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.
Aim: The present pilot RCT aimed to investigate the influence of a connective tissue graft (CTG) in combination with the immediate implant placement (IIP) on hard and soft tissue healing, without a bone replacement graft in the gap between the implant and the socket walls. Materials and Methods:Thirty patients requiring extraction of one anterior tooth (from premolar to premolar) were randomly assigned to one of the two treatment groups (test: IIP + CTG; control: IIP). Cone-beam computed tomography and optically scans were performed before tooth extraction and at 6-month follow-up. Then, DICOM files were superimposed in order to allow the evaluation of osseous ridge and buccal bone changes, while the superimposition of DICOM and Standard Tessellation Language files allowed for evaluating of soft tissue contour. For testing the differences between the two groups, the non-parametric test as Wilcoxon rank-sum test, was used.Results: Twenty-six of the 30 enrolled patients attended the 6-month follow-up visit.The four patients of the control group that were lost to follow-up were analysed under the intention-to-treat principle. No statistically significant differences between the groups were observed for the vertical buccal bone resorption (p = .90), as well as for the horizontal buccal bone resorption at all measured levels. Significant differences were found between the test and control groups in the horizontal dimensional changes of osseous ridge at the most coronal aspect (p = .0003 and p = .02).Changes in tissue contour were between À0.32 and À0.04 mm in the test group and between À1.94 and À1.08 mm in the control group, while changes in soft tissue thickness varied between 1.33 and 2.42 mm in the test group and between À0.16 and 0.88 mm in the control group, with statistically significant differences for both variables at all measured levels. At 6 months, the mean volume increase was 6.76 ± 8.94 mm 3 and 0.16 ± 0.42 mm 3 in the test and control groups, respectively, with a statistically significant difference. Conclusions:The findings of the present study indicate that the adjunct of a CTG at the time of IIP, without bone grafting, does not influence vertical bone resorption.
Background: Clinical research related to dimensional change after tooth extraction has mainly focused on the biology of bone, while the effect of soft tissue healing on bone modelling and dimensional changes in post-extraction sites have received little attention. Aim/Hypothesis: To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4 months after single tooth extraction and 3 different treatment modalities: spontaneous healing (SH), alveolar ridge preservation (DBBM/CM) and immediate implant placement (IMPL/DBBM/CM). Materials and Methods: 30 patients requiring single-rooted tooth extraction participated to the trial. After atraumatic tooth extraction, patients were randomly assigned to SH, DBBM/CM with a biomaterial and a collagen matrix seal and IMPL/DBBM/CM with a biomaterial in the gap and a collagen matrix seal. STL files from study casts obtained at baseline and after 4 months were matched to calculate buccal soft tissues linear and volumetric changes. DICOM file from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4 month. Results: No significant differences between groups were observed when analyzing baseline characteristics. All groups demonstrated at 4 months a horizontal reduction in the dimensions of the bucco-lingual tissue contours. Although a tendency towards less reduction was observed in DBBM/CM and IMPL/DBBM/CM group, no statistically significant differences were observed. A similar trend was observed at the buccal aspect, although a statistically significant change was observed at 5 mm, where SH group had significant more resorption (1.66 mm), if compared to DBBM-CM group (1.02 mm) and IMPL/DBBM/CM group (0.85 mm). Buccal volumetric reduction was observed after 4 months in all groups, with no significant differences between them. After 4 months of healing the soft tissue thickness at 3 mm under the most coronal soft tissue point demonstrated a significant mean increase (0.95 mm) for SH group, whereas DBBM/CM and IMPL/and DBBM/CM demonstrated a NO-significant change. Conclusions and Clinical Implications: Treatment modality may be considered less critical in terms of contour alterations on a soft tissue level, since no differences between the three treatment modalities were observed in linear and volumetric changes that occur at the buccal soft tissue profile after tooth extraction. Lack of difference may be due to a significant increase in soft tissue thickness in SH sites. This increase might improve flap manageability if bone augmentation procedures were to be required during implant placement
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