Clinical relevance of dimensional bone and soft tissue alterations post‐extraction in esthetic sites

Abstract

The key to achieving pleasing esthetics in implant dentistry is a thorough understanding of the biological processes driving dimensional bone and soft tissue alterations post-extraction. The aim of the present report is first to characterize the extent of bone and soft tissue changes post-extraction and second to identify potential factors influencing tissue preservation in order to facilitate successful treatment outcomes. The facial bone wall thickness has been identified as the most critical factor influencing bone resorption and can be used as a prognostic tool in order to identify sites at risk for future facial bone loss subsequent to tooth extraction. Clinical studies indicated that thin bone wall phenotypes exhibiting a facial bone wall thickness of 1 mm or less revealed progressive bone resorption with a vertical loss of 7.5 mm, whereas thick bone wall phenotypes showed only minor bone resorption with a vertical loss of 1.1 mm. This is in contrast to the dimensional soft tissue alterations. Thin bone wall phenotypes revealed a spontaneous soft tissue thickening after flapless extraction by a factor of seven, whereas thick bone wall phenotypes showed no significant changes in the soft tissue dimensions after 8 weeks of healing. In sites exhibiting a limited bone resorption rate, immediate implant placement may be considered. If such ideal conditions are not present, other timing protocols are recommended to achieve predictable and pleasing esthetics. Socket preservation techniques for ridge preservation utilizing different biomaterials and/or barrier membranes often result in a better maintenance of tissue volumes, although the inevitable biological process of post-extraction bone resorption and bone modeling cannot be arrested. In summary, the knowledge of the biological events driving dimensional tissue alterations post-extraction should be integrated into the comprehensive treatment plan in order to limit tissue loss and to maximize esthetic outcomes.

A long‐term prospective cohort study on immediately restored single tooth implants inserted in extraction sockets and healed ridges: CBCT analyses, soft tissue alterations, aesthetic ratings, and patient‐reported outcomes

“…[28][29][30] The present study showed stable vertical soft tissue levels in both cohorts after at least 8 years of follow-up. This is in agreement with earlier studies showing thickening of the buccal soft tissues following tooth extraction in patients with a thin bone wall phenotype and also following abutment connection.…”

Custom‐made root‐analogue zirconia implants: A scoping review on mechanical and biological benefits

“…The major advantages of immediate implant placement are the decrease in treatment time with fewer surgical interventions, overall cost reduction, alveolar bone resorption, and soft‐tissue regression due to early functional load (Table ) . Nevertheless, immediate implant placement does not preclude physiological bone remodeling activity after tooth extraction …”

Computer‐aided planning of soft tissue augmentation with prosthetic guidance for the establishment of a natural mucosal contour in late implant placement

“…This is in contrast to the findings of dimensional soft tissue alterations in the 8‐week postextraction healing period. Thin phenotypes revealed a spontaneous soft tissue thickening after flapless extraction by a factor of seven, whereas thick bone wall phenotypes showed no significant changes in the soft tissue dimensions after healing …”