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Background: Various grafting materials have been used for preservation of the dimensions of the residual alveolar ridge following tooth extraction. The purpose of this study was to evaluate clinical histomorphometric, and radiographic healing 4 months after tooth extraction with or without placement of a putty-form anorganic bovine-derived hydroxyapatite matrix combined with a synthetic cell binding peptide P-15 (Putty P15) to determine the effect on alveolar ridge preservation following exodontia. Methods: Twenty-four consecutive subjects in need of extraction of maxillary premolars were recruited. Recruited subjects were randomly assigned to the test (Putty P15 and bioabsorbable collagen wound dressing material) or control (bioabsorbable collagen wound dressing material only) group. Data were recorded at 1, 2, 4, 8, and 16 weeks after ridge preservation procedures. At 16 weeks, a reentry surgery was performed, clinical measurements were repeated, and bone core biopsies were obtained for histomorphometric analysis prior to dental implant placement. Results: The control group had a mean reduction in ridge height of -0.56 ± 1.04 mm, whereas alveolar ridge height appeared to remain unchanged in the test group (0.15 ± 1.76). The test group showed a mean reduction in ridge width of -1.31 ± 0.96 mm, whereas the mean value for the control group was -1.43 ± 1.05 mm. No statistical significance was observed between the groups. Mean bone density was significantly superior in the test group (2.08 ± 0.65 versus 3.33 ± 0.65). Histomorphometric analyses revealed similar percentages of bone vitality (test: 29.92% ± 8.46%; control: 36.54% ± 7.73%). Comparable percentages of bone marrow and fibrous tissue also were observed (test: 65.25% ± 6.41%; control: 62.67% ± 7.41%). Only 6.25% of the Putty P15 particles remained at 4 months in the analyzed biopsies. Conclusion: A favorable response was observed when Putty P15 was applied to extraction sockets, suggesting that it may be useful for alveolar ridge preservation prior to dental implant placement. [ABSTRACT FROM AUTHOR]

Background: Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics. Methods: Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery, Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plague index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months. Results: The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P<0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P>0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P>0.05). Conclusions: The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single tooth implants either immediately or delayed loaded. Other long term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study. [ABSTRACT FROM AUTHOR]

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