Fig. 7. ing a trephine bur. a Overview image of coronal-apical cut through the entire core biopsy showing formation of new bone (NB) next to old bone of the extraction socket (B). easy-graft CRYSTAL particles (Gr) are embedded in well perfused connective tissue (CT) and new bone (NB) (Azur II and Pararosanilin, original magnification ×50). b Integration of easy-graft CRYSTAL particle (Gr) into ...
Fig. 6. ntegration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 6. a–c Four-month postoperative CBCT showing graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 4. excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 4. a Second stage surgery followed by impression making. Note the excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 2. ssue approximation. A good width of keratinized tissue is visible along with ridge preservation. Ready for implant placement in the grafted areas. b Implant placed in 45 area. Core biopsy sample taken from area 46. Note the integration of graft particles in the preserved alveolar ridge also inside the osteotomy site of 46. c Two Xive (Dentsply) implants placed in the preserved ridge. d. ...
Fig. 1. ft tissue and no flap reflection on the surgical site. c Graft material condensed into the extraction sockets showing good initial graft stability. d Black silk sutures placed with tissue approximation and no releasing incision in the flaps
Fig. 1. a Clinical occlusal view with fractured 45 and 46. b Post-extraction view of the socket. Note minimal trauma to the soft tissue and no fla...
Patient no.
Gender
Patient’s age
Tooth no.
Time post extraction [month]
% New bone
...
Patient no.
Tooth no.
Ridge width baseline [mm]
Ridge width implant placement [mm]
Ridge width changes [mm]
...
ISQ level at implant placement
ISQ level at loading
Patient no.
Tooth no.
Buccal
Palatal
...
Kakar, A., Rao, B.H.S., Hegde, S. et al. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study.
Int J Implant Dent 3, 25 (2017). https://doi.org/10.1186/s40729-017-0086-2
Download citation
Received: 31 December 2016
Accepted: 25 May 2017
Published: 22 June 2017
DOI: htt...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Correspondence to
Ashish Kakar.
Yenepoya University Dental College, University Road, Mangalore, 575018, India
Ashish Kakar, Bappanadu H. Sripathi Rao & Shashikanth Hegde
Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
Nikhil Deshpande
Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
Annette ...
We acknowledge Sunstar Suisse SA, Etoy, Switzerland, for partly supporting this clinical study with a study grant. The authors declare that there is no conflict of interest regarding the publication of this paper.
Ashish Kakar, Bappanadu H. Sripathi Rao, Shashikanth Hegde, Nikhil Deshpande, Annette Lindner, Heiner Nagursky, Aditya Patney, and Harsh Mahajan declare that they have no competing inte...
Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39–66.
Smukler H, Landi L, Setayesh R. Hostomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allografts and barrier membrane. A pilot study. In...
Nair PNR, Luder H-U, Maspero FA, Fischer JH, Schug J. Biocompatibility of beta-tricalcium phosphateroot replicas in porcine tooth extraction sockets—a correlativehistological, ultrastructural, and x-ray microanalytical pilotstudy. J Biomater Appl. 2006;20(4):307–24.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different...
Araujo MG, Sukekava F, Wennstrom J, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32:645–52.
Van der Weijden F, Dell'Acqua F, Slot DE DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–58.
Schropp L, Wenzel A, Kos...
The results of this clinical study support the use of a biphasic in situ hardening alloplastic bone graft substitute for ridge preservation in intact post-extraction sites without the use of a dental membrane. Therefore, grafting of sockets without primary wound closure or using dental membranes or a soft tissue punch can be an effective minimally invasive method of preserving the contour and arch...
Likewise, the reported amount of residual grafting material in the defect site was similar. In average, only 26.2 ± 9.4% of the defect was occupied with residual graft material in this study which is well in line with 26.6 ± 5.2% reported for BCP but below the 37.7 ± 8.5% reported for xenograft [14].
All 15 implants could be placed without the need for additional bone augmentation....
As previously reported, secondary intention soft tissue healing of grafted post-extraction sites can be well achieved when using an in situ hardening and in situ stabilizing bone graft substitutes without the need of a dental membrane [18, 20]. Findings of the present report corroborate these results. The authors found that all sites healed uneventfully with coverage of soft tissue and no local co...
Ridge preservation following dental extractions is fundamental, preserving the ridge profile for subsequent implant placement and providing a sustained function and esthetics. This clinical trial reports on the successful application of an in situ hardening biphasic alloplastic bone graft substitute for ridge preservation and subsequent implant placement in 15 healthy patients. A routine but minim...
Cone beam computer tomography (CBCT) was performed before tooth extraction and at the time point of implant placement. Mean ridge width reduction before tooth extraction to implant placement was calculated to effect in 0.79 ± 0.73 mm horizontal bone loss (Table 2). Primary implant stability was achieved in all 15 cases, showed in average high ISQ levels 70.3 ± 9.7 (buccal/palatal), and...
Fifteen patients (4 females and 11 males) with a mean age of 51.3 + 14.8 years (range: 27 to 75 years) participated in this randomized clinical trial. The site specific areas and teeth numbers for the study are shown in Table 1.
In all cases, the postoperative healing was uneventful. Clinically, the soft tissue healing pattern observed was very similar in all cases. The soft tissue on all ...
Bone biopsies were harvested using a trephine bur at the site of implant placement. The trephine burs including the bone biopsies were fixed in 4% formalin for 5–7 days, rinsed in water, and dehydrated in serial steps of ethanol (70, 80, 90, and 100%), remaining for 1 day in each concentration. Specimens were then infiltrated, embedded, and polymerized in resin (Technovit 9100, Heraeus Kulzer,...
Antibiotic therapy consisting of 1 g amoxicillin every 12 h for 4 days and mouth rinsing with 0.2% chlorhexidine every 8 h for 10 days were prescribed. The suture was removed 1 week postoperatively. After 3 to 8 months (average 5.2 ± 2 months), the sites (Fig. 2a) were reentered for implant placement. A site-specific full thickness mucoperiosteal flap was elevated to expose the regen...
This study was approved by the Yenepoya University Ethics committee, Mangalore, India (Approval Number YOEC83/8/3/2014). Fifteen patients who required extraction of a maxillary or mandibular tooth and subsequent single-tooth implant placement and who met the inclusion and exclusion criteria were included in this prospective single-arm clinical study. The patients (4 females and 11 males) had a mea...
To our knowledge, this is the first systematic clinical, radiographic, and histological evaluation that assesses bone formation and ridge width preservation after socket grafting using an in situ hardening biphasic bone graft substitute in healthy patients.
Following tooth extraction, the alveolar ridge will decrease in volume and change its morphology [1, 2]. These changes are clinically significant [3] and can complicate the placement of a conventional bridge or an implant-supported crown. Post-extraction maintenance of the alveolar ridge following the principles of ridge preservation using bone graft substitutes minimizes ridge resorption and, thu...
Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane.
A total of 15 patients reported for tooth extraction were enrolled in t...
Fig. 7. image of coronal-apical cut through the entire core biopsy showing formation of new bone (NB) next to old bone of the extraction socket (B). easy-graft CRYSTAL particles (Gr) are embedded in well perfused connective tissue (CT) and new bone (NB) (Azur II and Pararosanilin, original magnification ×50). b Integration of easy-graft CRYSTAL particle (Gr) into newly formed bone (NB) and conn...
Fig. 6. graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 6. a–c Four-month postoperative CBCT showing graft integration and preservation of ridge without collapse of the buccal or lingual cortical plates also showing the cross sections in the grafted area
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 5. CBCT images of the extraction site. a Preoperative CBCT showing fractured and un-restorable teeth #45 and #46 planned to be extracted. b–d Cross sectional views
Fig. 4. lant crowns placed and loaded after 3 months of placement
Fig. 4. a Second stage surgery followed by impression making. Note the excellent width of keratinized tissue which was also preserved. b Implant crowns placed and loaded after 3 months of placement
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 3. Postoperative X ray showing the implant positions in the mandible where the teeth were extracted and ridge preservation was accomplished
Fig. 2. ximation. A good width of keratinized tissue is visible along with ridge preservation. Ready for implant placement in the grafted areas. b Implant placed in 45 area. Core biopsy sample taken from area 46. Note the integration of graft particles in the preserved alveolar ridge also inside the osteotomy site of 46. c Two Xive (Dentsply) implants placed in the preserved ridge. d. Postoperat...
Fig. 1. traction sockets showing good initial graft stability. d Black silk sutures placed with tissue approximation and no releasing incision in the flaps
Fig. 1. a Clinical occlusal view with fractured 45 and 46. b Post-extraction view of the socket. Note minimal trauma to the soft tissue and no flap reflection on the surgical site. c Graft material condensed into the extraction sockets sho...
Patient no.
Gender
Patient’s age
Tooth no.
Time post extraction [month]
% New bone
...
Patient no.
Tooth no.
Ridge width baseline [mm]
Ridge width implant placement [mm]
Ridge width changes [mm]
...
ISQ level at implant placement
ISQ level at loading
Patient no.
Tooth no.
Buccal
Palatal
...
Kakar, A., Rao, B.H.S., Hegde, S. et al. Ridge preservation using an in situ hardening biphasic calcium phosphate (β-TCP/HA) bone graft substitute—a clinical, radiological, and histological study.
Int J Implant Dent 3, 25 (2017). https://doi.org/10.1186/s40729-017-0086-2
Download citation
Received: 31 December 2016
Accepted: 25 May 2017
Published: 22 June 2017
DOI: htt...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Correspondence to
Ashish Kakar.
Yenepoya University Dental College, University Road, Mangalore, 575018, India
Ashish Kakar, Bappanadu H. Sripathi Rao & Shashikanth Hegde
Dental Foundations and Research Centre, Malad, Mumbai, 400064, India
Nikhil Deshpande
Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
Annette ...
We acknowledge Sunstar Suisse SA, Etoy, Switzerland, for partly supporting this clinical study with a study grant. The authors declare that there is no conflict of interest regarding the publication of this paper.
Ashish Kakar, Bappanadu H. Sripathi Rao, Shashikanth Hegde, Nikhil Deshpande, Annette Lindner, Heiner Nagursky, Aditya Patney, and Harsh Mahajan declare that they have no competing inte...
Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39–66.
Smukler H, Landi L, Setayesh R. Hostomorphometric evaluation of extraction sockets and deficient alveolar ridges treated with allografts and barrier membrane. A pilot study. In...
Nair PNR, Luder H-U, Maspero FA, Fischer JH, Schug J. Biocompatibility of beta-tricalcium phosphateroot replicas in porcine tooth extraction sockets—a correlativehistological, ultrastructural, and x-ray microanalytical pilotstudy. J Biomater Appl. 2006;20(4):307–24.
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different...
Araujo MG, Sukekava F, Wennstrom J, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32:645–52.
Van der Weijden F, Dell'Acqua F, Slot DE DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–58.
Schropp L, Wenzel A, Kos...
The results of this clinical study support the use of a biphasic in situ hardening alloplastic bone graft substitute for ridge preservation in intact post-extraction sites without the use of a dental membrane. Therefore, grafting of sockets without primary wound closure or using dental membranes or a soft tissue punch can be an effective minimally invasive method of preserving the contour and arch...
Likewise, the reported amount of residual grafting material in the defect site was similar. In average, only 26.2 ± 9.4% of the defect was occupied with residual graft material in this study which is well in line with 26.6 ± 5.2% reported for BCP but below the 37.7 ± 8.5% reported for xenograft [14].
All 15 implants could be placed without the need for additional bone augmentation....
As previously reported, secondary intention soft tissue healing of grafted post-extraction sites can be well achieved when using an in situ hardening and in situ stabilizing bone graft substitutes without the need of a dental membrane [18, 20]. Findings of the present report corroborate these results. The authors found that all sites healed uneventfully with coverage of soft tissue and no local co...
Ridge preservation following dental extractions is fundamental, preserving the ridge profile for subsequent implant placement and providing a sustained function and esthetics. This clinical trial reports on the successful application of an in situ hardening biphasic alloplastic bone graft substitute for ridge preservation and subsequent implant placement in 15 healthy patients. A routine but minim...
Cone beam computer tomography (CBCT) was performed before tooth extraction and at the time point of implant placement. Mean ridge width reduction before tooth extraction to implant placement was calculated to effect in 0.79 ± 0.73 mm horizontal bone loss (Table 2). Primary implant stability was achieved in all 15 cases, showed in average high ISQ levels 70.3 ± 9.7 (buccal/palatal), and...
Fifteen patients (4 females and 11 males) with a mean age of 51.3 + 14.8 years (range: 27 to 75 years) participated in this randomized clinical trial. The site specific areas and teeth numbers for the study are shown in Table 1.
In all cases, the postoperative healing was uneventful. Clinically, the soft tissue healing pattern observed was very similar in all cases. The soft tissue on all ...
Bone biopsies were harvested using a trephine bur at the site of implant placement. The trephine burs including the bone biopsies were fixed in 4% formalin for 5–7 days, rinsed in water, and dehydrated in serial steps of ethanol (70, 80, 90, and 100%), remaining for 1 day in each concentration. Specimens were then infiltrated, embedded, and polymerized in resin (Technovit 9100, Heraeus Kulzer,...
Antibiotic therapy consisting of 1 g amoxicillin every 12 h for 4 days and mouth rinsing with 0.2% chlorhexidine every 8 h for 10 days were prescribed. The suture was removed 1 week postoperatively. After 3 to 8 months (average 5.2 ± 2 months), the sites (Fig. 2a) were reentered for implant placement. A site-specific full thickness mucoperiosteal flap was elevated to expose the regen...
This study was approved by the Yenepoya University Ethics committee, Mangalore, India (Approval Number YOEC83/8/3/2014). Fifteen patients who required extraction of a maxillary or mandibular tooth and subsequent single-tooth implant placement and who met the inclusion and exclusion criteria were included in this prospective single-arm clinical study. The patients (4 females and 11 males) had a mea...
To our knowledge, this is the first systematic clinical, radiographic, and histological evaluation that assesses bone formation and ridge width preservation after socket grafting using an in situ hardening biphasic bone graft substitute in healthy patients.
Following tooth extraction, the alveolar ridge will decrease in volume and change its morphology [1, 2]. These changes are clinically significant [3] and can complicate the placement of a conventional bridge or an implant-supported crown. Post-extraction maintenance of the alveolar ridge following the principles of ridge preservation using bone graft substitutes minimizes ridge resorption and, thu...
Post-Extraction ridge preservation using bone graft substitutes is a conservative technique to maintain the width of the alveolar ridge. The objective of the present study was to evaluate an in situ hardening biphasic (HA/β-TCP) bone graft substitutes for ridge preservation without primary wound closure or a dental membrane.
A total of 15 patients reported for tooth extraction were enrolled in t...
Figure 41. Decrease in ridge width
On the contrary, the width of the alveolar ridge in single-rooted teeth will be decreased approximately by 50%, and two-thirds of this reduction will occur within the first 3 months after tooth extraction.