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Prospective, Comparative Volumetric Assessment of Alveolar Ridge Preservation Utilizing Different Bone Grafting Materials

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Prospective, Comparative Volumetric Assessment of Alveolar Ridge Preservation Utilizing Different Bone Grafting Materials PROSPECTIVE, COMPARATIVE VOLUMETRIC ASSESSMENT OF ALVEOLAR RIDGE PRESERVATION UTILIZING DIFFERENT BONE GRAFTING MATERIALS David Paul Semeniuk A thesis submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfilment of the requirements for the degree of Master of Science in Periodontology in the School of Dentistry. Chapel Hill 2017 Approved by: Jonathan Reside Ingeborg De Kok Donald Tyndall ã 2017 David Paul Semeniuk ALL RIGHTS RESERVED ii ABSTRACT David Paul Semeniuk: Prospective, comparative volumetric assessment of alveolar ridge preservation utilizing different bone grafting materials (Under the direction of Jonathan Reside) Objectives: Characterize dimensional changes of the alveolus and soft tissues 3 months following post extraction ridge preservation with different grafting materials. Methods: 80 patients were recruited. Post-extraction sockets were randomly treated with Allograft, Alloplast, or Xenograft bone graft with membrane coverage, or ungrafted control with membrane alone. CBCT imaging and impressions were taken at baseline and 3 months post extraction. Dimensional changes were evaluated using 3D Slicer. Implant planning using coDiagnostiXTM was used to evaluate the need for additional bone augmentation. Results: 12 patients provided pilot data. No differences in volumetric or linear dimensional changes were seen between treatment groups, but trend for improved hard and sot tissue maintenance were suggested compared to the control group. Buccal plate thickness was inversely related to bone loss when not grafted. Ideal implant positioning in treatment groups is achieved, with the control group often requiring further bone grafting. iii Conclusions: Ridge preservation procedures may reduce the amount of bone loss and reduce the need for additional bone grafting prior to implant surgery. iv ACKNOWLEDGEMENTS Firstly, I would like to thank and acknowledge firstly Dr Jonathan Reside for his mentorship, help and support, and friendship not only throughout this project but also throughout the entire residency program. Gratitude to Dr’s Lyndon Cooper, Ingeborg De Kok, and Jonathan Reside for their involvement in the initial conception of this project, along with securing the support from Industry. Thanks to Denstply for their financial support of this project. Many thanks also go to Dr Heidi Kohltfarber for her initial help and direction, putting me along the path which allowed me to generate the protocol; my committee members Drs Reside, De Kok and Tyndall for their support; Ms Gidget Jenkins and Teresa Etscovitz for their help and support with IRB and regulatory requirements. Lastly thank you to the staff of the graduate periodontics clinic, fellow residents and DDS students who helped out clinically, through moral support and patient referral. This project is supported by an unrestricted grant from Dentsply IH AB. v TABLE OF CONTENTS LIST OF FIGURES .................................................................................................... x LIST OF TABLES ................................................................................................... xii LIST OF ABBREVIATIONS ................................................................................... xiii LITERATURE REVIEW ............................................................................................. 1 Extraction Socket Healing ........................................................................... 2 Histological Healing of an Extraction Site ............................................ 2 Clinical Healing of an Extraction Site ................................................... 7 Factors Affecting Wound Healing of Extraction Sockets ....................... 13 Ridge Preservation ..................................................................................... 16 Rationale ............................................................................................ 16 Histologic Healing following ridge preservation ................................. 18 Ridge Preservation Materials .................................................................... 22 Autograft ............................................................................................ 23 Allograft .............................................................................................. 23 Xenograft ........................................................................................... 25 Alloplast ............................................................................................. 30 Resorbable and non-resorbable membranes .................................... 31 Ridge Preservation OutcoMes .................................................................. 35 Factors Affecting Outcome ................................................................ 35 vi Clinical and Histologic Outcomes ...................................................... 41 Clinical Outcome – Additional grafting needs, Ability to place implant ....................................................................... 48 IMMediate IMplants and Extraction Site Healing .................................... 52 New Technologies and DevelopMents in Ridge Preservation ..................................................................................... 54 Conclusions ................................................................................................ 59 AIMS AND OBJECTIVES ....................................................................................... 60 PriMary objective ........................................................................................ 61 Secondary objectives ................................................................................. 61 MATERIALS AND METHODS ................................................................................ 63 Graft Products ............................................................................................. 64 Inclusion and Exclusion Criteria ............................................................... 66 Inclusion criteria ................................................................................. 66 Exclusion criteria .................................................................................. 6 SaMple size calculation ............................................................................. 67 Clinical Visits .............................................................................................. 68 Visit 1: Screening ............................................................................... 68 Radiographic stent fabrication ........................................................... 69 Visit 2: Extraction, Initial CBCT, and Socket Preservation Surgery ......................................................................... 70 Visit 3: Post-Operative Visit (14 days ± 2 days) ................................ 75 Visit 4: Cone Beam Computed Tomography Imaging (12 weeks ± 7 days) ............................................................. 75 Data Collection and processing ................................................................ 76 vii Primary outcome variable – Volumetric osseous changes ............................................................................... 76 Secondary outcome variables ........................................................... 79 Measurement Error Calculations ....................................................... 84 Statistical analysis ..................................................................................... 86 RESULTS ................................................................................................................ 88 Baseline characteristics ............................................................................ 88 MeasureMent/Registration Error ............................................................... 89 SegMentation Error .................................................................................... 90 Linear MeasureMent Error ......................................................................... 91 VoluMe Calculation Error ........................................................................... 91 Change in Bone and Soft Tissue Volume ..................................................... 92 Change in Bone and Soft Tissue Linear DiMensions ............................. 97 Bone and Soft Tissue Loss Color Maps .......................................... 102 Correlation of Buccal Plate Thickness to Post-OperativeHealing OutcoMes .......................................................... 104 Ability to Place a Dental IMplant and Need for Additional AugMentation ......................................................................... 105 DISCUSSION ........................................................................................................ 108 Tissue VoluMe Change ............................................................................ 108 Linear Tissue Change .............................................................................. 111 Graft Material Selection ........................................................................... 114 Additional Grafting Needs ....................................................................... 117 Study Design ............................................................................................. 118 CONCLUSION ...................................................................................................... 123 viii REFERENCES .....................................................................................................
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