Radial plane tooth position and bone wall dimensions in the anterior maxilla: A CBCT classification for immediate implant placement

Gluckman, Howard; Pontes, Carla Cruvinel; Toit, Jonathan Du

doi:10.1016/j.prosdent.2017.09.005

Cited by 54 publications

(65 citation statements)

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“…Previous reports have been performed to evaluate the bone thickness of maxillary anterior teeth [2,13,14,15]. In a majority of cases, the thickness of the labial bony wall of the maxillary anterior teeth is thin [13].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the evaluated teeth had labial bone thickness less than 1 mm at 4 mm from the CEJ (62.9%) and the middle of the root (80.1%) [4]. Similarly, 83% and 92% of the anterior tooth had labial bone thickness 1 mm or less at the crest and middle of the root, respectively [15]. The average bone thickness at the coronal, middle, and apical thirds of the labial side of the roots was 0.73, 0.69, and 0.60 mm for the central incisor, respectively, and 0.70, 0.61, and 0.49 mm for the lateral incisors [13].…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Alveolar Bone Morphology of the Maxillary Central and Lateral Incisors with Normal Occlusion

et al. 2019

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Background and objectives: This study investigated the morphology of the labial and palatal bony wall of the maxillary central and lateral incisors using cone-beam computed tomography (CBCT). The difference between males and females and the measurement between right and left sides were measured. Materials and Methods: Twenty participants, consisting of 11 females and 9 males having normal occlusion, were used for the analysis. The mean age was 21.9 ± 3.0 years. The thickness of the labial bony wall and palatal bony wall, perpendicular to the long axis of the root, were evaluated at 3 and 5 mm apical from the cemento-enamel junction (CEJ) and at the root apex. The available bony wall below the apex of the central and lateral incisors, and the angulation between the long axis of the tested tooth and outer surface of the labial bone were measured. Results: The mean labial bony wall thickness at the 3 and 5 mm apical from the CEJ were 1.1 ± 0.3 mm and 1.0 ± 0.4 mm for central incisors, respectively, as well as 1.2 ± 0.4 mm and 1.0 ± 0.4 mm for lateral incisors, respectively. The mean palatal bony wall thickness at 5 mm from the CEJ was above 2 mm in the central and lateral incisors. The percentage of labial bony wall thickness 2 mm or greater at the root apex in central incisors was higher than in lateral incisors (62.5% vs. 55.0%). The percentage of palatal bony wall thickness ≥2 mm at 3 mm apical from the CEJ in the central incisors was higher than in the lateral incisors (37.5% vs. 15.0%). The results on the left and right sides did not show statistically significant differences, except in the labial and palatal bony wall thickness at 3 mm from the CEJ in the lateral incisor. Generally, no significant differences were seen between males and females, but males had a significantly higher labial bony wall thickness at 3 and 5 mm from the CEJ in the central and lateral incisors when compared with females. Conclusions: This study showed that a majority of the cases of Korean participants had less than 2 mm of labial bony wall thickness at 3 and 5 mm apical from the CEJ at central and lateral incisors, and this should be kept in mind while performing dental practices, including tooth extraction or immediate implantation in anterior regions. Preoperative analysis using CBCT may be beneficial for establishing the treatment plan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of Alveolar Bone Morphology of the Maxillary Central and Lateral Incisors with Normal Occlusion

et al. 2019

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“…[1,3,6,9] Note also that anterior edentulous site often has reduced bone width resulting in more challenge in implant placement and in long term maintaining peri-implant bone. [23,24] This study applied FEA to examine the effects of different clinical scenarios that had not been studied biomechanically. This includes a healed socket (HS), reduced bone width edentulous site (RB), and extraction socket with bone grafting (EG) on the peri-implant osseous structure around a one-piece Zir implant.…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of a one-piece zirconia implant in anterior single tooth implant applications

et al. 2020

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This study evaluated the von Mises stress (MPa) and equivalent strain occurring around monolithic yttria-zirconia (Zir) implant using three clinically simulated finite element analysis (FEA) models for a missing maxillary central incisor. Two unidentified patients' cone-beam computed tomography (CBCT) datasets with and without right maxillary central incisor were used to create the FEA models. Three different FEA models were made with bone structures that represent a healed socket (HS), reduced bone width edentulous site (RB), and immediate extraction socket with graft (EG). A one-piece abutment-implant fixture mimicking Straumann Standard Plus tissue level RN 4.1 X 11.8mm, for titanium alloy (Ti) and Zir were modeled. 178 N oblique load and 200 N vertical load were used to simulate occlusal loading. Von Mises stress and equivalent strain values for around each implant model were measured. Within the HS and RB models the labial-cervical region in the cortical bone exhibited highest stress, with Zir having statistically significant lower stress-strain means than Ti in both labial and palatal aspects. For the EG model the labial-cervical area had no statistically significant difference between Ti and Zir; however, Zir performed better than Ti against the graft. FEA models suggest that Ti, a more elastic material than Zir, contributes to the transduction of more overall forces to the socket compared to Zir. Thus, compared to Ti implants, Zir implants may be less prone to peri-implant bone overloading and subsequent bone loss in high stress areas especially in the labial-cervical region of the cortical bone. Zir implants respond to occlusal loading differently than Ti implants. Zir implants may be more favorable in non-grafted edentulous or immediate extraction with grafting.

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“…The rate and extent of buccal bone resorption can be affected by different factors, such as buccal plate thickness, implant position and gingival biotype (28)(29)(30). Buccal bone thickness has been linked to alveolar ridge alterations after immediate implant placement (29,31,32). An experimental study in dogs evaluated bone loss after immediate implant placement and reported marked changes in buccal and lingual walls, with greater resorption rate for thin buccal walls (9).…”

Section: I13 Factors That Affect Resorption Of the Buccal Wallmentioning

confidence: 99%

“…In order to achieve stable functional and aesthetic results in the anterior area over the long-term, it has been suggested that the buccal plate should have a minimum thickness of 2 mm (88) , which is far from clinical reality, considering that 80 to 90% of anterior teeth have a buccal plate below 1 mm, as evaluated through CBCT (19,31,89).…”

Section: I34 Partial Extraction Therapiesmentioning

confidence: 99%

Past, Present and Future of Partial Extraction Therapies

Gluckman¹

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Tooth loss has always been a challenge in dentistry due to the physiological alterations that occurs to the bone structure following extraction. The available treatment options are not able to prevent alveolar ridge collapse nor recreate the volume of bone lost. The concept of partial extraction therapies (PET) uses the tooth structures to maintain the bundle bone and the alveolar bone, thereby revolutionizing implant dentistry, particularly in cosmetically challenging areas. The overall objective of the studies included in this thesis was to provide proof of concept for PETs in terms of clinical application and long-term results, including implant survival, reproducibility, efficacy and safety of this approach. Immediate implant placement combined with the socket shield seems to provide similar survival rates as conventional immediate implants, with better results for bone levels and pink aesthetic scores. Root submergence and pontic shield techniques have the potential to preserve alveolar bone in pontic areas and under removable prosthesis and dentures, however, more studies are necessary to further validate these techniques. The use of PET holds promise in terms of maintenance of three dimensional ridge volume, aesthetics, safety and reliability. Additional prospective studies, particularly controlled clinical trials with larger samples and long follow-up are required to further explore this treatment strategy.

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Radial plane tooth position and bone wall dimensions in the anterior maxilla: A CBCT classification for immediate implant placement

Cited by 54 publications

References 20 publications

Analysis of Alveolar Bone Morphology of the Maxillary Central and Lateral Incisors with Normal Occlusion

Analysis of Alveolar Bone Morphology of the Maxillary Central and Lateral Incisors with Normal Occlusion

Finite element analysis of a one-piece zirconia implant in anterior single tooth implant applications

Past, Present and Future of Partial Extraction Therapies

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