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The aim of this study was to evaluate the level of mineralized tissue and expression of bone markers in sockets grafted with platelet-rich fibrin and bone marrow aspirate concentrate (BMAC). Patients requiring extraction of one maxillary anterior tooth were randomized into three groups. After tooth extraction, the sockets in the control group (CG) were permitted to fill with blood clot. In the platelet-rich fibrin group (PRFG), after blood processing, the sockets were grafted with PRF plug. In the bone marrow aspirate concentrate combined with platelet-rich fibrin group (BM/PG), after blood and bone marrow processing, the sockets were grafted with a mixture of PRF plug and BMAC. After 6 months, the sites were reopened and bone cores were harvested and prepared for histomorphometric and immunohistochemical evaluation. The following levels were measured: mineralized tissue, expression of RUNX-2, and osteocalcin. Fifteen patients were included in this study. The histomorphometric analysis showed a more pronounced level of mineralized tissue in PRFG and BM/PG (54.20 ± 4.31% and 64.70 ± 6.74%, respectively) when compared with CG (40.60 ± 5.98%) (p = 0.0283 and p = 0.0090, respectively). The expression of RUNX-2 was very low in BM/PG (0.80 ± 0.84%) and absent in CG and PRFG (p = 0.0528). Osteocalcin expression was higher for BM/PG (23.40 ± 1.52%) when compared with CG and PRFG (18.40 ± 2.07% and 16.20 ± 1.92%, respectively) (p = 0.0117 and p = 0.0088, respectively). This preliminary study indicates that clinical use of bone marrow aspirate concentrate, when combined with platelet-rich fibrin as a carrier, might have some potential to increase mineralization in fresh extraction sockets.

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SUMMARY: The aim of this study was to perform an in situ endoscopic analysis of the vascularization of post-extraction sites immediately after a non-traumatic extraction in terms of the number of blood vessels per field (NBV), relative area of blood vessels (RABV) and relative area of unmineralized bone (RAUB) in teeth with different periodontal status (PS). This assessment was performed using short distance support immersion endoscopy (SD-SIE). Ten patients (4 men/ 6 women, aged between 25 and 44) were selected. From them, 10 teeth were extracted due to periodontal reasons or other motives. These teeth were then categorized into 2 groups according to their PS, either as periodontally compromised (PC) (clinical attachment loss (CAL) > 7 mm and probing depth (PD) > 5 mm) or periodontally healthy (PH) (CAL < 7 mm and PD < 5 mm, without bleeding or suppuration during periodontal probing), and mobile (M) (> 1 mm horizontally) or immobile (I) (< 1 mm horizontally). The minimally invasive vertical tooth extractions were performed using the Benex ® extractor. Immediately after extraction, a rigid immersion endoscope with a diameter of 2.7 mm was introduced, and a video-alveoloscopy was carried out. This video was analyzed by ImageJ software for the quantification of NBV, RABV and RAUB per field of the post-extraction sites with different PS (PC, PH, M, I) were quantified. In the PC group, significantly greater values for RAUB were observed (33.45 %) compared to those from the PH group (19.65 %). Compared with the M group, the I group did not show significant differences in terms of RAUB or RABV. There were also no differences in NBV in both groups (Means: 33.8 vs. 30.5, respectively).

RESUMEN: El objetivo de este estudio fue realizar un análisis endoscópico in situ de la vascularización de los alvéolos post-extracción inmediatamente después de una extracción atraumática en términos de número de vasos sanguíneos por campo de observación (NBV), área relativa de vasos sanguíneos (RABV) y el área relativa de espacios no mineralizados (RAUB) en dientes con diferente estado periodontal (PS). Esta evaluación se realizó mediante endoscopía de inmersión de corta distancia (SD-SIE). Se seleccionaron diez pacientes (4 hombres / 6 mujeres, con edades comprendidas entre 25 y 44). De ellos, se extrajeron 10 dientes debido a razones periodontales u otros motivos. Estos dientes se clasificaron en 2 grupos según su PS, ya sea como periodontalmente comprometidos (PC), los que presentaban un nivel de inserción clínica (CAL) ≥ 7 mm y una profundidad de sondaje (PD) ≥ 5 mm; o periodontalmente sanos (PH) (CAL <7 mm y PD <5 mm, sin sangramiento o supuración durante el sondaje periodontal). También se categorizaron según su movilidad como móvil (M) (≥ 1 mm horizontalmente) o inmóvil (I) (<1 mm horizontalmente). Las extracciones verticales mínimamente invasivas se realizaron con el extractor Benex ®. Inmediatamente después de la extracción, se introdujo un endoscopio rígido de inmersión con un diámetro de 2.7 mm, con el cual se realizó una video-alveoloscopía. Este video fue analizado por el software ImageJ para la cuantificación de NBV, RABV y RAUB por campo, de los alvéolos post-extracción con diferente estado periodontal. En el grupo de dientes PC, se observaron valores significativamente mayores para RAUB (33.45%) en comparación con los del grupo PH (19.65 %). En comparación con el grupo M, el grupo I no mostró diferencias significativas en términos de RAUB o RABV. Tampoco hubo diferencias en el NBV en ambos grupos (Media: 33.8 frente a 30.5, respectivamente).

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Abstract This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

Resumo Este estudo teve como objetivo avaliar a reconstrução do osso alveolar após extração em 12 pacientes com perda da tábua óssea vestibular em dentes na região anterior da maxila usando a técnica da reconstrução alveolar proteticamente guiada (RAPG). Na RAPG, uma prótese parcial fixa provisória (PPFP [convencional ou adesiva]) com um pôntico com design específico mantém o coágulo numa posição mecanicamente estável. Além disso, o design do pôntico, com formato de ampulheta e localizado na área subgengival, também previne o colapso das margens gengivais. A recessão gengival foi avaliada durante o período de cicatrização de 6 meses. Tomografias computadorizadas cone beam (TCCB) foram feitas 1 mês antes e 8 meses após o tratamento com a RAPG. Para o desfecho primário, nas imagens panorâmicas, a área central do defeito ósseo em cada dente foi selecionada para as medições lineares. As medições do ganho vertical ósseo vestibular e do ganho em espessura na crista óssea alveolar foram realizadas. A análise estística descritiva e a análise do coeficiente de correlação intraclasse forma realizados. Após o tratamento, todos os pacientes apresentaram formação óssea (ganho vertical médio de 7,1±3,7 mm, associado a ganho horizontal médio de 4,5±1,4 mm na crista óssea alveolar). O coeficiente de correlação intraclasse foi de 0,999. Nenhuma retração gengival acima de 1 mm foi observada. Procedimentos com baixa morbidade sem o uso de biomateriais podem ser úteis na regeneração/preservação do rebordo após as extrações. A RAPG promove a formação do osso alveolar sem o uso de retalhos, enxertos e membranas.

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The aim of the present review was to describe the studies produced in Latin America that contributed to the elucidation of the effect of tooth extraction with and without immediate implant installation. An electronic search was conducted in MEDLINE (PubMed), Scopus, Scielo, Lilacs, and Embase to include clinical and experimental (animal) studies on immediate implants. The studies selected had to fulfill the following inclusion criteria: (i) to present clinical and/or histological data on socket healing with or without immediate implant installation; (ii) to be approved by a Latin American Ethic Committee or comparable; and (iii) to include at least one author from a Latin American institution or to be conducted in a Latin America institution. Latin American studies that fulfilled these criteria demonstrated that immediate implant installation was conducive for predictable osseointegration and high survival rates but failed to prevent bone modeling and dimensional reduction of the alveolar ridge. In addition, it was also shown that regenerative approaches, including hard and soft tissue grafts at the time of immediate implant placement, may be beneficial to compensate for the alveolar ridge reduction. Regenerative approaches immediately after tooth extraction may decrease the amount of dimension reduction of the alveolar ridge.

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AIM: The aim of this study was to examine the clinical and histological differences of using a combination of alloplastic beta triphasic calcium phosphate (ß-TCP) and a cross-linked collagen membrane versus autologous platelet-rich fibrin (PRF-L) in ridge preservation after dental extraction. MATERIAL AND METHODS: Fifty-one patients were included in this observational case-series study. Dental extractions were performed, after which 25 patients were grafted with ß-TCP and 26 with PRF-L. After four months of healing, clinical, radiological, histomorphometric and histological evaluations were performed. RESULTS: A significantly higher percentage of mineralized tissue was observed in samples from the PRF-L grafted areas. Cellularity was higher in PRF-L grafted areas (osteocytes in newly formed bone per mm² = 123.25 (5.12) vs. 84.02 (26.53) for PRF-L and ß-TCP, respectively, p = 0.01). However, sockets grafted with PRF-L showed a higher reduction in the bucco-lingual dimension after four months of healing (2.19 (0.80) vs. 1.16 (0.55) mm, p < 0.001), as well as a higher alteration in the final position of the mid muco-gingival junction (1.73 (1.34) vs. 0.88 (0.88) mm, p < 0.01). CONCLUSION: PRF-L concentrate accelerates wound healing in post-extraction sockets in terms of new mineralized tissue component. However, the use of ß-TCP biomaterial appears to be superior to maintain bucco-lingual volume and the final position of the muco-gingival junction.

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OBJECTIVES: This study aimed at evaluating soft and hard tissue dimensions after immediate implant placement and immediate temporization with or without alveolar preservation at the maxillary anterior region. MATERIALS AND METHODS: Twenty-two patients needing maxillary incisor extraction and with the possibility of immediate implant placement were randomly assigned to the following groups: test (n = 11): immediate implant placement + deproteinized bovine bone derived with collagen inserted into the alveolus or control (n = 11): immediate implant placement without biomaterial. All soft tissue measurements were evaluated at baseline, 3 months, and 6 months after implant therapy. Cone beam tomography was performed at baseline and at 6 months after implant placement to evaluate hard tissue dimension. RESULTS: The test group presented higher height of soft tissue at mesiobuccal and distobuccal sites at 3 months and 6 months when compared to the control group (p < 0.05). Regarding the bone tissue, the test group showed higher buccolingual ridge dimension at 6 months when compared to the control group (p < 0.05). CONCLUSIONS: It can be concluded that the use of deproteinized bovine bone derived with collagen together with immediate dental implants results in better soft and bone tissue outcomes than immediate implants alone. CLINICAL RELEVANCE: The use of deproteinized bovine bone derived with collagen may enhance the results regarding soft and bone tissue in combination with immediate implant and temporization.

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The aim was to describe the star volume analysis in ridge preservation using different grafting materials. Bilateral extraction of the first mandibular molars of sixteen male rabbits was performed, divided at random into four groups (n= 4 in each group) according to graft, using: blood clot (G1), xenograft (G2), pure phase beta-tricalcium phosphate (G3) and biphasic calcium phosphate (60 % HA / 40 % beta-TCP) (G4). Rabbits were euthanized at 4, 6, or 8 wk post-extraction; the trabecular bone structures was evaluated by star volume analysis. The Levene test was used to analyze variance, as was the independent sample t-test. A P-value of < 0.001 was used to establish a statistically significant. The star volume analysis of the mandibular trabecula shows that the marrow space star volume (V*m.space) was higher than the trabecular star volume (V*tr). At 6-week post-extraction, new trabecular bone was evident. At 8-week post-extraction V*tr increase in all groups and the V*m.space diminish, suggesting coarsening of the internal architecture. In G2, some trabecular bone was observed in the central region. In G3, most of the socket regions were occupied by newly formed and loose trabecular bone and in the G4, the sockets were almost entirely filled with trabecular bone. Star volume analysis is adequate to analysis of bone patterns formation using bone substitutes.

El objetivo de esta investigación fue describir el volumen estrella en preservación alveolar utilizando diferentes injertos óseos. La exodoncia bilateral del primer molar mandibular de 16 conejos machos fue realizada, dividiéndolos en 4 grupos (n= 4 en cada grupo) de acuerdo al injerto utilizado, siendo: coágulo sanguíneo (G1), xenoinjerto (G2), beta-tricalcio fosfato puro (G3) y fosfato de calcio bifásico (60 % HA / 40 % beta-TCP) (G4). Los conejos fueron sometidos a eutanasia a las 4, 6 u 8 semanas post exodoncia; el trabeculado óseo fue evaluado por medio del volumen estrella. La prueba de Levene fue utilizado para el análisis de varianza y luego la prueba t-test para muestras independientes. El valor de P menor a 0.001 fue establecido como significancia estadística. El análisis del volumen estrella del trabeculado mostró que el espacio medular de volumen estrella (V*m.space) fue mayor que trabeculado (V*tr). A 6 semanas post exodoncia, nuevo trabeculado óseo fue evidente. A las 8 semanas post exodoncia V*tr aumenta en todos los grupos y el V*m.space disminuye, sugiriendo un engrosamiento de la arquitectura interna. En el grupo G2, algún trabeculado óseo fue observado en la región central. En el G3, la mayoría del alveolo fue ocupado por nuevo hueso y perdió trabeculado óseo y en G4, el alveolo fue ocupado casi enteramente por hueso trabecular. El análisis de volumen estrella es adecuado para analizar el modelo de formación ósea utilizando sustitutos óseos.

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Este artigo teve por objetivo apresentar um caso clínico cuja prótese provisória utilizou um componente protético multifuncional de PEEK. Este é um polímero biocompatível personalizável e de boa aderência às resinas. O caso descrito é um implante imediato com carga imediata na região do 21. Foi realizado um approach palatino do implante, preenchimento do gap vestibular com um enxerto aloplástico (Nanosynt), um provisório imediato utilizando um componente provisório multifuncional de PEEK e um dente de estoque. O caso foi acompanhado até a fase de confecção da prótese defi nitiva, na qual foi verifi cada a arquitetura dos tecidos peri-implantares quanto à saúde e manutenção. Na Implantodontia contemporânea, o PEEK é a opção biológico-funcional com melhor custo-benefício nos casos de implantes colocados e carregados imediatamente.

The aim of this article was to present a clinical case where the provisional restoration was fabricated over a multifunctional PEEK healing abutment. This biocompatible polymer can be customized and has excellent bond strength to resin composites. A dental implant was loaded at the region of tooth 21. After a palatal approach for implant placement, the buccal gap was fi lled with an alloplastic graft (Nanosynt). Then, the immediate restoration was fabricated with the multifunctional PEEK and an acrylic tooth form. At the delivery of the defi nitive restoration, the peri-implant soft tissue health and architecture were preserved. In the contemporary implant dentistry, PEEK abutments provide the best biological and functional option with a signifi cant cost-benefi t ratio for cases of immediate implant loading

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OBJECTIVES: This study evaluated buccal bone crest remodeling, socket composition after healing, and dimensional ridge preservation after flapless tooth extraction procedures with or without a xenograft comparing histomorphometric and microcomputed tomographic (micro-CT) data. MATERIAL AND METHODS: The mandibular premolars of eight dogs were extracted without flaps. One socket on each side received a grafting material (test group), and the other remained only with a blood clot (control group). Twelve weeks after treatment, buccal bone crest, alveolar ridge dimensions, and composition were analyzed by histomorphometry and micro-CT. RESULTS: Two- and three-dimensional evaluations showed better results for the grafted group when compared to the non-grafted group. CONCLUSION: The flapless alveolar ridge preservation procedure with deproteinized bovine bone material enhanced buccal bone crest, alveolar ridge dimensions and bone formation when compared to sockets with the blood clot only, as observed by histomorphometric and micro-CT analysis.

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OBJECTIVES: This clinical trial explored the clinical and radiographic dimensional changes of the alveolar ridge in the first 4 months after tooth extraction in combination with the application of Leukocyte- and Platelet Rich Fibrin (L-PRF). METHODS: Eighteen single rooted maxillary and mandibular sockets were filled with L-PRF without soft tissue closure. Clinical measurements (bone sounding) were performed using a customized acrylic stent and radiographic measurements were accomplished using Cone Beam Computed Tomography (CBCT), immediately after tooth extraction and after 4 months. RESULTS: The clinical observations indicated a mean horizontal resorption of 1.18±2.4mm (p=0.8) at the crest, 1.25±2.0mm (p=0.57) and 0.83±2.0mm (p=0.78) at 2mm and 4mm apical to the crest, respectively. The buccal plate demonstrated a mean vertical loss of 0.44±3.5mm (p=0.9), the centre of the socket had a significant filling of 5.72±3.6mm (p=0.0001) and the oral cortical plate had a mean vertical gain of 0.09mm±1.57mm (p=0.9). The radiographic analysis demonstrated a mean vertical bone loss of 0.27±2.5mm (p=0.9) on the buccal and of 0.03±1.6mm (p=0.9) at the oral crest. The width of the alveolar ridge had a mean loss of 1.33mm±1.43mm. CONCLUSIONS: Within the limitations of this pilot study, it can be concluded that L-PRF might show clinical benefits for ridge preservation.

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PURPOSE: The aim of this study was to evaluate bone regeneration at surgically created dehiscence buccal defects at implants placed immediately into extraction sockets (IPIES) of small dimensions filled with autogenous bone or deproteinized bovine bone mineral (DBBM) associated with a collagen membrane. MATERIALS AND METHODS: Eight Labrador dogs were used and implants were placed immediately into the extraction sockets of the second premolar. The buccal wall was subsequently removed to create a standardized defect, 4 mm wide coronally, 2 mm wide apically, and 6 mm high. Autogenous bone particles (AB) or DBBM granules were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membrane and a non-submerged healing was allowed. After 4 months, the animals were euthanized and bone blocks harvested and processed for histomorphometric analysis. RESULTS: The bony crest at the buccal aspect (C) was located 2.3 ± 0.8 mm and 1.7 ± 0.7 mm apically to the implant shoulder (IS) at the AB and DBBM sites, respectively. The coronal levels of osseointegration at the buccal aspect (B) were located 2.7 ± 0.7 mm and 2.2 ± 1.0 mm apically to IS at the AB and DBBM sites, respectively. At the AB sites, the peri-implant mucosa was located 4.3 ± 0.9 mm, 4.7 ± 0.9 mm, and 2.0 ± 1.6 mm coronally to C, B, and IS, respectively. The corresponding values at the DBBM sites were 4.3 ± 0.6 mm, 4.8 ± 0.6 mm, and 2.5 ± 0.8 mm, respectively. No statistically significant differences were found. CONCLUSIONS: The treatment of surgically created buccal defects at IPIES sites using Bio-Oss® (Geistlich Biomaterials, Wolhusen, LU, Switzerland) or autogenous bone, concomitantly with a collagen membrane, engenders bone regeneration to a similar extent after 4 months of healing.

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BACKGROUND: It is expected that 40% to 60% of initial alveolar bone volume will be lost up to 6 months after tooth extraction. OsteoScaf(TM) (TRT, Toronto, ON, Canada) (poly (DL-lactide-co-glycololide/calcium phosphate [PLGA/CaP] scaffold) is a novel bone substitute material and represents a promising alternative for maintaining alveolar bone integrity in this clinical scenario. PURPOSE: Here it was hypothesized that OsteoScaf would reduce alveolar bone lost after tooth extraction in patient, acting as a clot-retention device. MATERIAL AND METHODS: A total of 10 patients (32 sockets) were included in the study, of which 16 sockets were grafted with OsteoScaf and 16 were used as control (coagulum alone). Cone beam computed tomography (CBCT) was performed both immediately following extraction and also at 120 days postoperatively, at which time biopsy samples were also harvested for histological analyses. RESULTS: Quantitative analysis of CBCT showed less bone resorption in the OsteoScaf groups, being 10.5% to 14.4% less bone lost in the center of the socket, 15.4% in the buccal region, and 12.6% in the palatal. Qualitative histological analysis showed new bone tissue in direct apposition to the scaffold - demonstrating its osteoconductive nature. CONCLUSION: OsteoScaf diminished the expected bone lost during the postextraction remodeling of the alveolar bone ridge at 120 days postextraction.

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PURPOSE: The aim of this paper was to study the healing of 1-1.4 mm wide buccal defects at implants placed immediately into extraction sockets (IPIES) filled with a mixture of synthetic hydroxyapatite (HA) 60% and beta-tricalciumphosphate (TCP) 40% or left with the clot alone and both covered with collagen membranes. MATERIAL AND METHODS: Eight Labrador dogs were used and implants were placed immediately into the extraction sockets of the first molar bilaterally. A mixture of synthetic HA 60% and beta-TCP 40% at the test or the clot alone at the control sites were used to fill the defects. All surgical sites were subsequently covered by a resorbable collagen membrane and a non-submerged healing was allowed. After 4 months, the animals were euthanized, biopsies harvested and processed for histomorphometric analysis. RESULTS: At the time of installation, residual buccal defects occurred that were 1.1 mm and 1.4 mm wide and 3 mm and 4 mm deep at the control and test sites, respectively. After 4 months of healing, the top of the bony crest and the coronal level of osseointegration were located respectively at 0.1 ± 1.8 mm and 1.5 ± 1.8 mm at the test, and 0.6 ± 1.6 mm and 1.2 ± 0.7 mm at the control sites apically to the implant shoulder. Bone-to-implant contact at the buccal aspect was 34.9 ± 25.9% and 36.4 ± 17.3% at the test and control sites, respectively. No statistically significant differences were found between test and control sites for any of the variables analyzed at the buccal aspects. CONCLUSIONS: The use of a mixture of synthetic HA 60% and beta-TCP 40% to fill residual buccal defects 1-1.4 mm wide at IPIES did not improve significantly the results of healing.

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The buccal alveolar wall represents the most important structure to provide shape and volume of the alveolous following tooth extraction. The aim of the study was the evaluation of buccal alveolar bone structures following minimally invasive surgery. In 15 patients (3 male, 12 female), aged 20­67 years, 3 central incisors, 5 lateral incisors, and 7 bicuspids were removed using flapless enucleation. The enucleation comprised endoscopically assisted mesiodistal root sectioning with inward fragmentation of the oral and apical parts followed by internal reduction of the buccal root lamella. Buccal bone height before extraction was 10.61 mm, following extraction 10.50 mm. Crestal width of the buccal bone plate was 1.11 mm before and 1.40 mm after tooth removal. Apical buccal bone width before was 0.66 mm and after extraction 0.40 mm. Gingival height was 13.58 mm before and 13.56 mm following extraction. Following transalveolar enucleation, the buccal alveolar bone wall remains unchanged concerning height and crestal width.

La pared alveolar bucal representa la estructura más importante para proveer la forma y el volumen de los alveólos dentales posterior a la extracción dental. El objetivo del estudio fue evaluar las estructuras de hueso alveolar bucal después de la cirugía mínimamente invasiva. En 15 pacientes (3 hombres, 12 mujeres), con edades entre 20 a 67 años, 3 incisivos centrales, 5 incisivos laterales y 7 premolares fueron removidos utilizando enucleación sin colgajo. La enucleación comprende el seccionamiento mesio-distal de la raíz dental endoscópicamente asisitido a través de fragmentación interna de la porción lingual y apical radicular y posteriomente una reducción interna de la lamela de raíz bucal. La altura ósea bucal antes de la extracción fue 10,61 mm y después de la extracción fue 10,50 mm. La anchura de la cresta ósea bucal fue 1,11 mm y 1,40 mm después de la extracción del diente. El grosor del hueso apical antes de la extracción fue 0,66 mm y 0,40 mm después de la extracción. La altura gingival fue 13,58 mm antes de la extracción y 13,56 mm después de la extracción. Después de la enucleación transalveolar, la pared del hueso alveolar bucal se mantiene sin cambios en relación con la altura y del grosor del reborde alveolar.

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OBJECTIVE: To evaluate dimensional alterations of the alveolar ridge that occurred following tooth extraction at sites grafted with Bio-Oss(®) Collagen. MATERIAL AND METHODS: Twenty-eight subjects with maxillary incisors, canines, and premolars scheduled for extraction were included. The tooth was carefully removed. The patients were randomly assigned to a test or a control group. In the test group patients, Bio-Oss(®) Collagen was placed in the fresh extraction socket while in the controls no grafting was performed. Radiographic examination (cone beam computed tomograms, CBCT) was performed immediately after tooth extraction and socket treatment. Four months later, a new CBCT was obtained. In the radiographs, (i) the distance (mm) between base of the alveolar process (apex) and the buccal and palatal crests was determined, (ii) the outer profile of alveolar process of the experimental sites was outlined, and the cross section of the area (mm(2) ) determined. RESULTS: After 4 months of healing, the buccal and to a less extent also the palatal bone plate had become markedly reduced in height. The placement of a biomaterial in the socket failed to prevent resorption of the buccal and palatal bone walls. The cross-sectional area of the control ridge was reduced about 25% and of the test ridge with 3%. CONCLUSION: The placement of a xenograft in fresh extraction sockets markedly counteracted the reduction in the hard tissue component of the edentulous sites.

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OBJECTIVE: Soft tissues and buccal bone plate remodeling after immediate implantation in sockets with thin buccal bone, using the flapless approach with or without bone graft into the buccal gap, was compared between sites with thin and normal gingiva. MATERIAL AND METHODS: Eight dogs had the gingiva of one side of the mandible thinned, the mandibular premolars were extracted without flaps, and 4 implants were installed in each side, positioned 1.5 mm from the buccal bone. The sites were randomly assigned into: TG (test group) = thin gingiva; TG + GM (TG with grafting material); CG (control group) = normal gingiva; and CG + GM (CG with grafting material). Buccal bone thickness (BBT), thickness of keratinized tissue (TKT), alveolar thickness (AT), gingival recession (GR), and probing depth (PD) were clinically evaluated. Within 12 weeks the dogs were sacrificed and the samples were analyzed by micro-computerized tomography. RESULTS: A thin BBT was observed in all the dogs. The presurgical procedures reduced TKT in the test group, with minimal changes of the AT. There were no statistically significant differences among the groups for the clinical parameters and the tomographic analysis showed similar linear and tri-dimensional bone reduction in all the groups. CONCLUSION: The thickness of the buccal bone was a fundamental factor in buccal bone plate resorption, even with flapless implantation. The decrease in gingival thickness or the addition of a biomaterial in the gap did not influence the results.

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OBJECTIVE: To compare with pristine sites bone resorption and soft tissue adaptation at implants placed immediately into extraction sockets (IPIES) in conjunction with deproteinized bovine bone mineral (DBBM) particles and a collagen membrane. MATERIAL AND METHODS: The mesial root of the third premolar in the left side of the mandible was endodontically treated (Test). Flaps were elevated, the tooth hemi-sectioned, and the distal root removed to allow the immediate installation of an implant into the extraction socket in a lingual position. DBBM particles were placed into the defect and on the outer contour of the buccal bony ridge, concomitantly with the placement of a collagen membrane. A non-submerged healing was allowed. The premolar on the right side of the mandible was left in situ (control). Ground sections from the center of the implant as well as from the center of the distal root of the third premolar of the opposite side of the mandible were obtained. The histological image from the implant site was superimposed to that of the contralateral pristine distal alveolus, and dimensional variation evaluated for the hard tissue and the alveolar ridge. RESULTS: After 3 months of healing, both histological and photographic evaluation revealed a reduction of hard and soft tissue dimensions. CONCLUSION: The contour augmentation performed with DBBM particles and a collagen membrane at the buccal aspects of implants placed IPIES was not able to maintain the tissue volume.

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BACKGROUND: Several approaches have been used to counteract alveolar bone resorption after tooth extraction. PURPOSE: The aim of the present study was to evaluate the influence of gingival thickness and bone grafting on buccal bone remodeling in extraction sockets with thin buccal bone, using a flapless approach. MATERIALS AND METHODS: The gingiva of 8 dogs was thinned at one side of the mandible and mandibular premolars were extracted without flaps. The sockets were randomly assigned to the test group (thin gingiva) (TG), the test group with grafting material TG + GM, the control group (normal gingiva) (CG), or the control group with grafting material CG + GM. Ground sections were prepared from 12-week healing biopsies, and histomorphometry and fluorescence analysis were performed. RESULTS: In the groups with thin gingiva, numerically greater buccal bone loss was observed, while there were no differences between grafted and nongrafted sites. A numerically higher rate of mineralization was observed for the grafted sites, as compared with the nongrafted sites, at 12 weeks. CONCLUSIONS: A thin buccal bone plate leads to higher bone loss in extraction sockets, even with flapless surgery. The gingival thickness or the use of a graft material did not prevent buccal bone resorption in a naturally thin biotype, but modified the mineralization process.

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Introdução: Após a exodontia, a cicatrização natural do alvéolo provoca alterações dimensionais no rebordo alveolar, com diminuição dos tecidos moles e duros. Diferentes técnicas podem ser utilizadas para tentar diminuir essas alterações, com a intenção de facilitar a reabilitação estética e funcional com implantes, principalmente em áreas de dentes anteriores. Objetivos: Os objetivos deste estudo foram verificar a eficácia da utilização do material de origem xenógena Orthogen® na preservação do rebordo alveolar pós-exodontia e avaliar as características histológicas após 4 meses de reparo. Materiais e Métodos: 20 pacientes foram divididos aleatoriamente em 2 grupos, de acordo com a abordagem que iriam receber após a exodontia de uma raiz residual. No grupo teste, os alvéolos foram preenchidos com Orthogen® e selados com EGL (Enxerto Gengival Livre). No grupo controle, um coágulo foi preservado no alvéolo e o mesmo também foi selado com EGL, sem a utilização do Orthogen®. Em ambos os grupos as exodontias foram realizadas de maneira minimamente traumática, com o Kit de Extração Atraumática Neodent®. Modelos de gesso obtidos antes das exodontias (tempo 1) e após 4 meses (tempo 2), momentos antes da instalação dos implantes, foram utilizadas para as medidas dimensionais, através do escanemento dos modelos e medidas no programa Orthoanalyzer®. Amostras ósseas obtidas após 4 meses de reparo foram utilizadas para a análise histológica descritiva. Resultados: Os resultados demonstraram que, após 4 meses de reparo alveolar, os dois grupos apresentaram remodelação do rebordo alveolar e diminuição nas medidas realizadas. Porém, a remodelação do rebordo foi mais evidente no grupo controle (coágulo). Histologicamente foi possível observar formação de novo osso ao redor das partículas do Orthogen®. Conclusões: A utilização do Orthogen® para preenchimento dos alvéolos e preservação do rebordo alveolar foi eficaz na diminuição das...

Introduction: After tooth extraction, the natural healing of the socket is followed by dimensional changes of ridge contour, with marked reduce of hard and soft tissues. Socket reservation techniques can be used to improve functional and esthetics of the dental implants in this areas, especially in anterior teeth areas. Objectives: The aims of this study are to verify the efficacy of use Orthogen® to ridge preservation and analysis the histological characteristics after 4 months repair of the sockets. Material and Methods: 20 patients were randomly distributed in 2 groups, according with the treatments. In test group, the sockets were filled with Orthogen® and closed with a gingival free graft. In control group, the clots were preserved into the socket and free gingival graft was sutured in the deepithelialized marginal tissue of the socket. Stone casts were used to analyze the ridge dimensional changes with the Orthoanalyzer® software. After 4 months, bone samples were obtained during the dental implant procedure and were used to describe the histological characteristics. Results: The results showed that, after 4 months of wound healing, both groups showed a decrease in the measurements. However, the remodeling of the ridge was most evident in the control group (clot). Histological images showed the formation of new bone around the Orthogen® particles. Conclusion: The use of Orthogen® to socket preservation can collaborate to reduce the dimensional changes of the hard and soft tissue in post-extraction alveolar ridge sites.

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RESUMO

Introdução: Após a exodontia, a cicatrização natural do alvéolo provoca alterações dimensionais no rebordo alveolar, com diminuição dos tecidos moles e duros. Diferentes técnicas podem ser utilizadas para tentar diminuir essas alterações, com a intenção de facilitar a reabilitação estética e funcional com implantes, principalmente em áreas de dentes anteriores. Objetivos: Os objetivos deste estudo foram verificar a eficácia da utilização do material de origem xenógena Orthogen® na preservação do rebordo alveolar pós-exodontia e avaliar as características histológicas após 4 meses de reparo. Materiais e Métodos: 20 pacientes foram divididos aleatoriamente em 2 grupos, de acordo com a abordagem que iriam receber após a exodontia de uma raiz residual. No grupo teste, os alvéolos foram preenchidos com Orthogen® e selados com EGL (Enxerto Gengival Livre). No grupo controle, um coágulo foi preservado no alvéolo e o mesmo também foi selado com EGL, sem a utilização do Orthogen®. Em ambos os grupos as exodontias foram realizadas de maneira minimamente traumática, com o Kit de Extração Atraumática Neodent®. Modelos de gesso obtidos antes das exodontias (tempo 1) e após 4 meses (tempo 2), momentos antes da instalação dos implantes, foram utilizadas para as medidas dimensionais, através do escanemento dos modelos e medidas no programa Orthoanalyzer®. Amostras ósseas obtidas após 4 meses de reparo foram utilizadas para a análise histológica descritiva. Resultados: Os resultados demonstraram que, após 4 meses de reparo alveolar, os dois grupos apresentaram remodelação do rebordo alveolar e diminuição nas medidas realizadas. Porém, a remodelação do rebordo foi mais evidente no grupo controle (coágulo). Histologicamente foi possível observar formação de novo osso ao redor das partículas do Orthogen®. Conclusões: A utilização do Orthogen® para preenchimento dos alvéolos e preservação do rebordo alveolar foi eficaz na diminuição...

Introduction: After tooth extraction, the natural healing of the socket is followed by dimensional changes of ridge contour, with marked reduce of hard and soft tissues. Socket reservation techniques can be used to improve functional and esthetics of the dental implants in this areas, especially in anterior teeth areas. Objectives: The aims of this study are to verify the efficacy of use Orthogen® to ridge preservation and analysis the histological characteristics after 4 months repair of the sockets. Material and Methods: 20 patients were randomly distributed in 2 groups, according with the treatments. In test group, the sockets were filled with Orthogen® and closed with a gingival free graft. In control group, the clots were preserved into the socket and free gingival graft was sutured in the deepithelialized marginal tissue of the socket. Stone casts were used to analyze the ridge dimensional changes with the Orthoanalyzer® software. After 4 months, bone samples were obtained during the dental implant procedure and were used to describe the histological characteristics. Results: The results showed that, after 4 months of wound healing, both groups showed a decrease in the measurements. However, the remodeling of the ridge was most evident in the control group (clot). Histological images showed the formation of new bone around the Orthogen® particles. Conclusion: The use of Orthogen® to socket preservation can collaborate to reduce the dimensional changes of the hard and soft tissue in post-extraction alveolar ridge sites...

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