• Journal of Periodontal and Implant Science
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• v.47 no.6
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• pp.381-387
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• 2017

Purpose: The aim of this study was to evaluate volumetric and histologic changes in edentulous alveolar ridge areas after ridge preservation using basic fibroblast growth factor-2 (bFGF-2) in combination with collagenated biphasic calcium phosphate (BCP). Methods: The experiments were performed in 6 adult male beagle dogs. The following 3 groups were created: 1) ridge preservation with bFGF-2 and collagenated BCP (experimental group), 2) ridge preservation with collagenated BCP (positive control group), and 3) a negative control group in which no ridge preservation procedure was performed. Volumetric change analysis was performed using an optical scanner and casts. Histological observations were made using light microscopy. Results: After the initial swelling subsided, the magnitude of the volumetric change in the experimental group and positive control group was smaller than in the negative control group. In the experimental group, a distinct trend was observed for the resorption of residual bone and collagen fibers at 4 weeks and for more mature bone and faster healing at 12 weeks. Conclusions: Based on the findings of the present study, bFGF-2 may be considered for use as a therapeutic molecule in ridge preservation procedures.

• Journal of Periodontal and Implant Science
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• v.47 no.1
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• pp.51-63
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• 2017

Purpose: Following tooth extraction, alveolar ridge preservation (ARP) can maintain the dimensions of ridge height and width. Although previous studies have demonstrated the effects of ARP, few if any studies have investigated the compressive force applied during grafting. The aim of this study was to determine the effects of different compressive forces on the graft materials during ARP. Methods: After tooth extraction, sockets were filled with deproteinized bovine bone mineral with 10% porcine collagen and covered by a resorbable collagen membrane in a double-layered fashion. The graft materials were compressed using a force of 5 N in the test group (n=12) and a force of 30 N in the control group (n=12). A hidden X suture was performed to secure the graft without primary closure. Cone-beam computed tomography (CBCT) was performed immediately after grafting and 4 months later, just before implant surgery. Tissue samples were retrieved using a trephine bur from the grafted sites during implant surgery for histologic and histomorphometric evaluations. Periotest values (PTVs) were measured to assess the initial stability of the dental implants. Results: Four patients dropped out from the control group and 20 patients finished the study. Both groups healed without any complications. The CBCT measurements showed that the ridge volume was comparably preserved vertically and horizontally in both groups (P>0.05). Histomorphometric analysis demonstrated that the ratio of new bone formation was significantly greater in the test group (P<0.05). The PTVs showed no significant differences between the 2 groups (P>0.05). Conclusions: The application of a greater compressive force on biomaterials during ARP significantly enhanced new bone formation while preserving the horizontal and vertical dimensions of the alveolar ridge. Further studies are required to identity the optimal compressive force for ARP.

• Imaging Science in Dentistry
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• v.44 no.2
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• pp.143-148
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• 2014

Purpose: This study evaluated the efficacy of alveolar ridge preservation methods with and without primary wound closure and the relationship between histometric and micro-computed tomographic (CT) data. Materials and Methods: Porcine hydroxyapatite with polytetrafluoroethylene membrane was implanted into a canine extraction socket. The density of the total mineralized tissue, remaining hydroxyapatite, and new bone was analyzed by histometry and micro-CT. The statistical association between these methods was evaluated. Results: Histometry and micro-CT showed that the group which underwent alveolar preservation without primary wound closure had significantly higher new bone density than the group with primary wound closure (P<0.05). However, there was no significant association between the data from histometry and micro-CT analysis. Conclusion: These results suggest that alveolar ridge preservation without primary wound closure enhanced new bone formation more effectively than that with primary wound closure. Further investigation is needed with respect to the comparison of histometry and micro-CT analysis.

• Journal of Periodontal and Implant Science
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• v.39 no.3
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• pp.367-373
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• 2009

Purpose: Following tooth extraction caused by severe periodontitis, alveolar ridge dimension lose their original volume. To reduce the alveolar ridge dimension, the ridge preservation technique has been introduced and tested in many clinical studies with membrane alone or membrane plus graft, achieving reduced ridge loss compared to extraction only. The aim of the present clinical study was to compare the post-extraction dimensional changes in the membrane exposure group to non-exposure group during healing period following ridge preservation technique. Methods: Ridge preservation was performed in 44 extraction sites. After extraction, deproteinized bovine bone mineral coated with synthetic oligopeptide (Ossgen-$X15^{(R)}$) or deproteinized bovine bone mineral (Bio-$Oss^{(R)}$) was implanted into the socket. A collagen membrane (Bio-$Gide^{(R)}$) was trimmed to cover the socket completely and applied to the entrance of the socket. Four clinical parameters were compared between baseline and 6 months. Results: During healing period, membrane exposure was observed at 19 sites. At the re-entry, hard newly formed tissue were observed at the ridge preservation site. The grafted socket sites were well preserved in their volume dimension. In both groups, horizontal ridge width was reduced and vertical height was increased. There were not statistically significant differences in horizontal (-1.32 mm vs -1.00 mm) and vertical ridge change (2.24 mm vs 2.37 mm at buccal crest, 1.36 mm vs. 1.53 mm at lingual crest) between two groups. Conclusions: The ridge preservation approach after tooth extraction effectively prevented resorption of hard tissue ridge in spite of membrane exposure during healing period.

• Journal of Periodontal and Implant Science
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• v.51 no.2
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• pp.100-113
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• 2021

Purpose: Previous studies have solely focused on fresh extraction sockets, whereas in clinical settings, alveolar sockets are commonly associated with chronic inflammation. Because the extent of tissue destruction varies depending on the origin and the severity of inflammation, infected alveolar sockets may display various configurations of their remaining soft and hard tissues following tooth extraction. The aim of this study was to classify infected alveolar sockets and to provide the appropriate treatment approaches. Methods: A proposed classification of extraction sockets with chronic inflammation was developed based upon the morphology of the bone defect and soft tissue at the time of tooth extraction. The prevalence of each type of the suggested classification was determined retrospectively in a cohort of patients who underwent, between 2011 and 2015, immediate bone grafting procedures (ridge preservation/augmentation) after tooth extractions at Seoul National University Dental Hospital. Results: The extraction sockets were classified into 5 types: type I, type II, type III, type IV (A & B), and type V. In this system, the severity of bone and soft tissue breakdown increases from type I to type V, while the reconstruction potential and treatment predictability decrease according to the same sequence of socket types. The retrospective screening of the included extraction sites revealed that most of the sockets assigned to ridge preservation displayed features of type IV (86.87%). Conclusions: The present article classified different types of commonly observed infected sockets based on diverse levels of ridge destruction. Type IV sockets, featuring an advanced breakdown of alveolar bone, appear to be more frequent than the other socket types.

• Journal of Periodontal and Implant Science
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• v.47 no.3
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• pp.165-173
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• 2017

Purpose: The aim of this study was to radiographically and clinically compare the effect of extracellular matrix (ECM) membranes on dimensional alterations following a ridge preservation procedure. Methods: One of 2 different ECM membranes was applied during a ridge preservation procedure. A widely used ECM membrane (WEM; Bio-Gide, Geistlich Biomaterials, Wolhusen, Switzerland) was applied in the treatment group and a newly developed ECM membrane (NEM; Lyso-Gide, Oscotec Inc., Seongnam, Korea) was applied in the control group. Cone-beam computed tomography (CBCT) scans and alginate impressions were obtained 1 week and 6 months after the ridge preservation procedure. Results were analyzed using the independent t-test and the nonparametric Mann-Whitney U test. Results: There were no significant differences between the ECM membranes in the changes in the dimension, width, and height of the extraction socket or the quantity of bone tissue. Conclusions: The NEM showed comparable clinical and radiographic results to the WEM following the ridge preservation procedure.

• Journal of Korean Dental Science
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• v.14 no.1
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• pp.1-11
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• 2021

Purpose: The alveolar ridge preservation (ARP) is widely conducted for implant placement. However, experimental results using deproteinized porcine bone mineral (DPBM) have been scarce. This retrospective study evaluated factors affecting the primary stability of implants in an area where ARP was performed using DPBM. Materials and Methods: Thirty-eight patients were divided into two groups based on the primary stability, with torque value of 30 Ncm as borderline. To determine the factors that affect the primary stability of implants, we collected data from patients' medical records including age, sex, reentry time, socket location, remaining bone wall at the time of extraction, and type of collagen membrane, as well as from radiographs and histomorphometric analysis. Result: The results showed statistically significant difference for the remaining extraction socket wall (P=0.014), residual graft (P=0.029), and fibrovascular tissue (P=0.02) between the two groups. There was an insignificant tendency toward the time of reentry surgery (P=0.052) and location (P=0.077). All implants placed in sites using DPBM functioned well up to 3 years. Conclusion: Within the limitations of the present study, extraction socket wall, residual graft, and fibrovascular tissue can affect the primary stability at the time of implant placement on grafted sites using DPBM and collagen membranes. In addition, reentry time and locations can be considered. In future studies, comparative experiments in quantified models will be required to supporting the findings.

• Journal of Periodontal and Implant Science
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• v.47 no.4
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• pp.194-210
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• 2017

Purpose: The aim of the present study was to evaluate the healing of post-extraction sockets following alveolar ridge preservation clinically, radiologically, and histologically. Methods: Overall, 7 extraction sockets in 7 patients were grafted with demineralised bovine bone mineral and covered with a porcine-derived non-crosslinked collagen matrix (CM). Soft tissue healing was clinically evaluated on the basis of a specific healing index. Horizontal and vertical ridge dimensional changes were assessed clinically and radiographically at baseline and 6 months after implant placement. For histological and histomorphometric analysis, bone biopsies were harvested from the augmented sites during implant surgery 6 months after the socket preservation procedure. Results: Clinically, healing proceeded uneventfully in all the sockets. A trend towards reduced horizontal and vertical socket dimensions was observed from baseline to the final examination. The mean width and height of resorption were 1.21 mm (P=0.005) and 0.46 mm (P=0.004), respectively. Histologically, residual xenograft particles ($31.97%{\pm}3.52%$) were surrounded by either newly formed bone ($16.02%{\pm}7.06%$) or connective tissue ($50.67%{\pm}8.42%$) without fibrous encapsulation. The CM underwent a physiological substitution process in favour of well-vascularised collagen-rich connective tissue. Conclusions: Socket preservation using demineralised bovine bone mineral in combination with CM provided stable dimensional changes of the alveolar ridge associated with good reepithelialisation of the soft tissues during a 6-month healing period.

• Journal of Periodontal and Implant Science
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• v.47 no.6
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• pp.372-380
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• 2017

Purpose: The aim of this prospective pilot study was to compare alveolar ridge preservation (ARP) procedures with open-healing approach using a single-layer and a double-layer coverage with collagen membranes using radiographic and clinical analyses. Methods: Eleven molars from 9 healthy patients requiring extraction of the maxillary or mandibular posterior teeth were included and allocated into 2 groups. After tooth extraction, deproteinized bovine bone mineral mixed with 10% collagen was grafted into the socket and covered either with a double-layer of resorbable non-cross-linked collagen membranes (DL group, n=6) or with a single-layer (SL group, n=5). Primary closure was not obtained. Cone-beam computed tomography images were taken immediately after the ARP procedure and after a healing period of 4 months before implant placement. Radiographic measurements were made of the width and height changes of the alveolar ridge. Results: All sites healed without any complications, and dental implants were placed at all operated sites with acceptable initial stability. The measurements showed that the reductions in width at the level 1 mm apical from the alveolar crest (including the bone graft) were $-1.7{\pm}0.5mm$ in the SL group and $-1.8{\pm}0.4mm$ in the DL group, and the horizontal changes in the other areas were also similar in the DL and SL groups. The reductions in height were also comparable between groups. Conclusions: Within the limitations of this study, single-layer and double-layer coverage with collagen membranes after ARP failed to show substantial differences in the preservation of horizontal or vertical dimensions or in clinical healing. Thus, both approaches seem to be suitable for open-healing ridge preservation procedures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.3
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• pp.238-247
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• 2005

The placement of different graft materials and/or the use of occlusive membranes to cover the extraction socket entrance are techniques aimed at reducing alveolar ridge resorption and enhancing bone formation. However, in spite of its clinical advantage, the use of graft materials in fresh extraction socket has been questioned because particles of the grafted material have been found in alveolar sockets with fibrous union. The purposes of this study were to evaluate whether alveolar ridge resorption following tooth extraction could be reduced and bone formation could be enhanced by the application of absorbable gelatin spongy or gelatin spongy soaked with platelet rich plasma(PRP) used as a space filler in clinical and radiographic aspects. Eighty patients who were scheduled for extraction of both third molars were participated and carried out by one experienced surgeon. Following extraction of teeth, one extracted socket were treated with gelatin spongy as an experimental group A and the other were treated with gelatin spongy and PRP as an experimental group B. The routine extracted socket were healed without any treatment as a control group. From the period of extraction to 12 weeks postoperatively, we examined the clinical course and radiographic evaluation on socket at regular interval. Both experimental groups showed faster wound healing process than control clinically. Vertical gingival height of the extraction socket were less changed statistically in both experimental groups than control. The horizontal width change of the extraction socket were not significant statistically in any group. Radiographic changes of the alveolar bone height were less changed in both experimental groups and bone density were showed higher than control. There were a little difference between experimental group A and B. In conclusion, absorbable gelatin sponge and with PRP were considered as having preservation effects of extraction socket and stimulation of bone formation process after extraction.