. While the result is often a straightforward, treatment-planning decision, the diagnosis and interim stages of sequential extraction cases leave numerous decisions to be made. The authors' goal is to highlight some of the major treatment planning decisions that need to be made for the interim portion of sequential extraction treatment. LEARNING OBJECTIVES: This article describes several of the treatment-planning decisions that clinicians must consider when preparing to treat the partially edentulous patient with implant therapy. Upon reading this article, the reader should be able to: Understand the various transitional approaches used to convert a patient from a tooth- to an implant-supported restoration. Identify the steps involved in the sequential extraction of failing teeth.