Buccal Plate Research Articles

Anti-resorptive effect of pamidronate on extraction socket wall in dogs.

The aim of this experimental in vivo investigation was to assess the anti-resorptive effect of low concentration pamidronate on the buccal plate in fresh extraction sockets. The distal roots of the third premolars were extracted bilaterally in six dogs. A collagen matrix loaded with either pamidronate (test group) or saline (control group) was positioned on the outer surface of buccal bone immediately after tooth extraction and subsequently covered with a coronally advanced flap. Histological and histomorphometric outcomes were evaluated 12weeks later. The mean vertical distance between the buccal and lingual bone crest differed significantly between the test and control groups (0.52±0.43 and 2.21±1.15mm, respectively; p=.037). The width of the buccal bone 1mm below the crest was significantly wider in the test group than the control group (4.68±0.68 vs. 3.44±0.60mm, p<.001). Local application of pamidronate onto a collagen matrix may reduce the dimensional changes of the buccal bone plate both vertically and horizontally.

Dento-alveolar measurements and histomorphometric parameters of maxillary and mandibular first molars, using micro-CT.

Micro-CT is a high-resolution, non-invasive, and non-destructive imaging technique, currently acknowledged as a gold standard modality for assessing quantitatively and objectively dental morphology and bone microarchitecture parameters. The aim of this study was to analyze critical dental and periodontal measurements characterizing the mandibular (MandFM) and maxillary (MaxFM) first molar architecture, as well as the corresponding bony socket, using micro-CT. Thirty-eight human dried skulls (22-76 years) were scanned to enable the virtual analysis of 61 first molars. Depending on the type of measurement, the parameters were recorded on two-dimensional sections or directly on three-dimensional models. Tooth morphology was described by four aspects (e.g., tooth width, trunk length, root length, and root span), while the socket architecture was assessed by buccal plate thicknesses and bone density measurements. Minimum, maximum, and mean distances as well as cortical and trabecular bone densities were recorded in MandFM and MaxFM. It is noteworthy that the buccal plate thickness was found to be less than 1 mm in more than 55% of cases in MaxFM, whereas only in 20.8% of cases in MandFM (and even 0% at two sites). A wide range of bone densities was observed and the comparison between MandFM and MaxFM did not show a significant difference. Furthermore, cortical densities were negatively correlated with aging, while trabecular densities were not influenced. Using micro-CT, three-dimensional aspects of the human first molar morphology and microstructural parameters of the surrounding bone were evaluated in the mandible and in the maxilla. These comprehensive measurements and their correlation with aging may be of great importance for the use of immediate implant placement in molar extraction sockets and thus the potential long-term success of this treatment modality.

Evaluation of the effects of miniscrew incorporation in palatal expanders for young adults using finite element analysis

ObjectiveThe aim of this study was to evaluate the stress distribution and displacement of various craniofacial structures after nonsurgical rapid palatal expansion (RPE) with conventional (C-RPE), bone-borne (B-RPE), and miniscrew-assisted (MARPE) expanders for young adults using three-dimensional finite element analysis (3D FEA).MethodsConventional, bone-borne, and miniscrew-assisted palatal expanders were designed to simulate expansion in a 3D FE model created from a 20-year-old human dry skull. Stress distribution and the displacement pattern for each circumaxillary suture and anchor tooth were calculated.ResultsThe results showed that C-RPE induced the greatest stress along the frontal process of the maxilla and around the anchor teeth, followed by the suture area, whereas B-RPE generated the greatest stress around the miniscrew, although the area was limited within the suture. Compared with the other appliances, MARPE caused relatively even stress distribution, decreased the stress on the buccal plate of the anchor teeth, and reduced tipping of the anchor teeth.ConclusionsThe findings of this study suggest that the incorporation of miniscrews in RPE devices may contribute to force delivery to the sutures and a decrease in excessive stress on the buccal plate. Thus, MARPE may serve as an effective modality for the nonsurgical treatment of transverse maxillary deficiency in young adults.

Split crest technique: a solution for atrophic anterior maxilla – case report

The rehabilitation of atrophic anterior maxilla can be done by different techniques. Among the procedures for bone augmentation, we can use block grafting, guided bone regeneration, and split crest technique (SCT). SCT consists in bone crest osteotomy, followed by manual/mechanical expansion up to the splitting of the buccal plate from the lingual/palatal plate through greenstick fracture. SCT advantage is the possibility of simultaneously installing a dental implant. However, SCT planning should consider the remaining bone width and the the flap type to obtain success. Objective: To report a case of implant-supported rehabilitation of an atrophic anterior maxilla using the split crest technique with insertion of 4 immediate implants, showing the effectiveness of the technique.

Bone grafting and osseointegration in the area of maxillary tooth agenesis. Case report

ABSTRACTThe high dental implant success rate is directly linked to the presence of adequate bone volume, which enables and maintains the osseointegration of dental implants. This study aimed to report a clinical case of a female with agenesis of the right maxillary lateral incisor (#12), due to cleft lip and palate.Because the bone and mucosal defects of the area, the treatment planning comprised guided bone regeneration with the association of autogenous bone, platelet rich plasm (PRP), and expanded polytetrafluoroethylene membrane (e-PTFE,Gore-Tex), performed in 2005. After nine months, a new evaluation was carried out and revealed that the area was still not suitable for implant placement. Thus, an allogenous bone graft was planned. Elapsed another nine months, the implant was placed. After six months, the implant was reopened and a metal-ceramic crown was installed. The 5-year following-up appointment showed the presence of fistula with purulent secretion at the buccal cortical plate. We attempted to control the fistula with antibiotics and follow-up clinically and radiographically. The examinations suggested a communication with the right nasal cavity, which decreased until nowadays. The osseointegrated dental implant was in function, without symptomatology. The autogenous bone graft is still more effective than allogenous bone graft. Further studies are necessary to achieve better evaluations. KeywordsBone graft; Dental implant; Osseointegration.

Is Bone Graft or Guided Bone Regeneration Needed When Placing Immediate Dental Implants? A Systematic Review.

To systematically review the effect and type of bone graft and guided bone regeneration around immediate implants on hard and soft tissue changes. Three electronic databases were searched up to June 2015. Outcomes consisted of hard and soft tissue dimensional changes. Eight studies were included according to inclusion criteria. Immediate implants with bone grafting had superior soft tissue stability and preserved horizontal ridge dimension and buccal plate thickness, when compared to no grafting. The use of a barrier alone significantly decreased buccal plate resorption and the remaining defects around the implants, and the use of both bone graft and membrane aided in soft tissue preservation. The optimal type of bone graft material was a combination of cortical autogenous and synthetic particulate when compared to each separately, whereas no difference was found between demineralized allograft and hydroxyapatite in decreasing bone loss. Quantitative data analysis was not possible due to heterogeneity of the included studies. Further randomized clinical trials with homogenous samples and proper controls are needed to support the results of this report.

The Application of Ridge Splitting Procedure in Severely Atrophied Maxillary Alveolar Ridge: Case Reports

When tooth is extracted because of deep caries, severe periodontal disease, trauma etc., alveolar ridge resorption happen inevitably. Alveolar ridge resorption after tooth extraction makes implant placement difficult. To overcome these alveolar bone deficiencies, additional procedures such as GBR, Block bone graft, Ridge splitting or Distraction osteogenesis is needed. In case of severe horizontal bone loss (Seibert classification, Class I), implant placement is usually done with Block bone graft or GBR procedure. Unlike these two procedures, the ridge splitting converts non-contained defect to contained defect that are favorable to be healed. Also ridge splitting have advantages such as the maintenance of buccal plate and rapid healing by the strong local metabolism. In these two cases, it is ascertained that implant placement with ridge splitting procedure is effective in the severely atrophied alveolar ridge.

Gongylonema Parasites of Rodents: A Key to Species and New Data on Gongylonema neoplasticum.

Specimens of the genus Gongylonema were collected from the gastric mucosa of rodents of Rattus rattus Linnaeus, 1758, and Rattus norvegicus Berkenhout, 1769, collected in urban areas in Belém, Pará, in the eastern Brazilian Amazon. The helminths were processed for analysis using light microscopy and scanning electron microscopy (SEM) techniques and presented taxonomic characteristics of the species Gongylonema neoplasticum. The SEM analyses revealed the presence of 2 developed buccal plates (1 dorsal, 1 ventral), also called interlabia, with a prominent and bifurcated ventral plaque. The occurrence of the bifurcated ventral interlabium had not yet been identified by any other author from G. neoplasticum. As a result of our extensive research on published data on Gongylonema spp., we propose a taxonomic key for species of this genus that parasitize rodents. This is the first record of G. neoplasticum in urban areas of the Brazilian Amazon.

Buccal Plate Preservation with Immediate Implant Placement and Provisionalization: 5-Year Follow-Up Outcomes.

Despite socket preservation and/or immediate implant placement, resorption of the buccal plate after dental extraction continues to pose esthetic challenges to clinicians. Buccal plate preservation (BPP) is a technique that has been recently proposed with an aim to reduce the incidence of such resorption. This study was conducted to assess the long-term efficacy of BPP in maintaining the thickness of the buccal cortical plate after immediate implant insertion and provisionalization. Ten consecutive patients were included in this study. Each patient underwent extraction of a non-restorable tooth, BPPPBPP, single immediate implant placement and immediate provisionalization. Cone beam CT scans were taken 3months after surgery (T1) and 5years after surgery (T2) to evaluate the effectiveness and longevity of the BPPPBPP technique in maintaining the augmented bone width. Two distinct measurements were taken for bone evaluation: (a) R1: 1mm apical to the implant platform and (b) R2: 5mm apical to the implant platform. The long axis of the implant was used as a fixed reference. Statistical test analysis was conducted using the SPSS software. Student's t test was used to assess statistical significance, and a p value of <0.05 was considered significant. There were six females and four males in the study. The mean age of the sample was 37.6years (range 23-64years). At T1, the mean bone thickness of the buccal plate was found to be 2.36mm at R1 (range: 1.9-3.1), and 2.23 at R2 (range: 1.9-3). At the T2 interval, the mean thickness of the plate was 2.28mm at R1 (range: 1.7-3) and 2.18 at R2 (range: 1.9-3). The differences in these mean values were not statistically significant. BPPPBPP is an effective means for augmentation and maintenance of the buccal cortical plate around an immediately placed and provisionalized dental implant. It is a viable alternative to socket preservation with the added benefit that it allows for immediate implant placement.

Gingival Perfusion and Tissue Biomarkers During Early Healing of Postextraction Regenerative Procedures: A Prospective Case Series.

Postextraction alveolar bone loss, mostly affecting the buccal plate, occurs despite regenerative procedures. To better understand possible determinants, this prospective case series assesses gingival blood perfusion and tissue molecular responses in relation to postextraction regenerative outcomes. Adults scheduled to receive bone grafting in maxillary, non-molar, single-tooth extraction sites were recruited. Clinical documentation included the following: 1) probing depth (PD); 2) keratinized tissue width (KT); 3) tissue biotype (TB); and 4) plaque level. Wound closure was clinically evaluated. Gingival blood perfusion was measured by laser Doppler flowmetry (LDF). Wound fluid (WF) and gingival biopsies were analyzed for protein levels and gene expression, respectively, of relevant molecular markers. Bone healing outcomes were determined radiographically (cone-beam computed tomography). Healing was followed for 4 months. Data from 15 patients are reported. Postoperatively, neither complications nor changes in PD, KT, or TB were observed. LDF revealed decreased perfusion followed by hyperemia that persisted for 1 month (P ≤0.05). WF levels of angiopoietin-2, interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and vascular endothelial growth factor peaked on day 6 (P ≤0.05) and decreased thereafter. Only IL-8 and TNF-α exhibited increased gene expression. Linear bone changes were negligible. Volumetric bone changes were minimal but statistically significant, with more bone loss when membrane was used (P = 0.05). Gingival blood perfusion after postextraction bone regenerative procedures follows an ischemia-reperfusion model. Transient increases in angiogenic factor levels and prolonged hyperemia characterize the soft tissue response. These soft tissue responses do not determine radiographic bone changes.

Morphological Characteristics and Classification of Mandibular First Molars Having 2 Distal Roots or Canals: 3-Dimensional Biometric Analysis Using Cone-beam Computed Tomography in a Korean Population

IntroductionThe aim of this study was to determine the morphologic characteristics of mandibular first molars having 2 canals in distal roots. Interorifice distance, buccal bone thickness, and root curvature were evaluated using cone-beam computed tomography images in a Korean population. MethodsIn total, 1958 mandibular first molars were evaluated in axial, coronal, sagittal, and paraxial planes. Distal roots having 2 canals were classified according to their root and canal shapes (2 roots, 2 canals [2R2C]; 1 root, 2 canals with 2 apical foramina [1R2C(2-2)]; and 1 root, 2 canals with 1 apical foramen [1R2C(2-1)]). The distances between orifices and the distance from the apex to the buccal bone plate were measured for each root canal shape (2R2C, 1R2C[2-2], and 1R2C[2-1]). The curvature of distolingual (DL) roots was classified according to severity using 3-dimensional reconstructed images, and the direction of curvature was determined. The relationships of these characteristics to sex and side were evaluated. ResultsThe prevalences of 2R2C, 1R2C(2-2), and 1R2C(2-1) were 25.89%, 10.32%, and 14.15%, respectively. The distances between distobuccal (DB) and DL orifices were 3.77 ± 0.74 mm for 2R2C, 3.02 ± 0.65 mm for 1R2C(2-2), and 2.44 ± 0.64 mm for 1R2C(2-1). The distances from the buccal plate to the DB canal were 3.84 ± 1.35 mm for 2R2C, 5.33 ± 1.41 mm for 1R2C(2-2), and 5.96 ± 1.63 mm for 1R2C(2-1). The distance from the buccal plate to the DL canal was 9.85 ± 1.46 mm for 2R2C, and 8.28 ± 1.50 mm for 1R2C(2-2). All distances differed significantly according to root canal configurations, and all were greater in men than women (P < .05), except for the DB-DL orifice distance in 1R2C(2-2) and the DB to buccal cortical plate distance in all root configurations (P > .05). No significant difference between the left and right sides was found (P > .05). The prevalence of most severely curved DL roots (type III) was 62.92%, and the direction was commonly toward the buccal side (69.03%). ConclusionsThe prevalence of mandibular first molars having 2 canals in distal roots was more than 50% in a Korean population. Interorifice distances between DB and DL canals and distances from the apex to the buccal cortical plate differed according to root and canal numbers and shapes.

Commentary: Cone-Beam Computed Tomography: An Essential Technology for Management of Complex Periodontal and Implant Cases.

Commentary: Cone-Beam Computed Tomography: An Essential Technology for Management of Complex Periodontal and Implant Cases.

Immediate implant placement after dental extraction with loss of the buccal plate. A retrospective study

Immediate implant placement after dental extraction with loss of the buccal plate. A retrospective study

The Efficacy of Immediate Implant Placement in Extraction Sockets for Alveolar Bone Preservation

The aim of this study was to determine the efficacy of immediate implant placement with alveolar bone augmentation on socket preservation following atraumatic tooth extraction and comparing it with a tooth alveolar socket that was allowed to heal in a conventional way.Twenty medically fit patients (8 males and 12 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of mandibular premolar teeth were divided randomly and equally into 2 groups. In Group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In Group II, the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilized bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. Cone beam computerized tomography images of the alveolar ridge and socket were analyzed to determine the structural changes of the alveolar ridge. Resonance frequency analysis was measured at 9 months for Group II to assess the degree of secondary stability of the implants by using Osstell machine.A significant difference of bone resorption of 1.49 mm (confidence interval, CI 95%, 0.63-2.35) was observed within the control group at 3 months, and 1.84 mm (P ≤ 0.05) at 9 months intervals. No significant changes of bone resorption were observed in Group II. Comparison between groups showed a highly significant difference at 3 months; 2.56 mm (CI 95% 4.22-0.90) and at 9 months intervals; 3.2 mm (CI 95%, 4.70-1.62) P ≤ 0.001 between Group I and II. High resonance frequency analysis values were observed at 9 months postoperative in Group II.In conclusion, the insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.

Morse Taper Implants Immediately Loaded in Fresh Extraction Sockets: A Prospective Cohort Study.

To evaluate survival rate and bone response around immediate loaded Morse taper implants installed in fresh sockets on the anterior area of the maxilla. The sample comprised 16 patients in whom 16 single implants were installed. All the teeth were extracted in a flapless surgery. Radiographic and tomographic evaluations were performed immediately after surgery (T1) and after 12 months (T2). The variables studied were height of the buccal wall (HBW), buccal wall width (BW) at 3 levels, and proximal bone height at 2 different areas: the alveolar crest level (CLH) and at the point where bone tissue meets the implant surface (BIS). Statistically significant differences were observed. The buccal plate showed bone loss in height (HBW = -0.50 ± 0.42 mm) and in width (BW-1 = -0.71 ± 0.48 mm; BW-2 = -0.48 ± 0.34 mm; BW-3 = -0.48 ± 0.34 mm). In the proximal areas, there was also bone loss in height (CLH-M = -0.85 ± 0.89 mm; BIS-M = -0.91 ± 0.70 mm; CLH-D = -0.64 ± 0.57 mm; and BIS-D = -0.68 ± 0.62 mm). There was 100% survival rate after a 12-month period, but bone loss was observed in all evaluated areas.

Efficacy of collagen matrix seal and collagen sponge on ridge preservation in combination with bone allograft: A randomized controlled clinical trial.

To test whether the use of collagen matrix seal (CMS) results in similar hard and soft tissue remodelling to that with collagen sponge (CS) used as barriers 4months following alveolar ridge preservation (ARP), in combination with freeze-dried bone allograft (FDBA). Twenty-eight patients were randomly assigned to the two groups. Clinical and radiographic measurements were recorded with the same stent at baseline and 4months for standardization. The flapless technique following a traumatic extraction was used for the two types of barriers. All patients completed the study, 14 in the CMS group and 14 in the CS group. Reduction in coronal ridge width (1.21mm-14.91% CMS and 1.47mm-20.40% CS) and vertical buccal bone resorption (0.30mm CMS and 0.79mm CS) were not significantly different. A slight increase in buccal gingival thickness at the coronal part was observed in both groups (0.9mm CMS and 0.5mm CS). Collagen matrix seal and CS, when combined with FDBA, significantly minimized ridge resorption in all dimensions and maintained buccal soft tissue thickness in sockets with a buccal plate loss of <2mm in comparison to previously reported findings recorded after tooth extraction without ARP.

Bilateral dentigerous cyst involving mandibular first molars- a case report

Dentigerous cyst is one of the common odontogenic cysts and they are associated with unerupted or impacted teeth. However, multiple dentigerous cysts are rare and they are usually associated with syndromes such as basal cell nevus syndrome, mucopolysaccharidosis (type VI) or cleidocranial dysplasia. Very few cases of multiple dentigerous cysts involving first permanent molars are reported. This report is of a rare case of bilateral dentigerous cyst involving mandibular first molars in a non- syndromic 7 year old male patient. A provisional diagnosis of a dentigerous cyst was given based on clinical finding of missing 36 and 46 with buccal cortical plate expansion and presence of a pericoronal radiolucency attached to the CEJ irt to 36 and 46 on panoramic image. The computed tomographic finding revealed a well defined expansile cystic lesion in right and left mandibular molar regions. Enucleation of the cyst with extraction of 36 and 46 was done and the specimen was sent for histopathological examination which confirmed the diagnosis of dentigerous cyst.

Alveolar Bone Morphology Following Periodontally Accelerated Osteogenic Orthodontics: A Clinical and Radiographic Analysis.

The aim of this study was to analyze alveolar bone morphology following periodontally accelerated osteogenic orthodontics. Treated patients were called for a full periodontal examination and a cone beam computed tomography scan. Mean treatment time was 6.08 months. Mean probing pocket depth was 2.7 mm. No gingival recessions were noted. In the maxilla, buccal plate thickness was 0.48 to 2.14 mm. In the mandible, bone thickness was 0.2 to 1.82 mm. Root fenestrations and dehiscences were present in up to 40% of the anterior teeth. Although clinical outcomes were favorable, due to the presence of multiple posttreatment bone fenestrations and dehiscences, a revision of the treatment protocol might be considered.

Retracted Article: Use of CBCT in Orthodontics- A Review

The article stands retracted due to double submission by the author Dr. Aakash Shah . It is quite regretful that such authors waste the time and resources of the journal. View the email sent by Dr. Aakash below. Lateral cephalometric radiographs are most commonly used as a diagnostic tool in orthognathic surgery as well as orthodontic treatment. But the limitation of lateral cephalograms is its 2 dimensional nature whereas the human body is 3 dimensional. Conventional 2D lateral cephalograms have numerous drawbacks in terms of investigating the changes in the alveolar bone and roots, particularly in the anterior region, as a consequence of the midsagittal projection. Additionally its accuracy is questionable as it has projection errors. The use of computed tomography in 3D imaging of human body is available in the field of medicine since last 30 years. CT scanning is the three dimensional imaging technique giving quantitative assessments of the buccal and lingual cortical bone plates and labiolingual width of alveolar bone with elevated accuracy and precision. But the use of computed tomography in dentistry is limited because the amount of radiation exposure with this technology is very high. Since the invention of Cone Beam Computed Tomography, the amount of radiation exposure in the patient is reduced. This enhances its use in obtaining the 3D images of the craniofacial structures. This technology helps in visualizing the hard and soft tissues of the craniofacial structures from various perspectives and helps in thorough diagnosis and treatment planning of orthognathic surgery and orthodontic patients. The principles of CBCT and its use in the field of orthodontics will be discussed in detail in this paper.

Simultaneous Implant Placement and Guided Bone Regeneration Using a Platelet‐Rich Fibrin Membrane: Case Report

Introduction: Ridge deformities in implant sites are common challenges that clinicians face. Great benefits, including reduced treatment cost and time, can be achieved if simultaneous implant placement and guided bone regeneration are feasible. This case report presents an innovative approach using platelet‐rich fibrin (PRF) and autografts to correct an atrophic ridge in conjunction with implant placement.Case Presentation: A 48‐year‐old male patient lost a molar tooth due to severe chronic periodontitis. Because of severe and active infection, socket augmentation was not feasible at the time of tooth extraction, resulting in prominent bone loss in the buccal plate. After implant placement, an autograft was applied for ridge augmentation along with a PRF membrane serving as a barrier. There were no adverse events during healing. An implant prosthesis was delivered 8 months postoperatively. After 1 year of function, both clinical and radiographic examinations revealed promising and stable treatment outcomes.Conclusion: Within the limitations of this case report, application of a PRF membrane may be a feasible approach to serve as a barrier membrane when performing simultaneous implant placement and ridge augmentation procedures.