The effects of sodium alendronate on socket healing after tooth extraction: a systematic review of animal studies

Abstract The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE's RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.

Dental implants placed buccally to the mandibular canal in molar regions with severe vertical bone loss: case reports

Introduction: Alveolar bone loss in posterior regions of the mandible is a serious limiting factor for the installation of osseointegrated dental implants. New surgical procedures are needed to circumvent the lack of vertical bone. Objective: The objective of this study was to present an alternative technique for dental implants in the lateral posterior region of the mandible in patients with severe vertical ridge atrophy Case Reports: Four patients with the specific anatomical characteristics that met the requirements of the technique were selected. Six implants were inserted buccally to the mandibular canal and were restored after at least two months of healing time. The mean follow up period of the implants was 3 years. No implant was lost during this time. All of them remained in excellent clinical condition and met the aesthetic criteria and functional demands of occlusion. Conclusion: The technique presented here proved to be minimally invasive, safe, conservative and effective as an alternative treatment option for dental rehabilitation in mandibular posterior regions with severe bone atrophy. However, it requires experience, preparation and skill of the professional in order not to damage the inferior alveolar nerve and at the same time install the implant in the correct position, thus allowing its functional and aesthetic rehabilitation.

Introdução: A perda óssea alveolar severa em região posterior de mandíbula é um sério fator limitante para instalação de implantes dentários osseointegráveis. Novas técnicas cirúrgicas são necessárias visando contornar a falta de osso vertical. Objetivo: O objetivo deste estudo foi apresentar uma técnica alternativa de inserção de implante dentário na região posterior lateral da mandíbula em pacientes com atrofia vertical severa de rebordo alveolar. Relatos de casos : Foram selecionados 4 pacientes com características anatômicas específicas que atendiam aos requisitos da técnica. Seis implantes foram instalados lateralmente ao canal mandibular por vestibular e foram restaurados após o tempo de cicatrização de pelo menos dois meses. A média da avaliação de seguimento do implante foi de 3 anos. Nenhum implante foi perdido e todos eles atenderam às exigências estéticas e funcionais da oclusão, estando em ótimas condições clínicas. Conclusão: A técnica mostrou-se minimamente invasiva, segura, conservadora e eficaz como alternativa de tratamento para reabilitação dentária em regiões posteriores de mandíbula com atrofia óssea severa. Entretanto, ela requer experiência, preparo e habilidade do profissional que visa não lesionar o nervo alveolar inferior e, ao mesmo tempo, instalar corretamente o implante em uma posição que permita sua restauração funcional e estética.

A guia anterior no estudo da oclusäo / Anterior guidance in the study of occlusion

A guia anterior é a relaçäo dinâmica do contorno lingual dos seis dentes antero-superiores sobre as bordas dos seis antero-inferiores quando estes se tocam na oclusäo cêntrica e durante os movimentos protrusivos, laterais ou látero-protrusivos normalemnte observada na dentiçäo natural. As quatro funçöes da guia anterior säo a incisäo de alimentos, fonética, estética e proteger os dentes posteriores pela desoclusão posterior que realiza durante a mastigaçäo. Dada a sua importância, os autores apresentam vários aspectos importantes da guia anterior no estudo da oclusäo, justificando porque ela seja talvez o fator mais importante na reconstruçäo total ou parcial do sistema estomatognático