• Journal of Periodontal and Implant Science
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• v.46 no.6
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• pp.415-425
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• 2016

Purpose: The present study investigated the impact of 2 different suture techniques, the conventional crossed mattress suture (X suture) and the novel hidden X suture, for alveolar ridge preservation (ARP) with an open healing approach. Methods: This study was a prospective randomized controlled clinical trial. Fourteen patients requiring extraction of the maxillary or mandibular posterior teeth were enrolled and allocated into 2 groups. After extraction, demineralized bovine bone matrix mixed with 10% collagen (DBBM-C) was grafted and the socket was covered by porcine collagen membrane in a double-layer fashion. No attempt to obtain primary closure was made. The hidden X suture and conventional X suture techniques were performed in the test and control groups, respectively. Cone-beam computed tomographic (CBCT) images were taken immediately after the graft procedure and before implant surgery 4 months later. Additionally, the change in the mucogingival junction (MGJ) position was measured and was compared after extraction, after suturing, and 4 months after the operation. Results: All sites healed without any complications. Clinical evaluations showed that the MGJ line shifted to the lingual side immediately after the application of the X suture by $1.56{\pm}0.90mm$ in the control group, while the application of the hidden X suture rather pushed the MGJ line slightly to the buccal side by $0.25{\pm}0.66mm$. It was demonstrated that the amount of keratinized tissue (KT) preserved on the buccal side was significantly greater in the hidden X suture group 4 months after the procedure (P<0.05). Radiographic analysis showed that the hidden X suture had a significant effect in preserving horizontal width and minimizing vertical reduction in comparison to X suture (P<0.05). Conclusions: Our study provided clinical and radiographic verification of the efficacy of the hidden X suture in preserving the width of KT and the dimensions of the alveolar ridge after ARP.

• Journal of Periodontal and Implant Science
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• v.50 no.3
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• pp.197-206
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• 2020

Purpose: The aim of this study was to determine the impact of different compressive forces on deproteinized bovine bone mineral (DBBM) particles covered by native bilayer collagen membrane (NBCM) during alveolar ridge preservation (ARP) in the molar area, and to identify any histomorphometric and clinical differences according to the compressive force applied. Methods: Sockets were filled with DBBM after tooth extraction, and different compressive forces (30 N and 5 N, respectively) were applied to the graft material in the test (30 N) and control (5 N) groups. The DBBM in both groups was covered with NBCM in a double-layered fashion. A crossed horizontal mattress suture (hidden X) was then made. A core biopsy was performed using a trephine bur without flap elevation at the implant placement site for histomorphometric evaluations after 4 months. The change of the marginal bone level was measured using radiography. Results: Twelve patients completed the study. The histomorphometric analysis demonstrated that the mean ratios of the areas of new bone, residual graft material, and soft tissue and the implant stability quotient did not differ significantly between the groups (P>0.05). However, the mean size of the residual graft material showed a significant intergroup difference (P<0.05). Conclusions: The application of 2 compressive forces (5 N, 30 N) on particulate DBBM grafts during open-healing ARP in the posterior area led to comparable new bone formation, implant feasibility and peri-implant bone level.

• Journal of Periodontal and Implant Science
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• v.40 no.5
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• pp.227-231
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• 2010

Purpose: The healing process following tooth extraction apparently results in a pronounced resorption of the alveolar ridge. As a result, the width of alveolar ridge is reduced and severe alveolar bone resorption occurs. The purpose of this experiment is to clinically and histologically evaluate the results of using horse-derived bone mineral for socket preservation. Methods: The study comprised 4 patients who were scheduled for extraction as a consequence of severe chronic periodontitis or apical lesion. The extraction was followed by socket preservation using horse-derived bone minerals. Clinical parameters included buccal-palatal width, mid-buccal crest height, and mid-palatal crest height. A histologic examination was conducted. Results: The surgical sites healed uneventfully. The mean ridge width was $7.75{\pm}2.75\;mm$ at baseline and $7.00{\pm}2.45\;mm$ at 6 months. The ridge width exhibited no significant difference between baseline and 6 months. The mean buccal crest height at baseline was $7.5{\pm}5.20\;mm$, and at 6 months, $3.50{\pm}0.58\;mm$. The mean palatal crest height at baseline was $7.75{\pm}3.10\;mm$, and at 6 months, $5.00{\pm}0.82\;mm$. There were no significant differences between baseline and 6 months regarding buccal and palatal crest heights. The amount of newly formed bone was $9.88{\pm}2.90%$, the amount of graft particles was $42.62{\pm}6.57%$, and the amount of soft tissue was $47.50{\pm}9.28%$. Conclusions: Socket preservation using horse-derived bone mineral can effectively maintain ridge dimensions following tooth extraction and can promote new bone formation through osteoconductive activities.

• The Journal of Korean Academy of Prosthodontics
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• v.23 no.1
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• pp.13-37
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• 1985

Biocompatibility of dense synthetic hydroxylapatite is well known and the direct bond with adjacent bone developed. The purpose of this study was to evaluate the potential of clinical application of tooth ash for preservation of alveolar ridge. For this purpose the author performed an experimental implantation of the particulate and root form of both pure dense hydroxylapatite and tooth ash in alveolar sockets immediately after extraction. The pure dense hydroxylapatite was particulate form and root form made by Calciteck Inc. The tooth ash was prepared by incineration at $950^{\circ}C$, and the syrindrical form of the tooth ash was sintered and trimmed to fit the size of the each extraction socket of 10 mongrel dogs. After sugery the clinical, roentgenographical, and histological observation was carried out. The results obtained were as follows; 1. Clinical observation disclosed no dehiscence and exfoliation due to tissue rejection. 2. Vertical resorption of alveolar bone occurred in all experimental sockets as well as the control sites on the roentgenograph. 3. Osteoclastic activity appeared at the inner surfaces of the crestal alveolar bone on the 1st week but disappeared on the 2nd week. 4. There were macrophages in the particulate form on the 1st and 2nd week after surgery but no macrophages appered in the root form. S. New bone formation was developed from the bony wall of experimental sockets and grew to bond with the implant materials. In particulate form the new bone formation did not occur in central zone independently. 6. Tooth ash implant sites were covered with the newly formed bony trabeculation from third week, but Calcitite particles were covered with soft tissue. 7. Generally the healing occurred more rapidly in control sites than in implant sites.

• The Journal of Advanced Prosthodontics
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• v.6 no.6
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• pp.521-527
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• 2014

This case series evaluated the clinical efficacy of autogenous tooth bone graft material (AutoBT) in alveolar ridge preservation of an extraction socket. Thirteen patients who received extraction socket graft using AutoBT followed by delayed implant placements from Nov. 2008 to Aug. 2010 were evaluated. A total of fifteen implants were placed. The primary and secondary stability of the placed implants were an average of 58 ISQ and 77.9 ISQ, respectively. The average amount of crestal bone loss around the implant was 0.05 mm during an average of 22.5 months (from 12 to 34 months) of functional loading. Newly formed tissues were evident from the 3-month specimen. Within the limitations of this case, autogenous tooth bone graft material can be a favorable bone substitute for extraction socket graft due to its good bone remodeling and osteoconductivity.

• Journal of Periodontal and Implant Science
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• v.54 no.2
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• pp.108-121
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• 2024

Purpose: The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. Methods: Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. Results: Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48 mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. Conclusions: Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

• Implantology
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• v.22 no.4
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• pp.220-235
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• 2018

Sinus lift procedure is frequently required for the maxillary molar implant placement. Previous studies have demonstrated alveolar ridge preservation (ARP) can maintain the dimensions of ridge height and width. However, there is a lack of studies which evaluated the effect of ARP to avoid sinus lift procedure. Purpose of this study is to describe a method reducing the need of sinus lift surgery by ARP in maxillary molar areas and to assess the feasibility clinically, radiologically and histologically. Ten maxillary molars in ten patients had severe vertical bone resorption with minimal residual bone height. They were considered having the high possibility of the necessity of sinus lift procedure for dental implant after the extraction. After extraction, open healing ARP with deproteinized bovine bone mineral mixed with 10% collagen and resorbable collagen membranes was performed. After sufficient healing, dental implants were placed, and evaluated clinically and radiologically. Histological observation was conducted just before the implantation in one patient. Implants were successfully placed without sinus lift in all ten cases. All the implants were restored with no sign of complications, and patients are now in a close follow-up up to 20 months post-loading. Histological observation showed minimal inflammatory reaction and newly formed bone was substantially noted. The ARP technique has successfully avoided the sinus lift surgeries. It appears that this procedure may improve the simplicity of the clinical process for the clinicians and reduce the discomfort of patients.

• Journal of Periodontal and Implant Science
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• v.28 no.3
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• pp.409-418
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• 1998

The socket preservation technique is very effective in preventing alveolar ridge collapse after tooth extraction. Many technigues have been proposed for the primary closure of the flap and we tested a new graft design, "wing graft", which is a modification of free connective tissue graft in this case report. With this technique, primary closure was achieved without shallowing the vestibule. Additionally some vertical ridge augmentation effect could be observed and therefore good esthetic and functional results were obtained from this technique even in the case where severe bone loss and gingival recession was present. Finally we observed good healing appearance in the donor site after 2weeks. The results from this report suggest that this "wing graft" can be used successfully as an adjunctive procedure with socket preservation technique.

• Journal of Korean Dental Science
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• v.9 no.2
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• pp.55-62
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• 2016

Purpose: Alveolar bone develops with tooth eruption and is absorbed following tooth extraction. Various ridge preservation techniques have sought to prevent ridge atrophy, with no superior technique evident. Collagen has a long history as a biocompatible material. Its usefulness and safety have been amply verified. The related compound, atelocollagen, is also safe and displays reduced antigenicity since telopeptides are not present. Materials and Methods: The current study evaluated whether the $Rapiderm^{(R)}$ atelocollagen plug (Dalim Tissen, Seoul, Korea) improves tissue healing of extraction sockets and assessed the sequential pattern of bone regeneration using histology and microcomputed tomography in six beagle dogs. To assess the change of extraction socket, hard tissues were examined 2, 4, 6, and 8 weeks after tooth extraction. Result: The experimental groups showed better bone fill with slow remodeling process compared to the control groups although there was no statistical difference between groups. Conclusion: The atelocollagen seems to have a tendency to slow bone remodeling in the early phase of healing period and maintain remodeling capacity until late phase of remodeling. Also, use of atelocollagen increased the bone-to-tissue ratio compared to healing of untreated extraction socket.

• Journal of Periodontal and Implant Science
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• v.50 no.4
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• pp.238-250
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• 2020

Purpose: This study aimed to evaluate the biocompatibility and the mechanical properties of ultraviolet (UV) cross-linked and biphasic calcium phosphate (BCP)-added collagen membranes and to compare the clinical results of ridge preservation to those obtained using chemically cross-linked collagen membranes. Methods: The study comprised an in vitro test and a clinical trial for membrane evaluation. BCP-added collagen membranes with UV cross-linking were prepared. In the in vitro test, scanning electron microscopy, a collagenase assay, and a tensile strength test were performed. The clinical trial involved 14 patients undergoing a ridge preservation procedure. All participants were randomly divided into the test group, which received UV cross-linked membranes (n=7), and the control group, which received chemically cross-linked membranes (n=7). BCP bone substitutes were used for both the test group and the control group. Cone-beam computed tomography (CBCT) scans were performed and alginate impressions were taken 1 week and 3 months after surgery. The casts were scanned via an optical scanner to measure the volumetric changes. The results were analyzed using the nonparametric Mann-Whitney U test. Results: The fastest degradation rate was found in the collagen membranes without the addition of BCP. The highest enzyme resistance and the highest tensile strength were found when the collagen-to-BCP ratio was 1:1. There was no significant difference in dimensional changes in the 3-dimensional modeling or CBCT scans between the test and control groups in the clinical trial (P>0.05). Conclusions: The addition of BCP and UV cross-linking improved the biocompatibility and the mechanical strength of the membranes. Within the limits of the clinical trial, the sites grafted using BCP in combination with UV cross-linked and BCP-added collagen membranes (test group) did not show any statistically significant difference in terms of dimensional change compared with the control group.