Bone Dimensional Changes Research Articles

Alveolar Ridge Preservation With Fibro-Gide or Connective Tissue Graft: A Randomized Controlled Trial of Soft and Hard Tissue Changes.

The aim of this study was to evaluate the effectiveness of a novel biomaterial (FG) for alveolar ridge preservation compared to CTG in terms of soft tissue thickness and bone dimensional changes. A randomized clinical trial was conducted on 30 patients who required extraction of 30 hopeless mandibular posterior teeth. All patients went through atraumatic tooth extraction, and then, they were randomly allocated to either a CTG, an FG, or a spontaneous healing (SH) group (1:1:1). All patients received a dental implant placed 6 months postoperatively. The soft tissue thickness and bone dimensional changes were measured before and 6 months after the procedure. The study's analysis revealed statistically significant differences in buccal gingival thickness and dimensional bone changes across the three examined groups after 6 months (p < 0.05). The SH group had lower gingival thickness (1.31 ± 0.65 mm) and higher vertical resorption (-1.46 ± 1.67 mm at the buccal aspect) compared with the CTG and FG groups. The CTG and FG groups had similar gingival thickness (2.42 ± 0.70 and 3.00 ± 0.71 mm, respectively) and bone width reduction (+0.86 ± 2.31 and +0.93 ± 2.38 mm, respectively), whereas the CTG group had lower vertical bone loss (-0.30 ± 1.09 mm at the buccal aspect) than the FG group (-0.47 ± 2.30 mm at the buccal aspect). FG and CTG demonstrate equivalent soft tissue thickness and comparable horizontal bone dimension outcomes in ARP.

Alveolar Ridge Preservation Procedures Performed with 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 postextraction changes. This case series evaluates the bone regenerative properties of a freeze-dried bone allograft (FDBA) and the clinical outcomes of implants in grafted extraction sites. A total of 33 patients were enrolled, undergoing single/multiple tooth extractions followed by ARP. Biopsy samples were harvested during implant placement for histologic and histomorphometric analysis. Clinical outcomes included marginal bone loss and pink esthetic score (PES). Twenty-five patients completed the study. FDBA-augmented sockets exhibited new bone formation adjacent to graft particles. Implants (n = 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 = .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. This case series provides valuable insights into ARP performed with FDBA (as 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 follow-up period.

Efficacy of the application of leukocyte and platelet-rich fibrin (L-PRF) on alveolar ridge preservation. A randomized controlled clinical trial.

Alveolar ridge preservation (ARP) is a well-defined treatment performed to reduce bone dimensional changes occurring during the healing of post-extraction sockets to allow for adequate implant placement. Leukocyte and platelet-rich fibrin (L-PRF) has been showing to potentially promote bone and tissue regeneration during wound healing. Therefore, the aim of this study is to evaluate its efficacy for ARP when applied to fresh extraction sockets, in comparison with spontaneous healing. Twenty-seven patients with hopeless non-molar teeth were treated. After randomization, fresh extraction sockets were either filled with L-PRF or allowed to heal spontaneously. CBCTs and intraoral scans were obtained immediately after extraction and at 4 months. Through superimposition of the obtained images, changes in the horizontal ridge width, height, buccal volume, and ridge contour changes were measured, as well as patient-reported outcome measures (PROM's). The ridge dimensions changed similarly in both groups. Although less reduction occurred in the test group at 1 mm from the bone crest, differences were not statistically significant (p > 0.05). Application of L-PRF did not prevent reductions of ridge contours, neither in the linear vertical aspect nor in volumetric changes. There were no differences between groups in the need for bone regeneration when placing implants. Patients in both groups reported similar outcomes in terms of bleeding, pain, inflammation, and function at 1 and 4 weeks postoperatively. Alveolar preservation with L-PRF neither minimized bone resorption occurring after tooth extraction in non-molar sites nor reduced the need for bone regeneration when placing implants. Furthermore, its use did not improve PROM's.

Dimensional changes of peri-implant tissue following immediate flapless implant placement and provisionalization with or without xenograft in the anterior maxilla: a study protocol for a randomized controlled trial

BackgroundDental implant therapy requires the preservation of peri-implant tissue in the cosmetic zone. Various surgical procedures have been presented, including ridge preservation, flapless method, and quick provisionalization. The goal of this research was to assess the buccal bone dimensional changes following immediate flapless implant implantation in the front maxilla, with or without xenografting.Method and designThirty patients who meet the inclusion criteria and have maxillary teeth (numbers 14 to 24) are candidates for the immediate implant with immediate provisionalization. Participants will be assigned randomly to one of two groups: (1) an immediate implant with xenograft and (2) an immediate implant without bone grafting. For 3 months, the temporary prosthesis will be installed shortly before the final restoration. Following temporary prosthesis insertion and 6 months after surgery, a CBCT radiograph will be used to examine bone tissue. Soft tissue will be assessed at three points: baseline, 3 months, and 6 months following implant therapy. Patients’ satisfaction, implant failure, prosthesis failure, and complications will be assessed as secondary outcomes after 6 months.DiscussionThe outcomes of this randomized clinical research will show if buccal bone augmentation with xenograft reduces vertical bone and gingiva recession. The findings and patient-reported outcomes will aid in the selection of therapy alternatives for implant treatment patients.Trial registrationIranian Registry of Clinical Trials IRCT20211119053106N1. Registered on 6 December 2021 and Open Science Framework (OSF) on May 20, 2022. Registration DOI https://doi.org/10.17605/OSF.IO/VUGFQ.

Evaluation of alveolar Bone dimensional Changes after flapless immediate implant placement

Evaluation of alveolar Bone dimensional Changes after flapless immediate implant placement

Alveolar ridge preservation with guided bone regeneration or socket seal technique. A randomised, single-blind controlled clinical trial.

ObjectivesTo compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket healing (Control).Material and methodsPatients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n= 14/). Cone Beam Computed Tomography (CBCT) images were recorded post‐extraction and at 4 months, the mid‐buccal and mid‐palatal alveolar ridge heights (BARH/PARH) were measured. The alveolar ridge width, cross‐sectional socket and alveolar‐process area changes, implant placement feasibility, requirement for bone augmentation and post‐surgical complications were also recorded.ResultsBARH and PARH was found to increase with the SS (0.65 mm ± 1.1/0.65 mm ± 1.42) techniques, stabilise with GBR (0.07 mm ± 0.83/0.86 mm ±1.37) and decrease in the Control (−0.52 mm ± 0.8/−0.43 mm ± 0.83). Statistically significance was found when comparing the GBR and SS BARH (p = .04/.005) and GBR PARH (p = .02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (−2.17 mm ± 0.84), when compared to the Control (−2.3 mm ± 1.11) (p = .89). A mid‐socket cross‐sectional area reduction of 4% (−2.27 mm2 ± 11.89), 1% (−0.88 mm2 ± 15.48) and 13% (−6.93 mm2 ± 8.22) was found with GBR, SS and Control groups (GBR vs. Control p = .01). The equivalent alveolar process area reduction was 8% (−7.36 mm2 ± 10.45), 6% (−7 mm2 ± 18.97) and 11% (−11.32 mm2 ± 10.92). All groups supported implant placement, with bone dehiscence noted in 57% (n = 4), 64%(n = 7) and 85%(n = 12) of GBR, SS and Control cases (GBR vs. Control p = .03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown.ConclusionGBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.

A novel approach to assess volumetric bone loss at immediate implant sites and comparison to linear measurements: A pilot study

ObjectivesStudies have evaluated changes in hard tissue following immediate implant placement (IIP) through cone beam computed tomography (CBCT) imaging. This study compared the 3D volumetric changes of the alveolar bone at immediate implant sites with 2D linear measurement outcomes by using a novel image analysis workflow. MethodsPreoperative and 6-month postoperative CBCT images of patients who underwent IIP and bone grafting in the maxillary esthetic area were acquired. Linear and volumetric measurements of buccal bone dimensions were taken using a specially designed workflow. The 2D and 3D measurements were compared, and their correlations were determined. ResultsImages from 13 patients (13 implants) were analyzed. Linear measurements revealed that the general linear buccal bone loss was less than 1mm in all segments. The 3D volumetric bone reduction (reported as median [first quantile, third quantile]) in the vertical, cervical, middle, and apical segments was 14.27 [11.33, 30.66] mm3 (51.30 [42.78, 66.91]%), 16.20 [10.35, 30.52] mm3 (18.20 [9.88, 24.74]%), 17.48 [8.42, 21.17] mm3 (24.05 [12.39, 28.22]%), and 6.87 [3.88, 9.45] mm3 (11.34 [5.14, 22.54]%), respectively. Significant positive correlations between 2D and 3D measurements were consistently identified in the cervical and middle segments, but no significant correlation was noted in the vertical segment. ConclusionsThe results revealed that linear measurements could not fully represent volumetric bone dimensional changes. Performing volumetric measurements and 3D rendering could be valuable in presenting the actual amount and topography of peri-implant bone remodeling. Clinical SignificanceLinear measurements only partially represent the real-life event of 3D bone changes at immediate implant sites. Factors affecting hard tissue alterations following IIP should be reassessed using 3D volumetric measurement outcomes.

Comparative Evaluation of Bone Dimensional Changes in Extraction Sockets Preserved With Calcium Phosphosilicate Bone Substitutes With and Without Platelet-Rich Fibrin: A Randomized Controlled Clinical Trial.

This study aimed to evaluate the bone dimensional changes associated with extraction sockets preserved with calcium phosphosilicate (CPS) morsels and platelet-rich fibrin (PRF) at 6 months posthealing. Thirty fresh extraction sockets were randomly allocated to one of the following groups and grafted using PRF: Control (n = 10), CPS morsels (Test I; n = 10), or CPS+PRF (Test II; n = 10). All sites were sealed with PRF as a socket seal. CBCT scans were taken at 1 week postsurgery and at 6 months posthealing. The intergroup comparison showed a statistically significant difference in mean horizontal bone dimensional changes, and no such significance was observed for vertical bone changes. Bone density measured using Hounsfield units (HU) fell within the range of 350 to 850 HU (D3 bone quality) at 6 months posthealing for all three groups. Within the limitations of this study, socket preservation using CPS morsels with and without PRF demonstrated more favorable conditions for future implant placement.

The Ti-Mesh Technique: Guided Bone Regeneration for Three-Dimensional Augmentations. Clinical Aspects: A Case Series.

This article presents the surgical aspects of, and evaluates bone dimensional changes following, the application of the guided bone regeneration (GBR) technique using individualized titanium mesh on atrophied alveolar ridges to achieve an optimal crest volume for implant placement. Six patients were included and evaluated clinically and radiologically for at least 3 years. Every patient presented bone resorption affecting implant placement in a proper prosthetic position. During the regenerative procedure, customized titanium mesh was used to secure the contour of the augmented site and the stability of xenograft particles deposited on the atrophied crest. After 6 months of healing, the mesh was removed, and implants were placed in planned, prosthetic positions. CBCT scans were taken before the regenerative procedures and after 6 months, before the second-stage surgeries. This allowed for assessment of the postaugmentation vertical and horizontal bone tissue gain. The average volumetric gain of the augmented sites was 5.2 mm horizontally and 2.75 mm vertically. In 50% of cases, minor soft tissue perforation was observed after a few weeks. This complication did not influence the implant placement procedure and was treated during the second-stage procedure with the GBR technique, using a resorbable membrane and xenograft particles to compensate the localized bone defect. No implant failed during the control period. Panoramic radiographs were taken 1 to 3 years after completion of definitive prosthetic treatment to assess potential bone resorption around implants. No crestal bone resorption was observed within this period. It can be concluded that the use of customized titanium mesh is a predictable technique for bone regeneration in advanced, three-dimensional defects.

Bone Dimensional Change Following Immediate Implant Placement in Posterior Teeth with CBCT: A 6-Month Prospective Clinical Study.

This prospective clinical study aimed to evaluate the peri-implant hard tissue dimensional change at 6 months of immediate implant placement with bone graft materials in the posterior area using cone-beam computed tomography (CBCT). Twelve dental implants were placed concurrently following tooth extraction in the posterior area and filled with xenograft particles. The CBCT images were taken immediately after surgical procedures and then at 6 months follow-up. To evaluate the hard tissue changes, the vertical and horizontal bone thickness were analyzed and measured using ImageJ software. Paired t-test or Wilcoxon match-pair signed-rank test was done to analyze the changes of hard tissue values at the same level between immediately and 6 months following immediate implant placement. Independent t-test or Mann–Whitney U test was used to analyze the dimensional change in the vertical and horizontal direction in buccal and lingual aspects. The level of significance was set at p value = 0.05. All implants were successfully osseointegrated. At 6 months follow-up, the vertical bone change at the buccal aspect was −0.69 mm and at the lingual aspect −0.39 mm. For horizontal bone thickness, the bone dimensional changes at 0, 1, 5, and 9 mm levels from the implant platform were −0.62 mm, −0.70 mm, −0.24 mm, and −0.22 mm, respectively. A significant bone reduction was observed in all measurement levels during the 6 months after implant placement (p value < 0.05). It was noted that even with bone grafting, a decrease in bone thickness was seen following the immediate implant placement. Therefore, this technique can be an alternative method to place the implant in the posterior area.

Buccal bone dimensional changes at immediate implant sites in the maxillary esthetic zone within a 4-12-month follow-up period: A systematic review and meta-analysis.

To evaluate the changes in buccal bone dimensions (CBD) following immediate implant placement in the maxillary esthetic zone and to identify the factors influencing the degree of buccal bone resorption for different placement and restoration protocols. An electronic search was conducted using the EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE (PubMed) databases, combined with a manual and gray literature search, up to January 2021. Selected clinical studies had to report the changes in horizontal buccal bone dimension in maxillary immediate implantation sites (premolar to premolar) at baseline and at follow-up visits within a year of implantation. A meta-analysis was conducted to calculate the mean value of the changes in horizontal and vertical buccal bone dimensions (CHBD and CVBD) around implants. To further investigate the heterogeneity and identify factors associated with buccal bone loss after immediate implant placement, subgroup analysis and univariate meta-regression were performed. From a total of 3498 articles, 4 randomized controlled trials and 12 nonrandomized controlled trials were included for analysis. The mean survival rate of 568 implants was 99.6%. The mean CHBD and CVBD values were 0.71 mm (95% confidence interval: [0.56, 0.86]) and 0.58 mm (95% confidence interval: [0.43, 0.72]), respectively. For possible factors that related to bone resorption, including buccal bone thickness, flap design, bone grafting, horizontal defect dimension, and restoration protocol, bone grafting was the only variable that significantly influenced CHBD. This study demonstrated that immediate implant placement in the esthetic zone does not prevent buccal bone from resorption. Due to data heterogeneity and the small sample size of the studies included in the analysis, further well-conducted, randomized controlled trials with homogeneous samples are required to investigate the correlation of CBD with different variables.

Immediate Implant Placement in Maxillary Esthetic Zone without Augmenting the Jumping Gap versus the Use of Autogenous Bone Particulates or Demineralized Bovine Bone Graft (Randomized Clinical Trial)

Aim: to assess Immediate Implant Placement in Maxillary Esthetic Zone without Augmenting the Jumping Gap versus the Use of Autogenous Bone Particulates or Demineralized Bovine Bone Graft. Material and Methods: This was a Randomized parallel controlled clinical trial conducted on 30 implant sites that indicated immediate implant placement in the maxillary esthetic zone divided into 3 groups equally: In group (A): immediate implants were inserted in the esthetic maxillary zone with no graft in the jumping gap. In group (B): immediate implants were inserted in the esthetic maxillary zone with demineralized bovine bone mineral (DBBM) in the jumping gap. In group (C): immediate implants were inserted in the esthetic maxillary zone with autogenous bone graft in the jumping gap. CBCT scans were performed immediately after the surgery and 6 months later for measuring horizontal bone changes at 3 levels (platform, mid implant, and apex level) of the labial plate of the bone and vertical bone changes labial and palatal plate of bone. Results: The mean horizontal bone loss at platform level was 1.57±0.283mm, 0.845±0.167 mm, and 1.226 mm at groups A (graft less group), B (xenograft group), and C (autogenous group) respectively. While at mean mid implant level was 1.155±0.3 mm,0.754±0.185 mm, and 0.829±0.31 mm at group A (graft less group), B (xenograft group) & C (autogenous group) respectively. Conclusion: the use of DBBM as a graft in the jumping gap showed the least bone dimensional changes compared to no graft and autogenous bone graft group in immediate implant placement.

Three dimensional changes of alveolar bone after flapless immediate implant placement

Objectives The aim of this study was to evaluate clinically and radiographically alveolar Bone dimensional Changes after flapless immediate implant placement. Material and methods: Thirty-two Patients were divided into two groups; Group A (control group): received flapped immediate implants combined with xeno graft. Group B (Test group): received flapless immediate implants combined by xeno-graft. Evaluation includes Presence of infection.Wound dehiscence. Implant exposure. Graft exposure or loss. Soft tissue dehiscence. Implant stability. Buccal bone height and lingual bone height of the extracted socket. Ridge width. Results: buccal bone height, flapless group showed a significant lower (0.09 mm)Change than flap (1.13 mm).Ridge width, at 2, 4, 6 mm, flapless group showed a significant lower Change than flap. Flapless group showed significant higher implant stability than flap. Conclusion:the flapless group has shown a lower reduction in height and width after placing immediate implants and filling the residual gap with an organic bovine bone. More ridge reduction was observed for the flapless group.

Clinical efficacy of simvastatin gel combined with polypropylene membrane on the healing of extraction sockets: A triple-blind, randomized clinical trial.

This study aimed to evaluate dimensional changes, level of soft tissue healing, and pain/discomfort perception in post-extraction sockets filling with 1.2% simvastatin (SIM) gel covered with polypropylene membranes (PPPM). Twenty-six post-extraction sockets of posterior teeth were randomly allocated in two groups: (a) socket filling with 1.2% SIM gel and covered with PPPM (n=13) and (b) socket filling with placebo gel and covered with PPPM (n=13). Cone-beam computed tomography (CBCT) images before and 90days after the extraction enabled alveolar bone dimensional changes calculation using horizontal and vertical measurements. The measurements occurred at three different levels for thickness located 1, 3, and 5mm from the top of the bone crest. The vertical (depth) measure was assessed from the most apical portion of the socket to the bone crest's most coronal portion. Seven days after the extractions, the level of soft tissue healing and pain perception were also analyzed. After 90days of extractions, the dimensional changes in thickness in the test group were significantly smaller in sections A (p=.044), B (p=.036) and C (p=.048) when compared to the control group. The test group showed a significantly lower height-dimensional change than the control group (p<.0001). Soft tissue healing index (p=.63), perception of pain (p=.23), and number of analgesics consumed (p=.25) were similar between groups. Simvastatin at 1.2% compared with placebo effectively reduced the dimensional changes in post-extraction sockets covered with PPPM. There was no significant difference in the level of soft tissue healing and postoperative pain between the test and control groups.

Changes in alveolar bone morphology after traction of buccally vs palatally unilateral maxillary impacted canines: A cone-beam computed tomography study

The objective of this study was to evaluate the 3-dimensional changes in alveolar bone morphology after traction of buccally vs palatally unilateral maxillary impacted canines (MIC). Following a split-mouth model, 27 cone-beam computed tomography images of unilaterally MIC (14 palatally and 13 buccally) and 27 contralateral unimpacted controls were obtained before and after traction using nickel-titanium closed-coil springs and a rigid anchorage appliance. Alveolar bone height and width were measured in the axial, coronal, and sagittal slides by 3 calibrated orthodontists, taking into account the impaction characteristics. A t test was used to compare the 2 groups, and a paired t test was applied for intragroup comparisons (both sides). A multiple linear regression model was used to evaluate the influence of the predictor variables on alveolar bone dimensional changes. The alveolar height showed a significantly greater decrease in palatally MIC (2.09 to 2.79mm) than buccally MIC (0.28 to 0.57mm)(P<0.05) for all surfaces. However, the alveolar width increased similarly in both groups up to 1.36mm. In general, the affected side had a more significant height loss and greater increases in alveolar width than the nonaffected side. Regression analysis indicated that buccally MIC and age decreased alveolar changes, whereas female sex increased alveolar changes (P<0.05). MIC traction with nickel-titanium closed-coil springs and heavy anchorage induces significant 3-dimensional changes in alveolar bone characterized by alveolar bone height decreases and cervical alveolar bone width increases. The height decrease is greater in palatally than in buccally MIC.

DIODE LASER PHOTOCOAGUALTION AS A NOVEL METHOD FOR SOCKET SEALING DURING ALVEOLAR SOCKET PRESERVATION

Introduction: Socket preservation is a procedure after tooth extraction to limit the post-extraction reduction of the ridge volume. Non-contact laser photocoagulation is a simple and atraumatic method used for socket sealing. Objectives: Compare the effect of diode laser photocoagulation to the non-resorbable dense polytetraflouoroethylene (dPTFE) membrane on the bone dimensional changes. Materials and methods: Thirty-six patients (n =18 for each group) with non-restorable maxillary anterior or premolar teeth were included in this study. After extraction, sites were grafted with deproteinized bovine bone xenograft and sealed either with laser photocoagulation or a non-resorbable dPTFE membrane. Measurements of the alveolar bone width were performed on cone beam computed tomographs, taken at the baseline before extraction and after 4 months. Results: Both groups showed a reduction in bone width. At the crest, the mean amount of reduction was 0.69 (0.33) mm and 0.78 (0.15) mm for the laser and membrane groups, respectively. As for the middle third, less amount of reduction was observed by a mean of 0.56 (0.36) mm and 0.58 (0.18) mm for the laser and membrane groups, respectively. The least amount of reduction was in the apical third with a mean of 0.26 (0.36) mm and 0.41 (0.17) mm for the laser and membrane groups, respectively. However, this reduction in bone dimensions was insignificant between both groups. Conclusion: The laser photocoagulation is as effective as the dPTFE membrane in sealing sockets after grafting.

Alveolar Ridge Preservation Utilizing Composite (Bioceramics/Collagen) Graft: A Cone-Beam Computed Tomography Assessment in a Randomized Split-Mouth Controlled Trial

Background: The vast percentage of the alveolar bone resorption process happens within the first 12 to 24 weeks post extraction; however, this phenomenon is chronic, and the alveolar ridge continues to resorb. In order to prevent this reduction or at least recompense the loss of bone dimensions, the alveolar ridge preservation (ARP) technique was developed. Objectives: This research studied the vertical and horizontal bone dimensional changes as a result of non-molar teeth extraction alone against extraction with alveolar ridge preservation utilizing composite (bioceramics/collagen) graft by cone-beam computed tomography radiographies analyses. Material and Methods: This research was a randomized split-mouth controlled trial. 12 patients need extraction of the maxillary non-molar teeth were enrolled and allocated into 2 groups. 12 sockets after atraumatic extraction were filled with a composite graft in the role of the test group, 12 sockets left to unassisted healing after atraumatic extraction without any graft materials in the role of the control group. Two CBCT radiographs were taken at baseline and at 4 months after extraction for comparison. Both vertical and horizontal resorptions of the alveolar ridge were analyzed between test and control group by CBCT radiographs. Results: 4 months after extraction, there was a mean of vertical alveolar bone resorption compared with the baseline (0.56 ± 0.15 mm) in the test group and (1.47 ± 0.30 mm) in the control group. Whereas it was a mean of horizontal alveolar bone resorption compared with the baseline (0.90 ± 0.16 mm) in the test group and (2.26 ± 0.30 mm) in the control group. Therefore, there was a significant difference between the two groups. Conclusions: Within the limitations of this research, we demonstrated that the osteogen-plug technique significantly decreased the reduction of the bone dimensional in comparison to the tooth extraction alone, and showed that the dimensional change of the alveolar ridge after tooth extraction was minimized by using an osteogen-plug.

Effect of enamel matrix derivative on alveolar ridge preservation in the posterior maxilla: A randomized controlled clinical trial.

EMD has been considered to exert positive effects on wound healing, postoperative discomfort, and bone regeneration. The aim of this randomized controlled clinical trial was to investigate and compare (a) horizontal and vertical bone dimensional changes, (b) early postoperative discomfort and soft tissue wound healing outcomes, and (c) treatment modalities for implant placement, following posterior maxillary alveolar ridge preservation (ARP) with and without adjunctive use of EMD. Twenty-eight participants were randomly assigned to three groups: extraction sockets filled with bovine bone mineral and membrane with EMD (test group 1, n = 10) and without EMD (test group 2, n = 10) and spontaneous healing (control group, n = 8). Alveolar bone dimensional changes were measured using cone-beam computed tomography 5 months after ARP, and postoperative pain and wound healing outcomes were also evaluated. There were no significant differences in horizontal or vertical bone dimensional changes between test groups 1 (horizontal width changes at 1 mm apically below the alveolar ridge crest [HW]: -1.44 ± 0.54 mm) and 2 (HW: -1.42 ± 0.26 mm), but the changes at HW (-2.36 ± 1.03 mm) in the control group were significantly greater than those in test groups 1 and 2 (P < .05). Early postoperative discomfort and soft tissue wound healing outcomes were not significantly different between the two test groups. Furthermore, unlike the control group, both the test groups 1 and 2 were implanted without sinus floor elevation using the lateral approach. Within the limitations of this study, EMD failed to provide additional benefits in ARP in the posterior maxilla.

A cone-beam computed tomographic evaluation of alveolar bone dimensional changes and the periodontal limits of mandibular incisor advancement in skeletal Class II patients.

To evaluate the presence of dehiscences and changes in alveolar bone height and width in the area of the mandibular central incisors pre- and post-orthodontic treatment. In 60 skeletal Class II patients, cone-beam computed tomographic (CBCT) images were obtained and the patients were divided into four groups based on the presence of dehiscences at pre- and post-orthodontic treatment. The alveolar bone height and width were measured on CBCT in cross section along the long axis of the teeth. Lateral cephalograms were analyzed. The changes in L1-NB and IMPA appeared to be correlated with vertical bone loss and dehiscence. Alveolar bone height appeared to follow a segmented relationship with these two variables, with changes below a threshold (L1-NB = 0.71 mm, IMPA = 3.02°) having relatively minimal or no effect on bone loss but with changes beyond the threshold correlated with extensive bone loss. Similarly, increases in L1-NB or IMPA correlated with decreases in alveolar bone width (L1-NB: -0.25 mm/mm, IMPA: -0.07 mm/°) and increased the probability of developing dehiscences, with an estimated 50% probability of vertical bone loss at a L1-NB change of 2.00 mm or, equivalently, an IMPA change of 8.02° was estimated. When treating skeletal Class II patients, the limits of incisor proclination/protraction are less than previously thought. To prevent undesired periodontal outcomes, careful three-dimensional diagnosis is advisable. Furthermore, when excessive protrusion and/or proclination is planned, additional treatment modalities, including orthognathic surgery, tooth extraction, and corticotomy with bone graft, should be considered.

A prospective cohort study of immediate implant placement into posterior compromised sockets with or without primary wound closure of reactive soft tissue.

Conventional wisdom states that reactive soft tissue consisting of granulation tissue and long junctional epithelium in compromised sites should be curetted completely, while others approve of its preservation in implant surgeries. To evaluate the presence of reactive soft tissue as wound closure for immediate implantation in posterior compromised sockets. Thirty-three implants were included in this study: (a) experimental group (EG), the reactive soft tissue was raised as the primary wound closure for the implant; (b) control group (CG), the reactive soft tissue was also elevated but failed to cover the site. Implants were inserted immediately after the tooth extraction. The bone dimensional changes were observed instantly after surgery (T1) and 6 months later (T2) by cone beam computed tomography. Soft tissue alterations were evaluated before tooth extraction (T0), at prosthesis delivery and at 1-year follow-up (T3). Measurements of marginal bone level (MBL) was obtained at the time of prosthesis placement and at T3. In all, 100% implant survival was reported during the study period. The buccal bone height and width of keratinized mucosa decreased less in the EG compared to the CG. At the 1-year follow-up, MBL and soft tissue changes were not significantly different between the two groups. Within the limitations of this study, the presence of reactive soft tissue as primary closure may contribute to hard-soft tissue augmentation during immediate implants into posterior compromised sockets.