Critical buccal bone dimensions along implants

Abstract

The buccal bone plate is a component of the alveolar process tightly related to the tooth it supports. A plethora of physiological and pathological events can induce its remodeling. Understanding this remodeling process and its extent is of major importance for the practitioner as it can affect the functional and esthetic outcome of implant surgery at the involved sites. Bone remodeling and resorption of the buccal bone plate are inevitable after tooth loss or extraction. To limit resorption, several ridge-preservation techniques of varying efficacy have been described. Bone resorption is equally found to occur upon implant placement and is thought to be a result of the surgical trauma inflicted as well as an adaptation process of the tissues to the new foreign body. Because of the implications of bone resorption on the soft-tissue levels and the general esthetic outcome, it is of primary importance for the practitioner to be able to evaluate the hard tissues and the inherent resorption risks in an effort to optimize the treatment strategies. Based on limited short-term data, the present general opinion advises the need for a 2-mm-thick buccal bone plate in order to avoid vertical bone resorption.

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

“…19,20 Based on a limited number of short-term studies, Merheb et al (2014) suggested that a thickness of at least 2 mm would be needed to avoid bone resorption. 19,20 Based on a limited number of short-term studies, Merheb et al (2014) suggested that a thickness of at least 2 mm would be needed to avoid bone resorption.…”

“…Good oral hygiene defined as a full mouth plaque score 25%. Presence of a single failing tooth or a single tooth gap in the anterior maxilla (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) with both neighboring teeth present. Presence of a single failing tooth or a single tooth gap in the anterior maxilla (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) with both neighboring teeth present.…”

Effect of connective tissue grafting on peri‐implant tissue in single immediate implant sites: A RCT

“…As demonstrated in animal studies, tooth extraction results in loss of bone and soft tissue, especially at the buccal side. This resorption process is not countered by immediate implant placement (Araujo, Sukekava, Wennstrom, & Lindhe, ; Merheb, Quirynen, & Teughels, ; Vignoletti et al., ). Presumed potential risk factors influencing ridge resorption and mid‐buccal mucosa recession are a thin or pre‐existing defect of the buccal bone wall, buccal implant position and a thin gingival biotype (Chen & Buser, ; Del Fabbro et al., ; Morton & Pollini, ; Zuiderveld, den Hartog, Vissink, Raghoebar, & Meijer, ).…”

“…Presumed potential risk factors influencing ridge resorption and mid‐buccal mucosa recession are a thin or pre‐existing defect of the buccal bone wall, buccal implant position and a thin gingival biotype (Chen & Buser, ; Del Fabbro et al., ; Morton & Pollini, ; Zuiderveld, den Hartog, Vissink, Raghoebar, & Meijer, ). To limit the effects of bone remodelling on the mid‐buccal mucosa, it was proposed to place implants at least 2 mm from the internal buccal socket wall and to fill the implant‐socket gap with a bone graft (Cardaropoli, Tamagnone, Roffredo, & Gaveglio, ; Lin, Chan, & Wang, ; Merheb et al., ). Additionally, it was suggested to place a connective tissue graft (CTG) during implant placement to thicken the soft tissue (Lee, Tao, & Stoupel, ; Lin et al., ).…”

Hard and soft tissue integration of immediate and delayed implants with a modified coronal macrodesign: Histological, micro‐CT and volumetric soft tissue changes from a pre‐clinical in vivo study

“…In spite of these high success rates, osseointegrated implants are susceptible to crestal bone level changes through physiological remodelling or due pathological processes, such as peri‐implantitis (Laurell & Lundgren, ). It is currently believed that early bone loss might be a risk factor for the initiation of peri‐implantitis (Schwarz, Sahm, & Becker, ), and therefore, there is an increased interest in maintaining peri‐implant bone levels, mainly the buccal bone, also due to the aesthetic implications of the possible concomitant loss of soft tissue volume (Merheb, Quirynen, & Teughels, ; Spray, Black, Morris, & Ochi, ).…”