Alveolar Socket Research Articles

Vertical and horizontal bone loss following alveolar socket preservation using bone grafts and autologous platelet concentrates vs bone grafts alone: a systematic review and meta-analysis

Abstract Background Socket preservation is a proactive approach that limits bone loss after tooth extraction to maintain adequate bone volume, height and width. Many methods have proven effective in achieving socket preservation, including using various bone grafts and autologous platelet concentrates (APCs). Combining these two methods may lead to improved results in socket preservation and patient outcomes. Aims To compare the combined use of APCs and bone grafts in socket preservation, with the use of bone grafts alone. Primary outcomes were radiographic vertical bone loss (VBL) and horizontal bone loss (HBL). Methods A search on Pubmed, Scopus, Embase and Google Scholar databases was conducted to identify human studies using APCs in extraction sockets between January 2014 and August 2024. The inclusion criteria involved comparative human studies ranging from evidence levels II to III (Oxford Centre for Evidence-Based Medicine Levels of Evidence). For assessing bias in the included studies, the Cochrane Risk of Bias tools were used. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of evidence available. Results A total of five randomised controlled trials (RCTs) were included in the analysis. Studies included the use of platelet rich fibrin (PRF), injectable platelet rich fibrin (i-PRF), advanced platelet rich fibrin (A-PRF), advanced platelet rich fibrin plus (A-PRF+) and concentrated growth factors (CGF). The risk of bias was judged high and moderate for two out of five RCTs. The analysis revealed a combined effect size for VBL reduction, with a standardized mean difference (SMD) of −0.83 (p < 0.001; 95% confidence interval (CI) = [−1.2, −0.57]; I² = 73.13%). For HBL reduction, the combined effect size was SMD = −0.72 (p < 0.001; 95% CI = [−1.08, −0.37]; I² = 68.34%). The overall evidence quality rating for the use of APCs in combination with bone grafts to reduce VBL during socket preservation was assessed as moderate, whereas to reduce HBL it was determined to be low. Conclusion The current literature demonstrates the added benefits of APCs combined with bone grafts in alveolar socket preservation compared to bone grafts alone in reducing vertical and horizontal bone loss. However, based on the GRADE assessment, the quality of evidence was judged low-to-moderate. Further randomised clinical studies would increase the certainty of the evidence.

Comparative Accuracy of dCAIS and Freehand Techniques for Immediate Implant Placement in the Maxillary Aesthetic Zone: An In Vitro Study

ObjectiveTo evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement. MethodsA total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters. ResultsGlobal entry deviations were not significantly different between the two techniques (p=0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p<0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001). ConclusionsdCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time. Clinical significancedCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery.

Chewing-Activated TRPV4/PIEZO1-HIF-1α-Zn Axes in a Rat Periodontal Complex.

The upstream mechanobiological pathways that regulate the downstream mineralization rates in periodontal tissues are limitedly understood. Herein, we spatially colocalized and correlated compression and tension strain profiles with the expressions of mechanosensory ion channels (MS-ion) TRPV4 and PIEZO1, biometal zinc, mitochondrial function marker (MFN2), cell senescence indicator (p16), and oxygen status marker hypoxia-inducible factor-1α (HIF-1α) in rats fed hard and soft foods. The observed zinc and related cellular homeostasis in vivo were ascertained by TRPV4 and PIEZO1 agonists and antagonists on human periodontal ligament fibroblasts ex vivo. Four-week-old male Sprague-Dawley rats were fed hard (n = 3) or soft (n = 3) foods for 4 wk (in vivo). Significant changes in alveolar socket and root shapes with decreased periodontal ligament space and increased cementum volume fraction were observed in maxillae on reduced loads (soft food). Reduced loads impaired distally localized compression-stimulated PIEZO1 and mesially localized tension-stimulated TRPV4, decreased mitochondrial function (MFN2), and increased cell senescence in mesial and distal periodontal regions. The switch in HIF-1α from hard food-distal to soft food-mesial indicated a plausible effect of shear-regulated blood and oxygen flows in the periodontal complex. Blunting or activating TRPV4 or PIEZO1 MS-ion channels by channel-specific antagonists or agonists in human periodontal ligament fibroblast cultures (in vitro) indicated a positive correlation between zinc levels and zinc transporters but not with MS-ion channel expressions. The effects of reduced chewing loads in vivo were analogous to TRPV4 and PIEZO1 antagonists in vitro. Study results collectively illustrated that tension-induced TRPV4 and compression-induced PIEZO1 activations are necessary for cell metabolism. An increased hypoxic state with reduced functional loads can be a conducive environment for cementum growth. From a practical standpoint, dose rate-controlled loads can modulate tension and compression-specific MS-ion channel activation, cellular zinc, and HIF-1α transcription. These mechanobiochemical events indicate the plausible catalytic role of biometal zinc in mineralization, periodontal maintenance, and dentoalveolar joint function.

Effect of initial bone morphology on alveolar bone remodeling following molar extraction: A retrospective study.

The clinical evidence about alveolar ridge changes following molar extraction and how the alveolar bone morphology influences the ridge dimensional changes remains limited. A total of 192 patients with 199 molar extractions were included in this retrospective study. Cone-beam computed tomography (CBCT) images of patients were obtained 0-3 months pre extraction and 6-12 months post extraction. Outcome variables included the change rate in ridge height and width. The effect of morphology on the outcomes was explored by single-factor analysis, correlation analysis, and a multiple linear regression model. Significant resorption of alveolar bone occurred vertically and horizontally after molar extraction. Jaw, furcation involvement, number of roots, number of bone wall defects, extraction reasons, overall relative bone loss (RBL), bone height of the furcation region, thickness of the lingual/palatal wall, and height difference between buccal and lingual/palatal walls (|HB-HL|) were significantly correlated with the change in the height of the central alveolar bone (HC). The number of bone wall defects, overall RBL, and |HB-HL| were significantly correlated with horizontal width change. HC resorption was higher in sockets with |HB-HL|>2.5mm and overall RBL>50%. The alveolar bone presented significant resorption after extraction. Anatomical characteristics affected the dimensions of the alveolar bone after molar extraction. When the initial overall RBL was severe or |HB-HL| was larger, the loss of alveolar bone dimensions was even more. In recent years, it has been demonstrated that the local anatomical morphology of extraction sites may influence the process of alveolar bone remodeling. However, most studies have focused on the anterior teeth, with fewer investigations addressing molar extraction sites. Therefore, we aimed to describe ridge changes following molar extraction and investigate how alveolar bone morphology influences ridge dimensional changes. In this retrospective study, we included a total of 199 alveolar sockets from 192 patients with molar extractions and obtained the corresponding cone-beam computed tomography (CBCT) images 0-3 months pre extraction and 6-12 months post extraction. The results showed significant resorption of the alveolar bone following molar extraction. We found that anatomical characteristics significantly affect the dimensions of the alveolar bone after molar extraction. Specifically, the loss of alveolar bone dimensions was greater when the initial overall relative bone loss (RBL) was severe or when the difference between buccal and lingual/palatal walls was greater.

Inhibition of MEK1/2 Signaling Pathway Limits M2 Macrophage Polarization and Interferes in the Dental Socket Repair Process in Mice

Inhibition of MEK1/2 Signaling Pathway Limits M2 Macrophage Polarization and Interferes in the Dental Socket Repair Process in Mice

Bioactive materials from berberine-treated human bone marrow mesenchymal stem cells accelerate tooth extraction socket healing through the jaw vascular unit.

Delayed tooth extraction socket (TES) healing can cause failure of subsequent oral implantation and increase socioeconomic burden on patients. Excessive amounts of M1 macrophages, apoptotic neutrophils (ANs), and neutrophil extracellular traps (NETs) impair alveolar bone regeneration during TES healing. In the present study, we first discovered that conditioned medium (CM) collected from berberine-treated human bone marrow mesenchymal stem cells (BBR-HB-CM) accelerated TES healing. BBR-HB-CM contained bioactive materials that promoted the polarization of macrophages from M1 to M2, impeded the formation of ANs and NETs, and modulated M2 macrophage efferocytosis in vivo and in vitro. Mechanistically, BBR-HB-CM promoted bone formation by inhibiting macrophage-myofibroblast transition and reprogrammed macrophage polarization through p85/AKT/mTOR pathway-dependent autophagy. The 3-methyladenine abolished the therapeutic effects of BBR-HB-CM. Further studies revealed that BBR-HB-CM accelerated TES healing in rats with type 2 diabetes mellitus. Overall, our results demonstrated that BBR-HB-CM had high potential to promote rapid TES healing.

A Scientometric Exploration of the Socket-shield Technique in Oral Implantology: Trends and Spatiotemporal Dynamics.

The socket-shield technique arises from the efforts to stop the dimensional changes of the bone crest and gingival tissues. This technique consists of leaving a vestibular fragment of a naturally attached root with the purpose of keeping the crestal bone nourished through the periodontium. The aim of this research was to perform a scientometric analysis of the scientific production on the socket-shield technique in oral implantology. A descriptive, observational study was carried out with a scientometric approach. A specialized search was performed, with variants of the keywords extracted from the Medical Subject Heading (MeSH) thesaurus of PubMed and the Embase thesaurus. For Web of Science (WOS) data, including only documents as original articles, reviews, and as sources corresponding to the subject. Production, trends, and impact indicators were performed. During the study period 2000-2023, the scientific production of research increased in the last 3 years. The journal with the highest scientific production of research was "Clinical Oral Implant Research", and the USA was found to be the dominant country in scientific production. Initially, the development of the research topic of interest was "tooth extraction and socket" between 2000 and 2015, and "dental implants and alveolar ridge preservation" between 2015 and 2023. The socket-shield technique in oral implantology is a growing field of research, with extensive international collaboration and significant impact in terms of citations. As this growth continues, we are likely to see even more advances and discoveries in this field. The study on the socket-shield technique in oral implantology highlights its clinical importance by demonstrating that this technique can preserve crestal bone and gingival tissues, improving the stability, and esthetics of dental implants. In addition, its growing research and international collaboration underscore its relevance and potential for future innovations in the field. How to cite this article: Buchelli-Ramirez C, Samillán-Arbulú R, Espinoza-Carhuancho F, et al. A Scientometric Exploration of the Socket-shield Technique in Oral Implantology: Trends and Spatiotemporal Dynamics. J Contemp Dent Pract 2024;25(10):941-949.

Is ADDM graft practical? A comparative study to evaluate ADDM graft in third molar surgery.

It has been outlined that LTM (Lower third molar) extracted from patients in which grinding, cleaning, sterilization & demineralization prove to be highly effective as graft material for filling the alveolar socket of the very same patient. These investigations aim to assess the efficiency of ADDM (Autogenous Demineralized Dentin Matrix) graft in third molar extraction sockets. To check the effectiveness of ADDM as graft material in extraction socket by evaluating pain, swelling, trismus, PD (Probing Depth) and bone density. A prospective, randomized control trial was conducted at our institute. The patients were haphazardly, non-blindly alienated into two groups. Group A (45 patients) on the test side after LTM impaction surgery will receive ADDM graft material with bio-collagen membrane and Group B (45 patients) on the control side underwent LTM removal, with the alveolus left to heal conventionally by forming a blood clot. Swelling showed significant difference between CG (Control Group) and TG (Test Group), the intergroup comparison of change in the swelling scores at seventh post-operative day (from pre-op level) was significantly higher in the TG (117.35) as compared to the CGs (115.92) (p = 0.001). A statistically significant difference in probing depth was also noted between the two groups, CG 4.46 ± 1.252 & TG 2.52 ± 0.641 in the post-operative examination at three months. In our study radiographical evaluation revealed progressive increase in bone density in TG (135.81 ± 8.73) when compared to CG (121.59 ± 13.83) over a period of three months. Pain and trismus evaluation did not reveal any significant difference between TG & CG. The clinical results of the ADDM graft procedure demonstrate satisfactory outcomes in extraction sockets. The findings of this study highlight the importance of preservation methods in maintaining the periodontal pocket depth distal to the second molar and the remaining alveolar ridge following extraction.

The greater palatine nerve and artery both supply the maxillary teeth: An anatomic and radiologic study.

It is generally accepted that the greater palatine nerve and artery supply the palatal mucosa, gingiva, and glands, but not the bone or tooth adjacent to those tissues. When the bony palate is observed closely, multiple small foramina are seen on the palatal surface of the alveolar process. The authors hypothesized that the greater palatine nerve and artery might supply the maxillary teeth via the foramina on the palatal surface of the alveolar process and the superior alveolar nerve and artery. The authors aimed to investigate the palatal innervation and blood supply of the maxillary teeth. Eight cadaveric maxillae containing most teeth or alveolar sockets were selected. The mean age at the time of death was 82.4 years. The samples were examined with colored water injection, latex injection, microcomputed tomography with contrast dye, gross anatomic dissection, and histologic observation. Through both injection studies and microcomputed tomographic analysis, the authors found that the small foramina on and around the greater palatine groove connected to the alveolar process and tooth sockets. The small foramina in the greater palatine and incisive canal also continued inside the alveolar process and the tooth sockets. The alveolar branches of the greater palatine nerve and artery as well as the nasopalatine nerve and sphenopalatine artery supply maxillary teeth, alveolar bone, and periodontal tissue via the palatal alveolar foramina with superior alveolar nerves and arteries. This knowledge is essential for dentists when administering local anesthetic to the maxillary teeth and performing an osteotomy. Anatomic and dental textbooks should be updated with this new knowledge for better patient care.

Periodontitis - Symptoms and Treatment

Periodontitis is a disease caused by bacteria, injury, or medications that results in inflammation of the connective tissue complex (periodontium) located between the tooth cement and the dental alveoli. In the general structure of dental diseases, periodontitis occurs in all age groups of patients and accounts for 25-30% of the total number of visits to dental institutions.

The effectiveness of vitamin C in dental alveolus healing after dental extraction: A scoping review.

Dental extraction is a common procedure in dentistry. It is accompanied by postoperative pain and inflammation. In addition, it decreases bone volume and density. Vitamin C is an antioxidant and cofactor that promotes the synthesis and maturation of collagen, the proliferation and migration of fibroblasts and osteoblasts, accelerating the final phase of inflammation, promoting healing. The objective of this scoping review is to evaluate the effectiveness of vitamin c in dental alveolus healing after extraction and synthesize the available evidence and tits clinical implications. This review is registered on the Open Science Framework platform (https://osf.io/bstwk/). It was carried out under the PRISMA-ScR protocol, using the question: Is vitamin C effective in alveolar healing in patients undergoing dental extraction? The Pubmed/MEDLINE, Scopus, Web of Science and OPENGREY databases were used. Limiting itself to primary studies. A total of 287 articles were identified, applying selection criteria, 3 were included. Of a total of 135 patients, 59.8% were administered vitamin C; 46.6% 600 mg, 34.2% 500 mg and 19.2% 1500 mg. A decrease in pain, inflammation, probing depth and mesiodistal length of the socket was observed. The role of vitamin C is essential for healing, and therefore, bone regeneration after tooth extraction, reducing adverse effects such as pain and inflammation. Its administration is recommended to promote postoperative recovery. More studies are suggested to observe its effects in oral and maxillofacial surgery.

Use of Deproteinized Bovine Bone in Association with Calcium Sulphate for Alveolar Socket Preservation.

Background: The aim of this retrospective study was to compare the histomorphometry of post-extractive sites previously grafted with deproteinized bovine bone, with or without the association of a calcium sulphate preparation. Methods: The retrospective evaluation comprehended patients previously selected and treated for the extraction of one or more mono-radicular teeth, followed by an implant-prosthetic rehabilitation. Post-extractive sites had been randomly assigned to test or control group, respectively, if deproteinized bovine bone was used in association with a calcium sulphate preparation or alone. In both cases, a collagen membrane was employed to cover the grafted area. After four months, a biopsy of regenerated bone was taken from all grafted sites and then processed for histomorphometric analysis. Results: Of 24 samples analyzed 4 months after extraction, vital bone was present in 62.5% of cases for the test group and in 31.25% for the control group. Acellular bone was respectively found in 5% of cases for the test group and in 32.91% for the control group. Both these differences were statistically significant (p < 0.05) between groups. Conclusions: Calcium sulphate in association with deproteinized bovine bone seems to promote proper vital bone formation, with less acellular bone compared to deproteinized bovine bone used alone. Socket preservation procedures with the use of specific osteoconductive materials improve the maintenance of width and height of remaining bone. Findings of the present study offer clinicians a predictable protocol for preserving vital bone in early healing of post-extraction sites, slowing down the resorption process at the same time.

Evaluating the effectiveness of cone-beam computed tomography reverse contrast images in the diagnosis of vertical root fractures: An in vitro pilot study

Abstract Introduction: The aim of this study is to investigate the effectiveness of cone-beam computed tomography (CBCT) reverse contrast images in the diagnosis of vertical root fractures (VRFs). Materials and Methods: In this study, 20 single-canal premolar teeth without cracks and internal resorption were selected and after root canal treatment, divided into two: experimental and control groups. In each of the teeth in the experimental group, an artificial fracture was created with the SANTAM device, then the teeth of both groups were randomly placed in the dental sockets of a dry mandible, and after preparing CBCT images of the teeth, the images were processed by reverse contrast software. Initial and reverse contrast images were examined by two radiologists and two endodontists. The data were analyzed by SPSS software version 22. Results: Observers reported higher sensitivity and positive and negative predictive value in normal contrast images than in reverse contrast images, but the specificity reported by endodontists in reverse contrast images was slightly higher than in normal contrast images. In comparing the results of radiologists and endodontists, there was a significant agreement in the review of the initial images (κ =0/59), but there was no significant agreement in the images with reverse contrast (κ = −0/1). There was not any notable distinction observed in the assessment of normal and reverse contrast images among the observers, nor in the comparison between radiologists and endodontists, except for the examination of normal contrast images by the two groups of radiologists and endodontists (P = 0.00). From this, it can be inferred that the diagnostic power of reverse contrast images in identifying VRFs is inferior to that of normal contrast images (P &gt; 0.05). Conclusion: According to the obtained results, it was concluded that reverse contrast CBCT images are not effective in diagnosing VRFs and cause error in diagnosis.

Allocation of Scattered Teeth From a Batavia 1629 Communal Grave

ABSTRACTWhen the Dutch ship Batavia wrecked in 1629 on Morning Reef in the Houtman Abrolhos Islands off the coast of Western Australia, most of the passengers and crew survived the wreck, but about 200 of the survivors later perished on and around Beacon Island where they had landed after the wreck. As many as 81 bodies may be buried on Beacon Island and 21 bodies have been excavated to date. During the 2017–2018 excavations, seven of the buried individuals were excavated from a communal grave. During the excavation, 18 teeth were found scattered in the soil around the bodies. A systematic method is presented to allocate isolated teeth to their appropriate skeleton using tooth morphology and tooth wear as the primary criteria for allocation. Tooth wear must be similar to the adjacent and opposing dentition before the tooth is considered for allocation. If the wear is similar, the tooth is gently fitted into the proposed tooth socket. The fit of the tooth in the tooth socket is visually assessed, and if close, the tooth is radiographed in situ to confirm the allocation. Each separated tooth must be tested in all the sites to which it is appropriate. If a tooth fits more than one site, it cannot be allocated. Use of this method allowed allocation of 10 separated teeth in 28 possible sites. The possible cause of the separation of teeth from the skeleton is discussed.

Swelling Misattributed to an Infected Tooth Socket

This is a case report of a patient seen on the dental emergency clinic that describes ophthalmic shingles reactivation soon after a tooth extraction with the potential to have led to a misdiagnosis of the condition. This can potentially have serious consequences, including effects on vision. This case report emphasizes the importance of a thorough history and careful examination when a patient presents in an urgent setting. CPD/Clinical Relevance: The importance of a thorough history and careful examination is highlighted.

Local Single-Dose Teriparatide Administration for BRONJ Prevention: Insights from a Rat Model Study.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents significant clinical challenges with uncertain treatment outcomes. Teriparatide, a fragment of human parathyroid hormone, shows potential in prevention strategies for BRONJ. This study investigates the impact of a single local dose of teriparatide on BRONJ prevention in an animal model. BRONJ was induced on 26 male Wistar rats via intraperitoneal injections of 0.06mg/kg Zoledronic acid weekly for four weeks. Following tooth extraction under general anesthesia, rats were divided into two groups: one received teriparatide via Gelatamp in the tooth socket and the other as a local injection in the vestibule. Control groups received the treatment without teriparatide. Histopathological assessments for bone remodeling, osteoclast number, inflammation, angiogenesis, and necrosis were performed after four weeks. Histopathological analysis indicated a significant improvement in bone remodeling and new bone formation in both treatment groups compared to controls, with notably better outcomes in the injection group (p = 0.01). Necrosis in the Gelatamp group was significantly higher in the control group than in the treatment group (p = 0.01), and bone formation was significantly higher in the injection group compared to the Gelatamp group (p = 0.03). Local administration of teriparatide significantly enhances bone remodeling and reduces necrosis, suggesting a potential role in the prevention of BRONJ. These findings support further clinical investigation into teriparatide as a preventive strategy against BRONJ.

Immediate implantation of simple taper retentive implants in chronic apical infected teeth in the posterior region: a 5-year clinical observation.

This study aims to evaluate the mid- and long-term clinical efficacies of simple taper retentive implants for immediate placement in chronic apical infected teeth in the posterior region. A total of 36 patients with 41 simple taper retentive implants were included in the study conducted. These patients underwent immediate implant treatment for teeth with chronic apical infection in the posterior region. The soft and hard tissues surrounding the implants were assessed and documented over a period of 5 years following the completion of crown restoration. During the 5 years follow-up period, one implant failed with mobility, and the implant survival rate was 97.6%. The mean marginal bone resorption was (-0.74±1.03) mm from the immediate post-implant placement to the immediate post-crown restoration, and the difference in marginal bone heights between the two time points was statistically significant (P<0.05). The mean marginal bone resorption was (-0.21±0.70) mm from the immediate post-crown restoration to the 5-year post-crown restoration, and the difference in marginal bone height between the two time points was not statistically significant (P>0.05). No significant difference (P>0.05) was observed in bone resorption between mesial and distal, maxillary and mandibular, different tooth positions, and different implant lengths. The soft tissue surrounding the implants remained healthy at the 5 years follow-up period, one implant exhibited peri-implantitis, and no mechanical complications were observed. The overall satisfaction of patients was good. Immediate placement of simple taper retentive implants after thorough debridement of chronic infected alveolar socket in the posterior region can achieve good mid- and long-term clinical outcomes after 5 years of loading. The soft and hard tissues were maintained in a steady state, which expanded the indications for immediate implantation.

Replantation of young permanent teeth: Techniques and Management of traumatic pulp exposure

Introduction: Dental traumatology is one of the most challenging pediatric treatment aspects. Avulsion of young permanent teeth is a rare and serious traumatic dental injury that needs immediate and complex management. Tooth avulsion is a severe dental trauma defined by complete displacement of the tooth out of its alveolar socket. The primary approach to managing such cases is tooth replantation. The management of replanting the tooth according by the guideline such as the extra oral time which should be very short, the time of pulp removal after replantation, and the appropriate storage medium. Case History: A 9-year-old male presented with history of fall from the slide he played and injuries sustained to the maxillary region. He was referred to the IGD RSKGM-P Airlangga Surabaya and complained that his upper tooth was loose from its socket around 2 hours of trauma. The tooth was soaked in normal saline. Discussion: The optimal treatment option following an avulsion injury is to replant the avulsed tooth immediately. The duration of the extraoral period and the storage conditions of the tooth significantly influence the prognosis. The prognosis for avulsion injuries is highly dependent on timely intervention, appropriate treatment planning and techniques, and effective emergency management. Post-replantation, regular monitoring is essential to assess for ankylosis, resorption, mobility, and vitality of the tooth. Conclusion: Successful replantation of young permanent teeth with traumatic pulp exposure relies on timely intervention, proper technique, and careful postoperative management.

Justifying the method chosen for bone bed preparation for immediate dental implantation

Despite the progress achieved in dental implantation, the problems of reducing the number of complications after implants placement and increasing their service life remain relevant. It is known that inflammatory complications that arise after intraosseous dental implantation serve as a serious aggravating factor affecting the stability and safety of the implant, which creates unfavorable conditions for further prosthodontics.The aim of the study is to conduct a comparative analysis of the different-method effectiveness of dental alveoli preparation based on molecular-genetic microbiological research.Research methods: clinical, molecular genetic, microbiological.A comparative analysis of the different-method effectiveness of dental alveoli preparation based on the results of a molecular genetic microbiological study is presented in the research. A mandatory stage of sanitation of the operating area is found by the presented research results. The mechanical method using a spherical bur and a physiodispenser, the piezosurgical method using a spherical nozzle with a diamond coating can be a method of choice for dental alveoli preparation.

Dental pulp stem cell‑derived extracellular vesicles loaded with hydrogels promote osteogenesis in rats with alveolar bone defects.

Alveolar bone defects caused by inflammation, trauma and tumors adversely affect periodontal health, causing tooth loosening or dentition defects, thus affecting denture or implant repair. Advancements in tissue engineering technology and stem cell biology have significantly improved the regenerative reconstruction of alveolar bone defects. The multiple trophic activities of extracellular vesicles (EVs) produced by mesenchymal stem cells play important roles in exerting their therapeutic effects. Several studies have reported the role of dental pulp stem cells (DPSCs) in bone regeneration, but the regenerative effects of DPSC‑EVs on alveolar bone defects are unclear. In the present study, the osteogenic effects of DPSC‑EVs on Hertwig's epithelial root sheath (HERS) cells in vitro and their osteoinductive effects in an alveolar bone defect rat model were investigated. The results showed that DPSC‑EVs significantly promoted the expression of osteogenic genes, such as runt‑related transcription factor 2 and alkaline phosphatase, and increased the osteogenic differentiation capability of HERS. These findings suggested that transforming growth factor β1 inhibition decreased DPSC‑EV‑induced Smad, MAPK and ERK phosphorylation in HERS. In vivo, DPSC‑EV‑loaded hydrogels were transplanted into the alveolar sockets of Sprague‑Dawley rats and observed for eight weeks. The new bone grew concentrically in the DPSC‑EV or DPSC‑EV‑loaded hydrogel group, with greater bone mass than that in the control group, and the bone volume/total volume increased notably. The results confirmed the osteogenic and osteoinductive effects of DPSC‑EVs and DPSC‑Exo‑loaded hydrogels on alveolar bone defects. Due to their low immunogenicity, high stability, good biocompatibility and osteogenic propensity, DPSC‑EV‑loaded hydrogels are a safe cell‑free therapeutic approach for defective alveolar bone regeneration.