Hopeless Teeth Research Articles

Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials.

The aim of this study was to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, 'In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?' The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.

Intentional replantation for a periodontally hopeless tooth: 6-month follow-up

Intentional replantation for a periodontally hopeless tooth: 6-month follow-up

Periodontal Regenerative Treatment of Hopeless Tooth with Wall Technique

Periodontal Regenerative Treatment of Hopeless Tooth with Wall Technique

Successful Treatment of Nasopalatine Duct Cyst After Maxillary Anterior Implant Surgery: A Case Report.

Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded 1 year after maxillary anterior implant placement following periodontally hopeless teeth extraction. The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. Seven years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

8-Month Follow-up of Replantation of a Periodontally Hopeless Teeth

8-Month Follow-up of Replantation of a Periodontally Hopeless Teeth

Investigation of the extent of post-extraction bone contraction and remodeling after 4 months. A prospective pilot study

ObjectivesTo investigate the correlation between the serum levels of 25(OH)D and the resorption of the alveolar bone walls and regeneration of the alveolar space after tooth extraction. Methods14 adults in need of extraction of hopeless teeth were enrolled. An intraoral digital impression was performed, and each patient was tested to assess serum vitamin D levels. Subsequently, extraction of teeth and contextual guided bone regeneration was performed using porcine origin graft material and a resorbable collagen membrane to covert the defect. After 4 months, an impression was taken, and the model was scanned using a professional scanner for lab. At the same time, a cone beam computed tomography was performed to plan implant insertion through fully digital computer guided surgery. Bone was collected to perform histological and histomorphometric analysis. Pre and postoperative scans were compared using a specific software to estimate the volumetric changes. Tests were applied to investigate the relationship between the different predictor variables and the outcome variables. Results14 patients were divided in 3 groups depending on the serum Vit-D levels, identifying three ranges corresponding to low (lower than 20), medium (between 20 and 30), and optimal vitamin D levels (higher than 30). Volumetric contraction after extraction was observed for all patients, without any significant difference between the groups. Focusing on the post-extraction regeneration, patients belonging to the group with lower levels of Vit-D displayed lower and more disorganized levels of bone. Immunohistochemistry analysis showed that Col1A1 and Osteocalcin had no physiological alteration. Osteopontin could be identified near the external surface of bone tissue granules. Runx2 signals were detected near the margins of bone trabeculae. ConclusionsSerum vit-D levels do not appear to influence the extent of post-extraction bone contraction; on the contrary, they seem to influence the post-extraction regeneration. Clinical SignificanceVit D serum levels may influence the regenerative aspect during post-extraction turn-over. This might suggest controlling and (in case of low levels) recommend Vit D supplement in the patient diet in case of extraction.

Esthetic Outcomes of Immediately Placed Implants with Convergent Transmucosal Profile: A Retrospective Single-Cohort Study.

Purpose: Immediate implant placement is a reliable solution to replace hopeless teeth, but this procedure may be associated to an increased risk of soft tissue complications in case of thin biotype. The use of tissue-level implants with a convergent transmucosal profile has been advocated to increase space for soft tissue, contributing to improve their stability and esthetics. The aim of this retrospective study was to evaluate the esthetic outcomes and the Patient-Reported Outcome Measures (PROMs) of immediately placed implants with a convergent transmucosal profile. Materials and methods: This single-cohort, monocentric, retrospective clinical study was conducted on patients treated with an immediately placed implant in the esthetic zone (from premolar to premolar). All the eligible patients were recalled for a clinical and radiographic follow-up visit. Results: This study included 20 patients (8 males, 12 females) with an average age of 55.5± 6.8 years, who received 20 implants, with a mean follow-up of 46.5± 15.3 months. At the time of follow-up, immediately placed implants showed a mean Marginal Bone Loss of 0.42± 0.49 mm, and a statistically significant improvement of the esthetic parameters from baseline to the last available follow-up; in particular, Pink and White esthetic scores (p=.001) and Papilla Index at mesial and distal sites (p<.001). All the patients reported a high satisfaction (VAS>9) both from esthetic and functional point of view. Conclusion: Immediately placed implants with convergent transmucosal profile in the esthetic zone showed good clinical and esthetic outcomes, with stable results over time.

Tooth preservation and "the treatable or hopeless tooth": Re-thinking a concept

The masticatory organ is at the center of dental practice. Tooth loss, regarded as an organ failure, is a core dispute in our profession, as it more often than not does not happen spon-taneously but is influenced by the dentist's treatment plan. Despite the prosthetic possibili-ties of tooth replacement, efforts should be made to preserve as many teeth as possible. Decisions between tooth preservation and extraction are complex and have far-reaching consequences. This article discusses this problem using a clinical case study of a 43-year-old female patient with pronounced localized periodontitis. After a comprehensive diagnosis and treatment planning, a daring regenerative therapy was carried out to try to preserve the tooth. The case shows that even seemingly hopeless teeth can be successfully treated syn-chronously using modern therapeutic approaches. Initial literature data supports the possi-bility of preserving severely compromised teeth in the long term in compliant patients. An integrative treatment approach based on individual patient factors and modern regenerative techniques may well be a viable alternative to tooth extraction and prosthetic restoration, albeit not inexpensive and uncomplicated. This communication emphasizes the need for precise diagnostics, a comprehensive treatment plan, and honest communication with pa-tients about the prospects of success and possible risks, and highlights the strengths of con-sistent tooth preservation.

Tooth autotransplantation with adjunctive application of enamel matrix derivatives using a digital workflow: A prospective case series

ObjectivesDigital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). MethodsTwelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period. ResultsSurvival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. ConclusionThe use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site. Clinical significanceThis is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.

Effect of Dental Implant System-Assisted Tooth Intentional Replantation in the Treatment of Anterior Teeth with Pathological Tooth Flaring, Drifting and Elongation in Patients with Stage III/IV Periodontitis: a Case Series.

To investigate the clinical effect of implant-assisted dental intentional replantation (IR) for the treatment of "drifted" anterior periodontally hopeless teeth (PHT). The present authors recruited 22 patients with stage III/IV periodontitis who suffered drifting of the maxillary anterior teeth, with a total of 25 teeth. The PHT were extracted for in vitro root canal treatment (RCT). The root surface was smoothed and the shape was trimmed, and the alveolar socket was scratched. The dental implant system was used to prepare the alveolar socket according to the direction, depth and shape of the tooth implantation. The PHT were reimplanted into the prepared alveolar socket. The periodontal indicators were analysed statistically before and after surgery. Twenty-two patients who completed the full course of treatment, with a total of 25 PHT, had a successful retention rate of 88%. Mean periodontal probing depth (PPD) decreased by 2.880 ± 0.556 mm and 3.390 ± 0.634 mm at 6 months and 1 year, respectively, and clinical attachment loss (CAL) decreased by 2.600 ± 0.622 mm and 2.959 ± 0.731 mm at the same time points, respectively, showing significant improvement (P < 0.05). Dental implant system-assisted IR can effectively preserve "drifted" natural PHT in patients with stage III/IV periodontitis.

Extraction Socket Seal Technique for Socket Preservation after Tooth Extraction: An Innovative Approach.

Background and objectives: Tooth extraction triggers the loss of surrounding alveolar soft tissue and bone. Numerous socket preservation techniques have been used by clinical surgeons; the issue with all existing techniques is the loss of soft tissue anatomy, resulting in a flat soft tissue architecture. Our study introduces an innovative ridge preservation technique that addresses this problem; it involved using an anatomically shaped composite resin lid that acts as a graft sealant and an approach for maintaining the soft tissue cervical profile. Material and Methods: The Extraction Socket Seal (ESS) technique was applied for 23 patients for socket preservation; atraumatic extraction of hopeless tooth was performed. The extraction socket was filled up with bone grafting material. After that, the composite resin lid, which was fabricated by the Cervico system was placed into the extraction socket. Finally, the lid was connected to the adjacent teeth with an adhesive system and composite resin material. The patients were evaluated for a three-month interval for any complications and success of Extraction Socket Seal (ESS) technique. The data were tested by descriptive data analysis using the Statistical Package for Social Sciences (SPSS, version 29). Results: The proposed technique has been successfully performed in twenty-three cases; 13 cases were male and 10 cases were female; and the mean age of all cases was 32 years. Extraction Socket Seal (ESS) technique utilizing a composite resin lid fabricated from the Cervico system was used as socket sealant placed directly to cover the bone graft, and we found that it provided an excellent “barrier” for the graft without any unwanted complications. After three months, radiographs showed good bone healing, and the mean socket soft tissue healing score was 4 (Very good wound healing), and most importantly the soft tissue architecture and shape were well preserved. Conclusions: We concluded that the Extraction Socket Seal (ESS) technique offers a very simple and time-saving technique for alveolar ridge preservation after tooth extraction for both anterior and posterior extraction sockets, and it provides a good seal for the graft material and the soft tissue anatomy was well preserved. Keywords: Alveolar ridge preservation, Extraction Socket Seal, ESS, Delayed implant placement, Socket preservation, Tooth extraction.

Hemisection: A Boon for the Hopeless Tooth

Hemisection: A Boon for the Hopeless Tooth

Accuracy of robotic surgery for dental implant placement: A systematic review and meta-analysis.

To systematically analyze the accuracy of robotic surgery for dental implant placement. PubMed, Embase, and Cochrane CENTRAL were searched on October 25, 2023. Model studies or clinical studies reporting the accuracy of robotic surgery for dental implant placement among patients with missing or hopeless teeth were included. Risks of bias in clinical studies were assessed. Meta-analyses were undertaken. Data from 8 clinical studies reporting on 109 patients and 242 implants and 13 preclinical studies were included. Positional accuracy was measured by comparing the implant plan in presurgery CBCT and the actual implant position in postsurgery CBCT. For clinical studies, the pooled (95% confidence interval) platform deviation, apex deviation, and angular deviation were 0.68 (0.57, 0.79) mm, 0.67 (0.58, 0.75) mm, and 1.69 (1.25, 2.12)°, respectively. There was no statistically significant difference between the accuracy of implants placed in partially or fully edentulous patients. For model studies, the pooled platform deviation, apex deviation, and angular deviation were 0.72 (0.58, 0.86) mm, 0.90 (0.74, 1.06) mm, and 1.46 (1.22, 1.70)°, respectively. No adverse event was reported. Within the limitation of the present systematic review, robotic surgery for dental implant placement showed suitable implant positional accuracy and had no reported obvious harm. Both robotic systems and clinical studies on robotic surgery for dental implant placement should be further developed.

Advances in Surgical Template Design in Dental Implantology

Background: Expansion of three-dimensional (3D) printing technology and improvements in planning software have led to increased accuracy and precision in dental implant positioning and new applications for surgical templates in implantology. The objective of this report is to demonstrate the application of locally printed surgical templates in various dental implant surgeries and site development procedures. Methods: Nine patients were referred to the Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Fort Eisenhower, GA, USA, for replacement of missing or hopeless teeth using dental implants. All surgeries were planned virtually and completed using customized surgical templates produced within the local facility. The presented cases demonstrate use of surgical templates to simplify surgery across a wide spectrum of clinical scenarios—placement of multiple adjacent implants, immediate implant placement, immediate provisionalization, sinus elevation in dentate and edentulous patients, removal of a retained root fragment in conjunction with implant surgery, alveoloplasty to increase interarch distance, and fully guided implant surgery. Results: In the presented dental implant surgeries, use of locally produced surgical templates permitted transfer of the planned implant positions to the patients with high reliability. Use of surgical templates in sinus elevation procedures ensured augmentation in the appropriate positions and simplified intraoperative management of complex anatomy. Conclusions: Specialized surgical templates have the potential to reduce the duration of surgery, limit patient morbidity, enhance communication among clinicians, and simplify the restorative phase of therapy. Accessibility to new technology has allowed implant surgeons to move beyond the era of accurate implant placement into a period characterized by creative solutions to clinical problems.

Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis.

This case series assessed the efficacy of Orthodontic Implant Site Development with Labial Root Torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multi-bracket of 2-3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404Å}311.7 days. Cone-beam computed tomography (CBCT) scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable post-extraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry.

Immediate dentoalveolar restoration (IDR) of central maxillary incisor using sinus lateral wall block graft to regenerate loss of facial and palatal bone: Literature review and 1 year follow-up.

Replacement of missing or hopeless teeth in the esthetic zone is one of dentistry's most critical challenges. In the past, multiple surgical procedures have been needed to reconstruct compromised extraction sites. The surgeries have been associated with long healing times and increased morbidity, all the while patients are using either fixed or removable interim restorations. The procedures identified in this paper minimize surgical operating times, healing times, and delays in obtaining definitive restorations by combining multiple surgical procedures in one visit. The procedures are technique sensitive. This particular patient has been followed for 1 year post-operatively with clinical photographs and CBCT scans. Excellent clinical results were obtained. Benefits and limitations of the procedures have also been identified.

Antiresorptive agent-related osteonecrosis of the jaw risk in cancer patients before bone-modifying agent therapy: A retrospective study of 511 patients.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a serious adverse event associated with therapies for advanced cancer involving bone-modifying agents (BMAs). Although many studies have investigated the risk factors for ARONJ, none have provided sufficient clarifications. We aimed to determine whether there is a correlation between tooth extraction before BMA therapy and the development of ARONJ. We included 511 patients who were admitted to our department before BMA therapy. The incidence of ARONJ and its risk factors was retrospectively evaluated, focusing on tooth extraction before BMA therapy and radiological findings of the extracted tooth. Of the 511 patients, 135 underwent tooth extraction before undergoing BMA therapy. ARONJ was observed in 17.7% and 7.2% of patients in the extraction and non-extraction groups, respectively (p=0.0002). Regarding the findings of panoramic radiographs before tooth extraction, the incidence of periapical disease was significantly higher in the ARONJ group than that in the non-ARONJ group (50% and 27%, respectively, p=0.034), and the proportion of bone sclerotic changes in the surrounding teeth was significantly higher in the ARONJ group (58.3%) than in the non-ARONJ group (24.4%) (p=0.0004). The presence of a hopeless tooth that requires extraction prior to BMA therapy is a risk factor for MRONJ. However, extraction of such teeth should be considered, as this is known to decrease the risk of MRONJ development after BMA therapy initiation. Moreover, the radiological findings of periapical disease and bone sclerotic changes in the extracted teeth identified in this study can be used as novel predictive factors for ARONJ.

Impact of COVID-19 Pandemic on the Iranian Dentists’ Practice Patterns

Background: The practice scheme of dentists during the coronavirus disease 19 (COVID-19) pandemic changed markedly around the world. The impacts of these changes on the economic concerns of dentists and the oral health of their patients have been the focus of some recent studies. This study aimed to assess probable alterations in the practice and patient mix of general dentists (GDs) and dental specialists in Isfahan, Iran during the COVID-19 outbreak. Methods: This analytic cross-sectional study was performed among dentists during the COVID-19 pandemic (April-June 2021). A specific self-administrated questionnaire was designed, the validity and reliability of which were verified by calculating the content validity index and intra-class coefficients (test-re-test techniques), respectively. The questionnaire had 21 items in four sections, including demographic and work characteristics, probable changes in the practice scheme, composition of patients, and the type of the provided treatments. The collected data were analyzed using the SPSS software, descriptive and analytical analysis, including t-test, Chi-square, and ANOVA (α= 0.05). Results: Overall, 152 general (response rate= 88%) and 171 specialist dentists were recruited, of whom 206 (63.8%) were males. In addition, 74% of the dentists, especially prosthodontists and restorative specialists, reduced the number of patients per working day (P&lt;0.001). Further, 68.5% reported a decrease in the number of their elderly patients. Based on the results, 77% of the dentists reported an increase in tooth decay and hopeless teeth. Although extraction, emergency treatments, and extensive restorations were increased, prophylactic treatments and follow-ups represented a decline. The highest concern was reported to be about family health (7 out of 10). Finally, prosthodontists, endodontists, and surgery specialists reported the least use of these facilities (P&lt;0.001). Conclusions: An increase in the number of hopeless and decayed teeth, as well as an increase in emergency treatments (pain and abscesses) and a decrease in preventive care, confirms an untoward change in the dental practice pattern during the pandemic.

Interdisciplinary Oral Rehabilitation of a Teenage Patient with Down Syndrome: A Case Report

Abstract This case report aimed to share the dental rehabilitation of a teenage patient with Down Syndrome who applied to our clinic with aesthetic complaints and to provide a guide to dentists on the treatment options of young syndromic patients with various dental problems.The clinical and radiographic examination of a 17-year-old male patient with Down Syndrome, who applied to the University of Health Sciences, Gülhane Department of Prosthodontics, with aesthetic complaints, revealed the necessity of occlusion regulation and the restoration of the existing teeth. Aesthetic need was taken into consideration and a treatment plan was made with the Department of Pediatric Dentistry. After the extraction of the patient's hopeless teeth, the missing teeth were corrected with a fixed partial denture, taking into account the patient's wishes. Onlay restorations made of 3D printed resins are planned for teeth that remain in infraocclusion. It was planned to restore anterior maxillary teethwith strip crowns in order to achieve aesthetics, and after the root canal treatment Finally, premolar forms were created for the maxillary permanent canine teeth with strip crowns to support the occlusion.The treatment of our patient was completed, and his function and phonation were maintained, as well as achieving the aesthetic he dreamed of.

Bilateral sinus augmentation using Hydrodynamics for Functional and Esthetic maxillary rehabilitation

Edentulism is a prevalent oral health issue that negatively impacts the quality of life of the patient on a social and psychological level. For the treatment of edentulism, implant-supported prosthesis replacement is the most successful and supported treatment plan. Placement of an implant in the maxillary arch exposes a clinician to various complications like the quality of bone, pneumatization of the maxillary sinus, atrophic ridge, etc. This issue can be addressed with bone augmentation techniques using various bone graft materials which can improve the quality of bone and can also protect the sinus membrane. Current concepts in implant dentistry rely on techniques that are minimally invasive. Elevation of the sinus membrane can be performed by a minimally invasive procedure with the help of DASK kits. This case report discusses the full mouth maxillary rehabilitation with immediate implant placement after extraction of hopeless teeth in the anterior region followed by bone augmentation, indirect sinus lift and delayed implant placement in the maxillary molar region using a hydraulic sinus lift DASK kit. The patient has been reviewed periodically and the maxillary arch was later restored using a malo-bridge.