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PubMed2005

Dimensional ridge alterations following tooth extraction. An experimental study in the dog.

OBJECTIVE: To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change. MATERIAL AND METHODS: Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope. RESULTS: It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall. CONCLUSIONS: The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood.

Alveolar Bone Loss↗
PubMed2005

Early loading of interforaminal implants immediately installed after extraction of teeth presenting endodontic and periodontal lesions.

BACKGROUND: Infection in tooth extraction sites has traditionally been considered an indication to postpone implant insertion until the infection has been resolved. PURPOSE: The aim of this study was to evaluate the survival rate of early-loaded implants placed immediately after extraction of teeth with endodontic and periodontal lesions in the mandible. MATERIALS AND METHODS: Twenty patients in need of mandibular implant treatment and with teeth showing signs of infection in the interforaminal area were included in the study. The patients received four to six implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in or close to the fresh extraction sockets and received a provisional prosthesis within 3 days. Final prostheses were delivered after 3 to 12 months. The surgical protocol paid special attention to the preservation of high implant stability and control of the inflammatory response. The patients were followed up for 15 to 44 months. RESULTS: No implants were lost, resulting in a 100% survival rate. A mean marginal bone loss of 0.7 mm (SD 1.2 mm) was registered during the observation period. No signs of infection around the implants were detected at any follow-up visit. CONCLUSION: A high survival rate can be achieved for immediately placed and early-loaded implants in the mandible despite the presence of infection at the extracted teeth.

Aged↗
PubMed1997

Dose-response effects of adrenergic drugs on axial movements of the rat mandibular incisor and on arterial blood pressure.

Axial tooth movements and arterial blood pressure were measured following the intravenous injection of 0, 0.01, 0.1, 1, or 10 micrograms/kg of adrenaline, noradrenaline or isoprenaline. Adrenaline caused a dose-dependent, rapid, extrusive tooth movement with a nearly simultaneous increase in blood pressure, followed by a marked intrusive tooth movement and a decrease in blood pressure. Noradrenaline caused a dose-dependent, rapid, extrusive tooth movement and an increase in blood pressure, but a subsequent intrusive tooth movement and decrease in blood pressure were not so marked. Isoprenaline caused a marked intrusive tooth movement and a decrease in blood pressure, without an extrusive tooth movement and increase in blood pressure. The time required to reach the maximum intrusive tooth movement was delayed after that to reach the maximum decrease in blood pressure. The recovery time of the intrusive tooth movement was much more delayed than that of blood pressure. These results suggest that the extrusive movement of the rat incisor was primarily related to the rise of arterial blood pressure due to stimulation of vascular alpha-receptors. It is also suggested that stimulation of beta-receptors would probably cause vasodilatation of arteries that would make the pressure in the small vessels in the microcirculation of the socket fall, so reducing the volume of blood and interstitial fluid in the socket followed by a marked and continuing intrusive tooth movement.

Adrenergic Agonists↗
PubMed2003

Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans.

BACKGROUND: Tooth extraction typically leads to loss of ridge width and height. The primary aim of this 6-month randomized, controlled, blinded, clinical study was to determine whether ridge preservation would prevent post-extraction resorptive changes as assessed by clinical and histologic parameters. METHODS: Twenty-four patients, 10 males and 14 females, aged 28 to 76 (mean 51.5 +/- 13.6), requiring a non-molar extraction and delayed implant placement were randomly selected to receive either extraction alone (EXT) or ridge preservation (RP) using tetracycline hydrated freeze-dried bone allograft (FDBA) and a collagen membrane. A replaced flap, which did not completely cover the sockets, was used. Following extraction, horizontal and vertical ridge dimensions were determined using a modified digital caliper and an acrylic stent, respectively. Prior to implant placement, a 2.7 x 6.0 mm trephine core was obtained and preserved in formalin for histologic analysis. RESULTS: The width of the RP group decreased from 9.2 +/- 1.2 mm to 8.0 +/- 1.4 mm (P<0.05), while the width of the EXT group decreased from 9.1 +/- 1.0 mm to 6.4 +/- 2.2 mm (P<0.05), a difference of 1.6 mm. Both the EXT and RP groups lost ridge width, although an improved result was obtained in the RP group. Most of the resorption occurred from the buccal; maxillary sites lost more width than mandibular sites. The vertical change for the RP group was a gain of 1.3 +/- 2.0 mm versus a loss of 0.9 +/- 1.6 mm for the EXT group (P<0.05), a height difference of 2.2 mm. Histologic analysis revealed more bone in the RP group: about 65 +/- 10% versus 54 +/- 12% in the EXT group. The RP group included both vital bone (28%) and non-vital (37%) FDBA fragments. CONCLUSIONS: Ridge preservation using FDBA and a collagen membrane improved ridge height and width dimensions when compared to extraction alone. These dimensions may be more suitable for implant placement, especially in areas where loss of ridge height would compromise the esthetic result. The quantity of bone observed on histologic analysis was slightly greater in preservation sites, although these sites included both vital and non-vital bone. The most predictable maintenance of ridge width, height, and position was achieved when a ridge preservation procedure was employed.

Adult↗
PubMed2004

Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes.

PURPOSE: The aim of this article was to review the current literature with regard to survival and success rates, along with the clinical procedures and outcomes associated with immediate and delayed implant placement. MATERIALS AND METHODS: A MEDLINE search was conducted of studies published between 1990 and June 2003. Randomized and nonrandomized clinical trials, cohort studies, case-control studies, and case reports with a minimum of 10 cases were included. Studies reporting on success and survival rates were required to have follow-up periods of at least 12 months. RESULTS: Thirty-one articles were identified. Most were short-term reports and were not randomized with respect to timing of placement and augmentation methods used. All studies reported implant survival data; there were no reports on clinical success. Peri-implant defects had a high potential for healing by regeneration of bone, irrespective of healing protocol and bone augmentation method. Sites with horizontal defects (HD) of 2 mm or less healed by spontaneous bone fill when implants with rough surfaces were used. In the presence of HDs larger than 2 mm, or when socket walls were damaged, concomitant augmentation procedures with barrier membranes and bone grafts were required. Delayed implant placement allowed for resolution of local infection and an increase in the area and volume of soft tissue for flap adaptation. However, these advantages were diminished by simultaneous buccolingual ridge resorption and increased requirements for tissue augmentation. DISCUSSION: Immediate and delayed immediate implants appear to be predictable treatment modalities, with survival rates comparable to implants in healed ridges. Relatively few long-term studies were found. Successful clinical outcomes in terms of bone fill of the peri-implant defect were well established. However, there was a paucity of data on long-term success as measured by peri-implant tissue health, prosthesis stability, and esthetic outcomes. CONCLUSIONS: Short-term survival rates and clinical outcomes of immediate and delayed implants were similar and were comparable to those of implants placed in healed alveolar ridges.

Alveolar Ridge Augmentation↗
PubMed1979

Pulpectomy procedure for deciduous teeth with severe pulpal necrosis.

Pulpectomies of deciduous teeth with severe pulpal necrosis should be considered as a possible treatment plan. Systemic and dental criteria have been devised to help the clinician to select cases in which successful results may be produced. A clinical success occurs when the pulpectomized tooth is painless, is firm in its alveolar socket, and is without a fistulous tract. Radiographically, any radiolucent area should be resolving with six months, and no pathologic root resorption should be observed. Research should determine whether pulpectomies may be done on children with severe systemic disease and should determine long-term consequences of underfilled and overfilled pulpectomies.

Dental Pulp Capping↗
PubMed1989

A three-dimensional evaluation of the effects of functional occlusal forces on the morphology of dental and periodontal tissues of the rat incisor.

We examined the effect of function on tooth and periodontal ligament (PDL) morphology in 40 lower incisors of adult female rats. Ten teeth were exposed to occlusal hyperfunction for three months, ten to hypofunction for three weeks, ten to hypofunction for three months, while ten teeth in normal occlusion served as control. Transverse ground sections were cut at various levels perpendicular to the tooth long axis, and their distances from the apex were calculated. The outlines of the tissues were traced and fed into a computer. We plotted the measurements according to their location and fitted them by second-order polynomials. We calculated tissue volume for the proximal 18 mm of bone-embedded tooth. Hyperfunction affected tooth shape, in that it became more rounded. The volumes of the dental tissues remained unchanged, while width and volume of the cementum-bordering PDL increased. Hypofunction did not alter tooth shape, but influenced its size: After three weeks, tooth circumference decreased, and after three months, it expanded. Dentin width was reduced, with concomitant increase of pulp size. The amount of enamel diminished initially, but after three months returned to normal values. The PDL bordering enamel expanded proportionally to the duration of hypofunction. The changes in socket size reflected the total dimensional variations in the tooth and its PDL. The results demonstrate that the shape and size of growing teeth and their periodontium are influenced by functional occlusal forces.

Alveolar Process↗
PubMed1983

The effect of extraction and orthodontic treatment on dentoalveolar support.

Full-mouth radiographs of ninety-six patients treated by extraction of four first premolars were taken at least 10 years postextraction. Three groups were established: one with extensive crowding in the full permanent dentition treated by extraction and fixed appliance therapy; one treated by serial extraction and fixed appliance therapy; and one treated by serial extraction only. Measurements of tooth length and alveolar bone height were made from the projected radiographs, and buccolingual socket areas were measured from direct tracings of the radiographs. Comparison between groups revealed reduced mean radiographic tooth lengths for incisors and mandibular molars in the orthodontically treated groups. The incidence of root resorption was similar for both treated groups. Reduced alveolar bone heights were noted in the extraction sites of the two orthodontically treated groups but not in the group treated by serial extraction only. Most reduction in long-term dentoalveolar support occurred as a result of root resorption except in the extraction sites, where it occurred largely as a result of bone loss. Root parallelism did not appear to influence proximal bone heights at the extraction site. In malocclusions involving arch length deficiency, maximally displaced canines had reduced long-term proximal bone compared to nondisplaced canines, supporting the concept of encouraging autonomous distal eruption through serial extraction.

Adult↗
PubMed1982

The effect of hypofunction on the mechanical properties of the periodontium in the rat mandibular first molar.

The right maxillary molars of male rats were removed under ether anaesthesia to eliminate occlusal contact with the mandibular molars. Groups of rats were killed at 1, 2, 4, 8 and 16 days after the experimental procedure. The dissected mandibles were radiographed and length of erupted portion of the tooth, height of alveolar crest and length of tooth were measured. The tensile strength of the periodontal ligament was measured by extracting the first molar from its socket. A marked and progressive decrease of the load required to extract the tooth was found in the first few days after the removal of the opposing teeth. No significant difference in extracting loads was found between the 8- and 16-day groups. Radiography showed that the teeth had erupted, that the height of alveolar crest had decreased and that the length of the root had increased during the experimental period. These changes were detectable only on the 8th or 16th day following the experimental procedure. It is suggested that the reduction in the mechanical strength of the hypofunctional rat molar periodontal ligament is closely associated with the progressive atrophy of the periodontal ligament and that normal functional activity of the teeth is important not only for maintenance of the structural integrity of the periodontal ligament but also to maintain the mechanical strength of the supporting tissues.

Animals↗
PubMedDate not supplied

Repair of a root perforation with a resin-ionomer using an intentional replantation technique.

The repair of a root perforation can be accomplished using different materials and techniques. When the defect is surgically inaccessible, the tooth can be carefully extracted, repaired extraorally, and placed back into the socket. This procedure, known as intentional replantation, is often a measure of last resort in an heroic effort to save a hopeless tooth. This case report describes the treatment of a tooth with an iatrogenic root perforation and the subsequent healing of the surrounding periodontium using an intentional replantation technique and resin-ionomer to repair the root defect.

Dental Restoration, Permanent↗
PubMed1990

[Experimental study of bone resorption after tooth extraction with implanted hydroxyapatite tooth root substitute].

Hydroxyapatite (HAP) tooth root substitute implantation have been applied to extraction sockets in many studies for purpose of preservating alveolar bone. Dimensional changes were measured with sectioned study cast of cephalometric X-ray photo. In this study, dimensional changes were determined by newly developed evaluation system which utilizing image analyzer (Immunomedica Co., Ltd.), in a view of conserving alveolar ridges beneath the denture base. Cone shaped HAP tooth roots (5 or 6 mm in length) were implanted to one subject and disk-like shaped HAP tooth roots (2 mm in length) were also implanted to the other subject. Preservation of alveolar bone was observed in both shaped HAP tooth roots implanted site compared to control site. Bony ankylosis between HAP tooth root and alveolar bone, observed on 1 month after histological specimens, may contribute to this result. Smaller changes of blood flow compared to controls were obtained on implanted site, which were measured with Laser Doppler blood flow meter (Perimed KB; Sweden) on buccal mucosa. We consider that HAP shows good biocompatibility and HAP tooth roots implantation decrease the wound volume consequently.

Alveolar Bone Loss↗
PubMed1999

Disturbed healing of extraction wounds.

Disturbed healing of a dental extraction wound can cause severe pain and can jeopardize attempts at dental implants or other treatments. The pathogenesis of disturbed healing was studied by histological examination of 221 postoperative biopsies taken for diagnostic purposes from human extraction wounds at different stages of healing. A relationship was observed between the healing stages and different disturbances such as dry socket, suppurative osteitis, necrotizing osteitis, and fibrous healing.

Dry Socket↗