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      Alveolar ridge resorption after tooth extraction: A consequence of a fundamental principle of bone physiology

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      Author(s): 1 , , 1 , 2
      Publication date (Electronic):
      Journal: Journal of Dental Biomechanics
      Publisher: SAGE Publications
      Keywords: bone resorption, tooth extraction, implant

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          Abstract

          It is well established that tooth extraction is followed by a reduction of the buccolingual as well as the apicocoronal dimension of the alveolar ridge. Different measures have been taken to avoid this bone modelling process, such as immediate implant placement and bone grafting, but in most cases with disappointing results. One fundamental principle of bone physiology is the adaptation of bone mass and bone structure to the levels and frequencies of strain. In the present article, it is shown that the reduction of the alveolar ridge dimensions after tooth extraction is a natural consequence of this physiological principle.

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          Dimensional ridge alterations following tooth extraction. An experimental study in the dog.

          Mauricio G Araújo, Jan Lindhe (2005)
          To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change. Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope. It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall. The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood. (c) Blackwell Munksgaard, 2005.
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            Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study.

            Lars Schropp, Ann Wenzel, Lambros Kostopoulos … (2003)
            Preservation of alveolar bone volume following tooth extraction facilitates subsequent placement of dental implants and leads to an improved esthetic and functional prosthodontic result. The aim of the present study was to assess bone formation in the alveolus and the contour changes of the alveolar process following tooth extraction. The tissue changes after removal of a premolar or molar in 46 patients were evaluated in a 12-month period by means of measurements on study casts, linear radiographic analyses, and subtraction radiography. The results demonstrated that major changes of an extraction site occurred during 1 year after tooth extraction.
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              Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs.

              G Cardaropoli, M. Araujo, J Lindhe (2003)
              The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Dent Biomech
                Journal ID (iso-abbrev): J Dent Biomech
                Journal ID (publisher-id): DBM
                Journal ID (hwp): spdbm
                Title: Journal of Dental Biomechanics
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 1758-7360
                Publication date Collection: 2012
                Publication date (Electronic): 16 August 2012
                Volume: 3
                Electronic Location Identifier: 1758736012456543
                Affiliations
                [1 ]Astra Tech AB, Mölndal, Sweden
                [2 ]Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
                Author notes
                [*]Stig Hansson, Astra Tech AB, P.O. Box 14, SE-431 21 Mölndal, Sweden. Email: stig.hansson@ 123456astratech.com
                Article
                Publisher ID: 10.1177_1758736012456543
                DOI: 10.1177/1758736012456543
                PMC ID: 3425398
                PubMed ID: 22924065
                SO-VID: d2832ceb-dd7c-4d77-96c8-d836cbf88cc8
                Copyright © © The Author(s) 2012
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Subject: Article

                ScienceOpen disciplines: Dentistry
                Keywords: implant,bone resorption,tooth extraction
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: implant, bone resorption, tooth extraction

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