Clinical trial results method of preserving bone tissue before implantation

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Authors

  • I.P. Ryzhova 1, PhD in Medical Sciences, full professor of the Prosthodontics Department
    ORCID: 0000-0002-1632-2149
  • N.M. Pogosyan 1, postgraduate at the Prosthodontics Department
    ORCID: 0000-0003-2421-6976
  • V.V. Chuev 1, 2, PhD in Medical Sciences, associate professor of the Therapeutic Dentistry Department; chief physician
  • A.A. Plugatyr 1, 2, Postgraduate at the Surgical Dentistry Department; deputy chief physician
    ORCID: 0000-0001-6625-8432
  • M.S. Novozhilova 3, PhD in Medical Sciences, dentist
    ORCID: 0000-0002-0339-0142
  • E.N. Adveev 1, PhD in Medical Sciences, assistant professor of the Prosthetic dentistry Department
    ORCID: 0000-0002-1149-5462
  • S.Yu. Ivanov 4, 5, Associate Member of the Russian Academy of Sciences, PhD in Medical Sciences, full professor of the Maxillofacial surgery Department; full professor of the Maxillofacial surgery Department
  • 1 Belgorod State University, 308015, Belgorod, Russia
  • 2 “VladMiVa Dental Centre” LLC, 308023, Belgorod, Russia
  • 3 Army Clinical Hospital no. 354, 620144, Ekaterinburg, Russia
  • 4 RUDN University, 117198, Moscow, Russia
  • 5 Sechenov University, 119991, Moscow, Russia

Abstract

Evaluated the effectiveness of the developed method of bone preserving after tooth extraction with using biological potential of own tissues in comparison with traditional methods of bone augmentation. The comparative analysis was carried out by comparing the results of computed tomography and densitometry. Main evaluation criteria is dynamic changes in the height and width of the alveolar bone, as well as its mineral composition during the treatment.
Results.
Analysis of results from computed tomography showed the advantages of developed method in comparison with traditional method of postoperative management. In group II, where the surgical bone preserving was by developed method, an increase in the height and weight of alveolar bone by 12.8% and 24.2% from initial parameters, it exceeds the results of group I (control group). In the group I, where was using traditional method of bone preservation, a decrease in the height and width of the alveolar bone was recorded by 5.77 and 11.4%. In group II, there was also an improvement in the quality of bone tissue by 21.6% compared to the initial volume. In group I, a decrease in bone mineral density was recorded by 12.8%.
Conclusion.
Due to the achievement of the optimal volume of the alveolar bone 3 months after tooth extraction, the use of the developed technique allows not only to reduce the time of the planned treatment, in particular implantation, but also to get a more predictable result.

Key words:

minimally invasive methods, implantation, osseointegration, replantation

For Citation

[1]
Ryzhova I.P., Pogosyan N.M., Chuev V.V., Plugatyr A.A., Novozhilova M.S., Adveev E.N., Ivanov S.Yu. Clinical trial results method of preserving bone tissue before implantation. Clinical Dentistry (Russia).  2021; 24 (2): 37—42

Introduction

The fundamental factor of successful implantation is the presence of enough alveolar bone tissue in the operating area, which is not always possible to provide after tooth extraction. Considering this fact, a protocol was developed to preserve the initial volume of alveolar bone tissue after tooth extraction using the biological potential of their own tissues.

There are many reasons that can lead to loss of alveolar bone tissue in the implantation area. This may be the presence of chronic inflammation, traumatic extraction, tooth injury, anatomical features. To prevent the loss of bone tissue after extraction, it is possible to use a number of common methods aimed at bone regeneration. Most often, these methods are based on the use of bone grafts and membranes and their use implies an increase in the rehabilitation time of patients, as well as possible repeated surgical interventions and related complications.

This article presents the results of using a minimally invasive method of preparing the alveolar bone in the area of the extracted tooth before implantation using the biological potential of its own tissues, which allows to shorten the treatment time and preserve the volume of the post-extraction alveolar bone.

Preparation of bone tissue before implantation is an important stage in planning prosthetic rehabilitation of patients. Since postextraction loss of alveolar bone tissue causes difficulties in planning treatment, and is also the cause of failures and complication of the planned implantation [1, 2]. Given the above fact, every dentist, before tooth extraction, is concerned about preventing the occurrence of a large loss of alveolar bone tissue to increase the success of implantation.

The loss of alveolar bone tissue and gums after tooth extraction can worsen the results of implantation and cause additional difficulties [3, 4]. Dental implantation occupies a leading place in the system of comprehensive rehabilitation of patients with dentition defects at the present stage of development. The actual problem of dentistry is to reduce the number of complications and reduce the time of dental rehabilitation. The long treatment time and the associated aesthetic and functional deficiencies can be very unpleasant, and sometimes become reasons for refusing orthopedic restoration on implants [5, 6]. Prosthetics on implants is currently one of the most reliable and predictable methods of dental prosthetics treatment and requires the creation of certain optimal conditions for their installation. Since alveolar bone tissue atrophy occurs after tooth extraction, it becomes impossible to install an implant without bone augmentation [7, 8]. The gold standard for increasing the volume of alveolar bone tissue is autotransplantation, as well as the technique of directed bone regeneration. To preserve and obtain the necessary volume of the alveolar bone, membranes (resorbable or non-resorbable) are used in combination with osteoplastic materials or autostructure [9, 10].

Both groups of drugs have a stimulating effect on the processes of bone tissue regeneration. The method of directed bone regeneration is a frequently used method in the practice of a dentist and helps to achieve the desired result [11, 12].

Osteoplastic materials for the replacement of defective bone tissue are allo-, auto- and xenografts. However, the use of bone graft is problematic due to its storage, transportation and the risk of immune conflict [13, 14]. The most common and widely used material is xenografts. A negative aspect in the use of xenogenic material is its high immunogenicity due to the presence of species-specific proteins in the material [15, 16].

The main disadvantage of directed bone regeneration in the restoration of alveolar bone defects is the complexity of adaptation and stability of fixation of the skeleton membrane to limit the reconstruction zone [17]. However, quite often, despite the carefully observed surgical protocol, osseoregeneration can be unpredictably complicated by the atypical course of the early postoperative period, the development of an inadequate inflammatory response, which may adversely affect the course of osteogenesis. The most common complication is the early divergence of sutures and the opening of the wound, which negatively affect the effectiveness, up to the complete leaching of bone augment [18—20].

In practice, there are various methods of preserving the volume of bone tissue of the alveolar bone of the extracted tooth, based on the natural resources of the body. All of them are aimed at preserving the initial volume of alveolar bone tissue and preventing its loss [21, 22]. These include the use of platelet-rich blood plasma and dental replantation. Dental replantation is an organ-preserving operation that prevents bone atrophy, the extension of antagonist teeth and the displacement of adjacent teeth. It has long been known that the removed tooth has a significant bioregenerative potential during replantation [23, 24].

Platelet cytoplasm is of great importance in the restoration of bone tissue, which contains two types of specialized granules: alpha and beta granules, the contents of which are released as a result of exocytosis during platelet activation [25, 26]. Platelets contain and secrete numerous growth factors, which leads to accelerated regeneration processes, reduced postoperative pain, and the use of the body's own reserves and potentials [27- 29].

Considering all possible ways to restore bone tissue, depending on the clinical situation, the doctor needs to choose the most predictable, less traumatic of them, which will provide a result for a long time and without complications, as well as having the ability to restore the required volume of the alveolar bone with various types of defects [30].

Based on the above facts, the aim of the study was to develop a method for minimally invasive and gentle preparation of the alveolar bone using the biological potential of the body before implantation and to study its effectiveness.

Material and methods.

35 patients (21 women and 14 men) aged 25—55 years were examined, aimed at surgical preparation of the alveolar bone before implantation. All patients were without identified concomitant somatic diseases. The criteria for inclusion in the study group were the presence of carious or non-carious lesions of the hard tissues of the teeth, chronic apical periodontitis, violation of the integrity of the crown of the teeth as a result of trauma.

The patients were divided into 2 groups. All patients underwent surgical preparation of the alveolar bone before implantation, which consisted for the I (control) group of atraumatic tooth extraction, taking venous blood into a vacuum tube with blood coagulation activator silica, making platelet-rich fibrin (PRF) by centrifugation and subsequent replenishment of the alveoli of the extracted tooth.

In the II (main) group, surgical training was used according to the developed technique (patent No. 2680797, effective from 22.05.2018). During the preimplantation period, atraumatic tooth extraction, extraction of a fragment of a removed tooth and its preparation for replantation were carried out. To do this, a fragment of the tooth root was cut out with cutters; the root canal was sealed with a filling material (ProRoot MTA) and treated antiseptically. In parallel with the preparation of the fragment of the removed tooth, the assistant prepared a platelet mass, which replenished the well. The operation ended with positioning the prepared fragment of the removed tooth in the alveolus to a depth of 2 mm and applying non-absorbable sutures.

Dynamic observation of patients in both groups included clinical examinations, examination and analysis of bone volume according to X-ray data and bone quality results according to densitometric studies. These studies were carried out using a Planmeca ProMax 3D CT tomograph.

Clinical examinations were carried out in 2 stages. The first stage is preimplantation: before tooth extraction, then on the 1st, 3rd, 7th day after surgical preparation of the postextraction alveola of the removed tooth and after 1 and 3 months.

After reaching the optimal volume of the alveolar bone, all patients underwent implantation. In group II, patients additionally underwent extraction of a fragment of a tooth integrated in the well of the removed tooth before implantation. The post-implantation follow-up period included clinical examinations of patients on the 1st, 3rd, 7th day after implantation. After 1 and 3 months, X-ray and densitometric studies of the integrated implants were carried out.

Results and discussion

The results of X-ray data on the control of the volume of bone tissue of the alveoli before tooth extraction, after 1 and 3 months shown in Table 1.The results of the densitometric study of bone density in Hounsfield units (HU) shown in Table 2.

Table 1. The volume of the alveolar bone according to CT in the pre-implantation period of treatment
Group Initially. Before tooth extraction After 1 month After 3 months
width (mm) height (mm) width (mm) height (mm) width (mm) height (mm)
I  5.31±0.37 6.03±0.40 4.30±0.25 5.62±0.33 4.70±0.25 5.70±0.33
II 5.52±0.42 6.12±0.35 5.70±0.41 6.25±0.5 6.23±0.41 7.60±0.5
Intergroup differences statistically significant at p≤0.05
Table 2. Bone tissue density in the preimplantation period of treatment (in Hounsfield units)
Group Before tooth extraction After 1 month After 3 month
I 746±102 350±107 650±95
II 678±100 365±106 810±103
Intergroup differences statistically significant at p≤0.05

As a result of the analysis of the data obtained at the first stage of the study, which included tooth extraction, insertion into the postextraction alveola (PRF) in the first group of patients, after 3 months, the result was obtained in the form of a change in the width of the alveolar bone by ±0.61 mm of data, this is 11.4% less than the initial indicators. According to the height of the indicators, ±0.33 mm is noted, which is 5.47% of the initial data before tooth extraction, respectively. The bone density was ±96 HU, which was 12.8% less than the initial parameters Table 3.

As a result of the analysis of computed tomography and densitometry data of patients of both groups at the 2nd stage of the study, there was a change in the width of the alveolar process from the initial data by 0.37 mm (7%) and a change in bone density by 118 HU (18%). In group II, the indicators were better. There was a change in the width of the alveolar process by 0.13 mm (2.08%), and the bone density decreased by only 60 HU (7.4% of the initial values; Table 4).

Table 3. The volume of the alveolar bone according to the results of computed tomography in the postimplantation period of treatment
Group Before implantation After 1 month After 3 months
width (mm) height (mm) width (mm) height (mm) width (mm) height (mm)
I 4.70±0.25 5.70±0.33 4.35±0.38 5.70±0.47 4.33±0.69 5.40±0.58
II 6.23±0.41 7.60±0.50 6.15±0.56 7.60±0.36 5.73±0.49 7.60±0.32
Intergroup differences statistically significant at p≤0.05
Table 4. Bone tissue density in the postimplantation period of treatment (in Hounsfield units)
Group Before implantation After 1 month After 3 months
I 650±95 350±107 532±95
II 810±103 365±106 750±103
Intergroup differences statistically significant at p≤0.05

Conclusion

The analysis of the obtained data of X-ray examination and densitometry during the study period showed that the group where the preparation of the alveolar bone was carried out by the developed method using platelet mass and the isolated fragment of the extracted tooth has significant advantages over the group where the preparation of the alveolar bone was carried out only using platelet mass. The developed method allows not only to preserve the existing volume of the alveolar bone, but also to reduce the duration of treatment, the financial costs of the patient, and there is also no need for repeated operations accompanied by the appearance of scarring.

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Received

March 31, 2021

Accepted

May 17, 2021

Published on

June 1, 2021