Alveolar Bone Gain Research Articles

Alveolar Bone gain in Vertical Bone Defect with Nonsurgical Periodontal Therapy in the Anterior Zone of Maxilla: A Case Report

Alveolar Bone gain in Vertical Bone Defect with Nonsurgical Periodontal Therapy in the Anterior Zone of Maxilla: A Case Report

Clinical and radiographic evaluation of the use of PRF, CGF, and autogenous bone in the treatment of periodontal intrabony defects: Treatment of periodontal defect by using autologous products.

The purpose of this randomized clinical study was to clinically evaluate and compare the efficiencies of platelet-rich fibrin (PRF), concentrated growth factor (CGF) and autogenous bone graft (ABG) in the treatment of intrabony pockets and to assess the alveolar bone gain (AB gain) radiographically (panoramic and CBCT images). Eighty intrabony pockets were divided into four groups: ojnly open flap debridement (OFD), OFD+PRF, OFD+CGF and OFD+ABG; each group consisted of 20 defects. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and tooth mobility (TM) by using Periotest M device were evaluated. Radiographic images were also taken to evaluate the AB gain. PRF was produced using a protocol of 2,700 RPM for 12 min and the relative centrifugal force (RCF) was evaluated. CGF was prepared as follows: 2min 2700rpm, 4min 2400rpm, 4min 2700rpm, 3min 3000rpm. The study results revealed a similar improvement in PI and GI values in all groups (p>0.05). There was a statistically significant decrease in PD and CAL in favor of ABG group at day 180 in comparison with other groups (p=0.001). There was also a statistically significant decrease in TM and alveolar bone height loss (ABHL), whereby the AB gain gradually increased among the groups with the best group being ABG, followed by CGF, PRF, and control groups, respectively (p=0.001). The study results support the treatment of periodontal intrabony pockets using OFD in combination with ABG, CGF, and PRF, as ABG showed the best results followed by CGF and PRF.

Third Molar Coronectomy vs Total Removal in Second Molar Periodontal Healing

The objective of this randomised controlled trial was to compare the periodontal healing at the distal of the adjacent second molar after coronectomy or surgical removal and the surgical morbidities of the 2 techniques. This is a pilot study of a split-mouth randomised clinical trial comparing the periodontal healing of the adjacent second molar after coronectomy or total removal of lower third molars, which was registered with the University of Hong Kong Clinical Trial Centre as HKUCTR-2948 on 21 February 2020. Cone beam computed tomography (CBCT) scans were taken preoperatively and at 6 months postoperatively. Changes in the bone level from the cemento-enamel junction, periodontal probing depth (PPD), and clinical attachment level (CAL) at the distal of the adjacent second molar were compared. Surgical morbidities in terms of pain, infection, neurologic deficit, root exposure, and need for second surgery for removal were assessed. Forty patients (22 male, 18 female) with mean age of 26.7 years were evaluated at 6 months postoperatively. Both coronectomy and total removal groups demonstrated statistically significant reduction in PPD and CAL. There was an alveolar bone gain of 1.28 ± 0.88 mm in the coronectomy group and 1.13 ± 0.73mm in the control group, which was statistically significant (P < .001 for both groups). Early findings show the periodontal healing at the adjacent second molar of coronectomy was as good as that of total removal of lower third molar. There were no differences in terms of surgical morbidities between both groups.

Role of periosteum in alveolar bone regeneration comparing with collagen membrane in a buccal dehiscence model of dogs

To investigate the role of periosteum on the treatment of buccal dehiscence defects comparing with collagen membrane in canine model. Bilateral dehiscence-type defects at the buccal side on the distal root of the lower 3rd/4th premolars were created in six beagle dogs with a total of 24 defects and assigned into three groups: Group A: blood clot in an untreated defect; Group B: deproteinized bovine bone material (DBBM) covered with an absorbable membrane; Group C: DBBM covered with the periosteum. The structural parameters for trabecular architecture and vertical bone regeneration were evaluated. Histological and histomorphometric evaluation were carried out to observe new bone formation and mineralization in the graft site. Immunohistochemical analysis was performed to identify the expression of osteopontin (OPN) and osteocalcin (OCN) at postoperative 3 months. Group C achieved greater vertical alveolar bone gain than that of group A and group B. The periosteum-covered group showed significantly greater new bone formation and accelerated mineralization. The greater immunolabeling for OPN and OCN was observed in group C than in group A. Periosteal coverage has explicit advantages over collagen membranes for the quality and quantity of new bone regeneration in dehiscence defects repairing.

Single-Tooth Immediate Placement and Provisionalization with Subcrestally Angulated Implants in Sites with Hard and Soft Tissue Facial Dehiscence in the Esthetic Zone: An Observational Study with 2 to 5 Years of Follow-up.

This study evaluated the survival and esthetic outcome of flapless postextraction placement and provisionalization in compromised single tooth sites in the esthetic area. Ten patients were included in the study, and 10 subcrestally angled (SCA) tapered implants were placed. Only maxillary central or lateral incisors and canines were included. Implants showed 100% survival rate, a limited mean marginal bone loss of 0.43 ± 0.23 mm, and a mean gain in coronal gingival level of 1.6 ± 1.17 mm; the mean vertical alveolar bone gain was 4.0 ± 1.5 mm, and the average pink esthetic score was 12.5 at a mean 3.5-year follow-up (range: 2 to 5 years). These results show that immediate replacement and restoration of a tooth with compromised hard and soft tissue condition in the esthetic area, with simultaneous use of connective tissue, bone graft, and membrane, could be a valid alternative to a more complex staged approach.

Assessment of alveolar bone changes in response to minimally invasive periodontal surgery: A cone-beam computed tomographic evaluation.

The aim of this study was to evaluate 3-dimensional cone-beam computed tomography (CBCT) images of alveolar bone changes in patients who underwent minimally invasive periodontal surgery-namely, the pinhole surgical technique (PST). Alveolar bone height was measured and compared on CBCT images of 254 teeth from 23 consecutive patients with Miller class I, II, or III recession who had undergone PST. No patient with active periodontal disease was selected for surgery. Two different methods were used to assess the alveolar bone changes postoperatively. In both methods, the distance between the apex of the tooth and the mid-buccal alveolar crestal bone on pre- and post-surgical CBCT studies was measured. An average alveolar bone gain >0.5 mm following PST was identified using CBCT (P=0.05). None of the demographic variables, including sex, age, and time since surgery, had any significant effect on bone gain during follow-up, which ranged from 8 months to 3 years. PST appears to be a promising treatment modality for recession that results in stable clinical outcomes and may lead to some level of resolution on the bone level. More long-term studies must be done to evaluate the impact of this novel technique on bone remodeling and to assess sustained bone levels within a larger study population.

Postoperative Study of Bone Gain in Mandibular Alveolar Bone Reconstructed with Screw-Guided Bone Regeneration Technique and Porcine-Derived Xenograft in 42 Edentulous Patient Candidates for Implant-Prosthetic Therapy

This study aimed to test whether alveolar bone gain (width and osteodensity) in mandible implant sites, augmented by the screw-guided bone regeneration (S-GBR) technique and the porcine-derived xenograft, differ from that of the mandible sites reconstructed with S-GBR and the bovine-derived xenograft. Materials and method. A total of 42 edentulous patients (mean age 54.60 ± 14.90) were randomly divided into a test group (S-GBR + porcine-derived xenograft) and a control group (S-GBR + bovine-derived xenograft). The immediate implants were placed simultaneously with grafting procedures. The implant site width was measured before teeth extractions and 6 months after the augmentation procedures. Osteodensity bone values were evaluated immediately after the implant placement and at 6 months follow-up. The CBCT sections and Sidexis XG/DVT (Densply/Sirona) software were used to evaluate the changes of the width in the augmented alveolar bone. The NNT Viewer/CT (NewTom) software was used to record the osteodensity changes. Statistical comparisons between the groups were performed by the Mann–Whitney and t-tests (significance level p &lt; 0.05). Results. The mean values of the bone gain at 6 months follow-up (control group vs. test group) were as follows: width (4.107 mm vs. 4.1624 mm); osteodensity (276.83 HU vs. 254.24 HU). The statistical analysis found the absence of statistically significant differences between the two groups regarding the bone gain (width and osteodensity) at 6 months after the augmentation and the immediate implant placement. Conclusions. The horizontal bone and osteodensity gains in the porcine-derived group were similar and without significant statistical differences when compared with the implant sites reconstructed with the bovine-derived xenografts group at 6 months postoperatively. The reconstruction of the mandibular alveolar bone by the S-GBR technique and the porcine-derived xenografts is a valid bone regeneration strategy for edentulous patients with moderate/severe horizontal resorption of the mandibular alveolar bone.

Intentıonal reımplantatıon of hopeless teeth: Cases serıes

Intentional replantation is an alternative for the treatment of advanced periodontal destruction of the anterior teeth. Systemically healthy three female patient was referred to our clinic with functional complaints. Diagnosis were chronic periodontitis and class III mobility was noted at the mandibular incisors with complete periodontal attachment loss. After phase I periodontal treatment periodontally involved teeth were extracted, endodontic treatment accomplished, the teeth were replanted and fixed to its place with fiber reinforced composite splint. At the end of 2 years tooth was in function with alveolar bone gain. Intentional replantation provided long-term maintenance of patient’s own teeth.

Survival rate of teeth with periodontally hopeless prognosis after therapies with intentional replantation and perioprosthetic procedures - a study of case series for 5-12 years.

The purpose of the present study was to evaluate the longitudinal survival rate of the treatment of teeth affected with periodontally hopeless prognosis and secondary occlusal traumatism (SOT) using intentional replantation (IR) and periodontal prosthesis. We collected data from 17 individuals who received IR and participated in the study during 1995 to 2014. Of the 17 teeth affected by periodontally extreme conditions with deep angular bone defects, severe alveolar bone loss extending to or beyond the apex, and SOT, was recognized as having hopeless prognosis. Those teeth were treated sequentially using procedures that included basic periodontal therapy, therapeutic provisional prosthesis, IR, fixed dental prosthesis, crown and sleeve‐coping telescopic dentures (CSCTDs), or fixed prosthesis and CSCTD combined. Longitudinal assessments of clinical parameters and radiographic bone change before and after IR were evaluated. Clinical results showed that the overall cumulative survival rate of assayed teeth after IR therapy (5–12 years) was 88.2%. The mean (±SD) estimated radiographic alveolar bone loss was 12.7 ± 2.1 mm (88.5% ± 13.3%) of the root length, initially, and estimated radiographic alveolar bone gain was 4.0 ± 2.2 mm ultimately, in 17 replanted teeth with SOT. Only one tooth (5.9%) exhibited root resorption. Ankylosis was not observed during the study. Periapical radiographs demonstrated that satisfactory periodontal healing of lamina dura and bone fills occurred in all replanted teeth with SOT. Generally, tooth mobility and SOT were significantly improved after therapy. Most treated teeth functioned well and remained stable clinically throughout the periods of study. The present study documented a promising outcome for autogenous IR and periprosthetic therapy of 17 periodontally hopeless teeth for 5–12 years. The present study revealed good bone gain and elimination of SOT and prominent occlusal function. We concluded that the application of IR, minocycline‐HCL and periodontal prosthetic procedures later elevated the prognosis of these otherwise hopeless teeth with SOT, which are valuable options for retaining teeth with periodontally extreme situations.

Optimizing Maxillary Aesthetics of a Severe Compromised Tooth through Orthodontic Movement and Dental Implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.

Electrical Mallet in Implants Placed in Fresh Extraction Sockets with Simultaneous Osteotome Sinus Floor Elevation

To report the application of an electrical mallet (magnetic mallet) in osteotome-assisted surgery for sinus floor elevation with implants placed in fresh sockets and 2-year follow-up. A total of 32 patients (70 implants, 36 in the molar and 34 in the premolar regions) requiring extractions of maxillary premolars and molars were included in this prospective study. In all cases, implants were positioned immediately after tooth extraction. The implant site was prepared with osteotomes pushed by a magnetic mallet. Intraoral digital radiographic measurements were reported at 70 days and 1 and 2 years. Initial alveolar bone height and mean gained alveolar bone height were calculated for each implant over time. All implants were followed for 2 years. One of 70 implants failed 1 month after surgery. This implant was successfully replaced 6 months later. The cumulative survival rate at 2 years was 98.57%. After surgery, no membrane perforation was reported, and no patient experienced vertigo, distress, nausea, and vomiting. Radiographic results were reported at 70 days and 1 and 2 years from implant placement. The alveolar bone gain following 70 days of healing resulted in a mean value of 2.63 ± 1.01 mm and, at 2 years from implant placement, was stable at 4.08 ± 1.25 mm. Statistically significant differences (P < .05) between values at 70 days and 1 year were reported, whereas there were no statistically significant differences (P > .05) between 1 and 2 years. The electrical mallet represents a fast and accurate instrument for placing bone expanders in fresh socket implants and simultaneous sinus floor elevation to avoid patient distress.

Multiple regenerative techniques for class II furcation defect

AbstractRegeneration of the periodontium is a major goal in the treatment of teeth affected by periodontitis. Periodontal regeneration is quite challenging, especially when it is in the furcation area. There are several techniques used alone or in combination, considered to achieve periodontal regeneration, including bone grafts or substitutes, guided tissue regeneration, root surface modification, and biological mediators. Many factors may account for variability in the response to regenerative therapy in class II furcation. This case report describes the management of a buccal class II furcation defect, with the help of surgical intervention, including the guided tissue regeneration (GTR) membrane and bone graft materials. This combined treatment resulted in a healthy periodontium, with radiographic evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of the etiological factors and utilizing combined treatment modalities, restored health and function of the tooth with severe attachment loss, at the 18-month follow-up.

Combined endodontic - Periodontal lesion: A clinical dilemma

Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. Periradicular bone loss secondary to endodontic pathosis is typically seen in teeth with necrotic pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium. Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. With advancements in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes case reports of combined endo-perio lesions which were first treated with conventional endodontic therapy and then followed by periodontal surgery. This combined treatment resulted in a radiographical evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion.

Guided tissue regeneration in endodontic – periodontal lesion: A case report

Clinicians often have diffïculty in the diagnosis and treatment of the combined endodontal and periodontal lesion in private practice. This case report demonstrates that proper diagnosis followed by etiological factors and utilizing the guided tissue regeneration technique combined with osseous grafting, will restore health and function to a tooth with severe attachment loss caused by an endo-perio lesion. This case report demonstrates a case of an endodontic –periodontal combined lesion on a maxillary left central incisor was first treated with conventional endodontic therapy. Periodontal surgery was then completed which include scaling and root planning and apical curettage on the tooth. The facial bony defect was then filled with a alloplastic graft material which was later covered by resorbable GTR membrane and periodontal flap sutured over this. This combined treatment resulted in minimunm probing deptli (3mm),maximal cllnlcal attachment gain (8mm),as well as radiographie cvidcncc of alveolar bone gain.

Osteotome Sinus Floor Elevation and Simultaneous Implant Placement in Grafted Biomaterial Sockets: 3 Years of Follow‐Up

Immediate bone grafting procedures were proposed to preserve bone volume in residual damaged alveolar walls and to prevent the expansion of the sinus floor in the maxillary molar region. The use of an osteotome allows vertical bone augmentation and localized sinus elevation with minimal surgical trauma. The aim of this study is to evaluate the clinical outcome of implants placed in previously grafted alveoli that were expanded at a second-stage surgery by an osteotome technique. Twenty patients requiring extraction of one or two upper molar teeth and/or a second premolar were selected. Thirty teeth were extracted, and their fresh sockets immediately received magnesium-enriched hydroxyapatite as a graft material. Three months after bone filling, osteotome sinus floor elevations were performed in grafted sites, and 30 titanium dental implants were placed. Three months after implant placement, temporary restorations were performed. Follow-up examinations and intraoral digital radiographs were taken at baseline and 6, 12, 24, and 36 months after implant placement to evaluate the alveolar bone gain for each implant. Comparisons among mean values of alveolar bone gain over time were performed by the Student two-tailed t test. At the 36-month follow-up, a survival rate of 100% was reported for all implants. The alveolar bone gain after 6 months of healing was 2.41 +/- 1.23 mm. Successively, after 12 months, the bone gain increased (3.85 +/- 1.37 mm). At 24 and 36 months after implant placement, the levels were stable (3.86 +/- 1.50 mm and 3.82 +/- 1.57 mm, respectively). Statistical analyses showed a significant difference (P <0.05) only between the 6- and 12-month values. At the 36-month follow-up, the use of the osteotome technique for vertical expansion of the grafted tissue was considered a predictable procedure in the implant surgery.

Periodontal Tissue Regeneration Using Fibroblast Growth Factor -2: Randomized Controlled Phase II Clinical Trial

BackgroundThe options for medical use of signaling molecules as stimulators of tissue regeneration are currently limited. Preclinical evidence suggests that fibroblast growth factor (FGF)-2 can promote periodontal regeneration. This study aimed to clarify the activity of FGF-2 in stimulating regeneration of periodontal tissue lost by periodontitis and to evaluate the safety of such stimulation.Methodology/Principal FindingsWe used recombinant human FGF-2 with 3% hydroxypropylcellulose (HPC) as vehicle and conducted a randomized double-blinded controlled trial involving 13 facilities. Subjects comprised 74 patients displaying a 2- or 3-walled vertical bone defect as measured ≥3 mm apical to the bone crest. Patients were randomly assigned to 4 groups: Group P, given HPC with no FGF-2; Group L, given HPC containing 0.03% FGF-2; Group M, given HPC containing 0.1% FGF-2; and Group H, given HPC containing 0.3% FGF-2. Each patient underwent flap operation during which we administered 200 µL of the appropriate investigational drug to the bone defect. Before and for 36 weeks following administration, patients underwent periodontal tissue inspections and standardized radiography of the region under investigation. As a result, a significant difference (p = 0.021) in rate of increase in alveolar bone height was identified between Group P (23.92%) and Group H (58.62%) at 36 weeks. The linear increase in alveolar bone height at 36 weeks in Group P and H was 0.95 mm and 1.85 mm, respectively (p = 0.132). No serious adverse events attributable to the investigational drug were identified.ConclusionsAlthough no statistically significant differences were noted for gains in clinical attachment level and alveolar bone gain for FGF-2 groups versus Group P, the significant difference in rate of increase in alveolar bone height (p = 0.021) between Groups P and H at 36 weeks suggests that some efficacy could be expected from FGF-2 in stimulating regeneration of periodontal tissue in patients with periodontitis.Trial RegistrationClinicalTrials.gov NCT00514657

Guided tissue regeneration using a polylactic acid barrier.

The purpose of this study was to determine the relative impact of various predictors responsible for the variability in treatment outcome after guided tissue regeneration (GTR) in intraosseous periodontal defects. 30 patients with chronic periodontitis and at least one intraosseous periodontal lesion (> or =4 mm) were enrolled. Following full-mouth scaling, GTR using polylactic acid membranes was performed at one site in each patient. Main periodontal pathogens, defect morphology, membrane exposure and smoking habit were assessed as predictor variables. Alveolar bone level change served as the primary outcome variable in a multiple regression analysis. After 12 months, the 29 patients completing the study showed alveolar bone changes ranging from 4 mm bone gain to 1 mm bone loss (mean: 1.6+/-0.4 mm gain). Active smoking (beta-weight:-0.49, P=0.003) and persistence of subgingival infection with P. gingivalis (P.g.) (beta-weight:-0.25, P=0.11) were associated with poor treatment outcome. Deep initial intraosseous defects (beta-weight: 0.32, P=0.045) were associated with favorable treatment outcome, and membrane exposure had no impact on bone gain. Active smoking was the strongest predictor variable negatively affecting alveolar bone gain following GTR in the treatment of periodontal defects. It was followed by a positive influence of a deeper intraosseous defect and by a negative effect by persistent subgingival infection of P. gingivalis. The relative impact of these factors may be useful in assessing the prognosis of GTR in intraosseous periodontal defects.

Impact of JPEG lossy image compression on quantitative digital subtraction radiography

OBJECTIVES The aim of the study was to evaluate the impact of JPEG lossy image compression on the estimation of alveolar bone gain by quantitative digital subtraction radiography (DSR). METHODS Nine dry domestic pig mandible posterior segments were radiographed three times ('Baseline', 'No change', and 'Gain') with standardized projection geometry. Bone gain was simulated by adding artificial bone chips (1, 4, and 15 mg). Images were either compressed before or after registration. No change areas in compressed and subtracted 'No change-Baseline' images and bone gain volumes in compressed and subtracted 'Gain-Baseline' images were calculated and compared to the corresponding measurements performed on original subtracted images. RESULTS Measurements of no change areas ('No change-Baseline') were only slightly affected by compressions down to JPEG 50 (J50) applied either before or after registration. Simulated gain of alveolar bone ('Gain-Baseline') was underestimated when compression before registration was performed. The underestimation was bigger when small bone chips of 1 mg were measured and when higher compression rates were used. Bone chips of 4 and 15 mg were only slightly underestimated when using J90, J70, and J50 compressions before registration. CONCLUSIONS Lossy JPEG compression does not affect the measurements of no change areas by DSR. Images undergoing subtraction should be registered before compression and if so, J90 compression with a compression ratio of 1:7 can be used to detect and measure 4 mg and larger bone gain.

A new approach to the treatment of true-combined endodontic-periodontic lesions by the guided tissue regeneration technique

Clinicians often have difficulty in the diagnosis and treatment of the combined endodontal and periodontal (endo-perio) lesion. A case of an endo-perio true-combined lesion on a maxillary premolar was first treated with conventional endodontic therapy. Periodontal surgery was then completed, which included scaling and root planing and apical curettage on the tooth. The facial bony defect was then filled with a decalcified freeze-dried bone allograft mixed with tetracycline powder. A non-resorbable Teflon membrane was then used to cover the bone material and the periodontal flap sutured over this. This combined treatment resulted in minimal probing depth (2 mm), maximal clinical attachment gain (8 mm), as well as radiographic evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the guided tissue regeneration technique combined with osseous grafting, will restore health and function to a tooth with severe attachment loss caused by an endo-perio lesion.

Two approaches to the treatment of true combined periodontal-endodontal lesions

Periodontal endodontal lesions present a difficult diagnostic and treatment challenge to the clinician and treatment often requires a combined therapeutic effort. Both endodontal and periodontal surgical procedures may be indicated for access and treatment of these lesions. This case report presents an early onset periodontitis patient with bilateral periodontal-endodontal lesions on mandibular first molars. Treatment included apical surgery followed by repeated scaling and root planing on one tooth and root canal obturation followed by a periodontal bone grafting procedure on the other. Both procedures resulted in clinical attachment gain as well as radiographic evidence of alveolar bone gain. This case report once again demonstrates that proper diagnosis followed by removal of etiologic factors and nonsurgical therapy or periodontal regenerative procedures can restore health and function in cases of severe attachment loss.