www.metdental.com

Author Acknowledgements

Guy Huynh-Ba, DDS MS

Associate Professor / Clinical

Department of Periodontics

University of Texas Health Science Center San

Antonio School of Dentistry

San Antonio, Texas

Dr. Huynh-Ba has no relevant financial

relationships to disclose.

The following commentary highlights

fundamental and commonly accepted practices

on the subject matter. The information is

intended as a general overview and is for

educational purposes only. This information

does not constitute legal advice, which can only

be provided by an attorney.

New York, NY. All materials subject to

this copyright may be photocopied for the

noncommercial purpose of scientific or

educational advancement.

Originally published February 2013.

Updated

and revised September 2016.

Expiration

date:

September 2019.

The content of this

Guide is subject to change as new scientific

information becomes available.

MetLife is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental

Association to assist dental professionals in

identifying quality providers of continuing dental

education. ADA CERP does not approve or

endorse individual courses or instructors, nor

does it imply acceptance of credit hours by

boards of dentistry.

Concerns or complaints about a CE provider

may be directed to the provider or to ADA

CERP at www.ada.org/goto/cerp.

Accepted Program Provider FAGD/MAGD

Credit 11/01/12 - 12/31/16.

Address comments to:

dentalquality@MetLife.com

MetLife Dental

Quality Initiatives Program

501 US Highway 22

Bridgewater, NJ 08807

Educational Objectives

Following this unit of instruction, the practitioner should be able to:

Describe the ridge dimensional alterations following tooth extraction and explain the

mechanism underlying.

Describe the ridge dimensional alterations following implant placement in fresh extraction

sockets.

Explain the advantages of ridge preservation.

Give examples of materials used for ridge preservation.

Recognize the

available scientific evidence to support specific materials.

Justify clinical situations for which ridge preservation may not be necessary.

What Happens to the Alveolar

Ridge Following Tooth

Extraction?

Following tooth extraction, it is well known that the

socket will undergo drastic modeling (resorption)

and remodeling. As a matter of fact, Pietrokovsky

already published data in 1967 regarding alveolar bone

dimensions changes subsequent to tooth extraction.

While the rationale, nowadays, to conduct such a study

is obvious in the light of assessing bone availability for

implant therapy, one may wonder what the rationale

was in 1967 to design such a study. The aim, at that

time, was to determine the morphologic changes and to

relate it to the prospective site of a conventional fixed

dental prosthesis (FDP) pontic. In other words, when

a tooth is extracted and replaced by means of a FDP,

where should the pontic be placed in relation to the

ridge once it has remodeled? This pioneer study led

the authors to conclude that following tooth extraction,

the resorption of the ridge was consistently greater

on the buccal than on the palatal/lingual side. As a

corollary the pontic has to be placed to the buccal of

the remodeled ridged in order to occupy the position of

the previous natural tooth.

Quality Resource Guide

Alveolar Ridge Preservation Following Tooth Extraction

MetLife designates this activity for

1.0 continuing education credit

for the review of this Quality Resource Guide

and successful completion of the post test.

SECOND EDITION

More recently, Schropp et al. (2003) evaluated the

tissues changes after premolar and molar extractions

and concluded that one year following extraction 50%

of the ridge width was lost. Moreover, two thirds of this

resorption happened during the first 3 months.

In addition to the alveolar ridge resorption in a

horizontal dimension (decrease in width), changes

in vertical dimensions have been reported. Araujo &

Lindhe (2005), in a canine model demonstrated that a

consistently greater decrease in vertical height of the

buccal bone plate in comparison with lingual plate was

to be expected following tooth extraction. The authors

suggested the following to explain the difference in

resorptive processes between the buccal and lingual

plates: The buccal plate is much thinner than the lingual

plate and it is mainly compose of bundle bone, which

is the portion of the alveolar bone in which collagen

fibers of the periodontal ligament are embedded. The

presence of bundle bone is dependent on functional

periodontal fibers transmitting occlusal load from the

tooth to the alveolar bone. As the function of these

fibers is lost following tooth extraction, the functionally

dependent bundle bone will resorb. The buccal plate

being mainly composed of bundle bone, its resoprtion