Surgical protocols for ridge preservation after tooth extraction. A systematic review. Preservation of ridge dimensions following grafting with coral granules of 48 post-traumatic and post-extraction dento-alveolar defects. Surgical protocols for early implant placement in post-extraction sockets: a systematic review. Ridge Preservation for Implant Therapy: a Review of the Literature Ridge preservation following tooth extraction using a polylactide and polyglycolide sponge as space filler: a clinical and histological study in humans. Effects of a putty-form hydroxyapatite matrix combined with the synthetic cell-binding peptide P-15 on alveolar ridge preservation. Dental implants placed in expanded narrow edentulous ridges with the Extension Crest device. A 1-3-year multicenter follow-up study. Comparison of the effectiveness of two different bone substitute materials for socket preservation after tooth extraction: a controlled clinical study. Ridge Preservation of the Molar Extraction Socket Using Collagen Sponge and Xenogeneic Bone Grafts Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. ridge preservation with secondary soft tissue healing. Porcine-derived xenograft combined with a soft cortical membrane versus extraction alone for implant site development: a clinical study in humans. A bone regenerative approach to alveolar ridge maintenance following tooth extraction. Report of 10 cases. Radiographic and clinical outcomes of implants placed in ridge preserved sites: a 12-month post-loading follow-up. A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results. Histologic healing following tooth extraction with ridge preservation using mineralized versus combined mineralized-demineralized freeze-dried bone allograft: a randomized controlled clinical trial. Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation. Alveolar ridge reconstruction and/or preservation using root form bioglass cones. Novel 3D polycaprolactone scaffold for ridge preservation--a pilot randomised controlled clinical trial. Immediate provisionalization of dental implants placed in healed alveolar ridges and extraction sockets: a 5-year prospective evaluation. Osteotome sinus floor elevation and simultaneous implant placement in grafted biomaterial sockets: 3 years of follow-up. A case-control study assessing oral-health-related quality of life after immediately loaded single implants in healed alveolar ridges or extraction sockets. Evaluation of recombinant human bone morphogenetic protein-2 in oral applications including the use of endosseous implants: 3-year results of a pilot study in humans. Clinical and Histological Evaluation of Postextraction Platelet-rich Fibrin Socket Filling: A Prospective Randomized Controlled Study
OBJECTIVE This systematic review aims to evaluate the scientific evidence on the efficacy in the surgical protocol s design ed for preserving the alveolar ridge after tooth extraction and to evaluate how these techniques affect the placement of dental implants and the final implant supported restoration . MATERIAL AND METHODS A thorough search in MEDLINE - PubMed , Embase and the Cochrane Central Register of controlled trials ( CENTRAL ) was conducted up to February 2011 . R and omized clinical trials and prospect i ve cohort studies with a follow-up of at least 3 months reporting changes on both the hard and soft tissues ( height and /or width ) of the alveolar process ( mm or % ) after tooth extraction were considered for inclusion . RESULTS The screening of titles and abstract s result ed in 14 publications meeting the eligibility criteria . Data from nine of these 14 studies could be grouped in the meta-analyses . Results from the meta-analyses showed a statistically significant greater ridge reduction in bone height for control groups as compared to test groups ( weighted mean differences , WMD = -1.47 mm ; 95 % CI [ -1.982 , -0.953 ] ; P < 0.001 ; heterogeneity : I(2 ) = 13.1 % ; χ(2 ) P-value = 0.314 ) and a significant greater reduction in bone width for control groups compared to the test groups ( WMD = -1.830 mm ; 95 % CI [ -2.947 , -0.732 ] ; P = 0.001 ; heterogeneity : I(2 ) = 0 % ; χ(2 ) P-value = 0.837 ) . Subgroup analysis was based on the surgical protocol used for the socket preservation ( flapless/flapped , barrier membrane/no membrane , primary intention healing/no primary healing ) and on the measurement method utilized to evaluate morphological changes . Meta-regression analyses demonstrated a statistically significant difference favoring the flapped subgroup in terms of bone width ( meta-regression ; slope = 2.26 ; 95 % IC [ 1.01 ; 3.51 ] ; P = 0.003 ) . CONCLUSIONS The potential benefit of socket preservation therapies was demonstrated result ing in significantly less vertical and horizontal contraction of the alveolar bone crest . The scientific evidence does not provide clear guidelines in regards to the type of bio material , or surgical procedure , although a significant positive effect of the flapped surgery was observed . There are no data available to draw conclusions on the consequences of such benefits on the long-term outcomes of implant therapy This prospect i ve clinical analysis reports on the use of coral granules in alveolar ridge preservation procedures in a population of young , growing patients . The sample consisted of 21 patients , 12 females and 9 males , with a mean age of 13.6 years . These 21 patients had 48 dento-alveolar defects suitable for augmentation with coral granules  , and were followed clinical ly and radiographically for 3 - 7 years after augmentation . There were two areas of augmentation : 17 defects in the anterior maxilla result ed from traumatic tooth loss , and 31 defects in the posterior maxilla and m and ible result ed from the extraction of ankylosed retained primary molars with no permanent succedaneous teeth . Between 1 - 2 ml of coral granules were implanted into the alveolar bone defects left by the extraction of teeth in both the areas . This was in order to preserve the remaining edentulous ridge from further alveolar ridge resorption . The goal of the procedure was to preserve the alveolus so that in the future , a dental implant could be placed to replace the missing tooth , after jaw growth had stopped , without the need for a bone graft . The coral granules appeared to be totally replaced by the host bone on follow-up clinical and radiographic examinations . The two areas of the jaws behaved quite differently . In the anterior maxilla , where tooth loss was secondary to trauma , the coral granules  restored the alveolar ridges temporarily . However , over the years of follow-up in this study , the coral granules failed to provide sufficient bone to support the placement of a dental implant without using a bone graft in 14 of the 17 defects or 82.4 % of sites . In the posterior maxilla and m and ible , where tooth loss was due to the elective removal of ankylosed primary molars , 29 of the 31 defects or 93.5 % of sites were successful as they were able to support the placement of an osseo-integrated dental implant without the use of a bone graft . The alveolar sparing technique was more successful in maintaining an alveolar ridge sufficient for the placement of a dental implant without bone grafting in the posterior maxilla and m and ible , where tooth loss was secondary to the elective removal of ankylosed deciduous molars than in the anterior maxilla , where tooth loss was secondary to trauma . Coral granules seem to be more suitable in the posterior maxilla and m and ible where there were ankylosed deciduous teeth and congenitally absent permanent teeth than in the traumatized anterior maxilla . In successful sites , coral granules can spare the alveolus from residual ridge atrophy or resorption , obviating the need for a bone graft . This reduces patient morbidity , as a second surgical donor site is avoided because bone graft harvesting is made unnecessary OBJECTIVES The aim of this systematic review was to evaluate the best timing for placing implants  after tooth extraction , by comparing early vs. delayed implant placement and evaluating the hard and /or soft tissue ridge dimensional changes and the outcomes related with implant survival and prosthesis success . MATERIAL AND METHODS An online search of the main data bases including The National Library of Medicine ( MEDLINE via Pubmed ) , Embase and The Cochrane Central Register of Controlled Trials was conducted up to February 2011 . R and omized controlled clinical trials ( RCTs ) , prospect i ve cohort studies and case-control retrospective studies , with a follow-up of at least 1 month after loading of dental implants  , comparing : ( i ) early vs. delayed implant placement , ( ii ) augmentation vs. no augmentation at implant placement in early placed implants and /or ( iii ) the comparison of various augmentation procedures at early implant placement , were conducted . A h and search of relevant journals was also performed . Screening of eligible studies , assessment of their method ological quality and data extraction were conducted in duplicate by two independent review ers . Authors of studies were contacted for clarification or missing information . RESULTS Eight studies were included , although meta- analysis could only be performed with the data from two studies comparing early vs. delayed implant . The percentage of bone height and bone width reduction favoured the early placement , with pooled mean difference between groups of 13.11 % ( 95 % CI : from 3.83 to 22.4 ; P = 0.057 ) and 19.85 % ( 95 % CI : from 13.85 to 25.81 ) respectively . Implant survival demonstrated a non-significant higher implant survival rate for the early group ( RR = 1.02 , 95 % CI : 0.96 - 1.1).With regard to patient satisfaction , statistically significant differences between the groups in favour of the early group for overall satisfaction and appearance with the restoration were demonstrated at 2 years , although these differences were lost at 5 years . CONCLUSIONS Placement of dental implants at an early timing after tooth extraction may offer advantages in terms of soft and hard tissue preservation , when compared with a delayed protocol . Nevertheless , well- design ed , high quality , r and omized clinical trials , are needed , because the available evidence is today limited in terms of available studies and quality Healing of the extraction socket after tooth removal involves retention of the blood clot followed by a sequence of events that lead to changes in the alveolar process in a three dimensional fashion . This normal healing event results in a minimal loss of vertical height ( around 1 mm ) , but a substantial loss of width in the buccal-lingual plane ( 4 - 6 mm ) . During the first three months following extraction that loss has been shown to be significant and may result in both a hard tissue and soft tissue deformity affecting the ability to restore the site with acceptable esthetics . Procedures that reduce the resorptive process have been shown to be predictable and potentially capable of eliminating secondary surgery for site preparation when implant therapy is planned . The key element is prior planning by the dental therapist to act at the time of extraction to prevent the collapse of the ridge due to the loss of the alveolus . Several techniques have been employed as ridge preservation procedures involving the use of bone grafts , barrier membranes and biologics to provide a better restorative outcome . This review will explore the evidence behind each technique and their efficacy in accomplishing site preparation . The literature does not identify a single technique as superior to others ; however , all accepted therapeutic procedures for ridge preservation have been shown to be more effective than blood clot alone in r and omized controlled studies BACKGROUND The placement of different graft material s and /or the use of occlusive membranes to cover the extraction socket entrance are techniques aim ed at preserving/reducing alveolar ridge resorption . The use of grafting material s in fresh extraction sockets has , however , been question ed because particles of the grafted material have been found in alveolar sockets 6 - 9 months following their insertion . AIM The aims of the study were to ( i ) . evaluate whether alveolar ridge resorption following tooth extraction could be prevented or reduced by the application of a bioabsorbable polylactide-polyglycolide sponge used as a space filler , compared to natural healing by clot formation , and ( ii ) . evaluate histologically the amount and quality of bone tissue formed in the sockets , 6 months after the use of the bioabsorbable material . MATERIAL AND METHODS Thirty-six patients , undergoing periodontal therapy , participated in this study . All patients were scheduled for extraction of one or more compromised teeth . Following elevation of full-thickness flaps and extraction of teeth , measurements were taken to evaluate the distance between three l and marks ( mesio-buccal , mid-buccal , disto-buccal ) on individually prefabricated stents , and the alveolar crest . Twenty-six alveolar sockets ( test ) were filled with a bioabsorbable polylactide-polyglycolide acid sponge ( Fisiograft ) , while 13 sockets ( controls ) were allowed to heal without any filling material . The flaps were sutured with no attempt to achieve primary closure of the surgical wound . Re-entry for implant surgery was performed 6 months following the extraction s. Thirteen biopsies ( 10 test and three control sites ) were harvested from the sites scheduled for implant placement . RESULTS The clinical measurements at 6 months revealed , in the mesial-buccal site , a loss of bone height of 0.2 mm ( 1.4 SD ) in the test and 0.6 mm ( 1.1 SD ) in the controls ; in the mid-buccal portion a gain of 1.3 mm ( 1.9 SD ) in the test and a loss of 0.8 mm ( 1.6 SD ) in the controls ; and in the distal portion a loss of 0.1 mm ( 1.1 SD ) in the test and of 0.8 ( 1.5 SD ) mm in the controls . The biopsies harvested from the test sites revealed that the new bone formed at 6 months was mineralized , mature and well structured . Particles of the grafted material could not be identified in any of the 10 test biopsies . The bone formed in the control sites was also mature and well structured . CONCLUSION The results of this study indicate that alveolar bone resorption following tooth extraction may be prevented or reduced by the use of a bioabsorbable synthetic sponge of polylactide-polyglycolide acid . The quality of bone formed seemed to be optimal for dental implant insertion BACKGROUND Various grafting material s have been used for preservation of the dimensions of the residual alveolar ridge following tooth extraction . The purpose of this study was to evaluate clinical , histomorphometric , and radiographic healing 4 months after tooth extraction with or without placement of a putty-form anorganic bovine-derived hydroxyapatite matrix combined with a synthetic cell-binding peptide P-15 ( Putty P15 ) to determine the effect on alveolar ridge preservation following exodontia . METHODS Twenty-four consecutive subjects in need of extraction of maxillary premolars were recruited . Recruited subjects were r and omly assigned to the test ( Putty P15 and bioabsorbable collagen wound dressing material ) or control ( bioabsorbable collagen wound dressing material only ) group . Data were recorded at 1 , 2 , 4 , 8 , and 16 weeks after ridge preservation procedures . At 16 weeks , a reentry surgery was performed , clinical measurements were repeated , and bone core biopsies were obtained for histomorphometric analysis prior to dental implant placement . RESULTS The control group had a mean reduction in ridge height of -0.56 + /- 1.04 mm , whereas alveolar ridge height appeared to remain unchanged in the test group ( 0.15 + /- 1.76 ) . The test group showed a mean reduction in ridge width of -1.31 + /- 0.96 mm , whereas the mean value for the control group was -1.43 + /- 1.05 mm . No statistical significance was observed between the groups . Mean bone density was significantly superior in the test group ( 2.08 + /- 0.65 versus 3.33 + /- 0.65 ) . Histomorphometric analyses revealed similar percentages of bone vitality ( test : 29.92 % + /- 8.46 % ; control : 36.54 % + /- 7.73 % ) . Comparable percentages of bone marrow and fibrous tissue also were observed ( test : 65.25 % + /- 6.41 % ; control : 62.67 % + /- 7.41 % ) . Only 6.25 % of the Putty P15 particles remained at 4 months in the analyzed biopsies . CONCLUSION A favorable response was observed when Putty P15 was applied to extraction sockets , suggesting that it may be useful for alveolar ridge preservation prior to dental implant placement OBJECTIVE This study has been design ed to evaluate the capability of a new surgical device ( Extension Crest ) to widen narrow edentulous alveolar ridges and to allow a correct placement of endosseous implants in horizontally atrophied sites . MATERIAL AND METHODS Forty-five patients , 20 males and 25 females , aged 20 - 66 years , affected by edentulism associated to horizontal resorption of the ridges , were treated by means of a sagittal osteotomy and expansion of the ridge with a new surgical device ( Extension Crest ) to obtain a wider bony base for ideal implant placement . In the same procedure in 33 patients , and 1 week afterwards in 12 patients , 110 endosseous titanium implants ( ITI TE ) were placed . Three to four months later , the patients were rehabilitated with implant-supported prostheses . RESULTS The success rate of the expansion technique was 97.8 % . A total of 110 implants were inserted in the exp and ed ridges . The mean follow-up after the start of prosthetic loading was 20.4 months . Three implants were removed before the start of prosthetic loading , because of non-integration , while no other implants failed after the completion of the prosthetic rehabilitation . Three implants , although integrated and in function , did not fulfill success criteria : cumulative success and survival rates at the end of the observation period were 95.4 % and 97.3 % , respectively . CONCLUSION Within the limits of this study , this technique appeared to be reliable and simple , with reduction of morbidity and times of dental rehabilitation as compared with other techniques such as autogenous bone grafts and guided bone regeneration . Survival and success rates of implants placed in the treated areas are consistent with those placed in native bone The aim of this study was to compare the effectiveness of two bone substitute material s for socket preservation after tooth extraction . Extraction sockets in 10 patients were filled with either inorganic bovine bone material ( Bio-Oss ) or with synthetic material consisting of hydroxyapatite and silicon dioxide ( NanoBone ) . Extraction sockets without filling served as the control . The results demonstrate the effectiveness of the presented protocol for socket preservation and that the choice of a suitable bone substitute material is crucial . The dimensions of the alveolar ridge were significantly better preserved with Bio-Oss than with NanoBone or without treatment . Bio-Oss treatment result ed in better bone quality and quantity for successful implant placement Objective : The purpose of this study was to evaluate the efficacy of the alveolar ridge preservation technique using collagen sponge and xenograft after extraction . Study Design : Twenty patients were divided into the control group and the experimental group , which contained about 10 patients each . The control group patients were planned  3-unit bridge without performing implant and without special treatments for the extraction socket , and prosthetic treatments were performed after 3 months . In the experimental group , using collagen sponge and xenogeneic bone graft , alveolar ridge preservation was performed simultaneously with tooth extraction ; implants were placed after 3 months . Clinical and histological evaluations and statistical analysis were performed . Results : The resorption rate of the width of alveolar bone 3 mm below the alveolar ridge of the control group was shown to be 20.74 % and of the experimental group was an average of 14.26 % , approximately a difference of 6 % was observed , and it was statistically significant . New bone formation in the vicinity of bone graft material s was achieved well , and inflammation findings were not observed . Conclusion : The results indicated that in the ridge preservation using collagen sponge and xenograft , xenograft prevents the horizontal resorption of the alveolar ridge , and the upper collagen sponge blocks the infiltration of soft tissues to the lower area , and thus it has the advantage of the enhancement of bone fill INTRODUCTION As a consequence of extraction , the height of the buccal wall tends to decrease and results in the disappearance of bundle bone . To modify bone remodelling after extraction , various ridge preservation techniques have been proposed . The present research was drawn up with the following considerations in mind : to evaluate and to compare changes of hard and soft tissues in post- extraction sockets which received a ridge preservation procedure , with post- extraction sockets which had healed naturally . MATERIAL S AND METHODS Each patient was r and omly allocated to a test or control group using a specific software package . After extraction , the sockets were carefully inspected and any granulation tissue was removed . The control sites received silk sutures to stabilize the clot without any grafting material . The test sites were grafted with corticocancellous porcine bone and a collagen membrane . All experimental sites had the membranes left exposed to the oral cavity with a secondary wound healing . The thickness of the buccal alveolar bone , if present , was carefully measured at the time of tooth extraction using a calliper at 1 mm from the edge of the wall . The following clinical parameters were evaluated at baseline and after 4 months at implant placement : vertical bone changes , horizontal bone changes and width of keratinized gingiva . The length , diameter and need for additional bone augmentation were assessed for both groups at the time of implant insertion . RESULTS The control group showed vertical bone resorption of 1 ± 0.7 mm , 2.1 ± 0.6 mm , 1 ± 0.8 mm and 2 ± 0.73 mm at the mesial , vestibular , distal and lingual sites respectively . Moreover , changes in horizontal dimension showed an average resorption of 3.6 ± 0.72 mm . The test sites showed a horizontal bone remodelling of 0.3 ± 0.76 mm , 1.1 ± 0.96 mm , 0.3 ± 0.85 mm , 0.9 ± 0.98 mm at the mesial , vestibular , distal and lingual sites respectively . The horizontal bone resorption at the test sites was 1.6 ± 0.55 mm . The keratinized gingiva showed a coronal shift of 0.7 mm in the control group when compared to 1.1 mm in the test group . In addition , 42 % of sites in the control group required an additional bone augmentation at implant placement , when compared to 7 % in the test sites . CONCLUSIONS This study clearly points out that an alveolar ridge preservation technique performed with collagenated porcine bone and a resorbable membrane -- according to the procedure reported in this study --was able to limit the contour changes after tooth extraction . Finally , the test sites showed a better preservation of facial keratinized tissue when compared to control sites ; grafted sites allowed the placement of longer and wider implants when compared to implants inserted in non-grafted sites BACKGROUND An adequate alveolar crest is essential for implant placement in terms of esthetics and function . The objective of this r and omized clinical trial was to compare the preservation of the alveolar ridge dimensions following tooth extraction using porcine-derived xenograft combined with a membrane versus extraction -alone ( EXT ) sites . METHODS Fifteen patients who required double extraction of contralateral premolars and delayed implant placement were r and omly selected to receive both ridge-preservation procedure and EXT . The test sites ( alveolar ridge preservation [ ARP ] ) included 15 sockets treated using a corticocancellous porcine bone xenograft ( OsteoBiol ® Gen-Os ; Tecnoss srl , Giaveno , Italy ) associated with a soft cortical membrane ( OsteoBiol ® Lamina ; Tecnoss srl ) , while the corresponding control sites ( EXT ) were left without grafting for EXT  . Horizontal and vertical ridge dimensions were recorded at baseline and 6 months after extraction s. RESULTS After 6 months , the EXT sites showed a significantly greater reabsorption of the buccolingual/palatal dimension of the alveolar ridge ( 3.7 ± 1.2 mm ) compared with the ARP sites ( 1.8 ± 1.3 mm ) . The mean vertical ridge height reduction in the control sockets was 3.1 ± 1.3 mm at the buccal sites and 2.4 ± 1.6 mm at the lingual sites compared with 0.6 ± 1.4 and 0.5 ± 1.3 mm , respectively , in the test sockets . The differences between test and control sockets were not significant for the mesial and distal measurements . CONCLUSIONS The placement of a porcine xenograft with a membrane in an extraction socket can be used to reduce the hard tissue reabsorption after tooth extraction compared with EXT TEN PATIENTS WHO REQUIRED two or more anterior teeth extraction s were utilized in this study . Extraction procedures were carried out with a full thickness surgical flap approach . After flap reflection , teeth were removed with a minimum of trauma to the surrounding bone . Following extraction silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions . One socket was covered with an exp and ed polytetrafluoroethylene ( ePTFE ) barrier membrane ( experimental site ) ; the other socket was a conventional control . The soft tissue flaps were then mobilized using periosteal releasing incision and the wound closed with ePTFE mattress sutures . Six months following extraction , patients were treated with flap surgery to expose both extraction s sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points . Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control ( P < or = 0.05 ) . Three patients with exposed membranes had similar dimensional changes as controls . Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry OBJECTIVE The aim of this clinical study was to evaluate the interproximal radiographic bone levels and the survival/success rate of  dental implants  placed in alveolar ridges previously preserved with a synthetic bone substitute or a bovine xenograft . MATERIAL AND METHODS Alveolar ridge preservation was performed in 27 patients who were r and omly assigned in two groups . In the test group ( n = 14 ) , the extraction socket was treated with a synthetic bone graft Straumann Bone Ceramic ; SBC and a collagen barrier , whereas in the control group ( n = 13 ) a deproteinized bovine bone mineral ( DBBM ) and the same collagen barrier were used . After 8 months of healing , titanium dental implants with a hydrophilic surface were placed in the preserved ridges . During surgery , 9/13 implants in the SBC group and 8/12 implants in the DBBM group presented with either dehiscence or fenestration defects and required additional bone augmentation . The implants were loaded at 4 months following placement and were followed up for 1 year post-loading . Interproximal radiographic bone levels were evaluated in st and ardized periapical radiographs at loading and 1 year post-loading . Probing pocket depth , gingival recession and bleeding upon probing were recorded at implants and neighbouring teeth . The success rate of the implants was evaluated according to criteria set by Albrektsson et al. ( 1986 ) . RESULTS The survival rate of the implants in both groups was 100 % at 1-year post-loading . No statistically significant differences in any of the clinical and radiographic measurements were detected between the two groups ( P < 0.05 ) . The success rate of the implants was 84.6 % ( 11/13 ) in the SBC group and 83.3 % ( 10/12 ) in the DBBM group . CONCLUSION Equivalent success and survival rates ( as well as similar radiographic changes ) of dental implants placed in alveolar ridges previously preserved with SBC or DBBM should be anticipated BACKGROUND The alveolar ridge undergoes reabsorption and atrophy subsequent to tooth removal and thus exhibits a wide range of dimensional changes . Preservation of the alveolar crest after tooth extraction is essential to enhance the surgical site before implant fixture placement . The aim of this r and omized clinical study is to investigate and compare the need for additional augmentation procedures at implant insertion , as well as the success rate and marginal bone loss for implants placed in the grafted sites versus those placed in naturally healed sites . METHODS Forty patients with ≥1 hopeless tooth were r and omly allocated to : 1 ) a test group , receiving extraction and grafting corticocancellous porcine bone ; and 2 ) a control group , receiving extraction without any graft . After 7 months of healing , implants were inserted in each of the sites . The implants were submerged and loaded after 4 months with metal-ceramic rehabilitation . The follow-up included evaluation of implant diameter and length , the need for additional augmentation procedures at implant placement , implant failure , and marginal bone level changes . All patients were followed over a 3-year period . RESULTS One implant failed in the control group at the second stage of surgery ( 6 months after placement ) ; one implant failed in the test group after 2 years of loading . The cumulative implant success rate at the 3-year follow-up visit reached 95 % for both groups . No statistically significant differences were detected for marginal bone changes between the two groups . CONCLUSIONS It was concluded that implants placed into grafted extraction sockets exhibited a clinical performance similar to implants placed into non-grafted sites in terms of implant survival and marginal bone loss . However , grafted sites allowed placement of larger implants and required less augmentation procedures at implant placement when compared to naturally healed sites BACKGROUND Mineralized and demineralized freeze-dried bone allografts ( FDBAs ) are used in alveolar ridge ( AR ) preservation ; however , each material has advantages and disadvantages . Combinations of allografts aim ed at capitalizing on the advantages each offers are available . To date , there is no evidence to indicate if a combination allograft is superior in this application . The primary objective of this study is to histologically evaluate and compare healing of non-molar extraction sites  grafted with either mineralized FDBA or a 70:30 mineralized : demineralized FDBA combination allograft in AR preservation . The secondary objective is to compare dimensional changes in ridge height and width after grafting with these two material s. METHODS Forty-two patients r and omized into two equal groups received  ridge preservation with either 100 % mineralized FDBA ( active control group ) or the combination 70 % mineralized : 30 % demineralized allograft ( test group ) . Sites were allowed to heal for 18 to 20 weeks , at which time core biopsies were obtained and dental implants were placed . AR dimensions were evaluated at the time of extraction and at implant placement , including change in ridge width and change in buccal and lingual ridge height . Histomorphometric analysis was performed to determine percentage of vital bone , residual graft , and connective tissue/other non-bone components . RESULTS There was no significant difference between groups in AR dimensional changes .  Combination allograft produced increased vital bone percentage ( 36.16 % ) compared to the FDBA group ( 24.69 % ; P = 0.0116 ) . The combination allograft also had a significantly lower mean percentage of residual graft particles ( 18.24 % ) compared to FDBA ( 27.04 % ; P = 0.0350 ) . CONCLUSIONS This study provides the first histologic evidence showing greater new bone formation with a combination mineralized/demineralized allograft compared to 100 % mineralized FDBA in AR preservation in humans . Combination allograft results in increased vital bone formation while providing similar dimensional stability of the AR compared to FDBA alone in AR preservation BACKGROUND Conventional dentoalveolar osseous reconstruction often involves the use of grafting material s with or without barrier membranes . The purpose of this study was to evaluate the efficacy of bone induction for the placement of dental implants by two concentrations of recombinant human bone morphogenetic protein-2 ( rhBMP-2 ) delivered on a bioabsorbable collagen sponge ( ACS ) compared to placebo ( ACS alone ) and no treatment in a human buccal wall defect model following tooth extraction . METHODS Eighty patients requiring local alveolar ridge augmentation for buccal wall defects ( > or = 50 % buccal bone loss of the extraction socket ) of the maxillary teeth ( bicuspids forward ) immediately following tooth extraction were enrolled . Two sequential cohorts of 40 patients each were r and omized in a double-masked manner to receive 0.75 mg/ml or 1.50 mg/ml rhBMP-2/ACS , placebo ( ACS alone ) , or no treatment in a 2:1:1 ratio . Efficacy was assessed by evaluating the amount of bone induction , the adequacy of the alveolar bone volume to support an endosseous dental implant , and the need for a secondary augmentation . RESULTS Assessment of the alveolar bone indicated that patients treated with 1.50 mg/ml rhBMP-2/ACS had significantly greater bone augmentation compared to controls ( P < or = 0.05 ) . The adequacy of bone for the placement of a dental implant was approximately twice as great in the rhBMP-2/ACS groups compared to no treatment or placebo . In addition , bone density and histology revealed no differences between newly induced and native bone . CONCLUSION The data from this r and omized , masked , placebo-controlled multicenter clinical study demonstrated that the novel combination of rhBMP-2 and a commonly utilized collagen sponge had a striking effect on de novo osseous formation for the placement of dental implants Extraction of a tooth necessitated by factors such as developmental problems , trauma , severe periodontal disease and endodontic problems often causes deformities of the residual alveolar ridge in the maxillary anterior region . These cases are usually difficult to restore prosthetically and they result in poor esthetics and insufficient occlusal function . This study investigated the efficacy of root form bioactive glass cones implanted into ( a ) artificial sockets produced by bone splitting of previous extraction sites ( group BS ) and ( b ) fresh extraction sockets ( group FES ) . We included conventional extraction sockets sutured without implanting the root form bioactive glass cones as a control ( group C ) . A total of 16 patients were treated for whom extraction s had been indicated due to severe periodontitis . 6 patients with 7 implant sites having Class II or III alveolar ridge deformities comprised the BS group . 5 patients with 10 implant sites comprised the FES group . Group C , comprised 5 patients with 10 extraction sites .  Alveolar ridge width and height measurements were obtained using study casts preoperatively , immediately postoperatively , and at 3 and 12 months after operation . In the BS group , while the width of the alveolar ridge increased by 2.8+/-1.18 mm immediately after ridge augmentation procedure and by 2.4+/-0.93 mm at 1 year after operation ( p<0.01 ) , the height of the alveolar ridge increased by 1.8+/-1.99 mm and 1.4+/-1.74 mm respectively ( p<0.05 ) . In the FES group , the differences between preoperative original ridge height and width and postoperative measurements were not statistically significant , which demonstrated the efficiency of this method in preserving the alveolar ridge . In group C , while alveolar ridge width after 12 months had not significantly changed , alveolar ridge height decreased significantly ( 1.35+/-1.05 mm , p<0.01 ) . After 12 months , no dehiscences were detected and the differences in height between the groups remained significant . The results of this study indicate that this procedure is efficient in reconstructing alveolar ridges deformed as a result of extraction , particularly relevant in relation to preparation for subsequent restorative treatment OBJECTIVES This pilot r and omised controlled clinical trial aim ed to evaluate the feasibility and effectiveness of using a polycaprolactone ( PCL ) scaffold in fresh extraction sockets for ridge preservation . The hypothesis was that the insertion of a 3D bioresorbable PCL scaffold in fresh extraction sockets allowed for normal bone healing and better maintenance of ridge dimensions after 6 months as compared to extraction sockets without the scaffold . MATERIAL AND METHODS Thirteen patients were r and omised to either the test group ( N = 6 ) where a PCL scaffold was inserted in the tooth socket after extraction or the control group ( N = 7 ) where no space filler was used .  Alveolar ridge height and width measurements were made at baseline and 6 months post- extraction , for the evaluation of bone resorption . At 6 months , a core of bone was trephined out from the healed ridge for microcomputed tomographic ( micro CT ) and histological analyses , immediately before Stage I dental implant surgery . Stage II dental implant surgery was performed 4 - 6 months later . RESULTS There was less vertical ridge resorption in the test group compared to the control group , and the difference was statistically significant in the mesio-buccal aspect ( P = 0.008 ) . Micro CT and histological observations showed mainly mineralised bone formation in both groups , except for one specimen in the test group . CONCLUSIONS The insertion of a 3D bioresorbable PCL scaffold in fresh extraction sockets allowed for normal bone healing , and there was better maintenance of ridge height after 6 months as compared to extraction sockets without the scaffold PURPOSE This 5-year prospect i ve multicenter study compared implant survival and success , peri-implant health and soft tissue responses , crestal bone level stability , and complication rates following immediate loading of single OsseoSpeed implants placed in anterior maxillary healed ridges or extraction sockets . MATERIAL S AND METHODS Individuals requiring anterior tooth replacement with single implants  were treated and immediately provisionalized . Definitive all-ceramic crowns were placed at 12 weeks . Implant survival , bone levels , soft tissue levels , and peri-implant health were monitored for 5 years . RESULTS One hundred thirteen patients received implants in fresh sockets ( 55 ) and healed ridges ( 58 ) . After 5 years , 45 and 49 patients remained for evaluation , respectively . During the first year , three implants  failed in the extraction socket group ( 94.6 % survival ) and one implant failed in the healed ridge group ( 98.3 % survival ) ; this difference was not significant . No further implant failures were recorded . After 5 years , the interproximal crestal bone levels were located a mean of 0.43 ± 0.63 mm and 0.38 ± 0.62 mm from the reference points of implants in sockets and healed ridges ( not a significant difference ) . In both groups , papillae increased over time and peri-implant mucosal zenith positions were stable from the time of definitive crown placement in sockets and healed ridges . Compared to flap surgery for implants in healed ridges , flapless surgery result ed in increased peri-implant mucosal tissue dimension ( average , 0.78 ± 1.34 mm vs 0.19 ± 0.79 mm ) . CONCLUSION After 5 years , the bone and soft tissue parameters that characterize implant success and contribute to dental implant esthetics were similar following the immediate provisionalization of implants in sockets and healed ridges . The overall tissue responses and reported implant survival support the immediate provisionalization of dental implants in situations involving healed ridges and , under ideal circumstances , extraction sockets BACKGROUND Immediate bone grafting procedures were proposed to preserve bone volume in residual damaged alveolar walls and to prevent the expansion of the sinus floor in the maxillary molar region . The use of an osteotome allows vertical bone augmentation and localized sinus elevation with minimal surgical trauma . The aim of this study is to evaluate the clinical outcome of implants placed in previously grafted alveoli that were exp and ed at a second-stage surgery by an osteotome technique . METHODS Twenty patients requiring extraction of one or two upper molar teeth and /or a second premolar were selected . Thirty teeth were extracted , and their fresh sockets immediately received magnesium-enriched hydroxyapatite as a graft material . Three months after bone filling , osteotome sinus floor elevations were performed in grafted sites , and 30 titanium dental implants were placed . Three months after implant placement , temporary restorations were performed . Follow-up examinations and intraoral digital radiographs were taken at baseline and 6 , 12 , 24 , and 36 months after implant placement to evaluate the alveolar bone gain for each implant . Comparisons among mean values of alveolar bone gain over time were performed by the Student two-tailed t test . RESULTS At the 36-month follow-up , a survival rate of 100 % was reported for all implants . The alveolar bone gain after 6 months of healing was 2.41 + /- 1.23 mm . Successively , after 12 months , the bone gain increased ( 3.85 + /- 1.37 mm ) . At 24 and 36 months after implant placement , the levels were stable ( 3.86 + /- 1.50 mm and 3.82 + /- 1.57 mm , respectively ) . Statistical analyses showed a significant difference ( P < 0.05 ) only between the 6- and 12-month values . CONCLUSION At the 36-month follow-up , the use of the osteotome technique for vertical expansion of the grafted tissue was considered a predictable procedure in the implant surgery INTRODUCTION Tooth loss reduces oral-health-related quality of life ( OHRQoL ) as assessed with the 14-item Oral Health Impact Profile question naire ( OHIP-14 ) . OBJECTIVES This prospect i ve multicenter case-control study sought to ( i ) establish OHRQoL in patients requiring a single implant in the anterior maxilla and to ( ii ) compare these changes following implant placement and immediate provisionalization in extraction sockets with healed alveolar ridges up to 1 year . MATERIAL AND METHODS Ninety-six patients were enrolled in the study with 102 single implants ( OsseoSpeed AstraTech ) provisionalized immediately after placement in sockets or after placement in healed ridges . A final crown was cemented after 12 weeks . OHIP-14 was registered before surgery ( baseline ) , after 1 ( provisional crown ) , 6 and 12 months ( final crown ) . Repeated measures ANOVA was performed for the seven conceptual OHIP Domains , the treatment group ( extraction site socket vs. healed alveolar ridge ) and time as within subjects variables . RESULTS Two implants failed , 1/48 ( 2.1 % ) in the extraction group ( n=46 patients ) and 1/54 ( 1.8 % ) in the healed ridge group ( n=50 patients ) . From 82 patients ( 87.5 % ) , OHIP-14 was available at all time points . The overall OHIP-14 based on the mean of the seven domains increases between baseline and 6 months and remained stable afterward for the total study group and both treatment groups . Comparison between extraction and healed groups revealed no significant difference at baseline but the healed group showed a significantly higher improvement for functional limitation , physical disability , physical pain and psychological discomfort ( P<0.05 ) . Between baseline and 1 year in the healed bone group , all seven domains improved significantly compared with only three domains in the extraction group . However , the overall OHIP-14 score between groups was not substantially different . Hence , both treatment modalities lead to similar OHRQoL improvement . CONCLUSION Patients in need of a single-tooth replacement have limited OHRQoL problems as reflected by the OHIP-14 score but improvements in several domains related to oral health were evaluated when implants were placed and provisionalized in healed bone and extraction sites BACKGROUND This study evaluated patients who had been treated with recombinant human bone morphogenetic protein-2 ( rhBMP-2 ) loaded in an absorbable collagen sponge ( ACS ) in human extraction sites or in sites that required alveolar ridge augmentation . An earlier report on the same patients revealed that after 4 months , implantation of rhBMP-2/ACS was safe , as determined by clinical , radiographic , systemic , and immunological analyses . In this longer-term follow-up , eligible patients were restored with endosseous dental implants in the area treated with rhBMP-2/ACS and bone biopsy sample s were taken for histological analysis of the treated human bone tissue . The primary objective was to monitor the long-term safety of patients treated with rhBMP-2/ACS .  Another objective was to evaluate the dental implants placed in the sites treated with rhBMP-2 . METHODS Patient safety was evaluated by clinical examinations , periapical radiographs , and occurrence of adverse experiences . Dental implants were evaluated by radiographic and clinical examination .  All 12 patients have been followed for 3 years . RESULTS Two years following surgical implantation of rhBMP-2/ACS , no serious or unexpected adverse experiences occurred . The adverse experiences that did occur were mostly benign and compatible with the dental implant surgeries performed in these patients . No adverse experiences were deemed as related to the rhBMP-2/ACS . Furthermore , no safety concerns in the local area of rhBMP-2/ACS placement were noted , based on oral wound examinations . In the 10 patients ( 6 extraction socket patients and 4 augmentation patients ) who received endosseous implants , all implants were clinical ly stable at all assessment s and all 10 patients have been functionally restored . Histological evaluation of the human bone core biopsies revealed normal bone tissue formation identical to the surrounding native bone . Three-year follow-up clinical examinations revealed that all implants had stable marginal bone levels and healthy peri-implant tissues . CONCLUSIONS These 3-year results demonstrate that rhBMP-2/ACS can be used safely in human patients . Human bone biopsies reveal normal bone formation in areas treated with rhBMP-2/ACS . Endosseous implants placed in these areas were all stable with no radiographic or clinical complications . The results from this study suggest that rhBMP-2/ACS ( 0.43 mg/ml ) can be safely used in tooth extraction sites and in local ridge augmentation procedures and that endosseous dental implants placed in bony areas treated with rhBMP-2/ACS are stable and can be functionally restored without complication Objectives : The aims were to investigate whether the use of platelet-rich fibrin membranes ( PRF ) for socket filling could improve microarchitecture and intrinsic bone tissue quality of the alveolar bone after premolar extraction and to assess the influence of the surgical procedure before implant placement . Material and Methods : Twenty-three patients requiring premolar extraction followed by implant placement were r and omized to three groups : ( 1 ) simple extraction and socket filling with PRF , ( 2 ) extraction with mucosal flap and socket filling with PRF , and ( 3 ) controls with simple extraction without socket filling . Implant placement was performed at week 8 , and a bone biopsy was obtained for histomorphometric analysis . Results : Analysis by microcomputed tomography showed better bone healing with improvement of the microarchitecture ( P < 0.05 ) in group 1 . This treatment had also a significant effect ( P < 0.05 ) on intrinsic bone tissue quality and preservation of the alveolar width . An invasive surgical procedure with a mucosal flap appeared to completely neutralize the advantages of the PRF . Conclusions : These results support the use of a minimally traumatic procedure for tooth extraction and socket filling with PRF to achieve preservation of hard tissue
The potential benefit of socket preservation therapies was demonstrated result ing in significantly less vertical and horizontal contraction of the alveolar bone crest .
The scientific evidence does not provide clear guidelines in regards to the type of bio material , or surgical procedure , although a significant positive effect of the flapped surgery was observed .
There are no data available to draw conclusions on the consequences of such benefits on the long-term outcomes of implant therapy
OBJECTIVE This systematic review aims to evaluate the scientific evidence on the efficacy in the surgical protocol s design ed for preserving the alveolar ridge after tooth extraction and to evaluate how these techniques affect the placement of dental implants and the final implant supported restoration .