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Araújo MG, Dias DR, Matarazzo F. Anatomical characteristics of the alveolar process and basal bone that have an effect on socket healing. Periodontol 2000 2023; 93:277-288. [PMID: 37533162 DOI: 10.1111/prd.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 08/04/2023]
Abstract
Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing.
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Affiliation(s)
- Maurício G Araújo
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Flavia Matarazzo
- Department of Dentistry, State University of Maringá, Maringá, Brazil
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Udeabor SE, Heselich A, Al-Maawi S, Alqahtani AF, Sader R, Ghanaati S. Current Knowledge on the Healing of the Extraction Socket: A Narrative Review. Bioengineering (Basel) 2023; 10:1145. [PMID: 37892875 PMCID: PMC10604628 DOI: 10.3390/bioengineering10101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures performed in the dental clinic. Understanding this healing process is of utmost importance because the outcome has a direct bearing on future prosthetic rehabilitation and, by extension, on patients' esthetics and masticatory function, among others. This mini review, therefore, summarized the current knowledge on the different stages of socket healing, including the biologic and clinical events that occur following tooth extraction up until the complete closure of the socket. Additionally, the modeling of the alveolar bone/process post extraction, and the resultant dimensional changes that, altogether, shape the bone, were reviewed and documented. The effects of various socket preservation interventions to mitigate these dimensional changes, and therefore preserve the alveolar process in a condition suitable for future prosthetic rehabilitation, were highlighted. Finally, a review of some of the factors that influence the entire process was also carried out.
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Affiliation(s)
- Samuel E. Udeabor
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Anja Heselich
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Sarah Al-Maawi
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Ali F. Alqahtani
- Department of Periodontics and Community Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
| | - Shahram Ghanaati
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery & Frankfurt Orofacial Regenerative Medicine (FORM) Lab, Johann Wolfgang Goethe University, 60590 Frankfurt am Main, Germany; (A.H.); (S.A.-M.); (R.S.)
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Vuylsteke F, Cosyn J, Tytgat M, Eghbali A. The Effect of Terra-Cortril as Local Pain Medication on the Healing Process of a Fresh Extraction Socket: A Retrospective Cohort Study. J Clin Med 2023; 12:4372. [PMID: 37445407 DOI: 10.3390/jcm12134372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Use of Terra-Cortril may reduce pain and discomfort after tooth extraction. It is widely used among dentists, especially for third molar extraction and for treatment of dry socket. Only few case reports described unsuccessful healing with formation of myospherulosis. (2) Aim: The primary objective of this retrospective cohort study was to compare the occurrence of unsuccessful healing between extraction sockets locally treated with Terra-Cortril (TC) (exposure cohort) and extraction sockets subjected to unassisted healing (non-exposure cohort). The assessment of the three-dimensional morphology of the bone was a secondary objective. (3) Material and methods: The records of patients who had one or more extractions between 1 January 2020 and 1 July 2021 followed by implant placement in one private practice were retrieved and data were extracted. At the time of implant placement, practitioners established, both clinically and radiographically, if the healing was successful or unsuccessful. Explanatory demographic as well as clinical variables were extracted from patient files, checked and supplemented by contacting patients in cases of missing data. (4) Results: 69 patients were included who had, in total, 99 extractions. The exposure cohort included 55 sites, while the non-exposure cohort included 44 sites. A total of 56 sites demonstrated successful healing, and 53 showed unsuccessful healing. The regression model identified TC as a significant predictor (p = 0.014) for unsuccessful healing with an odds ratio of 2.86. Sites treated with Terra-Cortril had a significantly greater bone defect at level -1 mm, level -3 mm, and level -5 mm from the bone crest, and significantly greater maximal vertical and horizontal bone defects. At sites where Terra-Cortril was used, significantly more surgical consequences were reported (70.91% vs. 18.18%, p < 0.001). (5) Conclusions: fresh extraction sockets treated with Terra-Cortril increased the likelihood of unsuccessful healing with an odds ratio of 2.86. The greater defect size leads to significantly more limitations when planning implants at sites previously treated with TC.
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Affiliation(s)
- Fauve Vuylsteke
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Oral Health Sciences, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium
| | - Jan Cosyn
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Oral Health Sciences, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium
| | - Manon Tytgat
- Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Oral Health Sciences, Ghent University, C. Heymanslaan 10, B-9000 Ghent, Belgium
| | - Aryan Eghbali
- Private Practice Orthoparocare, Mankevosstraat 5, B-1860 Meise, Belgium
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Shehabeldin M, Saleh MHA, Shih-Chang Tseng E, Sirinirund B, Zalucha J, Chan HL, Wang HL. Intrasocket reactive tissue: The state of current knowledge. Int J Oral Implantol (Berl) 2023; 16:95-103. [PMID: 37158179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This review focuses on intrasocket reactive tissue and its impact on extraction socket healing. It summarises the current knowledge about intrasocket reactive tissue from a histopathological and biological perspective and discusses the mechanisms by which residual intrasocket reactive tissue can have a positive or negative effect on healing. Additionally, it provides an overview of the various hand and rotary instruments that are currently used for intrasocket reactive tissue debridement. The review also discusses preserving intrasocket reactive tissue as a socket sealing material and the benefits this may offer. It presents clinical cases where either removal or preservation of intrasocket reactive tissue was adopted following extraction and prior to alveolar ridge preservation. Future studies are needed to investigate the suggested beneficial effects of intrasocket reactive tissue on socket healing outcomes.
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Mozzati M, Tumedei M, Gallesio G, Menicucci G, Manzella C, Testori T, Fabbro MD. Healing of Alveolar Sockets Treated with Concentrated Growth Factors: A Split-Mouth Study. Materials (Basel) 2022; 15:ma15144859. [PMID: 35888326 PMCID: PMC9318965 DOI: 10.3390/ma15144859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022]
Abstract
Background: tooth extraction is a common procedure in oral surgery. The socket healing process involves hard and soft tissues and is characterized by intense remodeling, which may determine consistent dimension changes. Several autologous platelet concentrates (APCs) proved to be effective for enhancing alveolar socket healing after tooth extraction, accelerating socket closure and countering alveolar bone resorption. Concentrated growth factors (CGFs) are one of the most recently developed APCs, and their effect on the socket healing process still needs to be confirmed. Aim: The aim of the present split-mouth study was to evaluate the effectiveness of CGFs in enhancing the healing process in the postextraction alveolar socket and reducing postoperative pain. Methods: One hundred and fifty-four extractions were performed. One of the extraction sockets of each patient was treated with CGFs (test site), and the other socket was unfilled (control site). The main outcomes were: healing index, alveolar dimensions at the crestal level, socket closure, and pain perception. Descriptive statistics of the results were analyzed. Follow-up data were compared to baseline using paired tests. Results: The healing index on day 7 was significantly better (p < 0.001) in the test group (5.01 ± 1.30) as compared to the control group (6.65 ± 1.41). The mean visual analog scale for pain (VAS) was significantly higher for the control group when compared to the CGF group in the first 5 days postextraction. There was a trend toward greater socket closure in the CGF group, indicating faster healing, as compared to the control group at 7, 14, and 21 days. Conclusions: CGFs can represent a useful adjunctive tool, considering their mechanical and biological properties, for improving alveolar socket healing and reducing postoperative patient discomfort.
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Affiliation(s)
- Marco Mozzati
- SIOM Oral Surgery and Implantology Center, 10126 Turin, Italy; (M.M.); (G.G.)
| | - Margherita Tumedei
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (M.T.); (T.T.)
| | - Giorgia Gallesio
- SIOM Oral Surgery and Implantology Center, 10126 Turin, Italy; (M.M.); (G.G.)
| | - Giulio Menicucci
- Prosthodontic Department, School of Dentistry, University of Turin, 10124 Turin, Italy; (G.M.); (C.M.)
| | - Carlo Manzella
- Prosthodontic Department, School of Dentistry, University of Turin, 10124 Turin, Italy; (G.M.); (C.M.)
| | - Tiziano Testori
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (M.T.); (T.T.)
- Dental Clinic, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, The University of Michigan, Ann Arbor, MI 48109, USA
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (M.T.); (T.T.)
- Dental Clinic, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
- Correspondence: ; Tel.: +39-02-50319950
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Menchini-Fabris GB, Toti P, Crespi R, Crespi G, Cosola S, Covani U. A Retrospective Digital Analysis of Contour Changing after Tooth Extraction with or without Using Less Traumatic Surgical Procedures. J Clin Med 2022; 11:922. [PMID: 35207192 DOI: 10.3390/jcm11040922] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The present retrospective analysis aimed to compare two different single tooth extraction surgical approaches in both premolar and molar areas: less traumatic magneto-electrical versus conventional tooth extraction in minimizing the edentulous ridge volume loss. METHODS In the present retrospective control trial, 48 patients who underwent one-tooth extraction, were allocated either to control (28 sites treated with conventional tooth extraction procedures) or test group (20 subjects treated with less traumatic tooth extraction procedures by tooth sectioning and magnetoelectric roots subluxation). Intraoperatively (during tooth extraction surgery just after the subsequent filling of the alveolar socket with the sterile fast re-absorbable gelatin sponge), and then four months later, contours of the sockets were acquired through a laser intra-oral scanner. The digitally superimposed models were converted to dicom (Digital Imaging and Communications in Medicine) format first, then volumetric and area evaluations were performed with a DentaScan tool package. Non-parametric tests were applied with a level of significance set at p < 0.01. RESULTS significant reductions of anatomical features were observed four months later in all the groups (p-values < 0.001) with volume losses leading to a final alveolar ridge volume of 0.87 ± 0.34 cm3 for atraumatic extractions and 0.66 ± 0.19 cm3 for conventional extractions. No significant differences were registered for outcomes related to the basal surface variables. When just molar tooth were considered, the outcomes relating to volume loss between baseline and four months (ΔV) and its percentage (ΔV%) showed a better behavior in the less traumatic procedure (ΔV = -0.30 ± 0.10 cm3 and ΔV% = -22.3 ± 8.4%) compared to the conventional extractions (ΔV = -0.59 ± 0.10 cm3 and ΔV% = -44.3 ± 5.8%) with p-values < 0.0001. CONCLUSIONS at four months, the less traumatic tooth extraction procedures by tooth sectioning and magnetoelectric root subluxation seemed to be able to better preserve the volume of the alveolar crest (reduction close to 22% with less traumatic extraction in molar sites) when compared to subjects treated with the conventional tooth extraction techniques.
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Bertoldi C, Generali L, Forabosco A, Zaffe D, Ferrari M, Narni F. Extraction socket healing in leukemic patients: a preliminary radiographic evaluation. J BIOL REG HOMEOS AG 2021; 34:2379-2385. [PMID: 33307667 DOI: 10.23812/20-514-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - L Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - A Forabosco
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - D Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - F Narni
- Department of Medical and Surgical Sciences for Children and Adults, Division of Haematology and Hemopoietic Stem Cell Transplant Program, University Hospital of Modena, Italy
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Tambella AM, Bartocetti F, Rossi G, Galosi L, Catone G, Falcone A, Vullo C. Effects of Autologous Platelet-Rich Fibrin in Post-Extraction Alveolar Sockets: A Randomized, Controlled Split-Mouth Trial in Dogs with Spontaneous Periodontal Disease. Animals (Basel) 2020; 10:E1343. [PMID: 32759693 DOI: 10.3390/ani10081343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The effects of autologous platelet-rich fibrin were evaluated in dogs with spontaneous periodontal disease after tooth extraction. Both radiographic and histological findings attributed to the platelet-rich fibrin a potential ability to stimulate the natural process of tissue healing and regeneration of bone and soft tissues. Platelet-rich fibrin could, therefore, be considered as a simple and effective therapeutic aid in the management of post-extraction socket healing in dogs. Abstract Periodontal disease (PD) is a common inflammatory condition in dogs; in severe stages, dental extraction is frequently required. Platelet-rich fibrin (PRF) has been used in human oral surgical procedures and has been experimentally tested on post-extraction sockets in healthy dogs. This is the first split-mouth, randomized, controlled trial designed to compare post-extractive alveolar socket healing with and without topical application of PRF in canine spontaneous PD. Clinical evaluation, radiographic density, and histological scores for inflammation and regeneration were assessed at recruitment (T0) and after a three-week follow up (T1) on 12 dogs, for a total of 31 pairs of sockets. No complications or clinically evident differences between the treated sites and the control sites were observed. Comparing the radiographic densities of the extraction sites measured at T0 and T1, a significant enhancement was observed within the PRF group, but not within control group. The histological score decreased significantly from T0 to T1 within group PRF, but not within the control group; at T1, the PRF group showed a significantly lower histological score than the control group. These findings suggest that PRF could be able to stimulate the natural process of tissue healing and regeneration of post-extraction sites in dogs with spontaneous periodontal disease (PD).
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Sybil D, Sawai M, Faisal M, Singh S, Jain V. Platelet-Rich Fibrin for Hard- and Soft-Tissue Healing in Mandibular Third Molar Extraction Socket. Ann Maxillofac Surg 2020; 10:102-107. [PMID: 32855924 PMCID: PMC7433944 DOI: 10.4103/ams.ams_228_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/18/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Successful management of patients reporting with extreme sensitivity in second molar after surgical extraction of deeply impacted mandibular third molar poses a big challenge to oral surgeons and periodontists worldwide. A variety of grafts, barrier membranes, and guided tissue regeneration techniques have been used postsurgically for soft- and hard-tissue formation. In the current study, platelet-rich fibrin (PRF), a second-generation platelet aggregate, was assessed for its effectiveness in promoting hard- and soft-tissue healing. Objective: The aim of the study was to evaluate the efficacy of PRF in hard- and soft-tissue healing after extraction of mandibular third molar. Materials and Methods: Bilateral surgical disimpaction of mandibular third molar was done on 25 patients. In every patient, randomly allocated test side received PRF and the other side acted as control. Pain, edema, tenderness, sensitivity, Sulcus Bleeding Index (SBI), Plaque Index, clinical attachment level (CAL), probing depth, and bone height were measured at different intervals for a maximum period of 6 months. Results: There was a statistically significant improvement in patients' signs and symptoms of pain, tenderness, edema, and sensitivity with the use of PRF. A statistically significant improvement was seen in SBI, Plaque Index, and probing depths, while CALs and bone height were not influenced by PRF use. Conclusion: PRF is a very viable and useful biomaterial for soft-tissue healing and relieving patient symptoms, however, it does not help in hard-tissue healing with respect to cortical bone.
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Affiliation(s)
- Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Jamia Millia Islamia, New Delhi, India
| | - Madhuri Sawai
- Department of Periodontics, Jamia Millia Islamia, New Delhi, India
| | - Mohammad Faisal
- Department of Oral and Maxillofacial Surgery, Jamia Millia Islamia, New Delhi, India
| | - Sanjay Singh
- Department of Oral and Maxillofacial Surgery, Jamia Millia Islamia, New Delhi, India
| | - Vanshika Jain
- Department of Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Cocero N, Ruggiero T, Pezzana A, Bezzi M, Carossa S. Efficacy of sodium hyaluronate and synthetic aminoacids in postextractive socket in patients with liver failure: split mouth study. J BIOL REG HOMEOS AG 2019; 33:1913-1919. [PMID: 31854180 DOI: 10.23812/19-246-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N Cocero
- Oral Surgery Department, Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - T Ruggiero
- Oral Surgery Department, Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - A Pezzana
- Oral Surgery Department, Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - M Bezzi
- Oral Surgery Department, Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - S Carossa
- Oral Surgery Department, Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
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Guo X, Hu H, Liu Y, Bao C, Wang L. The effect of haemostatic agents on early healing of the extraction socket. J Clin Periodontol 2019; 46:766-775. [PMID: 31038760 DOI: 10.1111/jcpe.13122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/06/2019] [Accepted: 04/23/2019] [Indexed: 02/05/2023]
Abstract
AIM This study aims to explore the effect of two commercially available haemostatic agents (i.e., collagen sponge and oxide cellulose) on early healing of the extraction socket. MATERIAL AND METHODS In a murine model, bilateral maxillary first molars were extracted and the sockets were filled with or without haemostatic agents. Histology, histomorphometry and immunostaining assays were performed on samples harvested on postextraction day 1, 3, 7 and 14. In vitro studies were also designed to investigate the effect of agents on the dynamics of pH and viability of cells. RESULTS Early socket healing was delayed by both agents but with different patterns. The migration of cells was impeded by oxide cellulose on postextraction day 1 compared with the collagen and the control group. The proliferation and osteogenic differentiation of cells were delayed by both materials. Moreover, apoptosis of periodontal ligament cells was present in the haemostatic agent groups. These effects are attributed to the compression to periodontal ligament by both agents, the acidic niche caused by oxide cellulose, and the intense foreign body reaction and inflammatory response caused by the agents. CONCLUSIONS The placement of haemostatic agents delay the early extraction socket healing via different biological mechanism.
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Affiliation(s)
- Xiaodong Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Haikun Hu
- West China Dental Implantology Hospital of Chengdu, Chengdu, China
| | - Yindong Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chongyun Bao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liao Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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12
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Zhao L, Wei Y, Xu T, Zhang B, Hu W, Chung KH. Changes in alveolar process dimensions following extraction of molars with advanced periodontal disease: A clinical pilot study. Clin Oral Implants Res 2019; 30:324-335. [PMID: 30803050 DOI: 10.1111/clr.13418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To use cone beam computed tomography (CBCT) to assess the alterations of socket dimensions after a 6-month healing period following molar extraction. MATERIALS AND METHODS Seventeen molars were extracted due to advanced periodontitis. CBCT scans were taken immediately after extraction and once more 6 months later. Superimposition of CBCT images was used to measure the following: horizontal changes at extraction sites at three corono-apical levels (-1, -3, and -5 mm) below the bone crest, three mesio-distal levels (mesial, central, and distal), vertical changes at nine regions of the alveolar crest, and alveolar bone volume. RESULTS The width of the central crests at -1 mm decreased by 0.59 and 0.72 mm in the buccal and 0.27 and 0.02 mm in the lingual, in the maxilla and mandible, respectively. No statistically significant decreases in the ridge height were observed except in the disto-palatal region with a 1.11 mm decrease in the maxilla (p < 0.05). Heights of the buccal and lingual bone plates decreased significantly and ranged from 0.56 to 1.38 mm in the mandible after 6 months of healing (p < 0.05). Overall, ridge height changes were not significantly different between the maxilla and mandible (p > 0.05) and no significant volumetric bone loss occurred in either maxillary or mandibular sockets after 6 months of healing. CONCLUSIONS Socket dimensions of molars with advanced periodontal disease showed a significant increase at the middle-central portion, although there were no significant changes of horizontal width 6 months following the procedures.
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Affiliation(s)
- Liping Zhao
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiping Wei
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tao Xu
- Department of Emergency, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bo Zhang
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Kwok-Hung Chung
- Department of Restorative Dentistry, University of Washington, Seattle, Washington
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Iocca O, Farcomeni A, Pardiñas Lopez S, Talib HS. Alveolar ridge preservation after tooth extraction: a Bayesian Network meta-analysis of grafting materials efficacy on prevention of bone height and width reduction. J Clin Periodontol 2016; 44:104-114. [PMID: 27712001 DOI: 10.1111/jcpe.12633] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Abstract
AIMS To conduct a traditional meta-analysis and a Bayesian Network meta-analysis to synthesize the information coming from randomized controlled trials on different socket grafting materials and combine the resulting indirect evidence in order to make inferences on treatments that have not been compared directly. MATERIALS AND METHODS RCTs were identified for inclusion in the systematic review and subsequent statistical analysis. Bone height and width remodelling were selected as the chosen summary measures for comparison. First, a series of pairwise meta-analyses were performed and overall mean difference (MD) in mm with 95% CI was calculated between grafted versus non-grafted sockets. Then, a Bayesian Network meta-analysis was performed to draw indirect conclusions on which grafting materials can be considered most likely the best compared to the others. RESULTS From the six included studies, seven comparisons were obtained. Traditional meta-analysis showed statistically significant results in favour of grafting the socket compared to no-graft both for height (MD 1.02, 95% CI 0.44-1.59, p value < 0.001) than for width (MD 1.52 95% CI 1.18-1.86, p value <0.000001) remodelling. Bayesian Network meta-analysis allowed to obtain a rank of intervention efficacy. CONCLUSIONS On the basis of the results of the present analysis, socket grafting seems to be more favourable than unassisted socket healing. Moreover, Bayesian Network meta-analysis indicates that freeze-dried bone graft plus membrane is the most likely effective in the reduction of bone height remodelling. Autologous bone marrow resulted the most likely effective when width remodelling was considered. Studies with larger samples and less risk of bias should be conducted in the future in order to further strengthen the results of this analysis.
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Affiliation(s)
- Oreste Iocca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,International Postgraduate Program in Oral Surgery, New York University College of Dentistry, New York, NY, USA
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Simon Pardiñas Lopez
- International Postgraduate Program in Oral Surgery, New York University College of Dentistry, New York, NY, USA.,Clínica Pardiñas, Private Practice, A Coruña, Spain
| | - Huzefa S Talib
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
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Alikhani M, Lopez JA, Alabdullah H, Vongthongleur T, Sangsuwon C, Alikhani M, Alansari S, Oliveira SM, Nervina JM, Teixeira CC. High-Frequency Acceleration: Therapeutic Tool to Preserve Bone following Tooth Extractions. J Dent Res 2015; 95:311-8. [PMID: 26672126 DOI: 10.1177/0022034515621495] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A common problem in clinical dentistry is the significant and rapid bone loss that occurs after tooth extraction. Currently there is no solution for the long-term preservation of alveolar bone. Previously, we showed that high-frequency acceleration (HFA) has an osteogenic effect on healthy alveolar bone. However, it is not known if HFA can preserve alveolar bone after extraction without negatively affecting wound healing. The purpose of this study was to evaluate the effect of HFA on alveolar bone loss and the rate of bone formation after tooth extraction. Eighty-five adult Sprague-Dawley rats were divided into 3 groups: control, static (static load), and HFA. In all groups, the maxillary right third molar was extracted. The HFA group received HFA for 5 min/d, applied through the second molar. The static group received the same magnitude of static load. The control group did not receive any stimulation. Some animals received fluorescent dyes at 26 and 54 d. Samples were collected on days 0, 7, 14, 28, and 56 for fluorescence microscopy, micro-computed tomography, histology, RNA, and protein analyses. We found that HFA increased bone volume in the extraction site and surrounding alveolar bone by 44% when compared with static, while fully preserving alveolar bone height and width long-term. These effects were accompanied by increased expression of osteogenic markers and intramembranous bone formation and by decreased expression of osteoclastic markers and bone resorption activity, as well as decreased expression of many inflammatory markers. HFA is a noninvasive safe treatment that can be used to prevent alveolar bone loss and/or accelerate bone healing after tooth extraction.
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Affiliation(s)
- M Alikhani
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA Department of Orthodontics, New York University College of Dentistry, New York, NY, USA Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - J A Lopez
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA Department of Orthodontics, New York University College of Dentistry, New York, NY, USA
| | - H Alabdullah
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA
| | - T Vongthongleur
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA
| | - C Sangsuwon
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA
| | - M Alikhani
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA
| | - S Alansari
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA Department of Orthodontics, New York University College of Dentistry, New York, NY, USA
| | - S M Oliveira
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA Department of Mechanical Engineering, Institute Polytechnic of Viseu, Viseu, Portugal
| | - J M Nervina
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA Department of Orthodontics, New York University College of Dentistry, New York, NY, USA
| | - C C Teixeira
- Consortium for Translational Orthodontic Research, New York University College of Dentistry, New York, NY, USA Department of Orthodontics, New York University College of Dentistry, New York, NY, USA Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY, USA
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15
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Spinato S, Rebaudi A, Bernardello F, Bertoldi C, Zaffe D. Piezosurgical treatment of crestal bone: quantitative comparison of post-extractive socket outcomes with those of traditional treatment. Clin Oral Implants Res 2015; 27:361-6. [PMID: 25639687 DOI: 10.1111/clr.12555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aimed to quantitatively compare, for the first time, the clinical outcomes of crestal bone volume resorption in sockets undergoing traditional extraction technique (TET) or piezosurgical extraction technique (PET), also considering the influence of buccal plate thickness. MATERIAL AND METHODS In this prospective study, 19 sockets were randomly treated with TET, and 18 sockets were randomly treated with PET. Furthermore, patients were split into subgroup A, with buccal bone plate thickness (BPT) ≤1 mm, and subgroup B, with BPT>1 mm. Buccal (BCH) and palatal (PCH) cortex height, bucco-palatal ridge (BPR) width were monitored at tooth extraction and after the 4-month post-extractive period of natural healing. RESULTS After 4 months, BCH, PCH and BPR width decreased more in the TET than in the PET group, but only the BPR decrease was statistically significant (P = 0.034) after ANOVA test. In both TET and PET groups, all B subgroup patients showed a lower decrease than A subgroup patients for both BCH, PCH and BPR, statistically significant for PCH (P = 0.019) and BPR (P < 0.001) of TET group, and BPR (P = 0.002) of PET group, after ANOVA. Both A and B subgroups of PET showed a statistically significant lower decrease than the corresponding subgroups of TET, comparing A (P = 0.005) and B (P = 0.037) subgroups for BPR, after ANOVA. CONCLUSIONS With both thin and thick buccal plates, the piezosurgical extraction technique of teeth significantly decreases the horizontal resorption of the hard tissue ridge, but not the vertical resorption. Moreover, buccal plate thickness seems to be a key factor in post-extractive bone resorption: the thinner the buccal plate the greater the horizontal crestal bone loss.
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Affiliation(s)
- Sergio Spinato
- Unit of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, Italy
| | - Alberto Rebaudi
- Department of Integrated Diagnostic and Surgical Sciences, School of Dentistry, University of Genova, Genova, Italy
| | | | - Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Kim JH, Susin C, Min JH, Suh HY, Sang EJ, Ku Y, Wikesjö UME, Koo KT. Extraction sockets: erratic healing impeding factors. J Clin Periodontol 2014; 41:80-5. [PMID: 24117498 DOI: 10.1111/jcpe.12173] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of this exploratory study was to analyse prevalence of extraction sockets showing erratic healing and evaluate factors potentially impeding healing. METHODS Erratic healing was defined as extraction sites showing clinical observations of fibrous scar tissue occupying the extraction site rather than bone following 12 or more weeks of healing. Computerized tomography was used to evaluate characteristics and calculate Hounsfield unit scores for sites showing erratic healing. RESULTS A total of 1226 dental records from Seoul National University Dental Hospital archives including patients subject to extractions prior to implant placement were evaluated. Seventy subjects (5.71%) and 97 sites (4.24%) exhibited erratic extraction socket healing. Maxillary incisor/canine sites showed the lowest (0.47%), whereas mandibular molar sites the highest (5.41%) occurrence. In the multivariable analysis, erratic healing was more likely to occur in subjects <60 years old (OR = 2.23, 95%CI = 1.26-3.94), subjects with hypertension (OR = 2.37, 95%CI = 1.24-4.55), in molar sites (OR = 4.91, 95%CI = 1.41-17.07), and following single tooth extractions (OR = 2.98, 95%CI = 1.36-6.53). Computerized tomography showed the highest incidence of bone loss for the buccal wall (49.3%). CONCLUSION Erratic extraction socket healing appears a not uncommon sequel and local factors seem to be major contributors to its occurrence.
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Affiliation(s)
- Jung-Hoon Kim
- School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
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