Publications by authors named "Fabio Vignoletti"

38 Publications

Immunohistochemical characteristics of lateral bone augmentation using different biomaterials around chronic peri-implant dehiscence defects: An experimental in vivo study.

Clin Oral Implants Res 2021 Feb 25. Epub 2021 Feb 25.

Department of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Aim: To investigate the immunohistochemical characteristics of a highly porous synthetic bone substitute and a cross-linked collagen membrane for guided bone regeneration.

Methods: Three experimental groups were randomly allocated at chronic peri-implant dehiscence defect in 8 beagle dogs: (i) biphasic calcium phosphate covered by a cross-linked collagen membrane (test group), (ii) deproteinized bovine bone mineral covered by a natural collagen membrane (positive control) and (iii) no treatment (negative control). After 8 and 16 weeks of submerged healing, dissected tissue blocks were processed for immunohistochemical analysis. Seven antibodies were used to detect the remaining osteogenic and angiogenic potential, and quantitative immunohistochemical analysis was done by software.

Results: The antigen reactivity of alkaline phosphatase was significantly higher in the test group compared to the positive and negative controls, and it maintained till 16 weeks. The intensity of osteocalcin was significantly higher in the positive control at 8 weeks than the other groups, but significantly decreased at 16 weeks and no difference was found between the groups. A significant large number of TRAP-positive cells were observed in the test group mainly around the remaining particles at 16 weeks. The angiogenic potential was comparable between the groups showing no difference in the expression of transglutaminase II and vascular endothelial growth factor.

Conclusion: Guided bone regeneration combining a highly porous biphasic calcium phosphate synthetic biomaterial with a crosslinked collagen membrane, resulted in extended osteogenic potential when compared to the combination of deproteinized bovine bone mineral and a native collagen membrane.
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http://dx.doi.org/10.1111/clr.13726DOI Listing
February 2021

The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Soft tissue findings from a randomized controlled clinical trial.

J Clin Periodontol 2020 12 21;47(12):1536-1546. Epub 2020 Oct 21.

Department of Periodontology, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy.

Aim: To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4 months after single-tooth extraction and three different treatment modalities: spontaneous healing (SH) and alveolar ridge preservation by means of a deproteinized bovine bone mineral and a collagen matrix, with (IMPL/DBBM/CM) or without (DBBM/CM) immediate implant placement.

Materials And Methods: STL files from study casts obtained at baseline and after 4 months were matched to calculate buccal soft tissue linear and volumetric changes. DICOM files from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4 months.

Results: Mean horizontal reduction accounted for 1.46 ± 0.20 (SH), 0.85 ± 0.38 (DBBM-CM) and 0.84 ± 0.30 IMPL/DBBM-CM, with no statistical differences. Soft tissue thickness had a significant mean increase of 0.95 for SH group, compared to a non-significant mean decrease for DBBM-CM (0.20) and IMPL/DBBM-CM groups (0.07).

Conclusion: A preservation technique with DBBM-CM, with or without immediate implant placement, did not reduce the horizontal linear and volumetric changes at the buccal soft tissue profile significantly at 4 months after tooth extraction when compared to spontaneous healing. This is due to a significant increase in soft tissue thickness in spontaneously healing sites.
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http://dx.doi.org/10.1111/jcpe.13369DOI Listing
December 2020

Periodontal regeneration using a xenogeneic bone substitute seeded with autologous periodontal ligament-derived mesenchymal stem cells: A 12-month quasi-randomized controlled pilot clinical trial.

J Clin Periodontol 2020 11;47(11):1391-1402

ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain.

Aim: To evaluate the safety and efficacy of autologous periodontal ligament-derived mesenchymal stem cells (PDL-MSCs) embedded in a xenogeneic bone substitute (XBS) for the regenerative treatment of intra-bony periodontal defects.

Material And Methods: This quasi-randomized controlled pilot phase II clinical trial included patients requiring a tooth extraction and presence of one intra-bony lesion (1-2 walls). Patients were allocated to either the experimental (XBS + 10 × 10 PDL-MSCs/100 mg) or the control group (XBS). Clinical and radiographical parameters were recorded at baseline, 6, 9 and 12 months. The presence of adverse events was also evaluated. Chi-square, Student's t test, Mann-Whitney U, repeated-measures ANOVA and regression models were used.

Results: Twenty patients were included. No serious adverse events were reported. Patients in the experimental group (n = 9) showed greater clinical attachment level (CAL) gain (1.44, standard deviation [SD] = 1.87) and probing pocket depth (PPD) reduction (2.33, SD = 1.32) than the control group (n = 10; CAL gain = 0.88, SD = 1.68, and PPD reduction = 2.10, SD = 2.46), without statistically significant differences.

Conclusion: The application of PDL-MSCs to XBS for the treatment of one- to two-wall intra-bony lesions was safe and resulted in low postoperative morbidity and appropriate healing, although its additional benefit, when compared with the XBS alone, was not demonstrated.
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http://dx.doi.org/10.1111/jcpe.13368DOI Listing
November 2020

Hard and soft tissue changes after guided bone regeneration using two different barrier membranes: an experimental in vivo investigation.

Clin Oral Investig 2021 Apr 26;25(4):2213-2227. Epub 2020 Aug 26.

Postgraduate Periodontology Clinic, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Objective: To assess the contour and volumetric changes of hard and soft tissues after guided bone regeneration (GBR) using two types of barrier membranes together with a xenogeneic bone substitute in dehiscence-type defects around dental implants.

Material And Methods: In 8 Beagle dogs, after tooth extraction, two-wall chronified bone defects were developed. Then, implants were placed with a buccal dehiscence defect that was treated with GBR using randomly: (i) deproteinized bovine bone mineral (DBBM) covered by a synthetic polylactic membrane (test group), (ii) DBBM plus a porcine natural collagen membrane (positive control) and (iii) defect only covered by the synthetic membrane (negative control group). Outcomes were evaluated at 4 and 12 weeks. Micro-CT was used to evaluate the hard tissue volumetric changes and STL files from digitized cast models were used to measure the soft tissues contour linear changes.

Results: Test and positive control groups were superior in terms of volume gain and contour changes when compared with the negative control. Soft tissue changes showed at 4 weeks statistically significant superiority for test and positive control groups compared with negative control. After 12 weeks, the results were superior for test and positive control groups but not statistically significant, although, with a lesser magnitude, the negative control group exhibited gains in both, soft and hard tissues.

Conclusions: Both types of membranes (collagen and synthetic) attained similar outcomes, in terms of hard tissue volume gain and soft tissue contours when used in combination with DBBM CLINICAL RELEVANCE: Synthetic membranes were a valid alternative to the "gold standard" natural collagen membrane for treating dehiscence-type defects around dental implants when used with a xenogeneic bone substitute scaffold.
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http://dx.doi.org/10.1007/s00784-020-03537-5DOI Listing
April 2021

Prevalence and risk indicators of gingival recessions in an Italian school of dentistry and dental hygiene: a cross-sectional study.

Clin Oral Investig 2020 Feb 5;24(2):991-1000. Epub 2019 Jul 5.

Department of Periodontology, Dental School, Vita-Salute San Raffaele University, via Olgettina, 58, Milan, Italy.

Objectives: The aim of this cross-sectional study is to (i) determine the prevalence, extent, severity, and distribution of gingival recessions and patient perception in a young population and (ii) to identify potential risk indicators.

Material And Methods: Two hundred fifty-one students with a mean age of 22.9 ± 4.7, attending the School of Dentistry and Dental Hygiene of Vita-Salute San Raffaele University (Milan, Italy) were included. The subjects had undergone a clinical evaluation, by two calibrated examiner, and a questionnaire. Demographic and clinical data were collected to evaluate association of these factors with gingival recessions.

Results: The prevalence of gingival recessions at patient and tooth level was 39% and 5.2%, respectively. The only factor associated with the presence of GR was age. On the other hand, age and smoking were associated with the extent, whereas BOP, NCCLs and KT were associated with the severity. Out of 98 subjects presenting at least one GR, 63 (64%) were conscious of the presence of the GR. NCCLs were also strongly associated with the perception of the recession by the patient.

Conclusions: There is a low prevalence of buccal gingival recessions in this sample of Italian students. More than 50% of the sample was aware of the problem. Almost all patients presenting symptomatology or aesthetic concern requested appropriate therapy.

Clinical Relevance: The findings highlight the low relevance of gingival recessions in daily practice and the importance of controlling potential risk indicators in young populations.
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http://dx.doi.org/10.1007/s00784-019-02996-9DOI Listing
February 2020

Management of the extraction socket and timing of implant placement: Consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology.

J Clin Periodontol 2019 06;46 Suppl 21:183-194

ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain.

Background: The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations.

Methods: Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool.

Results: The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions.

Conclusions: A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines.
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http://dx.doi.org/10.1111/jcpe.13131DOI Listing
June 2019

The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Radiographic results of a randomized controlled clinical trial.

J Clin Periodontol 2019 07 31;46(7):776-786. Epub 2019 May 31.

Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy.

Aim: To radiographically evaluate the effect of immediate implant placement plus alveolar ridge preservation (ARP) with a deproteneized bovine bone mineral and a collagen matrix (IMPL/DBBM/CM) as compared to ARP (DBBM/CM) or spontaneous healing (SH) on vertical and horizontal bone dimensional changes after 4 months of healing.

Materials And Methods: Thirty patients requiring extraction of one single-rooted tooth or premolar were randomly assigned to IMPL/DBBM/CM, ARP DBBM/CM or SH. Cone-beam computed tomography (CBCT) scans, performed before tooth extraction and after 4 months, were superimposed in order to assess changes in ridge height at the buccal and lingual aspect and in ridge width at 1 mm, 3 mm and 5 mm apical to the bone crest. Kruskal-Wallis test was applied for comparison of differences between groups.

Results: No statistically significant differences between the groups were observed for the vertical bone resorption of the buccal and the lingual side, while significant differences were found between SH group (-3.37 ± 1.55 mm; -43.2 ± 25.1%) and both DBBM/CM (-1.56 ± 0.76 mm; -19.2 ± 9.1%) and IMPL/DBBM/CM (-1.29 ± 0.38 mm; -14.9 ± 4.9%) groups in the horizontal dimension at the most coronal aspect.

Conclusion: Ridge preservation techniques using DBBM and CM reduce the horizontal bone morphological changes that occur, mostly in the coronal portion of the buccal bone plate following tooth extraction, when compared to spontaneous healing. This is true regardless of whether immediate implant placement is performed or not.
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http://dx.doi.org/10.1111/jcpe.13125DOI Listing
July 2019

Prevalence and risk indicators of peri-implantitis in a sample of university-based dental patients in Italy: A cross-sectional study.

J Clin Periodontol 2019 05;46(5):597-605

Department of Periodontology, Università Vita e Salute, San Raffaele, Milano, Italy.

Aim: Reports regarding prevalence of peri-implant diseases show widely varying prevalence rates, which can be explained partially by variable diagnostic criteria adopted. Furthermore, several different factors have been associated with peri-implant diseases. Hence, the aim of this cross-sectional study is to (a) determine the prevalence, extent and severity of peri-implant diseases in patients enrolled in a university dental clinic and (b) to evaluate the association between peri-implantitis and patient/implant-related factors.

Material And Methods: A total of 237 subjects from the Dental Department of Vita-Salute San Raffaele University (Milan, Italy) with 831 implants with more than 1 year of follow-up after loading were clinically evaluated. Implants showing bleeding on probing (BOP), with or without suppuration, and/or probing pocket depth (PPD) ≥ 4 mm, were radiographically analysed. Demographic and clinical data were collected to evaluate by multilevel regression analysis association with peri-implantitis.

Results: The prevalence of peri-implant mucositis and peri-implantitis was 38.8% and 35%, respectively. Patients with a FMBS > 25%, having ≥4 implants as well as implants with plaque, PPD ≥ 4 mm or less than 1 mm of keratinized mucosa presented higher odds ratios for peri-implantitis.

Conclusions: Peri-implant diseases are frequent conditions affecting >70% of the patients. Several patient/implant-related factors may influence the risk for peri-implantitis.
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http://dx.doi.org/10.1111/jcpe.13111DOI Listing
May 2019

Cellular therapy in periodontal regeneration.

Periodontol 2000 2019 02;79(1):107-116

Faculty of Odontology, Complutense University of Madrid, Madrid, Spain.

Periodontitis is a chronic inflammatory condition leading to destruction of the tooth supporting tissues, which if left untreated may cause tooth loss. The treatment of periodontitis mainly aims to arrest the inflammatory process by infection control measures, although in some specific lesions a limited periodontal regeneration can also be attained. Current regenerative approaches are aimed to guide the cells with regenerative capacity to repopulate the lesion and promote new cementum and new connective tissue attachment. The first phase in periodontal tissue regeneration involves the differentiation of mesenchymal cells into cementoblasts to promote new cementum, thus facilitating the attachment of new periodontal ligament fibers to the root and the alveolar bone. Current regenerative approaches limit themselves to the confines of the lesion by promoting the self-regenerative potential of periodontal tissues. With the advent of bioengineered therapies, several studies have investigated the potential use of cell therapies, mainly the use of undifferentiated mesenchymal cells combined with different scaffolds. The understanding of the origin and differentiation patterns of these cells is, therefore, important to elucidate their potential therapeutic use and their comparative efficacy with current technologies. This paper aims to review the in vitro and experimental studies using cell therapies based on application of cementoblasts and mesenchymal stem cells isolated from oral tissues when combined with different scaffolds.
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http://dx.doi.org/10.1111/prd.12250DOI Listing
February 2019

Ridge alterations after implant placement in fresh extraction sockets or in healed crests: An experimental in vivo investigation.

Clin Oral Implants Res 2019 Apr 3;30(4):353-363. Epub 2019 Apr 3.

Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Objectives: To study the early and late bone healing around implants placed according to a flapless immediate (test) or flapped delayed (control) implant surgical protocol.

Materials And Methods: In eight beagle dogs, immediate and delayed implants were placed. Test and control implants were randomly assigned, and horizontal and vertical bone remodelling, as well as bone-to-implant contact (BIC), were assessed with histology at 2 and 8 weeks. Teeth were used as negative controls.

Results: Similar results were attained in the two groups when the vertical resorption of the buccal bone crest was evaluated (approximately 0.5 mm). On the other hand, a marked horizontal buccal bone resorption was observed. Immediate implants attained a thinner buccal bone crest as compared to the delayed implant and the tooth. De novo bone formation on the implant surface appeared to be more pronounced at delayed sites at 2 weeks, whereas at 8 weeks, no difference in BIC was observed.

Conclusions: Ridge alterations occurred at both implant placement protocols, with similar limited amounts of vertical buccal bone reduction and a pronounced horizontal bone reduction. The process of horizontal bone remodelling differed between the two surgical protocols.
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http://dx.doi.org/10.1111/clr.13421DOI Listing
April 2019

Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis.

J Clin Periodontol 2019 06;46 Suppl 21:195-223

Department of Periodontology, Universidad Complutense de Madrid, Madrid, Spain.

Aim: The aim of this systematic review was to critically analyse the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient-centred outcomes.

Material And Methods: A comprehensive search aimed at identifying pertinent literature for the purpose of this review was conducted by two independent examiners. Only randomized clinical trials (RCTs) that met the eligibility criteria were selected. Relevant data from these RCTs were collated into evidence tables. Endpoints of interest included clinical, radiographic and patient-reported outcome measures (PROMs). Interventions reported in the selected studies were clustered into ARP treatment modalities. All these different ARP modalities were compared to the control therapy (i.e. spontaneous socket healing) in each individual study after a 3- to 6-month healing period. Random-effects meta-analyses were conducted if at least two studies within the same ARP treatment modality reported on the same outcome of interest.

Results: A combined database, grey literature and hand search identified 3,003 records, of which 1,789 were screened after removal of duplicates. Following the application of the eligibility criteria, 25 articles for a total of 22 RCTs were included in the final selection, from which nine different ARP treatment modalities were identified: (a) bovine bone particles (BBP) + socket sealing (SS), (b) construct made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, (c) cortico-cancellous porcine bone particles (CPBP) + SS, (d) allograft particles (AG) + SS, (e) alloplastic material (AP) with or without SS, (f) autologous blood-derived products (ABDP), (g) cell therapy (CTh), (h) recombinant morphogenic protein-2 (rhBMP-2) and (i) SS alone. Quantitative analyses for different ARP modalities, all of which involved socket grafting with a bone substitute, were feasible for a subset of clinical and radiographic outcomes. The results of a pooled quantitative analysis revealed that ARP via socket grafting (ARP-SG), as compared to tooth extraction alone, prevents horizontal (M = 1.99 mm; 95% CI 1.54-2.44; p < 0.00001), vertical mid-buccal (M = 1.72 mm; 95% CI 0.96-2.48; p < 0.00001) and vertical mid-lingual (M = 1.16 mm; 95% CI 0.81-1.52; p < 0.00001) bone resorption. Whether there is a superior ARP or SS approach could not be determined on the basis of the selected evidence. However, the application of particulate xenogenic or allogenic materials covered with an absorbable collagen membrane or a rapidly absorbable collagen sponge was associated with the most favourable outcomes in terms of horizontal ridge preservation. A specific quantitative analysis showed that sites presenting a buccal bone thickness >1.0 mm exhibited more favourable ridge preservation outcomes (difference between ARP [AG + SS] and control = 3.2 mm), as compared to sites with a thinner buccal wall (difference between ARP [AG + SS] and control = 1.29 mm). The effect of other local and systemic factors could not be assessed as part of the quantitative analyses. PROMs were comparable between the experimental and the control group in two studies involving the use of ABDP. The effect of other ARP modalities on PROMs could not be investigated, as these outcomes were not reported in any other clinical trial included in this study.

Conclusion: Alveolar ridge preservation is an effective therapy to attenuate the dimensional reduction of the alveolar ridge that normally takes place after tooth extraction.
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http://dx.doi.org/10.1111/jcpe.13057DOI Listing
June 2019

A novel methodological approach using superimposed Micro-CT and STL images to analyze hard and soft tissue volume in immediate and delayed implants with different cervical designs.

Clin Oral Implants Res 2018 Oct 23;29(10):986-995. Epub 2018 Sep 23.

Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Objectives: To study the hard and soft tissue volume after placing immediate (IMI) or delayed implants (DLI) with a triangular coronal macro-design (Test/T) or a conventional cylindrical design (Control/C).

Material And Methods: T/C implants were inserted in healed ridges or in fresh extraction sockets of eight beagle dogs. Biopsies were processed for Micro-CT analysis and dental stone casts were optically scanned to obtain STL files revealing the soft tissue contours at 12 weeks. Image analysis software was utilized to match common landmarks superimposing the two sets of data. Three distinct volumes were calculated; buccal bone volume (B-BV), soft tissue volume below the implant shoulder (EC-STV), and the soft tissue volume above the implant shoulder (SC-STV). Using linear measurements, the soft tissue height (STH), the mucosal thickness (MT-IS), and the distance from the implant shoulder to the bone crest (I-BC) were assessed in the digital images and in conventional histology to assess the concordance, reproducibility, and reliability.

Results: There were no significant differences between test and control implants regarding the buccal bone volume, although test implants had greater B-BV in all locations except for PM2. The soft tissue volume was similar at T/C implants. The surgical approach influenced the distribution of the total tissue volume. In the IMI, a low position of the bone crest was correlated with low values of B-BV, SC-STV, MT-IS, and STH. Linear measurements showed a high correlation between the histology and digital measurements and high inter and intra examiner agreement.

Conclusion: The superimposition of Micro-CT/STL allowed the analysis of soft and hard tissue volumes. Reduction of the implant buccal aspect resulted in nonsignificant higher bone volume although similar soft tissue volume while the surgical approach influenced soft tissue response.
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http://dx.doi.org/10.1111/clr.13365DOI Listing
October 2018

Outcomes After 25 Years of Periodontal Treatment and Maintenance of a Patient Affected by Generalized Severe Aggressive Periodontitis.

Int J Periodontics Restorative Dent 2018 May/Jun;38(3):347-354

This report describes the long-term outcomes of nonsurgical periodontal therapy and supportive periodontal treatment (SPT) of a 21-year-old patient affected by generalized aggressive periodontitis at multiple teeth with a compromised prognosis. After 25 years of SPT, no teeth had been extracted and no periodontal pockets associated with bleeding on probing were present. Radiographic analysis showed an improvement in infrabony defects, demonstrating long-term improvement is possible with nonsurgical periodontal treatment provided that smoking is not present and the patient is included in a strict SPT.
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http://dx.doi.org/10.11607/prd.3534DOI Listing
November 2018

Cell therapy with allogenic canine periodontal ligament-derived cells in periodontal regeneration of critical size defects.

J Clin Periodontol 2018 04 29;45(4):453-461. Epub 2018 Jan 29.

Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Aim: The objective of this in vivo experimental study to evaluate the regenerative potential of a cell therapy combining allogenic periodontal ligament-derived cells within a xenogeneic bone substitute in a similar experimental model.

Methods: In nine beagle dogs, critical size 6-mm supra-alveolar periodontal defects were created around the PIII and PIV. The resulting supra-alveolar defects were randomly treated with either 1.4 × 10 allogenic canine periodontal ligament-derived cells seeded on de-proteinized bovine bone mineral with 10% collagen (DBBM-C) (test group) or DBBM-C without cells (control group). Specimens were obtained at 3 months, and histological outcomes were studied.

Results: The histological analysis showed that total furcation closure occurred very seldom in both groups, being the extent of periodontal regeneration located in the apical third of the defect. The calculated amount of periodontal regeneration at the furcation area was comparable in both the test and control groups (1.93 ± 1.14 mm (17%) versus 2.35 ± 1.74 mm (22%), respectively (p = .37). Similarly, there were no significant differences in the amount of new cementum formation 4.49 ± 1.56 mm (41%) versus 4.97 ± 1.05 mm (47%), respectively (p = .45).

Conclusions: This experimental study was unable to demonstrate the added value of allogenic cell therapy in supra-crestal periodontal regeneration.
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http://dx.doi.org/10.1111/jcpe.12863DOI Listing
April 2018

Simultaneous lateral bone augmentation and implant placement using a particulated synthetic bone substitute around chronic peri-implant dehiscence defects in dogs.

J Clin Periodontol 2017 Nov 21;44(11):1172-1180. Epub 2017 Sep 21.

Faculty of Odontology, Department of Periodontology, University Complutense of Madrid, Madrid, Spain.

Aim: To determine the histological outcomes when using a highly porous synthetic bone substitute and a cross-linked collagen membrane for lateral bone augmentation of peri-implant dehiscence defects.

Methods: In eight dogs, three treatment groups were randomly allocated at each peri-implant dehiscence defect (mean height × depth = 3 × 1 mm) as follows: (i) synthetic bone substitute covered by a cross-linked collagen membrane (test group), (ii) deproteinized bovine bone mineral covered by a natural collagen membrane (positive control), and (iii) no treatment (negative control). Two healing periods (8 and 16 weeks) were applied.

Results: The differences in healing outcomes between the test and positive control groups were not significant at 8 weeks. Horizontal bone augmentation 2 mm below the implant shoulder was significantly greater in the test group (1.22 ± 0.53 mm) than in the positive and negative controls (0.42 ± 0.51 and 0.36 ± 0.50 mm, respectively) at 16 weeks. Similarly, the augmented tissue thickness at 0, 1, and 2 mm apical to the implant shoulder was significantly greater in the test group than in the positive control group.

Conclusion: The test group showed significantly better histological outcomes for lateral bone augmentation and tissue thickness at 16 weeks compared to both the positive and negative control groups.
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http://dx.doi.org/10.1111/jcpe.12802DOI Listing
November 2017

Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement.

Int J Implant Dent 2017 Dec 21;3(1):24. Epub 2017 Jun 21.

ETEP Research Group, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal, 28040, Madrid, Spain.

Background: The osteoconductive properties of collagen containing xenogeneic bone blocks (CCXBB) remain unclear. The aim of this prospective single-arm clinical study was to assess the histological outcomes of CCXBB blocks used as bone replacement grafts for lateral bone augmentation procedures.

Methods: In 15 patients with severe horizontal alveolar ridge resorption, lateral augmentation procedures were performed using CCXBB as bone replacement grafts. Twenty-six weeks postoperatively, a re-entry procedure was performed to evaluate the bone width for adequate implant placement and two histological specimens were retrieved from each patient, one being processed for ground sectioning and the other for decalcified paraffin-included sections. In non-decalcified sections, the relative proportions occupied by bone, biomaterials, and connective tissue present in the biopsies were identified. In de-calcified sections, structures and cells positive for osteopontin (OPN), tartrate-resistant acid phosphatase activity (TRAP), osteocalcin (OSC), and alkaline phosphatase (ALP) were assessed.

Results: Soft tissue dehiscence occurred during the follow-up in 5 out of 15 patients (33.3%). The mean crest width at baseline was 2.78 mm (SD 0.57) and the mean crest width at re-entry was 6.90 mm (SD 1.22), with a mean ridge width increase of 4.12 mm (SD 1.32). Twenty-six bone biopsies were obtained from 13 patients. Histomorphometric analysis showed a mean of 26.90% (SD 12.21) of mineralized vital bone (MVB), 21.37% (SD 7.36) of residual CCXBB, 47.13% (SD 19.15) of non-mineralized tissue, and 0.92% of DBBM. The immunohistochemical analysis revealed a large number of OPN-positive cells 8.12% (SD 4.73), a lower proportion of TRAP positive multinuclear cells 5.09% (SD 4.91), OSC-positive cells 4.09% (SD 4.34), and a limited amount of ALP positive cells 1.63% (SD 2).

Conclusions: CCXBB achieved significant horizontal crestal width allowing for staged implant placement in most of the patients. In light of the histological outcomes and implant failures, special attention must be placed to prevent soft tissue dehiscence when CCXBB is used in severe atrophic alveolar crests.
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http://dx.doi.org/10.1186/s40729-017-0087-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478548PMC
December 2017

Hard and soft tissue integration of immediate and delayed implants with a modified coronal macrodesign: Histological, micro-CT and volumetric soft tissue changes from a pre-clinical in vivo study.

J Clin Periodontol 2017 Aug 26;44(8):842-853. Epub 2017 Jul 26.

Section of Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain.

Aim: To study the healing of peri-implant tissues around implants with a triangular coronal third (test) or cylindrical (control).

Materials And Methods: In eight beagle dogs, immediate and delayed implants were placed. Test and control implants were randomly assigned and the hard and soft tissue healing was evaluated with histology and micro-CT analysis at 4 and 12 weeks. The soft tissue contour changes were assessed by image analysis software.

Results: When measured at the implant shoulder level, the buccal crestal width (primary outcome assessed in mm) attained similar values in test and control implants. More apically (3 mm) test implants had greater buccal crestal width in delayed and immediate sites. For vertical soft and hard tissue measurements, no significant differences were found between Test and Control. Micro-CT evaluation of the buccal volume of interest showed less volume of implant component in T implants in all sites, although bone volume was not significantly different between T/C. Soft tissue contours were similar around T/C implants.

Conclusion: Triangular implants showed similar percentage of osseointegration, buccal bone volume and soft tissue contours, although attaining greater buccal crestal bone width. No differences were found in regard to soft tissue dimensions and the position of the first bone-to-implant contact.
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http://dx.doi.org/10.1111/jcpe.12747DOI Listing
August 2017

Guided bone regeneration of non-contained mandibular buccal bone defects using deproteinized bovine bone mineral and a collagen membrane: an experimental in vivo investigation.

Clin Oral Implants Res 2017 Nov 27;28(11):1466-1476. Epub 2017 Mar 27.

Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Aim: The aim of this pre-clinical in vivo study was to analyse different stages of wound healing after guided bone regeneration in non-contained mandibular buccal bone defects.

Materials And Methods: Eighteen female beagle dogs, between 1.5 and 2 years old, were used. Buccal bone defects were created in the mandible following extraction of the mesial roots of M1, P4, the distal root of P3 and booth roots of P2. Augmentation procedures of the healed defects were performed 3 months later using a bone replacement graft (T1), an absorbable collagen membrane (T2) or a combination of both procedures (T3). Using a randomized block study design, four stages of healing in two groups of dogs were examined (4 days, 2, 6 weeks and 3 months). The animals were euthanized, and biopsies obtained at the end of each of the study periods were prepared for histological examination.

Results: The different reconstructive procedures resulted in regenerated tissue compartments of varying size that contained newly formed bone, non-mineralized tissue and bone augmentation biomaterial when a bone replacement graft was used. While the proportions of mineralized tissue increased and non-mineralized tissue decreased over time in the three groups, the changes in proportions of the DBBM material were small. Initial defect depth, healing time and treatment group significantly influenced the percentage of mineralized tissue obtained. The multivariate multilevel analysis showed that significantly larger area proportions of mineralized tissue were obtained when the T2 sites were compared with T1 and T3 sites, what highlights the importance of the barrier membrane effect for attaining new bone formation. Only in the larger size defects (M1) total ROI at T3 and T1 sites was significantly larger than at T2, what highlights the importance of using a bone replacement graft as a space maintenance scaffold.

Conclusion: It is suggested that healing following augmentation of non-contained buccal bone defects was characterized by a gradual shift in the relative proportions of non-mineralized and mineralized tissue components.
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http://dx.doi.org/10.1111/clr.13014DOI Listing
November 2017

Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial.

J Clin Periodontol 2016 12 7;43(12):1132-1141. Epub 2016 Nov 7.

Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

Aim: To assess patient-reported outcome measures (PROMs), aesthetics and stability of root coverage procedures from a previous 6-month RCT after 1 year.

Material & Methods: Forty-five patients (90 recessions) had received a coronally advanced flap (CAF = control) only or a xenogeneic collagen matrix in addition (CAF + CMX = test). Visual analogue scales (VAS) and questionnaires were used for PROMs and the root coverage aesthetic score (RES) for professional aesthetic evaluations.

Results: VAS scores (patient satisfaction) amounted to 8.58 ± 1.86 (test) versus 8.38 ± 2.46 (control). Six patients preferred CAF + CMX concerning surgical procedure and aesthetics, six preferred CAF and 29 were equally satisfied. RES was 7.85 ± 2.42 for the test group versus 7.34 ± 2.90 for the controls. Root coverage (RC) was 76.28% for test and 75.05% for control defects. The mean increase in keratinized tissue width was higher in test (from 1.97 to 3.02 mm) than in controls (from 2.00 to 2.64 mm) (p = 0.0413). Likewise, test sites showed more gain in gingival thickness (0.52 mm) than control sites (0.27 mm) (p = 0.0023). Compared to 6 months, clinical outcomes were stable.

Conclusions: Results for PROMs, RES and RC did not significantly differ between treatment groups. Thickness and width of keratinized tissue were enhanced following CAF + CMX compared to CAF alone.
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http://dx.doi.org/10.1111/jcpe.12626DOI Listing
December 2016

Key aspects on the use of bone substitutes for bone regeneration of edentulous ridges.

Dent Mater 2015 Jun 14;31(6):640-7. Epub 2015 Apr 14.

Faculty of Odontology, University Complutense of Madrid, Plaza Ramon y Cajal, 28040 Madrid, Spain. Electronic address:

Objectives: To review the histological and clinical outcomes of the use of bone substitues in different oral bone regenerative procedures: socket preservation, immediate implant placement, lateral and vertical bone augmentation.

Methods: Histological animal studies and clinical trials regarding the performances of bone substitutes, either allogenic, xenogeneic or alloplastic, have been evaluated. Different procedures examined separately and evidence-based results were provided.

Results: The use of deproteinized bovine bone mineral (DBBM) seems to be effective most clinical indications, due to their osteoconductivity, space maintenance characteristics and slow resorption. The combination of Hydroxyapatite and Beta Tricalcium Phospate (HA/TCP) has also reported similar histological evidence and clinical outcomes. The use of autogenous block grafts is still the method of choice in clinical situations in need of vertical bone augmentation.

Conclusions: The use of bone substitutes is the standard of therapy in current modalities of lateral bone augmentation, mainly when used in conjunction with implant placement.
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http://dx.doi.org/10.1016/j.dental.2015.03.005DOI Listing
June 2015

A randomized trial on the aesthetic outcomes of implant-supported restorations with zirconia or titanium abutments.

J Clin Periodontol 2014 Dec 21;41(12):1161-9. Epub 2014 Nov 21.

Section of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain.

Aim: To evaluate the aesthetic outcomes of zirconia versus titanium abutments for single tooth implant-supported crowns in the anterior maxilla.

Material & Methods: A parallel, double blind clinical trial was conducted at the Complutense University (Madrid), where 38 patients were recruited. After random allocation (via computer-generated permuted blocks), either zirconia (test) or titanium (control) abutments were placed. Intra- and inter-group differences in aesthetic (main outcome), clinical, radiographical, and patient-centred outcomes were evaluated at baseline (crown placement) and at 1-year follow-up.

Results: At 1 year, 25 of the 30 randomized patients were analysed (11 test and 14 control). Using the Implant Crown Aesthetic Index (ICAI), the scoring at baseline and 1-year were 7.9 and 7.6 for the test group and 10.6 and 11.3 for the control group, respectively. These differences were not statistically significant (sample size non-contrasted). Patient satisfaction was similarly high in both groups (visual analogue scale 8.5). Furthermore, no differences were observed in the clinical or radiographical outcomes. Two abutment fractures were registered in the test group.

Conclusions: The use of zirconia abutments demonstrated a tendency towards better aesthetic outcomes although the differences were not statistically significant. However, more technical complications were noted with the use of zirconia abutments.
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http://dx.doi.org/10.1111/jcpe.12312DOI Listing
December 2014

Immediate implants at fresh extraction sockets: from myth to reality.

Periodontol 2000 2014 Oct;66(1):132-52

In recent years, immediate implant placement has become a common clinical therapeutic protocol representing an alternative to the classical delayed surgical protocol of implant placement. This protocol, however, has not been fully validated, either in terms of fully understanding the influence of implant placement on the socket-healing process or on the clinical outcomes. This narrative review evaluates the different experimental studies in humans and animals assessing the bone-healing dynamics of the socket after tooth extraction and the dimensional changes occurring at the socket bone walls. These experimental studies describe, in detail, the hard- and soft-tissue healing of implants placed into fresh extraction sockets, demonstrating that marked morphological changes of the alveolar ridge will occur, independently of the implant installation, thus demonstrating that postextraction bone loss is an inevitable biological process. This evidence has also been corroborated in clinical studies in humans, demonstrating the risk of significant peri-implant tissue loss, mainly in the areas of high esthetic demand. There is a lack of long-term evidence on the impact of this protocol on the preservation of the peri-implant tissues. In conclusion, despite the obvious advantages of this surgical protocol, it also has limitations and is more technically demanding than placing an implant into a healed crest. When selecting this protocol, clinicians should always consider: (a) the gingival biotype of the patient; (b) the thickness and integrity of the socket bony walls; (c) the implant selection as well as the adequate vertical and horizontal position of the implant; and (d) the ideal patient (a nonsmoker with good plaque control).
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http://dx.doi.org/10.1111/prd.12044DOI Listing
October 2014

Healing of a xenogeneic collagen matrix for keratinized tissue augmentation.

Clin Oral Implants Res 2015 May 5;26(5):545-52. Epub 2014 Aug 5.

Department of Periodontology, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain.

Aim: To evaluate histologically the healing of a xenogeneic collagen matrix (CM) used to augment the width of keratinized tissue around teeth.

Materials And Methods: The gingiva on the buccal aspect of mandibular and maxillary premolars was surgically excised on 12 minipigs. After 1 month of plaque accumulation, the resulting defects were randomly treated by a periosteal retention procedure (control site) or by placing a collagen matrix after an apically repositioned flap (CM) (test site). Clinical and histological outcomes were evaluated at 1, 4 and at 12 weeks.

Results: Clinically, no gain of keratinized tissue was noted in either group. Histometrically, the thickness of the gingival unit was significantly higher in the test group at 1 month, although these differences were not significant at 3 months. There was a tendency in the test group towards less bone resorption (0.7 mm) and apical displacement (0.5 mm) of the gingival margin at 3 months.

Conclusions: The tested CM demonstrated uneventful healing, being resorbed within the surrounding tissues in absence of significant inflammation. When compared with periosteal retention alone, the CM group attained similar clinical and histological outcomes.
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http://dx.doi.org/10.1111/clr.12441DOI Listing
May 2015

Fresh extraction socket: spontaneous healing vs. immediate implant placement.

Clin Oral Implants Res 2015 Nov 17;26(11):1250-5. Epub 2014 Jul 17.

Postgraduate Periodontology, University Complutense of Madrid, Madrid, Spain.

Aim: To evaluate the impact that immediate implant placement may have on bone remodelling in comparison with adjacent sockets left to heal spontaneously.

Materials And Methods: In a beagle dog model (N = 16 dogs), mandibular premolars were extracted, and implants were placed in each distal socket (test) with the corresponding mesial site left to heal undisturbed (control). Healing was assessed measuring both the vertical distance between buccal and lingual crest (B'L') and the width of buccal and lingual walls at different levels. Five healing periods were evaluated. Differences between means for each variable and for each healing period between test and control were compared (Kruskal-Wallis test; Friedman test).

Results: At 2 and 8 weeks of healing, the B'L' distance revealed significant higher values at test compared to control sites, being this difference three times higher at the end of the study (P < 0.05). In the test group, the width of the crest was reduced between baseline (0.37 [0.04]) and 8 weeks healing (0.13 [0.64]), demonstrating a 62% reduction of the initial width. These differences were not observed in the control group.

Conclusions: Immediate implant placement into fresh extraction sockets may jeopardize the vertical bone remodelling of the socket. Furthermore, a tendency towards greater buccal horizontal resorption was observed in the most coronal aspect of the buccal bone crest.
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http://dx.doi.org/10.1111/clr.12447DOI Listing
November 2015

Soft tissue wound healing at teeth, dental implants and the edentulous ridge when using barrier membranes, growth and differentiation factors and soft tissue substitutes.

J Clin Periodontol 2014 Apr;41 Suppl 15:S23-35

Department of Periodontology, University Complutense of Madrid, Madrid, Spain.

Aim: To review the biological processes of wound healing following periodontal and periimplant plastic surgery when different technologies are used in a) the coverage of root and implant dehiscences, b) the augmentation of keratinized tissue (KT) and c) the augmentation of soft tissue volume.

Materials & Methods: An electronic search from The National Library of Medicine (MEDLINE-PubMed) was performed: English articles with research focus in oral soft tissue regeneration, providing histological outcomes, either from animal experimental studies or human biopsy material were included.

Results: Barrier membranes, enamel matrix derivatives, growth factors, allogeneic and xenogeneic soft tissue substitutes have been used in soft tissue regeneration demonstrating different degrees of regeneration. In root coverage, these technologies were able to improve new attachment, although none has shown complete regeneration. In KT augmentation, tissue-engineered allogenic products and xenogeneic collagen matrixes demonstrated integration within the host connective tissue and promotion of keratinization. In soft tissue augmentation and peri-implant plastic surgery there are no histological data currently available.

Conclusions: Soft tissue substitutes, growth differentiation factors demonstrated promising histological results in terms of soft tissue regeneration and keratinization, whereas there is a need for further studies to prove their added value in soft tissue augmentation.
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http://dx.doi.org/10.1111/jcpe.12191DOI Listing
April 2014

Early healing of the alveolar process after tooth extraction: an experimental study in the beagle dog.

J Clin Periodontol 2013 Jun 27;40(6):638-44. Epub 2013 Mar 27.

Postgraduate Periodontology, University Complutense of Madrid, Madrid, Spain.

Aim: To describe the early healing events in the alveolar socket during the first 8 weeks of spontaneous healing after tooth extraction.

Materials And Methods: 16 adult beagle dogs were selected and five healing periods were analysed (4 h, 1 week, 2 weeks, 4 weeks, 8 weeks). Mandibular premolars were extracted and each socket corresponding to the mesial root was left to heal undisturbed. In each healing period, three animals were euthanatized, each providing four study sites. Healing was assessed by descriptive histology and by histometric analysis using as landmarks: the vertical distance between buccal and lingual crest (B'L') and the width of buccal and lingual walls at three different levels. Differences between means for each variable for each healing period were compared (ANOVA; p < 0.05).

Results: B'L' at baseline was 0.45 (0.18) mm and decreased during the healing period to a final value of 0.18 (0.08) mm. The lingual width (Lw) remains almost unchanged while the buccal width (Bw) at 1 (Bw1) and 2 (Bw2) mm was reduced in about 40% of its initial value.

Conclusions: Minor vertical bone reduction in both the buccal and lingual socket walls were observed. A marked horizontal reduction of the buccal bone wall was observed mostly in its coronal aspect.
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http://dx.doi.org/10.1111/jcpe.12074DOI Listing
June 2013

Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial.

J Clin Periodontol 2013 Jan 10;40(1):82-9. Epub 2012 Oct 10.

Department of Periodontology, University of Bonn, Bonn, Germany.

Aim: To evaluate the clinical outcomes of the use of a xenogeneic collagen matrix (CM) in combination with the coronally advanced flap (CAF) in the treatment of localized recession defects.

Material & Methods: In a multicentre single-blinded, randomized, controlled, split-mouth trial, 90 recessions (Miller I, II) in 45 patients received either CAF + CM or CAF alone.

Results: At 6 months, root coverage (primary outcome) was 75.29% for test and 72.66% for control defects (p = 0.169), with 36% of test and 31% of control defects exhibiting complete coverage. The increase in mean width of keratinized tissue (KT) was higher in test (from 1.97 to 2.90 mm) than in control defects (from 2.00 to 2.57 mm) (p = 0.036). Likewise, test sites had more gain in gingival thickness (GT) (0.59 mm) than control sites (0.34 mm) (p = 0.003). Larger (≥3 mm) recessions (n = 35 patients) treated with CM showed higher root coverage (72.03% versus 66.16%, p = 0.043), as well as more gain in KT and GT.

Conclusions: CAF + CM was not superior with regard to root coverage, but enhanced gingival thickness and width of keratinized tissue when compared with CAF alone. For the coverage of larger defects, CAF + CM was more effective.
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http://dx.doi.org/10.1111/jcpe.12019DOI Listing
January 2013

Quality of reporting of experimental research in implant dentistry. Critical aspects in design, outcome assessment and model validation.

J Clin Periodontol 2012 Feb;39 Suppl 12:6-27

Department of Periodontology, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain.

Objective: The aim was to assess the quality of reporting of experimental research in implant dentistry by a critical evaluation of study design, outcome assessments and model validation.

Material & Methods: An online search was performed using the MEDLINE. Experimental studies performed in both animals and humans were included. A’stratified random sample of the included studies was extracted and used for quantitative and qualitative analyses. Modified versions of the ARRIVE guidelines were used for quality assessment.

Results: A total of 982 papers were eligible and used for quantitative analyses. A’stratified random sample of 193 publications was extracted. The dog model was the most used experimental model whereas experimental studies on humans were few. Intra-oral experimental sites dominated in human, monkey, dog and mini-pig studies. Extra oral sites dominated in rabbit, rodent and goat/sheep studies. Studies on the pathogenesis and treatment of peri-implant diseases were few.

Conclusion: Different animal models, experimental protocols and methods of analysis have been used to address different areas of experimental research in implant dentistry. Standardized designs for investigations within this type of experimental research seem to be lacking. Furthermore, in many of these studies there were limitations in reporting on methodology and statistical methods.
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http://dx.doi.org/10.1111/j.1600-051X.2011.01830.xDOI Listing
February 2012

Surgical protocols for ridge preservation after tooth extraction. A systematic review.

Clin Oral Implants Res 2012 Feb;23 Suppl 5:22-38

ETEP Research Group, University Complutense, Madrid, Spain.

Objective: This systematic review aims to evaluate the scientific evidence on the efficacy in the surgical protocols designed for preserving the alveolar ridge after tooth extraction and to evaluate how these techniques affect the placement of dental implants and the final implant supported restoration.

Material And Methods: A thorough search in MEDLINE-PubMed, Embase and the Cochrane Central Register of controlled trials (CENTRAL) was conducted up to February 2011. Randomized clinical trials and prospective cohort studies with a follow-up of at least 3 months reporting changes on both the hard and soft tissues (height and/or width) of the alveolar process (mm or %) after tooth extraction were considered for inclusion.

Results: The screening of titles and abstracts resulted in 14 publications meeting the eligibility criteria. Data from nine of these 14 studies could be grouped in the meta-analyses. Results from the meta-analyses showed a statistically significant greater ridge reduction in bone height for control groups as compared to test groups (weighted mean differences, WMD = -1.47 mm; 95% CI [-1.982, -0.953]; P < 0.001; heterogeneity: I(2) = 13.1%; χ(2) P-value = 0.314) and a significant greater reduction in bone width for control groups compared to the test groups (WMD = -1.830 mm; 95% CI [-2.947, -0.732]; P = 0.001; heterogeneity: I(2) = 0%; χ(2) P-value = 0.837). Subgroup analysis was based on the surgical protocol used for the socket preservation (flapless/flapped, barrier membrane/no membrane, primary intention healing/no primary healing) and on the measurement method utilized to evaluate morphological changes. Meta-regression analyses demonstrated a statistically significant difference favoring the flapped subgroup in terms of bone width (meta-regression; slope = 2.26; 95% IC [1.01; 3.51]; P = 0.003).

Conclusions: The potential benefit of socket preservation therapies was demonstrated resulting in significantly less vertical and horizontal contraction of the alveolar bone crest. The scientific evidence does not provide clear guidelines in regards to the type of biomaterial, or surgical procedure, although a significant positive effect of the flapped surgery was observed. There are no data available to draw conclusions on the consequences of such benefits on the long-term outcomes of implant therapy.
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http://dx.doi.org/10.1111/j.1600-0501.2011.02331.xDOI Listing
February 2012

Bone modelling at fresh extraction sockets: immediate implant placement versus spontaneous healing: an experimental study in the beagle dog.

J Clin Periodontol 2012 Jan 23;39(1):91-7. Epub 2011 Oct 23.

Graduate Periodontology, University Complutense of Madrid, Spain.

Objectives: The purpose of this investigation is to describe histologically the undisturbed healing of fresh extraction sockets when compared to immediate implant placement.

Methods: In eight beagle dogs, after extraction of the 3P3 and 4P4, implants were inserted into the distal sockets of the premolars, while the mesial sockets were left to heal spontaneously. Each animal provided four socket sites (control) and four implant sites (test). After 6 weeks, animals were sacrificed and tissue blocks were dissected, prepared for ground sectioning.

Results: The relative vertical buccal bone resorption in relation to the lingual bone was similar in both test and control groups. At immediate implant sites, however, the absolute buccal bone loss observed was 2.32 (SD 0.36) mm, what may indicate that while an apical shift of both the buccal and lingual bone crest occurred at the implant sites, this may not happen in naturally healing sockets.

Conclusions: The results from this investigation showed that after tooth extraction the buccal socket wall underwent bone resorption at both test and control sites. This resorption appeared to be more pronounced at the implant sites, although the limitations of the histological evaluation method utilized preclude a definite conclusion.
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http://dx.doi.org/10.1111/j.1600-051X.2011.01803.xDOI Listing
January 2012