Evaluation of Bone Preservation After Molar Extraction Using Photobiomodulation Combined With Biomaterial Grafting

Bone Substitutes Clinical Trial

Official title:

Evaluation of Alveolar Bone Preservation After Early Molar Extraction Using Photobiomodulation Combined With Grafting With Scaffold Biomaterial: Clinical, Randomized, Triple-blind Study.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06164626
• Other study ID #: Vanessa Dalapria
• Status: Recruiting
• Phase: Phase 1
• Start date: December 10, 2023
• Est. completion date: November 20, 2024

Study information

• Verified date: December 2023
• Source: University of Nove de Julho
• Contact: Sandra Kalil Bussadori, PhD
• Phone: 551132283400
• Email: sandra.skb[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Tooth loss is a global public health problem and is the main cause of occlusal and oral bone deformities. The tooth with the greatest tooth loss can be identified as first molars. The bone graft added to the tooth socket immediately after tooth extraction prevents atrophy and deformity of the bone at the site of tooth loss. Photobiomodulation accelerates bone healing; stimulates blood flow; activates osteoblasts, decreases osteoclastic activity and improves the integration of the biomaterial with bone tissue. The objective of the study is to develop a protocol for the management and preservation of alveolar bone after loss of first and/or second permanent molars in patients age from 18 years, with an indication for extraction associated or not with treatment with an 808 nm infrared laser. . Materials and methods: 60 patients age from 18 years will be randomized and randomly distributed into 4 groups, n= 15: Exo (extraction), Exo+Laser (extraction and laser treatment), Exo+Biomat (extraction with graft of biomaterial), Exo+Biomat+Laser (biomaterial extraction and grafting and laser treatment). The biomaterials of choice will be Plenum® OSShp and Plenum® Guide (Brazil), added to the socket immediately after molar extraction, groups that will receive the laser (λ = 808 nm, power = 100 mW, radiant energy 3J per point in 3 buccal, occlusal and lingual/palatal points), will receive irradiation during surgery and 10 days after surgery, in the Exo and Exo+Biomat groups a similar laser device will be used without emission of irradiation, the operator who will apply the laser and the patient will be blind to the device used and the patient will not know whether or not they received the biomaterial. Analysis: computed tomography and intraoral scanning performed pre-surgery and 4 months after surgery; to assess bone volume by measurements of the height and width of the socket in each group, as well as trabecular bone and the interdental space of the teeth lateral to the missing element. Statistical analysis will be performed using the Shapiro-Wilks test, Student's t-test or Wilcoxon-Mann-Whitney test for parametric and non-parametric data, respectively, will be two-tailed and the significance level adopted will be α = 0.05.

Description:

Tooth loss is a global public health problem and is the main cause of occlusal and oral bone deformities. The tooth with the greatest tooth loss can be identified as first molars. Bone graft added to the tooth socket immediately after tooth extraction prevents atrophy and deformity of the bone at the site of tooth loss. Photobiomodulation accelerates bone healing; stimulates blood flow; activates osteoblasts, decreases osteoclastic activity and improves the integration of the biomaterial with bone tissue. The objective of the study is to develop a protocol for the management and preservation of alveolar bone after loss of first and/or second permanent molars in patients aged 18 years and over, with indications for extraction associated or not with 808 nm infrared treatment. laser. . Materials and methods: 60 patients aged 18 years and over will be randomized and randomly distributed into 4 groups, n= 15: Exo (extraction), Exo+Laser (extraction and laser treatment), Exo+Biomat (extraction with bone graft). biomaterial), Exo+Biomat+Laser (extraction and grafting of biomaterials and laser treatment). The biomaterials of choice will be Plenum® OSShp and Plenum® Guide (Brazil), added to the socket immediately after molar extraction, groups that will receive the laser (λ = 808 nm, power = 100 mW, radiant energy 3J per point in 3 points buccal, occlusal and lingual/palatal), will receive irradiation during surgery and 10 days after surgery, in the Exo and Exo+Biomat groups a similar laser device will be used without emission of irradiation, the operator who will apply the laser and the patient will not have knowledge of the device used and will not know whether or not they received the biomaterial. Analysis: computed tomography performed preoperatively and 4 months after surgery; evaluate the bone volume by measuring the height and width of the socket in each group, as well as the trabecular bone and the interdental space of the teeth lateral to the missing element, and fractal analysis evaluating the volume and density of the formed bone. Statistical analysis will be performed using the Shapiro-Wilks test, Student's t test or Wilcoxon-Mann-Whitney test for parametric and non-parametric data, respectively, will be two-tailed and the significance level adopted will be α = 0.05.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 60
• Est. completion date: November 20, 2024
• Est. primary completion date: June 30, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• All genders,

• Aged over 18 years,

• Without comorbidities,

• Present satisfactory oral hygiene,

• Present a condition of loss of first or second permanent molar.

Exclusion Criteria:

• Habitual use of analgesic and anti-inflammatory medication for other comorbidities,

• Present allergies to the proposed drug protocol,

• In neurological/psychiatric treatment,

• Presence of teeth with lesions to be treated in the same hemiarch of the tooth to be removed,

• Current smoking habit,

• Pregnant or breast-feeding,

• Presenting photosensitivity disorders,

• With the presence of neoplasia in the oral region,

• Patients with operative complications whose surgical time exceeds 90 minutes

Related Conditions & MeSH terms

• Bone Substitutes

Intervention

Procedure:
• Extraction
extraction: in all groups, extraction will be performed

Radiation:
• low level laser therapy
extraction: in all groups, extraction will be performed Treatment with low-intensity infrared 808 nm laser therapy will be applied in 2 stages: one in the immediate postoperative period and 10 days after surgery.

Biological:
• Plenum® OSShp and Plenum® Guide
extraction: in all groups, extraction will be performed Immediately after tooth extraction, the biomaterials Plenum® OSShp and Plenum® Guide (Brazil) will be added to the dental socket, serving as a bone substitute and maintaining alveolar dimensions.

Locations

Country	Name	City	State
Brazil	Uniersidade Nove de Julho	São Paulo	SP

Sponsors (1)

Lead Sponsor	Collaborator
University of Nove de Julho

Country where clinical trial is conducted

Brazil, 

References & Publications (73)

AboElsaad NS, Soory M, Gadalla LM, Ragab LI, Dunne S, Zalata KR, Louca C. Effect of soft laser and bioactive glass on bone regeneration in the treatment of infra-bony defects (a clinical study). Lasers Med Sci. 2009 May;24(3):387-95. doi: 10.1007/s10103-008-0576-9. Epub 2008 Jun 26. — View Citation

Alkhadra T. A Systematic Review of the Consequences of Early Extraction of First Permanent First Molar in Different Mixed Dentition Stages. J Int Soc Prev Community Dent. 2017 Sep-Oct;7(5):223-226. doi: 10.4103/jispcd.JISPCD_222_17. Epub 2017 Sep 18. — View Citation

Araujo MG, da Silva JCC, de Mendonca AF, Lindhe J. Ridge alterations following grafting of fresh extraction sockets in man. A randomized clinical trial. Clin Oral Implants Res. 2015 Apr;26(4):407-412. doi: 10.1111/clr.12366. Epub 2014 Mar 12. — View Citation

Araujo MG, Lindhe J. Ridge preservation with the use of Bio-Oss collagen: A 6-month study in the dog. Clin Oral Implants Res. 2009 May;20(5):433-40. doi: 10.1111/j.1600-0501.2009.01705.x. — View Citation

Araujo MG, Lindhe J. Socket grafting with the use of autologous bone: an experimental study in the dog. Clin Oral Implants Res. 2011 Jan;22(1):9-13. doi: 10.1111/j.1600-0501.2010.01937.x. Epub 2010 Nov 22. — View Citation

Araujo MG, Sukekava F, Wennstrom JL, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005 Jun;32(6):645-52. doi: 10.1111/j.1600-051X.2005.00726.x. — View Citation

Artzi Z, Nemcovsky CE. The application of deproteinized bovine bone mineral for ridge preservation prior to implantation. Clinical and histological observations in a case report. J Periodontol. 1998 Sep;69(9):1062-7. doi: 10.1902/jop.1998.69.9.1062. — View Citation

Artzi Z, Weinreb M, Givol N, Rohrer MD, Nemcovsky CE, Prasad HS, Tal H. Biomaterial resorption rate and healing site morphology of inorganic bovine bone and beta-tricalcium phosphate in the canine: a 24-month longitudinal histologic study and morphometric analysis. Int J Oral Maxillofac Implants. 2004 May-Jun;19(3):357-68. — View Citation

Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 2014 Oct;93(10):950-8. doi: 10.1177/0022034514541127. Epub 2014 Jun 25. — View Citation

Barbos Pinheiro AL, Limeira Junior Fde A, Marquez Gerbi ME, Pedreira Ramalho LM, Marzola C, Carneiro Ponzi EA, Oliveira Soares A, Bandeira De Carvalho LC, Vieira Lima HC, Oliveira Goncalves T. Effect of 830-nm laser light on the repair of bone defects grafted with inorganic bovine bone and decalcified cortical osseous membrane. J Clin Laser Med Surg. 2003 Dec;21(6):383-8. doi: 10.1089/104454703322650202. — View Citation

Barone A, Aldini NN, Fini M, Giardino R, Calvo Guirado JL, Covani U. Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphometric study. J Periodontol. 2008 Aug;79(8):1370-7. doi: 10.1902/jop.2008.070628. — View Citation

Basford JR. Low intensity laser therapy: still not an established clinical tool. Lasers Surg Med. 1995;16(4):331-42. doi: 10.1002/lsm.1900160404. — View Citation

Basford JR. Low-energy laser therapy: controversies and new research findings. Lasers Surg Med. 1989;9(1):1-5. doi: 10.1002/lsm.1900090103. No abstract available. — View Citation

Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993 Nov;48(11):961-4. doi: 10.1111/j.1365-2044.1993.tb07474.x. — View Citation

Brignardello-Petersen R, Carrasco-Labra A, Araya I, Yanine N, Beyene J, Shah PS. Is adjuvant laser therapy effective for preventing pain, swelling, and trismus after surgical removal of impacted mandibular third molars? A systematic review and meta-analysis. J Oral Maxillofac Surg. 2012 Aug;70(8):1789-801. doi: 10.1016/j.joms.2012.01.008. Epub 2012 Mar 6. — View Citation

Casado PL, Duarte ME, Carvalho W, Esmeraldo da Silva L, Barboza EP. Ridge bone maintenance in human after extraction. Implant Dent. 2010 Aug;19(4):314-22. doi: 10.1097/ID.0b013e3181dec322. — View Citation

Cavalcanti TM, Almeida-Barros RQ, Catao MH, Feitosa AP, Lins RD. Knowledge of the physical properties and interaction of laser with biological tissue in dentistry. An Bras Dermatol. 2011 Sep-Oct;86(5):955-60. doi: 10.1590/s0365-05962011000500014. English, Portuguese. — View Citation

Chappard D, Guillaume B, Mallet R, Pascaretti-Grizon F, Basle MF, Libouban H. Sinus lift augmentation and beta-TCP: a microCT and histologic analysis on human bone biopsies. Micron. 2010 Jun;41(4):321-6. doi: 10.1016/j.micron.2009.12.005. Epub 2009 Dec 22. — View Citation

Chappuis V, Araujo MG, Buser D. Clinical relevance of dimensional bone and soft tissue alterations post-extraction in esthetic sites. Periodontol 2000. 2017 Feb;73(1):73-83. doi: 10.1111/prd.12167. — View Citation

Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012 Feb;40(2):516-33. doi: 10.1007/s10439-011-0454-7. Epub 2011 Nov 2. — View Citation

Coombe AR, Ho CT, Darendeliler MA, Hunter N, Philips JR, Chapple CC, Yum LW. The effects of low level laser irradiation on osteoblastic cells. Clin Orthod Res. 2001 Feb;4(1):3-14. doi: 10.1034/j.1600-0544.2001.040102.x. — View Citation

Dalapria V, Marcos RL, Bussadori SK, Anselmo G, Benetti C, da Silva Santana ACA, Marinho NSR, Pinto RS, de Sales RS, de Franca LS, Deana AM. LED photobiomodulation therapy combined with biomaterial as a scaffold promotes better bone quality in the dental alveolus in an experimental extraction model. Lasers Med Sci. 2022 Apr;37(3):1583-1592. doi: 10.1007/s10103-021-03407-w. Epub 2021 Nov 12. — View Citation

Davies N, Dobner S, Bezuidenhout D, Schmidt C, Beck M, Zisch AH, Zilla P. The dosage dependence of VEGF stimulation on scaffold neovascularisation. Biomaterials. 2008 Sep;29(26):3531-8. doi: 10.1016/j.biomaterials.2008.05.007. Epub 2008 Jun 9. — View Citation

De Marchi RJ, Hugo FN, Hilgert JB, Padilha DM. Association between oral health status and nutritional status in south Brazilian independent-living older people. Nutrition. 2008 Jun;24(6):546-53. doi: 10.1016/j.nut.2008.01.054. — View Citation

Faour O, Dimitriou R, Cousins CA, Giannoudis PV. The use of bone graft substitutes in large cancellous voids: any specific needs? Injury. 2011 Sep;42 Suppl 2:S87-90. doi: 10.1016/j.injury.2011.06.020. Epub 2011 Jul 2. — View Citation

Fickl S, Fischer K, Petersen N, Happe A, Schlee M, Schlagenhauf U, Kebschull M. Dimensional Evaluation of Different Ridge Preservation Techniques: A Randomized Clinical Study. Int J Periodontics Restorative Dent. 2017 May/Jun;37(3):403-410. doi: 10.11607/prd.2629. — View Citation

Gerbi ME, Marques AM, Ramalho LM, Ponzi EA, Carvalho CM, Santos Rde C, Oliveira PC, Noia M, Pinheiro AL. Infrared laser light further improves bone healing when associated with bone morphogenic proteins: an in vivo study in a rodent model. Photomed Laser Surg. 2008 Feb;26(1):55-60. doi: 10.1089/pho.2007.2026. — View Citation

Hillenkamp F. Laser radiation tissue interaction. Health Phys. 1989 May;56(5):613-6. doi: 10.1097/00004032-198905000-00002. — View Citation

Hoexter DL. Bone regeneration graft materials. J Oral Implantol. 2002;28(6):290-4. doi: 10.1563/1548-1336(2002)0282.3.CO;2. — View Citation

Holtrop ME, Cox KA, Glowacki J. Cells of the mononuclear phagocytic system resorb implanted bone matrix: a histologic and ultrastructural study. Calcif Tissue Int. 1982 Sep;34(5):488-94. doi: 10.1007/BF02411290. — View Citation

Huang YY, Chen AC, Carroll JD, Hamblin MR. Biphasic dose response in low level light therapy. Dose Response. 2009 Sep 1;7(4):358-83. doi: 10.2203/dose-response.09-027.Hamblin. — View Citation

Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, Scheetz JP. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol. 2003 Jul;74(7):990-9. doi: 10.1902/jop.2003.74.7.990. — View Citation

Jung RE, Siegenthaler DW, Hammerle CH. Postextraction tissue management: a soft tissue punch technique. Int J Periodontics Restorative Dent. 2004 Dec;24(6):545-53. — View Citation

Karu TI, Kolyakov SF. Exact action spectra for cellular responses relevant to phototherapy. Photomed Laser Surg. 2005 Aug;23(4):355-61. doi: 10.1089/pho.2005.23.355. — View Citation

Karu TI. [Molecular mechanism of the therapeutic effect of low-intensity laser irradiation]. Dokl Akad Nauk SSSR. 1986;291(5):1245-9. No abstract available. Russian. — View Citation

Kathuria V, Dhillon JK, Kalra G. Low Level Laser Therapy: A Panacea for oral maladies. Laser Ther. 2015 Oct 2;24(3):215-23. doi: 10.5978/islsm.15-RA-01. — View Citation

Kornman KS, Robertson PB. Fundamental principles affecting the outcomes of therapy for osseous lesions. Periodontol 2000. 2000 Feb;22:22-43. doi: 10.1034/j.1600-0757.2000.2220103.x. No abstract available. — View Citation

Landsberg CJ. Implementing socket seal surgery as a socket preservation technique for pontic site development: surgical steps revisited--a report of two cases. J Periodontol. 2008 May;79(5):945-54. doi: 10.1902/jop.2008.070298. — View Citation

LeGeros RZ. Calcium phosphate materials in restorative dentistry: a review. Adv Dent Res. 1988 Aug;2(1):164-80. doi: 10.1177/08959374880020011101. No abstract available. — View Citation

Lirani-Galvao AP, Jorgetti V, da Silva OL. Comparative study of how low-level laser therapy and low-intensity pulsed ultrasound affect bone repair in rats. Photomed Laser Surg. 2006 Dec;24(6):735-40. doi: 10.1089/pho.2006.24.735. — View Citation

Liu X, Lyon R, Meier HT, Thometz J, Haworth ST. Effect of lower-level laser therapy on rabbit tibial fracture. Photomed Laser Surg. 2007 Dec;25(6):487-94. doi: 10.1089/pho.2006.2075. — View Citation

Lopes CB, Pacheco MT, Silveira L Jr, Duarte J, Cangussu MC, Pinheiro AL. The effect of the association of NIR laser therapy BMPs, and guided bone regeneration on tibial fractures treated with wire osteosynthesis: Raman spectroscopy study. J Photochem Photobiol B. 2007 Dec 14;89(2-3):125-30. doi: 10.1016/j.jphotobiol.2007.09.011. Epub 2007 Oct 1. — View Citation

Merigo E, Vescovi P, Margalit M, Ricotti E, Stea S, Meleti M, Manfredi M, Fornaini C. Efficacy of LLLT in swelling and pain control after the extraction of lower impacted third molars. Laser Ther. 2015 Mar 31;24(1):39-46. doi: 10.5978/islsm.15-OR-05. — View Citation

Misch CE, Perez HM. Atraumatic extractions: a biomechanical rationale. Dent Today. 2008 Aug;27(8):98, 100-1. — View Citation

Nemcovsky CE, Artzi Z, Moses O. Rotated palatal flap in immediate implant procedures. Clinical evaluation of 26 consecutive cases. Clin Oral Implants Res. 2000 Feb;11(1):83-90. doi: 10.1034/j.1600-0501.2000.011001083.x. — View Citation

Ngeow WC, Lim D. Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery? Adv Ther. 2016 Jul;33(7):1105-39. doi: 10.1007/s12325-016-0357-y. Epub 2016 Jun 10. — View Citation

Nicola JH, Nicola EM. Wavelength, frequency, and color: absolute or relative concepts? J Clin Laser Med Surg. 2002 Dec;20(6):307-11. doi: 10.1089/104454702320901080. — View Citation

Ninomiya T, Miyamoto Y, Ito T, Yamashita A, Wakita M, Nishisaka T. High-intensity pulsed laser irradiation accelerates bone formation in metaphyseal trabecular bone in rat femur. J Bone Miner Metab. 2003;21(2):67-73. doi: 10.1007/s007740300011. — View Citation

Obradovic RR, Kesic LG, Pesevska S. Influence of low-level laser therapy on biomaterial osseointegration: a mini-review. Lasers Med Sci. 2009 May;24(3):447-51. doi: 10.1007/s10103-008-0573-z. Epub 2008 Jun 20. — View Citation

Osburn RC. Preservation of the alveolar ridge: a simplified technique for retaining teeth beneath removable appliances. J Indiana State Dent Assoc. 1974 Jan-Feb;53(1):8-11. No abstract available. — View Citation

Pandeshwar P, Roa MD, Das R, Shastry SP, Kaul R, Srinivasreddy MB. Photobiomodulation in oral medicine: a review. J Investig Clin Dent. 2016 May;7(2):114-26. doi: 10.1111/jicd.12148. Epub 2015 Feb 26. — View Citation

Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg. 2005 Jan;34(1):52-7. doi: 10.1016/j.ijom.2004.01.023. — View Citation

PELTIER LF. The use of plaster of Paris to fill defects in bone. Clin Orthop. 1961;21:1-31. No abstract available. — View Citation

Perk K, Ianconescu M, Yaniv A, Zimber A. Morphologic characterization of proliferative cells and virus particles in turkeys with lymphoproliferative disease. J Natl Cancer Inst. 1979 Jun;62(6):1483-7. — View Citation

Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003 Dec;31 Suppl 1:3-23. doi: 10.1046/j..2003.com122.x. — View Citation

Pogrel MA, Chen JW, Zhang K. Effects of low-energy gallium-aluminum-arsenide laser irradiation on cultured fibroblasts and keratinocytes. Lasers Surg Med. 1997;20(4):426-32. doi: 10.1002/(sici)1096-9101(1997)20:43.0.co;2-s. — View Citation

Renno AC, McDonnell PA, Parizotto NA, Laakso EL. The effects of laser irradiation on osteoblast and osteosarcoma cell proliferation and differentiation in vitro. Photomed Laser Surg. 2007 Aug;25(4):275-80. doi: 10.1089/pho.2007.2055. — View Citation

Rezaie M, Ghapanchi J, Haghnegahdar A, Khojastehpour L, Khorshidi H, Heidari H. A Radiographic Evaluation of Missing of Permanent First Molars in a Group of Iranian Children and Adults: A Retrospective Study. Int J Dent. 2018 Apr 1;2018:5253965. doi: 10.1155/2018/5253965. eCollection 2018. — View Citation

Rochkind S, Kogan G, Luger EG, Salame K, Karp E, Graif M, Weiss J. Molecular structure of the bony tissue after experimental trauma to the mandibular region followed by laser therapy. Photomed Laser Surg. 2004 Jun;22(3):249-53. doi: 10.1089/1549541041438579. — View Citation

Rola P, Doroszko A, Derkacz A. The Use of Low-Level Energy Laser Radiation in Basic and Clinical Research. Adv Clin Exp Med. 2014 September-October;23(5):835-842. doi: 10.17219/acem/37263. — View Citation

Romao MM, Marques MM, Cortes AR, Horliana AC, Moreira MS, Lascala CA. Micro-computed tomography and histomorphometric analysis of human alveolar bone repair induced by laser phototherapy: a pilot study. Int J Oral Maxillofac Surg. 2015 Dec;44(12):1521-8. doi: 10.1016/j.ijom.2015.08.989. Epub 2015 Sep 14. — View Citation

Rosero KAV, Sampaio RMF, Deboni MCZ, Correa L, Marques MM, Ferraz EP, da Graca Naclerio-Homem M. Photobiomodulation as an adjunctive therapy for alveolar socket preservation: a preliminary study in humans. Lasers Med Sci. 2020 Oct;35(8):1711-1720. doi: 10.1007/s10103-020-02962-y. Epub 2020 Jan 22. — View Citation

Saber AM, Altoukhi DH, Horaib MF, El-Housseiny AA, Alamoudi NM, Sabbagh HJ. Consequences of early extraction of compromised first permanent molar: a systematic review. BMC Oral Health. 2018 Apr 5;18(1):59. doi: 10.1186/s12903-018-0516-4. — View Citation

Saito S, Shimizu N. Stimulatory effects of low-power laser irradiation on bone regeneration in midpalatal suture during expansion in the rat. Am J Orthod Dentofacial Orthop. 1997 May;111(5):525-32. doi: 10.1016/s0889-5406(97)70152-5. — View Citation

Salama R, Burwell RD, Dickson IR. Recombined grafts of bone and marrow. The beneficial effect upon osteogenesis of impregnating xenograft (heterograft) bone with autologous red marrow. J Bone Joint Surg Br. 1973 May;55(2):402-17. No abstract available. — View Citation

Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003 Aug;23(4):313-23. — View Citation

Sclar AG. Strategies for management of single-tooth extraction sites in aesthetic implant therapy. J Oral Maxillofac Surg. 2004 Sep;62(9 Suppl 2):90-105. doi: 10.1016/j.joms.2004.06.041. Erratum In: J Oral Maxillofac Surg. 2005 Jan;63(1):158. — View Citation

Sella VR, do Bomfim FR, Machado PC, da Silva Morsoleto MJ, Chohfi M, Plapler H. Effect of low-level laser therapy on bone repair: a randomized controlled experimental study. Lasers Med Sci. 2015 Apr;30(3):1061-8. doi: 10.1007/s10103-015-1710-0. Epub 2015 Jan 18. — View Citation

Seymour RA, Hawkesford JE, Weldon M, Brewster D. An evaluation of different ibuprofen preparations in the control of postoperative pain after third molar surgery. Br J Clin Pharmacol. 1991 Jan;31(1):83-7. doi: 10.1111/j.1365-2125.1991.tb03861.x. — View Citation

Silveira PC, Silva LA, Freitas TP, Latini A, Pinho RA. Effects of low-power laser irradiation (LPLI) at different wavelengths and doses on oxidative stress and fibrogenesis parameters in an animal model of wound healing. Lasers Med Sci. 2011 Jan;26(1):125-31. doi: 10.1007/s10103-010-0839-0. Epub 2010 Sep 24. — View Citation

Tavares MG, Machado AP, Motta BG, Borsatto MC, Rosa AL, Xavier SP. Electro-acupuncture efficacy on pain control after mandibular third molar surgery. Braz Dent J. 2007;18(2):158-62. doi: 10.1590/s0103-64402007000200014. — View Citation

Van der Weijden F, Dell'Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009 Dec;36(12):1048-58. doi: 10.1111/j.1600-051X.2009.01482.x. — View Citation

Wood DL, Hoag PM, Donnenfeld OW, Rosenfeld LD. Alveolar crest reduction following full and partial thickness flaps. J Periodontol. 1972 Mar;43(3):141-4. doi: 10.1902/jop.1972.43.3.141. No abstract available. — View Citation

* Note: There are 73 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Surgical intervention phase	The computed tomography examination will be carried out in two moments, with the tooth before extraction and after 4 months of surgery and the measurements chosen for the dimensional measurement of the alveolar process will refer to the buccolingual thickness of the alveolus. In the orthoradial cut, the limits of the socket will be delimited based on the apex of the tooth to the maximum height of the bone crests. In the most central position, the vertical measurement will be taken and 3 buccolingual cuts will be made, proportional to each other according to the measured vertical measurement; and in each apical, middle and cervical third, measurements will be taken regarding the horizontal dimensions of the alveolus. For the fractal analysis, the area of interest encompassing the dental socket will be delimited and the Image J program, which is in the public domain, will be used to calculate the fractal dimension.	Baseline, pre surgical, 4 months
Secondary	Interdental distance	n the computed tomography, the horizontal distance will be measured with the limit in the mesial and distal bone crystals of the alveolus at two moments, pre-surgery with the tooth still in place and 4 months after extraction, to verify the maintenance of the interdental space.	Baseline, pre surgical, 4 months