A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Management Comparing a Wound Dressing and a Soft Tissue Substitute.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

Retrospective Study to Determine Patient Satisfaction of Immediately Placed and Provisionalized Implants in the Esthetic Zone From a US Private-Practice Research Network.

BACKGROUND: Immediately placed/immediately restored dental implants in the esthetic zone are judged by not only their functional success but also the appearance and acceptance of the restorative outcome. The purpose of this study was to retrospectively evaluate in a private-practice setting the satisfaction of both patients and doctors regarding immediately placed/immediately restored implants in the esthetic zone. METHODS: The author group consists of nine board-certified periodontists. Each private practice contributed to the patient population of this study through a primarily referral-based source. In a 6-month period, practices evaluated patients who were candidates for dental implant replacement with teeth Nos. 5 through 12 scheduled for extraction. All patients received informed consent and were asked if their data could be used with a visual analog scale (VAS) they graded. Pretreatment and 6-month post-final restoration loading was compared for statistically significant changes in reference to crestal bone changes, papilla index score (PIS), facial gingival margin stability (FGMS), and investigator/patient esthetic evaluations using a VAS. RESULTS: Thirty-five patients were included in the study with a total of 35 implants placed and 32 restored with a final restoration. Implants were followed for an average of 15.4 months prior to reporting. A total of three failures were encountered. The PIS resulted in an average score of 2.7. VAS resulted in an average score of 9.3 by the surgeons and 9.5 by the patients. The FGMS accounted for 76% of the implants with no change, 15% demonstrating recession, and 9% demonstrating coronal migration. CONCLUSIONS: Immediately placed and immediately temporized implants in the esthetic zone demonstrated a successful outcome that was highly acceptable to patients in private-practice settings from a diverse group of private periodontal practices.

A randomized, controlled, multicentre clinical trial of post-extraction alveolar ridge preservation.

AIM: To compare the effectiveness of two-ridge preservation treatments. MATERIALS AND METHODS: Forty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross-linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post-operatively, and biopsies were retrieved for histomorphometric analysis at 6 months. RESULTS: Primary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty-seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites. CONCLUSION: DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.

A Review of the Positive Influence of Crown Contours on Soft-Tissue Esthetics.

Successful crown restorations duplicate the natural tooth in hue, chroma, value, maverick colors, and surface texture. Equally important is the visual harmony of the facial and proximal soft-tissue contours, which requires the collaborative skills of the restorative dentist, periodontist, and dental technician. The treatment team must understand the biologic structures adjacent to natural dentition and dental implants. This report describes the potential for specifically designed restorative contours to dictate the optimal gingival profile for tooth-supported and implant-supported crowns. Showing several cases, the article explains how esthetic soft-tissue contours enhance the definitive crown restoration, highlights the importance of clinical evaluation of adjacent biologic structures, and discusses keys to predicting when the proximal papilla has the potential to return to a favorable height and shape.