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PubMed2005

Three-year analysis of Tapered Screw-Vent implants placed into extraction sockets grafted with mineralized bone allograft.

With clinicians placing more dental implants, it is becoming increasingly important to maintain bone volume after tooth extraction. This article reports the results of implants placed into extraction sites grafted with particulate mineralized bone allograft (Puros). A total of 313 extraction sites were grafted with mineralized bone graft during a 36-month period. A total of 252 Tapered Screw-Vent dental implants were placed into the grafted extraction sites after a 4- to 7-month healing period. All reentries revealed a bony hard structure acceptable for osteotomy preparation. A total of 244 of these implants have been restored with fixed prosthesis and 6 with removable overdentures for a total of 250 loaded implants. A total of 6 implants failed, which required their removal (2 implants before load and 4 after loading), resulting in a 97.6% implant success rate. We conclude that mineralized human allograft placed into extraction sites is clinically useful to maintain bone volume. This material provided a bony hard structure acceptable for implant placement with good success rates.

Adult↗
PubMed2001

Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man.

BACKGROUND: Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone. METHODS: Forty-eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second-stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non-demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant-bone contact (DBC) was calculated by a computerized microscopic digitizer. RESULTS: No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections. CONCLUSIONS: The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone.

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↗
PubMed1992

Occult hemophilia: prolonged bleeding follows extraction.

A 51-year-old man had delayed and recurrent bleeding after tooth extractions. Occult hemophilia B was discovered. This case emphasizes the importance of evaluating patients for an underlying coagulopathy when bleeding greater than expected occurs. In this case, the patient had no personal or family history of bleeding.

Blood Loss, Surgical↗
PubMed1982

Occult dental infection causing fever in renal transplant patients.

Fever secondary to odontogenic infection following successful renal transplantation is reported in three patients. All three patients initially lacked signs or symptoms localizing to the oral cavity, and two of the three patients did not have x-ray evidence of abscess formation. Two patients received antibiotic therapy without any apparent clinical response, and all three patients responded promptly to surgical extractions. Our patients illustrate that fever can be the only sign of dental sepsis in renal transplant recipients, and tooth extraction as empiric therapy may be necessary. Most important, however, is that the dental pathology responsible for their fever could have been detected and treated prior to transplantation. We recommend pretransplant dental evaluation of all patients with extraction of partially impacted molars and treatment of all periodontal disease and dental caries.

Adolescent↗
PubMed2006

Clinical evaluation of post-extraction site wound healing.

AIM: The aim of this prospective study was to evaluate the clinical pattern of post-extraction wound healing with a view to identify the types, incidence, and pattern of healing complications following non-surgical tooth extraction. STUDY DESIGN: A total of 311 patients, who were referred for non-surgical (intra-alveolar) extractions, were included in the study. The relevant pre-operative information recorded for each patient included age and gender of the patient, indications for extraction, and tooth/teeth removed. Extractions were performed under local anesthesia with dental forceps, elevators, or both. Patients were evaluated on the third and seventh postoperative days for alveolus healing assessment. Data recorded were: biodata, day of presentation for alveolus healing assessment, day of onset of any symptoms, body temperature (degrees C) in cases of alveolus infection, and presence or absence of pain. RESULTS: Two hundred eighty-two patients (282) with 318 extraction sites were evaluated for alveolus healing. Healing was uneventful in 283 alveoli (89%), while 35 alveoli (11%) developed healing complications. These complications were: localized osteitis 26 (8.2%); acutely infected alveolus 5 (1.6%); and an acutely inflamed alveolus 4 (1.2%). Females developed more complications than males (p=0.003). Most complications were found in molars (60%) and premolars (37.1%). Localized osteitis caused severe pain in all cases, while infected and inflamed alveolus caused mild or no pain. Thirty patients (12%) among those without healing complications experienced mild pain. CONCLUSIONS: Most of the post-extraction alveoli healed uneventfully. Apart from alveolar osteitis (AO), post-extraction alveolus healing was also complicated by acutely infected alveoli and acutely inflamed alveoli. This study also demonstrated a painful alveolus is not necessarily a disturbance of post-extraction site wound healing; a thorough clinical examination must, therefore, be made to exclude any of the complications.

Adolescent↗
PubMed2003

Lymphoma in the infraorbital region.

BACKGROUND: B-cell lymphomas are rare neoplasms in the oral cavity. They are significant to dentists because the oral complications associated with treatment mean that dentists can play an important role in their detection. CASE DESCRIPTION: The authors describe the case of a 55-year-old man with nonhealing ulcers, swelling and pain six months after maxillary left canine extraction. As it occurred in the infraorbital region after canine tooth extraction, the authors suspected B-cell lymphoma. Clinical examination revealed infraorbital edema with regional submandibular lymphadenopathy. Intraoral examination revealed a nonhealing ulceration with ill-defined borders in the surrounding mucosa. It was 5- x 5-centimeters in diameter and gray-white. The histopathologic examination showed diffuse, atypical, lymphoid cell infiltration and immuno-histochemically positive staining. After the histopathologic examination, the authors referred the patient to a medical center for treatment. CLINICAL IMPLICATIONS: Dentists should look for signs of B-cell lymphoma when a patient has extended pain and swelling after an extraction.

Facial Neoplasms↗
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↗
PubMedDate not supplied

Three cases of first permanent molar extractions where extraction of the adjacent second deciduous molar is also indicated.

UNLABELLED: Appropriately timed extraction of a carious first permanent molar can result in favourable mesial drift of the second permanent molar when space is not required for orthodontic treatment. However, when the second deciduous molar adjacent to the extracted tooth is not removed, distal drift of the unerupted second premolar may occur. This paper discusses three patients who had first permanent molars extracted without removal of the adjacent second deciduous molar, encouraging unfavourable distal drift of the second premolar in the first two cases. Timely extraction of the second deciduous molar in the third case should prevent this orthodontic problem. CLINICAL RELEVANCE: Treatment of gross caries in a first permanent molar requires assessment of the patient's orthodontic status prior to treatment planning.

Bicuspid↗
PubMed2000

Crown dilaceration of a first premolar caused by extraction of its deciduous predecessor: a case report.

This report describes a rare case of crown dilaceration of the mandibular first premolar caused by trauma during extraction of the precedent primary first molar. The mandibular first primary molar had been extracted at the age of 4 years 7 months. Compared to the pre-operative radiograph, the post-operative film showed that the direction of the first premolar tooth germ had changed, suggesting that crown dilaceration had been induced by the surgical procedures during tooth extraction. From radiographic examinations, the premolar was considered to have erupted spontaneously.

Bicuspid↗
PubMed2000

Maxillary sinus polyps secondary to dental extraction.

Polyps of the maxillary sinus were obtained from six patients who had reported upper tooth extraction with oroantral perforation prior to the development of symptoms, from 11 patients with chronic sinusitis, and from 12 patients with allergy. Histopathological features, scanning electron microscopy of the polyp epithelium and clinical data were compared in those groups of patients. The post-traumatic polyps differed from those of other aetiologies by showing the presence of granulomas, less numerous inflammatory cells with very few eosinophils, nearly normal surface epithelium (smaller surface area occupied by nonciliated epithelium, absence of epithelial squamous cells, normal frequence of goblet cells), rapid appearance of symptoms, and shorter duration of the disease. It seems that the specific characteristics of the injury-induced polyps results from a different mechanism of their formation, involving primarily abnormal mucosal repair and to a lesser extent an inflammatory process.

Adolescent↗
PubMedDate not supplied

Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading.

PURPOSE: This report of a clinical patient series indicates the relative safety and illustrates the procedures involved in the extraction of remaining teeth followed by immediate implant placement and loading with a simple acrylic resin fixed denture. MATERIALS AND METHODS: Ten consecutive patients who selected tooth extraction and implant-supported fixed denture rehabilitation of the mandible were treated using a 1-visit approach for extraction, implant placement, and restoration. Healthy individuals (10 women) were treated under local anesthesia. Fifty-four implants were placed in 10 patients. Five or 6 Astra Tech implants (11 or 13 mm long) were placed into the edentulous parasymphyseal region of the mandible. Four to 6 implants (48 of 54) were immediately loaded by the fabrication of a simple acrylic resin fixed denture. The criterion for loading was clinical judgment of primary stability, ie, the absence of axial or lateral mobility with physical resistance to rotation. Patients were recalled at 1, 3, and 12 weeks. At 12 weeks, impressions were made for the fabrication of a screw-retained fixed denture. The fixed dentures were completed using conventional fabrication and prosthetic techniques. RESULTS: After a period of 6 to 18 months, all 54 implants had survived and were considered 100% successful by independent testing of mobility and radiographic evidence of osseointegration. There were no surgical complications. Fracture and debonding of the acrylic resin provisional denture occurred for 1 patient during the first 12 weeks of treatment. DISCUSSION: Advantages to extraction with simultaneous replacement include the maintenance of vertical dimension, elimination of reline procedures and interim denture therapy, and potential improvement of soft tissue healing. CONCLUSION: This therapeutic approach simplifies patient care without apparent additional risk.

Adult↗
PubMed2004

[Antimicrobial photodynamic therapy for prevention of alveolar ostitis and post-extraction pain].

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.

Bacterial Infections↗
PubMed1993

Effect of bone mineral density in skeleton and mandible on extraction of teeth and clinical alveolar height.

Residual ridge resorption of the maxillae and mandible after tooth extraction adversely affects many edentulous people. The jaws of 355 postmenopausal women were examined clinically, and the number of teeth and the clinical height of alveolar ridges in edentulous jaws were determined. Each subject was asked when the last teeth had been extracted. To study the bone mineral status of each woman, the bone mineral densities of the femoral neck and the lumbar spine were measured by dual-energy x-ray absorptiometry. For 77 edentulous or almost edentulous women, the bone mineral density of the mandibular cortex and the spongiosa were measured by quantitative computed tomography. The results were studied to determine whether the general status of osteoporosis or the local bone mineral densities in the mandible affect the time of extraction of teeth or the remaining height of edentulous alveolar ridges. Neither the time when the teeth were lost nor the number of teeth was dependent on the general bone loss, but in some regions, the clinical height was affected.

Alveolar Process↗
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↗