Influence of a microgrooved collar design on soft and hard tissue healing of immediate implantation in fresh extraction sites in dogs

Objective: This study compared the alveolar bone reduction after immediate implantation using microgrooved and smooth collar implants in fresh extracted sockets. Material and methods: Four mongrel dogs were used in this study. The full buccal and lingual mucoperiosteal flaps were elevated and the third and fourth premolars of the mandible were removed. The implants were installed in the fresh extracted sockets. The animals were sacrificed after a 3‐month healing period. The mandibles were dissected and each implant site was removed and processed for a histological examination. Results: During healing, the marginal gaps in both groups, which were present between the implant and the socket walls at implantation, disappeared as a result of bone filling and resorption of the bone crest. The buccal bone crests were located apical of its lingual counterparts. At the 12‐week interval, the mean bone–implant contact in the microgrooved group was significantly higher than that of the turned surface group. From the observations in some of the microgrooved groups, we have found bone attachment to the 12 μm microgrooved surface and collagen fibers perpendicular to the long axis of the implants over the 8 μm microgrooved surface. Conclusion: Within the limitations of this study, microgrooved implants may provide more favorable conditions for the attachment of hard and soft tissues and reduce the level of marginal bone resorption and soft tissue recession. To cite this article:
Shin S‐Y., Han D‐H. Influence of microgrooved collar design on soft and hard tissue healing of immediate implantation in fresh extraction sites in dogs.
Clin. Oral Impl. Res. 21 , 2010; 804–814.
doi: 10.1111/j.1600‐0501.2010.01917.x     

种植体周围软组织质量对于边缘骨吸收的影响研究进展

影响种植体周围边缘骨吸收的因素有很多,种植体周围的软组织质量是其中很重要的一项.种植体周围的软组织质量可以应用角化黏膜宽度(keratinized mucosa width,KMW)、黏膜厚度(mucosa thickness,MT)和骨嵴上软组织高度(supracrestal tissue height,STH)等参...     

Histomorphometrical Analysis following Augmentation of Infected Extraction Sites Exhibiting Severe Bone Loss and Primarily Closed by Intrasocket Reactive Soft Tissue

Background: Intrasocket reactive soft tissue can be used for primary closure during augmentation of infected extraction sites exhibiting severe bone loss prior to implant placement. The present study evaluated the histological characteristics of the initially used intrasocket reactive soft tissue, the overlying soft tissue, and the histomorphometry of the newly formed bone during implant placement. Materials and Methods: Thirty‐six consecutive patients (43 sites) were included in the study. Extraction sites demonstrating extensive bone loss on preoperative periapical and panoramic radiographs served as inclusion criteria. Forty‐three implants were inserted after a healing period of 6 months. Porous bovine xenograft bone mineral was used as a single bone substitute. The intrasocket reactive soft tissue was sutured over the grafting material to seal the coronal portion of the socket. Biopsies of the intrasocket reactive soft tissue at augmentation, healed mucosa, and bone cores at implant placement were retrieved and evaluated. Results: The intrasocket reactive soft tissue demonstrated features compatible with granulation tissue and long junctional epithelium. The mucosal samples at implant placement demonstrated histopathological characteristics of keratinized mucosa with no residual elements of granulation tissue. Histomorphometrically, the mean composition of the bone cores was – vital bone 40 ± 19% (13.7–74.8%); bone substitute 25.7 ± 13% (0.6–51%); connective tissue 34.3 ± 15% (13.8–71.9%). Conclusions: Intrasocket reactive soft tissue used for primary closure following ridge augmentation is composed of granulation tissue and long junctional epithelium. At implant placement, clinical and histological results demonstrate its replacement by keratinized gingiva. The histomorphometrical results reveal considerable bone formation. Fresh extraction sites of hopeless teeth demonstrating chronic infection and severe bone loss may be grafted simultaneously with their removal.     

1例同种异体骨片在唇侧骨板缺损位点即刻种植中的应用

目的 探讨使用同种异体骨片在唇侧骨板缺损位点进行不翻瓣即刻种植的临床效果，以期为该术式的临床应用提供参考。方法 对1例左上前牙残根伴慢性根尖周炎的病例进行不翻瓣即刻种植，应用隧道技术植入同种异体骨片重塑唇侧骨板，联合同期跳跃间隙内植骨和游离结缔组织移植完成软硬组织处理。结果 在种植体植入6个月后完成延期永久修复，CBCT显示植入同种异体骨片在位，间隙内成骨良好，种植体骨结合良好，完成个性化角度螺丝固位全瓷修复体安装。最终牙龈形态协调，PES评分为12分，获得了可接受的临床疗效。结论 同种异体骨片结合不翻瓣种植手术为唇侧骨板缺损位点的即刻种植提供了可预期的临床效果，扩大了即刻种植的临床适应证，减少了手术的创伤，有助于获得理想的临床疗效。     

Implant placement in maxillary first premolar fresh extraction sockets: description of technique and report of preliminary results

BACKGROUND: The postextraction morphology of the maxillary first premolar extraction socket presents a number of challenges to clinicians seeking ideal implant position, including the morphology of the lateral walls of the extraction socket and the presence of the interradicular septum. A technique for simplification of implant placement at the time of maxillary first premolar extraction is described. METHODS: Sixty-three implants were placed in maxillary first premolar immediate extraction sockets in 57 patients (36 females and 21 males), utilizing a technique which includes removal of residual interradicular bone prior to preparing the osteotomy, use of the removed interradicular bone in the extraction socket defect surrounding the implant, and swaging of the buccal and palatal osseous plates against the implant. RESULTS: All implants demonstrated clinical stability upon uncovering. Forty-one of the implants placed have been restored and in function for a period of up to 2 years. CONCLUSIONS: The technique described affords a simplified and predictable manner for placement of implants into immediate maxillary first premolar extraction sockets. Further studies should be carried out to document long-term success and failure rates of implants placed utilizing this technique, and subsequently restored.     

Human histologic verification of osseointegration of an immediate implant placed into a fresh extraction socket with excessive gap distance without primary flap closure, graft, or membrane: a case report

The aim of this research was to verify clinically and histologically whether an excessively large horizontal and vertical gap distance of an implant placed into an immediate extraction socket would osseointegrate coronally at the implant-socket interface without primary flap closure, a bone graft, or a barrier membrane. An immediate implant and straight-profile healing abutment were placed at the palatal aspect of the extraction socket replacing a nonrestorable maxillary left canine. The residual horizontal defect measured 4.2 mm buccolingually and was allowed to heal by secondary intention. The implant was loaded after 5 months and biopsied after 10 months of placement, using the coronal portion of the buccal bone. The histologic section of the coronal aspect of the implant interface revealed intimate bone contact to the first thread. There was reestablishment of the implant biologic width coronal to the bone contact with connective tissue and junctional epithelium. This case report provides clinical and histologic proof that the immediate placement of implants into extraction sockets with an intact buccal wall allows healing and osseointegration despite a large gap distance and without primary flap closure, a bone graft, or a barrier membrane.     

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目的 评述近十年来关于即刻种植后种植体周围牙槽嵴垂直向和水平向的早期改建的相关文献,为即刻种植提供可靠的临床指导.方法 使用MeSH主题词在PubMed上搜索2000-01-0l至2011-12-30的电子英文文献,对相关的前瞻性研究和回顾性研究进行分析.结果 符合纳入标准的文献共10篇,其中9篇为前瞻性研究,1篇为回顾性研究.即刻种植无法阻止牙槽嵴的生理性改建,虽然不能减少牙槽嵴水平向吸收,但有可能减少牙槽嵴垂直向吸收.结论 在选择即刻种植的治疗方案时需要考虑到新鲜拔牙窝颊侧骨壁的厚度以及种植体植入应偏舌(腭)侧及牙槽嵴根方的位置,即刻种植后牙槽嵴垂直向吸收减少有利于软组织美学的形成.     

The use of a connective tissue graft for closure over an immediate implant covered with an occlusive membrane

Complete wound closure over an immediate implant is considered to be a desirable goal. This case report describes for the first time the use of a connective tissue autograft placed under the existing flap margins of an extraction socket to successfully achieve closure over an immediate implant covered with an occlusive membrane. The rationale of the method is described. Healing was uneventful and epithelization of the graft surface from surrounding tissues was achieved. This technique created an increased width of keratinized tissue and avoided the need to disrupt the normal anatomical relationships of the surrounding buccal tissues, in contrast to current techniques. The advantages of the technique, together with factors that may influence healing and predictability, are discussed.     

Localized vertical maxillary ridge preservation using bone cores and a rotated palatal flap

The aim of vertical augmentation of the alveolar ridge is to restore resorbed alveolar ridges. This technique is critical to the placement of dental implants in a favorable position and the enhancement of restoration esthetics. The present report describes a technique for surgical preservation of the anterior maxillary process using maxillary bone from the surgical site and raising a soft tissue rotated palatal flap. Maxillary lateral incisor extraction and periapical surgery of the central incisors were first carried out. Two bone cores were harvested from the neighboring buccal vestibular region and placed in the sockets of the lateral maxillary incisors. After 3 months, implants were placed; 12 weeks later, the prosthetic restorations were cemented. There were no complications after 2 years of follow-up. This technique constitutes a viable approach for preserving the anterior sector alveolar ridge with the posterior placement of dental implants.     

Immediate implant placement with transmucosal healing in areas of aesthetic priority. A multicentre randomized-controlled clinical trial I. Surgical outcomes

OBJECTIVES: To compare the clinical outcomes of standard, cylindrical, screw-shaped to novel tapered, transmucosal (Straumann Dental implants immediately placed into extraction sockets. Material and methods: In this randomized-controlled clinical trial, outcomes were evaluated over a 3-year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient-centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post-surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was >or=1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss and BioGide. The flaps were then sutured. During non-submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post-operatively. RESULTS: The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient-centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel-tapered implant was evident. CONCLUSIONS: This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short-term outcomes after immediate implant placement into the extraction socket.     

Hard and soft tissue augmentation in implant surgery: a case report

Correct pre- and postimplant hard and soft tissue management is prerequisite to achieving optimal esthetic and functional outcomes after implant-prosthesis treatment. Various different methods for preimplant hard tissue augmentation in alveolus maxillary atrophy are described. In some cases, non-resorbable titanium-reinforced membranes are employed for vertical augmentation of the edentulous crest. Also well documented is soft tissue management through mucus-gingival surgery techniques that increase the thickness of peri-implant keratinized gingiva, enhancing soft tissue esthetic and health. These methods also include the use of epithelial-connectival grafts collected from the palate. Here we present a clinical case of severe bone vertical resorption in edentulous areas treated with two vertical ridge augmentations by means of non-resorbable membranes in the retromandibular area and deferred insertion of six implants. Peri-implant plastic surgery techniques to improve the quantity of keratinized mucosa during the second surgery phase are also discussed. Combination of the two techniques resulted in harmonic tissue architecture and adequate presence of keratinized gingiva.     

Bio-Oss collagen in the buccal gap at immediate implants: a 6-month study in the dog

Background: Following tooth extraction and immediate implant installation, the edentulous site of the alveolar process undergoes substantial bone modeling and the ridge dimensions are reduced. Objective: The objective of the present experiment was to determine whether the process of bone modeling following tooth extraction and immediate implant placement was influenced by the placement of a xenogenic graft in the void that occurred between the implant and the walls of the fresh extraction socket. Material and methods: Five beagle dogs about 1 year old were used. The 4th premolar in both quadrants of the mandible (₄P₄) were selected and used as experimental sites. The premolars were hemi‐sected and the distal roots removed and, subsequently, implants were inserted in the distal sockets. In one side of the jaw, the marginal buccal‐approximal void that consistently occurred between the implant and the socket walls was grafted with Bio‐Oss^® Collagen while no grafting was performed in the contra‐lateral sites. After 6 months of healing, biopsies from each experimental site were obtained and prepared for histological analyses. Results: The outline of the marginal hard tissue of the control sites was markedly different from that of the grafted sites. Thus, while the buccal bone crest in the grafted sites was comparatively thick and located at or close to the SLA border, the corresponding crest at the control sites was thinner and located a varying distance below SLA border. Conclusions: It was demonstrated that the placement of Bio‐Oss^® Collagen in the void between the implant and the buccal‐approximal bone walls of fresh extraction sockets modified the process of hard tissue healing, provided additional amounts of hard tissue at the entrance of the previous socket and improved the level of marginal bone‐to‐implant contact. To cite this article:
Araújo MG, Linder E, Lindhe J. Bio‐Oss^® Collagen in the buccal gap at immediate implants: a 6‐month study in the dog.
Clin. Oral Impl. Res. 22 , 2011; 1–8.
doi: 10.1111/j.1600‐0501.2010.01920.x     

The effect of non-resorbable membrane on buccal bone healing at an immediate implant site: an experimental study in dogs

Objective: For successful implant treatment in the esthetic area, stable hard tissue and soft tissue are very important. At the buccal side without buccal bone defects, prophylactic guided bone regeneration (GBR) with bone substitute was frequently used for achieving thick buccal bone. The aim of this study was to evaluate the effect of GBR using a non‐resorbable membrane in an immediate implant site without bone defects. Material and methods: Immediate implants were placed into the mandibles of four mongrel dogs. In the experimental group (TM group), a non‐resorbable membrane was placed and fixed onto the buccal bone plate around the implant. In the control group, the implants were placed without membrane coverage. After 12 weeks, the dogs were sacrificed and histological specimens were prepared. The vertical distances from the smooth–rough surface interface (SRI) to the gingiva, the first‐bone contact, and the bone crest were measured on the buccal and lingual sides. The horizontal thicknesses of the gingiva and bone at 0, 1, 2, and 3 mm below the SRI were measured. Results: In the TM group, first‐bone contact on the buccal side was more coronally positioned approximately 0.8 mm than the control group (P=0.041). The buccal bone thickness of the TM group was well preserved and there was no difference between the buccal and lingual sides. Comparing the control group, implants of the TM group had 1 mm thicker buccal bone (P=0.0051 at bone 1 mm level, P=0.002 at bone 2 mm level). In the control group, buccal bone loss was observed and buccal bone was about 1 mm thinner than the lingual bone (P<0.05). Conclusions: GBR with a non‐resorbable membrane and no bone graft substitute could help to preserve buccal bone thickness on the immediate implant site without defects. To cite this article:
Park S‐Y, Kye S‐B, Yang S‐M, Shin S‐Y. The effect of non‐resorbable membrane on buccal bone healing at an immediate implant site: an experimental study in dogs.
Clin. Oral Impl. Res. 22 , 2011; 289–294.
doi: 10.1111/j.1600‐0501.2010.01995.x     

Rotated split palatal flap for soft tissue primary coverage over extraction sites with immediate implant placement. Description of the surgical procedure and clinical results.

Immediate implant placement after tooth extraction is becoming a common procedure in implant-supported oral rehabilitation. However, lack of primary full flap closure can jeopardize final results. A surgical approach that would enable predictable primary soft tissue closure over implants placed into fresh extraction sockets is described and evaluated. This technique is based on a rotated deep split thickness palatal flap (RSPF) containing periosteum and connective tissue, covering the implant and/or a barrier membrane. In 29 patients, 33 consecutive implants were placed immediately post extraction of 1 or 2 anterior or premolar maxillary teeth. Patients were divided in 2 groups: Group A (15 patients; n = 18 sites) where no barrier membrane was used and Group B (14 patients, n = 15 sites) where an occlusive resorbable collagen membrane was used. Distance between the alveolar crestal bone and the coronal aspect of the implant was measured at time of implant placement (Group A: mean 1.9 mm, SD 1.16; Group B: mean 4.6 mm, SD 1.18) and at second stage surgery (Group A: mean 0.3 mm, SD 0.46; Group B: mean 0. 7 mm, SD 0. 7). The difference between both records (crestal bone formation) was calculated (Group A: 1.7 mm, SD 1.03; Group B: 3.9 mm, SD 1.12) and found to be statistically significant (P <0.0001). Crestal bone formation, relative to the initial bone crest-implant distance at time of implant placement was approximately 85% in both groups. In 4 sites (2 in each group), where the cover screws were exposed before second stage surgery, complete crestal bone regeneration did not occur. Use of a barrier membrane may be obviated in appropriate cases while placing implants into fresh extraction sites. This procedure offers a predictable treatment approach in achieving complete soft tissue coverage, while allowing for healing of bony defects in immediate implantation procedures.     

Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique

Alveolar ridge resorption has long been considered an unavoidable consequence of tooth extraction. Guided bone regeneration techniques and the use of bone replacement materials have both been shown to enhance socket healing and to potentially modify the resorption process. This article will describe a surgical technique using textured, high-density polytetrafluoroethylene (PTFE) membrane and particulate bone replacement materials for graft containment and prevention of soft tissue ingrowth into healing extraction sites. The technique described does not require primary closure, facilitating the preservation of keratinized mucosa and gingival architecture.     

Immediate provisionalization of dental implants placed in fresh extraction sockets using a flapless technique

The aim of this clinical study was to evaluate the 24-month clinical outcomes of immediate provisionalization of dental implants placed in fresh extraction sockets using a flapless technique. Fifteen patients were included under strict inclusion and exclusion criteria. All patients required one or two teeth to be extracted for lesions with a hopeless prognosis in the maxillary monoradicular or first premolar region. Twenty implants were placed immediately after tooth extraction, and immediate provisionalization was performed. Sixteen implants had a diameter of 5 mm, and four implants had a diameter of 3.80 mm, all with a 13-mm length. After 24 months of follow-up, a cumulative survival rate of 100% was reported for all implants. Modified Bleeding Index (mBI), modified Plaque Index (mPI), probing depth (PD), marginal gingiva level (MGL), and keratinized mucosa (KM) remained stable for up to 24 months. Mean MGL at 24 months was 0.22 ± 0.15 mm; no significant changes occurred in MGL between baseline and 24 months. Mean KM remained stable from baseline to 24 months. At 24 months, a mean bone loss of 0.83 ± 0.52 mm was measured. The results of this study indicate that flapless surgery for immediately provisionalized implants placed in fresh extraction sockets provides soft tissue and marginal bone maintenance for up to 24 months of follow-up.     

种植体周骨缺损时羟基磷灰石颗粒植入的实验研究

目的为研究羟基磷灰石颗粒在即刻人工种植体的愈合过程中的作用。方法作者应用国产ＨＡ层钛种植体植入犬股骨中进行观察，术后１、２、３、４个月处死动物，通过Ｘ线检查及扫描电镜观察标本。结果即刻种植组中，用ＨＡ充填空隙后，其愈合情况在术后３个月与延期种植无明显差异，种植体和骨组织结合紧密；无ＨＡ充填的标本中与延期种植存在差异，４个月时颈部尚有部分骨组织缺损。结论即刻种植术中，在植入种植体的同时植入ＨＡ颗粒。有助于种植体的稳定，对种植体与周围骨组织早期愈合起到较大作用。     

Buccal periosteal inversion (BUPI) for defect closure and keratinized gingiva width preservation after tooth extraction – technique modification

IntroductionSeveral techniques and methods have been proposed to cover alveolar bone after tooth extraction when soft tissue is lacking. Some authors recommend soft tissue flap techniques, and others advocate different types of materials for socket covering. In this article, the authors use a modified buccal inversion technique for adequate coverage of the alveolar ridge to ensure its preservation and to minimize soft tissue shrinkage and loss of keratinized gingiva after tooth extraction. This local mucogingival-periosteal plastic procedure was named by the authors the “Buccal Periosteal Inversion technique” or simply BUPI.Materials and MethodsAfter extraction of a fractured, endodontically compromised lower right first molar, the BUPI technique was performed to cover the alveolus. After reflecting the two-sided full-thickness flap, the periosteum was split in the cranial direction. The inverted periosteum is used to provide tension-free defect closure of the postextractional defect. Detailed technique implementation and patient postoperative healing are presented here in detail.ResultsPostoperative evaluation at six weeks was presented with photos showing adequate surgical site healing, no signs of infection or dehiscence, and no crestal shift of the keratinized gingiva.ConclusionThe buccal periosteal inversion (BUPI) technique is a modified technique that allows full socket coverage, avoiding a keratinized gingiva shift in the crestal direction using only the periosteum as a cover material. By inverting the buccal ridge periosteum alone from its normal position, the osteoclastic effect on the buccal bony wall will be eliminated, and this procedure abolishes the need for additional alveolar coverage materials.     

Extraction Socket Healing in Humans After Ridge Preservation Techniques: Comparison Between Flapless and Flapped Procedures in a Randomized Clinical Trial

Background: The preservation of hard and soft tissue volume, partially lost after tooth removal, can potentially reduce the need for the more demanding augmentation procedures used in implant‐supported rehabilitation. The objective of this research study is to investigate the effect of filling with xenogeneic material the postextractive sockets of two surgical procedures (flapless versus flapped). Methods: In this prospective randomized clinical survey, two types of socket preservation were performed on two groups of patients: the control, treated via full‐thickness mucoperiosteal flap, and the test, via a flapless procedure. Anatomic measurements and related outcome variables at the third month were analyzed using multiway analysis of variance. Multiple comparison tests, using Tukey honestly significant difference test, and appropriate pairwise comparison tests for independent samples were carried out. Results: Sixty‐four patients were treated, 32 for each of the two socket preservation procedures. Statistically significant differences were registered for the output variables — changes in width of keratinized gingiva, changes in bucco‐lingual width, and vertical bone changes at four sites — between the two socket preservation techniques, with P values of <0.001, <0.001, and 0.0105, respectively. Conclusions: A full‐thickness mucoperiosteal flap gave significantly more negative results than that of the less‐demanding flapless procedure, with an increased width resorption of the postextraction site. Moreover, the increased value of the keratinized gingival width attested to the positive outcome of a flapless procedure in terms of soft tissue preservation and improvement. On the other hand, the flapped technique seemed to show less vertical bone resorption on the buccal aspect than the flapless technique.     

Placement of hydroxyapatite-coated implants into fresh or recent extraction sites.

Factors important in the placement of HA-coated dental implants in fresh or recent extraction sites are case selection, treatment planning, and surgical modifications. The importance of good periodontal health and effective oral hygiene cannot be over-emphasized. Technique variations include careful extraction of the tooth or teeth, use of a surgical guide stent to overcome the "guidance" of the sockets, placement of the implants at least 1 mm apical to the socket edges, use of grafting materials to fill residual voids adjacent to the cylindrical implants, and special soft tissue closure techniques. Guided tissue regeneration methods are often used to enhance wound closure and improve bone regeneration around the implants. Clinical results suggest that HA-coated implants clinically integrate equally well in both fresh sockets and healed edentulous areas. Clinicians can comfortably consider placement of HA-coated dental implants in fresh extraction sockets for their patients and can anticipate favorable results with the application provided that the proper principles are followed.