Cases of relatively safe dental implant treatment in patients with low-volume bisphosphonate (BP) have been gradually reported. Although bone augmentation is commonly used when the bone volume is insufficient for implant placement, the studies and case reports regarding the safety of bone augmentation in patients treated with BP remain insufficient. Herein, we report a case wherein bone augmentation was performed after BP treatment with bone healing realized according to imaging, and we review the literature regarding BP and bone augmentation. A 67-year-old Japanese woman requested implant treatment for a hopeless lower right second molar. She had been taking minodronic acid hydrate (50 mg/4 wk) for 18 months to treat steroid-induced osteoporosis. After obtaining informed consent, tooth extraction and bone augmentation within the extraction socket were performed. The tooth was extracted atraumatically to preserve the surrounding alveolar bone, and the extraction socket was intensely curetted. Subsequently, the socket was filled with carbonate apatite granules and covered with a biodegradable membrane, and the wound was sutured without tension. Although protracted wound healing without any symptoms of infection was observed, the wound healed completely. No clinical symptoms were observed, the color of the mucosa at the site was healthy, and imaging findings at 6 months postoperation indicated that osteogenesis had progressed uneventfully.

Background and Objectives: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets with and without periapical pathology. Materials and Methods: After the search and review of the literature in the electronic databases, 109 publications were achieved. The titles and abstracts of 66 publications were screened. After the evaluation of the full text of 22 publications, based on the inclusion criteria, six controlled clinical studies were included in this systematic review and meta-analysis. Results: The statistical calculation showed no heterogeneity among the studies included. The implant survival was 99.6% in the test (socket with periapical pathology) and control (socket without periapical pathology) groups of all the clinical trials. The results of the meta-analysis showed no statistically significant difference between test and control groups regarding the marginal bone level and the width of keratinized mucosa in all the studies. Other parameters indicating plaque level, bleeding on probing, and gingival recession also did not differ between test and control groups at the final follow-up in nearly all studies. Conclusions: Within the limitation of this systemic review and meta-analysis, the obtained data suggest that implants immediately placed into the extraction sockets of teeth exhibiting periapical pathology can be successfully osseointegrated for an extended period.

The aim of this systematic review was to answer the following question: \"Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models\"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE\'s RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.

BACKGROUND: Alveolar ridge preservation (ARP) procedures are designed to lessen dimensional changes in the alveolar ridge after tooth extraction. Wound healing after ridge preservation involves the formation of new vital bone in the former socket, and this vital bone is important in the osseointegration of dental implants.
METHODS: A series of ARP studies have been performed to help clinicians better understand the wound-healing events that occur following tooth extraction and ridge preservation. Different protocols have been examined using various materials and periods of healing time prior to implant placement. The primary aim of these studies was to ascertain the relative percentage of vital bone formation, residual graft material, and connective tissue (CT)/other at the healing site using histomorphometric examination of bone core biopsies obtained during osteotomy preparation.
RESULTS: For allografts, the use of demineralized bone alone or in combination with mineralized is associated with more vital bone formation than the use of mineralized allograft alone. For mineralized allografts, the use of cortical versus cancellous bone has only minimal impact on new bone formation. Xenografts from bovine and porcine sources appear to have similar vital bone formation. Longer healing times prior to implant placement are associated with increased vital bone formation and decreased residual graft material. The most stable component in most studies is the percentage of CT/other.
CONCLUSIONS: The percentage of vital bone and residual graft at ARP sites is dependent on the materials used and the length of healing time prior to obtaining core biopsies.
CONCLUSIONS: What factors may affect the amount of new bone at the ARP site? At a time point about 4 months after ARP, the type of graft material used for ARP plays a large role in new bone formation. Studies focus on means and standard deviations, but patients often do not \"follow the mean.\" Even if a single ARP protocol is used for all patients, there is great interindividual variability in new bone formation, and there is often variability between sites within a single patient. How long after ARP with an allograft should I wait to place an implant? Longer healing times such as 4-5 months generally provide higher amounts of vital bone formation than shorter healing times like 2-3 months. Differences in vital bone formation between ARP protocols tend to decrease with longer healing time. FDBA that contains demineralized bone, either alone or combined with mineralized FDBA, often provides higher amounts of new bone formation than 100% mineralized allograft, especially at shorter healing periods. Even a year after ARP with an allograft, residual graft material is often still present at the ARP site.

OBJECTIVE: Pigs are emerging as a preferred experimental in vivo model for bone regeneration. The study objective was to answer the focused PEO question: in the pig model (P), what is the capacity of experimental alveolar bone defects (E) for spontaneous regeneration in terms of new bone formation (O)?
METHODS: Following PRISMA guidelines, electronic databases were searched for studies reporting experimental bone defects or extraction socket healing in the maxillae or mandibles of pigs. The main inclusion criteria were the presence of a control group of untreated defects/sockets and the assessment of regeneration via 3D tomography [radiographic defect fill (RDF)] or 2D histomorphometry [new bone formation (NBF)]. Random effects meta-analyses were performed for the outcomes RDF and NBF.
RESULTS: Overall, 45 studies were included reporting on alveolar bone defects or extraction sockets, most frequently in the mandibles of minipigs. Based on morphology, defects were broadly classified as \'box-defects\' (BD) or \'cylinder-defects\' (CD) with a wide range of healing times (10 days to 52 weeks). Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 50% RDF (36.87%-63.15%) and 43.74% NBF (30.47%-57%) in BD, and 44% RDF (16.48%-71.61%) and 39.67% NBF (31.53%-47.81%) in CD, which were similar to estimates of socket-healing [48.74% RDF (40.35%-57.13%) and 38.73% NBF (28.57%-48.89%)]. Heterogeneity in the meta-analysis was high (I2 > 90%).
CONCLUSIONS: A substantial body of literature revealed a high capacity for spontaneous regeneration in experimental alveolar bone defects of (mini)pigs, which should be considered in future studies of bone regeneration in this animal model.

Background: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). Methods: The PICO strategy was used to formulate the hypothesis under study: \"For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?\" The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. Results: Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I2 = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results (p = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I2 = 45%), with no significant differences between studies (p = 0.91). Homogeneous results (I2 = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant (p < 0.00001) for this parameter. Conclusions: Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).

Patients may need removal of their teeth with placement of implants for rehabilitation. The clinical problem is the status of the remaining teeth and how this affects the timing for implant placement and the method for provisionalization. The importance of this review is to document the different strategies including sequential tooth removal and grafting and the use of teeth to provide a fixed provisional rather than a removable provisional, to provide surgeons with a reference to maintain patient function during their rehabilitation.
Pubmed.gov was the information source. Years reviewed included 1990 to 2022. Inclusion criteria included only articles in peer-reviewed journals. Variables evaluated included the success for placing implants immediately into extraction sites, and the methods to transition between steps in their rehabilitation. Data collected were results of systematic reviews and independent clinical series, as well as case reports of prosthetic methods for transitioning.
The search used terms which included implants in extraction sites (n = 205) and transitioning teeth to implants (n = 153). Twenty-one articles were reviewed involving extraction sites and 19 articles reviewed concerning transitioning from teeth to implants. The placement of implants immediately into excretion sites did have a relative risk for failure compared to implant placement in healed sites. The use of non-restorable teeth to support a fixed provisional prosthesis was successful; however, variability in reporting prevented a statistical analysis.
The surgeon needs to utilize teeth to provide support during treatment phases in order to provide the patient with a fixed provisional prosthesis to allow for implant integration and to provide time for graft healing. Specific methods used for transitioning do not have a significant evidence base to recommend one method but routine prosthetic techniques have been used and are reported in case reports.

OBJECTIVE: Conducting a scoping review (SR) to assess scientific evidence for topical simvastatin\'s impact on alveolar bone regeneration and determine its level of support for clinical applications.
METHODS: This SR followed the PRISMA-ScR and OSF registries protocol; systematic searching was conducted on MEDLINE/PubMed, Cochrane, Embase, Scopus, Web of Science, and LILACS, to identify relevant articles until June 2023. Inclusion criteria covered clinical trials, case series, prospective and retrospective studies, along with in vivo investigations, involving participants of any sex and age.
RESULTS: Out of 1312 identified studies, 20 (9 in vivo, 11 RCTs) met inclusion criteria. RCTs focused on third molar extraction, in vivo on mandibular incisor surgery. The majority of RCTs employed a collagen sponge and a simvastatin concentration of 10mg; conversely, most in vivo studies favored polylactide-co-glycolide and a 2 mg simvastatin concentration. RCTs had 3-month follow-ups; in vivo, studies extended to 8 weeks. Seven RCTs assessed pain outcomes, simvastatin did not significantly affect pain in six studies. Among four RCTs on postoperative swelling, only two observed a significant increase in the simvastatin group. In general, positive bone formation and the absence of adverse effects directly linked to topical simvastatin were observed across the study models.
CONCLUSIONS: Intra-alveolar simvastatin post-tooth extraction has been to be shown to be effective and safe for preserving alveolar bone, with varied concentrations and carriers, with no significant adverse effects.
CONCLUSIONS: This review provides critical insights into the effects of simvastatin on alveolar bone regeneration, informing potential benefits and possible challenges associated with its post-extraction application. OSF REGISTRY PROTOCOL: osf.io/q3bnf.

BACKGROUND: Autogenous particulate dentin (APD) has been used as a bone graft material for bone augmentation, but the specifics of its effect on alveolar ridge preservation (ARP) are uncertain. The aim of this study was to investigate the clinical and histomorphometric performance of APD compared with blood clot healing or other grafted materials in ARP.
METHODS: MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library and citation databases were searched until August 2, 2023 to identify randomized controlled trials that employed APD for ARP. Two independent meta-analyses were performed based on the different control groups (Group I: blood clot healing; Group II: other grafted materials). Weighted or mean differences (MDs) and corresponding 95% confidence intervals (CIs) were calculated. The protocol was prospectively registered with PROSPERO (CRD42023409339).
RESULTS: A total of 238 records were identified, of which ten studies with 182 participants were included. The meta-analysis indicated that APD resulted in fewer changes in horizontal ridge width (Group I: MD = 1.61, 95% CI 0.76-2.46; Group II: MD = 1.28, 95% CI 1.08-1.48) and labial bone height (Group I: MD = 1.75, 95% CI 0.56-2.94; Group II: P < .05) than the control treatments. Regarding histomorphometry, APD yielded a satisfactory proportion of vital bone area (MD = 10.51, 95% CI 4.70-16.32) and residual material area (MD = -8.76, 95% CI -12.81 to -4.71) in Group II, while there was no significant difference in Group I. Moreover, none of the secondary outcomes were significantly differed between groups.
CONCLUSIONS: Within this study limitations, APD effectively maintained the horizontal and vertical dimensions of the extraction sockets and exhibited favorable osteogenic properties and degradation capacity. Further well-designed randomized controlled trials with larger samples and longer follow-up periods are needed to evaluate whether APD is superior to other substitutes for ARP.

OBJECTIVE: To assess whether in animals or patients with ≥ 1 tooth extracted, hyaluronic acid (HyA) application results in superior healing and/or improved complication management compared to any other treatment or no treatment.
METHODS: Three databases were searched until April 2022. The most relevant eligibility criteria were (1) local application of HyA as adjunct to tooth extraction or as treatment of alveolar osteitis, and (2) reporting of clinical, radiographic, histological, or patient-reported data. New bone formation and/or quality were considered main outcome parameters in preclinical studies, while pain, swelling, and trismus were defined as main outcome parameters in clinical studies.
RESULTS: Five preclinical and 22 clinical studies (1062 patients at final evaluation) were included. In preclinical trials, HyA was applied into the extraction socket. Although a positive effect of HyA was seen in all individual studies on bone formation, this effect was not confirmed by meta-analysis. In clinical studies, HyA was applied into the extraction socket or used as spray or mouthwash. HyA application after non-surgical extraction of normally erupted teeth may have a positive effect on soft tissue healing. Based on meta-analyses, HyA application after surgical removal of lower third molars (LM3) resulted in significant reduction in pain perception 7 days postoperatively compared to either no additional wound manipulation or the application of a placebo/carrier. Early post-operative pain, trismus, and extent of swelling were unaffected.
CONCLUSIONS: HyA application may have a positive effect in pain reduction after LM3 removal, but not after extraction of normally erupted teeth.
CONCLUSIONS: HyA application may have a positive effect in pain reduction after surgical LM3 removal, but it does not seem to have any impact on other complications or after extraction of normally erupted teeth. Furthermore, it seems not to reduce post-extraction alveolar ridge modeling, even though preclinical studies show enhanced bone formation.