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Frank Schwarz - One of the best experts on this subject based on the ideXlab platform.
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histomorphometrical assessment of vertical Alveolar Ridge augmentation using extracted tooth roots in the canine
Clinical Oral Investigations, 2020Co-Authors: Puria Parvini, Carla Schliephake, Sarah Almaawi, Katrin Schwarz, Robert Sader, Shahram Ghanaati, Frank SchwarzAbstract:To histomorphometrically evaluate the influence of autoclavation on the efficacy of extracted tooth roots (TR) used for vertical Alveolar Ridge augmentation. Upper premolars were randomly assigned to either autoclavation (TR-A) or an untreated control group (TR-C) and used as block grafts for vertical Alveolar Ridge augmentation in both lower quadrants (n = 4 beagle dogs). Tissue biopsies were obtained after 15 weeks of submerged healing. Histological analyses considered gain in Ridge height (GRH), augmented area (AA), and the proportion of mineralized (MT) and non-mineralized tissue (NMT). TR-C and TR-A grafts were commonly associated with a complete replacement resorption and a marked gain in Ridge height. Significant differences between groups were noted for mean GRH [TR-C: 2.35 ± 0.55 vs. TR-A: 2.46 ± 0.21 mm] and AA [TR-C: 11.88 ± 4.31 vs. TR-A: 8.65 ± 1.59 mm2] values. Within AA, both groups revealed a comparable distribution of mean MT and NMT values. The linear regression analysis pointed to a significant correlation between NMT and AA values. Both TR-C and TR-A grafts supported vertical Alveolar Ridge augmentation; however, GRH was improved in the TR-A group. TR grafts may serve as a potential alternative for vertical Alveolar Ridge augmentation.
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regeneration of Alveolar Ridge defects consensus report of group 4 of the 15th european workshop on periodontology on bone regeneration
Journal of Clinical Periodontology, 2019Co-Authors: Soren Jepsen, Frank Schwarz, Luca Cordaro, Nadja Naenni, Jan Derks, Christoph H F Hammerle, Lisa J A Heitzmayfield, Federico Hernandezalfaro, Henny J A Meijer, Alberto OrtizvigonAbstract:BACKGROUND AND AIMS Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of Alveolar Ridge defects. MATERIAL AND METHODS The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures. RESULTS A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient Ridge width for implant placement. Also, vertical Ridge augmentation procedures were in many studies shown to be effective in treating deficient Alveolar Ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla. CONCLUSIONS The evaluated bone augmentation procedures were proven to be effective for the reconstruction of Alveolar Ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.
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efficacy of autogenous tooth roots for lateral Alveolar Ridge augmentation and staged implant placement a prospective controlled clinical study
Journal of Clinical Periodontology, 2018Co-Authors: Frank Schwarz, Robert Sader, Didem Hazar, Kathrin Becker, Jurgen C BeckerAbstract:OBJECTIVES To assess and compare the efficacy and safety of autogenous tooth roots (TR) and autogenous bone blocks (AB) for lateral Alveolar Ridge augmentation and two-stage implant placement. MATERIAL AND METHODS A total of 30 patients in need of implant therapy and lateral Ridge augmentation were allocated to parallel groups receiving either (a) healthy autogenous tooth roots (e.g. retained wisdom or impacted teeth) (n = 15) or (b) cortical autogenous bone blocks harvested from the retromolar area. After 26 weeks of submerged healing, the primary endpoint was defined as the crestal Ridge width (mm) (CW26) being sufficient to place an adequately dimensioned titanium implant at the respective sites. RESULTS Soft tissue healing was uneventful in both groups. CW26 at V isit 6 allowed for a successful implant placement in all patients of both TR (15/15) and AB groups (15/15). Mean CW26 values amounted to 10.06 ± 1.85 mm (median: 11.0) in the TR and 9.20 ± 2.09 mm (median: 8.50) in the AB group, respectively. The difference between both groups did not reach statistical significance (p = 0.241). CONCLUSIONS TR may serve as an alternative graft to support lateral Alveolar Ridge augmentation and two-stage implant placement.
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Radiographic outcomes following lateral Alveolar Ridge augmentation using autogenous tooth roots
SpringerOpen, 2018Co-Authors: Puria Parvini, Robert Sader, Didem Sahin, Jürgen Becker, Frank SchwarzAbstract:Abstract Background To assess and compare the radiographic outcomes following lateral Alveolar Ridge augmentation using autogenous tooth roots (TR) and autogenous bone (AB) blocks. Methods In a total of 30 patients, lateral Ridge augmentation was conducted in parallel groups using either (1) healthy autogenous tooth roots (e.g., retained wisdom or impacted teeth) (n = 15) or (2) cortical autogenous bone blocks harvested from the retromolar area. Cone-beam computed tomographic (CBCT) scans taken at 26 weeks of submerged healing were analyzed for the basal graft integration (i.e., contact between the graft and the host bone in %) (BI26) and the cross-sectional grafted area (mm2) (SA26). Results Both groups revealed a comparable clinical width of the Alveolar Ridge at baseline (CWb). Mean BI26 and SA26 values amounted to 69.26 ± 26.01% (median 72.44) and 22.07 ± 12.98 mm2 (median 18.83) in the TR group and 79.67 ± 15.66% (median 78.85) and 12.42 ± 10.11 mm2 (median 11.36) in the AB group, respectively. Between-group differences in mean SA26 values were statistically significant (p = 0.031). Linear regression analysis failed to reveal any significant correlations between BI26 and CWb/SA26 values in either group. Conclusions TR grafts may be associated with improved SA26 values following lateral Alveolar Ridge augmentation. Trial registration DRKS00009586. Registered 10 February 2016
Ulf M E Wikesjö - One of the best experts on this subject based on the ideXlab platform.
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Alveolar Ridge augmentation using implants coated with recombinant human bone morphogenetic protein 2 histologic observations
Journal of Clinical Periodontology, 2008Co-Authors: Ulf M E Wikesjö, Cristiano Susin, Michael D Rohrer, Mohammed Qahash, Giuseppe Polimeni, Richard H Shanaman, John M Wozney, Jan HallAbstract:Background: Studies using ectopic rodent, orthotopic canine, and non-human primate models show that bone morphogenetic proteins (BMPs) coated onto titanium surfaces induce local bone formation. The objective of this study was to examine the ability of recombinant human BMP-2 (rhBMP-2) coated onto a titanium porous oxide implant surface to stimulate local bone formation including osseointegration and vertical augmentation of the Alveolar Ridge. Material and Methods: Bilateral, critical-size, 5 mm, supra-Alveolar, peri-implant defects were created in 12 young adult Hound Labrador mongrel dogs. Six animals received implants coated with rhBMP-2 at 0.75 or 1.5 mg/ml, and six animals received implants coated with rhBMP-2 at 3.0 mg/ml or uncoated control. Treatments were randomized between jaw quadrants. The mucoperiosteal flaps were advanced, adapted and sutured to submerge the implants for primary intention healing. The animals received fluorescent bone markers at weeks 3, 4, 7 and 8 post-surgery when they were euthanized for histologic evaluation. Results: Jaw quadrants receiving implants coated with rhBMP-2 exhibited gradually regressing swelling that became hard to palpate disguising the contours of the implants. The histologic evaluation showed robust bone formation reaching or exceeding the implant platform. The newly formed bone exhibited characteristics of the adjoining resident Type II bone including cortex formation for sites receiving implants coated with rhBMP-2 at 0.75 or 1.5 mg/ml. Sites receiving implants coated with rhBMP-2 at 3.0 mg/ml exhibited more immature trabecular bone formation, seroma formation and peri-implant bone remodelling resulting in undesirable implant displacement. Control implants exhibited minimal, if any, bone formation. Thus, implants coated with rhBMP-2 at 0.75, 1.5 and 3.0 mg/ml exhibited significant bone formation (height and area) compared with the sham-surgery control averaging (± SD) 4.4 ± 0.4, 4.2 ± 0.7 and 4.2 ± 1.2 versus 0.8 ± 0.3 mm; and 5.0 ± 2.2, 5.6 ± 2.2 and 7.4 ± 3.5 versus 0.7 ± 0.3mm 2 , respectively (p<0.01). All the treatment groups exhibited clinically relevant osseointegration. Conclusions: rhBMP-2 coated onto titanium porous oxide implant surfaces induced clinically relevant local bone formation including vertical augmentation of the Alveolar Ridge and osseointegration. Higher concentrations/doses were associated with untoward effects.
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bone reconstruction following implantation of rhbmp 2 and guided bone regeneration in canine Alveolar Ridge defects
Clinical Oral Implants Research, 2007Co-Authors: Sascha A Jovanovic, John M Wozney, Dennis R Hunt, George W Bernard, Hubertus Spiekermann, Ulf M E WikesjöAbstract:Background: Alveolar Ridge aberrations commonly require bone augmentation procedures for optimal placement of endosseous dental implants. The objective of this study was to evaluate local bone formation following implantation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier with or without provisions for guided bone regeneration (GBR) as potential treatment modalities for Alveolar augmentation. Methods: Surgically induced, large, mandibular Alveolar Ridge saddle-type defects (2 defects/jaw quadrant) in seven young adult Hound dogs were assigned to receive rhBMP-2/ACS, rhBMP-2/ACS combined with GBR (rhBMP-2/GBR), GBR, and surgery controls. The animals were euthanized at 12 weeks post-surgery when block sections of the defect sites were collected for histologic analysis. Results: Clinical complications included swelling for sites receiving rhBMP-2 and wound failure with exposure of the barrier device for sites receiving GBR (4/6) or rhBMP-2/GBR (3/7). The radiographic evaluation showed substantial bone fill for sites receiving rhBMP-2/ACS, rhBMP-2/GBR, and GBR. In particular, sites receiving rhBMP-2/GBR presented with seroma-like radiolucencies. The surgery control exhibited moderate bone fill. To evaluate the biologic potential of the specific protocols, sites exhibiting wound failure were excluded from the histometric analysis. Sites receiving rhBMP-2/ACS or rhBMP-2/GBR exhibited bone fill averaging 101%. Bone fill averaged 92% and 60%, respectively, for sites receiving GBR and surgery controls. Bone density ranged from 50% to 57% for sites receiving rhBMP-2/ACS, GBR, or surgery controls. Bone density for sites receiving rhBMP-2/GBR averaged 34% largely due to seroma formation encompassing 13% to 97% of the sites. Conclusion: rhBMP-2/ACS appears to be an effective alternative to GBR in the reconstruction of advanced Alveolar Ridge defects. Combining rhBMP-2/ACS with GBR appears to be of limited value due to the potential for wound failure or persistent seromas.
Momen A Atieh - One of the best experts on this subject based on the ideXlab platform.
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interventions for replacing missing teeth Alveolar Ridge preservation techniques for dental implant site development
Cochrane Database of Systematic Reviews, 2015Co-Authors: Momen A Atieh, Nabeel H M Alsabeeha, Alan G T Payne, Warwick J Duncan, Clovis Mariano Faggion, Marco EspositoAbstract:BACKGROUND: Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar Ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. OBJECTIVES: To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 22 July 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 6), MEDLINE via OVID (1946 to 22 July 2014), EMBASE via OVID (1980 to 22 July 2014), LILACS via BIREME (1982 to 22 July 2014), the Meta Register of Current Controlled Trials (to 22 July 2014), ClinicalTrials.gov (to 22 July 2014), the World Health Organization International Clinical Trials Registry Platform (to 22 July 2014), Web of Science Conference Proceedings (1990 to 22 July 2014), Scopus (1966 to 22 July 2014), ProQuest Dissertations and Theses (1861 to 22 July 2014) and OpenGrey (to 22 July 2014). A number of journals were also handsearched. Trial authors were contacted to identify unpublished randomised controlled trials. There were no restrictions regarding language and date of publication in the searches of the electronic databases. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) on the use of Alveolar Ridge preservation techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of Alveolar Ridge, changes in the vertical height of the Alveolar Ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and assessed risk of bias for each included trial. Corresponding authors were contacted to obtain missing information. Results were combined using random-effects models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings. MAIN RESULTS: A total of 50 trials were potentially eligible for inclusion, of which 42 trials were excluded. We included eight RCTs with a total of 233 extraction sites in 184 participants. One trial was judged to be at unclear risk of bias and the remaining trials were at high risk of bias. From two trials comparing xenograft with extraction alone (70 participants, moderate quality evidence), there was some evidence of a reduction in loss of Alveolar Ridge height (MD -2.60 mm; 95% CI -3.43 to -1.76) and width (MD -1.97 mm; 95% CI -2.48 to -1.46). This was also found in one trial comparing allograft with extraction (24 participants, low quality evidence): Ridge height (MD -2.20 mm; 95% CI -0.75 to -3.65) and width (MD - 1.40 mm; 95% CI 0.00 to -2.80) and height. From two RCTs comparing alloplast versus xenograft no evidence was found that either Ridge preservation technique caused a smaller reduction in loss of Ridge height (MD -0.35 mm; 95% CI -0.86 to 0.16) or width (MD -0.44 mm; 95% CI -0.90 to 0.02; two trials (55 participants); moderate quality evidence). There was insufficient evidence to determine whether there are clinically significant differences between different ARP techniques and extraction based on the need for additional augmentation prior to implant placement, complications, implant failure, or changes in peri-implant marginal bone levels and probing depths of neighbouring teeth. We found no trials which evaluated parameters relating to clinical attachment levels, specific aesthetic or prosthodontic outcomes. AUTHORS' CONCLUSIONS: There is limited evidence that ARP techniques may minimise the overall changes in residual Ridge height and width six months after extraction. There is also lack of evidence of any differences in implant failure, aesthetic outcomes or any other clinical parameters due to the lack of information or long-term data. There is no convincing evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.
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interventions for replacing missing teeth Alveolar Ridge preservation techniques for dental implant site development
Cochrane Database of Systematic Reviews, 2015Co-Authors: Momen A Atieh, Nabeel H M Alsabeeha, Alan G T Payne, Warwick J Duncan, Clovis Mariano Faggion, Marco EspositoAbstract:Background Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar Ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. This is an update of the Cochrane Review first published in 2015. Objectives To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2021), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2021, Issue 2), MEDLINE Ovid (1946 to 19 March 2021), Embase Ovid (1980 to 19 March 2021), Latin American and Caribbean Health Science Information database (1982 to 19 March 2021), Web of Science Conference Proceedings (1990 to 19 March 2021), Scopus (1966 to 19 March 2021), ProQuest Dissertations and Theses (1861 to 19 March 2021), and OpenGrey (to 19 March 2021). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. A number of journals were also handsearched. Selection criteria We included all randomised controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of Alveolar Ridge, changes in the vertical height of the Alveolar Ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. Data collection and analysis We selected trials, extracted data, and assessed risk of bias in duplicate. Corresponding authors were contacted to obtain missing information. We estimated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings and assessed the certainty of the evidence using GRADE. Main results We included 16 RCTs conducted worldwide involving a total of 524 extraction sites in 426 adult participants. We assessed four trials as at overall high risk of bias and the remaining trials at unclear risk of bias. Nine new trials were included in this update with six new trials in the category of comparing ARP to extraction alone and three new trials in the category of comparing different grafting materials. ARP versus extraction: from the seven trials comparing xenografts with extraction alone, there is very low-certainty evidence of a reduction in loss of Alveolar Ridge width (MD -1.18 mm, 95% CI -1.82 to -0.54; P = 0.0003; 6 studies, 184 participants, 201 extraction sites), and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P Authors' conclusions ARP techniques may minimise the overall changes in residual Ridge height and width six months after extraction but the evidence is very uncertain. There is lack of evidence of any differences in the need for additional augmentation at the time of implant placement, implant failure, aesthetic outcomes, or any other clinical parameters due to lack of information or long-term data. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long-term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.
Marco Esposito - One of the best experts on this subject based on the ideXlab platform.
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interventions for replacing missing teeth Alveolar Ridge preservation techniques for dental implant site development
Cochrane Database of Systematic Reviews, 2015Co-Authors: Momen A Atieh, Nabeel H M Alsabeeha, Alan G T Payne, Warwick J Duncan, Clovis Mariano Faggion, Marco EspositoAbstract:BACKGROUND: Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar Ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. OBJECTIVES: To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 22 July 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 6), MEDLINE via OVID (1946 to 22 July 2014), EMBASE via OVID (1980 to 22 July 2014), LILACS via BIREME (1982 to 22 July 2014), the Meta Register of Current Controlled Trials (to 22 July 2014), ClinicalTrials.gov (to 22 July 2014), the World Health Organization International Clinical Trials Registry Platform (to 22 July 2014), Web of Science Conference Proceedings (1990 to 22 July 2014), Scopus (1966 to 22 July 2014), ProQuest Dissertations and Theses (1861 to 22 July 2014) and OpenGrey (to 22 July 2014). A number of journals were also handsearched. Trial authors were contacted to identify unpublished randomised controlled trials. There were no restrictions regarding language and date of publication in the searches of the electronic databases. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) on the use of Alveolar Ridge preservation techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of Alveolar Ridge, changes in the vertical height of the Alveolar Ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and assessed risk of bias for each included trial. Corresponding authors were contacted to obtain missing information. Results were combined using random-effects models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings. MAIN RESULTS: A total of 50 trials were potentially eligible for inclusion, of which 42 trials were excluded. We included eight RCTs with a total of 233 extraction sites in 184 participants. One trial was judged to be at unclear risk of bias and the remaining trials were at high risk of bias. From two trials comparing xenograft with extraction alone (70 participants, moderate quality evidence), there was some evidence of a reduction in loss of Alveolar Ridge height (MD -2.60 mm; 95% CI -3.43 to -1.76) and width (MD -1.97 mm; 95% CI -2.48 to -1.46). This was also found in one trial comparing allograft with extraction (24 participants, low quality evidence): Ridge height (MD -2.20 mm; 95% CI -0.75 to -3.65) and width (MD - 1.40 mm; 95% CI 0.00 to -2.80) and height. From two RCTs comparing alloplast versus xenograft no evidence was found that either Ridge preservation technique caused a smaller reduction in loss of Ridge height (MD -0.35 mm; 95% CI -0.86 to 0.16) or width (MD -0.44 mm; 95% CI -0.90 to 0.02; two trials (55 participants); moderate quality evidence). There was insufficient evidence to determine whether there are clinically significant differences between different ARP techniques and extraction based on the need for additional augmentation prior to implant placement, complications, implant failure, or changes in peri-implant marginal bone levels and probing depths of neighbouring teeth. We found no trials which evaluated parameters relating to clinical attachment levels, specific aesthetic or prosthodontic outcomes. AUTHORS' CONCLUSIONS: There is limited evidence that ARP techniques may minimise the overall changes in residual Ridge height and width six months after extraction. There is also lack of evidence of any differences in implant failure, aesthetic outcomes or any other clinical parameters due to the lack of information or long-term data. There is no convincing evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.
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interventions for replacing missing teeth Alveolar Ridge preservation techniques for dental implant site development
Cochrane Database of Systematic Reviews, 2015Co-Authors: Momen A Atieh, Nabeel H M Alsabeeha, Alan G T Payne, Warwick J Duncan, Clovis Mariano Faggion, Marco EspositoAbstract:Background Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar Ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. This is an update of the Cochrane Review first published in 2015. Objectives To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2021), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2021, Issue 2), MEDLINE Ovid (1946 to 19 March 2021), Embase Ovid (1980 to 19 March 2021), Latin American and Caribbean Health Science Information database (1982 to 19 March 2021), Web of Science Conference Proceedings (1990 to 19 March 2021), Scopus (1966 to 19 March 2021), ProQuest Dissertations and Theses (1861 to 19 March 2021), and OpenGrey (to 19 March 2021). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. A number of journals were also handsearched. Selection criteria We included all randomised controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of Alveolar Ridge, changes in the vertical height of the Alveolar Ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. Data collection and analysis We selected trials, extracted data, and assessed risk of bias in duplicate. Corresponding authors were contacted to obtain missing information. We estimated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings and assessed the certainty of the evidence using GRADE. Main results We included 16 RCTs conducted worldwide involving a total of 524 extraction sites in 426 adult participants. We assessed four trials as at overall high risk of bias and the remaining trials at unclear risk of bias. Nine new trials were included in this update with six new trials in the category of comparing ARP to extraction alone and three new trials in the category of comparing different grafting materials. ARP versus extraction: from the seven trials comparing xenografts with extraction alone, there is very low-certainty evidence of a reduction in loss of Alveolar Ridge width (MD -1.18 mm, 95% CI -1.82 to -0.54; P = 0.0003; 6 studies, 184 participants, 201 extraction sites), and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P Authors' conclusions ARP techniques may minimise the overall changes in residual Ridge height and width six months after extraction but the evidence is very uncertain. There is lack of evidence of any differences in the need for additional augmentation at the time of implant placement, implant failure, aesthetic outcomes, or any other clinical parameters due to lack of information or long-term data. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long-term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.
Reinhard Gruber - One of the best experts on this subject based on the ideXlab platform.
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caspase inhibitor attenuates the shape changes in the Alveolar Ridge following tooth extraction a pilot study in rats
Journal of Periodontal Research, 2021Co-Authors: Uwe Yacine Schwarze, Franz Josef Strauss, Reinhard GruberAbstract:OBJECTIVE The aim of the study was to determine whether the inhibition of apoptosis via pan-caspase inhibitors can attenuate the changes in the Alveolar Ridge upon tooth extraction. BACKGROUND Cells undergoing apoptosis might play a central role in the onset of Alveolar bone resorption and the ensuing bone atrophy following tooth extraction. Caspases are proteases that regulate apoptotic cell death. It is, therefore, reasonable to hypothesize that blocking apoptosis with pan-caspase inhibitors attenuates the changes in the Alveolar Ridge following tooth extraction. METHODS In 16 inbred rats, the mandibular first (M1) and second (M2) molars of one side were extracted. Following random allocation, the rats received either a cell-permeable pan-caspase inhibitor or diluent. After a healing period of 10 days, changes in shape and height of the Alveolar Ridge were examined using geometric morphometrics and linear measurements based on micro-computed tomography. RESULTS Geometric morphometric analysis revealed that the pan-caspase inhibitor prevented major shape changes of the Alveolar Ridge following M1 tooth extraction (P < .05). Furthermore, linear measurements confirmed that the pan-caspase inhibitor significantly prevented the atrophy of the Alveolar Ridge height following M1 tooth extraction compared to the diluent controls (-0.53 mm vs -0.24 mm; P = .012). M2 tooth extraction caused no shape changes of the Alveolar Ridge, and thus, the pan-caspase inhibitor group did not differ from the control group (-0.14 mm vs -0.05 mm; P = .931). CONCLUSIONS These findings suggest that the inhibition of apoptosis may attenuate shape changes of the Alveolar Ridge following M1 tooth extraction in rodents.