Retaining the buccal aspect of the root during implant placement does not appear to interfere with osseointegration and may be beneficial in preserving the buccal bone plate.
The results demonstrate that leaving the periosteum in place decreases the resorption rate of the extraction socket. Furthermore, the treatment of the extraction socket with BioOss Collagen and a free gingival graft seems beneficial in limiting the resorption process after tooth extraction.
Socket preservation techniques, used in the present experiment, were not able to entirely compensate for the alterations after tooth extraction. Yet, incorporation of BioOss Collagen seems to have the potential to limit but not avoid the post-operative contour shrinkage.
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.
In this study, alveolar ridge preservation techniques were not able to entirely compensate for alveolar ridge reduction. Covering the orifice of the extraction socket with a free gingival tissue graft seems to have the potential to limit but not avoid the post-operative external contour shrinkage based on optical scans.
The findings from the present study disclose that incorporation of BioOss Collagen into the extraction socket has only limited impact on the subsequent biologic process with particular respect to the buccal bone plate. The horizontal measurement of the alveolar ridge depicted that the loss of the buccal bone plate was replaced to a certain amount by newly generated bone guided by the BioOss Collagen scaffold. It seems that the mechanical stability provided by BioOss Collagen and furthermore by a free gingival graft could act as a placeholder preventing the soft tissue from collapsing.
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