A 3-year prospective randomized clinical trial of alveolar bone crest response and clinical parameters through 1, 2, and 3 years of clinical function of implants placed 4 months after alveolar ridge preservation using two different allogeneic bone-grafting materials (original) (raw)
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Dental Research Journal, 2016
Background: Alveolar ridge preservation could be performed immediately following tooth extraction to limit dimensional changes of alveolar process due to bone resorption. The aim of this study was to compare the clinical and histologic outcomes of socket preservation using two different graft materials; deproteinized bovine bone mineral (DBBM) and demineralized freeze-dried bone allograft (DFDBA) with absorbable collagen membrane. Materials and Methods: Twenty extraction sockets in 20 patients were randomly divided into 2 treatment groups: 10 sockets were augmented with DBBM and collagen membrane whereas 10 sockets were filled with DFDBA and covered by collagen membrane. Primary closure was achieved over extraction sockets by flap advancement. Horizontal and vertical ridge dimensional changes were assessed at baseline and after 4-6 months at the time of implant placement. For histological and histomorphometrical analysis, bone samples were harvested from the augmented sites with trephine during implant surgery. All data were analyzed using SPSS version 18 (α=0.05). Results: Clinical measurements revealed that average horizontal reduction was 2.3 ± 0.64 mm for DFDBA and 2.26 ± 0.51 mm for DBBM. Mean vertical ridge resorption at buccal side was 1.29 ± 0.68 mm for DFDBA and 1.1 ± 0.17 mm for DBBM. Moreover, mean vertical ridge reduction at lingual site was 0.41 ± 0.38 mm and 0.35 ± 0.34 mm for DFDBA and DBBM, respectively. No significant differences were seen between two groups in any of those clinical parameters. Histologic analysis showed statistically significant more new bone deposition for DFDBA compared to DBBM (34.49 ± 3.19 vs. 18.76 ± 3.54) (P < 0.01). Residual graft particles were identified significantly more in DBBM (12.77 ± 1.85) than DFDBA (6.06 ± 1.02). Conclusion: Based on the findings of this study, both materials have positive effect on alveolar ridge preservation after tooth extraction, but there was more new bone formation and less residual graft particles in DFDBA group than in DBBM group.
Oral and maxillofacial surgery clinics of North America, 2004
Based on data from the authors' three clinical trials that focused on the role exerted by various regenerative materials and techniques in preserving alveolar ridge dimensions following tooth extraction, there is evidence to support the use of nonresorbable and resorbable membranes in combination with a closed-socket approach. There also is evidence to support a higher predictability of the results with resorbable membranes compared with nonresorbable membranes because the latter can become exposed to the oral environment during healing. A combination of bioactive glass and calcium sulfate using an open-socket approach is of marginal benefit in preserving alveolar ridge dimensions following tooth extraction. More research is necessary on combining osseous graft/guided bone regeneration using a closed-socket approach, on assessing the quality of bone present in the previous extraction socket following various preservation techniques, and on how effectively preserved/regenerated b...
Radiographic alveolar bone changes following ridge preservation with two different biomaterials
Clinical Oral Implants Research, 2011
Objectives: The aim of this randomized controlled trial was to evaluate radiographical bone changes following alveolar ridge preservation with a synthetic bone substitute or a bovine xenograft. Methods: Alveolar ridge preservation was performed in 27 patients randomized in two groups. In the test group (n ¼ 14), the extraction socket was treated with Straumann bone ceramic s (SBC) and a collagen barrier membrane (Bio-Gide s ), whereas in the control group (n ¼ 13) with deproteinized bovine bone mineral and the same barrier. Standardized periapical X-rays were taken at 4 time points, BL: after tooth extraction, GR: immediately after socket grafting, 4M: 16 weeks, 8M: 32 weeks postoperatively. The levels of the alveolar bone crest at the mesial (Mh), and distal (Dh) and central aspects of the socket were measured at all time points. All the radiographs obtained were subtracted from the follow-up images. The gain, loss and unchanged areas in terms of grey values were tested for significant difference between the two groups. Results: In the test group, the Mh and Dh showed a mean difference (AE standard deviation) of 0.9 AE 1.2 and 0.7 AE 1.8 mm, respectively, among BL-8M. In the control group, the Mh and Dh showed a mean difference of 0.4 AE 1.3 and 0.7 AE 1.3 mm, respectively (P40.05). Both treatments presented similar gain in grey values between BL-GR, BL-4M and BL-8M. The SBC presented less loss in grey values between BL-4M and BL-8M (Po0.05). Radiographic assessment underestimated the intrasurgical measurements (mesial and distal) of an average 0.3 mm (95% CI, 0.02-0.6).
To what extent residual alveolar ridge can be preserved by implant? A systematic review
International Journal of Implant Dentistry, 2016
Background: It has been reported that the load for (or to) implant-supported restoration may lead to bone remodeling as bone resorption and/or formation. While many authors supported the process of bone resorption, others elaborated bone apposition and increasing bone density close and remote to implant body (or fixture). This may suggest the role of the implant to reserve alveolar ridge from physiologic/pathologic resorption. The aim of this systematic review was to predict to how extend dental implants can preserve the residual alveolar ridge based on previous clinical investigations. Methods: This systematic review based on the retrospective and prospective studies, randomized clinical trial, and case reports. The process of searching for proposed articles included PubMed, Ovid, and Web of Science databases, with specific inclusion and exclusion criterion. Results: A total 2139 citations were identified. After expunging the repeated articles between databases and application of exclusion and inclusion criteria, 18 articles were found to meet the topic of this systematic review. Many of the articles reported bone preservation with implant-assisted restorations, and the rest denoted noticeable bone apposition. Conclusion: According to the published clinical studies, the behavior of bone remodeling around implant predicts a sort of residual alveolar bone preservation.
The Efficacy of Immediate Implant Placement in Extraction Sockets for Alveolar Bone Preservation
Journal of Craniofacial Surgery, 2017
The aim of this study was to determine the efficacy of immediate implant placement with alveolar bone augmentation on socket preservation following atraumatic tooth extraction and comparing it with a tooth alveolar socket that was allowed to heal in a conventional way. Twenty medically fit patients (8 males and 12 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of mandibular premolar teeth were divided randomly and equally into 2 groups. In Group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In Group II, the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilized bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. Cone beam computerized tomography images of the alveolar ridge and socket were analyzed to determine the structural changes of the alveolar ridge. Resonance frequency analysis was measured at 9 months for Group II to assess the degree of secondary stability of the implants by using Osstell machine. A significant difference of bone resorption of 1.49 mm (confidence interval, CI 95%, 0.63-2.35) was observed within the control group at 3 months, and 1.84 mm (P 0.05) at 9 months intervals. No significant changes of bone resorption were observed in Group II. Comparison between groups showed a highly significant difference at 3 months; 2.56 mm (CI 95% 4.22-0.90) and at 9 months intervals; 3.2 mm (CI 95%, 4.70-1.62) P 0.001 between Group I and II. High resonance frequency analysis values were observed at 9 months postoperative in Group II. In conclusion, the insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.
Biomechanical and radiological assessment of immediate implants for alveolar ridge preservation
Dental research journal, 2018
Background: The aim of this study was to evaluate the stability of immediate implant placement for alveolar bone augmentation and preservation with bovine bone graft following atraumatic tooth extraction. Materials and Methods: This was a prospective interventional study with convenient sampling (n = 10). Thirty patients aged between 18 and 40 years, who needed noncomplicated tooth extraction of mandibular premolar tooth, were sequentially divided equally into three groups. In Group I, simple extraction was done and the empty extraction socket left to heal conventionally. In Group II, extraction sockets were filled with lyophilized bovine granules only. In Group III, immediate implants were placed into extraction sockets, and the buccal gap was also filled with bovine granules. All groups were subjected to cone beam computed tomography scan for radiological evaluation. Assessment of biomechanical stability (radiofrequency analysis [RFA] was performed at 9 months postoperative for Group III to assess the degree of secondary stability of the implants using Osstell. Repeated measure analysis of variance (ANOVA) test was applied when comparing within each group at three different time intervals, whereas one-way ANOVA was applied followed by post hoc-tukey test when comparing between groups. P < 0.05 was considered statistically significant. Results: Radiological assessment reveals a significant difference of bone resorption in alveolar dimension within Group I; 1.49 mm (P = 0.002), and 0.82 mm (P = 0.005), respectively, between day 0 and 3 months. Comparison between Group I and III showed a highly significant difference of bone resorption in ridge width at 3 months 2.56 mm (P = 0.001) and at 9 months interval 3.2 mm (P < 0.001). High RFA values demonstrating an excellent biomechanical stability were observed in Group III at 9 months postoperatively. Conclusion: The insertion of immediate implants in extraction sockets with bovine bone augmentation of the buccal gap was able to preserve a greater amount of alveolar ridge volume.
Clinical Oral Implants Research, 2010
Objectives: The aim of this randomized, controlled clinical trial was to compare the potential of a synthetic bone substitute or a bovine-derived xenograft combined with a collagen membrane to preserve the alveolar ridge dimensions following tooth extraction.Methods: Twenty-seven patients were randomized into two treatment groups following single tooth extraction in the incisor, canine and premolar area. In the test group, the alveolar socket was grafted with Straumann Bone Ceramic® (SBC), while in the control group, Bio-Oss® deproteinized bovine bone mineral (DBBM) was applied. In both groups, a collagen barrier was used to cover the grafting material. Complete soft tissue coverage of the barriers was not achieved. After 8 months, during re-entry procedures and before implant placement, the horizontal and vertical dimensions of the residual ridge were re-evaluated and trephine biopsies were performed for histological analysis in all patients.Results: Twenty-six patients completed the study. The bucco-lingual dimension of the alveolar ridge decreased by 1.1±1 mm in the SBC group and by 2.1±1 in the DBBM group (P<0.05). Both materials preserved the mesio-distal bone height of the ridge. No differences in the width of buccal and palatal bone plate were observed between the two groups. The histological analysis showed new bone formation in the apical part of the biopsies, which, in some instances, was in direct contact with both SBC and DBBM particles. The coronal part of the biopsies was occupied by a dense fibrous connective tissue surrounding the SBC and DBBM particles.Conclusion: Both biomaterials partially preserved the width and the interproximal bone height of the alveolar ridge.To cite this article: Mardas N, Chadha V, Donos N. Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clin. Oral Impl. Res. 21, 2010; 688–698.
Journal of Oral Biology and Craniofacial Research, 2020
Background: Alveolar bone loss can occur as a result of aggressive maneuvering due to iatrogenic trauma during teeth extraction or due to normal post-extraction socket healing. Tooth if used as a whole grafting material then successful osteoconductive remodeling can be expected because low-crystalline apatite is the main minerals in bone tissue. A study was conducted in the department of oral and maxillofacial surgery focused on the potential for osteoconduction, osteoinduction, and osteogenesis by growth factors in the tooth and related histogenesis between the tooth and bone. Radiographic evaluation of alveolar ridge preservation was performed using a 3D imaging technique as well as histologically using Autogenous fresh mineralized tooth graft prepared at the chairside. Results: A total of 30 patients were included in the study. The data was subjected to statistical analysis and the comparison of quantitative data was done using paired t-test. Conclusion: The outcome of this study suggests that chair side autogenous tooth graft can be used for socket survival, sinus and ridge augmentation as it is less time consuming, easy to prepare, with lower bone resorption speed, osteoinduction, osteoconduction, osteogenetic properties, and excellent primary implant stability.
Clinical Oral Investigations, 2023
Objective: The aim of the present randomized controlled trial (RCT) was to evaluate the e cacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements. Backround: Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures a bone grafting material, is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness. Materials and Methods: Forty-one patients were randomly assigned in four treatment groups: A) freezedried bone allograft (FDBA) covered with collagen sponge (CS), B) FDBA covered with free gingival graft (FGG), C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG and D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss. Results: Overall, groups A, B and C presented signi cantly less vertical and horizontal bone resorption compared to group D. No statistically signi cant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically signi cantly reduced bone loss compared to allograft (Group C vs Group B: adjusted β coef: 1.07 mm; 95%CI: 0.01, 2.10; p=0.05). No signi cant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA. Conclusions: No differences between FDBA and DBBM could practically be con rmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and the effect of CS and FGG on soft tissue dimensional changes. Clinical relevance: Xenograft and allograft were equally e cient in ARP 4 months after tooth extraction in horizontal level. Xenograft maintained the mid-buccal site of the socket marginally better than the allograft, in vertical level. FGG and CS were equally e cient as SS materials regarding the hard tissue dimensional alterations. Clinical trial registration Number: NCT 04934813 (clinicaltrials.gov)
Clinical Oral Implants Research, 2010
The aim of this randomized, controlled clinical trial was to compare the potential of a synthetic bone substitute or a bovine-derived xenograft combined with a collagen membrane to preserve the alveolar ridge dimensions following tooth extraction. Methods: Twenty-seven patients were randomized into two treatment groups following single tooth extraction in the incisor, canine and premolar area. In the test group, the alveolar socket was grafted with Straumann Bone Ceramic s (SBC), while in the control group, Bio-Oss s deproteinized bovine bone mineral (DBBM) was applied. In both groups, a collagen barrier was used to cover the grafting material. Complete soft tissue coverage of the barriers was not achieved. After 8 months, during re-entry procedures and before implant placement, the horizontal and vertical dimensions of the residual ridge were re-evaluated and trephine biopsies were performed for histological analysis in all patients. Results: Twenty-six patients completed the study. The bucco-lingual dimension of the alveolar ridge decreased by 1.1 AE 1 mm in the SBC group and by 2.1 AE 1 in the DBBM group (Po0.05). Both materials preserved the mesio-distal bone height of the ridge. No differences in the width of buccal and palatal bone plate were observed between the two groups. The histological analysis showed new bone formation in the apical part of the biopsies, which, in some instances, was in direct contact with both SBC and DBBM particles. The coronal part of the biopsies was occupied by a dense fibrous connective tissue surrounding the SBC and DBBM particles. Conclusion: Both biomaterials partially preserved the width and the interproximal bone height of the alveolar ridge.