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Implant Tribune Italian Edition No.2, 2016

27 Speciale Regeneration Implant Tribune Italian Edition - Maggio 2016 SR < < pagina 26 After the consent form had been signed, all of the patients underwent at least one session of scaling and root planing prior to the extraction procedures in order to provide a more favorable oral environment for wound healing. All of the patients underwent the tooth extraction and the ridge preservation procedure at baseline. Four months after tooth extraction, all of the sites were re-en- tered, bone biopsies were taken and implants were placed. Surgicalt reatment All of the patients received antibiotic therapy (2 gamoxicillin or 600 mg clindamycin, if allergic to penicillin) 1 h before the surgery and continued to taketheantibioticpostoperatively(1g amoxicillin or 300 mg clindamycin) b.i.d. for four days. All of the patients rinsed for 1 min with a 0.2% chlorhex- idine mouthwash prior to the sur- gery (as well as b.i.d. for the following three weeks) and were treated under local anesthesia using lidocaine with 1:50,000 epinephrine. All of the sur- gical procedures were performed by two surgeons (AB, FA), who received training during a one-week session before beginning the study. The training included calibration for the surgical and follow-up procedures, as well as the handling of any complica- tions. All of the patients were treated with the same surgical technique and periotomes were used around every tooth treated. Moreover, ultrasound bone surgery (PIEZOSURGERY, mec- tron, Italy) was performed where nec- essary in order to avoid buccolingual movements of the tooth, thus pre- venting damage to or a full fracture of the buccal bone wall. The extrac- tion sockets were thoroughly curet- ted and irrigated with a sterile saline solution. Cortico-cancellous porcine bone (mp3, OsteoBiol, Tecnoss Dental, Pianezza, Italy) was lightly condensed inside the socket and a resorbable collagen membrane (Evolution, Os- teo-Biol, Tecnoss Dental) was placed over it in order to cover the socket completely. The membrane, which was left exposed to the oral cavity, was stabilized with 4-0 silk sutures, and soft-tissue healing was by sec- ondary intention, since no flap was raised (Figs. 1-8). All of the pa- tients were instructed to continue the antibiotic therapy, and 550 mg naproxen sodium tablets were pre- scribed as an anti-inflammatory (b.i.d. as necessary). Removable pros- theses, if present, were not used for at least three weeks and then adjusted before reuse. The surgical re-entry was performed four months after the first-stage surgery. Bone biopsies were collected and implants (BL CT, Intra-Lock, Boca Raton, Fla., U.S.) were placed (Fig. 9). Of the implants placed, 61% had a diameter of 5 mm and 39% of 4 mm. Adjunctive augmentation procedures at the time of implant placement were necessary in 7% of the experimental sites. Three months after placement, the implants were uncovered and man- ually tested for stability (Fig. 10). At this time, impressions were taken us- ing a polyvinyl siloxane impression material (Flexitime, Heraeus Kulzer, Hanau, Germany) and customized resin impression trays. Final ceramic restorations were made and seated, andallofthepatientswereenrolledin an oral hygiene program, with a recall visit every three months (Figs. 11, 12). Clinical parameters Several clinical parameters were measured at each time of examina- tion, including at baseline and four months after the ridge preservation procedure. The clinical parameters taken into consideration in the pres- ent study were: – width of keratinized gingiva, measured at the midfacial point of the buccal aspect using a Wil- liams periodontal probe (at base- line, the measure corresponded to the distance between the mu- cogingival junction and the gin- gival margin; at the four-month examination, it was the distance between the mucogingival junc- tion and the highest part of the edentulous crest); – thicknessofthebuccalbone,meas- ured immediately after tooth ex- traction using a surgical caliper; – vertical bone changes, registered with a surgical stent positioned on the adjacent teeth and meas- ured with a Williams periodontal probe soon after the tooth extrac- tion and at the time of implant placement (four months after the first-stage surgery); – horizontal bone changes, meas- ured with a Williams periodontal probe soon after the tooth extrac- tion and after four months. Histological analysis Bone biopsies were collected during the secondstage surgery. The bone cores were immediately stored in a 10% buffered formalin solution and sent to the Department of Medical and Oral Sciences and Biotechnolo- gies, “Gabriele d’Annunzio” Universi- ty of Chieti-Pescara, Chieti, Italy. The samples were then processed to ob- tain thinground sections, using the Precise 1 Automated System (Assing, Rome, Italy). The specimens were de- hydrated in a graded series of etha- nol rinses and embedded in a glycol methacrylate resin (Technovit 7200 VLC, Heraeus Kulzer, Wehrheim, Germany). After polymerization, the specimens were sectioned along the longitudinal axis with a high-preci- sion diamond disc at approximately 150 μm and ground down to approx- imately 30 μm. Three slides were ob- tained from each specimen, stained with acid fuchsin and toluidine blue, andexaminedintransmittedandpo- larized light using a transmitted light microscope (Leitz Laborlux, Leitz, Wetzlar, Germany). One well-trained examiner (GI), who was not involved in the surgical treatment, evaluated the histological results. Statistical analysis Descriptive statistical analysis was performed on all of the data col- lected, with SPSS software (Version 6.1.2; SPSS, Chicago, Ill., US). Pearson’s chi-squared test was performed for categorical data. The p-value for sig- nificance was set at 0.05. All of the Fig. 12 - Final prosthesis. Fig. 11 - Radiographs three months after implant placement. Fig. 9 - Implant placement. Fig. 10 - Implant uncovering. measurements in the text and tables are given as medians and interquar- tile ranges (the difference between the 75th and 25th percentiles). Results A single-tooth extraction with a flap- less ridge preservation procedure was performed for each of the 37 patients enrolled in the study, with a total of 25 molars and 12 premolars that needed to be extracted owing to frac- ture (42%), nontreatable endodontic lesions (14%) and severe root decay (44%). All of the surgical procedures performed in this study were suc- cessful and no complications were observed during the healing period (Table 1). At baseline, the mean width of kerati- nizedgingivawas2.8±0.9mm(range of 1.0-5.0 mm). > > pagina 28 OsteoBiol ® ll timing naturale per la rigenerazione Biomateriali naturali collagenati R.O.E.N. S.a.s. Via Torino 23 - 10044 Pianezza (TO) - Italy Tel. +39 0119682604 - info@roen.it - www.roen.it C M Y CM MY CY CMY K ADV_OBL_ImplantTribune_168x237 PRINT.pdf 1 17/02/2016 12:23:52 Tel. +390119682604 - info@roen.it - www.roen.it ADV_OBL_ImplantTribune_168x237 PRINT.pdf 117/02/201612:23:52

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