Intact Sockets Research Articles

Use of autologous tooth-derived material as a graft in the post-extraction socket. Split-mouth study with radiological and histological analysis

BackgroundThe healing process after tooth removal involves bone remodelling which implies some loss of alveolar bone volume. Among materials proposed for minimising this remodelling and preserving the bone, autologous dental tissue is a promising option, but more data are needed. In this context, we evaluated size and density changes using cone beam computed tomography in autologous dental material (ADM)-preserved sockets compared to controls, and assessed biological responses by histological analysis.MethodsA split-mouth study was conducted including 22 patients, who underwent removal of ≥ 2 single-rooted teeth with intact sockets, assigning one socket to the experimental group which received ADM for alveolar preservation and another to the control group, which only underwent blood clot stabilisation. Cone beam computed tomography was performed postoperatively (week 0) and at weeks 8 and 16 to assess socket size and bone density. Histological analysis was carried out on trephine biopsies taken (Ø4 × 4.5 mm) from the experimental group.ResultsLess horizontal shrinkage was observed in the ADM group, especially at week 16 considering the group-by-time interaction for the following variables: difference in height between the lingual and buccal alveolar crests (-1.00; p < .01; 95% CI: -0.28 – -1.73), and half-widths, measured as the distance from the long axis of the missing tooth to the buccal alveolar crest at 1 mm (-0.61; p < .01; 95% CI: -0.18 – -1.04) and at 3 mm (-0.56; p < .01; 95% CI: -0.15 – -0.97) below the crest, with mean decreases of 1.07 and 2.14 mm in height difference, 0.66 and 1.32 mm in half-width at 1 mm and 0.43 and 1.02 mm in half-width at 3 mm in ADM and control groups respectively. Densitometry analysis showed higher bone densities in Hounsfield units in the ADM group considering all factors analysed regardless of time point and socket third (coronal, middle, or apical). Histologically, there were no signs of inflammation or foreign body reaction, and dentin particles were surrounded by and in close contact with bone tissue.ConclusionThese results add to the evidence that dentin can be used successfully as a material for alveolar socket preservation, given its desirable mechanical and biological properties, and warrant larger studies.

In vivo experimental study comparing alveolar ridge preservation versus guided bone regeneration after unassisted socket healing at intact and damaged sites in narrow alveolar ridges.

To compare bone regeneration and dimensional alteration of alveolar ridge at intact and damaged extraction sockets after alveolar ridge preservation (ARP) and implant placement versus unassisted socket healing followed by guided bone regeneration (GBR) with simultaneous implant placement. In 6 beagle dogs, 3 types of extraction sockets in the mandible were created: (1) intact sockets, (2) 1-wall defect sockets and (3) 2-wall defect sockets. The sockets were allocated to undergo either (1) ARP and implant placement 8weeks later (ARP group) or (2) GBR with simultaneous implant placement after 8weeks of unassisted socket healing (GBR group). After an additional healing period of 8weeks, bone regeneration and dimensional changes were evaluated radiographically and histologically. GBR showed superior bone formation and greater bone gains compared to ARP, regardless of the initial extraction-socket configuration. Although ARP maintained the preexisting alveolar ridge dimensions, peri-implant bone defects were still detected at 8weeks of follow-up. Histomorphometric analyses confirmed that GBR increased dimensions of the alveolar ridge compared to baseline, and the augmentation and bone regeneration were greater with GBR than with ARP. Early implant placement with ARP can mitigate alveolar ridge changes in the narrow alveolar ridge. However, early implant placement with simultaneous GBR creates the conditions for enhanced bone regeneration around the implant and greater ridge augmentation compared to ARP, irrespective of the extraction-socket configuration.

Marginal Bone Stability of Implants Placed in Alveolar Ridge Preservation Areas: a Preliminary Retrospective Analysis

&lt;p&gt;Abstract: After tooth extraction, the alveolar ridge undergoes resorption and atrophy, which usually leads to a wide range of tissue dimensional changes. Preservation of the alveolar ridge can maintain its volume, reduce ridge resorption, and help subsequent dental implant treatment. This retrospective cohort study aims to investigate the marginal bone stability of implants placed in alveolar ridge preservation areas using deproteinized bovine bone mineral with 10% collagen (DBBM-collagen) combined with a native collagen membrane (CM). In this study, forty-seven implant sites divided into either intact or defective extraction sockets were included, using vertical bite-wing films to measure the bone level at baseline, 6 months, and 12 months after implant prosthesis placement. The result of peri-implant mean bone loss was -0.03 &amp;plusmn; 0.84mm at 12 months compared to baseline. There was no significant difference in mesial and distal sites compared to baseline. In addition, no significant difference was found between the defective and intact sockets for marginal bone changes. Therefore, ridge preservation combined with DBBM-collagen and CM can provide an ideal alveolar ridge, simplify dental implant procedures, and maintain implant marginal bone stability.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Flapless Immediate Implant Placement and Provisionalization (FIIPP) in the Aesthetic Region: Surgical Protocol of a Prospective Clinical Cohort Study on 100 Patients – Two Case Reports: Intact Socket, and Defect Socket with a Thin Gingival Phenotype

Background: Immediate implant placement and provisionalization (IIPP) is considered as a high-risk treatment for aesthetic failure and generally only recommended in case of post-extraction intact sockets and a thick phenotype gingiva. During a prospective clinical cohort study on one-hundred consecutive patients, using this strict flapless immediate implant placement and provisionalization (FIIPP) protocol, we found high and stable aesthetic outcomes (WES/PES = 8.2/12.1) in both intact – and defect sockets, and both thin- as thick gingival phenotype. By means of one case report (Case 1), the total FIIPP treatment is illustrated. Results of two other cases, show that comparable high aesthetic outcomes can be reached in cases with a thin phenotype gingiva or buccal bone defect using the same protocol. Case Presentation: In a 24-year-old male with good general and oral health, root fracture of tooth 21 was diagnosed and FIIPP was indicated. Direct post-extraction, an implant was placed in a palatal position of an intact socket by a flapless approach. A minimum space of 2 mm in front of the implant was created and filled with a bone-substitute prior to implant placement. Subsequently, the implant was restored by use of a titanium abutment and a composite temporary crown. Three months later, the temporary crown was replaced by a customized zirconium abutment and ceramic crown resulting in a high aesthetic outcome. A comparable aesthetic outcome using this protocol can be reached in cases with a thin phenotype gingiva and/or a buccal bone defect (Case 2). Conclusion: Using described surgical FIIPP protocol, high aesthetic outcomes are reached in only 4 visits and within a treatment period of 4 months. A thin phenotype gingiva, or a pre-operative buccal bone defect, does not seem to affect the aesthetic outcome using this treatment method.

Morphological and morphometrical study of mental foramen in dry adult human mandible and its clinical relevance

Background: Mental foramen is situated in the anterolateral aspect of the body of the mandible. It lies below either the interval between the premolar teeth or the second premolar tooth, midway between the upper and lower borders of the body of the mandible. It transmits mental nerves, arteries, and veins. The mental nerve is a branch of the inferior alveolar nerve which supplies sensation to the lower lip, labial mucosa, lower canines, and premolars. The most useful injection for anaesthetizing the mandibular teeth is the inferior alveolar nerve block. To anaesthetize the anterior teeth including canines and premolars it is better to inject the anesthetic solution adjacent to the mental foramen instead of giving inferior alveolar nerve block. Aim: To Study the Morphological and Morphometrical Study of Mental Foramen in Dry Adult Human Mandible and Its Clinical Relevance in dental practice. Materials and methods: A total of 100 numbers of dry adult mandibles of unknown sex with complete dentition and intact alveolar sockets collected from the Department of Anatomy, Meenakshi Medical College Hospital and Research Centre, were used for this study. The shape, size, location, number of the mental foramen, direction of opening of mental foramen was measured on both sides of the mandible by using a vernier caliper. Results: The most frequent position of mental foramen was in line with the apex of the 2nd premolar (right side 86.1% and left side 84.75%). The second common position was between 1st and 2nd premolar (Right side 5.2% and Left side 5.85%). The shape of the mental foramen was oval in 63.3% and rounded in 36.7% respectively. The direction of opening of mental foramen in most of the mandible was posterosuperior. The mean distance from mental foramen to symphysis menti, lower border of the mandible, and posterior ramus of the mandible was 26.67mm, 11.76 mm, and 62.95mm respectively. The mean measurement of the angle of the mandible was 128°. Conclusion: Knowledge about the Morphometric measurement of mental foramen is important during various surgical dental procedures.

Evaluation of Horizontal and Vertical Buccal Ridge Dimensional Changes After Immediate Implant Placement and Immediate Temporization With and Without Bone Augmentation Procedures: Short-Term, 1-Year Results. A Randomized Controlled Clinical Trial.

This prospective randomized controlled clinical trial aimed to compare changes in the horizontal and vertical soft tissue and the alveolar ridge dimension over the course of 12 months following immediate implant placement and temporization with or without simultaneous augmentation with a deproteinized bovine bone mineral with 10% collagen (DBBM-C). Thirty-two patients with a hopeless maxillary anterior tooth and fully intact sockets received an immediate implant and provisional or custom healing abutment after a flapless extraction. Patients were randomized to a control group (n = 16), which received no graft, or to a test group (n = 16), which received DBBM-C grafts. Horizontal and vertical soft tissue changes as well as soft tissue thickness were compared digitally between groups on casts obtained from impressions made at baseline and 3, 6, and 12 months. The test group showed less horizontal dimensional change than the control group; however, the change between the two groups was not statistically significant. Vertical dimensional soft tissue changes from baseline to 12 months showed a statistically significant difference at the distal papilla, favoring the test group. No statistically significant difference was observed for vertical changes between both groups at mesial papillae and midbuccal soft tissue; however, the test group showed lower values overall. No statistically significant differences in soft tissue thickness between groups were detected. Immediate implant placement and temporization with and without adding DBBM-C demonstrate favorable clinical outcomes regarding horizontal and vertical soft tissue changes. Both groups showed loss of tissue volume. Adding DBBM-C in the gap of immediately placed implants slightly lowered the change in tissue parameters, which was not statistically significant, for the first 12 months after implant placement.

A one-year prospective study on alveolar ridge preservation using collagen-enriched deproteinized bovine bone mineral and saddle connective tissue graft: A cone beam computed tomography analysis.

Although there is ample research on alveolar ridge preservation (ARP), changes of the soft tissue profile are seldom reported. In addition, the use of a saddle connective tissue graft (S-CTG) has only been described in one study. To evaluate changes in bone and external soft tissue profile following ARP of intact and nonintact sockets using collagen-enriched deproteinized bovine bone mineral (C-DBBM) and a S-CTG (a); to assess the need for additional hard and soft tissue grafting after ARP (b). Patients in need of a single or multiple unit fixed reconstruction in the premaxilla were included in this prospective case series. After tooth extraction, sockets were grafted with C-DBBM and sealed with a S-CTG. Cone beam computed tomography slides taken before tooth extraction and 4 to 6 months after ARP were superimposed to measure changes in bone dimensions and external soft tissue profile. The need for additional hard and soft tissue grafting was registered. Implants were evaluated at 1 year. Patient-reported outcomes were registered on a 100 mm visual analogue scale at suture removal and 1 year following ARP. Nineteen teeth (10 with intact sockets, 9 with nonintact sockets) in 14 patients (11 females; mean age 34) were extracted and treated with the abovementioned protocol. Volume loss could not be prevented and mainly occurred at the buccal aspect. Maximum horizontal bone resorption was 1.27 mm and maximum horizontal shrinkage of the soft tissue profile amounted to 0.87 mm, both at the most cervical aspect. Additional GBR was necessary in two sites with a nonintact buccal bone wall. The need for additional soft tissue grafting was moderate in sites with intact (3/10) and high in nonintact sockets (6/9). Implants demonstrated favorable clinical and esthetic outcomes. Pain intensity and patient satisfaction were 17 and 94, respectively. Alveolar ridge preservation was not able to prevent relevant tissue changes. However, implants could be installed as planned. Although the application of a S-CTG partly compensated for the buccal bone loss, the need for additional soft tissue grafting was still moderate in intact sockets and high in nonintact sockets.

Histological and Histomorphometric Response to SocketKAP™ and SocketKAGE™ Used for Ridge Preservation and Repair: Results From a Randomized Controlled Clinical Trial

This study investigated the histologic tissue response to SocketKAP and SocketKAGE as novel devices designed for ridge preservation. This randomized controlled clinical trial recruited participants among patients who presented to a university dental clinic. The study protocol entailed randomization into 5 intervention groups after tooth extraction: unassisted healing of intact sockets (group A), SocketKAP (group B), anorganic bovine bone minerals (ABBM) plus SocketKAP (group C), unassisted healing of sockets with dehiscence (group D), and SocketKAGE plus ABBM plus SocketKAP (group E). The primary outcome variable was bone volume fraction of total volume (BV/TV). Secondary outcome variables were percentages of residual graft material (RG) and void volume (VV). One-way analysis of variance was run on BV/TV, RG, and VV based on the independent variable (treatment groups). Bone core samples were harvested from participants (N=22) who presented for implant installation at 6months after extraction. Sockets without biomaterial filler (groups A and B) showed more mature bone compared with grafted sockets. In groups in which sockets were filled with biomaterial (groups C and E), vital bone was observed in direct apposition to the graft particles. In group E, remnants of SocketKAGE were not readily discernable at 6months. No substantial inflammatory infiltrate or other adverse histologic patterns were detected. Quantitative analysis showed a statistically significant difference in BV/TV between groups A and C (P=.028) and between groups A and E (P=.019). Histologic and histomorphometric results showed that the application of SocketKAP and SocketKAGE did not interfere with wound healing of extraction sockets. In agreement with previous reports, the percentage of BV/TV within sites with ABBM was smaller than within sites without biomaterial. The favorable histologic response to SocketKAP and SocketKAGE observed in the present study provided additional insights to the authors' previous studies showing the benefits of these devices in decreasing postextraction dimensional alterations of alveolar bone and tissue contour.

Immediate implant placement into posterior sockets with or without buccal bone dehiscence defects: A retrospective cohort study

ObjectivesTo evaluate bone reconstruction and soft tissue reactions at immediate implants placed into intact sockets and those with buccal bone dehiscence defects. MethodsFifty-nine internal connection implants from four different manufacturers were immediately placed in intact sockets(non-dehiscence group, n=40), and in alveoli with buccal bone dehiscence defects: 1) Group 1(n= N10), the defect depth measured 3–5 mm from the gingival margin. 2) Group 2(n=9), the depth ranged from 5mm to 7mm. The surrounding bony voids were grafted with deproteinized bovine bone mineral (DBBM) particles. Cone beam computed tomography(CBCT) was performed immediately after surgery (T1), and at 6 months later(T2). Radiographs were taken at prosthesis placement and one year postloading(T3). Soft tissue parameters were measured at baseline (T0), prosthesis placement and T3. ResultsNo implants were lost during the observation period. For the dehiscence groups, the buccal bone plates were radiographically reconstructed to comparable horizontal and vertical bone volumes compared with the non-dehiscence group. Marginal bone loss occurred between the time of final restoration and 1-year postloading was not statistically different(P=0.732) between groups. Soft tissue parameters did not reveal inferior results for the dehiscence groups. ConclusionsWithin the limitations of this study, flapless implant placement into compromised sockets in combination with DBBM grafting may be a viable technique to reconstitute the defected buccal bone plates due to space maintenance and primary socket closure provided by healing abutments and bone grafts. Clinical significanceImmediate implants and DBBM grafting without using membranes may be indicated for sockets with buccal bone defects.

An open randomized controlled clinical trial to evaluate ridge preservation and repair using SocketKAP(™) and SocketKAGE(™) : part 1-three-dimensional volumetric soft tissue analysis of study casts.

The aims of this study were to evaluate (i) the efficacy of ridge preservation and repair involving SocketKAP(™) and SocketKAGE(™) devices following tooth removal; and (ii) ridge contour changes at 6months post-extraction in intact sockets and sockets with dehiscence defects. Thirty-six patients required a total of 61 teeth to be extracted. Five cohorts were established with groups A-C involving intact sockets and groups D and E involving facial dehiscence: (A) Negative Control; (B) SocketKAP(™) alone; (C) Anorganic Bovine Bone Mineral (ABBM)+SocketKAP(™) ; (D) Negative Control; and (E) ABBM+SocketKAP(™) +SocketKAGE(™) . Preoperative CBCT and laser-scanned casts were obtained. Teeth segmented from preoperative CBCT were merged with study cast images to allow for digital removal of teeth from the casts. Volumetric measurements of ridge contour were performed. Images of preoperative and 6months post-operative casts were superimposed to measure ridge contour changes. Post-extraction contour loss occurred in all sockets primarily in the crestal 3mm but was also detected up to 6mm from alveolar crest. For intact sockets, SocketKAP(™) or SocketKAP(™) +ABBM interventions led to greater percentages of remaining ridge contour when compared to controls. A significant difference favoring SocketKAP(™) +SocketKAGE(™) +ABBM treatment was observed for sockets with facial dehiscence when compared to controls. SocketKAP(™) , with or without ABBM, significantly limited post-extraction ridge contour loss in intact sockets. In the absence of a group treated with only the SocketKAGE(™) , it is not possible to determine its efficacy, although the combination of SocketKAGE(™) +SocketKAP(™) +ABBM was effective in limiting post-extraction ridge contour loss in sockets with dehiscence defects.

An open randomized controlled clinical trial to evaluate ridge preservation and repair using SocketKAP(™) and SocketKAGE(™) : part 2 - three-dimensional alveolar bone volumetric analysis of CBCT imaging.

The aims of this study were (i) to evaluate the efficacy of ridge preservation and repair procedures involving the application of SocketKAP(™) and SocketKAGE(™) devices following tooth removal and (ii) to evaluate alveolar bone volumetric changes at 6months post-extraction in intact sockets or those with facial wall dehiscence defects using 3-dimensional pre- and postoperative CBCT data. Thirty-six patients required 61 teeth extracted. Five cohorts were established: Group A: Intact Socket Negative Control Group B: Intact Socket + SocketKAP(™) Group C: Intact Socket Filled with Anorganic Bovine Bone Mineral (ABBM) + SocketKAP(™) Group D: Facial Dehiscence Socket Negative Control Group E: Facial Dehiscence Socket Filled with ABBM + SocketKAP(™) + SocketKAGE(™) . Preoperative CBCT scans were obtained followed by digital subtraction of the test teeth. At 6months post-extraction, another CBCT scan was obtained. The pre- and postoperative scans were then superimposed, allowing highly accurate quantitative determination of the 3D volumetric alveolar bone volume changes from baseline through 6months. Significant volumetric bone loss occurred in all sockets, localized mainly in the 0-3mm zone apical to the ridge crest. For intact sockets, SocketKAP(™) + ABBM treatment led to a statistically significant greater percentage of remaining mineralized tissue volume when compared to negative control group. A significant difference favoring SocketKAP(™) + SocketKAGE(™) + ABBM treatment was observed for sockets with facial dehiscence defects compared to the negative control group. SocketKAP(™) , with ABBM, appears effective in limiting post-extraction volumetric bone loss in intact sockets, while SocketKAP(™) + SocketKAGE + ABBM appears effective in limiting post-extraction bone loss in sockets with dehiscence defects.

Alveolar ridge dimensional changes following ridge preservation procedure: part-2 - CBCT 3D analysis in non-human primate model.

The aim of this study was to evaluate the efficacy of ridge preservation involving novel devices used for obturation of socket orifice (Socket cap; SocketKAP(™) ) and resorbable cage used for space maintenance in sites with facial wall dehiscence (Socket cage; SocketKAGE(™) ). Eight teeth were extracted in each of six Macaca fascicularis non-human primates. Six intervention groups consisted of the following: Group A: intact socket negative control. Group B: intact socket: socket cap. Group C: intact socket filled with anorganic bovine bone mineral (ABBM) + socket cap. Group D: dehiscence: negative control. Group E: dehiscence: socket cap + socket cage. Group F: dehiscence: filled with ABBM + socket cap + socket cage. CBCT scans were obtained preoperatively and at 6 and 12weeks following intervention. The pre- and postoperative scans were superimposed, to quantify 3D volumetric alveolar bone changes. Volumetric bone loss occurred in all sockets, not only within the cretal zone (0-3mm) to the ridge crest, as has been commonly reported by other investigators, but significant bone loss was also detected in the zone which was 3-6mm apical to the alveolar crest. For intact sockets, socket cap + ABBM led to significantly greater percentages of remaining bone volume when compared to groups A and B. A significant difference favoring socket cap + socket cage + ABBM treatment was observed for sockets with facial dehiscence defects compared to groups D and E. Socket cap in conjunction with ABBM appears effective in limiting post-extraction volumetric bone loss in intact sockets, while socket cap + socket cage + ABBM appears effective in limiting post-extraction bone loss in sockets with dehiscence defects.

Analysis of Socket Preservation Using Polylactide and Polyglycolide (PLA-PGA) Sponge: A Clinical, Radiographic, and Histologic Study

The aim of this study was to evaluate the extraction socket healing and dimensional changes following alveolar ridge preservation using polylactide and polyglycolide (PLA-PGA) sponge. Fifteen patients were selected for alveolar socket preservation immediately following tooth extraction. Monoradicular maxillary and mandibular teeth were evaluated. The selected sockets had intact sockets walls with a minimum of 7 mm of residual alveolar bone height. The test sites were thoroughly debrided and grafted with PLA-PGA sponge, while the control sites underwent natural healing. Computed tomography (CT) measurements were taken at baseline and 6 months. After 6 months of healing, final CT measurements were performed, and trephine core biopsy specimens were obtained for histologic analysis. Implants were placed immediately after biopsy harvesting. All subjects completed the study, and all sites healed without adverse events and allowed for implant placement. The mean difference in socket height, width, and density after 6 months was statistically significantly higher in the test sites compared with control sites. Clinical measurement at the midbuccal site of the alveolar socket showed a mean loss of 2.45 ± 0.67 mm in the control group, compared with a mean gain of 1.28 ± 0.58 mm in the test group. All test sites showed minimal ridge alterations, and statistically significant differences were observed between the test and control sites with respect to bone composition and horizontal and vertical bone loss, indicating that PLA-PGA sponge is suitable for alveolar ridge preservation.

Postextraction ridge preservation and augmentation with mineralized allograft with or without recombinant human platelet-derived growth factor BB (rhPDGF-BB): a consecutive case series.

In an attempt to reduce postextraction alveolar bone resorption, ridge preservation and augmentation procedures have become standard-of-care treatment following tooth removal. This consecutive case series compares histologic and histomorphometric bone regenerative findings at 4 months following grafting for ridge preservation and augmentation in intact sockets and sockets with buccal wall defects. Sites were treated with mineralized allograft alone (control) or in combination with 0.3 mg/mL recombinant human platelet-derived growth factor BB (rhPDGF-BB) (test). Sites were allowed to heal for 4 months and then re-entered for trephine core biopsy and implant placement. At the end of 4 months, the mean percent remaining mineralized allograft was statistically significantly less in the test group than in the control group. The difference in mean percent vital bone between the groups showed a strong trend toward greater bone formation for the test group (41.8%) compared to the control group (32.5%) at the end of 4 months. Addition of growth factor signaling molecules to current grafting procedures may lead to accelerated bone regeneration, making it possible to successfully place implants at earlier time points.

Demineralized Bone Matrix in Extraction Sockets

To evaluate its efficacy and predictability in immediate extraction sockets, this case series used demineralized bone matrix in a puttylike carrier (DBM putty) with and without mineralized bone chips. Each preparation was made from the long bones of the same tissue donor; the only excipient material was water. A single failing tooth was atraumatically extracted from each study subject, and the socket was debrided. Intact sockets were grafted with DBM putty (n = 6), and sockets with buccal defects were grafted with DBM putty with bone chips (n = 6). A bovine pericardium membrane was draped over the graft site, and tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft, and then, a dental implant was placed. Two subjects were withdrawn, and histologic data could not be obtained from 2 other patients. Mean new bone fill was 40.28% for DBM putty (n = 5) and 44.60% for DBM putty with bone chips (n = 4). Both preparations maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months. This finding warrants further research.

Guided Bone Regeneration for Socket Preservation in Molar Extraction Sites: Histomorphometric and 3D Computerized Tomography Analysis

Guided Bone Regeneration for Socket Preservation in Molar Extraction Sites: Histomorphometric and 3D Computerized Tomography Analysis

Retroacetabular osteolytic lesions behind well-fixed prosthetic cups: pilot study of bearings-retaining surgery

BackgroundOsteolytic lesions are common radiological findings behind acetabular prosthetic cups. If the cup is well-fixed, the management is quite controversial. Although implant exchange is the most reliable procedure, in most cases it could be considered overtreatment, with the potential for further morbidity and bone loss. Liner exchange associated with lesion debridement and grafting represents an alternative option that is less invasive. Here we present our experiences from a small pilot study of minimally invasive osteolysis treatment without bearings exchange in patients with no evidence of liner wear.Materials and methodsInclusion criteria: retroacetabular osteolytic lesions in ceramic-on-polyethylene or metal-on-polyethylene cementless total hip arthroplasties, affecting more than 50% of the bone–prosthesis interface on anteroposterior radiography. Exclusion criteria: head penetration into the liner, suspected loosening or infection. Six patients were selected, two asymptomatic and four symptomatic. Only the symptomatic patients accepted the proposed treatment (performed between June 2004 and March 2006). All of them received fluoroscopy-assisted lesion debridement through an iliac cortical window, morcellized bone allograft mixed with autologous platelet-rich plasma, joint exploration for culture and lavage through a small capsular window. Patients were followed up clinically and radiologically at six months, 12 months, and then yearly.ResultsThree patients out of four showed clinical and radiological improvement. One showed radiological improvement only, and recently underwent cup exchange for subsequent loosening. The visual analog scale (VAS) values for pain decreased on average, but not significantly. No major complications occurred. No recurrence was noted at 2.25–4 years’ follow-up.ConclusionsAlthough the small series does not allow any absolute conclusions to be drawn, the reported results seem to justify further, wider studies. It is still unclear if osteolytic lesions associated with no wear of the poly liner would progress to implant failure if left untreated. Until the problem is better understood, this procedure might represent an interesting way to prevent potential loosening and severe bone loss in intact sockets.

Socket wear assessment: A comparison of three different radiographic methods

Three different methods to measure wear of total hip sockets from plain radiographs were compared with the results obtained by direct assessment of the internal deformity of 28 retrieved sockets by means of a coordinate measuring machine. The values obtained by the uni-radiographic, the duo-radiographic, and the radiographic methods based on the change of distance between the centers of the socket and the prosthetic head (CEN) all correlated significantly with the standard obtained by the coordinate measuring machine, provided the sockets were not loose. The most accurate radiographic measurements were obtained with the CEN method. A prerequisite for a reliable estimation of socket wear rate is that it be based on observations of radiographically intact sockets.

Socket loosening after hip arthroplasty. Radiographic observations in 241 cases up to 15 years.

Serial radiographs of 241 consecutive, noninfected low friction arthroplasties performed between 1968 and 1972 were evaluated with respect to socket migration and the presence of radiolucencies, progressive or not. The number of intact sockets in 207 cases of arthrosis decreased slowly and, depending on their classification, approached 95-88 per cent about 10 years postoperatively. Contrary to previous reports, we could not observe any increase in the rate of loosening with time; half of the hips were observed for more than 10 years, and only a few cases of socket loosening were found beyond this point. In rheumatoid arthritis the number of intact sockets was significantly fewer--23 of 34--after about 10 years of service.