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      A new method to standardize CBCT for quantitative evaluation of alveolar ridge preservation in the mandible: a case report and review of the literature

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          Abstract

          Cone-beam computerized tomography (CBCT) is an effective technique for assessment of changes to the alveolar ridge (AR). However, its accuracy and reliability could be improved by standardization of imaging positions to remain unchanged during measurements. In this study, an alveolar ridge preservation procedure was performed on a left third molar (38) socket by filling it with a radiotransparent synthetic bone graft, mineralized collagen (MC). Photographic, X-ray and CBCT images were captured before and 3, 6 and 12 months after surgery. A new method was developed to standardize CBCT for quantitative evaluation. Obtained CBCT images showed good comparability. The post-extraction alveolar width and height were both over 95% of the original values, but some resorption of the lingual bone wall (>50%) and inter-crestal bone (>30%). It is concluded that an effective positional standardization method was developed for CBCT assessment of AR dimensional changes in the posterior mandible. The use of MC in combination with a collagen membrane improved dimensional preservation of the AR.

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          Most cited references27

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          Dimensional ridge alterations following tooth extraction. An experimental study in the dog.

          To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change. Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope. It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall. The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood. (c) Blackwell Munksgaard, 2005.
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            Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study.

            Preservation of alveolar bone volume following tooth extraction facilitates subsequent placement of dental implants and leads to an improved esthetic and functional prosthodontic result. The aim of the present study was to assess bone formation in the alveolus and the contour changes of the alveolar process following tooth extraction. The tissue changes after removal of a premolar or molar in 46 patients were evaluated in a 12-month period by means of measurements on study casts, linear radiographic analyses, and subtraction radiography. The results demonstrated that major changes of an extraction site occurred during 1 year after tooth extraction.
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              Ridge preservation with the use of Bio-Oss collagen: A 6-month study in the dog.

              In previous short-term studies, it was observed that while the placement of biomaterial in alveolar sockets may promote bone formation and ridge preservation, the graft may in fact also delay healing. The objective of the present experiment was to evaluate the more long-term effect on hard tissue formation and the amount of ridge augmentation that can occur by the placement of a xenogeneic graft in extraction sockets of dogs. Five beagle dogs were used. The third mandibular premolars were hemi-sected. The distal roots were carefully removed. A graft consisting of Bio-Oss collagen was placed in one socket while the contra-lateral site was left without grafting. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections - two from the mesial root and two from the healed socket - were prepared, stained and examined under a microscope. The placement of Bio-Oss collagen in the fresh extraction socket served as a scaffold for tissue modeling but did not enhance new bone formation. In comparison with the non-grafted sites, the dimension of the alveolar process as well as the profile of the ridge was better preserved in Bio-Oss-grafted sites. The placement of a biomaterial in an extraction socket may modify modeling and counteract marginal ridge contraction that occurs following tooth removal.
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                Author and article information

                Journal
                Regen Biomater
                Regen Biomater
                rb
                rbio
                Regenerative Biomaterials
                Oxford University Press
                2056-3418
                2056-3426
                December 2015
                14 October 2015
                14 October 2015
                : 2
                : 4
                : 251-260
                Affiliations
                1Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, China,
                2Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing, 210009, China,
                3Beijing Allgens Medical Science & Technology Co., Ltd, Beijing, 100176, China,
                4Suzhou Key Laboratory of Biomaterials and Technologies & Collaborative Innovation Center of Suzhou Nano Science and Technology, Suzhou, 215123, China
                Author notes
                *Correspondence address. Prosthodontics Division, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, China. Tel: +86-13801589779; Fax: +86-25-86516414. E-mail: fmzhang@ 123456njmu.edu.cn
                Article
                rbv017
                10.1093/rb/rbv017
                4676331
                26816648
                3b063ff8-1119-412e-aae3-5ed28b1d1b49
                © The Author(s) 2015. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 July 2015
                : 21 August 2015
                : 30 August 2015
                Page count
                Pages: 10
                Categories
                Research Articles

                cbct,quantitative evaluation,alveolar ridge preservation

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