OBJECTIVES:To test primary stability of delayed implants placed in post-extraction ridges preserved with autogenous mineralized dentin matrix (MDM) versus xenograft granules. Clinical, histological and pain experience outcomes were further assessed. MATERIAL AND METHODS:From March 2018 to July 2020, patients requiring ridge preservation in preparation for delayed implant placement in post-extraction sites were included. Participants were randomly allocated to either the test (MDM) or control group (xenograft granules) prior to ridge preservation. Visual analogue scale and analgesic consumption were measured every day for a week. Six months after preservation, trephine cores were harvested for histomorphometry prior to implant placement. Implants were then placed, and implant stability was measured immediately as well as two months after placement. Marginal bone loss and presence of mucositis/peri-implantitis were registered up to 18 months after prosthetic loading. RESULTS:Fifty-two patients (66 implants) completed the study. MDM and xenograft groups presented similar primary (77.1 ± 6.9 versus. 77.0 versus. 5.9) and secondary (81.8 ± 5.1 versus. 80.1 ± 3.8) implant stabilities. The percentage of newly formed bone in MDM (47.3%) was significantly higher than xenograft (34.9%) (p < .001), and the proportion of residual graft was significantly lower (12.2% in MDM and 22.1% in xenograft) (p < .001). No significant differences were found as far as clinical, radiographic and patient-related outcomes. CONCLUSIONS:Implants placed in sites preserved with MDM had similar primary stability in comparison to xenograft granules. MDM showed a significantly higher quantity of newly formed bone and lower amount of residual graft in histomorphometry results and equal clinical and patient-related outcomes.

This study clinically and histologically evaluated the new bone formation and soft tissue changes when an autogenous tooth-derived mineralized dentin matrix (DDM) graft covered with a free gingival graft (FGG) was used for alveolar ridge preservation, as compared to spontaneous healing. Using a split-mouth protocol, 14 consecutive patients who required two extractions of a single-rooted tooth in the maxillary arch were enrolled. In each patient, one extraction site was treated with DDM and FGG (test group), while the other extraction site was covered with FGG and healed spontaneously (control group). In both test and control sites, implant placement was performed after a 16-week healing period. Compared to baseline (immediately after tooth extraction), both treatments yielded statistically significant differences in some clinical parameters and in the bone micro-architecture within the augmented sites. However, the use of DDM with the FGG created greater new vital bone formation, more newly formed bone, and fewer dimensional tissue changes than spontaneous healing with FGG.

BACKGROUND:Alveolar ridge preservation can effectively decrease alveolar ridge resorption following tooth extraction, but it can be limited by reducing new bone formation and residual bone graft material. Efforts to develop more efficacious approaches are thus an area of active research. PURPOSE:To assess the impact of autologous concentrated growth factors (CGF) on alveolar ridge absorption and osteogenesis following posterior tooth extraction. MATERIALS AND METHODS:Fifty patients were randomly assigned to have extraction sockets treated with CGF or no treatment. At 10 days, 1 month, and 3 months postextraction, soft tissue color and texture were examined and evaluated with healing score. Cone-beam computed tomography (CBCT) scans were performed before and 3 months after extraction, while radiographic analyses were used to assess vertical and horizontal bone changes. Bone samples were collected from the extraction sockets during implant placement, and micro-computed tomography (micro-CT) scans and histological analysis were performed to evaluate new bone formation. t-Test or Mann-Whitney U test was used to compare data and the level of statistical significance was set at 0.05 for all analyses. RESULTS:Forty-six patients completed the trial. Sockets in the experimental group exhibited significantly better healing score on Day 10 postextraction relative to the control group, whereas comparable healing was observed in both groups at 1 and 3 months postextraction. Experimental group exhibited reduced vertical bone changes relative to the control (p < 0.05). Significant reductions were observed in ridge width changes at 1 and 2 mm apical to the crest (p < 0.05), although differences at 3 and 5 mm apical to the crest were not significant. Significant differences of bone mineral density (BMD) and microarchitecture of trabecular bone were observed via micro-CT analyses, and the experimental group had better results. CONCLUSION:CGF application following posterior tooth extraction may reduce vertical and horizontal bone resorption and promote new bone formation.

BACKGROUND:An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The choice of the graft material and its properties also could have an impact on the results. To prevent alveolar ridge dimensional changes, since numerous graft materials have been suggested and in the past years, a growing interest in teeth material has been observed as a valuable alternative to synthetic biomaterials. AIM:The aim of the study was to explore the histomorphometric outcomes of tooth derivative materials as used as bone substitute material in socket preservation procedure. METHODS:After alveolar socket preservation (ASP) procedures using autologous demineralized tooth as graft material prepared by means of an innovative device, was evaluated. A total of 101 histological samples, from 96 subjects, were analyzed by evaluating the total amount of bone (BV), residual tooth material (residual graft, TT), and vital bone (VB). The section from each sample was then split in nine subsections, resulting in 909 subsections, to allow statistical comparison between the different areas. RESULTS:It was not noticed a statistically significant difference between maxillary and mandibular sites, being the amount of VB in upper jaw sites 37.9 ± 21.9% and 38.0 ± 22.0% in lower jaw sites and the amount of TT was 7.7 ± 12.2% in maxilla and 7.0 ± 11.1% in mandibles. None of the other considered parameters, including defect type and section position, were statistically correlated to the results of the histomorphometric analysis. CONCLUSIONS:ASP procedure using demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone potentially capable to support dental implant rehabilitation.

OBJECTIVE:To volumetrically evaluate soft tissue changes of different ridge preservation techniques compared to spontaneous healing 6 months after tooth extraction. MATERIALS AND METHODS:In each of 40 patients, one single-rooted tooth was extracted and four treatment modalities were randomly assigned to the following groups (n = 10 each): A) ß-tricalcium-phosphate-particles with a polylactid coating (ß-TCP), B) demineralized bovine bone mineral with 10% collagen covered with a collagen matrix (DBBM-C/CM), C) DBBM with 10% collagen covered with an autogenous soft tissue punch graft (DBBM-C/PG), D) spontaneous healing (control). Impressions were obtained before extraction and 6 months later, casts were digitized and volumetric changes at the buccal soft tissues were determined. One-way anova was performed and pair-wise Wilcoxon rank sum test with Bonferroni-Holm method was applied for comparison of differences between two groups. RESULTS:After 6 months, horizontal contour changes accounted for -1.7 ± 0.7 mm (A), -1.2 ± 0.5 mm (B), -1.2 ± 0.7 mm (C) and -1.8 ± 0.8 mm (D). None of the group comparisons reached statistical significance. CONCLUSIONS:Six months after tooth extraction all groups revealed a horizontal volume change in the buccal soft tissue contour. Application of DBBM-C/CM or DBBM-C/PG reduced the amount of volume resorption compared to ß-TCP or spontaneous healing without reaching statistically significant difference.

BACKGROUND:Tooth extractions lead to morphological changes of the alveolar ridge. For oral rehabilitation sufficient bone volume of the alveolar ridge is required. This clinical study compared the ability of Bio-Oss Collagen to autogenous bone to preserve bone volume after tooth extraction. METHODS:A total of 17 patients with 20 extraction sites were examined. After extraction, 10 sockets were each filled with either autogenous bone or Bio-Oss Collagen and covered with a resorbable membrane. The width of the alveolar ridge was measured postoperatively, and after 4 and 6 months respectively. Prior to implant insertion, a bone biopsy was taken from the grafted sites and evaluated histologically. RESULTS:The width of the alveolar ridge in the Bio-Oss Collagen group decreased about 5.33 ± 6.62% after 4 months and 9.45 ± 10.51% after 6 months. The reduction in the group augmented with autogenous bone was 14.31 ± 21.41% after 4 months and 19.17 ± 8.38% after 6 months. No statistically significant differences were observed. The histological examination showed comparable area fractions of total bone in both groups (Bio-Oss Collagen: 59.99 ± 24.23%; autogenous bone: 61.55 ± 25.13%; p = 1.0). CONCLUSIONS:The present study demonstrated that autogenous bone and Bio-Oss Collagen are suitable for ridge preservation. However, both techniques could not entirely prevent tissue volume loss.

OBJECTIVES:To review and assess the efficiency of different post extraction socket preservation techniques. MATERIAL AND METHODS:An electronic literature search was performed on the MEDLINE and Embase databases. The review included human studies published between from January 1, 2007 to January 1, 2018, in English. Outcome measures included dimensional changes and/or histological evaluation of alveolar bone. RESULTS:Twenty-six full text articles were reviewed, 16 of which met the inclusion criteria and were selected for the study. Autogenous tooth graft prevented vertical resorption the most: -0.28 (SD 0.13) mm, observation period (OP): 4 months, while the least effective approach was beta tri-calcium phosphate (β-TCP): -1.72 (SD 0.56) mm, OP: 4 months. Estimating horizontal resorption, the most effective technique was biphasic calcium sulphate (BCS) with β-TCP and hydroxyapatite (HA) - BCS + TCP + HA: 0.03 (SD 2.32) mm, OP: 4 months, while β-TCP was the least efficient: -1.45 (SD 0.4) mm, OP: 4 months. Evaluating residual graft particles (RG) and newly formed bone (NFB) ratio the best results were achieved with demineralized freeze-dried bone allograft: RG: 8.88%, NFB: 38.42%, OP: 5 months, whereas magnesium-enriched hydroxyapatite was least effective: RG: 40.82%, NFB: 31.85%, OP: 4 months. CONCLUSIONS:This review revealed that even though there are numerous types of biomaterials for socket preservation none of them can completely stop alveolar bone loss after tooth extraction. Furthermore, lack of information about qualitative evaluation of bone was noticed indicating that further studies regarding this topic are needed.

This case series evaluated the clinical efficacy of autogenous tooth bone graft material (AutoBT) in alveolar ridge preservation of an extraction socket. Thirteen patients who received extraction socket graft using AutoBT followed by delayed implant placements from Nov. 2008 to Aug. 2010 were evaluated. A total of fifteen implants were placed. The primary and secondary stability of the placed implants were an average of 58 ISQ and 77.9 ISQ, respectively. The average amount of crestal bone loss around the implant was 0.05 mm during an average of 22.5 months (from 12 to 34 months) of functional loading. Newly formed tissues were evident from the 3-month specimen. Within the limitations of this case, autogenous tooth bone graft material can be a favorable bone substitute for extraction socket graft due to its good bone remodeling and osteoconductivity.

BACKGROUND:Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature. OBJECTIVE:To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance. MATERIALS AND METHODS:The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow-up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed. RESULTS:A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT). CONCLUSIONS:NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage. CLINICAL RELEVANCE:Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.