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Mardas N, Macbeth N, Donos N, Jung RE, Zuercher AN. Is alveolar ridge preservation an overtreatment? Periodontol 2000 2023; 93:289-308. [PMID: 37622682 DOI: 10.1111/prd.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/24/2023] [Accepted: 05/19/2023] [Indexed: 08/26/2023]
Abstract
The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing.
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Affiliation(s)
- Nikos Mardas
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
| | - Neil Macbeth
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
- Defence Centre for Rehabilitative Dentistry, Defence Primary Health Care (DPHC), Dental Centre Aldershot, Guildford, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Anina Nives Zuercher
- Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), Barts & The London School of Medicine & Dentistry, London, UK
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Ottenbacher N, Alkildani S, Korzinskas T, Pissarek J, Ulm C, Jung O, Sundag B, Bellmann O, Stojanovic S, Najman S, Zechner W, Barbeck M. Novel Histomorphometrical Approach to Evaluate the Integration Pattern and Functionality of Barrier Membranes. Dent J (Basel) 2021; 9:dj9110127. [PMID: 34821591 PMCID: PMC8618445 DOI: 10.3390/dj9110127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022] Open
Abstract
GBR (guided bone regeneration) is a standard procedure for building up bony defects in the jaw. In this procedure, resorbable membranes made of bovine and porcine collagen are increasingly being used, which, in addition to many possible advantages, could have the potential disadvantage of a shorter barrier functionality, especially when augmenting large-volume defects. Thus, it is of importance to evaluate the integration behavior and especially the standing time of barrier membranes using specialized methods to predict its respective biocompatibility. This study is intended to establish a new histomorphometrical analysis method to quantify the integration rate of collagen-based barrier membranes. Three commercially available barrier membranes, i.e., non-crosslinked membranes (BioGide® and Jason® membrane), a ribose-crosslinked membrane (Ossix® Plus), and a newly developed collagen–hyaluronic acid-based (Coll-HA) barrier membrane were implanted in the subcutaneous tissue of 48 6–8-week-old Wistar rats. The explants, after three timepoints (10, 30, and 60 days), were processed and prepared into histological sections for histopathological (host tissue response) and histomorphometrical (cellular invasion) analyses. 10 days after implantation, fragmentation was not evident in any of the study groups. The sections of the Coll-HA, Jason® and BioGide® membranes showed a similar mild inflammatory reaction within the surrounding tissue and an initial superficial cell immigration. Only in the Ossix® Plus group very little inflammation and no cell invasion was detected. While the results of the three commercially available membranes remained intact in the further course of the study, only fragments of the Coll-HA membrane were found 30 and 60 days after implantation. Histomorphometrically, it can be described that although initially (at 10 days post-implantation) similar results were found in all study groups, after 30 days post-implantation the cellular penetration depth of the hyaluronic acid-collagen membrane was significantly increased with time (**** p < 0.0001). Similarly, the percentage of cellular invasion per membrane thickness was also significantly higher in the Coll-HA group at all timepoints, compared to the other membranes (**** p < 0.0001). Altogether, these results show that the histomorphometrical analysis of the cellular migration can act as an indicator of integration and duration of barrier functionality. Via this approach, it was possible to semi-quantify the different levels of cellular penetration of GBR membranes that were only qualitatively analyzed through histopathological approaches before. Additionally, the results of the histopathological and histomorphometrical analyses revealed that hyaluronic acid addition to collagen does not lead to a prolonged standing time, but an increased integration of a collagen-based biomaterial. Therefore, it can only partially be used in the dental field for indications that require fast resorbed membranes and a fast cell or tissue influx such as periodontal regeneration processes.
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Affiliation(s)
- Nicola Ottenbacher
- Clinical Division of Oral Surgery, Dental University Clinic, Medical University of Vienna, 1090 Vienna, Austria; (N.O.); (C.U.); (W.Z.)
| | - Said Alkildani
- BerlinAnalytix GmbH, 12109 Berlin, Germany; (S.A.); (T.K.)
| | | | | | - Christian Ulm
- Clinical Division of Oral Surgery, Dental University Clinic, Medical University of Vienna, 1090 Vienna, Austria; (N.O.); (C.U.); (W.Z.)
| | - Ole Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (O.J.); (B.S.)
| | - Bernd Sundag
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (O.J.); (B.S.)
| | - Olaf Bellmann
- Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany;
| | - Sanja Stojanovic
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of of Niš, 18000 Niš, Serbia; (S.S.); (S.N.)
- Department of Biology and Human Genetics, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Stevo Najman
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of of Niš, 18000 Niš, Serbia; (S.S.); (S.N.)
- Department of Biology and Human Genetics, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Werner Zechner
- Clinical Division of Oral Surgery, Dental University Clinic, Medical University of Vienna, 1090 Vienna, Austria; (N.O.); (C.U.); (W.Z.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Mike Barbeck
- Department of Ceramic Materials, Chair of Advanced Ceramic Materials, Institute for Materials Science and Technologies, Technical University Berlin, 10623 Berlin, Germany
- Correspondence: ; Tel.: +49-(0)-176-8102-2467
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Guarnieri R, Savio L, Bermonds A, Testarelli L. Implants with a Laser-microgrooved Collar Placed in Grafted Posterior Maxillary Extraction Sockets and in Crestally Grafted Sinuses: a 5-Year Multicentre Retrospective Study. J Oral Maxillofac Res 2020; 11:e2. [PMID: 33598110 PMCID: PMC7875103 DOI: 10.5037/jomr.2020.11402] [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: 10/28/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
Objectives The aim of this retrospective multicentre cohort study was to compare clinical outcomes, soft tissues conditions and differences in marginal bone loss between implants with a laser-microgrooved collar placed in posterior maxillary extraction sockets grafted by 4 to 5 months, and in posterior maxillary pristine bone (spontaneously healed posterior maxillary extraction sockets) by means of osteotome-mediated sinus floor elevation, over a period of 5 years after functional loading. Material and Methods Patients of Group 1 underwent extractions with sockets preservation using porcine-derived bone, covered with collagen membrane. Group 2 underwent extractions without socket preservation. Patients of Group 1 received implants in grafted sites, and Group 2 received implants in spontaneously healed bone using a maxillary sinus lift with crestal approach. Results Over the observation period, the overall clinical success rate in Group 1 and Group 2 was 98% and 100%, respectively, with no differences between the procedures and implants used. Cumulative radiographic marginal bone loss ranged from 0.03 to 0.39 mm after 60 months of functional loading. There were no statistically significant differences in marginal bone loss between short and standard-length implants placed in grafted extraction sockets and in pristine bone. Conclusions Short and standard implants with a laser-microgrooved collar, placed in posterior maxillary extraction sockets grafted by 4 to 5 months, and in posterior maxillary pristine bone (spontaneously healed posterior maxillary extraction sockets) by means of osteotome-mediated sinus floor elevation, exhibited no statistical difference in success rate, clinical parameters and marginal bone loss.
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Affiliation(s)
- Renzo Guarnieri
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University "La Sapienza", RomeItaly.,Private practice, TorinoItaly
| | | | | | - Luca Testarelli
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University "La Sapienza", RomeItaly.,Department of Dental and Maxillofacial Sciences, School of Dentistry, University "La Sapienza", RomeItaly
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Majzoub J, Ravida A, Starch-Jensen T, Tattan M, Suárez-López Del Amo F. The Influence of Different Grafting Materials on Alveolar Ridge Preservation: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e6. [PMID: 31620268 PMCID: PMC6788425 DOI: 10.5037/jomr.2019.10306] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/05/2019] [Indexed: 11/22/2022]
Abstract
Objectives The purpose of the present review was to evaluate the effect of different bone substitutes used for alveolar ridge preservation on the post extraction dimensional changes. Material and Methods An electronic literature search in MEDLINE (PubMed), EMBASE (OVID) and Cochrane (CENTRAL) were performed, in addition to a manual search through all periodontics and implantology-related journals, up to December 2018. Inverse variance weighted means were calculated for all the treatment arms of the included trials for the quantitative analysis. Results Forty randomized controlled trials were included in the quantitative analysis. Dimensional changes were obtained from clinical measurements and three-dimensional imaging. The average amount of horizontal ridge resorption was 1.52 (SD 1.29) mm (allograft), 1.47 (SD 0.92) mm (xenograft), 2.31 (SD 1.19) mm (alloplast) and 3.1 (SD 1.07) mm for unassisted healing. Similarly, for all the evaluated parameters, the spontaneous healing of the socket led to higher bone loss rate than the use of a bone grafting material. Conclusions The utilization of a bone grafting material for alveolar ridge preservation reduces the resorption process occurring after tooth extraction. However, minimal differences in resorption rate were observed between allogeneic, xenogeneic and alloplastic grafting materials.
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Affiliation(s)
- Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MichiganUSA
| | - Andrea Ravida
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MichiganUSA
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IowaUSA
| | - Fernando Suárez-López Del Amo
- Department of Periodontics, University of Oklahoma Health Sciences Center - College of Dentistry, Oklahoma City, OklahomaUSA
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Lai VJ, Michalek JE, Liu Q, Mealey BL. Ridge preservation following tooth extraction using bovine xenograft compared with porcine xenograft: A randomized controlled clinical trial. J Periodontol 2019; 91:361-368. [PMID: 31380563 DOI: 10.1002/jper.19-0211] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The primary purpose of this study was to histologically determine if there is a significant difference in new bone formation, residual graft material, and connective tissue/other when ridge preservation is accomplished using a bovine versus a porcine xenograft. METHODS Forty-four patients needing a single rooted tooth extraction and ridge preservation in preparation for dental implant placement were recruited in the study. After minimally traumatic tooth extraction, alveolar ridge dimensions were measured using a custom-fabricated acrylic stent. Patients were then randomized 1:1 to receive ridge preservation using either bovine or porcine xenograft material. A trimmed dense polytetrafluoroethylene (d-PTFE) membrane was overlaid on the graft material, the mucoperiosteal flaps were replaced, and the surgical site was sutured. After 18 to 20 weeks of wound healing, sites were surgically re-entered, ridge dimensions were again measured using the previously fabricated acrylic stents and a bone core sample of the grafted site was harvested for histomorphometric analysis. RESULTS Thirty eight of the 44 enrolled patients completed the study, 17 from the bovine group and 21 from the porcine group. Histologically, there were no statistically significant differences between the groups for mean percentage of vital bone formation (bovine = 36.21%, porcine = 31.27%, P = 0.49), residual graft material (bovine = 20.47%, porcine = 19.52%, P = 0.82) and connective tissue/other (bovine = 43.32%, porcine = 49.21%, P = 0.19). For secondary outcomes, there were no significant differences between the groups for mean change in buccal ridge height, lingual ridge height, and ridge width. However, a higher number of patients in the porcine group had additional grafting at the time of implant placement, either because of thin buccal plate or failure of implant stability. CONCLUSION The findings suggest that ridge preservation with porcine xenograft results in comparable histomorphometric outcomes and dimensional stability with bovine xenograft.
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Affiliation(s)
- Veronica J Lai
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - Joel E Michalek
- Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX
| | - Qianqian Liu
- Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX
| | - Brian L Mealey
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
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Omar O, Elgali I, Dahlin C, Thomsen P. Barrier membranes: More than the barrier effect? J Clin Periodontol 2019; 46 Suppl 21:103-123. [PMID: 30667525 PMCID: PMC6704362 DOI: 10.1111/jcpe.13068] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
Abstract
AIM To review the knowledge on the mechanisms controlling membrane-host interactions in guided bone regeneration (GBR) and investigate the possible role of GBR membranes as bioactive compartments in addition to their established role as barriers. MATERIALS AND METHODS A narrative review was utilized based on in vitro, in vivo and available clinical studies on the cellular and molecular mechanisms underlying GBR and the possible bioactive role of membranes. RESULTS Emerging data demonstrate that the membrane contributes bioactively to the regeneration of underlying defects. The cellular and molecular activities in the membrane are intimately linked to the promoted bone regeneration in the underlying defect. Along with the native bioactivity of GBR membranes, incorporating growth factors and cells in membranes or with graft materials may augment the regenerative processes in underlying defects. CONCLUSION In parallel with its barrier function, the membrane plays an active role in hosting and modulating the molecular activities of the membrane-associated cells during GBR. The biological events in the membrane are linked to the bone regenerative and remodelling processes in the underlying defect. Furthermore, the bone-promoting environments in the two compartments can likely be boosted by strategies targeting both material aspects of the membrane and host tissue responses.
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Affiliation(s)
- Omar Omar
- Department of BiomaterialsInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Ibrahim Elgali
- Department of BiomaterialsInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Christer Dahlin
- Department of BiomaterialsInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Oral Maxillofacial Surgery/ENTNU‐Hospital OrganisationTrollhättanSweden
| | - Peter Thomsen
- Department of BiomaterialsInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Guarnieri R, Di Nardo D, Di Giorgio G, Miccoli G, Testarelli L. Effectiveness of Xenograft and Porcine-Derived Resorbable Membrane in Augmentation of Posterior Extraction Sockets with a Severe Wall Defect. A Radiographic/Tomographic Evaluation. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e3. [PMID: 31086644 PMCID: PMC6498814 DOI: 10.5037/jomr.2019.10103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/21/2019] [Indexed: 02/01/2023]
Abstract
Objectives The aim of the present prospective study was to evaluate, by means of intraoral periapical radiographs and cone-beam computed tomography, hard tissue changes after ridge augmentation procedures in posterior extraction sockets with severe wall defects. Material and Methods Twenty patients, with a non-restorable premolar/molar tooth and severe wall defect, were enrolled in the present study, and underwent single-tooth extraction. Extraction sites were grafted with porcine-derived bone covered by porcine-derived collagen membrane. Intraoral periapical radiographs and cone-beam computed tomography scans, obtained at enrolment, and 6 months after ridge augmentation procedures were analysed and compared. Results In the intraoral periapical radiographs, mean vertical bone gains detected at the distal, central and mesial aspects of the extraction sockets were 3.5 (SD 1.1) mm, 8.2 (SD 2.1) mm, and 3.9 (SD 1.7) mm, respectively. In the cone-beam computed tomography scans, the mean vertical bone gains detected at the more vestibular and more palatal aspects were 4.4 (SD 1.9) mm, and 3.3 (SD 2.8) mm, respectively. The mean horizontal bone gain was 3.5 (SD 1.6) mm. In all examined defects, mean vertical and horizontal bone levels showed a statistically significant increase (P < 0.05) at 6 months after extraction. Conclusions Within the limits of this study, the results suggest that porcine-derived bone graft covered by a collagen membrane can support significant vertical and horizontal bone gain at posterior post-extraction sockets with severe wall defects.
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Affiliation(s)
- Renzo Guarnieri
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University La Sapienza, RomeItaly
| | - Dario Di Nardo
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University La Sapienza, RomeItaly
| | - Gianni Di Giorgio
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University La Sapienza, RomeItaly
| | - Gabriele Miccoli
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University La Sapienza, RomeItaly
| | - Luca Testarelli
- Department of Dental and Maxillofacial Sciences, School of Dentistry, University La Sapienza, RomeItaly
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Minetti E, Berardini M, Trisi P. A New Tooth Processing Apparatus Allowing to Obtain Dentin Grafts for Bone Augmentation: The Tooth Transformer. Open Dent J 2019. [DOI: 10.2174/1874210601913010006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction:Human dentin matrix could be considered an excellent alternative to autologous or heterologous bone graft. Autologous tooth graft has been proposed since 1967 when the osteoinduction properties of autogenous demineralized dentin matrix were discovered.Methods:The preparation technique to transform autologous teeth in suitable grafting material still represents the fundamental step of the whole procedure.Aim:The aim of the present study was to test an innovative medical device that could obtain tooth graft materials starting from the whole tooth of the patient. 15 consecutive cases of tooth grafting procedures were performed with a mean follow up period of 18 months.Results:In all cases, after 6 months of healing, the defects were almost completely filled by newly formed hard tissue. The new tissue was examined after 6 months, both from a radiological point of view by CBCT scans and from a clinical observation. It showed a compactness similar to the medium-density bone. No signs of inflammations were observed. No infective complications were recorded during the post-operative healing. No graft particles or grains were visible in the regenerated bone structure that appeared homogeneous and uniform.Discussion:The results of the present study showed favorable bony healing in guided regenerative surgery procedures using autologous tooth graft. Future studies with long follow up period are needed in order to better evaluate the potential of demineralized dentin autografts.
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