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Chatzopoulos GS, Koidou VP, Sonnenberger M, Johnson D, Chu H, Wolff LF. Postextraction ridge preservation by using dense PTFE membranes: A systematic review and meta-analysis. J Prosthet Dent 2024; 131:410-419. [PMID: 35410705 DOI: 10.1016/j.prosdent.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/15/2022]
Abstract
STATEMENT OF PROBLEM The use of dense polytetrafluoroethylene (dPTFE) membranes in alveolar ridge preservation may help reduce the risk of bacterial contamination and infection, maintaining the soft-tissue anatomy. However, systematic reviews on their efficacy in postextraction sites are lacking. PURPOSE The purpose of this systematic review and meta-analysis was to assess the efficacy of alveolar ridge preservation with dPTFE membranes when used alone or in combination with bone grafting materials in postextraction sites. MATERIAL AND METHODS An electronic search up to February 2021 was conducted by using PubMed, Embase, and the Cochrane library to detect studies using dPTFE membranes in postextraction sites. An additional manual search was performed in relevant journals. Clinical and radiographic dimensional changes of the alveolar ridge, histomorphometric, microcomputed tomography, implant-related findings, and rate of complications were recorded. One-dimensional meta-analysis was performed to calculate the overall means and 95% confidence intervals (α=.05). RESULTS A total of 23 studies, 14 randomized controlled trials, 4 retrospective cohort studies, 3 case series, and 2 prospective nonrandomized clinical trials, met the inclusion criteria. Five studies were included in the quantitative analysis. The meta-analysis revealed that the use of dPTFE membranes resulted in a statistically significant (P=.042) increase in clinical keratinized tissue of 3.49 mm (95% confidence interval [CI]: 0.16, 6.83) when compared with extraction alone. Metaregression showed that the difference of 1.10 mm (95% CI: -0.14, 2.35) in the radiographic horizontal measurements was not significant (P=.082), but the difference of 1.06 mm (95% CI: 0.51, 1.62) in the radiographic vertical dimensional change between dPTFE membranes+allograft and extraction alone was statistically significant (P<.001). CONCLUSIONS The use of dPTFE membranes was better than extraction alone in terms of keratinized tissue width and radiographic vertical bone loss.
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Affiliation(s)
- Georgios S Chatzopoulos
- Diplomate of the American Board of Periodontology and Private practice Limited to Periodontics and Implant Dentistry, London, UK; Former Resident, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn.
| | - Vasiliki P Koidou
- PhD Candidate, Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University London (QMUL), London, UK; Diplomate of the American Board of Periodontology and Former Resident, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn
| | - Michelle Sonnenberger
- PhD Candidate, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minn
| | - Deborah Johnson
- Clinical Professor and Diplomate of the American Board of Periodontology, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn
| | - Haitao Chu
- Professor, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minn; Professor, Clinical Translational Science Institute (CTSI), University of Minnesota, Minneapolis, Minn
| | - Larry F Wolff
- Professor, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minn
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Ren C, Chen W, Chen J, Mao C, Liao C, Liu J. The fusion of keratinized epithelium, an indication of early implant placement in the aesthetic area: an animal study. BMC Oral Health 2023; 23:1016. [PMID: 38115040 PMCID: PMC10729501 DOI: 10.1186/s12903-023-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND In the period of the early implant placement, the socket is mainly occupied by provisional matrix (PM). Keratinized epithelium (KE) is critical for primary wound closure. Although both KE and PM are important, the detailed relationship among migrating KE, PM formation and indication of the early implant placement is still unclear. OBJECTIVE This research aimed to locate a healing stage of KE with highest osteogenic PM formation after tooth extraction, which could be treated as the optimal time point for early implant placement. MATERIAL AND METHODS Mice were sacrificed on days 1, 2, 3, 4 and 6 after incisor extraction. Clinical, histological, and immunohistochemical evaluations of the extraction sockets were performed, and statistical analyses were conducted. We then inserted implants into the PM with the greatest bioactivity and observed its osseointegration pattern for 3, 10, 17 and 30 days. RESULT When KE fusion was reached, sockets were dominated by PM with the greatest expression of osteocalcin (OC, P < 0.05) and high levels of CD34 and Runx2. OC and Runx2 expression were positively correlated with KE coverage (P < 0.05). When the implant was inserted at 4 days' healing, the PM maintained its osteogenic ability, and osseointegration proceeded perfectly. CONCLUSION The migration of KE was correlated with the formation of highly osteogenic and angiogenic PM. And the fusion of KE could be treated as an indication for early implant placement.
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Affiliation(s)
- Chengyan Ren
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Weihui Chen
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Jiangping Chen
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanqing Mao
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Caiyu Liao
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Jianan Liu
- Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Oral Diseases & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
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Matumoto EK, Corrêa MG, Couso-Queiruga E, Monteiro MF, Graham Z, Braz SHG, Ribeiro FV, Pimentel SP, Cirano FR, Casati MZ. Influence of partially exposed nonabsorbable membrane for alveolar ridge preservation: A randomized controlled trial. Clin Implant Dent Relat Res 2023. [PMID: 36946359 DOI: 10.1111/cid.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
AIM This randomized controlled trial evaluated the impact of a partially exposed non-absorbable membrane (dPTFE) in Alveolar Ridge Preservation (ARP) procedures on clinical, tomographic, immunoenzymatic, implant-related, and patient-centered outcomes. MATERIALS AND METHODS Patients with a hopeless maxillary single-rooted tooth demanding rehabilitation with implants were included. Patients were randomized into two groups: dPTFE (n = 22)-tooth extraction followed by ARP using a partially exposed dPTFE membrane; USH (n = 22)-unassisted socket healing. Clinical and tomographic analyses were performed at baseline and after 3 months. After 3 months, patients received one dental implant. Implant stability quotient was obtained following implant placement. Bone-related markers were analyzed in bone biopsies using an immunoenzymatic assay. RESULTS Greater gain in Keratinized Mucosa Width (KMW) was observed in the dPTFE (1.33 ± 0.98 mm) compared to USH (0.59 ± 0.98 mm) (Mann-Whitney test, Z = 2,28, p < 0.05). USH showed a reduction of pain/discomfort, edema, and interference with daily life from the seventh day (Friedman/Wilcoxon test, maxT = 7.48, 8.00, and 5.92, respectively, p < 0.05). dPTFE presents a reduction of edema and interference with daily life from the 7th day and pain/discomfort from the 14th day (Friedman/Wilcoxon test, maxT = 5.40, 5.26, and 4.78, respectively, p < 0.05). The dPTFE group presented higher pain/discomfort in the 35 and 42 days and higher edema from 7 to 42 days postoperatively than USH group (Mann-Whitney test, p < 0.05). No differences between groups were observed in the tomographic measures, immunoenzymatic analysis, and implant stability (p > 0.05). CONCLUSION dPTFE was superior to USH by increasing KMW gain. However, dPTFE without bone graft presented similar bone loss compared to USH. This clinical trial was not registered prior to participant recruitment and randomization (NCT04329351).
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Affiliation(s)
- Edson Ken Matumoto
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
| | | | - Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Zachary Graham
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | | | | | - Suzana Peres Pimentel
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil
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Li Y, Meng Y, Bai Y, Wang Y, Wang J, Heng B, Wei J, Jiang X, Gao M, Zheng X, Zhang X, Deng X. Restoring the electrical microenvironment using ferroelectric nanocomposite membranes to enhance alveolar ridge regeneration in a mini-pig preclinical model. J Mater Chem B 2023; 11:985-997. [PMID: 36520085 DOI: 10.1039/d2tb02054h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The maintenance and incremental growth of the alveolar bone at the tooth extraction site, to achieve the required height and width for implant restoration, remains a major clinical challenge. Here, the concept of restoring the electrical microenvironment to improve the effects of alveolar ridge preservation (ARP) was investigated in a mini-pig preclinical model. The endogeneous electrical microenvironment of the dental alveolar socket was recapitulated by fabricating a biomimetic ferroelectric BaTiO3/poly(vinylidene fluoridetrifluoroethylene) (BTO/P(VDF-TrFE)) non-resorbable nanocomposite membrane polarized by corona poling. The polarized nanocomposite membrane exhibited excellent electrical stability. After implantation with bone grafts and covering with the charged membrane in tooth extraction sites for three months, both the vertical and horizontal dimension resorption of the alveolar ridge were significantly prevented, as assessed by cone beam computed tomography (CBCT) analyses. Micro-CT analysis showed that the charged membrane induced significant enhancement of newly regenerated bone at the tooth extraction sites. Histological analysis further confirmed that the restoration of the electrical microenvironment significantly promoted buccal alveolar bone regeneration and maturation. In addition, the charged membranes can maintain their structural integrity during the entire implantation period and exhibit positive long-term systemic safety, as assessed by preclinical sub-chronic systemic toxicity. These findings thus provide an innovative strategy for restoring the electrical microenvironment to enhance ARP following dentition defect and edentulism, which could further advance prosthodontics implant technology.
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Affiliation(s)
- Yiping Li
- Department of Dental Materials & Dental Medical Devices Testing Center, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China. .,Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410078, P. R. China.,Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China.
| | - Yanze Meng
- Department of Dental Materials & Dental Medical Devices Testing Center, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China.
| | - Yunyang Bai
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China.
| | - Yijun Wang
- Department of Dental Materials & Dental Medical Devices Testing Center, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China.
| | - Jiaqi Wang
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410078, P. R. China
| | - Boonchin Heng
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China
| | - Jinqi Wei
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China
| | - Xi Jiang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China
| | - Min Gao
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China. .,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NMPA Key Laboratory for Dental Materials, Beijing Laboratory of Biomedical Materials & Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, P. R. China
| | - Xiaona Zheng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China. .,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NMPA Key Laboratory for Dental Materials, Beijing Laboratory of Biomedical Materials & Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, P. R. China
| | - Xuehui Zhang
- Department of Dental Materials & Dental Medical Devices Testing Center, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China. .,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NMPA Key Laboratory for Dental Materials, Beijing Laboratory of Biomedical Materials & Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, P. R. China
| | - Xuliang Deng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, P. R. China. .,National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, NMPA Key Laboratory for Dental Materials, Beijing Laboratory of Biomedical Materials & Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, P. R. China
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Kormas I, Pedercini A, Alassy H, Wolff LF. The Use of Biocompatible Membranes in Oral Surgery: The Past, Present & Future Directions. A Narrative Review. MEMBRANES 2022; 12:841. [PMID: 36135860 PMCID: PMC9503881 DOI: 10.3390/membranes12090841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
The use of biocompatible membranes in periodontal and oral surgery is an important part of regeneration. Over the years, several different membranes have been developed, ranging from non-resorbable membranes that have to be removed in a separate procedure, to collagen membranes that completely resorb on their own, thus avoiding the need for a second surgery. Autogenous membranes are becoming increasingly popular in more recent years. These membranes can be used with a great variety of techniques in the four main hard tissue regenerative procedures: guided tissue regeneration, alveolar ridge preservation, guided bone regeneration and sinus floor augmentation. A review of the literature was conducted in order to identify the most commonly used membranes in clinical practice, as well as the most promising ones for regeneration procedures in the future. The information provided in this review may serve as a guide to clinicians, in order to select the most applicable membrane for the clinical case treated as the correct choice of materials may be critical in the procedure's success.
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Affiliation(s)
- Ioannis Kormas
- Department of Periodontics, School of Dentistry, Texas A&M University, Dallas, TX 75246, USA
| | | | | | - Larry F. Wolff
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
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Al-Maawi S, Valenzuela P, Dohle E, Heselich A, Sader R, Ghanaati S. Comparison of Different Fixation Methods for Combined Histological and Biomolecular Analysis of Fixed and Decalcified Bone Samples. Methods Protoc 2022; 5:mps5040064. [PMID: 35893590 PMCID: PMC9326524 DOI: 10.3390/mps5040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
The combination of histological and biomolecular analyses provides deep understanding of different biological processes and is of high interest for basic and applied research. However, the available analytical methods are still limited, especially when considering bone samples. This study compared different fixation media to identify a sufficient analytical method for the combination of histological, immuno-histological and biomolecular analyses of the same fixed, processed and paraffin embedded bone sample. Bone core biopsies of rats’ femurs were fixed in different media (RNAlater + formaldehyde (R + FFPE), methacarn (MFPE) or formaldehyde (FFPE)) for 1 week prior to decalcification by EDTA and further histological processing and paraffin embedding. Snap freezing (unfixed frozen tissue, UFT) and incubation in RNAlater were used as additional controls. After gaining the paraffin sections for histological and immunohistological analysis, the samples were deparaffined and RNA was isolated by a modified TRIZOL protocol. Subsequently, gene expression was evaluated using RT-qPCR. Comparable histo-morphological and immuno-histological results were evident in all paraffin embedded samples of MFPE, FFPE and R + FFPE. The isolated RNA in the group of MFPE showed a high concentration and high purity, which was comparable to the UFT and RNAlater groups. However, in the groups of FFPE and R + FFPE, the RNA quality and quantity were statistically significantly lower when compared to MFPE, UFT and RNAlater. RT-qPCR results showed a comparable outcome in the group of MFPE and UFT, whereas the groups of FFPE and R + FFPE did not result in a correctly amplified gene product. Sample fixation by means of methacarn is of high interest for clinical samples to allow a combination of histological, immunohistological and biomolecular analysis. The implementation of such evaluation method in clinical research may allow a deeper understanding of the processes of bone formation and regeneration.
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Del Fabbro M, Tommasato G, Pesce P, Ravidà A, Khijmatgar S, Sculean A, Galli M, Antonacci D, Canullo L. Sealing materials for post-extraction site: a systematic review and network meta-analysis. Clin Oral Investig 2021; 26:1137-1154. [PMID: 34825280 PMCID: PMC8816783 DOI: 10.1007/s00784-021-04262-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 12/25/2022]
Abstract
Abstract Aim By means of a systematic review and network meta-analysis, this study aims to answer the following questions: (a) does the placement of a biomaterial over an extraction socket lead to better outcomes in terms of horizontal and vertical alveolar dimensional changes and percentage of new bone formation than healing without coverage? And (b) which biomaterial(s) provide(s) the better outcomes? Materials and methods Parallel and split-mouth randomized controlled trials treating ≥ 10 patients were included in this analysis. Studies were identified with MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials, and Scopus. Primary outcomes were preservation of horizontal and vertical alveolar dimension and new bone formation inside the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes. For NMA, prediction intervals were calculated to estimate clinical efficacy, and SUCRA was used to rank the materials based on their performance; multidimensional ranking was used to rank treatments based on dissimilarity. The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). Results Twelve trials were included in the qualitative and quantitative analysis: 312 sites were evaluated. Autologous soft tissue grafts were associated with better horizontal changes compared to resorbable membranes. A statistically significant difference in favor of resorbable membranes, when compared to no membrane, was found, with no statistically significant heterogeneity. For the comparison between crosslinked and non-crosslinked membranes, a statistically significant difference was found in favor of the latter and confirmed by histomorphometric NMA analysis. Given the relatively high heterogeneity detected in terms of treatment approaches, materials, and outcome assessment, the findings of the NMA must be interpreted cautiously. Conclusions Coverage of the healing site is associated with superior results compared to no coverage, but no specific sealing technique and/or biomaterial provides better results than others. RCTs with larger sample sizes are needed to better elucidate the trends emerged from the present analysis. Clinical relevance Autologous soft tissue grafts and membranes covering graft materials in post-extraction sites were proved to allow lower hard tissue shrinkage compared to the absence of coverage material with sealing effect. Histomorphometric analyses showed that non-crosslinked membranes provide improved hard tissue regeneration when compared to crosslinked ones. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04262-3.
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Affiliation(s)
- Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Grazia Tommasato
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | | | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | | | - Luigi Canullo
- Department of Periodontology, University of Bern, Bern, Switzerland.
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Atieh MA, Alsabeeha NH, Payne AG, Ali S, Faggion CMJ, Esposito M. Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. Cochrane Database Syst Rev 2021; 4:CD010176. [PMID: 33899930 PMCID: PMC8092674 DOI: 10.1002/14651858.cd010176.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. This is an update of the Cochrane Review first published in 2015. OBJECTIVES To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2021), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2021, Issue 2), MEDLINE Ovid (1946 to 19 March 2021), Embase Ovid (1980 to 19 March 2021), Latin American and Caribbean Health Science Information database (1982 to 19 March 2021), Web of Science Conference Proceedings (1990 to 19 March 2021), Scopus (1966 to 19 March 2021), ProQuest Dissertations and Theses (1861 to 19 March 2021), and OpenGrey (to 19 March 2021). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. A number of journals were also handsearched. SELECTION CRITERIA We included all randomised controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of alveolar ridge, changes in the vertical height of the alveolar ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. DATA COLLECTION AND ANALYSIS We selected trials, extracted data, and assessed risk of bias in duplicate. Corresponding authors were contacted to obtain missing information. We estimated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 16 RCTs conducted worldwide involving a total of 524 extraction sites in 426 adult participants. We assessed four trials as at overall high risk of bias and the remaining trials at unclear risk of bias. Nine new trials were included in this update with six new trials in the category of comparing ARP to extraction alone and three new trials in the category of comparing different grafting materials. ARP versus extraction: from the seven trials comparing xenografts with extraction alone, there is very low-certainty evidence of a reduction in loss of alveolar ridge width (MD -1.18 mm, 95% CI -1.82 to -0.54; P = 0.0003; 6 studies, 184 participants, 201 extraction sites), and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P < 0.0001; 6 studies, 184 participants, 201 extraction sites) in favour of xenografts, but we found no evidence of a significant difference for the need for additional augmentation (RR 0.68, 95% CI 0.29 to 1.62; P = 0.39; 4 studies, 154 participants, 156 extraction sites; very low-certainty evidence) or in implant failure rate (RR 1.00, 95% CI 0.07 to 14.90; 2 studies, 70 participants/extraction sites; very low-certainty evidence). From the one trial comparing alloplasts versus extraction, there is very low-certainty evidence of a reduction in loss of alveolar ridge height (MD -3.73 mm; 95% CI -4.05 to -3.41; 1 study, 15 participants, 60 extraction sites) in favour of alloplasts. This single trial did not report any other outcomes. Different grafting materials for ARP: three trials (87 participants/extraction sites) compared allograft versus xenograft, two trials (37 participants, 55 extraction sites) compared alloplast versus xenograft, one trial (20 participants/extraction sites) compared alloplast with and without membrane, one trial (18 participants, 36 extraction sites) compared allograft with and without synthetic cell-binding peptide P-15, and one trial (30 participants/extraction sites) compared alloplast with different particle sizes. The evidence was of very low certainty for most comparisons and insufficient to determine whether there are clinically significant differences between different ARP techniques based on changes in alveolar ridge width and height, the need for additional augmentation prior to implant placement, or implant failure. We found no trials which evaluated parameters relating to clinical attachment levels, specific aesthetic or prosthodontic outcomes for any of the comparisons. No serious adverse events were reported with most trials indicating that the procedure was uneventful. Among the complications reported were delayed healing with partial exposure of the buccal plate at suture removal, postoperative pain and swelling, moderate glazing, redness and oedema, membrane exposure and partial loss of grafting material, and fibrous adhesions at the cervical part of previously preserved sockets, for the comparisons xenografts versus extraction, allografts versus xenografts, alloplasts versus xenografts, and alloplasts with and without membrane. AUTHORS' CONCLUSIONS ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction but the evidence is very uncertain. There is lack of evidence of any differences in the need for additional augmentation at the time of implant placement, implant failure, aesthetic outcomes, or any other clinical parameters due to lack of information or long-term data. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long-term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.
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Affiliation(s)
- Momen A Atieh
- Mohammed bin Rashid University of Medicine and Health Sciences, Hamdan bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
| | - Nabeel Hm Alsabeeha
- RAK Dental Centre, Ministry of Health and Prevention, Ras Al-Khaimah, United Arab Emirates
| | - Alan Gt Payne
- Private practice, Northland Prosthodontics Ltd, c/o NorthShore Oral and Maxillofacial Surgeons, Auckland, New Zealand
| | - Sara Ali
- Mohammed bin Rashid University of Medicine and Health Sciences, Hamdan bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates
| | | | - Marco Esposito
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Cruz R, Moraschini V, Calasans-Maia MD, de Almeida DCF, Sartoretto SC, Granjeiro JM. Clinical efficacy of simvastatin gel combined with polypropylene membrane on the healing of extraction sockets: A triple-blind, randomized clinical trial. Clin Oral Implants Res 2021; 32:711-720. [PMID: 33715258 DOI: 10.1111/clr.13740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate dimensional changes, level of soft tissue healing, and pain/discomfort perception in post-extraction sockets filling with 1.2% simvastatin (SIM) gel covered with polypropylene membranes (PPPM). MATERIAL AND METHODS Twenty-six post-extraction sockets of posterior teeth were randomly allocated in two groups: (a) socket filling with 1.2% SIM gel and covered with PPPM (n = 13) and (b) socket filling with placebo gel and covered with PPPM (n = 13). Cone-beam computed tomography (CBCT) images before and 90 days after the extraction enabled alveolar bone dimensional changes calculation using horizontal and vertical measurements. The measurements occurred at three different levels for thickness located 1, 3, and 5 mm from the top of the bone crest. The vertical (depth) measure was assessed from the most apical portion of the socket to the bone crest's most coronal portion. Seven days after the extractions, the level of soft tissue healing and pain perception were also analyzed. RESULTS After 90 days of extractions, the dimensional changes in thickness in the test group were significantly smaller in sections A (p = .044), B (p = .036) and C (p = .048) when compared to the control group. The test group showed a significantly lower height-dimensional change than the control group (p < .0001). Soft tissue healing index (p = .63), perception of pain (p = .23), and number of analgesics consumed (p = .25) were similar between groups. CONCLUSIONS Simvastatin at 1.2% compared with placebo effectively reduced the dimensional changes in post-extraction sockets covered with PPPM. There was no significant difference in the level of soft tissue healing and postoperative pain between the test and control groups.
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Affiliation(s)
- Rebecca Cruz
- Doctoral Program, Fluminense Federal University, Niteroi Rio de Janeiro, Brazil
| | - Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | | | | | - Suelen Cristina Sartoretto
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - José Mauro Granjeiro
- Department of Dental Technics, School of Dentistry, Fluminense Federal University, Niterói, Brazil.,National Institute of Metrology, Quality, and Technology (INMETRO), Rio de Janeiro, Brazil
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10
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Bassi APF, Bizelli VF, Francatti TM, Rezende de Moares Ferreira AC, Carvalho Pereira J, Al-Sharani HM, de Almeida Lucas F, Faverani LP. Bone Regeneration Assessment of Polycaprolactone Membrane on Critical-Size Defects in Rat Calvaria. MEMBRANES 2021; 11:membranes11020124. [PMID: 33572318 PMCID: PMC7916152 DOI: 10.3390/membranes11020124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
Biomaterials for use in guided bone regeneration (GBR) are constantly being investigated and developed to improve clinical outcomes. The present study aimed to comparatively evaluate the biological performance of different membranes during the bone healing process of 8 mm critical defects in rat calvaria in order to assess their influence on the quality of the newly formed bone. Seventy-two adult male rats were divided into three experimental groups (n = 24) based on the membranes used: the CG—membrane-free control group (only blood clot, negative control), BG—porcine collagen membrane group (Bio-Guide®, positive control), and the PCL—polycaprolactone (enriched with 5% hydroxyapatite) membrane group (experimental group). Histological and histometric analyses were performed at 7, 15, 30, and 60 days postoperatively. The quantitative data were analyzed by two-way ANOVA and Tukey’s test (p < 0.05). At 7 and 15 days, the inflammatory responses in the BG and PCL groups were significantly different (p < 0.05). The PCL group, at 15 days, showed a large area of newly formed bone. At 30 and 60 days postoperatively, the PCL and BG groups exhibited similar bone healing, including some specimens showing complete closure of the critical defect (p = 0.799). Thus, the PCL membrane was biocompatible, and has the potential to help with GBR procedures.
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Affiliation(s)
- Ana Paula Farnezi Bassi
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (T.M.F.); (A.C.R.d.M.F.); (J.C.P.); (L.P.F.)
- Correspondence: ; Tel.: +55-18-36363242
| | - Vinícius Ferreira Bizelli
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (T.M.F.); (A.C.R.d.M.F.); (J.C.P.); (L.P.F.)
| | - Tamires Mello Francatti
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (T.M.F.); (A.C.R.d.M.F.); (J.C.P.); (L.P.F.)
| | - Ana Carulina Rezende de Moares Ferreira
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (T.M.F.); (A.C.R.d.M.F.); (J.C.P.); (L.P.F.)
| | - Járede Carvalho Pereira
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (T.M.F.); (A.C.R.d.M.F.); (J.C.P.); (L.P.F.)
| | - Hesham Mohammed Al-Sharani
- School of Dentistry, Faculty of Dentistry, Ibb University, Ibb, Yemen;
- Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin 150081, China
| | - Flavia de Almeida Lucas
- Araçatuba Veterinary Medicine School, UNESP—São Paulo State University, Araçatuba, São Paulo 16050-680, Brazil;
| | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (T.M.F.); (A.C.R.d.M.F.); (J.C.P.); (L.P.F.)
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11
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A retrospective cohort study of how alveolar ridge preservation affects the need of alveolar ridge augmentation at posterior tooth implant sites. Clin Oral Investig 2021; 25:4643-4649. [PMID: 33432420 PMCID: PMC8310513 DOI: 10.1007/s00784-021-03778-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
Objectives The aim of this study was to assess whether alveolar ridge preservation (ARP) can reduce the need of ridge augmentation at posterior tooth sites. Material and methods This study enrolled patients who received dental implants at posterior tooth sites during 2013–2019. Demographic data and dental treatment histories were collected. Based on healing patterns after tooth extraction, patients were divided into ARP and spontaneous healing (SH) groups. Three surgical treatment plans were devised according to the alveolar bone volume on cone-beam computed tomography (CBCT). The three treatment plans were to perform implant alone, simultaneous guided bone regeneration (GBR) and implantation, and staged GBR before implantation. Statistical analyses were performed to determine relationships. Results There were 92 implant records in the ARP group and 249 implant records in the SH group. A significant intergroup difference was observed regarding the frequency distribution of the treatment modality of staged GBR before implant (χ2 = 15.07, p = 0.0005). Based on the implant alone treatment modality and simple logistic regression, the SH pattern was related to staged GBR before implant (SH vs. ARP: crude odds ratio (OR) = 4.65, 95% confidence interval (CI) = 2.15–11.61, p = 0.0003). After adjusting confounding factors, the risk was still significant (adjusted OR = 5.02, 95% CI = 2.26–12.85, p = 0.0002). Conclusions The study results suggested that ARP is more likely to lead to the treatment modality of implant alone and reduce the need for staged GBR before implantation. Clinical relevance This study describes ARP capable of minimizing the need for staged GBR before implantation and shortening the treatment duration.
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12
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Schnutenhaus S, Edelmann C, Dreyhaupt J, Rudolph H, Luthardt RG, Goetz W. Alveolar ridge preservation with a collagen cone: Histological, histochemical, and immunohistochemical results of a randomized controlled clinical trial. Clin Exp Dent Res 2020; 6:345-355. [PMID: 31967736 PMCID: PMC7301397 DOI: 10.1002/cre2.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The objective of the present study was to examine the influence of a combination material of a collagen cone and a collagen membrane on the healing process of extraction sockets with regard to histological, histochemical, and immunohistochemical parameters. MATERIALS AND METHODS In a prospective randomized clinical study, 10 patients (test group) received a collagen combination material after tooth removal. The extraction sockets of 10 other patients (control group) were left to heal without further intervention. Eleven ±1 weeks after tooth extraction, histological biopsies were performed in both groups at the time of implant placement. Subsequently, the biopsies were evaluated semiquantitatively in terms of histological, histochemical, and immunohistochemical parameters for the identification of factors of bone metabolism and vascularization. RESULTS No significant difference between test and control group were found for any parameter. According to the descriptive data, the use of a collagen combination material seems to result in slightly higher values of the osteogenic Runt-related transcription factor 2 (Runx2) and vascularization. CONCLUSION The histological, histochemical, and immunohistochemical analysis of ARP with a collagen cone combined with a collagen membrane showed no significant differences in terms of bone metabolism and vascularization.
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Affiliation(s)
- Sigmar Schnutenhaus
- Center of Dentistry Dr. Schnutenhaus MVZ GmbHHilzingenGermany
- Department of Prosthetic Dentistry, Center of DentistryUlm UniversityUlmGermany
| | - Cornelia Edelmann
- Department of Prosthetic Dentistry, Center of DentistryUlm UniversityUlmGermany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical BiometryUlm UniversityUlmGermany
| | - Heike Rudolph
- Center of Dentistry Dr. Schnutenhaus MVZ GmbHHilzingenGermany
| | | | - Werner Goetz
- Department of Orthodontics, Oral Biology LaboratoryUniversity of BonnBonnGermany
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13
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Altiparmak N, Akdeniz SS, Akcay YE, Bayram B, Araz K. Experimental assessment of histological and biological properties of the induced membrane and the membrane formed around the d-PTFE membrane: A pilot study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:140-145. [PMID: 32145434 DOI: 10.1016/j.jormas.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this prospective pilot study is to find answers to the following question: In the treatment protocol of open membrane technique defined by Funakoshi, do the histological and biological properties of the tissue that has already covered the graft surface following the removal of the d-PTFE membrane resemble those properties of induced membrane? MATERIAL AND METHODS 4 male, white Vienna rabbits were used for experiments. Bicortical and 10mm in diameter four bone defects were created on each calvarial bone. 2 rabbits (8 defects) were accepted as group I and other 2 rabbits (8 defects) were accepted as group II. Bone cement was placed into the all-defect in group I. 8 defects were filled with Bi-Oss graft material and covered with d-PTFE membranes in group II. After 8 weeks, sacrifice of the rabbits was performed. In group I, without damaging the formed membrane around it, the bone cement was removed from the defects and the achieved membrane was sent to the pathology department. In group II, the thin film layer that formed under the d-PTFE membrane was sent for histological evaluations. Inflammation, edema, foreign body reaction, synovial-like epithelium existence, thickness, vascularisation (CD31, VEGF), fibrosis were assessed. RESULTS Inflammation, fibrosis and thickness measurements are significantly different between the groups (P<0,05) and for these parameters, the mean of d-PTFE group (Group II) is significantly higher than the mean of the induced-membrane group (Group I). There isn't any significant difference for other parameters. CONCLUSION The morphological characteristics of membranes of the two groups were similar. There was a cell-rich, vascularised tissue with fibrous structures; fibroblasts, myofibroblast, and collagen, orientated parallel to the cement.
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Affiliation(s)
- N Altiparmak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.
| | - S S Akdeniz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Y E Akcay
- Department of Pathology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - B Bayram
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - K Araz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey
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14
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Papi P, Di Murro B, Tromba M, Passarelli PC, D’Addona A, Pompa G. The Use of a Non-Absorbable Membrane as an Occlusive Barrier for Alveolar Ridge Preservation: A One Year Follow-Up Prospective Cohort Study. Antibiotics (Basel) 2020; 9:antibiotics9030110. [PMID: 32138241 PMCID: PMC7148478 DOI: 10.3390/antibiotics9030110] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 11/16/2022] Open
Abstract
:The aims of this study were to obtain preliminary data and test the clinical efficacy of a novel nonporous dense-polytetrafluoroethylene (d-PTFE) membrane (permamem®, botiss) in alveolar ridge preservation (ARP) procedures with a flapless approach. A traumatic extraction was performed in the premolar maxillary area, and a d-PTFE membrane was used to seal the alveolar cavity: no biomaterial was used to graft the socket and the membrane was left intentionally exposed and stabilized with sutures. The membrane was removed after four weeks and dental implants were placed four months after the procedure. The primary outcome variables were defined as the dimensional changes in the ridge width and height after four months. A total of 15 patients were enrolled in this study. The mean width of the alveolar cavity was 8.9 ± 1.1 mm immediately after tooth extraction, while four months later a mean reduction of 1.75 mm was experienced. A mean vertical reduction of 0.9 ± 0.42 mm on the buccal aspect and 0.6 ± 0.23 mm on the palatal aspect were recorded at implant placement. Within the limitations of this study, the d-PTFE membrane proved to be effective in alveolar ridge preservation, with the outcomes of the regeneration not affected by the complete exposure of this biomaterial.
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Affiliation(s)
- Piero Papi
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (B.D.M.); (M.T.); (G.P.)
- Correspondence:
| | - Bianca Di Murro
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (B.D.M.); (M.T.); (G.P.)
| | - Marco Tromba
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (B.D.M.); (M.T.); (G.P.)
| | - Pier Carmine Passarelli
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Catholic University of Sacred Hearth, Fondazione Policlinico Universitario Gemelli, 00168 Rome, Italy; (P.C.P.); (A.D.)
| | - Antonio D’Addona
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, Catholic University of Sacred Hearth, Fondazione Policlinico Universitario Gemelli, 00168 Rome, Italy; (P.C.P.); (A.D.)
| | - Giorgio Pompa
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (B.D.M.); (M.T.); (G.P.)
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