Evaluation of healing at molar extraction sites with ridge preservation using a non-resorbable dense polytetrafluoroethylene membrane: A four-arm cohort prospective study.

OBJECTIVES: To examine ridge dimensional changes and histologic parameters of healing when ridge preservation (RP) was performed at molar sites using dense polytetrafluoroethylene (dPTFE) membrane alone, without a bone graft. MATERIAL AND METHODS: Eighteen patients had molar extraction and RP using dPTFE membrane alone. Ridge dimensions were measured using two standardized cone beam computerized tomography (CBCT) scans taken within 72 h and 3 months following extraction. Following a 3-month healing period, an implant osteotomy was prepared using a trephine drill and bone cores were collected for histological analysis. Four-arm analyses were performed using data from three previously published study arms of the same research group. RESULTS: There was a significant change in the buccal ridge height between the four groups at all aspects of the socket. Alveolar ridge width reduction at 3 mm from crest for all aspects (mesial, midpoint, distal) of the socket showed statistically significant difference for dPTFE alone group compared to the other three groups. Percentage of vital bone formation (62.10%) was significantly greater in dPTFE alone group compared to the other groups. CONCLUSIONS: RP using dPTFE membrane alone in molar sites with intact socket walls showed successful outcomes in maintaining ridge dimensions and in histologic wound healing.

Healing at Molar Extraction Sites Using Freeze-Dried Bone Allograft and Collagen Wound Dressing: Case Series and Three-Arm Analyses.

PURPOSE: Ridge preservation limits dimensional changes after tooth extraction. However, it is still unclear if using a membrane may be advantageous over a collagen wound dressing. Therefore, the goal of this report was to evaluate the outcomes of ridge preservation using freeze-dried bone allograft with a collagen wound dressing. MATERIALS AND METHODS: This study included 21 patients who had one molar extracted, and the site received ridge preservation using freeze-dried bone allograft and a collagen wound dressing (test 2 group). Patients had two standardized cone beam computed tomography (CBCT) scans, taken within 72 hours and 3 months after extraction, to measure changes in ridge height and width, and buccal and lingual plate thicknesses. Changes in keratinized tissue width were recorded. Three-arm analyses were performed using historic data from a previous randomized controlled trial by the same study group, in which 20 molar sites received a collagen wound dressing alone (control) and 20 received ridge preservation with freeze-dried bone allograft and a dense polytetrafluoroethylene membrane (test 1) using the same methodology. RESULTS: There was a statistically significant difference in mean buccal ridge height changes between the control group (2.6 ± 2.06 mm) and test 2 group (1.55 ± 0.93 mm) but no difference in ridge and keratinized tissue width changes between groups. No correlation was found between buccal plate thickness and ridge width change. CONCLUSION: Freeze-dried bone allograft with collagen wound dressing as a barrier was used successfully for ridge preservation in intact molar extraction sites (< 50% bone loss) and can be considered as a treatment alternative to freeze-dried bone allograft with a dense polytetrafluoroethylene membrane.

Thickness of the Buccal Plate in Posterior Teeth: A Prospective Cone Beam Computed Tomography Study.

Buccal plate thickness is an important clinical parameter for postextraction implant treatment planning. The purpose of this study was to assess buccal plate thickness of the posterior maxilla and mandible using cone beam computed tomography (CBCT). A total of 265 patients and 934 teeth met the inclusion criteria for this study. CBCT volumes were taken and aligned for measurement at the ideal midsagittal cross-section. Buccal plate thickness was measured at 1, 3, and 5 mm apical to the alveolar crest. The frequency of thick (≥ 1 mm), thin (< 1 mm), and radiographic absence of the buccal plate were determined. The frequency of thin buccal plate decreases from anterior to posterior, with first premolars and first molar mesial roots most affected. Radiographic absence of the buccal plate was more common in the mandible, at first premolars, and among women. Thin and absent buccal plate are not uncommon in the posterior jaws; consequently, ridge preservation may be indicated even at posterior teeth.

Evaluation of Healing at Molar Extraction Sites With and Without Ridge Preservation: A Randomized Controlled Clinical Trial.

BACKGROUND: To date, limited evidence is available specifically evaluating ridge preservation (RP) and implant placement in molar sites. The primary aim of this study is to radiographically compare alveolar ridge changes with and without RP with cone-beam computed tomography (CBCT). METHODS: This parallel, two-arm randomized clinical trial included 40 patients evenly distributed between two treatment groups. After molar extraction, sites were allowed to heal naturally or received RP with freeze-dried bone allograft covered by a non-resorbable dense polytetrafluoroethylene membrane. CBCT scans were taken immediately and 3 months postextraction, and then a dental implant was placed. Width and height measurements were made radiographically. RESULTS: Significantly greater loss in alveolar ridge height was found in molar sites allowed to heal without RP on the buccal aspect of the socket (RP: -1.12 ± 1.60 mm versus no RP: -2.60 ± 2.06 mm, P = 0.01). No significant difference in ridge width loss was found between groups. Two-thirds ridge width reduction was experienced on the buccal aspect in sites without RP, but width loss was evenly distributed between buccal and lingual aspects when RP was performed. Bone grafting at time of placement was required in 25% of implants in the group without RP versus 10% of implants in the RP group. CONCLUSIONS: In molar extraction sites without RP, significantly more reduction in ridge height occurred, and the majority of ridge width loss was localized to the buccal aspect. When RP was performed, ridge width loss was not significantly decreased, but the loss was evenly distributed between facial and lingual aspects of the extraction site.

A cone beam computed tomography (CBCT) study of buccal plate thickness of the maxillary and mandibular posterior dentition.

BACKGROUND: Buccal plate thickness is of clinical importance in treatment planning for implants. The purpose of this study was to evaluate the buccal plate thickness in posterior dentate areas of both the maxilla and mandible using cone beam computed tomography in order to estimate the approximate distributions of this anatomic variable. METHODS: Two hundred and sixty-five subjects were included for a total of nine hundred and thirty-four roots assessed by cone beam computed tomography. CBCT scans were taken and evaluated at the ideal buccolingual cross-sections of each root at 1 mm, 3 mm, and 5 mm apical to the alveolar crest to measure buccal plate thickness. Data are reported by geometric means and 95% confidence intervals. RESULTS: Both arches demonstrated increasing buccal plate thickness from anterior to posterior. Maxillary teeth had a significant decrease in thickness from coronal to apical along the tooth root (P < 0.001), except at second molars. The first premolar and mesial root of the first molar were significantly thinner than all other roots in the maxilla. Conversely, the mandible demonstrated a significant increase in buccal plate thickness from coronal to apical (P < 0.001). The premolars were significantly thinner than all other roots. Age and sex were found to have limited impact on buccal plate thickness in both arches. CONCLUSIONS: Buccal plate thickness is highly dependent upon the arch position, tooth location, and measurement point, but age and sex have limited impact.

Relationship between clinical periodontal biotype and labial plate thickness: an in vivo study.

The primary aim of this study was to evaluate the differences in labial plate thickness in patients identified as having thin versus thick/average periodontal biotypes. The association between biotype and labial plate thickness was evaluated by correlating information obtained from cone beam computed tomographs, diagnostic impressions, and clinical examinations of the maxillary anterior teeth (canine to canine) in 60 patients. Compared to a thick/average biotype, a thin biotype was associated with thinner labial plate thickness (P < .001), narrower keratinized tissue width (P < .001), greater distance from the cementoenamel junction to the initial alveolar crest (P = .02), and probe visibility through the sulcus. There was no relationship between biotype and tooth height-to-width ratio or facial recession. Periodontal biotype is significantly related to labial plate thickness, alveolar crest position, keratinized tissue width, gingival architecture, and probe visibility but unrelated to facial recession.

The effect of ultrasound on bone dimensional changes following extraction: a pilot study.

BACKGROUND: Because of bone resorption following tooth extraction, preservation of adequate bony dimension is performed often for subsequent treatment with dental implants. This study evaluated a novel, non-invasive treatment using ultrasound to accelerate healing following extraction to minimize alveolar bone loss. The objective of this study was to evaluate the effect of ultrasound on the dimensional healing changes of alveolar bone following tooth extraction using cone-beam volumetric tomography (CBVT). METHODS: This randomized, split-mouth trial involved 12 subjects requiring extraction of two contralateral erupted permanent teeth. Baseline CBVT scans were captured 7 to 10 days following extraction, after which time ultrasound therapy commenced in test sites. Ultrasound therapy was delivered for 20 minutes using a piezoelectric transducer for 10 sessions over the subsequent 4 weeks. Follow-up radiographic scans were obtained at 4 weeks and 3 months postextraction. Analyses of variance and covariance were performed to assess dimensional changes over the 3-month healing period. RESULTS: Analysis of dimensional changes in all measures of vertical height and horizontal width demonstrated no statistically significant differences between the ultrasound and control groups from baseline to 3 months postextraction. Evaluation of correlations between dimensional changes demonstrated a moderately strong correlation (r = 0.67; P = 0.023) in the ultrasound group between the change in buccal vertical height and the baseline crestal ridge width. Analysis of the change in buccal vertical height relative to baseline crestal width demonstrated a statistically significant benefit to ultrasound compared to control (P = 0.016). This benefit was more pronounced in wider sockets compared to narrow sockets. CONCLUSIONS: In this pilot study, there was no significant benefit to ultrasound in absolute bony dimensional changes following tooth extraction. There was a significant interaction between the treatment rendered (ultrasound versus control) and the change in buccal ridge height relative to baseline ridge width at the crest and 3 mm apical to the crest. This benefit was apparent in wide sockets compared to narrow sockets; however, the clinical importance of these relative dimensional changes in the ultrasound group are difficult to determine given the inclusion of all tooth types in a pilot study with a small sample size.

A clinical comparison of a bovine-derived xenograft used alone and in combination with enamel matrix derivative for the treatment of periodontal osseous defects in humans.

BACKGROUND: Enamel matrix protein derivative (EMD) and particulate anorganic cancellous bovine-derived bone xenograft (BDX) have both shown favorable clinical results in reducing intrabony periodontal defects as compared to open flap debridement alone. These materials have shown results comparable to those obtained with guided tissue regeneration. The primary aim of the present study was to evaluate the effectiveness of EMD combined with BDX as compared to BDX alone, with a secondary aim to compare the treatment outcomes of the 2 modalities. METHODS: Seventeen patients with paired intrabony defects and probing depths measuring > or = 5 mm who were being treated for chronic periodontitis were selected for this controlled, blinded, split-mouth study. Following non-surgical periodontal therapy, sites were randomly selected to receive either a combination of EMD and BDX (test group) or BDX alone (positive control group). Baseline and 6-month surgical reentry measurements were taken by a calibrated examiner blinded to the treatment. A paired Student t test was utilized to evaluate differences between baseline and post-treatment and between the treatment groups. RESULTS: Favorable clinical outcomes for both hard and soft tissue measurements were achieved for both treatment groups when compared to baseline (P < 0.001). There was no statistically significant difference for any of the measured clinical parameters. Probing depth reduction for the test group and control group was 4.2 +/- 1.1 mm and 3.9 +/- 1.3 mm, respectively (P > 0.8). Mean gain in clinical attachment levels for the test and control groups was 3.8 +/- 0.9 mm and 3.7 +/- 1.5 mm, respectively (P > 0.6). Hard tissue measurements obtained at surgical reentry were used to calculate the bone fill (BF) and percent bone fill (%BF). The BF was 3.2 +/- 1.4 mm and 3.0 +/- 1.2 mm (P > 0.6), and the %BF was 63.3 +/- 16.3% and 67.0 +/- 19.0% (P > 0.4) for the EMD + BDX and BDX groups, respectively. CONCLUSIONS: In summary, both the particulate anorganic cancellous bovine-derived bone xenograft used alone and in combination with enamel matrix derivative are effective for the treatment of human intrabony periodontal lesions.