ARP results in a significant reduction in the vertical bone dimensional change following tooth extraction when compared to unassisted socket healing. The reduction in horizontal alveolar bone dimensional change was found to be variable. No evidence was identified to clearly indicate the superior impact of a type of ARP intervention (GBR, socket filler and socket seal) on bone dimensional preservation, bone formation, keratinised tissue dimensions and patient complications.

There is limited evidence to support the clinical benefit of ARP over USH in improving implant-related outcomes despite a decrease in the need for further ridge augmentation during implant placement. Similar implant placement feasibility, survival/success rates and marginal bone loss should be anticipated following ARP or USH. Currently, it is not clear which type of ARP intervention has a superior impact on implant outcomes.

Objectives: To compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket healing (Control). Material and methods:Patients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n= 14/). Cone Beam Computed Tomography (CBCT) images were recorded post-extraction and at 4 months, the mid-buccal and mid-palatal alveolar ridge heights (BARH/PARH) were measured. The alveolar ridge width, cross-sectional socket and alveolar-process area changes, implant placement feasibility, requirement for bone augmentation and postsurgical complications were also recorded.Results: BARH and PARH was found to increase with the SS (0.65 mm ± 1.1/0.65 mm ± 1.42) techniques, stabilise with GBR (0.07 mm ± 0.83/0.86 mm ±1.37) and decrease in the Control (−0.52 mm ± 0.8/−0.43 mm ± 0.83). Statistically significance was found when comparing the GBR and SS BARH (p = .04/.005) and GBR PARH (p = .02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (−2.17 mm ± 0.84), when compared to the Control (−2.3 mm ± 1.11) (p = .89). A mid-socket cross-sectional area reduction of 4% (−2.27 mm 2 ± 11.89), 1% (−0.88 mm 2 ± 15.48) and 13% (−6.93 mm 2 ± 8.22) was found with GBR, SS and Control groups (GBR vs. Control p = .01). The equivalent alveolar process area reduction was 8% (−7.36 mm 2 ± 10.45), 6% (−7 mm 2 ± 18.97) and 11% (−11.32 mm 2 ± 10.92). All groups supported implant placement, with bone dehiscence noted in 57% (n = 4), 64%(n = 7) and 85%(n = 12) of GBR, SS and Control cases (GBR vs. Control p = .03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown. Conclusion:GBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.

AimTo discuss the influence of Vitamin D defi ciency in the osseointegration process of a dental implant by way of a case report.SummaryA 29-year-old soldier attended clinic with a fractured mandibular premolar (tooth 44) that was traumatised following head trauma related to the detonation of an Improvised Explosive Device (IED) whilst serving on operational duty. The tooth was deemed unsalvageable and was extracted with immediate placement of a dental implant. The patient experienced no problems but at assessment, five months post-operatively, no osseo-integration of the implant was found. Concurrent medical investigations revealed that he was severely Vitamin D deficient and that this may have contributed to the implant failure.ConclusionVitamin D deficiency may play a role in the failure of osseointegration in dental implants. The assessment of vitamin D status in patients who have been in long-term hospital care or rehabilitation should be considered, prior to the placement of dental implants.

Supplementary sonic irrigation using the EndoActivator system was significantly more effective in removing stained collagen from the canal surface than syringe irrigation alone. EndoActivator used with large tip (size 35, .04 taper) and high power setting in size 40, .08 taper canals was more effective than other combinations.