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Clinical Outcomes of Socket Preservation Using Bovine-Derived

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Clinical Outcomes of Socket Preservation Using Bovine-Derived e290 Clinical Outcomes of Socket Preservation Using Bovine-Derived Xenograft Collagen and Collagen Membrane Post–Tooth Extraction: A 6-Month Randomized Controlled Clinical Trial Vincenzo Iorio-Siciliano, DDS, PhD1 Several studies have demonstrated Andrea Blasi, DDS, PhD1 that alveolar bone structures are lost Michele Nicolò, MD, DDS2 following tooth extraction.1–3 Dur- Alessandro Iorio-Siciliano, DDS3 ing the physiologic healing process, 2 Francesco Riccitiello, MD, DDS the bone loss will result in a ridge re- 3 Luca Ramaglia, MD, DDS duced in both vertical and horizontal dimensions.4 These physiologic alve- The aim of this study was to evaluate the clinical remodeling of the alveolar olar socket changes may limit bone socket following the application of bovine-derived xenograft collagen and availability, affecting conditions for collagen membrane compared to natural spontaneous healing during the ideal implant placement. For this rea- first 6 months following tooth extraction. A total of 20 patients with 20 fresh son, various bone grafts are used to alveolar sockets were randomly allocated into a test or control group. After a 6-month follow-up period, surgical reentry was performed and implants preserve the alveolar ridge following were placed. Significant statistical differences were recorded in terms of tooth extraction.5,6 Varying degrees vertical and horizontal bone changes between the test and control groups. of success have been reported in Within the limitations of this study, socket preservation procedures may maintaining the anatomical dimen- provide more favorable conditions for subsequent implant placement. Int J sions of the alveolar ridge after tooth Periodontics Restorative Dent 2017;37:e290–e296. doi: 10.11607/prd.2474 extraction.7–9 However, a recent sys- tematic review10 suggested that sock- et preservation techniques may not prevent physiologic resorptive bone processes after tooth extraction but may reduce the resultant dimension- al change to the bone. Vignoletti et al11 evaluated the scientific evidence on the efficacy of the surgical proto- cols designed to preserve the alveo- lar ridge after tooth removal. Results of meta-analyses showed statisti- 1Adjunct Professor, Department of Neurosciences, Reproductive and Odontostomatological cally significantly smaller variations Sciences, Department of Periodontology, University of Naples Federico II, Naples, Italy. 2Associate Professor, Department of Neurosciences, Reproductive and in bone height (1.47 mm) and width Odontostomatological Sciences, Department of Periodontology, University of Naples (1.83 mm) for grafted sites compared Federico II, Naples, Italy. to nongrafted sites. The potential 3Private Practice, Pomigliano d’Arco, Italy. benefit of socket preservation pro- Correspondence to: Dr Vincenzo Iorio-Siciliano, Department of Neurosciences, cedures has been demonstrated to Reproductive and Odontostomatological Sciences, Department of Periodontology, result in significantly less vertical and University of Naples Federico II, Naples, Italy. horizontal contraction of the alveolar Fax: +390818845462. Email: [email protected] bone crest.12 In recent experimental ©2017 by Quintessence Publishing Co Inc. studies,13,14 the placement of bovine- The International Journal of Periodontics & Restorative Dentistry © 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. e291 derived xenograft collagen into fresh extraction sockets appeared to pre- serve the dimension of the alveolar ridge and thereby counteract the marginal ridge contraction that oc- curs after tooth removal. The aim of the present study was to evaluate the clinical changes in fresh alveolar sockets treated with bovine-derived xenograft collagen and collagen membrane compared Fig 1 Occlusal view of fractured second Fig 2 Occlusal view of extraction socket. with spontaneous healing during a premolar. 6-month follow-up period. or control (ie, spontaneous healing). baseline; and presence of at least 2 The study protocol was submit- mm of keratinized tissue to allow flap Materials and Methods ted to and approved by the Ethical management. Subjects were exclud- Committee of the “Federico II” Uni- ed on the basis of the presence of Experimental Design versity, Naples, Italy (protocol No. any medical condition contraindicat- 25/14). Prior written consent was ob- ing surgical intervention, pregnancy The study was designed as a ran- tained, and the study was conduct- or lactation, or tobacco smoking. domized controlled clinical trial. In ed according to the principles of the the test sites, bovine-derived xeno- Declaration of Helsinki on experi- graft with 10% collagen (Bio-Oss, mentation involving human subjects. Experimental Procedures Geistlich) was placed immediately This report was conducted accord- after tooth extraction and covered ing to the CONSORT statement for Clinical Parameters with collagen membrane (Bio-Gide, improving the quality of reports of To achieve a baseline, FMPS15 and Geistlich), while in the control sites parallel-group randomized trials. FMBS16 were recorded at six sites regenerative procedures were not per tooth (distobuccal, buccal, me- performed. A single fresh alveolar siobuccal, mesiolingual, lingual, and socket was treated in each subject. Patient Population distolingual) using a manual peri- Each patient was unaware of which odontal probe (PCP-UNC 15, Hu- procedure had been performed. A total of 20 fresh alveolar sockets Friedy) and a probing force of 0.3 N. The fresh alveolar sockets were ran- in 20 patients were selected. The domly assigned to the test or control subjects were recruited from the Surgical Procedures group with the allocation conducted patient pool of the Department of After the elevation of the muco- using a commercially available com- Periodontology, “Federico II” Uni- periosteal flap extending one tooth puter software package (NCSS- versity, Naples, Italy. The following in the mesial and distal directions, PASS, Number Cruncher Statistical inclusion criteria were applied: aged tooth extraction was performed Systems). Treatment allocation was ≥ 18 years; presence of mandibular using forceps after a slight luxation performed at the time of surgery, or maxillary teeth to be extracted operated with rounded blades, so after tooth extraction, by opening because of an endodontic failure, that the periodontal socket fibers an envelope containing the informa- caries, or root fracture; integrity of were cut. Multirooted teeth were tion that the procedure was test (ie, extraction socket walls; Full-Mouth carefully extracted after separation bovine-derived xenograft with 10% Plaque Score (FMPS) and Full-Mouth of the roots (Figs 1 and 2). Granula- collagen and collagen membrane) Bleeding Score (FMBS) ≤ 25% at tion tissue was removed with hand Volume 37, Number 5, 2017 © 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. e292 Fig 3 Fresh alveolar socket filled with Fig 4 Bovine-derived xenograft with 10% Fig 5 The suture left the collagen bovine-derived xenograft with 10% collagen covered by collagen membrane. membrane partially uncovered. collagen. Fig 6 Vertical distance from reference Fig 7 Horizontal alveolar width (WIDTH). Fig 8 Thickness of buccal alveolar bone periodontal probe that connected the wall. cementoenamel junction of the adjacent teeth (CEJ) and the alveolar crest (AC). instruments, and the fresh alveolar it (Fig 5). For the control group, no The thickness was measured at the socket was rinsed with sterile saline. further treatment was applied, and center of the buccal and lingual Subjects were randomly assigned to the coagulum in the socket was left walls, 1 mm apically from the crest. the test (n = 10) or control (n = 10) open for spontaneous healing. Horizontal alveolar width and thick- group according to randomized ness of the alveolar walls were mea- procedures. For the test group, Intrasurgical Measurements sured using a manual caliper. bovine-derived xenograft with 10% After tooth extraction and before collagen (Bio-Oss, Geistlich) was randomization procedures, the fol- Postsurgical Instructions and placed into fresh alveolar sock- lowing intrasurgical measurements Infection Control ets, completely filling the socket were recorded: vertical distance For both groups, the sutures were but without applying compression from reference periodontal probe removed after 7 days. Patients re- (Fig 3), and covered with a colla- that connected the cementoenamel ceived ibuprofen (600 mg immedi- gen membrane (Bio-Gide, Geistlich) junction (CEJ) of the adjacent teeth ately after the surgical intervention (Fig 4). The collagen membrane was and alveolar crest (AC) (Fig 6), hori- and again after 4 hours) and system- left intentionally exposed to the oral zontal alveolar width (WIDTH) (Fig ic antibiotics (amoxicillin + clavulanic cavity, and nonresorbable monofila- 7), and thickness of the buccal and acid, 1 g twice per day for 7 days). ment sutures were used to stabilize lingual alveolar bone walls (Fig 8). Patients were instructed to rinse The International Journal of Periodontics & Restorative Dentistry © 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM
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