The Socket Shield Technique: Stability of the Buccal Peri-implant Bone after Partial Root Removal - A Prospective Case Series of 20 patients, with 18 Months Follow-up.

OBJECTIVE: This study aims to collect data on implant survival, bone volume maintenance, and complications associated with the socket shield technique. BACKGROUND DATA: The socket shield technique was introduced in 2010. Since then, several systematic reviews have been published, showing good clinical outcomes. The behaviour of the buccal bone plate is so far not completely understood. METHODS: The study involved the placement of 23 implants using the socket shield technique in 20 patients. AstraTech EV implants were used, and no bone substitutes or connective tissue grafts were applied. Patients were monitored for 18 months, recording implant survival, volumetric bone analysis on CBCT scans, interproximal bone levels, bone sounding, pink esthetic scores, and complications. Prosthetic procedures were also described, including temporary and final restorations. RESULTS: A 95.7% cumulative 18-month implant survival rate was obtained using the socket shield technique, with a significant but limited reduction in buccal bone thickness (BBT) after implant placement. One implant did not integrate and two shields were partially exposed. The mean pink esthetic score, 1 year after loading was 12.93 ± 1.22. CONCLUSION: The study suggests that the socket shield technique can result in limited reduction of the buccal bone volume, with a high implant survival rate. Re-entry studies are recommended to investigate the causes of bone resorption.

Mass Spectrometry-Based Proteomics of Poly(methylmethacrylate)-Embedded Bone.

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a widely employed technique in proteomics research for studying the proteome biology of various clinical samples. Hard tissues, such as bone and teeth, are routinely preserved using synthetic poly(methyl methacrylate) (PMMA) embedding resins that enable histological, immunohistochemical, and morphological examination. However, the suitability of PMMA-embedded hard tissues for large-scale proteomic analysis remained unexplored. This study is the first to report on the feasibility of PMMA-embedded bone samples for LC-MS/MS analysis. Conventional workflows yielded merely limited coverage of the bone proteome. Using advanced strategies of prefractionation by high-pH reversed-phase liquid chromatography in combination with isobaric tandem mass tag labeling resulted in proteome coverage exceeding 1000 protein identifications. The quantitative comparison with cryopreserved samples revealed that each sample preparation workflow had a distinct impact on the proteomic profile. However, workflow replicates exhibited a high reproducibility for PMMA-embedded samples. Our findings further demonstrate that decalcification prior to protein extraction, along with the analysis of solubilization fractions, is not preferred for PMMA-embedded bone. The biological applicability of the proposed workflow was demonstrated using samples of human PMMA-embedded alveolar bone and the iliac crest, which revealed anatomical site-specific proteomic profiles. Overall, these results establish a crucial foundation for large-scale proteomics studies contributing to our knowledge of bone biology.

Endodontic management of submerged roots following complicated traumatic dental injury (TDI) in children and adolescents: A systematic review.

INTRODUCTION: The International Association of Dental Traumatology (IADT) guidelines include the use of decoronation for the management of complex crown-root fractures but do not outline how this technique is best employed. The aim of this review is to reach a consensus in the management of the root canal system in decoronated permanent teeth undergoing root submergence and to determine whether this has an impact on the success and survival of the retained root. MATERIALS AND METHODS: Search included databases MEDLINE via Ebsco, EMBASE via Ovid, Web of Science via Clarivate, PubMed via PubMed.gov, the Cochrane Library via Wiley, cited reference searching and hand searching of relevant journals. Two independent reviewers performed study selection, data extraction and risk of bias assessment using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS AND DISCUSSION: In total, 18 articles were included in qualitative analysis: 17 of these were case reports and one case series. A total of 37 teeth were treated with decoronation either using the Malmgren or an alternative protocol (root submergence following endodontic treatment with gutta-percha [GP] or a calcium silicate cement and vital root submergence). Limited evidence from this review suggests that immediate decoronation and vital root submergence are successful in apexogenesis and preserving alveolar bone. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: registration number CRD42022316266).

Subsidence analysis of a cementless short stem THA using EBRA-FCA - A seven-year prospective multicentre study.

Background: Metaphyseal fixation of short stem THA allows for minimally invasive surgery, less bone removal, improved bone load transfer and reduced stress shielding. Short stems facilitate the anatomic restoration i.a. of leg length, femoroacetabular offset, and center of rotation. However, metaphyseal fixation might cause impaired primary and/or secondary stability resulting in an inherent tendency for early axial migration and aseptic loosening eventually. The objective of this study was to investigate the long-term outcome and migration pattern of a calcar-guided short stem. Methods: In a prospective multicenter study, 213 patients (224 THAs) were enrolled. Patients were followed for up to 84 months postoperatively. Clinical outcome was assessed using the Harris Hip Score and the VAS for pain and satisfaction. Standardized and calibrated radiographs were screened i.a. for stress shielding and loosening. Einzel-Bild-Roentgen-Analyse - femoral component analysis (EBRA-FCA) was used to detect longitudinal subsidence. Results: At 7 year follow-up, n = 139/224 cases were available for analysis. All clinical parameters improved significantly (p < 0.001) and improvement persisted. There were no radiographic changes indicating stress shielding. EBRA-FCA revealed a mean subsidence of -1.44 mm followed by a stabilization. Weight >80 kg (p = 0.115), BMI <30 kg/m2 (p = 0.282), male gender (p = 0.246), and age <65 years (p = 0.304) seemed to be associated with a higher risk for migration. The cumulative revision rate was 2.23%. Revisions due to stem migration (0.89%) occurred early (mean time between index surgery and revision: 3.3 months). Conclusions: If at all, there appears to be a pronounced initial subsidence, which stabilizes thereafter. Stem migration was rarely a compelling reason for failure or revision. Demographics do not seem to have a significant effect on migration pattern. The absence of radioluce lines, resorption or hypertrophy of the proximal femora support the hypothesis of a reduced stress shielding for metaphyseal anchoring short stems.

Evaluation of human growth hormone (somatropin) in socket healing: a split-mouth randomized controlled trial.

Techniques for preserving alveolar bone after tooth extraction are becoming a part of the usual clinical practice of clinicians. These techniques aim at minimizing postextraction bony resorption, hence, minimizing subsequent follow-up for implant insertion. This randomized clinical study aimed to measure and compare alveolar bone and soft tissue healing between extraction sockets treated with somatropin to untreated sockets. Methods: The study is designed as a split-mouth randomized clinical trial. The selected patients were indicated for bilateral symmetrical tooth extraction, where each patient had an indication to extract two symmetrical teeth in anatomy and number of roots. Somatropin was applied to the tooth socket of the randomly selected side after tooth extraction by gel foam, and the control side was filled with gel foam only. A clinical follow-up of the soft tissue was done 7 days after tooth extraction to evaluate clinical aspects of the healing process. Radiographic follow-up was performed using a cone-beam computed tomography scan to assess volumetric changes of alveolar bone in the extraction area prior to and 3 months after the surgical procedure. Results: A total of 23 patients (aged 29.1±9.5 years) participated. The results showed a statistically significant association between somatropin application and better preservation of the bony dimensions of the alveolar ridge. Bone loss was -0.691±0.628 mm for the buccal plate on the study side compared to -2.008±1.175 mm on the control side. The level of the lingual/palatal plate bone loss was -1.052±0.855 mm on the study side compared to -2.695±1.878 mm on the control side. The bone loss of alveolar width was -1.626±1.061 mm on the study side compared to -3.247±1.543 mm on the control side. The results also showed better healing of covering soft tissues (P<0.05), as well as bone density in the socket where somatropin was applied, which has been statistically significant. Conclusion: The data from this study demonstrated that the application of somatropin in tooth sockets postextraction showed an effective contribution to reducing alveolar bone resorption and improving bone density following extraction, in addition to better healing of covering soft tissue.

Frozen Stored Teeth: Autogenous Dentin as an Alternative Augmentation Material in Dentistry.

Tooth Shell Technique (TST) with the use of autologous dentin has proven to be a suitable method of grafting in the context of lateral ridge augmentation. This present feasibility study aimed to retrospectively evaluate the preservation by lyophilization of processed dentin. Thus, the frozen stored processed dentin matrix (FST: 19 patients with 26 implants) was re-examined with that of processed teeth used immediately after extraction (IUT: 23 patients with 32 implants). Parameters of biological complications, horizontal hard tissue loss, osseointegration, and buccal lamella integrity were used for evaluation. For complications, the observation period was 5 months. Only one graft was lost (IUT group). In the area of minor complications, without the loss of an implant or augmentation, there were two cases of wound dehiscence and one case with inflammation and suppuration (IUT: n = 3, FST: n = 0). Osseointegration and integrity of the buccal lamella were present in all implants without exception. Statistically, there was no difference between the groups studied for the mean resorption of the crestal width and the buccal lamella. Results of this study show that prepared autologous dentin preserved with a conventional freezer had no disadvantage compared to immediately use autologous dentin in terms of complications and graft resorption in the context of TST.

Early Clinical and Radiographic Outcomes of Total Hip Arthroplasty with DELTA ST-C Cup and MINIMA S Stem.

Background and Objectives: The uncemented threaded DELTA ST-C cup was introduced in last few years. It has a hemispheric shell, consisting of Ti6Al4V titanium alloy. The MINIMA S stem was developed according to the principles of proximal-loading and extended metaphyseal geometry applied to a short stem. The purpose of the study was to assess the clinical and radiographic outcomes and the short- and mid-term survivorship of the DELTA ST-C cup and MINIMA S stem in patients undergoing total hip arthroplasty (THA). The present is the first study to report outcomes and implant survivorship of the DELTA ST-C cup coupled with the MINIMA S femoral stem. Materials and Methods: The present study is a retrospective observational cohort study of a prospectively maintained database, evaluating clinical outcomes and implant survivorship in 95 patients undergoing THA with the MINIMA stem coupled with the DELTA ST-C cup with at least a 3-year follow-up. The clinical evaluation was assessed with a change in the Harris hip score (HHS), while the radiographic evaluation included anteroposterior views of the pelvis and lateral views of the affected hip. Results: The enrolled population's mean age was 69.3 years and most patients were female (64%). The MINIMA S standard stem was implanted in 68 patients (72%), the lateralized stem was implanted in 27 (28%), and the mean acetabular inclination was 48.2°. The HHS improved significantly from the preoperative value (median 46, IQR: 38-55), already at 1 month after surgery (median 76, IQR: 66-77), reaching excellent results at 1 year and 3 years postoperatively (median 96, IQR: 91-100). X-rays demonstrated good implant stability and biomechanics parameter restorations revealed no sign of subsidence, and the presence of radiolucent lines greater than 2 mm in the short stem area in five cases and in the acetabulum in one were not clinically significant. No revisions have been performed so far. Conclusions: The MINIMA S stem coupled with the DELTA ST-C cup demonstrated very good clinical and radiological results with a significant increase of the Harris hip score at short- and mid-term follow-up. This is the first study evaluating the DELTA ST-C cup, showing promising outcomes during the study's follow-up. The MINIMA S stem has been evaluated in a very few studies. However, the combination with this particular cup had not yet been studied. The design of the stem and the cup ensures primary stability and excellent early term outcomes, moreover the study demonstrates extraordinary implant survivorship, equal to 100%.

Downsizing and minimising medialisation of the acetabular component: Novel technique to preserve bone in THA.

Standard practice for acetabular component placement in total hip arthroplasty (THA) is to medialise the acetabular component. Bone preservation techniques during primary THA are beneficial for possible future revisions. The goal of this study is to examine the effect of downsizing and minimising medialisation of the acetabular component on bone resection volume. The volume of bone resected during acetabular preparation for different sizes of components was calculated and the volume of bone preserved by downsizing the cup was determined. Minimising medialisation of the acetabular component by 1-3 mm from the true floor was calculated. Absolute values and percentage of bone volume preserved when acetabular components are downsized or less medialised is presented. Downsizing the acetabular component by one size (2 mm) preserves between 2.6 cm3 (size 40 vs 42) and 8.4 cm3 (size 72 vs 74) of bone volume and consistently reduces resected bone volume by at least 35% (range 35.2%-37.5%). Similarly, reducing medialisation of a 56 mm acetabular cup (as an example of a commonly implanted component) by 3 mm reduces bone loss by 5.9 cm3- 44% less bone volume resection. Downsizing and minimising medialisation of the cup in THA substantially preserves bone which may benefit future revision surgeries. Surgeons could consider implanting the smallest acceptable acetabular shell to preserve bone without compromising on head size.

A promising era of immediate esthetic rehabilitation.

The extraction of a tooth in the anterior region can result in resorption of alveolar bone around the socket, especially the buccal bone leading to horizontal as well as vertical bone loss. This makes rehabilitation in the anterior region an esthetically complex situation. To preserve the buccal bone, the root is bisected and buccal two-thirds is preserved in the socket. This is called socket shield technique. Immediate implant placement and immediate provisionalization yield an esthetically pleasing and more acceptable outcome.

Short Stems and Stemless Shoulder Arthroplasty: Current Concepts Review.

Historically, the shoulder arthroplasty humeral component has been designed for the management of infections, tumours and fractures. In all these cases the stem was needed as a scaffold. Original humeral components were not developed for use in shoulder arthritis, so these designs and derivates had a long stem. The newest humeral implants innovations consist in shortening of the implant, or even removing the whole stem, to rely on stemless fixation at the level of the metaphysis. This implies the advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, easier implant removal at revision, and humeral component placement independent from the humeral diaphyseal axis. Nowadays, surgeons try to balance the need for a stable fixation of the humeral component with the potential need for revision surgery. Complications of revision shoulder arthroplasty are related to the need for removing a well-fixed humeral stem, the length of the procedure, and the need to treat severe bone loss.

An updated review of the effects of eicosapentaenoic acid- and docosahexaenoic acid-derived resolvins on bone preservation.

Resolvins are biosynthesized from omega-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in vivo by means of enzymatic activities, and these factors can attenuate inflammation and promote tissue regeneration. Inflammatory bone disorders can lead to bone loss and thereby be harmful to human health. The link between bone preservation and resolvins has been discussed in some experimental studies. Significant evidence has shown that resolvins benefit bone health and bone preservation by promoting the resolution of inflammation and directly regulating osteoclasts and osteoblasts. Therefore, this review highlights the role and beneficial impact of resolvins derived from EPA and DHA on inflammatory bone disorders, such as rheumatoid arthritis and periodontitis. In addition, the mechanisms by which resolvins exert their beneficial effects on bone preservation have also been summarized based on the available literature.

Bone Preservation in Total Hip Arthroplasty.

BACKGROUND: Preserving bone stock in younger and more active patients after total hip arthroplasty (THA) is important for future revision. Newer prosthesis designs, including short femoral stems and isoelastic acetabular cups, are likely to preserve more bone stock. However, long-term follow-up studies on bone remodeling after short-stem THA with an isoelastic monoblock acetabular cup are few. Therefore, we evaluated bone preservation after THA using these prostheses at a 5-year follow-up. METHODS: This prospective observational study is a 5-year follow-up of our previously reported 2-year observational study on the same cohort of patients. We included 45 patients with primary osteoarthritis treated with a calcar-guided femoral short-stem prosthesis and a monoblock press-fit acetabular cup. We evaluated bone mineral density (BMD) around the prostheses using dual-energy X-ray absorptiometry and reported functional outcomes preoperatively and at 3, 12, 24, and 60 months postoperatively. All complications were recorded. RESULTS: At the final follow-up, the BMD was comparable with that at 24 months in Gruen zones 3, 4, 5, 6, and 7, whereas it significantly differed in Gruen zones 1 (P < .0001) and 2 (P < .004). On the acetabular side, the BMD leveled off similarly in all DeLee and Charnley zones between 24 and 60 months (P > .05). Moreover, all measured clinical outcomes significantly improved (P < .001). One perioperative dislocation was reported. CONCLUSION: Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.

Pink esthetic and radiological scores around immediate implants placed in the esthetic zone - Socket-Shield Technique versus Immediate Conventional Technique: A Pilot Study.

OBJECTIVE: It is irrefutable that the extraction of teeth inextricably results in definitive changes in the surrounding hard and soft tissues. Recently, Socket-Shield Technique (SST) has been used to keep the buccal two-third of the root intact in the socket. This buccal shield further preserves the periodontium-bundle bone complex and hence preserves the buccal hard and soft tissue. The purpose of the study was to do a statistical comparative analysis of two different types of flapless and graftless techniques using the esthetic (Pink Esthetic Index) and radiological parameters. MATERIALS AND METHODS: A total of thirty nonrestorable tooth/root stumps (vital or nonvital) were selected and randomly allocated to two different groups: control group with immediate conventional implant placement (without SST) (Group C, n = 15) and test group with immediate implant placement using SST (Group S, n = 15). All of the sites received immediate chairside temporaries. All implants were restored either with screw- or cement-retained prostheses 4 months postoperative. Each control and test group was analyzed at two different durations: 15 days after placement of provisional and 15 days after placement of definitive prosthesis. Five parameters of Pink Esthetic Score (PES) were used for esthetic analysis, and digital periapical radiographs were used for radiographic analysis. RESULTS: Within the time frame of the study (15 days postplacement of definitive prosthesis), a statistically significant difference (p < 0.05) was observed between PES of the two techniques. Test group S (mean = 9.07) showed better scores than control group C (mean = 6.87). It was observed that buccal bone was maintained in all the cases of test group S while there was loss of buccal bone in almost all the cases of control group C. CONCLUSION: Within the limitations of this short-term pilot study, better soft-tissue parameters were observed with SST as compared to a conventional graftless technique whenever a restoration on immediate implant placement is considered.

Utilización de dentina autóloga como material de regeneración. Rehabilitación de un paciente mediante tratamiento quirúrgico y prostodóncico con flujo digital / Utilization of autologous dentin as regeneration material. A patients’ rehabilitation by surgical and prosthodontic treatment with digital workflow

Introducción: Existen numerosos procedimientos para conseguir un lecho óseo adecuado para colocar implantes tras la pérdida de dientes naturales. En los últimos años se han propuesto técnicas para la preservación del lecho tras la extracción dental. Los injertos de dentina autóloga ofrecen un sustrato conveniente con propiedades osteoinductivas y osteogénicas óptimas para la regeneración alveolar. Objetivo: Se presenta un caso clínico de un paciente rehabilitado mediante un tratamiento quirúrgico y prostodóntico, y una actualización de la bibliografía en relación con los injertos de dentina autóloga. Caso clínico: Varón de 64 años sin antecedentes médicos ni hábitos patológicos, que presenta desgastes severos, inestabilidad oclusal y problemas estéticos. Se realiza una rehabilitación integral del paciente combinando una técnica quirúrgica de preservación alveolar con injerto de dentina autóloga, tras la cual se procede a la colocación de implantes, con un tratamiento protésico de coronas de zirconio, incrustaciones de disilicato de litio y reconstrucciones de composite. El tratamiento protésico se realiza en dos fases, pasando por una fase de provisionalización previa a la colocación de las restauraciones definitivas, empleando el flujo digital. A los 6 meses el paciente se encuentra satisfecho y con una función y estética óptima. Conclusiones: El injerto de dentina autóloga parece una alternativa eficaz y predecible como material de regeneración alveolar. Combinando esta técnica de preservación con una planificación digital, se puede maximizar el resultado del tratamiento rehabilitador, consiguiendo una mayor satisfacción del paciente. (AU)

Introduction: There are multiple procedures to achieve an adequate bone site for implant placement after teeth loss. In the last years, numerous techniques have been proposed for alveolar preservation. Dentin autologous grafts offer a convenient substrate with osteoinductive and osteogenic properties, which are optimum for alveolar regeneration. Objective: In this article, a clinical case of a patient rehabilitated by surgical and prosthodontic treatment, and a review of the literature regarding autologous dentin grafts is presented. Case report: 64 years old male, with no medical records or parafunctional habits, presents severe wear, occlusal instability and aesthetic problems. An integral rehabilitation is performed combining a surgical preservation technique with autologous dentin graft, after which the placement of the implants takes place, and a prosthodontic treatment with zirconium crowns, lithium disilicate inlays and composite restorations. The prosthodontic treatment is accomplished in two phases, going through a provisionalization phase previous to the placement of the definitive restorations, and digital workflow is used. 6 months later, the patient is satisfied, and function and aesthetic are optimum. Conclusions: Dentin autologous graft offers a predictable and effective alternative as a material for alveolar regeneration. Combining this preservation technique, with a good digital planification, results can be maximized and satisfaction for the patient can be increased. (AU)

Bone fragment or bone powder? ATR-FTIR spectroscopy-based comparison of chemical composition and DNA preservation of bones after 10 years in a freezer.

Freezing bone samples to preserve their biomolecular properties for various analyses at a later time is a common practice. Storage temperature and freeze-thaw cycles are well-known factors affecting degradation of molecules in the bone, whereas less is known about the form in which the tissue is most stable. In general, as little intervention as possible is advised before storage. In the case of DNA analyses, homogenization of the bone shortly before DNA extraction is recommended. Because recent research on the DNA yield from frozen bone fragments and frozen bone powder indicates better DNA preservation in the latter, the aim of the study presented here was to investigate and compare the chemical composition of both types of samples (fragments versus powder) using ATR-FTIR spectroscopy. Pairs of bone fragments and bone powder originating from the same femur of 57 individuals from a Second World War mass grave, stored in a freezer at - 20 °C for 10 years, were analyzed. Prior to analysis, the stored fragments were ground into powder, whereas the stored powder was analyzed without any further preparation. Spectroscopic analysis was performed using ATR-FTIR spectroscopy. The spectra obtained were processed and analyzed to determine and compare the chemical composition of both types of samples. The results show that frozen powdered samples have significantly better-preserved organic matter and lower concentrations of B-type carbonates, but higher concentrations of A-type carbonates and stoichiometric apatite. In addition, there are more differences in the samples with a low DNA degradation index and less in the samples with a high DNA degradation index. Because the results are inconsistent with the current understanding of bone preservation, additional research into optimal preparation and long-term storage of bone samples is necessary.

Peri-implant bone preservation of a novel, self-cutting, and fully tapered implant in the healed crestal ridge of minipigs: submerged vs. transgingival healing.

OBJECTIVES: The aim of this study was to assess the influence of transgingival compared with submerged healing on peri-implant bone maintenance around a novel, fully tapered implant in a healed crestal ridge in minipigs. MATERIALS AND METHODS: In each of 12 minipigs, two implants (Straumann® BLX, Roxolid® SLActive®, Ø 3.75 × 8 mm) were placed. Implants were either left for submerged or for transgingival healing for 12 weeks. Measurements performed were bone-to-implant contact (BIC), first bone-to-implant contact (fBIC), bone area to total area (BATA), perpendicular bone crest to implant shoulder (pCIS), bone height change from placement, and bone overgrowth (for submerged implants). RESULTS: No significant differences were found between transgingival and submerged healing in any of the measured parameters, except for BATA on the buccal aspect in which significantly more bone formation was found for the transgingival healing group. For both groups, there was a gain in crestal bone height during the 12-week healing period. CONCLUSIONS: Loaded compared with unloaded implants displayed comparable levels of osseointegration and equivalent marginal bone levels. This qualifies the implant placement protocol with respect to the osteotomy dimensions and subcrestal placement protocol for immediate loading. CLINICAL RELEVANCE: The here presented results related to osseointegration and crestal bone maintenance after submerged or transgingival healing have demonstrated a high level of consistency in the used in vivo translational model. The obtained results support the translation of the novel implant type in conjunction with the developed surgical workflow and placement protocol into further clinical investigation and use.

Three-dimensional evaluation of the effects of injectable platelet rich fibrin (i-PRF) on alveolar bone and root length during orthodontic treatment: a randomized split mouth trial.

BACKGROUND: The role of injectable platelet rich fibrin (i-PRF) in orthodontic treatment has not been investigated with focus on its effect on dental and bony periodontal elements. OBJECTIVE: To evaluate the efficacy of i-PRF in bone preservation and prevention of root resorption. METHODS: A randomized split-mouth controlled trial included 21 patients aged 16-28 years (20.85 ± 3.85), who were treated for Class II malocclusion with the extraction of the maxillary first premolars. Right and left sides were randomly allocated to either experimental treated with i-PRF or control sides. After the leveling and alignment phase, the canines were retracted with 150gm forces. The i-PRF was prepared from the blood of each patient following a precise protocol, then injected immediately before canine retraction on the buccal and palatal aspects of the extraction sites. Localized maxillary cone beam computed tomography scans were taken before and after canine retraction to measure alveolar bone height and thickness and canine root length (indicative of root resorption), and the presence of dehiscence and fenestration. Paired sample t-tests and Wilcoxon signed rank tests were used to compare the changes between groups. RESULTS: No statistically significant differences in bone height, bone thickness were found between sides and between pre- and post-retraction period. However, root length was reduced post retraction but did not differ between sides. In both groups, postoperative dehiscence was observed buccally and palatally and fenestrations were recorded on only the buccal aspect. CONCLUSIONS: I-PRF did not affect bone quality during canine retraction or prevent canine root resorption. I-PRF did not reduce the prevalence of dehiscence and fenestration. Trial registration ClinicalTrials.gov (identifier number: NCT03399760. 16/01/2018).

Socket-shield Technique: A Systematic (Scoping) Review of Case Series and Case Reports.

AIM: The present study is aimed to evaluate the effectiveness of the socket-shield technique (SST) and immediate implant placement (IIP) as the treatment of choice for the stabilization of soft and hard tissues at the extraction site and correlate with patient-related and implant-related factors. METHODOLOGY: An electronic search was performed on Cochrane, EBSCO host, Medline/PubMed, Scopus, Wiley Library, Google website search, and Web of Science databases from January 2010 to September 2021. The search terms used were "socket-shield technique," "modified SST," "root membrane technique," "pontic shield technique," and "immediate implant." Case report and case series, both retrospective and prospective in nature, where SST procedures were done with IIP after tooth extraction were considered for the study. However, clinical trials on animals and studies with less than 3-month follow-up after implant placement were not considered for the study. The studies were collected, analyzed, and tabulated for further analysis to evaluate the aim and objectives of the study. RESULTS: Preliminary search identified through databases resulted in 350 articles, which on further screening led to exclusion of 299 articles based on the selection criteria. Therefore, 51 articles were considered for the final analysis which comprised 11 case studies and 40 case reports. With a wide age-group, the maxillary anterior region was the site of choice for the SST with IIP when compared to the posterior region. Better adaptability, maintenance of ridge contour, and good success rate followed by limited complications were observed among case series and reports. CONCLUSION: SST was successful in providing stability, esthetics, with lesser marginal bone loss and higher pink esthetic scores. However, well-designed prospective case series are few in number; thereby insufficient data on its reliability and longtime stability limit its application. CLINICAL SIGNIFICANCE: SST provides a promising result and better esthetic outcome with minimal requirement of soft tissue grafts, thereby increasing its popularity and its application. However, further studies with a larger sample size and effective clinical research designs with a follow-up period are a requirement to establish the procedure and its reliability.

Long-term management of avulsed "hopeless" teeth in the adult dentition.

OBJECTIVE: This case will demonstrate a thoughtful approach to the management of avulsed/replanted teeth in the adult dentition and their long-term maintenance. Often times these teeth are either not replanted, or extracted soon after replantation when resorptive lesions appear and the teeth are deemed "hopeless". The term "hopeless tooth" (HT) has become more popular since the advent of implants. Implants allowed for a simple solution to the HT by extraction and immediate replacement with a fixture and a restoration. However, now that we are realizing that implants do not last forever and also have attendant problems, saving the HT takes on a new light. CLINICAL CONSIDERATIONS: Prolonging the life of the HT can preserve bone and give the patient a functional, esthetic tooth for many years. With each additional year, clinicians garner new skills, and technology improves our future treatment outcomes. This will allow clinicians to improve and extend the life of future replacements. CONCLUSIONS: If there is minimal risk to adjacent structures, retaining the HT has many advantages for the patient and clinician. Clinicians should adopt a policy of thinking ahead and asking "What's Next"? when their prospective treatment fails or needs to be replaced. By prolonging the life of the HT, the "best ultimate treatment" has a greater chance to outlive the patient. CLINICAL SIGNIFICANCE: With the advent of single tooth implants, the term "hopeless tooth" has become more popular. It is easier to justify extraction of a tooth when it is deemed "hopeless". Many of these teeth could be saved. The advantages of this philosophy will be elucidated.

Técnica de preservação radicular: uma revisão de literatura / Socket-shield technique: a literature review

O objetivo dessa revisão foi descrever o estado de arte da técnica de preservação radicular (TPR), abordando suas indicações, contraindicações, vantagens, desvantagens e sobretudo os resultados alcançados seja do ponto de vista estético e funcional. Para isso, foi realizada uma pesquisa bibliográfica no PUBMED com as palavras-chave "socket-shield technique", "socket preservation", "bonepreservation", "immediateimplant", "dental implant" e esthetic. Além do mais, foram feitas pesquisa e seleção manual de trabalhos na lista de referências dos trabalhos encontrados mais o acréscimo de dois capítulos de livro de Implantodontia, totalizando 66 publicações para a confecção desta monografia. Com base nessa revisão de literatura, as conclusões foram de que deve-se selecionar criteriosamente cada caso, levando-se em conta possíveis limitações inerentes a técnica; a TPR é uma técnica sensível que requer uma execução atraumática e cuidadosa, com o intuito de não lesionar as fibras do ligamento periodontal que mantém o remanescente radicular em posição; a determinação do remanescente ósseo e da saúde dos tecidos periodontais são fundamentais para o planejamento da TPR; o uso de alternativas complementares, como a tomografia computadorizada Cone Bean(TCCB), na elaboração de guia cirúrgicos têm sido consideradas com o objetivo de reduzir possíveis riscos e complicações inerentes a técnica; a TPR tem apresentado resultados clínicos e radiográficos satisfatórios a curto prazo, quanto a manutenção dos tecidos duros e moles no local do implante; a TPR tem apresentado bons resultados estéticos quando comparada as técnicas convencionais ou ao implante imediato; ensaios clínicos randomizados são requeridos para a obtenção de maior evidência clínica quanto ao sucesso da terapia; acompanhamentos mais longos são precisos para determinar o prognóstico clínico a longo prazo.

The aim of this review is to describe the socket-shield technique (SST), discussing its indications, contraindications, advantages and disadvantages. Also, this study explores its functional and esthetics results. For this study, a bibliographic research was carried out in PUBMED database with "socket-shield technique", "socket preservation", "bone preservation", "immediate implant", "dental implant" and esthetic. Furthermore, research and manual selection were realized in the reference list of the selected articles, adding two chapters of Implantology's books. A total of 66 publications were added for the elaboration of this monograph. Based on this literature review, it can be concluded that each case must be carefully selected due to possible limitations from the technique; SST is a sensitive technique that requires an atraumatic procedure, in order to not injure fibers of periodontal ligament that keep the root's position; determination of the remaining bone and periodontal health are fundamental for the SST's planning; the use of alternative methods, such as cone beam computed tomography, in the surgical procedure guide, may reduce possible risks and complications inherent to SST; SST presented satisfactory short-term clinical and radiographic results due to the preservation of hard and soft tissues; SST showed good aesthetic results when compared to defined conventional techniques and immediate implantation; randomized clinical trials are required for further clinical evidence; longer follow-ups are needed to determine long-term clinical results.