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.

Performance of a multiphase bioactive socket plug with a barrier function for alveolar ridge preservation.

The natural healing process of extraction socket and traditional socket plug material could not prevent buccal bone wall resorption and down growth of epithelium from the socket orifice. A multiphase bioactive socket plug (BP) is designed to overcome the natural healing process by maintaining the three-dimensional (3D) volume of extraction sockets, particularly in sockets with wall defects, and later provide sufficient alveolar bone volume for implant placement. The study aimed to fabricate and evaluate the physical, chemical, and biological performance of BPin vitro. The BP was fabricated through freeze-drying and layer-by-layer assembly, comprised of a base serving as a scaffold, a central portion for promoting bone regeneration, an upper buccal portion for maintaining alveolar socket dimension with a covering collagen membrane (Memb) on the top and upper buccal surface to prevent soft tissue infiltration. The BP as the experimental group and a pure collagen plug (CP) as the control group were investigated and compared. Radiograph, scanning electron microscopy, and energy-dispersive spectroscopy mapping confirmed that the four-part BP was successfully assembled and fabricated. Swelling rate analysis indicated that BP, CP, and Memb reached swelling equilibrium within 1 hour. BP exhibited a high remaining weight percentage in collagenase solution (68.81 ± 2.21% on day 90) and sustained calcium ion release, reaching the maximum 0.13 ± 0.04 mmol l-1on day 14. In biological assays, BP exhibited excellent cell proliferation (The OD value increased from 0.02 on day 1 to 0.23 on day 21.). The BP group exhibited higher alkaline phosphatase activity and osteocalcin content than the CP group within 21 days. Memb and BP exhibited outstanding barrier function, as evidenced by Hematoxylin and eosin staining. In summary, the multiphase bioactive socket plug represents a promising scaffold for alveolar ridge preservation application.

Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial.

OBJECTIVE: To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS: Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS: The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION: The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE: These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

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.

Microbial colonization in the partially exposed nonabsorbable membrane during alveolar ridge preservation.

AIM: This study evaluated the impact of the partial exposition of the nonabsorbable membrane (dPTFE) on microbial colonization during bone healing. MATERIALS AND METHODS: Patients indicated for tooth extraction were randomized to dPTFE group (n = 22) - tooth extraction and alveolar ridge preservation (ARP) using an intentionally exposed dPTFE membrane and USH group (n = 22) - tooth extraction and unassisted socket healing. Biofilm samples were collected at the barrier in the dPTFE and on the natural healing site in the USH after 3 and 28 days. Samples from the inner surface of the dPTFE barrier were also collected (n = 13). The microbiome was evaluated using the Illumina MiSeq system. RESULTS: Beta diversity was different from 3 to 28 days in both groups, and at 28 days, different microbial communities were identified between therapies. The dPTFE was characterized by a higher prevalence and abundance of gram-negative and anaerobic species than USH. Furthermore, the inner surface of the dPTFE membrane was colonized by a different community than the one observed on the outer surface. CONCLUSION: Intentionally exposed dPTFE membrane modulates microbial colonization in the ARP site, creating a more homogeneous and anaerobic community on the inner and outer surfaces of the membrane. CLINICAL RELEVANCE: DPTFE promoted faster biofilm colonization and enrichment of gram-negative and anaerobes close to the regenerated site in the membrane's inner and outer surfaces. dPTFE membrane can be used exposed to the oral site, but approaches for biofilm control should still be considered. The study was retrospectively registered at Clinicaltrials.gov (NCT04329351).

Comparison of Immediate Implantation into the Socket with and without Periapical Pathology: Systematic Review and Meta-Analysis.

Background and Objectives: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets with and without periapical pathology. Materials and Methods: After the search and review of the literature in the electronic databases, 109 publications were achieved. The titles and abstracts of 66 publications were screened. After the evaluation of the full text of 22 publications, based on the inclusion criteria, six controlled clinical studies were included in this systematic review and meta-analysis. Results: The statistical calculation showed no heterogeneity among the studies included. The implant survival was 99.6% in the test (socket with periapical pathology) and control (socket without periapical pathology) groups of all the clinical trials. The results of the meta-analysis showed no statistically significant difference between test and control groups regarding the marginal bone level and the width of keratinized mucosa in all the studies. Other parameters indicating plaque level, bleeding on probing, and gingival recession also did not differ between test and control groups at the final follow-up in nearly all studies. Conclusions: Within the limitation of this systemic review and meta-analysis, the obtained data suggest that implants immediately placed into the extraction sockets of teeth exhibiting periapical pathology can be successfully osseointegrated for an extended period.

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.

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.

Dynamic analyses of a soft tissue-implant interface: Biological responses to immediate versus delayed dental implants.

AIM: To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around 'immediate' and 'delayed' implants. MATERIALS AND METHODS: Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri-implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control. RESULTS: No differences were observed in the rate of soft-tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft-tissue integration indicated an initially disorganized peri-implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri-implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri-implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction. CONCLUSIONS: Within the timeframe examined, quantitative analyses showed that connective tissue maturation never reached that observed around teeth. Hemidesmosomal attachment protein expression levels were also significantly reduced compared to those in an intact JE, although quantitative analyses indicated that macrophage density in the peri-implant environment was reduced over time, suggesting an improvement in PIE barrier functions. Perhaps most unexpectedly, maturation of the peri-implant soft tissues was a significantly slower process than osseointegration.

Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.

AIM: The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. MATERIALS AND METHODS: A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. RESULTS: Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. CONCLUSION: The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. CLINICAL SIGNIFICANCE: Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

[Dynamic monitoring and esthetic evaluation of dimensional changes in the peri-implant soft tissue contour after the immediate implant placement and provisionalization with the modified socket-shield technique in the esthetic zone].

Objective: To accurately measure the dynamic changes of peri-implant soft tissue within one year after the immediate implant placement and provisionalization with the modified socket-shield technique (MSST) in the esthetic zone, and to provide a basis for evaluating the effect of the modified socket-shield technique on the maintenance of peri-implant soft tissue. Methods: A total of 22 patients (22 implants) were prospectively included 1 year after completion of immediate implant placement and provisionalization (IIPP) within MSST in the esthetic zone from January 2022 to January 2024 at the Department of Oral Implantology in the Stomatological Hospital of Chongqing Medical University. The intraoral optical models of patients were obtained by an intraoral scanner system preoperatively and at 3, 6, and 12 months postoperatively, respectively. The standard tessellation language files of intraoral optical models at multiple time points were imported to Geomagic Studio 2013 to be superimposed and aligned for analyzing the peri-implant soft tissue contour on the labial side of the implant site at multiple levels. The amount of gingival margin recession, gingival papilla change, and thickness change of the labial side of the soft tissues at each postoperative point in time were measured at each postoperative time point, as well as evaluating the esthetic effect by the pink esthetic score (PES). Results: The patients were (40±13) years old (21-75 years), including 9 males and 13 females. No adverse events occurred in all the implants during the 12-month follow-up period. The recession level of the gingival margin of the implant site (GL) was 0.08 (0.07) mm, the recession level of the mesial papilla (ML) was 0.19 (0.25) mm, and the recession level of the distal papilla (DL) was 0.19 (0.10) mm. The average collapse thickness of the soft tissue contour on the labial side of the implant (ΔD) was (0.39±0.09) mm, mainly occurring within 2 mm of the root of the gingival margin. The height of the alveolar bone was reduced by (0.17±0.08) mm. The thickness of the labial alveolar bone at 1, 3, and 5 mm root side of the implant shoulder was reduced by (0.13±0.08), (0.12±0.10) and 0.04 (0.17) mm, respectively. The postoperative pink esthetic score was 13.00 (2.25) points at 12 months, which suggested that all implant sites achieved ideal esthetic results. Conclusions: The labial soft tissue contour at implant sites shows minimal change following immediate implant placement and provisionalization using the modified socket-shield technique for 1 year in the esthetic zone.

Histological Evaluation of Alveolar Ridge Preservation Using Different Bone Grafts: Clinical Study Analysis Part II.

To compare histologically the percentage of bone formation 12-20 weeks after ridge augmentation using 2 different techniques. Tooth loss is associated with 3-dimensional bone remodeling and ridge atrophy. Ridge preservation procedures can prevent alveolar bone volume loss. Different techniques and materials are used to preserve the alveolar ridge. Computer-generated randomization software was used to assign 2 ridge preservation techniques for 11 extraction sites. In group I, type I bovine Achilles tendon collagen plugs with bioactive resorbable calcium apatite crystals (CPCAC) were placed, and in group II, cortico-cancellous bone chips (CCBC) mix and an expanded polytetrafluoroethylene (ePTFE) barrier membrane were placed. The histomorphometric studies were performed using a computer-based image analysis system (ImageJ 1.4, National Institute of Health, Bethesda, Md) to calculate the pixel area of bone tissue and the remaining bone graft material. The histomorphometric data were analyzed using a Student t test to compare the measurements between the 2 experimental groups. This parametric statistical test was employed to determine if there were any statistically significant differences in the quantitative histological parameters between the groups. The sockets that received CPCAC showed a lower (31.89%) percentage of native bone surface area compared with the CCBC group (43.87%). However, the difference was not statistically significant (P < .05). In addition, the CPCAC group showed evidence of foreign-body reaction. The CCBC graft covered with an ePTFE barrier may induce more bone formation with minimal inflammation in an extraction socket compared with a collagen plug with calcium apatite crystals. In addition, histological analysis of the CPCAC graft showed evidence of foreign-body reaction, which indicates a negative clinical impact.

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.

Learn, unlearn, and relearn post-extraction alveolar socket healing: Evolving knowledge and practices.

OBJECTIVE: This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular events during alveolar socket healing, ii) the dimensional ridge alterations after socket healing and controversies relating to sinus pneumatisation, iii) the patient-specific factors, procedural elements, and site-related variables influencing socket healing, iv) techniques and effectiveness of alveolar ridge preservation (ARP) procedure, and v) the philosophies and cost-effectiveness of ARP in clinical practice. SOURCES AND STUDY SELECTION: To investigate the dimensional profiles of the alveolar ridge following unassisted healing, an overview of systematic reviews was conducted in February 2024 by two independent reviewers. Four electronic databases were searched in Pubmed, Embase, Web of science and Cochrane Library between 2004 and 2024 to identify all relevant systematic reviews on post-extraction healing. A further manual search of reviews was also conducted. The articles were further reviewed in full text for relevance. The AMSTAR-2 appraisal tool was adopted to assess methodological quality. Current research pertaining to other listed objectives was objectively analysed in narration. DATA: 11 out of 459 retrieved studies were selected and ultimately covered in this review on the dimensional changes of alveolar ridge following natural healing: Seven systematic reviews and four systematic reviews with meta-analyses. The methodological quality of all included reviews was critically low. CONCLUSION: This review thoroughly examines the healing profiles of post-extraction alveolar sockets and highlights the dynamic process with overlapping phases and the inter-individual variability in outcomes. ARP procedure is a potential strategy for facilitating prosthetic site development, while the current evidence is limited. Herein, an individualised and prosthetically driven approach is crucial. Further well sized and designed trials with novel biomaterials need to be undertaken, and the role of artificial intelligence in predicting healing and assisting clinical decision-making could be explored. CLINICAL SIGNIFICANCE: By advancing our understanding of alveolar socket healing and its management strategies, clinicians can make more informed decisions regarding patient and site level assessment and selection, surgical techniques, and biomaterial choices, ultimately contributing to the enhanced healing process with reduced complications and improved quality of life for patients undergoing tooth extraction and dental implant treatments.

A Modified Socket-Shield Technique: Simplifying the Root Sectioning Process.

Socket wall resorption leading to a loss of surrounding bone following tooth extraction has been documented in the dental literature. The use of various socket-shield techniques has been suggested as a solution to this issue. In these approaches, the tooth root is sectioned in two, and the coronal two-thirds of the buccal root is preserved in the socket. This allows the periodontium along with the bundle and buccal bone to remain intact, thus preventing or minimizing bone remodeling. According to the literature, this procedure is highly technique sensitive, especially when it comes to sectioning the root. Additionally, the procedure requires significant time, and several complications may occur, such as fenestration or luxation of the remaining root, requiring its complete extraction. This case report presents a modified socket-shield technique using a trephine bur guided by a computer-designed surgical guide to simplify root sectioning, thus reducing surgical time while increasing predictability of the outcome.

Histologic wound healing in studies using different ridge preservation protocols: A review.

BACKGROUND: Alveolar ridge preservation (ARP) procedures are designed to lessen dimensional changes in the alveolar ridge after tooth extraction. Wound healing after ridge preservation involves the formation of new vital bone in the former socket, and this vital bone is important in the osseointegration of dental implants. METHODS: A series of ARP studies have been performed to help clinicians better understand the wound-healing events that occur following tooth extraction and ridge preservation. Different protocols have been examined using various materials and periods of healing time prior to implant placement. The primary aim of these studies was to ascertain the relative percentage of vital bone formation, residual graft material, and connective tissue (CT)/other at the healing site using histomorphometric examination of bone core biopsies obtained during osteotomy preparation. RESULTS: For allografts, the use of demineralized bone alone or in combination with mineralized is associated with more vital bone formation than the use of mineralized allograft alone. For mineralized allografts, the use of cortical versus cancellous bone has only minimal impact on new bone formation. Xenografts from bovine and porcine sources appear to have similar vital bone formation. Longer healing times prior to implant placement are associated with increased vital bone formation and decreased residual graft material. The most stable component in most studies is the percentage of CT/other. CONCLUSIONS: The percentage of vital bone and residual graft at ARP sites is dependent on the materials used and the length of healing time prior to obtaining core biopsies. KEY POINTS: What factors may affect the amount of new bone at the ARP site? At a time point about 4 months after ARP, the type of graft material used for ARP plays a large role in new bone formation. Studies focus on means and standard deviations, but patients often do not "follow the mean." Even if a single ARP protocol is used for all patients, there is great interindividual variability in new bone formation, and there is often variability between sites within a single patient. How long after ARP with an allograft should I wait to place an implant? Longer healing times such as 4-5 months generally provide higher amounts of vital bone formation than shorter healing times like 2-3 months. Differences in vital bone formation between ARP protocols tend to decrease with longer healing time. FDBA that contains demineralized bone, either alone or combined with mineralized FDBA, often provides higher amounts of new bone formation than 100% mineralized allograft, especially at shorter healing periods. Even a year after ARP with an allograft, residual graft material is often still present at the ARP site.

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.

[A prospective cohort study on the effect of implant restoration following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis].

Objective: To evaluate the survival rate, success rate, soft tissue conditions and marginal bone level changes of implants following micro crestal flap-alveolar ridge preservation at molar extraction sockets with severe periodontitis, compared to natural healing. Methods: From March 2015 to January 2017, patients scheduled for molar extraction as a consequence of severe periodontitis and planned implant-retained prostheses from Department of Periodontology Peking University School and Hospital of Stomatology were selected. A total of 40 molar extraction sockets from 40 patients received implant placement following micro crestal flap-alveolar ridge preservation or natural healing. The front consecutive 20 teeth were assigned to the natural healing group, and the back ones were assigned to the micro crestal flap-alveolar ridge preservation (MCF-ARP) group. The superstructures were placed 6 months later. Within 2 weeks (baseline) and 1, 2 and 3 years after implant crown restoration, modified plaque index, probing depth, modified bleeding index and keratinized tissue width were recorded every six months. Parallel periapical radiographs were taken to evaluate the peri-implant marginal bone level and to calculate marginal bone loss. Independent sample t test or Mann-Whitney U test were used to compare the differences in the above clinical and imaging indicators between the two groups. Results: The implant survival rate and success rate of the two groups were both 100% (20/20). There were no significant differences in the modified plaque index, probing depth, modified bleeding index, buccal keratinized tissue width and marginal bone loss between two groups at 1, 2 and 3 years after implant crown restoration (all P>0.05). Marginal bone loss was 0.22 (0.14, 0.34) mm in the natural healing group and 0.21 (0.12, 0.30) mm in the MCF-ARP group at a 3-year post-loading evaluation. Conclusions: Within the limitations of the present study, implants placed at ridge preserved and naturally healed molar extraction sockets with severe periodontitis demonstrate comparable clinical outcomes at a 3-year post-loading evaluation.

[Healing effect of photodynamic therapy on extraction sockets of periodontally compromised teeth: a randomized, controlled, superiority clinical trial].

Objective: To evaluate the effects of photodynamic therapy (PDT) in extraction sockets of periodontally compromised molars on soft tissue healing, postoperative pain, bone density and bone height changes. Methods: This study is a single-center, single-blind, randomized controlled superiority clinical trial. Thirty-eight periodontally compromised molars requiring extraction in patients attending the Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, from December 2022 to September 2023 were included, and randomly assigned to PDT group and control group. The control group received routine debridement after extraction, while PDT group received routine debridement followed by PDT. The bucco-lingual and mesio-distal wound distances at 7 and 14 d after extraction were measured, and then the wound closure rates were calculated. Evaluating the soft tissue healing indexes at 7 and 14 d after extraction. The visual analogue scale was used to assess the pain level at 6 h, 1 d, 2 d, and 3 d after tooth extraction. Apical radiographs were taken immediately and 2 months after extraction in order to compare the changes of the bone density and height. Results: The wound closure rate at 1 week was (78.08±5.45)% in PDT group and (71.03±6.82)% in control group, with significant differences (P<0.01). The wound closure rate at 2 weeks in PDT group [(85.88±3.84) %] was significantly higher than that in the control group [(81.66±3.79) %] (P<0.01), but did not reach the superiority value of the superiority test (superiority value=10%, 95%CI at 1 week: 3.00%-11.12%, 95%CI at 2 weeks: 1.71%-6.73%). The soft tissue healing index of PDT group at 1 week was significantly better than the control group (P<0.05), but there was no significant difference between the two groups at 2 weeks (P>0.05). There was no significant difference between the two groups in terms of postoperative pain at 6 h, 1 d, 2 d and 3 d as well as in bone density and height changes at 2 months after tooth extraction (P>0.05). Conclusions: PDT could promote soft tissues healing to some extent, but did not provide additional assistance in the healing of extraction sockets of periodontally compromised teeth. PDT did not show benefits on postoperative pain, changes of the bone density and bone height after tooth extraction.