Endodontic management of submerged roots following complicated traumatic dental injury (TDI) in children and adolescents: A systematic review.

INTRODUCTION: The International Association of Dental Traumatology (IADT) guidelines include the use of decoronation for the management of complex crown-root fractures but do not outline how this technique is best employed. The aim of this review is to reach a consensus in the management of the root canal system in decoronated permanent teeth undergoing root submergence and to determine whether this has an impact on the success and survival of the retained root. MATERIALS AND METHODS: Search included databases MEDLINE via Ebsco, EMBASE via Ovid, Web of Science via Clarivate, PubMed via PubMed.gov, the Cochrane Library via Wiley, cited reference searching and hand searching of relevant journals. Two independent reviewers performed study selection, data extraction and risk of bias assessment using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS AND DISCUSSION: In total, 18 articles were included in qualitative analysis: 17 of these were case reports and one case series. A total of 37 teeth were treated with decoronation either using the Malmgren or an alternative protocol (root submergence following endodontic treatment with gutta-percha [GP] or a calcium silicate cement and vital root submergence). Limited evidence from this review suggests that immediate decoronation and vital root submergence are successful in apexogenesis and preserving alveolar bone. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: registration number CRD42022316266).

Three-dimensional evaluation of the effects of injectable platelet rich fibrin (i-PRF) on alveolar bone and root length during orthodontic treatment: a randomized split mouth trial.

BACKGROUND: The role of injectable platelet rich fibrin (i-PRF) in orthodontic treatment has not been investigated with focus on its effect on dental and bony periodontal elements. OBJECTIVE: To evaluate the efficacy of i-PRF in bone preservation and prevention of root resorption. METHODS: A randomized split-mouth controlled trial included 21 patients aged 16-28 years (20.85 ± 3.85), who were treated for Class II malocclusion with the extraction of the maxillary first premolars. Right and left sides were randomly allocated to either experimental treated with i-PRF or control sides. After the leveling and alignment phase, the canines were retracted with 150gm forces. The i-PRF was prepared from the blood of each patient following a precise protocol, then injected immediately before canine retraction on the buccal and palatal aspects of the extraction sites. Localized maxillary cone beam computed tomography scans were taken before and after canine retraction to measure alveolar bone height and thickness and canine root length (indicative of root resorption), and the presence of dehiscence and fenestration. Paired sample t-tests and Wilcoxon signed rank tests were used to compare the changes between groups. RESULTS: No statistically significant differences in bone height, bone thickness were found between sides and between pre- and post-retraction period. However, root length was reduced post retraction but did not differ between sides. In both groups, postoperative dehiscence was observed buccally and palatally and fenestrations were recorded on only the buccal aspect. CONCLUSIONS: I-PRF did not affect bone quality during canine retraction or prevent canine root resorption. I-PRF did not reduce the prevalence of dehiscence and fenestration. Trial registration ClinicalTrials.gov (identifier number: NCT03399760. 16/01/2018).

Alveolar bone preservation by a hydroxyapatite/collagen composite material after tooth extraction.

OBJECTIVE: The aim of this study was to assess the effectiveness of a hydroxyapatite/collagen composite material (HAp/Col) for preservation of alveolar bone after tooth extraction. MATERIALS AND METHODS: HAp/Col was applied to the alveolus bone ridge preservation after tooth extraction, because of subsequent dental implant placement in 35 regions of 24 patients (mean age, 59.3 years; range, 25-81 years). Cone beam computed tomography was used to assess changes in alveolar bone at the extraction site before and at 3 months (mean, 13.7 weeks; range, 10-17 weeks) after tooth extraction. Changes in height and width of the alveolar bone were measured to evaluate bone reduction after surgery. Bone biopsy was performed at 11 regions of dental implant placement to observe bone regeneration and remaining material in the extraction socket. RESULTS: The alveolar bone height was decreased by 0.00 ± 2.44 mm at the buccal side and 0.35 ± 1.73 mm at the lingual side, while the width was decreased by 1.02 ± 1.64 mm at 3 months after surgery. The middle of the socket floor was elevated by 5.71 ± 3.45 mm at 3 months after surgery. Bone biopsy specimens revealed no remaining implanted material, and approximately 49.79 ± 14.41% of the specimens were occupied by bone tissue. CONCLUSIONS: According to the result of this study, HAp/Col is a reliable material to presearve alveolar bone after tooth extraction. CLINICAL RELEVANCE: HAp/Col contributes dental implant treatment due to maintain the alveolar bone after tooth extraction.

Socket Shield Technique for immediate implant placement - clinical, radiographic and volumetric data after 5 years.

OBJECTIVES: Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes. MATERIAL AND METHODS: This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs). RESULTS: All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded. CONCLUSION: Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.

Evaluation of human growth hormone (somatropin) in socket healing: a split-mouth randomized controlled trial.

Techniques for preserving alveolar bone after tooth extraction are becoming a part of the usual clinical practice of clinicians. These techniques aim at minimizing postextraction bony resorption, hence, minimizing subsequent follow-up for implant insertion. This randomized clinical study aimed to measure and compare alveolar bone and soft tissue healing between extraction sockets treated with somatropin to untreated sockets. Methods: The study is designed as a split-mouth randomized clinical trial. The selected patients were indicated for bilateral symmetrical tooth extraction, where each patient had an indication to extract two symmetrical teeth in anatomy and number of roots. Somatropin was applied to the tooth socket of the randomly selected side after tooth extraction by gel foam, and the control side was filled with gel foam only. A clinical follow-up of the soft tissue was done 7 days after tooth extraction to evaluate clinical aspects of the healing process. Radiographic follow-up was performed using a cone-beam computed tomography scan to assess volumetric changes of alveolar bone in the extraction area prior to and 3 months after the surgical procedure. Results: A total of 23 patients (aged 29.1±9.5 years) participated. The results showed a statistically significant association between somatropin application and better preservation of the bony dimensions of the alveolar ridge. Bone loss was -0.691±0.628 mm for the buccal plate on the study side compared to -2.008±1.175 mm on the control side. The level of the lingual/palatal plate bone loss was -1.052±0.855 mm on the study side compared to -2.695±1.878 mm on the control side. The bone loss of alveolar width was -1.626±1.061 mm on the study side compared to -3.247±1.543 mm on the control side. The results also showed better healing of covering soft tissues (P<0.05), as well as bone density in the socket where somatropin was applied, which has been statistically significant. Conclusion: The data from this study demonstrated that the application of somatropin in tooth sockets postextraction showed an effective contribution to reducing alveolar bone resorption and improving bone density following extraction, in addition to better healing of covering soft tissue.

Frozen Stored Teeth: Autogenous Dentin as an Alternative Augmentation Material in Dentistry.

Tooth Shell Technique (TST) with the use of autologous dentin has proven to be a suitable method of grafting in the context of lateral ridge augmentation. This present feasibility study aimed to retrospectively evaluate the preservation by lyophilization of processed dentin. Thus, the frozen stored processed dentin matrix (FST: 19 patients with 26 implants) was re-examined with that of processed teeth used immediately after extraction (IUT: 23 patients with 32 implants). Parameters of biological complications, horizontal hard tissue loss, osseointegration, and buccal lamella integrity were used for evaluation. For complications, the observation period was 5 months. Only one graft was lost (IUT group). In the area of minor complications, without the loss of an implant or augmentation, there were two cases of wound dehiscence and one case with inflammation and suppuration (IUT: n = 3, FST: n = 0). Osseointegration and integrity of the buccal lamella were present in all implants without exception. Statistically, there was no difference between the groups studied for the mean resorption of the crestal width and the buccal lamella. Results of this study show that prepared autologous dentin preserved with a conventional freezer had no disadvantage compared to immediately use autologous dentin in terms of complications and graft resorption in the context of TST.

A promising era of immediate esthetic rehabilitation.

The extraction of a tooth in the anterior region can result in resorption of alveolar bone around the socket, especially the buccal bone leading to horizontal as well as vertical bone loss. This makes rehabilitation in the anterior region an esthetically complex situation. To preserve the buccal bone, the root is bisected and buccal two-thirds is preserved in the socket. This is called socket shield technique. Immediate implant placement and immediate provisionalization yield an esthetically pleasing and more acceptable outcome.

Pink esthetic and radiological scores around immediate implants placed in the esthetic zone - Socket-Shield Technique versus Immediate Conventional Technique: A Pilot Study.

OBJECTIVE: It is irrefutable that the extraction of teeth inextricably results in definitive changes in the surrounding hard and soft tissues. Recently, Socket-Shield Technique (SST) has been used to keep the buccal two-third of the root intact in the socket. This buccal shield further preserves the periodontium-bundle bone complex and hence preserves the buccal hard and soft tissue. The purpose of the study was to do a statistical comparative analysis of two different types of flapless and graftless techniques using the esthetic (Pink Esthetic Index) and radiological parameters. MATERIALS AND METHODS: A total of thirty nonrestorable tooth/root stumps (vital or nonvital) were selected and randomly allocated to two different groups: control group with immediate conventional implant placement (without SST) (Group C, n = 15) and test group with immediate implant placement using SST (Group S, n = 15). All of the sites received immediate chairside temporaries. All implants were restored either with screw- or cement-retained prostheses 4 months postoperative. Each control and test group was analyzed at two different durations: 15 days after placement of provisional and 15 days after placement of definitive prosthesis. Five parameters of Pink Esthetic Score (PES) were used for esthetic analysis, and digital periapical radiographs were used for radiographic analysis. RESULTS: Within the time frame of the study (15 days postplacement of definitive prosthesis), a statistically significant difference (p < 0.05) was observed between PES of the two techniques. Test group S (mean = 9.07) showed better scores than control group C (mean = 6.87). It was observed that buccal bone was maintained in all the cases of test group S while there was loss of buccal bone in almost all the cases of control group C. CONCLUSION: Within the limitations of this short-term pilot study, better soft-tissue parameters were observed with SST as compared to a conventional graftless technique whenever a restoration on immediate implant placement is considered.

Hard and soft tissue analysis of alveolar ridge preservation in esthetic zone using deproteinized bovine bone mineral and a saddle connective tissue graft: A long-term prospective case series.

AIM: Although alveolar ridge preservation (ARP) procedures appear to limit bone resorption after dental extraction, long-term outcomes remain limited. The objective of this prospective case series was to evaluate the long-term hard and soft tissue changes after ARP procedure in the aesthetic area, using deproteinized bovine bone mineral (DBBM) and saddle connective tissue graft. MATERIALS AND METHODS: Fifteen patients were subjected to ARP and impressions and CT scans were taken at baseline and 3 months. After 5 to 7 years, a secondary long-term clinical and radiological analysis was carried out. Horizontal alveolar bone changes, soft tissue profiles and implant outcomes were assessed. RESULTS: Although a limited hard and soft tissue remodeling occurred during the first 3 months after ARP, from 3 months to the long-term evaluation, the alveolar bone dimensions remained stable and the soft tissue profiles significantly increased, in the more cervical levels. The implant survival rate after 5 to 7 years yielded 100% and peri-implant bone levels and soft tissue health were good. CONCLUSION: Within the limits of the study, the present data confirms the long-term effectiveness of ARP using DBBM and a saddle connective tissue graft offering stable hard and soft tissue conditions up to 5 to 7 years.

Shield the socket: Procedure, case report and classification.

The extraction of a tooth leads to a cascade of events which results in resorption of the alveolar bone around the socket. The buccal bone loss that occurs postextraction leads to vertical and horizontal bone loss. It requires complex hard and soft-tissue reconstruction to achieve esthetically pleasing results in such cases. In the socket-shield technique (SST) the root is bisected, and the buccal two-third of the root is preserved in the socket so that the periodontium along with the bundle bone and the buccal bone remains intact. A classification of SST technique is proposed depending on the position of the shield in the socket. This classification is required so as to help in understanding the preparation design and the role of shield and in maximizing the usage of the shield to achieve best possible esthetics in immediate implant placement sites.

The effect of the heights and thicknesses of the remaining root segments on buccal bone resorption in the socket-shield technique: An experimental study in dogs.

BACKGROUND: To date only a few studies have been done on the use of the socket-shield technique for preserving the resorption of the buccal bone in aesthetically sensitive sites. Besides, there have been no further studies on the effect of the heights and thicknesses of the remaining root segments on buccal bone resorption when using this method. PURPOSE: The aim of this study was to evaluate the effect of different heights and thicknesses of the remaining root segments on bone resorption in the socket-shield technique. MATERIALS AND METHODS: Four healthy female beagle dogs were used in this study. The third premolar (P3) and the fourth premolar (P4) on both sides of the mandible were hemisected in the buccal-lingual direction, and the clinical crown of the distal root was beheaded. In the experimental groups, the roots were worn down in the apical direction until they were located at the buccal crestal level (Group A) or 1 mm higher than that level (Group B). In the control group, the distal root segments were extracted. Then, implant placement was performed into the distal root. After 3 months of healing, the specimens were prepared for histological diagnosis. RESULTS: There was no difference between Group A and Group B when using the socket-shield technique, but the results of both groups were better than those of the control group. CONCLUSIONS: The height of the root segments has little effect on the bone absorption of alveolar bone, while the bone absorption was strongly influenced by the thickness of the root segments. More precisely, the absorption may decrease if the thickness of the root fragment increases, when the thickness of the root plate is in the 0.5-1.5 mm range.

Different configuration of socket shield technique in peri-implant bone preservation: An experimental study in dog mandible.

The aim of this study was to evaluate the influence of the residual root and peri implant bone dimensions on the clinical success of the socket shield technique. Thirty-six dental implants were installed in 6 dogs. The clinical crowns of teeth P3, P4 and M1 were beheaded. Afterwards, the roots were worn down 2-3mm in apical direction until they were located at crestal level. Posterior implant beds were prepared in the center of the roots passing by 3mm apically forming 6 groups in accordance to the remaining root thickness. Radiography of the crestal bone level was performed on day 0 and after 12 weeks. Histomorphometric analyses of the specimens were carried out to measure the crestal bone level, the bone to implant contact and the buccal and lingual bone thickness at the implant shoulder portion. Correlations between groups were analyzed through nonparametric Friedman test, statistical significance was set as p<0.05. All 36 implants were osseointegrated, but 3 samples showed a clinical inflammatory reaction and some radicular fragments presented a small resorption process. On the buccal and lingual side, the radicular fragment was attached to the buccal bone plate by a physiologic periodontal ligament. In the areas where there was space between the implant and the fragment, newly formed bone was demonstrated directly on the implant surface. Within the limitations of an animal pilot study, root-T belt technique may be beneficial in preserving and protecting the bundle bone and preservation of soft tissues. If the thickness of the buccal bone is 3mm, and the thickness of the remaining root fragment is 2mm, the socket shield technique is more predictable and the bone contours can be maintained.

The socket-shield technique: first histological, clinical, and volumetrical observations after separation of the buccal tooth segment ­ a pilot study.

BACKGROUND: The "socket-shield technique" has shown its potential in preserving buccal tissues. However, front teeth often have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines. PURPOSE: The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the remaining buccal root segment in two pieces before immediate implant placement. MATERIAL AND METHODS: Three beagle dogs were selected in the study. The third and fourth premolars on both sides of the upper jaw were hemisected and the clinical crown of the distal root was removed. Then, the implant bed preparation was performed into the distal root so that a buccal segment of healthy tooth structure remained. This segment was then separated in a vertical direction into two pieces and implants placed lingual to it. After 4 months of healing, the specimens were processed for histological diagnosis. In a clinical case, the same technique was applied and impressions taken for volumetric evaluation by digital superimposition. RESULTS: The tooth segments showed healthy periodontal ligament on the buccal side. New bone was visible between implant surface and shield as well as inside the vertical drill line. No osteoclastic remodeling of the coronal part of the buccal plate was observed. The clinical volumetric analysis showed a mean loss of 0.88 mm in labial direction with a maximum of 1.67 mm and a minimum of 0.15 mm. CONCLUSION: The applied modification seems not to interfere with implant osseointegration and may still preserve the buccal plate. It may offer a feasible treatment option for vertically fractured teeth.