The Rate of Alveolar Ridge Height Resorption of Maxillary Anterior Arch in Patients Treated with Immediate Partial Denture

The aim of this study was to compare vertical and horizontal mandibular alveolar bone resorption by measuring bone morphological variation in Kennedy Class II removable partial denture (RPD) wearers and non-wearers using cone-beam computed tomography (CBCT). In total, 124 sites in the CBCT scans of 62 (29 RPD non-wearers, 33 RPD wearers) Kennedy Class II patients were analyzed retrospectively. Three-dimensional representations of the mandible with superimposed cross-sectional slices were developed with the CBCT scans to evaluate the mandibular alveolar height and width by measuring distances between the mandibular canal, mylohyoid ridge, alveolar crest, and lower border of the mandible in four regions (eight sites) of Kennedy Class II non-wearers and wearers of RPDs. Mandibular alveolar bone height and width were significantly lower in edentulous sites when compared with dentate sites in both Kennedy Class II non-wearers and wearers of RPDs (p < 0.05). Additionally, mean vertical and horizontal mandibular bone resorption was significantly higher in RPD wearers than in non-wearers (p < 0.05). Vertical and horizontal alveolar bone resorption was found to be higher in the RPD wearing patients when comparing the dentate and edentulous sites.

The aims: The aims of this study were to evaluate the alveolar bone resorption every 2.5 mm distal to the implant over denture to the retromolar pad in the mandibular arch, and to the maxillary tuberosity in the maxillary arch in edentulous patient according to number between two and four, and position of implants between canine and 2nd premolar. Materials and Methods: Eight patients (age range 45-60 years) were selected from the department of Prosthodontics/ College of Dentistry/Mosul University, who had at least one edentulous arch. All patients complaining from poorly retention conventional acrylic complete denture due to the residual ridge resoption, but the alveolar ridge height need at least 10 mm implant length.After completing the surgical steps of 26 implants (two or four implant screw type titanium), over denture type with one step surgery for all implant types were constructed in conventional method after one month healing period. The prosthesis was delivered to the patients after one months of making the period elapsed. Dentures were delivered without socket attachment(six months). For assessment of alveolar bone height, for each patient panoramic exposure of OPG was recorded – three times [base line(at time of placement) , 6 months and 12 months]. Results: Results of this study showed, that mean difference of bone resoption range between [-0.2 –(-0.6)mm], and there was a significant difference of bone resoption between base line and 12 months to p0.05 according to number and position of implants. Conclusions: The conclusion of this study showed that, there was no significant different of alveolar ridge bone resoption between implants

Alveolar ridge resorption after tooth extraction is a frequently observed phenomenon that may either decrease the predictability of dental implant placement or impair the final esthetic results.1,2 Better understanding of the biologic process behind extraction-socket healing has led to the development of techniques to preserve the natural architecture of the alveolus after extraction, such as immediate implant placement in fresh sockets and the use of osseous graft materials.3It is now known that resorption will especially target the buccal plate if the socket is not grafted immediately after dental extraction,3,4 thereby increasing the risk for facial soft tissue recession.4 Even when minimal, such resorption usually has significant adverse clinical effects, particularly in the esthetic zone. Despite successful osseointegration of a dental implant, an anterior implant restoration may be judged to be a failure if the soft tissue appearance is poor.5–8 Surgical techniques meant to preserve natural bone and soft tissue contours after tooth extraction are thus of great interest to contemporary clinicians, especially true if an implant is placed and provisionalized immediately after tooth extraction.Numerous studies have focused on immediate functional loading of dental implants to minimize the delay between the surgical and prosthetic treatment phases.9,10 This technique is increasingly being applied when replacing teeth in the maxillary anterior region, where esthetic outcomes are important.11–17 However, some studies12,15,16 have reported that recession of the marginal peri-implant mucosa may occur after immediate implant placement. This recession, in turn, may adversely affect the final esthetic outcome.Factors that have been reported to influence the frequency and extent of marginal mucosal recession include the tissue biotype,17 the condition and thickness of the facial bone,18 and the orofacial position of the implant shoulder.19,20 Connecting a provisional crown immediately after implant insertion8,21 and grafting of the facial peri-implant marginal defect with bone or bone substitutes21–23 also have been cited as factors. In addition to these parameters, an experimental study24 showed that the facial socket wall, which is composed almost entirely of bundle bone, may be susceptible to resorption in the vertical and horizontal planes. Such crestal bone resorption may lead to recession of the facial marginal mucosa.Any alteration of the soft or hard tissues may impair the final esthetic outcome of immediately loaded implants in the anterior area. To better preserve the alveolar ridge and maintain optimal soft tissue contours, we previously introduced a novel buccal plate preservation (BPP) technique.25,26This simple surgical technique may help to prevent recession of the facial wall of the extraction socket without interfering with the healing process. It involves placement of particulate bone-graft material underneath the soft tissues in a surgically created pouch adjoining the buccal plate. It thus maintains optimal soft tissue contours and predictably provides a solid base for optimal esthetics and functional replacement of a missing tooth. Although we originally used this technique in the wake of tooth extraction when a delayed implant placement was planned, it also can be used effectively in conjunction with immediate implant placement and provisionalization, as the following case report illustrates.The 66-year-old male patient was referred by his dentist for extraction of a left central incisor whose root had fractured (Figures 1 and 2). The treatment plan included rehabilitation with an implant-supported restoration with immediate placement after extraction and immediate provisionalization. The patient's past medical and social history were noncontributory, and he had good oral hygiene.The incisor was extracted atraumatically in 2 pieces. The socket was thoroughly debrided to remove residual granulation tissue (Figure 3). A straight periosteal elevator was used to carefully perform limited soft tissue dissection in a full-thickness manner, creating a pouch on the vestibular aspect of the middle of the socket facial to the buccal plate (Figure 4). This dissection started coronally, at the marginal bony ridge of the extraction socket, and slowly proceeded in the apical direction, using small mesiodistal movements. Extreme care was paid to avoid tearing the soft tissue. Once the dissection had advanced beyond the mucogingival line to approximately two-thirds the depth of the socket, a curved periosteal elevator was used to expand the pouch in the mesiodistal direction. The goal was to stretch the soft tissues away from the underlying bony plate (Figure 5), and no attempts were made to decorticate the buccal plate.Granules (500-1000 μm) of bovine sintered xenograft (Endobon Xenograft Granules, BIOMET 3i, Palm Beach Gardens, Fla) were rehydrated with saline and placed in the pouch using a syringe. The bone-graft material was then compressed with a small surgical curette, and more graft material was added and compressed until adequate filling of the pouch was achieved without overstretching the soft tissues. The quantity used was approximately 0.1 cm3 and normally is <0.2 cm3, regardless the size of the tooth. Care was taken to avoid the migration of the graft material too far apically, where the mucosa is more flexible and thin, although should migration occur, the graft material can be repositioned using manual pressure. The final appearance of the soft tissue should exaggerate the appearance of the root eminence of the tooth before extraction. This is done to counteract some dispersion and exfoliation of the graft (Figure 6).A 13 mm length × 4-mm-diameter tapered implant (BIOMET 3i, Palm Beach Gardens) was then placed according to the manufacturer's protocol, engaging the native bone above the alveolus, slightly palatal from the buccal plate (Figure 7). Additional xenograft material was placed in the gap between the buccal bone and the implant surface. After the completion of the surgical procedure, the position of the implant was transferred to a model with an impression pick-up that was connected to the surgical stent with self-curing resin. A healing abutment was then screwed to the implant, and the patient was dismissed with instructions to consume only a liquid diet and return in the afternoon for delivering of the provisional.A custom abutment and resin crown were fabricated immediately and delivered to the patient (Figure 8) a few hours after the surgical procedure. No sutures were required, and no attempt was made to coronally reposition the flap. The patient was maintained on the liquid diet for the next 2 wk. Chlorhexidine gluconate oral rinse also was prescribed for 2 wk to enhance plaque control. After 3 months, the final restoration was delivered (Figures 9 and 10).The appearance and the contours of the ridge were well maintained, after extraction. A convexity on the buccal aspect of the extraction area, giving an illusion of root eminence, was achieved, laying the ground for a good functional and esthetic replacement of the missing tooth with an implant-supported prosthesis.Extraction sockets are self-healing defects. In a relatively short time, the void left by the root of the extracted tooth is filled by new bone.1 As this biophysiologic phenomenon occurs, however, the architecture of the edentulous ridge may change adversely due to buccal bone resorption. Such changes may jeopardize implant placement or lead to an unfavorable esthetic final result.2 Although the degree of bone loss is neither certain nor constant, varying among individuals and anatomic situations, most alveolar width and height resorption occurs in the first 6 months after extraction.2When clinicians face situations where immediate implant placement is not indicated, two options have existed: (1) allow the socket to heal naturally without grafting or (2) graft the socket. Natural healing without grafting increases the risk of hard tissue loss, soft tissue loss, or both, especially on the buccal plate due to resorption. Grafting the socket requires a longer healing time before implant placement.We have developed a third option, namely, grafting not inside the socket but externally to the buccal plate in a surgically created pouch.25,26 This technique can only be applied when the natural architecture is intact and the buccal plate is present. In a 4-wall intact socket, this approach is aimed at optimizing the ability of the bone graft to improve regeneration and maintain or improve labial and buccal contours without interfering with the natural healing capability of the alveolus after extraction. The rationale behind it is that slowly resorbing or nonresorbing particles of bovine xenograft get incorporated in the soft tissues, thereby preventing recession and enhancing the soft tissue appearance of the edentulous ridge.Bovine xenograft has been shown to have a very low resorption rate in many different sites. This tendency may be regarded as less than ideal in potential implant-placement sites, but according to several studies, once incorporated in bone, the particles may help prevent resorption of the newly regenerated area in the long term.27,28 It also has been shown that in the esthetic area, regenerating the facial aspect of the buccal plate with a nonresorbable membrane and bovine xenograft may prevent bone remodeling from taking place at the head of the implant and causing soft tissue recession and other esthetic complications.18,29 The latter approach consists of a full guided bone regeneration procedure aiming to overbuild the bone around the neck of the implant and thus prevent bone resorption. This procedure is requiring the membrane removal and a later stage.The possibility of immediately connecting a provisional restoration to implants placed into fresh extraction sites has been extensively investigated.30–37 Some case reports have found a 100% 12-month survival rate for immediate, nonfunctional restorations of single-tooth postextraction implants.30–32 Favorable peri-implant tissue responses also have been reported around such implants, along with results that were clinically and radiographically comparable to those achieved after a conventional delayed protocol. Several uncontrolled prospective studies also have investigated the immediate functional loading of postextraction implants in edentulous mandibles33–35 or in partially edentulous sites.34Connecting a provisional crown immediately after implant insertion8,21 has been reported among the many factors that can influence the frequency and extent of marginal mucosal recession. In addition to these factors, an experimental study24 showed that the facial socket wall, which is composed almost entirely of bundle bone, may be susceptible to resorption in the vertical and horizontal planes. Such crestal bone resorption may lead to recession of the facial marginal mucosa. Any alteration of the soft or hard tissues may impair the final esthetic outcome of immediately loaded anterior implants.In 4-wall extraction sockets, the buccal plate preservation technique described in this article may help to maintain or improve the appearance and contours of the ridge after tooth extraction, laying the ground for a good functional and esthetic replacement of the missing tooth with an implant-supported prosthesis. The procedure also can enhance the soft tissue appearance when implant placement and loading are indicated immediately after tooth extraction. Although the preliminary results of using this technique are promising, further investigation is warranted to confirm its efficacy; understand the biology underlying it; and identify factors that may influence it, such as the thickness of buccal plate after extraction, presence of contiguous teeth, type of bone graft with or without membrane, and position of the implant.

The placement of different graft materials and/or the use of occlusive membranes to cover the extraction socket entrance are techniques aimed at preserving/reducing alveolar ridge resorption. The use of grafting materials in fresh extraction sockets has, however, been questioned because particles of the grafted material have been found in alveolar sockets 6-9 months following their insertion. The aims of the study were to (i). evaluate whether alveolar ridge resorption following tooth extraction could be prevented or reduced by the application of a bioabsorbable polylactide-polyglycolide sponge used as a space filler, compared to natural healing by clot formation, and (ii). evaluate histologically the amount and quality of bone tissue formed in the sockets, 6 months after the use of the bioabsorbable material. Thirty-six patients, undergoing periodontal therapy, participated in this study. All patients were scheduled for extraction of one or more compromised teeth. Following elevation of full-thickness flaps and extraction of teeth, measurements were taken to evaluate the distance between three landmarks (mesio-buccal, mid-buccal, disto-buccal) on individually prefabricated stents, and the alveolar crest. Twenty-six alveolar sockets (test) were filled with a bioabsorbable polylactide-polyglycolide acid sponge (Fisiograft), while 13 sockets (controls) were allowed to heal without any filling material. The flaps were sutured with no attempt to achieve primary closure of the surgical wound. Re-entry for implant surgery was performed 6 months following the extractions. Thirteen biopsies (10 test and three control sites) were harvested from the sites scheduled for implant placement. The clinical measurements at 6 months revealed, in the mesial-buccal site, a loss of bone height of 0.2 mm (1.4 SD) in the test and 0.6 mm (1.1 SD) in the controls; in the mid-buccal portion a gain of 1.3 mm (1.9 SD) in the test and a loss of 0.8 mm (1.6 SD) in the controls; and in the distal portion a loss of 0.1 mm (1.1 SD) in the test and of 0.8 (1.5 SD) mm in the controls. The biopsies harvested from the test sites revealed that the new bone formed at 6 months was mineralized, mature and well structured. Particles of the grafted material could not be identified in any of the 10 test biopsies. The bone formed in the control sites was also mature and well structured. The results of this study indicate that alveolar bone resorption following tooth extraction may be prevented or reduced by the use of a bioabsorbable synthetic sponge of polylactide-polyglycolide acid. The quality of bone formed seemed to be optimal for dental implant insertion.

Background:Following tooth extraction, alveolar ridge resorption, particularly in the mandible, is a chronic, progressive process that can extend beyond the alveolar ridge in severe cases. Research indicates that despite its dense structure, the mandibular ridge is highly susceptible to this type of resorption. This study aimed to evaluate mandibular ridge resorption following complete denture therapy over a six-month to one-year period, assessing changes at the masticatory centre and mental foramen. Differences between patients with complete dentures and those without were examined to determine whether denture fabrication impacts ridge resorption. Materials and Methods:The study was conducted over a five-year period at the Clinic for Removable Prosthodontics, Faculty of Dentistry, in Skopje. Sixty patients (32 men and 28 women), aged 51 to 70, participated and were divided into two groups: the first received complete dentures after an initial period of post-extraction bone healing, while the second did not receive dentures during this time. Results: Results demonstrated significantly lower resorption in denture-wearing patients, with a 4.3% resorption rate at the masticatory centre and 3.1% at the mental foramen, compared to 8.5% and 6.3% in the non-denture group, respectively (p &lt; 0.01). This difference indicates that patients with complete dentures experience notably reduced mandibular ridge resorption compared to those without dentures. Conclusion: Our findings suggest that timely, well-fitting complete denture fabrication shortly after tooth extraction plays an essential role in slowing alveolar ridge resorption and preserving ridge height, with potential implications for improved patient outcomes based on cultural, social, and economic factors.

BACKGROUND We used the 14-item Oral Health Impact Profile-14 (OHIP-14) questionnaire to evaluate the association between sociodemographic variables and oral health-related quality of life in 241 wearers of removable partial or complete dentures attending a single center in Yemen. MATERIAL AND METHODS A total of 241 partial dentures (PD) and complete dentures (CD) wearers were enrolled from the Department of Prosthodontics at the Faculty of Dentistry, Sana'a University, and the University of Science and Technology. Data were collected before the commencement of denture wearing and after 3-6 months of denture use. The questionnaire consisted of sociodemographic information and denture type, and another for the OHIP to assess oral health-related quality of life (OHRQoL), oral health impact profile scale comprises 7 subscales, each evaluating different aspects of oral health and functionality. Descriptive statistics were calculated for participants. Independent t tests were performed to compare different patient groups, focusing on PD and CD wearers. Paired-sample t tests were used to examine changes within patient groups before and after removable denture use. RESULTS Among all participants, 67.6% were male, wearers of CDs were 74.6% male, PDs were 58.3%, and was consistent for CD (71.0%) and PD (72.8%) wearers. The wearing prostheses significantly impacted the OHRQoL of patients using both PDs and CDs (P<0.01). Among CD wearers, 4 of these subscales (3-6) were statistically significant, but the handicaps subscale showed evident reductions in physical pain after treatment among PD wearers. CONCLUSIONS Wearing dentures positively affects the OHRQoL of patients, influencing various aspects of their health, including functional, physical, psychological, and social well-being.

To explore the digital manufacturing process of distal extension removable partial denture. From November 2021 to December 2022, 12 patients (7 males and 5 females) with free-ending situation were selected from the Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University. Three-dimensional model of the relationship between alveolar ridge and jaw position was obtained by intraoral scanning technique. After routine design, manufacturing and try-in of metal framework for removable partial denture, the metal framework was located in the mouth and scanned again to obtain the composite model of dentition, alveolar ridge and metal framework. The free-end modified model is obtained by merging the digital model of free-end alveolar ridge with the virtual model with the metal framework. The three-dimensional model of artificial dentition, and base plate was designed on the free-end modified model, and the resin model were made by digital milling technology. The removable partial denture was made by accurately positioning the artificial dentition and base plate, bonding metal framework with injection resin, grinding and polishing the artificial dentition and resin base. Compared with the design data after clinical trial, the results showed that there was an error of 0.4-1.0 mm and an error of 0.03-0.10 mm in the connection between the resin base of artificial dentition and the connecting rod of the in-place bolt and the connection between artificial dentition and resin base. After denturen delivery, only 2 patients needed grinding adjustment in follow-up visit due to tenderness, and the rest patients did not find any discomfort. The digital fabrication process of removable partial denture used in this study can basically solve the problems of digital fabrication of free-end modified model and assembly of artificial dentition with resin base and metal framework.

Tooth extraction triggers alveolar ridge resorption, and when this resorption is extensive, it can complicate subsequent reconstructive procedures that use dental implants. Clinical data demonstrate that the most significant dimensional changes in the ridge occur soon after tooth extraction. Here, we sought to understand whether a correlation existed between the rate at which an extraction socket heals and the extent of alveolar ridge resorption. Maxillary molars were extracted from young and osteoporotic rodents, and quantitative micro–computed tomographic imaging, histology, and immunohistochemistry were used to simultaneously follow socket repair and alveolar ridge resorption. Extraction sockets rapidly filled with new bone via the proliferation and differentiation of Wnt-responsive osteoprogenitor cells and their progeny. At the same time that new bone was being deposited in the socket, tartrate-resistant acid phosphatase–expressing osteoclasts were resorbing the ridge. Significantly faster socket repair in young animals was associated with significantly more Wnt-responsive osteoprogenitor cells and their progeny as compared with osteoporotic animals. Delivery of WNT3A to the extraction sockets of osteoporotic animals restored the number of Wnt-responsive cells and their progeny back to levels seen in young healthy animals and accelerated socket repair in osteoporotic animals back to rates seen in the young. In cases where the extraction socket was treated with WNT3A, alveolar ridge resorption was significantly reduced. These data demonstrate a causal link between enhancing socket repair via WNT3A and preserving alveolar ridge dimensions following tooth extraction.

Background: Loss and bone deformities of the alveolar ridge after a tooth extraction are some of the main challenges when fabricating a dental prosthesis. Purpose: To determine the effectiveness of preservation techniques on alveolar height and width loss of alveolar contours compared with socket without preservation by a systematic review of the literature. Methods: The search included databases Medline, Cochrane, Embase, Ovid, SciELO, LILACS, ScienceDirect, Hinary, Wiley Online (up to July 2012), about papers on changes in alveolar height and thickness after a dental extraction with or without preservation treatment as bone grafts, collagen membranes, or growth factors. Results: 272 references were found of which 19 articles met the inclusion criteria. There was heterogeneity among studies (p= 0.00001) with statistically significant differences (p ≤ 0.0001) favoring the experimental group (alveolar preservation) regarding alveolar ridge width and height after extraction. However, when comparing subgroups, the difference between intervention groups (intervention in both groups) did not turn out to be significant for width (p = 0.21) or for height (p = 0.96). Conclusions: Articles showed significant differences when comparing experimental groups with intervention and control groups without it, which indicates that performing a method of alveolar preservation after tooth extraction seems to positively influence the maintenance of the alveolar ridge.KEYWORDSalveolar bone loss; tooth extraction; alveolar ridge augmentation; biological dressings; boneresorption; dental implants

This study investigated the number and Kennedy Classification of the edentulous arches in patients treated at the Removable Partial Denture (RPD) Clinics of the Fluminense Federal University School of Dentistry (FO-UFF) in Rio de Janeiro, Brazil, from 2005 to 2010. A cross-sectional retrospective survey was conducted on patient record charts to identify gender, age, number, and location of the edentulous arches, and Kennedy Class type. One hundred and forty-six patients were analyzed for this study (96 [65.8%] women and 50 [34.2%] men). Two hundred and ninety-two arches were analyzed: 74 arches (25%) were found with intact dentitions, 18 (6.1%) were edentulous arches, and 200 (68.8%) were partially edentulous arches. Ninety-one patients (62.3%) needed oral rehabilitation with RPDs on one arch and 55 (37.7%) in both arches. One hundred and eight (53.2%) partially edentulous mandibles and 92 (46.8%) partially edentulous maxillae were found. Kennedy Class I was more frequent in the mandibular arch (58 patients; 29%) whereas Kennedy Class III was more frequent in the maxillary arch (40 patients; 20%). Patients aged between 51 and 60 years presented the highest percentage of partially edentulous arches (33.6%). Mandibular Kennedy Class I and maxillary Kennedy Class III presented the highest frequency in patients treated at the FO-UFF. These results are in agreement with previous studies that evaluated the different Kennedy classes in partially edentulous arches.

The aim of the present study was to evaluate the clinical efficacy of platelet-rich fibrin (PRF) in preserving the alveolar ridge following human tooth extraction. A total of 28 patients were divided into two groups: The experimental and control groups (n=14 each). Following tooth extraction, the experimental group was implanted with PRF membrane, whereas the control group was not. The gingival healing effect was assessed at 7 days, 1 and 3 months later. Cone-beam computed tomography was performed immediately and at 3 months following tooth extraction. The changes in alveolar ridge height, width, and bone mineral density were compared between the two groups. The alveolar bone was removed using the ring drill during the implant surgery at 3 months following tooth extraction. Histomorphometric evaluation was performed to compare new bone formation between groups. The patients in the experimental group reportedly felt better compared with the patients in the control group. The healing of gingival tissue was better in the experimental group than in the control group. A significantly greater novel bone area was observed in the PRF group compared with the control group (P<0.01). However, no statistically significant differences were observed in the mean value of buccal alveolar ridge height, lingual/palatal alveolar ridge height and alveolar ridge width between the two groups. These results suggested that PRF was advantageous in human alveolar ridge preservation with ease of use and simple handling. Histological analysis of novel bone formation confirmed that PRF increased the quality of the novel bone and enhanced the rate of bone formation, despite the effect of PRF was not significant to reduce alveolar bone resorption in the extraction socket alone.

The aim of the present study was to assess the efficacy of a ready-to-use injectable bone substitute on the prevention of alveolar ridge resorption after tooth extraction. Maxillary and mandibular premolars were extracted from 3 Beagle dogs with preservation of alveolar bone. Thereafter, distal sockets were filled with an injectable bone substitute (IBS), obtained by combining a polymer solution and granules of a biphasic calcium phosphate (BCP) ceramic. As a control, the mesial sockets were left unfilled. After a 3 months healing period, specimens were removed and prepared for histomorphometric evaluation with image analysis. Histomorphometric study allowed to measure the mean and the maximal heights of alveolar crest modifications. Results always showed an alveolar bone resorption in unfilled sockets. Resorption in filled maxillary sites was significantly lower than in control sites. Interestingly, an alveolar ridge augmentation was measured in mandibular filled sockets including 30% of newly-formed bone. It was concluded that an injectable bone substitute composed of a polymeric carrier and calcium phosphate can significantly increase alveolar ridge preservation after tooth extraction.

ObjectiveThis study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England.MethodsRoutine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008–2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients’ individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments.ResultsData on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years) and older adults (≥65 years) received preventive care in the form of ‘instruction and advice’, compared with 46% of working age adults (18–64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): ‘partial dentures’ (7%); ‘scale and polish’ (3.7%); ‘tooth extraction’ (3%; p = 0.001), and ‘instruction and advice’ (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive ‘instruction and advice’ than non-smokers (OR 4.124; 95% CI: 3.088–5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely to receive ‘tooth extraction’ when compared with least deprived, and less likely to receive preventive ‘instruction and advice’ (p = 0.01).ConclusionThis is the first study to model patient management data from a state-funded dental service and show that individual and contextual factors predict common treatments received. Implications of this research include the importance of making provision for our aging population and ensuring that preventative care is available to all. Further research is required to explain the interaction of organisational and system policies, practitioner and patient perspectives on care and, thus, inform effective commissioning and provision of dental services.

Background: The socket preservation technique involves filling the bone defect created after tooth extraction with a bone substitute material. This helps to reduce bone resorption of the post-extraction alveolar ridge. Various types of bone substitute biomaterials are used as augmentation materials, including autogeneic, allogeneic, and xenogeneic materials. The purpose of this study was to evaluate changes in alveolar ridge dimensions and alterations of optical bone density in sockets grafted with two different biomaterials. Additionally, bone biopsies taken from the grafted sites underwent histological evaluation. Methods: This study enrolled 10 generally healthy patients, who were divided into two equal groups. Patients in the first group were treated with an allogeneic material (BIOBank®, Biobank, Paris, France), while patients in the second group were treated with an xenogeneic material (Geistlich Bio-Oss®, Geistlich Pharma AG, Wolhusen, Switzerland). Tooth extraction was performed, following which the appropriate material was placed into the debrided socket. The material was secured with a collagen membrane (Geistlich Bio-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) and sutures, which were removed 7 to 10 days after the procedure. Micro-CBCT examinations were performed, for the evaluation of alveolar ridge dimensions and bone optical density, at 7–10 days and six months after the procedure. Bone trepanbiopsy was performed simultaneously to the implant placement, six months after socket preservation. The retrieved biopsy was subjected to histological examination via hematoxylin and eosin (H&E) staining and Masson’s trichrome staining. Results: The results showed that the allogeneic material was more effective in preserving alveolar buccal height and was probably more rapidly transformed into the patient’s own bone. Sockets grafted with the xenogeneic material presented higher optical bone density after six months. Both materials presented similar effectiveness in alveolar width preservation. Conclusions: Based on the outcomes of this study, it can be concluded that both materials are suitable for the socket preservation technique. However, the dimensional changes in the alveolar ridge and the quality of the newly formed bone may vary depending on the type of biomaterial used.

The process of tooth loss throughout life associated with severe occlusal wear may pose a challenge in the rehabilitation of partially edentulous arches. In these cases, many therapeutic procedures are necessary because each tooth must be restored to obtain the correct anatomical contour and recover the occlusal vertical dimension (OVD). A removable partial denture (RPD) with occlusal/incisal coverage, also known as an overlay RPD, is an alternative treatment option with fewer interventions, and, consequently, lower cost. This clinical report reviews the principles involved in the clinical indication for an overlay RPD, as well as the necessary planning and execution, to discuss the feasibility and clinical effectiveness of this treatment, identifying the indications, advantages, and disadvantages of this procedure through the presentation of a clinical case. The overlay RPD can be an alternative treatment for special situations involving partially edentulous arches in patients who need reestablishment of the OVD and/or realignment of the occlusal plane, and it can be used as a temporary or definitive treatment. The main advantages of this type of treatment are its simplicity, reversibility, and relatively low cost; however, further studies are needed to ensure the efficacy of this treatment option.