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.

A Hybrid Oral Rehabilitation of Hypohidrotic Ectodermal Dysplasia: A Conservative Approach with Three-Year Follow-Up

This case report presents a 19-year-old male patient with hypohidrotic ectodermal dysplasia, having a chief complaint of multiple missing teeth. Atraumatic extraction of the teeth with hopeless prognosis was done, and teeth with grade 2 mobility were submerged using cast dowel and coping. Following this, incremental increase in the vertical dimension was made using removable flexible splint of two-millimeter thickness. After facebow transfer and making appropriate eccentric bite records to program the semiadjustable articulator, wax-up was done at the desired vertical dimension (VD). The upper arch was finally restored using a long-span fixed partial denture and lower arch using bilateral attachment (Rhein 83) retained cast removable partial denture as a definitive prosthesis. Therefore, in conditions like hypodontia or oligodontia caused due to ectodermal dysplasia, attachment retained removable partial denture may prove beneficial by effectively distributing the occlusal forces. In clinical scenarios where implant is not feasible or not opted by the patient, this combination treatment may be a viable option.

CLINICAL AND RADIOGRAPHIC EVALUATION OF INTENTIONAL REPLANTATION OF TEETH UTILIZING ATRAUMATIC EXTRACTION TECHNIQUE AND BIODENTIN AS ROOT END RESTORATIVE MATERIAL. AN IN VIVO STUDY

Aims: Aim is to evaluate the clinical and radiographic outcome of Intentional Replantation of teeth utilizing Atraumatic extraction technique and Biodentin as root end restorative material Materials and Methods: Any patients irrespective of age & sex who reported to the Department of Conservative Dentistry & Endodontics, D. J. College of Dental Sciences & Research with the post endodontic treatment periapical pathology where orthograde retreatment and apical surgery was unfeasible or declined by patients and where extraction be the last resort was selected for the procedure. Informed consent was taken. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing <6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P < .05). Bivariate associations of the investigated variables with the main complications (ankylosis, periapical radiolucency, external root resorption) evaluated. Results: Cumulative healed rates from 60% at 6 months to 92% at 12months seen. Complications leading to extraction observed in 1 of 15 attending teeth. The Kaplan-Meier survival function suggested an expected 1-year cumulative retention rate of 92%. Among the 15 teeth, 1 tooth with complication was due to persistent periapical radiolucency and mobility. Null hypothesis was that IR is to preserve the natural dentition, there by upholding the main goal of Conservative treatment. Conclusions: Within the limitations of this study, after analyzing the results and obtaining a complete follow up of 12 months radiographically and clinically, it can be concluded that Intentional replantation is an alternative treatment and should be included in the savior procedures as it has shown a success rate of 92%. Keywords: endodontic complications, intentional replantation, physics forceps, Biodentin

Surgical Field Isolation Through Rubber Dam to Prevent COVID-19 Exposure During Tooth Extraction: Case Report

Background: At the beginning of 2020, a new pathogen named SARS-CoV-2 spread from China to the globe, becoming responsible for a potentially lethal acute respiratory syndrome: COVID-19. Direct contact and airborne contamination are the most frequent infection ways of SARS-CoV-2. During routine dental practice, SARS-CoV-2 transmission can occur through direct contact with mucous membranes, oral fluids, and contaminated instruments or inhalation of aerosol from infected patients. Introduction: Tooth extraction often involves exposure to blood and oral fluids, and the use of a rubber dam could be indicated to minimize direct contact and to decrease the amount of potentially infected droplets around the operatory field. The aim of this clinical case is to show how the use of a rubber dam could help in preventing or minimizing COVID-19 exposure during dental extraction. Materials and Methods: A 32-year-old patient reported severe pain and discomfort to an upper first molar due to a deep carious lesion and vertical tooth fracture. Under local anaesthesia, a rubber dam was placed, isolating the whole upper right sextant, and an atraumatic extraction was performed. Results: All three roots were intact, the bone septum was stable, and no oro-antral communication was present. A gauze swab was placed onto the socket and compressed slightly. After 5 minutes, the socket stopped bleeding, and both clamp and rubber dam, were removed. Conclusion: Within the limits of this single case report, the use rubber dam prior to tooth extraction could be a useful device to decrease aerosol spread and exposure to blood.

The retrieval of a surgical blade broken within the alveolar bone during minimally traumatic tooth extraction

Minimally traumatic tooth removal is the norm for removing teeth when a dental implant is planned at that site. The quantity of available bone is the primary requisite to place an implant. The initial use of a scalpel blade to widen the periodontal space followed by the use of luxators is one of the techniques that is being followed for atraumatic extraction. A case of accidental breakage of a number 11 scalpel blade while attempting tooth removal and the method adopted in removing this portion of the blade without further bone destruction is reported here. The authors have not found any previously published cases, reporting the breakage of a scalpel blade during the bone expansion procedure and its management.

Multiple myeloma and pulmonary aspergillosis: dental treatment prior to chemotherapy and management of post extraction complications

This case study discusses the dental management of a patient with a history of multiple myeloma and pulmonary aspergillosis, whom was referred to a hospital-based dental service for urgent dental review. The patient had received a dental assessment in primary care prior to commencement of chemotherapy and had four teeth extracted without complications. However, following the commencement of chemotherapy, he presented with a significant infection associated with two of his wisdom teeth resulting in extraction. Despite atraumatic extraction, the upper right wisdom tooth socket developed an oroantral fistula. A multidisciplinary team approach was required to enable effective patient management in this complex patient regarding myeloma, aspergillosis and the medications used including bisphosphonates and chemotherapy. It highlights the higher risk of oral complications that can arise in myelosuppressed patients and emphasises the need to identify potential sources of dental infection prior to the commencement of chemotherapy.

Immediate Ridge Augmentation Using Autogenous Tooth Root as a Block Graft in a Periodontally Hopeless Extraction Site: A Pilot Study

The aim of the our study was to assess the efficacy of autogenous tooth root as block bone graft in reconstructing the vertical and horizontal dimensions at periodontally hopeless extraction sites both clinically and radiographically. Methods: A total of 13 patients having a tooth with periodontally hopeless prognosis indicated for extraction were included in the study. Following atraumatic extraction the tooth was processed to create a decoronated cementum free dentin block which was used to augment the extraction socket. Results: The augmentation of periodontally hopeless socket with tooth block autograft resulted in gain of clinical ridge width of 5.9mm radiographically, apico-coronal defect depth reduced upto 8.2 mm (p 0.001) and gain in ridge width of 5.8 mm post-operatively after 6 months (p 0.001). Conclusion: The present study demonstrated the effectiveness of using tooth root as a block graft for ridge augmentation in the periodontally hopeless extraction site making it suitable for implant placement in future.