Tooth Extraction Socket Research Articles

Взаимосвязь анатомии области расположения и особенностей формирования третьего моляра нижней челюсти с частотой развития альвеолита его лунки

INTRODUCTION: Socket alveolitis is the most unpleasant and frequent complication of the tooth extraction operation. According to the data of numerous studies, it most often occurs after extraction of the third mandibular molar. The causes of inflammation of the extracted tooth socket are well known. They include absence (“dry socket”) or decay of a blood clot which forms immediately after the operation and performs protective and reparative function during physiological healing of the socket. In turn, the risk factors provoking “dry socket” formation or blood clot fibrinolysis are mechanical injury of the socket, use of high concentration of adrenaline in local anesthetic solution, inadequate socket curettage, bleeding in the postoperative period, technically complicated surgical procedure and many others. However, all the mentioned factors leading to alveolitis, equally influence the inflammatory activity in the socket of any extracted tooth, including the lower third molar. Consequently, the anatomical location of the lower wisdom tooth, its germ and formation, have some peculiarities. The data analysis was carried out in the following Internet resources: eLibrary, Cyberleninka, disserCat, National Library of Medicine, ResearchGate (48 sources for the time period from 1967 to 2021). In the review article, the collected data of different studies on the frequency of alveolitis after tooth extraction, after the third lower molar extraction, on the main causes of the socket inflammation are given; generalized information of the anatomical characteristics of third molar location, its germ and formation is presented. CONCLUSION: The highest incidence of alveolitis of the mandibular wisdom tooth socket is probably associated with peculiarities of its supply with blood, the existence of high quantity of adipose tissue and loose connective tissue around it, difficult rupture and other anatomical and physiological parameters, which create conditions for development of intensive inflammatory process.

Lansoprazole and zoledronate delays hard tissue healing of tooth extraction sockets in dexamethasone-treated mice.

Proton pump inhibitors (PPIs) are among the most commonly prescribed medicines for the management of acid-related gastrointestinal diseases. Osteonecrosis of the jaw (ONJ) is a serious adverse event that is associated with the use of antiresorptive and antiangiogenic agents. According to previous clinical reports, the use of PPIs contributes to the pathogenesis of severe ONJ that requires surgery. Here, we investigated the effects of lansoprazole (LP) or LP in combination with zoledronate (ZOL) on ONJ development in mice. C57BL/6J mice were administered ZOL (125μg/kg intravenously, twice weekly) and/or LP (10mg/kg intraperitoneally; 3 weeks of 3 consecutive days followed by 1day off). One week after initiation of the study, the first molar was atraumatically extracted. Concurrently with ZOL administration, dexamethasone (Dex) was administered (5mg/kg intraperitoneally, twice weekly). Micro-computed tomography and histological evaluation were performed to characterize femoral structures, tooth extraction sockets, and osteonecrosis areas. The results showed that ZOL/Dex significantly increased bone mass compared to saline/Dex, while the simultaneous administration of LP and ZOL/Dex diminished the ZOL-induced enhancement of bone mass. In the alveolar bone around the tooth extraction socket, necrotic bone was significantly increased in the LP/Dex group compared to the saline/Dex group. However, no signs of more severe ONJ-like lesions were observed following combined administration of LP and ZOL/Dex, other than an increase in the number of non-attached TRAP-positive cells. Our findings in a mouse model suggest that LP use can be a risk factor for the development of ONJ.

Alveolar Bone Remodeling with or without Collagen Filling of the Extraction Socket: A High-Resolution X-ray Tomography Animal Study

The healing process of the tooth extraction socket often leads to significant resorption of the alveolar bone, eventually causing clinical difficulties for future implant-supported rehabilitations. The aim of the present animal study was to evaluate alveolar bone remodeling after tooth extraction in a rabbit model, either with or without the use of a plain collagen plug inside the socket, by means of micro-computed tomography. The study included the micro-tomography analysis of 36 rabbits’ incisor extraction sockets, either left empty or filled with a collagen plug. All animals were euthanized in a staggered manner, in order to address molecular, histologic, and radiographic analyses at different time-points, up to 90 days after surgery. The three-dimensional evaluation was carried out using micro-computed tomography technology on excised bone blocks including the alveolus and the contralateral bone. Both linear and volumetric measures were recorded: the percentage of bone volume change (ΔBV) within the region of interest was considered the primary endpoint of the study. The micro-CT analysis revealed mean volumetric changes of −58.1% ± from baseline to 3 months for the control group, and almost no bone loss for the test group, −4.6%. The sockets treated with the collagen plug showed significantly less dimensional resorption, while the natural-healing group showed an evident collapse of the alveolar bone three months after extraction surgery.

EFFECT OF FIBROIN SPONGE ON ALVEOLAR BONE REMODELING PROCESS POST TOOTH EXTRACTION

Background: There are still quite a lot of cases of tooth extraction in Indonesia because of the cavities are not treated or because of other cases. Extraction is the main cause of 90% of bone destruction and a risk of infection and bleeding. Fibroin sponge is a natural polymer material derived from Bombyx mori silk cocoon which contains of 18 amino acids and have a good mechanically, biodegradable and biocompatible. This study aimed to determine the effect of fibroin sponge on the remodeling of post tooth extraction sockets. Method: This study was a laboratory experiment with quasy experimental design using 30 Sprague dawley rats divided into 2 groups. Each group had the mandibular left incisor extracted. The first group as a control was given 15 ug of Curaspon and the second group was given 15 ug of fibroin sponge intra alveolar. Result: The results were observed after the 3rd, 7th, 14th, 21st, 28th days under a light microscope and identified by scoring bone remodeling based on predetermined criteria. Data were analyzed using the Mann-Whitney Test followed by the Kruskall-Wallis Test. The results showed that there was no difference in the process of bone remodeling post tooth extraction in the fibroin sponge group compared to Curaspon (p>0.05). Conclusion: Fibroin sponge has the same effect on the bone remodeling process as Curaspon.

Yes-associated protein promotes bone healing after tooth extraction in mice

In this study, a tooth extraction socket model was established in vivo, and Lv-YAP1-GFP, Lv-GFP or saline was injected locally into the extraction socket. Expression of markers of osteogenesis, osteoclastogenesis, adipogenesis, proliferation and apoptosis explore whether YAP can promote bone formation in the process of tooth extraction socket healing. 66 BALB/c mice were divided into 3 groups and underwent left maxillary first molar extraction, Lv-YAP1-GFP, Lv-GFP or saline was injected into the tooth extraction socket. The maxilla was harvested 1, 3, 7, and 10 days after operation for subsequent analysis by Micro-CT and immunohistochemical analysis. Quantitative analysis of the expression of TRAP, ALP, BMP2, RUNX2, Osterix, OCN, RANKL, PPARγ, and PCNA was conducted. The results of immunofluorescence showed that the lentivirus was successfully transfected into the extraction socket. On the middle and last stage of tooth extraction healing, results of Micro-CT showed that the BV/TV, Tb.Th and Tb.N were significantly higher in the experimental group, results of immunohistochemistry showed that the overexpression of YAP increase in the expression of BMP2, ALP, RUNX2, Osterix, OCN, and PCNA. The expression of PPARγ and TUNEL staining results were significantly lower in the experimental group. The expression of TRAP and RANKL showed no significant differences among the 3 groups. We conclude that YAP could promote bone formation in the middle and late stages of tooth extraction socket healing. The overexpression of YAP increased bone formation and cell proliferation, decreased adipogenic differentiation and apoptosis.

A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial

Objective: To compare the effectiveness of different oral antibiotics for prevention of dry socket and infection in adults following the surgical extraction of teeth under LA. Methods: This randomized controlled study was conducted from 10 September 2020 until 10 May 2021. Forty-six patients were randomly allocated to three groups. Sixteen patients were in the postoperative co-amoxiclav (625 mg) group, fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative metronidazole (500 mg) group and fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative amoxicillin (500 mg) group. Evaluation of the postoperative signs of alveolar osteitis and infection was made by a dental surgeon five days postoperatively. Evaluation of the post-surgical extraction pain was made by patients immediately and five days postoperatively on standard 100 mm visual analogue scales (VAS). Furthermore, difficulty of surgery was recorded for all patients immediately postoperatively using (VAS). Results: all antibiotics used in this study were effective. Only 15% of patients had painful alveolar osteitis and 2% had oral infections. There was no significant decrease in the number of patients with severe alveolar osteitis or infection for co-amoxiclav plus metronidazole and co-amoxiclav plus amoxicillin groups compared to co-amoxiclav group at 5 days post-operation (p-values: 0.715, 0.819 & 0.309). Clinically, metronidazole was more effective in protecting the extracted tooth socket from alveolar osteitis compared to co-amoxiclav and amoxicillin. Moreover, there were significant decreases in mean pain scores at 5 days post-operation compared with the levels of pain immediately after surgery (p-value: 0.001). Conclusions: Administration of a single preoperative dose of co-amoxiclav with a full postoperative dose of amoxicillin or metronidazole was more effective than conventional treatment with postoperative co-amoxilcalv in reducing the incidence of both alveolar osteitis and infection after surgical extractions. However, these differences were not statistically significant. Interestingly, patients in metronidazole group had the lowest incidence of dry socket.

Pathological differences in the bone healing processes between tooth extraction socket and femoral fracture

Despite various reports on the bone healing processes of tooth extraction socket and long bone fracture, the differences of pathological changes during these healing processes remain elusive. This study aims to elucidate the underlying mechanisms behind the pathophysiology of bone regeneration between the tooth extraction socket and femoral fractures through a comparative study. Eight-week-old male mice were used in the experiments. The maxillary first molar was extracted, and intramedullary nailing femoral fracture (semistabilized fracture repair) was performed in the femur. Pathological changes in these bone injuries were investigated by micro-CT, histology, immunohistochemistry, and RT-PCR until day 7 post operation. Pathological changes in drill hole injury created in cortical bone of femur were also examined. Micro-CT analyses revealed increases in mineralized tissues in both the tooth extraction socket and femoral fracture. Histological examinations revealed that tooth socket was repaired by intramembranous ossification, and intramedullary nailing femoral fracture was healed by endochondral ossification. Immunohistochemical investigation revealed that tooth socket healing associated with Sp7-positive cells but not Sox9, aggrecan, and type II collagen, while femoral fracture models exhibited positive signals for all antibodies. RT-PCR analyses revealed the expression of Sp7, Col1a1, and Col2a1 in tooth socket healing, and the expression of Sp7, Col1a1, Runx2, Sox9, Acan, Col2a1, and Col10a1 in intramedullary nailing femoral fracture. Drill hole injury was repaired primarily by intramembranous ossification when the periosteum was removed before making the hole. The present study demonstrated that the absence of cartilage appearance during tooth extraction socket healing indicates it as distinctly different pathological features from the healing processes of semistabilized femoral fracture. This study contributes to the understanding of the molecular and cellular characteristics of bone healing among the different sites of bone injury.

A comparative study of the effects of platelet-rich fibrin, concentrated growth factor and platelet-poor plasma on the healing of tooth extraction sockets in rabbits

BackgroundAutologous platelet concentrate has been widely used to encourage the regeneration of hard and soft tissues. Up to now, there are three generations of autologous platelet concentrates. Many studies have shown that the three autologous concentrates have different effects, but the specific diversities have not been studied. The purpose of this study was to explore and compare the effects of platelet-rich fibrin, concentrated growth factor and platelet-poor plasma on the healing of tooth extraction sockets in New Zealand rabbits.MethodsA total of 24 healthy male New Zealand white rabbits aged 8–12 weeks were selected. The experimental animals were randomly divided into four groups: three experimental groups were respectively implanted with PPP, CGF and PRF gel after bilateral mandibular anterior teeth were extracted, and the control group did not implant any material. The alveolar bone of the mandibular anterior region was taken at 2, 4 and 8 weeks after operation. The height and width of the extraction wound were detected by CBCT, the growth of the new bone was observed by HE and Masson staining, and the expression of osteogenic genes was detected by real-time PCR. Data were analyzed using IBM SPSS statistical package 22.0.ResultsThe radiological results showed that alveolar bone resorption in all groups gradually increased over time. However, the experimental groups showed lower amounts of bone resorption. The histological results showed that new bone formation was observed in all groups. Over time, the new bone trabeculae of the CGF group became closely aligned while those in the PPP and PRF groups remained scattered. PCR results showed that the expression of BMP-2 and ALP was higher in the experimental groups than the control group.ConclusionIn conclusion, the application of PRF, CGF and PPP in tooth extraction sockets effectively promoted bone regeneration. CGF showed more effective bone induction and tissue regeneration ability in the long term.

Assessment of inflammatory status of peri-implant soft tissue around functionally loaded immediate implants placed in periodontally compromised tooth extraction sockets

The present study was aimed at assessment of the soft tissue condition around immediate implants used to replace periodontally compromised mandibular anterior teeth.A longitudinal study was conducted on 17 functionally loaded immediate implants placed in periodontally compromised sockets at mandibular anterior region. Clinical and biochemical assessment of inflammatory status of peri-implant mucosa were recorded at 2 week, 6and 12-month intervals after loading. Clinical parameters included modified Plaque Index (mPI), modified Bleeding Index (mBI), marginal soft tissue level (ML), Papilla Index (PI) and width of attached mucosa (AM). Biochemical parameter was the levels of Aspartate aminotransferase (AST) enzyme in peri-implant crevicular fluid (PCF).Inter-comparison of observations were statistically analysed using repeated-measures ANOVA. The mean mPI score was 0.71, 0.41 and 0.53 at three intervals (p=0.354) indicating moderate score. The mean mBI was1.06, 0.35 and 0.29 at various intervals (p=0.000), pointing reduced bleeding tendency. Throughout the study, 70.588% of sites had positive ML, suggesting soft tissue stability. Mean PI scores were 1.71, 2.06 and 2.65 and for AM were 2.41, 2.41 and 2.94 respectively at the three intervals, with a statistically significant p-value of 0.000 for both. The mean AST level in PCF was 1876.47 μIU, 1729.41 μIU and 2117.65 μIU (p=0.431), pointing no increase in inflammation.Considering the results obtained, implants under study exhibited no major inflammatory changes in the soft tissue, during the study period.

Efficacy of Bovine Hydroxyapatite and Collagen Along With Platelet-Rich Fibrin as a Scaffold and Human Chorion as a Membrane for Ridge Preservation: A Case-Control Study

Aim: The present study aims to determine the efficacy of bovine hydroxyapatite and collagen (G-graft) mixed with platelet-rich fibrin (PRF) used as a scaffold and chorion membrane as a barrier in post-extraction sockets with extraction sites alone.Methods and material: Thirty individuals were randomly assigned into two groups. In the control group, after debridement of the extracted tooth socket, no additional treatment was done. In the test group, after debridement of the extracted tooth socket, the sockets were filled with bovine hydroxyapatite and collagen (G-graft) mixed with PRF. They were covered by a chorion membrane, and a non-absorbable suture material was used to secure the membrane in place. Clinical parameters assessed were plaque index, gingival index, buccolingual width, buccal bone plate height, and lingual bone plate height at baseline and at six months.Results: Clinically, there was a more significant reduction in the buccolingual width of the control group than the test group after six months. A statistically significant difference between the two groups for vertical ridge height at the mesial and distal socket sites was observed. No statistically significant difference in buccal and lingual bone plate height was observed between the two groups (p>0.05).Conclusions: Both groups showed a significant reduction in the Buccolingual width, but it was less in the ridge preservation group. Thus, the use of G-graft with PRF and chorion membrane was highly effective in ridge preservation.Key messages: Natural bovine bone mineral, along with PRF and chorion as a membrane, can be utilized effectively for ridge preservation in extracted tooth sockets due to periodontal disease.

Success Factors of Additive Manufactured Root Analogue Implants.

Dental implantation is an effective method for the treatment of loose teeth, but the threaded dental implants used in the clinic cannot match with the tooth extraction socket. A root analogue implant (RAI) has the congruence shape, which reduces the damage to bone and soft tissue. Additive manufacturing (AM) technologies have the advantages of high precision, flexibility, and easy operation, becoming the main manufacturing method of RAI in basic research. The purpose of this systematic review is to summarize AM technologies used for RAI manufacturing as well as the factors affecting successful implantation. First, it introduces the AM technologies according to different operating principles and summarizes the advantages and disadvantages of each method. Then the influences of materials, structure design, surface characteristics, implant site, and positioning are discussed, providing reference for designers and dentists. Finally, it addresses the gap between basic research and clinical application for additive manufactured RAIs and discusses the current challenges and future research directions for this field.

Characterizations of alveolar repair after mandibular second molar extraction: an experimental study in rats.

Characterizations of rat mandibular second molar extraction socket with significantly different buccal and lingual alveolar ridge width remain unclear.Objective:To observe alterations in the alveolar ridge after extraction of mandibular second molars, and to examine processes of alveolar socket healing in an experimental model of alveolar ridge absorption and preservation.Methodology:Eighteen Wistar rats were included and divided into six groups regarding healing time in the study. Bilateral mandibular second molars were extracted. The rats with tooth extraction sockets took 0, 1.5, 2, 3, 4 and 8 weeks of healing. Histological observation, tartrate-resistant acidic phosphatase (TRAP) staining, Masson’s trichrome staining, immunohistochemical staining and micro-computed tomography (micro-CT) were applied to estimate alterations in the alveolar ridge.Results:Different buccal and lingual alveolar ridge width led to different height loss. Lingual wall height (LH) decreased significantly two weeks after tooth extraction. Buccal wall height rarely reduced its higher ridge width. From two to eight weeks after extraction, bone volume (BV/TV), density (BMD), and trabecular thickness (Tb.Th) progressively increased in the alveolar socket, which gradually decreased in Tb.Sp and Tb.N. LH showed no significant change during the same period. Osteogenic marker OCN and OPN increased during bone repair from two to eight weeks. The reduced height of the lingual wall of the tooth extraction socket was rarely repaired in the later repair stage. Osteoclast activity led to absorption of the alveolar ridge of the alveolar bone wall within two weeks after operation. We observed positive expression of EMMPRIN and MMP-9 in osteoclasts that participated in the absorption of the spire region.Conclusion:Extraction of rat mandibular second molars may help the study of alveolar ridge absorption and preservation. The EMMPRIN-MMP-9 pathway may be a candidate for further study on attenuating bone resorption after tooth extraction.

Enhanced healing process of tooth sockets using strontium-doped TiO2.

Prevention of residual ridge resorption is important for tooth socket healing in clinical treatment. As a well known biomaterial, titanium dioxide (TiO2) has been reported to show desirable bone regeneration capability. On the other hand, strontium plays a role in maintaining normal function in organisms and balancing bone remodeling. Hence, we synthesized strontium-doped titanium dioxide mesoporous nanospheres functionalized with amino-group using diphenyl diisocyanate. After incorporation with segmented polyurethane, the obtained injectable SPU/Sr-TiO2/MDI nanocomposite adhesive showed satisfactory antibacterial activity and cell nontoxicity. This nanocomposite was used for tooth socket healing, and greatly promoted the formation of new bone tissue in the tooth extraction socket.

Increased Expression of RUNX2 and ALP Resulting from a Combination of Propolis Extract and Bovine Bone Graft in Socket Preservation Material

The aim of this study was to determine the inductive effect of a combination of propolis and BBG extract on RUNX2 and ALP expression in the tooth extraction sockets of Cavia cobaya. Fifty- six Cavia cobaya were divided into four groups: polyethylene glycol (PEG), propolis extract + PEG, BBG + PEG, and propolis extract + BBG + PEG. The lower left incisor was extracted, and the socket subsequently filled with material according to the specific group of which the subject was a member. The subjects were sacrificed on the 14th and 30th days. Immunohistochemical staining was carried out under a light microscope at 400x magnification. Statistical analysis was then carried out by means of One-Way ANOVA and Tukey HSD tests. The mean number of RUNX2 and ALP expressions in each group was significantly different. The highest number of RUNX2 and ALP expressions occurred in the propolis + BBG + PEG group on the 30th day, while the lowest expressions were observed in the control group on the 14th day. A combination of propolis and BBG extract at a concentration of 2% of active substance effectively increases the expression of RUNX2 and ALP in preserving the tooth extraction sockets of Cavia cobaya.

Suppression of Bone Necrosis around Tooth Extraction Socket in a MRONJ-like Mouse Model by E-rhBMP-2 Containing Artificial Bone Graft Administration.

Medication-related osteonecrosis of the jaw (MRONJ) is related to impaired bone healing conditions in the maxillomandibular bone region as a complication of bisphosphonate intake. Although there are several hypotheses for the onset of MRONJ symptoms, one of the possible causes is the inhibition of bone turnover and blood supply leading to bone necrosis. The optimal treatment strategy for MRONJ has not been established either. BMP-2, a member of the TGF-β superfamily, is well known for regulating bone remodeling and homeostasis prenatally and postnatally. Therefore, the objectives of this study were to evaluate whether cyclophosphamide/zoledronate (CY/ZA) induces necrosis of the bone surrounding the tooth extraction socket, and to examine the therapeutic potential of BMP-2 in combination with the hard osteoinductive biomaterial, β-tricalcium phosphate (β-TCP), in the prevention and treatment of alveolar bone loss around the tooth extraction socket in MRONJ-like mice models. First, CY/ZA was intraperitoneally administered for three weeks, and alveolar bone necrosis was evaluated before and after tooth extraction. Next, the effect of BMP-2/β-TCP was investigated in both MRONJ-like prevention and treatment models. In the prevention model, CY/ZA was continuously administered for four weeks after BMP-2/β-TCP transplantation. In the treatment model, CY/ZA administration was suspended after transplantation of BMP-2/β-TCP. The results showed that CY/ZA induced a significant decrease in the number of empty lacunae, a sign of bone necrosis, in the alveolar bone around the tooth extraction socket after tooth extraction. Histological analysis showed a significant decrease in the necrotic alveolar bone around tooth extraction sockets in the BMP-2/β-TCP transplantation group compared to the non-transplanted control group in both MRONJ-like prevention and treatment models. However, bone mineral density, determined by micro-CT analysis, was significantly higher in the BMP-2/β-TCP transplanted group than in the control group in the prevention model only. These results clarified that alveolar bone necrosis around tooth extraction sockets can be induced after surgical intervention under CY/ZA administration. In addition, transplantation of BMP-2/β-TCP reduced the necrotic alveolar bone around the tooth extraction socket. Therefore, a combination of BMP-2/β-TCP could be an alternative approach for both prevention and treatment of MRONJ-like symptoms.

Space-making effect for new bone formation by suppressing scar contraction of mucosal epithelium of rat tooth extraction wound using diode laser and CO2 laser treatment

Background/purposeAs an extraction wound closes, the mucosal epithelium of the tooth extraction wound impedes the space for new bone formation by invading into the extraction socket. Thus, the height of the alveolar crest decreases, causing significant depression of the alveolar mucosa. In this study, we created a rat tooth extraction model and examined the effects of laser irradiation by CO2 and diode on the dynamics of myofibroblast expression through α-SMA, and TGF-β1. Materials and methodsAfter tooth extraction of five-week-old male Wistar rats, they were divided into two laser treatment groups (CO2 laser or diode laser was irradiated into tooth extraction socket) and non-laser treatment group (control group). Surrounding tissues, including the extraction socket, were removed at 3, 5, 7, and 21 days after tooth extraction and the expression of α-SMA and TGF-β1 was verified using immunohistological techniques (6 animals in each group and each period, 72 animals in total). Resultsα-SMA-positive cells and TGF-β1-positive areas were significantly lower in the two laser treatment groups than in the control group. Particularly, the diode group almost had no TGF-β1-positive areas on the 21st day when healing after tooth extraction was deemed to be completed. ConclusionBoth CO2 and diode laser irradiation of tooth extraction wounds decreases α-SMA-positive cells and TGF-β1-positive areas. Further, it causes a decrease in myofibroblast expression and suppresses the invasion of mucosal epithelium into the extraction socket. Therefore, laser irradiation may exert a space-making effect for new bone formation and also contribute to socket preservation.

Therapeutic effect of fluvastatin on medication-related osteonecrosis of the jaw.

Refractory jaw osteonecrosis that occurs in osteoporotic or cancer patients treated with bisphosphonates is called medication-related osteonecrosis of the jaw but its underlying mechanism is unclear. Statins, therapeutic agents for dyslipidemia, lower blood low-density lipoprotein cholesterol. Fluvastatin promotes the healing of tooth extraction sockets and reduces the risk of developing medication-related osteonecrosis of the jaw-like lesions. We used a rat model to investigate whether injecting fluvastatin at extraction sites promoted the healing of medication-related osteonecrosis of the jaw-like lesions. Upper first molars of rats administered zoledronate and dexamethasone for 2weeks were extracted. Two weeks after tooth extraction, rats with medication-related osteonecrosis of the jaw-like lesions (bone exposure) were included in this study. A single injection of fluvastatin was administered in the vicinity of the medication-related osteonecrosis of the jaw-like onset site in rats. The distance between the edges of the epithelia, the length of the necrotic bone exposed toward the oral cavity, the area of the necrotic bone, and the necrotic bone ratio were significantly smaller in the fluvastatin-administered group compared with the saline group. A single application of fluvastatin near the site of medication-related osteonecrosis of the jaw onset showed a tendency to close the epithelium, reduce necrotic bone, and form new bone, even when symptoms had already developed. This study suggests that a single topical administration of fluvastatin may be a novel treatment for medication-related osteonecrosis of the jaw.

The effect of Persea americana Mill. seed extract on inflammatory cells and fibroblast formation in tooth extraction socket healing

Background: Inflammatory cells and fibroblasts have an essential role in the wound healing process. Persea americana Mill. seed categorises as a waste; it contains rich nutrients that can accelerate wound healing activity. Purpose: This study aims to determine the effect of Persea americana Mill. seed against inflammatory cells and fibroblast formation in tooth extraction socket healing. Methods: Ninety-six Sprague Dawley rats had their lower left molars removed. Forty-eight rats tested for inflammatory cells were divided into four groups: negative control group (IC1), positive control group (IC2), Persea americana Mill. seed extract concentrations of 50% (IE1) and 90% (IE2). Another 48 rats used for fibroblast were divided into three groups: the control group (FC1), Persea americana Mill. seed concentrations of 50% (FE1) and 90% (FE2). The gel was applied to the socket under general anaesthesia. Four rats from each group were decapitated for histopathological tissue preparations with Haematoxylin Eosin (HE) staining on the 3rd, 5th and 7th days for inflammatory cells and the 3rd, 5th, 7th and 14th days for fibroblast formation. The preparations for each research were scored under the microscope at 40x magnification. The obtained data was analysed using the Kruska—Wallis and the Mann—Whitney test. Results: A significant decrease (p<0.05) of inflammatory cells in IE2 on the 5th and 7th day. A significant increase (p<0.05) of fibroblast formation between treatment and control groups and no significant difference (p>0.05) between FE1 and FE2 was based on the interval days. Conclusion: Persea americana Mill. seed extract can decrease the inflammatory cells and accelerate the fibroblast formation in tooth extraction socket healing.

Beneficial Effect of Arabica Coffee Fruit Skin (Coffea Arabica) on Epithelial Thickness after Tooth Extraction

Background: In Indonesia, tooth extraction is the most common practice in dentistry. A successful indicator of tooth extraction is a perfect healing process. One of the parameters of a perfect healing process is epithelial formation. Based on previous research, arabica coffee fruit skin has proven potential to accelerate the wound healing process. The compounds in the arabica coffee fruit skin are mostly composed of flavonoids, tannins, and chlorogenic acid. Purpose: This research is proposed to understand the beneficial effect of arabica coffee fruit skin (Coffea arabica) towards the increase of epithelial thickness in post tooth extraction socket. Material and Method: The type of this research was laboratory experimental in vivo with post-test only control group design using 24 Wistar rats as a sample. The sample was separated into two groups, control and intervention groups with 12 Wistar rats each. Treatment in both groups was given during 3, 5, and 7 days. Afterward, tissue processing undergoes with buccolingual cutting and HE coloring. Measurements are carried out with the ImageRaster software in the thickest and thinnest part of the epithelium that covers the tooth socket. Result: Epithelial thickness after tooth extraction increased significantly (p<0.05) in the intervention group compared to the control group. Conclusion: Arabica coffee fruit skin has the beneficial effect of increasing the epithelial thickness after tooth extraction.

Zoledronic Acid Deteriorates Soft and Hard Tissue Healing of Murine Tooth Extraction Sockets in a Dose-Dependent Manner.

The pathophysiology, histopathology, and immunopathology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) Stage 0 remain unclear. The aim of this study was to investigate the effects of high-dose bisphosphonates on tooth extraction socket healing by creating a murine model of BRONJ Stage 0-like lesions using 8-week-old female C57BL/6J mice. Zoledronic acid (Zol) was administered subcutaneously twice a week for 7weeks at doses of 0.1mg/kg/week (moderate dose; Zol-M), 0.5mg/kg/week (high dose; Zol-H1), and 1.0mg/kg/week (higher dose; Zol-H2). Saline was used as a control (VC). Both maxillary first molars were extracted 3weeks after drug treatment. Maxillae, long bones, and sera were collected 4weeks post-extraction (n = 7 mice/group). Microcomputed tomography, histological, immunohistochemical, and ELISA analyses were performed. A ceiling effect for Zol was noted at the Zol-H1 dose. Osseous healing of extraction sites was significantly impaired with increased necrotic bone and the number of empty lacunae in a Zol dose-dependent manner. Zol significantly decreased epithelial thickness, due to a decrease in thickness of the stratum spinosum, in both Zol-H1 and Zol-H2. Both Zol-H1 and Zol-H2 significantly suppressed the distribution of F4/80+ macrophages in the connective tissue of tooth extraction sockets, although gross healing appeared to be normal. Intriguingly, both Zol-H1 and Zol-H2 significantly increased the numbers of TRAP+ mononuclear cells and detached osteoclasts in the connective tissue and bone marrow of extraction sites compared to VC and Zol-M, correlated with serum TRAcP5b levels. The created murine model of BRONJ Stage 0-like lesions becoming more severe in a dose-dependent manner may help to understand the pathophysiology and histopathology of BRONJ Stage 0 in humans.