Buccal Plate Thickness Research Articles

Healing at Molar Extraction Sites Using Freeze-Dried Bone Allograft and Collagen Wound Dressing: Case Series and Three-Arm Analyses.

Ridge preservation limits dimensional changes after tooth extraction. However, it is still unclear if using a membrane may be advantageous over a collagen wound dressing. Therefore, the goal of this report was to evaluate the outcomes of ridge preservation using freeze-dried bone allograft with a collagen wound dressing. This study included 21 patients who had one molar extracted, and the site received ridge preservation using freeze-dried bone allograft and a collagen wound dressing (test 2 group). Patients had two standardized cone beam computed tomography (CBCT) scans, taken within 72 hours and 3 months after extraction, to measure changes in ridge height and width, and buccal and lingual plate thicknesses. Changes in keratinized tissue width were recorded. Three-arm analyses were performed using historic data from a previous randomized controlled trial by the same study group, in which 20 molar sites received a collagen wound dressing alone (control) and 20 received ridge preservation with freeze-dried bone allograft and a dense polytetrafluoroethylene membrane (test 1) using the same methodology. There was a statistically significant difference in mean buccal ridge height changes between the control group (2.6 ± 2.06 mm) and test 2 group (1.55 ± 0.93 mm) but no difference in ridge and keratinized tissue width changes between groups. No correlation was found between buccal plate thickness and ridge width change. Freeze-dried bone allograft with collagen wound dressing as a barrier was used successfully for ridge preservation in intact molar extraction sites (< 50% bone loss) and can be considered as a treatment alternative to freeze-dried bone allograft with a dense polytetrafluoroethylene membrane.

Evaluation of healing at molar extraction sites with and without ridge preservation: A three-arm histologic analysis.

Little evidence is available regarding the benefit of ridge preservation (RP) at molar sites. The primary objective of this three-arm cohort study was to histologically compare the healing outcome between natural healing after molar tooth extraction and two different techniques of RP using freeze-dried bone allograft (FDBA) and a nonresorbable dense polytetrafluoroethylene (dPTFE) membrane, or an absorbable collagen sponge as a barrier. Seventy-nine patients requiring extraction and delayed implant placement were placed into three groups: extraction alone (control); ridge preserved using FDBA; and either dPTFE (Test1) or collagen sponge (Test2). Bone cores were harvested from implant osteotomies at ≈3 months after extraction for histomorphometric analysis to determine the percentage of vital bone, residual graft, and connective or other tissue. Ridge dimension changes were also evaluated radiographically (cone-beam computed tomography). The percentage of vital bone was significantly greater in control group compared with Test1 but was not statistically different among other groups. Test2 showed significantly less connective or other tissue than control and Test1. The percentage of residual graft was significantly lower in Test1 compared with Test2. There was no significant correlation between the percentage of vital bone or residual graft and the following parameters: healing time, patient age, gender, buccal plate thickness, or radiographic changes in ridge dimensions. RP at molar sites using FDBA and an absorbable collagen sponge may be a sufficient and economic way to preserve the ridge dimension without interfering with the amount of new bone formation.

The accuracy of cone-beam computed tomography in the evaluation of boney support of teeth among patients with a unilateral cleft of lip and palate among IraqiPopulation

Background: To evaluate the bony supports of the teeth adjacent to the area of cleft in patient with unilateral cleft lip and palate and to compare these measurements with the measurements of the same teeth in non-cleft side by using CBCT. Materials and methods: The CBCT scans of 30 patients having cleft lip( unilateral) and palate(unilateral), were analyzed and the measurements of the alveolar bony support for teeth that are adjacent to the cleft area were measured with those teeth located on opposite side (non- clef) side. For each tooth, the measurements will taken for the distance between the( cementoenamel junction) (CEJ) and the bony crest (AC) at the( buccal area) was measured and the thickness of the buccal plate At zero, one, two, and four mm. Results: The thickness of the bony support of central incisor at zero and one mm apically were statistically significantly thinner in cleft regions than in the non cleft regions. The CEJ-AC distance of the central teeth that are adjacent to the area of cleft was higher significantly than those for non-cleft area. For the canine teeth at 0, 1, 2, and 4mm apically were similar to those results obtained for central teeth at 0 and 1mm levels. Also, the CEJ-AC distance of the canine teeth that are adjacent to the cleft area was higher significantly than those for non-cleft area. Conclusion: person with unilateral cleft lip and palate showed a reduced alveolar bony support of the teeth located adjacent to the area of cleft when compared with the controls and This will cause a lot of problems in the future, so professional dental control is very essential for the maintaining of good periodontal health for those patients

Thickness of Buccal and Lingual Alveolar Bone Plates according to the Position of Impacted Mandibular Third Molars on Cone-Beam Computed Tomography Scans.

Objectives:This study sought to assess the thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography (CBCT) scans.Materials and Methods:Eighty-four CBCT scans of impacted mandibular third molars were evaluated in this retrospective study. All images had been obtained by ProMax 3D CBCT system with the exposure settings of 78 kVp, 12 mA, 16 s time, 0.2 mm voxel size and 10 × 9 cm field of view. The impaction angle of teeth and the thickness of buccal and lingual cortical plates were determined on images by drawing lines in the anterior, middle, posterior, superior, central and inferior regions. Thickness of bone plates was analyzed according to the position of impacted molars relative to the buccal and lingual plates using the Student t-test and relative to the second molars using one-way ANOVA and Tukey’s test.Results:In the buccolingual direction, the buccal plate thickness was maximum in lingual position followed by central position, and minimum in buccal position of the teeth. The lingual plate thickness was minimum in horizontal and distoangular positions and maximum in the mesioangular position of impacted teeth.Conclusion:Risk of lingual plate preformation is higher in surgical removal of impacted third molars with distoangular and horizontal positions. Thus, further attention must be paid by the surgeons to such cases.

PR616: Buccal plate thickness in the maxillary esthetic zone for immediate implant placement: a systematic review

PR616: Buccal plate thickness in the maxillary esthetic zone for immediate implant placement: a systematic review

Dento-alveolar measurements and histomorphometric parameters of maxillary and mandibular first molars, using micro-CT.

Micro-CT is a high-resolution, non-invasive, and non-destructive imaging technique, currently acknowledged as a gold standard modality for assessing quantitatively and objectively dental morphology and bone microarchitecture parameters. The aim of this study was to analyze critical dental and periodontal measurements characterizing the mandibular (MandFM) and maxillary (MaxFM) first molar architecture, as well as the corresponding bony socket, using micro-CT. Thirty-eight human dried skulls (22-76 years) were scanned to enable the virtual analysis of 61 first molars. Depending on the type of measurement, the parameters were recorded on two-dimensional sections or directly on three-dimensional models. Tooth morphology was described by four aspects (e.g., tooth width, trunk length, root length, and root span), while the socket architecture was assessed by buccal plate thicknesses and bone density measurements. Minimum, maximum, and mean distances as well as cortical and trabecular bone densities were recorded in MandFM and MaxFM. It is noteworthy that the buccal plate thickness was found to be less than 1 mm in more than 55% of cases in MaxFM, whereas only in 20.8% of cases in MandFM (and even 0% at two sites). A wide range of bone densities was observed and the comparison between MandFM and MaxFM did not show a significant difference. Furthermore, cortical densities were negatively correlated with aging, while trabecular densities were not influenced. Using micro-CT, three-dimensional aspects of the human first molar morphology and microstructural parameters of the surrounding bone were evaluated in the mandible and in the maxilla. These comprehensive measurements and their correlation with aging may be of great importance for the use of immediate implant placement in molar extraction sockets and thus the potential long-term success of this treatment modality.

Is Bone Graft or Guided Bone Regeneration Needed When Placing Immediate Dental Implants? A Systematic Review.

To systematically review the effect and type of bone graft and guided bone regeneration around immediate implants on hard and soft tissue changes. Three electronic databases were searched up to June 2015. Outcomes consisted of hard and soft tissue dimensional changes. Eight studies were included according to inclusion criteria. Immediate implants with bone grafting had superior soft tissue stability and preserved horizontal ridge dimension and buccal plate thickness, when compared to no grafting. The use of a barrier alone significantly decreased buccal plate resorption and the remaining defects around the implants, and the use of both bone graft and membrane aided in soft tissue preservation. The optimal type of bone graft material was a combination of cortical autogenous and synthetic particulate when compared to each separately, whereas no difference was found between demineralized allograft and hydroxyapatite in decreasing bone loss. Quantitative data analysis was not possible due to heterogeneity of the included studies. Further randomized clinical trials with homogenous samples and proper controls are needed to support the results of this report.

Alveolar Bone Morphology Following Periodontally Accelerated Osteogenic Orthodontics: A Clinical and Radiographic Analysis.

The aim of this study was to analyze alveolar bone morphology following periodontally accelerated osteogenic orthodontics. Treated patients were called for a full periodontal examination and a cone beam computed tomography scan. Mean treatment time was 6.08 months. Mean probing pocket depth was 2.7 mm. No gingival recessions were noted. In the maxilla, buccal plate thickness was 0.48 to 2.14 mm. In the mandible, bone thickness was 0.2 to 1.82 mm. Root fenestrations and dehiscences were present in up to 40% of the anterior teeth. Although clinical outcomes were favorable, due to the presence of multiple posttreatment bone fenestrations and dehiscences, a revision of the treatment protocol might be considered.

Conservative Socket Regeneration with Buccal Wall Defect Using Guided Tissue.

Progressive alveolar bone resorption after tooth extraction may lead to surgical and prosthetic-driven difficulties, especially when deciding to use a dental implant to replace the extracted tooth. This case report discusses an irreparable lower left second premolar tooth with a periodontal lesion on the buccal side. A preservative tooth extraction was performed. Then, the socket was grafted with bovine bone, a collagen membrane was placed between the buccal bone and the attached gingiva, covering the bone dehiscence buccally, and the socket without a flap was raised. After a 6-month healing period, there was minimal socket width resorption and a shallow buccal vestibule. The implant was placed with high primary stability and sufficient buccal plate thickness. In conclusion, this guided tissue regeneration technique can minimize alveolar bone resorption in a socket with buccal dehiscence, but technical difficulties and shallowing of the buccal vestibule still exist.

Periodontally accelerated osteogenic orthodontics

This case report demonstrates an orthodontic method that offers short treatment time and the ability to simultaneously reshape and increase the buccolingual thickness of the supporting alveolar bone. A 23-year-old female with Angle’s Class I moderately to severely crowded malocclusion with periodontal pocket with 31 and reduced thickness of the buccal cortical plate of lower anteriors, requested shortened orthodontic treatment time. This surgery technique included buccal full-thickness flaps, selective partial decortication of the cortical plates, concomitant bone grafting/augmentation, and primary flap closure. Following the surgery, orthodontic adjustments were made approximately every 2 weeks. From bracketing to debracketing, the case was completed in approximately 7 months and 3 weeks. Posttreatment evaluation of patient revealed good results. Preexisting thin labial bony cortical plate with lower anteriors was covered. This finding suggests credence to the incorporation of the bone augmentation procedure into the corticotomy surgery because this made it possible to complete the orthodontic treatment with a more intact periodontium. The rapid expansive tooth movements with no significant apical root resorption may be attributed to the osteoclastic or catabolic phase of the regional acceleratory phenomenon.

Influence of anatomic position and intraoperative exposure of the inferior alveolar nerve on neurosensory disturbance after sagittal split ramus osteotomy: a three-dimensional computed tomography study

To evaluate the influence of the anatomic position and intraoperative exposure of the inferior alveolar nerve on neurosensory disturbance (NSD) in sagittal split ramus osteotomy. The anatomic factors of the nerve were measured on preoperative three-dimensional computed tomography in 98 patients. The intraoperative nerve exposure was assessed. NSD was evaluated for 1year after surgery. The correlations between NSD and the factors were analyzed. The NSD decreased as the lateral marrow space from the nerve increased (P<.01). The complete nerve exposure increased NSD by 7.6 times (P=.01). The nerve exposure increased as the buccal plate thickness increased (P=.01) and decreased as the vertical marrow space from the nerve increased (P=.01). The nerve exposure and the lateral marrow space from the nerve affected NSD. The buccal plate thickness and the vertical marrow space indirectly affected NSD through nerve exposure.

Prospective Clinical and Radiographic Study of Alveolar Ridge Preservation Combining Freeze-Dried Bone Allograft With Two Xenogeneic Collagen Matrices.

Tooth extractions are followed by significant dimensional changes in the alveolar crest that may preclude implant placement. This randomized, controlled, prospective compares the preservation of soft and hard tissue dimensional changes after alveolar ridge preservation (ARP) using two membranes consisting of collagen matrix (CM) or extracellular matrix (ECM) as barriers over freeze-dried bone allograft (FDBA). Standardized clinical and radiographic measurements of soft and hard tissues were recorded by means of a stent before and 4 months after ARP. The surgery entailed sulcular incisions with minimal flap elevation and repositioning without advancement. Of 11 patients in the CM group and 12 in the ECM group who completed the study, gingival thickness (GT) increased from 0.1 to 0.2 mm for both groups along with a 0.5-mm decrease in the width of keratinized tissue after healing. Reductions in ridge width were most pronounced on the coronal aspect, 1.8 mm for CM and 2.0 mm for ECM, whereas vertical reduction was most pronounced on the buccal aspect, 0.7 to 1.0 mm. Differences between groups were not statistically significant. However, significant correlation for changes in GT (P = 0.001) and crestal bone width (P = 0.002) with preoperative buccal plate thickness (BPT) was observed. Both xenogeneic collagen matrices combined with FDBA were effective in maintaining soft tissues and minimizing ridge resorption in all dimensions after ARP. BPT was an important determinant for amount of change in crestal GT and ridge width.

A cone beam computed tomography (CBCT) study of buccal plate thickness of the maxillary and mandibular posterior dentition

Buccal plate thickness is of clinical importance in treatment planning for implants. The purpose of this study was to evaluate the buccal plate thickness in posterior dentate areas of both the maxilla and mandible using cone beam computed tomography in order to estimate the approximate distributions of this anatomic variable. Two hundred and sixty-five subjects were included for a total of nine hundred and thirty-four roots assessed by cone beam computed tomography. CBCT scans were taken and evaluated at the ideal buccolingual cross-sections of each root at 1mm, 3mm, and 5mm apical to the alveolar crest to measure buccal plate thickness. Data are reported by geometric means and 95% confidence intervals. Both arches demonstrated increasing buccal plate thickness from anterior to posterior. Maxillary teeth had a significant decrease in thickness from coronal to apical along the tooth root (P<0.001), except at second molars. The first premolar and mesial root of the first molar were significantly thinner than all other roots in the maxilla. Conversely, the mandible demonstrated a significant increase in buccal plate thickness from coronal to apical (P<0.001). The premolars were significantly thinner than all other roots. Age and sex were found to have limited impact on buccal plate thickness in both arches. Buccal plate thickness is highly dependent upon the arch position, tooth location, and measurement point, but age and sex have limited impact.

Immediately placed front tooth implants 1. Analysis with cone beam computed tomography after remodelling of the buccal plate

In the period 1 January 2008 to 1 January 2012, an implant was installed in 186 patients immediately after the removal of a maxillary incisor. Subsequent to the placement of the implant, the 2 mm gap between implant and buccal plate was filled with a bone substitute. In the case of 16 patients, in addition to a preoperative and immediately postoperative cone beam computer tomogram, a late-postoperative cone beam computer tomogram was also produced.Immediately post-operative, the buccal plate thickness increased by 1.5 mmfrom 0.9 mm to 2.4 mm. During the evaluation period of 1 to 4 years a reduction took place resulting in a final buccal plate thickness of 1.8 mm on average. Surprisingly, the buccal plate bone height increased by 1.6 mm, to an average of 1.2 mm above the implant shoulder. It was crucial in this case that the implant was placed in such a way that a gap of a minimum of 2.0 mm was created between the original buccal plate and the implant, and that this gap was filled with a bone substitute.

Immediate postextraction implant with simultaneous buccal plate augmentation, restored with lithium disilicate abutment and veneer: A clinical report

To describe the successful use of biphasic calcium sulfate for improving the buccal plate thickness in an immediate postextraction implant, and its fi nal restoration with custom lithium disilicate abutment and veneer. A hopeless lateral incisor was replaced with an immediate postextraction implant in conjunction with a buccal plate augmentation based on biphasic calcium sulfate. Satisfactory soft tissue height and quality were maintained following healing. The fi nal restoration managed the severely reduced prosthetic space due to deep bite, and allowed an adhesive luting procedure.

Effects of Currently Available Surgical and Restorative Interventions on Reducing Midfacial Mucosal Recession of Immediately Placed Single‐Tooth Implants: A Systematic Review

Procedures to improve peri-implant soft-tissue outcomes of single, immediately placed implants are a topic of interest. This systematic review investigates the effect of various surgical and restorative interventions on implant mid-buccal mucosal level. An electronic search of five databases (January 1990 to December 2012) and a manual search of peer-reviewed journals for relevant articles were performed. Randomized controlled clinical trials (RCTs), prospective cohort studies, and case series with at least nine participants were included, with data on midfacial mucosal recession (MR) of immediately placed implants following various surgical and restorative interventions with a follow-up period of at least 6 months. Thirty-six studies, eight RCTs, one cohort study, and 27 case series were eligible. Six interventions were identified and reviewed: 1) palatal/lingual implant position; 2) platform-switched abutments; 3) flapless approach; 4) bone grafts to fill the gap between buccal plate and fixture; 5) connective tissue grafts; and 6) immediate provisionalization. Three studies consistently showed that palatally/lingually positioned implants had significantly less MR when using tissue-level implants. Mixed results were reported for interventions 2, 3, 5, and 6. One study was available for intervention 4 and did not show a benefit. Some interventions might be adopted to reduce the amount of MR on implants with the immediate placement approach, as suggested by the included studies, with various levels of evidence. The conflicting results among studies might be a result of differences in patient and site characteristics, e.g., tissue biotype and buccal plate thickness. Therefore, the use of these interventions might be reserved for patients with moderate to high risk of esthetic complications.

Relationship Between the Buccal Bone Plate Thickness and the Healing of Postextraction Sockets With/Without Ridge Preservation

In 48 postextraction sites, sockets were grafted with bovine bone mineral plus collagen membrane (test) or had spontaneous healing (control). After 4 months, horizontal ridge width reduction was 0.71 mm in the test group and 4.04 mm in the control group, while vertical ridge loss was 0.58 mm and 1.67 mm, respectively. No correlation was found between the thickness of the buccal bone wall and the alveolar bone loss in the test group, while an inverse correlation was found in the control group. Ridge preservation compensated for postextraction alveolar ridge resorption irrespective of the buccal plate thickness, whereas leaving the extraction socket undisturbed may result in alveolar bone loss.

Ridge Width Gain With Screw Spreaders

The aim of this cadaver study was to evaluate the amount of ridge expansion with screw spreaders. Eleven edentulous maxillae providing 20 eligible sites were used. Ridges with initial width of 3 to 6 mm were expanded using a set of 6 screw spreaders, and implants (ø3.7 × 10 mm) were subsequently placed. Ridge width at 2 mm apical to the crest was measured at the baseline, after expansion, and implant placement. Buccal plate thickness and incidence of buccal dehiscence after implant placement were measured. The mean initial ridge width was 3.97 ± 0.82 mm. After the expansion, the mean ridge width increased to 4.76 ± 0.77 mm (Δ = 0.79 mm). Majority of sites (7/9 sites) with an initial ridge width of <4 mm had a buccal dehiscence after implant placement. A buccal plate thickness of ≥1 mm was consistently present in cases with an initial ridge width of ≥4.5 mm after implant placement. The screw spreaders had a modest effect on ridge expansion. Their use might be limited because additional bone augmentation might be required to prevent or correct the bony dehiscence encountered in ridges <4.5 mm wide. Therefore, using this particular instrument kit for horizontal ridge augmentation is only indicated in specific cases.

Determinants of alveolar ridge preservation differ by anatomic location

To investigate and compare outcomes following alveolar ridge preservation (ARP) in posterior maxilla and mandible. Twenty-four patients (54±3years) with single posterior tooth extraction were included. ARP was performed with freeze-dried bone allograft and collagen membrane. Clinical parameters were recorded at extraction and re-entry. Harvested bone cores were analysed by microcomputed tomography (micro-CT), histomorphometry and immunohistochemistry. In both jaws, ARP prevented ridge height loss, but ridge width was significantly reduced by approximately 2.5mm. Healing time, initial clinical attachment loss and amount of keratinized tissue at extraction site were identified as determinants of ridge height outcome. Buccal plate thickness and tooth root length were identified as determinants of ridge width outcome. In addition, initial ridge width was positively correlated with ridge width loss. Micro-CT revealed greater mineralization per unit volume in new bone compared with existing bone in mandible (p<0.001). Distributions of residual graft, new cellular bone and immature tissue were similar in both jaws. Within the limitations of this study, the results indicate that in different anatomic locations different factors may determine ARP outcomes. Further studies are needed to better understand determinants of ARP outcomes.

Cone beam computed tomography evaluation after palatal expansion and orthodontics

BackgroundRapid palatal expansion (RPE) is accepted as a valid and effective method in the correction of different types of malocclusions. An understanding of the long-term effects of RPE to the buccal plate is critical. ObjectiveThe purpose of this study was to evaluate and compare dentoalveolar changes, using cone beam computed tomography (CBCT) images, to the maxillary first premolars and permanent first molars from initial to more than 6 months in retention after comprehensive orthodontics where a hyrax tooth-borne expander was used. MethodsThe CBCTs on 14 patients were evaluated at three time points: before treatment, 3 months after palatal expansion, and more than 6 months in retention after comprehensive orthodontics. ResultsGreater tipping and greater crest height recession were observed at the first premolars. There was significant recovery of buccal plate thickness for both teeth after RPE and orthodontics. ConclusionsOne can expect significant recovery after active treatment, long term, after rapid palatal expansion. There were no clinical differences between the rapid and slow expansion groups.