Close-meshed MRIs follow-ups for dynamic healing evaluation after tooth extraction: A conceptual case study

Close-meshed MRIs follow-ups for dynamic healing evaluation after tooth extraction: A conceptual case study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Close-meshed MRIs follow-ups for dynamic healing evaluation after tooth extraction: A conceptual case study Kai R. Fischer, Félix P. Kuhn, Tabea Flügge, Patrick R. Schmidlin, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7106478/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Nov, 2025 Read the published version in Periodontal and Implant Research → Version 1 posted 12 You are reading this latest preprint version Abstract Purpose To apply a close-meshed magnetic resonance imaging (MRI) protocol for socket healing – with or without alveolar ridge preservation - and discuss the advantages and disadvantages as compared to computed tomography (CT). Methods A molar (tooth 36) was atraumatically extracted and the mesial socket was filled with a xenograft, while the distal was left for spontaneous healing; the socket orifice was covered with a collagen membrane. MRIs were taken preoperatively (t0) and 1 (t1), 2 (t2), 4 (t3), 8 (t4), and 16 (t5) weeks after tooth extraction, respectively. At t0 and t5, the patient received CT scans for comparison. MRI and CT images were used for the analysis and comparison of extraction socket healing at different time points. Image data were processed with 3D segmentation software. Results Socket healing was uneventful and could be tracked within MRI. Bone volume (cm 3 ) constantly reduced from 4.83 (t0) to 4.15 (t16) for MRI over time. Conclusions MRI has been proven to be suitable for imaging in different dental applications. Using this radiation-free technology might allow a more stringent and frequent follow-up in practice and, especially, in clinical trials. Technique-inherent limitations need to be considered. extraction socket socket healing computed tomography (CT) magnetic resonance imaging (MRI) alveolar ridge preservation Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Two-dimensional radiographs still represent the basic standard of diagnostics for dental hard tissues, but should always be interpreted with caution, especially when superimpositions and image distortions hamper adequate interpretation and decision-making [ 1 ][ 2 ]. Three-dimensional imaging has therefore emerged as an important component of enhanced diagnostics limiting these shortcomings and providing an anatomic method for diagnosis, planning and simulation of different surgical therapeutic procedures [ 3 ][ 4 ]. Especially cone-beam computed tomography (CBCT) has become more and more a consolidated diagnostic tool, especially in the arsenal for elective dental issues in hard tissue diagnostics compared to conventional radiography, e.g. when it comes to minimize the risk of nerve damage during implant placement, evaluation of sinus anatomy before respective lifting procedures, adequate biological and prosthetic-driven implant placement and the respective evaluation for bone augmentation including the fabrication of data-based blocks and meshes [ 5 ]. Even though the use of CBCT significantly reduces radiation exposure as compared to conventional CT scans [ 6 ], the principles of a so-called “radiation hygiene” should therefore always be taken into account, since stochastic effects, a possible lifetime-attributable risk increase of cancers, must be discussed, and current guidelines stress to restrict the use to justifiable indications and to apply stringent radiation management protocols using the "as low as reasonably achievable" (ALARA) or "as low as diagnostically acceptable" (ALADA) principle whenever possible [ 7 ]. Although modern radiation-based sectional imaging such as CBCT undergoes a continuous indication-adapted optimization process of examination protocols and rapid technical advancements for dose reduction, alternatives – even if possible radiation-free - remain greatly warranted, especially within experimental set-ups, i.e. clinical studies dealing with a higher frequency of image-taking allowing for close longitudinal evaluations and comparisons of healing and treatment outcomes. While CBCT is valuable mainly for the visualization of bony structures with exceptionally high accuracy, the introduction of innovative new magnetic resonance imaging (MRI) techniques enables high-resolution, non-invasive and radiation-free diagnostic three-dimensional imaging of teeth and adjacent soft tissue and bone structures. Therefore, MRI offers an important alternative for (experimental) diagnostics in dentistry, oral medicine and maxillofacial surgery [ 8 ]. Noteworthy, MRI remains largely restricted for visualizing soft tissue structures with excellent contrast properties [ 9 ]. By providing high spatial resolution and excellent soft tissue contrast, special MR imaging protocols will become a valuable alternative to CBCT in future dental imaging, also for dental hard tissue evaluations [ 10 ]. However, according to the author’s best knowledge, applications, for instance in socket healing, are still scarce. Therefore, the present case presentation aimed to evaluate a stringent and close-meshed imaging protocol for socket healing – w/o alveolar ridge preservation - and discuss the advantages and disadvantages as compared to conventional CT. Methods Case presentation In this case report, we report on a 47-year old healthy female patient, who gave her written informed consent to monitor and document wound healing after extraction with close MRI scans in addition to CT after extraction and after 4 months healing. The patient showed a distinct radiolucency at the middle of mesial aspect of the mesial root of tooth 36 extending to the distal aspect of the root of tooth 35. The prognosis was considered hopeless and the tooth was extracted as minimally invasive as possible to avoid any damage to the surrounding bone. Granulation tissue was thoroughly removed and a sample of the excised material of the mesial root was submitted for histological evaluation. The mesial root was filled with a xenograft (BioOss Collagen, Geistlich, Wolhusen, Switzerland) up to the alveolar bone level while the distal root remained unfilled; both sockets were covered with an absorbable membrane (Smartbrane, Regedent, Zurich, Switzerland) and - prior to this – bone substitute material and the alveolus were treated with hyaluronic acid (HyadentBG, Regedent). The wound edges were adapted and closed with a modified cross suture and left to open wound healing. Immediately after extraction and socket treatment as described, a MRI and a CT scan were performed. MRIs were taken preoperatively (t0) and 1 (t1), 2 (t2), 4 (t3), 8 (t4), and 16 (t5) weeks after tooth extraction. At the final 16 weeks evaluation, the patient received another CT scan for comparison at baseline and after the last evaluation. MRI and CT MRI was performed on a Magnetom Skyra 3T (Siemens Healthcare, Erlangen, Germany) with a dedicated 64-channel receive coil. The MRI protocol consisted of 3 sequences: a T2 weighted TSE with DIXON based fat suppression to primarily assess intra-socket healing processes (slice thickness 2 mm, acquisition matrix 320 x 256, FOV 200x200 mm 2 , bandwidth 390 Hz/Px, spacing between slices 2.3 mm, echo time 76 ms), a 3D T1 weighted SPACE (0.65 mm isovoxel) and the ultrashort echo time (UTE) sequence PETRA (0.78 mm isovoxel) both to allow for comparison of volumetric changes within the bony structures. CT images were acquired on a Somatom Definition AS 128 (Siemens Healthcare, Erlangen, Germany) with a slice thickness of 0.75 mm and a pitch of 0.8. With both modalities the oral cavity, the upper and lower jaw and adjacent soft tissue structures were imaged. The applied ultrashort echo time MRI sequence UTE enabled visualization of bone, the T1 weighted sequence provided information about the bone marrow and the T2 weighted sequence with fat suppression allowed for the assessment of oedematous and reparative processes. The CT visualized the texture of cortical and cancellous/trabecular mandibular bone. Analysis and comparison of MRI and CT data sets MRI and CT images were used for the analysis and comparison of extraction socket healing at different time points. Image data were processed with 3D segmentation software ( https://www.slicer.org , version 4.11.20210226) [ 11 ]. A T2-weighted TSE sequence with DIXON based fat suppression was chosen for the analysis of MRI images due to its favorable display of the hard tissue surrounding the extraction socket compared to the two other sequences. The bone surrounding the socket was segmented for a better understanding of the healing process of the alveolar bone post-extraction. Its volume was measured at different time points to monitor the dimensional changes over time. The extraction socket and adjacent structures were identified and located on axial MR images. Reproducible anatomical landmarks were selected to define the mandibular region to be segmented around the extraction socket. Based on these, mesial and distal planes were drawn to delimit the region of interest reproducibly. Mesially of the alveolus, a plane was defined passing through the coronal pulp and the apex of tooth 35. Distally, the plane was oriented along the course of the furcation and the apex of the mesial root of tooth 37, as shown in Fig. 3 . The mandibular bone was manually segmented, including the portions of teeth 35 and 37 located within the previously defined area. The teeth and cortical bone were detected by their low signal intensity, particularly evident in the mandible through direct contact with the hyperintense signal of the adjacent soft tissue. The mentioned structures were manually delineated in each axial slice and the total volume was obtained by adding the volume on each slice. Figure 4 shows the model of the segmented bone used to calculate the corresponding bone volume and the same model in context with an axial MRI image and tooth 35 shown in blue. The preoperative CT and postoperative CT scans after 16 weeks were evaluated and analyzed using the similar protocol as for MRI analysis. The cortical bone of the mandible and the teeth were well demarcated from the surrounding tissue due to their hyperdensity. The planes delimiting the evaluation area were identified and marked using the same anatomical landmarks as in the MRI. The bone was manually segmented in each axial slice, as described above, and the volume was calculated accordingly. Results Volumetric changes Table 1 shows the calculated bone volume within the previously defined range at the different acquisition times. Over time, the loss of bone volume was evident on the crestal aspect of the alveolar process both buccally and lingually without evident differences between the mesial and distal alveolus. Greater volumes have been measured for MRI compared to CT. Within CT, hardly any volumetric change was seen. Table 1 Calculated bone volume within the area of interest at different timepoints comparing MRI and CT images. t in weeks Volume [cm 3 ] MRI 0 4.829 1 4.684 2 4.636 4 4.624 8 4.143 16 4.154 CT 0 3.453 16 3.419 Alterations of the MRI signal In the early phases after tooth extraction, there was a prominent T2 hyperintense signal within the socket corresponding to edematous alterations and newly formed fibrous tissue. Signal intensity slightly decreased in correspondence to scar tissue formation. The T1 signal did not alter significantly during the observation period. The ultrashort echo time UTE sequence provides information on the bony circumference of the socket similar to the information in the CT scan. Interestingly, no clear difference was observed between the grafted and non-grafted part of the extraction socket within the MRI. Discussion With this study, we aimed to evaluate the applicability of MRI imaging compared to CT scans in the assessment of an extraction socket related to alveolar healing, bone regeneration and volumetric changes, respectively. To the authors best knowledge, this is the first report in this field and MRI, as a radiation-free technology, might offer significant advantages not only clinical practice but especially in longitudinal scientific trials. Within the six MRI scans over the 16 weeks healing phase, it was possible to not only assess the volumetric changes of the bone but also the different steps of regeneration inside the alveolus. Sequence selection and reduction of movement artefacts are decisive for picture quality and, therefore, equality to the gold standard of CT or CBCT imaging. MRI is a well-established imaging technology, being the modality of choice for most soft tissue and functional imaging indications compared to CT/CBCT primarily indicated for hard tissue. The science and application of MRI continue to advance, with several developments having potential implications for the practice of dentistry. These developments lead to investigations in various dental fields, however, MRI has not become a standard procedure in daily practice since been considered prohibitively costly. In periodontology, correct assessment of furcation involvement is crucial for prognosis estimation and treatment planning, respectively [ 12 ]. Dental MRI has been shown equivalent to CBCT with high levels of sensitivity and specificity in assessing furcation involvement in maxillary molars, hence, can be regarded as an accurate, non-invasive tool to improve diagnosis – compared to standard periodontal examination – and surgical treatment of upper molars [ 13 , 14 ]. Future applications in this field may also include diagnosis of infrabony defects or follow-up studies of periodontal regeneration. Recently, the potential of MRI for diagnostic purposes in operative dentistry has been evaluated [ 15 ]. Besides the limited and heterogenic data, possible settings for MRI might be diagnostic of caries lesions, presentation of pulp tissues and periapical lesions. In addition, preoperative assessment of the localization of impacted teeth e.g. third molars and their spatial relation to anatomical structures like inferior alveolar nerves with potential advantages in the detection of accessory [ 16 ] [ 15 ]. In endodontics, despite MRI is less prone to artefacts from radiodens materials as root fillings or posts compared to CBCT, further improvements are warranted in the detection of root cracks and fractures [ 17 ]. MRI based pre-operative planning and surgical guide manufacturing seems especially promising in implant dentistry as 3D-imaging might be necessary at different stages of the treatment. MRI in combination with intra-oral optical scans seems to be a reliable and sufficiently accurate to identify all relevant anatomical structures and to enable fully guided implant surgery [ 18 , 19 ], however, might not reach the same accuracy as CBCT in certain situation as shortened dental arches [ 20 ]. Very recently, the first report on preoperative buccal bone thickness assessment for immediate implant placement has been published without significant disadvantages comparing “black bone” sequences to CBCT while displaying soft and hard tissue with high spatial resolution and minimal artifacts [ 21 ]. Limitations to this study are significantly thicker slices in the selected MRI sequence compared to the CT images that are a factor in the generation of partial volume artifacts [ 22 ]. This effect can lead to a limited assessment of the volume in the marginal areas of the segments and could lead to deviations in the volume calculation. A longer acquisition time for MRI than in CT may cause motion artifacts and lead to an overestimation of bone volume. The evaluated T2 sequence is 2 mm thick, however, was primarily intended for the assessment of the internal texture of the extraction socket. Originally, ultra-short echo sequence were chosen with layer thickness 0.78 mm isovoxel primarily for bone imaging [ 23 ]. Unfortunately, the sequence shows various motion artifacts in the presented patient, so it did not seem to be suitable for volumetric analysis. Moreover, a T1 SPACE sequence was recorded with a layer thickness 0.65 mm isovoxel. However, this sequence also showed certain blurring in the area of interest due to magnetic field inhomogeneities caused by filling etc., therefore dental imaging in MRI in elderly patients is often only possible to a limited extent. Hence, only the T2 sequence was available for comparison. This observed issues need to be taken into account when using MRI for volumetric assessments in future clinical trials. Overall, the loss of volume over time was more pronounced in the MRI than in the CT. Due to the lack of direct comparability, no statement can be made as to whether this observation is based on one of the potential sources of artifacts discussed above. In conclusion, MRI offers many potential indications as a non-invasive and radiation-free imaging technology in dentistry. Until now, however, primarily single diagnostic settings have been reported while this proof-of-concept clearly shows advantages in any situation where multiple scans are necessary or for clinical trials assessing e.g. ridge preservation, guided tissue or bone regeneration in a tighter and more frequent fashion as possible with CT/CBCT due to “radiation hygiene” and ethical considerations. Abbreviations CBCT - cone-beam computed tomography CT - computed tomography MRI - magnetic resonance imaging USE - ultrashort echo time Declarations Ethics approval and consent to participate not applicable; presented patient gave her written informed consent to monitor and document wound healing after extraction. Consent for publication not applicable Availability of data and material All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding not applicable Authors' contributions KF proposed the original research idea, coordinated the study protocol and finalized the manuscript. PS performed the surgery and was a major contributor in writing the manuscript. FK was responsible for imaging acquisition as well as interpretation of the MRI scans. JS and TF analyzed and compared the MRI and CT images and JS was a major contributor in writing the manuscript. All authors read and approved the final manuscript. Acknowledgements not applicable References Winter, C.M.; Woelfel, J.B.; Igarashi, T. Distortion and other errors in oblique cephalometric radiography. Angle Orthod 1984 , 54 , 330-346, doi:10.1043/0003-3219(1984)0542.0.CO;2. Bergersen, E.O. Enlargement and distortion in cephalometric radiography: compensation tables for linear measurements. Angle Orthod 1980 , 50 , 230-244, doi:10.1043/0003-3219(1980)0502.0.CO;2. Whyms, B.J.; Vorperian, H.K.; Gentry, L.R.; Schimek, E.M.; Bersu, E.T.; Chung, M.K. The effect of computed tomographic scanner parameters and 3-dimensional volume rendering techniques on the accuracy of linear, angular, and volumetric measurements of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2013 , 115 , 682-691, doi:10.1016/j.oooo.2013.02.008. von Wilmowsky, C.; Bergauer, B.; Nkenke, E.; Neukam, F.W.; Neuhuber, W.; Lell, M.; Keller, A.; Eitner, S.; Matta, R.E. A new, highly precise measurement technology for the in vitro evaluation of the accuracy of digital imaging data. J Craniomaxillofac Surg 2015 , 43 , 1335-1339, doi:10.1016/j.jcms.2015.06.021. Li, L.; Wang, C.; Li, X.; Fu, G.; Chen, D.; Huang, Y. Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: A retrospective case series study. Clin Implant Dent Relat Res 2021 , 23 , 5-18, doi:10.1111/cid.12966. Yeung, A.W.K.; Jacobs, R.; Bornstein, M.M. Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. Clinical oral investigations 2019 , 23 , 2573-2581, doi:10.1007/s00784-019-02907-y. Jaju, P.P.; Jaju, S.P. Cone-beam computed tomography: Time to move from ALARA to ALADA. Imaging Sci Dent 2015 , 45 , 263-265, doi:10.5624/isd.2015.45.4.263. Traser, L.; Flugge, T.V.; Burdumy, M.; Kamberger, R.; Richter, B.; Hassepass, F.; Korvink, J.G.; Echternach, M. A Comparison of Different Methods to Generate Tooth Surface Models Without Applying Ionizing Radiation for Digital 3-Dimensional Image Fusion With Magnetic Resonance Imaging-Based Data of the Head and Neck Region. J Comput Assist Tomogr 2015 , 39 , 882-889, doi:10.1097/RCT.0000000000000293. Al-Haj Husain, A.; Solomons, M.; Stadlinger, B.; Pejicic, R.; Winklhofer, S.; Piccirelli, M.; Valdec, S. Visualization of the Inferior Alveolar Nerve and Lingual Nerve Using MRI in Oral and Maxillofacial Surgery: A Systematic Review. Diagnostics (Basel) 2021 , 11 , doi:10.3390/diagnostics11091657. Valdec, S.; Al-Haj Husain, A.; Winklhofer, S.; Muller, M.; Piccirelli, M.; Stadlinger, B. Comparison of Preoperative Cone-Beam Computed Tomography and 3D-Double Echo Steady-State MRI in Third Molar Surgery. J Clin Med 2021 , 10 , doi:10.3390/jcm10204768. Fedorov, A.; Beichel, R.; Kalpathy-Cramer, J.; Finet, J.; Fillion-Robin, J.C.; Pujol, S.; Bauer, C.; Jennings, D.; Fennessy, F.; Sonka, M.; et al. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 2012 , 30 , 1323-1341, doi:10.1016/j.mri.2012.05.001. Nibali, L.; Zavattini, A.; Nagata, K.; Di Iorio, A.; Lin, G.H.; Needleman, I.; Donos, N. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. J Clin Periodontol 2016 , 43 , 156-166, doi:10.1111/jcpe.12497. Juerchott, A.; Sohani, M.; Schwindling, F.S.; Jende, J.M.E.; Kurz, F.T.; Rammelsberg, P.; Heiland, S.; Bendszus, M.; Hilgenfeld, T. Comparison of non-contrast-enhanced dental magnetic resonance imaging and cone-beam computed tomography in assessing the horizontal and vertical components of furcation defects in maxillary molars: An in vivo feasibility study. J Clin Periodontol 2020 , 47 , 1485-1495, doi:https://doi.org/10.1111/jcpe.13374. Juerchott, A.; Sohani, M.; Schwindling, F.S.; Jende, J.M.E.; Kurz, F.T.; Rammelsberg, P.; Heiland, S.; Bendszus, M.; Hilgenfeld, T. In vivo accuracy of dental magnetic resonance imaging in assessing maxillary molar furcation involvement: A feasibility study in humans. J Clin Periodontol 2020 , 47 , 809-815, doi:https://doi.org/10.1111/jcpe.13299. Mendes, S.; Rinne, C.A.; Schmidt, J.C.; Dagassan-Berndt, D.; Walter, C. Evaluation of magnetic resonance imaging for diagnostic purposes in operative dentistry-a systematic review. Clinical oral investigations 2020 , 24 , 547-557, doi:10.1007/s00784-019-03103-8. Beck, F.; Austermann, S.; Bertl, K.; Ulm, C.; Lettner, S.; Toelly, A.; Gahleitner, A. Is MRI a viable alternative to CT/CBCT to identify the course of the inferior alveolar nerve in relation to the roots of the third molars? Clinical oral investigations 2021 , 25 , 3861-3871, doi:10.1007/s00784-020-03716-4. Schuurmans, T.J.; Nixdorf, D.R.; Idiyatullin, D.S.; Law, A.S.; Barsness, B.D.; Roach, S.H.; Gaalaas, L. Accuracy and Reliability of Root Crack and Fracture Detection in Teeth Using Magnetic Resonance Imaging. J Endod 2019 , 45 , 750-755 e752, doi:10.1016/j.joen.2019.03.008. Flugge, T.; Ludwig, U.; Hovener, J.B.; Kohal, R.; Wismeijer, D.; Nelson, K. Virtual implant planning and fully guided implant surgery using magnetic resonance imaging-Proof of principle. Clin Oral Implants Res 2020 , 31 , 575-583, doi:10.1111/clr.13592. Flugge, T.; Ludwig, U.; Winter, G.; Amrein, P.; Kernen, F.; Nelson, K. Fully guided implant surgery using Magnetic Resonance Imaging - An in vitro study on accuracy in human mandibles. Clin Oral Implants Res 2020 , 31 , 737-746, doi:10.1111/clr.13622. Hilgenfeld, T.; Juerchott, A.; Jende, J.M.E.; Rammelsberg, P.; Heiland, S.; Bendszus, M.; Schwindling, F.S. Use of dental MRI for radiation-free guided dental implant planning: a prospective, in vivo study of accuracy and reliability. European Radiology 2020 , 30 , 6392-6401, doi:10.1007/s00330-020-07262-1. Al-Haj Husain, A.; Stadlinger, B.; Ozcan, M.; Schonegg, D.; Winklhofer, S.; Al-Haj Husain, N.; Piccirelli, M.; Valdec, S. Buccal bone thickness assessment for immediate anterior dental implant planning: A pilot study comparing cone-beam computed tomography and 3D double-echo steady-state MRI. Clin Implant Dent Relat Res 2023 , 25 , 35-45, doi:10.1111/cid.13160. Heuscher, D.J.; Vembar, M. Reduced partial volume artifacts using spiral computed tomography and an integrating interpolator. Med Phys 1999 , 26 , 276-286, doi:10.1118/1.598523. Manoliu, A.; Ho, M.; Nanz, D.; Dappa, E.; Boss, A.; Grodzki, D.M.; Liu, W.; Chhabra, A.; Andreisek, G.; Kuhn, F.P. MR neurographic orthopantomogram: Ultrashort echo-time imaging of mandibular bone and teeth complemented with high-resolution morphological and functional MR neurography. J Magn Reson Imaging 2016 , 44 , 393-400, doi:10.1002/jmri.25178. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Nov, 2025 Read the published version in Periodontal and Implant Research → Version 1 posted Editorial decision: Revision requested 18 Aug, 2025 Reviews received at journal 05 Aug, 2025 Reviews received at journal 02 Aug, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviews received at journal 28 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviewers invited by journal 16 Jul, 2025 Editor assigned by journal 16 Jul, 2025 Submission checks completed at journal 15 Jul, 2025 First submitted to journal 12 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7106478","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":486463979,"identity":"68c6efcd-9a8f-4270-a7ac-92eaa7641604","order_by":0,"name":"Kai R. Fischer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACCQbGBiAlx8PAAEQMFWBBA2K0GEO1nCFKCxgYM4C1MLYRoUWy/XADcwWDgYx8+9mDjyvn1UYbHGDe+ACfFmmexAbGMwwGPAZn8pINz247njuzga0YrzVyDEAtDQx/eAwkeMwkG7cdy+1n4DGTwKuF/yFIiwGP/Awe85+Nc47ltjHwmP/A6zCJRIgWhhs8ZoyNDTVgW/DpYJCc8bDhYIMByC85xpINxw7kzmxmK8brMInz6Q8fNlQY2Mu3nzH82FBTl7vhePPGD3itAYIDSBFxmIGBmZB6NFBHovpRMApGwSgYCQAA3qFD6iNu+SkAAAAASUVORK5CYII=","orcid":"","institution":"University of Zurich","correspondingAuthor":true,"prefix":"","firstName":"Kai","middleName":"R.","lastName":"Fischer","suffix":""},{"id":486463980,"identity":"4c668941-e400-433c-ba27-9fa1a0a53e19","order_by":1,"name":"Félix P. Kuhn","email":"","orcid":"","institution":"University of Zurich","correspondingAuthor":false,"prefix":"","firstName":"Félix","middleName":"P.","lastName":"Kuhn","suffix":""},{"id":486463981,"identity":"7fa927f2-95a1-4f96-9978-773256a5398a","order_by":2,"name":"Tabea Flügge","email":"","orcid":"","institution":"Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health","correspondingAuthor":false,"prefix":"","firstName":"Tabea","middleName":"","lastName":"Flügge","suffix":""},{"id":486463983,"identity":"592e3084-b553-477f-901b-5fa9c2cf3dc1","order_by":3,"name":"Patrick R. Schmidlin","email":"","orcid":"","institution":"University of Zurich","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"R.","lastName":"Schmidlin","suffix":""},{"id":486463985,"identity":"f89cef63-3003-468a-80fa-ae55e8ff4299","order_by":4,"name":"Johanna Schmitz","email":"","orcid":"","institution":"Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health","correspondingAuthor":false,"prefix":"","firstName":"Johanna","middleName":"","lastName":"Schmitz","suffix":""}],"badges":[],"createdAt":"2025-07-12 07:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7106478/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7106478/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s41894-025-00163-w","type":"published","date":"2025-11-26T15:57:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87373222,"identity":"cfa45000-f37c-4b92-ba54-df1acaea340f","added_by":"auto","created_at":"2025-07-23 07:29:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":883746,"visible":true,"origin":"","legend":"\u003cp\u003ePre-/post-surgery intraoral radiographs and clinical pictures of the atraumatic removal of the lower left first molar.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7106478/v1/43bb0dcf0908c42bc02d60fb.png"},{"id":87373224,"identity":"2f2833ba-4710-4b5b-94fb-a6386551bca5","added_by":"auto","created_at":"2025-07-23 07:29:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":422056,"visible":true,"origin":"","legend":"\u003cp\u003egives an overview of the MRI images at different time points during the healing process at the level of the extraction socket.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7106478/v1/cd9dfc08727110f477cddd95.png"},{"id":87373225,"identity":"975d5faa-48f4-4cb8-805d-5021afe54120","added_by":"auto","created_at":"2025-07-23 07:29:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":289424,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThis picture shows an example of the two auxiliary planes. On the left picture in the area of the apices of 35 and the mesial root of 37. On the right picture the same planes are shown in the area of the pulp of 35 and the function of 37.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7106478/v1/65db2a9f2e46abbadd560f59.png"},{"id":87373232,"identity":"09da83e8-e36e-4af6-9b88-133de3a51c32","added_by":"auto","created_at":"2025-07-23 07:29:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":214740,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThis image shows the model of the segmented volume. On the right image the volume is shown in relation to the MRI and in blue a separate segmentation of tooth 35.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7106478/v1/33232c234a9fb03d7f536cd1.png"},{"id":97179284,"identity":"9d1903ec-c9f9-4978-854a-24eb362c79f4","added_by":"auto","created_at":"2025-12-01 16:14:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2832298,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7106478/v1/c9bb40bc-3bec-42d6-bbf2-b8c6c8fc29a6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Close-meshed MRIs follow-ups for dynamic healing evaluation after tooth extraction: A conceptual case study","fulltext":[{"header":"Background","content":"\u003cp\u003eTwo-dimensional radiographs still represent the basic standard of diagnostics for dental hard tissues, but should always be interpreted with caution, especially when superimpositions and image distortions hamper adequate interpretation and decision-making [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Three-dimensional imaging has therefore emerged as an important component of enhanced diagnostics limiting these shortcomings and providing an anatomic method for diagnosis, planning and simulation of different surgical therapeutic procedures [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Especially cone-beam computed tomography (CBCT) has become more and more a consolidated diagnostic tool, especially in the arsenal for elective dental issues in hard tissue diagnostics compared to conventional radiography, e.g. when it comes to minimize the risk of nerve damage during implant placement, evaluation of sinus anatomy before respective lifting procedures, adequate biological and prosthetic-driven implant placement and the respective evaluation for bone augmentation including the fabrication of data-based blocks and meshes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Even though the use of CBCT significantly reduces radiation exposure as compared to conventional CT scans [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the principles of a so-called “radiation hygiene” should therefore always be taken into account, since stochastic effects, a possible lifetime-attributable risk increase of cancers, must be discussed, and current guidelines stress to restrict the use to justifiable indications and to apply stringent radiation management protocols using the \"as low as reasonably achievable\" (ALARA) or \"as low as diagnostically acceptable\" (ALADA) principle whenever possible [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough modern radiation-based sectional imaging such as CBCT undergoes a continuous indication-adapted optimization process of examination protocols and rapid technical advancements for dose reduction, alternatives – even if possible radiation-free - remain greatly warranted, especially within experimental set-ups, i.e. clinical studies dealing with a higher frequency of image-taking allowing for close longitudinal evaluations and comparisons of healing and treatment outcomes. While CBCT is valuable mainly for the visualization of bony structures with exceptionally high accuracy, the introduction of innovative new magnetic resonance imaging (MRI) techniques enables high-resolution, non-invasive and radiation-free diagnostic three-dimensional imaging of teeth and adjacent soft tissue and bone structures. Therefore, MRI offers an important alternative for (experimental) diagnostics in dentistry, oral medicine and maxillofacial surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Noteworthy, MRI remains largely restricted for visualizing soft tissue structures with excellent contrast properties [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. By providing high spatial resolution and excellent soft tissue contrast, special MR imaging protocols will become a valuable alternative to CBCT in future dental imaging, also for dental hard tissue evaluations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, according to the author’s best knowledge, applications, for instance in socket healing, are still scarce. Therefore, the present case presentation aimed to evaluate a stringent and close-meshed imaging protocol for socket healing – w/o alveolar ridge preservation - and discuss the advantages and disadvantages as compared to conventional CT.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eCase presentation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn this case report, we report on a 47-year old healthy female patient, who gave her written informed consent to monitor and document wound healing after extraction with close MRI scans in addition to CT after extraction and after 4 months healing.\u003c/p\u003e\u003cp\u003eThe patient showed a distinct radiolucency at the middle of mesial aspect of the mesial root of tooth 36 extending to the distal aspect of the root of tooth 35. The prognosis was considered hopeless and the tooth was extracted as minimally invasive as possible to avoid any damage to the surrounding bone. Granulation tissue was thoroughly removed and a sample of the excised material of the mesial root was submitted for histological evaluation.\u003c/p\u003e\u003cp\u003eThe mesial root was filled with a xenograft (BioOss Collagen, Geistlich, Wolhusen, Switzerland) up to the alveolar bone level while the distal root remained unfilled; both sockets were covered with an absorbable membrane (Smartbrane, Regedent, Zurich, Switzerland) and - prior to this – bone substitute material and the alveolus were treated with hyaluronic acid (HyadentBG, Regedent). The wound edges were adapted and closed with a modified cross suture and left to open wound healing.\u003c/p\u003e\u003cp\u003eImmediately after extraction and socket treatment as described, a MRI and a CT scan were performed.\u003c/p\u003e\u003cp\u003eMRIs were taken preoperatively (t0) and 1 (t1), 2 (t2), 4 (t3), 8 (t4), and 16 (t5) weeks after tooth extraction. At the final 16 weeks evaluation, the patient received another CT scan for comparison at baseline and after the last evaluation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMRI and CT\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMRI was performed on a Magnetom Skyra 3T (Siemens Healthcare, Erlangen, Germany) with a dedicated 64-channel receive coil. The MRI protocol consisted of 3 sequences: a T2 weighted TSE with DIXON based fat suppression to primarily assess intra-socket healing processes (slice thickness 2 mm, acquisition matrix 320 x 256, FOV 200x200 mm\u003csup\u003e2\u003c/sup\u003e, bandwidth 390 Hz/Px, spacing between slices 2.3 mm, echo time 76 ms), a 3D T1 weighted SPACE (0.65 mm isovoxel) and the ultrashort echo time (UTE) sequence PETRA (0.78 mm isovoxel) both to allow for comparison of volumetric changes within the bony structures. CT images were acquired on a Somatom Definition AS 128 (Siemens Healthcare, Erlangen, Germany) with a slice thickness of 0.75 mm and a pitch of 0.8. With both modalities the oral cavity, the upper and lower jaw and adjacent soft tissue structures were imaged.\u003c/p\u003e\u003cp\u003eThe applied ultrashort echo time MRI sequence UTE enabled visualization of bone, the T1 weighted sequence provided information about the bone marrow and the T2 weighted sequence with fat suppression allowed for the assessment of oedematous and reparative processes. The CT visualized the texture of cortical and cancellous/trabecular mandibular bone.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAnalysis and comparison of MRI and CT data sets\u003c/em\u003e\u003c/p\u003e\u003cp\u003eMRI and CT images were used for the analysis and comparison of extraction socket healing at different time points. Image data were processed with 3D segmentation software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.slicer.org\u003c/span\u003e\u003cspan address=\"https://www.slicer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, version 4.11.20210226) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A T2-weighted TSE sequence with DIXON based fat suppression was chosen for the analysis of MRI images due to its favorable display of the hard tissue surrounding the extraction socket compared to the two other sequences. The bone surrounding the socket was segmented for a better understanding of the healing process of the alveolar bone post-extraction. Its volume was measured at different time points to monitor the dimensional changes over time.\u003c/p\u003e\u003cp\u003eThe extraction socket and adjacent structures were identified and located on axial MR images. Reproducible anatomical landmarks were selected to define the mandibular region to be segmented around the extraction socket. Based on these, mesial and distal planes were drawn to delimit the region of interest reproducibly. Mesially of the alveolus, a plane was defined passing through the coronal pulp and the apex of tooth 35. Distally, the plane was oriented along the course of the furcation and the apex of the mesial root of tooth 37, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe mandibular bone was manually segmented, including the portions of teeth 35 and 37 located within the previously defined area. The teeth and cortical bone were detected by their low signal intensity, particularly evident in the mandible through direct contact with the hyperintense signal of the adjacent soft tissue. The mentioned structures were manually delineated in each axial slice and the total volume was obtained by adding the volume on each slice. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the model of the segmented bone used to calculate the corresponding bone volume and the same model in context with an axial MRI image and tooth 35 shown in blue.\u003c/p\u003e\u003cp\u003eThe preoperative CT and postoperative CT scans after 16 weeks were evaluated and analyzed using the similar protocol as for MRI analysis. The cortical bone of the mandible and the teeth were well demarcated from the surrounding tissue due to their hyperdensity. The planes delimiting the evaluation area were identified and marked using the same anatomical landmarks as in the MRI. The bone was manually segmented in each axial slice, as described above, and the volume was calculated accordingly.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eVolumetric changes\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the calculated bone volume within the previously defined range at the different acquisition times. Over time, the loss of bone volume was evident on the crestal aspect of the alveolar process both buccally and lingually without evident differences between the mesial and distal alveolus. Greater volumes have been measured for MRI compared to CT. Within CT, hardly any volumetric change was seen.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCalculated bone volume within the area of interest at different timepoints comparing MRI and CT images.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003et in weeks\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVolume [cm\u003csup\u003e3\u003c/sup\u003e]\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.829\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.684\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.636\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.624\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.143\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.154\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.453\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eAlterations of the MRI signal\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn the early phases after tooth extraction, there was a prominent T2 hyperintense signal within the socket corresponding to edematous alterations and newly formed fibrous tissue. Signal intensity slightly decreased in correspondence to scar tissue formation. The T1 signal did not alter significantly during the observation period. The ultrashort echo time UTE sequence provides information on the bony circumference of the socket similar to the information in the CT scan. Interestingly, no clear difference was observed between the grafted and non-grafted part of the extraction socket within the MRI.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith this study, we aimed to evaluate the applicability of MRI imaging compared to CT scans in the assessment of an extraction socket related to alveolar healing, bone regeneration and volumetric changes, respectively. To the authors best knowledge, this is the first report in this field and MRI, as a radiation-free technology, might offer significant advantages not only clinical practice but especially in longitudinal scientific trials. Within the six MRI scans over the 16 weeks healing phase, it was possible to not only assess the volumetric changes of the bone but also the different steps of regeneration inside the alveolus. Sequence selection and reduction of movement artefacts are decisive for picture quality and, therefore, equality to the gold standard of CT or CBCT imaging.\u003c/p\u003e\u003cp\u003eMRI is a well-established imaging technology, being the modality of choice for most soft tissue and functional imaging indications compared to CT/CBCT primarily indicated for hard tissue. The science and application of MRI continue to advance, with several developments having potential implications for the practice of dentistry. These developments lead to investigations in various dental fields, however, MRI has not become a standard procedure in daily practice since been considered prohibitively costly. In periodontology, correct assessment of furcation involvement is crucial for prognosis estimation and treatment planning, respectively [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Dental MRI has been shown equivalent to CBCT with high levels of sensitivity and specificity in assessing furcation involvement in maxillary molars, hence, can be regarded as an accurate, non-invasive tool to improve diagnosis \u0026ndash; compared to standard periodontal examination \u0026ndash; and surgical treatment of upper molars [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Future applications in this field may also include diagnosis of infrabony defects or follow-up studies of periodontal regeneration. Recently, the potential of MRI for diagnostic purposes in operative dentistry has been evaluated [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Besides the limited and heterogenic data, possible settings for MRI might be diagnostic of caries lesions, presentation of pulp tissues and periapical lesions. In addition, preoperative assessment of the localization of impacted teeth e.g. third molars and their spatial relation to anatomical structures like inferior alveolar nerves with potential advantages in the detection of accessory [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In endodontics, despite MRI is less prone to artefacts from radiodens materials as root fillings or posts compared to CBCT, further improvements are warranted in the detection of root cracks and fractures [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. MRI based pre-operative planning and surgical guide manufacturing seems especially promising in implant dentistry as 3D-imaging might be necessary at different stages of the treatment. MRI in combination with intra-oral optical scans seems to be a reliable and sufficiently accurate to identify all relevant anatomical structures and to enable fully guided implant surgery [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], however, might not reach the same accuracy as CBCT in certain situation as shortened dental arches [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Very recently, the first report on preoperative buccal bone thickness assessment for immediate implant placement has been published without significant disadvantages comparing \u0026ldquo;black bone\u0026rdquo; sequences to CBCT while displaying soft and hard tissue with high spatial resolution and minimal artifacts [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLimitations to this study are significantly thicker slices in the selected MRI sequence compared to the CT images that are a factor in the generation of partial volume artifacts [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This effect can lead to a limited assessment of the volume in the marginal areas of the segments and could lead to deviations in the volume calculation. A longer acquisition time for MRI than in CT may cause motion artifacts and lead to an overestimation of bone volume. The evaluated T2 sequence is 2 mm thick, however, was primarily intended for the assessment of the internal texture of the extraction socket. Originally, ultra-short echo sequence were chosen with layer thickness 0.78 mm isovoxel primarily for bone imaging [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Unfortunately, the sequence shows various motion artifacts in the presented patient, so it did not seem to be suitable for volumetric analysis. Moreover, a T1 SPACE sequence was recorded with a layer thickness 0.65 mm isovoxel. However, this sequence also showed certain blurring in the area of interest due to magnetic field inhomogeneities caused by filling etc., therefore dental imaging in MRI in elderly patients is often only possible to a limited extent. Hence, only the T2 sequence was available for comparison. This observed issues need to be taken into account when using MRI for volumetric assessments in future clinical trials.\u003c/p\u003e\u003cp\u003eOverall, the loss of volume over time was more pronounced in the MRI than in the CT. Due to the lack of direct comparability, no statement can be made as to whether this observation is based on one of the potential sources of artifacts discussed above.\u003c/p\u003e\u003cp\u003eIn conclusion, MRI offers many potential indications as a non-invasive and radiation-free imaging technology in dentistry. Until now, however, primarily single diagnostic settings have been reported while this proof-of-concept clearly shows advantages in any situation where multiple scans are necessary or for clinical trials assessing e.g. ridge preservation, guided tissue or bone regeneration in a tighter and more frequent fashion as possible with CT/CBCT due to \u0026ldquo;radiation hygiene\u0026rdquo; and ethical considerations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBCT - cone-beam computed tomography\u003c/p\u003e\n\u003cp\u003eCT - computed tomography\u003c/p\u003e\n\u003cp\u003eMRI - magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eUSE - ultrashort echo time\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003enot applicable; presented patient gave\u0026nbsp;her written informed consent to monitor and document wound healing after extraction.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and material\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKF proposed the original research idea, coordinated the study protocol and finalized the manuscript. PS performed the surgery and was a major contributor in writing the manuscript. FK was responsible for imaging acquisition as well as interpretation of the MRI scans. JS and TF analyzed and compared the MRI and CT images and JS was a major contributor in writing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWinter, C.M.; Woelfel, J.B.; Igarashi, T. Distortion and other errors in oblique cephalometric radiography. \u003cem\u003eAngle Orthod \u003c/em\u003e\u003cstrong\u003e1984\u003c/strong\u003e, \u003cem\u003e54\u003c/em\u003e, 330-346, doi:10.1043/0003-3219(1984)054\u0026lt;0330:DAOEIO\u0026gt;2.0.CO;2.\u003c/li\u003e\n\u003cli\u003eBergersen, E.O. Enlargement and distortion in cephalometric radiography: compensation tables for linear measurements. \u003cem\u003eAngle Orthod \u003c/em\u003e\u003cstrong\u003e1980\u003c/strong\u003e, \u003cem\u003e50\u003c/em\u003e, 230-244, doi:10.1043/0003-3219(1980)050\u0026lt;0230:EADICR\u0026gt;2.0.CO;2.\u003c/li\u003e\n\u003cli\u003eWhyms, B.J.; Vorperian, H.K.; Gentry, L.R.; Schimek, E.M.; Bersu, E.T.; Chung, M.K. The effect of computed tomographic scanner parameters and 3-dimensional volume rendering techniques on the accuracy of linear, angular, and volumetric measurements of the mandible. \u003cem\u003eOral Surg Oral Med Oral Pathol Oral Radiol \u003c/em\u003e\u003cstrong\u003e2013\u003c/strong\u003e, \u003cem\u003e115\u003c/em\u003e, 682-691, doi:10.1016/j.oooo.2013.02.008.\u003c/li\u003e\n\u003cli\u003evon Wilmowsky, C.; Bergauer, B.; Nkenke, E.; Neukam, F.W.; Neuhuber, W.; Lell, M.; Keller, A.; Eitner, S.; Matta, R.E. A new, highly precise measurement technology for the in vitro evaluation of the accuracy of digital imaging data. \u003cem\u003eJ Craniomaxillofac Surg \u003c/em\u003e\u003cstrong\u003e2015\u003c/strong\u003e, \u003cem\u003e43\u003c/em\u003e, 1335-1339, doi:10.1016/j.jcms.2015.06.021.\u003c/li\u003e\n\u003cli\u003eLi, L.; Wang, C.; Li, X.; Fu, G.; Chen, D.; Huang, Y. Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: A retrospective case series study. \u003cem\u003eClin Implant Dent Relat Res \u003c/em\u003e\u003cstrong\u003e2021\u003c/strong\u003e, \u003cem\u003e23\u003c/em\u003e, 5-18, doi:10.1111/cid.12966.\u003c/li\u003e\n\u003cli\u003eYeung, A.W.K.; Jacobs, R.; Bornstein, M.M. Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. \u003cem\u003eClinical oral investigations \u003c/em\u003e\u003cstrong\u003e2019\u003c/strong\u003e, \u003cem\u003e23\u003c/em\u003e, 2573-2581, doi:10.1007/s00784-019-02907-y.\u003c/li\u003e\n\u003cli\u003eJaju, P.P.; Jaju, S.P. Cone-beam computed tomography: Time to move from ALARA to ALADA. \u003cem\u003eImaging Sci Dent \u003c/em\u003e\u003cstrong\u003e2015\u003c/strong\u003e, \u003cem\u003e45\u003c/em\u003e, 263-265, doi:10.5624/isd.2015.45.4.263.\u003c/li\u003e\n\u003cli\u003eTraser, L.; Flugge, T.V.; Burdumy, M.; Kamberger, R.; Richter, B.; Hassepass, F.; Korvink, J.G.; Echternach, M. A Comparison of Different Methods to Generate Tooth Surface Models Without Applying Ionizing Radiation for Digital 3-Dimensional Image Fusion With Magnetic Resonance Imaging-Based Data of the Head and Neck Region. \u003cem\u003eJ Comput Assist Tomogr \u003c/em\u003e\u003cstrong\u003e2015\u003c/strong\u003e, \u003cem\u003e39\u003c/em\u003e, 882-889, doi:10.1097/RCT.0000000000000293.\u003c/li\u003e\n\u003cli\u003eAl-Haj Husain, A.; Solomons, M.; Stadlinger, B.; Pejicic, R.; Winklhofer, S.; Piccirelli, M.; Valdec, S. Visualization of the Inferior Alveolar Nerve and Lingual Nerve Using MRI in Oral and Maxillofacial Surgery: A Systematic Review. \u003cem\u003eDiagnostics (Basel) \u003c/em\u003e\u003cstrong\u003e2021\u003c/strong\u003e, \u003cem\u003e11\u003c/em\u003e, doi:10.3390/diagnostics11091657.\u003c/li\u003e\n\u003cli\u003eValdec, S.; Al-Haj Husain, A.; Winklhofer, S.; Muller, M.; Piccirelli, M.; Stadlinger, B. Comparison of Preoperative Cone-Beam Computed Tomography and 3D-Double Echo Steady-State MRI in Third Molar Surgery. \u003cem\u003eJ Clin Med \u003c/em\u003e\u003cstrong\u003e2021\u003c/strong\u003e, \u003cem\u003e10\u003c/em\u003e, doi:10.3390/jcm10204768.\u003c/li\u003e\n\u003cli\u003eFedorov, A.; Beichel, R.; Kalpathy-Cramer, J.; Finet, J.; Fillion-Robin, J.C.; Pujol, S.; Bauer, C.; Jennings, D.; Fennessy, F.; Sonka, M.; et al. 3D Slicer as an image computing platform for the Quantitative Imaging Network. \u003cem\u003eMagn Reson Imaging \u003c/em\u003e\u003cstrong\u003e2012\u003c/strong\u003e, \u003cem\u003e30\u003c/em\u003e, 1323-1341, doi:10.1016/j.mri.2012.05.001.\u003c/li\u003e\n\u003cli\u003eNibali, L.; Zavattini, A.; Nagata, K.; Di Iorio, A.; Lin, G.H.; Needleman, I.; Donos, N. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis. \u003cem\u003eJ Clin Periodontol \u003c/em\u003e\u003cstrong\u003e2016\u003c/strong\u003e, \u003cem\u003e43\u003c/em\u003e, 156-166, doi:10.1111/jcpe.12497.\u003c/li\u003e\n\u003cli\u003eJuerchott, A.; Sohani, M.; Schwindling, F.S.; Jende, J.M.E.; Kurz, F.T.; Rammelsberg, P.; Heiland, S.; Bendszus, M.; Hilgenfeld, T. Comparison of non-contrast-enhanced dental magnetic resonance imaging and cone-beam computed tomography in assessing the horizontal and vertical components of furcation defects in maxillary molars: An in vivo feasibility study. \u003cem\u003eJ Clin Periodontol \u003c/em\u003e\u003cstrong\u003e2020\u003c/strong\u003e, \u003cem\u003e47\u003c/em\u003e, 1485-1495, doi:https://doi.org/10.1111/jcpe.13374.\u003c/li\u003e\n\u003cli\u003eJuerchott, A.; Sohani, M.; Schwindling, F.S.; Jende, J.M.E.; Kurz, F.T.; Rammelsberg, P.; Heiland, S.; Bendszus, M.; Hilgenfeld, T. In vivo accuracy of dental magnetic resonance imaging in assessing maxillary molar furcation involvement: A feasibility study in humans. \u003cem\u003eJ Clin Periodontol \u003c/em\u003e\u003cstrong\u003e2020\u003c/strong\u003e, \u003cem\u003e47\u003c/em\u003e, 809-815, doi:https://doi.org/10.1111/jcpe.13299.\u003c/li\u003e\n\u003cli\u003eMendes, S.; Rinne, C.A.; Schmidt, J.C.; Dagassan-Berndt, D.; Walter, C. Evaluation of magnetic resonance imaging for diagnostic purposes in operative dentistry-a systematic review. \u003cem\u003eClinical oral investigations \u003c/em\u003e\u003cstrong\u003e2020\u003c/strong\u003e, \u003cem\u003e24\u003c/em\u003e, 547-557, doi:10.1007/s00784-019-03103-8.\u003c/li\u003e\n\u003cli\u003eBeck, F.; Austermann, S.; Bertl, K.; Ulm, C.; Lettner, S.; Toelly, A.; Gahleitner, A. Is MRI a viable alternative to CT/CBCT to identify the course of the inferior alveolar nerve in relation to the roots of the third molars? \u003cem\u003eClinical oral investigations \u003c/em\u003e\u003cstrong\u003e2021\u003c/strong\u003e, \u003cem\u003e25\u003c/em\u003e, 3861-3871, doi:10.1007/s00784-020-03716-4.\u003c/li\u003e\n\u003cli\u003eSchuurmans, T.J.; Nixdorf, D.R.; Idiyatullin, D.S.; Law, A.S.; Barsness, B.D.; Roach, S.H.; Gaalaas, L. Accuracy and Reliability of Root Crack and Fracture Detection in Teeth Using Magnetic Resonance Imaging. \u003cem\u003eJ Endod \u003c/em\u003e\u003cstrong\u003e2019\u003c/strong\u003e, \u003cem\u003e45\u003c/em\u003e, 750-755 e752, doi:10.1016/j.joen.2019.03.008.\u003c/li\u003e\n\u003cli\u003eFlugge, T.; Ludwig, U.; Hovener, J.B.; Kohal, R.; Wismeijer, D.; Nelson, K. Virtual implant planning and fully guided implant surgery using magnetic resonance imaging-Proof of principle. \u003cem\u003eClin Oral Implants Res \u003c/em\u003e\u003cstrong\u003e2020\u003c/strong\u003e, \u003cem\u003e31\u003c/em\u003e, 575-583, doi:10.1111/clr.13592.\u003c/li\u003e\n\u003cli\u003eFlugge, T.; Ludwig, U.; Winter, G.; Amrein, P.; Kernen, F.; Nelson, K. Fully guided implant surgery using Magnetic Resonance Imaging - An in vitro study on accuracy in human mandibles. \u003cem\u003eClin Oral Implants Res \u003c/em\u003e\u003cstrong\u003e2020\u003c/strong\u003e, \u003cem\u003e31\u003c/em\u003e, 737-746, doi:10.1111/clr.13622.\u003c/li\u003e\n\u003cli\u003eHilgenfeld, T.; Juerchott, A.; Jende, J.M.E.; Rammelsberg, P.; Heiland, S.; Bendszus, M.; Schwindling, F.S. Use of dental MRI for radiation-free guided dental implant planning: a prospective, in vivo study of accuracy and reliability. \u003cem\u003eEuropean Radiology \u003c/em\u003e\u003cstrong\u003e2020\u003c/strong\u003e, \u003cem\u003e30\u003c/em\u003e, 6392-6401, doi:10.1007/s00330-020-07262-1.\u003c/li\u003e\n\u003cli\u003eAl-Haj Husain, A.; Stadlinger, B.; Ozcan, M.; Schonegg, D.; Winklhofer, S.; Al-Haj Husain, N.; Piccirelli, M.; Valdec, S. Buccal bone thickness assessment for immediate anterior dental implant planning: A pilot study comparing cone-beam computed tomography and 3D double-echo steady-state MRI. \u003cem\u003eClin Implant Dent Relat Res \u003c/em\u003e\u003cstrong\u003e2023\u003c/strong\u003e, \u003cem\u003e25\u003c/em\u003e, 35-45, doi:10.1111/cid.13160.\u003c/li\u003e\n\u003cli\u003eHeuscher, D.J.; Vembar, M. Reduced partial volume artifacts using spiral computed tomography and an integrating interpolator. \u003cem\u003eMed Phys \u003c/em\u003e\u003cstrong\u003e1999\u003c/strong\u003e, \u003cem\u003e26\u003c/em\u003e, 276-286, doi:10.1118/1.598523.\u003c/li\u003e\n\u003cli\u003eManoliu, A.; Ho, M.; Nanz, D.; Dappa, E.; Boss, A.; Grodzki, D.M.; Liu, W.; Chhabra, A.; Andreisek, G.; Kuhn, F.P. MR neurographic orthopantomogram: Ultrashort echo-time imaging of mandibular bone and teeth complemented with high-resolution morphological and functional MR neurography. \u003cem\u003eJ Magn Reson Imaging \u003c/em\u003e\u003cstrong\u003e2016\u003c/strong\u003e, \u003cem\u003e44\u003c/em\u003e, 393-400, doi:10.1002/jmri.25178.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"periodontal-and-implant-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Periodontal and Implant Research](https://link.springer.com/journal/41894)","snPcode":"41894","submissionUrl":"https://submission.springernature.com/new-submission/41894/3","title":"Periodontal and Implant Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"extraction socket, socket healing, computed tomography (CT), magnetic resonance imaging (MRI), alveolar ridge preservation","lastPublishedDoi":"10.21203/rs.3.rs-7106478/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7106478/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo apply a close-meshed magnetic resonance imaging (MRI) protocol for socket healing \u0026ndash; with or without alveolar ridge preservation - and discuss the advantages and disadvantages as compared to computed tomography (CT).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA molar (tooth 36) was atraumatically extracted and the mesial socket was filled with a xenograft, while the distal was left for spontaneous healing; the socket orifice was covered with a collagen membrane. MRIs were taken preoperatively (t0) and 1 (t1), 2 (t2), 4 (t3), 8 (t4), and 16 (t5) weeks after tooth extraction, respectively. At t0 and t5, the patient received CT scans for comparison. MRI and CT images were used for the analysis and comparison of extraction socket healing at different time points. Image data were processed with 3D segmentation software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSocket healing was uneventful and could be tracked within MRI. Bone volume (cm\u003csup\u003e3\u003c/sup\u003e) constantly reduced from 4.83 (t0) to 4.15 (t16) for MRI over time.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMRI has been proven to be suitable for imaging in different dental applications. Using this radiation-free technology might allow a more stringent and frequent follow-up in practice and, especially, in clinical trials. Technique-inherent limitations need to be considered.\u003c/p\u003e","manuscriptTitle":"Close-meshed MRIs follow-ups for dynamic healing evaluation after tooth extraction: A conceptual case study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 07:28:56","doi":"10.21203/rs.3.rs-7106478/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-18T13:56:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-05T04:49:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-02T20:32:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86693332959606515005463624796881665094","date":"2025-07-29T08:25:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279799199848315516501615808947220196759","date":"2025-07-29T04:51:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T13:42:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66601255723436288111026702223355403271","date":"2025-07-23T22:19:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123390243057141161090081353596970488501","date":"2025-07-23T14:04:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-16T14:12:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-16T06:43:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-16T01:00:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Periodontal and Implant Research","date":"2025-07-12T07:26:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"periodontal-and-implant-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Periodontal and Implant Research](https://link.springer.com/journal/41894)","snPcode":"41894","submissionUrl":"https://submission.springernature.com/new-submission/41894/3","title":"Periodontal and Implant Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cb6d720b-0f7f-4022-a6d0-8329d6bc41f5","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:08:47+00:00","versionOfRecord":{"articleIdentity":"rs-7106478","link":"https://doi.org/10.1007/s41894-025-00163-w","journal":{"identity":"periodontal-and-implant-research","isVorOnly":false,"title":"Periodontal and Implant Research"},"publishedOn":"2025-11-26 15:57:33","publishedOnDateReadable":"November 26th, 2025"},"versionCreatedAt":"2025-07-23 07:28:56","video":"","vorDoi":"10.1007/s41894-025-00163-w","vorDoiUrl":"https://doi.org/10.1007/s41894-025-00163-w","workflowStages":[]},"version":"v1","identity":"rs-7106478","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7106478","identity":"rs-7106478","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}