Alveolar Bone Thickness Clinical Trial
Official title:
Assessment of Alveolar Bone Thickness Buccal to Maxillary Anterior and Premolar Teeth in a Sample of Egyptian Population Using CBCT: An Observational Cross-Sectional Study
Tooth loss in an aesthetic area is often undesired experience for the patient. Dental implant
offers the most long term solution for missing teeth replacement, replicating the root and
crown of the natural tooth. This procedure reserves both the gingival mucosa and the
remaining alveolar bone without damage to adjacent teeth.
According to the conventional protocol of dental implant, a period of 3-4 months is required
for socket healing, followed by implants insertion, then additional 3-4 months are needed for
implant integration with surrounding bone. Moreover, one additional step is required to load
the prosthetic abutment. This conventional protocol consumes extended period of time leaving
the patient with missing tooth. Many attempts to shorten the overall length of treatment had
focused on approaches of immediate or early implant placement especially in the aesthetic
zone.
The advantages of the immediate implant placement include, less surgical intervention
procedures, so reduction in therapy time, preservation of the bone and gingival tissues, and
psychological confidence for the patient. In spite of the advantage of the immediate implant
placement, it is still a challenging treatment option for the clinician and presents a higher
incidence of complications. It reported that the anatomic factors which influence the
outcomes of immediate implant placement at the anterior region are the gingival biotype, the
thickness and height of the existing alveolar bone, the amount of bone beyond the apex, and
the buccal gap.
Following tooth extraction, high degree of resorption is expected, which is more severe in
the buccal alveolar wall thickness. In other words, the bone change is more suspected in the
buccal alveolar bone and the palatal alveolar bone is less affected area. Also it was
reported that the resorption of the buccal alveolar bone in the anterior are more affected
than posterior areas, since the bone resorption is more siginficant where the walls are
initially thinner. The vertical and horizontal reduction of bone dimensions is unavoidable.
In the first 3 months after dental extraction, this resorption is more noticeable. However,
bone remodeling may last for 12 months but less intense, resulting in dimensional change. In
some opinions, the buccal alveolar bone thickness should be at least 2 mm to prevent labial
gingival recession and to achieve an optimal biologic and esthetic outcome.
Hence in most situations, bone augmentation procedure has been recommended with immediate
implant placement in the aesthetic zone.
Recently, several studies have been published discussing if there is enough thickness in the
labial alveolar bone for immediate implant placement in an anterior maxillary region.
Nevertheless, the existing studies only include anterior teeth. There is not enough research
regarding the premolars although they play a role in the aesthetic region.Therefore, this
study is designed to investigate the thickness of the buccal alveolar bone of maxillary
anterior and premolar teeth in a sample of Egyptian population using Cone beam computed
tomography (CBCT) at different levels that are clinically relevant.
- Retrospective Data Analysis will be performed after the CBCT images are pooled from the
computer database of "Dokki radiology center"
- Scans scanned using PaX-i3D Green VATECH with 0.2 voxel resolution will be examined.
- Exposure parameters of the scans was varied depending on the individual patient's sizes.
- CBCT images will be analysed using OnDemand3D ® DENTAL (Cybermed, Seoul, Korea) using
the 3D module. In the axial plane, the reference line will be oriented to pass through
the center of the examined tooth perpendicular to the long axis of the tooth and buccal
alveolar bone. The long axis of the tooth will dictate the orientation of the vertical
slice. Bone thickness will be measured from the sagittal cross sectional cut where the
CEJ will be identified and followed by the measurements in 3 different locations (figure
3): A, 1 mm apical to alveolar crest ; B, 3 mm from the alveolar crest; and C, 5 mm away
from alveolar crest.
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