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Introduction
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The research protocol of this investigation was approved by the ethical committee of Biomatech (Namsa Company,
Lyon, France).
Surgical protocol
thiopenthal sodium was given (NesdonalND, Merial, Lyon, France 1015 mg/
kg intravenous) and the animals were
placed on an O2N2O isoflurane (1
4%) mixture. Local anaesthesia was
induced by a subcutaneous injection of
articain (Ultracains, Hoechst, Frankfurt,
Germany 1%).
In both quadrants of the mandible, the
distal root of the third and fourth premolars (P3, P4) served as experimental
sites. In order to mimic extraction sites of
single-rooted teeth, the mandibular premolars were hemisected with the use of a
fissure bur. The distal roots were removed
using a forceps without elevation of a
muco-periosteal flap or compromising the
marginal gingiva. The pulp tissues of the
mesial roots were extirpated and engaged
with a Gates-Glidden bur. After filling the
root canals with gutta-percha, the coronal
part of the pulp chamber was sealed with
an auto-polymerizing resin material
(Clearfil Cores, Kuraray, Tokyo, Japan).
One of the following treatment modalities
was randomly assigned to each site:
Tx 1 (n 5 5): The extraction socket
was filled with deproteinized bovine
bone material integrated in a 10%
collagen matrix (BioOss Collagens,
Geistlich Biomaterials, Wolhusen, Switzerland). Consecutively, a free soft
tissue punch according to the technique
of Jung et al. (2004) and Landsberg &
Bichacho (1994) was harvested from the
palate with a thickness of approximately
3 mm. Several interrupted sutures (Seralene 7-0s, Serag Wiesner, Naila, Germany) were applied to fix the free soft
tissue graft to the previously deepithelized marginal gingiva of the extraction
socket (Fig. 1a and b).
Tx 2 (n 5 5): Following intra-sulcular
incision, a full-thickness preparation of
the buccal bone plate of the distal
root was performed without vertical
releasing incisions. BioOss Collagens
was placed on the outer surface of the
buccal bone plate and covered with
an adsorbable collagen membrane
(BioGides, Geistlich Biomaterials),
thus performing guided bone regeneration (GBR). Subsequently, the extraction socket was filled with DBBM
(BioOss Collagens) and closed with a
free gingival autograft, according to Tx
1 (Fig. 2).
Tx 3 (n 5 5): The buccal bone plate was
forced into a buccal direction with a
specially designed instrument mobilizing
the buccal bone plate approximately
5 mm. DBBM (BioOss Collagens) was
packed into the socket to prevent the
443
buccal bone plate from re-collapsing. Subsequently, the extraction socket was closed
with a free gingival autograft (Fig. 3).
Tx 4 (n 5 5): The extraction socket was
filled with DBBM (BioOss Collagens).
Consecutively, an undermining splitthickness preparation of the buccal aspect
was performed and a combined free gingival/connective tissue graft was obtained
from the palate. The connective tissue
portion of the graft was inserted into the
undermined buccal pouch and sutured
with several interrupted sutures (Seralene
7-0s, Serag Wiesner) (Fig. 4).
After surgery, the following regimen
was administered:
The animals were observed once
daily for any clinical abnormality.
Fig. 2. Treatment group 2 (Tx 2): after elevation of a muco-periosteal flap, the buccal
bone plate is augmented using the GBRtechnique (BioOss Collagens/BioGides)
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Fickl et al.
Fig. 4. Treatment group 4 (Tx 4): after incorporation of BioOss Collagens into the
extraction socket a gingival autograft with a
connective tissue portion is incorporated into
a buccal pouch and sutured in place.
Fig. 5. (a) Optical scan of the casts using the Cerec 3D camera. (b) Digital image of cast
(baseline), after import in Match3D software. (c) Volume changes after superposition of
optical impressions representing baseline and two-month follow-up. Red areas represent loss,
white areas gain of volume. (d) Example of measured area.
r 2009 John Wiley & Sons A/S
Results
445
Area
(mm2)
Dvolume/area
t0 t2 (mm)
Dvolume/area
t2 t4 (mm)
Dvolume/area
t0 t4 (mm)
1181.00
1608.00
1440.00
4750.00
2188.00
2233.40
1454.60
683.57
474.69
278.94
758.83
540.75
547.35
187.51
941.64
398.28
185.58
768.71
561.08
571.06
297.88
1625.20
872.97
464.52
1527.54
1101.82
1118.41
477.57
2226.00
2723.00
385.00
1975.00
3493.00
2160.40
1149.25
1021.51
459.59
715.89
416.78
28.75
528.50
369.17
1041.07
1445.18
302.14
486.51
925.36
840.05
455.03
2062.58
1904.76
1018.03
903.29
954.10
1368.55
565.75
2396.00
3366.00
2791.00
2519.00
4005.00
3015.40
667.58
244.94
314.34
645.13
197.40
5.25
153.58
352.16
2311.02
1198.55
1473.72
1238.93
1034.29
1451.30
505.60
2066.08
1512.89
828.58
1041.53
1039.54
1297.72
497.26
2987.00
2400.00
4634.00
3235.00
3612.00
721.97
611.37
85.56
646.03
795.29
786.68
561.05
701.27
781.65
1069.31
1508.65
1172.42
615.71
1427.68
1864.61
Mean
SD
3373.60
830.96
537.82
355.64
779.99
185.67
1317.82
464.10
Mean
SD
2
Mean
SD
3
Mean
SD
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Fickl et al.
Fig. 6. Volumetric alterations at five measured sites and mean change for the different treatment groups.
References
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Clinical Relevance