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PubMed2003

Clinical management and control of alveolalgia ("dry socket") with vitamin C.

PURPOSE: To monitor the incidence of dry socket in a sample of 696 consecutive tooth extraction patients and to test the possible therapeutic effects of vitamin C. MATERIALS AND METHODS: Following standardized extractions, 24 dry socket patients were provided 4,000 mg/day dosages of Vitamin C. Demographic and health history data were collected. RESULTS: The occurrence of dry socket (3.5% overall) was greater in females and individuals with lower overall health status, and supplemental Vitamin C was associated with rapid recovery.

Adolescent↗
PubMed2004

Bone healing in osteoporotic female rats following intra-alveolar grafting of bioactive glass.

We have investigated the effect of ovariectomy combined with a low Ca diet on bone healing following the implantation of bioactive glass into extraction sockets, in rats. Ovariectomized rats received a low Ca diet from the day of surgery until sacrifice while sham-operated animals were fed a standard laboratory chow. Two weeks after surgery the upper incisors were extracted and the alveolar sockets in both groups were partially filled with a particulate bioglass (PerioGlas). The animals were killed 1, 2, 3 and 9 weeks after tooth extraction and the relative volume fraction of the healing components (bone trabeculae, connective tissue and coagulum remnants) was estimated in histological paraffin sections by a histometric differential point-counting method. The bioglass particles persisted inside the socket for all the experimental periods and, as bone repair proceeded, they were progressively enclosed in newly formed bone trabeculae which in some cases established a close contact with their surface. The volume fraction of neoformed bone trabeculae relative to the volume fraction of connective tissue and coagulum remnants was greater in the sockets of ovariectomized animals implanted with bioglass than in those of the overiectomized non-implanted groups.

Animals↗
PubMed2005

Orthodontic extrusion of an extensively broken down anterior tooth: a clinical report.

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure.

Adult↗
PubMed2003

Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs.

OBJECTIVES: The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. MATERIAL AND METHODS: Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. RESULTS: During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. CONCLUSION: The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.

Animals↗
PubMed2004

Bucco-lingual crestal bone changes after immediate and delayed implant placement.

BACKGROUND: Implants placed immediately after tooth extraction offer several advantages, but many authors have reported problems in filling the residual gap between the implant and the socket walls. Barrier and grafting techniques have been tested and yield varying results, so it has been suggested that the timing of implant placement may be important for success. The aim of this study was to analyze bone healing and coronal bone remodeling around 35 implants, 20 placed immediately after tooth removal and 15 placed 6 to 8 weeks after extraction. METHODS: All the implants were submerged and placed within the alveoli confines, leaving circumferential defects because the implants did not contact the bone at their coronal aspects; stabilization was achieved in the bone apically. After implant placement the mean distance from buccal bone to lingual bone was 10 mm (SD 1.522) for immediate implants and 8.86 mm (SD 2.356) for delayed implants. No membrane or filling materials were used. Primary flap closure was accomplished in all cases. RESULTS: At second-stage surgery all peri-implant defects were filled, and the mean distance from buccal bone to lingual bone was 8.1 mm (SD 1.334) for immediate implants and 5.8 mm (SD 1.265) for delayed implants. This pattern of coronal bone remodeling, showing a narrowing of the bucco-lingual width, was clinically similar for the two groups, although it should be noted that the delayed implants exhibited smaller bucco-lingual bone width already at the first measurement: it can be speculated that early remodeling may start immediately after tooth extraction and continue, non-uniformly, even after delayed implant placement. CONCLUSIONS: This study suggests that circumferential defects could heal clinically without any guided bone regeneration (GBR) in both experimental groups, and that the procedure was virtually free from complications in the postoperative period, probably because of the absence of barrier membranes and/or grafting materials. Histologically, peri-implant defects of over 1.5 mm heal by connective tissue apposition, rather than by direct bone-to-implant contact, but clinically this healing may be very successful. No histological analysis was carried out in the present study, but even the largest residual gaps were filled with hard tissue that could not be probed. Thus, such outcomes can be considered clinically successful. The different rate of bone remodeling around immediate or delayed implants could have implications for the preferred timing of implant placement in sites of high esthetic concern.

Adolescent↗
PubMed1998

The application of deproteinized bovine bone mineral for ridge preservation prior to implantation. Clinical and histological observations in a case report.

Alveolar ridge preservation following tooth extraction is important when implant-supported oral rehabilitation is considered. The ability to maintain the ridge allows implant placement in an ideal position, fulfilling both functional and esthetic demands. A deproteinized bovine bone mineral (DBBM) was used as a socket site filler material to maintain ridge configuration, without applying an occlusive membrane. The material was grafted and packed onto the socket sites immediately after extractions, and subsequently primary soft tissue closure was attempted. The ridge healed for 9 months before the second surgical procedure, in which the implant was placed. New bone formation was observed in all histological specimens. DBBM particles adhered to a highly osteocyte-rich woven and lamellar-type bone. Clinically and histologically, this report demonstrated DBBM particles to be an effective biocompatible filler agent in extraction sockets for ridge preservation prior to titanium fixture implantation. Randomized controlled clinical trials are needed to fully evaluate the usefulness of this material in ridge preservation after tooth extraction.

Adult↗
PubMed2001

Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique.

Alveolar ridge resorption has long been considered an unavoidable consequence of tooth extraction. Guided bone regeneration techniques and the use of bone replacement materials have both been shown to enhance socket healing and to potentially modify the resorption process. This article will describe a surgical technique using textured, high-density polytetrafluoroethylene (PTFE) membrane and particulate bone replacement materials for graft containment and prevention of soft tissue ingrowth into healing extraction sites. The technique described does not require primary closure, facilitating the preservation of keratinized mucosa and gingival architecture.

Alveolar Bone Loss↗
PubMed1998

Preservation of alveolar bone in extraction sockets using bioabsorbable membranes.

The purpose of this study was to evaluate the clinical effectiveness of a bioabsorbable membrane made of glycolide and lactide polymers in preserving alveolar ridges following tooth extraction using a surgical technique based on the principles of guided bone regeneration. Sixteen patients requiring extractions of 2 anterior teeth or bicuspids participated in the study (split-mouth design). Following elevation of buccal and lingual full-thickness flaps and extraction of teeth, experimental sites were covered with bioabsorbable membranes; control sites did not receive any membrane. Titanium pins served as fixed reference points for measurements. Flaps were advanced in order to achieve primary closure of the surgical wound. No membrane became exposed in the course of healing. Reentry surgeries were performed at 6 months. Results showed that experimental sites presented with significantly less loss of alveolar bone height, more internal socket bone fill, and less horizontal resorption of the alveolar bone ridge. This study suggests that treatment of extraction sockets with membranes made of glycolide and lactide polymers is valuable in preserving alveolar bone in extraction sockets and preventing alveolar ridge defects.

Absorption↗
PubMed1994

Replantation for the treatment of transverse intra-alveolar root fracture.

This case report examines the effectiveness of extraoral treatment of a traumatized maxillary central incisor with a transverse intra-alveolar root fracture. Both the coronal and root segments were extracted after anesthetic injection. After treatment of the pulpal cavity, the segments were synthesized with a composite resin and a canal reamer. The extracted tooth was replanted into the original socket. This method is an alternative treatment for transverse intra-alveolar root fracture, which is presently an indication for dental extraction in almost all cases.

Adult↗
PubMed2003

Enhancement of osseointegration of implants placed into extraction sockets of healthy and periodontally diseased teeth by using graft material, an ePTFE membrane, or a combination.

BACKGROUND: Advanced periodontal disease as well as failed endodontic teeth are the most common reasons for tooth removal and simultaneous implant placement. PURPOSE: To determine whether the addition of a bone substitute graft material and/or a guided bone regeneration membrane added to the site of an immediately placed implant would increase the development of lamellated bone, particularly in the presence of bone defects. MATERIALS AND METHODS: Four treatment modalities associated with the immediate placement of hydroxyapatite-coated endosteal screw implants into extraction sockets of healthy (C/H) and periodontally diseased teeth (T/PD) were tested. Five dogs with healthy teeth and five dogs with naturally occurring periodontitis were chosen for the study. Each dog received eight implants after extraction of four mandibular and four maxillary premolars. Four implants were submerged for 3 months and four for 6 months. The implants were either inserted alone (subgroup A); surrounded by a GORE-TEX membrane (subgroup B; W.L. Gore & Associates Inc., Flagstaff, AZ, USA); surrounded by PepGen P-15 (Dentsply Friadent CeraMed Dental Co. Denver, CO, USA) at coronal area (subgroup C); or surrounded by a combination of graft material and the ePTFE membrane (subgroup D). Implants in group A were osseointegrated in both C/H and T/PD groups with similar bone-implant contact ratios (BICRs). RESULTS: ePTFE membrane significantly improved the BICR of the 6-months implants, whereas graft material significantly increased the BICR at 3 months and maintained the gain thereafter. The graft material and membrane combination further improved the BICR and significantly increased lamellated bone in crestal bone of all implants. CONCLUSIONS: This study provides experimental evidence in support of use of graft material with immediately placed implants, particularly in presence of bone defects that initially reduce the BICR such as in periodontitis. Adding an ePTFE membrane to graft material resulted in a greater replacement of woven bone by lamellated bone. Clinical trials in humans are recommended as a follow-up of this experimental study.

Analysis of Variance↗
PubMed2005

Immediate implant placement: diagnosis, treatment planning and treatment steps/or successful outcomes.

Diagnosis and treatment planning are key factors in achieving successful outcomes after placing and restoring implants placed immediately after tooth extraction. The efficacy of immediate implant placement has been established and shown to be predictable if reasonable guidelines are followed. Some or all of the following suggestions, depending on individual circumstances should be considered when evaluating a patient for dental implants: thorough medical and dental histories, clinical photographs, study casts, periapical and panogram radiographs, as well as a linear tomography or computerized tomography of the proposed implant sites. Reasons for tooth extraction include, but are not limited to, insufficient crown to root ratios, remaining root length, periodontal attachment levels, periodontal health of teeth adjacent to the proposed implant sites, unrestorable caries, root fractures with large endodontic posts, root resorption, teeth with deep furcation invasions being considered as abutments for fixed partial dentures, and questionable teeth in need of endodontic retreatment. Teeth requiring root amputations, hemisections or advanced periodontal procedures may have a questionable prognosis, and patients should be given the implant option before these procedures are implemented. Similarly, nonvital teeth, fractured at the gingival margin with roots shorter than 13 mm should be considered for the implant option. This review will describe the steps for immediate implant placement at the time of extraction as well as the "gap" and socket preservation.

Animals↗
PubMed2004

Hard-tissue alterations following immediate implant placement in extraction sites.

BACKGROUND: The marginal gap that may occur following implant installation in an extraction socket may be resolved by hard-tissue fill during healing. OBJECTIVE: To study dimensional alterations of hard tissues that occur following tooth extraction and immediate placement of implants. MATERIAL AND METHODS: Eighteen subjects with a total of 21 teeth scheduled for extraction were included. Following flap elevation and the removal of a tooth and implant installation, clinical measurements were made to characterize the dimension of the surrounding bone walls, as well as the marginal defect. No membranes or filler material was used. The flaps were subsequently replaced and secured with sutures in such a way that the healing cap of the implant was exposed to the oral environment. After 4 months of healing a re-entry procedure was performed and the clinical measurements were repeated. RESULTS: Fifty-two marginal defects exceeding 3 mm were present at baseline: 21 at buccal, 17 at lingual/palatal, and 14 at approximal surfaces. At the re-entry eight defects exceeding 3.0 mm remained. During the 4 months of healing, the bone walls of the extraction underwent marked change. The horizontal resorption of the buccal bone dimension amounted to about 56%. The corresponding resorption of the lingual/palatal bone was 30%. The vertical bone crest resorption amounted to 0.3+/-0.6 mm (buccal), 0.6+/-1.0 mm (lingual/palatal), 0.2+/-0.7 mm (mesial), and 0.5+/-0.9 mm (distal). CONCLUSION: The marginal gap that occurred between the metal rod and the bone tissue following implant installation in an extraction socket may predictably heal with new bone formation and defect resolution. The current results further documented that marginal gaps in buccal and palatal/lingual locations were resolved through new bone formation from the inside of the defects and substantial bone resorption from the outside of the ridge.

Adult↗
PubMed2000

A histological study of root-resected and root-transected rat incisors when eruption ceases, shortly before they are exfoliated from the socket.

Resection of the odontogenic region or root transection of normal (impeded) rat lower incisors showed that eruption ceased from 1 to 13 weeks when the base of the resected teeth (87.5%) or of the distal segment of the transected ones (86%) reached the alveolar-crest region. When the operated teeth reached the crestal region, the enamel-related periodontal tissues were absent and the periodontal ligament (PDL) was the only periodontal tissue that remained. The PDL of the crestal region may be considered as mature PDL, showing a length of approx. 5-6 6 mm at the mesial face of the tooth, 4-5 mm at lingual face and 1 mm at distal face; from these limits towards the apical end of the socket the PDL becomes gradually immature. The mature PDL seems not to have a role in the process of tooth eruption. Several factors can be suggested to explain the more frequent retention, at the crestal region of the socket, of impeded rather than unimpeded incisors submitted to the same procedures. The connective tissue that develops between the base of the tooth and the bone that fills the alveolus may have more time to organize itself in impeded than in unimpeded teeth, which erupt at a faster rate; this tissue could support and retain the impeded operated teeth longer than the unimpeded ones. The decrease in the mechanical properties of the PDL in the unimpeded condition may ease the traumatic effects and lead to exfoliation. Eruption might be stopped by the increase in occlusal forces, per unit area of root surface, as the root becomes shorter; this effect is likely to be greater in impeded than unimpeded teeth.

Alveolar Process↗
PubMed2003

Use of third molar transplantation for closure of the oroantral communication after tooth extraction: a report of 2 cases.

OBJECTIVE: This clinical report introduces a promising and unique method for the immediate closure of the oroantral communication (OAC) after tooth extraction: the use of the transplanted third molar with closed apices. STUDY DESIGN: In 2 adult patients, OAC caused by the extraction of an upper molar was immediately closed by using a transplanted third molar with complete root formation. After tooth extraction at the recipient site, OAC with perforated mucosa of the sinus floor was confirmed and the donor third molar was transferred to the prepared recipient socket. Endodontic therapy of the transplanted third molar began at 3 weeks after surgery, and prosthetic treatment was completed at 5 months after the operation. These 2 patients were carefully observed both clinically and radiographically. RESULTS: Closure of the OAC was successfully performed, and the transplanted teeth became fixed with the passage of time in these 2 patients. Root resorption did not occur, and good functional results were obtained without any complications. CONCLUSIONS: Tooth transplantation of a mature third molar for closure of the OAC is a simple and excellent method because the transplanted tooth not only closes the communication to the maxillary sinus, but it also satisfactorily functions at the recipient site during mastication, even in adult patients.

Adult↗
PubMed2007

Influence of trans-operative complications on socket healing following dental extractions.

AIM: Extraction healing complications have been attributed to several factors. The influence of trans-operative complications on an extraction site wound healing was the focus of this investigation. METHODS AND MATERIALS: This prospective study was conducted at the Oral Surgery Clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (LUTH) in Nigeria . Subjects selected were those referred for one or two adjacent extractions and who satisfied the inclusion criteria for the study. The relevant pre-operative information recorded for each patient were age and sex of patient, indications for extraction, time taken to extract the tooth, tooth/teeth removed, and any trans-operative complications. Extractions were performed with dental forceps, elevators, or both under local anaesthesia. Patients were blindly evaluated on the third and seventh post-operative day for socket healing assessment without reference to pre-operative information on the patients. RESULTS: Seventy-three (24.25%) of 301 teeth considered for socket healing assessment had various trans-operative complications due to accidental crown, root, or alveolar bone fractures. Of the 73 extractions with trans-operative complications during extraction, 18 developed a socket healing complication, while 17 of the 228 extractions without trans-operative complications developed socket healing complications (p = .000). The mean (SD) time taken to extract teeth developing healing complications was also found to be significantly longer than those without healing complications (p < .01). CONCLUSIONS: The study demonstrated the combination of tooth/bone fragments in the socket and increased time of extraction due to trans-operative complications and accidents predispose to the development of extraction site wound healing disturbance.

Adolescent↗
PubMed2005

Acellular dermal matrix and hydroxyapatite in prevention of ridge deformities after tooth extraction.

The aim of this study was to evaluate the role of acellular dermal matrix graft (ADMG) acting as a membrane, associated with a resorbable hydroxyapatite (RHA) in bone regeneration to prevent ridge deformities after tooth extraction. Fifteen patients who had at least 2 noncontiguous, uniradicular teeth indicated for extraction were selected. In group I, the extraction sockets were covered by ADMG alone; and in group II, the alveoli were filled with RHA before the placement of the ADMG. After 6 months, re-entry surgeries and biopsies were performed. Although ridge thickness had been preserved in both groups, the means were significantly greater (P < 0.05) for group II when compared to group I (6,8 +/- 1.26 and 5.53 +/- 1.06). The histologic analysis showed small bone formation in some samples for group II, where the presence of a highly vascularized fibrous connective tissue surrounding the particles was a common finding. Based on the results, it can be concluded that the ADMG was able to preserve ridge thickness and that the additional use of RHA favored the preservation of the ridges along with an increase in the width of keratinized tissue.

Absorbable Implants↗