Aim: to evaluate the efficacy of healing of a preservation technique for the post-extractive socket bone healing using an epithelial-connective tissue graft harvested from the palate. By the use of this technique we expect to get a better bone tissue in order to position an implant in a second time. Methods: 24 patients, requiring a single tooth extraction, were selected to enter the study and were randomly divided in two groups. In the first group the socket healed spontaneously. In the second group, an epithelial-connective tissue graft harvested from the palate was sutured over the post-extractive socket. After surgery, an anti-inflammatory drug was prescribed to all patients. Patients were asked to return for a follow up immediately after the first surgery and after three months for implant positioning procedures. At the implant surgery, a tissue sample was collected from the healed socket and was processed and studied under the microscope in the laboratory. Three parameters were analyzed: bone cell and lamella maturation and percentage of bone tissue on the total area analyzed, using a specific software (MatLab). A Wilcoxon-Mann-Whitney Test was conducted on the percentage of the bone tissue and on the sum of the three parameters. Results: 6 grafts became necrotic and were excluded from the study. At the third month after tooth extraction, the other 18 patients presented a clinically healed soft tissue, both in the tooth site and in the donor site, and the bone healed uneventfully. Implants obtained a good primary stability and they showed a physiological osteointegration during the follow up. Test group showed an average of 56% of bone tissue, whereas the control group only of 34%. This difference between the two groups is statistically significant, as well as the difference between the sum of the three parameters, with α≤0,01. Conclusions: this technique demonstrates important results in favor of the preservation of the post-extractive socket with epithelial-connective tissue graft. All three parameters, bone cell and lamella maturation and percentage of bone tissue, were higher in the test group. Future studies should be run to understand more deeply the biological impact of this technique.
Scopo: valutare l’efficacia di guarigione dell’alveolo post-estrattivo utilizzando un innesto epitelio-connettivale prelevato da palato. Da questa tecnica ci si aspetta di ottenere una qualità ossea migliore al fine di poter procedere successivamente con l’inserimento implantare. Metodi: 24 pazienti con la necessità di estrarre un dente singolo sono stati selezionati e divisi casualmente in due gruppi. Nel primo gruppo l’alveolo è guarito spontaneamente. Nel secondo gruppo è stato prelevato un innesto epitelio-connettivale dal palato ed è stato suturato sui margini dell’alveolo post-estrattivo. I pazienti sono tornati regolarmente per il follow-up e dopo tre mesi dall’intervento si è proceduto con l’inserimento implantare, momento in cui è stato prelevato un campione osseo dal sito. Il campione è stato successivamente processato in laboratorio e studiato al microscopio. Sono stati analizzati tre parametri: la maturazione delle cellule e delle lamelle ossee e la percentuale di tessuto osseo sul totale dell’area di campione analizzata, tramite l’utilizzo del software MatLab. I dati sono stati analizzati con il test statistico di Wilcoxon-Mann-Whitney. Risultati: 6 innesti sono andati incontro a necrosi e sono stati esclusi dallo studio. Al terzo mese dall’estrazione, gli altri 18 pazienti si sono presentati con i tessuti guariti in modo ottimale, sia nel sito dell’estrazione sia nel sito donatore. Il gruppo test ha presentato in media il 56% di area occupata da tessuto osseo, mentre il gruppo controllo solo il 34%. Questa differenza tra i due gruppi è statisticamente significativa, così come la differenza tra le somme dei tre parametri, con α≤0,01. Conclusione: questa tecnica dimostra risultati promettenti in favore della socket preservation tramite l’utilizzo di innesto epitelio-connettivale. Tutti e tre i parametri, la maturazione di cellule e lamelle ossee e la percentuale di tessuto osseo, sono più elevati nel gruppo test, con differenza statisticamente significativa. Futuri studi potranno dimostrare in modo maggiormente approfondito l’impatto biologico di questa tecnica.
Guarigione dell’alveolo post-estrattivo: RCT con innesto epitelio-connettivale
OLIVIERI, GIORGIA
2020/2021
Abstract
Aim: to evaluate the efficacy of healing of a preservation technique for the post-extractive socket bone healing using an epithelial-connective tissue graft harvested from the palate. By the use of this technique we expect to get a better bone tissue in order to position an implant in a second time. Methods: 24 patients, requiring a single tooth extraction, were selected to enter the study and were randomly divided in two groups. In the first group the socket healed spontaneously. In the second group, an epithelial-connective tissue graft harvested from the palate was sutured over the post-extractive socket. After surgery, an anti-inflammatory drug was prescribed to all patients. Patients were asked to return for a follow up immediately after the first surgery and after three months for implant positioning procedures. At the implant surgery, a tissue sample was collected from the healed socket and was processed and studied under the microscope in the laboratory. Three parameters were analyzed: bone cell and lamella maturation and percentage of bone tissue on the total area analyzed, using a specific software (MatLab). A Wilcoxon-Mann-Whitney Test was conducted on the percentage of the bone tissue and on the sum of the three parameters. Results: 6 grafts became necrotic and were excluded from the study. At the third month after tooth extraction, the other 18 patients presented a clinically healed soft tissue, both in the tooth site and in the donor site, and the bone healed uneventfully. Implants obtained a good primary stability and they showed a physiological osteointegration during the follow up. Test group showed an average of 56% of bone tissue, whereas the control group only of 34%. This difference between the two groups is statistically significant, as well as the difference between the sum of the three parameters, with α≤0,01. Conclusions: this technique demonstrates important results in favor of the preservation of the post-extractive socket with epithelial-connective tissue graft. All three parameters, bone cell and lamella maturation and percentage of bone tissue, were higher in the test group. Future studies should be run to understand more deeply the biological impact of this technique.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/13389