Quality Resource Guide –

Alveolar Ridge Preservation Following Tooth Extraction 2nd Edition

www.metdental.com

Page 4

Huynh-Ba et al. (2010) showed that the buccal plate

was consistently thinner in the maxillary anterior sites

(canine to canine) as compared to maxillary premolar

sites. 87.5% of the anterior sites had a buccal bone

thickness of 1mm or less while for the premolar

sites this figure amounted to 59.3% (Table 2).

A recent radiographic study (Braut et al. 2012)

demonstrated that mandibular molars display

thicker buccal bone wall than mandibular premolars.

The mean buccal bone thickness measured at

4mm apical to the cemento-enamel junction

tooth was 0.13mm, 0.23mm, 0.60mm, 0.99mm

for mandibular first premolar, second premolar,

first molar and second molar, respectively.

Cardaropoli et al. (2014) showed that in non-

grafted premolar and molar sites there was an

inverse

relationship

between

buccal

plate

thickness and ridge width changes. The greater the

thickness, the less ridge resorption was observed.

Collectively, these studies suggests that ridge

preservation is probably warranted in anterior

maxillary sites while sites with thicker bone

wall plate, especially molar sites may not be

as susceptible to alveolar ridge dimension

alterations following extraction. If the clinician

is in doubt, the more conservative approach

would

recommend

grafting

the

extraction

site to minimize ridge dimensional changes.

Technique:

After local anesthesia has been delivered, the least

traumatic possible extraction is performed with

care to maintain all the bony walls of the extraction

socket intact. For this purpose, periotomes may be

preferred over larger, bulkier traditional elevators.

Once the tooth has been extracted, the integrity

of the buccal bone wall plate should be checked

and if all the walls are intact, the grafting procedure

can be performed. Small quantities of graft should

be applied successively and condensed in the

extraction socket. This allow for an optimal filling of

the socket. The most coronal part of the socket can

be covered with a collagen wound dressing before

a figure eight suture is placed over the extraction

site to maintain the stability of the graft.

In instances where, despite careful extraction, the

buccal plate has fractured, digital pressure applied

on the buccal surface of the extraction site will lead

to soft tissue depression into the extraction site

confirming the loss of integrity of the buccal wall

plate. A full-thickness mucoperiosteal flap should

be elevated to expose the full extent of the extracted

site including the buccal dehiscence.

A releasing

incision, at least a tooth away from the extraction

site, may be necessary to allow flap elevation and

access for visualization of the defect. Grafting

and contouring of the site should be performed

and a membrane placed over the grafted site. A

periosteal incision may help in advancing the flap

coronally before it is sutured back. The healing

time should be extended considering the absence

of buccal bone plate.

Post-operative care usually includes the prescription

of systemic antibiotics for 7 to 10 days, analgesics

and rinsing with a 0.12% Chorhexidine solution

twice a day for 7 to 14 days.

Table 2 - Frequency distribution of buccal bone plate thickness in the anterior

(canine to canine) and posterior (premolars) maxilla according to Huynh-Ba et al. 2010

Huynh-Ba et al. 2010

0.5

1.5

2.5

10%

40%

20%

30%

50%

60%

70%

Frequency distribution

Conclusion

Ridge preservation is a straightforward

procedure and, if performed at the time

of extraction, may prevent drastic ridge

dimensions

alterations.

This,

turn,

maximizes the chances to proceed with

dental implant placement, once healing has

occurred, with little or no need for technique-

sensitive guide bone regeneration (GBR)

procedures.

Acknowledgements

All the clinical illustrations in the present

manuscript are the courtesy of the Graduate

Periodontics Program at the University of

Texas Health Science Center at San Antonio

(UTHSCSA) and the United States Air Force

Periodontics Residency Program at Lackland

Air Force Base, TX.

Width [mm]