Search Results (50)

Alveolar ridge preservation using biomaterials is a well-established approach to counteract post-extraction bone resorption and optimize conditions for implant placement. However, most studies rely only on a single evaluation method and thereby risk overlooking essential aspects of alveolar regeneration. This preliminary analysis aimed to assess alveolar ridge preservation outcome using a multimodal approach combining histomorphometric, radiological, and image-based visualization methods. Twenty out of a planned 60 patients per group from an ongoing randomized controlled clinical trial were included. Patients were allocated to alveolar ridge preservation with a bone substitute material (BSM), a collagen-based material, a combination of both, or natural healing as control. Outcomes included CBCT-based volumetric analysis, histomorphometry, and primary implant stability via ISQ. Mineralized bone volume was significantly better preserved in bone substitute material groups compared to other groups, with BSM combined with collagen yielding the highest values. Histomorphometrically determined hard tissue fractions and implant stability were comparable across groups. Notably, CBCT-based visualization revealed non-ossified hypodense regions, so-called cavitations or covered socket residuum (CSR) within the former extraction sockets across all groups, independent of the biomaterial applied. BSM-based alveolar ridge preservation, particularly combined with a collagen membrane, most effectively maintained mineralized bone volume after extraction. Beside volumetric benefits, this preliminary in-dept analysis of the first part of the trial highlights cavitations/CSRs as a potentially underrecognized feature of post-extraction healing. Integrating quantitative with qualitative visualization-based assessments provides a more complete understanding of alveolar bone regeneration. Full article

Adequate alveolar bone volume is a prerequisite for predictable and long-term success in dental implant therapy. Physiological post-extraction remodeling frequently results in horizontal and vertical ridge deficiencies, which may compromise optimal implant placement. Guided bone regeneration (GBR) has become a cornerstone procedure in implant dentistry, with clinical outcomes largely influenced by the biological and mechanical characteristics of grafting materials. Different bone grafts and their combinations are currently clinically applicable, each exhibiting distinct osteogenic, osteoinductive, and osteoconductive properties, as well as varying resorption profiles and volumetric stability. This narrative review aims to analyze the biological principles of alveolar ridge augmentation, compare the properties of commonly used graft materials, evaluate clinical outcomes, and discuss emerging regenerative strategies. Literature published between 2000 and 2025 was assessed to synthesize current evidence regarding graft integration, bone formation, desorption dynamics, and clinical indications. Autogenous bone remains the gold standard due to its combined osteogenic, osteoinductive, and osteoconductive potential; however, its limitations have driven the development of alternative materials, including allografts, xenografts, alloplastic substitutes, demineralized tooth matrices, platelet concentrates, and customized scaffolds. While no single material is universally ideal, appropriate selection based on defect characteristics and clinical objectives is essential for predictable outcomes. Future research should prioritize long-term comparative trials, biomaterial standardization, and biologically enhanced regenerative approaches. Full article

The global prevalence of osteoporosis is rising, particularly among the elderly and post-menopausal population. Although natural flavonoids can inhibit osteoclast overactivation, their low abundance and extraction challenges limit clinical translation. In this study, we synthesized a flavonoid derivative, SZQ-4, and evaluated its therapeutic potential for post-menopausal osteoporosis (PMO). Using an RANKL-induced osteoclastogenesis model in vitro, we demonstrated through TRAP staining, RT-qPCR, and bone resorption assays that SZQ-4 significantly suppresses osteoclast formation and activity. Mechanistically, RNA-seq, Western blot, siRNA knockdown, and plasmid-based overexpression experiments revealed that SZQ-4 reduces RANKL-induced reactive oxygen species (ROS) production, regulates SIRT3 expression, and improves mitochondrial function, thereby attenuating osteoclast differentiation. In an ovariectomy-induced bone loss mouse model, SZQ-4 treatment markedly alleviated femoral bone loss, decreased osteoclast numbers, and lowered ROS levels in the bone marrow microenvironment. Collectively, our findings indicate that SZQ-4 inhibits osteoclast-driven bone resorption by modulating the ROS-SIRT3–mitochondrial function axis, highlighting its potential as a candidate for preventing pathological bone loss. Full article

Background: While hydroxyapatite (HA) is considered stable and non-resorbable, other calcium phosphate phases such as Tricalcium Phosphate (TCP), Brushite, and Monetite are characterized by higher solubility and biodegradation rates. This review aims to map the clinical evidence of these resorbable phases. Objective: The aim of this scoping review was to map and synthesize the available clinical evidence on resorbable calcium phosphate phases, focusing on TCP-, brushite-, and monetite-based biomaterials in alveolar bone regeneration. The review evaluates clinical indications, surgical protocols, reported outcomes, and existing knowledge gaps. Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines. A comprehensive literature search was performed in PubMed, MEDLINE, Scopus, and SCI Clarivate databases without language or time restrictions (from June 2025 to August 2025) using terms related to brushite, monetite, dicalcium phosphate anhydrous, ridge augmentation, bone regeneration, and dental implants. Clinical studies involving brushite- or monetite-based biomaterials used for alveolar bone regeneration were eligible, including randomized controlled trials, prospective cohort studies, and case series. Data were charted descriptively with respect to study design, patient characteristics, clinical scenario, biomaterials used, surgical approach, healing time, outcome measures, and reported complications. No meta-analysis or formal assessment of comparative clinical effectiveness was undertaken, in line with scoping review methodology. Results: Seven clinical studies were included. The identified evidence encompassed heterogeneous clinical scenarios, including post-extraction alveolar ridge preservation, localized ridge augmentation, and periodontal or intraosseous defects with relevance to future implant placement. Study designs, defect characteristics, biomaterial formulations, and outcome measures varied substantially. Across studies, brushite- and monetite-based materials were associated with new bone formation and progressive graft resorption, as assessed by clinical, radiographic, and histological outcomes. Direct comparisons between studies were not feasible due to methodological and clinical heterogeneity. Conclusions: The available literature on brushite- and monetite-based biomaterials in alveolar bone regeneration is limited and heterogeneous. Current evidence supports their biocompatibility and resorbable nature across different clinical contexts, but does not allow conclusions regarding comparative clinical effectiveness. This scoping review highlights important gaps in the literature, particularly the need for well-designed randomized clinical trials with standardized indications and outcome measures. Full article

Background: Post-extraction alveolar bone resorption complicates implant planning and compromises functional and aesthetic outcomes. High-power lasers, including surgically applied Er:YAG and Nd:YAG lasers, as well as Nd:YAG-based photobiomodulation (PBM), have been proposed as adjunctive approaches to decontaminate extraction sockets, modulate inflammation, and stimulate osteogenesis, potentially limiting post-extraction ridge collapse. Methods: This systematic review and meta-analysis included prospective and retrospective clinical studies evaluating changes in alveolar ridge height, width, volume, or density following tooth extraction treated with Er:YAG, surgically applied Nd:YAG, or Nd:YAG-based PBM. Outcomes were assessed using cone-beam computed tomography (CBCT) or calibrated mechanical or optical measurement methods. Study selection followed PRISMA guidelines. Quantitative synthesis was performed using random-effects meta-analysis, and certainty of evidence was assessed using the GRADE approach. Results: All laser modalities demonstrated statistically and clinically significant preservation of alveolar bone compared with standard care. Er:YAG laser therapy resulted in a mean ridge preservation of 1.12 mm (95% CI: 0.9–1.4), while surgically applied Nd:YAG achieved a comparable effect of 1.15 mm (95% CI: 0.88–1.4). Nd:YAG-based PBM showed the most consistent effect, with a mean difference of 1.20 mm (95% CI: 1.0–1.4) and the lowest heterogeneity (I² = 22%). The largest effects were observed within the first month after extraction (mean difference 1.26 mm) and diminished with longer follow-up. CBCT-based assessments demonstrated the highest measurement precision, with an average effect of 1.32 mm. Overall certainty of evidence was rated as moderate due to risk of bias, incomplete methodological reporting, and possible publication bias. Conclusions: Er:YAG, Nd:YAG, and Nd:YAG-based PBM represent effective adjunctive approaches for alveolar ridge preservation following tooth extraction, particularly during the early healing phase. Their effects appear enhanced when combined with barrier membranes or osteoconductive grafting materials. CBCT should be preferred for outcome assessment in both clinical practice and research. These findings support the evidence-based integration of laser technologies into ridge preservation protocols in implant dentistry and oral surgery. Full article

Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4–6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a “sticky bone” (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type. Full article

Background: Osseointegration is the main factor that ensures the long-term success of implant-prosthetic therapy, but besides this, there are other important factors, such as the quality of the alveolar bone and the time of placement of dental implants. The study aimed to analyze changes in the alveolar bone following tooth extraction, comparing natural healing with immediate implant placement, using fractal analysis on OPG images. Methods: This retrospective study included OPG images obtained before tooth extraction and 3 months after surgery in 91 patients who underwent maxillary and mandibular molar extractions and opted for either natural healing or immediate dental implant placement. Fractal analysis of OPG images was performed using Image J software, and the resulting measurements were subsequently statistically analyzed. Results: Most extractions were performed in the maxilla, and most were at the level of the first molar. The study group showed a faster healing process following immediate placement of dental implants, regardless of location, and a similar distribution of bone resorption and healing, with clear differences in location: the mandible had a faster healing process than the maxilla. Conclusions: Fractal analysis showed a better and quicker bone healing of the alveolar bone in immediate implant placement in molar areas compared with post-extraction natural healing, especially in the lower jaw. Full article

Magnesium (Mg) alloys, particularly Mg AZ31, have emerged as promising biomaterials for orthopedic applications due to their biodegradability and favorable mechanical characteristics. Among these, the Mg AZ31+SPF alloy, subjected to hydrothermal (HT) treatment, has demonstrated enhanced bioactivity. Our previous research established that this surface modification supports the osteogenic differentiation of human mesenchymal stem cells (hMSCs) by modulating both canonical and non-canonical signaling pathways, including those implicated in osteogenesis, hypoxic response, exosome biogenesis, and lipid metabolism. In the present study, we extended our investigation to assess the effects of Mg AZ31+SPF+HT and Mg AZ31+SPF extracts on murine pre-osteoclasts (RAW 264.7 cells) over 3- and 6-day treatment periods. The primary objectives were to evaluate biocompatibility and to investigate potential impacts on osteoclastogenesis induction and miRNA expression profiles. Methods: To assess cytocompatibility, metabolic activity, DNA integrity, and morphological alterations in RAW 264.7 cells were evaluated. Osteoclast differentiation was quantified using TRAP staining, alongside the assessment of osteoclastogenic marker expression by qRT-PCR and ELISA. The immunomodulatory properties of the extracts were examined using multiplex BioPlex assays to quantify soluble factors involved in bone healing. Additionally, global miRNA expression profiling was performed using a specialized panel targeting 82 microRNAs implicated in bone remodeling and inflammatory signaling. Results: Mg AZ31+SPF+HT extract exhibited high biocompatibility, with no observable adverse effects on cell viability. Notably, a significant reduction in the number of TRAP-positive and multinucleated cells was observed relative to the Mg AZ31+SPF group. This effect was corroborated by the downregulation of osteoclast-specific gene expression and decreased MMP9 protein levels. Cytokine profiling indicated that Mg AZ31+SPF+HT extract promoted an earlier release of key cytokines involved in maintaining the balance between bone formation and resorption, suggesting a beneficial role in bone healing. Furthermore, miRNA profiling revealed a distinct regulatory signature in Mg AZ31+SPF+HT-treated cells, with differentially expressed miRNAs associated with inflammation, osteoclast differentiation, apoptosis, bone resorption, hypoxic response, and metabolic processes compared to Mg AZ31+SPF-treated cells. Conclusions: Collectively, these findings indicate that hydrothermal treatment of Mg AZ31+SPF (resulting in Mg AZ31+SPF+HT) attenuates pre-osteoclast activation by influencing cellular morphology, gene and protein expression, as well as post-transcriptional regulation via modulation of miRNAs. The preliminary identification of miRNAs and the activation of their regulatory networks in pre-osteoclasts exposed to hydrothermally treated Mg alloy are described herein. In the context of orthopedic surgery—where balanced bone remodeling is imperative—our results emphasize the dual significance of promoting bone formation while modulating bone resorption to achieve optimal implant integration and ensure long-term bone health. Full article

Background: In modern dentistry, alveolar socket preservation after tooth extraction plays a critical role in maintaining the alveolar ridge for future dental implants. This retrospective clinical study evaluated bone-level changes 15 years after immediate implant placement, coupled with alveolar ridge preservation. Methods: Fifty non-smoking patients aged 25 to 75 (30 males and 20 females) who underwent single-implant rehabilitation in both anterior and posterior regions of the upper and lower jaws were included. The study examined bone levels and implant survival over time, using standardized intraoral radiographs at 1, 5, and 15 years post-loading. Implants were placed immediately after atraumatic extraction, and the residual gap was grafted with bovine hydroxyapatite and covered with a collagen membrane. The primary outcome was bone-level stability, while secondary outcomes included implant failure. No temporary crowns or removable dentures were provided during healing. Radiographs were digitized for detailed analysis. Results: The results for 50 patients with immediate implant placement showed that bone-resorption levels were significantly higher in the upper jaw than in the lower jaw. Conclusions: Posterior implants exhibited greater bone loss than anterior implants, particularly at 1 year and 15 years, while no implant failures occurred. Full article

Background: The socket preservation technique involves filling the bone defect created after tooth extraction with a bone substitute material. This helps to reduce bone resorption of the post-extraction alveolar ridge. Various types of bone substitute biomaterials are used as augmentation materials, including autogeneic, allogeneic, and xenogeneic materials. The purpose of this study was to evaluate changes in alveolar ridge dimensions and alterations of optical bone density in sockets grafted with two different biomaterials. Additionally, bone biopsies taken from the grafted sites underwent histological evaluation. Methods: This study enrolled 10 generally healthy patients, who were divided into two equal groups. Patients in the first group were treated with an allogeneic material (BIOBank^®, Biobank, Paris, France), while patients in the second group were treated with an xenogeneic material (Geistlich Bio-Oss^®, Geistlich Pharma AG, Wolhusen, Switzerland). Tooth extraction was performed, following which the appropriate material was placed into the debrided socket. The material was secured with a collagen membrane (Geistlich Bio-Gide^®, Geistlich Pharma AG, Wolhusen, Switzerland) and sutures, which were removed 7 to 10 days after the procedure. Micro-CBCT examinations were performed, for the evaluation of alveolar ridge dimensions and bone optical density, at 7–10 days and six months after the procedure. Bone trepanbiopsy was performed simultaneously to the implant placement, six months after socket preservation. The retrieved biopsy was subjected to histological examination via hematoxylin and eosin (H&E) staining and Masson’s trichrome staining. Results: The results showed that the allogeneic material was more effective in preserving alveolar buccal height and was probably more rapidly transformed into the patient’s own bone. Sockets grafted with the xenogeneic material presented higher optical bone density after six months. Both materials presented similar effectiveness in alveolar width preservation. Conclusions: Based on the outcomes of this study, it can be concluded that both materials are suitable for the socket preservation technique. However, the dimensional changes in the alveolar ridge and the quality of the newly formed bone may vary depending on the type of biomaterial used. Full article

Background: Implant-prosthetic therapy requires a detailed assessment of the bone structure before designing a personalized treatment plan. Tooth extraction at the molar level is followed by a series of bone changes dependent on the patient’s general condition and age and the area in which it was performed. The fractal analysis of cone beam computed tomography (CBCT) represents a way to assess the quality of post-extraction bone regeneration. The purpose of this study was to analyze the alveolar bone changes after tooth extraction using fractal analysis on CBCT images. Methods: This retrospective study included pre- and post-extraction CBCTs at 3 months of 60 patients who underwent 100 extractions of first and/or second molars. Fractal analysis on CBCT images was performed using ImageJ, and the data obtained from the measurements were statistically processed. A multiple regression model was used to assess factors influencing bone remodeling. Results: Fractal analysis performed on CBCT images showed that most patients experienced advanced bone remodeling, this being more pronounced in those from rural areas, in the vertical plane at the mandible and at the second molar. The multiple regression model showed that the factors that play an important role in predicting bone resorption are represented by age group (age above 56 years old is associated with less bone resorption), location (bone resorption is more pronounced at the mandible level), and molar (bone resorption for the second molar is higher). Conclusions: Post-extraction bone changes were influenced by the age of the patient and by the location of the extraction, with the maxilla and first molar having better fractal analysis values compared to the mandible and second molar. These results emphasize the importance of training implantologists in CBCT evaluation to improve personalized implant-prosthetic treatment decisions. Full article

Background: Turmeric (Curcuma longa L.) rhizomes, whose secondary metabolites include polyphenols and terpenoids, have been used medicinally for millennia. However, modern scientific inquiry has primarily focused on medicinal effects of turmeric’s polyphenolic curcuminoids, including when evaluating turmeric use to maintain bone health. Methods: Disease-specific biological effects of turmeric’s major secondary metabolites (polyphenols and/or terpenoids), with or without associated turmeric rhizome-derived polysaccharides, were determined in vivo using pre-clinical models of clinically relevant resorptive bone diseases induced by different mechanisms. These included inflammatory arthritis, cancer-driven osteolytic bone metastases, and hormone deficiency-driven post-menopausal osteoporosis. Results: In the arthritis model, the safety profile of curcuminoids alone was superior. However, curcuminoids and terpenoids each had anti-inflammatory effects and prevented bone resorption, with polysaccharide-containing curcuminoid extracts having greater effect than curcuminoids alone. In the human osteolytic breast cancer bone metastases model, curcuminoid extracts containing polysaccharides tended to yield greater effects in reducing bone osteolysis and tumor progression than curcuminoids alone or more complex extracts. In contrast, only purified curcuminoids prevented bone loss in a post-menopausal osteoporosis model, while polysaccharide-containing curcuminoid extracts were without effect. In vitro metabolite effects on disease-specific mechanistic pathways in synoviocytes, osteoclasts, or breast cancer cells were consistent with documented in vivo outcomes and included differential metabolite-specific effects. Conclusions: In summary, these findings suggest that turmeric’s potential medicinal musculoskeletal effects are complex, pathway- and target-specific, and not limited to curcuminoids, with safety concerns potentially limiting certain uses. Full article

Background/Objectives: The socket-shield technique (SST) was developed to preserve the facial/buccal portion of a tooth root to prevent post-extraction ridge resorption. It has gained attention for use in anterior implant sites, but its application in posterior sites remains unexplored. The aim of this case report was to report a proof-of-principle case using SST in a lower molar site and evaluate its effectiveness in preserving tissues. Methods: A 34-year-old non-smoking patient with a non-restorable mandibular first molar (tooth #36) underwent immediate implant placement with the SST. The tooth’s crown was removed, and the buccal segments of the roots were retained as “shields” while the implant was placed in the center of the socket. Preoperative and postoperative cone-beam CT (CBCT) scans and clinical exams were used to assess outcomes up to 12 months. Results: The SST procedure was completed uneventfully. CBCT after 4 months and 12 months showed minimal horizontal bone loss: ~0.2 mm at 4 months; ~0.1 mm additional loss by 12 months. The peri-implant soft tissue profile remained stable, and the implant achieved osseointegration with high primary and secondary stability. Conclusions: In this clinical case, the socket-shield technique effectively preserved alveolar bone and soft tissue contours in a molar extraction site, avoiding the ridge collapse often seen post-extraction. This suggests SST may be a viable tissue preservation approach in posterior sites; however, long-term follow-up and further studies are needed to confirm sustained outcomes and validate the technique’s predictability. Full article

Objectives: This systematic review evaluates the biological activity and regenerative potential of hyaluronic acid (HA) in alveolar ridge preservation (ARP) following tooth extraction, assessing its efficacy in reducing bone resorption and promoting bone regeneration when combined with xenografts. Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Lilacs databases, adhering to PRISMA guidelines. Studies from 2012 to December 2024 involving human participants were included based on a PECO framework. Four studies met the inclusion criteria, with data extracted and analyzed for clinical and histological outcomes. The risk of bias was assessed using the ROBINS-E tool. Results: The included studies demonstrated that HA combined with xenografts significantly reduced post-extraction bone resorption compared to controls. HA-enhanced grafts showed superior radiographic and histological outcomes, including increased bone density and reduced graft shrinkage. While one randomized controlled trial found no significant differences in wound healing or patient-reported outcomes between HA and control groups, other studies reported improved bone formation and graft stability with HA. Variability in study design and sample size was noted, with a generally moderate to high risk of bias in some studies. Conclusions: The evidence supports the beneficial role of HA as an adjuvant in ARP procedures, enhancing bone regeneration and limiting resorption. However, further research with larger samples and standardized methodologies is required to confirm these findings and optimize clinical protocols. Full article

Background: Hydrostatic pressure in the periodontal ligament (PDL) plays a critical role in orthodontic treatment, influencing tooth movement and remodeling of periodontal tissue. The relationship between alveolar cortical bone density and the risk of root resorption due to excessive stress in the PDL has not been clearly defined. Objective: This study aimed to analyze hydrostatic pressure in the periodontal ligament of the tooth roots during en-masse retraction of the maxillary incisors using temporary skeletal anchorage devices (TISADs) after the first premolar extractions, as well as during full arch retraction. Methods: A numerical model was used, varying the Young’s modulus of cortical bone from 12.5 GPa to 27.5 GPa in increments of 3.0 GPa. Extreme values for bone stiffness were derived from the literature. In all the cases analyzed, the hook height was fixed at 6 mm, and the cranial surface was constrained. Results: Doubling the stiffness of the cortical bone approximately reduced the hydrostatic pressure in the PDL by 1.5 times for both full-arch retraction and post-first premolar extraction retraction. A critical hydrostatic pressure of 4.7 kPa was exceeded in full-arch retraction for low Young’s modulus of 12.5 Gpa values at forces as low as 600 g. On the contrary, for cortical bone with a high Young’s modulus of 27.5 GPa, this critical pressure was reached only at forces around 960 g, approximately 1.6 times higher. Conclusions: The density of the alveolar cortical bone significantly influences the hydrostatic pressure in the PDL of most tooth roots during orthodontic treatment. This parameter can be a critical factor in the risk of root resorption when optimal forces are exceeded. Further research is necessary to better understand these dynamics. Individual protocols for orthodontic treatment and CBCT imaging are necessary to minimize complications in the form of root resorption. Full article