Wound Healing In Extraction Sockets Research Articles

The Role of Sodium Fluoride Mouthwash in Regulating FGF-2 and TGF-β Expression in Human Gingival Fibroblasts.

Sodium fluoride (NaF) is a fluoride application recommended by the World Health Organization for its efficacy and safety in preventing dental caries. Gingival fibroblasts that constitute the majority of connective tissue cells play a major role in wound healing via the expression of growth factors, including fibroblast growth factor-2 (FGF-2) and transforming growth factor-beta (TGF-β). This study examined the effect of NaF mouthwash on FGF-2 and TGF-β expression in human gingival fibroblasts (HGnFs). Fibroblasts were exposed to a medium with 225 ppmF NaF for 1 min, then switched to either 15 ppmF NaF for continuous stimulation or no NaF for transient stimulation. Continuous NaF stimulation significantly increased the gene and protein expression of FGF-2 and TGF-β in HGnFs compared to controls, suggesting NaF's potential role in modulating periodontal tissue wound healing. Signaling pathway investigations showed the involvement of heterotrimeric GTP-binding proteins, calcium/calmodulin-dependent kinase II (CaMKII), and extracellular signal-regulated kinase (ERK) phosphorylation. Inhibiting CaMKII reduced NaF-induced FGF-2 and TGF-β expression, while ERK phosphorylation increased after NaF stimulation. These results highlight NaF mouthwash's potential in promoting wound healing in extraction sockets, particularly during the mixed dentition period. Understanding NaF's effects is clinically relevant due to the common use of fluoride products.

Effect of low-level laser therapy in wound healing of primary molar teeth extraction

IntroductionTooth extraction in children requires attention to wound healing and pain management, which are influenced by patient-related factors and behavioral guidance. Aim of the study: The study aimed to evaluate the effect of LLLT on healing sockets in pediatric patients with bilateral primary molar teeth extraction and determine its impact on pain management.Methods6–10 years of age, systemically healthy, and with atraumatic extraction indications of bilateral primary molar teeth were included in the study (n = 40). In the first session, randomly selected teeth were extracted under local anesthesia. In the control group, only clot formation in the socket was observed and photographed. The other group extractions were performed 2 weeks later. The low-level laser therapy (LLLT) group was treated with a 980 nm wavelength, in a continuous emission mode, 0.5 W power, 300 J of energy, 400 µm tip, 60 s diode laser and photographed. Nonepithelialized surface measurements were performed using ImageJ. Pain assessment was performed using the Wong-Baker Pain Scale. Statistical analyses were performed using SPSS software.ResultsThere was a statistically significant difference between the groups in the Wong-Baker values in 3rd day (p < 0.05). In soft tissue healing on the 3rd and 7th day, the nonepithelialized surface of the laser socket was smaller than that of the control group, and the measurement results were found to be statistically significant (p < 0.05).ConclusionAlthough LLLT was not found to be very effective in reducing postoperative discomfort after extraction of primary molars, it provided better wound healing in extraction sockets.

Low-level laser therapy prevents medication-related osteonecrosis of the jaw-like lesions via IL-1RA-mediated primary gingival wound healing

BackgroundMedication-related osteonecrosis of the jaw (MRONJ) is a serious debilitating disease caused by anti-resorption and anti-angiogenesis drugs, significantly affecting patients' quality of life. Recent studies suggested that primary gingival wound healing may effectively prevent the development of MRONJ. This study aimed to evaluate the effects of low-level light therapy (LLLT) on promoting gingival wound healing in extraction sockets of MRONJ-like mice and preventing the occurrence of MRONJ. Furthermore, we explored underlying mechanisms.MethodsMice were randomly divided into the Ctrl, Zol, and Zol + LLLT groups. Administration of zoledronate and tooth extraction of bilateral maxillary second molars were used to build the MRONJ model, and LLLT was locally administered into the tooth sockets to examine the effect of LLLT. Next, to explore the function of IL-1RA, we performed LLLT with interleukin-1 receptor antagonist (IL-1RA) neutralizing antibody (named Zol + LLLT + IL-1RA NAb group) or negative control antibodies for tooth extraction in subsequent rescue animal experiments. Stereoscope observations, micro-computed tomography, and histological examination were conducted to evaluate gingival wound healing and bone regeneration in tooth sockets. The effects of LLLT on the migration capacities of zoledronate-treated epithelial cells were assessed in vitro.ResultsLLLT promoted primary gingival wound healing without exposed necrotic bone. Micro-computed tomography results showed higher bone volume and mineral density of the tooth sockets after LLLT. Histology analysis showed complete gingival coverage, obvious bone regeneration, and reduced soft tissue inflammation, with down-regulated pro-inflammation cytokines, like interleukin-1 beta (IL-1β) and tumor necrosis factor-α (TNF-α), and up-regulated IL-1RA expression in the gingival tissue in the LLLT group. The rescue assay further showed that the effects of LLLT promoting gingival wound healing and preventing MRONJ might be partially abolished by IL-1RA neutralizing antibodies. In vitro studies demonstrated that LLLT accelerated zoledronate-treated epithelial cell migration.ConclusionsLLLT might promote primary gingival wound healing and contribute to subsequent bone regeneration of the tooth extractions in MRONJ-like lesions via IL-1RA-mediated pro-inflammation signaling suppression.

Effects of Super-Activated Platelet Lysate on Early Healing of Tooth Extraction Sockets in Rats

PurposeTo evaluate the effect of super-activated platelet lysate (sPL) on wound healing of tooth extraction sockets in rats.MethodsRat models of the tooth extraction socket were established. Thirty-six rats were divided into control and sPL groups and sacrificed on days 7, 14, and 28 after tooth extraction. Bone formation in tooth extraction sockets were observed by microscopic computed tomography (micro-CT) and hematoxylin and eosin (HE) staining; osteoprotegerin (OPG), receptor activator of nuclear factor kappa-Β ligand (RANKL), interleukin 6(IL-6), and tumor necrosis factor-alpha (TNF-α) proteins were detected by immunohistochemistry; and chemokine and osteogenic gene expressions were detected by polymerase chain reaction (PCR).ResultssPL accelerated soft tissue wound healing in the extraction socket of rats. Micro-CT showed that the amount of bone formation and bone volume fraction were higher in the sPL group than the control 14 days after extraction. HE staining showed promotion of the formation of bony trabeculae by sPL in the apical third of the extraction socket 7 days after extraction and more mature and organized bony trabeculae in the sPL group than the control 14 days after extraction; mature bony trabeculae filling most of the fossa with lesser bone porosity in the socket in the sPL group than the control 28 days after extraction. Immunohistochemistry showed that sPL induced OPG expressions 7 and 14 days after tooth extraction but did not affect the RANKL expression while transiently promoting the IL-6 expression 7 days after extraction. PCR showed that sPL promoted chemokine expressions 7 and 14 days after extraction. The expressions of osteogenesis-related factors were higher in the sPL group than the control 7 and 28 days after extraction, while the opposite trend was observed 14 days after extraction.ConclusionsPL has a transient pro-inflammatory effect and promotes soft tissue healing and bone formation during early wound healing of extraction sockets in rats.

A Histologic and Histomorphometric Retrospective Analysis of the Outcomes of Ridge Preservation Using Anorganic Bovine Bone Minerals and a Nonresorbable Membrane

The objective of this study was to examine wound healing in extraction sockets following ridge preservation and the outcome of implants placed in those sites. Extraction sockets (N = 31) were grafted with anorganic bovine bone mineral (ABBM) and covered with dense polytetrafluoroethylene membrane. Bone cores obtained during implant placement were examined histologically and histomorphometrically. Percentages of vital bone and residual graft were 37.5% ± 21.3% and 12.5% ± 8.9%, respectively. New vital bone showed a negative correlation with patient age. Percentage of vital bone formation in sockets was correlated with neither postgraft wound healing time nor peri-implant marginal bone level.

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

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

The Effects of Topical Hemocoagulase Solution on the Healing Process of Post-extraction Wounds: A Split Mouth Design.

To evaluate the effects of topical hemocoagulase on intra-oral extraction sockets and impact on the healing process as well as to produce a clinico-histological healing score. This prospective study compared two extraction sites in each subject. One site received topical hemocoagulase while other site did not receive it. Both the sites were chosen in the same patient and extraction was done at separate intervals. The biopsy was done on a random basis with the pathologist being blinded to the study. Clinical evaluation was done on days 7, 14 and 21. Biopsy was done either on days 7 or 14 for the case as well as for the control. A clinical as well as histological score was developed and the healing was assessed. Statistical analysis was done using Wilcoxon signed rank test and p value ≤ 0.05 was considered significant and z-score was also calculated. The clinical score did not show any statistical significance. The histological total score on day 14 and combined overall analysis of days 7 and 14 showed statistical significance. There was an increased incidence (n=4) of osteoid formation in the hemocoagulase group on day 14. The application of hemocoagulase may improve and accelerates the process of wound healing in extraction sockets.

Wound healing of extraction sockets

The extraction of a tooth initiates a series of reparative processes involving both hard tissue (i.e. alveolar bone) and soft tissues (periodontal ligament, gingiva). The biological events occurring during the healing of an extraction socket and their chronological sequence have been evaluated in different animal and human studies. In the present review, the healing process of a tooth extraction wound was described. Factors affecting the histological aspects of the healing phase as well as the post extraction alterations of the ridge dimensions were also considered. Additionally, the healing of an extraction socket where a dental implant has been placed immediately after tooth removal was described in details. Finally, the histological and clinical outcomes of the application of different reconstructive technologies to the post‐extraction socket was evaluated.