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PubMed2005

Tissue healing in implants immediately placed into postextraction sockets: a pilot study in a mini-pig model.

OBJECTIVE: A pilot in vivo study was conducted to evaluate (1) the rate of osseointegration at apical, middle, and coronal levels of oral implants immediately installed into fresh extraction sockets; (2) the maturation of the newly formed bone surrounding implants during 60 days of healing; and (3) the epithelium seal development. STUDY DESIGN: The premolars of 8 male adult mini-pigs were extracted at each mandibular site under general anesthesia. In the experimental side, Frialit-2 implants were immediately inserted. The gap between bone and implants ranged between 3 and 6 mm circumferencially. Bone specimens were obtained at 7, 15, 30, and 60 days after surgery for histologic and histomorphometric studies. Bone-to-implant contact (BIC), bone volume, trabecular thickness, number, and separation were recorded. Nonparametric exact tests were used to evaluate data. RESULTS: BIC at the coronal level was observed close to 0% at day 7 and increased up to 60% at day 60 after surgery on an average. BIC increased from 11.7% to 47.38% at middle level and from 53.4% to 67.38% at apical level from day 7 to day 60. With respect to bone maturation, in the earlier stages of healing, many thin trabeculae were observed, which, particularly at coronal level, became significantly fewer and thicker in more advanced stages. At day 60, the features of the bone were similar to those of baseline. The epithelium never migrated more than 1.8 mm apically to the top of the alveolar bone level. CONCLUSION: When implants are placed immediately into fresh extraction sockets, in minipig models osseointegration also occurs without initial bone contact.

Analysis of Variance↗
PubMed2004

Bacteremia following surgical dental extraction with an emphasis on anaerobic strains.

Our aim was to investigate bacteremia caused by surgical extraction of partly erupted mandibular third molars. From 16 young adults, bacterial samples were taken from the third-molar pericoronal pocket and post-operatively from the extraction socket, and blood samples were drawn from the ante-cubital vein up to 30 min after surgery. Of the subjects, 88% had detectable bacteremia-50% 1 min after the incision, 44% immediately after extraction. The respective percentages at 10, 15, and 30 min were 44%, 25%, and 13%. Blood cultures contained 31 species (74% anaerobes), with 3.9 +/- 2.6 species isolated per subject. Most prevalent were the anaerobes Prevotella, Eubacterium, and Peptostreptococcus sp. and the aerobes viridans-group streptococci and Streptococcus milleri group. Any species found in the blood was also isolated from the mouth, from 93% of the pericoronal pockets and from 43% of the extraction sockets. Surgical dental extraction clearly causes bacteremia of a high frequency and lasting longer than thus far assumed.

Adult↗
PubMed1999

A new injectable calcium phosphate biomaterial for immediate bone filling of extraction sockets: a preliminary study in dogs.

BACKGROUND: Many different bone substitutes, such as autografts, allografts or synthetic biomaterials have been proposed to restore alveolar bone loss and support efficient placement of dental implants. This experimental study evaluated the osteoconductive properties of an injectable bone substitute (IBS) composed of a polymeric carrier and a calcium phosphate mineral phase, used to fill mandibular and maxillary canine extraction sockets. METHODS: The polymer was a cellulose derivative (methyl-hydroxy-propyl-cellulose, MHPC), and the mineral phase consisted of granules of biphasic calcium phosphate (BCP) ceramics 200 to 500 microm in diameter. Mandibular and maxillary premolars extracted from 3 dogs (a total of 60 extraction sites) were immediately treated with the IBS or left unfilled as control sites. Animals were sacrificed 3 months after implantation and all extraction sockets were prepared for histological evaluation. RESULTS: Qualitative histological studies showed that the IBS was able to support the extensive apposition of well-mineralized newly formed lamellar bone over the entire socket surface and appeared to prevent alveolar ridge bone loss in treated extraction sites. Quantitative evaluation showed that the amount of newly formed bone was significantly higher in mandibular than maxillary extraction sockets for both treated and control sites. CONCLUSIONS: An injectable bone substitute composed of a polymeric carrier and calcium phosphate was effective in enhancing the bone fill of extraction sockets. This approach may prove promising for periodontal lesions. The material expressed osteoconductive capacities, and the biological properties of the mineral phase were conserved.

Animals↗
PubMed1999

Measurement of changes in dimensions of resorbing alveolar bone: description of a method.

This study evaluated a cast-measuring device used to investigate effects of augmenting fresh extraction sockets with dense hydroxyapatite granules. Following reproducible location of the casts, alterations in ridge tracings were related to radiographically determined ridge height alterations. A randomised controlled study compared two groups of immediate complete denture wearers. One group received conventional immediate dentures, the other received immediate complete dentures after dense hydroxyapatite implantation into canine sockets. Ridge height alterations with time were recorded from radiographs. Alterations in ridge form were recorded from several models transferred reproducibly to a mounting jig attached to a profiling apparatus. Further, the osteo-retentive ability of the hydroxyapatite in the sockets was seen to be close to significance (after six months width differences, in the canine region: P = 0.059, LHS, and P = 0.065, RHS).

Aged↗
PubMed2005

Accuracy of navigation-guided socket drilling before implant installation compared to the conventional free-hand method in a synthetic edentulous lower jaw model.

In this study, the three-dimensional (3D) accuracy of navigation-guided (NG) socket drilling before implant installation was compared to the conventional free-hand (CF) method in a synthetic edentulous lower jaw model. The drillings were performed by two surgeons with different years of working experience. The inter-individual outcome was assessed. NG drillings were performed using an optical computerized tomography (CT)-based navigation system. CF drillings were performed using a surgical template. The coordinates of the drilled sockets were determined on the basis of CT scans. A total of n=224 drillings was evaluated. Inter-individual differences in terms of the surgeons' years of work experience were without statistical significance. The mean deviation of the CF drilled sockets (n=112) on the vestibulo-oral and mesio-distal direction was 11.2+/-5.6 degrees (range: 4.1-25.3 degrees ). With respect to the NG drilled sockets (n=112), the mean deviation was 4.2+/-1.8 degrees (range: 2.3-11.5). The mean distance to the mandibular canal was 1.1+/-0.6 mm (range: 0.1-2.3 mm) for CF-drilled sockets and 0.7+/-0.5 mm (range: 0.1-1.8 mm) for NG drilled sockets. The differences between the two methods were highly significant (P<0.01). A potential benefit from image-data-based navigation in implant surgery is discussed against the background of cost-effectiveness.

Analysis of Variance↗
PubMedDate not supplied

Bone regeneration by recombinant human bone morphogenetic protein-2 around immediate implants: a pilot study in rats.

PURPOSE: Difficulties relating to bone regeneration that complicate immediate implant placement include buccal and/or lingual fenestrations, primary anchorage of the implants, and the need for protection from functional loading during the osseointegration period. The objective of this pilot study was to evaluate bone regeneration by recombinant human bone morphogenetic protein-2 (rhBMP-2) around immediate implants placed in maxillary sockets in rats. MATERIALS AND METHODS: A total of 16 cylindric 0.8 x 1.8-mm commercially pure, solid titanium Implants were placed immediately after gentle extraction of the maxillary first molar teeth of 8 male Wistar rats. The sockets were randomly divided into 3 groups: group 1 (n = 6) received rhBMP-2 with polylactic acid/polyglycolic acid copolymer-coated gelatin sponge carrier; group 2 (n = 5) received only the carrier; and group 3 (n = 5) received no grafting materials following placement The rats were euthanized at 90 days postsurgery for microscopic analysis. RESULTS: In group 1, the implant body remained submerged completely, including the coronal part, which was fully covered by a significant amount (30% of total height) of regenerated cortical bone, even though the implant could easily be pulled out by a tweezer at the time of placement. Close approximation between the implant surface and regenerated bone could also be detected, indicating good bone-to-implant contact. In contrast, only peri-implant bone regeneration occurred in group 2, and an approximate 0.3-mm coronal part of the implant remained exposed. When no grafting materials were used (group 3), almost one third of the total length of the implant was exfoliated out of the socket when no grafting materials were used. DISCUSSION AND CONCLUSIONS: Based on previous study and data from 16 sockets of the present study, it could be concluded that rhBMP-2 facilitated the regeneration of bone around immediate implants. In particular, the bone covering the coronal part could have been regenerated shortly after surgery, which helped to maintain the implant body inside the socket during the integration period in rats.

Animals↗
PubMed1999

Case reports offer a challenge to treatment strategies for immediate implants.

The placement of osseointegrated implants in extraction sockets is a commonly used and reliable procedure. Many operative protocols have been suggested for use with both submerged and nonsubmerged implants, and some prerequisites have been defined for their successful placement. Dealing exclusively with implants placed in intact extraction sockets, this paper reviews these commonly suggested prerequisites, discusses their clinical relevance, and presents case reports in which clinical success was obtained despite the violation of more than 1 of these factors. Techniques to obtain primary implant stability, procedures to regenerate residual bone defects, the need to submerge implants in the healing phase, and treatment strategy in infected sites are reviewed. Because the simultaneous violation of some prerequisite factors allows postextractive implants to be performed with a single surgical approach, a new classification is proposed based on the number of surgical stages required to replace a failing tooth with an implant-supported restoration.

Adult↗
PubMed2000

Porous bovine bone mineral in healing of human extraction sockets. Part 1: histomorphometric evaluations at 9 months.

BACKGROUND: Extraction socket wound healing is characterized by resorption of the alveolar bone at the extraction site. This produces a decrease in ridge volume, deformations of ridge contours, and, thus, difficulties in delayed placement of root-form implants in an ideal position. Cancellous porous bovine bone mineral (PBBM) applied to fresh extraction sockets has recently been proposed to minimize the reduction in ridge volume. The aim of this study was to investigate the influence of PBBM grafted particles on the histopathologic pattern of the intrasocket regenerated bone and to evaluate histomorphometrically the healed PBBM grafted extraction socket site at 9 months' post-extraction. METHODS: PBBM particles (250 to 1,000 microns in size) were grafted in 15 fresh human extraction sockets in 15 patients. Socket wall bone height was measured from the crestal ridge level before the mineral particles were inserted. Primary soft tissue closure was performed to protect the grafted particles via a pediculated split palatal flap. At 9 months, socket bone walls were remeasured and cylinder bone samples of the previously PBBM-grafted sites were obtained. Decalcified specimens were sectioned at a cross-horizontal plane and stained with hematoxylin and eosin for histopathologic and histomorphologic examination. Tissue area percentage of bone, PBBM, and connective tissue (CT) was calculated for each specimen from the crestal to the apical region and changes in values compared. RESULTS: Average clinical overall bone fill of the augmented socket sites was 82.3%. Histologically, PBBM particles were observed in all specimens. Newly formed bone was characterized by abundance of cellular woven-type bone in the coronal area, while lamellar arrangements could be identified only in the more apical region. New osseous tissue adhered to the PBBM. Histomorphometric measurements showed an increase of mean bone tissue area along the histological sections from 15.9% in the coronal part to 63.9% apically (average 46.3%). CT fraction decreased from 52.4% to 9.5% (average 22.9%) from the crestal to the apical region. PBBM area fraction varied from 26.4% to 35.1% (average 30.8%). Statistical analysis of the comparison between areas of bone, CT, and PBBM was performed in different points along the coronal-apical axis. Differences were significant (P <0.01) at the most crestal, middle, and apical section cut areas, but not at the cervical section cuts. Bone area fraction increased in the apical direction as much as CT correlatively decreased. Unlike CT and bone, PBBM retained constant relative volume (approximately 30%), regardless of the depth of the specimen cores. CONCLUSIONS: PBBM particles are an appropriate biocompatible bone derivative in fresh extraction sockets for ridge preservation. The resorbability of this xenograft could not be recognized in a 9-month period. Further investigation is needed to clarify the resorptive mechanisms of PBBM.

Adult↗
PubMedDate not supplied

The use of tricalcium phosphate to preserve alveolar bone in a patient with ectodermal dysplasia: a case report.

The prosthodontic management of the child with ectodermal dysplasia is made difficult because of the under-development of the alveolar ridges. This paper describes a case where tricalcium phosphate was placed in sockets immediately following the extraction of the primary incisor teeth to help maintain alveolar bone width, offering a valuable alternative treatment option in the prosthodontic management of the child patient with ectodermal dysplasia.

Alveolar Bone Loss↗
PubMed2004

Alcohol intake and osseointegration around implants: a histometric and scanning electron microscopy study.

Alveolar wound healing can be modified by local and systemic factors. The aim of this study was to evaluate the possible effect of alcoholic beverage administration (sugarcane brandy) on reparative bone formation around hydroxyapatite/tricalcium phosphate implants inside the alveolar socket. Male Wistar rats had their upper right incisors extracted and the bioceramic granules implanted in the alveoli. The animals received increasing concentrations of brandy until 30 degrees Gay-Lussac was achieved starting 30 days before dental extraction and maintained for periods varying from 1 hour to 6 weeks, until sacrifice. Blood alcohol concentration analysis was performed as well as histological and histometric analysis through light and scanning electron microscopy to examine the relation between alveolar healing components, including new bone trabeculae, and the implants. Blood alcohol concentration was significantly higher in treated animals compared with controls. A significant delay in reparative bone formation was detected in the alveolus of alcoholic rats by a histometric differential point counting method, whereas the presence of the bioceramic in the alveolar socket improved alveolar wound healing in alcohol-treated rats. It is suggested that the osteoconductive properties of this bioceramic accelerated alveolar wound healing in alcoholic rats.

Alcohol Drinking↗
PubMed2003

Instrument for extraction socket measurement in immediate implant installation.

The aim of the present study was to create an instrument and a computer program for measurement of extraction sockets and for planning of the immediate replacement of teeth using screw-shaped dental implants. Ten titanium screw-shaped Osteofix Dental Implant System implants (Osteofix, Oulu, Finland) were immediately installed after extraction in nine patients, four women and five men (age 17-62 years). The measurements of fresh extraction sockets were taken at six points (mesio-buccal, buccal, disto-buccal, disto-lingual, lingual and mesio-lingual) using an instrument created by the author. The area of no contact between bone and dental implant was 11-40% (mean 31%, SD 9%), calculated by computer program. If less than 30% of the implant surface area would be in contact with the bone, immediate replacement was abandoned because sufficient primary stability could not be achieved. Guided bone regeneration was promoted by covering the implant and bone defect with deproteinized bovine bone mineral (Bio-Oss, Geistlich AG, Wolhusen, Switzerland) and bioresorbable collagen membrane (Bio-Gide, Geistlich AG), fixed in place with resorbable pins (Resor Pin, Geistlich AG). After 6 months a considerable, statistically significant (P < 0.05) defect reduction of 90% (SD 7%) was noted. It was concluded that an instrument and a computer program created for extraction socket measurement are useful in some borderline cases when there is lack of bone and the success of one-stage implantation is doubtful.

Absorbable Implants↗
PubMed2003

Evaluation of hard tissue replacement composite graft material as a ridge preservation/augmentation material in conjunction with immediate hydroxyapatite-coated dental implants.

BACKGROUND: Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bone replacement grafts are often used to correct these problems. This study evaluated the use of a layered composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxyl-ethyl-methacrylate), and calcium hydroxide grafts (HTR) as a ridge preservation/ augmentation material used in conjunction with an immediate DI placement technique. METHODS: Twenty-three patients requiring 1 or 2 extractions that were treatment planned for immediate DI placement received 4.0 or 3.25 mm diameter hydroxyapatite-coated cylindrical implants in the extraction sockets. HTR was used to fill the remaining socket void and enhance the facial ridge width. A collagen hemostatic was placed to cover the DI sites, flaps released, and primary closure attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total ridge width at DI placement and uncovering. RESULTS: Thirty DIs were placed in the 23 patients. Mean initial internal socket width was 6.9 mm. The total ridge width showed a mean change from 9.1 mm to 8.4 mm; 60% of the areas showed a net increase or no change, while 40% showed a decrease in overall ridge width. DI success rate was 97% out to 6 months of loading. CONCLUSION: The results of this study suggest that HTR is a useful adjunct in the placement of immediate DIs for filling of socket voids and preservation of ridge width.

Adolescent↗
PubMed2003

Clinical, radiographic, histologic, and histomorphometric comparison of PepGen P-15 particulate and PepGen P-15 flow in extraction sockets: a same-mouth case study.

PURPOSE: Although the efficacy of PepGen P-15 particulate has been conclusively demonstrated in two multicenter clinical studies, the effect of a new hydrogel formulation containing PepGen P-15 on bone repair has not been previously demonstrated. MATERIALS AND METHODS: PepGen P-15 Flow contains PepGen P-15 particulate in a biocompatible hydrogel, which provides spacing between the particles. In this case study, bone repair of both PepGen P-15 particles and PepGen P-15 Flow was compared to natural bone in same-mouth extraction sockets. RESULTS: The radiographic, histologic, and histomorphometric evaluations showed enhanced bone formation and faster particle resorption with PepGen P-15 Flow compared to the PepGen P-15 particulate. CONCLUSION: The accelerated bone formation by PepGen P-15 Flow may provide faster implant placement.

Alveolar Process↗
PubMed2006

Effect of a topical antimicrobial paste on healing after extraction of molars in HIV positive patients: randomised controlled clinical trial.

AIM: To assess the efficacy of a medicated dressing in the socket on the healing after dental extractions in HIV positive patients. PATIENTS AND METHODS: Forty HIV positive patients with CD4 counts below 200 cells/mm(3) who were to have molar teeth extracted were randomly allocated to have the socket dressed with a medicated paste (Rifocort) with camphorated parachlorophenol and iodoform) and sutured (treated group), or merely sutured (control group). RESULTS: The sockets in the treated group healed more quickly than in the control group.

Administration, Topical↗
PubMed2001

Freestanding and multiunit immediate loading of the expandable implant: an up-to-40-month prospective survival study.

STATEMENT OF PROBLEM: The subject of immediate loading of dental implants has received substantial attention, although it appears to conflict with the basic principles of dental implant therapies developed and established over the past 20 years. Clinicians would welcome the use of a reliable, immediate-loading implant system. PURPOSE: The purpose of this study was to evaluate the effectiveness of an expandable implant design for immediate and delayed loading and for freestanding and multiunit situations. MATERIAL AND METHODS: Two hundred eighty-six immediate-load Sargon implants were placed in 75 patients during a 40-month period. Of the 273 implants that survived, 81 were placed into fresh extraction sockets and immediately loaded, 162 were placed into healed sites and immediately loaded, and 30 were delay loaded. Some implants that had failed to remain stable after immediate loading became stable and osseointegrated after the load was removed and their expansion mechanisms were reactivated. RESULTS: The overall survival rate during the 40-month period was 96.0% in the maxilla and 94.8% in the mandible. Implants placed in fresh extraction sockets showed a 98.9% survival rate. Healed sites showed a 93.9% survival rate. Immediate loading of 52 fresh extraction socket implants in the maxilla showed a 100% survival rate during the evaluation period. CONCLUSION: Within the limitations of this study, it was shown that the feature of mechanical expandability may provide operators some control over implant stability during the vulnerable period after immediate loading of single, freestanding implants.

Adult↗
PubMed2004

Immediate Dental Implant Placement in Sockets Augmented With HTR Synthetic Bone.

PURPOSE: The purpose of this article is to present the results of using immediate implant placement in combination with HTR synthetic bone socket grafting to achieve a predictable restorative result. MATERIAL AND METHODS: Twenty-three hydroxylapatite-coated cylinder implants (Spline, CenterPulse Dental, Carlsbad, CA) were placed into fresh extraction sockets in 19 patients. In each case, HTR synthetic bone (Bioplant, Inc., South Norwalk, CT) was used to fill any voids remaining in the sockets and to augment the facial aspect of the ridge. The restorative phase was initiated approximately 6 months after implant placement. Conventional impression techniques were used and porcelain-fused-to-metal crowns were selected as the final restorations. RESULTS: The prosthetic outcome was evaluated as generally favorable. Only 4 (17%) of the dental implants required an angled abutment. The gingival contour was excellent in 61% and good in 35% of the cases. The emergence profile was evaluated as class I (full papilla) in 37% and class II, III, and IV in 21% each. CONCLUSIONS: The clinical results of this study demonstrate that immediate implant placement in combination with HTR synthetic bone grafting of residual socket voids and crestal deformities is a predictable procedure and provides a good base for successful prosthetic reconstruction. Adequate gingival contour and favorable emergence profile can be expected when combining immediate implant placement and HTR grafting material.

Alveolar Ridge Augmentation↗
PubMed2000

Postextraction ridge preservation using a synthetic alloplast.

Ridge preservation is the prevention of the 40% to 60% jaw-bone atrophy that normally takes place 2 to 3 years postextraction and continues at a rate of 0.25% to 0.5% per year until death. It is achieved by the immediate grafting of the extraction socket with or without the use of an immediate implant. It offers the dentist the ability to preserve the alveolar ridge for future implant and restorative dentistry, to achieve anterior esthetics, and to prevent postoperative pain and bleeding. The practice of ridge preservation involves advanced extraction therapy and replacement therapy.

Alveoloplasty↗
PubMedDate not supplied

Histologic and histomorphometric comparison of immediately placed hydroxyapatite-coated and titanium plasma-sprayed implants: a pilot study in dogs.

The purpose of this pilot study was to make a histologic and histomorphometric comparison of hydroxyapatite-(HA) coated and titanium plasma-sprayed (TPS) root-form implants that were placed in 2 mongrel dogs immediately after extraction of mandibular premolars. After 8 weeks of healing, the implant-containing segments of the mandible were removed en bloc and bone blocks including implants were sectioned. Histologic and histomorphometric analyses were performed by evaluating bone sections. The mean bone contact percentage of HA-coated implants was 61.84 +/- 7.84%, with a range of 52.09% to 75.7%, and the mean bone contact percentage of TPS implants was 51.35 +/- 12.1%, with a range of 30.1% to 70.6%. This pilot study suggests that HA-coated implants placed into fresh extraction sockets can achieve better bone contact than TPS implants, but there was evidence that the surface of the HA layer can be resorbed, so long-term stability of HA coatings in immediate implantation must be investigated.

Animals↗