Analysis of the socket bone wall dimensions in the upper maxilla in relation to immediate implant placement

Abstract

Animal and human researches have shown that immediate implant placement into extraction sockets failed to prevent socket dimensional changes following tooth extraction. It has been suggested that a minimal width of 1-2 mm of buccal bone is necessary to maintain a stable vertical dimension of the alveolar crest. To determine the dimensions of the bony wall at extraction sites in the esthetic zone (anterior teeth and premolars in the maxilla) and relate it to immediate implant placement. As part of an ongoing prospective randomized-controlled multicenter clinical study on immediate implant placement, the width of the buccal and palatal bony walls was recorded at 93 extraction sites. The mean width of the buccal and palatal bony walls was 1 and 1.2 mm, respectively (P<0.05). For the anterior sites (canine to canine), the mean width of the buccal bony wall was 0.8 mm. For the posterior (premolar) sites, it was 1.1 mm (P<0.05). In the anterior sites, 87% of the buccal bony walls had a width < or = 1 mm and 3% of the walls were 2 mm wide. In the posterior sites, the corresponding values were 59% and 9%, respectively. If the criterion of a minimal buccal bone width of 2 mm to maintain a stable buccal bony wall is valid, only a limited number of sites in the anterior maxilla display such a clinical situation. The data suggested that in the majority of extraction sites in the anterior maxilla, thin (< or = 1 mm) buccal walls were present. This, in turn, means that in most clinical situations encountered, augmentation procedures are needed to achieve adequate bony contours around the implant.