Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study.

Introduction: Immediate placement of implants in a fresh post-extraction socket is an increasingly popular and established treatment option. However, active infection in the extraction site may adversely affect the outcome of this procedure. This study was designed to assess the clinical results of immediate placement of dental implants in infected extraction sockets using a standardized protocol, which included (a) the use of an Er,Cr:YSGG laser for the decontamination of the infected socket prior to implant insertion, and (b) the utilization of an in situ hardening alloplastic bone graft substitute to augment the gap between the implant surface and the labial plate of bone. Patients and Methods: A retrospective record review was used to identify 68 patients who had implants placed as per the described protocol. A total of 126 implants were placed in 68 patients (65 implants in the maxilla, 61 implants in the mandible). The implants were loaded 136 ± 73 days (mean ± standard deviation; range: 37-400 days) after implant placement. Eight patients (16 implants) were subsequently lost to follow up. Results: 105 of the 110 implants (95.45%) placed immediately in the infected sites using the described protocol survived after prosthetic loading. Conclusion: Immediate implant placement in previously infected sites using the protocols mentioned in our study with laser decontamination of the socket, grafting with an in situ hardening alloplastic bone graft material and non-submerged healing shows a similar survival rate to the published success rates for immediate implants placed in non-infected sites.

Minimally Invasive Alveolar Ridge Preservation Utilizing an In Situ Hardening ß-Tricalcium Phosphate Bone Substitute: A Multicenter Case Series.

Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (ß-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that ß-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques.

Bone grafting: history, rationale, and selection of materials and techniques.

In the 100-year history of bone replacement in the human body for different purposes, a wide variety of surgical approaches and materials have been used. The techniques and materials selected significantly affect the outcome of bone replacement procedures in terms of bone formation volume and the quality and amount of vital bone. The choices facing the dental surgeon at the time of extraction, ridge augmentation, or sinus graft are wide-ranging. When choosing a bone graft material the surgeon should consider its ultimate effect on healing patterns in and around the alveolar bone at the endpoint of the procedure. As this article concludes, a better understanding of the materials and the results that can be predictably achieved with them can be valuable to the appropriately trained surgeon when preparing for these procedures.

Extraction site preservation using an in-situ hardening alloplastic bone graft substitute.

This case report highlights the use of an in-situ hardening alloplastic bone grafting material composed of beta-tricalcium phosphate (ß-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) to preserve the dimensions and architecture of the alveolar ridge after atraumatic extraction. This material provided a stable scaffold that, although left uncovered, deterred the ingrowth of unwanted soft tissue, allowing newly formed keratinized soft tissue to proliferate over the healing grafted socket and gradually cover the site. At re-entry after 4 months adequate newly formed bone was observed, allowing for the correct positional placement of an implant. The results of this case suggest that an in-situ hardening alloplastic grafting material can be successfully utilized with minimally invasive procedures to preserve the bone and the soft-tissue profile of the alveolar ridge for future implant rehabilitation.

Biological response to ß-tricalcium phosphate/calcium sulfate synthetic graft material: an experimental study.

PURPOSE: The aim of this study was to evaluate the effect of a biphasic synthetic bone graft material composed of ß-tricalcium phosphate (ß-TCP) and calcium sulfate (CS) in 12 New Zealand rabbits. MATERIALS AND METHODS: A circular bicortical critical-size cranial defect was created in each of 12 rabbits. The defects were grafted with ß-TCP/CS. Animals were euthanized at 3 and 6 weeks. Harvested tissue specimens were evaluated histologically and histomorphometrically. Parameters associated with new bone formation and graft resorption were measured and calculated. The results were statistically analyzed using the Mann-Whitney test. RESULTS: Our data demonstrated the biocompatibility of synthetic ß-TCP/CS, as no inflammatory response was observed, and no fibrosis was developed between the graft particles and the newly formed bone. Moreover, ß-TCP/CS acted as an osteoconductive scaffold that allowed a significant bone regeneration and graft biodegradation with time. CONCLUSION: In this animal model, synthetic ß-TCP/CS proved to be a biocompatible, osteoconductive, and bioresorbable bone graft substitute.

Experimental study of the effect of autologous platelet-rich plasma on the early phases of osteoinduction by allogenic demineralized bone matrix.

PURPOSE: To evaluate the effect of autologous platelet-rich plasma (PRP) on the early phases of osteoinduction by allogenic demineralized bone matrix (DBM) in rabbit intramuscular positions. MATERIALS AND METHODS: Allogenic DBM was produced from bones of 3 healthy rabbits. In each of 6 experimental animals, 0.3 mL autologous PRP was prepared and 2 muscle pouches were created, where 250 mg DBM + PRP (experimental sites) and 250 mg DBM without PRP (control sites) were randomly implanted. Animals were euthanized 3 weeks postoperatively. RESULTS: Histologic examination revealed uneventful healing in all cases, whereas remineralization of the periphery of the bone graft particles was a constant finding. In both control and experimental sites, fibroblasts and other mesenchymal cells (probably osteoprogenitor cells and preosteoblasts) were observed. The main histological difference was the recolonization of the empty lacunae of the bone graft particles by osteocytes at the control sites. The degradation of the graft at the control sites was statistically significantly quicker, although a statistically significant difference regarding the amount of the newly formed fibrous connective tissue was not observed. CONCLUSION: The present study demonstrated that in this experimental model, the addition of PRP to DBM had a negative effect on the early phases of osteoinduction at 3 weeks of observation.

Osteogenic activity of ß-tricalcium phosphate in a hydroxyl sulphate matrix and demineralized bone matrix: a histological study in rabbit mandible.

Currently, in oral and maxillofacial surgery, there is a clinical need for efficient bone grafting materials, and various efforts are being made to improve materials used as bone substitutes to facilitate faster and denser bone regeneration. The purpose of this study was to evaluate in vivo the osteogenic potential of synthetic ß-tricalcium phosphate in a hydroxyl sulphate matrix (ß-TCP/HS) and human demineralized bone matrix (DBM) putty. Sixteen New Zealand White rabbits were used. In each animal, two bone defects (8 mm length × 3 mm width × 3 mm depth) were created in the left and right regions of the mandible, respectively. The defect on one side, chosen randomly, was filled with ß-TCP/HS (group A) or DBM putty (group B), while the defect on the opposite side was left unfilled in order to serve as a control site. Two animals in each group were sacrificed at the end of the 1st, 3rd, 5th and 6th week after surgery, respectively, and the osteotomy sites were processed for histological evaluation. Our findings confirmed that ß-TCP/HS and human DBM putty possess osteogenic activity and can support new bone formation, although at a slower rate than the spontaneous healing response, in rabbit mandibular osseous defects.

Sinonasal myxoma in an infant.

Myxomas of the maxillofacial region are neoplastic entities of mesenchymal origin most often associated with odontogenic origin; sinonasal myxoma is rare, located in the nasolabial region and originating from the sinonasal tract. The aim of the current study was to report a well-documented case of sinonasal myxoma in a 12-month-old boy, initially presenting with obliteration of his left nasolacrimal duct. A soft-tissue mass of the nasobuccal groove, firmly attached to the underlying bone, was revealed. After biopsy where benign fibroblastic elements were found, the tumor was removed surgically in wide margins, whereas great care was taken to reconstruct the involved adjacent anatomic structures and preserve facial aesthetics. Histopathologic findings were compatible with an extragnathic, nonodontogenic sinonasal myxoma originating from the nasolacrimal duct. The clinical significance of the case presented was its rather rare location and origin. Three and a half years postoperatively, functional and aesthetic results were satisfactory with no sign of recurrence. To the authors' knowledge, this is the second youngest reported case in the literature.

Peripheral osteoma of the maxillary alveolar process.

Osteoma is a benign, slow-growing tumor characterized by proliferation of compact or cancellous bone. Solitary osteomas are classified as peripheral, central, or extraskeletal. Peripheral osteomas of the oral cavity are unusual and the maxilla is rarely affected. They manifest as asymptomatic, fixed tumors of bony-hard consistency that may be sessile or pedunculated. Radiographically, a well-circumscribed round or oval radiopaque mass is seen that is microscopically composed of cancellous or trabecular bone. A case of a compact, peripheral osteoma arising from the buccal plate of the alveolar ridge of the maxilla in a 64-year-old patient is presented. According to our literature review, this is the seventh case reported in the maxillary ridge.

Localized jaw enlargement in renal osteodystrophy: report of a case and review of the literature.

Renal osteodystrophy is a common long-term complication of end-stage renal disease. Involvement of the jaws is common and radiographic alterations are often one of the earliest signs of chronic renal disease. However, marked enlargement of the jaws is a rare complication of renal osteodystrophy. A case of localized asymptomatic enlargement of the mandible in a 38-year-old woman with chronic renal failure is presented. The clinical, radiographic, and histological findings were consistent with renal osteodystrophy. To our knowledge, this is the third case of localized mandibular enlargement of renal osteodystrophy reported in the English-language literature.