Aim To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing. Materials and methods The protocol of this PRISMA-compliant systematic review (SRs) was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random-effects meta-analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest. Results Twenty-eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non-molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed clinically in non-molar sites was 2.73 mm (95% CI: 2.36-3.11), 1.71 mm (95% CI: 1.30-2.12) and 1.44 mm (95% CI: 0.78-2.10), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in non-molar sites was 2.54 mm (95% CI: 1.97-3.11), 1.65 mm (95% CI: 0.42-2.88) and 0.87 mm (95% CI: 0.36-1.38), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in molar sites was 3.61 mm (95% CI: 3.24-3.98), 1.46 mm (95% CI: 0.73-2.20) and 1.20 mm (95% CI: 0.56-1.83), respectively. Conclusion A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.

Post-extraction dimensional changes: A systematic review and meta-analysis.

The aim of this randomized controlled trial was to evaluate the survival rate, the marginal bone level, and the aesthetic outcome; at 3 years' follow-up, of dental implants placed into a high-esthetic aesthetic zone by comparing 2 techniques of postextraction implant with immediate loading: the socket shied technique and the conventional insertion technique.Several clinical studies suggested that the avulsion of a dental element causes dimensional alterations of both soft and hard tissues at the postextractive site. To increase the aesthetic outcomes, the "socket-shield technique" has been proposed. This method involves maintaining the vestibular root portion and immediate insertion of the dental implant in close proximity to the root.Patients enrolled in this study were randomized to receive a postextraction implant in the aesthetic zone, either with the socket shied technique or with the conventional insertion technique. Implant survival, marginal bone level, and the pink aesthetic score were the outcomes evaluated.Implant survival rate was 100% in both the groups at 3 years. Implants inserted with the socket shield technique showed better values of both marginal bone level and pink aesthetic score (P < 0.05).Although such preliminary results need to be further confirmed, the socket shield technique seems to be a safe surgical technique that allows an implant rehabilitation characterized by better aesthetic outcomes.

Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol.

Statement of problem Immediate implantation has been established to shorten waiting time before definitive restoration, offering the ability to deliver a predictable esthetic and functional outcome for patients. However, this approach remains controversial for a tooth with a periodontal or periapical lesion. Purpose The purpose of this systematic review was to analyze the treatment outcomes of immediate implant placement into extraction sockets with or without infection of periodontal or periapical origin in the esthetic zone and to provide treatment protocols based on current studies. Material and methods An electronic search was performed in PubMed, ISI Web of Knowledge, and the Cochrane Library between January 2009 and October 2017. A subsequent manual search included all clinical studies published in the English language and excluded any reviews or animal studies. An article quality assessment scale, Newcastle-Ottawa Scale (NOS), was used to evaluate the quality of studies enrolled. The implant survival rate was expressed as risk ratio, whereas bone level changes and gingiva level changes were expressed as mean differences in millimeters with 95% confidence intervals. The meta-analysis was conducted by using commercial software. Results The search initially found 1171 references. The manual search of the reference lists of identified articles yielded additional papers. Altogether, 9 studies were identified within the selection criteria, with NOS scores between 5 and 8. Compared with the healthy sites, immediate implant placement in infected sites in the esthetic zone showed similar survival rates (97.6% vs. 98.4%, respectively; risk ratio [RR], 0.99; 95% confidence interval [CI], 0.97 to 1.00; P=.138). No statistically significant differences were found in bone level changes (mean difference [MD], 0.03; 95%CI, −0.09 to 0.14; P=.667) or in gingiva level changes (MD, −0.06; 95% CI, −0.13 to 0.01; P=.070) between the 2 groups. Conclusions Meta-analysis showed that immediate implant placement into infected sites and noninfected sites in esthetic zone had similar survival rates, bone level changes, and gingiva level changes.

Immediate placement of dental implants into infected versus noninfected sites in the esthetic zone: A systematic review and meta-analysis.

Aim To study the soft and hard tissue alterations of the alveolar ridge after socket-shield technique. Materials and methods In four Beagle dogs, the following treatments (Tx) were randomly assigned to 32 extraction sockets: Tx1: blood clot; Tx2: Bio-Oss Collagen; Tx3: socket-shield technique and blood clot; Tx4: socket-shield technique and Bio-Oss Collagen. The width and height alterations of the buccal bone plate were calculated by CBCT scans. The dimensional alterations of the buccal aspect of the alveolar ridge at different time points were calculated by impressions using digital imaging analysis. The dogs were sacrificed for micro-CT and histologic analysis 3 months after surgery. Results Width, height and dimensional alterations of Tx3 and Tx4 were significantly lower than those of Tx1 and Tx2. Bone morphological parameters displayed no significant differences among four groups except for the trabecular thickness of Tx1 and Tx2. The quantity and quality of hard tissue containing the residual teeth of Tx3 and Tx4 were much greater than those of Tx1 and Tx2. Conclusions Socket-shield technique may be beneficial in preserving the soft and hard tissue of the alveolar ridge, which is better than simple bone grafting in the extraction socket.

Effect of socket-shield technique on alveolar ridge soft and hard tissue in dogs.

Objectives: To evaluate the socket shield technique and compare the survival, stability, esthetic outcome and complication rates of immediate implants in the esthetic zone placed using this technique with the traditional guided bone regeneration technique.Patients and Methods: 20 Patients were enrolled in this study, they were randomized into two equal groups, after receiving a post extraction implant in the esthetic zone; Group I patients were managed with guided bone regeneration technique, while group II patients were treated with socket shied technique. Functional and esthetic outcomes of the treatment in term of implant survival and marginal bone level were evaluated.Results: Implant survival rate after 1 year was 100% in both groups. Implants inserted with the socket shield technique demonstrated better values of marginal bone level and were statistically significant.Conclusions: Socket shield technique is a highly promising addition to dental implantlogy that seems to be a feasible surgical option characterized by better esthetic outcomes when compared to guided bone regeneration technique.

https://edj.journals.ekb.eg/article_76748_f01c55b93ea0d8dc7cde36b106cf4873.pdf

Socket- shield technique versus guided bone regeneration technique for ridge preservation with immediate implant placement in the esthetic zone

The aim of this study was to determine the efficacy of immediate implant placement with alveolar bone augmentation on socket preservation following atraumatic tooth extraction and comparing it with a tooth alveolar socket that was allowed to heal in a conventional way.Twenty medically fit patients (8 males and 12 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of mandibular premolar teeth were divided randomly and equally into 2 groups. In Group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In Group II, the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilized bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. Cone beam computerized tomography images of the alveolar ridge and socket were analyzed to determine the structural changes of the alveolar ridge. Resonance frequency analysis was measured at 9 months for Group II to assess the degree of secondary stability of the implants by using Osstell machine.A significant difference of bone resorption of 1.49 mm (confidence interval, CI 95%, 0.63-2.35) was observed within the control group at 3 months, and 1.84 mm (P ≤ 0.05) at 9 months intervals. No significant changes of bone resorption were observed in Group II. Comparison between groups showed a highly significant difference at 3 months; 2.56 mm (CI 95% 4.22-0.90) and at 9 months intervals; 3.2 mm (CI 95%, 4.70-1.62) P ≤ 0.001 between Group I and II. High resonance frequency analysis values were observed at 9 months postoperative in Group II.In conclusion, the insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.

The Efficacy of Immediate Implant Placement in Extraction Sockets for Alveolar Bone Preservation: A Clinical Evaluation Using Three-Dimensional Cone Beam Computerized Tomography and Resonance Frequency Analysis Value.

Presence of maxillary sinus septa, an anatomical variant, has never been documented as a possible complication of Le Fort I orthognathic surgery procedure. This case report describes the difficulty faced by an experienced surgeon during Le Fort I down-fracture procedure. The osteotomized maxilla remained firm despite confirmation that all osteotomy cuts have been performed adequately. The presence of a bilateral sagittally oriented maxillary sinus septa extending from the floor to the roof of the sinus in this case had prevented separation of the lower maxilla during down-fracture maneuver. Such normal anatomical variant must be identified during orthognathic surgery treatment planning session to avoid grave complications.

Le Fort I Osteotomy Complicated by Presence of Maxillary Sinus Septa.

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The Efficacy of Immediate Implant Placement in Extraction Sockets for Alveolar Bone Preservation: A Clinical Evaluation Using Three-Dimensional Cone Beam Computerized Tomography and Resonance Frequency Analysis Value.

Le Fort I Osteotomy Complicated by Presence of Maxillary Sinus Septa.