Alveolar Preservation with Albumin and Gentamycin-Coated Allograft after Third Molar Tooth Removal: A Randomized Clinical Trial

Fanni Minya,Laszlo Simonffy,Zsombor Lacza,Szabolcs Gyulai-Gaal,Balint Trimmel,Csaba Dobo-Nagy

doi:10.3390/app11020586

Fanni Minya, Laszlo Simonffy + Show 4 more

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https://doi.org/10.3390/app11020586

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Abstract

Alveolar preservation can minimize bone resorption after tooth removal and additional topical antibiotics might also be considered. The goal of this study was to observe alveolar preservation with albumin and gentamycin-coated allograft compared to unfilled control sockets after mandibular third molar removal. Twenty-two patients were involved, 11 in the control group and 11 in the test group. CBCT analysis and micromorphometric analysis were performed. After one year, graft integration was observed with remaining graft particles. Micromorphometric analysis showed increased density and lower trabeculae formation in the grafted group. The buccal height reduction of the alveolar ridge was significantly lower when alveolar preservation was applied (control: 2.54 ± 2.01 mm, graft: 1.37 ± 1.04 mm, p < 0.05). Horizontal bone loss prevention was not significant. At the distal site of the second molar, the marginal bone level (MBL) was significantly lower in the control group. At the control group, five pockets persisted from the eight initial and all healed in the graft group. Alveolar preservation improves bone formation, helps to preserve the buccal bone crest, and minimizes MBL loss and pocket formation on the adjacent teeth. Thus, it needs to be also considered after third molar surgical removal.

Highlights

Inadequate alveolar bone poses great challenge when rehabilitation is planned with dental implants [1]
Topical antibiotics have been used for preventing perioperative inflammation, treating chronic osteomyelitis or severe bone necrosis caused by compromised healing of patients with diabetes mellitus [4,5,6]
Gentamycin and albumin-coated allografts were used for alveolar preservation after mandibular third molar surgical removal

Summary

Introduction

Inadequate alveolar bone poses great challenge when rehabilitation is planned with dental implants [1]. Bone resorbs progressively without loading in both horizontal and vertical dimensions. After tooth extraction, it might be prevented with alveolar preservation [2,3]. The presence of bacteria and inflammation often compromises bone grafting at the time of tooth removal. The use of topical antibiotics is widespread both in orthopedics and oral surgery because it is difficult to reach a sufficient concentration of antibiotics in the bone due to its low metabolic rate. High local concentration and progressive elution might prevent the adhesion and proliferation of bacteria on the surface of grafts. Topical antibiotics have been used for preventing perioperative inflammation, treating chronic osteomyelitis or severe bone necrosis caused by compromised healing of patients with diabetes mellitus [4,5,6]. Gentamycin, vancomycin, and tobramycin are the first-choice antibiotics due to their broad antibacterial spectrum and low percent existence of resistant bacteria species [4,5,7]

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