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PubMed1994

Combined dental implant and guided tissue regeneration therapy in humans.

This study evaluated wound healing and osseointegration of dental implants placed in immediate postextraction sockets in humans. Ten healthy adults had one or more teeth extracted and replaced with ITI dental implants, which were centered in the residual socket and covered with a polytetrafluoroethylene membrane and a flap to attain primary closure. Measurements were made to document the relationship of bone to implant at the time of implant placement and at the 6-month reentry. All implants were clinically osseointegrated at the 6-month reentry procedure; narrow bony defects showed complete bone fill, while wide defects showed partial bone fill. There was less bone regeneration in areas of thin cortical bone or preexisting dehiscences and in implant sites with early membrane exposure. Implants placed in immediate postextraction sockets demonstrated successful osseointegration with irregular bone-healing patterns, which were related to variations in existing bony anatomy and socket location.

Alveolar Bone Loss↗
PubMed2005

The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study.

PURPOSE: The purpose of this investigation was to assess the frequency of complications of third molar surgery, both intraoperatively and postoperatively, specifically for patients 25 years of age or older. MATERIALS AND METHODS: This prospective study evaluated 3,760 patients, 25 years of age or older, who were to undergo third molar surgery by oral and maxillofacial surgeons practicing in the United States. The predictor variables were categorized as demographic (age, gender), American Society of Anesthesiologists classification, chronic conditions and medical risk factors, and preoperative description of third molars (present or absent, type of impaction, abnormalities or association with pathology). Outcome variables were intraoperative and postoperative complications, as well as quality of life issues (days of work missed or normal activity curtailed). Frequencies for data collected were tabulated. RESULTS: The sample was provided by 63 surgeons, and was composed of 3,760 patients with 9,845 third molars who were 25 years of age or older, of which 8,333 third molars were removed. Alveolar osteitis was the most frequently encountered postoperative problem (0.2% to 12.7%). Postoperative inferior alveolar nerve anesthesia/paresthesia occurred with a frequency of 1.1% to 1.7%, while lingual nerve anesthesia/paresthesia was calculated as 0.3%. All other complications also occurred with a frequency of less than 1%. CONCLUSION: The findings of this study indicate that third molar surgery in patients 25 years of age or older is associated with minimal morbidity, a low incidence of postoperative complications, and minimal impact on the patients quality of life.

Absenteeism↗
PubMed1988

Effect of a topical drug combination on the early healing of extraction sockets in the vervet monkey.

An animal trial was undertaken in 9 vervet monkeys to test the effect of a medicament combination on extraction socket healing. All 4 third molar teeth were extracted and 2 of the sockets in each animal were packed with Gelfoam sponge impregnated with a medicament containing a local anaesthetic, antiseptic, 2 potent antifibrinolytic agents and metronidazole. The remaining 2 sockets acted as controls: one of the sockets was packed with Gelfoam sponge alone and the other allowed to heal spontaneously with no implant. The healing of these sockets was evaluated histometrically in 4-, 6- and 8-day specimens, and from the results it was concluded that sockets containing the medicament compound showed enhanced early socket healing.

Administration, Topical↗
PubMed2005

Emdogain does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study.

Emdogain has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis. The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain was not able to prevent or cure ankylosis.

Adolescent↗
PubMed1997

Hemostatic treatment after tooth extraction in a patient with factor V deficiency.

BACKGROUND: Factor V deficiency is a very rare hereditary coagulation disorder and tooth extraction in the patient with factor V deficiency has not been reported except in one case. PATIENTS AND TREATMENT: A 38-year-old woman with factor V deficiency was referred for extraction of the impacted lower third molar. After intravenous administration of frozen fresh plasma (FFP) and recognition of an increase of factor V level from 1-31%, upper and lower third molars were extracted. Eighteen and 48 h after the extraction, factor V was intermittently supplemented by injection of 4 and 2 units of FFP, respectively, and factor V was maintained above 12%. To form fast coagula and to protect the wound, the lower extraction socket was filled with a fibrin glue composed of factor XIII and fibrinogen (Beriplast P) and a plastic splint was applied. The wound was healed and epithelized within 2 weeks after the extraction without any bleeding or infectious consequences. CONCLUSION: Extraction in the patient with factor V hereditary deficiency is safely performed by both supplementation of factor V and application of local hemostasis.

Adult↗
PubMed1985

Blood loss following dental extractions in anticoagulated rabbits: effects of tranexamic acid and socket packing.

The present study demonstrates the feasibility of chronic anticoagulation in rabbits and of estimating the resulting increase in blood loss following extraction of four front teeth from labeled red cell disappearance curves. This setup proved useful for the evaluation of hemostatic techniques. Socket packing with oxidized cellulose soaked in thrombin solution or local application of cyanobutylacrylate reduced early blood loss; oral administration of tranexamic acid reduced both early and late bleeding; the combination of socket packing and oral tranexamic acid completely abolished the excessive blood loss that resulted from anticoagulation alone.

Administration, Oral↗
PubMed1984

A comparison between 2 absorbable hemostatic agents: gelatin sponge (Spongostan) and oxidized regenerated cellulose (Surgicel).

Oxidized, regenerated cellulose (Surgicel) and gelatin sponge (Spongostan) were packed in the sockets of upper third molars after surgical removal in 10 and 11 patients, respectively. The other side in each patient functioned as control. The study revealed that more pain was apparent on the sides, where the materials were packed, especially in the gelatin sponge group, although more patients preferred this material to oxidized, regenerated cellulose. The 2 materials did not differ with regard to swelling or bleeding. No complications were encountered. Use of these materials in post-extraction sockets did not seem to impair closure of the wound as estimated by epithelial cover of the sockets, although healing was slightly delayed in the gelatin group.

Adult↗
PubMed2002

Complications in HIV-infected and non-HIV-infected haemophiliacs and other patients after oral surgery.

Dental extractions and other oral surgical procedures, including local analgesic injections, potentially can cause problems in haemophiliac and HIV infected persons. There are few data on treatment results in HIV-infected haemophiliacs compared with non-HIV-infected haemophiliacs. The oral surgery treatment results in 48 patients with special needs, including HIV-infected haemophiliacs, non-HIV-infected haemophiliacs, HIV-infected non-haemophiliacs, and a group with other medical problems were therefore studied. Around 20% of the haemophiliacs developed post-oral surgical complications, which was not significantly different whether or not they were HIV-infected. However, complications were less frequent (8%) in HIV-infected non-haemophiliacs or other patients with special needs. Although the patient groups are not large, it would appear that haemophiliacs had more postoperative complications but that the presence of HIV infection had no notable influence on treatment outcome.

Adult↗
PubMed1975

[Quantitative study on the effects of occlusal overload on the remodelling of the alveolar process in the rat].

A quantitative study of alveolar bone resorption around the first lower rat molar has been conducted on horizontal sections. The number of osteoclasts/mm2 and the percentage of resorbing periodontal membrane surface of the socket rose through an increase in occlusal forces induced by an amalgam filling in slight occlusal overbite. The increase in resorption was significantly related to the duration of force application. The number of osteoclasts was more than tripled after 18 days. But this increase was observed in areas already previously submitted to osteoclastic resorption during bone remodeling associated with physiological tooth drift.

Alveolar Process↗
PubMed1990

Relationships between tooth eruption, occlusion and alveolar bone resorption: histochemical and cytological studies of bone remodeling on rat incisor alveolar bone facing the enamel after root resection.

The labial side of rat incisor alveolar bone facing the enamel is continuously resorbed as the result of compressive force produced by the occlusion and eruption of incisors. In order to clarify the relationship between this mechanical compressive force and the bone cells involved in bone remodeling, we examined morphological changes occurring in the alveolar bone once the compressive force was eliminated by the removal of the proliferative odontogenic base (root resection according to Berkovitz and Thomas, 1969). After root resection, the incisor migrated halfway along the socket. On the crestal part where incisor still existed, active osteoclasts were prominent on the bone surface, and flattened mononuclear cells lay close upon active osteoclasts. Sinusoidal blood vessels or capillaries were observed at short distances from the bone surface. On the basal part where socket was vacant, osteoblasts lined up on the newly formed bone, and the osteogenic cell layer lay on the osteoblasts. Between the two parts, which correspond to the reversal phase proposed by Baron (1977), osteoblastic cells with developed cell organelles increased in number and the distance between blood vessels and bone surface increased. Osteoclasts reduced their activities, and osteoblastic cells often wedged themselves between the osteoclasts and bone surface. These findings indicate that the elimination of compressive force mediated by incisors leads to the activation of osteoblastic cells and inactivation of osteoclasts, which results in a conversion from bone resorption to bone formation. Thus, osteoblastic cells may play an important role in controlling osteoclastic activity in conversion from bone resorption to bone formation, partly by a direct effect and partly by controlling the access of blood vessels to the bone surface.

Acid Phosphatase↗
PubMedDate not supplied

Immediate implants after extraction. A review of the current situation.

Immediate implants are positioned in the course of surgical extraction of the tooth to be replaced. The percentage success of such procedures varies among authors from 92.7-98.0%. The main indication of immediate implantation is the replacement of teeth with pathologies not amenable to treatment. Its advantages with respect to delayed implantation include reduced post-extraction alveolar bone resorption, a shortening of the rehabilitation treatment time, and the avoidance of a second surgical intervention. The inconveniences in turn comprise a general requirement for membrane-guided bone regeneration techniques, with the associated risk of exposure and infection, and the need for mucogingival grafts to seal the socket space and/or cover the membranes. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material. Primary stability is an essential requirement, and is achieved with an implant exceeding the alveolar apex by 3-5 mm, or by placing an implant of greater diameter than the remnant alveolus. Esthetic emergence in the anterior zone is achieved by 1-3 mm sub-crest implantation. Regarding guided regeneration of the alveolar bone, the literature lacks consensus on the use of membranes and the type of filler material required. While primary wound closure is desirable, some authors do not consider it to be of great relevance.

Animals↗
PubMed1993

Placement of hydroxyapatite-coated endosseous implants in fresh extraction sites: a case report.

This case illustrates the use of the principles of guided tissue regeneration to achieve osseointegration of an endosseous dental implant. One implant was placed immediately, with hydroxyapatite and a barrier membrane, in an extraction site, while another was placed in a healed site. Eighteen months postinsertion, the implant placed in the extraction socket exhibited better maintenance of crestal height than did the implant inserted in the healed site.

Adult↗
PubMed1985

Healing after root reimplantation in the monkey.

The aim of the present investigation was to evaluate the regenerative potential of the periodontal tissues following tooth reimplantation using a model which excluded the dentogingival epithelium from the process of healing. Maxillary and mandibular incisors, premolars and molars of 5 monkeys were used. Following root filling of all experimental teeth, the teeth were divided into 3 experimental groups. In 1 group, the teeth were extracted following the elevation of full thickness flaps. The crowns were separated from the roots at the level of the buccal cemento-enamel junction and the roots immediately reimplanted into their sockets. The flaps were replaced and sutured to accomplish complete coverage of the roots. In a 2nd group, the teeth were subjected to the same experimental procedure, but in addition, the buccal alveolar bone was removed to about half its original height prior to root reimplantation. The teeth of the 3rd group were subjected to identical experimental procedures as for group II with the addition that the buccal root surfaces were planed to the level of the surgically created bone crest. The animals were sacrificed after 6 months of healing. The jaws were removed and histological specimens prepared for microscopic examination. The results showed that a complete fibrous re-attachment formed onto roots on which the original periodontal ligament tissue was preserved. This occurred irrespective of whether the roots were reimplanted into sockets with normal (group I) or reduced (group II) bone height. When the original periodontal ligament tissue was removed by root planing before reimplantation (group III), healing resulted in a significant amount of new connective tissue attachment. However, coronal to the newly formed fibrous attachment, the root surface frequently showed signs of resorption and particularly so in those roots which remained covered by the soft tissue during the entire course of healing. In the majority of the roots which perforated the covering soft tissue during the early phase of healing, the dentogingival epithelium had migrated apically into contact with the coronally generated fibrous attachment. In these cases, root resorption was never discernible. New bone formation occurred to a variable extent in the roots of groups II-III. No relationship was found, however, between the amount of connective tissue reattachment or new attachment and newly formed alveolar bone, which in turn indicates that bone tissue regrowth and periodontal ligament regeneration are unrelated phenomena.

Alveolar Process↗
PubMed2001

Post-extraction complications seen at a referral dental clinic in Dar Es Salaam, Tanzania.

AIM: To investigate the types and magnitude of post extraction complications. SETTING: A referral hospital in Dar es Salaam, Tanzania. SUBJECTS: All dental patients who had their teeth extracted at the Muhimbili Medical Centre dental outpatient clinic during the study period (May September 1999). A total of 3,818 extractions were performed under local anaesthetic in 3,732 patients. METHOD: Oral examination of all patients who reported back with post-extraction problems. RESULTS: The frequency of post extraction complications was low (1.1 per cent), and was mainly due to; infected sockets (48.7 per cent), followed by bleeding sockets (41.0 per cent) and retained roots (10.3 per cent). There were eight 'other' complications suffered by 11 patients: necrotising fasciitis (n=l), herpes zoster (n=l), Ludwig's angina (n=l), infections of the submandibular (n=l), parapharyngeal (n=2), masticator (n=2) and submasseteric spaces (n =2), and reaction to local anaesthesia (2ml of 2 per cent lignocaine hydrochloride) (n=1). CONCLUSION: The results of this study indicate that post-extraction complications are few, mostly minor, self-limiting and easily treatable. The study does not support routine antibiotic prophylaxis or special pre-extraction procedures, even in this patient population with poor oral hygiene and high HIV seroprevalence.

Abscess↗
PubMed1998

Histologic findings after implantation and evaluation of different grafting materials and titanium micro screws into extraction sockets: case reports.

The purpose of this study was to compare extraction socket healing in 8 patients after implantation with either xenogenic bovine bone (n=5 sites), demineralized freeze-dried bone (DFDBA) (n=3 sites), autologous bone (n=3 sites), or human bone morphogenetic proteins in an osteocalcein/osteonectin carrier (hBMP/NCP) (n=2 sites). Three of the patients received 6 commercially pure micro screws which were fixed into extraction sockets, after which the sockets were implanted with either bovine bone (n=3 sites), DFDBA (n=2 sites) or intraoral autologous bone (n=1 site). Biopsies of the extraction sockets were taken from 3 to 6 months after treatment (average, 4.6 months). For comparison of healing between the implanted materials, histologic evaluation and bone scores were determined. Bone scores of 0 indicated an absence of new bone, with dead implanted bone particles entrapped within connective tissue, while a score of 3 indicated the entire field consisted of vital bone. Biopsies from bovine bone sockets revealed dead implanted particles surrounded by connective tissue. Isolated sections showed host bone in contact with the bovine bone particles. Bone scores ranged from 0 to 3. Biopsies from DFDBA-implanted sites revealed dead particles entrapped with dense connective tissue. The bone scores ranged from 0 to 1. Biopsies from sites implanted with hBMP/NCP revealed a combination of woven and lamellar bone with bone scores of 3. Five of the 6 micro screws were processed and evaluated. One screw was mobile at the time of removal and was not evaluated. Bone scores were used to compare new bone formation adjacent to the micro screws. Bone scores ranged from 0 to 2. A score of 0 indicated non-vital implant material in contact with host bone and connective tissue in contact with implant; 2 indicated vital bone in contact with the majority of the implant surface. Retrieved sockets with micro screws implanted with bovine bone (n=2) demonstrated a connective tissue interface between the screws and the surrounding tissues (bone score 0). The adjacent tissues showed dead bovine particles entrapped within fibrous tissue. Retrieved screws implanted with DFDBA (n=2) were surrounded by connective tissue, with dead bone particles enmeshed within fibrous tissue (bone score 0). The screw implanted with intra-oral autologous bone was primarily surrounded by vital bone with a connective tissue interface (bone score 1). Three implant threads were in contact with bone. The results of this study indicate that bovine bone, DFDBA, and intraoral autologous bone do not promote extraction socket healing. Sockets implanted with hBMP/NCP contained vital woven and lamellar bone. Xenogenic bovine bone and DFDBA did not contribute to bone to micro screw contacts and are not recommended for enhancement of vital bone to implant contacts. Intraoral autogenous bone also does not appear to significantly contribute to bone to implant contacts. Intraoral autologous bone, xenogenic bone, and DFDBA appear to interfere with normal extraction socket healing.

Aged↗
PubMed1984

Changes in axial mobility of undisturbed teeth and following sustained intrusive forces in adult monkeys (Macaca fascicularis).

The axial mobility and changes in rest position were studied over 3-h periods. No loads were applied to 10 teeth. All displayed reduction in mobility; eight became extruded. Other teeth were displaced into their sockets to a sustained level by a screw for 3 h. Mobility decreased for those teeth which were intruded a distance equivalent to less than 800 mN force, but increased following greater intrusion. It is argued that vascular changes played no part; it is more likely that aggregation of proteoglycans occurred in the periodontal ground substance when there was little or no displacement of the tooth. Displacement would have generated tension in the collagen fibres of the periodontal ligament, leading to smaller proteoglycan molecules being formed and a consequent increase in mobility.

Alveolar Process↗
PubMed1998

Exogenous estrogen may exacerbate thrombophilia, impair bone healing and contribute to development of chronic facial pain.

A 32 year old white female, in apparently good health, failed to respond to conservative wound care for alveolar osteitis after a routine mandibular first molar extraction. Curettage and biopsy of necrotic alveolar bone from the #30 socket escalated her pain such that hospitalization was necessary for pain management with intravenous morphine. Twelve months prior to admission she had been placed on exogenous estrogen (Premarin, 0.625 mg/day) after a partial oophorectomy. While hospitalized, she was found to have resistance to activated protein C (APCR). Premarin was discontinued. After discharge, weekly changes of an antibiotic impregnated dressing allowed for progressive regeneration of bone and epithelium with gradual reduction in her pain. She was found to be heterozygous for the mutant Factor V Leiden, a heritable factor for increased tendency to form thrombi, so-called thrombophilia. We speculate that the exogenous estrogen administration exacerbated the thrombophilia associated with the Factor V Leiden mutation by compounding the patient's resistance to activated protein C thereby contributing to her development of osteonecrosis and severe alveolar neuralgia.

Adult↗
PubMed1993

Extraction site healing in rats. A radiologic densitometric study.

The present study uses a simple, objective method to radiographically evaluate the changes that occur during socket healing in rats. Mandibular left first molars were extracted in 35 Wistar rats, which were then sacrificed at 0, 7, 14, 21, 28, 45, and 60 days after surgery. Mandibles were removed, placed on an ANSI size 2 film, and exposed with an aluminum step-wedge, 0.5 to 3.0 mm. Socket density was measured with a digital densitometer and related to the equivalent density of aluminum. Increased density of the image of the apical and crestal areas of the socket was observed on day 7. Maximum density was reached by day 28 in the apical area; in the crestal area, density increased at a slower rate. The density changes found in the present study agree with the known histologic reports of socket healing in rats. Densitometric evaluation of extraction socket healing, using a step-wedge with 0.5 mm increments, is a useful and reliable tool to objectively assess bone formation and mineralization.

Aluminum↗