Application of platelet-rich plasma for alveolar ridge preservation. A review article

INTRODUCTION: Bone quality and quantity are key prerequisites for dental implant surgery. The methods of reducing tissue resorption after tooth extraction are called alveolar ridge preservation and have recently gained increasing popularity. One of them is the application of autologous platelet concentrates. They release an abundance of growth factors with the potential to accelerate the healing process.AIM:The present review aims to observe the application of platelet-rich plasma in postextraction dental sockets and evaluate its efficacy for hard and soft tissue healing and preservation according to the literature. We carefully analyzed, compared, and summarized the collected data and found numerous research and methodological gaps that can explain the heterogeneity in the studies.MATERIALS AND METHODS: The review is based on the existing scientific database and includes 222 studies. It provides a comparative analysis and guidelines for further research. RESULTS: There is high heterogeneity among studies, regarding the effect of platelet concentrates and platelet-rich plasma in particular on alveolar ridge preservation. Most of them validate its beneficial impact on tissue healing and volumetric preservation, which facilitate the subsequent implant placement.       CONCLUSION: The scientific data about the efficacy of platelet concentrates for soft tissue healing and preservation of the alveolar ridge are not univocal. Further research, longitudinal studies, randomized controlled trials, systematic reviews, and meta-analyses are required to evaluate its efficacy and determine whether it is superior to other methods for socket preservation

Immediate implant placement using customized healing abutments as a method of hard and soft tissue preservation. A review article

INTRODUCTION: Dental implant placement with its excellent and predictable results is becoming the treatment of choice after tooth removal. A key step in creating a proper environment and conditions for it is the process of tissue preservation after the extraction. Various ridge preservation procedures have been suggested and performed, one of which is the application of immediate implant protocol using customized healing abutments. AIM: This review observes immediate implants not only as a definitive treatment after tooth extraction but also as a method for ridge preservation, especially in conjunction with customized healing abutments. We compared and evaluated the reports on their application and summarized their features, advantages, and limitations. MATERIALS AND METHODS: The present article is based on 61 articles. A manual and electronic search using PubMed and Google Scholar databases was conducted until June 2022. RESULTS: The majority of studies support the concept of immediate implant placement with customized healing abutments as a successful and reliable strategy for tissue preservation. It has numerous advantages, some of which are reduced healing time and post-operative discomfort, and excellent aesthetic results without the need for additional surgical stages. CONCLUSION: Further investigation is still necessary to clarify the exact protocols and indications for this treatment, and to point out the conditions, which demand greater caution

Bisphosphonate-Related Osteonecrosis of the Jaw

Introduction: Bisphosphonates are efficiently used to treat osteoporosis, bone metastases of malignant tumors, Paget`s disease and multiple myeloma. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) represents a severe side effect, consisting of progressive bone destruction in the maxillofacial region. The aim of the study is to present clinical information from patients diagnosed with medication-related osteonecrosis of the jaw.Materials and Methods: A retrospective study was performed involving 32 patients hospitalized at the Specialized Hospital for Maxillofacial Surgery in Sofia, Bulgaria with diagnosis of osteonecrosis of the jaws. The selection criteria of the patients were based on the existence of history of bisphosphonate treatment.Results: Thirty-one patients were on a bisphosphonate therapy for bone metastasis. Among cancer patients, the use of denosumab and zoledronic acid was reported. One patient had received oral treatment with ibandronic acid for osteoporosis. In 23 patients, the bone lesions involved the lower jaw, while in 9 patients the lesions persisted in the maxillary bone. Twenty-eight patients were diagnosed with a second stage of BRONJ. Exposed bone, purulent secretion, fistulas and swelling were clinically observed among patients. All of the patients received antibiotic treatment for BRONJ, while 2 of them were treated surgically. All patients were discharged with improvement after the treatment. Six patients were hospitalized again after time due to remission.Conclusion: In conclusion, the study shows that BRONJ is mainly associated with the use of denosumab and zoledronic acid. Most of the patients seek medical attention in second stage of osteonecrosis. The recommended conservative treatment with antibiotics can lead to remission only in some cases.