Bone Preservation Research Articles

Early implant placement Type 2, using flapless technique in one surgical stage. Five years follow-up

Postextractional implants placement is frecvently discussed in the literature as a method aimed to facilitate implant-prosthetic rehabilitation and preservation of alveolar bone. However, the opinions are divergent while the obtained results often are unfavorable due to bone loss and mucosal recessions. An alternative for postextractional placement is early type 2 implants placement. The study was based on results evaluation of 51 implants insearted in early period after teeth extractions (type 2) in one surgical step, using flapless surgery, without removing the socket content. For evaluation of healing process in the socket, histological analyses of it’s content were performed at 2, 4 and 8 weeks periods. The obained results showed that early implant placement type 2 is a safe method with an integration rate similar to the conventional method. The presence of healed soft tissues is an advantage upon the postextractional placement. The preservation of socket primary matrix lead to a good bone healing around implants without necessity of grafting.

Gingival phenotype role in early peri-implant bone remodeling

According to the literature the preservation of peri-implant bone is multi-factorial process and one of the key factor is the quality and quantity of soft tissues. If necessary, it can be created by different grafting procedures before implant placement, during insertion or even after it. It is necessary to appreciate the influence of gingival phenotype upon periimplant bone loss during healing period. The aim of the study was to evaluate the soft tissue influence upon peri-implant bone remodeling during the healing period. The study was performed by analyzing the bone loss around 109 two-piece dental implants installed in one surgical step in 64 patients in posterior sides of the lower jaw (premolar and molar regions) who presented different thickness of the mucosa. After correlation analysis it was determined that the gingival phenotype have no impact on peri-implant bone loss during the healing period. Thus, gingival grafting can be performed before implant placement, during insertion or even after it.

Interpretation through a literature review of the benefits of post-extraction dental implants

The objective of the study was to interpret, through a literature review, the benefits of post-extraction dental implant placement. A documentary, exploratory, and non-experimental research was conducted by searching for articles in databases such as Pubmed, Scielo, Google Scholar, and Clinical Key, limiting the period to investigations from 2018 to 2023. A total of 21 articles selected from 40 were analyzed. The results indicated that the placement of immediate post-extraction implants presents a success rate comparable to that of implants placed in healed alveolar bone, with significant benefits in terms of bone and soft tissue preservation, reduction of surgical interventions, and aesthetic improvement. The importance of proper prosthodontic planning and case selection to ensure treatment success was highlighted. The findings suggest the need for additional studies on post-extraction bone resorption and implant placement

Association between prosthesis contour and peri-implantitis in patients compliant with supportive periodontal therapy: A retrospective cohort study.

Poor contour of the implant restoration causes plaque accumulation and increases the risk of peri-implantitis. This study aimed to investigate whether the prosthodontic components of dental implants were associated with the prevalence of peri-implantitis. We enrolled 185 patients with 348 implants who underwent at least 1-year follow-up after the delivery of the prosthesis from February 2010 to January 2021. Demographic data of the patients and implants and the follow-up period were recorded. The emergence angle, type of cervical crown contour, and contour angle were analyzed using annual bite-wing radiographs. Peri-implantitis in this study was diagnosed if the peri-implant bone loss was greater than 2 mm between the bite-wing radiographs taken at baseline and the latest. Chi-square test, two-sample t-test, and multivariate logistic regression were used to investigate the differences and odds ratios between the peri-implantitis and non-peri-implantitis groups. The incidence of peri-implantitis was 14.9% during a follow-up period of 1509 days after the delivery of the prosthesis for at least 1-year. Based on the prevalence of non-peri-implantitis and after adjusting for confounding factors, the risk factors identified were bone types for implants (native bone vs. alveolar ridge preservation: adjusted odds ratio = 2.43, P = 0.04). Sex, arch, and guided bone regeneration vs. alveolar ridge preservation have the potential for a statistical difference. Compared with implants at alveolar ridge preservation sites, implants in the native bone were more prone to peri-implantitis. Further randomized controlled trials are required to determine these associations.

The study of dental status through determination of the degree of preservation of paleoanthropological material.

Aim: To introduce a simple classification system for the degree of preservation and quality of the dentoalveolar apparatus into scientific circulation to further investigate dental diseases in ancestral populations.. Materials and Methods: The sample analyzed consisted of the remains of 499 individuals from the human populations that existed in the territories of Ukraine from the Copper Age to the Bronze Age. Teeth and jaws were examined macroscopically under bright light; dental changes were evaluated by probing. Dental radiographic examinations were performed using retroalveolar and panoramic X-ray films in adult individuals. Results: The authors divide the dentoalveolar apparatus of fossil and subfossil skeletons into ten levels for further medical investigation of dental diseases. These levels depend on the preservation degree and changes in jaws and teeth. Conclusions: The study of bone and tooth preservation, determination of skeletal sex, and age characteristics is a separate section and stage in reconstructing the physical type of individuals and the health status of a community. Studying the taphonomic features of odontologic anthropological material should be a mandatory prerequisite preceding its analysis in paleopathology. The condition of the dentoalveolar system can be classified into ten levels for paleopathological conclusions. This classification will be helpful to doctors specializing in forensic medicine and anthropologists.

Therapeutic approach in periimplantitis

Peri–implantitis is a frequent a polyetiological disease. Currently its treatment is a challenge, the treatment algorithms still being unclear. Purpose of the study: Evaluation of etiological factors of complications in implant– prosthetic rehabilitation and comparative analysis of available management methods. Materials and methods: 47 patients and 108 implants were included in the study. The parameters of interest were: gender, age of the patients, number of affected implants, spreading of peri–implantitis according to the teeth position and distribution between the jaws, possible etiological factors, distribution of defects according to Schwarz classification, level of bone resorption, applied treatment. Results: Among 34 treated implants, an improvement was achieved in 6 cases, among 72 extracted implants favourable conditions were obtained in all cases. Priority is given to maximum bone preservation and the possibility of subsequent replantation. Radical surgical treatment in extensive defects shows greater predictability than conservative treatment.

The modified socket shield technique with immediate implant placement-A case report with procedural tips

The tooth root always aids in preserving the surrounding hard and soft tissues, favouring their functionality and aesthetics. Resorption of the alveolar bone following tooth extraction leads to deficits in both the hard and soft tissues. In order to prevent resorption after extraction, immediate implant placement, the use of graft materials, and the use of barrier membranes have all been reported in the literature. Despite different degrees of cortical bone preservation, none of these procedures completely avoided mid-facial recession after immediate implant placement. The socket shield technique can be used to prevent this. Here, in this clinical case report we present “the modified socket shield technique” in achieving successful aesthetic and functional outcome with procedural tips.

Biomechanical comparison of a novel circular glenoid with peripheral ring fixation to a standard anchor pegged glenoid in total shoulder arthroplasty

BackgroundCurrent standard total shoulder pegged glenoid component designs have a high rate of loosening, which accounts for the most common long-term reason for surgical failure. Glenoid design, method of fixation, and implantation version all play a role in component stability. This study aimed to evaluate the biomechanical stability of a novel circular glenoid with peripheral ring fixation and compare to a standard anchor pegged glenoid both directly and to historical biomechanical data. Additionally, we compared the estimated bone removal for the glenoid design types. MethodsBiomechanical testing was performed to assess the circular glenoid with peripheral ring fixation with regards to stability and resistance to “rocking horse” effect, torsional loosening, resistance to torque dissociation, and axial pullout strength. This was compared directly (pullout strength) and to historical (“rocking horse”) biomechanical data obtained for a standard anchor pegged glenoid. A 3D Computer-Aided Design model of five different scapula sizes and shapes was also utilized to estimate volume bone removed when using implant specific prep instrumentation for each glenoid system. ResultsTensile displacement of the worst-case ring fixation component (size medium) after dynamic rocking was 0.060 mm requiring an average peak torque of 6.21N-m to dissociate the glenoid. The ring fixation component demonstrated a mean pullout strength of 1367 N compared with 645 N for the standard anchor pegged glenoid component. The ring fixation component revealed no loosening when placed under torsional stress. The peripheral ring fixation glenoid preparation on average removed 45% less bone than a standard anchor pegged glenoid. ConclusionThe circular glenoid with peripheral ring fixation demonstrated superior maximum pullout strength and more bone preservation with glenoid preparation when compared to the standard pear-shaped, pegged glenoid components. Compared to published standard pegged glenoid component controls, the glenoid with peripheral ring fixation demonstrated diminished “rocking horse” displacement. Despite the circular anchor ring design, there was no evidence of loosening under torsional stress. Initial biomechanical data is overall promising for this novel glenoid design.

The impact of immediate versus delayed mini-screw placement on alveolar bone preservation and bone density following tooth extraction: evidence from a canine model

The aim of this study was to evaluate the impact of mini-screw placement on the alveolar ridge using a split-mouth design. Twelve beagles underwent bilateral extraction of their lateral teeth. In the immediate group, a mini-screw was unilaterally placed approximately 3–4 mm below the alveolar crest of the extraction site on the experimental side. The delayed group received mini-screws six weeks after tooth extraction. On average, the dogs were sacrificed after 11 weeks, and the maxillary bones were excised and scanned using cone-beam computed tomography (CBCT). Histopathological examinations were conducted to assess inflammation and bone formation scores. The results showed that in the immediate group, bone height was significantly greater on the intervention side compared to the control side (p < 0.05), whereas there was no significant difference in the delayed group. In both groups, there was a significant increase in bone density around the mini-screws compared to the control sides (p < 0.05). Mini-screw insertion led to a significant enhancement of bone growth in both groups (p < 0.05), with no notable differences between the two groups. The mini-screws did not have any impact on bone inflammation or width. Overall, both immediate and delayed mini-screw placement in the extraction socket positively influenced bone dimensions, density, and histological properties. However, immediate insertion was more effective than delayed placement in preserving vertical bone height, despite delayed insertion resulting in higher bone density.

BMP-7 Expression After Induction of Hydroxyapatite Bovine Tooth Graft Gel as A Socket Preservation of The Alveolar Bone (Laboratory Experimental of The Alveolar Bone)

Background: Hemisection is an endodontic surgical procedure that can leave alveolar bone defects. Changes in the dimensions of the alveolar bone can be minimized by preserving the alveolar bone socket using a bone graft. Induction of Hydroxyapatite Bovine Tooth Graft (HAp-BTG) in the alveolar bone socket is expected to increase the expression of BMP-7 which is a growth factor in osteogenesis. Purpose: To describe the increase in BMP-7 expression after induction of hydroxyapatite bovine tooth graft gel as a socket preservation of the alveolar bone of Wistar rats on the 14th and 28th days. Methods: 28 Wistar rats were extracted on the lower left incisor. Post-extraction sockets were induced by Polyethylene Glycol (PEG) as the control group and HAp-BTG + PEG as the treatment group. On the 14th and 28th day the Wistar rats were euthanized and the mandibles were taken. By using immunohistochemical staining on anatomic histopathological examination, BMP-7 expression was observed using a microscope with 1000× magnification. The research results were analyzed using One Way ANOVA. Results: There was a significant increase in BMP-7 expression between the control group and the treatment group. Conclusion: BMP-7 expression after induction of hydroxyapatite bovine tooth graft gel as a socket preservation of the alveolar bone of Wistar rats increased on the 14th and 28th days.

Intrawound navigation for custom-made acetabular component in revision total hip arthroplasty: Does it improve implant positioning?

BackgroundThe number of hip revisions makes up over 12 % of all hip arthroplasty cases. For large acetabular defects custom-made acetabular component (CMAC) are required. Rates of malposition of CMACs are highly variable. Our study aims to develop a readily available, reliable and easily reproducible method for positioning of the CMAC. We tried to answer the following questions: 1) how often does the postoperative position of the implant corresponds to the planned one; 2) is the use of intrawound navigation improve the precision of acetabular implant position. MethodsThis was a single-center observational cohort study and included two groups: the experimental group (use of 3D navigation for implant positioning) and the control group (no navigation use). All the patients were scheduled for acetabular revision surgery with custom-made 3D-printed acetabular components. All surgeries took place between 2016 and 2020. Results25 % freehand group, 85 % implants in the navigation group matched accuracy positioning criteria. The relative risk of malposition was significantly higher without the intraoperative navigation, with 5 times greater risk of malpositioning in the freehand group versus the navigation group. ConclusionNavigation method allows planning of the implant and reamer sizes for optimal bone preparation and preservation. It provides easier implantation of the complex implant with reliable, stable primary fixation in massive bone defects. It reliably decreases malposition rate, allowing for implant placement in a proper position with sufficient bone-implant contact. Further research is needed to determine the relationship between CMAC position accuracy and long-term clinical and radiographic outcomes.

Long-term effects of buried vertebrate carcasses on soil biogeochemistry in the Northern Great Plains.

Decomposing vertebrates impact ecosystems by stimulating animal, insect, and microbial scavengers, perturbing biogeochemical cycles, and transferring elements back to the environment. Most studies exploring the impacts of vertebrate decomposition focus on surface decay scenarios over timescales of days to years. Accordingly, our knowledge of ecosystem impacts of vertebrate decomposition in burial contexts and over longer time scales is limited. In 2000, six animal carcasses were buried in a shallow grave (<1.0 m) and allowed to decompose naturally until partial excavation in 2021, enabling evaluation of long-term soil biogeochemical responses to decomposing vertebrates. Soils were sampled along three vertical transects from the surface to the bone-bearing layer (~40 cm depth) and below. Comparison of the physical and chemical properties of the grave and control soils from equivalent depths indicate significant perturbations even 21 years after burial. Notably, soil pH was significantly more acidic in grave soils (p = 0.0296), and conductivity was significantly elevated (p = 0.0009). Grave soils were significantly enriched with respect to nitrogen stable isotopes, exhibiting δ15N values of 10.48 ± 3.6‰, which is ~5‰ greater than controls. Carbon and nitrogen content was also disrupted in the burial, with five times more nitrogen in the bone-bearing layer and almost double the carbon. Water and acid-based extractions of soils revealed significant differences between grave and control soils, driven largely by calcium, phosphorus (P), magnesium, and iron concentrations. P concentrations in acid extracts were significantly enriched at the bone-bearing layer, suggesting release of P from the bones. This study demonstrates that decomposition may result in long-lived impacts to burial environments and soil biogeochemistry, even after soft tissues decay. While not typically considered in ecosystem models, buried remains contribute to soils for decades or longer, and soil biogeochemistry serves a critical role in facilitating or preventing the long-term preservation of bone.

Verbascoside Inhibits/Repairs the Damage of LPS-Induced Inflammation by Regulating Apoptosis, Oxidative Stress, and Bone Remodeling.

Osteocytes play an important role as regulators of both osteoclasts and osteoblasts, and some proteins that are secreted from them play a role in bone remodeling and modeling. LPS affects bone structure because it is an inflammatory factor, despite verbascoside's potential for bone preservation and healing. Osteocytes may also be involved in the control of the bone's response to immunological changes in inflammatory situations. MLO-Y4 cells were cultured in either supplemented -MEM alone with a low serum to inhibit cell growth or media with LPS (10 ng/mL) and/or verbascoside (50 g/mL) to show the LPS effect. In our research, LPS treatment increased RANKL levels while decreasing OPG and RUNX2 expression. Treatment with verbascoside reduced RANKL expression. In our work, verbascoside increased the expression of OPG and RUNX2. In MLO-Y4 cells exposed to verbascoside, SOD, CAT, and GSH activities as well as the expression levels of bone mineralization proteins like PHEX, RUNX2, and OPG were all elevated.

Tooth supported overdentures: Procedure, problems &amp; solutions

Preservation of residual alveolar bone is one of the most challenging tasks in hands of a Prosthodontist. With Preventive Prosthodontics gaining popularity, all attempts are made to preserve the natural tooth structure. Overdentures have been a commonly used treatment option that helps in preservation of bone and maintains the proprioceptive sensory impulses. The treatment option has been widely exercised with implants as implant supported overdentures as well. The treatment modality has some inherent challenges and require proper deliberation and well executed treatment plan to avoid post insertion complications and ensure longevity of prosthesis. The article showcases two cases of tooth supported overdentures, some common problems, and possible solutions.

Effect of six weeks of resistance training on bone preservation in older adults: a randomized control trial.

It has been established that chronic resistance exercise contributes to positive changes to bone in older adults. This study evaluated the effect of 6weeks of resistance exercise with either elastic bands or dumbbells vs. a control period on bone morphology of older adults. Fifty-seven adults (mean ± SD; age = 66.5 ± 7.09 yrs; height = 165.2 ± 10.6cm; body mass = 74.5 ± 14.6kg) were randomized into three groups (dumbbell, elastic, or control). Participants underwent a total body dual-energy X-ray absorptiometry (DXA) scan for total body and segmental bone mineral content (BMC) and bone mineral density (BMD) before and following 6-week intervention. Age-matched Z-scores for BMD and BMC were recorded. Data were analyzed using two-way repeated measures ANOVAs and 0.05 significance level. BMCarm improved for the dumbbell group (p = 0.016) after the training, with no change in BMD for any group (p > 0.05). Additionally, significant (time x treatment group) interaction (p = 0.024) of age-matched Z-scores indicated an improvement in only the dumbbell group after 6weeks (p = 0.015), with no change in the elastic group despite them having greater Z-scores than the control group. This study is the first to demonstrate acute normative adaptations as dumbbell-based programs may promote positive maintenance of bone metrics over 6weeks, despite the lack of significant change in absolute BMC or BMD. Adults did not lose relative bone mass with acute exercise using dumbbells as the external load applied and this may lead to positive changes following chronic training. There was no bone-related impact from elastic bands, suggesting a weighted load or force produced relative to gravity is beneficial.

Custom, 3-Dimensional Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty: Part 3—Prosthesis Placement, Subscapularis Repair, and Postoperative Rehabilitation

The proposed benefits of stemless humeral implants include greater bone preservation, decreased cortical stress shielding, less risk of diaphyseal stress risers, decreased surgical time, and greater ease of implant removal during revision surgery. In part 3 of this comprehensive technique series on the management of glenohumeral arthritis, we present our step-by-step surgical technique for use of a patient-specific 3-dimensionally printed glenoid drill guide, placement of a stemless anatomic total shoulder prosthesis, and subscapularis repair, and we highlight our protocol for postoperative rehabilitation.

Stemless Reverse Shoulder Arthroplasty.

Since the Food and Drug Administration (FDA) approval nearly two decades ago, the indications for and utilization of reverse shoulder arthroplasty (RSA) have expanded considerably. Stemless RSA designs have been used in Europe since 2005, but have only recently been introduced in domestic Investigational Device Exemption trials. Potential advantages of stemless RSA are similar to those of stemless anatomic total shoulder arthroplasty, which may include fewer shaft-related complications, avoidance of stress shielding, bone preservation, and easier revision surgery. European data support similar outcomes between certain stemless RSA prostheses compared with that of stemmed RSA implants at early and mid-term follow-up. However, long-term outcomes remain to be seen and differences exist between the stemless RSA designs used in Europe and those being studied in domestic clinical trials. An understanding of the potential advantages and disadvantages of stemless RSA, differences between existing designs, and reported clinical outcomes is prudent for the safe and meaningful implementation of this new technology in the United States.

Does flapless immediate implant placement lead to significant preservation of buccal bone compared to flap surgical protocol?

A systematic review and meta-analysis of randomized clinical trials. The electronic search included Pubmed, Web of Science, Embase, and Cochrane databases up to June 2022. Cross-referencing, searching for gray literature at ( www. gov ), and hand searching of seven relevant journals were also performed. Inclusion criteria consisted of: randomized clinical trials (RCTs) published in English comparing flapless to flap surgery for IIP using single titanium implants in the esthetic zone of healthy ≥18 years old patients. Prospective and retrospective case series, cross-sectional studies, letters to editors and reviews were excluded. The key study factor was to assess the impact of the surgical approach (flap versus flapless surgery) on buccal hard and soft tissue changes after single immediate implants for the anterior teeth in healthy adult patients. The primary outcome was horizontal buccal bone change (HBBC), measured by CBCT. Secondary outcomes were implant survival, vertical buccal bone change, postoperative pain, and clinical and esthetic parameters. Two independent reviewers conducted both electronic and manual searches for eligible clinical studies. The evaluation was carried out at the title level followed by the abstract level, and the full texts of the qualified articles were then examined. Any disagreements were resolved by discussion with a third reviewer. Quality assessment of the included RCTs was conducted by two additional reviewers who were not part in the search process using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis was conducted on outcome variables that were documented in three or more articles. Five RCTs fully met the selection criteria for the final qualitative analysis comprising data of 140 patients who received 140 single immediate implants (flapless: 68; flap:72) with a mean age ranging from 30 to 67 years. Follow-up extended for 6-12 months. Two RCTs showed an overall low risk of bias, whereas the other three RCTs had an overall high risk, basically due to using inappropriate methods of outcome measurements. Meta-analysis included three RCTs and revealed a mean difference of 0.48 mm (95% CI [0.13,0.84], p = 0.007) in HBBC between surgical approaches, favoring flapless surgery. Heterogeneity among the studies was low (I2 = 29%; p = 0.250). For implant survival, however, meta-analysis failed to find a significant difference among the groups (RR 1.00, 95% CI [0.93, 1.07], p = 0.920). Due to limited data, meta-analyses could not be conducted for other secondary outcomes. Available studies consistently showed a favorable effect of flapless surgery in terms of vertical buccal bone change and pain, while only one study assessed the vertical midfacial soft tissue change, and no data were reported on esthetic outcomes. According to CBCT data, flapless IIP resulted in greater preservation of buccal bone as compared to flap IIP. However, the clinical significance of this finding remains uncertain since clinical and esthetic outcomes were insufficiently reported.

Both Acetabular and Femoral Reconstructions With Impaction Bone Grafting in Revision Total Hip Arthroplasty: Case Series and Literature Review

BackgroundExtensive bone loss on femur and acetabulum posed a big challenge to orthopedists in total hip revision surgeries. Impaction bone grafting (IBG) as a valuable bone preservation technique could effectively address this problem. Either IBG revision on the femoral or acetabular side was well studied, while its use on both sides in one operation was not. The aim of this study is to present the outcomes of IBG on both femoral and acetabular sides at first-time hip revision. MethodsWe retrospectively reviewed 8 patients (mean follow-up of 5.8 years) undergoing first-time revision with IBG on both acetabular and femoral sides at our institution. The Paprosky classification system was used to classify bone defects. Freeze-dried allografts and cemented prostheses were used in all patients. Postoperative complications and rerevision rates were reported. ResultsFive patients presented a Paprosky type IIC acetabular defect, 3 with a type IIIB, IIIA, and IIC defect, respectively. Three patients presented with a type IV femoral defect, 3 with a type IIIB defect, and 2 with a type II defect. Two patients developed complications, while one had an intraoperative femoral fracture and one had delayed wound healing. At the latest follow-up, no patient had rerevisions or operations related to the prosthesis. ConclusionsIBG in combination with cemented prosthesis is a profitable biological reconstruction revision technique that could provide satisfying midterm outcomes. We first propose the use of blood clots mixed with bone grafts for potential bone incorporation enhancement, while its specific effects need to be verified in further studies.

The effect of triangular cross-section neck design on crestal bone stability in the anterior mandible: A retrospective study with a 5-year follow-up.

The objective of this study, which included a 5-year follow-up, was to compare peri-implant soft tissue health, crestal bone loss (CBL), and buccal bone thickness (BBT) around triangular cross-section neck (TN) or round neck (RN) implants, using cone-beam computed tomography. This study was initially designed as a prospective 1-year randomized controlled study and then extended with a 5-year retrospective evaluation of clinical and radiographic records. In the initial 1-year study, a total of 20edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN or TN groups using a split-mouth design. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were recorded at postoperative month 12. CBL and BBT at three levels (0, -2, and -4 mm) were evaluated 1 year after insertion. Five years after insertion, PPD, PI, GI, CBL, and BBT were recorded as patients were recalled for clinical and radiographic monitoring. Nineteen patients completed the study. After 5 years, no significant differences in PPD, PI, and GI scores and BBT values between the two groups (p > .05). The mean ± SD CBL values at the final follow-up visit were -0.71 ± 0.69 mm for TN and -1.03 ± 0.86 mm for RN (p < .01). These results suggest better crestal bone preservation using implants with TN when compared to RN after a 5-year follow-up. However, TN showed similar results to RN regarding peri-implant soft tissue health and BBT.