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Polylactic acid (PLA) Membrane as a Sole Treatment For Alveolar Ridge Preservation

Lemke, Matthew Jon

Abstract Details

2014, Master of Science, Ohio State University, Dentistry.
Abstract Background: The combination of membranes and bone grafting materials has been shown to preserve the post-extraction dimensions of the alveolar ridge and constitutes the currently accepted protocol for socket preservation. However, the use of bone grafting materials in extraction sockets has been questioned because of possible interference with bone formation in the wound sites; particles of graft material have been found in alveolar sockets more than 6 months after placement. Histologic examination of extraction sockets filled with allograft bone revealed the presence of graft particles with no evidence of bone formation on the particle surface, suggesting that the allograft bone may delay healing and affect the quality of regenerated bone. The purpose of this preliminary study is to determine whether use of a polylactic acid (PLA) membrane alone (without bone graft) after tooth extraction results in sufficient bone formation for implant placement and to determine the quality of the newly formed bone. Methods: Patients with single rooted non-esthetic teeth deemed hopeless for various reasons and in need of extraction, socket preservation and implant placement were recruited at the Graduate Periodontology Clinic, College of Dentistry, The Ohio State University. Extraction sites were randomly assigned to either control group (extraction alone) or test group (extraction + PLA membrane). Clinical measurements, including relative ridge height and soft tissue level, were recorded using a pre-fabricated plastic stent before and immediately after extraction, and pre-implant placement. Clinical parameter measurements were recorded at six different positions (MB, B, DB, ML, L, and DL) per extraction site. Bone cores (2 x 6 mm) were retrieved with a trephine immediately before implant placement and subjected to micro-computed tomography (micro-CT) and cone beam CT (CBCT) scans followed by histomorphometric analysis. Results: A total of 18 subjects fulfilled the inclusion criteria and were recruited for the study. Twelve subjects (5 control and 7 test) successfully completed the bone core harvesting during implant placement. Six subjects (4 experimental and 2 control) were removed from the study due to the need for bone grafting at the time of implant placement. Fifteen subjects (8 control and 7 test) completed the clinical measurements before and immediate after tooth extraction. When comparing the relative ridge heights and soft tissue levels prior to and immediately after tooth extraction, there were no statistically significant differences in either control or test groups (p = 0.05). When comparing the relative ridge height immediately after extraction and before implant placement (4 months after extraction), there was a statistically significant bone loss at MB (1.43 mm; p=0.037), B (2.06 mm; p=0.031), L (2.0 mm; p=0.001) and DL (1.87 mm; p=0.013) aspects in the control group. However, no statistically significant difference was found regarding changes in bone height in the test group in all six surfaces (p>0.05). After grouping the measurements at the mesial and distal sites of the extraction tooth, again only the control group showed statistically significant difference in loss of bone height at mesial (1.19 mm; p=0.0373) and distal (1.38 mm; p=0.0464) aspects. Furthermore, when all 6 measurements were averaged into one value, the control group showed a significant amount of 1.5 mm (p=0.0063) bone loss, whereas no significant changes in bone level were identified in the test group. Changes in soft tissue levels, after tooth extraction and before implant placement, were not statistically significant in either control or test groups, when either the mesial and distal sites of the socket were examined or all 6 measurements were averaged into one value. CBCT and Micro-CT analyses - Using a paired t-test, the mean value of grey level (equal to degree of bone mineralization (DBM) was compared between control and test groups. There was no statistically significant difference in the CBCT (p=0.616) and micro-CT (p=0.319) analyses. Histograms of DMB obtained from micro-CT scan of bone core specimen showed similar plots and peak values between the control and test groups. Histomorphometric analysis - Examination of each bone core sample showed similar distribution of viable bone in both groups with abundant lacunae present. A different level of connective tissue versus bone was present. Conclusions: Within the limits of this study, the use of PLA membrane alone after tooth extraction may prevent post-extraction vertical bone loss. Nevertheless, bone quality may not improve beyond control by the use of PLA membrane. More studies with a larger sample size are needed to confirm these findings.
Hua-Hong Chien (Advisor)
Dimitris Tatakis (Committee Member)
Do-Gyoon Kim (Committee Member)
57 p.

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Citations

  • Lemke, M. J. (2014). Polylactic acid (PLA) Membrane as a Sole Treatment For Alveolar Ridge Preservation [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1402664234

    APA Style (7th edition)

  • Lemke, Matthew. Polylactic acid (PLA) Membrane as a Sole Treatment For Alveolar Ridge Preservation. 2014. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1402664234.

    MLA Style (8th edition)

  • Lemke, Matthew. "Polylactic acid (PLA) Membrane as a Sole Treatment For Alveolar Ridge Preservation." Master's thesis, Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1402664234

    Chicago Manual of Style (17th edition)