Use of autologous tooth-derived material as a graft in the post-extraction socket. Split-mouth study with radiological and histological analysis.

BACKGROUND: The healing process after tooth removal involves bone remodelling which implies some loss of alveolar bone volume. Among materials proposed for minimising this remodelling and preserving the bone, autologous dental tissue is a promising option, but more data are needed. In this context, we evaluated size and density changes using cone beam computed tomography in autologous dental material (ADM)-preserved sockets compared to controls, and assessed biological responses by histological analysis. METHODS: A split-mouth study was conducted including 22 patients, who underwent removal of ≥ 2 single-rooted teeth with intact sockets, assigning one socket to the experimental group which received ADM for alveolar preservation and another to the control group, which only underwent blood clot stabilisation. Cone beam computed tomography was performed postoperatively (week 0) and at weeks 8 and 16 to assess socket size and bone density. Histological analysis was carried out on trephine biopsies taken (Ø4 × 4.5 mm) from the experimental group. RESULTS: Less horizontal shrinkage was observed in the ADM group, especially at week 16 considering the group-by-time interaction for the following variables: difference in height between the lingual and buccal alveolar crests (-1.00; p < .01; 95% CI: -0.28 - -1.73), and half-widths, measured as the distance from the long axis of the missing tooth to the buccal alveolar crest at 1 mm (-0.61; p < .01; 95% CI: -0.18 - -1.04) and at 3 mm (-0.56; p < .01; 95% CI: -0.15 - -0.97) below the crest, with mean decreases of 1.07 and 2.14 mm in height difference, 0.66 and 1.32 mm in half-width at 1 mm and 0.43 and 1.02 mm in half-width at 3 mm in ADM and control groups respectively. Densitometry analysis showed higher bone densities in Hounsfield units in the ADM group considering all factors analysed regardless of time point and socket third (coronal, middle, or apical). Histologically, there were no signs of inflammation or foreign body reaction, and dentin particles were surrounded by and in close contact with bone tissue. CONCLUSION: These results add to the evidence that dentin can be used successfully as a material for alveolar socket preservation, given its desirable mechanical and biological properties, and warrant larger studies.

Alveolar Ridge Preservation Using a Novel Species-Specific Collagen-Enriched Deproteinized Bovine Bone Mineral: Histological Evaluation of a Prospective Case Series.

In recent years, the significance of maintaining the alveolar ridge following tooth extractions has markedly increased. Alveolar ridge preservation (ARP) is a commonly utilized technique and a variety of bone substitute materials and biologics are applied in different combinations. For this purpose, a histological evaluation and the clinical necessity of subsequent guided bone regeneration (GBR) in delayed implantations were investigated in a prospective case series after ARP with a novel deproteinized bovine bone material (95%) in combination with a species-specific collagen (5%) (C-DBBM). Notably, block-form bone substitutes without porcine collagen are limited, and moreover, the availability of histological data on this material remains limited. Ten patients, each scheduled for tooth extraction and desiring future implantation, were included in this study. Following tooth extraction, ARP was performed using a block form of C-DBBM in conjunction with a double-folded bovine cross-linked collagen membrane (xCM). This membrane was openly exposed to the oral cavity and secured using a crisscross suture. After a healing period ranging from 130 to 319 days, guided trephine drilling was performed for implant insertion utilizing static computer-aided implant surgery (s-CAIS). Cores harvested from the area previously treated with ARP were histologically processed and examined. Guided bone regeneration (GBR) was not necessary for any of the implantations. Histological examination revealed the development of a lattice of cancellous bone trabeculae through appositional membranous osteogenesis at various stages surrounding C-DBBM granules as well as larger spongy or compact ossicles with minimal remnants. The clinical follow-up period ranged from 2.5 to 4.5 years, during which no biological or technical complications occurred. Within the limitations of this prospective case series, it can be concluded that ARP using this novel C-DBBM in combination with a bovine xCM could be a treatment option to avoid the need for subsequent GBR in delayed implantations with the opportunity of a bovine species-specific biomaterial chain.

Role of sclerostin deletion in bisphosphonate-induced osteonecrosis of the jaw.

PURPOSE: Bone resorption inhibitors, such as bisphosphonates (BP) and denosumab, are frequently used for the management of osteoporosis. Although both drugs reduce the risk of osteoporotic fractures, they are associated with a serious side effect known as medication-related osteonecrosis of the jaw (MRONJ). Sclerostin antibodies (romosozumab) increase bone formation and decrease the risk of osteoporotic fractures: however, their anti-resorptive effect increases ONJ. Thus, this study aimed to elucidate the role of sclerostin deletion in the development of MRONJ. METHODS: Sclerostin knockout (SostΔ26/Δ26) mice were used to confirm the development of ONJ by performing tooth extractions. To confirm the role of sclerostin deficiency in a more ONJ-prone situation, we used the BP-induced ONJ model in combination with severe periodontitis to evaluate the development of ONJ and bone formation in wild-type (WT) and SostΔ26/Δ26 mice. Wound healing assay using gingival fibroblasts with or without sclerostin stimulation and tooth extraction socket healing were evaluated in the WT and SostΔ26/Δ26 mice. RESULTS: ONJ was not detected in the extraction socket of SostΔ26/Δ26 mice. Moreover, the incidence of ONJ was significantly lower in the SostΔ26/Δ26 mice treated with BP compared to that of the WT mice. Osteogenic proteins, osteocalcin, and runt-related transcription factor 2, were expressed in the bone surface in SostΔ26/Δ26 mice. Recombinant sclerostin inhibited gingival fibroblast migration. The wound healing rate of the extraction socket was faster in SostΔ26/Δ26 mice than in WT mice. CONCLUSION: Sclerostin deficiency did not cause ONJ and reduced the risk of developing BP-induced ONJ. Enhanced bone formation and wound healing were observed in the tooth extraction socket. The use of romosozumab (anti-sclerostin antibody) has proven to be safe for surgical procedures of the jaw.

Alveolar Ridge Preservation With Fibro-Gide or Connective Tissue Graft: A Randomized Controlled Trial of Soft and Hard Tissue Changes.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a novel biomaterial (FG) for alveolar ridge preservation compared to CTG in terms of soft tissue thickness and bone dimensional changes. MATERIALS AND METHODS: A randomized clinical trial was conducted on 30 patients who required extraction of 30 hopeless mandibular posterior teeth. All patients went through atraumatic tooth extraction, and then, they were randomly allocated to either a CTG, an FG, or a spontaneous healing (SH) group (1:1:1). All patients received a dental implant placed 6 months postoperatively. The soft tissue thickness and bone dimensional changes were measured before and 6 months after the procedure. RESULTS: The study's analysis revealed statistically significant differences in buccal gingival thickness and dimensional bone changes across the three examined groups after 6 months (p < 0.05). The SH group had lower gingival thickness (1.31 ± 0.65 mm) and higher vertical resorption (-1.46 ± 1.67 mm at the buccal aspect) compared with the CTG and FG groups. The CTG and FG groups had similar gingival thickness (2.42 ± 0.70 and 3.00 ± 0.71 mm, respectively) and bone width reduction (+0.86 ± 2.31 and +0.93 ± 2.38 mm, respectively), whereas the CTG group had lower vertical bone loss (-0.30 ± 1.09 mm at the buccal aspect) than the FG group (-0.47 ± 2.30 mm at the buccal aspect). CONCLUSION: FG and CTG demonstrate equivalent soft tissue thickness and comparable horizontal bone dimension outcomes in ARP.

An Injectable Black Phosphorus Hydrogel for Rapid Tooth Extraction Socket Healing.

The excess production of reactive oxygen species (ROS) will delay tooth extraction socket (TES) healing. In this study, we developed an injectable thermosensitive hydrogel (NBP@BP@CS) used to treat TES healing. The hydrogel formulation incorporated black phosphorus (BP) nanoflakes, recognized for their accelerated alveolar bone regeneration and ROS-scavenging properties, and dl-3-n-butylphthalide (NBP), a vasodilator aimed at enhancing angiogenesis. In vivo investigations strongly demonstrated that NBP@BP@CS improved TES healing due to antioxidation and promotion of alveolar bone regeneration by BP nanoflakes. The sustained release of NBP from the hydrogel promoted neovascularization and vascular remodeling. Our results demonstrated that the designed thermosensitive hydrogel provided great opportunity not only for ROS elimination but also for the promotion of osteogenesis and angiogenesis, reflecting the "three birds with one stone" concept, and has tremendous potential for rapid TES healing.

Effect of radiation cross-linked collagen scaffold in alveolar ridge preservation of extraction socket.

This study aimed to evaluate the properties of radiation cross-linked collagen scaffold (RCS) and its efficacy for alveolar ridge preservation (ARP). RCS was prepared from collagen dispersion by electron beam irradiation and freeze-drying. The microstructure, swelling ratio, area alteration and mechanical properties of RCS were characterized. Fifty-four New Zealand rabbits performing incisor extraction on maxilla and mandible were randomly assigned into positive, sham operation or treatment groups. Micro-computed tomography (micro-CT) scans, performed after 1, 4, and 12 weeks of surgery, were to assess changes in ridge height at buccal and palatal side, in ridge width and in micromorphological parameters. Histological analysis accessed socket microarchitecture. The results showed that RCS had stable mechanical properties and morphologic features that provided a reliable physical support for ARP. Dimensional changes in treatment group revealed significantly greater vertical height at buccal (5.32 [3.37, 7.26] mm, p < .0001) and palatal (4.37 [2.66, 6.09] mm, p < .0001) side, and horizontal width at the maxilla (0.16 [0.04, 0.28] mm, p < .01) and mandible (0.33 [0.11, 0.54] mm, p < .01) than those in sham operation group after 12 weeks. The treatment group had advantage than positive group in vertical height preservation, quantitatively. The order and density of bone trabeculae were improved in treatment group. These findings indicated that RCS had the potential to serve as an effective scaffold for ARP.

Evaluation of 4 and 8 Weeks of Healing in a Murine Implant Model.

Dental implants are increasing in prevalence as desirable options for replacing missing teeth. Unfortunately, implants come with complications, and animal models are crucial to studying the pathophysiology of complications. Current murine model experiments can be lengthy, with 8 weeks of extraction socket healing before implant placement. Therefore, we aimed to investigate the efficacy of decreasing extraction healing time from 8 to 4 weeks in a dental implant mouse model. Thirty-one 3-week-old C57BL/6J male mice underwent maxillary first and second molar extractions followed by 8 (control) or 4 (test) weeks of extraction socket healing before implant placement. Mice were euthanized after 4 weeks of implant osseointegration. Samples were analyzed via microcomputerized tomography and histology. When mice received implants 4 weeks after extractions, there was no statistical difference in initial bone crest remodeling or surrounding bone volume compared to those after 8 weeks of healing. Histologically, the hard and soft tissues surrounding both groups of implants displayed similar alveolar bone levels, inflammatory infiltrate, osteoclast count, and collagen organization. A 4-week extraction healing period can be utilized without concern for osseointegration in a murine implant model and is a viable experimental alternative to the previous eight weeks of healing. While small animal implant models are less directly applicable to humans, advancements in experimental methods will ultimately benefit patients receiving dental implants through improved prevention and treatment of complications. Subsequent research could investigate occlusal effects or whether healing time affects prognosis after induction of peri-implantitis.

Comparison of Different Suturing Techniques in Post-Extraction Socket Healing.

Background: The process of post-extraction socket healing is critical for ensuring proper tissue repair and minimizing complications in dental practice. Suturing techniques play a pivotal role in this process, influencing wound closure, hemostasis, and overall healing. Materials and Methods: This prospective clinical trial involved 80 participants who required single-tooth extractions. Patients were randomly assigned to four groups, each receiving a distinct suturing technique: simple interrupted sutures, horizontal mattress sutures, vertical mattress sutures, and continuous sutures. Standardized assessments, including clinical examination and cone-beam computed tomography (CBCT) scans, were performed at baseline, 1 week, and 4 weeks post-extraction. Wound dehiscence, soft tissue healing, and bone preservation were evaluated. Results: At 1-week post-extraction, the continuous suture group exhibited the lowest rate of wound dehiscence (5%) compared to other groups (simple interrupted, 15%; horizontal mattress, 10%; vertical mattress, 12%). Soft tissue healing scores at 4 weeks were significantly higher in the continuous suture group (8.7 ± 0.5) than in the other groups (simple interrupted, 7.2 ± 0.8; horizontal mattress, 7.8 ± 0.7; vertical mattress, 7.5 ± 0.6). CBCT analysis revealed superior bone preservation in the continuous suture group (98% remaining bone volume) compared to the other groups (simple interrupted, 92%; horizontal mattress, 95%; vertical mattress, 94%). Conclusion: This study demonstrates that the continuous suturing technique offers advantages in post-extraction socket healing, including reduced wound dehiscence, improved soft tissue healing, and better bone preservation.

Flapless early implant placement into the uncalcified provisional matrix-Does it lead to osseointegration of the implant? A preclinical study.

AIM: To test whether early implant placement into the extraction socket containing an uncalcified provisional matrix leads to successful osseointegration and stable marginal bone levels. MATERIALS AND METHODS: In six mongrel dogs, the mandibular molars were extracted. Three weeks later, early implant placement was performed according to three experimental protocols: (i) flapless implant placement with preservation of the provisional matrix; (ii) flap elevation, socket debridement and implant placement; and (iii) flap elevation, socket debridement, implant placement and guided bone regeneration (GBR). One untreated extraction socket served as a control group. Data analyses were based on histologic slides 3 months after implant placement. RESULTS: There were no differences in bone-to-implant contact between the three experimental groups (66.97%, 58.89% and 60.89%, respectively) (inter-group comparison p = .42). Marginal bone levels, first bone-to-implant contact as well as the thickness of the connective tissue did not reveal any significant differences between the groups (p = .85, .60 and .65, respectively). CONCLUSIONS: Flapless early implant placement into posterior extraction sockets was as effective as an open flap approach in conjunction with GBR. Mineralization of the socket seems to occur irrespective of the presence of dental implants or biomaterials.

Clinical outcomes of dental implants placed in fresh sockets: A five-year retrospective study.

Purpose: This retrospective clinical study aimed to evaluate the implants placed in fresh sockets and investigate the effect of varied oral health conditions and treatment plan details on the clinical and radiographic outcomes. Materials and methods: Fifty-nine participants (102 implants) were included in this study. Four variables, including mean probing depth (PD), mean marginal bone loss (MBL), pink esthetic score (PES), and patient satisfaction, were significant dependent variables, and the effects of independent variables on these four items were studied. The data were analyzed by the analysis of covariance (ANCOVA) using a statistical software. Results: The mean follow-up period was 4.75 ± 1.74 years, and the mean MBL was 1.21 ± 0.81 mm. The survival rate was 97 %. There were significant effects of the finish line site, keratinized gingival width, and attached gingival width on PD after adjusting the factors. Also, the implant brand, plaque index, and uncemented prosthesis affected MBL significantly. In addition, significant effects of the surgeon, implant brand, and proximal contact on PES were found. Conclusion: More PD was found around restorations with a finish line site > 1.5 mm subgingival. Sufficient attached gingiva was a more effective factor on PD than keratinized gingiva. Implants with more plaque scores showed more MBL.

Bone formation in large/moderate gap after immediate implantation in response to different treatments: a pre-clinical study in the canine posterior mandible.

OBJECTIVES: This study aims to investigate different treatments on new bone formation around immediate implants in the canine posterior mandible with varying sized mesial-distal gap. MATERIALS AND METHODS: The 4th premolar and the 1st molar of six Labrador dogs were extracted from the mandible, and 4 dental implants were placed 1 mm below the level of the buccal bone crest. Moderate/large mesial-distal gaps between the implants and the sockets were treated with one of four methods and divided into the following groups: (1) the blank group, (2) the collagen membrane (CM) group, (3) the deproteinized bovine bone mineral (DBBM) group, and (4) the DBBM + CM group. Sequential fluorescent labeling was performed at 4, 8, and 10 weeks after the operation. After 12 weeks, the dogs were euthanized, and specimens were collected for micro-CT scanning and histological analysis. RESULTS: The survival rate of immediate implant was 100%. Micro-CT showed significant differences in bone mineral density (BMD) and bone volume fraction (BVF) among groups (P = 0.040, P = 0.009); other indicators were not significantly different among groups. Histological analysis showed the proportion of new bone formation and bone-to-implant contact were not significantly different among groups. No significant difference in bone reduction height around dental implant among four groups and varied mesial-distal gap size. CONCLUSION: Owing to the restricted sample size, this pilot study lacks conclusive findings. Within the limitation, this study demonstrated that although DBBM significantly increase BMD and BVF, the use of DBBM/CM didn't significantly improve bone formation and healing in extraction sockets around the implants in both moderate and large mesial-distal gap. CLINICAL RELEVANCE: The use of deproteinized bovine bone in conjunction with collagen is a common practice in immediate implantation procedures in the posterior mandible. However, there is a lack of conclusive evidence regarding the timing and circumstances under which they should be employed.

The facial-coronal ridge crest alterations after single immediate implant placement and provisionalization with thin buccal plate phenotype in anterior maxilla: A radiographic case-series study.

AIM: To explore the features of and potential landmarks that predict crestal ridge remodeling after immediate implant placement and provisionalization (IIPP) with thin buccal plate phenotype in the anterior maxilla. MATERIALS AND METHODS: Patients requiring IIPP of single maxillary incisor with thin buccal bone plate (<1 mm) were recruited. Cone-beam computed tomography (CBCT), performed before and 6 months after the intervention, were three-dimensionally superimposed. A virtual line connecting the bony emergence points of adjacent teeth was drawn as a reference. The facial-coronal alveolar crest of the extraction socket and healed ridge were located in mesial, middle and distal cross-sectional planes, and linear ridge reductions were measured. The correlation between ridge reduction and local factors was analyzed. RESULTS: Fifty patients were included. From the extraction socket to healed ridge, the alveolar crest underwent linear bone reduction of 1.50 ± 0.50, 1.54 ± 0.66 and 1.65 ± 0.73 mm in the mesial, middle, and distal regions in an apical-palatal direction. The middle region had significantly higher horizontal (facial-palatal) but lower vertical (coronal-apical) bone reduction than the mesial and distal areas (P < 0.01). The facial-coronal ridge crest of the healed ridge located close to the reference line. Ridge reduction positively correlated with the distance between the initial facial-coronal crest of the extraction socket and the reference line (P < 0.01). CONCLUSIONS: Alveolar crest of the socket lost its curvature and tended to attain a flat profile after IIPP due to inconsistent ridge reduction in middle, mesial and distal areas. The reference line may be a potential landmark for predicting the ridge crest after remodeling.

Evaluation of the effects of platelet-rich fibrin and diode laser on gingival blood perfusion and early bone healing of the extraction socket: a randomized controlled clinical trial.

Evaluation and comparison of the effect of platelet-rich fibrin (PRF), diode laser, and combination of PRF and diode laser on gingival blood perfusion and early bone formation of the extraction socket. Forty maxillary premolar sockets were randomized to four groups: control group, PRF group, diode laser group, and PRF + diode laser group. Gingival blood perfusion was measured at preoperative and postoperative 1, 3, 7, and 30 days. Fractal dimension analysis was performed immediately after the procedure and in the postoperative first month. Gingival perfusions significantly increased during 1 week compared to baseline for all groups with a mean of -4.43 ± 3.20, -5.99 ± 3.68, -5.45 ± 3.01, and -4.78 ± 2.82 respectively, and were at baseline 1 month later. There were no statistically significant differences between the groups at any time point. Although the increase of fractal dimension was higher in the PRF or diode laser group than in the control group with a mean of 0.085 ± 0.05, 0.100 ± 0.04, and 0.072 ± 0.04 respectively, no statistically significant differences were detected. Fractal dimension was significantly greater in PRF + diode laser group than in the control group with a mean of 0.138 ± 0.05 (p = 0.04). PRF, diode laser, and PRF + diode laser did not significantly affect the gingival perfusion, and the combined application of PRF and diode laser had positive effects on early bone regeneration in the extraction socket. PRF, diode laser, and PRF + diode laser provide better tissue healing of the extraction socket.

Current Knowledge on the Healing of the Extraction Socket: A Narrative Review.

The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures performed in the dental clinic. Understanding this healing process is of utmost importance because the outcome has a direct bearing on future prosthetic rehabilitation and, by extension, on patients' esthetics and masticatory function, among others. This mini review, therefore, summarized the current knowledge on the different stages of socket healing, including the biologic and clinical events that occur following tooth extraction up until the complete closure of the socket. Additionally, the modeling of the alveolar bone/process post extraction, and the resultant dimensional changes that, altogether, shape the bone, were reviewed and documented. The effects of various socket preservation interventions to mitigate these dimensional changes, and therefore preserve the alveolar process in a condition suitable for future prosthetic rehabilitation, were highlighted. Finally, a review of some of the factors that influence the entire process was also carried out.

The Survival Rate of Posterior Immediate Implants in the Maxilla and Mandible: An Observational Retrospective Study of 158 Dental Implants.

BACKGROUND: Immediate implants are popular for the anterior sextants of the mouth and have shown a high success rate for the same. However, their installation in a fresh extraction socket in the posterior segments can also be beneficial to the patients and limit the time for the patient to start the masticatory function. However, there have been contradicting results in different studies. OBJECTIVES: The primary objective of this retrospective study was to establish correlations between factors such as implant dimensions, implant categories, implant location, and various demographic parameters in relation to the longevity of implants. This investigation was conducted through a comprehensive clinical evaluation of immediate implants situated within the molar sections of both the upper (maxillary) and lower (mandibular) jaws. METHODS: Between October 2015 and August 2022, a total of 158 implants were implanted, with 87 males and 71 females undergoing implant placement following tooth extraction. All implants were reinstated between 12 and 18 weeks after they were placed. Inferential statistics were performed using SPSS Statistics version 23 (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). The Chi-square test was employed to determine statistical significance (p=0.05) between survived and failed implants in relation to various study factors. Lastly, in order to measure the survival rate under different time periods after implant placement, the life table method and Kaplan-Meier survival rate analysis were used. RESULTS: Success of implants was observed at 149 sites, whereas implant failure was seen at nine sites in total. From placement to loading, the implant failed at five sites, and the cumulative survival rate was found to be 96.83%, from loading to one year, implant failure was seen at three sites, and the cumulative survival rate was found to be 94.9%, from one to two years after loading implant failure was seen at only one site with cumulative survival rate to be 94.93%. From two to three years after loading, implant failure was not seen at any site. CONCLUSIONS: Regardless of implant size or insertion location, rapid implant implantation in fresh extraction sockets can result in predictable clinical outcomes.

The Bone Bridge Technique Utilizing Bone from the Lateral Wall of the Maxillary Sinus for Ridge Augmentation: Case Reports of a 1-7 Year Follow-Up.

The post-extraction socket of a periodontally compromised tooth/implant is oftentimes accompanied by a very wide-deep alveolar ridge defect. The commonly utilized treatment is ridge preservation followed by delayed implant placement 4 to 6 months after extraction. In the four cases presented in this study, a novel technique of utilizing a bone block obtained from the lateral wall of the maxillary sinus is introduced. Due to the severe localized vertical ridge deficiency, an intraoral autogenous bone block was obtained from the ipsilateral sinus bony window. After the obtained bone block was properly trimmed, it was fixed in the form of a bridge over the vertical defect by the press-fit method. In two cases, the gap between the autogenous bone and defect was filled with a particulate synthetic bone graft, and in another two cases, the gap was left without grafting. All cases were covered with a resorbable collagen membrane. At the time of re-entry after 5 to 6 months, the bone bridge was well incorporated beside the adjacent native bone and helped by the implant placement. Uncovering was performed after 3 to 6 months, and prostheses were delivered after 2 months. Oral function was maintained without any change in the marginal bone level even after the 1- to 7-year post-prosthesis delivery. This case series showed that the bone bridge technique performed using an ipsilateral sinus bony window for a localized vertical deficiency of a post-extraction socket can be used for successful vertical ridge augmentation (VRA).

Evaluation of efficacy of simvastatin in bone regeneration following local application in third molar extraction socket: A randomized control trial.

Aims and Objectives: The aim of this study is to study the efficacy of simvastatin in bone regeneration following the local application in third molar extraction sockets. Materials and Methods: This is a randomized controlled trial done on 50 patients involving 100 third molar teeth extraction sockets. The patients were randomly divided based on the placement of simvastatin. Extraction sockets which were treated with simvastatin were considered study sockets and without simvastatin were considered control sockets. The study socket was assigned for the placement of simvastatin (10 mg) powder along with gelfoam as carrier moistened with normal saline solution and control socket was assigned for the placement of gelfoam moistened with saline. Intraoral periapical radiographs were taken on the 1st, 4th, 8th, and 12th weeks, and mean gray scale values indicating bone density were evaluated for both the groups. Cone-beam computed tomography (CBCT) was taken by the end of the 12th week to further evaluate the osseous regeneration. Patients were compared and evaluated for bone density, pain, and swelling. Pain and swelling were evaluated on postoperative days 1 and 7. Results: The mean gray-level histogram values (bone density) were statistically highly significant in the study group compared to the control group in the 1st, 4th, 8th, and 12th weeks, and CBCT also showed statistically significant difference between the control and study group by the end of the 12th week. Conclusion: The present data suggest that the local application of simvastatin promotes and enhances bone formation in the extraction sockets, which provides a very cost-effective way for faster bone regeneration.

Accuracy of freehand versus guided immediate implant placement: A randomized controlled trial.

PURPOSE: This randomized controlled trial (RCT) aimed to compare the accuracy of immediate implant placement with freehand and static guided surgery. METHODS: An RCT was conducted on 61 subjects who received a total of 80 dental implants. The enrolled patients were randomly allocated to two groups: freehand surgery (control group, n = 40 implants) and static guided surgery with R2Gate® (Megagen, Gyeongbuk, South Korea, test group, n = 40 implants). Crestal and apical deviations in both mesiodistal and buccolingual dimensions, as well as depth and angular deviations, were calculated by comparing the three-dimensional (3D) position of the implant in the planning software with the final implant position, revealed by an intraoral scan of the fixture after placement. The Mann-Whitney test was used for comparative assessment. RESULTS: In the freehand group (control), crestal deviations of 1.13 ± 0.89 mm and 1.00 ± 0.76 mm were found in the mesiodistal and buccolingual directions, respectively, versus 0.34 ± 0.26 mm (p<0.001) and 0.37 ± 0.24 mm (p = 0.03) in the static guided surgery group (test). Apical deviation was also higher in the freehand group (control) than in the static guided surgery group (test) in the mesiodistal (4.04 ± 1.90 mm vs. 0.97 ± 0.55 mm, p = 0.04) and buccolingual directions (3.46 ± 1.82 mm vs. 0.94 ± 0.67 mm, p = 0.02). Freehand surgery had greater angular deviation (6.09° ± 3.23) compared to guided surgery (0.83° ± 0.53, p = 0.02). However, depth deviation was similar in the freehand surgery group (2.24 ± 1.58 mm) and static guided surgery group (0.66 ± 0.43, p = 0.09). CONCLUSIONS: Immediate implant placement with static guided surgery demonstrated better accuracy than freehand surgery. STATEMENT OF CLINICAL RELEVANCE: Guided implant surgery showed fewer deviations compared to freehand surgery in fresh extraction sockets; therefore, the use of static guides should be given preference over the freehand modality.

The Effect of Terra-Cortril as Local Pain Medication on the Healing Process of a Fresh Extraction Socket: A Retrospective Cohort Study.

(1) Background: Use of Terra-Cortril may reduce pain and discomfort after tooth extraction. It is widely used among dentists, especially for third molar extraction and for treatment of dry socket. Only few case reports described unsuccessful healing with formation of myospherulosis. (2) Aim: The primary objective of this retrospective cohort study was to compare the occurrence of unsuccessful healing between extraction sockets locally treated with Terra-Cortril (TC) (exposure cohort) and extraction sockets subjected to unassisted healing (non-exposure cohort). The assessment of the three-dimensional morphology of the bone was a secondary objective. (3) Material and methods: The records of patients who had one or more extractions between 1 January 2020 and 1 July 2021 followed by implant placement in one private practice were retrieved and data were extracted. At the time of implant placement, practitioners established, both clinically and radiographically, if the healing was successful or unsuccessful. Explanatory demographic as well as clinical variables were extracted from patient files, checked and supplemented by contacting patients in cases of missing data. (4) Results: 69 patients were included who had, in total, 99 extractions. The exposure cohort included 55 sites, while the non-exposure cohort included 44 sites. A total of 56 sites demonstrated successful healing, and 53 showed unsuccessful healing. The regression model identified TC as a significant predictor (p = 0.014) for unsuccessful healing with an odds ratio of 2.86. Sites treated with Terra-Cortril had a significantly greater bone defect at level -1 mm, level -3 mm, and level -5 mm from the bone crest, and significantly greater maximal vertical and horizontal bone defects. At sites where Terra-Cortril was used, significantly more surgical consequences were reported (70.91% vs. 18.18%, p < 0.001). (5) Conclusions: fresh extraction sockets treated with Terra-Cortril increased the likelihood of unsuccessful healing with an odds ratio of 2.86. The greater defect size leads to significantly more limitations when planning implants at sites previously treated with TC.

Kangfuxin Accelerates Extraction Socket Healing by Promoting Angiogenesis Via Upregulation of CCL2 in Stem Cells.

Kangfuxin (KFX) shows potential in wound healing, but its role in socket healing is unclear. This research finds increased bone mass, mineralization, and collagen deposition in KFX-treated mice. Mouse bone marrow mesenchymal stem cells, human periodontal ligament stem cells (hPDLSCs), and human dental pulp stem cells (hDPSCs) are treated with KFX under osteogenic induction. RNA-sequencing reveals upregulated chemokine-related genes, with a threefold increase in chemokine (C-C motif) ligand 2 (Ccl2). The conditioned medium (CM) of hPDLSCs and hDPSCs treated with KFX promotes endothelial cell migration and angiogenesis. Ccl2 knockdown abolishes CM-induced endothelial cell migration and angiogenesis, which can be reversed by recombinant CCL2 treatment. KFX-treated mice showed increased vasculature. In conclusion, KFX increases the expression of CCL2 in stem cells, promoting bone formation and mineralization in the extraction socket by inducing endothelial cell angiogenesis. © 2023 American Society for Bone and Mineral Research (ASBMR).