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PubMed2003

Spatial and temporal localization of transforming growth factor-beta1, bone morphogenetic protein-2, and platelet-derived growth factor-A in healing tooth extraction sockets in a rabbit model.

PURPOSE: The purpose of this study was to test the hypothesis that spatial and temporal localization of growth factors transforming growth factor (TGF)-beta1, bone morphogenetic protein (BMP)-2, and platelet derived growth factor (PDGF)-A in a rabbit tooth extraction model correlate with the histologic events contributing toward healing. MATERIALS AND METHODS: Twenty-four male New Zealand White rabbits were used in the study. Incisor teeth were extracted from both jaws, and the healing extraction socket with the surrounding jaw bone was harvested at 48 hours, 4 days, and 1, 2, 4, 8, 12, and 16 weeks. Tissues were fixed, decalcified, and processed for hematoxylin and eosin and immunohistochemical staining. The sections were stained to detect TGF-beta1, BMP-2, and PDGF-A. Stained sections were then imaged, and an automated computer program was used to detect the brown 3,3'-diaminobenzidine regions representing the location of growth factors of interest. The data were collected in terms of percentage area and intensity of stain, and an analysis of variance was conducted (Tukey-Kramer and Scheffe's test) for statistical comparison between different time points, jaws, and growth factors. These results were also compared with hematoxylin and eosin-stained histologic specimens obtained at similar time points. RESULTS: Spatial and temporal differences in localization of TGF-beta1, BMP-2, and PDGF-A were observed across all time frames in both jaws. Statistically significant differences in percentage area and intensity of brown diaminobenzidine stain were detected temporally between TGF-beta1, BMP-2, and PDGF-A (P < or =.0001). CONCLUSION: The results of this study showed positive correlation between histologic events and the spatial and temporal localization of TGF-beta1, BMP-2, and PDGF-A in a rabbit tooth extraction model.

3,3'-Diaminobenzidine↗
PubMed2003

Ridge preservation following tooth extraction using a polylactide and polyglycolide sponge as space filler: a clinical and histological study in humans.

BACKGROUND: The placement of different graft materials and/or the use of occlusive membranes to cover the extraction socket entrance are techniques aimed at preserving/reducing alveolar ridge resorption. The use of grafting materials in fresh extraction sockets has, however, been questioned because particles of the grafted material have been found in alveolar sockets 6-9 months following their insertion. AIM: The aims of the study were to (i). evaluate whether alveolar ridge resorption following tooth extraction could be prevented or reduced by the application of a bioabsorbable polylactide-polyglycolide sponge used as a space filler, compared to natural healing by clot formation, and (ii). evaluate histologically the amount and quality of bone tissue formed in the sockets, 6 months after the use of the bioabsorbable material. MATERIAL AND METHODS: Thirty-six patients, undergoing periodontal therapy, participated in this study. All patients were scheduled for extraction of one or more compromised teeth. Following elevation of full-thickness flaps and extraction of teeth, measurements were taken to evaluate the distance between three landmarks (mesio-buccal, mid-buccal, disto-buccal) on individually prefabricated stents, and the alveolar crest. Twenty-six alveolar sockets (test) were filled with a bioabsorbable polylactide-polyglycolide acid sponge (Fisiograft), while 13 sockets (controls) were allowed to heal without any filling material. The flaps were sutured with no attempt to achieve primary closure of the surgical wound. Re-entry for implant surgery was performed 6 months following the extractions. Thirteen biopsies (10 test and three control sites) were harvested from the sites scheduled for implant placement. RESULTS: The clinical measurements at 6 months revealed, in the mesial-buccal site, a loss of bone height of 0.2 mm (1.4 SD) in the test and 0.6 mm (1.1 SD) in the controls; in the mid-buccal portion a gain of 1.3 mm (1.9 SD) in the test and a loss of 0.8 mm (1.6 SD) in the controls; and in the distal portion a loss of 0.1 mm (1.1 SD) in the test and of 0.8 (1.5 SD) mm in the controls. The biopsies harvested from the test sites revealed that the new bone formed at 6 months was mineralized, mature and well structured. Particles of the grafted material could not be identified in any of the 10 test biopsies. The bone formed in the control sites was also mature and well structured. CONCLUSION: The results of this study indicate that alveolar bone resorption following tooth extraction may be prevented or reduced by the use of a bioabsorbable synthetic sponge of polylactide-polyglycolide acid. The quality of bone formed seemed to be optimal for dental implant insertion.

Adult↗
PubMed2004

Strategies for management of single-tooth extraction sites in aesthetic implant therapy.

Achieving predictable aesthetic outcomes following the planned removal of a natural tooth suffering from structural, endodontic, or periodontal compromise depends on a multitude of factors that, once identified, guide the implant team in selecting the surgical and prosthetic treatment options best suited for the individual clinical scenario. This article presents pertinent information regarding systematic patient evaluation and special treatment planning considerations for patients facing the loss of a single tooth in an area of high aesthetic importance. The rationale for and details of performing the Bio-Col site preservation technique at the time of tooth removal; guidelines for immediate versus delayed implant placement; selection and sequencing of site-development procedures according to the types of alveolar ridge defects encountered following tooth removal despite the use of site preservation; and a description of prosthetic techniques necessary for the successful management of single-tooth extraction sites in areas of aesthetic concern also are reviewed.

Alveolar Process↗
PubMed1985

Tooth extraction by orthodontic force after radiation therapy: report of case.

This report presents a therapeutic approach to orthodontic tooth extraction in a patient at high risk for the development of osteoradionecrosis with conventional techniques. The rationale for this procedure is discussed in detail, combining principles of radiation biology, clinical radiation therapy, and biomechanics of tooth movement.

Adult↗
PubMed2001

Evaluation of oral antimicrobial agent levels in tooth extraction sites.

OBJECTIVE: The purpose of this study was to evaluate various oral antimicrobial agent levels in tooth extraction sites. STUDY DESIGN: The concentration of dental alveolar blood in extraction wounds after the oral administration of talampicillin (500 mg), cefaclor (500 mg), cefteram pivoxil (200 mg), cefuroxime axetil (250 mg), cefdinir (200 mg), and ofloxacin (100 mg) was determined in 338 patients and was assessed on the basis of its antimicrobial activity against Streptococcus isolated in odontogenic infections. RESULTS: The percentage of patients whose concentrations exceeded the minimum inhibitory concentration for 90% of Streptococcus was 62.5% to 100% for talampicillin at 30 to 360 minutes, 0% to 12.5% for cefaclor at 30 to 360 minutes, 18.2% to 100% for cefteram pivoxil at 30 to 480 minutes, 50% to 100% for cefuroxime axetil at 30 to 480 minutes, 0% to 50% for cefdinir at 16 to 290 minutes, and 0% to 40% for ofloxacin at 30 to 480 minutes. CONCLUSION: These results indicate that talampicillin, cefteram pivoxil, and cefuroxime axetil have minimum inhibitory concentration levels for 90% of Streptococcus in tooth sockets.

Administration, Oral↗
PubMed2003

Long-term effect of full-mouth tooth extraction on the responsiveness of peripheral blood monocytes.

BACKGROUND: As some residual inflammation may remain after periodontal therapy, the present pilot study investigated the long-term effect of full-mouth tooth extraction therapy on the responsiveness of peripheral blood monocytes in a case with generalized terminal adult periodontitis. METHODS: Before and 3, 9, 20 and 32 months after therapy, venous blood was collected. Total and differential white blood cell counts were determined and whole blood cell cultures (WBCC) were incubated with lipopolysaccharide (LPS) to stimulate the production of inflammatory mediators by monocytes. RESULTS: After full-mouth tooth extraction, the numbers of total peripheral white blood cells and neutrophils decreased over time. The release of the chemokines interleukin (IL)-8 and macrophage chemoattractant protein (MCP)-1 in the cultures decreased twofold over time, whereas no changes were seen for the other studied cytokines, chemokines and prostaglandin E2. CONCLUSION: On the basis of previous studies and the present case, the high production of IL-8 and MCP-1 by monocytes in LPS-stimulated WBCC from periodontitis patients is most likely acquired, as their levels decrease over time when the periodontal infection is controlled. The possible connection between periodontitis and atherosclerosis through IL-8 and MCP-1 is discussed.

Adult↗
PubMed2006

Injectable bone substitute to preserve alveolar ridge resorption after tooth extraction: a study in dog.

The aim of the present study was to assess the efficacy of a ready-to-use injectable bone substitute on the prevention of alveolar ridge resorption after tooth extraction. Maxillary and mandibular premolars were extracted from 3 Beagle dogs with preservation of alveolar bone. Thereafter, distal sockets were filled with an injectable bone substitute (IBS), obtained by combining a polymer solution and granules of a biphasic calcium phosphate (BCP) ceramic. As a control, the mesial sockets were left unfilled. After a 3 months healing period, specimens were removed and prepared for histomorphometric evaluation with image analysis. Histomorphometric study allowed to measure the mean and the maximal heights of alveolar crest modifications. Results always showed an alveolar bone resorption in unfilled sockets. Resorption in filled maxillary sites was significantly lower than in control sites. Interestingly, an alveolar ridge augmentation was measured in mandibular filled sockets including 30% of newly-formed bone. It was concluded that an injectable bone substitute composed of a polymeric carrier and calcium phosphate can significantly increase alveolar ridge preservation after tooth extraction.

Alveolar Process↗
PubMed1989

[Influence of tooth extraction on postural stability].

A study was conducted to analyze how tooth extraction procedure would affect patient's physical equilibrium sensation, using the positional centric equilibrium measuring device. Forty-five health subjects, between the ages of 20 to 30, with no systemic nor equilibrium abnormalities were selected for this study. The results obtained were as follows. 1. No noticeable changes in the centric movement were observed during the postural change from a sitting to a standing position. 2. Centric movement was transiently increased immediately after the movement from a horizontal to standing position. The average arterial pressure was decreased immediately after the alteration in body posture, suggesting that changes in body posture may influence the controlling mechanism of BP. 3. Increases in the area and velocity of the centric movement were found immediately after and up to 10 minutes after, respectively, topical administration of the anesthetic. During this time span, no correlation found between centric movement changes and circulatory changes suggested that topical anesthesia might influence the recovery reflex via central nervous system. 4. The effect of the extraction procedure on the centric movement area and the anteroposterior centric movement speed lasted for 10 minutes after extraction. On the other hand, the increase in the velocity of bilateral centric movement as well as whole body centric movement was found up to a point immediately after extraction. No correlation was found between circulatory changes and centric movement changes. It therefore was assumed that the topical anesthesia affected the recovery reflex via central nervous system.

Adolescent↗
PubMed2005

Dimensional ridge alterations following tooth extraction. An experimental study in the dog.

OBJECTIVE: To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change. MATERIAL AND METHODS: Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope. RESULTS: It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall. CONCLUSIONS: The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood.

Alveolar Bone Loss↗
PubMed2003

Immediate tooth extraction, placement of a Tapered Screw-Vent implant, and provisionalization in the esthetic zone: a case report.

PURPOSE: This clinical report describes an immediate tooth extraction, followed by placement and provisional restoration of a dental implant in the prepared socket of a right maxillary central incisor. MATERIALS AND METHODS: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. A flapless, transmucosal surgical approach was used to prepare the socket and insert a tapered implant. The implant was immediately restored with a provisional abutment and crown without occlusal contacts. An impression was made 22 days after implant insertion, and a definitive, all-ceramic restoration was placed 3 days later. RESULTS: During the period of provisional progressive loading, no significant soft tissue contraction was observed related to noninvasive operating techniques and the immediate insertion of the provisional restoration. The patient exhibited no clinical or radiologic complications through 8 months of clinical monitoring after loading. CONCLUSION: The Tapered Screw-Vent implant and all-ceramic restoration provided the patient with immediate esthetics, function, and comfort without any complications during the postloading follow-up period.

Adult↗
PubMed1975

Tooth extraction in a patient with Glanzmann's thrombasthenia.

A 14-year-old Japanese boy suffering from Glanzmann's thrombasthenia required extraction of two permanent teeth and one primary tooth. This report deals with the details of the procedure and discusses the effect of platelet transfusion and local management in tooth extraction of patients with this hemorrhagic diathesis.

Adolescent↗
PubMed2006

Biocompatibility of Beta-tricalcium phosphate root replicas in porcine tooth extraction sockets - a correlative histological, ultrastructural, and x-ray microanalytical pilot study.

This investigation studies porcine tissue response in tooth extraction sockets treated with root replicas made out of Beta-tricalcium phosphate (Beta-TCP; Beta-Ca(3)(PO(4))(2)) granules, molded and held together by thermal fusion of a thin film of polyglycolic-polylactic acid copolymer. Six left mandibular third incisors (n (1)/4 6) of experimental pigs are treated with the root replicas and four contralateral incisors are used as nontreated controls (n (1)/4 4). Two animals each were killed at 20, 40, and 60 weeks of observation periods. The mandibular jaw segments were prepared in toto for light microscopy by resin embedding and serial ground sectioning. Additionally, one Beta-TCP-treated socket at 60 weeks was thoroughly investigated by correlative light, electron microscopic and electron probe X-ray microanalysis to assess the bio-absorbability and host removal of the replica material from the implant site. The extraction wounds of the animals healed satisfactorily with very little histologically observable differences in the healing pattern of the test and control sites. The Beta-TCP was completely removed from extracellular sites, but at 60 weeks, remnants of it were found in the cytoplasm of multinucleated giant cells. The root replicas made out of Beta-TCP were biocompatible and bioabsorbable. Osseous healing occurred both in the test and control sockets, but the healing process was delayed due to the presence of Beta-TCP particles.

Animals↗
PubMed2004

Recalcitrant osteomyelitis following tooth extraction in a case of malignant osteopetrosis.

Malignant osteopetrosis generally begins in utero and often results in stillbirth. Besides, failure to thrive, increased bone fragility resulting in frequent fractures and recurrent bone infections are the other characteristic features. Infections after tooth extraction and fracture of the sclerotic bone following mild trauma are serious complications, as these ordinarily common problems are very difficult to treat in such patients. Poor bone vascularisation and reduced local defences prolong the defensive response. A rare case of malignant osteopetrosis in a 19-year-old girl, who presented with the complication of osteomyelitis of the mandible following tooth extraction, is presented. The case is of interest for two reasons: it is very rare for a case of malignant osteopetrosis to survive until adulthood and to be aware of the potential dental and oral complications of the disorder.

Adult↗
PubMed1998

A prospective clinical trial of endosseous screw-shaped implants placed at the time of tooth extraction without augmentation.

This prospective clinical trial evaluated 134 implants in 81 patients. The implants were placed at the time of tooth extraction and were not augmented with barrier membranes or graft materials. The implants were placed into good jaw bone anatomy and quality and were restored by dentists familiar with the implant system. Forty-seven implants were followed between 4 to 5 years with a cumulative success rate of 93.3%. Marginal bone levels were measured for 61 patients with 108 implants. The average mesial-distal measurements for maxillary implants at abutment connection were 1.02 mm (SD+/-0.59) and 1.36 mm (SD+/-0.78) at an average of 32 months follow-up. These differences were not significant. The average mandibular mesial-distal measurements at abutment connection were 1.05 mm (SD+/-0.92) and 1.54 mm (SD+/-0.91) at follow-up. These differences were statistically significant (P = 0.0027). Removal of one patient (5 implants) with advanced marginal bone loss from the data provided a marginal bone level of 1.20 mm (SD+/-0.94) at abutment connection and 1.30 mm (SD+/-0.87) at follow-up. These differences were not significant. The results of this study indicate that implants placed at the time of extraction without augmentation or grafting have excellent long-term cumulative success rates.

Adult↗
PubMed1994

Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction. (I). Clinical parameters.

The aim of the present study was to evaluate the effects of a 1-month period of chlorhexidine (CHX) rinses on the periodontal conditions of teeth adjacent to extraction sockets. 40 patients signed consent forms for this double blind trial and were randomly assigned to either the test group rinsing 2 x daily with 15 ml of a 0.12% CHX solution (Peridex) starting 2 days after tooth extraction or the control group rinsing with a placebo solution for 30 days. Clinical periodontal parameters were obtained from test sites located adjacent to as well as matched controls distant to the extraction sites. The measurements were performed at baseline before the extraction and 1, 2, 3 and 6 months thereafter. During the observation period, the patients were exposed to initial periodontal therapy. The test sites of the group rinsing with CHX demonstrated significantly reduced (p < 0.05) plaque indices, gingival indices and lower %s of sites bleeding on probing one month following the extraction. The test sites of the control group rinsing with the placebo demonstrated a tendency for loss of clinical attachment between 1 and 2 months after the tooth extraction. The mean pocket probing depth (PPD) at test sites of the CHX rinsing group was smaller than in the placebo rinsing group at the one month examination. Also, the mean PPD of the test sites in the CHX group was significantly smaller than at the control sites at 1 month. This difference was not observed in the control group rinsing with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Acute airway obstruction following tooth extraction in hereditary angioedema.

Life threatening airway obstruction occurred following a single tooth extraction in a patient who had hereditary angioedema, despite preoperative administration of FFP and danazol. Emergency intubation was performed in the operating room, and assisted respiration was required during the acute attack. The clinician should be aware that an acute attack of HAE may occur even though recommended medical management regimens are followed and should be prepared for emergency airway control.

Adult↗