Comparison between two bone substitutes for alveolar ridge preservation after tooth extraction: Cone-beam computed tomography results of a non-inferiority randomized controlled trial

AIM To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to DBBM with 10% collagen (DBBM-C) for maintenance of bone volume after tooth extraction in the anterior maxilla. MATERIALS AND METHODS Sixty-six patients were randomly treated with DBBM or DBBM-C, both of which were covered with a collagen matrix for ridge preservation in the anterior maxilla. Cone-beam computed tomographic analysis was performed immediately and 4 months after treatment. The primary outcome, for which non-inferiority of DBBM was tested, was change in the horizontal ridge width 1 mm below the buccal alveolar crest (HW-1) 4 months after extraction. RESULTS Four months after extraction, HW-1 measured -1.60 mm ± 0.82 mm for DBBM-C, while the DBBM group showed a mean loss of -1.37 mm ± 0.84 mm (p = 0.28, 0.23 [95% CI: -0.19; 0.64]). The horizontal ridge width at 3 mm (HW-3) showed -0.98 mm (±0.67 mm) for DBBM-C and -0.84 mm (±0.62 mm) for DBBM (p = 0.40, 0.12 [95% CI: -0.19; 0.45]), and the horizontal ridge width at 5 mm (HW-5) showed -0.67 mm (±0.47 mm) for DBBM-C and -0.56 mm (±0.48 mm) for DBBM (p = 0.36, 0.11 [95% CI: -0.13; 0.34]). CONCLUSIONS The present clinical trial demonstrated non-inferiority of DBBM compared to DBBM-C for maintenance of alveolar bone volume 4 months after tooth extraction in the anterior maxilla

Profilometric changes of peri-implant tissues over 5 years: a study comparing a one- and two-piece implant system

Avaliar as alterações profilométricas dos tecidos moles vestibulares entre o exame inicial e os 5 anos de acompanhamento, utilizando sistemas de implantes dentários de um e dois estágios. Sessenta pacientes receberam aleatoriamente implantes dentários de dois estágios (BRA) ou de estágio único (STM). Os modelos foram obtidos no início do estudo (após a inserção da coroa), no primeiro ano e no quinto ano de acompanhamento. Os arquivos de estereolitografia foram obtidos dos modelos para superposição digital. Um implante e o dente natural contralateral foram selecionados para a análise. Trinta e três pacientes (BRA = 16; STM = 17) foram incluídos. As medidas incluíram mudanças para altura da coroa (CH) e espessura estimada do tecido mole, bem como a mudança profilométrica no implante e no local do dente. Métodos não paramétricos foram aplicados para as análises estatísticas, medianas e quartis foram apresentados. O grupo BRA perdeu -0,39 mm e o grupo STM perdeu -0,40 mm de volume entre o início e o acompanhamento de 5 anos no local do implante (p> 0,05). O local do dente perdeu -0,18 mm (BRA) e -0,12 mm (STM) (p> 0,05). As diferenças de volume entre implantes e dentes foram de -0,05 mm (inicial a 1 ano) e -0,25 mm (inicial a 5 anos) para BRA, enquanto para STM, os valores foram de 0,03 mm (inicial a 1 ano) e -0,16 mm (inicial a 5 anos). As mudanças para CH em 1 e 5 anos de acompanhamento foram de 0,10 e 0,09 mm (BRA) e 0,03 e 0,22 mm para STM. As mudanças na espessura do tecido em 1 e 5 anos no grupo BRA foram de -0,28 e -0,66 mm a 1 mm, -0,21 e -0,46 mm a 3 mm e -0,32 e -0,45 mm a 5 mm, respectivamente. As mudanças no grupo STM foram de -0,15 e -0,54 mm a 1 mm, -0,24 e -0,48 mm a 3 mm e -0,32 e -0,57 mm a 5 mm, respectivamente. Nenhuma mediana significativamente diferente foi observada. Alterações mínimas, lineares e profilométricas, ocorreram nos locais dos implantes entre o exame inicial e os 5 anos, entre os locais do implante e do dente e entre os dois sistemas de implantes.To assess the profilometric changes of the buccal soft tissues between baseline and 5 years of loading using a one- and two-piece dental implant system. Sixty patients randomly received dental implants of either a two-piece type (BRA) or a one-piece type (STM). Casts were obtained at baseline (after crown insertion), at the 1-year and at the 5-year followup. Stereolithography files were obtained from the casts for digital superimposition. One implant and the contralateral natural tooth were selected for the analysis. Thirty-three patients (BRA = 16; STM = 17) were included. Measurements included changes for crown height (CH) and estimated soft tissue thickness, as well as the profilometric change at the implant and the tooth site. Nonparametric methods were applied for the statistical analyses and medians and quartiles presented. The BRA group lost -0.39 mm and the STM group lost -0.40 mm of volume between baseline and the 5-year follow-up at the implant site (p > 0.05). The tooth site lost -0.18 mm (BRA) and -0.12 mm (STM) (p > 0.05). Volume differences between implants and teeth amounted to -0.05 mm (baseline to 1 year) and -0.25 mm (baseline to 5 years) for BRA, while for STM, the values were 0.03 mm (baseline to 1 year) and -0.16 mm (baseline to 5 years). The changes for implant CH at 1 and 5 years of follow-up amounted 0.10 and 0.09 mm (BRA) and to 0.03 and 0.22 mm (STM). The changes in tissue thickness at 1 and 5 years in the BRA group amounted to -0.28 and -0.66 mm at 1 mm, -0.21 and -0.46 mm at 3 mm, and -0.32 and -0.45 mm at 5 mm, respectively. The changes in the STM group amounted to -0.15 and -0.54 mm at 1 mm, -0.24 and -0.48 mm at 3 mm, and -0.32 and -0.57 mm at 5 mm, respectively. No significantly different medians were observed. Minimal profilometric and linear changes occurred at implant sites between baseline and 5 years, between implant and tooth sites and between the two implant systems

Profilometric changes of peri-implant tissues over 5 years: a study comparing a one- and two-piece implant system

Avaliar as alterações profilométricas dos tecidos moles vestibulares entre o exame inicial e os 5 anos de acompanhamento, utilizando sistemas de implantes dentários de um e dois estágios. Sessenta pacientes receberam aleatoriamente implantes dentários de dois estágios (BRA) ou de estágio único (STM). Os modelos foram obtidos no início do estudo (após a inserção da coroa), no primeiro ano e no quinto ano de acompanhamento. Os arquivos de estereolitografia foram obtidos dos modelos para superposição digital. Um implante e o dente natural contralateral foram selecionados para a análise. Trinta e três pacientes (BRA = 16; STM = 17) foram incluídos. As medidas incluíram mudanças para altura da coroa (CH) e espessura estimada do tecido mole, bem como a mudança profilométrica no implante e no local do dente. Métodos não paramétricos foram aplicados para as análises estatísticas, medianas e quartis foram apresentados. O grupo BRA perdeu -0,39 mm e o grupo STM perdeu -0,40 mm de volume entre o início e o acompanhamento de 5 anos no local do implante (p> 0,05). O local do dente perdeu -0,18 mm (BRA) e -0,12 mm (STM) (p> 0,05). As diferenças de volume entre implantes e dentes foram de -0,05 mm (inicial a 1 ano) e -0,25 mm (inicial a 5 anos) para BRA, enquanto para STM, os valores foram de 0,03 mm (inicial a 1 ano) e -0,16 mm (inicial a 5 anos). As mudanças para CH em 1 e 5 anos de acompanhamento foram de 0,10 e 0,09 mm (BRA) e 0,03 e 0,22 mm para STM. As mudanças na espessura do tecido em 1 e 5 anos no grupo BRA foram de -0,28 e -0,66 mm a 1 mm, -0,21 e -0,46 mm a 3 mm e -0,32 e -0,45 mm a 5 mm, respectivamente. As mudanças no grupo STM foram de -0,15 e -0,54 mm a 1 mm, -0,24 e -0,48 mm a 3 mm e -0,32 e -0,57 mm a 5 mm, respectivamente. Nenhuma mediana significativamente diferente foi observada. Alterações mínimas, lineares e profilométricas, ocorreram nos locais dos implantes entre o exame inicial e os 5 anos, entre os locais do implante e do dente e entre os dois sistemas de implantes.To assess the profilometric changes of the buccal soft tissues between baseline and 5 years of loading using a one- and two-piece dental implant system. Sixty patients randomly received dental implants of either a two-piece type (BRA) or a one-piece type (STM). Casts were obtained at baseline (after crown insertion), at the 1-year and at the 5-year followup. Stereolithography files were obtained from the casts for digital superimposition. One implant and the contralateral natural tooth were selected for the analysis. Thirty-three patients (BRA = 16; STM = 17) were included. Measurements included changes for crown height (CH) and estimated soft tissue thickness, as well as the profilometric change at the implant and the tooth site. Nonparametric methods were applied for the statistical analyses and medians and quartiles presented. The BRA group lost -0.39 mm and the STM group lost -0.40 mm of volume between baseline and the 5-year follow-up at the implant site (p > 0.05). The tooth site lost -0.18 mm (BRA) and -0.12 mm (STM) (p > 0.05). Volume differences between implants and teeth amounted to -0.05 mm (baseline to 1 year) and -0.25 mm (baseline to 5 years) for BRA, while for STM, the values were 0.03 mm (baseline to 1 year) and -0.16 mm (baseline to 5 years). The changes for implant CH at 1 and 5 years of follow-up amounted 0.10 and 0.09 mm (BRA) and to 0.03 and 0.22 mm (STM). The changes in tissue thickness at 1 and 5 years in the BRA group amounted to -0.28 and -0.66 mm at 1 mm, -0.21 and -0.46 mm at 3 mm, and -0.32 and -0.45 mm at 5 mm, respectively. The changes in the STM group amounted to -0.15 and -0.54 mm at 1 mm, -0.24 and -0.48 mm at 3 mm, and -0.32 and -0.57 mm at 5 mm, respectively. No significantly different medians were observed. Minimal profilometric and linear changes occurred at implant sites between baseline and 5 years, between implant and tooth sites and between the two implant systems

Simultaneous Assessment of Soft and Hard Tissue Behaviors After Alveolar Ridge Preservation Using Bone Substitutes

This study aimed to simultaneously assess hard and soft tissues alterations and their proportions after alveolar ridge preservation (ARP). Participants (n = 65) who were previously enrolled in a clinical trial investigating ARP healing were selected. The CBCT DICOM (Digital Imaging and Communications in Medicine) and the cast STL (stereolithographic) files of each subject were imported, segmented, and superimposed. A cross-section view of the superimposed image presented the outlines from each DICOM and STL file. The center of preserved ridge was selected in the superimposed image and used to draw the reference lines to realize the measurements. Horizontal linear measurements determined ridge width (RW) and its respective hard/soft tissue proportion (H:S) at 1, 3, 5, and 7 mm below the buccal bone crest immediately after ARP and at the 4-month follow-up. At 1 mm, the baseline RW was 11.6 mm and reduced to 10 mm after 4 months. The baseline H:S was 65%:35% and was 43%:57% at the 4-month follow-up. Considering only the buccal half of the ridge, baseline H:S was 77%:23%, while after 4 months it shifted to 58%:42%. A similar pattern was observed at 3, 5, and 7 mm but with decreased resorption degree. The present study showed that hard tissue is mostly responsible for RW loss after healing, especially in the first 3 mm below the buccal bone crest. Soft tissue partially compensated for the hard tissue shrinkage, gaining thickness in the analyzed areas