Short-term outcomes of lateral extraction socket augmentation using autogenous tooth roots: A prospective observational study.

Resorption of the alveolar ridge may lead to ridge deformities that make dental implant placement difficult or impossible. Augmentation of the alveolar ridge may restore appropriate ridge form to allow implant placement. Forty-four patients with edentulous spaces completed this multicenter prospective trial to clinically and radiographically evaluate the efficacy of a bovine pericardium membrane and a particulate mineralized cancellous bone allograft in promoting lateral ridge augmentation. Overall, 38 of 44 patients (86.4%) were able to receive dental implants in the appropriate restoratively driven position 6 months after ridge augmentation. The mean gain in clinical ridge width after augmentation was 2.61 mm, while radiographically the mean gain in ridge width was 1.65 mm at a level 3 mm apical to the bony crest and 1.93 mm at a level 6 mm apical to the crest. On average, approximately 50% of the graft material added horizontally during surgery was displaced or resorbed during healing. Histomorphometric evaluation of cores taken from the augmented ridge at 6 months revealed that approximately 58% of the tissue volume was vital bone, with 12% residual allograft particles and 30% nonmineralized tissue.

Previous research revealed that autogenous tooth roots may be biologically equivalent to conventional bone grafts for lateral ridge augmentation. However, these analyses were limited to two dimensions, whereas healing is a volumetric process. The present study aimed at volumetrically assessing the microstructure following lateral ridge augmentation using extracted tooth roots. The roots of differently conditioned maxillary premolars (i.e., healthy: PM-C; endodontically treated: PM-E; ligature-induced periodontitis: PM-P) and retromolar cortical autogenous bone (AB) blocks were used for lateral ridge augmentation at chronic-type defects in the lower quadrants of n = 16 foxhounds. At 12weeks, titanium implants were inserted and left to heal for another 3weeks. Tissue biopsies were scanned using microcomputed tomography (μCT), and volumes of interest were separated at the buccal and oral aspects to measure bone volume per tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and connectivity density (Conn.D). All groups investigated revealed comparable BV/TV, Tb.Th, Tb.Sp, and Conn.D values at either the augmented buccal or pristine oral aspects, respectively. A gradual but heterogeneous replacement of grafts was observed in all groups, but residual PM fragments were particularly noted in PM-C and PM-P groups. Differently conditioned PM and AB grafts were associated with a comparable bone microstructure within the grafted area. The duration of replacement resorption may vary considerably among the subjects. Autogenous tooth roots may serve as potential alternative to AB for localized alveolar ridge augmentation.

Objective: To evaluate the efficacy of the technique for ridge augmentation prior to implant placement. Material and Methods: Six patients with nine sites presenting an initial ridge width of smaller than 4 mm were included in this study. The tent-pole technique (combination of osteosynthesis screws measuring 1.5 mm in diameter, ABBM, and resorbable collagen membrane) was applied at defect sites. After eight months of healing time, implants were placed in the treated sites. The primary outcomes (radiographic initial ridge width, re-entry ridge width, ridge width gain) were measured by cone-beam computed tomography in reference buccopalatal cross-sections and the secondary outcomes (clinical parameters) were recorded by a digital caliper at the first and second stages. Results: After grafting, the radiographic ridge width increased by 3.02 ± 1.11 mm (1.57-4.75 mm) at 2 mm below the crest and 3.32 ± 1.70 mm (0.23-5.66 mm) at 6 mm below the crest significantly (p< 0.05). For clinical results, the mean horizontal dimension gain was 3.21 ± 1.04 mm (1.83-4.57 mm), while the mean reduction in dimension was 0.38 ± 0.33 mm. These results were statistically significant (p<0.05). Uneventful healing and no infections or membrane exposure were recorded at all sites during the study process. Three of nine (33.33%) defect sites required additional bone grafting. Conclusion: The tent-pole technique is an effective method for increasing the horizontal ridge dimension, minimizing postoperative complications, and facilitating subsequent implant placement.

PurposePrevious studies have solely focused on fresh extraction sockets, whereas in clinical settings, alveolar sockets are commonly associated with chronic inflammation. Because the extent of tissue destruction varies depending on the origin and the severity of inflammation, infected alveolar sockets may display various configurations of their remaining soft and hard tissues following tooth extraction. The aim of this study was to classify infected alveolar sockets and to provide the appropriate treatment approaches.MethodsA proposed classification of extraction sockets with chronic inflammation was developed based upon the morphology of the bone defect and soft tissue at the time of tooth extraction. The prevalence of each type of the suggested classification was determined retrospectively in a cohort of patients who underwent, between 2011 and 2015, immediate bone grafting procedures (ridge preservation/augmentation) after tooth extractions at Seoul National University Dental Hospital.ResultsThe extraction sockets were classified into 5 types: type I, type II, type III, type IV (A & B), and type V. In this system, the severity of bone and soft tissue breakdown increases from type I to type V, while the reconstruction potential and treatment predictability decrease according to the same sequence of socket types. The retrospective screening of the included extraction sites revealed that most of the sockets assigned to ridge preservation displayed features of type IV (86.87%).ConclusionsThe present article classified different types of commonly observed infected sockets based on diverse levels of ridge destruction. Type IV sockets, featuring an advanced breakdown of alveolar bone, appear to be more frequent than the other socket types.

Traditional guided bone regeneration techniques include flap mobilization and placement of a bone graft, often with the use of space-maintaining devices and cell-occlusive membranes. This approach is associated with frequent complications that negatively affect the outcome of the augmentation and the peri-implant soft tissue esthetics. Although current tunneling techniques have focused on periodontal soft tissue applications, earlier publications described their use for horizontal augmentation of mandibular posterior edentulous ridges in full-denture patients. More recently, the use of recombinant human platelet-derived growth factor (rhPDGF-BB) was tested with different bone matrices to treat maxillary anterior edentulous spans. The present case series reports the use of a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) to treat 60 single and multiple edentulous, dentate, and implant sites on 21 patients and five treatment categories with a follow-up period ranging from 4 to 30 months. The technique includes the use of a laparoscopic approach to deliver a growth factor/xenograft combination into a subperiosteal pouch. No flap elevation, cell-occlusive membranes, space-maintaining devices, or decortication procedures were used. The results from this case series demonstrated predictable and consistent bone regeneration. The average gain in ridge width for all treatment categories was 5.11 mm (SD 0.76 mm), which compares favorably with previously published reports. Morbidity and complication rates were consistently reduced as well. Human histology results show xenograft particles surrounded by newly formed bone. The role of the periosteum as a source of pluripotent cells in growth factor–mediated bone regeneration is discussed.

Background: After the extraction, a biological remodeling phase of the alveolar ridge follows, resulting in resorption both vertically and horizontally. To a large extent, this has the effect of installing a dental implant in a correct 3D position. In order to maintain the width and height of the alveolar ridge, a large number of operative techniques for preserving the extraction wound are used. In our article, a preservation technique is presented using the NO-resorptive dPTFE membrane and xenograft. Aim/Hypothesis: Use of bone substitutes in combination with the NO-resorbable dPTFE membrane are examined, for preservation of the extraction socket. We expect to preserve the dimensions of the alveolar ridge in the vertical and horizontal direction in order to place the implant in the correct prosthetic position. Materials and Methods: At the University Dental Clinical Center “St. Pantelejmon – Skopje”, an intervention was performed for preservation of the alveolar ridge in the upper jaw after extraction, in projection of the premolar region. Alveolar preservation was performed using bovine xenograft (cerabone®, botiss biomaterials GmbH). Each preserved socket was covered with ultra-thin (˜0.08 mm) dPTFE membrane (permamem®, botiss biomaterials GmbH) and it was fixed with individual sutures (silk 3/0 Astra Med). The installed non-resorbable membrane was removed after 4 weeks without any additional surgery and the wound was left to heal freely, giving instructions to the patient to maintain oral hygiene by rinsing his mouth twice daily with 0.1% chlorhexidine gluconate. CBCT was performed before the time of tooth extraction and after 6 months from the application of the graft material. With this CBCT we measured the changes of the alveolar ridge and we accurately determined the extent of its dimensional remodeling. Results: Although the NO-resorbable membrane was left uncovered during wound healing, the patient showed no clinical symptoms such as pain, swelling, infection, allergic reaction, or loss. After removal of the membrane in the fourth week, a young granulation of NO-epithelial tissue was observed under the NO-resorbable membrane itself. Six months after the placement of the dental implants, complete healing and integration of the bone graft material was observed, and the performed CBCT images showed minimal remodeling in both horizontal and vertical direction of 1.5 mm. Conclusions and Clinical Implications: The use of NO-resorbable dPTFE membranes, which allow open healing of extraction wounds, in combination with bone substitutes of xenogenic origin, gives predictable and reliable results in the preservation of extraction wounds with minimal bone loss. Keywords: preservation of the alveolar ridge, NO-resorbable membrane

Background The immediate placement of implants provides significant advantages, including fewer surgical procedures, shorter treatment time, and improved esthetics. Many studies were also to compare many biomaterial placed between gap distance for evaluating buccal plate. There were many following arguments that what kind of biomaterial was the best for grafting inside fresh socket. This study would evaluate the effect of PRF in fresh socket with simultaneous implant placement. Aim/Hypothesis Aim - To measure radiographically buccal extraction socket using autologous platelet rich fibrin (PRF). Hypothesis -It is hypothesized that if PRF can produce and maintain ridge width and height after immediate placement then PRF can be used as grafting material. Material and Methods All 17 adult patients (over 18 years old) with inclusion criteria who need one or more immediate placement in area 13–23 were eligible for this study. The immediate implant placement was performed (Osstem TSIII SA fixture) and the shoulder of implant would be at least 1 millimeter deeper compared with the original position of tooth. The PRF preparation with venous blood was collected in sterile vacutainer tube of 10 ml. capacity without anticoagulant and placed in a centrifugal machine (Medifuge MF200, Silfradent, Italy). Then 12 minutes later (manufacturer recommendation) it was divided into PRF layer. After implant was placed, the PRF was carefully filled in the buccal gap and no suture obtained. Cone-Beam Computed Tomography (Kodak Carestream CS9000 3D; Carestream Health Inc., USA) was performed immediately after implant was placed and 6 months follow-up examination. CBCT landmark was located for indicating ridge width and height at the day of surgery and 6 months follow-up. Results All 17 inserted implants were integrated. There were no implant failure and clinical exposure of fixtures in this study. CBCT was performed at 6 months after implant insertion with the following landmark- - Outer crest at top level of implant (OT) to Palatal aspect at top level of implant (PT), indicating the ridge width at the top of implant.- Outer crest at apical level of implant (OA) to Palatal aspect at apical level of implant (PA), indicating the ridge width at the apex of implant.- Outer crest at apical level of implant (OA) to top of crest (C) indicating the ridge height. The study demonstrated that the extraction of a tooth and the immediate insertion of an implant together with PRF resulted in alterations of the bone width and bone height of alveolar ridge using Paired samples T-Test. The width of ridge at top and apical of implant was reduced at 6 months (respectively, P = 0.000 and 0.001). the height of ridge was also reduced at 6 months (P = 0.009). Conclusion and Clinical Implications Although buccal bone were still presented in CBCT, the results of this study show that implant placement into extraction socket together with PRF alone can result even in the evident alterations of alveolar ridge width and height with statistical significant. For clinical benefit, PRF can produce and maintain ridge width and height after immediate placement. So PRF can be used as grafting material but clinicians have to concern about limitation and selection of the cases with this procedure.

The primary aim was to investigate whether ridge preservation done at extraction will preserve at least 6 mm of alveolar ridge width in the anterior maxillary zone and obviate the need for secondary bone augmentation during implant insertion. Sixty patients with single implants placed in the anterior maxillary zone were classified in two groups. In the test group, 40 patients underwent ridge preservation at the time of tooth extraction, while the remaining 20 patients in the control group did not. Preimplant CBCT was evaluated to investigate if at least 6 mm of alveolar ridge width existed before implant insertion. The records were studied to investigate if secondary bone augmentation was done during implantation. The mean patient age was 48.4 years. In the test group, mean healing time before implant placement was 5.0 ± 3.7 months (2 to 22 months); in the control groups, 13.0 + 12.7 months (1.2 to 38 months). In the test group, 82.5% of the subjects had a preimplant alveolar ridge width measuring at least 6 mm. In comparison, only 35% of the subjects in the control group had a preimplant alveolar ridge width measuring at least 6 mm. The odds of having at least 6 mm preimplant alveolar ridge width was significantly higher than the control group (p < 0.001). The need for secondary augmentation in the esthetic zone was less in the test group, the difference was not significant (p = 0.218). Within the test group, subjects received either xenografts or allografts as the ridge preservation material. There was no significant difference in the alveolar ridge width between these two materials (p = 1) CONCLUSION: Ridge preservation was effective in providing a sufficient ridge width in the anterior maxilla at the time of implantation and reduced the need for further bone augmentation. The results of this study give the clinician insight into whether ridge preservation is required during extraction in the anterior maxilla in preparation for an implant restoration. (J Esthet Restor Dent 29:137-145, 2017).

Techniques allowing implant placement in extraction sockets require either high diameter implants in surgically enlarged sockets or grafting and/or regenerative procedures around implants after their primary surgical stabilization. This study aimed to evaluate the ability of calcium phosphate hydraulic cement (CPHC) to immobilize commercially available titanium implants in extraction sockets. CPHC was used in seven fresh dog extraction sockets in conjunction with ITI TPS implants. Three extraction sockets without CPHC were used as controls. Initial implant stability was measured after 10 min hardening with periostest. The dogs were sacrificed after 9 months. Non-decalcified specimens were prepared for histologic and histomor-phometric examination. The surface percentage of implant-to-mineralized bone contact and bone density was calculated for each specimen. The periotest values were significantly different for implants stabilized with CPHC than for the controls, and simi-lar to values reported for osteointegrated implants. New alveolar bone was formed in intimate contact with titanium. In two cases, non-resorbed CPHC residues were observed closely bound to the implant. This study clearly demonstrates that CPHC cement is suitable for immediate implant immobilization in extraction sockets.

The aim of this study was to evaluate the stability of immediate implant placement for alveolar bone augmentation and preservation with bovine bone graft following atraumatic tooth extraction. This was a prospective interventional study with convenient sampling (n = 10). Thirty patients aged between 18 and 40 years, who needed noncomplicated tooth extraction of mandibular premolar tooth, were sequentially divided equally into three groups. In Group I, simple extraction was done and the empty extraction socket left to heal conventionally. In Group II, extraction sockets were filled with lyophilized bovine granules only. In Group III, immediate implants were placed into extraction sockets, and the buccal gap was also filled with bovine granules. All groups were subjected to cone beam computed tomography scan for radiological evaluation. Assessment of biomechanical stability (radiofrequency analysis [RFA] was performed at 9 months postoperative for Group III to assess the degree of secondary stability of the implants using Osstell. Repeated measure analysis of variance (ANOVA) test was applied when comparing within each group at three different time intervals, whereas one-way ANOVA was applied followed by post hoc-tukey test when comparing between groups. P < 0.05 was considered statistically significant. Radiological assessment reveals a significant difference of bone resorption in alveolar dimension within Group I; 1.49 mm (P = 0.002), and 0.82 mm (P = 0.005), respectively, between day 0 and 3 months. Comparison between Group I and III showed a highly significant difference of bone resorption in ridge width at 3 months 2.56 mm (P = 0.001) and at 9 months interval 3.2 mm (P < 0.001). High RFA values demonstrating an excellent biomechanical stability were observed in Group III at 9 months postoperatively. The insertion of immediate implants in extraction sockets with bovine bone augmentation of the buccal gap was able to preserve a greater amount of alveolar ridge volume.

Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study

The aim of the present study was to compare the anchorage of TiO2-blasted screw and cylindrical implants with conventionally used machine-produced screw and cylindrical implants inserted immediately in extraction sockets on dogs. 6 adult mongrel dogs had 3rd and 4th mandibular premolars extracted bilaterally and 24 commercial pure titanium implants were placed immediately in extraction sockets and covered with mucoperiosteum. Each dog had inserted 4 implants: 1 screw implant and 1 cylindrical implant blasted with titanium-dioxide-particles; 1 screw implant and 1 cylindrical implant with machine-produced (m.p.) surface (controls). After a healing period of 12 weeks, 16 implants from 4 animals were used for removal torque test, which demonstrated that significantly higher removal torque force was needed to unscrew the implants blasted with titanium-dioxide-particles, than the normal m.p. implants. The medians for the TiO2-blasted screw and cylindrical implants were > 150 Ncm and 105 Ncm, respectively, while the values for the m.p. implants were 60 Ncm and 35 Ncm, respectively. The SEM investigation demonstrated a high irregularity of the TiO2-blasted surface compared to the machined surface. The Ra and Rz values for surface roughness were higher for the TiO2-blasted implants than for the normal m.p. implants. Histomorphometrically, the arithmetic mean of the direct bone-implant contact fraction was 69%. There was no significant difference in direct bone-implant contact length fraction between TiO2-blasted implants and the control implants. The implants blasted with titanium-dioxide-particles in this study showed a better anchorage than implants with a machine-produced surface. The screw implants showed a better anchorage than the cylindrical implants.

The objective of this study is to compare histologic and clinical healing following tooth extraction and ridge preservation with either cortical or cancellous freeze-dried bone allograft (FDBA) in non-molar extraction sockets. Forty patients requiring implant placement were enrolled, with 20 patients randomly assigned to each group (cortical versus cancellous FDBA). All of the allograft materials were obtained from the same donor to control for variability between donors and processing. Patients returned after 17 to 21 weeks (average: 18.2 weeks), and a 2-mm-diameter core biopsy was obtained before implant placement. Histomorphometric analysis was performed to determine percentage of new bone formation, residual graft material, and non-mineralized connective tissue (CT)/other material. Clinical measurements of ridge dimensions were taken at the time of tooth extraction and again at implant placement. There was no significant difference in new bone formation between the cortical and cancellous FDBA groups (P = 0.857). A significantly greater percentage of residual graft material was detected in the cortical FDBA group compared with the cancellous FDBA group (P = 0.019). A significantly greater percentage of non-mineralized CT/other material was found in the cancellous FDBA group compared with the cortical FDBA group (P = 0.040). The only significant clinical difference between groups was a greater loss of lingual ridge height in the cancellous group. This is the first reported study to compare the histologic changes following tooth extraction with ridge preservation in humans using cortical versus cancellous FDBA. There were no differences in the percentage of new bone formation between the groups.

Aim: The present study was designed to evaluate the possible synergistic effect or inhibitory effect of melatonin and nano-hydroxyapatite graft in alveolar socket preservation. Subjects and Methods: This study was designed as a randomized controlled clinical and radiographic study carried out on a total twenty patients of both sexes (8 females and 12 males ranged in age from (20-35 years). All patients were selected from those attending at the outpatient clinic of Oral Medicine and Periodontology Department, Faculty of Dentistry, Al-Azhar University, Assiut Branch. And planned for extraction of one or more hopeless tooth. The patients included in this study were divided in two groups: Group 1: 10 patients received nano hydroxyapatite mixed with melatonin as a grafting material for the extraction socket, and Group 2: 10 patients received nano hydroxyapatite as a grafting material for the extraction socket. Results: There was no statistically significant difference between Group (I) and Group (II) at baseline (P=0.212) while after 3 months there was a statistically significant difference between Group (I) and Group (II) (P=0.015) and after 6 months there was a statistically significant difference between both groups (P=0.002) in clinical buccolingual width of alveolar ridge. There was no statistically significant difference between Group (I) and Group (II) at baseline (P=0.239) while there was a statistically significant difference between Group (I) and Group (II) after 3 months (P=0.013) and after 6 months (P=0.002) in coronal width. There was no statistically significant difference between Group (I) and Group (II) at baseline (P=0.523), while there was a statistically significant comparisons between Group (I) and Group (II) after 3 months (P=0.049) and after 6 months (P=0.002) regarding bone density. Conclusions: Placement of Melatonin combined with Nanohydroxyapatite bone graft in extraction socket showed higher effect in alveolar socket preservation than Nanohydroxyapatite alone. Coronal portion of extraction socket was associated with high rate of bone resorption than remaining parts of the socket

BackgroundDiabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycaemia, affecting various metabolic processes and leading to multiple complications, particularly in wound healing. This study aims to evaluate the impact of diabetes on the healing of extraction sockets in non-diabetic, prediabetic, and type 2 diabetic patients in Saudi Arabia.MethodologyA prospective observational study was conducted with 72 participants who were divided equally (n = 24 for each group) into three groups, viz. non-diabetic, prediabetic, and diabetic groups based on glycated hemoglobin (HbA1c) and random blood glucose levels. Tooth extractions were performed by an experienced maxillofacial surgeon. Healing outcomes were assessed by measuring extraction socket size, post-operative pain, discharge, swelling, infection, erythema, dry socket occurrence, and analgesic consumption over one week. Initially descriptive statistics were calculated and one way Analysis of Variance (ANOVA) test was done to compare the reduction in socket size between groups. The level of statistical significance was set at P ≤ 0.05.ResultsOut of 275 screened participants, 104 provided informed consent, and 72 completed the study. Significant differences were found in socket size reduction, with non-diabetic patients showing a 62.5% reduction, prediabetic 56.4%, and diabetic 48.6% (p < 0.001). Diabetic patients experienced more post-operative pain (p = 0.039) and a higher incidence of complications such as swelling, infection, and discharge, although not statistically significant (p = 0.141).ConclusionDiabetes significantly affects post-operative healing in dental extractions, leading to less socket size reduction, higher pain levels, and increased complications. These findings underscore the necessity for specialized post-operative care for diabetic patients, including stringent infection control and pain management strategies. Further research with larger sample sizes and extended follow-up periods is recommended to better understand the long-term impacts of diabetes on oral health.