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PubMed2006

[Effects of progressive loading on implants placed into extraction sockets: a preliminary study].

OBJECTIVE: To study the effects of progressive loading on implants placed into extraction sockets. METHODS: Bilateral 3rd, 4th and 2nd premolar of 4 beagle dogs were extracted and the implants were immediately inserted at 0, 14 and 21 days. The progressive loading procedure was conducted after 24 hours. The vertical bone loss (VBL) and the bone/biomaterials reactions were detected by X-ray and SEM. RESULTS: The VBL in control groups was larger than that for the experimental groups at 14, 21 and 28 days (P<0.05). Scan electron microscopy detected that the mineralization speed of experimental groups was many times as faster as the control groups. CONCLUSION: Progressive loading of implants placed into extraction sockets can be performed without disturbing the osseointegration process. The potential of new bone formation in the extraction sockets and the physical strains can congenerously promote osseointegration.

Animals↗
PubMed2006

Tissue modeling following implant placement in fresh extraction sockets.

OBJECTIVE: To study whether osseointegration once established following implant placement in a fresh extraction socket may be lost as a result of tissue modeling. MATERIAL AND METHODS: Seven beagle dogs were used. The third and fourth premolars in both quadrants of the mandible were used as experimental teeth. Buccal and lingual full-thickness flaps were elevated and distal roots were removed. Implants were installed in the fresh extraction socket. Semi-submerged healing of the implant sites was allowed. In five dogs, the experimental procedure was first performed in the right side of the mandible and 2 months later in the left mandible. These five animals were sacrificed 1 month after the final implant installation. In two dogs, the premolar sites on both sides of the mandible were treated in one surgical session and biopsies were obtained immediately after implant placement. All biopsies were processed for ground sectioning and stained. RESULTS: The void that existed between the implant and the socket walls at surgery was filled at 4 weeks with woven bone that made contact with the SLA surface. In this interval, (i) the buccal and lingual bone walls underwent marked surface resorption and (ii) the height of the thin buccal hard tissue wall was reduced. The process of healing continued, and the buccal bone crest shifted further in the apical direction. After 12 weeks, the buccal crest was located>2 mm apical of the marginal border of the SLA surface. CONCLUSION: The bone-to-implant contact that was established during the early phase of socket healing following implant installation was in part lost when the buccal bone wall underwent continued resorption.

Animals↗
PubMed1992

Alveolar bone remodeling after tooth extraction in normal and osteopetrotic (ia) rats.

One of the osteopetrotic mutations in the rat, incisors-absent (ia), exhibits generalized skeletal sclerosis and failure or delay of tooth eruption, characteristics of other osteopetrotic mutations. Osteopetrosis in ia rats is known to be due to a reduction in bone resorption, the result of the inability of ia osteoclasts to elaborate a ruffled border. During healing of extraction wounds, especially the initial period, osteoclastic resorption of alveolar bone is considered to be a significant feature, followed by new bone formation. We have studied extraction wound healing in osteopetrotic (ia) rats histologically in order to determine if their systemic reduction in bone resorption changes the sequence or rate of alveolar bone healing within and outside the socket after tooth extraction, In ia rats, the healing process was delayed in comparison to that of normal rats. Many osteoclasts were observed on the surface of alveolar bone, but there was little evidence of resorption. Bone formation in the socket following bone resorption was reduced and the newly formed trabeculae were irregular. In contrast, the quantity of resorption-independent (periosteal) new bone formation outside the socket was exaggerated compared to normal animals. These data indicate that the disturbance of new bone formation in the socket is probably related to the reduction in osteoclastic bone resorption.

Alveolar Bone Loss↗
PubMed2000

Progress of ossification and epithelialization of wounds after simple or surgical extractions of teeth in rats with chronic renal failure: an experimental study.

Our aim was to investigate the progress of wound healing after simple and surgical removal of the first two molars of the right and left maxillary segments, respectively, in Wistar rats with experimentally induced moderate chronic renal failure (CRF). Sixty Wistar rats were divided into two groups of 30 rats each: experimental and control. CRF was induced in the experimental group by an intraperitoneal injection of cisplatin, 5 mg/kg body weight (BW) initially and then with two maintenance doses of 2.5 mg/kg BW at intervals of one month. The teeth were extracted one month after the last dose of cisplatin. The sockets and the kidneys of all the rats of both groups were evaluated. The mandibles of the 15 rats in the experimental group that developed moderate CRF, together with those of two controls, were evaluated for abnormalities that suggested renal osteodystrophy. The histopathological examination showed: (a) that there were no significant differences in the pattern of wound healing no matter how the tooth was extracted; (b) there were no specific abnormalities in the mandible to indicate of secondary hyperparathyroidism or renal osteodystrophy; and (c) the kidneys of the rats of the experimental group underwent histopathological changes that were significantly different from those in the controls (P < 0.001). Our results indicate that moderate CRF does not have any appreciable or significant modifying effect on wound healing after tooth extraction in Wistar rats.

Adolescent↗
PubMed2006

Bone tissue formation adjacent to implants placed in fresh extraction sockets: an experimental study in dogs.

OBJECTIVE: To study the healing of marginal defects that occurred at implants placed in a healed ridge or in fresh extraction sockets. MATERIAL AND METHODS: Six dogs were used. The right side of the mandible was used in the first part of the study. The first, second premolars and first molars were extracted. After 3 months of healing the bone was prepared for implant installation in these premolar and molar sites. The marginal 5 mm of each recipient site was widened with a conical drill. Following implant installation a gap of varying dimension occurred around the titanium rod (artificial defect (A) sites). At this interval the third and fourth premolars were extracted and implants were installed in the distal socket of the two teeth (natural defect (N) sites). The flaps were sutured to allow non-submerged healing. After 2 months, the procedures were repeated in the left side. Two months later the animals were euthanized, and biopsies were obtained and prepared for histological examination. RESULTS: The length of the zone of de novo'bone-to-implant contact' in the defect region was longer at the A sites than at the N sites both at the 2- and the 4-month interval. Further, while after 4 months of healing the marginal bone crest at the A sites was located close to the abutment/fixture junction, at the N sites a marked reduction of the height of the bone crest was documented. Hence, most A site defects became completely resolved whereas healing of the N site defects was incomplete. CONCLUSION: The process of bone modeling and remodeling at an implant placed in a fresh extraction socket differs from the resolution of marginal defects that may occur following implant installation in a healed ridge.

Animals↗
PubMed2001

Acute effects of ovariectomy on wound healing of alveolar bone after maxillary molar extraction in aged rats.

Acute effects of ovariectomy on the bone wound healing processes after maxillary molar extraction in aged rats were examined by means of quantitative scanning electron microscopy (SEM), backscattered electron image (BSE) analysis and energy-dispersive X-ray (EDX) microanalysis. Six-month-old female rats underwent either sham operation or bilateral ovariectomy, and 7 days postoperatively, the maxillary first molars were extracted. On post-extraction days 7, 30 and 60, the dissected maxillary bone surfaces were examined by SEM to reveal the bone formative and resorptive areas around the extracted alveolar sockets. In addition, the resin-embedded maxillae were micromilled in the transverse direction through the extracted alveolar sockets, and the newly-formed bone mass on the buccal bone surfaces and within the extracted sockets was examined by BSE analysis. Compared with sham-operated controls, the extent of newly-formed bone mass on the buccal bone surfaces in OVX rats was significantly decreased, due to increased bone resorption. On the other hand, new bone formation within the extracted sockets was similar in the experimental groups. In EDX microanalysis of these newly-formed bone matrices, both Ca and P weight % and Ca/P molar ratio were similar in the experimental groups. Our results suggest that 1) acute estrogen deficiency induced by ovariectomy stimulates sustained bone resorption, but has less effect on bone formation, and 2) bone wound healing after maxillary molar extraction within extracted alveolar sockets is not significantly delayed by ovariectomy, but bony support by newly-formed bone mass on the maxillary bone surfaces at the buccal side of the extracted sockets is significantly decreased, due to increased bone resorption.

Acute Disease↗
PubMed2006

Study of recombinant human osteogenic protein-1 expressed in prokaryocyte on the repair of extracted socket in rabbits.

The study investigated the effect of recombinant human osteogenic protein-1 (rhOP-1) expressed in prokaryocyte, to promote the healing of alveolar socket. A model of rabbit extracted socket into which the composites of rhOP-1 and gelatin sponge was immediately implanted was created and the osteoinduction of rhOP-1 was assessed by histological method, quantitative measurement of calcium content and alkaline phosphatase (ALP) activity. The result of histology showed that bone healing in rhOP-1 side is 4-6 weeks earlier than that of the control side. ALP activity and calcium content in rhOP-1 side were significantly high compared with that of the control side. rhOP-1 has a satisfactory osteoinduction ability to promote the healing of extracted socket.

Alkaline Phosphatase↗
PubMed2004

The impact of image compression on diagnostic quality of digital images for detection of chemically-induced periapical lesions.

OBJECTIVES: To test the hypothesis that there is no significant difference in the detectability of chemically-induced periapical lesions between a non-compressed image and one subjected to a Joint Photographic Experts Group (JPEG) lossy compression technique at a ratio of 23:1 or less. METHOD: Chemically-induced periapical lesions were created by placing a solution of 70% perchloric acid at the apex of extracted teeth in 13 human jaw cadaver specimens. Acid was applied in seven incremental time periods from 0-32 h. Extracted teeth were replaced in the socket and images were made using the Schick CDR digital sensor. Using a JPEG lossy compression algorithm, five compression ratios of 2:1, 14:1, 23:1, 28:1 and 47:1 were applied to the images. Images were viewed three times by three observers who ranked the presence or absence of a lesion at three sites, the mesial area, distal area and apex of the tooth, on a 5-point confidence scale. Intraobserver and interobserver agreement and agreement between the compressed and the original images were assessed with intraclass correlation coefficients (ICCs). RESULTS: Overall ICCs for measuring intraobserver agreement using all images were 0.77, 0.84, and 0.50 for the three observers, respectively. The overall ICC for assessing agreement between observers was 0.57. There was no significant difference (P>0.05) between compressed and original images for any site at compression ratios of 2:1, 23:1 and 28:1. There were significant differences for a compression ratio of 47:1. CONCLUSION: JPEG compression does not impact detectability of artificial periapical lesions at low and moderate compression ratios up to and including 28:1.

Algorithms↗
PubMed2001

The effect of cyclosporin A on the activity of matrix metalloproteinases during the healing of rat molar extraction wounds.

Cyclosporin A (CyA) is a cyclic peptide used as an immunosuppressive agent because it can block the synthesis of interleukin-2 and other cytokines produced by CD4+ lymphocytes. It is widely used for the prevention of allograft rejection and treatment of autoimmune diseases. Several side-effects of CyA treatment have been reported, among which are chronic nephrotoxicity, hepatotoxicity and neurotoxicity, lymphoproliferative neoplasms, hypertension, thromboembolic complications and gingival overgrowth. Here, using a rat molar model, it is demonstrated that CyA immunosuppression inhibits the activity of matrix metalloproteinases 2 and 9 in the early phase of granulation tissue in the healing dental socket. These observations suggest that CyA may interfere with the wound healing following dental extractions.

Animals↗
PubMedDate not supplied

Preliminary data of a prospective clinical study on the Osseotite NT implant: 18-month follow-up.

PURPOSE: This article provides preliminary clinical results on the Osseotite NT implant, which was developed to simplify surgical procedure and cover an extended range of indications. Placement characteristics of NT and standard Osseotite implants were also compared in an in vitro study. MATERIALS AND METHODS: The in vitro placement characteristics of NT and standard Osseotite implants of 4.0 mm diameter and 8.5 to 15 mm in length were compared. In addition, a total of 182 NT implants (96 maxillary and 86 mandibular) were placed in 92 patients; of these, 87.9% were placed using a 1-stage technique. The implants were placed in healed sites (43.9%), fresh extraction sockets (37.4%), or recent extraction sites (2 months postextraction) (18.7%). Before restoration, healing times of 3 to 4 months in the mandible and 5 to 6 months in the maxilla were allowed. The entered implant length in the osteotomy site before contacting the bony walls (EILOS) was compared, as well as the number of turns and the time required to seat the implants. Cumulative survival rates (CSRs) were calculated for up to 18 months of follow-up after surgery. RESULTS: The EILOS was between 47.3% and 57.6% of implant length for the NT implants; for the standard implants, it was between 12.0% and 21.2%. With the NT implants, the number of turns and the placement time were reduced by 61% to 64% and 61% to 65%, respectively. In the clinical study, 4 implants failed during the healing period; none failed after prosthesis placement. The CSR was 97.79% for implants placed into fresh or recent extraction sites; in healed sites, the CSR was 98.75%. The cumulative prosthetic success rate was 100%. DISCUSSION: This new implant design is seated with special drills; the drilling sequence requires less time and less torque than that used for standard implants. The low failure rate after prosthetic loading was consistent with that observed for standard Osseotite implants. CONCLUSION: These preliminary data suggest that the NT implant can be predictable in healed sites and fresh or relatively recent extraction sockets.

Adult↗
PubMed1981

Periodontal healing after replantation and autotransplantation of incisors in monkeys.

The effect of injury to the cemental or alveolar part of the periodontal ligament upon periodontal healing after replantation and autotransplantation of teeth was studied in green Vervet monkeys. Sixty-six maxillary central incisors were replanted or autotransplanted after extra-alveolar periods of 18 min. saline storage or 120 min. dry storage. The animals were sacrificed after 8 weeks and the teeth examined histometrically. Identical healing was found in the following experimental groups: replantation or autotransplantation after 18 min. and replantation with or without removal of periodontal ligament in the alveolus. A significant increase in replacement resorption (ankylosis) compared to the 18 min. replantation group was found in the following groups: replantation and autotransplantation after 120 min., replantation after removal of periodontal ligament on the root surface and autotransplantation after 120 min. to a socket where the tooth was extracted 18 min. earlier. Autotransplantation after 18 min. to a socket where a tooth had been extracted 120 min. earlier led to a significant increase in the amount of replacement resorption compared to transplantation to an 18 min. socket. Based on these findings, it is concluded that the presence of an intact and viable periodontal ligament on the root surface is the most important factor in assuring healing without root resorption. The length of the extra-alveolar period also seems to exert some influence upon the socket, enhancing the development of ankylosis.

Animals↗
PubMed2001

Evaluation of the effect of immediate grafting of mandibular postextraction sockets with synthetic bone.

Immediate mandibular complete dentures were placed in 18 patients. To prevent ridge resorption, bone grafts with hard tissue replacement synthetic bone were placed in sockets on one side of the mandible. The untreated sockets on the contralateral side served as controls. Bone density as shown in panoramic radiographs was reported at the time of placement, at 5 months to 6 months postsurgery, at 12 months to 14 months postsurgery, and at 20 months to 24 months postsurgery. The sites treated with hard tissue replacement synthetic bone not only prevented ridge resorption but also showed increased optical (socket) density of regenerating bone in the initial phase of the study, and maintained that elevated level at 24 months postextraction.

Alveolar Bone Loss↗
PubMedDate not supplied

Evaluation of mesenchymal stem cells following implantation in alveolar sockets: a canine safety study.

PURPOSE: The overall goal of this project was to evaluate culture-expanded bone-marrow-derived mesenchymal stem cells (MSCs) for alveolar bone repair in terms of safety and potential efficacy. MATERIALS AND METHODS: MSCs isolated from bone marrow aspirations were culture-expanded and cryopreserved. Thawed cells were incubated with 3.2 x 5-mm hydroxyapatite/tricalcium phosphate (HA/TCP) cylinders in a closed system containing 5 x 10(7) cells/mL. Cells alone, cell-free constructs, or cell-loaded constructs were rinsed in saline and implanted in extraction sockets in the mandibular second and fourth premolar sites of 14 beagle dogs. Acute reactions were evaluated histologically after 7 or 21 days, and bone formation was examined after 49 days. RESULTS: Neither implanted MSC-related inflammation nor ectopic osteogenesis was observed. At 7 and 21 days, dil-labeled canine MSCs were found in more than 80% of the implant sites. Few canine MSCs were found in neighboring tissue. Mild inflammation present at 7 days diminished by 21 days. After 49 days, measured bone formation was 34%, 25%, and 35% for cell-loaded, cell-free, and untreated sockets, respectively (P < .05). At 21 days, bone formation was evident in all sites. Wound dehiscence was a complication associated with cell exclusionary membranes and resulted in local inflammation. DISCUSSION: The extraction model indicates the safety of MSCs implanted adherent to HA/TCP. Local bone repair occurred in the absence of nonspecific differentiation or migration with distant osteogenesis. CONCLUSIONS: An alveolar socket model may be an appropriate model for initial clinical investigation of MSC-mediated bone repair.

Animals↗
PubMed2002

Implant placement in maxillary first premolar fresh extraction sockets: description of technique and report of preliminary results.

BACKGROUND: The postextraction morphology of the maxillary first premolar extraction socket presents a number of challenges to clinicians seeking ideal implant position, including the morphology of the lateral walls of the extraction socket and the presence of the interradicular septum. A technique for simplification of implant placement at the time of maxillary first premolar extraction is described. METHODS: Sixty-three implants were placed in maxillary first premolar immediate extraction sockets in 57 patients (36 females and 21 males), utilizing a technique which includes removal of residual interradicular bone prior to preparing the osteotomy, use of the removed interradicular bone in the extraction socket defect surrounding the implant, and swaging of the buccal and palatal osseous plates against the implant. RESULTS: All implants demonstrated clinical stability upon uncovering. Forty-one of the implants placed have been restored and in function for a period of up to 2 years. CONCLUSIONS: The technique described affords a simplified and predictable manner for placement of implants into immediate maxillary first premolar extraction sockets. Further studies should be carried out to document long-term success and failure rates of implants placed utilizing this technique, and subsequently restored.

Adult↗
PubMed2001

A model to evaluate bone substitutes for immediate implant placement.

A calcified alloplast was evaluated as a gap-filling material around implants placed immediately into fresh extraction sockets. Periodontal measurements and computed tomography scans were obtained to evaluate the clinical effectiveness of the alloplast when compared with demineralized freeze-dried bone. To determine whether this alloplast would be a suitable grafting material, 14 patients were selected to evaluate the extraction socket as a model for routine histologic confirmation of the efficacy and biocompatibility of bone substitutes. The results of this study showed the following: (1) human extraction sockets can be models for the study of bone/implant interaction; (2) the alloplast was well tolerated and demonstrated no inflammation through histologic evaluation of core biopsies; (3) the alloplast was a suitable material when used as a gap-filling graft in sockets around immediately placed implants; and (4) dental computed tomography scans and periodontal measurements around grafted implants 6 months after the procedure provide valuable clinical information about graft healing and osteointegration.

Alveolar Bone Loss↗
PubMedDate not supplied

Therapeutic management for immediate implant placement in sites with periapical deficiencies where coronal bone is present: technique and case report.

A surgical approach is presented that enables the clinician to repair apical bony defects during immediate dental implant placement without compromising the integrity of the coronal bone and gingiva. This apical surgical technique retains the soft tissue form in the coronal aspect of the gingiva and allows the clinician to repair the apical bone loss or fenestration. A clinical case is presented to describe the technique. This technique is utilized in cases of immediate implant placement. After extraction of the tooth, the socket is evaluated. In cases where coronal bone is intact but apical bone is deficient, a flap technique is utilized to expose the defect. The implant osteotomy is prepared, and the implant is placed. A healing cap or gingival prosthetic component is connected. The bony defect is repaired with a bone graft and, where necessary, a membrane. The apicoectomy flap is sutured. The clinical results obtained using this technique will enable the clinician to accomplish the bone regenerative procedure without extending the flap to the coronal aspect of the socket during immediate implant placement. This technique assists in the maintenance and integrity of the soft tissue form, which is critical for optimal esthetic results.

Apicoectomy↗
PubMed2000

Bone wound healing after maxillary molar extraction in ovariectomized aged rats: quantitative backscattered electron image analysis.

The processes of bone wound healing after maxillary molar extraction in ovariectomized aged rats were examined by means of quantitative backscattered electron image analysis and energy-dispersive X-ray microanalysis. Six-month-old female rats were either sham-operated or underwent bilateral ovariectomy (OVX), and 60 days postoperatively, the maxillary first molars were extracted. On post-extraction days 7, 30, and 60, the dissected and resin-embedded maxillae were micromilled in the transverse direction through the extracted alveolar sockets, and new bone formation on the buccal maxillary bone surface and within the extracted alveolar sockets was examined. In both sham-operated control and OVX rats, new bone formation was recognized on the buccal bone surface, as well as within the extracted sockets, and increased daily through to day 60. In comparison to sham-operated controls, new bone formation in OVX rats was significantly decreased both on the buccal bone surface and within the extracted sockets. Our results suggest that bone wound healing by new bone formation after maxillary molar extraction is significantly decreased in OVX-induced osteoporosis.

Age Factors↗
PubMed2006

Peri-implant tissue healing in implant placed in post-extraction sockets of maxillary premolars.

AIM: The aim of this study was the clinical and radiographic evaluation of peri-implant tissues healing associated with two-stage implants performed with one-stage surgery and placed into post-extraction sockets of maxillary premolars. METHODS: Ten natural tapered submerged titanium implants with double acid-etched surface were installed in post-extraction sockets of maxillary premolars showing no bone dehiscence or fenestrations. Implants were selected according to the greatest dimension compatible to vertical and horizontal diameters of the post-extraction sockets. Peri-implant defects showing more than 2 mm of distance between the marginal palatal bone and the implant margin, were not treated with a regenerative procedure but with a bone swaging technique by means of piezoelectric surgery. At 16 weeks osteointegration of implants was examined with a clinical and standardized radiographic evaluation. RESULTS: All patients showed good clinical healing without any complication. At 16 weeks all implants, either those with reduced marginal defect or those with modified crestal bone profile, were osteointegrated. CONCLUSIONS: The use of two-stage implants performed with one-stage surgery in 4 walls post-extraction sockets of maxillary premolars, seems to allow osteointegration both in reduced peri-implant horizontal defects as well as in defects larger than 2 mm. Furthermore, these procedures seem to simplify the management of soft peri-implant tissues.

Adult↗