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Preserving the alveolar ridge after extraction is crucial for implants; different biomaterials and techniques allow predictable outcomes. This study aimed to assess laser photo-biomodulation (PBM) as a complement for socket seal surgery (SSS) when extraction sockets are grafted with bioactive glass and sealed by platelet-rich fibrin (PRF) membrane in humans. 45 sites were randomly and equally distributed into 3 groups: Control: PRF membrane for socket seal, with no more interference; it is a unified step in all groups, Test I: bioactive glass, and Test II: received the same as Test I plus PBM-irradiation. Cone-beam computed tomography (CBCT) was used to assess the dimensional changes in height and width measurements of the alveolar ridge at 0 and 9 months postoperatively. Bone samples were obtained from osteotomy sites at the time of implant placement, and then sent for histological staining using hematoxylin and eosin and Masson trichrome stain for assessment of newly formed bone and histomorphometric analysis in terms of percentage (%) of new bone surface area and % of unmineralized bone, respectively. The Control group revealed a significant reduction in alveolar ridge dimensions over time compared to the test groups ( P-value  < 0.001). Test II has shown less bone reduction over time, with a P-value  < 0.001. Histological results revealed that Test II showed large areas of connected, highly mature bone trabeculae without any collagen fibers or immature matrix in between. Compared to the other two groups, Test II provided superior bone quality. PBM can be considered as a promising adjunctive therapy for socket seal approaches when combined with bioactive glass, as evidenced by the better clinical improvement and the remarkable histological findings for bone repair compared with the non-lased group. Trial registration: The current randomized clinical trial was registered at ClinicalTrials.gov (Registration number: NCT06764732) and it was released on 8/1 /2025 .

Aim This study evaluated the impact of the partial exposition of the nonabsorbable membrane (dPTFE) on microbial colonization during bone healing. Materials and Methods Patients indicated for tooth extraction were randomized to dPTFE group ( n  = 22) - tooth extraction and alveolar ridge preservation (ARP) using an intentionally exposed dPTFE membrane and USH group ( n  = 22) - tooth extraction and unassisted socket healing. Biofilm samples were collected at the barrier in the dPTFE and on the natural healing site in the USH after 3 and 28 days. Samples from the inner surface of the dPTFE barrier were also collected ( n  = 13). The microbiome was evaluated using the Illumina MiSeq system. Results Beta diversity was different from 3 to 28 days in both groups, and at 28 days, different microbial communities were identified between therapies. The dPTFE was characterized by a higher prevalence and abundance of gram-negative and anaerobic species than USH. Furthermore, the inner surface of the dPTFE membrane was colonized by a different community than the one observed on the outer surface. Conclusion Intentionally exposed dPTFE membrane modulates microbial colonization in the ARP site, creating a more homogeneous and anaerobic community on the inner and outer surfaces of the membrane. Clinical relevance DPTFE promoted faster biofilm colonization and enrichment of gram-negative and anaerobes close to the regenerated site in the membrane’s inner and outer surfaces. dPTFE membrane can be used exposed to the oral site, but approaches for biofilm control should still be considered. The study was retrospectively registered at Clinicaltrials.gov (NCT04329351).

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 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.

Background The healing process after tooth removal involves bone remodelling which implies some loss of alveolar bone volume. Among materials proposed for minimising this remodelling and preserving the bone, autologous dental tissue is a promising option, but more data are needed. In this context, we evaluated size and density changes using cone beam computed tomography in autologous dental material (ADM)-preserved sockets compared to controls, and assessed biological responses by histological analysis. Methods A split-mouth study was conducted including 22 patients, who underwent removal of ≥ 2 single-rooted teeth with intact sockets, assigning one socket to the experimental group which received ADM for alveolar preservation and another to the control group, which only underwent blood clot stabilisation. Cone beam computed tomography was performed postoperatively (week 0) and at weeks 8 and 16 to assess socket size and bone density. Histological analysis was carried out on trephine biopsies taken (Ø4 × 4.5 mm) from the experimental group. Results Less horizontal shrinkage was observed in the ADM group, especially at week 16 considering the group-by-time interaction for the following variables: difference in height between the lingual and buccal alveolar crests (-1.00; p  < .01; 95% CI: -0.28 – -1.73), and half-widths, measured as the distance from the long axis of the missing tooth to the buccal alveolar crest at 1 mm (-0.61; p  < .01; 95% CI: -0.18 – -1.04) and at 3 mm (-0.56; p  < .01; 95% CI: -0.15 – -0.97) below the crest, with mean decreases of 1.07 and 2.14 mm in height difference, 0.66 and 1.32 mm in half-width at 1 mm and 0.43 and 1.02 mm in half-width at 3 mm in ADM and control groups respectively. Densitometry analysis showed higher bone densities in Hounsfield units in the ADM group considering all factors analysed regardless of time point and socket third (coronal, middle, or apical). Histologically, there were no signs of inflammation or foreign body reaction, and dentin particles were surrounded by and in close contact with bone tissue. Conclusion These results add to the evidence that dentin can be used successfully as a material for alveolar socket preservation, given its desirable mechanical and biological properties, and warrant larger studies.

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.

Objectives Platelet-rich plasma has been used in the treatment of extraction socket; however, randomized controlled clinical trial is still lacking to evaluate its effect on extraction socket healing. Materials and methods Single center, assessor-blinded, parallel group, randomized controlled clinical trial was conducted. Sixty patients with indication of a simple one molar extraction in the mandible were randomized to receive plasma rich in growth factors (PRGF) or blood clot. A cross-stitch suture was placed in both groups. Clinical, radiographical, and histological assessments were performed during 10–12 weeks of follow-up. Results Cone beam CT analysis has shown that the percentage of patients where the sockets are regenerated at ≥75 % of the baseline volume was significantly higher in PRGF group (96.7 %) than the control group (45.5 %). Pain and inflammation (day 3 and day 7) have been significantly lower in PRGF group than the control group but not at day 15. Soft tissue healing scores have been significantly higher in the test group. No serious adverse events have been occurred in both groups. Histological analysis has indicated the presence of significantly thicker keratinized epithelium and significantly higher newly formed bone in the PRGF group. Conclusions PRGF was associated with enhanced healing of extraction socket of mandibular molars throughout the observation period. Clinical relevance Plasma rich in growth factors could be a useful tool to enhance the healing of extraction sockets by minimizing postoperative complications and stimulating the hard and soft tissues regeneration.

Objectives After tooth extraction, marked resorption occurs in extraction socket walls, leading to functional and esthetic problems in that area. One of the methods introduced to reduce this resorption is the use of platelet derivatives. This study aimed to evaluate the effects of leukocyte and platelet-rich fibrin (L-PRF) on the changes following tooth extraction. Materials and methods The participants were 24 patients who needed to replace at least one single-rooted tooth with an implant. They were randomly divided into test and control groups. After the tooth extraction, the sockets in the test group received LPRF clots, while in the control group, the sockets were left free of any interventions. CBCT scans were obtained from the extraction site both immediately after the tooth extraction and 8 weeks later. The histologic biopsy was also obtained while the implant site was being prepared 8 weeks after the extraction. Results The average vertical bone loss in the buccal crest was not significantly different between the two groups (1.67 ± 1.67 in the test group and 2.3 ± 1.36 in the control group; mean difference =  − 0.36, 95% CI: − 1.65–0.93, p -value = 0.57). Nor was the difference in resorption of the palatal wall (mean difference =  − 0.19, 95% CI: − 1.51.12, p -value = 0.76). The mean ridge width resorption in 25% of the coronal aspect of sockets was also measured in the test (1.30 ± 0.66) and control group (0.58 ± 0.95) (mean difference = 0.73, 95% CI: 0.03–1.42, p -value = 0.04). The new bone formation in histologic view was not statistically different between groups ( p -value = 0.15). Conclusion The LPRF neither reduces the rate of ridge resorption in vertical or horizontal dimensions of extraction sockets nor induces more new bone formation. Clinical relevance This study helps dentists choose the appropriate material for ridge preservation.

Aim The aim of this systematic review was to evaluate the efficacy of immediate implant placement (IIP) compared to implants placed after alveolar ridge preservation (ARP) in terms of clinical, esthetic, and patient-reported outcomes. Methods A manual and electronic search (National Library of Medicine) was performed for controlled clinical trials, with at least 12 months of follow-up. Primary outcome variable was implant survival and secondary outcomes were marginal bone level (MBL) (change), pink esthetic score (PES), mid-facial mucosal level (change), papilla index score, complications, and patient-reported outcomes. Results A total of 10 publications were included (7 randomized clinical trials and 3 controlled clinical trials). The results from the meta-analyses showed that survival rate was significantly lower in the IIP group compared to ARP group [RR = 0.33; 95% CI (0.14; 0.78); p  = 0.01]. No significant differences between the two groups were observed regarding radiographic MBL, PES scores, or mid-facial mucosal level ( p  > 0.05). Conclusion The results from this systematic review and meta-analysis showed that IIP had lower survival rates and similar esthetic results when compared to ARP. Clinical relevance Clinicians should weigh the benefits and disadvantages of each intervention to select the optimal timing of implant placement.

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.