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Purpose: To evaluate the dimensional changes in the alveolar crest after buccal overbuilding was performed prior to tooth extraction in a dog model. Materials and Methods: At the test sites, alveolar crest overbuilding was performed on the buccal aspect of the distal root of the third premolar using xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both third premolars were extracted and implants were immediately placed into the alveolus, allowing nonsubmerged healing. After 3 months, biopsy samples were collected. Results: Upon histologic analysis, no statistically significant differences in hard tissue dimensions were found. The buccal bone plate at the test sites presented a tendency for higher resorption compared to the control sites. However, if the contribution of the residue of biomaterial is considered, a higher volumetric gain was registered at the test than at the control sites. Conclusions: The buccal overbuilding performed prior to tooth extraction did not contribute to the preservation of the alveolar crest dimensions after extraction. This could be due to failure to incorporate the graft into the newly formed bone. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) therapy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult patients who underwent maxillary single-tooth extraction with or without ARP therapy were included. Surface scans were obtained and CBCT was performed to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regression models were conducted to investigate the individual effect of demographic and clinical variables. Ninety -six subjects (USH = 49; ARP = 47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P < .0001). ARP therapy significantly attenuated interproximal soft tissue height reduction compared to USH: -2.0 ± 0.9 mm mesially for USH vs -1.0 ± 0.5 mm mesially for ARP; -1.9 ± 0.7 mm distally for USH vs -1.1 ± 0.5 mm distally for ARP (P < .0001). Thin (< 1 mm) facial bone thickness (FBT) upon extraction was associated with greater interproximal soft tissue atrophy compared to thick FBT (> 1 mm), independent of the treatment received (P < .0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height, especially in thin bone phenotype, by a factor of 2 for the mesial site (+1.3 mm) and by a factor of 1.6 for the distal site (+0.9 mm). This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional reduction after maxillary single-tooth extraction compared to USH. [ABSTRACT FROM AUTHOR]

Objective: An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal and provide a protocol for managing nerve injuries in such incidents. Case presentation: A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into the inferior alveolar nerve canal during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was atraumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and mineral trioxide aggregate. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. After completion of the endodontic treatment, a stainless steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success. Conclusion: Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To assess the healing process of the extraction socket and the dimensional changes that occur after alveolar ridge preservation utilizing a polylactide-co-glycolide scaffold (PLGA). Materials and Methods: The present study involved the extraction of 28 teeth from 14 patients. The total number of sockets was 28, which were divided into two groups consisting of 14 test sockets and 14 control sockets. The study group (SG) was subjected to socket preservation with a PLGA scaffold while the control group (CG) was left for spontaneous healing. The dimensions were measured before and after operation at 1, 3, and 5 mm below the alveolar crest horizontally and the height of buccolingual bone vertically. Results: According to the histologic analyses, the PLGA scaffold was resorbed within 4 months. CBCT imaging revealed a decrease in the horizontal crest dimension at three distinct coronoapical levels in SG, measuring 2.05 ± 1.05 mm at -1 mm, 1.51 ± 0.89 mm at -3 mm, and 0.92 ± 0.7 mm at -5 mm. CG showed readings of 1.22 ± 1 at -1 mm, 0.92 ± 0.67 at -3 mm, and 0.73 ± 0.69 at -5 mm. In comparison to CG, SG showed a significant reduction in horizontal losses at -1 mm. Vertical crest dimensions decreased by 1.64 ± 1.11 mm for the buccal bone height and by 1.56 ± 1.08 mm for lingual bone height in SG; in CG, the buccal and lingual bone height had mean values of 2.08 ± 1.44 mm and 1.73 ± 1.27 mm, respectively. There was no statistically significant difference observed in the vertical losses between the groups. Conclusions: Following a period of 4 months, the PLGA scaffold was completely resorbed. Based on CBCT measurements, horizontal resorption was lower than CG at -1 mm coronally. [ABSTRACT FROM AUTHOR]

Dental implants are commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at a maxillary central incisor site and a partial ceramic veneer bonded to the adjacent central incisor. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of interleukin-6 (IL-6) inhibitor (tocilizumab) on bacterial infection-associated bone resorption around implants during osseointegration in rabbits. Materials and Methods: At total of 24 male, 9-monthold New Zealand white rabbits were included, and their two mandibular anterior teeth were extracted. Three months after extraction, 24 one-piece Dentium implants (Ø 2.5 mm, intraosseous length of 12 mm) were inserted in the anterior mandible, and the rabbits were divided into four groups (n = 6 per group). Different treatment methods were used in each group: blank control group (BC); only silk ligation (negative control [NC]); silk ligation and injection with minocycline hydrochloride ointment (positive control [PC]); and silk ligation and injection with tocilizumab at 8 mg/kg via the auricle vein (experimental [EP]). Eight weeks later, the animals were sacrificed, and samples were collected and then analyzed using microcomputed tomography (microCT) scanning, immunohistochemical analysis, and histologic analysis. Results: From the microCT measurement, the ratio of the bone volume to the total volume (BV/TV) in the EP group was 67.00% ± 2.72%, which was higher than that in the other three groups (58.85% ± 2.43% in the BC group, 55.72% ± 2.48% in the PC group, and 36.52% ± 3.02% in the NC group). From immunohistochemical analysis, the expression of IL-6 was found to be higher in the NC group than in the BC, PC, and EP groups, but there was no statistical difference between these three groups. Furthermore, the RANKL (receptor activator of nuclear factor-κB ligand) expression was the lowest in the EP group, followed by the BC group, the PC group, and the NC group, which had the highest expression; there was no difference between the NC and PC groups. Upon histologic analysis, significant new bone was found on the implant surfaces in the EP group, sparse and less new bone could be seen in the BC and PC groups, and the most serious bone resorption occurred in the NC group. Conclusions: Tocilizumab, an inhibitor of IL-6, has a certain effect in preventing bone loss around implants caused by bacterial infection during the osseointegration period. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the dimensional stability and quality of the alveolar ridge augmented using a synthetic bone block (SBB) at damaged extraction sockets. Four participants were included, and socket augmentation was performed using SBB and a collagen membrane. Intraoral and CBCT scans were performed before extraction (baseline), immediately postoperative (IP), and at 6 months postoperative (6M). At 6M, a trephine biopsy sample was obtained during implant placement, and the sample was observed using synchrotron. Soft tissue profile changes were assessed using profilometric analysis of the intraoral scan data, while dimensional changes in hard tissue were evaluated based on CBCT measurements. Bone quality was analyzed using synchrotron imaging. There were minimal changes in the soft tissue profile between baseline and IP, baseline and 6M, and IP and 6M (0.11 ± 1.08 mm³, 0.02 ± 0.8 mm³, and -0.65 ± 0.82 mm3, respectively). Horizontal bone width was measured at 1-mm increments from the augmented bone crest to 5 mm apically and revealed only a slight reduction (< 1 mm) at all levels between IP and 6M. The augmented bone height was well maintained from IP until 6M (-0.21 ± 0.53 mm). Synchrotron analysis revealed low to moderate bone quality after 6M (percentage of new bone: 16.49% ± 4.91%). Socket augmentation using SBB appears to be a viable technique for regenerating damaged extraction sockets, with the augmented ridge dimensions maintained up to 6M. Further long-term randomized clinical trials are needed. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the impact of injectable plateletrich fibrin (iPRF) and concentrated growth factor on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and concentrated growth factor. The secondary objective was to compare the postoperative effects of these products. Method and materials: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variables were the use of concentrated growth factor and i-PRF. They were categorized as concentrated growth factor, i-PRF, and control groups. The outcome variables include pain levels and analgesic consumption measured on a visual analog scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. Results: Total analgesic use was notably lower in the concentrated growth factor group (P = .044). Concentrated growth factor and iPRF outperformed the control group in all edema measurements by postoperative day 7 (tragus–pogonion, lateral canthus–angulus, tragus–commissura; P < .05). Concentrated growth factor significantly reduced trismus on days 2 and 7. Quality of life was notably higher in the concentrated growth factor group than in the control group (P = .026), although iPRF group differences were not significant. Conclusion: The results indicate that concentrated growth factor has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with concentrated growth factor highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results [ABSTRACT FROM AUTHOR]

Purpose: To compare the volumetric loss of clinical crown structure in commonly encountered clinical situations for monolithic ceramic crowns, occlusal overlays, and partial-coverage onlays. Materials and Methods: Typodont teeth made with preexisting mesio-occlusodistal (MOD) preparations for mandibular first molars and maxillary first premolars were prepared with three different preparations: a full-contour monolithic zirconia crown, a lithium disilicate occlusal overlay, and mesio-occlusodistobuccal/mesio-occlusodistolingual (MODB/MODL) lithium disilicate onlays for premolars and molars. 3D-metrologic software was used to evaluate the volumetric loss of clinical crown structure for each preparation type. Subsequently, the mesiolingual cusps of mandibular molars and buccal cusps of maxillary premolars were excluded for a separate analysis to simulate patient presentation with an existing restoration and sheared-off cusp. Results: Full-coverage monolithic zirconia crowns removed 45.37 to 219.53 mm³ of the remaining clinical tooth structure, depending on the clinical scenario and tooth position, while lithium disilicate overlays removed 27.48 to 105.13 mm³ and MODB/MODL lithium disilicate onlays removed 5.48 to 47.45 mm³. In each scenario tested, MODB/MODL onlays removed significantly less clinical crown structure than overlays (P < .001); both MODB/MODL onlays and overlays removed significantly less structure than full-coverage crowns (P < .001). Conclusions: Monolithic zirconia crown restorations require significantly more removal of remaining tooth structure than lithium disilicate occlusal overlays and partial-coverage onlays for commonly occurring clinical situations requiring indirect restorations. [ABSTRACT FROM AUTHOR]

The socket shield technique has been proposed as a surgical method to prevent the collapse of the buccal plate following tooth extraction, leading to excellent soft tissue stability and long-term esthetic outcomes. Despite its success, this technique is still not without potential risks. One of the most common complications is internal exposure of the socket shield, which can present as inner soft tissue inflammation with or without exposure of a portion of the shield. This case series discusses this complication's etiology, diagnosis, treatment, management, and prevention. Data from 10 patients with 12 internally exposed sites are presented. [ABSTRACT FROM AUTHOR]

Radiation treatment plays a mainstream role in the management of head and necksquamous cell carcinomas (HNSCCs). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathologic fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCCs. Adverse impacts on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCCs exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathologic fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC who had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with the growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dental practitioner may encoun-tersuch patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management. [ABSTRACT FROM AUTHOR]

Purpose: To assess the handling properties and clinical function of a new class of material, a so-called mineral-organic bone adhesive (Tetranite; TN), which as yet has no precedent in orthopedic or oral and maxillofacial surgery, for clinically unstable implants placed in immediate extraction sockets and immediately temporized in the anterior maxilla. Materials and Methods: A cohort of up to 15 patients requiring between one and four immediate dental implants placed into maxillary extraction sockets from canine to canine were eligible for inclusion. Implants had to be unstable with an insertion torque of < 15 Ncm. Implants were then stabilized using TN, which was allowed to set before reassessing stability using both torque and resonance frequency measurements. Implant stability quotients (ISQs) taken after TN setting were compared to ISQs taken prior to its application, and the implants had to demonstrate resistance to a forward torque of 20 Ncm to be considered stable. ISQs were monitored at 1 week and 1, 3, 7, and 12 months postplacement. In addition, peri-implant tissue health was monitored, adverse events were recorded, and implant success was determined at 1 year postplacement. Results: Eleven patients received a total of 14 implants. Three out of the first six implants failed within 1 month (50%), and thus a protocol amendment was made to remove steps considered potentially destructive to the bonding process. As a result of these amendments, only one further failure was experienced for the next eight implants placed (12.5%). Mean ISQ data averaged for buccolingual and mesiodistal measurements demonstrated a baseline value before TN application of 59.1 Ncm (SD: ± 9.7; range: 40.5 to 73.0). After final setting of the TN, mean ISQ measured 71.9 Ncm (± 6.5; 56.0 to 80.0). At 3 months, just prior to restoration placement, mean ISQ measured 71.0 Ncm (± 6.6; 57.0 to 78.0). Thereafter, the mean ISQ continued to increase at both the 7- and 12-month follow-ups with scores of 78.9 (± 4.6; 72.0 to 84.5) and 80.3 (± 3.8; 74.5 to 85.0), respectively. The surviving 10 implants went on to be fully restored and remained in function beyond the end of the study period to yield a final success rate of 71.4%. Conclusions: The purpose of a first-in-human study is to demonstrate an extrapolation of preclinical data into the controlled human clinical arena. It is an opportunity to learn what does and does not translate well from experimental data. In that regard, the current pilot study can be deemed a complete success. The implant survival rate of 71.4%, while disappointing, should be considered in light of the protocol amendments identified, the user handling experience learned, and the opportunity to modify the material to better perform in the human patient, as all represent important lessons learned. The notable increase in ISQ sheds light on the nature by which the glue was substituted for bone to yield a stable implant by the end of the study period. [ABSTRACT FROM AUTHOR]

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to evaluate clinical and radiographic outcomes of implants placed in alveolar sockets treated by means of alveolar ridge preservation after 10 years of follow-up. Method and materials: Eleven patients treated with 11 implants placed after alveolar ridge preservation using bovine-derived xenograft particles and collagen membrane were selected. Full-mouth plaque score, full-mouth bleeding score, probing depth at four sites per implant, and radiographic marginal bone level at mesial and distal aspects for each implant were recorded at baseline and after 10 years of follow-up. The primary outcome was the radiographic marginal bone loss. The marginal bone loss was considered as the difference between marginal bone level at baseline and after 10 years of observation time. Results: After 10 years of follow-up, full-mouth plaque score increased significantly (P < .05), while no statistically significant differences were found in the change in full-mouth bleeding score (P = .05). At the 10-year observation period, a significant increase in probing depth was observed at all sites (P < .05), except at the mesial aspects (P = .05). Radiographic marginal bone loss was 1.1 ± 0.1 mm and 1.0 ± 0.1 mm at mesial and distal sites, respectively. Conclusion: Whitin the limitations of the present study, implants placed in post-extraction sockets treated with alveolar ridge preservation yielded stable clinical and radiographic results after 10 years of follow-up. [ABSTRACT FROM AUTHOR]

Tooth loss or extraction is associated with significant reduction in alveolar ridge volume, extensively expressed in the anterior zone, and immediate implant placement is insufficient to overcome this problem. The proposed approach combined immediate implant placement with buccal tissue enhancement by applying a crosslinked collagen matrix hydrated with crosslinked hyaluronic acid (xHyA). All 10 cases presented with a retained but narrow buccal socket wall, so immediate implant placement with the "tunneled sandwich" technique was performed after tooth extraction. The tunneled sandwich technique helped create a subperiosteal pouch for insertion of the collagen matrix buccal to the alveolar bone crest. The implants healed transmucosally by receiving either a gingiva former or an immediate temporary restoration. Ten sites in 10 patients demonstrated stable, noninflamed peri-implant conditions and suitable ridge volume at the implant neck and achieved high pink esthetic scores 6 months after implant loading. The tunneled sandwich technique is a suitable method to preserve buccal volume, which biologically and esthetically contributes to favorable long-term results. [ABSTRACT FROM AUTHOR]

Purpose: Alveolar ridge split (ARS) is ridge augmentation to mitigate ridge width loss that typically follows tooth extraction. This study aimed to determine the efficacy of ARS on alveolar ridge horizontal dimensional changes and the survival rates of implants placed into the same sites. Materials and Methods: An electronic and manual search was conducted for English articles published up to January 1, 2021. The PICO (problem, intervention, comparison, outcome) model for quantitative studies was established to address the following two focused questions: (1) What are the effects of the ARS technique on increasing alveolar width and implant survival?; and (2) what are the factors that influence the efficacy of the ARS technique? The outcome measures in this systematic review and meta-analysis were mean alveolar ridge gain—horizontal (buccolingual) in millimeters from baseline (initial presentation) to final assessment (minimum of 12 weeks after ARS), implant survival rate, and patient-reported complication rate. The risk of bias was evaluated using the ROBINS-I assessment tool for non-randomized interventional studies. Weighted means were calculated, and pooled effects and 95% confidence intervals (95% CI) were depicted on forest plots. Publication bias was assessed by funnel plot and Rosenthal Statistics. A sensitivity analysis was undertaken to assess the primary outcome. Results: Overall, 35 studies met the inclusion criteria and were included in the systematic review. The mean alveolar ridge gain for ARS was 3.06 mm (95% CI: 3.01 to 3.12 mm). A mean gain of 2.99 mm (95% CI: 2.93 to 3.04 mm) was found after sensitivity analysis, excluding one article with a high risk of bias. There were no significant differences in ridge width in the group with bone graft (mean difference [95% CI] of 2.97 mm [2.91 to 3.03 mm]) and in the group without bone graft (mean difference [95% CI] of 3.06 mm [2.92 to 3.20 mm]). The ARS technique demonstrated a 98.17% implant survival rate in 4,446 implants, 4,103 of which were placed at the time of ARS with a 97.72% implant survival rate, and 343 placed in a delayed approach with a 99.14% implant survival rate. The risk of bias was low in 14.2%, low to moderate in 68.5%, moderate in 11.4%, and severe/moderate in 5.7% of the included studies. Conclusions: ARS shows a high implant survival rate in narrow alveolar ridges, adequate horizontal alveolar ridge dimensional gain regardless of adding grafting material, and minimal patient-reported complications. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to assess the histomorphometric outcomes of extraction sockets grafted with freeze-dried bone allograft (FDBA) and sealed with a collagen membrane after 3 months of healing in specific region of interest (ROI) areas. The secondary aims were to analyze the biomaterial resorption rate, the bone-to-biomaterial contact (BBC), and the area and perimeter of grafted particles compared with commercially available FDBA particles. Fifteen patients underwent tooth extractions and ridge preservation procedures performed with FDBA and a collagen membrane. Bone biopsy samples were harvested after 3 months at the time of implant placement for histologic and histomorphometric analysis. Two areas of concern (ROI1 and ROI2) with different histologic features were identified within the biopsy samples; ROI1, ROI2, and commercially available particles were analyzed and compared. The following parameters were analyzed: newly formed bone, marrow space, residual graft particles, perimeter and area of FDBA particles, and BBC. The histomorphometric analysis showed 35.22% ± 10.79% newly formed bone, 52.55% ± 16.06% marrow spaces, and 12.41% ± 7.87% residual graft particles. Moreover, the histologic data from ROI1 and ROI2 showed that (1) the mean percentage of BBC was 64.61% ± 27.14%; (2) the newly formed bone was significantly higher in ROI1 than in ROI2; (3) the marrow space was significantly lower in ROI1 than in ROI2; and (4) the FDBA particles in ROI1 sites showed significantly lower area and perimeter when compared to commercially available FDBA particles. This latter data led to the hypothesis that FDBA particles embedded in newly formed bone undergo a resorption/remodeling process. [ABSTRACT FROM AUTHOR]

Albers-Schönberg disease is a rare bone syndrome characterized by increased bone density and infectious complications after dental extraction or minor surgery. The prosthodontic management of such edentulous patients with osteomyelitis is very challenging and requires special strategies due to a high risk of failure and worsening of the condition. This clinical report describes the rehabilitation of a 31-year-old edentulous woman presenting with Albers-Schönberg disease, secondary chronic osteomyelitis, maxillary hypoplasia, compromised oral conditions, temporomandibular disorders, and psychologic distress. The treatment included a mandibulectomy and removable prostheses. A crucial element for the successful long-term treatment and quality of life improvement observed in this patient was the 1-year transitional phase with interim dentures and frequent follow-up appointments. The complications and management proposed during a 10-year follow-up are presented. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the peri-implant outcomes of customized healing abutments (CstHA) placed on dental implants inserted in fresh tooth extraction sockets. Materials and Methods: The study was registered on PROSPERO: CRD42022304320. A systematic search in PubMed, Scopus, and Web of Science was conducted between April 2022 and October 2022 to identify clinical studies involving immediate implant surgery associated with CstHA placement. The Joanna Briggs Institute Critical Appraisal and RoB2 tool were performed for the risk of bias analysis. Results: A total of 12 studies were included, most of them with low risk of bias. Four studies compared CstHA vs conventional healing abutments (CnvtHA), two compared CstHA vs cover screw and collagen matrix (CMa), and six were clinical case series. For the CstHA vs CnvtHA comparison, favorable results were observed for CstHA considering papilla maintenance and probing depth, yet the mean marginal bone level was statistically similar between CstHA and CnvtHA. CstHA showed advantages when compared to CMa for total bone volume, papilla height, and midfacial mucosa maintenance. Significantly less horizonal bone loss was reported when using CstHA compared with CMa. Horizontal and vertical bone loss was observed in a few (or no) sites in the case series using CstHA. Conclusions: CstHA provides favorable peri-implant response because in general it does not result in a significant loss of soft and hard tissues. [ABSTRACT FROM AUTHOR]

Purpose: To compare bone substitutes composed of glycated collagen with synthetic micro-sized (1 to 10 µm) hydroxyapatite (OB) vs non-cross-linked collagen matrix with large-particle (250 to 1,000 µm) bovine-derived hydroxyapatite (BOC). Materials and Methods: The P1 to P4 premolars were bilaterally extracted from the mandibles of 19 Beagle dogs. After 21 days, osteotomies were created in each dog that received OB or BOC and were covered with a collagen membrane or were left untreated. The animals were randomly divided into three groups based on sacrifice time (4, 12, or 24 weeks). The right and left hemimandibles were trimmed to facilitate imaging and histology, and all tissues were placed in 10% neutral-buffered formalin. Microcomputed tomography (MicroCT 40 Scanner, Scanco) was used to analyze bone sections. Bone volume, residual material volume, and bone mineral density were determined for each treatment site (OB and BOC) based on a volume of interest that encompassed the original defect. Additionally, blinded histopathologic assessment (based on the ISO 10993-6 scoring system) and histomorphometry were performed on sections ground to < 100 µm thick and stained with Stevenel's blue. Results: No clinical side effects were noted. No statistical differences were observed for OB vs BOC regarding the mineral volume percentage. Compared to OB, BOC had significantly higher mean mineralization densities at 12 weeks (P < .01), but this difference did not extend to 24 weeks. For residual grafting material, bone maturation, alveolar ridge restoration, and inflammatory response, OB showed a residual amount of bone graft and no statistical differences compared to BOC. Conclusion: Both OB and BOC represent valid treatment options for critically sized bone defects. Both bone fillers outperformed the sham-operated, ungrafted (empty) control, demonstrating statistically improved bone growth and ridge restoration. [ABSTRACT FROM AUTHOR]

Purpose: To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas. Materials and Methods: Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P < .01. Results: No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value < .0001 from the baseline (0.983 ± 0.172 cm3) to the 1-year survey (0.865 ± 0.156 cm3). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value < .0001) was registered for only the bone tissues (from 0.434 ± 0.075 to 0.355 ± 0.061 cm3). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 ± 0.067) appeared to be significantly different from the overall volume loss (-0.118 ± 0.083 cm3). A shrinkage in width (-0.5 ± 0.7 mm) was found from baseline (12.6 ± 0.6 mm) to the 1-year followup (12.1 ± 0.9 mm). Marginal bone levels were 0.97 ± 0.70 mm and 0.39 ± 0.78 mm, respectively, at the mesial and distal aspects of the implants. Conclusions: The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery. [ABSTRACT FROM AUTHOR]

Partial extraction therapy (PET) is a group of surgical techniques that preserve the periodontium and peri-implant tissues during restorative and implant therapy by conserving a portion of the patient's own root structure to maintain the blood supply, derived from the periodontal ligament complex. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). Although their clinical success and benefits have been demonstrated, several studies report possible complications. The focus of this article is to highlight management strategies for the most common complications associated with PET, including internal root fragment exposure, external root fragment exposure, and root fragment mobility. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate the performance of implants placed with the All-on-4 technique after a mean time in function of 9 years. A total of 34 patients with 156 implants were selected for this study: 18 patients underwent tooth extraction on the day of implant placement (Group D), and 16 patients were already edentulous (Group E). A periapical radiograph was taken at a mean follow-up of 9 years (range: 5 to 14 years). Success and survival rates and the prevalence of peri-implantitis were calculated. Statistical analysis was used to assess comparisons between groups. After a mean follow-up of 9 years, the cumulative survival rate was 97.4% and the success rate was 77.4%. The difference between the initial and final radiographs resulted in a mean marginal bone loss (MBL) of 1.3 ± 1.06 mm (range: 0.1 to 5.3 mm). No differences were seen between Groups D and E. Peri-implantitis affected 15 implants (9.6%) in 9 patients (26.5%). This study shows that the All-on-4 technique is a reliable treatment method for both edentulous patients and patients requiring tooth extractions, with results maintained over a long follow-up period. The present MBL results are similar to those around implants in other rehabilitation types. [ABSTRACT FROM AUTHOR]

Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is widely used and documented around the world. The present pilot clinical trial evaluated and compared the clinical and morphologic alterations of extraction sites after ARP using two commercially available yet differently processed bovine bone grafts. A total of 20 adjacent extraction sites in 10 patients were included. All sites received the exact same ARP therapy except for the type of bovine bone graft, which was randomly assigned between two adjacent extraction sockets in 10 patients (Group A received Bio-Oss particles and Group B received Cerabone particles). At all sites, healing was monitored at the time of surgery and at 1, 2, 3, and 4 months postoperative. All of the augmented extraction sites achieved successful implant therapy regardless of the bone graft material used for ARP. Six weeks after implant placement, second-stage/uncovering procedures were performed without complications. Intergroup comparisons of the crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) were in favor of Group A sites (treatment with Bio-Oss particles). [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusion “Liver clots” are an uncommon complication following periodontal surgery, characterized by their distinctive gelatinous consistency and color resembling 'liver' tissue. Despite anecdotal reports, there is a lack of comprehensive evidence in the literature regarding its incidence, etiopathogenesis and optimal management strategies. This study aimed to address this knowledge gap by retrospectively analyzing cases to provide insights into this unusual post‐operative complication.In this retrospective descriptive study, data spanning a decade (June 2013–June 2024) were collected from various dental centres. The data included patient demographics, medical history, surgical procedures performed, occurrence of “liver clot” formation, management measures and treatment outcomes.The 10‐year retrospective data revealed a 2.03% incidence of “liver clots” among various periodontal procedures. The highest occurrence was observed following dental extractions, followed by periodontal surgical procedures. The observations also indicated a higher frequency in systemically healthy individuals.“Liver clot” formation is a rare, but specific complication after periodontal surgery. Minimally invasive management approaches are effective, highlighting the importance of vigilance and prompt intervention for optimal patient outcomes. Further research is warranted to elucidate the exact etiopathogenesis and to establish evidence‐based management protocols for this unusual complication. [ABSTRACT FROM AUTHOR]

Introduction: The esthetics of immediate implant dentistry can be challenging. Clinical considerations for immediate implant placement have demonstrated long‐term success rates comparable to traditional delayed implant protocols. However, it is a sensitive technique that requires proper treatment planning as well as meticulous execution to be predictable and successful in the long term. Methods: This clinical situation demands extensive knowledge of soft and hard tissue management for atraumatic tooth extraction followed by implant therapy, along with an understanding of the available materials to meet esthetic needs. This case report features a female patient with the chief complaint of needing to replace an anterior crown due to loss of retention. After a comprehensive oral assessment and cone beam computed tomography (CBCT) radiographic examination, it was determined that the crown on Tooth #9 was fractured at the subgingival level. Furthermore, gingival zenith positions displayed differences at the keratinized mucosa level in Teeth #7, #8, and #9, and the metal marginal areas of the porcelain‐fused‐to‐metal (PFM) crowns in the anterior area of Teeth #5, #7, #8, #9, and #10 were apparent. The procedure involved atraumatic extraction of Tooth #9, followed by immediate implant placement. Crowns on Teeth #5, #7, #8, and #10 were replaced, and veneers on Teeth #6 and #11 were fabricated using press lithium disilicate‐reinforced ceramic. Connective tissue graft (CTG) was contoured before final implant restorations. Results: The final implant crown was restored using a prefabricated abutment with a titanium base and lithium disilicate ceramic dental material. A well‐planned combined treatment, including atraumatic tooth extractions for immediate implants and ideal contouring of soft tissues, can significantly impact the outcome of esthetic restorations. Conclusions: Single immediate implant–supported crowns in the esthetic zone were able to fulfill the patient's esthetic expectations. [ABSTRACT FROM AUTHOR]

Objectives: To compare early implant placement (EP) to alveolar ridge preservation and delayed implant placement (ARP/DP) in terms of contour changes, along with clinician‐ and patient‐reported outcome measures (PROMs) until the delivery of the implant‐supported restoration. Materials and Methods: Patients with a failing single tooth in the maxilla or mandible were recruited in two centres. After tooth extraction, patients were randomly assigned (1:1) to either EP or ARP/DP. At abutment connection and crown delivery, the buccal contour changes at 3 mm below the mucosal margin (primary outcome) along with clinician‐ (ease of treatment) and patient‐reported outcomes were assessed using numeric rating scales and OHIP‐14. Results: A total of 46 patients were analysed. The mean buccal contour at abutment connection decreased by −1.2 ± 0.6 mm in group EP and −1.6 ± 0.8 mm in group ARP/DP (estimated mean difference; 0.45 [95%CI, −0.02; 0.94]; p =.061) with no significant differences between the groups. ARP/DP was consistently easier than EP across all stages of the surgery (estimated mean difference; 2.0 [95%CI, 1.3; 2.7] p <.001): during flap elevation (EP: 4.8 vs. ARP/DP: 1.6), implant placement (EP: 5.7 vs. ARP/DP: 2.2) and wound closure (EP: 3.4 vs. ARP/DP: 1.6). Both interventions improved quality of life but patients who underwent ARP/DP were significantly more satisfied at the time of crown delivery (ARP/DP: 9.6 vs. EP: 9.1, p =.02). Conclusions: EP and ARP/DP show no significant differences in buccal contour changes, aesthetics and patient‐reported outcomes. However, ARP/DP is an easier procedure at all stages of the surgery compared to EP and could therefore be the preferred therapy for less experienced clinicians. [ABSTRACT FROM AUTHOR]

Objectives: Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing. Materials and Methods: Forty‐two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4‐month healing period. Forty‐two samples underwent Back‐Scattered Electrons ‐Scanning Electron Microscopy (BSE‐SEM) imaging, with 15 samples examined using Xray Micro‐Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration). Results: BSE‐SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p <.004) and SS (27.62% ± 17.76/p <.005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE‐SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS. Conclusion: GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone. [ABSTRACT FROM AUTHOR]

Objective: This case report presents a female adult patient who exhibits poor oral hygiene, a mutilated dentition with multiple missing teeth, and skeletal asymmetry. Clinical Considerations: Interdisciplinary treatment was necessary to maintain oral hygiene, treat caries, extract residual roots, and upright a horizontally impacted third molar using a miniplate. Additionally, orthodontic mini‐implants were utilized as anchorage to improve sagittal relationship and space closing. Space management was completed with orthodontic treatment, followed by restoration of the multiple missing teeth with dental implants. Conclusion: Consequently, an esthetic smile and functional occlusion were achieved by interdisciplinary treatment using orthodontic skeletal anchorage devices and dental implants. Clinical Significance: Missing mandibular first molar spaces were closed with retraction of the anterior teeth and protraction of the mandibular second molars using orthodontic mini‐implants. The mandibular right third molar, which should have erupted, was protracted with the second molar, while the horizontally impacted mandibular left third molar was uprighted using a miniplate and was protracted with an orthodontic mini‐implant. The missing maxillary lateral incisors were replaced with the maxillary canines, and the maxillary canines were replaced with the maxillary first premolars. The missing maxillary right second premolar and first molar and left first and second molars were successfully restored with dental implants. [ABSTRACT FROM AUTHOR]

Objective: To determine whether blended learning results in better educational outcomes compared to traditional learning in the acquisition of oral surgery technical skills for 4th‐year undergraduate dental students. Materials and Methods: Seventy‐three students participated in this two‐arm parallel randomized controlled trial. Only students in the blended learning group had access to the online preparation platform for oral surgery practical work (PW) on a pig's jaw and to the debriefing. Kirkpatrick's four‐level model was used to assess the educational outcomes directly after (levels 1 and 2) and 6 months later, after the start of the students' clinical activity (levels 3 and 4). Results: For level 1, higher global satisfaction scores were found for students in the blended learning compared to the traditional learning group (p =.002). For level 2, blended learning resulted in an increase in knowledge score (p <.01), comparable to that observed in the traditional learning group. For level 3, students in the blended group made more progress in 6 months than those in the traditional group in terms of feeling able to assess and perform anaesthesia (p =.040) and surgical tooth extraction (p =.043). No difference in level 4 was found for the 6‐month clinical surgical activity between groups, but students in the blended group felt more able to assess and perform the surgical management of a failed extraction requiring bone removal (p =.044). Conclusion: Blended learning for oral surgery PW had a positive impact on three of the four Kirkpatrick levels (level 1, 3 and 4). Efforts should focus on the procedures that are perceived as the most difficult. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to evaluate whether platelet-rich-fibrin (PRF) is effective in preventing postoperative bleeding after dental extractions in patients on anticoagulation or antiplatelet therapy compared to stitches alone and different hemostatic agents. Materials and methods: This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42024562289). Two authors independently performed searches in several databases, including PubMed, EMBASE, Cochrane Library, and SCOPUS. Results: In total, 789 studies were identified, of which 11 met the inclusion criteria after full-text screening. Four studies evaluated the efficiency of PRF in patients on antiplatelet therapy, and seven studies analyzed its hemostatic effect in patients on anticoagulants. All studies showed sufficient hemostasis when PRF was used, but due to heterogeneity meta-analysis was not possible. Conclusions: Despite the use of different protocols and control groups, PRF treatment seems to be superior to only stitches and inferior to chitosan dressings concerning the time of hemostasis. Additionally, PRF seems to be beneficial in terms of faster wound healing and less postoperative pain. Clinical relevance: PRF is known to enhance soft tissue healing and reduce postoperative pain. As a fully autologous platelet concentrate, it can support hemostasis after dental extractions in patients on antiplatelet or anticoagulation therapy. This systematic review aims to provide an update of the existing literature on PRF and its hemostatic capacity in patients with blood thinning medication. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to analyze the influence of patients´ age on perioperative complications in impacted third molar surgery and how established risk factors are affected by age. Materials and methods: The clinical findings, digital panoramic radiographs and perioperative data of 200 patients (554 impacted third molars) that had been subjected to tooth extraction, from July 2023 until July 2024, were analyzed. Perioperative complications (Inferior alveolar nerve (IAN) hypesthesia, oroantral communication (OAC), lingual nerve (LN) hypesthesia, postoperative bleeding, postoperative infection) as well as impaction patterns and risk factors (angulation type, bone coverage, depth- and risk scores) were analyzed by age (cut-off 30 years). Results: The population was divided into two groups by age (Group A = ≥ 30 years (n = 52) vs. Group B = < 30 years (n = 148)). Upper third molars showed significantly deeper bone coverage, higher depth scores, higher risk scores and different angulation types in patients aged < 30 years. Mandibular third molars showed significantly deeper bone coverage, higher depth scores, higher risk scores according and different angulation types in patients aged ≥ 30 years. However, IAN hypesthesia, LN hypesthesia, postoperative bleeding and postoperative infection did not show any significant differences regarding patients' age. Conclusion: The current findings suggest that age (cut-off 30 years) does not statistically correlate with a higher risk for postoperative complications in impacted third molar surgery in contrast to recent publications. Clinical relevance: In contrast to recent publications, the present study falsified a positive correlation between patients' age and the occurrence of postoperative complications in impacted third molar surgery. Therefore, other risk factors should be investigated in order to minimize these procedure specific complications. [ABSTRACT FROM AUTHOR]

The article describes the case of an eight-year-old girl who complained of multiple carious lesions, causing pain upon eating and teeth brushing. Topics discussed including findings on radiographic examination, treatment given to the patient, and the introduction of prefabricated zirconia crowns (PZCs) for first permanent molars (FPMs) after the success and wide acceptance of the PZCs for primary teeth.

Background: Paediatric‐preformed zirconia crowns have been associated with several issues, primarily their inability to be crimped and the need for extensive tooth preparation. Additionally, the capacity to adjust the size, shape, and fit of these crowns is very limited. Aim: To evaluate and compare the fracture strength of four different types of dental crowns intended for paediatric patients. Design: The fracture resistance of four types of paediatric crowns was evaluated using the universal testing machine; freshly extracted primary molars received one of the following: preformed zirconia crowns, custom‐made computer‐aided design and computer‐aided manufacturing (CAD–CAM) zirconia crowns, custom‐made CAD–CAM ceramic crowns, and custom‐made CAD–CAM hybrid composite crowns. Data were statistically compared using the Kruskal–Wallis test followed by the Bonferroni test, and the level of significance was set at 5%. Results: Results showed that there was a statistically significant difference among the four groups (p <.001). The highest value of fracture force was observed for the milled zirconia crown and the lowest for the prefabricated zirconia. Conclusion: The implementation of the CAD–CAM digital crown fabrication technique has the potential to address issues associated with preformed crowns in paediatric patients, particularly in terms of fracture resistance. [ABSTRACT FROM AUTHOR]

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ABSTRACT Aim Materials and Methods Results Conclusion This first randomized controlled trial in humans aimed to assess the efficacy and safety of low‐dosage Escherichia coli‐derived recombinant human bone morphogenetic protein 2 (ErhBMP‐2)‐incorporated biomimetic calcium phosphate coating‐functionalized β‐TCP (ErhBMP‐2/BioCaP/β‐TCP) as a novel bone substitute using the tooth‐extraction‐socket‐healing model.Forty patients requiring dental implants after single‐root tooth extraction were enrolled in this study and randomly assigned into three groups: ErhBMP‐2/BioCaP/β‐TCP (N = 15), β‐TCP (N = 15) and natural healing (N = 10). New bone volume density from histomorphometric analyses was evaluated 6 weeks post‐operatively as the primary outcome, and other histomorphometric analyses, alveolar bone and soft‐tissue changes were the secondary outcomes. Safety parameters included adverse events, soft‐tissue healing, oral health impact profile, serum BMP‐2 concentrations and other laboratory tests.The findings revealed a significant increase in new bone volume density in patients treated with ErhBMP‐2/BioCaP/β‐TCP compared to those receiving β‐TCP alone. The required bone augmentation procedures during implant placement surgery in the ErhBMP‐2/BioCaP/β‐TCP group were significantly less than in the natural healing group. There were no significant differences in safety parameters among the three groups.This clinical trial primarily proved the safety and efficacy of ErhBMP‐2/BioCaP/β‐TCP as a promising bone substitute. [ABSTRACT FROM AUTHOR]

Background: To ensure comprehensive dental treatment under general anesthesia(GA) is a viable option, postoperative complications must be minimized. This study investigates the incidence and determinants of acute psychological complications following comprehensive dental treatment under general anesthesia in uncooperative children. Materials and methods: This study included 71 healthy children aged 5 to 10 years who exhibited uncooperative behavior during dental examinations. All participants received parental consent. Data was collected using a checklist encompassing demographic information, treatment details, physical complications, and psychological complications. The Modified Child Dental Anxiety Scale faces version (MCDASf) questionnaire was administered pre-operatively and five days post-operatively. Results: The first day exhibited the most pronounced physical and psychological complications. While the most physical complications had diminished by the fifth day, the psychological effects remained permanent. Tooth extraction was associated with a statistically significant impact on fear of being left alone(P < 0.001), unspecified fear (P = 0.001), nyctophobia (P = 0.001), and excessive crying(P < 0.001). Conclusion: Psychological complications persisted for a longer period compared to physical complications. The number of extracted teeth under GA had a significant influence on children's fear. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Materials and Methods Results Conclusion The objective of this study was to compare open versus closed healing of soft and hard tissue following alveolar ridge preservation (ARP) procedures in damaged extraction sockets.ARP was performed in five mongrel dogs using collagenated deproteinized bovine bone mineral (cDBBM) and a resorbable non‐cross‐linked collagen membrane (NCCM) in damaged extraction sockets, with each socket entrance left either open (open group) or closed (closed group). Clinical wound epithelization at the socket entrance and the dimensions of keratinized tissue were evaluated over time. Additionally, the augmented ridge dimensions and new bone formation were assessed radiographically and histologically at 8 weeks after surgery.The dimensions of the socket entrance gradually decreased in the open group, and wound epithelization was almost complete within 4 weeks. The mucogingival junction was maintained more apically in the open group than in the closed group (0.14 ± 0.40 mm vs. −0.86 ± 0.71 mm [mean ± SD], p < 0.05). The augmented ridge dimensions did not differ significantly between the open and closed groups (93.1% ± 5.4% vs. 88.3% ± 11.2%, p > 0.05). Histological analyses revealed no significant differences in the amount of newly formed bone. However, membrane resorption in the crestal region was more pronounced in the open group.Open and closed healing approaches for ARP in extraction sockets with damaged buccal wall resulted in similar ridge dimensions and new bone formation. However, there was less reduction of the buccal bone crest and wider keratinized tissue width after open healing. [ABSTRACT FROM AUTHOR]

The bone volume preservation after dental extraction is challenging in case of implant rehabilitation for functional and aesthetics results. Photobiomodulation (or LLLT) is used in medicine for its properties of accelerating the healing process. The aim of the systematic review was to determine if the use of photobiomodulation had an impact on implant stability and on alveolar bone healing, either in quality or in quantity. A systematic review following the PRISMA guidelines was conducted on the databases PubMed, Science Direct, Scopus and Google Scholar. The review was registered on Prospero under the number CRD42023467581. 414 articles were screened, of which 12 were selected for the review. In 10 of the 12 articles, LLLT seemed to show a positive impact on bone healing and implant stability. Regarding alveolar preservation, 6 out of 8 studies found statistically significant results. Regarding implant stability, 3 out of the 4 articles found a statistically significant impact of photobiomodulation versus control group. Despite the great heterogeneity of the studies, some LLLT protocols seemed consensual: the use of a Ga-Al-As laser with an emission over 800 nm with a continuous emission consisting of 3 to 4 sessions each with a duration of 4 to 5 min, on a sole application point. The use of photobiomodulation seemed to inhance the alveolar bone healing after a dental extraction, and the implant stability in case of immediate extraction-implantation. Further randomized controlled trials with a placebo group seem mandatory to corroborate the results. [ABSTRACT FROM AUTHOR]

Objective: Medication-related osteonecrosis of the jaw bones (MRONJ) is a well-known complication of antiresorptive and antiangiogenic drugs. Since the first report, more occurrences of MRONJ have been described worldwide. Dental extraction has been described by many studies as one of the risk factors for MRONJ. Comprehensive dental care (CDC) is a preventive dental method provided to patients prior to drug commencement. This study aims to determine the association between CDC and MRONJ. Patients and methods. A retrospective analysis was performed on 75 medical records of patients on antiresorptive and/or antiangiogenic drugs between February 2018 and May 2021. Demographics and clinical and radiographic data were collected. Univariate and multivariate analyses were performed to determine the factors associated with MRONJ. Results: Of the 75 patients who met the inclusion criteria, 11 (14.7%) developed MRONJ. Three out of 11 patients (27.2%) developed MRONJ spontaneously, while eight patients (72.8%) developed it after trauma from dentures or dental extractions. Following a binary logistic regression analysis, the lack of CDC was identified as a significant predictor of MRONJ. Patients who did not receive CDC had an odds ratio of 8.64 (95% confidence interval (CI): 1.27–58.62, p = 0.03). However, dental extraction did not show a statistically significant association with MRONJ in both the univariate and multivariate analyses. Conclusion: CDC before treatment with antiresorptive and antiangiogenic drugs is a potentially effective preventive method for reducing MRONJ. Dental extraction was not a significant factor in relation to MRONJ. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To explore the context in which general dental practitioners (GDPs) decide to refrain from further treatment, that is, ortho‐ or retrograde retreatment or extraction of a root canal filled tooth with persistent asymptomatic apical periodontitis (PAAP).Fifteen GDPs were strategically selected for in‐depth interviews. The informants were encouraged to describe in their own words and in as much detail as possible, the three most recent patient cases of PAAP of a root canal filled tooth, in which they decided to refrain from further treatment. The interviews were recorded digitally and transcribed verbatim. The collected material was analysed according to Qualitative Content Analysis with an inductive approach.A pattern of varying degrees of uncertainty associated with the decision process was identified. The motives to refrain intervention had great diversity. The result from analysis of the qualitative data was formulated in an overall theme ‘Between doubt and certainty in a complex clinical context’ covering the latent content. The first main category covering the manifest content was ‘The continuum of confidence’ with three subcategories ‘Experienced uncertainty’, ‘Reluctant approval’ and ‘At ease with refraining’ illustrating the feelings and attitudes experienced by the informants. The second category was ‘In support of acceptance’ with three subcategories ‘Patient's autonomy, risks and cost‐benefits’, ‘Emotional aspects’ and ‘Relieving measures’ representing the reasons for refraining from intervention.The decision to refrain from further treatment, that is, ortho‐ or retrograde retreatment or extraction of a root canal filled tooth with PAAP was made with some measure of confidence, combined with compensatory strategies to support the decision, taking into account not only values beneficial to the patient and awareness of limited external resources, but also factors related to the informants' personal preferences, convenience, concerns, ambition and emotions. [ABSTRACT FROM AUTHOR]

Background: Robotic computer-assisted implant surgery (r-CAIS) is a revolutionary innovation in oral implantation; however, the clinical feasibility of r-CAIS for immediate implant placement (IIP) in posterior teeth has not been verified. Thus, this study aimed to evaluate the accuracy of r-CAIS for IIP in posterior tooth regions. Methods: Patients with posterior teeth to be extracted and indicated to undergo r-CAIS were evaluated. The patients had positioning markers installed in the oral cavity and underwent cone-beam computed tomography (CBCT). Subsequently, minimally invasive tooth extractions were performed, and an individualised surgical plan was generated in the robotic software. After marker registration, implantation surgery was performed by the robotic arm under the supervision and assistance of the surgeons. Finally, the deviations between the planned and placed implants were evaluated based on preoperative and postoperative CBCT data. Results: A total of 12 patients were evaluated. No adverse events occurred during the surgery. The mean global coronal, global apical, and angular deviations were 0.46 ± 0.15 mm (95%CI:0.36 to 0.56 mm), 0.46 ± 0.14 mm (95%CI:0.37 to 0.54 mm), and 1.05 ± 0.55° (0.69 to 1.40°), respectively. Conclusions: Under the limited conditions of this study, the r-CAIS exhibited high accuracy in posterior teeth IIP surgery. Further multicentre randomised controlled studies are required to confirm the feasibility of this technology. [ABSTRACT FROM AUTHOR]

Background: The extraction of impacted supernumerary teeth requires precision and accuracy to mitigate iatrogenic damage to crucial anatomical structures during dental surgical procedures, thereby enhancing postoperative healing outcomes. Dynamic navigation systems (DNS) have been applied in dentistry in maxillofacial fractures, orthognathic surgery, root canal treatment, and endodontic surgery. Case Report: A 22-year-old female patient visited our department to assess and manage unerupted third molars. An initial cone beam computed tomography (CBCT) scan was obtained. Radiographic and clinical examinations showed the presence of a supernumerary tooth impacted on the lingual side between the root of the lower second premolar and the lower first molar and bilateral lower impacted third molars. The patient agreed to removal of these teeth. To perform the treatment planning of this case and to guide the surgeon intraoperatively, a dynamic surgical navigation system was recommended for surgical extraction of a supernumerary tooth and the impacted third molars. Conclusions: The dynamic navigation system coupled with a high-speed contra-angle handpiece for the extraction of supernumerary teeth is a personalized, digitally-driven, precise, minimally invasive, and efficient treatment approach. In this case, the DNS and the high-speed contra-angle handpiece were seamlessly integrated to facilitate visualization of the surgical procedure, thereby safeguarding of surrounding vital anatomical structures while enhancing patient comfort. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate external apical root resorption (EARR) in cases with extraction and non-extraction fixed orthodontic treatment. Methods: Ninety subjects were included in this study. The patients were divided into two groups: 43 with extraction treatment and 47 with non-extraction orthodontic treatment. EARR was measured using the crown-to-root ratio of the maxillary and mandibular incisors and canines on panoramic radiographs taken at the beginning (T0) and end of the treatment (T1). The Bonferroni corrected Z test was used for multiple comparisons. Results: There were 24 (55.8%) individuals in the extraction group and 12 (25.5%) in the non-extraction group, with a minimum of one tooth with severe resorption. There was no resorption in 0% of individuals in the extraction group and five (10.6%) individuals in the non-extraction group. There was a statistically significant correlation between the groups and the degree of resorption (p = 0.008). When the maxillary and mandibular teeth in the extraction group were compared, a significant difference was found in all degrees of resorption except for mild resorption. Conclusions: There was a significant difference in EARR between the extraction and non-extraction treatment groups, with maxillary incisors showing more resorption in the extraction treatment. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the clinical efficacy of applying real-time dynamic navigation (RDN) in the extraction of deep horizontal mandibular impacted third molars, hypothesizing that RDN reduces surgical time and minimizes the risk of injury to adjacent anatomical structures. Methods: A prospective study was conducted on 160 patients aged between 18 and 37 years with deep horizontal impaction of the mandibular third molar. The participants were randomly assigned to either the experimental group (receiving RDN-assisted extractions) or the control group (undergoing traditional extraction methods). Preoperative planning utilized cone beam computed tomography (CBCT) and Mimics software for the accurate localization and segmentation of impacted teeth. Parametric data were analysed via an independent t test for intergroup comparisons, and significance was set to p < 0.05. Results: In the experimental group, an average of 11 ± 1 min was required for preoperative planning via RDN, which was not required in the control group. The setup of the navigation system took an average of 4 ± 1 min in the experimental group and 0 min in the control group. The experimental group demonstrated a significantly shorter average surgical time (22 ± 3 min) than did the control group (36 ± 3 min). The differences in the preoperative design time, surgical time, and complication rates between the two groups were statistically significant (p = 0.005). Additionally, the RDN group reported no complications related to adjacent tooth damage or nerve injury. Conclusion: The precision, safety, real-time guidance of RDN supports its use in complicated dental extractions, which would introduce a new era of oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Dental caries is the most widespread form of disease, affecting over 90% of the global population. Amalgam fillings, which have been in use for nearly two centuries, will face an European Union ban by 2025. Although photocomposite fillings are a suitable alternative, health concerns persist because of potential substance release into the oral cavity. This study aimed to evaluate the release of photoinitiator substances and monomers from dental materials into various solvents at different temperatures over 30 days. Cylindrical specimens of the composite resins were submerged in different extraction solutions and incubated at 37 and 50°C. The findings demonstrated that both the extraction solvent and extraction temperature significantly influenced the quantity of leachables (p < 0.05). Furthermore, most leachables were released within the initial days, although some monomers continued to elute for over 30 days. The estimated daily intake was calculated for the worst‐case scenario, confirming the biocompatibility of the composite fillings. The weight loss of dental materials ranged up to 3.5% after 30 days, regardless of the extraction conditions and dental material (p > 0.05). In conclusion, this study contributes to filling several research gaps in the field by addressing the biocompatibility of various dental materials through quantitative and qualitative analyses supported by statistical evaluation. [ABSTRACT FROM AUTHOR]

Background: Extracting the premolars is an effective strategy for patients with bimaxillary dentoalveolar protrusion. Clear aligners (CAs) close the extraction spaces through shortening the length of aligners. The contraction force generated by the terminal of aligners makes the posterior teeth tip mesially, which is known as the roller coaster effect. This phenomenon is even worse in the 2nd premolar extraction cases. Posterior anchorage preparation is commonly used to protect the angulation of molars, taking the form of presetting distal tipping value. However, the distal tipping design aggravates the anchorage loss of anterior teeth simultaneously. This study aimed to explore the different anchorage loss of the posterior teeth when the 1st or 2nd premolars were extracted using CAs, respectively in maxillary and mandibular arches, further providing guidance for anchorage preparation design in clinical practice. Methods: Two bimaxillary finite element models with different extraction patterns were established to simulate the anterior en-masse retraction process of the CAs. In Model 1, the maxillary and mandibular 1st premolars were extracted, while in Model 2, the 2nd premolars were extracted. Finite element analysis methods were utilized to analyze the tipping angle of the anterior and posterior teeth. Results: Compared between two models, the anterior teeth exhibited a greater lingual inclination tendency and the posterior teeth exhibited a slighter mesial tipping tendency in Model 1 regarding individual tooth. The closer to the extraction spaces, the greater the tip, and the distal tipping tendency of the 1st premolars was more evident than the mesial tipping tendency of the 1st molars in Model 2. Compared between the maxillary and mandibular arches, the mesial tipping tendency of individual posterior tooth was more evident in the maxilla. In addition, the highest hydrostatic stress of the periodontal ligaments was concentrated on the cervical and apical parts directly adjacent to the extraction spaces, and it exhibited relatively uniform distribution in Model 1. Conclusions: The individual posterior tooth showed the same mesial tipping direction but to different degree when the 1st or the 2nd premolars were extracted during clear aligner treatment. Presetting anchorage preparation design for the posterior teeth is essential to alleviate the roller coaster effect, especially in the 2nd premolar extraction cases. Furthermore, larger anchorage preparation value should be proposed for the maxillary posterior teeth. [ABSTRACT FROM AUTHOR]

Objectives: Post tooth extraction type of wound healing is a convoluted process that helps wounds reform. This study aims to evaluate the impact of polycaprolactone-hydroxyapatite zeolite nanocomposites on the healing processes of mucosa overlying post-extraction alveolus. Materials and Methods: Fifteen healthy cats with premolar lower tooth involvement were selected for tooth extraction. The biopsy sampling from the mucosa of the alveolus was performed on the 10th postoperative day. The cats were grouped as control, plateletrich plasma (PRP), and nano polycaprolactone-hydroxyapatite zeolite. Results: The histopathologic analysis showed that contrary to controls and PRP, the nano group had a lower presence of inflammatory cells, a complete irregular thick epithelium, more granulation tissue, and more fibrosis. So, nano polycaprolactonehydroxyapatite zeolite accelerated the healing process after tooth extraction. Conclusion: Nanocomposite containing nano zeolite can improve wound healing after tooth extraction. [ABSTRACT FROM AUTHOR]

Introduction: In modern times, endodontic intervention is preferred and tooth extraction is becoming increasingly rare. Root Canal Therapy (RCT) is well-established, with success rates exceeding 90%. A key contributor to post-endodontic pain is the extrusion of debris into the periapical region, which causes inflammation and nerve compression. The amount of debris extruded varies with instrumentation techniques and no current technology completely prevents it. Rotary and reciprocating Nickel-Titanium (NiTi) instruments, each with distinct designs and kinematics, play a critical role in managing this complication. Aim: To evaluate postoperative pain using rotary and reciprocating file systems in single visit endodontics. Materials and Methods: This prospective, parallel-group, singlecentre, double-blinded, equivalence, randomised clinical study was conducted at the Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed To be University), Karad, Maharashtra, India, from October 2023 to March 2024, with the aim of comparing postoperative pain following endodontic therapy using two reciprocating systems, WaveOne Gold (WOG) and E-Flex Rec, versus two rotary systems, Mtwo and XP Endo Shaper (XPES). A total of 80 patients with symptomatic irreversible pulpitis were enrolled and randomly assigned to four groups, each treated with one of the four endodontic file systems. Patients were randomised into four groups: 1A-Mtwo (Dentsply-Maillefer, Ballaigues, Switzerland); 1B-XP Endo Shaper (XPS; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland); 2A-Eighteeth E-Flex Rec File; and 2B-WOG (Dentsply Sirona, York, PA). Postoperative pain scores were measured using the Visual Analogue Scale (VAS) at 24, 48 and 72 hours and seven days post-treatment. Statistical analysis was conducted using One-way Analysis of Variance (ANOVA) with Tukey's post-hoc test and Chi-square tests for categorical data using Statistical Package for Social Sciences (SPSS) software version 21.0, with p-values<0.05 considered significant. Results: According to the study's findings, postoperative pain was significantly higher in the rotary file systems compared to the reciprocating file systems at all time intervals (p-value<0.001). The mean ages were 39.00±12.70 years for Group 1A, 34.70±9.48 years for Group 1B, 42.15±12.59 years for Group 2A, and 39.10±13.65 years for Group 2B. Additionally, the consumption of analgesics was significantly higher in the rotary file systems compared to the reciprocating file systems at 24 hours (p-value=0.001) and 48 hours (p-value=0.003), highlighting the importance of file design and kinematics in managing postoperative pain. Conclusion: Compared to the rotary systems (XPES and Mtwo), the use of the reciprocating instrumentation systems (WOG and E-Flex) demonstrated noticeably less postoperative pain, both in terms of intensity and duration. [ABSTRACT FROM AUTHOR]

Introduction: Third molar extraction is a common surgical procedure that can have unintended consequences, such as periodontal disease that results in bone loss on the distal part of the second molar. By halting the atrophy of the alveolar ridge, socket and ridge preservation procedures enable restorations that are both functional and aesthetically acceptable. Maintaining the volume of the alveolar socket after tooth extraction is the primary objective of alveolar management, as it prevents substantial resorption and facilitates socket repair. Numerous methods have been reported on socket healing following tooth extractions. Grafting materials may promote healing of the post-extraction socket in three separate ways: osteogenesis, osteoinduction and osteoconduction. Need of the study: This study is necessary because managing bony defects after the extraction of impacted mandibular third molars is critically dependent on successful interventions. Third molars that are impacted often need to be surgically removed, resulting in bony defects that require proper regeneration for the best possible outcome after surgery. An important consideration in this process is the selection of grafting materials. It is imperative to comprehend the relative effectiveness of dentine graft and Platelet-rich Fibrin (PRF) to assist clinicians in deciding the best treatment option. Both PRF and dentine graft have shown promise in fostering bone regeneration; however, to develop evidence-based guidelines for clinical practice, a direct comparison using a rigorous split-mouth study is essential. Aim: To compare and evaluate outcomes of dentine graft against PRF in postoperative impacted mandibular third molar bony defects. Materials and Methods: A prospective randomised split-mouth study will be conducted in the Department of Oral and Maxillofacial Surgery at Sharad Pawar Dental College, DMIHER, Sawangi, Wardha, Maharastra, India from April 2023 to January 2025. After the extraction of the 3rd molar, the patient will be instructed to bite on a sterile swab while waiting for the biomaterials to be ready. Following the examination of the extraction socket, the particulate dentine graft and liquid PRF preparation will be made and then placed in the extraction socket. The patient will then be instructed to use chlorhexidine mouth rinse (0.2%) twice a day in place of mechanical plaque management in the treated region for one week, as part of the postoperative regimen. Postoperative pain, wound healing, bone regeneration, and complications, if any will be assessed at a specified interval. Fisher's-exact test will be used for statistical analysis, and the level of significance will be set at p<0.05. [ABSTRACT FROM AUTHOR]