Evaluation of healing at molar extraction sites with ridge preservation using a non-resorbable dense polytetrafluoroethylene membrane: A four-arm cohort prospective study.
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ABSTRACT: Objectives
To examine ridge dimensional changes and histologic parameters of healing when ridge preservation (RP) was performed at molar sites using dense polytetrafluoroethylene (dPTFE) membrane alone, without a bone graft.Material and methods
Eighteen patients had molar extraction and RP using dPTFE membrane alone. Ridge dimensions were measured using two standardized cone beam computerized tomography (CBCT) scans taken within 72 h and 3 months following extraction. Following a 3-month healing period, an implant osteotomy was prepared using a trephine drill and bone cores were collected for histological analysis. Four-arm analyses were performed using data from three previously published study arms of the same research group.Results
There was a significant change in the buccal ridge height between the four groups at all aspects of the socket. Alveolar ridge width reduction at 3 mm from crest for all aspects (mesial, midpoint, distal) of the socket showed statistically significant difference for dPTFE alone group compared to the other three groups. Percentage of vital bone formation (62.10%) was significantly greater in dPTFE alone group compared to the other groups.Conclusions
RP using dPTFE membrane alone in molar sites with intact socket walls showed successful outcomes in maintaining ridge dimensions and in histologic wound healing.
SUBMITTER: Al Hugail AM
PROVIDER: S-EPMC8638281 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background and objectives: Non-resorbable dense polytetrafluoroethylene (dPTFE) membranes are widely used for regeneration procedures, alone or in combination with particulate materials. The aim of this work was to examine the efficacy of a newly developed dPTFE membrane in the management of extraction socket healing. Materials and Methods: The extraction premolar sockets of 44 patients (20 men and 24 women) were preserved. One group received prosthetic rehabilitation with a fixed partial denture (FPD) (PROS group, N = 19) and a second group received immediate implant placement (IMPL group, N = 25). The PROS group sockets were augmented with a bovine derived xenograft and covered with a newly developed dPTFE membrane prior to FPD rehabilitation. Results: In the IMPL group, socket preservation was combined with immediate implant placement. Before (T0) and 6 months after surgery (T1), horizontal and vertical dimensions were measured with customized stents. No significant differences in alveolar bone loss from T0 to T1 were observed between the PROS and IMPL groups in the horizontal dimension for any tooth type. There was a significant difference in alveolar bone loss from T0 to T1 between the two groups for only single-rooted maxillary premolars in the vertical dimension. Conclusions: The use of the examined new dPTFE membrane consistently led to the preservation of hard tissue in the extraction sites.
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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.
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Project description:Aim:To evaluate, with three-dimensional analysis, the effectiveness of alveolar ridge preservation (ARP) after maxillary molar extraction in reducing alveolar bone resorption and maxillary sinus pneumatization when compared to unassisted socket healing. Methods:Patients were included in the study following inclusion criteria and underwent minimally traumatic maxillary molar extraction followed by ARP using synthetic nanohydroxyapatite (Fisiograft Bone, Ghimas, Italy) (test group) or unassisted socket healing (control group). Cone-beam computerized tomographies (CBCT) were performed immediately after tooth extraction (T0) and 6 months postoperatively (T1). CBCTs were superimposed by using a specific software (Amira, Thermo Fisher Scientific, USA) and the following items were analyzed in both groups: (i) postextractive maxillary sinus floor expansion in coronal direction and (ii) postextractive alveolar bone dimensional changes (both vertical and horizontal). All data were tested for normality and equality of variance and subsequently analyzed by independent samples T-test and Mann-Whitney test. Results:Thirty patients were treated by three centers and twenty-six (test n=13; control n=13) were included in the final analysis. Mean sinus pneumatization at T1 was 0.69±0.48 mm in the test group and 1.04±0.67 mm in the control group (p=0.15). Mean vertical reduction of the alveolar bone at T1 was 1.62±0.49 mm in the test group and 2.01±0.84 mm in the control group (p=0.08). Mean horizontal resorption of crestal bone at T1 was 2.73±1.68 mm in test group and 3.63±2.24 mm in control group (p=0.24). Conclusions:It could be suggested that ARP performed after maxillary molar extraction may reduce the entity of sinus pneumatization and alveolar bone resorption, compared to unassisted socket healing. This technique could decrease the necessity of advanced regenerative procedures prior to dental implant placement in posterior maxilla.
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Project description:Objectives:The purpose of this systematic review was to assess quantitatively and qualitatively the influence of two different factors: membranes and soft tissue graft influence for the extraction socket preservation. Material and Methods:A wide-ranging electronic search was performed in six databases up to 30 of November 2018 in order to identify all the clinical and randomized clinical trials performed in humans published with no data restriction. The inclusion criteria were extraction socket preservation with and without membranes or a soft tissue graft in a intact socket with at least six months of follow-up, have more than 12 patients or treat more than 12 sites per group and evaluated at least one of the primary outcomes measures (radiographic measures histological assessment, clinical measures). Results:From an initial search of 1524 studies only 6 papers fulfil the inclusion and exclusion criterions. All the six selected papers, presented a wide heterogeneity of treatments used, evaluated variables and observation period that made impossible to recommend any specific techniques and/or material to achieve better results. The limited data found suggest that the used of membrane reveals to achieve better results. It wasn't possible to observe in any clinical trial that compares the used of soft tissue graft. Conclusions:New trials need to be performed in order to identify what specific techniques and/or materials are better to decrease the reabsorption of the socket after tooth extraction. Clinical trials designed to understand when/how the soft tissues grafts influence at the socket preservation is needed.
| S-EPMC6788420 | biostudies-literature
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: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:Alveolar ridge preservation strategies are indicated to minimize the loss of ridge volume that typically follows tooth extraction. The aim of this systematic review was to determine the effect that socket filling with a bone grafting material has on the prevention of postextraction alveolar ridge volume loss as compared with tooth extraction alone in nonmolar teeth. Five electronic databases were searched to identify randomized clinical trials that fulfilled the eligibility criteria. Literature screening and article selection were conducted by 3 independent reviewers, while data extraction was performed by 2 independent reviewers. Outcome measures were mean horizontal ridge changes (buccolingual) and vertical ridge changes (midbuccal, midlingual, mesial, and distal). The influence of several variables of interest (i.e., flap elevation, membrane usage, and type of bone substitute employed) on the outcomes of ridge preservation therapy was explored via subgroup analyses. We found that alveolar ridge preservation is effective in limiting physiologic ridge reduction as compared with tooth extraction alone. The clinical magnitude of the effect was 1.89 mm (95% confidence interval [CI]: 1.41, 2.36; p < .001) in terms of buccolingual width, 2.07 mm (95% CI: 1.03, 3.12; p < .001) for midbuccal height, 1.18 mm (95% CI: 0.17, 2.19; p = .022) for midlingual height, 0.48 mm (95% CI: 0.18, 0.79; p = .002) for mesial height, and 0.24 mm (95% CI: -0.05, 0.53; p = .102) for distal height changes. Subgroup analyses revealed that flap elevation, the usage of a membrane, and the application of a xenograft or an allograft are associated with superior outcomes, particularly on midbuccal and midlingual height preservation.
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Project description:ABSTRACT Context: In the present era of allopathic medication usage, there is always a risk of toxicity. Turmeric is a wonderful natural herb with excellent healing properties and a plethora of many clinical trials in dentistry. Hence, this study aims to evaluate the efficacy of healing in mandibular molar extraction sockets with and without turmeric gel. Aim: This study aimed to evaluate the efficacy of turmeric gel with the objective of analyzing the soft tissue healing in mandibular molar extraction sockets with and without turmeric gel. Settings and Design: The split-mouth study design with randomization of the sites was done using the sequentially numbered opaque sealed envelope (SNOSE) in the same patient indicated for bilateral lower molar extraction. A total of 50 patients were included in the study, who were divided into group A, 25 patients in the experimental site using turmeric gel, and group B, 25 patients in the control site without turmeric gel. Materials and Methods: Turmeric in the form of gel was used in the experimental site to evaluate its efficacy in soft tissue healing of the mandibular molar extraction socket. The extraction sites of the same patient were evaluated for soft tissue healing on postoperative day 1, day 7, and day 21 using Landry, Turn Bell, and Howley scale. Statistical Analysis: A comparison of soft tissue healing between group A and group B, which showed a consequential difference in group A on day 7 with P = 0.001 and day 21 with P = 0.001, was significant. Results: Results revealed postoperative day 1 showed a significant beginning of healthy granulation tissue formation in both the groups. There was a consequential difference in soft tissue healing in group A on postoperative day 7 and day 21 as compared to group B. The turmeric in the form of gel proved to enhance the soft tissue healing in the mandibular molar extraction socket. Conclusions: The present study revealed that enhanced soft tissue healing of the extraction socket of the mandibular molar was present in the turmeric gel group on postoperative day 7 and day 21 than in without the turmeric gel group.
| S-EPMC10474527 | biostudies-literature
Project description:IntroductionTooth extraction in children requires attention to wound healing and pain management, which are influenced by patient-related factors and behavioral guidance.Aim of the studyThe study aimed to evaluate the effect of LLLT on healing sockets in pediatric patients with bilateral primary molar teeth extraction and determine its impact on pain management.Methods6-10 years of age, systemically healthy, and with atraumatic extraction indications of bilateral primary molar teeth were included in the study (n = 40). In the first session, randomly selected teeth were extracted under local anesthesia. In the control group, only clot formation in the socket was observed and photographed. The other group extractions were performed 2 weeks later. The low-level laser therapy (LLLT) group was treated with a 980 nm wavelength, in a continuous emission mode, 0.5 W power, 300 J of energy, 400 µm tip, 60 s diode laser and photographed. Nonepithelialized surface measurements were performed using ImageJ. Pain assessment was performed using the Wong-Baker Pain Scale. Statistical analyses were performed using SPSS software.ResultsThere was a statistically significant difference between the groups in the Wong-Baker values in 3rd day (p < 0.05). In soft tissue healing on the 3rd and 7th day, the nonepithelialized surface of the laser socket was smaller than that of the control group, and the measurement results were found to be statistically significant (p < 0.05).ConclusionAlthough LLLT was not found to be very effective in reducing postoperative discomfort after extraction of primary molars, it provided better wound healing in extraction sockets.
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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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