Peri-implantitis Diagnosis and Prognosis Using Biomarkers: A Systematic Literature Review.

PURPOSE: To summarize the latest scientific literature regarding the concentrations of biomarkers in saliva and peri-implant crevicular fluid (PICF) of healthy implant (HI) patients and patients with peri-implant mucositis (PIM) and peri-implantitis (PI). MATERIALS AND METHODS: The literature review was performed according to PRISMA guidelines. The databases used were PubMed MEDLINE, ScienceDirect, and Cochrane Library. A combination of keywords was used, and selection criteria were applied. Selected articles were published between February 1, 2017, and February 1, 2022, written in English, conducted in humans, and examined the levels of saliva and PICF biomarkers in PI patients and compared them to HI/PIM patients. RESULTS: A total of 16 publications were selected, involving a total of 1,117 patients with 1,346 implants. Qualitative analysis revealed 49 different biomarkers, the levels of which were compared between groups. After evaluating the most frequently studied biomarkers, significantly higher values of IL-1ß, RANKL, sRANKL, IL-6, TNF-α, TNFSF12, MMP2, and MMP8 levels were observed in the PI group than in the HI group. CONCLUSIONS: Of all 49 biomarkers evaluated, IL-1ß and RANKL have potentially the highest diagnostic significance in the assessment of peri-implant inflammatory conditions, as differences were observed between all three groups (HI < PIM < PI), but data from current publications were not fully sufficient to provide strong evidence.

Differences in Titanium, Titanium-Zirconium, Zirconia Implants Treatment Outcomes: a Systematic Literature Review and Meta-Analysis.

Objectives: The objective of this systematic review is to test the hypothesis that treatment with titanium, titanium-zirconium and zirconia dental implants has different clinical outcomes in survival rate, marginal bone loss, bleeding on probing, plaque control record, and probing depth. Material and Methods: A systematic electronic search through the PubMed (MEDLINE) and Cochrane Library databases was performed to identify studies published between January 1, 2013 and January 1, 2023 containing a minimum of 10 patients per study comparing titanium (Ti), titanium-zirconium (Ti-Zr), and zirconia (Zr) dental implants. Ti, Ti-Zr, and Zr dental implant clinical outcomes were determined by evaluating survival rate, marginal bone level, bleeding on probing, probing depth, plaque control record. Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool. Results: A total of 1361 articles were screened, with 10 meeting the inclusion criteria and being utilized for this systematic review and meta-analysis. A total of 301 patients with 637 implants (304 Ti, 134 Ti-Zr, and 199 Zr) were evaluated, showing a survival rate of 97.7% for Ti, 98.6% for Ti-Zr, and 93.8% for Zr implants respectively. In a meta-analysis, no difference in marginal bone level was found between Ti, Ti-Zr, and Zr implants (P = 0.84). Conclusions: Dental implant survival rate was lower in zirconia group. Assessment of marginal bone loss and bleeding on probing showed better results with titanium-zirconium dental implants. Plaque control result was similar in all groups. Due to limited sample size assessed it was not possible to obtain conclusion on probing depth parameter.

Assessment Results of Dental Students' Knowledge about Bisphosphonates and Bisphosphonate-Related Osteonecrosis of the Jaw.

Objectives: The aim of this cross-sectional study is to evaluate Lithuanian fourth- and fifth-year dental students' knowledge about bisphosphonates and bisphosphonate-related osteonecrosis of the jaw. Material and Methods: The anonymous survey using a questionnaire was conducted from February to March 2022. The survey was sent to 173 students at Lithuanian University of Health Sciences (LSMU) and 107 of them were completed. It consisted of student data, questions about the main properties of bisphosphonates, bisphosphonate-related osteonecrosis of the jaw (BRONJ), and the necessity of additional studies for students. Chi-square test and Cramér's V coefficient were used for the analysis of variables. Results: Most of the fifth-year students knew the main properties of bisphosphonates and what diseases they are used to treat. Twenty fifth-year students (33.9%) knew the accurate definition of BRONJ, while only 11 fourth-year students (22.9%) chose the same correct answer. Statistically significant (P < 0.05) data were found about the knowledge of main properties of bisphosphonates. The vast majority of fourth- and fifth-year students (39 [81.3%] and 45 [76.3%]), agreed that the University should provide more information about bisphosphonates. Conclusions: The study revealed that fifth-year students demonstrated better knowledge about bisphosphonates compared to fourth-year students and this was due to a curriculum supplemented with information about this pathology. The overall findings of this research suggest that Universities need to expand their student curricula by providing more knowledge about bisphosphonates and its relation to bisphosphonate-related osteonecrosis of the jaw.

The Use of Autogenous Teeth Tissues Grafts for Alveolar Bone Reconstruction: a Systematic Review.

Objectives: Enough bone around the implant is an important factor in ensuring the stability and longevity of the implant. Therefore, alveolar bone regeneration procedures are often required. A relatively new bone substitute is made from autogenous teeth. There are more and more studies in the scientific literature that perform regenerative alveolar bone procedures using autogenous tissues substitutes made from extracted teeth. The objective of this systematic literature review is to systematize information and present conclusions about the effectiveness of this regenerative material. Material and Methods: Scientific articles were selected using the PRISMA recommendations. Publications have been carried out since January 1, 2012 to January 1, 2022. The review includes articles in English, clinical studies in humans who underwent bone augmentation prior to or during dental implantation using an autogenous teeth tissues substitute. Results: A total of 7 publications were included in this systematic literature review. Summarizing the data of the publications, 258 patients participated in the studies, 240 subjects were included in the results for various reasons, and a total of 298 implants were inserted. No statistically significant results were found in the five studies. Two studies comparing autogenous tooth graft with xenogeneic bone graft and autogenous teeth tissues showed statistically significant positive results in autogenous tooth group. Conclusions: Within the limitations of this study, autogenous tissues graft derived from teeth are an effective material and can be used as an alternative to other bone grafts existing on the market. Further studies with a longer follow-up period are needed to validate these findings.

Dental Implant Placement in Focal Osteoporotic Bone Marrow Defect: a Case Report and Treatment Recommendations.

Background: Focal osteoporotic bone marrow defect is asymptomatic radiolucent area usually discovered incidentally during radiographic examination of the jaws. This bone condition can lead to clinical complications during dental implant placement or during osseointegration process. Methods: A 54-year-old woman was referred to private dental implant centre for a dental implant rehabilitation treatment in May 17, 2016. Oral examination revealed a healthy mucosa with no visible pathology. Adentia of tooth #46 and moderate atrophy of the edentulous alveolar process were found. Panoramic radiography of the jaws showed 2 cm x 2 cm radiolucency with irregular borders located in tooth #46 region. The margins of the bone defect were uneven, single trabeculae were visible, and the cortical layer was not deformed. In the absence of signs of pathology, it was decided to perform a dental implant surgery in the edentulous jaw segment #46. Results: The osteoporotic focus was filled with natural bovine bone substitute Cerabone®. The granules were gently condensed to the sides - to the buccal and lingual walls until they filled the entire cavity. A 10 mm long, 4.1 mm diameter Straumann® Tissue Level implant was surgically placed with the shoulder of the implant resting on the margins of the osteotomy. It was proposed six steps protocol for surgical dental implant installation in focal osteoporotic bone marrow defect in mandible. Conclusions: A six-step protocol for surgical placement of dental implants in focal osteoporotic bone marrow defects may be a useful tool for clinicians in implant dentistry.

Comparison of Classifications and Indexes for Extraction Socket and Implant Supported Restoration in the Aesthetic Zone: a Systematic Review.

Objectives: The primary objective of the present systematic review is to test the hypothesis - the revision of the complexity of the extraction sockets morphology classifications will reveal the most important parameters for implant aesthetic and functional success in case of immediate dental implant placement in aesthetic zone. The secondary objective is to revise the most important parameters of aesthetic indexes created for implant-supported restoration in aesthetic zone. Material and Methods: MEDLINE (PubMed) and Cochrane Library search in combination with hand-search of relevant journals was conducted including human studies published in English between 1 January 2005 and 1 February 2022. After evaluation of the titles and abstracts in accordance with the PRISMA guidelines, risk-of-bias assessment was evaluated and data was extracted from the full papers. Results: Electronic and hand searching resulted in 477 entries. Five systematic reviews, research syntheses and 7 prospective studies met the inclusion criteria and were included in the final data synthesis. Selected articles reported the different classifications complexity of the extraction sockets morphology and aesthetic indexes for implant supported restoration in aesthetic zone. Conclusions: The most important parameters for implant aesthetics and functional success, incorporated in classifications of extraction sockets are facial soft tissue level and quality, gingival biotype, keratinized gingival, mesial and distal papillae appearance, buccal bone level and thickness, labial and buccal bone plates damage and bone lesions. The most important aesthetic indexes parameters are soft tissue contour position, including colour and texture, interdental papilla, mesial and distal interproximal bone height, gingival biotype.

Periosteum-Derived Mesenchymal Stem Cells Secretome - Cell-Free Strategy for Endogenous Bone Regeneration: Proteomic Analysis in Vitro.

OBJECTIVES: Millions of people worldwide are affected by diseases or injuries which lead to bone/tooth loss and defects. While such clinical situations are daily practice in most of the hospitals, the widely used treatment methods still have disadvantages. Therefore, this field of medicine is actively searching new tissue regeneration techniques, one of which could be stem cell secretome. Thus, the purpose of this research study was to perform the detail proteomic analysis of periosteum-derived mesenchymal stem cells secretome in order to evaluate if it is capable to induce osteo-regenerative process. MATERIAL AND METHODS: Periosteum-derived mesenchymal stem cells (PMSCs) were extracted from adult male New Zealand White rabbits. Cells were characterised by evaluating their differentiation potential. After characterisation PMSCs secretomes were collected and their proteomic analysis was performed. RESULTS: PMSCs were extracted from adult male New Zealand White rabbits. In order to characterise the extracted PMSCs, they were differentiated in the directions which mainly describes MSC multipotency - osteogenic, myogenic and adipogenic. A total of 146 proteins were detected. After characterisation PMSCs secretomes were collected and their proteomic analysis was performed. The resulting protein composition indicates the ability to promote bone regeneration to fully mature bone. CONCLUSIONS: Bioactive molecules detected in periosteum-derived mesenchymal stem cells secretome initiates the processes required for the formation of a fully functional bone.

Complications and Management of Patients with Inherited Bleeding Disorders During Dental Extractions: a Systematic Literature Review.

OBJECTIVES: The systematic literature review aims to assess patients' dental extraction with inherited bleeding disorders, to understand the type, dosage, and modality of administration of the haemostatic agents for safe intra- and postoperational results. MATERIAL AND METHODS: The search was undertaken in MEDLINE (PubMed) databases and Cochrane library for articles published in English from 1 January, 2010 till 31 October, 2020. Before the full-text articles were considered, titles and abstracts were screened. RESULTS: A total of 78 articles were screened, from which 3 met the necessary criteria and were used for the review. Minor complications, such as postoperative bleedings from the socket and epistaxis, were observed, but they were resolved with proper medical care. No major fatal complications were reported. Generally, all the articles provided evidence of successful extractions with correct treatment plans made by haematologists and surgeons. CONCLUSIONS: Available clinical trials demonstrate that local and systemic haemostatic therapies in combination are effective in preventing bleeding during dental extractions in patients with coagulopathies.

Assessment of the Bone Healing Process Mediated by Periosteum-Derived Mesenchymal Stem Cells' Secretome and a Xenogenic Bioceramic-An In Vivo Study in the Rabbit Critical Size Calvarial Defect Model.

The mesenchymal stem cell (MSC) secretome has been considered an innovative therapeutic biological approach, able to modulate cellular crosstalk and functionality for enhanced tissue repair and regeneration. This study aims to evaluate the functionality of the secretome isolated from periosteum-derived MSCs, from either basal or osteogenic-induced conditions, in the healing of a critical size calvarial bone defect in the rabbit model. A bioceramic xenograft was used as the vehicle for secretome delivery, and the biological response to the established biocomposite system was assessed by clinical, histological, histomorphometric, and microtomographic analysis. A comparative analysis revealed that the osteogenic-induced secretome presented an increased diversity of proteins, with emphasis on those related to osteogenesis. Microtomographic and histological morphometric analysis revealed that bioceramic xenografts implanted with secretomes enhanced the new bone formation process, with the osteogenic-induced secretome inducing the highest bone tissue formation. The application of the MSC secretome, particularly from osteogenic-induced populations, may be regarded as an effective therapeutic approach to enhance bone tissue healing and regeneration.

Effects of Different Bone Substitutes on Reactive Oxygen Species Release in Leukocytes in Vitro: A Pilot Study.

PURPOSE: To evaluate the formation of reactive oxygen species in human leukocytes promoted by bone substitutes that are different in origin and morphology used for jawbone tissue regeneration. MATERIALS AND METHODS: This preclinical prospective randomized crossover study involved 10 subjects, from whom venous blood samples were taken. Leukocytes were separated and standardized. Sixty experimental samples consisted of leukocytes incubated with allogeneic, xenogeneic, or alloplastic bone substitutes at different bone weights (12.5 and 25 mg). The control samples consisted only of incubated leukocytes. Reactive oxygen species were quantitatively determined with the fluorimetric method. Statistical analysis was carried out using SPSS 23 software. RESULTS: The highest average reactive oxygen species values were obtained in the allogeneic bone substitute group (P < .05), while the xenogeneic bone substitute group and control group presented equal reactive oxygen species formation rates (P > .05). A proportional difference (P < .05) of reactive oxygen species emission was obtained between different masses of bone substitute in the samples. CONCLUSION: Allogeneic and alloplastic bone substitutes affect leukocytes and promote reactive oxygen species emission. Xenogeneic bone substitute presents no leukocyte stimulation and maintains anti-inflammatory conditions. Larger bone substitute mass provokes greater oxidative stress.

Three-dimensional analysis of dimensional changes after alveolar ridge preservation with bone substitutes or plasma rich in growth factors: Randomized and controlled clinical trial.

OBJECTIVES: To evaluate alveolar ridge dimensional changes of different alveolar ridge preservation techniques after 3 months of tooth extraction and to compare the efficacy of autologous plasma rich in growth factor (PRGF) to the bone substitutes in alveolar ridge preservation and sites left to heal spontaneously. MATERIALS AND METHODS: Forty patients requiring tooth extraction in the anterior maxilla were randomly allocated to the four following treatment modalities: spontaneous healing (control), natural bovine bone mineral covered with resorbable native collagen membrane (BBM/CM), freeze-dried bone allograft covered with resorbable native collagen membrane (FDBA/CM) and PRGF alone. Cone beam computed tomography (CBCT) scans were taken after surgery and 3 months later. The measurements of height and width (at 1, 3, and 5 mm below the crest) were performed after superimposing the 2 consecutive CBCT scans. RESULTS: The greatest horizontal alveolar bone resorption at 1 mm below bone crest was observed in the control group (-1.61 ± 1.76 mm, P = .037), whereas the least reduction in width was found in the BBM/CM group (-0.68 ± 0.67 mm, P = .037). The most pronounced alveolar height reduction was observed in the control group (-0.86 ± 0.43 mm), whereas alveolar ridge preservation with BBMC/CM (-0.26 ± 0.91 mm) and PRGF (-0.54 ± 0.86 mm) successfully reduced the alveolar height reduction as compared to the control group. CONCLUSIONS: Alveolar ridge preservation technique in the esthetic zone using BBM/CM or using PRGF is beneficial to reduce horizontal and vertical bone changes.

Immediate Implant Placement in Non-Infected Sockets versus Infected Sockets: a Systematic Review and Meta-Analysis.

OBJECTIVES: The aim of this systematic review is to compare immediate implant placement in infected extraction sockets with non-infected extraction sockets in terms of implant survival and function. MATERIAL AND METHODS: An electronic search was conducted in PubMed, ScienceDirect, ISI Web of Knowledge and Google Scholar between January 2010 and February 2020. Studies evaluating implant survival rate and main clinical parameters were included for a qualitative and quantitative analysis. RESULTS: In total, nine studies were included and a pool of 2281 sockets were analysed. Compared with the non-infected group, the infected group showed no significant differences in implant survival rates (risk ratio [RR] = 0.99; 95% confidence interval [CI] = 0.98 to 1; P = 0.08). No significant statistical differences were found in marginal bone level (mean difference [MD] = -0.03; 95% CI = -0.1 to 0.04; P = 0.41), marginal gingival level (MD = -0.07; 95% CI = -0.17 to 0.04; P = 0.23), probing depth (MD = 0.06; 95% CI = -0.24 to 0.36; P = 0.7), modified bleeding index (MD = -0.00162196; 95% CI = -0.09 to 0.09; P = 0.97) and slight but significant changes were seen in width of keratinized gingiva (MD = 0.25; 95% CI = -0.3 to 0.8; P = 0.38) between the groups at the latest follow-up. CONCLUSIONS: There were no significant difference in implant survival rates, marginal bone level, marginal gingival level, modified bleeding index and probing depth between infected sockets and non-infected sockets. However, slight but significant changes were seen in width of keratinized gingiva favouring the non-infected group.

The Use of Botulinum Toxin A in the Management of Trigeminal Neuralgia: a Systematic Literature Review.

OBJECTIVES: The purpose of this article is to systematically review the use, efficacy, differences between botulinum toxin type A doses and side effects of botulinum toxin type A therapy in patients with trigeminal neuralgia. MATERIAL AND METHODS: The search for the performed reviews was done in PubMed and Cochrane library in English language from January 2010 up to February 2020. Inclusion criteria: full-text studies in English language, in which visual assessment scale (VAS) was present, in which patients with trigeminal neuralgia (TN) were participated and the comparison between botulinum toxin type A (BT-A) and saline was done. RESULTS: The review included 4 randomized, double-blind, placebo-controlled trials with 8 to 12 weeks follow-up to observe changes in VAS and in frequency of TN attacks, differences between dosages of BT-A in therapy and side effects. Mean VAS of BT-A group decreased by approximately 68% and of palcebo group decreased by approximately 21.6% after the therapy. Mean frequency of TN attacks in 3 studies of BT-A group decreased by 85%, while in palcebo by only 15.9%. CONCLUSIONS: Botulinum toxin type A injection therapy is a safe and effective method in management of trigeminal neuralgia. No differences between dosages of botulinum toxin type A were found. Maximum efficacy was noticed between 6 weeks and 3 months after the procedure. Side effects were mostly facial asymmetry after injection, headaches, haematoma, which disappeared in one week.

Genetic and proteomic biomarkers of head-and-neck cancer: A systematic review.

Development of human genetic and proteomic research has increased the interest in alternative head-and-neck cancer (HNC) detection methods. The aim of this article, the second of two-part series, was to review the scientific literature about novel HNC genetic and proteomic biomarkers. A comprehensive review of the current literature was conducted according to the Preferred Reporting Item for Systematic Review and Meta-analyses guidelines by accessing the NCBI PubMed database. Authors conducted the search of articles in English language published from 2004 to 2015. A total of 50 relevant studies were included in the review. Thirty of them concerned proteomic and twenty genetic alterations in HNC. The present systematic review discovered 242 genes and 44 proteins associated with HNC. Due to inconsistent and sparse results, novel biomarkers cannot be firmly established. Prognostic capacity of genetic markers was not evaluated. Proteins (14-3-3γ, extracellular matrix metalloproteinase inducer, and PA28γ) were described as most valuable for prognostic observation of HNC. A strict methodological protocol for molecular studies must be established.

Bone regeneration in rabbit calvarial defects using PRGF and adipose-derived stem cells: histomorphometrical analysis.

Aim: The aim of this study was to evaluate the osteogenic potential of adipose-derived stem cells (ADSCs) and to assess the influence of plasma rich in growth factors (PRGF) on bone regeneration using ADSCs. Materials & methods: Bone defects were randomly allocated to the five treatment modalities: spontaneous healing, natural bovine bone mineral (BBM), BBM loaded with PRGF, BBM loaded with ADSCs and BBM loaded with a combination of ADSCs and PRGF. Results: The PRGF significantly enhanced the biomaterial-to-bone contact. Defects treated with ADSCs and PRGF or a combination of both showed the greatest bone regeneration. Conclusion: Combining PRGF and ADSCs boosts the bone graft regenerative potential at the earliest period of healing.

Novel Yttria-Stabilized Zirconium Oxide and Lithium Disilicate Coatings on Titanium Alloy Substrate for Implant Abutments and Biomedical Application.

This study aimed to create novel bioceramic coatings on a titanium alloy and evaluate their surface properties in comparison with conventional prosthetic materials. The highly polished titanium alloy Ti6Al4V (Ti) was used as a substrate for yttria-stabilized zirconium oxide (3YSZ) and lithium disilicate (LS2) coatings. They were generated using sol-gel strategies. In comparison, highly polished surfaces of Ti, yttria-stabilized zirconium oxide (ZrO2), polyether ether ketone (PEEK) composite, and poly(methyl methacrylate) (PMMA) were utilized. Novel coatings were characterized by an X-ray diffractometer (XRD) and scanning electron microscope (SEM). The roughness by atomic force microscope (AFM), water contact angle (WCA), and surface free energy (SFE) were determined. Additionally, biocompatibility and human gingival fibroblast (HGF) adhesion processes (using a confocal laser scanning microscope (CLSM)) were observed. The deposition of 3YSZ and LS2 coatings changed the physicochemical properties of the Ti. Both coatings were biocompatible, while Ti-3YSZ demonstrated the most significant cell area of 2630 µm2 (p ≤ 0.05) and the significantly highest, 66.75 ± 4.91, focal adhesions (FAs) per cell after 24 h (p ≤ 0.05). By contrast, PEEK and PMMA demonstrated the highest roughness and WCA and the lowest results for cellular response. Thus, Ti-3YSZ and Ti-LS2 surfaces might be promising for biomedical applications.

Randomized and Controlled Clinical Trial of Bone Healing After Alveolar Ridge Preservation Using Xenografts and Allografts Versus Plasma Rich in Growth Factors.

The aim of this study was to compare bone regeneration in the anterior maxilla between bone substitutes and autologous platelet concentrate in alveolar ridge preservation. Forty patients requiring tooth extraction in the anterior maxilla were randomly allocated to the following 4 treatment modalities: spontaneous healing (control), natural bovine bone mineral covered with resorbable native collagen membrane (BBM/CM), freeze-dried bone allograft covered with resorbable native collagen membrane (FDBA/CM), and plasma rich in growth factors (PRGF) alone. Bone biopsies and histomorphometrical analysis were performed after 3 months of healing. The following parameters were assessed: newly formed mineralized tissue, newly formed nonmineralized tissue, and residual bone-grafting material (if applicable). Statistical analysis was performed to provide descriptive analysis and to compare the parameters of the bone regeneration between the study groups. Histomorphometrical analysis revealed the highest new mineralized tissue formation in the PRGF group. Statistically significant differences in new mineralized tissue formation were found between control/PRGF (46.4% ± 15.2% vs 75.5% ± 16.3%), control/(BBM/CM) (46.4% ± 15.2% vs 20.3% ± 21.9%), control/(FDBA/CM) (46.4% ± 15.2% vs 7.2% ± 8.6%), PRGF/(BBM/CM) (75.5% ± 16.3% vs 20.3% ± 21.9%), and PRGF/(FDBA/CM) (75.5% ± 16.3% vs 7.2% ± 8.6%) groups. The new mineralized tissue formation was in the following order: PRGF > control > BBM > FDBA. Alveolar ridge preservation in the esthetic zone with PRGF was the most effective for bone regeneration of the alveolar ridge.

Morphological Classification of Extraction Sockets and Clinical Decision Tree for Socket Preservation/Augmentation after Tooth Extraction: a Systematic Review.

OBJECTIVES: The aim of present study was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. MATERIAL AND METHODS: The search protocol used the electronic MEDLINE (PubMed) and EMBASE databases for articles published between January 1 2009 and May 1 2019. The search included only human studies published in English. Outcomes were the indications and reasons for socket preservation/augmentation and classification of extraction sockets. RESULTS: Ten studies fulfilled the inclusion criteria and were selected for the study. Although there are various types of extraction socket classifications none of them could completely evaluate all morphological parameters of alveolar ridge. Furthermore, present study revealed that indications for extraction socket preservation/augmentation have wider spectrum than socket morphology and are related to surrounding tissue anatomy or dental implantation operation indications and timing. Based on currently proposed extraction socket classifications and rationales, a novel decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic area was suggested. CONCLUSIONS: The need of extraction socket preservation/augmentation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint. A novel clinical decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic zones can be useful tool in socket preservation/augmentation procedures.

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and Consensus Statements: Group I - Biological Aspects of Tooth Extraction, Socket Healing and Indications for Socket Preservation.

INTRODUCTION: The task of Group I was to review and update the existing data concerning the physiologic process of socket healing, in the absence or presence of grafting materials or platelet concentrates, addressing the associated molecular and cellular events that culminate in the restoration of the lost tissue architecture and functionality. The second task was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. MATERIAL AND METHODS: The main areas indicated by this group were as follows: socket healing process, including haemostasis and coagulation, inflammatory phase, proliferative phase, bone tissue modelling and remodelling; socket healing with graft materials and autologous platelet concentrates; extraction socket classifications; indications and reasons for extraction socket preservation/augmentation. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was screened and reported following the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in Preface chapter. RESULTS: The results and conclusions of the review process are presented in the respective papers. One theoretical review-analysis and one systematic review were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.