Alveolar Bone Loss Clinical Trial
Official title:
Effectiveness of Different Alveolar Preservation Procedures in the Upper Molar Zone in Limiting the Need to Elevate the Maxillary Sinus to Allow the Placement of Dental Implants: a Prospective Cohort Multicentre Clinical Study.
The aim of the present study is to evaluate the effectiveness of different alveolar preservation procedures performed at the time of extraction of the first or second upper molar in avoiding a maxillary sinus elevation or at least limiting the size, to allow the insertion of dental implants. The residual bone height will be radiographically evaluated on the sinus sinus floor at the time of extraction and after 6 months by comparing the cases where alveolar preservation is performed using a nanocrystalline synthetic hydroxyapatite graft (group A) with cases where the procedure of alveolar preservation is performed using bovine collagen sponge (group B).
Bone resorption and contraction of bone volumes are physiologically occurring after the
extraction of any dental element. This reabsorption of the alveolar process results in a
reduction in the size of the alveolar crest both in width and in height. Numerous studies
have attempted to quantify the size and timing of contraction of bone volumes after a dental
flotation. The data reported in the literature show an average horizontal reduction of about
2.5 mm, which appears more marked by the vestibular side than the palatal one. The vertical
contraction of the crest is estimated at 25-30%, with bone loss of 1-2 mm and a soft
contraction of soft tissues of about 2 mm. In the area of the first and second upper molars,
however, the total contraction of the alveoli is greater because the residual crest at the
insertion of the implant would have undergone a double reduction, namely from the coronal
side with the mechanisms just indicated, but also from the apex , for maxillary sinus
pneumonia due to the absence of dental element6. For this reason, insertion of an implant in
this area may be difficult due to an inadequate height of the remaining bone, which
necessitates a bone regeneration procedure, ie a maxillary sinus elevation. This procedure
allows you to regain the abdominal apex lost and the insertion of adequate lengths. In the
presence of satisfactory residual bone height, maxillary sinus breast can be performed
crestally, while in more markedly atrophic cases, especially in the presence of anatomically
wide breasts, a side-by-side approach is preferable.
Various grafting materials have been used to perform alveolar retention with the aim of
limiting the contraction of bone volumes and improving bone formation: autologous bone,
homologous bone and bone substitutes of heterologous origin or alloplastic.
The use of autologous bone in alveolar preservation was soon abandoned for bone marrow
morbidity, especially when deciding to use a donor site other than the extraction area. The
homologous bone, although showing excellent results, is still to date problematic use in
Italy. The heterologous grafts have been widely used for alveolar preservation; however,
especially if bovine bone is used, significant percentages of graft (up to 25%) are
histologically observable at 9 months from graft.
For these reasons, in this study it was decided to use as a graft in Group A a synthetic
material (nanocrystalline synthetic hydroxyapatite) and in group B a collagen of bovine
origin.
Bovine collagen, while having reduced dimensional stability over time, has the advantage of
contributing to stabilizing the clot, an essential basis for bone healing, and is completely
replaced by newly formed tissue in a short time. Synthetic hydroxyapatite, used as a
biomaterial, has shown ability to stimulate osteoconduction and is slowly but completely
replaced over time by newly formed bone, thus providing a great capacity for maintaining
volumes.
Moreover, nanostructured porous hydroxyapatite appear to favor adhesion of bone matrix
proteins and promote differentiation of osteogenetic cells. Although the nanocrystalline
hydroxyapatite in a silica gel matrix has already been successfully tested as a clotting
material in the maxillary sinus, the behavior of pure sintered nano-hydroxyapatite granules
has not yet been evaluated in terms of osteoconductive potential and dimensional stability in
time at post-mining sites.
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