Alveolar ridge regeneration in two-wall-damaged extraction sockets of an in vivo experimental model.
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ABSTRACT: Aim
To determine the healing outcome following grafting with deproteinized porcine bone mineral (DPBM) with or without collagen membrane coverage in two-wall (both buccal and lingual)-damaged extraction sockets.Materials and methods
Distal roots of three mandibular premolars in six beagle dogs were extracted, and the whole buccal and lingual bony walls were surgically removed. Three treatment protocols were then applied according to the following group allocation: no graft (None), grafting DPBM (BG), and grafting DPBM with coverage by a collagen membrane (BG + M). Two observational periods (2 and 8 weeks) were used with the split-mouth design, and quantitative and qualitative analyses were performed by microcomputed tomography and histology.Results
The dimensions of the alveolar ridge at both grafted sites (BG and BG + M) remained similar to those of the pristine ridge in the histologic and radiographic analyses, whereas the ungrafted sites (None) collapsed both vertically and horizontally. Both grafting protocols produced substantial bony regeneration, but the addition of a covering membrane enhanced the proportion of mineralized tissue within the augmented area, and the BG + M group also showed a significantly larger area of regenerated ridge than the None group (p < .05).Conclusions
Bone grafting with collagen membrane can maintain the alveolar ridge dimensions with substantial bone regeneration in a two-wall-damaged extraction socket.
SUBMITTER: Tien HK
PROVIDER: S-EPMC8453892 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundsClinical benefits in bone grafting of intact extraction socket have been widely known, but limited evidence is available for the procedure in damaged extraction sockets due to periodontal disease.PurposeThis study aimed to determine the dimensional alteration of alveolar ridge following bone grafting of damaged extraction sockets, and compare the outcomes of using deproteinized bovine (DBBM) versus porcine bone mineral (DPBM) in the damaged sockets.Materials and methodsOne hundred patients (n = 50 for each group) with periodontitis-induced damaged extraction socket were included in this randomized, single-blind trial. After removal of tooth and granulation tissue, sites were grafted with either DBBM (DBBM group) or DPBM (DPBM group), and covered with collagen membrane. Linear/volumetric analyses of hard and soft-tissue dimensions were performed on reconstructed/superimposed computed tomography and scanned cast images, taken immediately and 4 months after surgery.ResultsThe two groups showed comparable hard tissue augmentation with minimal reductions in the grafted volume, as well as in vertical (1.22 ± 2.16 and 1.45 ± 1.92 mm for DPBM and DBBM group, respectively) and horizontal (1.43 ± 3.40 and 1.83 ± 2.85 mm on the central section, respectively) dimensions at 4 months after surgery. However, several cases showed large variations in maintenance of the grafted volume. None of the measured parameters in hard and soft tissue dimensions differed significantly between DBBM and DPBM sites.ConclusionsDBBM and DPBM can comparably augment damaged extraction sockets with minimal postoperative reduction of the grafted volume. However, the large variations in the results should be further evaluated for application in routine dental clinics.
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Project description:BackgroundTo minimize alveolar bone resorption, alveolar ridge preservation (ARP) has been proposed. Recently, interest in improving the feasibility of implant placement has gradually increased, especially in situations of infection such as periodontal and/or endodontic lesions. The aim of this study was to investigate if ARP improves feasibility of implant placement compared with no ARP in periodontally compromised sites. Secondary endpoints were the necessity of bone graft at the time of implant placement and implant failure before loading at ARP compared with no ARP.Material and methodsThis retrospective study was performed using dental records and radiographs obtained from patients who underwent tooth extraction due to chronic periodontal pathology. Outcomes including the feasibility of implant placement, horizontal bone augmentation, vertical bone augmentation, sinus floor elevation, total bone augmentation at the time of implant placement, and implant failure before loading were investigated. Multivariable logistic regression analysis was performed to examine the influence of multiple variables on the clinical outcomes.ResultsIn total, 418 extraction sites (171 without ARP and 247 with ARP) in 287 patients were included in this study. The ARP group (0.8%) shows significantly lower implant placement infeasibility than the no ARP group (4.7%). Horizontal and vertical bone augmentations were significantly influenced by location and no ARP. Total bone augmentation was significantly influenced by sex, location, and no ARP.ConclusionARP in periodontally compromised sites may improve the feasibility of implant placement. In addition, ARP attenuate the severity of the bone augmentation procedure.
| S-EPMC7994480 | biostudies-literature
Project description:ObjectiveThe objective of this study is to retrospectively evaluate the clinical outcomes of alveolar ridge preservation (ARP) in the compromised extraction sockets using autogenous cortical-lamina anchoring technique (CAT).Material and methodsTwenty patients were treated with ARP in the compromised extraction sockets by applying CAT. Then implant placement and crown delivery was performed. A planned follow-up was performed by analyzing various outcome measures to evaluate the clinical outcomes, including primary outcome measures [radiographic assessment of residual alveolar ridge height (RARH) and residual alveolar ridge width (RARW)] and secondary outcome measures [clinical assessment of the healing of the soft and hard tissue, survival rates of implants, marginal bone loss (MBL) evaluation of implants, buccal bone thickness (BBT), and esthetic treatment outcomes].ResultsAmong the 20 patients, 17 were consecutively treated and 3 dropped out after implant crown delivery because of loss to follow-up. After the ARP, the initial RARH (12.37 mm) significantly increased to 19.29 mm (P < .05). No significant difference was detected in the RARW before (7.92 ± 1.18 mm) and after (7.92 ± 1.18 mm) the ARP, but reduce to 6.99 ± 1.18 mm at the implant placement and 6.64 ± 0.77 mm at the 3-year follow-up (P < .05). The MBL at the implant crown delivery (0.13 ± 0.12 mm) significantly increased to 0.31 ± 0.14 mm at 1-year follow-up and 0.56 ± 0.23 mm at 3-year follow-up, respectively. The bone loss was limited (<1 mm) but statistically significant (P < .05). The BBT at the implant placement (2.53 ± 0.56 mm) significantly reduced to 2.23 ± 0.44 mm at implant crown delivery and 2.14 ± 0.40 mm at 3-year follow-up, respectively. The bone loss was also limited (<0.5 mm) but statistically significant (P < .05). Each implant site showed acceptable aesthetic outcome and the average score was 16.4. The incisions healed uneventful in all patients and the implant survival rate was 100% during the 3-year follow-up.ConclusionAutogenous CAT was successfully applied to preserve the height and width of alveolar ridge in the compromised extraction sockets.
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Project description:Bone is a unique tissue that has the ability to repair itself and return to full function. Bone regeneration is a well synchronized biological process that recapitulates embryonic bone development. The establishment of a functional vascular supply has been shown to be essential for proper ossification of newly deposited bone, and impaired angiogenesis as in advanced age, diabetes, and anti-cancer treatments affect bone repair. Endothelial Guanosine, 3', 5'-Cyclic Monophophate(cGMP) is known to support angiogenesis, and sildenafil, a Phosphodiesterase 5 (PDE5) antagonist, prevents cGMP hydrolysis and thereby, promotes the formation of new blood vessels. Since the development of functional vascular networks is critical to bone repair, we investigated the effects of sildenafil on early alveolar bone regeneration following exodontia. Our results demonstrate that per-oral administration of sildenafil (10 mg/kg/day) in rats delays the dissolution and replacement of the sanguine clot with granulation tissue. As a result, the number of replicating cells, a hallmark of regenerating tissue, observed on day 4 was remarkably lower in sildenafil-treated animals than their control counterparts (mean±SD; control: 47.35±9.21; sildenafil: 11.47±5.14). Similarly, cells expressing transcription factor Cbfa-1/Runx2 and osteopontin, markers of differentiating osteoblasts, were fewer in treated animals (mean±SD; control: 83.18 ± 4.60; sildenafil: 13.77 ± 4.63). Treatment with hydrolysis-resistant cyclic GMP (cGMP) showed findings similar to sildenafil-treated animals suggesting a negative impact of cGMP on early inflammatory phase of bone healing. However, histological differences were not significant between the 2 groups on day 8. Based on these findings, we conclude that sildenafil temporarily retards early events in alveolar bone healing.
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Project description:Pathological mandibular fracture after dental extraction usually occurs in dogs with moderate to severe periodontitis. A nanohydroxyapatite-based hydrogel (HAP hydrogel) was developed to diminish the limitations of hydroxyapatite for post-extraction socket preservation (PSP). However, the effect of the HAP hydrogel in dogs has still not been widely investigated. Moreover, there are few studies on PSP in dogs suffering from clinical periodontitis. The purpose of this study was to evaluate the effectiveness of the HAP hydrogel for PSP in dogs with periodontitis. In five dogs with periodontitis, the first molar (309 and 409) of each hemimandible was extracted. Consequently, all the ten sockets were filled with HAP-hydrogel. Intraoral radiography was performed on the day of operation and 2, 4, 8 and 12 weeks post operation. The Kruskal-Wallis test and paired t-test were adopted for alveolar bone regeneration analysis. The results demonstrated that the radiographic grading, bone height measurement, and bone regeneration analysis were positively significant at all follow-up times compared to the day of operation. Moreover, the scanning electron microscopy with energy-dispersive X-ray spectroscopy imaging after immersion showed a homogeneous distribution of apatite formation on the hydrogel surface. Our investigation suggested that the HAP hydrogel effectively enhances socket regeneration in dogs with periodontitis and can be applied as a bone substitute for PSP in veterinary dentistry.
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Project description:BackgroundVarious approaches are used for alveolar ridge preservation (ARP); however, there is no standard method or material.PurposeTo investigate the effect of ARP with a dense polytetrafluoroethylene (d-PTFE) membrane and freeze-dried irradiated allogenic bone for sockets with bone deficiency.Materials and methodsThirty-four patients (with sockets exhibiting ≥3 mm hard tissue loss in ≥1 walls) were randomized to undergo natural socket healing (control) or ARP with a d-PTFE membrane and freeze-dried irradiated allogenic bone (test group). After 4 months, horizontal and vertical ridge changes were measured using cone beam computed tomography.ResultsRidge width at l mm below the ridge crest demonstrated significantly less change in the test group (median =2.3; Q1 = 0.6; Q3 = 4.3 mm) than in the control group (median =3.9; Q1 =2.6; Q3 = 7.8 mm; P = .021). There was no significant difference between the two groups in horizontal ridge changes at 3 and 5 mm below the crest or vertical changes (P > .05). Requirement for bone augmentation at implant placement was significantly reduced in the test group compared to the control group (P < .001).ConclusionARP with a d-PTFE membrane and freeze-dried irradiated allogenic bone substitute reduced horizontal bone resorption in sockets with bone deficiency.
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Project description:AIM:To compare the effectiveness of two-ridge preservation treatments. MATERIALS AND METHODS:Forty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross-linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post-operatively, and biopsies were retrieved for histomorphometric analysis at 6 months. RESULTS:Primary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty-seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites. CONCLUSION:DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.
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Project description:Alveolar Bone loss occurs frequently during the first six months after tooth extraction. Various studies have proposed different methods to reduce as much as possible the atrophy of the alveolar ridge after tooth extraction. Filling the socket with biomaterials after extraction can reduce the resorption of the alveolar ridge. We compared the height of the alveolar process at the mesial and distal aspects of the extraction site and the resorption rate was calculated after the application of HA/β-TCP or synthetic co-polymer polyglycolic - polylactic acid PLGA mixed with blood to prevent socket resorption immediately and after tooth extraction. The study was conducted on 24 extraction sockets of impacted mandibular third molars bilaterally, vertically, and completely covered, with a thin bony layer. HA/β-TCP was inserted into 12 of the dental sockets immediately after extraction, and the synthetic polymer PLGA was inserted into 12 of the dental sockets. All sockets were covered completely with a full-thickness envelope flap. Follow-up was performed for one year after extraction, using radiographs and stents for the vertical alveolar ridge measurements. The mean resorption rate in the HA/β-TCP and PLGA groups was ± 1.23 mm and ± 0.1 mm, respectively. A minimal alveolar bone height reduction of HA/β-TCP was observed after 9 months, the reduction showed a slight decrease to 0.93 mm, while this rate was 0.04 mm after 9 months in the PLGA group. Moreover, the bone height was maintained after three months, indicating a good HA/β-TCP graft performance in preserving alveolar bone (1.04 mm) while this rate was (0.04 mm) for PLGA. The PLGA graft demonstrated adequate safety and efficacy in dental socket preservation following tooth extraction. However, HA/β-TCP causes greater resorption at augmented sites than PLGA, which clinicians should consider during treatment planning.
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Project description:Tooth extraction results in alveolar bone resorption and is accompanied by postoperative swelling and pain. Maresin 1 (MaR1) is a proresolving lipid mediator produced by macrophages during the resolution phase of inflammation, bridging healing and tissue regeneration. The aim of this study was to examine the effects of MaR1 on tooth extraction socket wound healing in a preclinical rat model. The maxillary right first molars of Sprague-Dawley rats were extracted, and gelatin scaffolds were placed into the sockets with or without MaR1. Topical application was also given twice a week until complete socket wound closure up to 14 d. Immediate postoperative pain was assessed by 3 scores. Histology and microcomputed tomography were used to assess socket bone fill and alveolar ridge dimensional changes at selected dates. The assessments of coded specimens were performed by masked, calibrated examiners. Local application of MaR1 potently accelerated extraction socket healing. Macroscopic and histologic analysis revealed a reduced soft tissue wound opening and more rapid re-epithelialization with MaR1 delivery versus vehicle on socket healing. Under micro-computed tomography analysis, MaR1 (especially at 0.05 μg/μL) stimulated greater socket bone fill at day 10 as compared with the vehicle-treated animals, resulting in less buccal plate resorption and a wider alveolar ridge by day 21. Interestingly, an increased ratio of CD206+:CD68+ macrophages was identified in the sockets with MaR1 application under immunohistochemistry and immunofluorescence analysis. As compared with the vehicle therapy, local delivery of MaR1 reduced immediate postoperative surrogate pain score panels. In summary, MaR1 accelerated extraction wound healing, promoted socket bone fill, preserved alveolar ridge bone, and reduced postoperative pain in vivo with a rodent preclinical model. Local administration of MaR1 offers clinical potential to accelerate extraction socket wound healing for more predictable dental implant reconstruction.
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Project description:This study aimed to develop a functionally graded membrane (FGM) to prevent infection and promote tissue regeneration. Poly(l-lactide-co-d,l-lactide) encapsulating platelet-derived growth factor (PDLLA-PDGF) or metronidazole (PDLLA-MTZ) was electrospun to form a nanofibrous layer on the inner or outer surface of a clinically available collagen membrane, respectively. The membrane was characterized for the morphology, molecule release profile, in vitro and in vivo biocompatibility, and preclinical efficiency for alveolar ridge regeneration. The PDLLA-MTZ and PDLLA-PDGF nanofibers were 800-900 nm in diameter, and the thicknesses of the functional layers were 20-30 μm, with sustained molecule release over 28 days. All of the membranes tested were compatible with cell survival in vitro and showed good tissue integration with minimal fibrous capsule formation or inflammation. Cell proliferation was especially prominent on the PDLLA-PDGF layer in vivo. On the alveolar ridge, all FGMs reduced wound dehiscence compared with the control collagen membrane, and the FGM with PDLLA-PDGF promoted osteogenesis significantly. In conclusion, the FGMs with PDLLA-PDGF and PDLLA-MTZ showed high biocompatibility and facilitated wound healing compared with conventional membrane, and the FGM with PDLLA-PDGF enhanced alveolar ridge regeneration in vivo. The design represents a beneficial modification, which may be easily adapted for future clinical use.
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