Labial Bone Thickness Research Articles

Comparing the modified socket-shield technique with the conventional immediate implantation technique in the anterior dentition: A 5-year retrospective clinical study.

The aim of this retrospective clinical study was to compare the 5-year radiological and clinical outcomes of patients undergoing immediate implantation with or without the modified socket-shield technique. Patients who underwent anterior tooth replacement via the modified socket-shield technique (MSST) or the conventional immediate implantation technique (CIIT) between 2016 and 2017 were included. The labial bone thickness was assessed at different measurement levels (0, 2, 4 and 6 mm apical to the implant shoulder (IS)) postoperatively (T1), 6 months postoperatively (T2) and 5 years postoperatively (T3). The pink aesthetic score (PES) was evaluated before surgery (T0) and at T2 and T3. Implant success, complications and patient satisfaction were evaluated at every visit. Thirty-six patients (18 in the MSST group) underwent follow-up for 5 years, with no cases of implant failure. Two cases of exposure were detected in the MSST group, but there were no significant effects on hard or soft tissue. Patients in the MSST group showed less and more stable bone resorption than did those in the CIIT group at any measurement level and any time. A higher PES was achieved in the MSST group. Patient satisfaction was similar in both groups. The MSST is a reliable immediate implantation method because of its ability to preserve the alveolar bone and provide superior recovery of aesthetics.

Evaluation of dentoalveolar changes following maxillary incisor intrusion with one vs two anterior miniscrews in subjects with gummy smile: a randomized clinical trial.

To examine dentoalveolar changes following intrusion of maxillary incisors with one or two anterior miniscrews in subjects with gummy smile and deep bite. Forty-three subjects were selected and divided into two groups: group I (22 subjects: 15 women, 7 men; mean age 30 ± 10 years) received one miniscrew between the upper central incisors, and group II (21 subjects: 16 women, 5 men; mean age 30 ± 10 years) received two miniscrews between the canines and lateral incisors. Dentoalveolar parameters, including amount of intrusion, root resorption, incisor inclination, alveolar bone thickness, and buccal alveolar crest height (cementoenamel junction to labial alveolar crest), were evaluated using cone-beam computed tomography scans obtained before and after intrusion. The intergroup comparison was analyzed using a paired t-test and unpaired t-test to determine significant changes within and between groups. The amount of intrusion was significantly greater in group II than in group I (P < .05). No statistically significant differences were found between groups I and II for changes in incisor inclination, labial bone thickness, and buccal alveolar crest height (P > .05). Maxillary central and lateral incisor intrusion was significantly greater in subjects treated with two miniscrews. Root resorption of the maxillary central incisors was notably greater in subjects with one miniscrew, while maxillary lateral incisor resorption was greater in subjects treated with two miniscrews.

Application of sticky bone combined with concentrated growth factor (CGF) for horizontal alveolar ridge augmentation of anterior teeth: a randomized controlled clinical study.

This study was designed to estimate the effect of sticky bone combined with concentrated growth factor (CGF) on anterior alveolar horizontal augmentation during implantation. Twenty-eight patients were randomly assigned to either the test group (Group 1, n = 14) or the control group (Group 2, n = 14). Patients in Group 1 and Group 2 underwent GBR using sticky bone combined with CGF and bone powders mixed with saline, respectively. On postoperative Day 7, the patients completed the visual analogue scale (VAS). Three-dimensional models of maxillary alveolar bone were reconstructed from CBCT data at different periods, and the bone volume conversion rate was calculated with the assistance of a measurement marker guide. Labial bone thickness before and after trauma closure and bone density at six months postoperatively were also measured. The mean bone volume conversion rate for Group 1 (72.09 ± 12.18%) was greater than that for Group 2 (57.47 ± 9.62%, P = 0.002). The VAS score was lower for Group 1 than for Group 2 (P = 0.032). At six months postoperatively, greater bone density was found in patients in Group 1 than in those in Group 2, although the difference was not statistically significant (P > 0.05). The change in the thickness of the labial bone graft material in Group 1 was smaller than that in Group 2 (P = 0.025). Sticky bone combined with CGF was able to achieve better bone augmentation than conventional GBR. With excellent mechanical properties and the capacity to release growth factors, sticky bone is an ideal material for bone grafting. The study was registered at the Chinese Clinical Trial Registry on 10/04/2022 (Identification number: ChiCTR2200058500).

Does the sagittal root position of maxillary anterior teeth affect the decision making on immediate implants in the anterior maxilla? A CBCT-based study.

Immediate implant placement in the maxillary esthetic zone is a challenging and demanding task. To achieve favorable results, proper case selection and treatment planning are necessary. Variables like the sagittal root position (SRP) and the labial bone thickness (LBT) of maxillary anterior teeth are of paramount importance for predictable outcomes. The aim of the present study was to evaluate the SRP and LBT of maxillary anterior teeth in the context of immediate implant placement by using cone-beam computed tomography (CBCT) in a sample of the Pakistani population. A cross-sectional study was conducted using the CBCT scans of patients. The SRP of each tooth (maxillary canine to canine) was evaluated in the sagittal section of a CBCT scan according to the classification by Kan et al. The LBT of each tooth was measured perpendicularly to the long axis of tooth at 3 sites: at the alveolar crest (P1); 2 mm from the alveolar crest (P2); and 4 mm from the alveolar crest (P3). Descriptive statistics were reported for SRP and LBT. The χ2 test was employed to assess any association between the variables. Class I SRP was the most prevalent (n = 196, 81.7%), while Class III was the least frequent (n = 1, 0.4%). The association between the tooth type and SRP was statistically non-significant (p = 0.510). In the evaluated sample of the Pakistani population, the most frequent type of the SRP of maxillary anterior teeth was Class I, which is most favorable for immediate implant placement. Furthermore, the labial bone in the maxillary esthetic zone was found to be mostly thin - LBT was within the range of 0.5-0.9 mm - which makes immediate implant placement in the anterior maxilla a challenge. The results of the present study could serve as a guide for clinicians in terms of appropriate patient selection for immediate implant placement in the maxillary esthetic zone.

Recovery bone formation on radiographic palatal bone dehiscences after incisor retraction with microimplants.

To investigate the difference in labial and palatal alveolar bone thickness and height during the retention period after incisor retraction treatment with microimplant. A sample of 21 patients (mean age: 17.80 ± 4.38 years) who underwent incisor retraction treatment using microimplants after premolar extraction was investigated. The cone-beam computed tomography images at pretreatment, posttreatment, and retention were used to measure anterior alveolar bone thickness (labial, palatal, and total; at three vertical levels) and height (labial and palatal) and differences in the incisor position during treatment or retention. Repeated-measures analysis of variance with Bonferroni correction was performed to compare the variables at T0, T1, and T2. The maxillary central incisor moved posteriorly by approximately 8.0 mm along with intrusive movement of 1.8 mm after treatment. The alveolar bone thickness significantly decreased on the palatal side and increased on the labial side after treatment. Thereafter, the palatal bone thickness significantly increased and labial bone thickness decreased during the retention period. The palatal interdental bone depressed by incisor retraction showed substantial bone deposition after retention. Radiographic palatal bone dehiscences on the incisor root and palatal bone depression between the incisor roots were apparent after treatment. This palatal bone loss around the incisor roots noticeably recovered with newly formed bone during retention.

Alveolar bone changes around maxillary incisors after intrusion and retraction with controlled tipping versus bodily movement : Aretrospective cone-beam computed tomography study.

To compare the effect of maxillary incisor intrusion and retraction with controlled tipping (CT) versus bodily movement (BM) in extraction cases on alveolar bone height and thickness, using cone-beam computed tomography (CBCT). Correlations between changes in alveolar dimensions and crown or root retraction, incisor inclination, and intrusion were also investigated. In all, 144 incisors of 36 women were retrospectively evaluated. All patients were treated with anterior intrusion and retraction with either controlled tipping (CT) (group1) or bodily movement (BM) (group2). CBCT scans were taken before and after retraction and intrusion and measurements of alveolar bone height and thickness at the level of mid-root and root apex were measured. The prevalence of dehiscence was also calculated. Labial bone thickness (BT) increased at the level of the root apex with increased total BT in the CT group (p < 0.05). The BM group showed decreased palatal BT. Significant vertical bone loss with an increased incidence of dehiscences occurred on the palatal side in both groups. Changes in palatal bone area was negatively correlated with the amount of root apex retraction, while the total BT at the level of root apex was positively correlated with amount of intrusion. Bodily retraction can result in reduced palatal bone dimensions and an increase risk of iatrogenic sequelae following anterior retraction in extraction cases. Vertical bone loss and an increased incidence of dehiscences is to be expected following anterior retraction. Careful attention must be paid to the bone boundary conditions to avoid moving the incisors out of the alveolar housing.

The bone shielding versus dual-zone concept in treating thin-walled fresh extraction sockets with immediate implant placement: Soft and hard tissue changes. A randomized clinical trial.

To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual-zone (DZ) technique versus the bone shielding concept in patients with intact thin-walled sockets in the esthetic zone. This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco-palatal ridge dimensional changes were measured and assessed using intra-oral digital scans at baseline and 1 year post-procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year. The bone shielding group provided bucco-palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco-palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco-palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively. The bone shielding concept might offer a reliable alternative for restoring thin-walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization." NCT05381467.

Morphological changes in alveolar bone thickness and height after orthodontic proclination or labial movement combined with autogenous soft tissue grafting: a CBCT evaluation

BackgroundAutogenous soft tissue grafting is indicated in thin gingival biotypes before orthodontic proclination or labial movements to increase the keratinized gingiva and prevent gingival recession. However, its effect on local alveolar bone remodeling is unclear. The aim of this study was to investigate the effects of autogenous soft tissue grafting on local alveolar bone after orthodontic proclination or labial movements.MethodsSixteen patients with a thin scalloped gingival biotype, narrow keratinized gingiva, or thin cortical bone requiring orthodontic proclination or labial movement of teeth were included. Cone-beam computed tomography (CBCT) images were obtained before grafting and at least 6 months after surgery. Sixty mandibular teeth were included, and the vertical bone level and horizontal labial bone thickness were measured. The results were compared using paired t-tests or Wilcoxon signed-rank test.ResultsThe horizontal labial bone thickness increased, especially at 6 mm below the cementoenamel junction (CEJ) in the mandibular central and lateral incisors (P < 0.05). The total alveolar bone area of the canines, first premolars, and second premolars increased at 3, 6, and 9 mm below the CEJ, respectively, and the differences were statistically significant (P < 0.05). Additionally, vertical bone height increased minimally on the labial side, but the differences were not statistically significant (P > 0.05).ConclusionsNew bone regeneration was observed on the labial (pressure) side after autogenous soft tissue grafting, which may represent a mechanism to effectively prevent gingival recession and maintain periodontal health.IRB approvalAll the experimental procedures involving humans in this study were approved by the Medical Ethics Committee of Xiangya Stomatological Hospital, Central South University ( No. 20190048).

Long-term morphometric changes in the anterior alveolar bone in adolescents and adults after space closure: A retrospective study.

To analyse the morphometric changes in the anterior alveolar bone of both the maxilla and mandible after space closure and retention for 18-36 mo in adults and adolescents. Forty-two subjects with 4 first premolars extracted followed by retracting anterior teeth were included and divided into two age groups: adult group (4 males, 17 females, mean age: 23.67 ± 5.29 y, treatment duration: 27.95 mo, retention duration: 26.96 mo, ANB: 4.8 ± 2.1, U1-L1: 117.2 ± 9.2, U1-PP: 120.2 ± 7.2, L1-MP: 99.2 ± 5.3) and adolescent group (6 males, 15 females, mean age: 11.52 ± 1.21 y, treatment duration: 26.18 mo, retention duration: 25.79 mo, ANB: 5.2 ± 2.1, U1-L1: 116.0 ± 8.6, U1-PP: 119.8 ± 4.9, L1-MP: 99.7 ± 4.9). Alveolar bone height and thickness of anterior teeth in both groups were measured using cone beam computed tomography (CBCT) imaging performed at the pretreatment (T1), posttreatment (T2) and retention phases (T3). One-way repeated-measure ANOVAs were performed to evaluate the alveolar bone changes. Voxel-based superimpositions were performed to measure the amount of tooth movement. After orthodontic treatment, the lingual bone height and thickness of both arches and the labial bone height of the mandible decreased significantly in both age groups (P < .05). Most of the labial bone height and thickness of the maxilla in both groups remained unchanged (P > .05). After retention, the lingual bone height and thickness increased significantly in both age groups (P < .05). The amounts of increased height ranged from 1.08 to 1.64 mm in adults and from 0.78 to 1.21 mm in adolescents, and the amounts of increased thickness ranged from 0.23 mm to 0.62 mm in adults and from 0.16 mm to 0.36 mm in adolescents. Obvious movements of the anterior teeth during retention were not found (P > .05). Although lingual alveolar bone loss occurred in adolescents and adults during orthodontic treatment, continuous remodelling occurred in the later retention phase, which provides a reference for clinical treatment planning of bimaxillary dentoalveolar protrusion.

Changes of maxillary central incisor and alveolar bone in Class II Division 2 nonextraction treatment with a fixed appliance or clear aligner: A pilot cone-beam computed tomography study

This retrospective clinical study investigated the clinical changes of maxillary central incisor and alveolar bone in Class II Division 2 nonextraction treatment with fixed appliances or clear aligners on the basis of cone-beam computed tomography. Fifty-nine Chinese Han patients with similar demographic characteristics were collected from a conventional bracket group, a self-ligating bracket group, and a clear aligner group. All measurements about root resorption and alveolar bone thickness on the cone-beam computed tomography images were tested. Changes between pretreatment and posttreatment were evaluated by paired-sample t test. The variation among the 3 groups was compared by 1-way analysis of variance. The resistance center of the maxillary central incisor showed upward or forward movement, and the axial inclination was increased in 3 groups (P<0.0001). Root volume loss in the clear aligner group (23.68 ± 4.82 mm3) was significantly less than that in the fixed appliances group (28.24 ± 6.44 mm3 in the conventional bracket group, 28.17 ± 6.07 mm3 in the self-ligating bracket group) (P<0.05). All 3 groups showed a significant decrease in palatal alveolar bone and total bone thickness at all 3 levels at posttreatment. In contrast, labial bone thickness significantly increased except for crestal level l. Among the 3 groups, the clear aligner group had a prominent increase in labial bone thickness at the apical level (P= 0.0235). Clear aligner treatment for Class II Division 2 malocclusions could effectively reduce the incidence of fenestration and root resorption. Our findings will be beneficial to comprehensively understand the effectiveness of different appliances for Class II Division 2 malocclusions treatment.

How teeth moved and alveolar bone changed after mandibular incisor retraction with intrusion: A retrospective cephalometric and CBCT study

ABSTRACT Purpose To investigate the changes of mandibular incisors in position and alveolar bone thickness and height after retraction with intrusion in adults. Materials and Methods Cephalometric radiograph tracings were evaluated before and after retraction and divided into two groups: pure retraction (PR) and retraction with intrusion (RI). Distances of tooth movements and alveolar bone changes were recorded in cephalograms. Tooth movements in anteroposterior and vertical directions were measured at the incisal edge (IE) and root apex(AXE). Changes of labial bone thickness (LaBT), lingual bone thickness (LiBT) and bone height (BH) were assessed at crestal (S1), mid-root (S2), and apical (S3) levels from 86 Cephalograms (46PR/40RI) and 33 CBCT (17PR/16RI). T-tests were applied for cephalometric group (Ceph-M) and non-parametric tests for CBCT groups (CBCT-M). Results Retraction distances at IE were not different between PR and RI but significant intrusion was observed in RI. Amount of retraction and intrusion at AXE was greater in RI. In PR, LaBT was maintained at S1 and S2 in Ceph-M but only S2 in CBCT-M, whereas S3 exhibited significant bone gain. In RI, LaBT was maintained at S1 in Ceph-M but at S2 in CBCT-M, significant bone gain occurred at S2 and S3 in Ceph-M but at only S3 in CBCT-M. LiBT in both groups showed significant bone thinning at all three levels. LaBH and LiBH in both groups exhibited BH loss. RI showed significantly greater bone gain in LaBT at S3. Conclusions RI provided more lingual and apical movement at AXE with comparable labial and lingual bone response to PR with more apical labial bone gain in RI.

Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial.

The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year. Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n= 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n= 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap. All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p< 0.001). Similarly, changes in mesial papilla (test=-0.64 ± 0.95 mm, control=-1.20 ± 0.81 mm), distal papilla (test=-0.56 ± 1.17 mm, control=-1.26 ± 0.63 mm), horizontal soft-tissue (test=-0.82 ± 0.95 mm, control=-1.84 ± 0.88 mm; p< 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes. The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.

Labial alveolar bone thickness and its correlation with buccolingual maxillary incisors angulation: a CBCT based study.

Understanding the labial alveolar bone thickness (ABT) and buccolingual teeth angulation may reduce the complication that might arise during or post-operative treatment. The operator could determine the precise method to ensure long-term treatment success. This study aimed to evaluate the ABT with buccolingual upper incisor teeth angulation based on the maxillary plane by using the cone-beam computed tomography (CBCT). A total of 371 CBCT radiographs were initially assessed and 100 CBCT radiographs were included. On the maxillary incisors, the labial alveolar bone thickness is evaluated at three points (Point A: Four mm below from CEJ, Point B: Midpoint from the labial alveolar-palatal alveolar crest plane and root apex. Point C: Root Apex of the tooth). The distance from these points to labial alveolar bone was measured for the ABT. Moreover, buccolingual angulation of the tooth was measured by the angle formed by the maxillary plane and the long axis of the tooth. There is no significant difference observed between genders in the labial alveolar bone thickness. The labial alveolar bone thickness grew gradually from the cementoenamel junction (CEJ) level to the apical level. Moreover, there was a statistically significant positive correlation observed between labial alveolar bone thickness at the apical level (Point C) and angulation (p<0.05). The labial bone thickness was less than 2 mm in the majority of cases at the three points among maxillary incisors. In addition, there is a correlation between buccolingual angulation of the maxillary incisors and labial alveolar bone thickness.

Influence of bone morphology on the mechanobiological stimuli distribution of maxillary anterior labial bone: A biomechanical study.

This study intended to ascertain the dimensional effects of labial bone thickness and height on the mechanobiological stimuli distribution of maxillary anterior labial bone through biomechanical analysis. Twelve 3D finite element models of an anterior maxillary region with an implant were computer-simulated, including four levels of labial bone thicknesses (2, 1.5, 1.0, and 0.5 mm) and three levels of labial bone heights (normal, reduced by 1/3, reduced by 1/2). A 45° buccolingual oblique load of 100 N was applied to the implant restoration. Equivalent stress and principal strain mainly concentrated on crestal bone around the implant neck. The maximum equivalent stress in bone decreased as labial bone mass decreased, while the maximum principal strain and the displacement of dental implant increased as labial bone mass decreased. No significant difference of these three indicators was observed, when the labial bone thickness changed in the range of 2.0-1.0 mm with sufficient labial bone height. In terms of biomechanics, the thickness of labial bone plate was recommended ≥1 mm. Sufficient labial bone height was warranted to prevent the stability of the implants from being seriously affected. The labial bone heights were more effective than thicknesses on the mechanobiological stimuli response of the dental implant-bone system. For this 3D finite element study, the biomechanical responses under different bone mass conditions were explored, in order to predict the process of bone remodeling and provide valid clinical recommendations for the decision-making process regarding the choices of tissue augmentation for some specific esthetic implantation cases for future clinical applications.

Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial

BackgroundOrthodontic treatment is commonly more time-consuming in adults than in teenagers, especially when it comes to the maxillary en-masse retraction, which may take 9 months or even longer. As to solve this concern, orthodontists have been striving to seek new methods for shortening orthodontic treatment time. Piezocision, as a popular alternative treatment, has been widely used in different types of tooth movement. However, its effect on en-masse retraction of maxillary anterior teeth remains unclear. This randomized controlled trial intends to figure out the role piezocision plays in accelerating en-masse retraction.MethodsThis protocol is designed for a prospective, single-center, assessor-blinded and parallel-group randomized controlled trial. Twenty adult patients aged from 18 to 40 whose orthodontic treatment required bilateral maxillary first premolars extraction will be randomly assigned to the piezocision group and the control group at a ratio of 1:1. The piezocision group will undergo en-masse retraction immediately after the piezo surgery, while the control group will start en-masse retraction directly. Both groups will be followed up every 2 weeks to maintain the retraction force until the end of space closure. The space closing time is set as the primary endpoint. Meanwhile, the secondary endpoints include the change of root length, labial and palatal alveolar bone thickness, vertical bone height, probing depth of maxillary anterior teeth, cephalometric measurements, visual analogue scale, and postoperative satisfaction questionnaire.DiscussionThis study will attempt to provide more convincing evidence to verify whether piezocision will shorten the time of en-masse retraction or not. Distinguished with previous studies, our study has made some innovations in orthodontic procedure and primary outcome measurement, aiming to clarify the efficacy and safety of piezocision-assisted en-masse retraction in Chinese population.Trial registrationChinese Clinical Trial Registry ChiCTR 1900024297. Registered on 5 July 2019

Does Grafting the Jumping Gap in Immediately Placed Anterior Implants Using Vestibular Socket Therapy Influence the Labial Bone Thickness?

There is no consensus in the literature on whether grafting the jumping gap (the distance between the inner surface of the labial bone plate and the implant surface) in immediately placed implants influences the thickness of the labial bone plate. This study aimed to compare the efficacy of particulate bone graft filling material and spontaneous bone healing following blood clot formation when placing immediate implants in the esthetic zone. A double-blind randomized controlled clinical trial was conducted in a private practice on patients scheduled for immediate implant placement using the vestibular socket therapy between November and December 2019. Participants were assigned to 2 groups. In Group 1, the jumping gap was filled with a mixture of 75% autogenous bone chips and 25% deproteinized bovine bone mineral (DBBM). In Group 2, the gap was unfilled. The regenerated facial bone thickness was evaluated using CBCT. Measurements were taken at baseline before tooth extraction and 12months postoperatively. The Mann Whitney U test was used for between group comparisons and Wilcoxon signed-rank test for within-group comparisons. Twenty-two patients (8 men and 14 women; mean age, 45.22years) were randomly assigned to Group 1 or Group 2, with 11 patients each. A statistically significant difference in bone thickness was found between groups (P=.008). The mean (SD) overall bone thickness was 2.95 (0.97) mm for the particulate bone group compared to 1.45 (0.92) mm preoperatively. While, for the unfilled group, the mean (SD) overall bone thickness was 1.98 (0.56) mm compared to 0.79 (0.49) mm preoperatively. The results suggested that grafting the jumping gap with particulate bone graft when implementing the vestibular socket therapy enhanced the thickness of the labial bone plate of immediately placed implants in the esthetic zone.

Anterior Maxillary Labial Bone Thickness on Cone Beam Computed Tomography

AimThe objective of this research was to measure the labial bone thickness (LBT) in relation to the 6 anterior maxillary teeth at different levels along the long axis and the distance between cementoenamel junction and bone crest (CEJ-BC) based on cone beam computed tomography (CBCT) scans retrieved from patients of Arab ethnicity and identify any association with patients’ characteristics. Materials and methodsA total of 100 CBCT scans were evaluated by one calibrated examiner. The thickness of the labial bone was measured perpendicular to the long axis of the tooth at 1, 3, and 5 mm from the alveolar crest (LBT-1, LBT-3, and LBT-5, respectively) and CEJ-BC using a medical imaging viewer. ResultsCBCT scans of 58 female patients and 42 male patients with a mean age of 39.7 ± 9.5 years were included. A high variation of CEJ-BC was observed (range, 0.55-3.90 mm). Statistically significant higher CEJ-BC values were associated with men and increased age (>50 years). The overall means of LBT-1 were 0.76 ± 0.26, 0.79 ± 0.26, and 0.83 ± 0.37 mm; LBT-3: 0.92 ± 0.36, 1.05 ± 0.46, and 1.03 ± 0.48 mm; LBT-5: 1.17 ± 0.52, 0.80 ± 0.45, and 0.81 ± 0.40 mm for central incisors, lateral incisors, and canines, respectively. The LBT was <1 mm in 74.2% of all maxillary anterior teeth, with central incisors showing the highest predilection (85% with LBT <1 mm). No significant association between LBT and patient characteristics was observed. ConclusionsThe CEJ-BC distance is greater in men and increases with age, particularly in those aged 50 years and older. The LBT in the 6 maxillary anterior teeth is predominantly thin (<1 mm) and has no correlation to age or sex. An increased LBT was observed at a 3-mm level when compared with LBT-1 and LBT-5. Such variability should be taken into consideration when planning for implant placement.

Assessment of the relationship between labial gingival thickness and the underlying bone thickness in maxillary anterior teeth by two digital techniques

This study aimed to noninvasively assess the relationship between the labial gingival thickness (GT) and the underlying bone thickness (BT) of maxillary anterior teeth by two digital techniques. A total of 30 periodontally healthy participants with 172 maxillary anterior teeth were enrolled. GT and BT were measured at 2, 4 and 6 mm apical to the cemento-enamel junction (CEJ) by two digital techniques: M1—cone-beam computed tomography (CBCT) and M2—digital intraoral scanning (DIS) combined with CBCT. The Pearson's correlation coefficient was calculated to determine the correlation between GT and BT. A significant negative correlation was identified between GT and BT at 2 mm apical to the CEJ for central incisors (CI), lateral incisors (LI), and canines (CA) both by M1 and M2, while a weak negative correlation at 4 mm apical to the CEJ was observed by M1 for CA. No significant correlation was found at other sites by both M1 and M2. The labial BT was < 1 mm in most cases (85% of CI; 97% of LI; and 90% of CA). Within the limitation of this study, it was concluded that GT and BT seemed to be negatively correlated at 2 mm apical to the CEJ. Therefore, caution is warranted when implant restoration at the esthetic area of the anterior teeth.

Short-Term Evaluation of Guided Bone Reconstruction with Titanium Mesh Membranes and CGF Membranes in Immediate Implantation of Anterior Maxillary Tooth.

Purpose The aim of the present prospective study was to evaluate the effect of titanium mesh and concentrated growth factor (CGF) membranes in reconstructing severe labial bone defects during immediate implantation of anterior maxillary tooth. Methods Patients with severe defects presenting on the anterior labial bone plate of maxillary were enrolled in this study. During immediate implantation, the titanium mesh was used to maintain the space of bone graft, collagen membrane, and xenograft bone that were used to guide bone regeneration (GBR). Cone beam computed tomography (CBCT) was used to measure the height and the labial bone thickness around the implant at the time of the second stage surgery, 6 months, 1 year, and 2 years after restoration. The pink esthetic score (PES) was used to evaluate the esthetic outcomes after restoration. Results 18 patients were enrolled in this study. The survival rate of implants was 100%, and no complication was observed, except for 1 case of titanium mesh exposure which did not affect osteogenesis. In the second stage of surgery, the labial bone was completely reconstructed, and the top of the implant was covered with a small amount of new bone. The thickness of the labial bone was 3.01 mm (±0.23), 2.96 mm (±0.21), 2.93 mm (±0.19), and 2.92 mm (±0.16) at the time of the second stage surgery, 6 months, 1 year, and 2 years after restoration, respectively. The height of the marginal bone around implants was above the top of implant at the time of the second stage surgery and then reduced 0.72 mm (±0.07), 0.91 mm (±0.08), and 0.90 mm (±0.07) at the time point of 6 months, 1 year, and 2 years after restoration, respectively. The changes of bone thickness and height were statistically significant within one year, but stable after one year. The PES values showed the same tendency. Conclusions With the limitation of the present prospective study, the combination of titanium mesh and CGF membrane could provide space maintenance for bone augmentation of alveolar bone defects and improve the bone regeneration in patients with severe labial bone defect when immediate implant of anterior maxillary.

Hard tissue stability after guided bone regeneration: a comparison between digital titanium mesh and resorbable membrane

Guided bone regeneration (GBR) uses resorbable and non-resorbable membranes as biological barriers. This study compared the differences in hard tissue stability between GBR using evidence-based digital titanium mesh and resorbable collagen membranes during implant placement. A total of 40 patients (65 implant sites) were enrolled and divided into two groups: resorbable membrane and digital titanium mesh groups. The alveolar bone was analyzed at two- and three-dimensional levels using cone-beam computed tomography and by reconstructing and superimposing the hard tissues at four time points: preoperatively, postoperatively, before second-stage surgery, and 1 year after loading. The use of digital titanium mesh showed less alveolar bone resorption in vertical and horizontal directions two-dimensionally before the second-stage surgery and 1 year after loading. Regarding volumetric stability, the percentage of resorption after 6 months of healing with resorbable membrane coverage reached 37.5%. However, it was only 23.4% with titanium mesh. Although postoperative bone volume was greater at all labial sites with resorbable membrane than with digital titanium mesh, after substantial bone resorption within 1 year of loading, the labial bone thickness at the upper part of implants was thinner with resorbable membrane than with digital titanium mesh. Furthermore, digital titanium meshes made according to ideal bone arch contour reduced soft tissue irritation, and the exposure rate was only 10%. Therefore, although both resorbable membrane and digital titanium mesh in GBR were able to successfully reconstruct the bone defect, digital titanium meshes were better at maintaining the hard tissue volume in the osteogenic space.