BackgroundThe use of the operating microscope (OM) for extraction and alveolar ridge augmentation (ARP) is increasing due to enhanced magnification and illumination. The primary objective was to compare the wound healing and crestal bone quality after the use of OM and dental loupes (DL) for ARP.MethodsForty non‐molar teeth with periapical lesions in need of extraction and ARP from 33 patients were randomly assigned to 2 groups: DL (control) or OM (test). All procedures were performed by 1 surgeon and assessments done by masked examiners. ARP was performed with an allograft and a resorbable collagen membrane. The presence of granulomatous tissue remnants after debridement was recorded. Cone‐beam computed tomography (CBCT) and ultrasound (US) scans were taken during the healing phase up to 16‐week visits. Bone cores were retrieved from implant osteotomies for histologic analysis. Patient‐reported outcome measurements (PROMs) were assessed.ResultsAll patients completed all study visits except 1 who dropped out before the last visit. After socket debridement, the test group exhibited significantly fewer sites with tissue remnants (p = 0.01) and a better healing score at 2‐week (p = 0.04) and 4‐week (p = 0.01) time points. There were no significant differences in 12‐week crestal bone healing by histology (p = 0.1), US (p = 0.85), and CBCT healing (p = 0.64) at 12 weeks, as well as PROMs (p > 0.1).ConclusionWithin the limitation of the study, the use of OM for ARP resulted in significantly fewer tissue remnants and favorable early visual wound healing. CBCT and US‐derived‐crestal bone quality did not show a difference between the 2 groups.Plain Language SummaryAlveolar ridge preservation (ARP) by placing bone particulates in the extraction socket, covered by a wound dressing material, is commonly applied immediately after tooth extraction to reduce jawbone shrinkage in preparation for implant placement later. The jawbone healing varies, depending largely on the ability to remove the etiology, socket features, extent of surgical trauma, and wound stability. Healed jawbone with good quality is favorable for easiness of implant placement and could be related to maintenance of long‐term implant health. The surgical microscope with high magnification (up to ∼25×) and co‐axial illumination is ideal for assistance in the removal of granulomatous tissue that is believed to interfere with healing, performance of minimally invasive extraction, and stabilization of the wound with meticulous tissue management and fine sutures. This study compared the use of the surgical microscope to dental loupes for ARP in a randomized controlled design. The microscope‐assisted ARP is associated with a significantly higher chance of removing granulomatous tissue, favorable early healing, and similar crestal bone quality. Removal of granulomatous tissue is significant for immediate implant placement. This study serves as a model for testing the benefits of the surgical microscope for encouraging early healing in more challenging intraoral surgical procedures.

中文翻译：

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使用手术显微镜保留牙槽嵴的临床结果： 一项随机对照试验


背景由于增强的放大倍率和照明，手术显微镜 （OM） 在提取和牙槽嵴增强 （ARP） 中的使用正在增加。主要目的是比较使用 OM 和牙科放大镜 （DL） 治疗 ARP 后的伤口愈合和牙槽嵴骨质量。方法将 33 例患者 40 颗需要拔除根尖周病变且 ARP 的非磨牙随机分为 2 组： DL （对照） 或 OM （测试）。所有手术均由 1 名外科医生执行，评估由戴口罩的检查员完成。ARP 使用同种异体移植物和可吸收胶原膜进行。记录清创后肉芽肿组织残留物的存在。在愈合阶段进行锥形束计算机断层扫描 （CBCT） 和超声 （US） 扫描，最长可达 16 周。从种植体截骨术中取出骨芯进行组织学分析。评估患者报告的结果测量 （PROM）。结果除 1 例患者在最后一次就诊前退出外，所有患者均完成了所有研究访视。接受腔清创术后，测试组在 2 周 （p = 0.04） 和 4 周 （p = 0.01） 时间点表现出组织残留部位显着减少，愈合评分更好。12 周时组织学 （p = 0.1） 、 US （p = 0.85） 和 CBCT 愈合 （p = 0.64） 以及 PROM （p > 0.1） 的 12 周牙槽嵴愈合没有显著差异。结论在研究的限制范围内，使用 OM 治疗 ARP 导致组织残余明显减少，有利于早期视觉伤口愈合。CBCT 和 US 来源的牙槽嵴骨质量在 2 组之间没有显示差异。通俗易懂的语言摘要通过将骨颗粒放入拔牙窝中，用伤口敷料材料覆盖来保留牙槽嵴 （ARP），通常在拔牙后立即应用，以减少颚骨收缩，为以后的种植体植入做准备。颚骨愈合情况各不相同，很大程度上取决于去除病因的能力、牙槽特征、手术创伤的程度和伤口的稳定性。质量好的愈合颚骨有利于种植体植入的便利性，并且可能与维持种植体的长期健康有关。具有高放大倍率（高达 ∼25×）和同轴照明的手术显微镜非常适合帮助去除被认为会干扰愈合的肉芽肿组织、进行微创提取以及通过细致的组织管理和精细缝合来稳定伤口。本研究在随机对照设计中比较了手术显微镜与牙科放大镜对 ARP 的使用。显微镜辅助 ARP 与去除肉芽肿组织的机会显着增加、良好的早期愈合和相似的牙槽嵴骨质量相关。去除肉芽肿组织对于立即植入种植体很重要。本研究作为测试手术显微镜在更具挑战性的口内外科手术中促进早期愈合的好处的模型。