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PubMed2005

Immediate restoration of implants placed into fresh extraction sockets for single-tooth replacement: a prospective clinical study.

The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns. A series of 22 cases with a 12-month follow-up is presented. Twenty-two patients (15 women and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical or horizontal root fracture, caries, endodontic lesions, or periodontal disease were treated with immediate postextraction implant placement. The implant was then restored with a screw-retained prosthetic restoration within 24 hours. Radiographic assessments were made at baseline and 12 months after implant placement. Clinical parameters, such as plaque score, mucositis score, probing attachment level, mucosal margin position, variation of gingival level, and variation of papilla position, were also measured at baseline and after 12 months of follow-up. At 12 months, no implants had failed. Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline. The mean variation of gingival level, compared to the neighboring teeth, was -0.75 mm. Probing attachment levels were 0.79, 0.45, and 0.54 mm at proximal, buccal, and lingual sites, respectively. The values for the mucosal margin position were 2.9, 2.2, and 2.4 mm at proximal, buccal, and lingual sites, respectively. Regarding variation of papilla position, according to Jemt's index, 27 papillae presented with a score of 2 (61%) and 17 with a score of 3 (39%). An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13%. Furthermore, mucositis (score 2) was not observed at any of the peri-implant units. Primary implant stability did not significantly increase over time. The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure. The success rate and radiographic and clinical results were comparable to those obtained following the standard protocol. Within the limits of the present investigation, immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth. However, long-term clinical trials are needed to confirm the present results.

Adult↗
PubMed2003

Connective tissue growth factor expressed in rat alveolar bone regeneration sites after tooth extraction.

OBJECTIVE: To understand bone regeneration process after tooth extraction could be a clue to develop a new strategy for alveolar bone reconstruction. Recently, accumulated evidences support that connective tissue growth factor (CTGF) is implicated in tissue repair of many tissues. In this study, we investigated the spatial and temporal expression of CTGF in the rat tooth extraction sockets. DESIGN: Five weeks old wild type male rats (weighing 120 g) were used for this experiment. Expression of CTGF was determined by immunohistochemistry and in situ hybridization in the rat upper molar tooth extraction sockets at 2, 4, 7, 10 and 14 days after tooth extraction. RESULTS: CTGF was expressed strongly in the endothelial cells migrating into the granulation tissue at the bottom of the sockets during 4 days after tooth extraction. During the reparative process, no apparent chondrocyte-like cell appeared in the sockets, while osteoblast-like cells proliferated in the sockets with low CTGF expression at 7, 10, 14 days after extraction. As expected, no staining was observed with the preimmune rabbit IgG and CTGF sense probe. CTGF may play an important role in angiogenesis and granulation tissue formation specifically at early healing stage after tooth extraction to initiate alveolar bone repair. CONCLUSION: CTGF was expressed at early healing stage of the rat tooth extraction wound.

Animals↗
PubMed2000

Early bone healing events following rat molar tooth extraction.

Healing of the rat tooth extraction socket occurs rapidly, indicating a mechanism for cancellous bone formation occurring swiftly throughout the matrix. The residual periodontal ligament is evident at 2 days after extraction and its rich collagen type III fibre content may form a template for future cancellous bone formation. In the remainder of the early tooth extraction socket, fibronectin staining was generalized. The widespread distribution of fibronectin staining has given rise to speculation that the function of fibronectin may be important in granulation tissue formation, by providing a template matrix for fibroblast migration. Osteoprogenitor cells migrated into the socket from the surrounding bone, and produced decorin and proMMP-13 (procollagenase-3). ProMMP-13 was only expressed at sites of new bone formation, e.g. the border of the recently formed trabecular islands or the periphery of the closing socket. Collagen type I fibres were formed later, and were especially evident at 6 days after extraction. The pattern of distribution of both collagen type I and III fibres were similar as they passed from the bone margin towards the centre of the socket - in the same direction as the forming bone trabeculae. Bone formation occurs by rapid movement of the osteoprogenitor cells along these collagen fibres to allow a rapid healing, rather than that of resorption followed by slow bone deposition.

Animals↗
PubMed2002

The treatment of an avulsed maxillary central incisor by transplantation of an embedded mandibular premolar.

Avulsion, following traumatic injuries, is relatively infrequent. The treatment of avulsed teeth is by replantation of the avulsed tooth into its own socket. However, sometimes the avulsed tooth cannot be found at the accident site. We report a case in which the avulsed maxillary central incisor is replaced by an embedded lower premolar. A 2-year follow-up shows complete periodontal healing and a very satisfactory clinical result.

Adolescent↗
PubMed2000

Immediate and delayed implant placement into extraction sockets: a 5-year report.

BACKGROUND: As a complement to the earlier reported 3-year results from a prospective multicenter study of immediate and delayed placement of implants into fresh extraction sockets, the 5-year results are reported. PURPOSE: The purpose of this 5-year report was to evaluate the immediate and long-term success of implants placed into fresh extraction sockets, with respect to implant size and type, bone quality and quantity, implant position, initial socket depth, and reason for tooth extraction. MATERIALS AND METHODS: This paper presents the 5-year results of the original 12 centers that participated with 143 consecutively included patients. A total of 264 implants were placed either immediately after tooth extraction or after a short soft-tissue healing time (3-5 weeks). The patients were divided into five subgroups, depending on the type of insertion method used. RESULTS: The outcome demonstrated that the cumulative implant survival rate after 5 years of loading has not changed and remains 92.4% in the maxilla and 94.7% in the mandible. No difference in failure rates can be seen between the groups when relating the failures to insertion method. CONCLUSION: This prospective study demonstrated that placing Brånemark implants into fresh extraction sites can be successful over a period of 5 years of loading. One of the outcomes of the study shows that there is a clinical correlation between implant failure and periodontitis as a reason for tooth extraction, even if it is difficult to give it a casual association. It can be hypothesized that periodontitis affected tissues might have a negative local influence because of the presence of infrabony defects that could possibly increase the gap between bone and implant or jeopardize achievement of primary stability.

Bone Density↗
PubMed2003

Intentional replantation of endodontically treated teeth: an update.

The IR technique is a clinically successful procedure, so long as the following conditions, as outlined by Niemczyk, are met: 1) Avoid any crushing or scraping contact with the root surface or socket; 2) Root surface must be continually hydrated with tissue culture media (e.g., HBSS); 3) Tooth should be splinted, if indicated; and 4) Soft diet and hygiene instructions must be implemented and reinforced. The IR technique should not be considered a procedure of last resort. Rather, it should be used in situations where conventional apical surgery is difficult or places the patient at risk. The IR technique expands potential treatment alternatives and allows the patient to successfully retain his or her own tooth following treatment.

Apicoectomy↗
PubMed2001

Immediate implants in fresh posterior extraction sockets: report of two cases.

This article demonstrates the use of an implant insertion method for the posterior region. Following an atraumatic extraction of a posterior tooth, an immediate implant can be placed at the time of the extraction. A surgical technique that involves the insertion of the implant into the interseptal bone of a multirooted posterior tooth extraction socket in a manner to provide initial stabilization of the implant and partial fill of the extraction sockets is described. Bone graft and a membrane are also required to augment the remainder of the extraction socket and provide maximum bone fill around the implant. The advantages, disadvantages, and indications for the procedure are described.

Adult↗
PubMed2004

[Preservation of alveolar bone of un-restorable traumatized maxillary incisors for future].

UNLABELLED: Anterior maxillary implantation is a challenging treatment for both the surgeon and prosthodontist due to high esthetic demands in this area. However, it is the most traumatized and most exposed region to habits. Prompt and appropriate management can significantly improve prognosis of many dentoalveolar injuries, especially in young patients. Unfortunately, many traumatized teeth are overtreated or left untreated, which lead to a much more complicated treatment at the time of permanent restoration at adulthood. The facial cortical plate over the roots of the maxillary teeth is thin and porous. Periapical infections, as well as prolonged and stubborn surgical treatments (repeated root end surgeries) can cause resorption of the labial plate, migrate to a more palatal position, and may later require an augmentation procedure prior to implant placement. The treatment-options of traumatized, anterior maxillary, un-restorable fractured root and ankylosed infraocluded teeth, in relation to preservation of the adjacent alveolar bone for future use of dental implantation will be discussed. The recommended treatment of crown-root fracture of permanent incisor includes removal of the coronal fragment and supragingival restoration of the fractured root. In severe cases in which the fracture line positions deeply under the gingival margin, this treatment may be supplemented by gingivectomy and/or osteotomy, as well as surgical or orthodontic extrusion of the root. In young patients, use of these treatment options as temporary treatment to preserve the facial cortical plate is important. Preservation of alveolar dimension will enable implantation after the completion of growth and development. Dento-alveolar ankylosis accompanied by replacement resorption is a serious complication following severe injury to the periodontal membrane. This complication develops mainly following avulsion and intrusion but also following lateral luxation and root fracture. Replacement resorption develops after severe damage to the periodontal ligament cells that cover the root surface. As a result of this damage, the periodontal ligament is replaced by bone tissue, causing ankylosis between bone and tooth. Following ankylosis, resorption of cementum and root dentin occurs. These processes eventually result in replacement of the entire root by bone. In young children it could arrest the growth of the alveolar process and create an infra-occluded tooth, resulting in a severe bony defect that is difficult to correct. In addition, loss of the maxillary incisor leads to serious esthetic and restorative problems, particularly when the trauma occurs at a young age. Therefore, ankylosed teeth should be treated as soon as diagnosed. Alternative treatments include intentional extraction and immediate replantation of the ankylosed tooth to its socket after embedding the tooth and the socket in Emdogain. This treatment is indicated only when the ankylosis or the replacement resorption is diagnosed at an early stage or has affected only a small area of the root. When the resorption is diagnosed at a later stage, auto transplantation of first lower pre-molar to the anterior region or decoronation of the ankylosed tooth may be considered. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It should be considered as a treatment option for teeth affected by replacement resorption. The alternative treatment of surgical extraction of an ankylosed tooth often leads to considerable bone loss and reduced bone volume in the oro-facial dimension. This may later necessitate an augmentation procedure. CONCLUSION: Scrupulous diagnosis of teeth and the alveolar bone after a traumatic injury is necessary. Treatment is multidisciplinary, requiring endodontic, surgical, orthodontic, operative and prosthetic compliance. An individual treatment plan for each patient is necessary. General rule do not apply. Periodic check-up is essential.

Adult↗
PubMedDate not supplied

Ridge preservation: important buzzwords in dentistry.

Ridge preservations is the prevention of the 40-60% jawbone atrophy that normally takes place two to three years postextraction. It is the new paradigm in patient care that is effective, simple, and beneficial for a multitude of reasons. It is achieved by the immediate grafting of the extraction socket with or without the use of an immediate implant. The ability to not only preserve the alveolar ridge for future restorative dentistry but also to preserve and restore esthetics and prevent postoperative pain and bleeding makes this modality important for all practicing dentists.

Alveolar Bone Loss↗
PubMed2004

Deproteinized bovine bone and biodegradable barrier membranes to support healing following immediate placement of transmucosal implants: a short-term controlled clinical trial.

This 6-month clinical study evaluated the use of a porous bone mineral matrix xenograft (Bio-Oss) as an adjunct to a biodegradable barrier membrane (Bio-Gide) to support healing following the immediate placement of transmucosal implants into extraction sockets. Twenty adult patients scheduled for tooth replacement with dental implants were accepted for participation. Following implant placement into the extraction site, subjects were assigned to one of two treatment alternatives for the remaining bone defect around the implant: (1) Bio-Oss + Bio-Gide membrane (test); or (2) Bio-Gide membrane (control). The treatment outcome was evaluated after 6 months by the use of clinical and radiographic variables. The null hypothesis of no treatment group differences was tested by ANOVA. At 6 months, the radiographic bone level remained unchanged compared to baseline in the test and control groups. No differences were observed between test and control groups in terms of mean probing attachment level. At proximal sites, the soft tissue margin was located 2.6 mm more coronal than the shoulder of the implant in the test group, compared to 1.3 mm in the control group. The corresponding figures for the lingual aspect were 2.3 mm and 1.1 mm, respectively, and at buccal sites 2.1 mm and 0.9 mm, respectively. The use of deproteinized bovine bone mineral as a membrane support at immediately placed transmucosal implants may offer an advantage in areas with high esthetic demands in terms of soft tissue support.

Absorbable Implants↗
PubMed2003

Bucco-lingual bone remodeling around implants placed into immediate extraction sockets: a case series.

BACKGROUND: Implants placed immediately after tooth extraction have shown high percentages of clinical success. Few studies in the scientific literature have observed the horizontal bone remodeling in the buccal-lingual direction after immediate placement of implants. The aim of this study was to analyze bone healing and coronal bone remodeling around 15 implants placed immediately after tooth removal without the use of guided bone regeneration (GBR) techniques. METHODS: Ten patients received a total of 15 implants placed immediately after removal of 15 single-rooted teeth. All implants were placed within the alveolar confines, limiting, in most cases, small peri-implant bone defects. After implant placement, the distance from the buccal to lingual bone plate was measured. No membranes or filling materials were used. Primary flap closure was performed in all cases. RESULTS: At second-stage surgery, all peri-implant defects were completely filled and the distance from buccal to lingual bone was measured again. The pattern of bone healing around the neck of immediate implants showed an absence of peri-implant defects and a narrowing of bone crest width in a buccal-lingual direction. The mean distance between buccal bone and lingual bone at the time of implant placement was 10.5 mm (+/- 1.52) and, at second-stage surgery, 6.8 mm (+/- 1.33). CONCLUSIONS: The coronal bone remodeling around immediate implants showed a healing pattern with new bone apposition around the neck of the implants and, at the same time, bone resorption with horizontal width reduction of the bone ridge. The small peri-implant bone defects were completely healed without the use of GBR procedures. An absence of complications during the healing period was also observed, probably due to the absence of barrier membranes and grafting materials.

Adolescent↗
PubMed1991

Biomechanical association of dental and temporomandibular pathology in a medieval Nubian population.

An analysis of the relationship between oral pathology and degenerative change at the temporomandibular joint (TMJ) was undertaken on an archaeological sample of 122 adult crania from the Medieval site of Kulubnarti in Sudanese Nubia. The crania were sorted into 2 groups: those demonstrating clearly visible bony changes at the joint (TMJ+) and those without visible change (TMJ-). These groups were compared according to 1) age; 2) sex; 3) active dental pathologies (abscesses, caries, partial socket resorption); 4) tooth loss with complete socket resorption; and 5) dental attrition. No statistically significant association was evident between degenerative change at the TMJ and age, active dental pathologies, or dental attrition; however, sex differences and posterior tooth loss with complete socket resorption revealed a significant correspondence to degenerative TMJ changes. Both of these factors agree with the clinical literature and with biomechanical models (most notably that of Hylander) based upon modern populations. Furthermore, the results support the contention that paleopathological conditions can be analyzed from a clinical and functional biomechanical perspective.

History, Medieval↗
PubMedDate not supplied

[The healing characteristics of the sockets following surgery in tooth extraction in workers in viscose manufacturing].

The study of cicatrization after the teeth extraction in workers of viscous rayon industry which had had a long contact with sulfuric carbon revealed a lower regeneration potential and increased complication incidence as compared to control patient group. Preventive measures are designed providing for control check-ups 3 to 5 days after the intervention and the use of rehabilitation period in presurgical preparation of the patients.

Alveolar Process↗
PubMed2003

Implant treatment and the role of platelet rich plasma.

Implant supported restorations have become and continue to be a very popular clinical option for patients who are either partially or completely edentulous. This article, the third in a series dealing with implant dentistry, describes the role of platelet rich plasma as an adjunct to help with the healing process following tooth extraction, socket preservation, and, ultimately, replacement with implant supported restorations. A clinical case is used to illustrate surgical options available in the restoration of the posterior partially edentulous maxilla.

Alveolar Ridge Augmentation↗
PubMed1999

Effect of human bone morphogenetic protein 2 implant on tooth eruption in an experimental design.

This study evaluated the influence of recombinant human bone morphogenetic protein 2 (rhBMP-2) on the development and eruption of the secondary dentition. Primary premolar tooth extraction sockets in 12 16-week-old felines were implanted with either rhBMP-2, in collagen sponge or with buffer/absorbable collagen sponge (ACS). Unoperated jaw quadrants served as controls. Experimental conditions were randomized between jaw quadrants in all animals. Two animals receiving rhBMP-2/ACS and buffer/ACS in two quadrants per implant were sacrificed at 4 weeks postsurgery. Ten animals receiving rhBMP-2/ACS (two quadrants), buffer/ACS implants (one quadrant), and one quadrant serving as an unoperated control were evaluated at 12 weeks postsurgery. Clinical assessments included healing, eruption patterns, and crown development. Radiographic assessments included tooth development, eruption patterns, and bone formation. Histological observations were also made from the 4-week animals. The secondary dentition remained unerupted at 4 weeks postsurgery. Histological analysis showed normal alveolar bone coronal to the erupting teeth in rhBMP-2/ACS-implanted quadrants. At 12 weeks postsurgery, all teeth were erupted without differences between quadrants. Clinically, the crowns of all teeth were normal. Radiographs suggested that teeth in rhBMP-2/ACS- and buffer/ACS-implanted jaw quadrants exhibited similar tooth development and eruption patterns as the normal control. The evidence from this study suggests that surgical implantation of rh-BMP-2/ACS in the pathway of the developing and erupting secondary dentition does not interfere with the normal development and eruption patterns of the teeth.

Absorbable Implants↗
PubMedDate not supplied

Potential for osseous regeneration of platelet-rich plasma--a comparative study in mandibular third molar sockets.

Platelet-rich plasma (PRP), the concentrate of platelets in plasma contains various growth factors that enhance osseous regeneration. This study utilized homologous platelet-rich plasma in the treatment of third molar extraction sockets in a total of fourteen human subjects, who were randomly assigned into one control and one test group, each comprising of seven members. Clinical parameters like pain on palpation, number of analgesic tablets consumed, swelling, degree of mouth opening, and condition of mucosa overlying the surgical site were assessed at intervals of 1,3,5,7,9,12, and 16 weeks post operatively. The margins between the socket and surrounding bone, radiopacity of bone filling the socket, and presence oftrabecular bone formation were evaluated simultaneously. Soft tissue healing differed significantly between the two groups, with the test group exhibiting better results. Radiographic evidence of bone formation was visible as early as I week in test subjects. It was concluded that PRP contributed to better healing of soft tissues and bone and is a viable means of growth factor delivery.

Adult↗
PubMed2002

Effects of calcium phosphate ceramic bone graft materials on permanent teeth eruption in beagles.

OBJECTIVE: The aim of this study was to evaluate the use of calcium phosphate ceramic (CPC) materials as a potential alternative to autogenous secondary alveolar bone grafting in cleft lip and palate patients who are in mixed dentition. SAMPLE: Four 12-week-old beagles and one 15-week-old beagle were used as subjects. INTERVENTIONS: In each experimental beagle, the third and fourth deciduous premolars were extracted. The sockets were filled with four different CPC materials and sutured. MAIN OUTCOME MEASURES The beagles were fed a soft diet for the following 8 weeks and then sacrificed for clinical, radiological, histological, transmission electron microscope (TEM), and infrared (IR) absorption analysis. RESULTS: All four experimental graft materials allowed normal development and eruption of permanent premolars. In histological sections, small particles of biphasic calcium phosphate (BCP) and carbonate apatite (CO(3)-AP) were resorbed, and large particulate forms served as bone frames in cortical bones. Polymer coated with carbonate apatite (Poly/CO(3)-AP) did not cause inflammation but was pushed away to the soft tissue by erupting teeth. Alginate coated with carbonate apatite (alginate/CO(3)-AP) caused a severe inflammatory reaction to the point of destroying a part of the dental follicle and cortical bone. In TEM, resorption activity by phagocytic cells was observed only in CO(3)-AP. Direct bonding of CO(3)-AP to the bone was observed as the electron-dense interface between bone and CO(3)-AP. CONCLUSION: BCP and CO(3)-AP proved to be suitable as alveolar bone graft materials in areas where tooth eruption occurs. Of the four materials tested, CO(3)-AP produced the best results.

Alginates↗
PubMed2001

Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars.

PURPOSE: This study compared the number of unfavorable fractures after sagittal split osteotomies (SSOs) of the mandible when third molars were present or absent. PATIENTS AND METHODS: The treatment records of 262 patients (500 SSOs) were retrospectively evaluated. Group 1 consisted of 250 SSOs and concomitant removal of impacted mandibular third molars and group 2 consisted of 250 SSOs with absence of third molars. A modified SSO technique with inferior border cuts was used on all patients, and the third molars, when present, were removed after separation of the proximal and distal segments. Rigid fixation was applied using bicortical bone screws. Bone plates with monocortical screws were additionally used to secure the free bony segments of the proximal segment in cases with unfavorable fracture. RESULTS: There were 11 (2.2%) unfavorable fractures in 500 SSO procedures. The incidence of unfavorable splits was 3.2% in group 1 and 1.2 % in group 2. In group 1, all fractures occurred in teenagers, with 7 of 8 fractures extending through the extraction socket in the distal segment. Six of the 8 fractures were associated with completely impacted third molars, and 2 involved partially impacted teeth. All 3 fractures in group 2 occurred in the proximal segment. No significant difference was seen in the amount of relapse in patients with unfavorable or favorable splits. CONCLUSIONS: The occurrence of unfavorable splits is uncommon when using a modification of the SSO that includes an inferior border osteotomy. Although more unfavorable fractures occurred in teenage patients with third molars, this had no impact on the stability of the final result.

Adolescent↗