Thin Buccal Plate Research Articles

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The cover image is based on the Original Article The facial–coronal ridge crest alterations after single immediate implant placement and provisionalization with thin buccal plate phenotype in anterior maxilla: A radiographic case‐series study by Chun Yi DMD et al., https://doi.org/10.1111/cid.13280. image

Buccal soft tissue dehiscence defects at dental implants-associated factors and frequency of occurrence: A systematic review and meta-analysis.

To identify the factors associated with buccal peri-implant soft tissue dehiscences (BSTDs) and their frequency of occurrence. Randomized controlled trials, controlled clinical trials, cohort studies, and case series assessing the frequency of occurrence of BSTD were included. BSTD was defined as an apical migration of the peri-implant soft tissues of ≥1mm from the baseline examination (final restoration) or in comparison with the adjacent or contralateral natural tooth. Frequency distributions of BSTD related to the presence or absence of any surgical, prosthetic, or anatomic factor that may have contributed to the development of BSTD were recorded. Random-effects meta-analyses using odds ratios (OR) were performed to investigate the association of certain factors with the development of BSTD. Twenty-four articles were finally included belonging to 22clinical investigations. Patients at higher risk of developing BSTD were associated with thin biotype (OR=2.85 [1.40, 5.8], n=5, p=.003) and with buccally placed implants (OR=14.37 [4.58, 45.14], n=3, p≤.001). Patients without connective tissue grafting (CTG) had greater odds of developing BSTD (OR=9.00 [3.11, 26.02], n=5, p≤.001), while buccal bone plate thickness of <1mm and immediately placed implants were not associated with greater BSTD (OR=1.29 [0.35, 4.77], n=2, p=.704 and OR=1.56 [0.46, 5.26], n=4, p=.477, respectively). The frequency of occurrence of BSTD varied across the included studies with a range from 0% to 61%. Thin tissue biotype and buccally placed implants were associated with BSTD, whereas CTG seemed to have a protective effect. Thin buccal plates and immediately placed implants did not demonstrate a higher risk of BSTD.

CLINICAL OUTCOME OF PERI-IMPLANT SOFT AND HARD TISSUES AFTER IMMEDIATE IMPLANT PLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: One of the most important challenges in dental implant placement is supporting and preserving soft tissue and bone structures. Numerous studies on fixation of soft and hard tissues at the single or double teeth site have reported immediate placement using a flapless protocol, while many studies have reported fewer results in molar extraction solutions. The current study aims to determine the clinical outcome of peri-implant soft and hard tissues following immediate implant placement. Materials &amp; Methods: This study was conducted in the Department of Orthodontics, College of Stomatology, Xi’an Jiaotong University, Xi’an, China, from January 2021 to September 2021. In this systematic review, the search strategy was to screen electronically all relevant, authentic articles on databases of Embase, LIVIVO, EBSCO, Web of Science, LILACS, Scopus, and PubMed, published from 2011 to September 2021. Risk ratio (RR) was determined for implant failure, and mean differences (MD) were determined for soft tissue, horizontal and vertical buccal bone resorption by 95% CI, Inverse-variance, and fixed effect model or Mantel-Haenszel method between the intervention (bone substitute material) and control (no bone substitute material) groups through Stata/MP v.16. Results: Risk ratio of implant failure was similar in intervention and control group 0.02 (RR=0.02; 95%CI=-0.04 to 0.08; p=0.49). Mean differences were statistically greater in intervention than control group for soft tissue 1.65 mm (95%CI=1.05 to 2.25; p=0.00), horizontal bone resorption -0.47 mm (95%CI=-0.77 to -0.17 mm; p=0.00) and vertical buccal bone resorption -0.14 mm (95%CI=-0.24 to -0.03 mm; p=0.01). Conclusion: Our findings revealed no significant difference in implant failure between an intervention (bone substitute material) and control (no bone substitute material) groups. Mean differences were statistically greater in the intervention than the control group for soft tissue, horizontal bone resorption, and vertical buccal bone resorption. Using bone substitute material can improve long-term peri-implant soft tissue, horizontal and vertical buccal bone resorption. It is recommended to use bone-substitute material with a thin buccal plate.

Ridge preservation of a novel extraction socket applying Bio-Oss® collagen: An experimental study in dogs

BackgroundBio-Oss® collagen (BC) has been used in clinical applications for years but the ridge preservation property of BC remains controversial. There is no animal model accurately simulates the extraction socket in people. The aim of this study was to assess the ridge preservation of a novel extraction sockets with a thin buccal plate using BC. Materials and methodsTwo beagle dogs were used to assess the characterization of the novel extraction socket. The width and height of the socket were measured and biopsies of the socket were collected for histologic examination. Four beagle dogs were used to assess the ridge preservation property of BC. BC was placed in the socket and socket left untreated was set as control group (CT). Cone-beam computed tomography analysis, histological examination, and micro-CT analysis were used to evaluate the ridge preservation. ResultsThe novel extraction socket had obvious larger volume with a markedly narrow buccal wall than mandible extraction sockets. At 12 weeks, the width of the crest of the alveolar ridge preservation ratios was 34% for the CT and 82% for the BC. BC group had larger socket volume compare to CT group. BC group had a significant higher bone density in the middle and apical areas of the alveolar bone. Socket placed with BC showed significantly less vertical bone loss compared with CT group. ConclusionExtraction site with a significantly larger dimension and a very thin buccal plate was established. Extraction sockets filled with BC exhibit excellent maintenance of alveolar bone volume.

Immediate Implant Placement with Buccal Bone Augmentation in the Anterior Maxilla with Thin Buccal Plate: A One-Year Follow-Up Case Series.

To evaluate the buccal bone thickness of immediate implant placement with buccal bone augmentation in patients with a thin buccal plate in the esthetic zone. Eighteen consecutive patients requiring a single tooth replacement in the anterior maxillary zone with a thin plate (<1 mm) were included and received immediate implant placement with narrow-diameter implants. Patients received buccal bone augmentation (both internal and external socket bone grafting) with deproteinized bovine bone mineral (DBBM) and an absorbable membrane. The final restoration was delivered after 8 months. Cone-beam CT scans were performed before surgery (CBCT0), immediately after surgery (CBCT1), at final restoration delivery (CBCT2), and at 1-year follow-up after the final restoration (CBCT3) to evaluate the buccal bone thickness and ridge width. A repeated measures ANOVA and Bonferroni correction for multiple comparisons were applied for statistical analysis of changes within different time points (α = 0.05). Fifteen of the 18 enrolled patients were available for analysis at the 1-year follow-up after final restoration. The mean buccal bone thickness at 2 mm apical to the implant-abutment junction (IAJ-2) were 3.59 mm (range: 3.04-4.58 mm), 2.79 mm (range: 2.25-3.78 mm), and 2.52 mm (range: 1.72-3.36 mm), respectively, at CBCT1, CBCT2, and CBCT3. A statistical significance was observed for buccal bone thickness change between CBCT1 and CBCT2 at IAJ-2 (F = 17.948, p = 0.001). The net gains of the ridge width from CBCT0 to CBCT1, CBCT1 to CBCT2, and CBCT2 to CBCT3 were 1.08 mm, -0.94 mm and -0.04 mm at 4 mm apical to the cementum-enamel junction, respectively. No statistical significance was observed for the change in ridge width from CBCT0 to CBCT3 (F = 10.518, p = 1.000). Simultaneous buccal bone augmentation may maintain a predictable buccal bone thickness for immediate implant placement in the maxillary anterior sites with a thin buccal plate (<1 mm) at 1-year follow-up after final restoration.

Ridge preservation following tooth extraction using bovine xenograft compared with porcine xenograft: A randomized controlled clinical trial.

The primary purpose of this study was to histologically determine if there is a significant difference in new bone formation, residual graft material, and connective tissue/other when ridge preservation is accomplished using a bovine versus a porcine xenograft. Forty-four patients needing a single rooted tooth extraction and ridge preservation in preparation for dental implant placement were recruited in the study. After minimally traumatic tooth extraction, alveolar ridge dimensions were measured using a custom-fabricated acrylic stent. Patients were then randomized 1:1 to receive ridge preservation using either bovine or porcine xenograft material. A trimmed dense polytetrafluoroethylene (d-PTFE) membrane was overlaid on the graft material, the mucoperiosteal flaps were replaced, and the surgical site was sutured. After 18 to 20weeks of wound healing, sites were surgically re-entered, ridge dimensions were again measured using the previously fabricated acrylic stents and a bone core sample of the grafted site was harvested for histomorphometric analysis. Thirty eight of the 44 enrolled patients completed the study, 17 from the bovine group and 21 from the porcine group. Histologically, there were no statistically significant differences between the groups for mean percentage of vital bone formation (bovine=36.21%, porcine=31.27%, P=0.49), residual graft material (bovine=20.47%, porcine=19.52%, P=0.82) and connective tissue/other (bovine=43.32%, porcine=49.21%, P=0.19). For secondary outcomes, there were no significant differences between the groups for mean change in buccal ridge height, lingual ridge height, and ridge width. However, a higher number of patients in the porcine group had additional grafting at the time of implant placement, either because of thin buccal plate or failure of implant stability. The findings suggest that ridge preservation with porcine xenograft results in comparable histomorphometric outcomes and dimensional stability with bovine xenograft.

The fate of buccal bone around dental implants. A 12-month postloading follow-up study.

Buccal bone thickness is considered to be an important factor during implant surgery. Its resorption might have an effect on the soft tissue stability and eventually on implant survival. This study aimed to investigate the resorption of the buccal bone over the first 12months after implant loading. Twenty-four subjects (47 implants) were included. The buccal bone thickness was measured during implant surgery at several distances from the implant shoulder using a specifically designed device which allows buccal bone thickness measurements without the elevation of a muco-periostal flap. These measurements were repeated after 12months of loading. Sixteen implants were placed flapless and 31 with the elevation of a flap. Of the latter, 19 were placed following a one-stage protocol and 12 following a two-stage protocol. The mean reduction in buccal bone thickness, when all groups pooled, was 0.26, 0.36, 0.35 and 0.27mm at the shoulder and 2, 4 and 6mm apically. Implants with initial bone thickness <1mm (thin buccal plate) did not lose significantly more bone than those with an initial thickness ≥1mm (thick bone plate) except in the 'open-flap, one-stage' group (P=0.009). A flapless procedure leads to less bone resorption compared to an open-flap procedure (P=0.03). However, the number of surgeries (one stage vs. two stages) did not influence the rate of bone resorption (P=0.23). Within the limitations of this study, one might question the necessity of having a thick bone plate at the vestibular site of the implant.

Evaluation of buccal plate after human bone allografting: clinical and CBCT outcomes of immediate anterior implants in eight consecutive cases.

The aim of this clinical case series was to evaluate buccal bone thickness using cone beam computed tomography and to demonstrate optimal clinical outcomes for implants placed into extraction sockets in the anterior maxilla with a thin biotype, by placing a graft of mineralized and demineralized human bone allograft into the buccal gap. The preliminary outcomes showed good preservation of soft and hard tissue architecture after 1 year in function. In particular, in eight patients, this allograft mixture appeared to minimize the amount of buccal contour change in the extraction site ridge with a thin buccal plate.

Is socket healing conditioned by buccal plate thickness? A clinical and histologic study 4 months after mineralized human bone allografting

The aim of this study was to clinically and histologically analyze the healing of grafted sockets by mineralized human bone allograft (MHBA) and nongrafted sockets, correlating the results with buccal plate thickness. Thirty-one sockets were randomly split into control (CG) and treatment (MHBA grafted) (TG) groups and, subsequently, into four subgroups according to buccal plate thickness: a ≤ 1 mm and b > 1 mm. Ridge thickness, depth, and height were monitored. Four months after, at implant placement, a bone core biopsy for histologic and morphometric analyses was taken. The differences of buccal height (TG-a -0.27 and CG-a -1.17 mm) and width (TG-a 0.55 and CG-a 2.67 mm, TG-b 0.12 and CG-b 1.17 mm) were statistically significant. The increase in bone amount CG-b (28.17%) compared with CG-a (16.98%) was statistically significant. Soft tissue amount of TG-b (54.21%) and TG-a (56.91%) was lower than that of CG-b (71.83%) and CG-a (83.01%), both being statistically significant (P = 0.002). The results proved that thin buccal plates had a worse outcome on socket healing and that network formation by MBHA not only predisposes a successful implant insertion but also acts as size keeper.

Periodontal‐Endodontic Lesion of a Three‐Rooted Maxillary Premolar: Report of a Case

A 43-year-old African American male initially presented for a dental evaluation of a recurrent swelling on the buccal aspect of tooth #12. His medical history was unremarkable except for a 20-pack year history of smoking. He was eventually diagnosed as having a necrotic pulp #12, and received root canal treatment. The patient's problem was unresolved, and he was subsequently referred for a periodontal evaluation with a presumptive diagnosis of a periodontal abscess. A flap was reflected from teeth #11 through #15. A buccal furcation invasion was discovered on #12. Shortly thereafter, three distinct roots with three grade III furcation invasions were located. The tooth was deemed untreatable, and was extracted. The thin buccal plate of the extraction socket was preserved using freeze-dried bone allograft to facilitate future prosthodontic replacement. Healing was uneventful. Periodontal open flap debridement surgery was provided for the remainder of the mouth, and the patient was placed on a 3-month recall program. Periodontitis associated with endodontic lesions are among the most daunting diagnostic and therapeutic challenges faced by periodontists. This is particularly true for maxillary premolars with multiple roots. The tooth in this case, once periodontally involved, had a very poor prognosis. The prognosis was further compromised by the pulpal involvement. Therapy consisted of extraction of the tooth to relieve the patient's discomfort and treating the adjacent teeth with periodontal open flap debridement surgery. A review of the literature pertinent to the diagnosis and management of periodontal-endodontic lesions is also presented.