Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy.

BACKGROUND: There is limited information on the need for bone augmentation in the context of delayed implant placement whether alveolar ridge preservation (ARP) is previously performed or not. The primary aim of this retrospective cohort study was to evaluate the efficacy of ARP therapy after tooth extraction compared with unassisted socket healing (USH) in reducing the need for ancillary bone augmentation before or at the time of implant placement. METHODS: Adult subjects that underwent non-molar single tooth extraction with or without simultaneous ARP therapy were included in this study. Cone beam computed tomography scans obtained before tooth extraction and after a variable healing period were used to record the baseline facial bone thickness and to virtually plan implant placement according to a standard method. A logistic regression model was used to evaluate the effect of facial alveolar bone thickness upon tooth extraction and baseline therapy (USH or ARP) on the need for additional bone augmentation, adjusting for several covariates (i.e., age, sex, baseline KMW, and tooth type). RESULTS: One hundred and forty subjects that were equally distributed between both baseline therapy groups constituted the study population. Implant placement was deemed virtually feasible in all study sites. Simultaneous bone augmentation was considered necessary in 60% and 11.4% of the sites in the USH and ARP group, respectively. Most of these sites (64.2% in the USH group and 87.5% in the ARP group) exhibited a thin facial bone phenotype (<1 mm) at baseline. Logistic regression revealed that the odds of not needing ancillary bone augmentation were 17.8 times higher in sites that received ARP therapy. Furthermore, the need for additional bone augmentation was reduced 7.7 times for every 1 mm increase in facial bone thickness, regardless of baseline therapy. CONCLUSIONS: Based on a digital analysis, ARP therapy, compared with USH, and thick facial alveolar bone largely reduce the need for ancillary bone augmentation at the time of implant placement in non-molar sites.

Reconstructive surgical treatment of isolated deep intrabony defects with guided tissue regeneration using entire papilla preservation technique: A prospective case series.

BACKGROUND: The aim of this prospective study is to evaluate the clinical applicability of the entire papilla preservation (EPP) technique in the regenerative treatment of isolated deep intrabony defects using native collagen membrane and bone grafting materials. METHODS: Fifteen healthy and non-smoker patients (nine males and six females; mean age: 47.73 ± 12.18; range 21 to 63 years) with one isolated deep intrabony defect each (baseline probing depth (PD): 9.03 ± 1.62 mm; clinical attachment level (CAL): 11.16 ± 1.81 mm) were treated with guided tissue regeneration. Surgical access to the defect was provided by a single buccal vertical incision with an interdental tunneling flap. Following the granulation tissue removal, intrabony defect was filled with bone substitutes. A collagen barrier was trimmed and placed under the intact defect-associated papilla with palatal positioning suture. Microsurgical sutures were used for primary closure. RESULTS: At 1 week, healing of the 15 sites was uneventful. During the study, all sites showed 100% primary closure rate. At 1-year follow-up, an average CAL gain of 5.86 ± 1.28 mm (P < 0.0001), PD reduction of 6.1 ± 1.47 mm (P < 0.0001), and minimal increase in gingival recession of 0.23 ± 0.62 mm (P = 0.168) were observed. CONCLUSION: This novel surgical technique, that keeps the interdental papilla intact, seems promising to provide optimal biomaterial protection and healing conditions, even when a collagen barrier and bone substitutes are applied.

Evaluation of the mechanical properties and clinical efficacy of biphasic calcium phosphate-added collagen membrane in ridge preservation.

PURPOSE: This study aimed to evaluate the biocompatibility and the mechanical properties of ultraviolet (UV) cross-linked and biphasic calcium phosphate (BCP)-added collagen membranes and to compare the clinical results of ridge preservation to those obtained using chemically cross-linked collagen membranes. METHODS: The study comprised an in vitro test and a clinical trial for membrane evaluation. BCP-added collagen membranes with UV cross-linking were prepared. In the in vitro test, scanning electron microscopy, a collagenase assay, and a tensile strength test were performed. The clinical trial involved 14 patients undergoing a ridge preservation procedure. All participants were randomly divided into the test group, which received UV cross-linked membranes (n=7), and the control group, which received chemically cross-linked membranes (n=7). BCP bone substitutes were used for both the test group and the control group. Cone-beam computed tomography (CBCT) scans were performed and alginate impressions were taken 1 week and 3 months after surgery. The casts were scanned via an optical scanner to measure the volumetric changes. The results were analyzed using the nonparametric Mann-Whitney U test. RESULTS: The fastest degradation rate was found in the collagen membranes without the addition of BCP. The highest enzyme resistance and the highest tensile strength were found when the collagen-to-BCP ratio was 1:1. There was no significant difference in dimensional changes in the 3-dimensional modeling or CBCT scans between the test and control groups in the clinical trial (P>0.05). CONCLUSIONS: The addition of BCP and UV cross-linking improved the biocompatibility and the mechanical strength of the membranes. Within the limits of the clinical trial, the sites grafted using BCP in combination with UV cross-linked and BCP-added collagen membranes (test group) did not show any statistically significant difference in terms of dimensional change compared with the control group.

Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabony defects: A randomized controlled clinical trial.

AIM: This study compared the clinical efficacy of the entire papilla preservation technique (EPP) alone and in combination with enamel matrix proteins plus bovine-derived bone substitutes (EPP EMD + BS) in the treatment of isolated inter-dental intrabony defects. MATERIAL AND METHODS: Thirty patients, each with one isolated intrabony defect, were randomly assigned to EPP EMD + BS or EPP alone. Clinical outcomes were assessed 1-year post-surgery. RESULTS: Early healing phase was uneventful in all cases, and 100% primary wound closure was maintained throughout the study period. Intragroup differences between baseline and 1-year were statistically significant in both groups in terms of clinical attachment level (CAL) gain and probing depth (PD) reduction (p ≤ .001). No statistically significant differences were detected in gingival recession (REC) (p > .05). No statistically significant differences were detected in terms of CAL gain (6.3 ± 2.5 mm vs. 5.83 ± 1.12 mm), PD reduction (6.5 ± 2.65 mm vs. 6.2 ± 1.33 mm) or increase in gingival recession (0.2 ± 0.25 mm vs. 0.36 ± 0.54 mm) between the groups treated with EPP EMD + BS or EPP alone. CONCLUSIONS: Application of EPP with and without regenerative biomaterials resulted in significant amounts of CAL gain and PD reduction, with negligible increase in gingival recession. Within the limits of the present study, it can be concluded that the addition of regenerative biomaterials does not improve the clinical outcomes of EPP alone. NCT03923465.

Use of Buccal Fat Pad in the Treatment of Peri-Implant Mucosal Defect: A Case Report.

The present study describes a clinical case in which the buccal fat pad (BFP) was used to improve the contour of the peri-implant mucosa. To our knowledge, this is the first case report of such an application in the literature. A 58-year-old woman presented with teeth #2 and #3 missing and an indication for extraction of tooth #4. After clinical examination and CBCT analysis, immediate implants were placed in the region of the extracted tooth and that of tooth #2 for prosthetic rehabilitation using a three-unit fixed partial denture. There was an extensive mucosal defect in the region of tooth #3, with vertical and horizontal changes in the contour of the mucosa. As an alternative to the use of a subepithelial connective tissue graft, we opted for displacement of the BFP and its accommodation on the alveolar ridge of tooth #3 to improve the buccal tissue contour. After 5 years of follow-up, satisfactory gain and maintenance of mucosal volume were observed in the treated area, as well as improvement of buccal tissue contour. The use of BFP seems to be a feasible alternative for filling and treating peri-implant mucosal defects.

Efficacy of recombinant human fibroblast growth factor 2 impregnated absorbable collagen membrane in the treatment of Miller's Class I and II gingival recession defects Preliminary results from the first in human clinical trial.

AIMS: This study was a single-arm trial to obtain preliminary data on the efficacy of collagen membranes impregnated with recombinant human fibroblast growth factor-2 (rhFGF-2) in the treatment of Miller's Class I and II gingival recessions. MATERIALS AND METHODS: Twenty-one individuals (34 sites) presenting with localized Miller's Class I and II gingival recessions were included in this study. Following a standard surgical protocol, rhFGF-2-impregnated membranes were placed in sites with gingival recession. Clinical parameters such as width of keratinized gingiva (wKG), recession depth (RD), and probing depth were measured at baseline and after therapy completion at 3 and 6 months. RESULTS: Most of the sites exhibited favorable clinical healing; the most common complications were persistent edematous and inflamed gingivae beyond 1 week (n = 3), development of residual periodontal pockets (n = 2), and no reduction in RDs (n = 2). Significant improvements in wKG and RD were noted from baseline to 6 months. CONCLUSION: rhFGF-2-impregnated collagen membranes showed promising results in terms of increasing the wKG and recession coverage. A comparison with other standard therapies and agents in subsequent trials may shed more light on the clinical efficacy of this material.

Implementation of orthodontic extraction for pre-implant soft tissue management: A systematic review.

OBJECTIVE: This systematic review aims to define the recommendations allowing an optimized clinical implementation for orthodontic extraction as a pre-implant soft tissue management procedure. MATERIALS AND METHODS: A digital search was performed in the Cochrane Library, PubMed, Scopus, and DOSS databases; a pre-screening was conducted according to the title and summary of the articles. After a complete reading, only the articles meeting all of our inclusion criteria were selected, and a second search, this time manual, was performed within their references. The selected articles were then analysed according to twelve parameters. RESULTS: Thirty-nine articles were included. Despite low statistical evidence in the available literature, some principal guidelines, which seem generally accepted by the scientific community, could be highlighted based on this analysis. However, no ideal clinical protocol could be established. CONCLUSIONS: Orthodontic extraction is an efficient procedure for pre-implant soft tissue management, however, further studies are needed to establish full clinical recommendations and optimize its clinical implementation.

Point-of-care HbA1c screening predicts diabetic status of dental patients.

PURPOSE: Mutual production of proinflammatory cytokines causes a deleterious cyclic relationship between uncontrolled diabetes and periodontal disease. The prevalence of diabetes is escalating out of control. Early detection of pre-diabetes and diabetes may respectively prevent or delay disease onset and eliminate or decrease complications. The dental office offers an opportune site for diabetes screening. This study investigated the ability to precisely screen previously unidentified dental patients for diabetes and pre-diabetes. METHODS: In this predictive correlational study, participants were chosen by convenience sampling, and were included based on self-proclaimed risk factors. A point-of-care (POC) fingerstick HbA1c screening identified participants for confirming venous HbA1c laboratory screenings. Kendall's tau analyzed the relationship between POC HbA1c results and classification as diabetic or pre-diabetic based on laboratory HbA1c results. Chi Square, Likelihood Ratio, Cramer's V and Lambda compared the expected and observed results. RESULTS: Of the 104 diabetes risk questionnaires completed, 75 participants were included in the POC screening. Of these, 34 (71% female and 29% male) had HbA1c levels at or above the American Diabetes Association's (ADA) recommended 5.7% cut-point for pre-diabetes. Three participants were less than age 44, 10 were 44 to 57, and 21 were over 57. Laboratory results categorized 6 participants as normoglycemic and 28 with HbA1c greater than or equal to 5.7%. Kendall's tau (p=0.004) determined POC results can predict diabetic or pre-diabetic laboratory group assignment. Pearson's chi-square (p=0.004), Likelihood ratio (p=0.004) and Cramer's V (p<0.001) concluded a relationship existed between group assignment based on POC HbA1c results and those of subsequent laboratory HbA1c results; Lambda (p=0.145) did not. CONCLUSION: Within the limits of this study, it was established that a safe and minimally invasive dental chair-side POC HbA1c screening unveiled previously unidentified diabetic and pre-diabetic patients.

Enxertos ósseo e gengival para instalação de implantes dentários em áreas estéticas / Hard and soft tissue augmentation for dental implant restoration in the aesthetic area

A reconstrução do rebordo alveolar para instalação de implantes dentários é muito comum, e uma alternativa favorável para pacientes com problemas estéticos devido à falta de dentes anteriores. O sucesso depende do tipo de enxerto, o qual deve gerar o volume necessário para corrigir o defeito. É preferível escolher um material com excelentes características biomorfológicas. Os enxertos autógenos são o padrão-ouro de regeneração óssea guiada (ROG), por suas propriedades únicas. A combinação de enxertos ósseos e técnicas mucogengivais visa alcançar excelentes resultados estéticos e sucesso clínico em Implantodontia. Este relato de caso mostra a aplicação de um enxerto autólogo em bloco do ramo da mandíbula antes da colocação de implantes dentários em um paciente com um defeito ósseo horizontal em área estética. Também foi feito um enxerto gengival e condicionamento gengival através de provisório imediato.

Alveolar ridge augmentation prior to dental implant placement is a favourable alternative for patients with single-tooth loss in the aesthetic region. However, optimal results depend heavily on the type of graft used to generate the appropriate volume to correct the defect. It is preferable to choose a material with great biomorphologic characteristics. Autologous grafts are the gold standard of guided bone regeneration (ROG) because of it unique properties. Excellent aesthetics and clinical success are achievable with the combination of autografts and mucogingival techniques. This case report shows the application of a ramus autologous block graft previous to dental implant treatment and connective tissue graft in a patient with horizontal ridge deficiency in the aesthetic region. Also, gingival graft an soft tissue conditioning were performed using an immediate provisional restoration.