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Muthukumar Santhanakrishnan,1 Vedavalli Subramanian,2 Nithyakalyani Ramesh,2 R Kamaleeshwari2 1Faculty of Dental Sciences, Department of Periodontology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India; 2Department of Periodontology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, IndiaCorrespondence: Muthukumar Santhanakrishnan Tel +9884118681Email muthukumars@sriramachandra.edu.inObjective: The purpose of this study was assessment of the changes in soft and hard tissues in the esthetic zone of maxilla following immediate implant placement (IIP) with and without the socket shield technique (SST) and placement of implants 4 months following socket preservation (DIP) in terms of alterations in crestal bone thickness (CBT) and soft tissue changes evaluated by means of pink esthetic scores (PES) following placement of implants in the esthetic zone of maxilla.Materials and Methods: In the maxillary esthetic region, 75 dental implants were placed totally, with 25 implants each in the SST, IIP, and DIP groups. All participants were subjected to undergo CBCT for assessing the variations in thickness of crestal aspect of facial/buccal/labial alveolar bone (CBT). PES and PROMS (patient-related outcome measures) were assessed using VAS for pain threshold and esthetic satisfaction following implant placement and after 6th post-operative month.Results: The mean reduction in CBT showed a statistically significant difference between and within the groups, in comparison to IIP and DIP groups, which demonstrated an average reduction in CBT 0.4 ± 0.1 and 0.2 ± 0.1 at 6 months following implant placement, respectively. The SST group showed a significantly lesser reduction in CBT of 0.05 ± 0.02. However, the mean difference in PES within and among the groups showed no significant difference statistically at P < 0.05. On comparison of individual scores of PES between the groups, the results showed significant difference statistically at P < 0.001.Conclusion: The SST group demonstrated minimal reduction in CBT and a superior PES at the end of 6 months compared with the IIP and DIP groups.Keywords: socket shield technique, immediate implant placement, socket preservation, randomized controlled trial, pink esthetic score

Introduction: Primary closure is the most important step following tooth extraction. Primary closure using cut back incision technique helps in preserving the bone graft in socket and to preserve it in their desired position. Aim: To assess the healing outcome with and without cut back incision technique in adult population for the purpose of socket preservation at baseline, 1 week and 4 weeks. Material and Methods: In this single blinded randomized controlled trial forty-two sites were planned for extraction with bone augmentation and were randomly divided. In group 1 sockets were preserved using cutback incision technique and in group 2 sockets were grafted without cutback incision technique. Clinical standardized measurements were used to assess the dimensional alterations of the extraction socket. Various non-parametric tests have been used for comparisons. Results: Intergroup comparison showed statistical higher difference on Pain on VAS (p >0.00 6) and KGW (p 0.039) at 1 week and primary healing showed no significant results at all time intervals. Conclusion: The present finding concluded that use of cutback incision technique enhances primary closure and the socket seal of the extraction site with minimal pain, morbidity and low cost. Keywords: Cutback, Socket preservation, Primary healing, Grafting, Randomised controlled trial

Dental implants represent the gold standard for the treatment of single edentulism, even in anterior areas. Today, the basic criteria for implant success has changed from mobility, pain, radiolucency, and peri-implant bone loss (>1.5 mm) to prosthetic level success, aesthetics, soft tissue parameters, as well as patient satisfaction. This case report documents a combination of surgical and prosthetic procedures for the treatment of gingival recessions in the anterior maxilla, appearing after tooth extraction, socket preservation, and staged guided implant placement. Prosthetic management of the temporary restoration, orthodontic treatment, and a connective tissue graft were performed. The decision-making process and step-by-step execution of the treatments are presented to describe the entire clinical and surgical management of the reported case. Finally, good aesthetic outcomes, patient satisfaction, and recovery of the soft tissue recession were observed with the combination of these techniques.

Objective: The present study was performed to evaluate the effect of addition of human serum albumin and platelet rich fibrin to xenograft bone for socket preservation. Material and Methods: 20 patients seeking treatment for badly broken teeth (lower premolars and molars) 10 patients in each group. In the first (study) group, the patients will be subjecting to extraction of badly decayed non restorable tooth then insertion of human albumin coated xenograft bone (OneGraft natural collagenated bovine bone graft 1.0 -2.0mm grain size Bioimplon, Germany) and platelet rich fibrin. In the second (controlled) group, the patients will be subjecting to extraction of badly decayed non restorable tooth without xenograft insertion. CBCT was done to evaluate; bone density, alveolar bone height at the site of extraction and bone graft addition. Bone Density and height was measured at alveolar bone crest & middle of the socket at region of interest (ROI) immediately & at 6 months post operatively. Results: In albumin coated xenograft with PRF group showed less decrease in buccal, lingual height and width , increase in bottom of socket and increase in bone density measurements. Conclusion: the use of albumin coated xenograft with PRF were effective in socket preservation , significantly minimized ridge resorption in all dimensions, accelerate the bone healing and shorting the time period for rehabilitation than the normal sequence of healing.

Aim: The study was aimed at determining the evaluation of hard and soft tissues at the extraction site when using advanced platelet rich fibrin compared to natural healing. Methodology: The present study was conducted on 30 subjects. The patients were allocated to receive either advanced platelet rich fibrin (APRF) (test group) or left for natural healing (control group). Alveolar ridge width was measured at 2 months and 4 months follow up and then it was subjected to a statistical analysis. Results: The buccolingual width result in the test group was decreased to 6.37±1.16mm while for the control groups, the values decreased to 5.95±0.53mm after 4 months with no statistical significance between the 2 groups. Both treatment protocols could not prevent bone resorption after 4 months. Conclusion: Despite the fact that ARP using APRF in our study did not totally avert bone loss, the values observed after 4 months were much lower than unassisted extraction.

Objectives: this current study attempted the evaluation of the effect of using platelets rich fibrin and mineralized plasmatic matrix platelets concentrates after surgical extraction of lower third molar. Materials and Methods: A total of 40 requiring extraction of at least one mandibular non-restorable impacted wisdom tooth. (n=40). The samples were divided into two main groups (20 each) (Group A) extraction of mandibular impacted wisdom tooth and socket was filled using platelets rich fibrin (PRF) and (Group B) extraction of mandibular impacted wisdom tooth with application of mineralized plasmatic matrix (MPM) and platelet-rich fibrin for socket preservation. Participants were evaluated at 1st, 3rd and7th day, 6 months postoperative. Data were statistically analyzed using IBM SPSS software version 20.0. (Armonk, NY: IBM Corp). Results: This study showed At 7th day, MPM group showed a significant higher maximum mouth opening measurement than PRF group. At 6 months, postoperatively MPM group showed a significant higher bone density measurement than PRF group and showed a less percentage of change in density measurement than PRF group. Conclusion: MPM not only enhances the rate of new bone formation, but also increases the quality (density) of the newly formed bone

espanolObjetivo: Evaluar el uso de dientes extraidos autogenos para la preservacion del alveolo tras la extraccion dental.Material y Metodos: Se realizo una busqueda en las bases de datos Cochrane, Scopus y PubMed para identificar estudios clinicos en humanos que informaban los resultados clinicos, radiograficos y / o histologicos de las tecnicas de preservacion de alveolos con dientes extraidos autogenos. Solo se incluyeron estudios publicados en ingles en los ultimos 10 anos. Resultados: En total se identificaron 82 articulos. Se incluyeron cinco articulos en la revision. Incluyeron 58 dientes que se prepararon como injerto para la preservacion del alveolo. Los injertos derivados de dientes autogenos se presentaron en tres formas: particulas, bloques y polvo. La perdida osea media oscilo entre 0,28 mm y 0,41 mm de altura y 0,15 mm de ancho. Conclusion: El diente autogeno extraido de forma inmediata utilizado como material de injerto para la conservacion del alveolo fresco es prometedor para la practica clinica diaria futura. Se necesitan mas estudios clinicos comparativos. EnglishObjectives: To evaluate the use of extracted autogenous teeth for socket preservation after tooth extraction. Material and Methods: Cochrane, Scopus, and PubMed databases search was conducted to identify human clinical studies reporting the clinical, radiographic and/or histological outcomes of socket preservation techniques with autogenous extracted tooth Only studies published in English language in the last 10 years were included in the study. Results:In total, 82 articles were identified. Five articles were included in the review. They included 58 teeth that were prepared as a graft for socket preservation. The grafts derived from autogenous teeth were presented in three forms: particles, blocks and powder. The mean bone loss ranged from 0.28 mm to 0.41mm in height and 0.15 mm in width.Conclusion: Immediate autogenous extracted tooth as a grafting material for fresh socket preservation is promising for future daily clinical practice. More clinical comparative studies are needed.

Background Post‐extraction bone resorption may affect the outcome of ensuing restorations. Purpose This study aimed to evaluate a comprehensive laser post‐extraction protocol by comparing resulting alveolar bone regeneration with that obtained after standard extraction procedure. Materials and Methods About 53 simple extractions were randomized to either laser or control group. In the laser group, erbium (Er:YAG; 2940 nm) and neodymium (Nd:YAG; 1064 nm) lasers were used for degranulation, disinfection, de‐epithelialization of the surrounding gingiva, clot stabilization, and photobiomodulation. The primary outcome measure was change in bone density in the extraction area between day 1 and 4 months after extraction. Patients were monitored for potential side effects. Results Increase in bone density at the follow‐up CBCT was significantly higher in laser than in control group (p

Relevance. Immediate implant placement with immediate temporisation is method of choice in case of central incisors extractions. In nowadays there are many protocols aimed on optimisation of the immediate prosthetic result. Some of them are based on using CAD/CAM technology, others stress the importance of peri-implant grafting procedures as a means of clinical success. The aim of the study is to analyse tactic of treatment in cases of immediate implant prosthetic replacement of maxilla central incisors using assessment of clinical example and elaboration of the optimal treatment option. Materials and methods. We conducted the evaluation of the 54 year old male patient with the use of clinical and paraclinical examination methods (OPG, CBCT). Implant placement in the position of the teeth 1.1, 2.1 was performed utilising new NobelParallel Conical Connection TiUltra (NobelBiocare, USA) 4.3*13 mm followed by implant supported Procera Zirconia prosthesis. We used international indices PES and it’s modification WES for the assessment of the achieved results. Results. The final result received following scores: PES index = 7, WES index = 8. Conclusion. Choice of implant design is a major influencing factor on the immediate implant placement prognosis. Utilising Nobel Active implant in the described clinical situation combining its placement with grafting of the connective tissue taken from the tuberosity area led to the decrease in total treatment time and achievement of the superior esthetic and functional result.

Aim: Successful functional and esthetic rehabilitation of edentulous jaws with implants depends on the optimal timing of placement, surgical protocol, materials used, cost-effectiveness, and satisfying patient needs. Increasing demand for shorter treatment times necessitates the immediate placement protocol. However, researchers have demonstrateda higher failure rate. A-PRF (Advanced platelet-rich fibrin) has exhibited accelerated bone regeneration potential. Early implant placement with a limited healing period, along with A-PRF, can be beneficial over conventional and immediate implant placement. Settings and Design: This prospective randomized clinical trial aims to assess the outcome of early implant placement in sockets preserved using A-PRF at six weeks and eight weeks of post-extraction. Two groups of 10 participantseach were formed. All patients underwent atraumatic extraction and socket preservation using A-PRF. Materials and Methods: A Partial-thickness pedicle graft was raised, and the extraction socket wasclosed. Implants wereplaced in at six and eight weeks of post-extraction in group A group B, respectively. The histomorphometric analysisassessedthe bone quality present at the timeof surgery. The insertion torque values were recorded during implant placement. Statistical Analysis Used: The obtained data were statistically analyzed using parametric tests, namely independent T-test for intergroup comparison. Results: T-test for torque values indicated a significantly higher torque value at eight weeks. The meanhistomorphometric value showeda significantly higher percentage of bone formation at eight weeks than at six weeks (P = 0.03). Conclusion: Within the study's limitations, early implant placement in extraction sockets preserved with A-PRF had significantly higher insertion torque values and predictable bone at eight weeks compared to six weeks.

Introduction. Extracted teeth are still considered clinical waste and therefore are being discarded. It is evident that obtained and prepared autogenous dentin graft (ADG) may be used for guided bone regeneration (GBR) due to its similar biochemical characteristics to human bone. The aim was to present a novel procedure in a clinical setting that employs freshly extracted teeth that are processed into a bacteria-free particulate dentin, and then grafted immediately into the extraction sites or bone deffects. Monitoring the clinical and radiological parameters (vertical and horizontal dimensional changes on the alveolar ridge and vertical dimension of intrabony defects at the distal aspect of the second molar after extraction of third molar) for a period of 6 months, proved rapid healing capacity of ADG on the bone and soft tissue structures in the jawbones. Material and methods. Clinical measurements were performed using a questionnaire for monitoring the postoperative clinical manifestation, bone measuring calipers for measuring horizontal changes of the alveolar ridge and graduated probe for measuring vertical dimensional changes, also paraclinical-radiological examinations to follow-up bone density. Results. During the follow up period of six months, clinical measurements of post-extraction dimensional changes of the alveolar ridges showed minimal horizontal and vertical bone resorption with preserved alveolar ridge volume, with an accelerated bone regenerative process without special postoperative complications. Conclusion. Dentin particulate grafted immediately after extractions should be considered as gold standard due to its osteogenetic, osteoinductive and osteoconductive effects on bone tissue regeneration. With the use of mineralized dentin matrix we get maximum utilization of our own biological potential without the use of other artificial graft materials.

Extraction socket preservation (ESP) is widely performed after tooth extraction for future implant placement. For successful outcome of implants after extractions, clinicians should be acquainted with the principles and indications of ESP. It is recommended that ESP be actively implemented in cases of esthetic areas, severe bone defects, and delayed implant placement. Dental implant placement is recommended at least 4 months after ESP.

The placement of immediate implants in aesthetic anterior region usually possess a challenge in implant dentistry. After tooth extraction, the buccal bone inevitably undergoes remodelling with associated resorption and diminished horizontal and vertical size of the alveolar ridge. To maintain the original buccal bone dimension after tooth extraction practitioners can choose multiple techniques like atraumatic extraction, immediate implant placement, socket preservation, socket augmentation and extensive buccal bone grafts and barrier membranes. However these techniques could partly compensate but not avoid the resorption process thus a better technique called socket shield technique have been proposed. In socket shield technique, a partial buccal root fragment is retained around an immediately placed implant with the aim of avoiding facial tissue alterations after tooth extraction. The literature related to socket shield technique reports promising solution and hold significant potential for immediate implant placement specifically in anterior aesthetic region. Keywords: Socket Shield, Atraumatic extraction, Immediate implantation Key Message: Socket Shield physiologically helps to preserve labial and buccal bone. Socket shield technique requires minimal material and is minimal invasive. Socket shield with immediate implant placement reduces the required treatment time and number of surgical procedures as compared to a delayed conventional approach

Purpose Deproteinized bovine bone mineral (DBBM) is a type of bone substitute material widely used in tooth extraction sites. However, there is a lack of evidence supporting the benefit of DBBM used for postextraction socket preservation with regard to new bone formation. This meta-analysis and systematic review was conducted to explore whether site preservation (SP) using DBBM could provide benefits with regard to new bone formation compared with natural healing. Materials and methods Studies reporting histological results for postextraction SP with DBBM and natural healing from 2000 to 2019 were identified in three databases, and a meta-analysis was conducted. Results Five studies were included. The DBBM group had a significantly lower new bone percentage than the natural healing group, with a MD of −24.75 [95% CI: −39.77, −9.73] (P = 0.001). The percentage of connective tissue in the extraction site was not significantly different between the two groups, with a MD of 0.60 [95% CI: −4.85, 6.05] (P = 0.83). Conclusions SP using DBBM provided no additional benefit with regard to postextraction new bone formation in comparison with natural healing. Due to the lack of high-quality research, further large-sample studies and standard studies are needed to confirm these conclusions.

Background The present study aimed to analyze the early soft tissue healing characteristics and Fractal Dimension (FD) of extraction sockets preserved by Leukocyte-platelet-rich fibrin (L-PRF) and titanium prepared platelet-rich fibrin (T-PRF). Materials and methods 57 single-tooth extraction sockets were included in the study, three groups were prepared: post-extraction sockets filled with L-PRF (n = 19) and T-PRF (n = 19), and control group; naturally healing sockets (n = 19). Three months after tooth extraction, FD measurement was made in the center of the healing socket. The Landry Wound Healing Index (LWHI) and H2O2 bubbling test results for the complete wound epithelization (CWE) rates were recorded 1 and 2 weeks postoperatively. All patients were asked to record a visual analog scale (VAS) value for pain and the number of analgesics taken during the 3 days after the extraction. Results CWE using H2O2 test result showed a significantly lower rate in the controls than in L-PRF and T-PRF groups at 1st week. At 2nd weeks, both of the test groups showed 100% CWE compared with only 40.7% in the control group. The VAS pain score was significantly higher in the control group than in L-PRF and T-PRF groups on the 1st day. However, no significant difference was found among the groups on 2nd day. FD value of control group was significantly lower than the L-PRF group and T-PRF group. Conclusions T-PRF and L-PRF similarly enhanced wound epithelization and reduced postoperative discomfort at extraction sockets. The T-PRF procedure resulted in higher FD compared to the L-PRF and control group.

Background: The extracted teeth have proven to be a ready source of bone substitute material and thus, they are no longer viewed as clinical leftover. Many techniques are employed to process the teeth into particles with different sizes, shapes and calcium composition. Aim: The aim of the trial is to compare autogenous tooth (AT) biomaterial and the autogenous decalcified dentin (ADD) biomaterial for their efficacy in socket preservation procedures in relation to the radiographic dentistry measured on cone beam computed tomography (CBCT) images. Methodology: A total of 12 hopeless teeth were randomly assigned into both study groups. After executing atraumatic extraction, the tooth was cleaned and milled then it was prepared into either AT or ADD with decalcification in hydrochloric acid with pH=1 then inserted in the extraction socket. Baseline CBCT and the final images taken after six months were compared for radiographic density expressed in Hounsfield units (Hu). Results: After six months, all sites achieved soft tissue closure and were filled with bone without incidents. Radiographic bone density values were 830.67±115.5 and 742.83±148.84 Hounsfield units for the AT group and the ADD group respectively without a statistical difference. Conclusions: Both types of biomaterials were similarly effective in bone healing after extraction by providing radiographic density in treated sites.

Objective: The aim of present study is to evaluate effect of using two different biomaterials, Bio-oss graft and PRF membrane for ridge preservation after tooth extraction, clinically and radiographically. Patient&Methods: This study was conducted on 20 patients indicated for extraction, from those attending the outpatient clinics of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University Hospitals. Patients were divided into two groups: Group I: Extraction socket preservation with bio-oss graft and PRF membrane (10 patients). Group II: Extraction socket without grafting (10 patients). All patients were evaluated clinically after 24-hour, one week and two weeks for pain and edema. They were also evaluated immediately and after six months for bone gain in height and width using cone beam computed tomography. Results: The bone width between the two groups was found to be statistically significant where the bone height was not statistically significant between the study and control groups. Conclusion: Post extraction alveolar ridge resorption is an inevitable process. Bio-oss placed in extraction socket give better bone quality and quantity than empty socket. The PRF membrane is used effectively as a membrane to cover the bone graft.

A bone graft may be used in a variety of clinically practiced implant surgeries, namely, guided bone regeneration, extraction socket preservation or reconstruction, ridge augmentation, and sinus membrane elevation. The bone graft is of various types depending on the material, for instance, autogenous bone graft, allograft, xenograft, alloplastic graft, and autogenous bone graft with demineralized dentin matrix, which may be used alone or with other materials. Bioactive agents that promote bone formation, such as recombinant human bone morphogenetic protein-2 (rhBMP-2), have been shown to exhibit a clinically beneficial effect on bone regeneration. Here, we intend to present surgical guidelines for bone grafts and criteria for selection of bone graft materials by referring to evidence-based studies and recent lectures on the subject of ‘bone grafts for implant dentistry’ at the Amapá society of implantodontics, 2020.

Background: Telescopic overdenture is a prosthesis consisting of a primary coping, or an inner crown, that is attached to a supporting tooth in the oral cavity, and a secondary coping, or an outer crown, attached to a denture, which must be compatible with the primary coping. Purpose: The purpose of this study was to restore function and aesthetics and uplift the psychological status of the patient by fabrication of a fixed removable prosthesis using the existing abutment teeth as a telescopic overdenture. Case: A 36-year-old female came to the Prosthodontic RSGM UNAIR speciality clinic on her own volition to make front dentures for her upper and lower jaws after a traffic accident one and a half years ago. The patient had an arch bar installed two months after the accident, which was removed after two months. The patient wanted new dentures to improve both her ability to eat and her appearance. Case Management: Preliminary treatments performed were; maxillary and mandibular scaling and root planing; crown lengthening of tooth 15; extraction of teeth 16, 41, 42, and 43; and alveolectomy of the mandibular anterior region. Before the definitive treatment to improve the aesthetic appearance could be carried out, the first step was to make maxillary and mandibular transitional dentures. These were to be used while waiting for healing to occur, following the socket preservation in the mandibular area. Then, for the definitive restoration, we used telescopic overdenture for the maxilla and a removable partial denture for the mandible. Conclusion: Telescopic overdenture is recommended for patients who need good aesthetics for anterior tooth loss. Telescopic overdenture uses double crowns as the retentive elements, which give better aesthetic results compared to clasps, thereby improving the psychological status of the patient. In addition, they have better retention and stability compared to conventional complete dentures.

Introduction: Sufficient bone volume, as well as the bone quality characteristics are necessary prerequisites to ensure optimal mechanical stability of the implants and subsequent osseointegration. Aim: The aim of the present study was to assess the correlation between bone density values obtained by cone-beam computed tomography (CBCT), the primary stability of dental implants and the histomorphometric analysis of bone quality. Materials and methods: Following tooth extraction, socket preservation with frieze-dried bone allograft or protein-rich fibrin (PRF) was performed on 30 patients with 30 maxillary teeth in the region from second premolar to second premolar. Four months after the procedure, CBCT was used to assess the bone density (Hounsfield units) in the area of extraction. Thirty bone samples were harvested from implant sites using a trephine drill. They were analyzed with Image J software. Immediately after placing the implant, the implant stability quotient was measured using the Osstell Idx device. Results: The results revealed significant correlations between bone density and primary stability along the vestibulo-oral (r=0.392, p=0.032) and mesiodistal axes (r=0.407, p=0.026). Bone density also correlated strongly with the percentage of newly formed bone (r=0.776, p Conclusion: Bone quality, in terms of bone density measured in CBCT and new bone formation are correlated to the primary stability of the dental implants and vice versa.

Objective This study was designed to evaluate N-acetyl cysteine with Nano-hydroxyapatite bone graft for preservation of alveolar ridge after teeth extraction clinically, and radiographically. Subjects and methods Nano-hydroxyapatite bone graft and N-acetyl cysteine were used to preserve sockets after extraction of badly decayed lower molars. To assess alveolar bone height, width and density, preoperative panorama and CBCT were done , immediately after extraction ,at 3 and at 6 months . Results Regarding alveolar bone height and width, NAC showed the least decrease in lingual height, Nano-hydroxyapatite +NAC and NAC alone showed the higher increase in bottom and the least decrease in width measurements. Density measurements showed that Nano-hydroxyapatite + NAC and NAC alone showed the highest increase in density measurements. Conclusion The use of NAC was safe and there were no complications and addition of NAC to Nano-hydroxyapatite resulted in marked enhancement of bone width. Keywords N-acrtylcysteine, Socket Preservation, Bone Graft

Aim: To compare socket bone preservation using Osteon II Collagen mixed with Hyaluronic Acid (Hy A) versus autologous concentrated growth factors enriched bone graft matrix (sticky bone) assessed by 3D cone beam computed tomography and histological evaluation. Patients and methods: 30 patients were treatment planned for extraction of mandibular first molar teeth, leaving 30 sockets for the study. Sockets were divided randomly into two equal groups. Sockets were grafted as follows: Group (I) sockets were grafted by Osteon II Collagen mixed with Hy A, Group (II) sockets were grafted by sticky bone graft. A cone beam computed tomography (CBCT) radiographs at one day, 3 and 6 months were postoperatively done to assess bone density and tooth socket dimensions. Microscopic evaluation was performed at 6 months before implant insertion. All readings were recorded and analyzed statistically. Results: There is a high statistically significant difference between study groups as regards the mean values of bone density, bone height, and percentage of volume change. In another the side, other parameters showed insignificant differences between the study groups. Histological study referred to more maturation of bone in group I than group II. Conclusion: The results clearly concluded that both Osteon II Collagen mixed with HyA and sticky bone are successful in achieving clinical and 3D volumetric socket bone preservation with superiority for Osteon II Collagen mixed with HyA .

Objective: The objective of the present study was to compare the effect of mixing simvastatin with Nanobone graft on thehealing process of extraction sockets regarding to the histological parameter.Materials and Methods: In a prospective randomized clinical study, ten patients (study group, Group II) treated by simvastatinmixed with Nanobone after tooth extraction. The other ten patients (Control group, Group I) received Nanobone only. Threemonths after tooth extraction and socket preservation, histological biopsies were taken at the time of implant placement. Thebiopsies were evaluated in the terms of the histological parameter for the identification of vascularization and bone metabolismfactors.Results: The use of simvastatin combination results in slightly higher values of mineralized area of newly formed boneandnumerous well differentiated capillary vascularization.Conclusion: Simvastatin and Nanobone combination showed improvement in socket preservation.

The management of the alveolar socket is fundamental to create conditions that would allow the positioning of dental implants in the same site, when required. A number of biomaterials were described in scientific literature to be used for alveolar socket preservation immediately after tooth extraction: autogenous grafts, allograft (of various origin), and synthetic products. Among the autogenous biomaterials, some authors proposed the use of autogenous dentin and/or enamel, retrieved from teeth, adequately managed, and purified. The present case report with two-year follow-up shows one case of alveolar socket preservation by using tooth graft material that was subsequently treated with one implant-supported rehabilitation in the same site. The paper presents clinical and histological outcomes and confirms the feasibility of adopting such autogenous biomaterial in standard procedures.

Background. Alveolar bone remodeling after tooth loss results in reduced ridge dimensions in horizontaland vertical planes. To prevent this, various authors have proposed different ridge preservationtechniques. A collagen plug is a novel material that has shown promising results in preserving thealveolar bone. PRP has also yielded favorable outcomes in wound healing and promoted osteoinductionand osteoconduction Methods. Thirty patients of both sexes with an age range of 30–18 years requiring bilateral extractionof teeth with similar tooth root anatomy in the maxilla or mandible were included in the study. Theextraction of teeth was carried out atraumatically. The patients’ arches were randomly divided andlabeled as the test or control sides. Bone width was measured on both sides. A collagen plug, with PRP,was placed, and the extraction socket was sutured on the test side. The control side was just sutured. Abaseline RVG was taken to record the apico-coronal height. The patients were recalled after 10 days forsuture removal and evaluation of wound healing. Parameters were re-evaluated at three and six monthspostoperatively. The data were subjected to t-test and one-way ANOVA. Results. The height of the crestal bone on the grafted side was more when compared to the non-graftedside three and six months after tooth extractions, and the difference was statically significant (P0.05). Conclusion. Collagen and PRP provided reasonable socket preservation as simple and inexpensiveoptions as compared to other materials.

Aim: This study was designed to evaluate the socket preservation using a synthetic nanocrystalline hydroxyapatite followed by collagen membrane. Subjects and methods: Fourteen patients were selected from Oral and Maxillofacial clinic of the Faculty of Oral and Dental Medicine, Al-Azhar University, Cairo, Boys. Extraction of tooth of lower premolar area was done to all participants. Then they were divided into 2 groups, where 7 sockets were preserved and the 7 were kept as control. After tooth extraction in the test group nanobone putty form was grafted into the socket. An additional covering was performed by a collagen membrane. A cone beam computed tomography (CBCT) radiograph at 3 and 6 months were done to assess bone density and socket dimensions. All readings were recorded and analyzed statistically. Results: Among the study group, there is a high statistically significant difference between the three measurements (soon after extraction, after 3- and 6- months from operation) as regards the mean of bone density and the three dimensions .Conclusion: Nano hydroxyapatite together with collagen membrane to seal the socket accelerates the formation of bone filling in the extracted bony socket

Background: Maintaining a good ridge is required during prosthodontic treatment. Hence, adequate alveolar bone support is considered an important factor in pursuing successful dentures. Propolis extract combined with bovine bone graft is a recent and innovative material in the process of socket preservation, as the caffeic acid phenethyl ester (CAPE) it contains can suppress the inflammatory process. Purpose: This study aims to determine the effective dose of propolis extract combined with bovine bone graft on the number of osteoblasts and osteoclasts in socket preservation. Methods: Twenty-eight Cavia cobaya animals were divided into four groups of seven. Group I was given 25 grams of PEG, while Group II were given a propolis extract at a dose of 0.5% combined with bovine bone graft. Group III were given a propolis extract at a dose of 1% combined with bovine bone graft and Group IV were given a propolis extract at a dose of 2% combined with bovine bone graft. On day 30, the lower incisor of each subject was extracted and induced with PEG and propolis (dose 0.5%, 1%, 2%). Histopathological examinations of osteoblasts and osteoclasts were measured with a 400x magnification light microscope. One-way ANOVA and Tukey HSD tests were performed to analyse data statistically. Results: The propolis extract combined with bovine bone graft not only increased the number of osteoblasts but also reduced the number of osteoclasts. The most effective dose for the propolis extract combined with bovine bone graft was 2%. Conclusion: The propolis extract combined with bovine bone graft could be effective in tooth extraction socket preservation at a dose of 2%.

Aim: This in vivo study compared clinical, histological, and radiological differences in bone formation in human extraction sockets grafted with demineralized freeze-dried bone allograft (DFDBA) and platelet-rich fibrin (PRF), with nongrafted sockets and bone–implant contact (BIC) at 3 and 6 months after implant placement. Settings and Design: Randomised controlled trial. Materials and Methods: The study comprised thirty posterior teeth sockets in either arch in patients ranging from 25 to 60 years. The patients were divided into two equal groups – Group I: control group wherein no graft was placed and the extraction socket was left to heal normally and Group II: test group in which DFDBA and PRF were placed after extraction. 12–16 weeks after extraction, a trephine biopsy was done just prior to implant placement, followed by implant placement. Cone-beam computed tomography (CBCT) at 3 and 6 months after implant placement was done to assess BIC. Statistical Analysis Used: Descriptive and Inferential statistical analysis was done. Parametric test: Independent t-test was used for intergroup analysis and dependent t-test for intra-group analysis. Results: Lower buccal bone levels were seen in the control group versus test group at all intervals though moderately significant. Lingual bone levels significantly reduced at all the three intervals for the control group as compared to the test group. Ridge width in both groups reduced in a time span of 6–7 months without any significant difference. Better bone conversion was noted in the preserved sockets. The preserved sockets also showed better BIC 3 months after implant placement and loading. Conclusion: Indigenously developed DFDBA material shows promising results as an osteoinductive material.

Aim The aim of this study was to analyze, by the aid of microbiological analysis and the field emission scanning electron microscopical (FE-SEM) analysis, the role of high-density polytetrafluoroethylene (d-PTFE) membranes in avoiding the microbial colonization of a nanocrystalline hydroxyapatite (nc-HA) bone graft and the involvement of this colonization in the healing process. Materials and methods Six patients underwent extraction of unrecoverable teeth, and a socket preservation technique was carried out with nc-HA synthetic bone graft and then covered with a d-PTFE membrane. After 28 days from surgery, FE-SEM analysis and BioTimer assay technique to assess the microbiological count of streptococci species were carried out. Data were collected and analyzed by the Student's t test (confidence interval: 95%). Results The mean amount of bacteria measured on the upper side of the membrane was 6.52 ± 0.50 CFU, while on the lower side, it was 6.59 ± 0.40 CFU. Significant differences were not found between the two sides of the membrane or between the different sectors (p > 0.05). The FE-SEM analysis revealed structured biofilms on both sides of the membrane: species of cocci, bacilli, and fusobacteria were recognizable in occasional settled vegetations. Conclusion Since the amount of bacteria found was low, the improved impermeability of the d-PTFE membrane permitted the healing process to proceed uneventful and without signs of infection or inflammation. Clinical relevance The infection of the graft site could lead to a failure of the socket preservation technique which could delay or compromise the rehabilitation following procedures. The use of d-PTFE can improve the bone regeneration thanks to its antimicrobial properties.

INTRODUCTION: Tooth extraction socket healing is a complex process, which involves tissue repair and regeneration. Concurrent with bone growth into the socket, there is also well-documented resorption of the alveolar ridges. Therefore, the socket preservation concept was introduced. One of the top ranked evidence-based herbal medicines, which has been described as the “miracle herb of the century” is Nigella sativa (NS). N. sativa has been extensively studied for its biological activities and therapeutic potential and shown to possess wide spectrum of activities. OBJECTIVES: To evaluate the biological effect of Nigella sativa on socket healing in rabbits. MATERIALS AND METHODS: Twelve healthy rabbits were used in this study, lower first premolars (right and left) were extracted. All right sockets were left for normal healing as a control group, while the left sockets are considered as the study group and they were treated with Nigella Sativa. All sockets were sutured. Rabbits were sacrificed after two weeks. Their mandibles were dissected out to be processed for histological examination under the light microscope. RESULTS: In the control group, the histological examination of the socket revealed randomly arranged thin bony spicules lined by flattened layer of osteoblast cells on its surface, enclosing fibrous bone marrow with limited vascularity. Osteocytes were of moderate size and density. In the Nigella sativa treated group sockets exhibited more active bone formation, thick trabeculae with highly vascular bone marrow and large numerous osteocytes. Certain areas show replacement of woven bone with mature bone where bone remodeling takes place. CONCLUSIONS: Use of Nigella sativa after extraction in the healing sockets could enhance bone formation and accelerate the process of socket healing

Aim. To analyse the effi ciency of osteoplastic material application in order to reduce the resorption level after tooth extraction in the preimplantation period according to the data of cone beam computed tomography.Materials and methods. The study involved 80 patients who were divided into 4 equal groups depending on the preservation material used. The fi rst group was treated with Cerabone (Botiss, Germany) xenomaterial based on natural bovine bone. Plasma enriched with PRGF growth factors obtained by the BTI Endoret (Spain) technology was used for the patients of the second group. The third group consisted of patients who underwent a socket preservation of the extracted tooth with a powdered autologous dentin matrix (ADM) obtained from their own tooth. In the fourth group, bone-plastic material based on hydroxyapatite with Collapan-L lincomycin hydrochloride (Intermedapatit, Russia) was used to prevent socket resorption. All patients had a cone beam computed tomography of the maxillofacial region before the extraction and 3 months after the preservation in order to evaluate the level of bone resorption. After the installation of dental implants, a comparative assessment of the bone resorption level in the vertical and horizontal directions before tooth extraction and in the preimplantation period was carried out.Results. The smallest level of vertical bone resorption after socket preservation was observed in group 1 (Cerabone) and group 3 (ADM). The median value of the socket resorption level in group 1 was 0.7 mm (8.54 %) in the vertical direction and 0.5 mm (9.45 %) in horizontal measurement as compared to the level of bone tissue before tooth extraction. Similar indicators were observed in the group using an autologous dentin matrix. The vertical decrease in the socket bone tissue was 0.61 mm (7.75 %), horizontal — 0.51 mm (6.2 %). The level of bone resorption was signifi cantly higher using two other materials.Conclusions. The use of three-dimensional radiation research methods allows a comprehensive assessment of the bone tissue volume to be carried out, which in turn determines the choice of the dental implant size, the need for further bone-plastic surgery to increase the width/height of the alveolar ridge. The use of cone beam computed tomography showed that the most optimal results can be obtained by introducing Cerabone material into the socket of the extracted tooth, as well as using the innovative method of preservation with the patient’s own powdered tooth (ADM).

Progressive bone resorption after extraction of tooth may lead to prosthetic-driven and surgical difficulties when a dental implant has to be placed after extraction of tooth. This case report discusses an irreparable upper right first premolar with a dehiscence on buccal wall. A conservative tooth extraction was performed and the dehiscence was exposed after reflecting a full thickness mucoperiosteal flap. The socket and the dehiscence were then grafted using Nova bone putty and amnion membrane. After a healing period of 3 months and 9 months a CBCT analysis was done to check for regeneration in the grafted site. It can be concluded that grafting technique can lessen the alveolar bone resorption in the socket with dehiscence.

Background To evaluate and compare the long-term clinical and radiological outcomes of post-extraction sockets after ridge preservation either with porcine xenograft or collagen alone. Patients underwent single-tooth extraction in the posterior mandible. Fresh extraction sockets were filled with pre-hydrated cortico-cancellous porcine bone or collagen sponge. Two or 3 months later, a ridge expansion technique with immediate implant positioning placement was performed. Primary (alveolar width changes) and secondary outcomes (adverse events and long-term maintenance of buccal plate covering the implant) were evaluated. Results Thirty-four women and 20 men were selected: 30 implants (group A) placed into healed post-extraction sockets grafted with porcine bone and 24 (group B) into sockets filled with a collagen sponge. There was a significant loss in width in both groups from the first and second surgery (ranging between 2.7 mm and 4.5 mm). The ridge splitting with bone expansion resulted in significant long-term increases in width for both procedures and implant sites. Non-significant differences in alveolar width were registered between the groups at 10-year follow-up even if the analysis of the implant buccal bone coverage suggested that group A had significantly worst results. Conclusions Porcine bone group had significantly better short-term outcomes with lower long-term maintenance of the buccal plate.

The aim of the present clinical study was to assess and compare the histomorphometric results and efficacy of freeze-dried bone allograft (FDBA) in combination with platelet-rich fibrin (PRF), and PRF as a sole grafting material for socket preservation. Ninety patients in need of tooth extraction and implant restoration were included in this study. The participants were randomly divided into three groups based on post-extraction clinical protocol: socket preservation procedure with allograft in combination with a PRF membrane (PRFm), PRF as a sole grafting material, and a control group. A total of 90 implants were placed four months post-extraction. During the surgical re-entry a bone biopsy was harvested with a trephine drill. Histological samples were prepared and analyzed for percentage vital bone and connective tissue. One-way ANOVA with Bonferroni post-hoc analysis were used to assess the results. Both test groups revealed a significantly higher percentage of vital bone formation compared to the control group. No statistically significant differences regarding vital bone formation and connective tissue quantity between the tested groups were observed (FDBA + PRFm: 3.29 ± 13.03%, and PRF: 60.79 ± 9.72%). From a clinical and histological point of view, both materials in the test groups are suitable for the filling of post-extraction sockets without bone defects. Both of the tested groups revealed a significantly higher percentage of vital bone formation compared to the control group.

To assess alveolar bone changes and treatment modality alterations after ridge preservation on maxillary molar extraction sockets with severe periodontitis, compared to natural healing. Thirty-six maxillary infected-molar teeth either receiving ridge preservation (RG group) or undergoing natural healing (NT group) were investigated. Cone-beam computed tomography (CBCT) scanning was performed immediately after surgery (the baseline) and repeated 6 months later to measure the linear and volumetric changes of the sockets. Based on radiographic measurements, alveolar bone width decreased by 1.58 ± 4.61 mm in the NT group but increased by 3.74 ± 4.17 mm in the RG group (p < 0.05). Significant increases in ridge height at the center of both the NT (7.54 ± 4.54 mm) and RG (9.20 ± 3.26 mm) groups were observed. Mean sinus pneumatization was 0.19 ± 0.45 mm in the RG group and 0.59 ± 0.63 mm in the NT group (p < 0.05). The relative increase in total ridge volume was 8.0% and 35.5% in the NT and RG group, respectively (p < 0.05). Implant placement with additional sinus augmentation procedure was performed in 16.7% of the RG group cases, whereas 50% in the NT group cases. Ridge preservation in the maxillary molar extraction sockets with severe periodontitis can improve alveolar ridge dimensions and decrease the necessity of advanced regenerative procedures at implant placement compared to natural healing. Ridge preservation on maxillary molar extraction sockets with severe periodontitis maintained the vertical bone height more efficiently and resulted in less need for sinus augmentation procedures at 6 months compared to natural healing.

Background: This study aims to evaluate whether there is a correlation between implant stability, bone density, vital bone formation and implant diameter and length. Methods: Ninety patients were enrolled in this study. They underwent a socket preservation procedure with allograft or PRF and after 4 months, a total of 90 implants were placed. CBCT scans were assigned prior to implant placement in order to assess the bone density. During the surgical re-entry, a bone biopsy was harvested with a trephine drill. Immediately after implant insertion, the primary stability was measured. The secondary stability was measured 4 months after implant placement. Results: Primary stability showed a significant positive linear correlation with bone density (r = 0.471, p &lt, 0.001) as well as with percentage of new bone formation (r = 0.567, p &lt, 0.001). An average significant association of secondary stability with bone density (rs = 0.498, p &lt, 0.001) and percentage of newly formed bone (r = 0.477, p &lt, 0.001) was revealed. The mean values of primary stability in all three implant sizes, regarding the diameter of the implants, were similar (narrow 67.75, standard 66.78, wide 71.21) with no significant difference (p = 0.262). The same tendency was observed for secondary stability (narrow 73.83, standard 75.25, wide 74.93), with no significant difference (p = 0.277). Conclusions: The study revealed a high correlation between primary and secondary implant stability, and bone density, as well as with the percentage of vital bone formation. Implant length and diameter revealed no linear correlation with the implant stability.

The present study investigated the capacity of Suprathel® (a copolymer membrane, so far validated for skin regeneration) to also regenerate oral tissue – mucosa and bone, by comparing this biomaterial, in a split-mouth rabbit model, to Mucoderm®, a xenogeneic collagen matrix certified for keratinized oral mucosa healing. The clinical reason behind this experimental animal model was to determine whether the benefits of this advanced skin regeneration product (Suprathel®) could be conveyed for future evaluation in clinical trials of oral tissue regeneration in humans. The outcomes of this study validated the use of Suprathel®, a terpolymer of polylactide with trimethylene carbonate and ε-caprolactone, for stimulation of oral epithelium and alveolar bone regeneration in rabbits. Both Suprathel® and Mucoderm® exhibited comparable results and the null hypothesis stating a comparable regenerating effect of these two materials could not be rejected.

Extraction of the natural tooth may be a prelude to implant placement. This may be done using an immediate placement protocol or require a delayed approach depending on multiple factors that include; residual infection related to the failed tooth being extracted, availability of bone to stabilize the implant at placement or soft tissue issues. Socket preservation is recommended when the delayed approach is selected to create an osseous bed that can accommodate the implant that is planned. This also helps preserve what crestal bone remains following the extraction that may resorb in the absence of socket preservation during the extraction socket healing phase. The use of osseous graft materials and guided bone-regeneration has demonstrated enhancement of socket healing by potentially modifying the resorption process, yielding preservation of the crestal bone while limiting resorption potential during healing. Various graft materials have been reported including, allografts, xenografts, non-biologics and synthetics. Calcium sulfate as a graft material has been used for many decades in maxillofacial surgeries, plastic surgery, oncologic and orthopedics in the treatment of osseous voids, traumatic or inflammatory bone deficiencies. This article will review a case using biphasic calcium sulfate with a delayed implant protocol and the histology demonstrating conversion of the graft material to host bone following healing.

Background Platelet-rich fibrin (PRF) can be used in the alveolar socket preservation (ARP). However, the hard tissue-regeneration property of PRF in alveolar socket preservation is still unclear. Purpose To compare the new bone formation ratio between using PRF as a socket preservation material and normal wound healing, by means of histomorphometric analysis. Materials and methods Thirty-three healthy volunteers were recruited and randomized into PRF and control group. Minimally traumatic extractions were performed. Eighteen patients were treated with ARP using PRF, while the rest were left to heal naturally. Bone specimens were harvested using trephine bur 2 months after the extraction process. Histomorphometric analysis of new bone formation area compared with total socket area was performed using the software Fiji Is Just Image J (version 2, GNU General Public License). Results Thirty-three volunteers were participated. Twenty-eight bone specimens were collected. The new bone formation ratio was higher in PRF group than in control group (31.33 ± 18% and 26.33 ± 19.63%, respectively). However, there was no statistically significant difference in the ratio between the PRF and control groups (P = .431). Conclusions It may be concluded that the use of PRF in ARP does not statistically significant enhance new bone formation after tooth extraction compared to normal wound healing (P > .05).

Purpose The extraction of a tooth is followed by hard and soft tissue changes that can compromise implant placement. The aim of the present retrospective study was to compare the clinical and radiographic outcomes of different ridge preservation procedures based on the use of leukocyte and platelet-rich fibrin (L-PRF). Materials and Methods The study population consisted of all patients who had undergone surgery from January 1, 2017 to January 1, 2018 for alveolar ridge preservation on single posterior teeth using 3 clinical protocols: L-PRF alone, L-PRF mixed with a bone xenograft, and bone xenograft alone. Clinical and radiographic measures were recorded preoperatively and at 6 months postoperatively to determine the horizontal and vertical ridge resorption. Results A total of 45 patients were included in the present study. All the surgeries were performed successfully, and no intraoperative complications developed. The L-PRF group experienced significantly greater horizontal and vertical bone resorption. The L-PRF plus bone xenograft group had less vertical and horizontal bone resorption than the bone xenograft alone group. Statistically significant differences in postoperative pain and wound healing were observed, with the bone xenograft alone group, in particular, having higher values for pain and experiencing delayed wound healing. Conclusions Within the limitations of the present retrospective study, the use of a bone xenograft alone or L-PRF combined with a bone xenograft to perform alveolar ridge preservation procedures significantly limited bone resorption.

Introduction Axenfeld-Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal dominant condition defined by craniofacial, ocular, dental, periumbilical, and systemic anomalies. Case presentation This case report describes in detail a multidisciplinary approach to successfully restore the oral function and esthetics of a 22-year-old patient diagnosed with ARS. The patient's clinical evaluation revealed that the area corresponding with teeth #13, #12, #11, #21, #22, and #23 was occupied by four malformed and/or deciduous teeth. The four anterior teeth were extracted, and socket preservation was performed using bovine-derived porous bone mineral. Six months after extractions, two implants were placed in the location of the lateral incisors and additional bone graft was performed. Two months after the initial healing, a temporary fixed partial was delivered and 9 months after implant placement the implants were restored with a porcelain-fused-to-metal fixed partial denture. Conclusions The use of implant-supported fixed partial dentures to restore missing teeth in patients with ARS provides biological and mechanical advantages over conventional, fixed, or removable prosthodontics. Further evaluation is needed to determine the longevity and long-term prognosis of dental implants in patients with ARS.

Purpose Among all platelet concentrates, platelet-rich fibrin has been shown to possess fibrin, leukocytes, and a variety of growth factors that could promote wound healing. The purpose of this study was to compare the bone healing in natural healing sockets (control group) versus that in sockets under ridge preservation with platelet-rich fibrin alone (test group). Materials and methods Searches were conducted via electronic and manual approaches for randomized controlled trials and controlled clinical trials published up to May 2018 that evaluated alveolar ridge outcomes (at least 1-month follow-up) in both natural healing sites and sites with platelet-rich fibrin placement alone for ridge preservation. Changes of ridge height and width, osteoblastic activity, and the number of sites were extracted from original articles for meta-analyses. Weighted mean difference and 95% confidence interval were calculated using a random-effects model. Results Eight human studies (six randomized controlled trials and two controlled clinical trials) that fulfilled the inclusion criteria were included in the study. Data obtained in the study showed a favorable outcome in platelet-rich fibrin for socket preservation, although the difference was not statistically significant when compared to the natural healing group with regard to alveolar bone height change (weighted mean difference: -0.28 mm, 95% confidence interval: -0.55 to 0.00, P = .051), alveolar bone width change (weighted mean difference: -1.73 mm, 95% confidence interval: -3.58 to 0.12, P = .067), or osteoblastic activity (weighted mean difference: -0.01 [unit], 95% confidence interval: -0.50 to 0.49, P = .982). Conclusion This study revealed that platelet-rich fibrin alone in ridge preservation does not provide significant additional benefit when compared to natural healing sockets with regard to bone volume, bone density, and osteoblastic activity.

Aim This review critically appraises the available knowledge on the pre-clinical and clinical use of bioactive factors for bone regeneration in the cranial and maxillofacial area. Materials and methods The use of growth factors, amelogenins and autologous platelet concentrates (APCs) for bone regeneration was reviewed in a systematic manner. More specifically, pre-clinical and clinical studies on ridge preservation, alveolar ridge augmentation, regeneration of peri-implant defects and sinus augmentation models were considered. Results Amongst different bioactive factors, the highest pre-clinical and clinical evidence of a positive effect on bone formation is associated with rhBMP-2 and the lowest with amelogenins. While APCs seem to accelerate clinical healing and reduce postoperative discomfort, there is insufficient and contrasting evidence of a significant effect on hard tissue regeneration for the different clinical applications. Conclusions Although there is increasing evidence that bioactive factors might enhance the bone regeneration process, the great heterogeneity of the available studies and the limited number of RCTs do not allow to draw robust conclusions. Issues that still need to be investigated include the optimal carriers for bioactive agents (direct vs. indirect), the dosage, the timing of administration, as well as the possibility of combining different agents to promote synergistic effects.

Various grafting materials have been used in oral and periodontal surgeries to augment and rebuild bone intraorally. Calcium sulfate, a synthetic material, also known as an alloplast, has been used for decades in orthopedics, plastic surgery, and oncologic and maxillofacial surgeries for the treatment of osseous deficiencies caused by trauma or inflammation. Biphasic calcium sulfate provides benefits as a short-term space maintainer. Use of biphasic calcium sulfate as the sole material are limited to relatively small osseous defects surrounded by at least 3 bony walls (eg, extraction sockets). Thus, for augmenting large and more complex bone deficiencies Bond Apatite, a composite graft formulation, is indicated. This work will review the various clinical applications of Bond Apatite as an alternative to other graft materials.

The vascularized tunneled combine epithelialize‐subepithelialize connective tissue graft may yield biological outcomes superior to those achieved separately by rotated vascularization or combination interposition onlay tissue graft. This technique may provide clinicians with pathway to improve socket seal by improving the vascularity and the volume of the tissue seal, which would be paramount for the definitive esthetic and functional outcome for modern demand of our patients.

This clinical study evaluated the outcome of bone regeneration using an open-healing approach. We performed 80 atraumatic extraction with socket preservation in n=69 patients (0.98 sex ratio). Post extraction sockets were filled with platelet-rich autologous plasma factors Endoret® (PRGF®) clots covered with fibrin membrane and were left exposed during healing. The bone volume was measured and the need for an additional augmentation in the implant stage was assessed using CBCT scans at t=8 weeks. This analysis showed that open healing technique using PRGF allowed uneventful healing and sufficient bone formation. Thereby, soft-tissue problems associated with extensive flap mobilization and tension may be avoided. We concluded that the use of PRGF in socket preservation with the open healing approach can be favorable from both clinical and radiological points of view. Furthermore, there was almost no need for additional augmentation in the implant stage and the number of complications was limited.

Background: The ultimate goal of periodontal therapy is the regeneration of tissues destroyed by periodontal disease Fibronectin belongs to a group of high molecular weight glycoproteins that exist on cell surfaces. It is known to play a role in cell-to-cell and cell-to-substrate adhesion, as well as an essential role in osseointegration due to its capacity to make osteoblasts attach to the extracellular matrix(ECM) components. Combination of Fibronectin and commercially available bone grafts may hold a promising potential of enhanced bone regeneration.Objective: Comparison of the effect of fibronectin, Bovine-Derived Xenograft (BDX)and their combination for socket preservation through histologic and histomorphometric analysis.Material and Method: Thirty six clinically healthy adult New Zealand white male rabbits, were used in this study. The animals were equally divided into three groups; I-control group (defect was left empty as control), II- bio group (bio- oss was applied on the socket ) and III-( Bio Fibro group) bone and fibronectin group( socket was filled with Bovine-Derived Xenograft Bio-Oss® with fibronectin). At 4 and eight weeks the animals were sacrificed. Bone regeneration among the three groups was evaluated through histologic and histomorphometric analysis.Results: The most significant value of area percent of newly formed bone was observed in the (bone and fibronectin) group, then the fibronectin group, with the least amount recorded in the control group. The difference was extremely statistically significant (p