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Electron spin resonance was used to measure out 160 tooth root surfaces. These data represent a measure for wound area sizes after tooth extractions. A comparison of these values with clinical data results in a correlation between the size of wound area and the frequency of inflammatory healing disorders after tooth extractions.
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Today, most tooth replacement in the esthetic zone is done using implants placed in a delayed surgical protocol. Unfortunately, this delay can result in loss of both hard and soft tissue during the healing period, necessitating guided tissue regeneration techniques at the time of implant placement. Recent developments with tapered implants have facilitated predictable immediate implant placement, preserving the osseous structure surrounding the socket. Further developments with custom healing abutments can preserve the crestal soft tissues, including the papillae. This article reviews techniques that provide for the preservation of both bone and soft tissue while enhancing the esthetic results around implants.
BACKGROUND: Some of the original surgical protocols for implant surgery have been reassessed to satisfy the patient's continuously increasing expectation for shorter rehabilitation time, improved esthetics, and increased comfort. The aim of this study was to evaluate the 12-month clinical success of 18 single-tooth implants inserted immediately after tooth extraction and restored the same day with non-functional loading. METHODS: A total of 18 patients (12 women and six men), 22 to 60 years old, were enrolled in this study. Eighteen single implants were inserted in fresh extraction sockets and immediately restored with temporary abutments and crowns. All experimental sites showed an absence of fenestrations or dehiscences of the bone walls and a residual gap between implant surfaces and surrounding bone walls < or =2 mm. All temporary prostheses were positioned the same day of surgery and were not in occlusal contact with opposing arches. The comparison between the baseline and 12-month visits was performed with the Student t test for paired data (statistically significant at a level of alpha = 0.05). RESULTS: During the 12-month follow-up period, one fixture was removed 4 weeks after implant placement following an abscess. All remaining implants healed uneventfully with no complications and were assessed as stable and successful at the 12-month checkup. No technical complications such as screw loosening, resin fracture, or pain during chewing were registered during the 12-month period. CONCLUSIONS: Within the limits of the data from this study, it can be suggested that immediate placement and restoration of a single implant can be a valid and successful option of treatment in the case of single compromised teeth. Moreover, this treatment protocol eliminates the need for removable provisional restoration and seems to maintain the preexisting architecture of soft and hard tissues in most cases. Nonetheless, further prospective and long-term studies are required to obtain a better insight into the limitations of this protocol.
Immediate implant placement after tooth extraction is becoming a common procedure in implant-supported oral rehabilitation. However, lack of primary full flap closure can jeopardize final results. A surgical approach that would enable predictable primary soft tissue closure over implants placed into fresh extraction sockets is described and evaluated. This technique is based on a rotated deep split thickness palatal flap (RSPF) containing periosteum and connective tissue, covering the implant and/or a barrier membrane. In 29 patients, 33 consecutive implants were placed immediately post extraction of 1 or 2 anterior or premolar maxillary teeth. Patients were divided in 2 groups: Group A (15 patients; n = 18 sites) where no barrier membrane was used and Group B (14 patients, n = 15 sites) where an occlusive resorbable collagen membrane was used. Distance between the alveolar crestal bone and the coronal aspect of the implant was measured at time of implant placement (Group A: mean 1.9 mm, SD 1.16; Group B: mean 4.6 mm, SD 1.18) and at second stage surgery (Group A: mean 0.3 mm, SD 0.46; Group B: mean 0. 7 mm, SD 0. 7). The difference between both records (crestal bone formation) was calculated (Group A: 1.7 mm, SD 1.03; Group B: 3.9 mm, SD 1.12) and found to be statistically significant (P <0.0001). Crestal bone formation, relative to the initial bone crest-implant distance at time of implant placement was approximately 85% in both groups. In 4 sites (2 in each group), where the cover screws were exposed before second stage surgery, complete crestal bone regeneration did not occur. Use of a barrier membrane may be obviated in appropriate cases while placing implants into fresh extraction sites. This procedure offers a predictable treatment approach in achieving complete soft tissue coverage, while allowing for healing of bony defects in immediate implantation procedures.
The present study was undertaken in 9 monkeys to test the effect of a teflon membrane to augment the healing of extraction sockets. The 4 lateral incisors of each animal were extracted using a surgical flap approach. Two of the sockets on one side were covered with teflon membrane (experimental sites), while the same procedure was repeated with the exception of the applications of the teflon membrane on the remaining two sockets of the contralateral side (controls). The distal surfaces of the central incisors were notched at the level of the crest of the alveolar bone as the reference points for measurements of alveolar bone response. Re-entries were performed on three monkeys at 50, 90 and 150 days after tooth extraction and the bone fill of the sockets was evaluated. It was concluded from the results that there was a tendency for the teflon membrane placement to result in a greater amount of clinical alveolar bone fill and lesser extent of bone resorption after tooth extraction.
A clinical investigation was undertaken to find the incidence of dry socket as a post-operative complication of dental extraction on an out-patient basis. Two thousand three hundred and sixty three extractions were carried out under local anaesthesia by clinical staff and students over a four month period. The results are presented and their significance discussed, the incidence of dry socket being found to be dependent upon the site of the tooth extracted, the relative difficulty of the extraction and upon the integrity and size of the blood clot in the extraction socket.
Conventional implant therapy dictates a period of 1 to 2 years from the start of treatment to the completion of the restoration. In contrast, immediate implant placement has resulted in the initiation of prosthetic treatment in as little as 3 to 6 months with the additional benefit of reducing alveolar bone resorption, patient morbidity, and expense. This article reports on the criteria for immediate implant placement into an extraction socket, as well as a reliable technique and a retrospective analysis of 1,081 implants placed immediately into extraction sockets. Of the 1,081 implants placed, 35% were followed for 1 year, 46% were followed for 2 to 5 years, and 19% for 5 to 11 years postloading. The criteria for success were complete stability and no further bone loss than had appeared at the second stage surgery and on the day of restoration. The overall survival rate in this current study is 95%.
BACKGROUND: The placement of different graft materials and/or the use of occlusive membranes to cover the extraction socket entrance are techniques aimed at preserving/reducing alveolar ridge resorption. The use of grafting materials in fresh extraction sockets has, however, been questioned because particles of the grafted material have been found in alveolar sockets 6-9 months following their insertion. AIM: The aims of the study were to (i). evaluate whether alveolar ridge resorption following tooth extraction could be prevented or reduced by the application of a bioabsorbable polylactide-polyglycolide sponge used as a space filler, compared to natural healing by clot formation, and (ii). evaluate histologically the amount and quality of bone tissue formed in the sockets, 6 months after the use of the bioabsorbable material. MATERIAL AND METHODS: Thirty-six patients, undergoing periodontal therapy, participated in this study. All patients were scheduled for extraction of one or more compromised teeth. Following elevation of full-thickness flaps and extraction of teeth, measurements were taken to evaluate the distance between three landmarks (mesio-buccal, mid-buccal, disto-buccal) on individually prefabricated stents, and the alveolar crest. Twenty-six alveolar sockets (test) were filled with a bioabsorbable polylactide-polyglycolide acid sponge (Fisiograft), while 13 sockets (controls) were allowed to heal without any filling material. The flaps were sutured with no attempt to achieve primary closure of the surgical wound. Re-entry for implant surgery was performed 6 months following the extractions. Thirteen biopsies (10 test and three control sites) were harvested from the sites scheduled for implant placement. RESULTS: The clinical measurements at 6 months revealed, in the mesial-buccal site, a loss of bone height of 0.2 mm (1.4 SD) in the test and 0.6 mm (1.1 SD) in the controls; in the mid-buccal portion a gain of 1.3 mm (1.9 SD) in the test and a loss of 0.8 mm (1.6 SD) in the controls; and in the distal portion a loss of 0.1 mm (1.1 SD) in the test and of 0.8 (1.5 SD) mm in the controls. The biopsies harvested from the test sites revealed that the new bone formed at 6 months was mineralized, mature and well structured. Particles of the grafted material could not be identified in any of the 10 test biopsies. The bone formed in the control sites was also mature and well structured. CONCLUSION: The results of this study indicate that alveolar bone resorption following tooth extraction may be prevented or reduced by the use of a bioabsorbable synthetic sponge of polylactide-polyglycolide acid. The quality of bone formed seemed to be optimal for dental implant insertion.
Tooth drift requires the deformation of the root socket and the adjustment of the other components of the attachment apparatus, namely, the periodontal ligament (PDL) and the cementum. Indomethacin (7.5 mg/kg/d), an inhibitor of prostanoid synthesis, provoked in rats a depression in the bone resorption effecting the deformation of the socket (Lasfargues and Saffar, Anat. Rec., 234:310-316, 1992). In the present paper we examined the consequence of this treatment both on the PDL and the root surface. After 3 days of treatment, when osteoclastic resorption was not yet disturbed, the root had been markedly resorbed (P < 0.05) opposite the resorbing bone surface; at that time the PDL width remained in the normal range. After 7 days, i.e., when the bone resorption was depressed, the PDL was widened as the result of the ongoing root resorption. Despite the extensive root resorption, the anchorage of the PDL fibers appeared to remain effective, suggesting that it was rapidly restored. On day 14 at the time of the bone resorption recovery, cementum was deposited in the root resorption lacunae and the PDL width had returned to its control value. As early as day 3 the daily rate of dentine formation increased in the pulp area subjacent to the root resorption lacunae (P < 0.01). These data demonstrate that i) the responses of the different components of the periodontal apparatus are coordinated to allow for the maintainance of the PDL width so that when bone resorption is disturbed, root resorption compensates for it, and ii) the odontoclasts can differentiate and resorb under prostanoid inhibition whilst osteoclastic resorption of the bone socket is inhibited.
Following extraction of a maxillary left first molar tooth in an eight year-old retriever, the dog re-presented five days later because of oral pain, which did not respond to analgesic therapy. The extraction site contained a foul-smelling fluid, but did not contain a clot or granulation tissue. Alveolar osteitis (dry socket) was diagnosed. The alveolus was curetted and flushed, and the dog was given cefalexine and prednisolone. The alveolus was filling with healthy granulation tissue one week later and the dog was no longer in pain.
The odontogenic organ of 10 male albino rats weighing 200 g has been exposed by a longitudinal incision through the masseter muscle. Its site could be identified as a bluish elevation of the mandible. Into this region through the bone, a 2 X 2 mm. tinfoil has been inserted, deep into the odontogenic organ. The tinfoil direction was generally parallel or slightly oblique to the tooth longitudinal axis. The animals were killed after 1 month. Their lower incisors in the bony sockets were fixed and decalcified, cut sagittally and processed histologically. In 3 sockets two separate teeth could be identified, a labial and a lingual tooth. Generally only the labial tooth was covered by enamel, in one case however both teeth exhibited a regular enamel layer. Both teeth were separated by a periodontal ligament and exhibited separate tooth cavities. This experiment demonstrates the capability of the odontogenic organ to reproduce a whole new complex organ, the tooth. A phenomenon hitherto observed only in Urodela in which a severed limb regenerates from primitive pluripotential stem cells known as blastema. Contrary to the newt however, the incisor blastema reproduces continuously throughout the life of the individual and responds to the tinfoil stimulus by a production of an extra tooth.
BACKGROUND AND PURPOSE: The resorption of alveolar bone following tooth extraction results in a narrowing and shortening of the residual ridge, which leads to esthetic and restorative problems, and reduces the bone volume available for implant therapy. The aim of this study was to evaluate the prevention of alveolar collapse after tooth extraction, using titanium membrane (Frios Boneshield; DENTSPLY Friadent, Mannheim, Germany), associated (or not) with autologous bone graft. MATERIALS AND METHODS: A total of 10 nonsmoking healthy subjects, ranging from 35 to 60 years old, were selected for this study. Each patient had a minimum of 2 uni-radicular periodontally hopeless teeth, which were scheduled for extraction. After the procedure, 2 titanium pins were fixed on the vestibular bone surfaces that were used as references for the initial measures (depth, width, and height) of the socket. Of the sockets,1 was randomly chosen to be filled with autologous bone graft (test) removed from superior maxillary tuber, and the other one did not receive the graft (control). A titanium membrane was adapted and fixed, covering the sockets, which remained for at least 10 weeks. After a 6-month healing, the final measures were performed. RESULTS: There was exposure of the membrane in 5 of the 10 treated subjects. Average bone filling (+/-standard deviation) among the 10 subjects was 8.80 +/- 2.93 mm (range 4-13) in the control group and 8.40 +/- 3.35 mm (range 4-13) in the test group. Average bone loss in width in both group was 1.40 +/- 1.97 mm (range -4-1) in the control group and 1.40 +/- 0.98 mm (range -4-0) in the test group. There was no significant statistical difference between groups considering the evaluated standards. CONCLUSION: The use of titanium membrane, alone or in association with autogenous bone, favored the prevention of alveolar ridge after tooth extraction. This membrane seems to be a possible and safe alternative to other nonresorbable membranes when the prevention of alveolar ridge resorption is the objective.
Extraction of a tooth necessitated by factors such as developmental problems, trauma, severe periodontal disease and endodontic problems often causes deformities of the residual alveolar ridge in the maxillary anterior region. These cases are usually difficult to restore prosthetically and they result in poor esthetics and insufficient occlusal function. This study investigated the efficacy of root form bioactive glass cones implanted into (a) artificial sockets produced by bone splitting of previous extraction sites (group BS) and (b) fresh extraction sockets (group FES). We included conventional extraction sockets sutured without implanting the root form bioactive glass cones as a control (group C). A total of 16 patients were treated for whom extractions had been indicated due to severe periodontitis. 6 patients with 7 implant sites having Class II or III alveolar ridge deformities comprised the BS group. 5 patients with 10 implant sites comprised the FES group. Group C, comprised 5 patients with 10 extraction sites. Alveolar ridge width and height measurements were obtained using study casts preoperatively, immediately postoperatively, and at 3 and 12 months after operation. In the BS group, while the width of the alveolar ridge increased by 2.8+/-1.18 mm immediately after ridge augmentation procedure and by 2.4+/-0.93 mm at 1 year after operation (p<0.01), the height of the alveolar ridge increased by 1.8+/-1.99 mm and 1.4+/-1.74 mm respectively (p<0.05). In the FES group, the differences between preoperative original ridge height and width and postoperative measurements were not statistically significant, which demonstrated the efficiency of this method in preserving the alveolar ridge. In group C, while alveolar ridge width after 12 months had not significantly changed, alveolar ridge height decreased significantly (1.35+/-1.05 mm, p<0.01). After 12 months, no dehiscences were detected and the differences in height between the groups remained significant. The results of this study indicate that this procedure is efficient in reconstructing alveolar ridges deformed as a result of extraction, particularly relevant in relation to preparation for subsequent restorative treatment.
AIM: Alveolar ostitis occurs with an incidence of 3-25% after tooth extraction. Antimicrobial photodynamic therapy (aPDT) with HELBO Blue and TheraLite laser enables local decontamination of the extraction socket. The aim of the study was to evaluate the possibility of aPDT with HELBO Blue and diode soft laser to reduce the prevalence of alveolar ostitis. MATERIAL AND METHODS: In an intraindividual study with 100 patients in 130 jaws, one or multiple contralateral teeth were removed at 1-week intervals. Randomly each side was treated with or without aPDT with a standardized protocol. At recall the evaluation of the extraction socket was performed by the investigator and the postoperative pain sensation was judged by the patient on an analog pain scale (0-100). RESULTS: In the group with aPDT alveolar ostitis occurred at one extraction site and in the control group without aPDT in 13 cases. The subjective pain assessment on the day after tooth removal was scored with 11.2+/-9.8 in the aPDT-group and with 19.0+/-12.2 in the control group. One week after extraction the pain sensation in the aPDT group was scored with 2.4+/-9.2 and in the control group with 13.1+/-25.2. The difference was significantly lower with p=0.000 for the 1st and 8th post-surgical days in the aPDTgroup. CONCLUSIONS: The significantly lower incidence of alveolar ostitis after antimicrobial photodynamic therapy seems to be a new and promising possibility for the prevention of alveolar ostitis.
OBJECTIVES: To study the tissue reaction to orthodontic load in normal, high, and low bone turnover states. DESIGN: 'Split mouth' design performing orthodontic tooth movement in 52, 6-month-old male rats with: normal (n = 19), high (n = 16), and low bone turnover (n = 17), the latter two being obtained by induction of hyperthyroidism and hypothyroidism, respectively. Performed at the Department of Orthodontics at Aarhus University. EXPERIMENTAL VARIABLE: The upper left first molar was moved for 21 days. Bone markers were administered 7 and 2 days before killing. Histological sections were cut at the coronal and apical levels. OUTCOME MEASURE: Alveolar socket area, periodontal ligament width, the relative extension of alveolar wall with erosion surfaces, and the mineralizing surfaces were measured and compared in the three groups. RESULTS: Alveolar socket, periodontal ligament width, and erosion surface were larger on the treated than on the control side in the three groups. The normal and hypothyroid groups showed a wider periodontal ligament at the bucco-distal site at the coronal level, while the hyperthyroid group showed a widening which was not spatially oriented. The normal and hyperthyroid groups showed higher erosion at the corono-mesial site. The mineralizing surfaces were larger on the treated than on the control side in the normal and hypothyroid groups, but not in the hyperthyroid group. CONCLUSION: In the hyperthyroid group, the widening of the periodontal ligament was not spatially oriented and the increased erosion was not accompanied by increased formation, as observed in the normal and hypothyroid groups.
AIM: To report the multidisciplinary care of an unaesthetic geminated maxillary lateral incisor tooth, which allowed its preservation in the mouth. SUMMARY: Preoperative examination of an unsightly geminated maxillary lateral incisor (tooth 22) demonstrated two pulp chambers and open apices, with normal pulp sensitivity responses. At surgery, a periodontal mucoperiosteal flap was reflected and the distal part of the geminated tooth was removed. The exposed root canal of the preserved tooth was sealed with mineral trioxide aggregate (MTA). The extraction socket and osseous defect was grafted with decalcified freeze-dried bone allograft (DFDBA) before flap closure. During follow-up, distal caries in tooth 22 and a diastema between tooth 22 and 23 were managed with composite resin restorations. Forty-two months postoperatively, normal thermal and electrical pulp sensitivity tests confirmed pulp health. Convincing apexogenesis and dentinogenesis of the developing root was confirmed by radiographic examination. Acceptable periodontal health including 3-4 mm clinical probing depths was achieved. Optimizing aesthetics and occlusion was accomplished without orthodontic treatment.
To determine if there is a need for close conformation of a hydroxylapatite implant to the root socket for successful prevention of alveolar ridge resorption after tooth extraction, second premolars and lateral incisors of six mature baboons were extracted bilaterally, and custom-fitted root replicas or half-length, plug-shaped forms of hydroxylapatite were implanted in the fresh sockets. Results showed that precise fit, as achieved by a custom-fitted implant, was not necessary for success. All implants were completely accepted, with evidence of new bone formation continuing for up to six months, the duration of the study. No resorption of the alveolar ridge was observed by gross or microscopic examination.