Skip to main content

Advertisement

SpringerLink
Log in

Histologic analyses of flapless ridge preservation in sockets with buccal dehiscence defects using two alloplastic bone graft substitutes

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To investigate whether one of two synthetic bone substitute materials used for ridge preservation in the extraction sockets with buccal dehiscence defects was superior regarding new bone formation and ridge preservation and to compare it to sites left for spontaneous healing.

Materials and methods

In sixteen dogs, P3 and P4 were hemi-sectioned and the respective distal roots were extracted. Following the preparation of a mucoperiosteal flap without vertical releasing incisions, 50% of the buccal bone was carefully removed. The extraction sites were randomly assigned either to a ridge preservation procedure (alloplastic bone substitute material (two test groups)) or to spontaneous healing (control group). Descriptive histology and histomorphometric analyses were performed at healing times of 4, 8, and 16 weeks. In case of homogeneous variances, the results were analyzed by one-way ANOVA, followed by Tukey’s post-hoc test. If inhomogeneous, the data was analyzed using Welch-type ANOVA, followed by the Games–Howell post-hoc test.

Results

The use of bone substitute material led to significantly greater horizontal dimensions amounting to 3.3 mm (SD = 0.67; test 1) and 3.5 mm (SD = 0.72; test 2) compared to spontaneous healing (1.7 mm, SD = 0.23) at 16 weeks of healing (p < 0.0001). A significant difference was observed between spontaneous healing and the test groups in terms of newly formed bone tissue at 4, 8, and 16 weeks (p = 0.001), with values reaching 7.9, 21.8, and 36.8% (test 1), 5.0, 10.4, and 29% (test 2), and 26.2, 43.5, and 56.4% (control), but there were no significant differences between the test groups (p > 0.05). The final ridge profile was more favorable after ridge preservation (p < 0.001) as demonstrated by a loss of 28.8% (spontaneous healing) and an increase in both test groups at 16 weeks (test 1 = 60.5% and test 2 = 31.2%).

Conclusions

The use of alloplastic materials rendered greater horizontal dimensions and a more favorable maintenance of the ridge profile.

Clinical relevance

Alloplastic bone substitute materials can successfully be used for ridge preservation procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Al Salamah L, Babay N, Anil S, Al Rasheed A, Bukhary M (2012) Guided bone regeneration using resorbable and non-resorbable membranes: a histological study in dogs. Odonto-Stomatol Trop 35:43–50

    Google Scholar 

  2. Araujo M, Linder E, Wennstrom J, Lindhe J (2008) The influence of Bio-Oss collagen on healing of an extraction socket: an experimental study in the dog. Int J Periodontics Restorative Dent 28:123–135

    PubMed  Google Scholar 

  3. Araujo MG, da Silva JC, de Mendonca AF, Lindhe J (2015a) Ridge alterations following grafting of fresh extraction sockets in man. A randomized clinical trial. Clin Oral Implants Res 26:407–412. https://doi.org/10.1111/clr.12366

    Article  PubMed  Google Scholar 

  4. Araujo MG, Lindhe J (2005) Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 32:212–218. https://doi.org/10.1111/j.1600-051X.2005.00642.x

    Article  PubMed  Google Scholar 

  5. Araujo MG, Lindhe J (2009) Ridge preservation with the use of Bio-Oss collagen: a 6-month study in the dog. Clin Oral Implants Res 20:433–440. https://doi.org/10.1111/j.1600-0501.2009.01705.x

    Article  PubMed  Google Scholar 

  6. Araujo MG, Silva CO, Misawa M, Sukekava F (2015b) Alveolar socket healing: what can we learn? Periodontology 2000(68):122–134. https://doi.org/10.1111/prd.12082

    Article  Google Scholar 

  7. Atieh MA, Alsabeeha NH, Payne AG, Duncan W, Faggion CM, Esposito M (2015) Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. Cochrane Database Syst Rev:CD010176. https://doi.org/10.1002/14651858.CD010176.pub2

  8. Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV (2014) Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res 93:950–958. https://doi.org/10.1177/0022034514541127

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cardaropoli G, Araujo M, Hayacibara R, Sukekava F, Lindhe J (2005) Healing of extraction sockets and surgically produced—augmented and non-augmented—defects in the alveolar ridge. An experimental study in the dog. J Clin Periodontol 32:435–440. https://doi.org/10.1111/j.1600-051X.2005.00692.x

    Article  PubMed  Google Scholar 

  10. Danesh-Sani SA, Engebretson SP, Janal MN (2017) Histomorphometric results of different grafting materials and effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res 52:301–312. https://doi.org/10.1111/jre.12402

    Article  PubMed  Google Scholar 

  11. de Barros RRM, Novaes AB Jr, de Carvalho JP, de Almeida ALG (2017) The effect of a flapless alveolar ridge preservation procedure with or without a xenograft on buccal bone crest remodeling compared by histomorphometric and microcomputed tomographic analysis. Clin Oral Implants Res 28:938–945. https://doi.org/10.1111/clr.12900

    Article  PubMed  Google Scholar 

  12. Favero V, Lang NP, Canullo L, Urbizo Velez J, Bengazi F, Botticelli D (2016) Sinus floor elevation outcomes following perforation of the Schneiderian membrane. An experimental study in sheep. Clin Oral Implants Res 27:233–240. https://doi.org/10.1111/clr.12576

    Article  PubMed  Google Scholar 

  13. Gholami GA, Najafi B, Mashhadiabbas F, Goetz W, Najafi S (2012) Clinical, histologic and histomorphometric evaluation of socket preservation using a synthetic nanocrystalline hydroxyapatite in comparison with a bovine xenograft: a randomized clinical trial. Clin Oral Implants Res 23:1198–1204. https://doi.org/10.1111/j.1600-0501.2011.02288.x

    Article  PubMed  Google Scholar 

  14. Jambhekar S, Kernen F, Bidra AS (2015) Clinical and histologic outcomes of socket grafting after flapless tooth extraction: a systematic review of randomized controlled clinical trials. J Prosthet Dent 113:371–382. https://doi.org/10.1016/j.prosdent.2014.12.009

    Article  PubMed  Google Scholar 

  15. Jung RE, Sapata VM, Hämmerle CHF, Wu H, Hu XL, Lin Y (2018) Combined use of xenogeneic bone substitute material covered with a native bilayer collagen membrane for alveolar ridge preservation: a randomized controlled clinical trial. Clin Oral Implants Res 29(5):522–529. https://doi.org/10.1111/clr.13149

  16. Kakar A, Rao BHS, Hegde S, Deshpande N, Lindner A, Nagursky H, Patney A, Mahajan H (2017) Ridge preservation using an in situ hardening biphasic calcium phosphate (beta-TCP/HA) bone graft substitute—a clinical, radiological, and histological study. Int J Implant Dent 3:25. https://doi.org/10.1186/s40729-017-0086-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kilkenny C, Browne W, Cuthill IC, Emerson M, Altman DG (2011) Animal research: reporting in vivo experiments—the ARRIVE guidelines. J Cereb Blood Flow Metab 31:991–993. https://doi.org/10.1038/jcbfm.2010.220

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lindhe J, Araujo MG, Bufler M, Liljenberg B (2013) Biphasic alloplastic graft used to preserve the dimension of the edentulous ridge: an experimental study in the dog. Clin Oral Implants Res 24:1158–1163. https://doi.org/10.1111/j.1600-0501.2012.02527.x

    Article  PubMed  Google Scholar 

  19. Mardas N, Chadha V, Donos N (2010) Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clin Oral Implants Res 21:688–698. https://doi.org/10.1111/j.1600-0501.2010.01918.x

    Article  PubMed  Google Scholar 

  20. Mardas N, D'Aiuto F, Mezzomo L, Arzoumanidi M, Donos N (2011) Radiographic alveolar bone changes following ridge preservation with two different biomaterials. Clin Oral Implants Res 22:416–423. https://doi.org/10.1111/j.1600-0501.2010.02154.x

    Article  PubMed  Google Scholar 

  21. Naenni N, Sapata V, Bienz SP, Leventis M, Jung RE, Hammerle CH, Thoma DS (2017) Effect of flapless ridge preservation with two different alloplastic materials in sockets with buccal dehiscence defects—volumetric and linear changes. Clin Oral Inv. https://doi.org/10.1007/s00784-017-2309-6

  22. Papageorgiou SN, Papageorgiou PN, Deschner J, Gotz W (2016) Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: systematic review and network meta-analysis of parallel and cluster randomized controlled trials. J Dent 48:1–8. https://doi.org/10.1016/j.jdent.2016.03.010

    Article  PubMed  Google Scholar 

  23. Rolvien T, Barbeck M, Wenisch S, Amling M, Krause M (2018) Cellular mechanisms responsible for success and failure of bone substitute materials. Int J Mol Sci 19. https://doi.org/10.3390/ijms19102893

  24. Schropp L, Wenzel A, Kostopoulos L, Karring T (2003) Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 23:313–323

    PubMed  Google Scholar 

  25. Thoma DS, Jung RE, Schneider D, Cochran DL, Ender A, Jones AA, Gorlach C, Uebersax L, Graf-Hausner U, Hammerle CH (2010) Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis. J Clin Periodontol 37:659–666. https://doi.org/10.1111/j.1600-051X.2010.01581.x

    Article  PubMed  Google Scholar 

  26. Valdivia-Gandur I, Engelke W, Beltran V, Borie E, Fuentes R, Manzanares-Cespedes MC (2016) Novel use of cranial epidural space in rabbits as an animal model to investigate bone volume augmentation potential of different bone graft substitutes. Head Face Med 12:35. https://doi.org/10.1186/s13005-016-0131-z

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wildburger A, Bubalo V, Magyar M, Nagursky H, Jakse N, Schmelzeisen R, Sauerbier S (2017) Sinus floor augmentation comparing an in situ hardening biphasic calcium phosphate (hydroxyapatite/beta-tricalcium phosphate) bone graft substitute with a particulate biphasic calcium phosphate (hydroxyapatite/beta-tricalcium phosphate) bone graft substitute: an experimental study in sheep. Tissue Eng Part C Methods 23:404–411. https://doi.org/10.1089/ten.TEC.2016.0549

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the animal care team at the NAMSA, Lyon, France, for assistance during surgery. The support and expertise of Dr. Lorenz Uebersax, Sunstar Suisse SA, Etoy, Switzerland, is highly appreciated. The statistical analysis performed by Prof. Juerg Huesler, University, of Zurich, Zurich, Switzerland is very much appreciated.

Funding

This study was funded by Sunstar Suisse SA, Etoy, Switzerland, and the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.

Author information

Author notes

  1. Nadja Naenni and Stefan P. Bienz contributed equally.

Authors and Affiliations

  1. Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland

    Nadja Naenni, Stefan P. Bienz, Ronald E. Jung, Christoph H.F. Hämmerle & Daniel S. Thoma

Authors
  1. Nadja Naenni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan P. Bienz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronald E. Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christoph H.F. Hämmerle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel S. Thoma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadja Naenni.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naenni, N., Bienz, S.P., Jung, R.E. et al. Histologic analyses of flapless ridge preservation in sockets with buccal dehiscence defects using two alloplastic bone graft substitutes. Clin Oral Invest 23, 3589–3599 (2019). https://doi.org/10.1007/s00784-018-2784-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-018-2784-4

Keywords

Search

Navigation