Alveolar Ridge Preservation Procedures Research Articles

The adjunctive effect of polydeoxyribonucleotide on bone formation in alveolar ridge preservation: A pre-clinical in vivo study.

This study investigated the adjunctive effect of polydeoxyribonucleotide (PDRN) on bone formation in alveolar ridge preservation (ARP) sockets. Both mandibular second, third and fourth premolars of eight beagle dogs were randomly divided into ARP and ARP/PDRN groups. Following tooth extraction, ARP procedures were conducted using collagenized alloplastic graft material and bilayer collagen membrane soaked with normal saline (ARP group) or PDRN (ARP/PDRN group) for 10 min before application. Both groups were also randomly allocated to 2-, 4- or 12-week healing subgroups. The primary endpoint of this study was to compare histomorphometric differences between ARP and ARP/PDRN. The secondary endpoints of this study were to compare micro-CT analysis and three-dimensional volumetric measurement between the two groups. In the histomorphometric analysis, the ARP/PDRN group exhibited greater new bone formation at coronal, middle and total position compared with the ARP group at 2-week healing. The number of newly formed blood vessels was higher in the ARP/PDRN group than in the ARP group at 2- and 4-week healing. In micro-CT analysis, the mean new bone volume/total bone volume between ARP and ARP/PDRN was statistically significant at 2-week healing. Ridge volume alterations were significantly decreased in the ARP/PDRN group during entire healing time compared with the ARP group, especially on the buccal side. The application of PDRN in ARP might provide additional benefits for early bone regeneration and maintenance of buccal ridge volume.

Histologic wound healing in studies using different ridge preservation protocols: A review.

Alveolar ridge preservation (ARP) procedures are designed to lessen dimensional changes in the alveolar ridge after tooth extraction. Wound healing after ridge preservation involves the formation of new vital bone in the former socket, and this vital bone is important in the osseointegration of dental implants. A series of ARP studies have been performed to help clinicians better understand the wound-healing events that occur following tooth extraction and ridge preservation. Different protocols have been examined using various materials and periods of healing time prior to implant placement. The primary aim of these studies was to ascertain the relative percentage of vital bone formation, residual graft material, and connective tissue (CT)/other at the healing site using histomorphometric examination of bone core biopsies obtained during osteotomy preparation. For allografts, the use of demineralized bone alone or in combination with mineralized is associated with more vital bone formation than the use of mineralized allograft alone. For mineralized allografts, the use of cortical versus cancellous bone has only minimal impact on new bone formation. Xenografts from bovine and porcine sources appear to have similar vital bone formation. Longer healing times prior to implant placement are associated with increased vital bone formation and decreased residual graft material. The most stable component in most studies is the percentage of CT/other. The percentage of vital bone and residual graft at ARP sites is dependent on the materials used and the length of healing time prior to obtaining core biopsies. What factors may affect the amount of new bone at the ARP site? At a time point about 4 months after ARP, the type of graft material used for ARP plays a large role in new bone formation. Studies focus on means and standard deviations, but patients often do not "follow the mean." Even if a single ARP protocol is used for all patients, there is great interindividual variability in new bone formation, and there is often variability between sites within a single patient. How long after ARP with an allograft should I wait to place an implant? Longer healing times such as 4-5 months generally provide higher amounts of vital bone formation than shorter healing times like 2-3 months. Differences in vital bone formation between ARP protocols tend to decrease with longer healing time. FDBA that contains demineralized bone, either alone or combined with mineralized FDBA, often provides higher amounts of new bone formation than 100% mineralized allograft, especially at shorter healing periods. Even a year after ARP with an allograft, residual graft material is often still present at the ARP site.

Alveolar Ridge Preservation Procedures Performed with a Freeze-Dried Bone Allograft: Clinical and Histologic Outcomes in a Case Series: Part II.

Tooth extractions can result in alveolar bone dimensional changes, necessitating additional bone grafting for implant placement. Alveolar Ridge Preservation (ARP) aims to counteract post-extraction changes. This study evaluates the bone regenerative properties of a freeze-dried bone allograft (FDBA) and the clinical outcomes of implants in grafted extraction sites. This case series enrolled 33 patients undergoing single/multiple tooth extractions followed by ARP. Biopsies were harvested during implant placement for histologic and histomorphometric analysis. Clinical outcomes included marginal bone loss and Pink Esthetic Score (PES). 25 patients completed the study. FDBA augmented sockets exhibited new bone formation adjacent to graft particles. Implants (n&#61;25) showed 100% survival and success rates at 1 and 2 years. PES improved significantly over time (p<.001), while marginal bone loss did not significantly differ at 1 and 2 years (p&#61;.096). Specimens showed trabecular bone, residual FDBA particles, and marrow spaces. High magnification revealed immature bone and woven bone bridges around graft particles. No inflammatory cells were observed. The case series provides valuable insights into ARP performed with FDBA; implants were placed after 3 months of healing without any additional bone augmentation, the histologic outcomes were favorable, and implants were successful after a 2-year period of follow-up.

Alveolar Ridge Preservation Procedures Performed with A Freeze-Dried Bone Allograft: Histologic Outcomes in a Cohort Study: Part I.

The primary aim of this study was to assess the histomorphometric outcomes of extraction sockets grafted with freeze-dried bone allograft (FDBA) and sealed with a collagen membrane after 3 months of healing in the ROI (region of interest) areas. The secondary aims were to analyze the biomaterial resorption rate, the bone to biomaterial contact and the area/perimeter of grafted particles compared with commercially available FDBA particles. Fifteen patients underwent tooth extractions and ridge preservation procedures performed with FDBA and a collagen membrane. Bone biopsies were harvested after 3 months at the time of implant insertion for histologic and histomorphometric analysis. Two areas of concern ROI1 and ROI2 with different histological features were identified within the biopsy samples; the ROI1, ROI2 and commercially available particles were analyzed and compared . The following parameters were analyzed: newly formed bone (NFB), marrow space (MS), residual graft particles (RGP), perimeter/area of FDBA particles and bone to biomaterial contact. The histomorphometric analysis showed 35.22 ± 10.79 % of newly formed bone, 52.55 ± 16.06 % of marrow spaces and 12.41 ± 7.87 % of residual graft. Moreover, the histologic data from the regions of interest (ROI) 1 and 2 showed that: a) the mean percentage of bone-to-biomaterial contact (BBC) was 64.61 ± 27.14 %; b) the Newly Formed Bone was significantly higher in ROI1 than in ROI2; c) the Marrow Space was significantly lower in ROI1 than ROI2 and d) the FDBA particles in ROI1 areas showed significant lower area and perimeter when compared to commercially available FDBA particles. This latter data lead to the hypothesis that FBA particles embedded in newly formed bone undergo a resorption/remodeling process.

Efficacy of concentrated growth factor (CGF) in the surgical treatment of oral diseases: a systematic review and meta-analysis

BackgroundConcentrated growth factor (CGF), a new autologous platelet concentrate, has been widely investigated to the adjunctive treatment of oral diseases. This study aims to evaluate the efficacy of CGF in the surgical treatment of oral diseases.MethodsMEDLINE, Web of Science, Scopus, Cochrane, and EMBASE databases were searched up to July 2023. Only randomized clinical trials were included. The methodologic quality was evaluated by the Cochrane Risk of Bias Tool. RevMan 5.4 software was used for data analysis.ResultsIn the treatment of periodontal intrabony defects, bone graft combined with CGF was significantly superior to bone graft (P < 0.01), with mean intrabony defect depth reduction of 1.41 mm and mean clinical attachment level gain of 0.55 mm. In the regenerative surgery of furcation defects, the effect of CGF group was significantly better than control group (P < 0.0001), with mean probing depth reduction of 0.99 mm, vertical bone gain of 0.25 mm, and horizontal bone gain of 0.34 mm. CGF combined with coronally advanced flap (CAF) was more effective than CAF alone (mean keratinized tissue width increase of 0.41 mm, mean gingival thickness increase of 0.26 mm, P < 0.00001), but less effective than connective tissue graft (CTG) combined with CAF (mean root coverage difference of -15.1%, mean gingival thickness difference of -0.5 mm, P < 0.0001). In the alveolar ridge preservation, additional use of CGF reduced horizontal bone resorption by 1.41 mm and buccal vertical bone resorption by 1.01 mm compared to control group (P < 0.0001). The VAS score of CGF group was significantly lower than that of the control group at the 1st and 7th day after oral surgery (P < 0.0001).ConclusionsCGF can exert a positive adjunctive effect for the regenerative surgery of periodontal intrabony defects, furcation defects, and alveolar ridge preservation procedure. CGF combined with CAF has a better therapeutic effect on gingival recession compared to CAF alone, although it is not as effective as CTG combined with CAF. CGF could promote postoperative healing and pain relief in oral surgery within a week. There is currently not enough evidence to support the clinical benefits of CGF in other oral surgeries.

Alveolar Ridge Preservation with The Use of Demineralized Bone Matrix Putty: Clinical, Radiographic and Histological Observations in A Case Series

&lt;p&gt;Alveolar ridge preservation (ARP) can minimize alveolar ridge resorption following tooth ex&amp;not;traction and facilitate restorative-driven implant placement. Demineralized bone matrix (DBM) comprises a human allograft that is osteoinductive and osteoconductive. This report describes radiographic, histologic and clinical findings of ARP using DBM putty and non-resorbable high-density polytetrafluoroethylene (d-PTFE) membrane in three cases. &lt;/p&gt; &lt;p&gt;Materials and Methods: From January 2018 to May 2018, three patients underwent the ARP procedure. The surgery involved atraumatic extraction, socket debridement, filling the socket with DBM putty, applying a d-PTFE membrane, and suturing with 5-0 nylon. After healing for 6&amp;ndash;7 months, an implant was placed and biopsy specimens were collected simultaneously. Using the same customized surgical stent and computed tomography, the preoperative and postoperative alveolar ridge heights and widths were measured. Histological evaluations in&amp;not;cluding the percentage of newly formed bone, residual graft particles, and fibrous connective tissue were performed. &lt;/p&gt; &lt;p&gt;Results: In all three cases, the health status of the hard and soft tissue improved (mean fol&amp;not;low-up: 54 months). Guided bone regeneration was not required during implant placement. Radiographically, the mean change was 0.5 mm in the alveolar ridge height and 1.2, 0.87, and 0.73 mm in the alveolar ridge width at 2, 4, and 6 mm apical to the initial vertical measure&amp;not;ment, respectively. Histologically, the mean percentage of new bone, residual graft particles, and fibrous connective tissue was 40.5&amp;plusmn;5.9%, 10.7&amp;plusmn;6.9%, and 48.8&amp;plusmn;9.6%, respectively, and the voids were not included in these calculations. &lt;/p&gt; &lt;p&gt;Conclusion: This case series demonstrated the effectiveness of DBM putty as a biocompatible filler in extraction sockets for ridge preservation prior to implantation. Further longitudinal studies regarding the efficacy and stability of DBM putty in ridge preservation are required.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Success of Xenografts in Alveolar Ridge Preservation Based on Histomorphometric Outcomes.

Different xenograft approaches in alveolar ridge preservation (ARP) are essential to understand relative to their histomorphometric outcomes. Therefore, the aim of this study involved studying biomaterials of a xenograft nature that are used in ARP procedures, to compare the different approaches and evaluate their efficacy in relation to histomorphometric data. An electronic search was completed using the databases: Ovid (Medline), Google Scholar and Wiley Online Library, including a hand search for relevant articles and grey literature. Only randomised controlled trials, using xenograft biomaterials for alveolar ridge preservation procedures involving human studies, dated from 2010-2022 were included in the review. An initial search yielded 4918 articles, after application of the eligibility criteria, 18 studies were deemed eligible for inclusion in the systematic review. The two main xenograft groups found were of bovine origin and of porcine origin. The main histomorphometric outcomes evaluated included new bone percentage (N.B%) and residual graft percentage (R.G%). The mean N.B% for the bovine and porcine groups were 33.46% and 39.63% respectively and the mean R.G% for the bovine and porcine groups were 19.40% and 18.63% respectively. The current evidence suggests that the two main xenograft biomaterials used in ARP procedures after tooth extraction, which are of bovine and porcine origin, displayed effectiveness in producing new bone.

Alveolar ridge preservation of damaged or periodontally compromised extraction sockets with bovine- and porcine-derived block bone substitutes: A retrospective case-control study.

Alveolar ridge preservation (ARP) was introduced to minimize postextraction alveolar bone loss and extraction socket remodeling; however, current knowledge of the ARP procedure for nonintact extraction sockets is still limited and inconclusive. This retrospective study aimed to evaluate the difference between using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and deproteinized porcine bone mineral with 10% collagen (DPBM-C) when performing ARP procedures in damaged or periodontally compromised extraction sockets based on clinical, radiographic, and profilometric outcomes. In total, 108 extraction sockets were grafted with 67 DBBM-C and 41 DPBM-C. Changes in radiographic (horizontal width and vertical height) and profilometric outcomes were measured after the ARP procedure and before the implant surgery. Postoperative discomfort (including the severity and duration of pain and swelling), early wound healing outcomes (including spontaneous bleeding and persistent swelling), implant stability, and treatment modalities for implant placement were also assessed. Radiographically, the DBBM-C group decreased by -1.70 ± 2.26 mm (-21.50%) and - 1.39 ± 1.85 mm (-30.47%) horizontally and vertically, and the corresponding DPBM-C group decreased by -1.66 ± 1.80 mm (-20.82%) and -1.44 ± 1.97 mm (-27.89%) horizontally and vertically at an average of 5.6 months. There were no serious or adverse complications in any of the cases, and none of the measured parameters differed significantly between the groups. Within the limitations of this study, ARP with DBBM-C and DPBM-C showed similar clinical, radiographic, and profilometric outcomes in nonintact extraction sockets.

Alveolar Ridge Preservation: A Review

A number of changes occur in the alveolar ridge following tooth extraction such as remodeling of bone in the alveolar ridge that can lead to loss of alveolar ridge width and height. Studies have shown that most of the changes occur in the first three months following teeth extraction. The goal of alveolar ridge preservation procedures is to maintain the dimensions of the extraction site, reduce significant loss of alveolar ridge and height and maintain adequate bone for dental implant placement. Alveolar ridge preservation also helps prevent the need for additional procedures prior to dental implants such as utilization of block grafting for ridge augmentation and sinus augmentation. It is indicated for both intact extraction sockets and extraction sites with significant damage to its walls. The goal of this article is to present two case reports on patient management for extraction sockets with damaged boney walls using Alveolar ridge preservation.

Extraction and Socket Preservation before Implant Placement Using Freeze-Dried Allograft (FDBA) and Platelet-Rich Fibrin in Smokers: Radiographic and Histological Evaluation

Background: Dental extraction can initiate a sequence of biological events that may lead to an insufficient bone volume, which can compromise implant placement. To minimize bone loss, alveolar ridge preservation procedures were developed. However, smoking has been shown to adversely affect the outcomes of the procedures. Hence, this clinical study aimed to assess the ability of platelet-rich fibrin to maintain ridge volume and its ability to generate vital bone in smokers. Methods: Eighteen current heavy smokers with a total of forty upper molars indicated for extraction and implant placement were randomly allocated to four different groups: an advanced platelet-rich fibrin group (A-PRF) (n = 10), a factor-enriched bone graft matrix covered by A-PRF group (A/S-PRF) (n = 10); a freeze-dried bone allograft covered by a crosslinked collagen membrane group (FDBA/CM) (n = 10), which served as a positive control; and a negative-control resorbable collagen plug group (RCP) (n = 10). Two consecutive high-resolution CBCT images were taken for each augmented socket to evaluate the bone volume, one at baseline and the other after six months, and four different measurements (vertical height, horizontal 1 mm H1, horizontal 3 mm, and horizontal 5 mm) were taken for each image. To evaluate the bone vitality, three bone samples were harvested for each group and were analyzed histologically using H and E staining. The results were analyzed using SPSS version 26.0 through the Wilcoxon sign rank test and Kruskal–Wallis test. Results: In terms of preserving bone volume, A/S-PRF showed no significant reduction in bone after six months, while A-PRF showed a significant loss according to two measurements (vertical and horizontal 5 mm), and the last two groups showed a significant loss in all four measurements. For vital bone formation, three groups (A-PRF, A/S-PRF, and RCP) showed the generation of only vital bone, while the fourth group (FDBA/CM) showed the generation of a mixture of vital and non-vital bone. Conclusions: Based on the outcomes of this study, PRF was able to minimize bone loss following dental extraction and generate vital bone in smokers.

Major aspects of mesenchymal stem cell signaling and differentiation into osteoblasts in the optimization of bone formation for dental implant: a systematic review

Introduction: In recent decades, the number of dental implant procedures has shown significant growth worldwide, reaching about one million dental implants per year. In Brazil, in recent decades, there has been a very rapid evolution in implant dentistry with high success rates. Several materials can be used as a bone graft, each with different properties, for example, regarding neovascularization. Guided bone regeneration favors the formation of new bone tissue. When grafting procedures are required, the focus is often on the type of biomaterial to be used and the success and predictability of the results. Objective: It was to carry out a concise systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for implant dentistry. Methods: The survey was carried out from January to February 2023 in the Scopus, PubMed, Science Direct, and Scielo databases, using older scientific articles with a gold standard reference up to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias by the Cochrane instrument. Results and Conclusion: It was founded on 128 studies that underwent eligibility analysis. The final sample had 34 eligible studies that were described in the systematic review. Most studies showed homogeneity in their results, with X2=89.8.8% &lt;50%. Due to bone regeneration and biological barriers in graft surgeries, there has been a technological growth of these materials as they point to potential tools for treating bone loss. The greater potential of guided bone regeneration was associated with the graft material due to the higher grade of vital bone and the lower percentage of residual graft particles. All studied bone substitute materials resulted in efficient bone formation for dental implants and alveolar ridge preservation procedures.

Influence of partially exposed nonabsorbable membrane for alveolar ridge preservation: A randomized controlled trial.

This randomized controlled trial evaluated the impact of a partially exposed non-absorbable membrane (dPTFE) in Alveolar Ridge Preservation (ARP) procedures on clinical, tomographic, immunoenzymatic, implant-related, and patient-centered outcomes. Patients with a hopeless maxillary single-rooted tooth demanding rehabilitation with implants were included. Patients were randomized into two groups: dPTFE (n=22)-tooth extraction followed by ARP using a partially exposed dPTFE membrane; USH (n=22)-unassisted socket healing. Clinical and tomographic analyses were performed at baseline and after 3 months. After 3 months, patients received one dental implant. Implant stability quotient was obtained following implant placement. Bone-related markers were analyzed in bone biopsies using an immunoenzymatic assay. Greater gain in Keratinized Mucosa Width (KMW) was observed in the dPTFE (1.33 ± 0.98 mm) compared to USH (0.59± 0.98 mm) (Mann-Whitney test, Z=2,28, p < 0.05). USH showed a reduction of pain/discomfort, edema, and interference with daily life from the seventh day (Friedman/Wilcoxon test, maxT=7.48, 8.00, and 5.92, respectively, p < 0.05). dPTFE presents a reduction of edema and interference with daily life from the 7th day and pain/discomfort from the 14th day (Friedman/Wilcoxon test, maxT=5.40, 5.26, and 4.78, respectively, p < 0.05). The dPTFE group presented higher pain/discomfort in the 35 and 42 days and higher edema from 7 to 42 days postoperatively than USH group (Mann-Whitney test, p < 0.05). No differences between groups were observed in the tomographic measures, immunoenzymatic analysis, and implant stability (p > 0.05). dPTFE was superior to USH by increasing KMW gain. However, dPTFE without bone graft presented similar bone loss compared to USH. This clinical trial was not registered prior to participant recruitment and randomization (NCT04329351).

Modified Periosteal Inhibition (MPI) Technique for Extraction Sockets: A Case Series Report

Several Alveolar Ridge Preservation (ARP) procedures have been proposed over the years. The purpose of this study was to describe the new Modified Periosteal Inhibition (MPI) technique for ARP. Seven patients were enrolled (age range: 28–72 years old; 5 males, 2 females). In total, nine hopeless teeth were treated. Following the elevation of a full-thickness flap, atraumatic tooth extraction was conducted, preserving the buccal bone of the alveolar socket. OsteoBiol® Lamina Soft (Tecnoss®, Giaveno, Italy), 0.5 mm thick, was suitably shaped (8–10 mm in height, extending from the mesial and to the distal corners of the socket). The lamina was gently positioned between the buccal periosteum and the buccal bone plate. Tisseel® (Baxter Healthcare Corporation, Deerfield, IL, USA) was applied to seal the cortical membrane. The flaps were sutured with PTFE 4-0 (Omnia, Fidenza, Italy). Postoperative instructions were provided. Patients were strictly monitored during the follow-up. No early or late biological complications were experienced. Cone Beam Computed Tomography (CBCT) exams were performed at baseline and 4 months later. The thickness of the buccal cortical bone at baseline was 1.18 ± 0.57 mm. The pre-operative and post-operative ridge widths were 10.74 ± 1.54 mm and 11.16 ± 1.57 mm, respectively. A horizontal ridge increase of 0.41 ± 0.21 mm was observed during the healing period. At 4 months of healing, the bone volume was adequate for implant placement and no additional bone regeneration procedures were required. MPI technique was effective in preventing the horizontal contraction of the post-extraction socket. Further studies will be needed in the future to confirm our positive results.

Alveolar ridge preservation in extraction sockets of periodontally compromised teeth: A systematic review and meta-analysis.

Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the outcomes of ARP following extraction of periodontally compromised teeth in comparison with extraction alone in terms of hard tissue changes, need for additional augmentation at the time of implant placement, and patient-reported outcomes. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared ARP in periodontally compromised sockets with spontaneous socket healing. The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. Five studies with 134 extraction sockets in 126 participants were included. Of these, ARP was performed in 77 sites, while the remaining sites were intentionally left to heal without any ARP treatment. The follow-up time varied between 6 and 12 months. Overall meta-analysis showed significant differences in changes in ridge height (mean difference (MD) -0.95; 95% confidence interval (CI) -1.43 to -0.47; p=.0001) and bone volume (MD -38.70; 95% CI -52.17 to -25.24; p < .0001) in favor of ARP. The use of ARP following extraction of periodontally compromised tooth was also associated with significantly less need for additional bone grafting at the time of implant placement. Within the limitation of this review, ARP following extraction of periodontally compromised teeth may have short-term positive effects on alveolar ridge height and bone volume and minimize the need for additional augmentation procedures. However, the evidence is of very low to low certainty.

ALVEOLAR RIDGE PRESERVATION IN THE AESTHETIC ZONE.

INTRODUCTION: Following tooth extraction various alterations in the aesthetic zone of the oral cavity can be expected. These are alveolar bone loss as well as structural and compositional changes of the covering soft tissues. Thus, the clinician is confronted with a challenging situation regarding the decision-making process required to provide an optimal treatment solution. PURPOSE: To highlight the importance of preserving the alveolar ridge in the aesthetic zone as well as presenting the methods that exist to achieve it. METHOD: A review of the literature of the last five years was performed, with keywords such as: alveolar soft tissue volume; assessment method; esthetic dentistry; extraction socket; wound healing. RESULTS: The criteria that affect the maintenance of the alveolar ridge, are the time of placement of the implant, the quality of the bone in the extraction socket and the amount of bone remaining in it. The clinician should also have a picture of the quality of the soft tissues that surround the bone socket. CONCLUSIONS: It is very important to realize that the clinical decision-making process for alveolar ridge preservation in the esthetic zone starts before tooth extraction. The placement of a dental implant in the aesthetic zone can be performed after 2 months if the soft tissues remain Intact. In all other cases where implant placement is not possible, alveolar ridge preservation procedures should be considered.

Classification Based on Extraction Socket Buccal Bone Morphology and Related Treatment Decision Tree.

Background: Alveolar ridge preservation (ARP) can successfully reduce volumetric ridge changes. However, there is still no consensus on what technique is the most advantageous for each specific clinical scenario. Hence, the aim of the present paper was to provide a treatment decision tree to guide the choice of predictable ARP procedures based on extraction socket buccal bone morphology and integrity. Material and Methods: Three socket types (ST) are proposed and discussed based on buccal bone morphology (intact, dehiscence or fenestration). Results: A decision tree for ARP was developed in order to merge ST classification with suitable treatment modalities. In the decision tree, the issue of when to allow unassisted healing or ARP was discussed. Described methods included bone grafting and collagen plug, and absorbable membrane or non-resorbable membrane, with or without flap elevation. Conclusion: A decision tree for ARP procedures was provided to guide clinicians towards the most conservative and predictable treatment approach based on remaining socket anatomical structures after extraction.

Consensus Report by the Italian Academy of Osseointegration on the Use of Graft Materials in Postextraction Sites.

After tooth extraction, a modeling and remodeling phase of bone and soft tissues occurs. It has been fully demonstrated that bone resorption as high as 50% can take place regarding ridge width and a variable amount concerning ridge height, making it difficult to perform implant surgery. Active members of the Italian Academy of Osseointegration (IAO) participated in this Consensus Conference, and three systematic reviews were conducted before the meeting to provide guidelines on alveolar ridge preservation procedures. The systematic reviews covered the following topics: (1) What material best preserves the dimensions of the ridge horizontally and vertically?; (2) what material favors the formation of the highest quantity of new bone?; (3) which technique would best seal the socket?; and (4) what effect does alveolar ridge preservation have on soft tissues? The main conclusions reached by the assembly were that alveolar ridge preservation is advisable after dental extraction, particularly in esthetic areas, in proximity of anatomical structures (ie, maxillary sinus, inferior alveolar nerve, and mental foramen), whenever the treatment plan requires delayed placement, and whenever patients ask to postpone implant insertion for various reasons. Socket debridement is advised before the use of a "regenerative material," and xenograft is considered the gold standard material to maintain ridge dimensions. Another indication is antibiotic therapy, which is recommended in the case of alveolar ridge preservation (amoxicillin 2 g 1 hour before the intervention and 1 g every 12 hours for 6 days). A membrane or autologous soft tissue should be used to seal the socket and protect the regenerative material, and the indicated reentry time (implant insertion) is 4 to 6 months. This Consensus Conference agreed that the adoption of alveolar ridge preservation can effectively prevent physiologic bone loss, especially in esthetic areas. It is recommended to cover the xenograft material with a membrane or autologous soft tissue, and antibiotic therapy is advisable.

Extraction site reconstruction by alveolar ridge preservation and indirect sinus lifting procedure for dental implant placement

Dimensional changes to the alveolar ridge are inexorable following tooth extraction. To avoid this hard-tissue loss, alveolar ridge preservation (ARP) soon after extraction needs to be done. However, despite taking precautions to prevent the ridge loss, some cases might require ridge and sinus augmentation procedures for dental implant placement subsequent to tooth extraction. The present case report briefs on management of extraction site by ARP and indirect sinus lifting by osteotome sinus floor elevation approach, for dental implant placement.

Bone Level Tapered Implants in the Maxillary Esthetic Zone: A 1-Year Prospective Case Series in Healed Sites.

Bone level tapered implants have an advantage in terms of stability and less need for additional bone augmentation procedures in healed sites, which might be advantageous for the esthetic zone. The aim of this study was to assess the clinical, radiographic, and esthetic performance of bone level tapered implants placed in healed sites in the maxillary esthetic region during a 1-year evaluation period. Thirty participants (15 male, 15 female) with a single-tooth diastema that had healed without an alveolar ridge preservation procedure received a bone level tapered implant. Buccal bone augmentation procedures were performed at implant placement if the labial bone wall thickness was < 2 mm. A provisional crown was connected after a healing phase of 3 months. A definitive crown was placed 3 months after the provisional restoration. Implant stability, peri-implant soft and hard tissue health, esthetics, and patient-reported outcomes were recorded. All the placed implants demonstrated good stability. A labial bone augmentation technique was needed in 23 of the 30 cases. The median implant stability quotient value was 73 (68;76) at implant placement and had increased to 79 (76;81) when the definitive restoration was inserted (P < .005). All patients were present at the 1-year evaluation, and none had lost an implant. The mean loss of marginal bone was 0.07 ± 0.10 mm. The midbuccal mucosa-level recession was 0.14 ± 0.40 mm. There was an overall gain in papilla height: +0.05 ± 0.60 mm mesially and +0.06 ± 0.53 mm distally. Median values of the pink esthetic score and white esthetic score were 6 (4;7 interquartile range) and 8 (7;8.3 interquartile range), respectively. The participants' mean overall satisfaction was 90.1 ± 6.5 on a visual analog scale. No complications occurred. It can be concluded from a 1-year followup that treatment with the bone level tapered implant system resulted in good implant stability, healthy peri-implant soft and hard tissues, satisfying esthetics, and good patient-reported outcomes.

Ridge Preservation Procedures: Review of Current Literature

Alveolar ridge preservation (ARP) procedures have become one of the most commonly performed surgical procedures in dentistry, due to increased demand for dental implant therapy. Previous studies have repeatedly shown a naturally healed socket could lose up to 50% of its buccolingual width, which in turn would negatively impact the future implant placement. ARP procedures have been shown to consistently reduce the amount of post-extraction horizontal and vertical bone loss; however, it is still not conclusive which biomaterial or technique is the most superior. The purpose of this article is to review current evidence on various ARP procedures. The electronic database search was limited to the past 3 years (publication dates between January 1, 2017, and February 29, 2020) and to human clinical studies (including controlled clinical trials and randomized controlled trials) investigating dimensional changes in alveolar sockets after various ARP techniques with outcomes measured from 3 to 6 months postoperatively. A total of 31 articles were reviewed, with approximately half of the selected studies using bovine (14) bone substitutes. Other biomaterials used in the studies included porcine bone substitutes, allografts (both freeze-dried and solvent-dehydrated), alloplasts (biphasic calcium phosphate, β-tricalcium phosphate, and hydroxyapatite), biologics (platelet-rich fibrin and recombinant bone morphogenetic protein-2), collagen and high-density polytetrafluoroethylene membranes, and micro-titanium stent. Collagenated deproteinized bovine bone matrix (DBBM-C) was the most studied biomaterial in the past 3 years. Most studies showed DBBM-C plus barrier membranes resulted in comparable clinical and radiographic outcomes with DBBM and allografts. Consistent with previous studies, most of the ARP procedures reviewed in this article demonstrated effective reduction of alveolar ridge dimensional changes. Based on the selected articles and recent systematic reviews and meta-analysis, ARP procedure using bovine and porcine xenografts, as well as allografts, in conjunction with either collagen membranes or high-density polytetrafluoroethylene membranes gives similar results and should be considered when indicated.