Effect of ridge preservation for early implant placement – is there a need to remove the biomaterial?

Abstract

AIM To assess (i) bone regeneration around implants placed early in sites with or without ridge preservation and (ii) if the bone substitute material (DBBM-C) has to be removed at implant placement. MATERIALS AND METHODS In eight beagle dogs, three sites were randomly assigned to ridge preservation (DBBM-C plus collagen matrix (CMX)) (two sites; RP) or spontaneous healing (1 site; SH). Four weeks later, in one of the RP sites, dental implants were placed without removing the DBBM-C (RP1), whereas in RP2 and SH sites all non-integrated DBBM-C and/or granulation tissue were removed before implant placement and concomitant GBR. Histomorphometric outcomes were assessed at 4 and 12 weeks. RESULTS The median buccal fBIC (first bone-to-implant contact) was located more apical in groups RP1: 1.34 mm (0.09; 2.96) and RP2: 1.41 mm (0.54; 2.72) than in group SH: 0.79 mm (0.26; 1.50) (p = 0.452) at 4 weeks. At 12 weeks, median buccal fBIC values were for RP1: 0.88 mm (0.00; 2.33), for RP2: 0.16 mm (0.00; 1.33) and for SH: 0.00 mm (0.00; 0.98) (p = 0.362). BIC values increased over 12 weeks in all groups. CONCLUSIONS Ridge preservation followed by early implant placement led to higher BIC values at 12 than at 4 weeks. There is no need to remove the biomaterial at implant placement to ensure osseointegration. No relevant differences were observed between the three groups for any outcome measure. Materials and methods:In eight beagle dogs, three sites were randomly assigned to ridge preservation (DBBM-C plus collagen matrix (CMX)) (two sites; RP) or spontaneous healing(1 site; SH). Four weeks later, in one of the RP sites, dental implants were placed without removing the DBBM-C (RP1), whereas in RP2 and SH sites all non-integrated DBBM-C and/or granulation tissue was removed before implant placement and concomitant GBR.Histomorphometric outcomes were assessed at 4 and 12 weeks. Results:The median buccal fBIC (first bone-to-implant contact) was located more apical in Conclusions: Ridge preservation followed by early implant placement led to higher BIC values at 12 than at 4 weeks. There is no need to remove the biomaterial at implant placement to ensure osseointegration. No relevant differences were observed between the three groups for any outcome measure.3 Clinical RelevanceScientific rationale for the study: Alveolar ridge preservation procedures are frequently performed rendering similar implant survival rates as implants placed in native bone.Disadvantages include a relatively long healing time prior to implant placement to allow for maturation of the bone graft material. Early implant placement following ridge preservation has not been investigated so far.Principal findings: Ridge preservation using DBBM-C and a CMX followed by early implant placement leads to higher BIC values at 12 weeks than at 4 weeks. There is no need to remove the biomaterial at implant placement to ensure osseointegration. Practical implications:Alveolar ridge preservation appears to allow for early implant placement without the need to ...

Volumetric changes following ridge preservation or spontaneous healing and early implant placement with simultaneous guided bone regeneration

“…Thus, it might help to establish new therapeutic concepts. The effect of the different treatments regarding histomorphometric outcomes has been published in a previous paper (Thoma et al., ) and supports the volumetric and linear results obtained and also showed no significant differences between the three treatment groups. Whether a future procedure could consist of leaving non‐integrated DBBM after ridge preservation at the time of implant placement has to be investigated separately in a clinical setting.…”

“…Ridge preservation is a widely accepted procedure applied to minimize volume loss following tooth extraction (Thoma et al., ). Although ridge preservation procedures cannot prevent from distinct bone remodelling processes, they limit a ridge collapse and might therefore facilitate subsequent implant placement (Avila‐Ortiz, Elangovan, Kramer, Blanchette, & Dawson, ).…”

“…A collagen matrix (CMX) was placed on top of the bone substitute material and sutured with four single sutures (Dafilon ® , B.Braun Medical AG, Melsungen, Germany). SH sites were cleaned and rinsed with sterile saline and left for secondary healing (Figure ; Thoma et al., ).…”

“…The membrane was apically stabilized using two biodegradable pins (Inion GTR™ Tack, Tampere, Finland). Primary wound closure was obtained applying one horizontal mattress suture and 2–3 single interrupted sutures per site (Gore Tex 5‐0 ® , W.L.Gore & Associates, Inc, Flagstaff AZ, USA; Figure ; Thoma et al., ).…”

Ridge preservation in molar extraction sites with an open‐healing approach: A randomized controlled clinical trial

“…One might criticize the delayed healing after ARP with open‐healing approach compared with natural healing, considering the percentage of new bone formation. However, it can be expected that eventual bone‐to‐implant contact percentages would reach similar levels in both the ARP site and the naturally healed site (Thoma et al, ). Recent long‐term studies exhibiting high survival rates of implants placed in ARP sites appear to support this (Apostolopoulos & Darby, ; Roccuzzo, Gaudioso, Bunino, & Dalmasso, ).…”