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This randomized controlled trial evaluated the efficacy of titanium-prepared platelet-rich fibrin (T-PRF) for alveolar ridge preservation (ARP) compared with leukocyte and platelet rich fibrin (L-PRF) and spontaneous healing. Thirty single-rooted teeth requiring extraction were randomly assigned to one of three groups (ARP with T-PRF, ARP with L-PRF, and spontaneous healing) using a flapless, atraumatic extraction approach. Radiographic measurements (bone width, height, and density) were obtained pre-operatively and at four months via OnDemand3D software, and clinical parameters—including post-operative pain, analgesic consumption, soft-tissue healing, periodontal probing depth, gingival recession, and keratinized tissue width—were assessed. At four months, the T-PRF group demonstrated substantially greater preservation of ridge dimensions ( P  = 0.000), and higher bone density ( P  = 0.000), along with improved soft-tissue healing ( P  < 0.05), lower pain scores ( P  = 0.000), and reduced analgesic use ( P  < 0.05). Periodontal parameters remained stable across the groups, except for keratinized tissue width (KTW), which was substantially greater in the T-PRF group ( P  = 0.020). There were substantial differences among the groups in the need for bone regeneration when implants were placed ( P  < 0.05). These findings support the clinical advantage of T-PRF in optimizing post-extraction outcomes for implant site development. This trial was registered in the UK’s Clinical Study Registry ISRCTN (ISRCTN60191547).

This study evaluated the clinical, radiographic, and histological outcomes of alveolar ridge preservation (ARP) using collagen sponge with xenografts (CS + Xenografts) versus collagen sponge (CS) alone, compared to spontaneous healing. 36 extraction sockets were randomly allocated into three groups: Group I (CS + Xenografts), Group II (CS alone), and Group III (control) spontaneous healing. Soft tissue assessment and CBCT imaging were conducted before tooth extraction (baseline) and 6 months post-extraction, followed by histologic and histomorphometric analysis of bone biopsies. Groups I and II exhibited minimal vertical and horizontal soft tissue changes compared to the control group ( P  < 0.001), with no statistically significant difference between Group I and II ( P  ≥ 0.05). Vertical and horizontal bone resorption was significantly lower in Groups I and II than in the control group ( P  < 0.001), with no statistically significant difference between Groups I and II regarding vertical bone loss ( P  = 0.477 and 0.108, respectively); percent of changes were 8.68 ± 2.69 and 8.61 ± 2.14 respectively. The greatest reduction in alveolar bone width was observed at 1 mm: 17.81 ± 3.97 (Group I), 19 ± 2.77 (Group II), and 41.79 ± 10.3 (Group III); overall P  < 0.001. Histologically, Group I had the highest area% of lamellar bone and no residual inflammation, followed by Group II, which showed more inflammation; Group III had the lowest area% of lamellar bone. Intervention techniques were clinically and radiographically proven effective in ARP, however, CS + Xenografts histological results showed more lamellar bone and less residual inflammations.

Objectives To assess and compare the clinical, radiological, and histological outcomes of socket seal surgery between two protocols: deproteinized demineralized tooth matrix (dpDTM) and freeze-dried bone allograft (FDBA) each covered with a free gingival graft. Materials and methods Twenty extraction sockets in the anterior or premolar region were randomly allocated to either the dpDTM or FDBA protocol ( n  = 10 per group). Measurements of the alveolar ridge changes were obtained using an intraoral scanner and cone-beam computed tomography at 3 months post-operation. Three-month post surgery, the dental implant was installed ( n  = 5 per group), bone biopsies were obtained for histomorphometrical and micro-computed tomography analyses. Implant stability quotients (ISQs) were determined and compared at 3 months post-implant. Results Lower significant reductions in buccal alveolar ridge height and hard tissue volume were observed in dpDTM group compared to FDBA group at 3 months (0.25 ± 0.35 mm vs. 1.60 ± 0.66 mm [ p  = .000] and 9.64 ± 15.39% mm 3 vs. 31.45 ± 18.11% mm 3 [ p  = .010], respectively). At the same time, lower soft tissue volume reduction was detected in the dpDTM group compared to FDBA group (4.21 ± 5.25% mm 3 vs. 5.25 ± 5.79% mm 3 ). No statistically significant difference in the percentage of mineralized tissue formation was found between dpDTM group (53.39 ± 11.16%) and FDBA group (49.90 ± 3.27%). Even though the ISQ in the dpDTM group showed a higher value than the FDBA group at 3 months post-implant, the results were without statistical significance. Conclusions Alveolar ridge preservation using dpDTM is an efficacious procedure for providing the conditions for the development of functional and esthetic implants.

Abstract ObjectivesThis study aimed to improve the performance and mode of administration of a glass-reinforced hydroxyapatite synthetic bone substitute, Bonelike by Biosckin® (BL®), by association with a dextrin-based hydrogel, DEXGEL, to achieve an injectable and moldable device named DEXGEL Bone.MethodsTwelve participants requiring pre-molar tooth extraction and implant placement were enrolled in this study. BL® granules (250–500 µm) were administered to 6 randomized participants whereas the other 6 received DEXGEL Bone. After 6 months, a bone biopsy of the grafted area was collected for histological and histomorphometric evaluation, prior to implant placement. The performance of DEXGEL Bone and BL® treatments on alveolar preservation were further analyzed by computed tomography and Hounsfield density analysis. Primary implant stability was analyzed by implant stability coefficient technique.ResultsThe healing of defects was free of any local or systemic complications. Both treatments showed good osseointegration with no signs of adverse reaction. DEXGEL Bone exhibited increased granule resorption (p = 0.029) accompanied by a tendency for more new bone ingrowth (although not statistically significant) compared to the BL® group. The addition of DEXGEL to BL® granules did not compromise bone volume or density, being even beneficial for implant primary stability (p = 0.017).ConclusionsThe hydrogel-reinforced biomaterial exhibited an easier handling, a better defect filling, and benefits in implant stability.Clinical relevanceThis study validates DEXGEL Bone safety and performance as an injectable carrier of granular bone substitutes for alveolar ridge preservation.Trial registrationEuropean Databank on Medical Devices (EUDAMED) No. CIV-PT-18–01-02,705; Registo Nacional de Estudos Clínicos, RNEC, No. 30122.

This prospective, randomized, controlled clinical trial reports clinical, radiographic, histologic and immunohistochemical results of autologous dentin graft (ADG) and its comparison with a mixture of bovine xenograft with autologous bone (BX+AB). After tooth extraction in the esthetic zone of maxilla, the alveolar ridge of 20 patients in the test group was augmented with ADG, while 17 patients in the control group received the combination of BX+AB. Cone beam computed tomography (CBCT) was performed before tooth extraction and after 4 months when a total of 22 bone biopsies were harvested and subjected to histological and immunohistochemical analysis. Radiological analysis showed comparable results of bone dimension loss in both groups. Quantitative histologic analysis showed comparable results with no statistically significant differences between the groups. Immunohistochemical staining with TNF-α and BMP-4 antibodies revealed immunopositivity in both groups. A statistically significant difference between the groups was found in the intensity of TNF-α in the area of newly formed bone (p = 0.0003) and around remaining biomaterial particles (p = 0.0027), and in the intensity of BMP-4 in the area around biomaterial particles (p = 0.0001). Overall, ADG showed biocompatibility and achieved successful bone regeneration in the esthetic zone of the maxilla similar to BX+AB.

Background It is common to see patients who need orthodontic treatment but with insufficient alveolar bone volume. However, safe and effective tooth movement requires sufficient alveolar bone width and height. The aim of this study is to compare the bone augmentation efficacy of Autologous Partially Demineralized Dentin Matrix (APDDM) and Deproteinized Bovine Bone Mineral (DBBM) in orthodontic patients with insufficient bone by using a randomized controlled clinical trial approach. Materials and methods Twenty-seven orthodontic patients involving 40 posterior teeth alveolar sites ( n  = 40) with insufficient alveolar bone volume were randomly divided into a control group ( n  = 20) and an experimental group ( n  = 20). The patients in the experimental group were treated with APDDM, and those in the control group were treated with DBBM. After surgery, the adjacent teeth are moved toward the bone grafting sites according to the orthodontic treatment plan. Patients completed a postoperative response questionnaire by the Visual Analogue Scale (VAS) score to indicate pain and swelling in the bone grafted area at the time of suture removal; and CBCT scans were conducted before surgery, 6 months and 2 years after surgery to assess changes in buccal and central alveolar heights, as well as widths at the alveolar ridge apex and 3 mm, 5 mm below the apex, respectively. The CBCT image sequences were imported into Mimics 21.0 software in DICOM format. The data of the patients in both groups were collected and analyzed by SPSS 25.0. Results The VAS scores were significantly lower in the APDDM group than in the DBBM group ( p  < 0.05). Significant increases were observed in alveolar bone height and width at 6 months and 2 years postoperative ( p  < 0.05); At 2 years, the APDDM group exhibited a reduction in buccal crest height and in 3 mm, 5 mm width below alveolar ridge apex, relative to 6 months ( p  < 0.05), while the DBBM group showed a decrease only in the central height of the alveolar bone ( p  < 0.05). There was a significant bone augmentation increase found only 3 mm below the alveolar ridge apex in the APDDM group compared with the DBBM group among all 6 months group comparison ( p  < 0.05). At 2 years, the augmentation effects were similar across both groups ( p  > 0.05). Conclusion Radiomics analysis indicates that APDDM serves as a viable bone augmentation material for orthodontic patients with insufficient alveolar bone volume, achieving comparable clinical efficacy to DBBM. Additionally, APDDM is associated with a milder postoperative response than DBBM. The registration number (TRN) ChiCTR2400084607.

Background Horizontal augmentation of the anterior maxilla is a highly demanding and yet predictable procedure. This study aimed to investigate the efficiency and accuracy of a full computer-guided symphyseal shell harvesting and positioning approach versus the conventional procedure for the treatment of horizontally atrophic anterior maxillary ridges. Patients and methods Twenty patients with horizontally deficient anterior maxilla were randomly allocated into two groups, ten patients each. The study group received a fully guided horizontal augmentation of their atrophic anterior maxillary ridges using symphyseal shells. While the control group received the same treatment but without surgical guides. Bone gain was calculated for both groups and the accuracy of the computer guidance was investigated in the study group. Results After four months of graft consolidation, there was no statistically significant difference between both groups regarding the horizontal bone gain and the mean bone gain percent, measuring a mean of 3.66 ± 0.63 mm and 105.71% ± 29.75 mm in the guided group while for the control group, it measured 3.33 ± 1.07 mm and 90.41% ±31.77 mm respectively (P-values = 0.4 and 0.28). In the study group, there was no statistically significant difference between the planned and the achieved horizontal augmentation ( p  = 0.97). Conclusion Despite the lack of statistically significant difference between both groups with regard to horizontal bone gain, computer-guided cortical shell technique allowed for accurate, simple, and safe graft positioning and fixation; it is worth further investigations to explore its different applications. Trial registration Retrospectively registered on www.clinicaltrials.gov with ID: NCT05311332 on 27-03-2022. Clinical trials.gov registered ID NCT05311332.

Objectives After tooth extraction, the alveolar ridge undergoes significant absorption, and the alveolar ridge preservation (ARP) will alleviate the complexity of implantation operations in specific clinical occasions and then improve the functionality and aesthetics of subsequent restoration. However, the effectiveness of β-tricalcium phosphate (β-TCP) composite materials for ARP needs to be confirmed by more clinical trials and more sufficient evidence. This study was aimed at evaluating the effects of β-TCP coating porous bovine deproteinization bone (β-TCP/PBDB) on ARP when compared with Bio-Oss ® . Materials and methods After baseline clinical examination, teeth extractions and the ARP were conducted randomly by β-TCP/PBDB or the Bio-Oss ® . A collagen sponge was applied over the bone substitutes. After 6 months, clinical examination and cone-beam computerized tomography (CBCT) imaging analysis were conducted to evaluate the changes in alveolar bone volume. Results In the clinical trial, a total of 123 patients successfully completed the protocol. The surgical socket and the soft tissues healed well. The reduction of alveolar ridge width was 1.27 ± 1.32 mm, 0.89 ± 1.31 mm, and 0.63 ± 1.37 mm at three levels (1 mm, 3 mm, 5 mm) below the crest of alveolar ridge respectively using β-TCP/PBDB, while those were 1.12 ± 1.65 mm, 0.55 ± 1.41 mm, 0.56 ± 1.32 mm respectively in the Bio-Oss ® group. The reduction of alveolar ridge height was 0.75 ± 1.96 mm in buccal and 0.95 ± 1.96 mm in lingual using β-TCP/PBDB while those were 1.01 ± 2.44 mm and 0.99 ± 2.13 mm respectively in the Bio-Oss ® group. There is no significant difference in the width and height changes of the alveolar ridge compared to Bio-Oss ® ( p  > 0.05). Conclusions This prospective, randomized, controlled clinical trial provided evidence that β-TCP/PBDB is a safe material and the effectiveness of β-TCP/PBDB in maintaining the volume and contour of the alveolar ridge is comparable to that of the Bio-Oss ® material. Clinical relevance The β-TCP/PBDB can be used as one option of bone substitute material for ARP.

The aim of this study was to clinically evaluate the guided bone regeneration (GBR) potential of allograft, xenograft, and alloplastic materials in combination with resorbable membranes in extraction sockets. The qualitative and quantitative assessments of this prospective study were accomplished through histologic and histomorphometric analysis. Three experimental groups and 1 control group for comparison (n = 8) received either an allograft (human cancellous bone, freeze dried, Deutsches Institut für Zell und Gewebeersatz, Berlin, Germany), xenograft (BioOss, Geistlich Pharma AG, Wolhusen, Switzerland), or alloplast (biphasic calcium sulphate, Bondbone, MIS Implants Technologies Ltd., Charlotte, NC). The negative control group received no regenerative material. Tissue samples were then qualitatively and quantitatively evaluated as a function of percentage of new vital bone, graft particles content, soft tissue, and bone marrow over time. All 3 study groups presented bone volume suitable for the successful placement of a dental implant. The xenograft group yielded significantly less amount of vital bone compared with the allograft and alloplast groups. When comparing the percentage of residual graft particles, there was significantly greater amounts associated with the xenograft group in contrast to the allograft and alloplast groups. Similarly, a significantly increased amount of soft tissue percentage was observed within the xenograft group relative to all other groups. No significant differences were observed in the percentage of residual graft particles between the allograft and alloplast groups. There were also no significant differences detected in vital bone percentage between the allograft, alloplast, and control groups. When evaluating the bone marrow percentage, the only significant difference detected was between the xenograft and alloplast materials. Overall, no complications (ie, fever, malaise, purulence or fistula) were observed during the entirety of clinical trial among all patients. The greatest GBR potential was associated with the allograft material because of the greater degree of vital bone and the lowest percentage of residual graft particles. All studied bone substitute materials resulted in bone apposition for efficient use in alveolar ridge preservation procedures.

Objectives To compare effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters. Materials and methods Thirty subjects with indication of mandibular posterior teeth extraction were randomly assigned to either test or control group. After atraumatic extraction, ridge preservation was performed using APD or DFDBA mixed with i-PRF in test and control groups respectively. Both groups had sockets sealed with A-PRF membrane. Clinical parameters (plaque, gingival and healing indices) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Statistical analysis was performed using an independent t-test to compare clinical and radiographic parameters between the groups. Results Both groups had significant decreases in ridge dimensions over 6 months ( p  < 0.001). The test group showed less reduction in ridge dimensions than control group at 6 months ( p  < 0.001). Mean change in vertical height was not significant (1.37 ± 1.32, 1.7311 ± 0.563), but in horizontal ridge width (1.3120 ± 1.13, 1.8093 ± 1.16) was significantly different between test and control groups respectively. There was no statistical difference in clinical parameters between the groups at 6 months ( p  > 0.001). Conclusions APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to DFDBA group. Clinical relevance Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.