Effect of using a hemostatic gelatin sponge versus a dense polytetrafluorethylene membrane for socket sealing following immediate implant placement. A randomized clinical study

Effect of using a hemostatic gelatin sponge versus a dense polytetrafluorethylene membrane for socket sealing following immediate implant placement. A randomized clinical 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 Research Article Effect of using a hemostatic gelatin sponge versus a dense polytetrafluorethylene membrane for socket sealing following immediate implant placement. A randomized clinical study Mahmoud Shalash, Aalaa Emara This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5475035/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jan, 2025 Read the published version in Bulletin of the National Research Centre → Version 1 posted 3 You are reading this latest preprint version Abstract Background Socket sealing following flapless immediate implant placement involves placing a barrier membrane to prevent the ingrowth of bacteria or contaminants to the dental implant during the early phase of healing. Dense polytetrafluoroethylene membranes have been the gold standard socket sealing barrier due to their impermeability to the oral flora, which allows for undisturbed implant healing. The search for a more cost-efficient material, that is easy to handle and apply for sealing the socket without compromising implant osseointegration was sought. This study aims to evaluate the effectiveness of socket sealing after immediate implant placement in the premolar/molar region using a gelatin sponge, as opposed to a dense polytetrafluoroethylene membrane, and its impact on clinical implant osseointegration. Materials and Methods The study was conducted on 20 patients, comprising 12 males and 8 females with an age range of 25–60 years. Those meeting the eligibility criteria of immediate implant placement were selected and divided equally into two groups. A control group, where an immediate implant and a dense polytetrafluorethylene membrane was used, and a test group where an immediate implant and a gelatin sponge was used. Exclusion criteria included smokers, presence of systemic or metabolic conditions, or a local pathology that would contraindicate implant placement. Teeth were extracted using a flapless approach. Implants were placed, and sockets were sealed using the allocated barrier. In the control group, the membrane was removed after 4 weeks. For the test group, the gelatin sponge was left to resorb spontaneously. After 4 months, implants were uncovered, and a 30 N/cm reverse torque test was applied to assess the clinical osseointegration. Results All implants healed uneventfully, without any radiographic evidence of bone loss. There was no clinical or radiographic difference between the outcomes in the control and the test groups. For the 20 dental implants subjected to a 30 N/cm reverse torque test, clinical integration was observed. Conclusion Within the limitations of this study, both dense polytetrafluorethylene membranes and gelatin sponges are effective methods for socket sealing, allowing for successful osseointegration following flapless immediate implant placement in posterior sites, with gelatin sponge offering easier handling and a reduced cost compared to dense polytetrafluorethylene. A larger study sample to verify the outcomes of this study is recommended. Flapless extraction immediate implants gelatin sponge dense polytetrafluorethylene reverse torque test Figures Figure 1 Figure 2 Figure 3 Introduction Dental implants are considered the gold standard for the management of edentulous spaces. The original protocol for implant placement required a 6-month healing period for osseous healing following tooth extraction [ 1 ]. With the aim of reducing the number of surgical procedures and reducing the overall treatment time, immediate implants have been proposed [ 2 ]. Several studies have reported comparable success and survival rates for implants placed immediately into fresh extraction sockets compared to those placed in healed sites [ 3 ]. When considering immediate implants, a flapless approach is recommended. This offers several advantages, namely, maintaining the periosteal blood supply to the labial/buccal plate of bone and avoiding disruption of the keratinized mucosal band and soft tissue architecture, resulting in a faster healing time and less patient morbidity [ 4 – 5 ]. When primary implant stability is inadequate, submerged healing of immediate implants is recommended. To promote healing by secondary intention once the implant is inserted in its correct 3D position, sealing the socket with an adequate barrier is mandatory to protect the implant and contain the bone graft material placed in the jumping gap [ 6 – 7 ]. With both resorbable and non-resorbable barrier membranes available, dense polytetrafluoroethylene membranes (d-PTFE) have been widely used for ridge preservation following tooth extraction and for socket sealing following immediate implant placement. With a porosity of 0.2–0.3 microns, d-PTFE membranes are bioinert and impermeable to the oral flora, allowing for safe use in these cases without the need for primary closure [ 8 – 10 ]. Some of the drawbacks to using d-PTFE membranes include difficulty in handling and the high cost, which may add a financial burden on the patient. On the other hand, gelatin sponges have been widely used in oral surgical procedures and following tooth extraction, with excellent results in terms of hemostasis and rate of resorption [ 11 – 14 ]. The primary outcome of this study is to assess clinical socket healing and implant osseointegration following immediate implant placement. The null hypothesis is that a hemostatic gelatin sponge can be used as a membrane for socket sealing following flapless immediate implant placement as effectively as a d-PTFE membrane. Materials and methods A total of 20 patients (12 males, 8 females, with a mean age range of 25–60 years) meeting the eligibility criteria for immediate implant placement were selected and randomized into two equal groups by the means of sealed envelopes. A control group, where an immediate implant and a d-PTFE membrane was used, and a test group where an immediate implant and a gelatin sponge was used. Patients were selected from the outpatient clinic of the oral surgery department at the faculty of dentistry, Cairo University. Patients with badly broken-down maxillary or mandibular posterior teeth with no clinical signs of infection, allowing for extraction and immediate implant placement, were selected. The patients were free from any systemic or metabolic diseases that would contraindicate implant placement, non-smokers, and had an acceptable oral hygiene. The study was approved by the Ethics Committee at the Faculty of Dentistry, Cairo University, in February 2023 and registered as a clinical trial, NCT 05982353, on 08/08/2023. The participants in this study have provided written informed consent for publication. The following steps were carried out for all patients. 1. Preoperative preparation Following initial clinical assessment, cone beam CT scans (CBCT) (Soredex, Cranex, 3DX, Finland) were ordered for all patients to assess socket morphology and alveolar ridge dimensions in order to select the appropriate implant size accordingly ( Fig. 1 ). For all patients, Amoxicillin/Clavulanate 1 gm (Augmentin, GlaxoSmithKline, England) oral tablet was given as an antimicrobial prophylaxis 1 hour before the surgery. In cases of allergy to penicillin, clindamycin 600 mg (Dalacin C, Pfizer, USA) was prescribed. 2. Surgical procedure: Under local anesthesia (Articaine 4%, 1:100000, Artinbsa, Spain) , the target tooth was extracted using a flapless, minimally traumatic technique using a combination of micro elevators and a Piezotome using surgical extraction tips (Satelc solo led 2, Acteon group, Italy). Following extraction, the socket was debrided and irrigated using normal saline solution. Implant osteotomy was performed following the drilling sequence recommended by the manufacturer. Implants (JD Evolution Plus, Jdentalcare, Italy) were inserted using a motor-driven approach (Implantmed, W&H, Austria) , which allowed for the measurement of the implant final seating torque using the built-in torque curve function. Following implant insertion, all the gaps around the implants were filled with cortico-cancellous allograft (Maxgraft, Botiss biomaterials GmbH, Germany). For the control group, a 15*20 mm d-PTFE membrane (Permamem, Botiss biomaterials GmBH, Germany) was shaped to the socket and gently tucked underneath the buccal and palatal mucoperiosteum, extending 3–4 mm beyond the socket walls. A figure-eight sutures and/or single interrupted sutures were used to secure the membrane in place ( Fig. 2 ). For the test group, a gelatin sponge (Cutanplast Standard, Mascia Brunelli, Milano, Italy) was cut and shaped to the socket, applied in two separate layers, and finally secured with sutures, sealing the socket in a similar manner to the control group. ( Fig. 3 ) In both groups, no flap mobilization or primary closure was performed. Standard post-operative instructions were given to all patients. A follow-up appointment was scheduled after one week for sutures removal. For the control group, the membrane was removed after 4 weeks. 3. Follow up Implants were allowed to heal for 4 months, after which they were uncovered using a full-thickness flap. At the time of uncovering, all implants were subjected to a reverse torque test of 30 N/cm using a calibrated torque wrench (Jdentalcare, Italy) to assess implant secondary stability. The presence of any movement in the implant or pain that was noted by the patient was considered a sign of implant failure. The next step involved connecting either a custom healing or a stock abutment, which allowed for shaping the emergence profile. The definitive prosthesis was connected one month later. Results The present study tested the clinical outcome of 20 immediate dental implants placed in different areas of the upper and lower posterior jaws, based on ideal selection criteria for immediate implant placement. Patients were recruited and procedures, carried out and finalized between March 2023 and January 2024. In the control group, 4 implants were placed in the maxillary molar region, 3 implants in the mandibular molar region, and 3 in the maxillary premolar region. In the test group, 4 implants were placed in the maxillary molar region, 4 in the mandibular molar region, and 2 in the maxillary premolar region. Torque curve values for primary implant stability in both groups showed a mean of 29.8 N/cm. All implants were subjected to a 30 N/cm reverse torque test during second-stage surgery. Table 1 presents the torque values and implant dimensions for both groups. Table 1 showing torque values, implant length and diameter for both groups. Insertion Torque value (N/cm) Implant Diameter*Length (cm) Insertion Torque value (N/cm) Implant Diameter*Length (cm) Group I Group II 1 35 4.3*11.5 31 4.3*13 2 33 5*10 33 4.3*11.5 3 27 4.3*11.5 29 4.3*10 4 28 4.3*10 35 4.3*11.5 5 25 4.3*13 27 5*11.5 6 29 5*11.5 29 4.3*11.5 7 31 4.3*11.5 24 4.3*10 8 25 4.3*10 29 4.3*11.5 9 29 4.3*13 27 4.3*11.5 10 31 4.3*11.5 33 5*10 Mean 29.3 29.7 Mean final seating torque 29.5 N/cm* All implants healed uneventfully, without any radiographic evidence of bone loss. There was no clinical or radiographic difference between the outcomes in the control and the test groups. For the 20 dental implants subjected to a 30 N/cm reverse torque test, the expected clinical integration was observed. There was no evidence of mobility, or clinical signs of discomfort, or pain upon application of the test, allowing the placement of the definitive restoration in all 20 cases. Discussion This study aimed to test the clinical outcome of using a d-PTFE barrier membrane versus a hemostatic gelatin sponge in 20 patients, following flapless immediate implant placement. d-PTFE membranes have been widely used and accepted as a standard barrier for flapless post-extraction ridge preservation or immediate implant placement. These membranes are inert, do not cause any localized tissue inflammation or reaction and can be left exposed in the oral cavity, acting like a scaffold to guide soft tissue healing [ 15 – 17 ]. Currently there is no consensus on the optimum time for their removal when used as a barrier to seal the socket. We chose to remove it at 4 weeks with several studies recommending their removal sometime between 3 and 6 weeks. [ 18 – 21 ] Gelatin sponge is a sterile, compressed, water-insoluble device prepared from purified animal collagen and can absorb up to forty times its weight of whole blood [ 22 – 23 ]. It is widely used as a local hemostatic agent and for wound dressing following oral surgical procedures. An advantage to its use compared to collagen dressings, is the ease of preparation and the lack of antigenicity [ 11 , 24 – 25 ]. It’s role in supporting the proliferation and differentiation of osteoblasts, as carriers for bone graft materials, in enhancing bone regeneration in cystic defects and in maxillary sinus grafting has been described [ 26 – 28 ]. The effect on enhancing bone regeneration has however been questioned [ 12 ]. In our study, the use of the gelatin sponge as a barrier for sealing the socket following immediate implant placement, resulted in successful uncomplicated healing of the implants. The normal cascade of socket healing, containment of the graft particles in the jumping gap by a fibrin clot was evident at 10 days post-surgery. At 4 weeks, complete epithelialization of the socket was evident. It was recently shown that the use of a gelatin sponge as a palatal wound dressing, following free gingival graft harvesting was advantageous for wound healing in terms of the speed of re-epithelialization of the donor site, and reduced patient discomfort during the healing phase [ 29 – 30 ]. For the clinical assessment of osseointegration, several subjective and objective methods have been proposed; clinical mobility test, percussion test, radiographic assessment, reverse torque test and resonance frequency analysis (RFA) have been used individually or combined; with indefinite conclusions regarding the bone-titanium interface and its correlation to the clinical findings [ 31 – 34 ]. In our study, a 30 N/cm reverse torque test was used to verify clinical implant stability at the second stage surgery. Recently, in a human study, the reverse torque test has been verified as an accepted, non -invasive clinical method, that can be used for early verification of initial osseointgeration [ 35 ]. Recent studies, have shown that a minimum of 200-Ncm reverse torque is required for removal of osseointegrated implants, so a 30 N/cm can be confirmed as a predictive measure for osseointegration. It is worth noting, that most implant manufacturers will recommend torquing prosthetic abutments to the implant at 30 N/cm which is considered a safety margin for the implants at the time of prosthetic connection [ 36 – 37 ]. Although RFA has gained popularity in recent years as a measure of implant stability during different time points, the interpretation of its results can vary and will depend on how tight the smart pegs are connected and the contact angle applied to the implant by the transducer which can affect the reliability of the results. A reverse torque test is believed to be a cheap, noninvasive method capable of differentiating between a stable and a mobile implant and help predict the prognosis of an osseointegrated dental implants [ 35 , 38 ]. Currently there is no consensus regarding the optimum torque at which a custom healing abutment can be connected to an immediate implant in posterior teeth. For delayed implants, when insertion torque values are < 30 N/cm, an unloaded healing period is recommended [ 39 ]. Higher rates of osseointegration were observed when insertion torque values for non-submerged implants were 30 N/cm [ 40 ]. For non-functional loading of immediate single tooth implants, an insertion torque value ≥ 35 N/cm has been recommended [ 41 – 42 ] Considering that the connection of a custom healing abutment a form of loading that can result in micromotions being transferred to the implant, and since the mean torque values for all implants placed in our study was < 30 N/cm, we decided to proceed with a submerged, two-stage implant placement. To our knowledge, this is the first clinical study, comparing d-PTFE and gelatin sponges as barriers for socket sealing in immediate implant placement. Conclusion Within the limitations of this study, both d-PTFE membranes and gelatin sponges are effective methods for socket sealing allowing for successful osseointegration following flapless immediate implant placement in posterior sites. Moreover, the gelatin sponge offers a better option in terms of handling and reduced cost compared to d-PTFE. A larger study sample to verify the outcomes of this study is recommended. Declarations Competing interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval This prospective clinical study was performed in line with the declaration of Helsinki, approved by the Ethics Committee of the faculty of dentistry, Cairo University. Consent to participate Informed consent was obtained from all individual participants included in the study. All risks associated with the procedure and possible complications were discussed with the patients, and a written informed consent was obtained from them. Consent to publish The participants have consented to the submission of their data to the journal. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution (M.S.): Study conception and design, clinical work, writing the manuscript.(A.S.): Randomization, sequence allocation, patient recruitment, Writing the manuscript.All authors read and approved the final manuscript. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983;50(3):399–410. doi: 10.1016/s0022-3913(83)80101-2 . PMID: 6352924. Lazzara RJ. Immediate implant placement into extraction sites: surgical and restorative advantages. Int J Periodontics Restorative Dent. 1989;9(5):332–43. PMID: 2640210. Gallucci GO, Hamilton A, Zhou W, Buser D, Chen S. Implant placement and loading protocols in partially edentulous patients: A systematic review. Clin Oral Implants Res. 2018;29 Suppl 16:106–134. doi: 10.1111/clr.13276 . PMID: 30328194. Tarnow DP, Chu SJ, Salama MA, Stappert CF, Salama H, Garber DA, Sarnachiaro GO, Sarnachiaro E, Gotta SL, Saito H. Flapless postextraction socket implant placement in the esthetic zone: part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Int J Periodontics Restorative Dent. 2014 May-Jun;34(3):323 – 31 doi: 10.11607/prd.1821 . PMID: 24804283 Buser D, Chappuis V, Belser UC, Chen S. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontol 2000. 2017;73(1):84–102. doi: 10.1111/prd.12170 . PMID: 28000278. Bartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique. J Oral Implantol. 2001;27(4):194–7. doi: 10.1563/1548-1336(2001)0272.3 .CO;2. PMID: 12500878. Cooper LF, Reside GJ, Raes F, Garriga JS, Tarrida LG, Wiltfang J, Kern M, De Bruyn H. Immediate provisionalization of dental implants placed in healed alveolar ridges and extraction sockets: a 5-year prospective evaluation. Int J Oral Maxillofac Implants. 2014 May-Jun;29(3):709 – 17. doi: 10.11607/jomi.3617 . PMID: 24818212. Carbonell JM, Martín IS, Santos A, Pujol A, Sanz-Moliner JD, Nart J. High-density polytetrafluoroethylene membranes in guided bone and tissue regeneration procedures: a literature review. Int J Oral Maxillofac Surg. 2014;43(1):75–84. doi: 10.1016/j.ijom.2013.05.017. Epub 2013 Jun 28. PMID: 23810680.Proussaefs P. Use of CAD/CAM healing abutment immediately after dental implant placement for the non-esthetic zone. A guided soft tissue healing technique. J Oral Implantol . 2016;42(2):189–193. Luongo R, Tallarico M, Canciani E, Graziano D, Dellavia C, Gargari M, Ceruso FM, Melodia D, Canullo L. Histomorphometry of Bone after Intentionally Exposed Non-Resorbable d-PTFE Membrane or Guided Bone Regeneration for the Treatment of Post-Extractive Alveolar Bone Defects with Implant-Supported Restorations: A Pilot Randomized Controlled Trial. Materials (Basel). 2022;15(17):5838. doi: 10.3390/ma15175838 . PMID: 36079220; PMCID: PMC9457509. Al Hugail AM, Mealey BL, Walker C, Al Harthi S, Duong M, Noujeim M, Lasho DJ, Prihoda TJ, Huynh-Ba G. Evaluation of healing at molar extraction sites with ridge preservation using a non-resorbable dense polytetrafluoroethylene membrane: A four-arm cohort prospective study. Clin Exp Dent Res. 2021;7(6):1103–1111. doi: 10.1002/cre2.459. Epub 2021 Jun 6. PMID: 34096195; PMCID: PMC8638281 Finn MD, Schow SR, Schneiderman ED. Osseous regeneration in the presence of four common hemostatic agents. J Oral Maxillofac Surg. 1992;50(6):608 – 12. doi: 10.1016/0278-2391(92)90443-4 . PMID: 1593323. Bodner L. Osseous regeneration in the jaws using demineralized allogenic bone implants. J Craniomaxillofac Surg. 1998;26(2):116 – 20. doi: 10.1016/s1010-5182(98)80051-6 . PMID: 9617677. Singh M, Bhate K, Kulkarni D, Santhosh Kumar SN, Kathariya R. The effect of alloplastic bone graft and absorbable gelatin sponge in prevention of periodontal defects on the distal aspect of mandibular second molars, after surgical removal of impacted mandibular third molar: a comparative prospective study. J Maxillofac Oral Surg. 2015;14(1):101–6. doi: 10.1007/s12663-013-0599-z . Epub 2013 Nov 14. PMID: 25729233; PMCID: PMC4339342. Sharifi S, Maleki Dizaj S, Ahmadian E, Karimpour A, Maleki A, Memar MY, Ghavimi MA, Dalir Abdolahinia E, Goh KW. A Biodegradable Flexible Micro/Nano-Structured Porous Hemostatic Dental Sponge. Nanomaterials (Basel). 2022;12(19):3436. doi: 10.3390/nano12193436 . PMID: 36234564; PMCID: PMC9565827. Schonauer C, Tessitore E, Barbagallo G, Albanese V, Moraci A. The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J. 2004;13 Suppl 1(Suppl 1):S89-96. doi: 10.1007/s00586-004-0727-z . Epub 2004 Jun 22. PMID: 15221572; PMCID: PMC3592193. Trombelli L, Farina R, Marzola A, Bozzi L, Liljenberg B, Lindhe J. Modeling and remodeling of human extraction sockets. J Clin Periodontol. 2008;35(7):630–9. doi: 10.1111/j.1600-051X.2008.01246 . x. Epub 2008 May 21. PMID: 18498382. Zafiropoulos, G.-G.; Kačarević, Z.P.; Qasim, S.S.B.; Trajkovski, B. Open-Healing Socket Preservation with a Novel Dense Polytetrafluoroethylene (dPTFE) Membrane: A Retrospective Clinical Study. Medicina 2020, 56, 216. https://doi.org/10.3390/medicina56050216 Barboza EP, Stutz B, Ferreira VF, Carvalho W. Guided bone regeneration using nonexpanded polytetrafluoroethylene membranes in preparation for dental implant placements–a report of 420 cases. Implant Dent. 2010;19(1):2–7. doi: 10.1097/ID.0b013e3181cda72c . PMID: 20147810. Waasdorp J, Feldman S. Bone regeneration around immediate implants utilizing a dense polytetrafluoroethylene membrane without primary closure: a report of 3 cases. J Oral Implantol. 2013;39(3):355–61. doi: 10.1563/AAID-JOI-D-10-00128. Epub 2011 Sep 9. PMID: 21905904. Waasdorp J, Feldman S. Bone regeneration around immediate implants utilizing a dense polytetrafluoroethylene membrane without primary closure: a report of 3 cases. J Oral Implantol. 2013;39(3):355–61. doi: 10.1563/AAID-JOI-D-10-00128. Epub 2011 Sep 9. PMID: 21905904. de Carvalho Formiga M, Dayube URC, Chiapetti CK, de Rossi Figueiredo D, Shibli JA. Socket Preservation Using a (Dense) PTFE Barrier with or without Xenograft Material: A Randomized Clinical Trial. Materials (Basel). 2019;12(18):2902. doi: 10.3390/ma12182902 . PMID: 31500375; PMCID: PMC6766191. Tomizawa, Y. Clinical benefits, and risk analysis of topical hemostats: a review. J Artif Organs 8, 137–142 (2005). https://doi.org/10.1007/s10047-005-0296-x Pereira BM, Bortoto JB, Fraga GP. Topical hemostatic agents in surgery: review and prospects. Rev Col Bras Cir. 2018;45(5):e1900. Portuguese, English. doi: 10.1590/0100-6991e-20181900 . PMID: 30365692. Ockerman A, Miclotte I, Vanhaverbeke M, Verhamme P, Poortmans LL, Vanassche T, Politis C, Jacobs R. Local haemostatic measures after tooth removal in patients on antithrombotic therapy: a systematic review. Clin Oral Investig. 2019;23(4):1695–1708. doi: 10.1007/s00784-018-2576-x . Epub 2018 Aug 28. PMID: 30155575. Römer, P., Heimes, D., Pabst, A. et al. Bleeding disorders in implant dentistry: a narrative review and a treatment guide. Int J Implant Dent 8, 20 (2022). https://doi.org/10.1186/s40729-022-00418-2 Rohanizadeh R, Swain MV, Mason RS. Gelatin sponges (Gelfoam) as a scaffold for osteoblasts. J Mater Sci Mater Med. 2008;19(3):1173–82. doi: 10.1007/s10856-007-3154-y . Epub 2007 Aug 15. PMID: 17701305. Sohn DS, Moon JW, Moon KN, Cho SC, Kang PS. New bone formation in the maxillary sinus using only absorbable gelatin sponge. J Oral Maxillofac Surg. 2010;68(6):1327-33. doi: 10.1016/j.joms.2010.02.014 . PMID: 20493382. Kuttappan S, Mathew D, Nair MB. Biomimetic composite scaffolds containing bioceramics and collagen/gelatin for bone tissue engineering - A mini review. Int J Biol Macromol. 2016;93(Pt B):1390–1401. doi: 10.1016/j.ijbiomac.2016 .06.043. Epub 2016 Jun 15. PMID: 27316767.Tavelli L, Asa'ad F, Acunzo R, Pagni G, Consonni D, Rasperini G. Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study. Int J Periodontics Restorative Dent. 2018 Nov/Dec;38(6):e127-e134.doi: 10.11607/prd.3581. PMID: 30304077. Tavelli L, Asa'ad F, Acunzo R, Pagni G, Consonni D, Rasperini G. Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study. Int J Periodontics Restorative Dent. 2018 Nov/Dec;38(6):e127-e134. doi: 10.11607/prd.3581 . PMID: 30304077. Ehab, K., Abouldahab, O., Hassan, A. et al. Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial. Clin Oral Invest 24, 1517–1525 (2020). https://doi.org/10.1007/s00784-020-03254-z Albrektsson T, Jacobson M. Bone metal interface in osseointegration. J Prosthet Dent. 1987;57:597–607. doi: 10.1016/0022-3913(87)90344-1 . Becker W, Sennerby L, Bedrossian E, Becker BE, Lucchini JP. Implant stability measurements for implants placed at the time of extraction: a cohort, prospective clinical trial. J Periodontol. 2005;76(3):391-7. doi: 10.1902/jop.2005.76.3.391 . PMID: 15857073. Monje A, Ravidà A, Wang HL, Helms JA, Brunski JB. Relationship Between Primary/Mechanical and Secondary/Biological Implant Stability. Int J Oral Maxillofac Implants. 2019 Suppl;34:s7-s23. doi: 10.11607/jomi.19suppl.g1 . PMID: 31116830. Kästel I, de Quincey G, Neugebauer J, Sader R, Gehrke P. Does the manual insertion torque of smartpegs affect the outcome of implant stability quotients (ISQ) during resonance frequency analysis (RFA)? Int J Implant Dent. 2019;5(1):42. doi: 10.1186/s40729-019-0195-1 . PMID: 31828457; PMCID: PMC6906278. Simeone SG, Rios M, Simonpietri J. "Reverse torque of 30 Ncm applied to dental implants as test for osseointegration"-a human observational study. Int J Implant Dent. 2016;2(1):26. doi: 10.1186/s40729-016-0060-4 . Epub 2016 Dec 7. PMID: 27928768; PMCID: PMC5143334. Roy M, Loutan L, Garavaglia G, Hashim D. Removal of osseointegrated dental implants: a systematic review of explantation techniques. Clin Oral Investig. 2020;24(1):47–60. doi: 10.1007/s00784-019-03127-0 . Epub 2019 Nov 15. PMID: 31729576. Young L, Brown T, Lamont TJ. A comparison of techniques for the explantation of osseointegrated dental implants. Evid Based Dent. 2020;21(4):126–127. doi: 10.1038/s41432-020-0133-3 . PMID: 33339970. Chen MH, Lyons KM, Tawse-Smith A, Ma S. Clinical Significance of the Use of Resonance Frequency Analysis in Assessing Implant Stability: A Systematic Review. Int J Prosthodont. 2019 Jan/Feb;32(1):51–58. doi: 10.11607/ijp.6048 . PMID: 30677112. Gjelvold B, Kisch J, Mohammed DJH, Chrcanovic BR, Albrektsson T, Wennerberg A. Immediate Loading of Single Implants, Guided Surgery, and Intraoral Scanning: A Nonrandomized Study. Int J Prosthodont. 2020 Sep/Oct;33(5):513–522. doi: 10.11607/ijp.6701 . PMID: 32956432. Amari, Y., Piattelli, A., Apaza Alccayhuaman, K.A. et al. Bone healing at non-submerged implants installed with different insertion torques: a split-mouth histomorphometric randomized controlled trial. Int J Implant Dent 5, 39 (2019). https://doi.org/10.1186/s40729-019-0194-2 den Hartog L, Raghoebar GM, Stellingsma K, Vissink A, Meijer HJ. Immediate non-occlusal loading of single implants in the aesthetic zone: a randomized clinical trial. J Clin Periodontol. 2011;38(2):186–94. doi: 10.1111/j.1600-051X.2010.01650.x. Epub 2010 Nov 18. PMID: 21087294. Gallucci GO, Benic GI, Eckert SE, Papaspyridakos P, Schimmel M, Schrott A, Weber HP. Consensus statements and clinical recommendations for implant loading protocols. Int J Oral Maxillofac Implants. 2014;29 Suppl:287 – 90. doi: 10.11607/jomi.2013.g4 . PMID: 24660204. Cite Share Download PDF Status: Published Journal Publication published 08 Jan, 2025 Read the published version in Bulletin of the National Research Centre → Version 1 posted Editorial decision: Revision requested 21 Nov, 2024 Submission checks completed at journal 19 Nov, 2024 First submitted to journal 19 Nov, 2024 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-5475035","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381962308,"identity":"c5b3c681-ff88-43e2-b31b-b2741036c59c","order_by":0,"name":"Mahmoud Shalash","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBADfn4og4doLZIzG0jWsuEAsUp12w+wffhRcVjC+Hbvww8Mf+xkGNjbL+DVYnYmgXlmz5nDEmZ3jhtLMLYl8zDwnCnAr+VAAjMDb9vhOrMbaWwMjA0HeBgkchLwazn/gJnxbxvQYTOAWhj+ALXIvyGg5UYCMzPQFgkDCZAWNpAt7AcIaHnYzCxzJl1C4kYas0Qi0C9sPDl4dQAdlnyY8U2FtQT/jDTGDx/+2Nnzsx9/gF8P0MsINsgTbAw8BgS0YAJ2QraMglEwCkbBCAMAi8s+XFSlYAYAAAAASUVORK5CYII=","orcid":"","institution":"Surgery and Oral Medicine Department, National Research Centre, Cairo, Egypt","correspondingAuthor":true,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Shalash","suffix":""},{"id":381962309,"identity":"d6af4a76-05ff-4ab9-a50e-6f72fad30df8","order_by":1,"name":"Aalaa Emara","email":"","orcid":"","institution":"Oral and Maxillofacial Surgery Department, Cairo University, Cairo, Egypt","correspondingAuthor":false,"prefix":"","firstName":"Aalaa","middleName":"","lastName":"Emara","suffix":""}],"badges":[],"createdAt":"2024-11-18 10:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5475035/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5475035/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s42269-025-01299-2","type":"published","date":"2025-01-08T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71894742,"identity":"6820b999-fd34-402e-9d27-7dd2903a3872","added_by":"auto","created_at":"2024-12-19 13:36:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":182898,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative clinical and radiographic assessment using CBCT\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5475035/v1/4063e054243df0e1fd6bc3bc.png"},{"id":71896242,"identity":"2c28d8d5-1c3d-40bb-9d23-f5361b653cac","added_by":"auto","created_at":"2024-12-19 13:44:20","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":105319,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e-Initial situation \u003cstrong\u003eb\u003c/strong\u003e-Atraumatic flapless extraction \u003cstrong\u003ec\u003c/strong\u003e-Immediate implant placement tooth 24 \u003cstrong\u003ed\u003c/strong\u003e- \u003cstrong\u003ee\u003c/strong\u003eSocket sealing with d-PTFE membrane \u003cstrong\u003ef\u003c/strong\u003e-Socket epithelization evident at 4 weeks following membrane removal \u003cstrong\u003eg\u003c/strong\u003e-Emergence profile creation using custom healing abutments. \u003cstrong\u003eh\u003c/strong\u003e-Delivery of the final restoration \u003cstrong\u003ei\u003c/strong\u003e-Radiographic control of the final prosthesis.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5475035/v1/00a3ebdff312b35b65cb4a19.jpeg"},{"id":71894747,"identity":"027d5301-5f65-4f7d-9212-776a62a04cdf","added_by":"auto","created_at":"2024-12-19 13:36:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1092931,"visible":true,"origin":"","legend":"\u003cp\u003eShowing treatment sequence for group II (test group) using the gelatin sponge to seal the socket. a- initial presentation. B-atraumatic flapless extraction and osteotomy. c-implant placement. d-Gelatin sponge applied to seal the sockets. e-Suturing to stabilize the gelfoam in place. f- fibrin clot formation evident at 10 days post operatively. e-Healed implants. h-Final Restoration.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5475035/v1/645be98dbdb500bc4f0fcc6b.png"},{"id":73693921,"identity":"4ef5be40-27ed-41c0-be18-f8b26c42e2f0","added_by":"auto","created_at":"2025-01-13 16:09:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2098697,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5475035/v1/a95ec556-bfb8-4ed2-835a-56c7e2bf25c8.pdf"}],"financialInterests":"","formattedTitle":"Effect of using a hemostatic gelatin sponge versus a dense polytetrafluorethylene membrane for socket sealing following immediate implant placement. A randomized clinical study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental implants are considered the gold standard for the management of edentulous spaces. The original protocol for implant placement required a 6-month healing period for osseous healing following tooth extraction [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the aim of reducing the number of surgical procedures and reducing the overall treatment time, immediate implants have been proposed [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Several studies have reported comparable success and survival rates for implants placed immediately into fresh extraction sockets compared to those placed in healed sites [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen considering immediate implants, a flapless approach is recommended. This offers several advantages, namely, maintaining the periosteal blood supply to the labial/buccal plate of bone and avoiding disruption of the keratinized mucosal band and soft tissue architecture, resulting in a faster healing time and less patient morbidity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen primary implant stability is inadequate, submerged healing of immediate implants is recommended. To promote healing by secondary intention once the implant is inserted in its correct 3D position, sealing the socket with an adequate barrier is mandatory to protect the implant and contain the bone graft material placed in the jumping gap [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith both resorbable and non-resorbable barrier membranes available, dense polytetrafluoroethylene membranes (d-PTFE) have been widely used for ridge preservation following tooth extraction and for socket sealing following immediate implant placement. With a porosity of 0.2\u0026ndash;0.3 microns, d-PTFE membranes are bioinert and impermeable to the oral flora, allowing for safe use in these cases without the need for primary closure [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Some of the drawbacks to using d-PTFE membranes include difficulty in handling and the high cost, which may add a financial burden on the patient. On the other hand, gelatin sponges have been widely used in oral surgical procedures and following tooth extraction, with excellent results in terms of hemostasis and rate of resorption [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary outcome of this study is to assess clinical socket healing and implant osseointegration following immediate implant placement. The null hypothesis is that a hemostatic gelatin sponge can be used as a membrane for socket sealing following flapless immediate implant placement as effectively as a d-PTFE membrane.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eA total of 20 patients (12 males, 8 females, with a mean age range of 25\u0026ndash;60 years) meeting the eligibility criteria for immediate implant placement were selected and randomized into two equal groups by the means of sealed envelopes. A control group, where an immediate implant and a d-PTFE membrane was used, and a test group where an immediate implant and a gelatin sponge was used. Patients were selected from the outpatient clinic of the oral surgery department at the faculty of dentistry, Cairo University. Patients with badly broken-down maxillary or mandibular posterior teeth with no clinical signs of infection, allowing for extraction and immediate implant placement, were selected. The patients were free from any systemic or metabolic diseases that would contraindicate implant placement, non-smokers, and had an acceptable oral hygiene. The study was approved by the Ethics Committee at the Faculty of Dentistry, Cairo University, in February 2023 and registered as a clinical trial, NCT 05982353, on 08/08/2023. The participants in this study have provided written informed consent for publication.\u003c/p\u003e \u003cp\u003eThe following steps were carried out for all patients.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1. Preoperative preparation\u003c/h2\u003e \u003cp\u003eFollowing initial clinical assessment, cone beam CT scans (CBCT) \u003cb\u003e(Soredex, Cranex, 3DX, Finland)\u003c/b\u003e were ordered for all patients to assess socket morphology and alveolar ridge dimensions in order to select the appropriate implant size accordingly \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e For all patients, Amoxicillin/Clavulanate 1 gm \u003cb\u003e(Augmentin, GlaxoSmithKline, England)\u003c/b\u003e oral tablet was given as an antimicrobial prophylaxis 1 hour before the surgery. In cases of allergy to penicillin, clindamycin 600 mg \u003cb\u003e(Dalacin C, Pfizer, USA)\u003c/b\u003e was prescribed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2. Surgical procedure:\u003c/h3\u003e\n\u003cp\u003eUnder local anesthesia \u003cb\u003e(Articaine 4%, 1:100000, Artinbsa, Spain)\u003c/b\u003e, the target tooth was extracted using a flapless, minimally traumatic technique using a combination of micro elevators and a Piezotome using surgical extraction tips \u003cb\u003e(Satelc solo led 2, Acteon group, Italy).\u003c/b\u003e Following extraction, the socket was debrided and irrigated using normal saline solution. Implant osteotomy was performed following the drilling sequence recommended by the manufacturer. Implants \u003cb\u003e(JD Evolution Plus, Jdentalcare, Italy)\u003c/b\u003e were inserted using a motor-driven approach \u003cb\u003e(Implantmed, W\u0026amp;H, Austria)\u003c/b\u003e, which allowed for the measurement of the implant final seating torque using the built-in torque curve function. Following implant insertion, all the gaps around the implants were filled with cortico-cancellous allograft \u003cb\u003e(Maxgraft, Botiss biomaterials GmbH, Germany).\u003c/b\u003e For the control group, a 15*20 mm d-PTFE membrane \u003cb\u003e(Permamem, Botiss biomaterials GmBH, Germany)\u003c/b\u003e was shaped to the socket and gently tucked underneath the buccal and palatal mucoperiosteum, extending 3\u0026ndash;4 mm beyond the socket walls. A figure-eight sutures and/or single interrupted sutures were used to secure the membrane in place \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e For the test group, a gelatin sponge \u003cb\u003e(Cutanplast Standard, Mascia Brunelli, Milano, Italy)\u003c/b\u003e was cut and shaped to the socket, applied in two separate layers, and finally secured with sutures, sealing the socket in a similar manner to the control group. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e In both groups, no flap mobilization or primary closure was performed.\u003c/p\u003e \u003cp\u003eStandard post-operative instructions were given to all patients. A follow-up appointment was scheduled after one week for sutures removal. For the control group, the membrane was removed after 4 weeks.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003e3. Follow up\u003c/h3\u003e\n\u003cp\u003eImplants were allowed to heal for 4 months, after which they were uncovered using a full-thickness flap. At the time of uncovering, all implants were subjected to a reverse torque test of 30 N/cm using a calibrated torque wrench \u003cb\u003e(Jdentalcare, Italy)\u003c/b\u003e to assess implant secondary stability. The presence of any movement in the implant or pain that was noted by the patient was considered a sign of implant failure. The next step involved connecting either a custom healing or a stock abutment, which allowed for shaping the emergence profile. The definitive prosthesis was connected one month later.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe present study tested the clinical outcome of 20 immediate dental implants placed in different areas of the upper and lower posterior jaws, based on ideal selection criteria for immediate implant placement. Patients were recruited and procedures, carried out and finalized between March 2023 and January 2024. In the control group, 4 implants were placed in the maxillary molar region, 3 implants in the mandibular molar region, and 3 in the maxillary premolar region. In the test group, 4 implants were placed in the maxillary molar region, 4 in the mandibular molar region, and 2 in the maxillary premolar region. Torque curve values for primary implant stability in both groups showed a mean of 29.8 N/cm. All implants were subjected to a 30 N/cm reverse torque test during second-stage surgery. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the torque values and implant dimensions for both groups.\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\u003eshowing torque values, implant length and diameter for both groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsertion Torque value\u003c/p\u003e \u003cp\u003e(N/cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImplant Diameter*Length\u003c/p\u003e \u003cp\u003e(cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInsertion Torque value\u003c/p\u003e \u003cp\u003e(N/cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eImplant Diameter*Length\u003c/p\u003e \u003cp\u003e(cm)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup I\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGroup II\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5*10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5*11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5*11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3*11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5*10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMean final seating torque 29.5 N/cm*\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\u003eAll implants healed uneventfully, without any radiographic evidence of bone loss. There was no clinical or radiographic difference between the outcomes in the control and the test groups. For the 20 dental implants subjected to a 30 N/cm reverse torque test, the expected clinical integration was observed. There was no evidence of mobility, or clinical signs of discomfort, or pain upon application of the test, allowing the placement of the definitive restoration in all 20 cases.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to test the clinical outcome of using a d-PTFE barrier membrane versus a hemostatic gelatin sponge in 20 patients, following flapless immediate implant placement. d-PTFE membranes have been widely used and accepted as a standard barrier for flapless post-extraction ridge preservation or immediate implant placement. These membranes are inert, do not cause any localized tissue inflammation or reaction and can be left exposed in the oral cavity, acting like a scaffold to guide soft tissue healing [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Currently there is no consensus on the optimum time for their removal when used as a barrier to seal the socket. We chose to remove it at 4 weeks with several studies recommending their removal sometime between 3 and 6 weeks. [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGelatin sponge is a sterile, compressed, water-insoluble device prepared from purified animal collagen and can absorb up to forty times its weight of whole blood [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It is widely used as a local hemostatic agent and for wound dressing following oral surgical procedures. An advantage to its use compared to collagen dressings, is the ease of preparation and the lack of antigenicity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It\u0026rsquo;s role in supporting the proliferation and differentiation of osteoblasts, as carriers for bone graft materials, in enhancing bone regeneration in cystic defects and in maxillary sinus grafting has been described [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The effect on enhancing bone regeneration has however been questioned [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, the use of the gelatin sponge as a barrier for sealing the socket following immediate implant placement, resulted in successful uncomplicated healing of the implants. The normal cascade of socket healing, containment of the graft particles in the jumping gap by a fibrin clot was evident at 10 days post-surgery. At 4 weeks, complete epithelialization of the socket was evident. It was recently shown that the use of a gelatin sponge as a palatal wound dressing, following free gingival graft harvesting was advantageous for wound healing in terms of the speed of re-epithelialization of the donor site, and reduced patient discomfort during the healing phase [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor the clinical assessment of osseointegration, several subjective and objective methods have been proposed; clinical mobility test, percussion test, radiographic assessment, reverse torque test and resonance frequency analysis (RFA) have been used individually or combined; with indefinite conclusions regarding the bone-titanium interface and its correlation to the clinical findings [\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In our study, a 30 N/cm reverse torque test was used to verify clinical implant stability at the second stage surgery. Recently, in a human study, the reverse torque test has been verified as an accepted, non -invasive clinical method, that can be used for early verification of initial osseointgeration [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Recent studies, have shown that a minimum of 200-Ncm reverse torque is required for removal of osseointegrated implants, so a 30 N/cm can be confirmed as a predictive measure for osseointegration. It is worth noting, that most implant manufacturers will recommend torquing prosthetic abutments to the implant at 30 N/cm which is considered a safety margin for the implants at the time of prosthetic connection [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough RFA has gained popularity in recent years as a measure of implant stability during different time points, the interpretation of its results can vary and will depend on how tight the smart pegs are connected and the contact angle applied to the implant by the transducer which can affect the reliability of the results. A reverse torque test is believed to be a cheap, noninvasive method capable of differentiating between a stable and a mobile implant and help predict the prognosis of an osseointegrated dental implants [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently there is no consensus regarding the optimum torque at which a custom healing abutment can be connected to an immediate implant in posterior teeth. For delayed implants, when insertion torque values are \u0026lt;\u0026thinsp;30 N/cm, an unloaded healing period is recommended [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Higher rates of osseointegration were observed when insertion torque values for non-submerged implants were 30 N/cm [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. For non-functional loading of immediate single tooth implants, an insertion torque value\u0026thinsp;\u0026ge;\u0026thinsp;35 N/cm has been recommended [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eConsidering that the connection of a custom healing abutment a form of loading that can result in micromotions being transferred to the implant, and since the mean torque values for all implants placed in our study was \u0026lt;\u0026thinsp;30 N/cm, we decided to proceed with a submerged, two-stage implant placement.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first clinical study, comparing d-PTFE and gelatin sponges as barriers for socket sealing in immediate implant placement.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWithin the limitations of this study, both d-PTFE membranes and gelatin sponges are effective methods for socket sealing allowing for successful osseointegration following flapless immediate implant placement in posterior sites. Moreover, the gelatin sponge offers a better option in terms of handling and reduced cost compared to d-PTFE. A larger study sample to verify the outcomes of this study is recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e This prospective clinical study was performed in line with the declaration of Helsinki, approved by the Ethics Committee of the faculty of dentistry, Cairo University.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study. All risks associated with the procedure and possible complications were discussed with the patients, and a written informed consent was obtained from them.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish\u003c/strong\u003e \u003cp\u003eThe participants have consented to the submission of their data to the journal.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e(M.S.): Study conception and design, clinical work, writing the manuscript.(A.S.): Randomization, sequence allocation, patient recruitment, Writing the manuscript.All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBr\u0026aring;nemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983;50(3):399\u0026ndash;410. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0022-3913(83)80101-2\u003c/span\u003e\u003cspan address=\"10.1016/s0022-3913(83)80101-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 6352924.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazzara RJ. Immediate implant placement into extraction sites: surgical and restorative advantages. Int J Periodontics Restorative Dent. 1989;9(5):332\u0026ndash;43. PMID: 2640210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallucci GO, Hamilton A, Zhou W, Buser D, Chen S. Implant placement and loading protocols in partially edentulous patients: A systematic review. Clin Oral Implants Res. 2018;29 Suppl 16:106\u0026ndash;134. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/clr.13276\u003c/span\u003e\u003cspan address=\"10.1111/clr.13276\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30328194.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarnow DP, Chu SJ, Salama MA, Stappert CF, Salama H, Garber DA, Sarnachiaro GO, Sarnachiaro E, Gotta SL, Saito H. Flapless postextraction socket implant placement in the esthetic zone: part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Int J Periodontics Restorative Dent. 2014 May-Jun;34(3):323\u0026thinsp;\u0026ndash;\u0026thinsp;31 doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/prd.1821\u003c/span\u003e\u003cspan address=\"10.11607/prd.1821\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 24804283\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuser D, Chappuis V, Belser UC, Chen S. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontol 2000. 2017;73(1):84\u0026ndash;102. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/prd.12170\u003c/span\u003e\u003cspan address=\"10.1111/prd.12170\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 28000278.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique. J Oral Implantol. 2001;27(4):194\u0026ndash;7. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1563/1548-1336(2001)027\u0026lt;0194:ESRFAR\u0026gt;2.3\u003c/span\u003e\u003cspan address=\"10.1563/1548-1336(2001)027%3C0194:ESRFAR%3E2.3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.CO;2. PMID: 12500878.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooper LF, Reside GJ, Raes F, Garriga JS, Tarrida LG, Wiltfang J, Kern M, De Bruyn H. Immediate provisionalization of dental implants placed in healed alveolar ridges and extraction sockets: a 5-year prospective evaluation. Int J Oral Maxillofac Implants. 2014 May-Jun;29(3):709\u0026thinsp;\u0026ndash;\u0026thinsp;17. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/jomi.3617\u003c/span\u003e\u003cspan address=\"10.11607/jomi.3617\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 24818212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarbonell JM, Mart\u0026iacute;n IS, Santos A, Pujol A, Sanz-Moliner JD, Nart J. High-density polytetrafluoroethylene membranes in guided bone and tissue regeneration procedures: a literature review. Int J Oral Maxillofac Surg. 2014;43(1):75\u0026ndash;84. doi: 10.1016/j.ijom.2013.05.017. Epub 2013 Jun 28. PMID: 23810680.Proussaefs P. Use of CAD/CAM healing abutment immediately after dental implant placement for the non-esthetic zone. A guided soft tissue healing technique. \u003cem\u003eJ Oral Implantol\u003c/em\u003e. 2016;42(2):189\u0026ndash;193.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuongo R, Tallarico M, Canciani E, Graziano D, Dellavia C, Gargari M, Ceruso FM, Melodia D, Canullo L. Histomorphometry of Bone after Intentionally Exposed Non-Resorbable d-PTFE Membrane or Guided Bone Regeneration for the Treatment of Post-Extractive Alveolar Bone Defects with Implant-Supported Restorations: A Pilot Randomized Controlled Trial. Materials (Basel). 2022;15(17):5838. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ma15175838\u003c/span\u003e\u003cspan address=\"10.3390/ma15175838\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 36079220; PMCID: PMC9457509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Hugail AM, Mealey BL, Walker C, Al Harthi S, Duong M, Noujeim M, Lasho DJ, Prihoda TJ, Huynh-Ba G. Evaluation of healing at molar extraction sites with ridge preservation using a non-resorbable dense polytetrafluoroethylene membrane: A four-arm cohort prospective study. Clin Exp Dent Res. 2021;7(6):1103\u0026ndash;1111. doi: 10.1002/cre2.459. Epub 2021 Jun 6. PMID: 34096195; PMCID: PMC8638281\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinn MD, Schow SR, Schneiderman ED. Osseous regeneration in the presence of four common hemostatic agents. J Oral Maxillofac Surg. 1992;50(6):608\u0026thinsp;\u0026ndash;\u0026thinsp;12. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0278-2391(92)90443-4\u003c/span\u003e\u003cspan address=\"10.1016/0278-2391(92)90443-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 1593323.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBodner L. Osseous regeneration in the jaws using demineralized allogenic bone implants. J Craniomaxillofac Surg. 1998;26(2):116\u0026thinsp;\u0026ndash;\u0026thinsp;20. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s1010-5182(98)80051-6\u003c/span\u003e\u003cspan address=\"10.1016/s1010-5182(98)80051-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 9617677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh M, Bhate K, Kulkarni D, Santhosh Kumar SN, Kathariya R. The effect of alloplastic bone graft and absorbable gelatin sponge in prevention of periodontal defects on the distal aspect of mandibular second molars, after surgical removal of impacted mandibular third molar: a comparative prospective study. J Maxillofac Oral Surg. 2015;14(1):101\u0026ndash;6. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12663-013-0599-z\u003c/span\u003e\u003cspan address=\"10.1007/s12663-013-0599-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2013 Nov 14. PMID: 25729233; PMCID: PMC4339342.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharifi S, Maleki Dizaj S, Ahmadian E, Karimpour A, Maleki A, Memar MY, Ghavimi MA, Dalir Abdolahinia E, Goh KW. A Biodegradable Flexible Micro/Nano-Structured Porous Hemostatic Dental Sponge. Nanomaterials (Basel). 2022;12(19):3436. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nano12193436\u003c/span\u003e\u003cspan address=\"10.3390/nano12193436\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 36234564; PMCID: PMC9565827.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchonauer C, Tessitore E, Barbagallo G, Albanese V, Moraci A. The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J. 2004;13 Suppl 1(Suppl 1):S89-96. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00586-004-0727-z\u003c/span\u003e\u003cspan address=\"10.1007/s00586-004-0727-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2004 Jun 22. PMID: 15221572; PMCID: PMC3592193.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrombelli L, Farina R, Marzola A, Bozzi L, Liljenberg B, Lindhe J. Modeling and remodeling of human extraction sockets. J Clin Periodontol. 2008;35(7):630\u0026ndash;9. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1600-051X.2008.01246\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-051X.2008.01246\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. x. Epub 2008 May 21. PMID: 18498382.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZafiropoulos, G.-G.; Kačarević, Z.P.; Qasim, S.S.B.; Trajkovski, B. Open-Healing Socket Preservation with a Novel Dense Polytetrafluoroethylene (dPTFE) Membrane: A Retrospective Clinical Study. Medicina 2020, 56, 216. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina56050216\u003c/span\u003e\u003cspan address=\"10.3390/medicina56050216\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarboza EP, Stutz B, Ferreira VF, Carvalho W. Guided bone regeneration using nonexpanded polytetrafluoroethylene membranes in preparation for dental implant placements\u0026ndash;a report of 420 cases. Implant Dent. 2010;19(1):2\u0026ndash;7. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ID.0b013e3181cda72c\u003c/span\u003e\u003cspan address=\"10.1097/ID.0b013e3181cda72c\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 20147810.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaasdorp J, Feldman S. Bone regeneration around immediate implants utilizing a dense polytetrafluoroethylene membrane without primary closure: a report of 3 cases. J Oral Implantol. 2013;39(3):355\u0026ndash;61. doi: 10.1563/AAID-JOI-D-10-00128. Epub 2011 Sep 9. PMID: 21905904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaasdorp J, Feldman S. Bone regeneration around immediate implants utilizing a dense polytetrafluoroethylene membrane without primary closure: a report of 3 cases. J Oral Implantol. 2013;39(3):355\u0026ndash;61. doi: 10.1563/AAID-JOI-D-10-00128. Epub 2011 Sep 9. PMID: 21905904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Carvalho Formiga M, Dayube URC, Chiapetti CK, de Rossi Figueiredo D, Shibli JA. Socket Preservation Using a (Dense) PTFE Barrier with or without Xenograft Material: A Randomized Clinical Trial. Materials (Basel). 2019;12(18):2902. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ma12182902\u003c/span\u003e\u003cspan address=\"10.3390/ma12182902\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31500375; PMCID: PMC6766191.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomizawa, Y. Clinical benefits, and risk analysis of topical hemostats: a review. J Artif Organs 8, 137\u0026ndash;142 (2005). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10047-005-0296-x\u003c/span\u003e\u003cspan address=\"10.1007/s10047-005-0296-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira BM, Bortoto JB, Fraga GP. Topical hemostatic agents in surgery: review and prospects. Rev Col Bras Cir. 2018;45(5):e1900. Portuguese, English. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/0100-6991e-20181900\u003c/span\u003e\u003cspan address=\"10.1590/0100-6991e-20181900\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30365692.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOckerman A, Miclotte I, Vanhaverbeke M, Verhamme P, Poortmans LL, Vanassche T, Politis C, Jacobs R. Local haemostatic measures after tooth removal in patients on antithrombotic therapy: a systematic review. Clin Oral Investig. 2019;23(4):1695\u0026ndash;1708. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00784-018-2576-x\u003c/span\u003e\u003cspan address=\"10.1007/s00784-018-2576-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Aug 28. PMID: 30155575.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR\u0026ouml;mer, P., Heimes, D., Pabst, A. et al. Bleeding disorders in implant dentistry: a narrative review and a treatment guide. Int J Implant Dent 8, 20 (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40729-022-00418-2\u003c/span\u003e\u003cspan address=\"10.1186/s40729-022-00418-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRohanizadeh R, Swain MV, Mason RS. Gelatin sponges (Gelfoam) as a scaffold for osteoblasts. J Mater Sci Mater Med. 2008;19(3):1173\u0026ndash;82. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10856-007-3154-y\u003c/span\u003e\u003cspan address=\"10.1007/s10856-007-3154-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2007 Aug 15. PMID: 17701305.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSohn DS, Moon JW, Moon KN, Cho SC, Kang PS. New bone formation in the maxillary sinus using only absorbable gelatin sponge. J Oral Maxillofac Surg. 2010;68(6):1327-33. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.joms.2010.02.014\u003c/span\u003e\u003cspan address=\"10.1016/j.joms.2010.02.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 20493382.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuttappan S, Mathew D, Nair MB. Biomimetic composite scaffolds containing bioceramics and collagen/gelatin for bone tissue engineering - A mini review. Int J Biol Macromol. 2016;93(Pt B):1390\u0026ndash;1401. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijbiomac.2016\u003c/span\u003e\u003cspan address=\"10.1016/j.ijbiomac.2016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.06.043. Epub 2016 Jun 15. PMID: 27316767.Tavelli L, Asa'ad F, Acunzo R, Pagni G, Consonni D, Rasperini G. Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study. Int J Periodontics Restorative Dent. 2018 Nov/Dec;38(6):e127-e134.doi: 10.11607/prd.3581. PMID: 30304077.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTavelli L, Asa'ad F, Acunzo R, Pagni G, Consonni D, Rasperini G. Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study. Int J Periodontics Restorative Dent. 2018 Nov/Dec;38(6):e127-e134. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/prd.3581\u003c/span\u003e\u003cspan address=\"10.11607/prd.3581\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30304077.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEhab, K., Abouldahab, O., Hassan, A. et al. Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial. Clin Oral Invest 24, 1517\u0026ndash;1525 (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00784-020-03254-z\u003c/span\u003e\u003cspan address=\"10.1007/s00784-020-03254-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbrektsson T, Jacobson M. Bone metal interface in osseointegration. J Prosthet Dent. 1987;57:597\u0026ndash;607. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0022-3913(87)90344-1\u003c/span\u003e\u003cspan address=\"10.1016/0022-3913(87)90344-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecker W, Sennerby L, Bedrossian E, Becker BE, Lucchini JP. Implant stability measurements for implants placed at the time of extraction: a cohort, prospective clinical trial. J Periodontol. 2005;76(3):391-7. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1902/jop.2005.76.3.391\u003c/span\u003e\u003cspan address=\"10.1902/jop.2005.76.3.391\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15857073.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonje A, Ravid\u0026agrave; A, Wang HL, Helms JA, Brunski JB. Relationship Between Primary/Mechanical and Secondary/Biological Implant Stability. Int J Oral Maxillofac Implants. 2019 Suppl;34:s7-s23. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/jomi.19suppl.g1\u003c/span\u003e\u003cspan address=\"10.11607/jomi.19suppl.g1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31116830.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026auml;stel I, de Quincey G, Neugebauer J, Sader R, Gehrke P. Does the manual insertion torque of smartpegs affect the outcome of implant stability quotients (ISQ) during resonance frequency analysis (RFA)? Int J Implant Dent. 2019;5(1):42. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40729-019-0195-1\u003c/span\u003e\u003cspan address=\"10.1186/s40729-019-0195-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31828457; PMCID: PMC6906278.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimeone SG, Rios M, Simonpietri J. \"Reverse torque of 30 Ncm applied to dental implants as test for osseointegration\"-a human observational study. Int J Implant Dent. 2016;2(1):26. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40729-016-0060-4\u003c/span\u003e\u003cspan address=\"10.1186/s40729-016-0060-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2016 Dec 7. PMID: 27928768; PMCID: PMC5143334.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoy M, Loutan L, Garavaglia G, Hashim D. Removal of osseointegrated dental implants: a systematic review of explantation techniques. Clin Oral Investig. 2020;24(1):47\u0026ndash;60. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00784-019-03127-0\u003c/span\u003e\u003cspan address=\"10.1007/s00784-019-03127-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2019 Nov 15. PMID: 31729576.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung L, Brown T, Lamont TJ. A comparison of techniques for the explantation of osseointegrated dental implants. Evid Based Dent. 2020;21(4):126\u0026ndash;127. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41432-020-0133-3\u003c/span\u003e\u003cspan address=\"10.1038/s41432-020-0133-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33339970.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen MH, Lyons KM, Tawse-Smith A, Ma S. Clinical Significance of the Use of Resonance Frequency Analysis in Assessing Implant Stability: A Systematic Review. Int J Prosthodont. 2019 Jan/Feb;32(1):51\u0026ndash;58. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/ijp.6048\u003c/span\u003e\u003cspan address=\"10.11607/ijp.6048\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30677112.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGjelvold B, Kisch J, Mohammed DJH, Chrcanovic BR, Albrektsson T, Wennerberg A. Immediate Loading of Single Implants, Guided Surgery, and Intraoral Scanning: A Nonrandomized Study. Int J Prosthodont. 2020 Sep/Oct;33(5):513\u0026ndash;522. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/ijp.6701\u003c/span\u003e\u003cspan address=\"10.11607/ijp.6701\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 32956432.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmari, Y., Piattelli, A., Apaza Alccayhuaman, K.A. et al. Bone healing at non-submerged implants installed with different insertion torques: a split-mouth histomorphometric randomized controlled trial. Int J Implant Dent 5, 39 (2019). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40729-019-0194-2\u003c/span\u003e\u003cspan address=\"10.1186/s40729-019-0194-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eden Hartog L, Raghoebar GM, Stellingsma K, Vissink A, Meijer HJ. Immediate non-occlusal loading of single implants in the aesthetic zone: a randomized clinical trial. J Clin Periodontol. 2011;38(2):186\u0026ndash;94. doi: 10.1111/j.1600-051X.2010.01650.x. Epub 2010 Nov 18. PMID: 21087294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallucci GO, Benic GI, Eckert SE, Papaspyridakos P, Schimmel M, Schrott A, Weber HP. Consensus statements and clinical recommendations for implant loading protocols. Int J Oral Maxillofac Implants. 2014;29 Suppl:287\u0026thinsp;\u0026ndash;\u0026thinsp;90. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11607/jomi.2013.g4\u003c/span\u003e\u003cspan address=\"10.11607/jomi.2013.g4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 24660204.\u003c/span\u003e\u003c/li\u003e\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":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Flapless extraction, immediate implants, gelatin sponge, dense polytetrafluorethylene, reverse torque test","lastPublishedDoi":"10.21203/rs.3.rs-5475035/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5475035/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSocket sealing following flapless immediate implant placement involves placing a barrier membrane to prevent the ingrowth of bacteria or contaminants to the dental implant during the early phase of healing. Dense polytetrafluoroethylene membranes have been the gold standard socket sealing barrier due to their impermeability to the oral flora, which allows for undisturbed implant healing. The search for a more cost-efficient material, that is easy to handle and apply for sealing the socket without compromising implant osseointegration was sought. This study aims to evaluate the effectiveness of socket sealing after immediate implant placement in the premolar/molar region using a gelatin sponge, as opposed to a dense polytetrafluoroethylene membrane, and its impact on clinical implant osseointegration.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThe study was conducted on 20 patients, comprising 12 males and 8 females with an age range of 25\u0026ndash;60 years. Those meeting the eligibility criteria of immediate implant placement were selected and divided equally into two groups. A control group, where an immediate implant and a dense polytetrafluorethylene membrane was used, and a test group where an immediate implant and a gelatin sponge was used. Exclusion criteria included smokers, presence of systemic or metabolic conditions, or a local pathology that would contraindicate implant placement. Teeth were extracted using a flapless approach. Implants were placed, and sockets were sealed using the allocated barrier. In the control group, the membrane was removed after 4 weeks. For the test group, the gelatin sponge was left to resorb spontaneously. After 4 months, implants were uncovered, and a 30 N/cm reverse torque test was applied to assess the clinical osseointegration.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll implants healed uneventfully, without any radiographic evidence of bone loss. There was no clinical or radiographic difference between the outcomes in the control and the test groups. For the 20 dental implants subjected to a 30 N/cm reverse torque test, clinical integration was observed.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWithin the limitations of this study, both dense polytetrafluorethylene membranes and gelatin sponges are effective methods for socket sealing, allowing for successful osseointegration following flapless immediate implant placement in posterior sites, with gelatin sponge offering easier handling and a reduced cost compared to dense polytetrafluorethylene. A larger study sample to verify the outcomes of this study is recommended.\u003c/p\u003e","manuscriptTitle":"Effect of using a hemostatic gelatin sponge versus a dense polytetrafluorethylene membrane for socket sealing following immediate implant placement. A randomized clinical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 13:36:15","doi":"10.21203/rs.3.rs-5475035/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-21T15:32:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-19T23:17:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bulletin of the National Research Centre","date":"2024-11-19T19:42:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"98204135-21be-47b3-b379-79f625e6e958","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:01:27+00:00","versionOfRecord":{"articleIdentity":"rs-5475035","link":"https://doi.org/10.1186/s42269-025-01299-2","journal":{"identity":"bulletin-of-the-national-research-centre","isVorOnly":false,"title":"Bulletin of the National Research Centre"},"publishedOn":"2025-01-08 15:57:27","publishedOnDateReadable":"January 8th, 2025"},"versionCreatedAt":"2024-12-19 13:36:15","video":"","vorDoi":"10.1186/s42269-025-01299-2","vorDoiUrl":"https://doi.org/10.1186/s42269-025-01299-2","workflowStages":[]},"version":"v1","identity":"rs-5475035","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5475035","identity":"rs-5475035","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}