Healing Of Extraction Sockets Research Articles

Transplantation of Noncultured Stromal Vascular Fraction Cells of Adipose Tissue Ameliorates Osteonecrosis of the Jaw-Like Lesions in Mice.

The precise pathoetiology and effective treatment strategies for bisphosphonate-related osteonecrosis of the jaw (BRONJ) remain unknown. Transplantation of noncultured stromal vascular fraction (SVF) cells has been shown to be a useful method for regenerative medicine in place of stem cell therapy. This study investigated the effects of noncultured SVF transplantation on tooth extraction socket healing in mice. Both chemotherapeutic/bisphosphonate combination therapy for 7 weeks and tooth extraction of maxillary first molars at 3 weeks after drug administration were performed using female C57BL/6J mice. Osseous and soft tissue wound healing were validated at 4 weeks postextraction using gross wound healing and histomorphometry. Here, we created a new animal model of high-prevalence ONJ-like lesions that mimic human progression, because human ONJ mainly occurs in female patients taking both chemotherapeutic and bisphosphonate following tooth extraction. Moreover, mice with chemotherapeutic and bisphosphonate combination therapy for 5 weeks received SVF transplantation just after tooth extraction at 3 weeks post-drug administration. Euthanasia was performed at 2 weeks postextraction to assess the transplantation effects on wound healing using gross wound healing, histomorphometry, immunohistomorphometry, quantitative real-time polymerase chain reaction, and microcomputed tomography. We showed that systemic transplantation of noncultured SVF cells ameliorates ONJ-like lesions by improving both osseous and soft tissue healing of tooth extraction sockets. SVF therapy significantly increased blood vessels and the ratio of M2/M1 macrophages. In addition, SVF transplantation reduced the increases in tartrate-resistant acid phosphatase-positive (TRAP+ ) mononuclear cells (MNCs) and nonattached osteoclasts from the bone surface, which were significantly detected in the connective tissue of tooth extraction sockets and bone marrow by chemotherapeutic/bisphosphonate combination therapy. Our findings suggest that transplantation of noncultured SVF cells is a suitable treatment for BRONJ. Abnormal TRAP+ MNCs and nonattached osteoclasts in systemic and local environments may contribute to the development of BRONJ. © 2017 American Society for Bone and Mineral Research.

Long-term therapy with intravenous zoledronate increases the number of nonattached osteoclasts

The purpose of this study was to investigate the influence of long-term therapy with intravenous zoledronate (ZA) on the healing of extraction sockets in rats. Forty rats, divided into groups C (Control) and Z (Zoledronate), received intravenous injections of either saline solution or ZA for 24 weeks. Their right maxillary incisor was extracted. Euthanasia was performed at 7 or 28 days postoperative. Histomorphometric (Newly Formed Bone Area) and immunohistochemical (RANKL, OPG and TRAP) analyses were performed. Data were statistically analyzed (ANOVA, Tukey's test and Kruskal–Wallis, Dunn's Multiple Comparison test).Groups C and Z showed similar new bone area, RANKL and OPG immunolabeling. The number of TRAP-positive multinucleated cells was significantly higher in Group Z than in Group C at 28 days. A significantly higher proportion of nonattached osteoclasts were seen in Group Z than in Group C at both periods of analysis. Long-term therapy with intravenous ZA stimulated nonattached osteoclast formation in extraction sockets in rats, thus decreasing local bone resorption. However, it did not influence bone formation by osteoblasts.

UNIQUE CLINICAL PRESENTATIONS OF DEEP FUNGAL INFECTIONS INVOLVING THE ORAL CAVITY: A REPORT OF TWO CASES AND REVIEW OF THE LITERATURE

Oral alterations associated with systemic fungal infections typically present as chronic mucosal ulceration or granular soft tissue overgrowth, mimicking malignancy. We report two cases of deep fungal infections exhibiting unusual oral findings. Case 1: A 73-year-old male presented with one-month history of bilateral ulcerations of the oral commissures, with significant involvement of the perioral facial skin. With a clinical diagnosis of angular cheilitis and to exclude malignancy, incisional biopsy was performed. Histopathologic evaluation showed chronically inflamed granulation tissue and staining by the GMS method revealed numerous yeast forms, consistent with Histoplasma capsulatum. Systemic itraconazole (400 mg daily) resulted in uneventful resolution. Case 2: A 49- year-old male presented for evaluation of a non- healing extraction socket of the posterior mandible. The patient's medical history was significant for renal cell carcinoma recently treated with complete nephrectomy of the affected kidney. A large, ulceroproliferative soft tissue mass was noted in association with the extraction socket, with mobility of the adjacent dentition. Together with an ill-defined radiolucency on panoramic radiograph, concern was raised for metastatic disease. Incisional biopsy showed subacutely inflamed granulation tissue supporting numerous multinucleated giant cells in association with occasional large yeasts, consistent with Blastomyces dermatitidis. While uncommon, deep fungal infections may involve oral and maxillofacial structures, including both soft tissues and gnathic bones. Vigilance regarding this diagnostic consideration can support timely diagnosis and proper treatment.

Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study.

AimThe aim of this study was to evaluate clinically and radiographically, extraction socket healing using autologous platelet rich fibrin (PRF).Materials and methodsTwenty-four subjects needing single tooth simple extractions were selected. Twenty-four extraction sockets were divided into test group (PRF, n = 12) and control group (blood clot, n = 12). PRF was prepared with blood drawn from individuals after extraction using standard technique. PRF was placed in test group sockets followed by pressure application and figure 8 sutures. Sockets in control group were allowed to heal in the presence of blood clot and received a figure 8 suture. Ridge width was assessed using cast analysis with the help of acrylic stent and a pair of calipers. Radiographic analysis of socket surface area was performed using computer graphic software program. The clinical follow up assessments were performed at 1, 4 and 8 weeks. Collected data was assessed using ANOVA and multiple comparisons test.ResultsSubjects were aged between 25 and 50 (mean 37.8) years, including 15 females. The mean horizontal ridge width for sockets in the test group were 11.70 ± 2.37 mm, 11.33 ± 2.30 mm and 10.97 ± 2.33 mm at 1, 4 and 8 weeks respectively. Ridge width proportions were significantly higher among test group as compared to control group between baseline to 4 and 8 weeks respectively. The mean radiographic bone fill (RBF) percentage in the test group, was 74.05 ± 1.66%, 81.54 ± 3.33% and 88.81 ± 1.53% at 1, 4 and 8 weeks respectively. The mean RBF was significantly higher in the test group than control group at all time intervals.ConclusionThe study outcomes demonstrate that the use of PRF accelerate socket wound healing after tooth extraction as noticed by increased bone fill and reduced alveolar bone width resorption using clinical and radiographic methods.

Regenerative properties of collagenated porcine bone grafts in human maxilla: demonstrative study of the kinetics by synchrotron radiation microtomography and light microscopy.

Recently, it has been reported that heterologous biomaterials, where the collagen matrix is preserved, seem to facilitate blood clotting and the subsequent invasion of repairing and regenerative cells. This study aimed at evaluating the healing of human extraction sockets grafted with a collagenated cortico-cancellous porcine bone (mp3®, OsteoBiol®, Tecnoss®, Giaveno, Italy) by synchrotron radiation X-ray microtomography (microCT) and histology in order to have a 3D quantitative characterization over time. Ridge preservation with porcine bone and collagen membrane was performed on 21 patients using a flapless approach and a secondary soft tissue closure. At the time of implant placement, six bone samples were harvested, two in the 3-month group, two in the 6-month group, one in the 12-month group post-surgery, and one spontaneously healed control, and evaluated by microCT and histology. MicroCT revealed that in the grafted sites there were a greater number of trabeculae, although they appeared thinner than in the control sites; these trabeculae homogenously filled the defects, suggesting an improved strength of the socket. Histology showed that over time, the amount of biomaterial decreased and the newly formed bone increased, while less dense bone with wider marrow spaces was detected in the control sample, supporting synchrotron findings. The morphometric data converge to indicate the suitability of porcine bone for the preservation of post-extraction sockets. The use of mp3 is encouraged to preserve and heal sockets.

Oncologic doses of zoledronic acid induce site specific suppression of bone modelling in rice rats.

To examine the effect of zoledronic acid (ZOL) on cortical bone modelling and healing of extraction sockets in the jaw bones of a rodent model. We hypothesized ZOL suppresses both the bone formation in the modelling mode in the jaw bones and alters the extraction site healing. Rice rats were administered saline solution and two dose regimens of ZOL: 0.1mg/kg, twice a week, for 4weeks (n=17, saline=8 & ZOL=9) and a higher dose of 0.4mg/kg, weekly, for 9weeks (n=30, saline=15 & ZOL=15). Two pairs of fluorochrome bone labels were administered. Extraction of maxillary teeth was performed in maxilla. Mineral apposition rate, mineralizing surface and bone formation rate (BFR) were quantified on periodontal (PDL), alveolar and basal bone surfaces, and in the trabecular bone of proximal tibia. Bone volume (BV) was evaluated at extraction sockets. Multivariate Gaussian models were used to account for repeated measurements, and analyzes were conducted in SAS V9.3. ZOL suppressed bone modelling (BFR/BS) at the PDL surfaces in the mandible (P<.05), but its effect was not significant at the periosteal surfaces of both jaws. BV for the healing sockets of ZOL treated animals was not significantly different (P=.07) compared to the saline group. ZOL suppressive effect was higher in the tibia compared to the jaws. ZOL severely suppresses coupled remodelling in the tibia, and the suppression of bone formation in the modelling mode in the jaws demonstrates the site specific effects of ZOL in rice rats.

Radiographic and Histological Evaluation of the Healing of Extraction Sockets Filled With Bovine-Derived Xenograft: An Experimental Study in Rats.

To evaluate the microenvironment changes in the sockets substituted with bovine-derived xenografts during the early healing period. After extraction of the right maxillary incisor of Sprague Dawley rats, 48 rats were randomly divided into 2 groups. The extraction sockets of the test group were filled with Bio-Oss, whereas the control group was allowed to heal without intervention. The bone quality of the extraction sockets was observed through micro-CT and immunohistochemistry. Micro-CT scanning showed that the bone mineral density in the test group was significantly higher than that in the control group during the early healing period, whereas immunohistochemistry showed that the bone formation-related factors were significantly different between the test and control groups. The bovine-derived xenografts may interfere with the healing process of the extraction socket in the early healing stage. Bone formation of the extraction socket was delayed after grafting with bone substitute.

Healing of extraction socket following local application of simvastatin: A split mouth prospective study

BackgroundThe role of simvastatin in lowering serum cholesterol level is well described. However, recent findings suggest they have a role in bone formation as well. Aim and objectivesThe present prospective study was conducted to evaluate the efficacy of simvastatin on bone formation in extraction sockets. Materials and methods15 patients undergoing all four first premolar extraction were selected based on inclusion and exclusion criteria. Extraction sockets of left premolars (24 and 34) were considered as cases and right premolars (14 and 44) as controls. Overall 30 extraction sites were assigned to each group. Atraumatic extraction was done in all cases following which simvastatin mixed with gelatin sponge was placed in extraction socket of 24 and 34 while only gelatin sponge was placed in 14 and 44. All sockets were then closed with 3-0 vicryl. The patients were kept on follow-up and complications such as dry socket, pain, and swelling were recorded. Intra oral peri apical radiographs were taken immediately after extraction and at 2nd month and 4th month to record changes in the density of alveolar bone. The radiographic measurements were compared and the differences were statistically analyzed. ResultPercent increase in bone density at the end of 8th week and 16th week was significantly high in case as compared to the control group. ConclusionLocal application of simvastatin induces bone formation in extraction sockets. Application is very simple and provides a very cost effective way of faster bone regeneration following tooth extraction.

A novel image processing technique for 3D volumetric analysis of severely resorbed alveolar sockets with CBCT.

The aim of this study was to present and validate a novel procedure for the quantitative volumetric assessment of extraction sockets that combines cone-beam computed tomography (CBCT) and image processing techniques. The CBCT dataset of 9 severely resorbed extraction sockets was analyzed by means of two image processing software, Image J and Mimics, using manual and automated segmentation techniques. They were also applied on 5-mm spherical aluminum markers of known volume and on a polyvinyl chloride model of one alveolar socket scanned with Micro-CT to test the accuracy. Statistical differences in alveolar socket volume were found between the different methods of volumetric analysis (P<0.0001). The automated segmentation using Mimics was the most reliable and accurate method with a relative error of 1.5%, considerably smaller than the error of 7% and of 10% introduced by the manual method using Mimics and by the automated method using ImageJ. The currently proposed automated segmentation protocol for the three-dimensional rendering of alveolar sockets showed more accurate results, excellent inter-observer similarity and increased user friendliness. The clinical application of this method enables a three-dimensional evaluation of extraction socket healing after the reconstructive procedures and during the follow-up visits.

Absorbable collagen sponges loaded with recombinant bone morphogenetic protein 9 induces greater osteoblast differentiation when compared to bone morphogenetic protein 2.

The use of growth factors for the regeneration of soft and hard tissues has been utilized extensively in dental medicine over the past decade. Recently our group found that recombinant human bone morphogenetic protein 9 (rhBMP9) was more osteopromotive than recombinant human bone morphogenetic protein 2 (rhBMP2) when combined with a deprotenized bovine bone mineral bone grafting material. The aim of the present in vitro study was to evaluate the regenerative potential of an absorbable collagen sponge(ACS) specifically designed for extraction socket healing loaded with rhBMP9 when compared to rhBMP2. The adsorption and release kinetics of rhBMP2 and rhBMP9 were first investigated by enzyme‐linked immunosorbent assay quantification. Then, the cellular effects of stromal cell line (ST2) preosteoblasts were investigated utilizing four groups including rhBMP2 and rhBMP9 at both low(10 ng/ml) and high(100 ng/ml) concentrations loaded onto ACS. Cellular attachment(8 hours) and proliferation(1, 3, and 5 days) as well as osteoblast differentiation were investigated by real‐time polymerase chain reaction (PCR) at 3 and 14 days, alkaline phosphatase (ALP) activity at 7 days, and alizarin red staining at 14 days. ACS fully adsorbed both rhBMP2 and rhBMP9 that were slowly released up to 10 days. Although neither rhBMP2 nor rhBMP9 had any effects on cell attachment or proliferation, pronounced effects were observed on osteoblast differentiation. ALP activity was increased seven‐fold with rhBMP2‐high, whereas a marked 10‐fold and 20‐fold increase was observed with rhBMP9‐low and high loaded to ACS, respectively. Furthermore, mRNA levels of collagen1, ALP, bone sialoprotein, and osteocalcin were all significantly higher for rhBMP9 when compared to control or rhBMP2 groups. Alizarin red staining further confirmed that rhBMP9‐low and high demonstrated marked increases in mineralization potential when compared to rhBMP2‐high. The results demonstrate the marked effect of rhBMP9 on osteoblast differentiation when combined with ACS in comparison to rhBMP2 at doses as much as 10 times lower. Further in vivo studies are necessary to investigate whether the regenerative potential is equally as potent.

Periodontal and endodontic pathology delays extraction socket healing in a canine model.

PurposeThe aim of the present exploratory study was to evaluate extraction socket healing at sites with a history of periodontal and endodontic pathology.MethodsThe mandibular 4th premolar teeth in 5 adult beagle dogs served as experimental units. Periodontal and endodontic lesions were induced in 1 premolar site in each animal using wire ligatures and pulpal exposure over 3 months (diseased sites). The contralateral premolar sites served as healthy controls. The mandibular 4th premolar teeth were then extracted with minimal trauma, followed by careful wound debridement. The animals were sacrificed at days 1, 7, 30, 60, and 90 post-extraction for analysis, and the healing patterns at the healthy and diseased extraction sites were compared using radiography, scanning electron microscopy, histology, and histometry.ResultsDuring the first 7 days of healing, a significant presence of inflammatory granulation tissue was noted at the diseased sites (day 1), along with a slightly accelerated rate of fibrin clot resolution on day 7. On day 30, the diseased extraction sites showed a greater percentage of persistent fibrous connective tissue, and an absence of bone marrow formation. In contrast, healthy sites showed initial signs of bone marrow formation on day 30, and subsequently a significantly greater proportion of mature bone marrow formation on both days 60 and 90. Radiographs exhibited sclerotic changes adjoining apical endodontic lesions, with scanning electron microscopy showing collapsed Volkmann canals protruding from these regions in the diseased sites. Furthermore, periodontal ligament fibers exhibited a parallel orientation to the alveolar walls of the diseased sites, in contrast to a perpendicular arrangement in the healthy sites.ConclusionsWithin the limitations of this study, it appears that a history of periodontal and endodontic pathology may critically affect bone formation and maturation, leading to delayed and compromised extraction socket healing.

EVALUATION OF THE BONE REGENERATION EFFICACY OF MAGNESIUM BIOACTIVE GLASS VERSUS ZINC BIOACTIVE GLASS BOTH LOADED WITH BONE MORPHOGENETIC PROTEIN-2 IN EXTRACTION SOCKETS OF DIABETIC ALBINO RATS

Background: Delayed wound healing is one of the major complications of diabetes. The aim of the present study was to enhance bone regeneration in extraction sockets of diabetic rats through controlled release of bone morphogenetic protein-2 (BMP-2) from 2 types of bioactive glass scaffoldsMethods: Ninety male Albino rats were utilized in this study. Diabetes was induced by 4 daily intraperitoneal injections of streptozotocin. The first right mandibular molar was extracted for all rats. The rats were randomly assigned into three groups (GI, GII and GIII) (30 rats each) according to the date of sacrifice 3,7 and 9 days after extraction. The three main groups were subdivided into: Control subgroup (Con), Mg (Mg) and Zn (Zn) Bioactive glass subgroups. The bone regenerative efficacy of the scaffold materials were evaluated histologically, immunohistochemically and histomorphometrically. Results: A significant increase in the newly formed bone area percentage has been recorded in the Zn subgroup more than the Mg subgroup within GII and GIII where (P<0.001). The immunohistochemical results revealed a significant increase in vascular endothelial growth factor (VEGF) expression within GI and GIII subgroups where (P=0.002 and P=0.001) respectively. On the other hand there was a non significant increase in VEGF expression between GII different subgroups (P=0.267).Conclusions: Mg and Zn enriched bioactive glass mixed with BMP-2 were capable to enhance wound healing and bone formation in extraction sockets of diabetic rats. Zn bioactive glass was more effective as it enhanced angiogenesis in the healing sockets.

Holistic Healing Through Herbs: Effectiveness of Aloe Vera on Post Extraction Socket Healing.

Advances in the field of alternative medicine has encouraged the use of various natural products for multiple uses in the field of dentistry for treatment of various oral diseases. A natural herbal product is Aloe vera, which has number of benefits with no reported side effects and gaining considerable importance in clinical research. The aim of this cross-sectional randomized interventional study was to evaluate the effectiveness of Aloe vera in the healing of post extraction sockets. A sample size of 40 patients undergoing atraumatic extraction was divided into two groups. Group A-patients were prescribed only analgesics and followed for seven consecutive days and socket healing assessment was done. Group B-Patients were given Aloe vera soaked gel foams, followed up to the third and seventh day by two observers and the socket healing was assessed using the standardized index by Landry, Turnbull and Howley. In addition to healing the common complaint associated with extraction wound, the pain was assessed using numerical rating scale. Data obtained was statistically analysed using Mann-whitney U test, Wilcoxon Signed ranks test and Spearman's rank correlation method. Control group on the third and the seventh day showed healing of 60% and 70% respectively and the Aloe vera group showed a better result having a healing potential of 70% on the third day and 90% on the seventh day which was statistically significant with a (p-value<0.001). Aloe vera group showed a significant decrease in pain after two hours on the day of extraction followed by second, third and seventh day which was statistically significant (p-value<0.001) and better than the control group. Aloe vera has been proved to have a unique property that is implicated in better healing than other group without any side effects. Aloe vera is economical, effective, powerful nutritional supplement and antioxidant that protects and promotes wound healing.

Pseudo-osteomyelitis.

Sir, We would like to report an interesting case of a 12-year-old child who reported to the dental clinic with a complaint of pain in the left lower jaw posteriorly. Intraoral examination revealed a large carious lesion associated with the mandibular left first molar. The tooth was tender on percussion. An orthopantamogram (OPG) revealed periapical radiolucency in relation to the mandibular left first molar. Because the patient belonged to a low socioeconomic background, root canal treatment was not financially feasible. Hence, the tooth was extracted under local anesthesia. Healing was uneventful. Three months later the patient was referred back to our dental clinic by a dermatologist with complaint of a draining sinus on the lower left side of the face [Figure 1]. The discharge was purulent. The dermatologist had been treating the patient with oral amoxicillin and a topical antiseptic cream for 1 month.Figure 1: (a) Extraoral photograph of the patient showing a draining sinus on the lower left side of the face. (b) Intraoral picture showing a completely healed extraction woundA CBvi was advised along with an OPG [Figure 2]. The OPG showed a healing extraction socket while the CBvi showed an extraction tooth socket with a sinus tract perforating the lingual cortex. A sample of the discharge was sent for culture and antibiotic sensitivity. The culture was positive for Pseudomonas aeruginosa and Enterococcus species, and the organisms were sensitive to ciprofloxacin. A culture for acid fast bacilli was negative after 6 weeks of incubation. The extraoral sinus tract was debrided and cleaned and the patient was put on oral ciprofloxacin. The sinus tract healed within 2 weeks of the treatment with no scarring [Figure 3].Figure 2: Orthopantamogramshowing the healing extraction socketFigure 3: Extraoral photograph of the healed sinus tract after treatment with no scar formationIt is common for practitioners to misdiagnose the cause of cutaneous sinus tracts on face, and they usually fail to recognize that the cause may be odontogenic. Any long standing infection around the apex of the root of a tooth can drain into the mouth or less commonly into the skin via a sinus tract.[1] Patients assume that the sinus tract may not be related to a dental infection and may seek the help of a dermatologist or their family physician.[2] In the present case, the patient visited the dermatologist for the draining sinus tract assuming it to be of a nondental origin. Any topical therapy provided due to the misdiagnosis can result in delayed healing of the wound and lead to recurrence. The sinus tract healed uneventfully after the change in the antibiotics thus emphasizing the need for a thorough dental evaluation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The effect of combined Moringa oleifera and demineralized freeze-dried bovine bone xenograft on the amount of osteoblast and osteoclast in the healing of tooth extraction socket of Cavia cobaya

Background: Alveolar bone has an important role in providing support to teeth and dentures. Loss of support caused by alveolar resorption will cause functional and aesthetic problems. Preservation socket using bone graft is one way to maintain the dimensions of the alveolar bone. Moringa oleifera leaf can increase the activity of bone graft in the formation of new bone. Purpose: This study was aimed to evaluate the effect of combined Moringa oleivera leaf extract and demineralized freeze-dried bovine bone xenograft (DFDBBX) towards the formation of osteoblasts and osteoclasts in the tooth extraction sockets of cavia cobaya. Method: This study used 28 cavia cobayas divided into four groups. The combination of Moringa oleifera leaf extract and DFDBBX was inducted into the sockets of lower incisor tooth with certain dose in each group, ointment 1 containing PEG (a mixture of PEG 400 and PEG 4000) for control group, ointment 2 containing Moringa oleifera leaf extract and DFDBBX and PEG (at active subtance consentration of 0.5%) for group 1, ointment 3 containing Moringa oleifera leaf extract and DFDBBX and PEG (at active substance concentration of 1%) for group 2, and Ointment 4 containing Moringa oleifera leaf extract and DFDBBX and PEG (at active substance consentration of 2%) for group 3. paraffin block preparations were made for histopathology examination using hematoxylin eosin staining. Result: The results showed that there were significant differences of the number of osteoblasts and osteoclasts in each treatment group (p &lt;0.05). Conclusion: It can be concluded that the combination of Moringa oleifera leaf extract and DFDBBX at 2% cocentration can increase the number of osteoblasts and decrease osteoclasts in the healing of tooth extraction sockets of cavia cobaya.

EVALUATION OF LOCAL ADMINISTRATION OF SIMVASTATIN ON HEIGHT AND WIDTH OF THE HEALING EXTRACTION SOCKET IN RAT MANDIBLE

INTRODUCTION: studies concerning healing of extraction sockets revealed that sockets were filled with new bone by as much as two thirds in 40 days and completely filled with new bone in 10 weeks. There have been many studies demonstrating the bone-promoting effect of simvastatin local application in animal models. Simvastatin was shown to increase bone volume, bone formation rate, and bone compressive strength. The use of statins for bone regeneration is a promising and growing area of research. OBJECTIVES: The aim of this study was to compare between the amounts of resorption that occurs in the healing extraction socket left to heal spontaneously to the amount of resorption that occurs in the healing extraction socket filled with simvastatin gel. MATERIALS AND METHODS: Right and left first molars were extracted from 20 rats’ mandibles’. Right side extraction sockets (Experimental) were filled with 2.5% simvastatin gel, while the left side sockets (Controls) were allowed to heal spontaneously. The rats were humanely sacrificed at 1st,2nd,3rd and 4th week postoperatively, and the specimens’ height and width were measured using a bone caliper. RESULTS: The mid-buccal height as well as the buccolingual width of the alveolar bone on the simvastatin-treated side was relatively higher and thicker than the control side indicating that less resorption had occurred on that side. CONCLUSIONS: The present study provided evidence that a single topical application of 2.5% simvastatin gel improve the quality of the new bone of the healing extraction socket and decreases bone resorption.

Osteogain® loaded onto an absorbable collagen sponge induces attachment and osteoblast differentiation of ST2 cells in vitro.

Dimensional changes of the alveolar bone following tooth extraction are a major challenge in daily dental practice. To limit bone loss, a variety of biomaterials including bone grafts, barrier membranes, and growth factors have been utilized either alone or in combination therapies to increase the speed and quality of new bone formation. The aim of the present in vitro study was to investigate the regenerative potential of Osteogain®, a new liquid carrier system of enamel matrix derivative (EMD) in combination with an absorbable collagen sponge (ACS) specifically designed for extraction socket healing. The potential of ACS was first investigated using ELISA to quantify total amelogenin adsorption and release from 0 to 10days. Thereafter, the cellular effects of ST2 pre-osteoblasts were investigated for cellular attachment at 8h and cell proliferation at 1, 3, and 5days as well as osteoblast differentiation by real-time PCR and alizarin red staining for cells seeded on (1) tissue culture plastic, (2) ACS alone, and (3) ACS + Osteogain®. ACS efficiently loaded nearly 100% of the amelogenin proteins found in Osteogain® which were gradually released up to a 10-day period. Osteogain® also significantly induced a 1.5-fold increase in cell attachment and resulted in a 2-6-fold increase in mRNA levels of osteoblast differentiation markers including runt-related transcription factor 2 (Runx2), collagen1a2, alkaline phosphatase, and bone sialoprotein as well as induced alizarin red staining when combined with ACS. In summary, these findings suggest that Osteogain® is capable of inducing osteoblast attachment and differentiation when combined with ACS. Future animal studies and randomized human clinical trials are necessary to further support these findings. The use of Osteogain® in combination with ACS may provide a valuable means to limit dimensional changes following tooth extraction.

Dimensional changes of hard and soft tissue after immediate implantation in comparison with conventional tooth extraction

Introduction: Immediate implantation in single-root teeth has been claimed to possess some benefits, especially bone preservation. The aim of this study was to evaluate ridge changes after immediate implantation in comparison with tooth extraction and dental socket healing.Methods and Materials: In this study, 21 patients with hopeless single-root teeth were selected. After impression and cast making, the patients were divided into test and control groups. Each group included twelve dental sockets. For all teeth the extraction was performed atraumatically. Measurements included bucco-lingual ridge dimensions at 3mm and 7mm apical to an imaginary line connecting the CEJs of the two adjacent teeth (CEJ line) as well as vertical distance between the mentioned line and bone crest at the misobuccal, midbuccal, distobuccal, mesiopalatal, midpalatal, and distopalatal aspects. In addition, soft tissue measurements similar to hard tissue ones were taken using stone casts and acrylic stents. In test group immediate implantation was carried out following extraction whereas in the control group dental sockets were left for natural healing. Four months after the operation, in both groups, the flap was reflected and measurements taken at baseline were repeated.Results: Vertical changes of soft tissues in test group were significantly less than control group at all points except in mid-buccal aspect (p=0.033 for mesiobuccal, p=0.026 for distobuccal, p=0.004 for midpalatal, p=0.002 mesiopalatal, p=0.022 for distopalatal, p=0.016 for distal, p=0.048 for mesial). Horizontal dimension change of soft tissue at 7mm apical to the CEJ line in test group, were also significantly less than control group (p= 0.051). Vertical changes of hard tissue, measured in all points, in test group were less than those of control group. These changes were significant in mid-buccal, mid-palatal, mesiopalatal and distopalatal points (p= 0.046, 0.029, 0.020 and 0.026 respectively). Horizontal changes of hard tissue at 3mm and 7mm apical to the CEJ line in test group were also less than control group. However, this was significant only at the 3mm point (p=0.028).Conclusion: According to the results of this study, it can be concluded that immediate implantation is to some extent effective in reducing the expected vertical and horizontal bone and soft tissue changes occurring following conventional tooth extraction and natural socket healing. Further investigation is warranted to determine the optimum method of preventing these changes.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.335-342

The In Vitro and In Vivo Osteogenic Capability of the Extraction Socket-Derived Early Healing Tissue.

Healed extraction socket is one autologous bone source. Extraction socket-derived early healing tissue (ESEHT) contains stem cells, osteoblasts, and growth factors, suggesting that it should have an osteogenic potential. The objective of this preliminary study is to explore the in vitro and in vivo osteogenic ability of ESEHT. ESEHT from 2-week healing extraction sockets and proper alveolar bone (PAB) from interdental septa or surrounding socket walls were acquired from beagle dogs. For in vitro experiments, ESEHT and PAB were separately cocultured with mouse bone marrow-derived stromal cell lines (st2 cells) using a transwell system. The effect of ESEHT or PAB on migration, proliferation, and osteogenic differentiation of st2 cells was investigated. For in vivo study, 36 inflammatory Class II furcation defects in the bilateral mandibles of dogs were surgically created, and then ESEHT and PAB from the maxilla of the same dogs were implanted into defects. Histologic observation and histometric analysis were performed after an 8-week healing period. The in vitro results indicated that ESEHT and PAB significantly promoted cellular migration, proliferation, alkaline phosphatase activity, expressions of bone sialoprotein, and Runt-related transcription factor 2 in messenger RNA and protein levels and, moreover, that ESEHT showed stronger activities than PAB except in chemotactic activity. The in vivo tests showed that ESEHT and PAB had a similar function in enhancing percentages of regenerated cementum and regenerated bone, which were significantly higher than those in blank control groups. Results showed that ESEHT possesses better effects on migration, proliferation, and osteogenic differentiation of mesenchymal stem cells in vitro but similar promotion effect on periodontal regeneration in vivo compared with PAB, suggesting that ESEHT may be one of the most effective graft materials for periodontal regeneration.

Regenerative Needs Following Alveolar Ridge Preservation Procedures in Compromised and Noncompromised Extraction Sockets: A Cone Beam Computed Tomography Study.

The aim of this study was to evaluate the necessity for additional regenerative procedures following healing of compromised and noncompromised extraction sockets with alveolar ridge preservation procedures through the use of virtual implant imaging software. The cohort was comprised of 87 consecutive patients subjected to a single maxillary tooth extraction with an alveolar ridge preservation procedure for subsequent implant placement. Patients were divided into two main groups based on the integrity of the buccal bone plate following teeth extraction. Patients in the compromised socket (CS) group (n = 52) had partial or complete buccal bone plate loss, and patients in the noncompromised socket (NCS) group (n = 35) exhibited no bone loss of their socket walls following tooth extraction. Following 4 to 6 months of healing, all patients had a cone beam computed tomography (CBCT) study. Root-formed implants were placed virtually in an ideal prosthetic position. The number of implants per group and location (anterior, premolar, molar) exhibiting exposed buccal implant surface was calculated. In the CS group, 5 out of 19 anterior implants (26.3%), 4 out of 14 premolar implants (28.5%), and 7 out of 19 molar implants (36.8%) had exposed buccal surfaces. In the NCS group, 4 out of 9 anterior implants (44.4%), 2 out of 9 premolar implants (22.2%), and 4 out of 17 molar implants (23.5%) had exposed buccal surfaces. There were no statistically significant differences for intragroup and intergroup comparisons (χ² test, P > .05). This study failed to find statistically significant differences in the frequency of implants with exposed buccal surfaces placed virtually, following treatment of compromised and noncompromised sockets. A high proportion (22% to 44%) of sites had implants that potentially needed additional regenerative procedures.