Randomized,Double Blind,Controlled Clinical Study Of The Effect Of Inflammatory Granulation Tissue On The Healing Of Tooth Socket

According to the different period of granulation tissue,it can be divided into two categories:inflammatory granulation tissue and reparative granulation tissue.When the lesion area is full of inflammatory cells,we called it inflammatory cells and when there are mainly collagen fibers,we call it reparative granulation tissue.Both are composed of capillaries,fibroblasts,neutrophils,lymphocytes,macrophages and other components.Early formation of inflammatory granulation tissue is mainly macrophages,lymphocytes infiltration,followed by plasma cell infiltration,increased angiogenesis,and finally fibroblasts into the formation of collagen fibers.Chronic inflammatory process is mainly a large number of inflammatory cells infiltration of inflammatory granulation tissue.The main sources of inflammatory granulation tissue in the alveolar include: the infection from the pulp through the root canal system into the apical area;from the periodontal infection through the periodontal pocket into the periodontal tissue;from the periodontal pulp Lesions of the infection into the periodontal and apical weeks.Infections from the root canal and the periodontal pocket form inflammatory granulation tissue in the alveolar through long-term,chronic stimulation.Chronic periodontitis,periapical periodontitis is a common oral disease,due to clinical symptoms are not obvious,patients are easy to ignoreand delay the timing of treatment.Therefore,chronic periodontitis,periapical periodontitis and periodontal pulp associated with lesions is caused by the teeth can not be retained and the need to remove the important reasons.Usually remove such teeth,there are residual inflammatory granulation tissue in the socket.The traditional view is that: the granulation tissue in the alveolar caused wound bleeding,infection,and delayed tooth healing,so it's necessary to curettage the inflammatory granulation tissue completely.In recent years,with the development of oral planting technology,especially the immediate implant denture,in order to shorten the traditional planting treatment time,immediate implant is more accepted by patients;but planting techniques need good recovery soft tissue and bone tissue,and need to clear the alveolar Inflammatory granulation tissue which is considered to be an important factor affecting the survival rate of the implant.Therefore,it is emphasized that the inflammatory granulation tissue in the tooth socket should be cleaned up thoroughly and thoroughly.In the literature,some scholars had begun to question the consensus of inflammatory granulation tissue must be removed after tooth extraction:(1)traditional view is that inflammatory granulation tissue caused bleeding after tooth extraction,infection,but through careful analysis,we can find that these studies are based on clinical experience and there is no clinical comparison experiments to support this conclusion.(2)There are many kinds of cells in the normal periodontal ligament,in which the periodontal ligament stem cells can differentiate into osteoblasts or osteoblasts,etc.These cell components are important in the repair of periodontal tissue.In the process of scraping the inflammatory granulation tissue,it is possible to damage the normal periodontal ligament remaining on the wall of the tooth socket,which is not conducive to the healing of the tooth socket.(3)It was confirmed that Oroantral Communications(OAC)or inferior alveolar nerve injury(Inferior Alveolar)was associated with the use of a curette scratching the tooth socket when the removal teeth was closely to the maxillary sinus or mandibular canal Nerve Injury,IANI)caused by lower limb numbness and other serious complications.(4)inflammatory granulation tissue after appropriate treatment can be transformed intoreparative granulation tissue,and conducive to bone healing.(5)some study confirmedthat there are many cellular components in inflammatory granulation tissue rich in cellular components,the variety of ingredients can promote the healing of the tooth socket,if not in the inflammatory environment.Based on these,we present a randomized,double-blind,controlled trial of the effect of inflammatory granulation on the healing of extraction.Objective: To study the effects of the inflammatory granulation tissue on the healing of the tooth socket,so as to provide the basis for clinical practice.Methods: This study collected the patients who need to extract the tooth with chronic periapical periodontitis in The Fourth Military Medical University Hospital of Stomatology of surgical from December 1,2015 to September 30,2016.through clinical examination and preoperative imaging,if the examination showed that there are low density around the teeth.the final clinical trials included a total of 100 cases study on the standard of patients with a total of 109 sockets,all teeth were randomly divided into two groups,the experimental group conclude 55 tooth sockets,control group conclud 54 sockets.Inflammatory granulation tissue retained in experimental group after tooth extraction,the inflammatory granulation tissue were removed in control group.All patients need to be observed the soft tissue healing after 1 weeks;Compared the CBCT images of 12 weeks after tooth extraction and immediately after surgery,to evaluate the hard tissue recovery.Results: after 1 weeks,the 2 groups of extraction socket healing of soft tissue were good,there were no signs of infection,and no significant difference between groups(P>0.05).12 weeks and immediate postoperative CBCT images showed that there are different degrees of absorption of alveolar ridge both in width and height,but there were no significant differences between 2 groups(P>0.05).Conclusion: Our preliminary clinical study showed that:(1)the presence of inflammatory granulation tissue in the sockets did not lead to the risk of bleeding after tooth extraction;(2)the presence of inflammatory granulation tissue in the dental implants did not lead to an increased risk of infection.(3)Through the clinical observation we found that the presence of inflammatory granulation tissue did not affect the healing of tooth socket;(4)through CBCT comparison study found that the presence of inflammatorygranulation tissue did not affect the healing of the sockets.Therefore,we recommend chronic apical periodontitis and periodontitis in patients with tooth extraction,the inflammatory granulation tissue need not be removed,especially when the tooth root are closely to the maxillary sinus or mandibular canal tube,in order to avoid serious complications,we should not use the curettage to remove granulation tissue.