Open Healing: A Minimally Invasive Protocol with Flapless Ridge Preservation in Implant Patients

We aimed to validate the safety and efficacy of the minimally invasive “open healing” flapless technique for post-extraction socket and alveolar ridge preservation, while assessing the alveolar bone changes. The study enrolled (n = 104) patients (0.55 sex ratio), with atraumatic extraction of (N = 135) hopeless teeth, followed by either immediate placement of tissue level implants (N1 = 26), or later stage implant insertion (N2 = 109). No flap was raised in either situation. Post-extraction sockets were filled with deproteinized bovine bone granules and covered by collagen resorbable membrane—left purposely exposed during healing. This yielded an uneventful healing, with sufficient bone formation, while avoiding soft-tissue problems. The need for additional augmentation was assessed clinically and by calibrated CBCT scans at six months, before either loading (N1) or implant insertion (N2). Implant success and survival rate were evaluated at 12-, 24-, and 60-month follow-up control sessions. The inserted implants had a survival rate of 98.5% and a success rate of 94.8% at five-year follow-up. Open healing technique with flapless approach can be favorable for preserving the 3D architecture of the post-extraction socket, as well as the alveolar ridge width and height.

Comparative efficacy of different flapless ridge preservation techniques: A systematic review and meta-analysis

Although the efficacy of ridge preservation is well-documented, there is a lack of robust evidence regarding the influence of different surgical techniques. Flapless approaches are thought to be better at preserving soft tissue architecture and have been suggested for mild to moderate defects. This review investigates the efficacy of different flapless techniques for ridge preservation in mild to moderate defects with <50% buccal bone loss. PubMed, EMBASE, and Cochrane Library databases were searched to obtain relevant articles published in English from 1974 to December 2019. The primary outcome was horizontal and vertical hard tissue dimensional changes. Soft tissue changes were evaluated as a secondary outcome. The Bio-Col technique, subperiosteal tunnel technique, and hard tissue with autogenous soft tissue graft/collagen matrix technique were identified. Eight studies were included, and quantitative analyses were performed for four studies for the primary outcome variables. The meta-analysis revealed significant reductions for horizontal changes (WMD = 2.56 mm, 95% CI [2.18, 2.95]), vertical mid-buccal (WMD = 1.47 mm, 95% CI [1.04, 1.90]), and vertical mid-lingual (WMD = 1.28 mm, 95% CI [0.68, 1.87]), in favor of flapless ridge preservation techniques. Subgroup analysis based on technique suggest minimal hard tissue differences. The efficacy of flapless ridge preservation techniques on soft tissue changes was inconclusive. In conclusion, flapless ridge preservation techniques are effective for mild to moderate defects. The technique or material used to close the extraction socket does not seem to significantly affect hard tissue changes, while the effect on soft tissue changes warrants further investigation.

Clinical application of concentrate growth factors combined with bone substitute in Alveolar ridge preservation of anterior teeth

Objective: To investigate the clinical effect of concentrated growth factors (CGF) combined with Bio-oss bone powder on Alveolar ridge preservation (ARP) during implantology. Methods: A total of 38 patients were selected and randomly divided into 2 groups, with 19 cases in each group. The extraction sockets were filled with Bio-oss bone powder with or without CGF. VAS pain score was recorded within1 week and Landry wound healing index (LWHI) was recorded at 1, 2 and 3 weeks after operation. CBCT was taken 3 and 6 months after operation to measure and compare the changes of vertical height, width and gray value of alveolar bone at extraction site. The changes of alveolar bone contour were observed clinically and compared between the two groups. Results: The VAS score of CGF group was lower than control group on the 1st and 3rd day after operation (P < 0.05). The LWHI of CGF group was higher than control group 1 week after operation (P < 0.05). The absorption of the labial and palatal plates height and the width in the CGF group was significantly less than the control group at 3 months (P<0.05). The gray value of alveolar bone in CGF group was significantly higher than control group at 3 months (P < 0.05). There was no significant difference in new bone contour between the two groups (P > 0.05). 94.7% cases in CGF group did not undergo bone grafting, which was significantly higher than control group (78.9%). Conclusions: The use of CGF combined with Bio-oss bone powder can help to reduce postoperative pain at the early stage of healing, form sufficient keratinized gingival tissue, effectively maintain the height and width of alveolar bone in the three-dimensional direction and provide good conditions for implant repair in the future.

Double Layer Socket Preservation Technique Associated with Xenogenous Bone Graft and Polypropylene Membrane: A Case Report

With the demand for tooth/gum aesthetics in implant-supported rehabilitations, the surgeon, whether an implant specialist or not, increasingly needs to be mindful of proper care for socket preservation following extraction. The paper presented here reports the case of a male patient who manifested dental impairment of the Upper Left First Molar (tooth #26) [in FDI notation]; following tomographic analysis and after reaching a consensus with the patient, the decision was made to extract said tooth and preserve the socket for subsequent implant placement. The aim of the case report is to present a clinical case of alveolar ridge preservation through the “Double Layer Socket Preservation” technique, a technique created by Barry Barthee, whereby a xenogenous graft under an xenogenous type III collagen membrane was combined with a polypropylene barrier. Following research and study results on the subject, it was concluded that by applying this technique, the alveolar ridge is greatly preserved and bone volume is maintained, both of which are very important factors for good health of the tissues surrounding the implant and consequent increase in the survival of the implant itself.

Efficacy and safety of rhBMP/β-TCP in alveolar ridge preservation: a multicenter, randomized, open-label, comparative, investigator-blinded clinical trial

Background The aim of this multicenter, randomized, open-label, comparative, investigator-blinded study was to investigate the efficacy and safety of recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with β-TCP (rhBMP-2/β-TCP) in alveolar ridge preservation. Materials and methods Eighty-four subjects from three centers were enrolled in this clinical trial. After tooth extraction, rhBMP-2/β-TCP (n = 41, test group) or β-TCP (n = 43, control group) were grafted to the extraction socket with an absorbable barrier membrane for alveolar ridge preservation. Using computed tomography images obtained immediately after and 12 weeks after surgery, changes in the alveolar bone height and width were analyzed for each group and compared between the two groups. Results Both the test and control groups showed a significant decrease in alveolar bone height in the 12 weeks after surgery (both groups, p < 0.0001). However, the test group exhibited a significantly lower decrease in alveolar bone height than the control group (p = 0.0004). Alveolar bone width also showed significantly less resorption in the test group than in the control group for all extraction socket levels (ESL) (p = 0.0152 for 75% ESL; p < 0.0001 for 50% ESL; p < 0.0001 for 25% ESL). There were no statistically significant differences in the incidence of adverse events between the two groups. No severe adverse events occurred in either group. Conclusions The results of this study suggest that rhBMP-2/β-TCP is a safe graft material that provides a high alveolar bone preservation effect in patients receiving dental extraction. Trial registration Clinicaltrials.gov, NCT02714829, Registered 22 March 2016

Clinical applications of concentrated growth factors combined with bone substitutes for alveolar ridge preservation in maxillary molar area: a randomized controlled trial

Purpose To evaluate the clinical effects of concentrated growth factors (CGFs) combined with bone substitutes for alveolar ridge preservation (ARP) in the maxillary molar area. Methods Thirty-six patients who underwent extraction of the upper molars were recruited and randomly divided into three groups: 1. Grafted with CGFs combined with deproteinized bovine bone mineral (DBBM) and covered with CGFs membrane (CGFs/DBBM group), 2. Grafted with DBBM alone and covered with collagen membrane (DBBM group), 3. Control group spontaneous healing. The area of the alveolar bone in center (C-), mesial (M-) and distal (D-) section was compared with preoperative in radiography. Bone cores were obtained for histopathology observation and comparison. Results In C-, M- and D-section, the alveolar ridge area in all three groups was significantly reduced at 8 months postoperatively compared to the baseline (P < 0.05). The alveolar ridge area declines in the CGFs/DBBM group (C-12.75 ± 2.22 mm2, M-14.69 ± 2.82 mm2, D-16.95 ± 4.17 mm2) and DBBM group (C-14.08 ± 2.51 mm2, M-15.42 ± 3.47 mm2, D-16.09 ± 3.97 mm2) were non-significant differences. They were significantly less than the decline in the control group (C-45.04 ± 8.38 mm2 M-31.98 ± 8.34 mm2, D-31.85 ± 8.52 mm2) (P < 0.05). The percentage of newly formed bone in the CGFs/DBBM group (41.99 ± 12.99%) was significantly greater than that in DBBM group (30.68 ± 10.95%) (P < 0.05). The percentage of residual materials in the CGFs/DBBM group (16.19 ± 6.63%) was significantly less than that in the DBBM group (28.35 ± 11.70%) (P < 0.05). Conclusion Combined application of CGFs and DBBM effectively reduced the resorption of alveolar ridge and resulted in more newly formed bone than the use of DBBM with collagen membranes.