Abstract
After tooth extraction, notable ridge alterations occur due to resorption of bundle bones during the healing process. In areas with thin or damaged socket walls and multiple adjacent tooth extraction, dimensional changes are more prominent in the marginal proportion. In addition to the marginal changes, upper molar teeth are also vulnerable to pneumatization of the maxillary sinus. To reduce dimensional changes in extraction sockets, alveolar ridge preservation (ARP) is favored by many clinicians in areas where a large amount of dimensional change is expected. This case report presents two cases of ARP using collagenated demineralized bovine bone mineral and demineralized porcine bone mineral in the apically involved upper premolar and molar, respectively. Implants were placed one and two years, respectively, after the ARP. Radiographic analyses of residual bone height and volume were measured using cone-beam-computed tomography (CBCT) and histologic analysis of newly formed mineralized bone and residual graft material percentages were measured from the collected tissue samples using a trephine bur. Implants were placed using a simple technique, without any additional bone grafts at the marginal proportion. The ARP technique could maintain the alveolar bone height and volume, as well as minimize the invasiveness of surgical procedures during implant surgery.
Highlights
It has been demonstrated that physiologic changes after tooth extraction are inevitable [1,2]
From the lateral view of the cone-beam-computed tomography (CBCT) radiographs (Figure 3a,c), alveolar bone heights of the two grafted sites are comparative to the adjacent teeth, and the cross-sectional view shows an edentulous bone type A [23]
During an implant planning using CBCT radiographs, from 10 to 12 mm of alveolar bone height was measured in Case I, with a sufficient horizontal alveolar bone width of from 7 to 8 mm
Summary
It has been demonstrated that physiologic changes after tooth extraction are inevitable [1,2]. In areas with thin bundle bone or a damaged socket, significant reductions in facial-lingual width and vertical height could be observed [3,4]. To compensate for these post-extraction alterations, alveolar ridge preservation (ARP) has been advocated by many clinicians based upon the rationale that this therapeutic option could reduce the dimensional changes in the ridge after tooth extractions [5,6]. A recent randomized clinical study had revealed that ARP in the posterior maxilla could maintain the vertical bone height and possibly reduce the need for a subsequent sinus augmentation during implant placement in the posterior region [11]
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