Effect of periodontal phenotype characteristics on post‐extraction dimensional changes of the alveolar ridge: A prospective case series

Abstract

Aim This study was primarily aimed at assessing the effect that specific periodontal phenotypical characteristics have on alveolar ridge remodelling after tooth extraction. Materials and Methods Patients in need of extraction of a non‐molar maxillary tooth were enrolled. Baseline phenotypical characteristics (i.e., mid‐facial and mid‐palatal soft tissue and bone thickness, and supracrestal soft tissue height [STH]) were recorded upon extraction. A set of clinical, digital imaging (linear and volumetric), and patient‐reported outcomes were assessed over a 14‐week healing period. Results A total of 78 subjects were screened. Forty‐two subjects completed the study. Linear and volumetric bone changes, as well as vertical linear soft tissue and alveolar ridge volume (soft tissue contour) variations, were indicative of a marked dimensional reduction of the alveolar ridge over time. Horizontal facial and palatal soft tissue thickness gain was observed. Thin facial bone (≤1 mm) upon extraction, compared with thick facial bone (>1 mm), was associated with greater linear horizontal (−4.57 ± 2.31 mm vs. –2.17 ± 1.65 mm, p = .003) and vertical mid‐facial (−0.95 ± 0.67 mm vs. –4.08 ± 3.52 mm, p < 0.001) and mid‐palatal (−2.03 ± 2.08 mm vs. –1.12 ± 0.99 mm, p = 0.027) bone loss, as well as greater total (−34% ± 10% vs. 15% ± 6%, p < 0.001), facial (−51% ± 19% vs. 28% ± 18%, p = 0.040), and palatal bone volume reduction (−26% ± 14% vs. –8% ± 10%, p < 0.001). Aside from alveolar bone thickness, STH was also found to be a predictor of alveolar ridge resorption since this variable was directly correlated with bone volume reduction. Patient‐reported discomfort scores progressively decreased over time, and the mean satisfaction upon study completion was 94.5 ± 0.83 out of 100. Conclusions Alveolar ridge remodelling is a physiological phenomenon that occurs after tooth extraction. Post‐extraction alveolar ridge atrophy is more marked on the facio‐coronal aspect. These dimensional changes are more pronounced in sites exhibiting a thin facial bone phenotype (http://clinicaltrials.gov NCT02668289).

Alveolar ridge changes 1‐year after early implant placement, with or without alveolar ridge preservation at single‐implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial

“…This further underscores the notion that profilometric changes may be less robust compared to radiographic changes, in accordance with the current findings 28 . Moreover, a recent case series evaluated periodontal phenotype characteristics on post‐extraction dimensional changes of the alveolar ridge 29 . The authors found significant associations between baseline bone characteristics and subsequent bone changes, but they did not find such significant associations with profilometric outcomes, consistent with the present observations.…”

“…28 Moreover, a recent case series evaluated periodontal phenotype characteristics on post-extraction dimensional changes of the alveolar ridge. 29 The authors found significant associations between baseline bone characteristics and subsequent bone changes, but they did not find such significant associations with profilometric outcomes, consistent with the present observations. Nevertheless, the unassisted healing group clearly showed a higher tendency to exhibit the greater gains than the ARP groups.…”

Effect of alveolar ridge preservation on peri‐implant mucositis and peri‐implantitis prevalence: A multicenter, cross‐sectional study

“…[1][2][3] The volume shrinkage of the alveolar bone ridge, observed after tooth extraction, may affects the chance to replace the missing tooth with a dental implant 3 and it might require additional bone grafting procedures to achieve a prosthetically driven implant placement. 4 According to the most recent literature, 5 the burden of alveolar bone resorption depends on multiple factors, including the periodontal phenotypic characteristics of the site and its location.…”

Non‐invasive assessment of peri‐implant mucosal thickness: A cross‐sectional study

“…22 Although clinical outcome measures are still more frequently reported, there is a trend in the field indicating a shift from traditional clinical assessment methods to the use of advanced imaging based on digital technologies. 23 The use of CBCT with or without the superimposition of an STL file has been widely applied in recent years in both research and clinical practice to evaluate the periodontal phenotype, 14,17,[24][25][26][27] with results that are comparable with direct clinical and histologic assessments. 17,18 However, image artifacts due to the presence of dental implants and metal-made restorative components can have an impact on the accuracy of MT assessment using Digital Imaging and Communication in Medicine (DICOM) files.…”

“…The use of CBCT with or without the superimposition of an STL file has been widely applied in recent years in both research and clinical practice to evaluate the periodontal phenotype, 14,17,24–27 with results that are comparable with direct clinical and histologic assessments 17,18 . However, image artifacts due to the presence of dental implants and metal‐made restorative components can have an impact on the accuracy of MT assessment using Digital Imaging and Communication in Medicine (DICOM) files 28 .…”