Abstract
The key to achieving pleasing esthetics in implant dentistry is a thorough understanding of the biological processes driving dimensional bone and soft tissue alterations post-extraction. The aim of the present report is first to characterize the extent of bone and soft tissue changes post-extraction and second to identify potential factors influencing tissue preservation in order to facilitate successful treatment outcomes. The facial bone wall thickness has been identified as the most critical factor influencing bone resorption and can be used as a prognostic tool in order to identify sites at risk for future facial bone loss subsequent to tooth extraction. Clinical studies indicated that thin bone wall phenotypes exhibiting a facial bone wall thickness of 1mm or less revealed progressive bone resorption with a vertical loss of 7.5mm, whereas thick bone wall phenotypes showed only minor bone resorption with a vertical loss of 1.1mm. This is in contrast to the dimensional soft tissue alterations. Thin bone wall phenotypes revealed a spontaneous soft tissue thickening after flapless extraction by a factor of seven, whereas thick bone wall phenotypes showed no significant changes in the soft tissue dimensions after 8weeks of healing. In sites exhibiting a limited bone resorption rate, immediate implant placement may be considered. If such ideal conditions are not present, other timing protocols are recommended to achieve predictable and pleasing esthetics. Socket preservation techniques for ridge preservation utilizing different biomaterials and/or barrier membranes often result in a better maintenance of tissue volumes, although the inevitable biological process of post-extraction bone resorption and bone modeling cannot be arrested. In summary, the knowledge of the biological events driving dimensional tissue alterations post-extraction should be integrated into the comprehensive treatment plan in order to limit tissue loss and to maximize esthetic outcomes.
Highlights
Attaining pleasing esthetics in the anterior maxilla involves many clinical parameters but is principally related to the peri-implant mucosal architecture in comparison with the contra-lateral natural tooth [31]
The aim of this review is to summarize the degree of tissue alterations in single tooth extraction sites of the anterior maxilla and to identify associated modulating factors in order to assist the clinician in the selection of the most appropriate treatment protocols to facilitate pleasing esthetic treatment outcomes
The dimensional bone and soft tissue alterations following tooth extraction in the anterior maxilla have a significant impact on the esthetic outcome of implant-supported restorations
Summary
The dimensional and structural alterations following tooth extraction have been studied in detail in mandibular premolar sites of beagle dogs [8, 25] (Fig. 1). These catabolic changes are initiated by the resorption of the bundle bone that lines the extraction socket. As the bundle bone is a tooth-dependent structure, it is gradually resorbed following tooth Note the location of the bone crest at the buccal and lingual aspects of the implant. Toluidine blue staining; original magnification 3 16 (with permission from Ref. [12])
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