Dimensional Alterations Clinical Trial
Official title:
Ridge Alterations Following Single Tooth Extraction in the Anterior Maxilla - A Prospective Clinical Study
Bone modeling after tooth extraction has a major consequence on implant therapy, in particular in the esthetic zone. In esthetic sites, no tissue loss should occur if an optimal esthetic outcome is expected. Recent experimental studies in dogs have shown that neither an immediate implant insertion nor ridge preservation techniques can prevent this bone modeling process.
Background
The alveolar process is a tooth dependent tissue and develops in conjunction with the
eruption of teeth. The size and the form of the tooth, the axis of eruption and eventual
inclination determine the local volume as well as the shape of the alveolar process. It has
been shown that after removing all teeth in humans, the alveolar ridge undergoes a process
of resorption and atrophy.
In a recent animal study, Cardaropoli et al. (2003) assessed the healing events occurring in
the extraction socket following tooth removal. The findings of this study demonstrated that
the healing of an extraction socket involved a series of events including the formation of a
coagulum that was replaced by a provisional connective tissue matrix, woven bone and
lamellar bone and bone marrow. On day 30, mineralized bone occupied 88% of the socket
volume. Hard tissue formation had started already after 2 weeks of healing, and then, after
a month, the socket was filled with woven bone. Later, the woven bone was gradually replaced
by lamellar bone and bone marrow. After 3 months of healing, a hard tissue bridge was
consistently found to cover the crestal portion of the extraction site, which was formed by
woven bone and lamellar bone. Araújo et al. (2005) analysed in an experimental study in dogs
the ridge alterations following the extraction of premolars in the mandible. The authors
observed that the resorption of the buccal and lingual walls occurred in two overlapping
phases. Phase 1: The bundle bone - that lost its function and blood supply - was resorbed
and replaced with woven bone. Vertical resorption was considerably greater on the buccal
aspect of the alveolar crest, since this bone wall was much thinner then the lingual wall
and was primarily comprised of bundle bone. Phase 2: An additional resorption occurred from
the outer surfaces of both bone walls. The reason for this additional resorption has not
been clearly ascertained. The hypothesis could be: Impaired superficial vascularisation by
raising a mucoperiosteal flap; adjusting to the lack of continuous function; or the
reestablishment of the ridge shape, which is genetically determined in the absence of teeth.
A recent animal study confirmed that flap elevation plays an important role for a more
pronounced superficial bone resorption following extraction , therefore, it seems critical
that tooth extraction should be carried out without elevation of a mucoperiosteal flap. Even
ridge preservation techniques are not able to prevent the contour changes after tooth
extraction.
Objective
The aim of the present clinical study is to examine the dimensional changes of the alveolar
ridge following single tooth extraction in the anterior maxilla of patients, in particular
on the facial aspect of the alveolar ridge. These horizontal and vertical changes will be
sequentially documented up to 8 weeks of healing before an implant is inserted using the
concept of early implant placement. The study will also provide information about the
anatomic situation of the facial bone wall in the anterior maxilla at the time of
extraction, and the prevalence and extent of bone deficiencies on the facial aspect, when
teeth need to be extracted.
Methods
To document these changes over time, two methods will be applied. Firstly, two cone beam
computed tomographies (CBCT) will be obtained, one directly after tooth extraction, the
other one at 8 weeks of socket healing prior to implant placement. The two CBCT's will be
analyzed with a novel software program (InVivo Dental). Secondly, consecutive impressions
will be made at day 0 (day of extraction), day 14, 28, 42, and 56 to digitally produce
virtual 3D study models. These models can be analyzed with another software program
(Geomagic) to document the variations of the soft tissue in the extraction site.
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Observational Model: Cohort, Time Perspective: Prospective