Histological and Histomorphometric Evaluation of Post-Extractive Sites Filled with a New Bone Substitute with or without Autologous Plate Concentrates: One-Year Randomized Controlled Trial

The purpose of the present study was to evaluate the histological and histomorphometric characteristics of post-extraction sites grafted with decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin after four months of healing. This study was designed as a randomized controlled trial of parallel groups. Patients in need of a single, implant-supported restoration to replace a hopeless tooth were recruited for tooth extraction and implant placement four months after socket preservation procedure. After tooth extraction, patients were randomly allocated to receive decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin. After four months of healing, tapered implants were inserted with an insertion torque between 35 and 45 Ncm. Two months later, implants were loaded with screw-retained definitive crowns. Outcome measures were implant (ISR) and prosthesis (PSR) survival rates, complications, histological and histomorphometric analyses, radiographic marginal bone-level changes, and patients’ satisfaction. Clinical data were collected up to one year after tooth extraction and socket preservation procedures. Thirty patients were consecutively enrolled in the trial (15 in each group). Unfortunately, due to the COVID-19 pandemic, bone samples were collected only in 19 patients. Two implants failed before definitive prosthesis delivery (ISR 93.3%). No prosthesis failed (PSR 100%). Three complications were experienced in the control group. The mean bone percentage was 40.64 ± 18.76 in the test group and 33.40 ± 22.38 in the control group. The difference was not statistically significant (p = 0.4846). The mean soft tissue percentage was 32.55 ± 19.45 in the test group and 55.23 ± 17.64 in the control group. The difference was statistically significant (p = 0.0235). The mean residual graft was 24.59 ± 18.39 in the test group and 11.37 ± 12.12 in the control group. The difference was not statistically significant (p = 0.0992). Mean marginal bone loss, as well as patient satisfaction, showed no differences between groups. With the limitations of the present study, socket preservation with L-PRF mixed with decellularized bovine compact bone demonstrated favorable results, comparing with decellularized bovine compact bone from bovine femur alone. Further studies with larger sample size and longer follow-up are needed to confirm these preliminary results.

Effectiveness of a Nanohydroxyapatite-Based Hydrogel on Alveolar Bone Regeneration in Post-Extraction Sockets of Dogs with Naturally Occurring Periodontitis

Pathological mandibular fracture after dental extraction usually occurs in dogs with moderate to severe periodontitis. A nanohydroxyapatite-based hydrogel (HAP hydrogel) was developed to diminish the limitations of hydroxyapatite for post-extraction socket preservation (PSP). However, the effect of the HAP hydrogel in dogs has still not been widely investigated. Moreover, there are few studies on PSP in dogs suffering from clinical periodontitis. The purpose of this study was to evaluate the effectiveness of the HAP hydrogel for PSP in dogs with periodontitis. In five dogs with periodontitis, the first molar (309 and 409) of each hemimandible was extracted. Consequently, all the ten sockets were filled with HAP-hydrogel. Intraoral radiography was performed on the day of operation and 2, 4, 8 and 12 weeks post operation. The Kruskal–Wallis test and paired t-test were adopted for alveolar bone regeneration analysis. The results demonstrated that the radiographic grading, bone height measurement, and bone regeneration analysis were positively significant at all follow-up times compared to the day of operation. Moreover, the scanning electron microscopy with energy-dispersive X-ray spectroscopy imaging after immersion showed a homogeneous distribution of apatite formation on the hydrogel surface. Our investigation suggested that the HAP hydrogel effectively enhances socket regeneration in dogs with periodontitis and can be applied as a bone substitute for PSP in veterinary dentistry.

Comparison of Bone Morphogenic Proteins’ and Platelet Rich Fibrins’ Effectiveness in Socket Preservation

The dentist faces a difficult challenge in preserving the quantity and quality of gum and bone tissues. Furthermore, the processes adopted should meet these objectives while posing no substantial future issues. In current dental and maxillofacial surgery, a variety of materials as Morphogenic Protein of Bone (BMP) and Platelet Rich Fibrins (PRF) are employed to repair and reconstruct bone tissue. The purpose of this review was to compare the efficiency of both BMP’s and PRF’s in Socket preservation. Reviewing the literature was conducted by using the following search strategies: Bone Morphogenic Proteins, Platelet Rich Fibrins, socket preservation approach, comparison of BMPs and PRFs, Bone Morphogenic Proteins and effectiveness in socket preservation and Platelet Rich Fibrins’ effectiveness in socket preservation. In conclusion, BMPs have been studied more completely than PRFs, and they have higher impacts on hard tissue regeneration and repair, according to the research. The fact that PRFs increase soft tissue healing shows how promising they are. Especially when we consider that soft tissue healing is more important than socket care in implant dentistry.

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.

Clinical and Radio Graphical Evaluation of Implants Placed in Ridge Preserved Sites versus Naturally Healed Sites

Introduction: Dental implant has proved to be a pioneer in prosthetic rehabilitation overcoming the disadvantage of a removable or a fixed partial denture. The aim of the study was to clinically and radiographically evaluate and compare changes of hard and soft tissues around the implants which will be placed in ridge preserved sites with implant placed in naturally healed extraction sites. Materials and Methods: In this study 10 Patients having tooth with hopeless prognosis requiring tooth extraction followed by implant placement were enrolled. These patients were randomly divided in to two groups. Group I: Socket preservation with demineralized bone matrix putty group. Group II: Naturally healed socket after extraction, followed by implant placement in both groups. Results: The results of the current study indicated that demineralisedbone matrix putty, when used in patients for dental augmentation in either mandibular or maxillary sites, resulted in replacement of the graft material with bone by as early as 4-6 months, there upon enabling implant placement and subsequent prosthetic reconstruction. Conclusion: Bucco lingual ridge width and width of keratinized gingiva can be preserved by ridge preservation after extraction. Short-term survival rates and clinical outcomes of both groups were similar and were comparable. Further clinical trials with longer duration follow up with larger sample size should be done to get more affirmative and conclusive results.

Hard and Soft Tissue Augmentation with Single-Implant Restoration in the Esthetic Zone

The removal of the central incisor of the upper jaw is a challenging process, since the restoration of a single implant in the esthetic zone is of great responsibility. When tooth extraction with immediate implant placement is not possible, modern protocols imply the use of the socket preservation technique. This method of preserving socket properties significantly reduces changes that occur during the healing process of the postextracted area and along with soft tissue augmentation allows to achieve a satisfying aesthetic result. The aim of present case report is to assess capabilities of socket preservation concept and application of soft tissue augmentation in the anterior maxillary region. The treatment steps of a 35-year-old woman who needed to remove tooth 11 with further dental implant placement are described. The clinical case is of interest because after socket preservation and soft tissue augmentation, an acceptable aesthetic result was not reached. However, additional soft tissue augmentation made it possible to achieve the desired result, which was stable for 7 years.