Maxillary Sockets Research Articles

Single Immediate Implant Placement into Anterior Maxillary Sockets with Facial Bone Defects: A 5-Year Retrospective Study

Purpose: To evaluate the long-term functional and esthetic effects of immediate implantation combined with guided bone regeneration in patients with labial bone plate defects. Materials and Methods: A total of 46 implants were immediately placed into anterior maxillary fresh sockets with buccal bone defects. Jumping space and the outer side of buccal defects were densely filled with hydroxyapatite bioceramics and covered with biomembrane. CBCT was performed immediately after surgery (T1), 6 months later (T2), and after 5 years (T3). Radiographs were taken at 1 month after surgery (RT1), definitive crown delivery (RT2), and once a year after prosthetic loading (RT3 to RT7) for 5 years. Pink esthetic score (PES) was evaluated at the time of definitive crown delivery (PT1) and at follow-up visits 1, 3, and 5 years (PT2 to PT4) after crown fixation. Results: No implants were lost during the observational period. The labial bone was radiographically reconstructed to acceptable volumes, with an average 2.86-mm horizontal bone and 2.2-mm vertical bone. Significant marginal bone loss occurred within 1 year after delivery of the definitive prosthesis. PES scores did not reveal inferior results at the 5-year follow-up. Conclusion: When other conditions are met for immediate implant placement, small labial plate defects (≤ 5 mm) will not affect the long-term esthetic effect.

The Effect of Different Socket Types on Implant Therapy While Using Flapless Ridge Preservation

This retrospective study compared the effects of different extraction sockets when using flapless ridge preservation during dental implant therapy. The extraction sockets were divided into four groups: Class I, intact soft tissue wall and bone walls; Class II, intact soft tissue wall with the destruction of at least one bone wall; Class III, the recession of all soft tissue walls by ≤5 mm; and Class IV, the recession of at least one soft tissue wall by >5 mm. We compared clinical parameters of dental implant therapy using flapless ridge preservation among these groups. Seventy patients with 92 dental implants, including 53 maxillary and 39 mandibular implants, involving flapless ridge preservation were enrolled. The implant survival rate was not affected by socket morphology. Total treatment time from extraction to final prosthesis placement was significantly longer in Class II and III than in Class I, among the maxillary sockets. However, there was no significant difference in the total treatment time among the different groups in the mandible. Therefore, implant survival rates did not differ according to socket morphology; however, total treatment time was significantly affected by socket morphology in the maxilla and was longer in socket classes associated with periodontitis.

Low- Intensity pulsed ultrasound application improves bone healing in maxillary sockets.

Background: Low-Intensity Pulsed Ultrasound (LIPU) stimulates bone cells and accelerates the repair process. This article aims to evaluate its effect on bone formation by assessing bone density in a maxillary socket after extraction of a central incisor. Methods: A RCT was designed;16 patients with badly decayed upper central incisors were selected. Eight adult patients were randomly assigned to each group. The ultrasound group were subjected to LIPU immediately after extraction through an ultrasound device and the 15 sessions scheduled at five sessions per week for three weeks. The control group patients were not exposed to any intervention. Bone density changes were measured by digital radiographs on days one and 90postoperatively. Results: The bone density of each group was significantly increased at day 90. The estimated mean change in bone density at day 90 was significantly larger in the ultrasound group than the control group (71.555 and 55.764 respectively) after deducting the difference at day 1. Conclusions: the results suggest that LIPU enhances bone healing of maxillary bony extraction sockets. This may be an adjunct modality to avoid healing delays of maxillofacial bony defects as in extraction sockets and cystic defects. Keywords—Bone density, ultrasonic waves, tooth extraction, maxilla, LIPU

Efficacy of Flat-Top Hand-Piece Using 980 nm Diode Laser Photobiomodulation on Socket Healing after Extraction: Split-Mouth Experimental Model in Dogs.

The objective was to evaluate the effect of photobiomodulation (PBM) using 980nm diode laser therapy (0.60W, 0.77Wcm-2 , 36J, 46Jcm-2 , 60s) irradiated in continuous wave mode by flat-top hand-piece on socket healing in the maxilla and mandible. A split-mouth experimental design was performed on 6 dogs. The 3rd premolar tooth was extracted from the maxilla and mandibles for both sides. The right-sided sockets were irradiated (PBM group), and the left-sided sockets were kept as control. Irradiation was done after extraction and at 48-h interval for 14days. Both the buccal and lingual sides were irradiated to reach a total irradiation time of 120s. Bone density was evaluated at 3, 4 and 5weeks using cone beam computed tomography. We showed that maxillary sockets in the PBM group had higher bone density compared to control one at 3, 4, 5weeks (P=0.029, <0.001, <0.001), respectively. Mandibular sockets revealed no significant difference between PBM and control at 3weeks (P=0.347), while at 4 and 5weeks PBM group showed higher bone density (P=0.004, <0.001). In both groups, there was a significant increase (P<0.001) in bone density by time which was higher in the PBM group. We concluded that PBM using a flat-top hand-piece of 980-nm improved the bone density of extraction sockets.

The Noncell Autonomous Requirement of Proboscipedia for Growth and Differentiation of the Distal Maxillary Palp during Metamorphosis of Drosophila melanogaster.

The Drosophila maxillary palpus that develops during metamorphosis is composed of two elements: the proximal maxillary socket and distal maxillary palp. The HOX protein, Proboscipedia (PB), was required for development of the proximal maxillary socket and distal maxillary palp. For growth and differentiation of the distal maxillary palp, PB was required in the cells of, or close to, the maxillary socket, as well as the cells of the distal maxillary palp. Therefore, PB is required in cells outside the distal maxillary palp for the expression, by some mechanism, of a growth factor or factors that promote the growth of the distal maxillary palp. Both wingless (wg) and hedgehog (hh) genes were expressed in cells outside the distal maxillary palp in the lancinia and maxillary socket, respectively. Both wg and hh were required for distal maxillary palp growth, and hh was required noncell autonomously for distal maxillary palp growth. However, expression of wg-GAL4 and hh-GAL4 during maxillary palp differentiation did not require PB, ruling out a direct role for PB in the regulation of transcription of these growth factors.

POSTERIOR MAXILLARY SOCKET PRESERVATION USING COLLAGENATED CORTICO-CANCELLOUS XENOGRAFT

The current study was conducted to evaluate posterior maxillary socket preservation using Prehydrated Collagenated Cortico-Cancellous Equine Xenograft (Osteobiol®) compared to normal socket healing. 22 posterior maxillary extraction sites, indicated for socket preservation and implant placement were included in this study. They were randomly divided into two equal groups; 1-Study group: in which the extraction socket was filled with the bone graft. 2-Control group: in which the extraction socket was left to heal without bone grafting. All patients underwent preoperative evaluation, the target tooth was extracted atraumatically and the alveolar ridge was preserved using Osteobiol Putty bone graft material in the study group cases. All patients underwent follow up for 9 months. During this period they were regularly examined clinically to monitor healing and assess for any complications. Nine months after the first operative phase, bone core biopsy was taken from all cases of both groups, followed by implant placement. Histologic and histomorphometric evaluation of the retrieved biopsies was performed to assess for the amount, type, percentage of new bone formation as well as the osteoblastic/osteoclastic ratio. No major intraoperative or postoperative clinical complications were encountered in both groups. Histologic and histomorphometric examination of the bone biopsies revealed new bone formation in both groups. Morphometric analysis showed that the mean area fraction of the total bone matrix and the lamellar bone area fraction were significantly higher in the study group than the control group. The osteoblastic/osteoclastic ratio was significantly higher in the study group than in the control group. The used grafting material could be successfully utilized for socket preservation in posterior maxilla with minimally invasive procedures without the use of a barrier membrane or a mucoperiosteal flap.

Levels of bacterial contamination in fresh extraction sites after a saline rinse.

To determine the level of bacterial contamination in immediate implantation or augmentation sites vs pristine bone, before and after saline rinses. Bacterial samples were taken from fresh extraction sites (17 patients) and pristine bone (15 patients) before performing implant dentistry surgical procedures. Levels of bacterial contamination were estimated before and after saline rinses. Samples from the socket were placed on an agar plate for total bacterial account and on selective plates for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis counts. The level of bacterial contamination before saline rinse was 1.2 × 10(4) units of bacterial colony (CFU)/mL in fresh extraction sites (study group) and 5 × 10(2) CFU/mL in pristine bone sites (control group). After a saline rinse, the bacterial level was lowered significantly to 5.2 × 10(3) CFU/mL in the study group and to zero in the control group (P < .05). Levels of bacterial contamination were higher in the mandibular sockets (7.5 × 10(3) CFU/ml) than in the maxillary sockets (5.6 × 10(3) CFU/mL), and the difference was statistically significant (P = .034). All implanted/augmented fresh or pristine sites survived in the follow-up period. Fresh extraction sockets with clinical signs of infection show bacterial presence. Pristine bone shows a lower bacterial level. Saline rinse in addition to a decontamination protocol may reduce the level of bacterial contamination significantly both in fresh extraction sites and pristine bone.

Evaluation of the effects of the use of platelet-rich plasma (PRP) on alveolar bone repair following extraction of impacted third molars: Prospective study

Platelet-rich plasma (PRP) is rich in growth factors, target-specific polypeptides that play a role in cell proliferation and differentiation and can thus encourage wound repair. This study sought to assess the effects of PRP on new bone formation in a sample of 25 patients with clinical indications for extraction of all four impacted third molars with similar orientation, depth, and root morphology. Immediately after extraction, sockets on one side received PRP, whereas those on the other side (control) did not. Patients underwent 6 months of clinical and radiographic follow-up. Periapical radiographs were scanned and bone repair was assessed by image histogram analysis. The radiographic densities of the extraction sockets were compared to the densities of the distal surfaces of the adjacent teeth, with the difference between both serving to distinguish the PRP and control sides. Results showed that healing of PRP-treated sockets was significantly different from that of control sockets at 1-, 3-, and 6-month follow-up, in mandibular and maxillary sockets alike. The results of this sample suggest that PRP provides a safe and effective means of speeding alveolar bone repair.

Comparison of Bone Grafting Materials in Human Extraction Sockets: Clinical, Histologic, and Histomorphometric Evaluations

Although there are a number of bone replacement graft materials that are currently available for clinical use, there are few studies that directly compare efficacy among graft treatments before implant placement. The purpose of this report was to compare 3 bone replacement graft materials (PepGen P-15 228 FLOW [DENTSPLY Friadent CeraMed, Lakewood, CO], Puros [Zimmer Dental, Carlsbad, CA], and C-Graft 228 [Clinician's Preference, Golden, CO]) for bone formation by clinical, histologic, and histomorphometric evaluation. In this prospective, intraoral pilot study, 13 maxillary sockets in 2 patients (both smokers) were grafted immediately after tooth extraction with C-Graft 228, Puros, or PepGen P-15 228 FLOW (containing additional PepGen P-15 228 particles; FLOW PUTTY). After 4 months, bone cores were retrieved and analyzed histologically. PepGen P-15 228 FLOW PUTTY produced a significantly (P <0.01) higher amount of vital bone than C-Graft 228 or Puros. The amount of vital bone for FLOW PUTTY was 12-fold higher than for C-Graft 228 and 4-fold higher than Puros. Of 7 FLOW PUTTY treated sites, 7 showed >14% vital bone versus 0 of 3 C-Graft 228 and 0 of 3 Puros treated sites. FLOW PUTTY treated sites showed new vital bone between particles of residual graft. C-Graft 228 treated sites showed residual particles in a background of connective tissue with very little bone. Puros treated sites showed nonvital bone particles in a background of connective tissue, with some new vital bone forming around the nonvital bone. PepGen P-15 228 FLOW PUTTY produced significantly greater vital bone as compared to Puros and C-Graft 228 after 4 months. A larger clinical study is required to confirm these results.