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PubMed2006

Survival of immediately loaded dental implants in deficient alveolar bone sites augmented with beta-tricalcium phosphate.

PURPOSE: Dental implant placement in atrophic alveolar ridges often necessitates grafting procedures, followed by immediate or delayed implant placement. This study assessed the survival of immediately loaded dental implants placed in deficient alveolar bone sites at bone grafting. MATERIALS: From 1999 to May 2002, 1 operator (A.P.) inserted 1065 implants (607 in mandibles, 458 in maxillae) into 338 partially edentulous patients. Most implants were placed into compromised residual ridges or prepared tooth extraction sockets. Implants placed in augmented areas were splinted to implants in nonaugmented sites for stability. In all cases, beta-tricalcium phosphate was mixed with blood from the surgical site to augment the ridge level or fill spaces between the implant and socket wall. When indicated, the same materials were used for sinus floor augmentation. All implants were tapered screws with roughened surfaces, primarily (75%) from 1 manufacturer. One of the authors (Z.O.) prosthetically restored a total of 189 implants that were placed in 35 patients. In this group of patients, complete restorative data were available. All implants were monitored for 12-48 months (mean = 19.2; median = 24). RESULTS: A total of 1039 implants survived, and 26 failed, including 5 in the anterior mandible and 21 in the maxillae. In the restorative group, 186 implants survived, and 3 maxillary implants failed. All implant failures in this study occurred in the augmented sites. CONCLUSION: Within the limitations of this study, immediate loading of splinted implants in augmented sites is a predictable procedure.

Alveolar Ridge Augmentation↗
PubMed2004

Effect of exposed inferior alveolar neurovascular bundle during surgical removal of impacted lower third molars.

PURPOSE: In this prospective study, we sought to determine the incidence of inferior alveolar nerve (IAN) paresthesia in patients with an exposed IAN bundle seen intraoperatively. PATIENTS AND METHODS: We included consecutive patients undergoing third molar surgery in whom an exposed IAN bundle was seen in the third molar socket intraoperatively. Data recorded from patients included radiographic findings, variations in surgical method, intraoperative findings, complications, and postoperative sequelae. Patients were reviewed 1 week after surgery and evaluated subjectively and objectively to determine the incidence of paresthesia when the IAN bundle was exposed. Patients with paresthesia were followed for 2 years or until it resolved. RESULTS: An exposed IAN bundle was seen in 192 operation sites in 170 patients over a 5-year period, of which 166 patients with 187 operation sites were included in this study. Thirty-eight operation sites (20.3%) showed paresthesia at 1 week after surgery (95% confidence interval, 14.5% to 26.1%); 20 sites (15.0%) showed abnormal objective assessment results. By 3 months from surgery, 57.9% of nerves had recovered to normal sensation, 65.8% of nerves recovered by 6 months, and 71.1% of nerves recovered by 1 year. Eight patients were lost to follow-up. Logistic regression showed that the operator, male gender, older age, and root curvature were significant risk factors for paresthesia. CONCLUSIONS: Sighting an exposed intact IAN bundle during third molar surgery indicates its intimate relationship with the third molar and carries a 20% risk of paresthesia, with a 70% chance of recovery by 1 year from surgery.

Adolescent↗
PubMed2000

Dental extraction wound management: medicating postextraction sockets.

The rather impressive percentage of extraction sites undergoing clot loss and deranged healing results in significant morbidity for the patient and frequent visits to the surgeon to effect relief of discomfort, most often by the use of anodyne dressings. The amount of work lost by patients needing such palliative treatment, and loss of productive time for the surgeon, translate into an unknown, but potentially large, economic loss to society. This would mandate that economical methods of ensuring normal extraction socket healing with minimal morbidity be developed. The most useful socket medicaments to prevent socket healing derangements would include broad-spectrum antibiotics, specifically clindamycin and tetracycline. Not discussed in this article, but possibly germane to the subject of clot stabilization and healing, is consideration of resorbable substances such as gelatin sponge, polylactic acid, and methylcellulose as clot-stabilizing socket implants. The record of such substances in preventing AO is mixed, but the combinations of these inexpensive materials with topical socket medicaments may yield a decreased tendency for clot lysis and greater mechanical strength to the bulk blood clot, as has been demonstrated with difficult mandibular third molar impactions in one study involving polylactic acid, tetracycline, and hydrocortisone.

Anti-Bacterial Agents↗
PubMed2005

A comparison between enamel matrix derivative and a bioabsorbable membrane to enhance healing around transmucosal immediate post-extraction implants.

BACKGROUND: This clinical report compares the use of an enamel matrix derivative (EMD) and bioabsorbable barrier membrane to enhance healing following the immediate placement of transmucosal implants into extraction sockets. METHODS: Thirty-two adult patients scheduled for tooth replacement with dental implants agreed to participate. Following the insertion of a transmucosal implant into the extraction site, the subjects were assigned to one of two treatment alternatives of the remaining bone defects around the implants: 1) the residual bone defects were filled with EMD (EMD group) or 2) the residual bone defects were covered with a bioabsorbable membrane (membrane group). Flaps were then coronally positioned around implant cover screws. Patients followed weekly maintenance recalls for the first 6 weeks and then monthly recalls until the final prosthetic restoration was completed (after 6 months). The treatment outcome was evaluated after 12 months by the use of clinical variables. The null hypothesis of no treatment group differences was tested by the use of analysis of variance (ANOVA). RESULTS: At a 12-month follow-up, all of the implants were completely osseointegrated and successfully functioning, showing a success rate of 100%. The membrane group showed a significantly lower mean probing attachment level than the EMD group at proximal (0.60 mm, standard deviation (SD) 0.37 versus 1.19 mm, SD 1.10), buccal (0.80 mm, SD 0.79 versus 1.77 mm, SD 1.16), and lingual sites (0.44 mm, SD 0.52 versus 1.48 mm, SD 1.46). The difference was statistically significant at all sites (P < 0.05). With respect to the position of the soft tissue margin around the implant shoulder, the membrane group showed a consistently higher value than the EMD group at, respectively, proximal (1.30 mm, SD 2.37 versus 1.16 mm, SD 1.0), buccal (0.90 mm, SD 1.29 versus 0.22 mm, SD 1.47), and lingual sites (1.12 mm, SD 1.10 versus 0.55 mm, SD 1.42). CONCLUSIONS: The membrane group obtained more favorable results in terms of both the probing attachment level and peri-implant position of soft tissues compared to the EMD group. The use of a bioabsorbable membrane around immediately placed transmucosal implants enhanced soft and hard tissue healing and might be an advisable treatment choice particularly in areas with high esthetic demands.

Absorbable Implants↗
PubMed2006

Comparison of bone grafting materials in human extraction sockets: clinical, histologic, and histomorphometric evaluations.

PURPOSE: Although there are a number of bone replacement graft materials that are currently available for clinical use, there are few studies that directly compare efficacy among graft treatments before implant placement. The purpose of this report was to compare 3 bone replacement graft materials (PepGen P-15 228 FLOW [DENTSPLY Friadent CeraMed, Lakewood, CO], Puros [Zimmer Dental, Carlsbad, CA], and C-Graft 228 [Clinician's Preference, Golden, CO]) for bone formation by clinical, histologic, and histomorphometric evaluation. MATERIALS AND METHODS: In this prospective, intraoral pilot study, 13 maxillary sockets in 2 patients (both smokers) were grafted immediately after tooth extraction with C-Graft 228, Puros, or PepGen P-15 228 FLOW (containing additional PepGen P-15 228 particles; FLOW PUTTY). After 4 months, bone cores were retrieved and analyzed histologically. RESULTS: PepGen P-15 228 FLOW PUTTY produced a significantly (P <0.01) higher amount of vital bone than C-Graft 228 or Puros. The amount of vital bone for FLOW PUTTY was 12-fold higher than for C-Graft 228 and 4-fold higher than Puros. Of 7 FLOW PUTTY treated sites, 7 showed >14% vital bone versus 0 of 3 C-Graft 228 and 0 of 3 Puros treated sites. FLOW PUTTY treated sites showed new vital bone between particles of residual graft. C-Graft 228 treated sites showed residual particles in a background of connective tissue with very little bone. Puros treated sites showed nonvital bone particles in a background of connective tissue, with some new vital bone forming around the nonvital bone. CONCLUSION: PepGen P-15 228 FLOW PUTTY produced significantly greater vital bone as compared to Puros and C-Graft 228 after 4 months. A larger clinical study is required to confirm these results.

Adult↗
PubMed2000

Placement of implants into ridges grafted with bioplant HTR synthetic bone: histological long-term case history reports.

Following alveolar ridge grafting procedures for ridge preservation, for example, the immediate filling of extraction sockets, and ridge augmentation, for example, the building up of the atrophic jawbone, punch biopsies were obtained at various times postextraction prior to the placement of endosseous root-form implants. These histological sections provided an opportunity to study the bony regenerative response to an osteoconductive synthetic graft material and longer term interactions over a period from 8 months to 12 years. The formation and remodeling of healthy dense lamina of bone in areas where bone voids previously existed either from healed or immediate extraction sockets or where there was jawbone atrophy resulting from multiple tooth loss was observed. The grafting procedures enabled dentists to place implants into sites that would have been impossible if not for these preimplant grafting procedures. The jawbone areas studied involved grafted single sites and quadrants as well as full arch augmentation with a calcified microporous copolymer (Bioplant HTR Synthetic Bone, Bioplant Inc, South Norwalk, Conn) graft material. Retrospective case reports of 24 patients were followed radiographically and clinically to 12 years post-alveolar-ridge grafting and subsequently to 5 years after implants were placed into these augmented ridges. Implant and grafting histories from 4.7 months to 17 years are reported for three of these patients. General applications of synthetic bone grafting before implant placement are recommended.

Adult↗
PubMed1989

[Effects on repaired bone with hydroxyapatite by the changes of dynamics in the alveolar bone].

Hydroxyapatite (HAP) is regarded as a useful material for grafting in procedure aimed at bone replacement. The purpose of this investigation, as a basic experiment, was to demonstrate bone formation in the dental extraction sockets during orthodontic movement of the neighboring teeth in the initial wound healing phase, and to clarify effects of indirect forces through alveolar bone on repairing bone in extraction sockets. Secondary we examined changes in the bone formation in the sockets during the tooth movement which were plugged with HAP granules and compared with the repairing bone without HAP. For this study seven dogs were used and were scarificed according to a schedule yielding observation periods up to 6 weeks. The animals were injected continuously with tetracycline during the experimental period. Undecalcified mesio-distal specimens 65-100 microns of thickness were prepared at first for microradiogram and then subjected to fluorescence microscopy. The observations indicated that the bone formation seemed to be accelerated with HAP implantation, however the alveolar trabeculae around HAP were developed during the tooth movement less than the control. The tooth movement in implanted sites was faster than in the sites without HAP implantation. The decreased response on alveolar bone formation, incident to experimental tooth movement into extraction sockets, was found in the pressure area, mesial part of socketswall. It might be induced by excessive stress during the tooth movement, amplified by the change of bone repairing due to the HAP implantation.

Alveolar Bone Loss↗
PubMed1994

Tunnel traction of infraosseous impacted maxillary canines. A three-year periodontal follow-up.

A surgical orthodontic procedure was used to treat deep infraosseous impacted canines (test teeth) associated with the persistence of the deciduous tooth in 15 patients who had the contralateral canine normally erupted (control teeth). The periodontal outcome was evaluated at the end of the orthodontic treatment and 3 years later. After extraction of the deciduous canine, a mucoperiosteal flap was raised on the buccal (seven cases) or palatal (eight cases) aspect, to expose the cusp of the impacted tooth. The empty socket of the deciduous tooth was extended to reach the impacted cusp and to form an osseous tunnel. A chain was passed through the tunnel and fixed to a bonded device on the impacted cusp. The flap was sutured back into its original position. The chain was used for traction to the impacted canine toward the center of the alveolar ridge. No attachment loss and no recession were observed at the end of the active therapy or 3 years later. No significant differences in keratinized tissue width were observed between test and control teeth at the follow-up examination.

Adolescent↗
PubMed2005

Three-year analysis of Tapered Screw-Vent implants placed into extraction sockets grafted with mineralized bone allograft.

With clinicians placing more dental implants, it is becoming increasingly important to maintain bone volume after tooth extraction. This article reports the results of implants placed into extraction sites grafted with particulate mineralized bone allograft (Puros). A total of 313 extraction sites were grafted with mineralized bone graft during a 36-month period. A total of 252 Tapered Screw-Vent dental implants were placed into the grafted extraction sites after a 4- to 7-month healing period. All reentries revealed a bony hard structure acceptable for osteotomy preparation. A total of 244 of these implants have been restored with fixed prosthesis and 6 with removable overdentures for a total of 250 loaded implants. A total of 6 implants failed, which required their removal (2 implants before load and 4 after loading), resulting in a 97.6% implant success rate. We conclude that mineralized human allograft placed into extraction sites is clinically useful to maintain bone volume. This material provided a bony hard structure acceptable for implant placement with good success rates.

Adult↗
PubMed2001

Prolonged immobilization-induced stress delays alveolar bone healing. A histometric study in rats.

The purpose of the present study was to investigate the effect of prolonged immobilization-induced stress on reparative bone formation, using the rat alveolar healing as an experimental protocol. Stress was attained by immobilization for 2 hours a day, beginning three days before extraction of the upper right incisors and continuing until sacrifice. The stress condition was assayed on the basis of plasma corticosterone concentration (measured by double-antibody radioimmunoassay), which increased by 2.5 to 4 times in rats submitted to immobilization. The volume density of neoformed bone filling the alveolar socket was quantified by a histometric differential point-counting method 7 to 21 days following tooth extraction. Stress caused a significant delay in reparative bone increment, somewhat related to impairment of coagulum remission and/or organization.

Animals↗
PubMed2001

Ultrastructural changes in postcapillary-sized venule morphology in aged mouse periodontal ligament.

The aim of this study was to compare the postcapillary-sized venule (PCV) morphology of four young ALCA mice (35 days) and four colony-related aged mice (365 days) using the transmission electron microscope (TEM). Right and left mandibular first molar mesial roots with associated periodontal ligament (PDL) and bony socket, were used for TEM assessment. Five PCV profiles were selected at each 160 microm interval, from the alveolar crest to the tooth apex. PCV profile dimensions were measured on standardised micrographs magnified x2900. Age affects were tested using multiple regression analysis. The number of PCV profiles in the tooth third of the PDL was higher in aged mice (p < 0.01) and comprised predominantly apericytic vessels (p < 0.001). The number of PCV profiles increased significantly (p < 0.001) in aged mice in the PDL middle circumferential third halfway down the molar root. Age had no significant affect on PCV diameter. Aged PDL permeability studies are needed to investigate whether the changes in aged PCV profile number are associated with functional modification of the PDL microvasculature.

Aging↗