JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jpor
Review
Strategies for alveolar ridge reconstruction and preservation for implant therapy Chihiro Masaki DDS, PhDa,*, Tetsuji Nakamoto DDS, PhDb, Taro Mukaibo DDS, PhDa, Yusuke Kondo DDS, PhDa, Ryuji Hosokawa DDS, PhDa a
Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Japan Department of Prosthodontics, Graduate School of Oral & Maxillofacial Biology, School of Dentistry, Matsumoto Dental University, Japan b
article info
abstract
Article history:
Purpose: In dental implant treatment, ridge preservation and immediate or early implant
Received 6 April 2015
placement are recommended to minimize bone resorption after tooth extraction and
Received in revised form
achieve esthetic outcomes. However, there is no consensus concerning the efficacy of this
21 April 2015
surgical method. There is also no consensus on the efficacy of bone and soft tissue grafts and
Accepted 23 April 2015
surgical methods for alveolar ridge reconstruction.
Available online xxx
Study selection: This paper reports ridge alteration in the anterior maxilla after tooth
Keywords:
diate or early implant placement as alveolar ridge preservation methods to minimize bone
Ridge alteration
resorption after tooth extraction. The advantages and complications of alveolar ridge
extraction, and summarizes the efficacy of various ridge preservation methods and imme-
Ridge preservation
reconstruction methods, and the efficacy and surgical method of soft tissue graft are
Immediate placement
reviewed.
Early placement
Results: The anterior maxilla is in the esthetic zone, and the thickness of the bone on the
Tissue augmentation
labial side around the natural tooth is less than 1 mm in many cases. Therefore, it is impossible to prevent bone resorption completely, even if ridge preservation and immediate or early implant placement are performed after tooth extraction. It is necessary to obtain stable and long-term esthetics by combining connective tissue and free gingival grafts, in addition to hard tissue augmentation. Conclusions: It is important to consider the burden and level of satisfaction of patients, such as in terms of donor site morbidity in hard and soft tissue grafting, and to pay attention to appropriate indications to avoid overtreatment. # 2015 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
* Corresponding author at: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita, Kitakyushu, Fukuoka 803-8580, Japan. Tel.: +81 93 582 1131; fax: +81 93 592 3230. E-mail address: [email protected] (C. Masaki). http://dx.doi.org/10.1016/j.jpor.2015.04.005 1883-1958/# 2015 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9
2
journal of prosthodontic research xxx (2015) xxx–xxx
Contents 1. 2. 3. 4. 5. 6. 7.
1.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . Ridge alterations following tooth extraction . . Ridge preservation after tooth extraction . . . . Immediate or early implant placement . . . . . Hard tissue augmentation in implant therapy Soft tissue augmentation in implant therapy . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
Introduction
Successful implant treatment involves not only obtaining osseointegration but also placing a prosthesis with longterm stability and good esthetic results, function, and cleaning property. Although a horizontal bone width on the labial side of more than 2 mm and sufficient gingival thickness are considered ideal for a prosthesis with good esthetic results, the volume of the hard and soft tissues is often insufficient due to the ridge alteration after tooth extraction; an approach to overcome this issue is eagerly anticipated. Socket preservation and immediate or early implant placement are recommended to minimize bone resorption after tooth extraction. However, there is no consensus concerning the efficacy of this surgical method. For hard tissue reconstruction, block bone graft using autogenous bone, guided bone regeneration (GBR), and distraction methods have been applied as vertical and horizontal bone augmentation. However, considering that these methods require surgical invasion and are associated with the risk of complications such as infection, they are not appropriate in all cases. For soft tissue, free gingival graft (FGG) and connective tissue graft (CTG) were combined to increase the soft tissue, and results with long-term stability were obtained. However, considering the burden and level of satisfaction of patients, these methods cannot be applied to all cases. Case selection criteria should thus be established to avoid overtreatment. The aim of the present review is to clarify whether socket preservation and immediate implant placement are effective as an alveolar ridge preservation method, and to investigate the latest evidence on various strategies of alveolar ridge reconstruction, and application criteria and the surgical method of soft tissue graft.
2.
Ridge alterations following tooth extraction
A key prerequisite for esthetic outcomes in the anterior maxilla is adequate bone volume, including a facial bone wall of sufficient thickness and height [1,2]. Therefore, it is extremely important to understand ridge alteration after tooth extraction for implant treatment in the esthetic zone. An experimental study on canine mandibular premolar sites was performed to evaluate bone resorption after tooth extraction, and a change in the facial bone in the extraction
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
000 000 000 000 000 000 000 000
socket at 8 weeks after tooth extraction was observed. The result showed 2.2 mm vertical resorption of the facial bone wall in the mid-facial area [3]. These changes start with bundle bone resorption adjacent to the periodontal ligament, into which Sharpey fibers are inserted. Tan et al. reviewed alveolar ridge alteration in humans up to 12 months after tooth extraction [4]. This systematic review demonstrated that horizontal reduction (3.79 mm) was greater than vertical reduction (1.24 mm at buccal, 0.84 mm at mesial, and 0.8 mm at distal sites) at 6 months. The horizontal bone resorption change was 29–63% and the vertical change was 11–12% at 6 months [4]. Factors affecting dimensional change after tooth extraction include a flap or flapless status [5,6], smoking [7], single-rooted tooth or multiple-rooted tooth [8], and immediate denture [9]. In contrast, a study on three-dimensional ridge alteration in the esthetic zone after tooth extraction using CBCT showed that the median vertical bone loss in the central sites of the buccal bone wall was 5.2 mm (48.3%) at 8 weeks after tooth extraction, and the median horizontal bone loss was 0.3 mm (3.8%), suggesting larger vertical bone resorption. In the thick-wall phenotypes where facial bone wall thickness is more than 1 mm, vertical median bone loss was 1.1 mm. In contrast, in the thin-wall phenotypes where facial bone wall thickness was less than 1 mm, vertical median bone loss was approximately 7.5 mm [10]. These results suggested that vertical bone loss was 3.5 times more severe than findings reported in a canine model when the facial bone thickness was less than 1 mm. Especially in the esthetic zone, it was shown to be rare for facial bone wall thickness to be more than 1 mm [11]. In a study on facial bone wall thickness of the anterior maxilla, where the distance from apical region to the CEJ was 4 mm, as measured in 125 subjects using CBCT, median facial bone wall thickness was 0.47 mm in central incisors, 0.54 mm in lateral incisors, 0.45 mm in canines, and 0.73 mm in first premolars, suggesting that facial bone wall thickness was less than 1 mm in all areas. The proportions with more than 1 mm bone wall thickness were 4.6% in central incisors, 11.5% in lateral incisors, 8.6% in canines, and 27.5% in first premolars. These results showed that more than 1 mm bone wall thickness was noted in only about 25%, even in first premolars, where the labial bone was the thickest [12]. Since facial bone was thin, and surrounding bone mostly consisted of bundle bone, vertical bone resorption after tooth extraction was more severe in the esthetic zone (Fig. 1). Ridge preservation, immediate or early loading, and reconstruction of the hard and soft tissues need to be considered to avoid ridge resorption for esthetic implant treatment (Fig. 2).
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
3
Ridge alterations following tooth extraction At 6 months aer extracon Horizontal reducon in width Mean 3.8 ± 0.2 mm Bone resorpon change 29-63 %
>
Vercal reducon in height Mean 1.2 ± 0.1 mm Bone resorpon change 11-12 % Tan et al., 2012 4
At 8 weeks aer extracon With a facial bone wall thickness of ≤ 1 mm Vercal median bone loss 7.5 mm
>
With a facial bone wall thickness of > 1 mm Vercal median bone loss 1.1 mm Chappuis et al., 2014 10
Fig. 1 – Ridge alterations following tooth extraction.
Fig. 2 – Ridge alteration after immediate or early implant placement.
3.
Ridge preservation after tooth extraction
Various ridge preservation techniques have been introduced in the last 2 decades to prevent bone resorption in the alveolar socket. Materials including autografts, allografts [13,14], xenografts [15,16], and alloplasts [17,18] were introduced. Other techniques include the use of membranes, namely, absorbable [19] and nonabsorbable ones [20,21], and the combination of graft and materials [22,23]. Nevins et al. reported in a study on deproteinized bovine bone mineral used in the extraction socket in the anterior maxilla that resorption was prevented in the buccal plate of the alveolar ridge compared with that in non-grafted control sites [24]. These findings were also confirmed in animal studies using a canine model [25,26]. Furthermore, clinical results of ridge preservation in which Bio-Oss1 Collagen was placed in the fresh extraction socket and covered with a soft tissue graft of the palatal mucosa were reported. The cross-sectional area decreased by approximately 25% in the control group where no hard or tissue grafting was performed, but only by 3% in the Bio-Oss1 Collagen group, suggesting the potential of ridge preservation. In a systematic review and meta-analysis by Avila-Ortiz et al. [27], 8 randomized control trials were selected to evaluate the effect of alveolar ridge preservation [28–34,22]. The mean
horizontal ridge changes were 2.6 to 4.5 mm in the control group for which nothing was placed in the extraction socket, and 1.1 to 3.5 mm in the experimental group for which socket preservation was performed. The vertical ridge changes in the midbuccal area were 0.9 to 4.2 mm in the control group and +1.1 to 1.6 mm in the experimental group. The meta-analysis results showed that median buccolingual width change was 1.89 mm, median midbuccal height change was 2.07 mm, median midlingual height change was 1.18 mm, median mesial height change was 0.48 mm, and median distal height change was 0.24 mm. These results suggested that socket preservation was effective to prevent horizontal and vertical bone resorption after tooth extraction. Factors affecting ridge resorption after tooth extraction were investigated, and it was elucidated that flap elevation, the use of a membrane, and the application of a xenograft or an allograft lead to superior outcomes for the prevention of midbuccal and midlingual bone height resorption. However, bone resorption cannot be prevented completely, which is considered to be due to the influence of local and systematic factors that are not fully understood. A systematic review of alteration in bone quality after socket preservation with grafting materials by Chan et al. demonstrated that the proportion of remaining graft particles was 0–5% after 6 months when autogenous bone and bioactive glass were used [35]. On the other hand, the
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9
4
journal of prosthodontic research xxx (2015) xxx–xxx
proportion of remaining graft particles was greater with hydroxyapatite and xenograft (15–36%) than with calcium sulfate and demineralized freeze-dried bone allograft (5–15%). Xenografts such as Bio-Oss are integrated into bone, but are not absorbable, which allows the bone mass to be maintained [36]. Therefore, the use of this method is effective in the pontic area of the bridge. Caution should be exercised in terms of the timing of placement when implant treatment is planned.
4.
Immediate or early implant placement
According to the conventional protocol, an implant should be placed after 2–3 months of healing after tooth extraction. However, the longer the wait for healing of the extraction socket, the longer the treatment period, which causes ridge resorption in the edentulous area. Immediate or early placement after tooth extraction is considered effective from the esthetic point of view. Paolantonio et al. suggested that early implantation may preserve the alveolar anatomy and that the placement of a fixture in a fresh extraction socket may help maintain the bony crest structure [37]. In contrast, Arau´jo et al. elucidated in an animal study using a dog that the placement of an implant in the fresh extraction site does not prevent remodeling in the socket wall at 3 months after tooth extraction [38]. A number of clinical reports on immediate placement have been published since then [39–41], and it was demonstrated that bone resorption cannot be prevented completely by immediate placement. The results of a systematic review regarding alterations of the bone dimensions following immediate implant placement into an extraction socket by Lee et al. showed that the median amount of buccal bone resorption at 4–12 months after immediate placement was 1.07 mm horizontally and 0.78 mm vertically [42]. The weighted mean palatal bone dimensional reduction was 0.62 mm horizontally and 0.50 mm vertically. Meta-analysis results showed that the only factor affecting labial bone resorption was buccal plate thickness of the post-extraction socket. In the thinner buccal plate of an immediate implantation site, there was a tendency for vertical bone resorption to be higher, but for horizontal bone resorption to be lower than with a thicker buccal plate. The reduction of crestal bone height at sites with a thin buccal plate poses a significant clinical problem, even if the horizontal bone dimensional change may be less than at a site with a thick buccal plate. Chen et al. compared the esthetic outcomes between immediate placement and early placement in the anterior maxilla [43]. Recession of the midfacial mucosa of more than 1 mm was observed in 26% (9–41%) on average. When immediate implant placement with a bone graft was performed, the facial bone wall was not detectable on CBCT at 36–57% of sites, and these non-detectable sites had more recession of midfacial mucosa than sites with detectable facial bone. In immediate placement with simultaneous GBR, there is a high risk of membrane exposure. In early placement with simultaneous GBR, facial bone wall was confirmed on CBCT in more than 90% of cases. It was reported that the thickness of facial bone and the position of the facial bone crest are important factors affecting long-term esthetic stability after immediate placement. A systematic review of early implant
placement by Sanz et al. demonstrated that such placement is effective for soft and hard tissue preservation compared with delayed implant placement [44]. The proportions of bone height and width reductions were 13.11% and 19.85%, respectively. There was no significant difference in the implant survival rate compared with that for a delayed implant. Although a high success rate has been reported in both immediate and early placements, there is a high risk for gingival recession in the former. Therefore, caution should be exercised for smokers, and those with buccal bone of less than 1 mm, gingival biotype, and labial side implant being positioned in the esthetic zone [44,45]. Although the molar area shows a high success rate and a low rate of complications, soft and hard tissue augmentation is often required, depending on the size of the extraction socket. Although immediate and early placement is suggested in the premolar area due to a high percentage of thick buccal bone width and low esthetic requirements compared with those in the anterior area, it is safe to choose early placement in the anterior area, where esthetic requirements are greater.
5. Hard tissue augmentation in implant therapy A number of ridge augmentation methods of implant therapy have been reported, including guided bone regeneration (GBR) [46,47], maxillary sinus floor augmentation (MSFA) [48–51], vertical and/or lateral alveolar ridge augmentation [52–55], and distraction [56,57]. In the GBR method, barrier membrane with or without titanium reinforcement composed of expanded polytetrafluoroethylene (e-PTFE) is used [58]. However, biodegradable membranes composed of dura mater, poly-Llactic acid, and polyglycolic and collagen have been introduced to avoid second surgery for membrane removal [59,60]. A systematic review on the effectiveness of barrier membranes on bone regeneration [61] showed that the use of such membranes would increase the amount of vertical augmented bone (mean difference, 0.32 mm; P = 0.006). Furthermore, membranes do not increase postoperative infection, wound dehiscence, or membrane/bone graft exposure in either human or animal models. A systematic review comparing bone substitute materials (BSM) and autogenous bone (AB) showed that the mean implant survival rates were 98.6% for BSM, 88.6% for BSM mixed with AB, and 97.4% for AB alone, regarding MSFA [62]. A meta-analysis showed a trend towards higher implant survival when using BSM rather than AB, but the difference was not statistically significant. Concerning vertical and/or lateral alveolar ridge augmentation, mean implant survival rates were 97.4% for BSM, 100% for BSM mixed with AB, and 98.6% for AB alone. A meta-analysis of these studies showed no statistically significant difference between BSM and AB. Cochrane systematic review [63] on this topic showed that, although it is effective to use a bone substitute (Bio-Oss) for horizontal bone augmentation, implants placed in bone augmented with Bio-Oss showed an increased failure rate, and the healing time was increased by 3 months compared with that of autogenous bone. Although the distraction technique costs more than GBR and bone grafting, it could shorten the treatment period, so
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
5
Fig. 3 – The summary of hard tissue augmentation in implant therapy.
this technique is effective for vertical ridge augmentation. However, the distraction technique is difficult to apply to thin knife-edge bone. In any case, vertical augmentation techniques are associated with high complication rates (20–60%) [56,64]. Moreover, when comparing whether vertical augmentation procedures were more advantageous than short implants, a meta-analysis of two trials showed more implant failure, OR = 5.74 (95% CI, 0.92–35.82; borderline significance, P = 0.06), and statistically significantly more complications, OR = 4.97 (95% CI, 1.10–22.40), in the vertically augmented group. These results suggested that clinicians and patients should carefully evaluate the benefits and risks of possible treatment before deciding whether to use vertical ridge augmentation techniques or not (Fig. 3).
6. Soft tissue augmentation in implant therapy Berglundh and Lindhe proposed that mucosal attachment with certain minimum dimensions is necessary to protect osseointegration in an animal study, which is regarded as the ‘‘biological width’’ of the implant [65]. The 1-year prospective controlled clinical trial showed a potential of crestal bone loss after implant placement up to 1.45 mm within a year, even if the implant-abutment interface was in a supracrestal position when the initial gingival tissue thickness was 2.0 mm or less [66]. Nozawa et al. reported that there was a close relationship between the height and width of supra-implant mucosa, and proposed a hypothesis that the ratio of the height and width was approximately 1:1.5 [67]. It is considered that mucosal thickness is important for the stability of an implant surrounding bone, and a connective tissue graft (CTG) that increases the mucosal width is effective to maintain the height of surrounding mucosa. In terms of the CTG effect around implants, a 3-year retrospective study showed mucosal thickness gain of 1.4 mm on average 3 years after soft tissue grafting [68]. A split-mouth randomized controlled clinical trial that evaluated the effect of CTG for thickening peri-implant tissue in premolar or molar areas showed that the soft tissue at augmented sites was 1.3 mm thicker (P < 0.001) and had a significantly better pink esthetic score (P < 0.001) at 1 year after loading. Although patients were highly satisfied, half of the patients did not desire second surgery of CTG [69]. A one-year prospective cohort study evaluating peri-implant tissue volume gain and
stability after bone and soft tissue augmentation showed an increase of 1.3 mm on average between the preoperative period and immediately after crown placement. Labial thickness had decreased by only 0.04 mm on average at 1 year after prosthesis placement, and gingival recession was approximately 0.2 mm [70]. The effectiveness of CTG against immediate implant placement has also been reported. Yoshino et al. compared immediate placement with and without subepithelial connective tissue graft (SCTG) [71]. The results showed that mean gingival level change at 1 year postoperatively was significantly more pronounced in the control group ( 0.70 mm) than in the test group ( 0.25 mm). These findings suggested the effectiveness of CTG for maintenance of the peri-implant facial gingival level. There are two methods for collecting connective tissue, namely, those for vascularized interpositional periosteal-connective tissue and for free subepithelial connective tissue. A randomized controlled clinical trial by Akcalı et al. demonstrated that both soft tissue augmentation techniques were effective in increasing the volume of defective alveolar ridge in the anterior maxilla [72]. However, after 6 months, sites treated with a pediculated graft were superior in terms of maintaining the initially augmented volume and showed less shrinkage of the graft. A common donor site of free subepithelial connective tissue is the palate, so it is necessary to understand the anatomy of the palatal area. The distance from the gingival margin to the greater palatine artery was shown to range from 12 mm at the canine level to 14 mm at the mid-palatal aspect of the second molar level [73]. The greater palatine nerve is located in the apical area of the second to third molars [74], and it is said that the thickness of the palatal mucosa is greatest in the premolar area and smallest in the first molar area [75]. Caution is required to avoid an incision of more than 10 mm in depth from the CEJ of the upper molar area between the canine and the mesial side of the first molar. Maxillary tuberosity has been used as a donor site in addition to the palate in recent years. The connective tissue grafted from the tuberosity is stable in the first few months, but hyperplastic reaction and unesthetic white tissue patch appearance are often observed [76,77]. There is a report on the keratinized mucosa around implants describing that a significant correlation was found between keratinized gingiva of more than 2 mm in width and resorption of the surrounding bone [78,79]. In contrast, there is also a report describing that there was no correlation between the keratinized mucosa width and
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9
6
journal of prosthodontic research xxx (2015) xxx–xxx
Fig. 4 – The summary of soft tissue augmentation in implant therapy.
inflammation of the surrounding gingiva [80], or between keratinized mucosa and bone resorption [81]. When the keratinized mucosa width is more than 2 mm, the risk of bone resorption is low. However, it is necessary to consider whether the peri-implant area is easy to clean [82]. On the other hand, since these autogenous techniques require an additional donor site and have associated morbidity, allogenic graft materials have been introduced. A study comparing the effect between acellular dermal matrix (ADM) and SCTG showed that both groups exhibited increased tissue thickness (SCTG: 63% and ADM: 105%), reduced concavity measures (SCTG: 82% and ADM: 96%), and improved recessions (SCTG: 40% and ADM: 28%) from baseline to 6 months [83]. A randomized controlled prospective clinical trial evaluating the efficacy of a xenogeneic collagen matrix (Mucograft1) to augment the keratinized tissue around implants showed that there were similar esthetic results and significant increases in the vestibular depth in both groups as a result of the surgery. However, the patients treated with the Mucograft1 reported less pain, needed less pain medication, and the surgical time was shorter, although these differences from the CTG group were not statistically significant [84]. ADM and collagen matrix grafting materials will be used instead of connective tissue in the future to reduce patient burden (Fig. 4).
7.
Conclusion
It is important to understand alveolar ridge alteration and to minimize bone resorption after tooth extraction in order to achieve esthetic outcomes. Bone resorption cannot be avoided completely even if gentle tooth extraction, ridge preservation, and immediate or early placement are performed. Therefore, hard and soft tissue grafting is essential in esthetic implant treatment. The selection of grafting materials and augmentation methods should be carefully planned for bone augmentation, and it is ideal to ensure sufficient thickness of the soft tissue for long-term implant stability. It is also important to consider the burden and level of satisfaction of patients, such as in terms of donor site morbidity in hard and soft tissue grafting, and to pay attention to appropriate indications to avoid overtreatment.
Conflict of interest The authors have no conflict of interest with respect to the manuscript content or funding.
references
[1] Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19 Suppl.:43–61. [2] Grunder U, Gracis S, Capelli M. Influence of the 3-D boneto-implant relationship on esthetics. Int J Periodontics Restorative Dent 2005;25:113–9. [3] Arau´jo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 2005;32:212–8. [4] Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res 2012;23(Suppl. 5):1–21. [5] Blanco J, Nun˜ez V, Aracil L, Mun˜oz F, Ramos I. Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery. J Clin Periodontol 2008;35:640–8. [6] Arau´jo MG, Lindhe J. Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog. Clin Oral Implants Res 2009;20:545–9. [7] Saldanha JB, Casati MZ, Neto FH, Sallum EA, Nociti Jr FH. Smoking ay affect the alveolar process dimensions and radiographic bone density in maxillary extraction sites: a prospective study in humans. J Oral Maxillofac Surg 2006;64:1359–65. [8] Moya-Villaescusa MJ, Sa´nchez-Pe´rez A. Measurement of ridge alterations following tooth removal: a radiographic study in humans. Clin Oral Implants Res 2010;21:237–42. [9] Carlsson GE, Persson G. Morphologic changes of the mandible after extraction and wearing of dentures. A longitudinal, clinical, and X-ray cephalometric study covering 5 years. Odontol Revy 1967;18:27–54. [10] Chappuis V, Engel O, Reyes M, Shahim K, Nolte LP, Buser D. Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res 2013;92: 195S–201S. [11] Janua´rio AL, Duarte WR, Barriviera M, Mesti JC, Arau´jo MG, Lindhe J. Dimension of the facial bone wall in the anterior maxilla: a cone-beam computed tomography study. Clin Oral Implants Res 2011;22:1168–71. [12] Braut V, Bornstein MM, Belser U, Buser D. Thickness of the anterior maxillary facial bone wall – a retrospective radiographic study using cone beam computed tomography. Int J Periodontics Restorative Dent 2011;31:125–31. [13] Froum S, Cho SC, Rosenberg E, Rohrer M, Tarnow D. Histological comparison of healing extraction sockets implanted with bioactive glass or demineralized
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
freeze-dried bone allograft: a pilot study. J Periodontol 2002;73:94–102. Zubillaga G, Von Hagen S, Simon BI, Deasy MJ. Changes in alveolar bone height and width following post-extraction ridge augmentation using a fixed bioabsorbable membrane and demineralized freeze-dried bone osteoinductive graft. J Periodontol 2003;74:965–75. Artzi Z, Nemcovsky CE. The application of deproteinized bovine bone mineral for ridge preservation prior to implantation. Clinical and histological observations in a case report. J Periodontol 1998;69:1062–7. Carmagnola D, Adriaens P, Berglundh T. Healing of human extraction sockets filled with Bio-Oss. Clin Oral Implants Res 2003;14:137–43. Sa`ndor GK, Kainulainen VT, Queiroz JO, Carmichael RP, Oikarinen KS. Preservation of ridge dimensions following grafting with coral granules of 48 post-traumatic and postextraction dento-alveolar defects. Dent Traumatol 2003;19:221–7. Guarnieri R, Pecora G, Fini M, Aldini NN, Giardino R, Orsini G, et al. Medical grade calcium sulfate hemihydrate in healing of human extraction sockets: clinical and histological observations at 3 months. J Periodontol 2004;75:902–8. Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, et al. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol 1998;69:1044–9. Die`s F, Etienne D, Abboud NB, Ouhayoun JP. Bone regeneration in extraction sites after immediate placement of an e-PTFE membrane with or without a biomaterial. A report on 12 consecutive cases. Clin Oral Implants Res 1996;7:277–85. Bartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique. J Oral Implantol 2001;27:194–7. Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol 2003;74: 990–9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Br Med J 2009;339:b2700. Nevins M, Camelo M, De Paoli S, Friedland B, Schenk RK, Parma-Benfenati S, et al. A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots. Int J Periodontics Restorative Dent 2006;26:19–29. Arau´jo MG, Lindhe J. Ridge preservation with the use of Biooss collagen: a 6-month study in the dog. Clin Oral Implants Res 2009;20:433–40. Arau´jo MG, Liljenberg B, Lindhe J. Dynamics of Bio-Oss Collagen incorporation in fresh extraction wounds: an experimental study in the dog. Clin Oral Implants Res 2010;21:55–64. Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res 2014;93:950–8. Aimetti M, Romano F, Griga FB, Godio L. Clinical and histologic healing of human extraction sockets filled with calcium sulfate. Int J Oral Maxillofac Implants 2009;24:902–9. Azizi A, Moghadam SA. A study on the effect of Bio-Oss and collagen membrane on the repair of dental socket. J Isfahan Dent Sch 2009;5:133–9.
[30] Barone A, Aldini NN, Fini M, Giardino R, Calvo Guirado JL, Covani U. Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphometric study. J Periodontol 2008;79: 1370–7. [31] Barone A, Orlando B, Cingano L, Marconcini S, Derchi G, Covani U. A randomized clinical trial to evaluate and compare implants placed in augmented versus nonaugmented extraction sockets: 3-year results. J Periodontol 2012;83:836–46. [32] Camargo PM, Lekovic V, Weinlaender M, Klokkevold PR, Kenney EB, Dimitrijevic B, et al. Influence of bioactive glass on changes in alveolar process dimensions after exodontia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:581–6. [33] Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L, Cardaropoli G. Socket preservation using bovine bone mineral and collagen membrane: a randomized controlled clinical trial with histologic analysis. Int J Periodontics Restorative Dent 2012;32:421–30. [34] Festa VM, Addabbo F, Laino L, Femiano F, Rullo R. Porcinederived xenograft combined with a soft cortical membrane versus extraction alone for implant site development: a clinical study in humans. Clin Implant Dent Relat Res 2013;15:707–13. [35] Chan HL, Lin GH, Fu JH, Wang HL. Alterations in bone quality after socket preservation with grafting materials: a systematic review. Int J Oral Maxillofac Implants 2013;28:710–20. [36] Gholami GA, Najafi B, Mashhadiabbas F, Goetz W, Najafi S. Clinical, histologic and histomorphometric evaluation of socket preservation using a synthetic nanocrystalline hydroxyapatite in comparison with a bovine xenograft: a randomized clinical trial. Clin Oral Implants Res 2012;23:1198–204. [37] Paolantonio M, Dolci M, Scarano A, d’Archivio D, di Placido G, Tumini V, et al. Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man. J Periodontol 2001;72:1560–71. [38] Arau´jo MG, Sukekava F, Wennstro¨m JL, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol 2005;32:645–52. [39] Esposito M, Grusovin MG, Polyzos IP, Felice P, Worthington HV. Timing of implant placement after tooth extraction: immediate, immediate-delayed or delayed implants? A Cochrane systematic review. Eur J Oral Implantol 2010;3:189–205. [40] Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res 2012;23(Suppl. 5):39–66. [41] Schropp L, Isidor F. Papilla dimension and soft tissue level after early vs. delayed placement of single-tooth implants: 10 year results from a randomized controlled clinical trial. Clin Oral Implants Res 2015;26:278–86. [42] Lee CT, Chiu TS, Chuang SK, Tarnow D, Stoupel J. Alterations of the bone dimension following immediate implant placement into extraction socket: systematic review and meta-analysis. J Clin Periodontol 2014;41: 914–26. [43] Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla – a systematic review. Int J Oral Maxillofac Implants 2014;29 Suppl.:186–215. [44] Sanz I, Garcia-Gargallo M, Herrera D, Martin C, Figuero E, Sanz M. Surgical protocols for early implant placement in post-extraction sockets; a systematic review. Clin Oral Implants Res 2012;23(Suppl. 5):67–79.
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
7
JPOR-280; No. of Pages 9
8
journal of prosthodontic research xxx (2015) xxx–xxx
[45] Ha¨mmerle CH, Arau´jo MG, Simion M. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res 2012;23(Suppl. 5):80–2. [46] Rakhmatia YD, Ayukawa Y, Furuhashi A, Koyano K. Current barrier membranes: titanium mesh and other membranes for guided bone regeneration in dental applications. J Prosthodont Res 2013;57:3–14. [47] Chiapasco M, Romeo E, Casentini P, Rimondini L. Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: a 1–3-year prospective study on humans. Clin Oral Implants Res 2004;15:82–95. [48] Hallman M, Sennerby L, Lundgren S. A clinical and histologic evaluation of implant integration in the posterior maxilla after sinus floor augmentation with autogenous bone, bovine hydroxyapatite, or a 20:80 mixture. Int J Oral Maxillofac Implants 2002;17:635–43. [49] Merli M, Moscatelli M, Mariotti G, Rotundo R, Nieri M. Autogenous bone versus deproteinised bovine bone matrix in 1-stage lateral sinus floor elevation in the severely atrophied maxilla: a randomised controlled trial. Eur J Oral Implantol 2013;6:27–37. [50] Sbordone L, Levin L, Guidetti F, Sbordone C, Glikman A, Schwartz-Arad D. Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning. Clin Oral Implants Res 2011;22:485–91. [51] Velich N, Ne´meth Z, To´th C, Szabo´ G. Long-term results with different bone substitutes used for sinus floor elevation. J Craniofac Surg 2004;15:38–41. [52] Dottore AM, Kawakami PY, Bechara K, Rodrigues JA, Cassoni A, Figueiredo LC, et al. Stability of implants placed in augmented posterior mandible after alveolar osteotomy using resorbable nonceramic hydroxyapatite or intraoral autogenous bone: 12-month follow-up. Clin Implant Dent Relat Res 2014;16:330–6. [53] Lopez-Cedrun JL. Implant rehabilitation of the edentulous posterior atrophic mandible: the sandwich osteotomy revisited. Int J Oral Maxillofac Implants 2011;26:195–202. [54] Meijndert L, Raghoebar GM, Meijer HJ, Vissink A. Clinical and radiographic characteristics of single-tooth replacements preceded by local ridge augmentation: a prospective randomized clinical trial. Clin Oral Implants Res 2008;19:1295–303. [55] Simion M, Jovanovic SA, Tinti C, Benfenati SP. Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up. Clin Oral Implants Res 2001;12:35–45. [56] Bianchi A, Felice P, Lizio G, Marchetti C. Alveolar distraction osteogenesis versus inlay bone grafting in posterior mandibular atrophy: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:282–92. [57] Vega LG, Bilbao A. Alveolar distraction osteogenesis for dental implant preparation: an update. Oral Maxillofac Surg Clin North Am 2010;22:369–85. [58] Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg 1988;81:672–6. [59] Simion M, Misitano U, Gionso L, Salvato A. Treatment of dehiscences and fenestrations around dental implants using resorbable and nonresorbable membranes associated with bone autografts: a comparative clinical study. Int J Oral Maxillofac Implants 1997;12:159–67. [60] Merli M, Moscatelli M, Mariotti G, Rotundo R, Bernardelli F, Nieri M. Bone level variation after vertical ridge augmentation: resorbable barriers versus
[61]
[62]
[63]
[64]
[65]
[66]
[67]
[68]
[69]
[70]
[71]
[72]
[73]
[74]
[75]
titanium-reinforced barriers. A 6-year double-blind randomized clinical trial. Int J Oral Maxillofac Implants 2014;29:905–13. Khojasteh A, Soheilifar S, Mohajerani H, Nowzari H. The effectiveness of barrier membranes on bone regeneration in localized bony defects: a systematic review. Int J Oral Maxillofac Implants 2013;28:1076–89. Al-Nawas B, Schiegnitz E. Augmentation procedures using bone substitute materials or autogenous bone – a systematic review and meta-analysis. Eur J Oral Implantol 2014;7(Suppl. 2):S219–34. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The efficacy of horizontal and vertical bone augmentation procedures for dental implants – a Cochrane systematic review. Eur J Oral Implantol 2009;2:167–84. Felice P, Marchetti C, Iezzi G, Piattelli A, Worthington H, Pellegrino G, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-controlled clinical trial. Clin Oral Implants Res 2009;20:1386–93. Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 1996;23:971–3. Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants 2009;24:712–9. Nozawa T, Enomoto H, Tsurumaki S, Ito K. Biologic heightwidth ratio of the buccal supra-implant mucosa. Eur J Esthet Dent 2006;1:208–14. Speroni S, Cicciu M, Maridati P, Grossi GB, Maiorana C. Clinical investigation of mucosal thickness stability after soft tissue grafting around implants: a 3-year retrospective study. Indian J Dent Res 2010;21:474–9. Wiesner G, Esposito M, Worthington H, Schlee M. Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory split-mouth randomised controlled clinical trial. Eur J Oral Implantol 2010;3:27–35. Schneider D, Grunder U, Ender A, Ha¨mmerle CH, Jung RE. Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study. Clin Oral Implants Res 2011;22:28–37. Yoshino S, Kan JY, Rungcharassaeng K, Roe P, Lozada JL. Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study. Int J Oral Maxillofac Implants 2014;29:432–40. Akcalı A, Schneider D, Unlu¨ F, Bıcakcı N, Ko¨se T, Ha¨mmerle CH. Soft tissue augmentation of ridge defects in the maxillary anterior area using two different methods: a randomized controlled clinical trial. Clin Oral Implants Res 2015;26:688–95. Monnet-Corti V, Santini A, Glise JM, Fouque-Deruelle C, Dillier FL, Lie´bart MF, et al. Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site. J Periodontol 2006;77:899–902. Klosek SK, Rungruang T. Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site. Surg Radiol Anat 2009;31:245–50. Studer SP, Allen EP, Rees TC, Kouba A. The thickness of masticatory mucosa in the human hard palate and
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
[76]
[77]
[78]
[79]
[80]
tuberosity as potential donor sites for ridge augmentation procedures. J Periodontol 1997;68:145–51. Jung UW, Um YJ, Choi SH. Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J Periodontol 2008;79:934–40. Dellavia C, Ricci G, Pettinari L, Allievi C, Grizzi F, Gagliano N. Human palatal and tuberosity mucosa as donor sites for ridge augmentation. Int J Periodontics Restorative Dent 2014;34:179–86. Roos-Jansa˚ker AM, Lindahl C, Renvert H, Renvert S. Nine- to fourteen-year follow-up of implant treatment. Part I: implant loss and associations to various factors. J Clin Periodontol 2006;33:283–9. Bouri Jr A, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 2008;23: 323–6. Wennstro¨m JL, Bengazi F, Lekholm U. The influence of the masticatory mucosa on the peri-implant
[81]
[82]
[83]
[84]
soft tissue condition. Clin Oral Implants Res 1994;5:1–8. Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410–20. Wennstro¨m JL, Derks J. Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Clin Oral Implants Res 2012;23(Suppl. 6):136–46. Anderson LE, Inglehart MR, El-Kholy K, Eber R, Wang HL. Implant associated soft tissue defects in the anterior maxilla: a randomized control trial comparing subepithelial connective tissue graft and acellular dermal matrix allograft. Implant Dent 2014;23:416–25. Lorenzo R, Garcı´a V, Orsini M, Martin C, Sanz M. Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clin Oral Implants Res 2012;23:316–24.
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
9
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/jpor
Review
Strategies for alveolar ridge reconstruction and preservation for implant therapy Chihiro Masaki DDS, PhDa,*, Tetsuji Nakamoto DDS, PhDb, Taro Mukaibo DDS, PhDa, Yusuke Kondo DDS, PhDa, Ryuji Hosokawa DDS, PhDa a
Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Japan Department of Prosthodontics, Graduate School of Oral & Maxillofacial Biology, School of Dentistry, Matsumoto Dental University, Japan b
article info
abstract
Article history:
Purpose: In dental implant treatment, ridge preservation and immediate or early implant
Received 6 April 2015
placement are recommended to minimize bone resorption after tooth extraction and
Received in revised form
achieve esthetic outcomes. However, there is no consensus concerning the efficacy of this
21 April 2015
surgical method. There is also no consensus on the efficacy of bone and soft tissue grafts and
Accepted 23 April 2015
surgical methods for alveolar ridge reconstruction.
Available online xxx
Study selection: This paper reports ridge alteration in the anterior maxilla after tooth
Keywords:
diate or early implant placement as alveolar ridge preservation methods to minimize bone
Ridge alteration
resorption after tooth extraction. The advantages and complications of alveolar ridge
extraction, and summarizes the efficacy of various ridge preservation methods and imme-
Ridge preservation
reconstruction methods, and the efficacy and surgical method of soft tissue graft are
Immediate placement
reviewed.
Early placement
Results: The anterior maxilla is in the esthetic zone, and the thickness of the bone on the
Tissue augmentation
labial side around the natural tooth is less than 1 mm in many cases. Therefore, it is impossible to prevent bone resorption completely, even if ridge preservation and immediate or early implant placement are performed after tooth extraction. It is necessary to obtain stable and long-term esthetics by combining connective tissue and free gingival grafts, in addition to hard tissue augmentation. Conclusions: It is important to consider the burden and level of satisfaction of patients, such as in terms of donor site morbidity in hard and soft tissue grafting, and to pay attention to appropriate indications to avoid overtreatment. # 2015 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
* Corresponding author at: Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita, Kitakyushu, Fukuoka 803-8580, Japan. Tel.: +81 93 582 1131; fax: +81 93 592 3230. E-mail address: [email protected] (C. Masaki). http://dx.doi.org/10.1016/j.jpor.2015.04.005 1883-1958/# 2015 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9
2
journal of prosthodontic research xxx (2015) xxx–xxx
Contents 1. 2. 3. 4. 5. 6. 7.
1.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . Ridge alterations following tooth extraction . . Ridge preservation after tooth extraction . . . . Immediate or early implant placement . . . . . Hard tissue augmentation in implant therapy Soft tissue augmentation in implant therapy . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
Introduction
Successful implant treatment involves not only obtaining osseointegration but also placing a prosthesis with longterm stability and good esthetic results, function, and cleaning property. Although a horizontal bone width on the labial side of more than 2 mm and sufficient gingival thickness are considered ideal for a prosthesis with good esthetic results, the volume of the hard and soft tissues is often insufficient due to the ridge alteration after tooth extraction; an approach to overcome this issue is eagerly anticipated. Socket preservation and immediate or early implant placement are recommended to minimize bone resorption after tooth extraction. However, there is no consensus concerning the efficacy of this surgical method. For hard tissue reconstruction, block bone graft using autogenous bone, guided bone regeneration (GBR), and distraction methods have been applied as vertical and horizontal bone augmentation. However, considering that these methods require surgical invasion and are associated with the risk of complications such as infection, they are not appropriate in all cases. For soft tissue, free gingival graft (FGG) and connective tissue graft (CTG) were combined to increase the soft tissue, and results with long-term stability were obtained. However, considering the burden and level of satisfaction of patients, these methods cannot be applied to all cases. Case selection criteria should thus be established to avoid overtreatment. The aim of the present review is to clarify whether socket preservation and immediate implant placement are effective as an alveolar ridge preservation method, and to investigate the latest evidence on various strategies of alveolar ridge reconstruction, and application criteria and the surgical method of soft tissue graft.
2.
Ridge alterations following tooth extraction
A key prerequisite for esthetic outcomes in the anterior maxilla is adequate bone volume, including a facial bone wall of sufficient thickness and height [1,2]. Therefore, it is extremely important to understand ridge alteration after tooth extraction for implant treatment in the esthetic zone. An experimental study on canine mandibular premolar sites was performed to evaluate bone resorption after tooth extraction, and a change in the facial bone in the extraction
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
000 000 000 000 000 000 000 000
socket at 8 weeks after tooth extraction was observed. The result showed 2.2 mm vertical resorption of the facial bone wall in the mid-facial area [3]. These changes start with bundle bone resorption adjacent to the periodontal ligament, into which Sharpey fibers are inserted. Tan et al. reviewed alveolar ridge alteration in humans up to 12 months after tooth extraction [4]. This systematic review demonstrated that horizontal reduction (3.79 mm) was greater than vertical reduction (1.24 mm at buccal, 0.84 mm at mesial, and 0.8 mm at distal sites) at 6 months. The horizontal bone resorption change was 29–63% and the vertical change was 11–12% at 6 months [4]. Factors affecting dimensional change after tooth extraction include a flap or flapless status [5,6], smoking [7], single-rooted tooth or multiple-rooted tooth [8], and immediate denture [9]. In contrast, a study on three-dimensional ridge alteration in the esthetic zone after tooth extraction using CBCT showed that the median vertical bone loss in the central sites of the buccal bone wall was 5.2 mm (48.3%) at 8 weeks after tooth extraction, and the median horizontal bone loss was 0.3 mm (3.8%), suggesting larger vertical bone resorption. In the thick-wall phenotypes where facial bone wall thickness is more than 1 mm, vertical median bone loss was 1.1 mm. In contrast, in the thin-wall phenotypes where facial bone wall thickness was less than 1 mm, vertical median bone loss was approximately 7.5 mm [10]. These results suggested that vertical bone loss was 3.5 times more severe than findings reported in a canine model when the facial bone thickness was less than 1 mm. Especially in the esthetic zone, it was shown to be rare for facial bone wall thickness to be more than 1 mm [11]. In a study on facial bone wall thickness of the anterior maxilla, where the distance from apical region to the CEJ was 4 mm, as measured in 125 subjects using CBCT, median facial bone wall thickness was 0.47 mm in central incisors, 0.54 mm in lateral incisors, 0.45 mm in canines, and 0.73 mm in first premolars, suggesting that facial bone wall thickness was less than 1 mm in all areas. The proportions with more than 1 mm bone wall thickness were 4.6% in central incisors, 11.5% in lateral incisors, 8.6% in canines, and 27.5% in first premolars. These results showed that more than 1 mm bone wall thickness was noted in only about 25%, even in first premolars, where the labial bone was the thickest [12]. Since facial bone was thin, and surrounding bone mostly consisted of bundle bone, vertical bone resorption after tooth extraction was more severe in the esthetic zone (Fig. 1). Ridge preservation, immediate or early loading, and reconstruction of the hard and soft tissues need to be considered to avoid ridge resorption for esthetic implant treatment (Fig. 2).
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
3
Ridge alterations following tooth extraction At 6 months aer extracon Horizontal reducon in width Mean 3.8 ± 0.2 mm Bone resorpon change 29-63 %
>
Vercal reducon in height Mean 1.2 ± 0.1 mm Bone resorpon change 11-12 % Tan et al., 2012 4
At 8 weeks aer extracon With a facial bone wall thickness of ≤ 1 mm Vercal median bone loss 7.5 mm
>
With a facial bone wall thickness of > 1 mm Vercal median bone loss 1.1 mm Chappuis et al., 2014 10
Fig. 1 – Ridge alterations following tooth extraction.
Fig. 2 – Ridge alteration after immediate or early implant placement.
3.
Ridge preservation after tooth extraction
Various ridge preservation techniques have been introduced in the last 2 decades to prevent bone resorption in the alveolar socket. Materials including autografts, allografts [13,14], xenografts [15,16], and alloplasts [17,18] were introduced. Other techniques include the use of membranes, namely, absorbable [19] and nonabsorbable ones [20,21], and the combination of graft and materials [22,23]. Nevins et al. reported in a study on deproteinized bovine bone mineral used in the extraction socket in the anterior maxilla that resorption was prevented in the buccal plate of the alveolar ridge compared with that in non-grafted control sites [24]. These findings were also confirmed in animal studies using a canine model [25,26]. Furthermore, clinical results of ridge preservation in which Bio-Oss1 Collagen was placed in the fresh extraction socket and covered with a soft tissue graft of the palatal mucosa were reported. The cross-sectional area decreased by approximately 25% in the control group where no hard or tissue grafting was performed, but only by 3% in the Bio-Oss1 Collagen group, suggesting the potential of ridge preservation. In a systematic review and meta-analysis by Avila-Ortiz et al. [27], 8 randomized control trials were selected to evaluate the effect of alveolar ridge preservation [28–34,22]. The mean
horizontal ridge changes were 2.6 to 4.5 mm in the control group for which nothing was placed in the extraction socket, and 1.1 to 3.5 mm in the experimental group for which socket preservation was performed. The vertical ridge changes in the midbuccal area were 0.9 to 4.2 mm in the control group and +1.1 to 1.6 mm in the experimental group. The meta-analysis results showed that median buccolingual width change was 1.89 mm, median midbuccal height change was 2.07 mm, median midlingual height change was 1.18 mm, median mesial height change was 0.48 mm, and median distal height change was 0.24 mm. These results suggested that socket preservation was effective to prevent horizontal and vertical bone resorption after tooth extraction. Factors affecting ridge resorption after tooth extraction were investigated, and it was elucidated that flap elevation, the use of a membrane, and the application of a xenograft or an allograft lead to superior outcomes for the prevention of midbuccal and midlingual bone height resorption. However, bone resorption cannot be prevented completely, which is considered to be due to the influence of local and systematic factors that are not fully understood. A systematic review of alteration in bone quality after socket preservation with grafting materials by Chan et al. demonstrated that the proportion of remaining graft particles was 0–5% after 6 months when autogenous bone and bioactive glass were used [35]. On the other hand, the
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9
4
journal of prosthodontic research xxx (2015) xxx–xxx
proportion of remaining graft particles was greater with hydroxyapatite and xenograft (15–36%) than with calcium sulfate and demineralized freeze-dried bone allograft (5–15%). Xenografts such as Bio-Oss are integrated into bone, but are not absorbable, which allows the bone mass to be maintained [36]. Therefore, the use of this method is effective in the pontic area of the bridge. Caution should be exercised in terms of the timing of placement when implant treatment is planned.
4.
Immediate or early implant placement
According to the conventional protocol, an implant should be placed after 2–3 months of healing after tooth extraction. However, the longer the wait for healing of the extraction socket, the longer the treatment period, which causes ridge resorption in the edentulous area. Immediate or early placement after tooth extraction is considered effective from the esthetic point of view. Paolantonio et al. suggested that early implantation may preserve the alveolar anatomy and that the placement of a fixture in a fresh extraction socket may help maintain the bony crest structure [37]. In contrast, Arau´jo et al. elucidated in an animal study using a dog that the placement of an implant in the fresh extraction site does not prevent remodeling in the socket wall at 3 months after tooth extraction [38]. A number of clinical reports on immediate placement have been published since then [39–41], and it was demonstrated that bone resorption cannot be prevented completely by immediate placement. The results of a systematic review regarding alterations of the bone dimensions following immediate implant placement into an extraction socket by Lee et al. showed that the median amount of buccal bone resorption at 4–12 months after immediate placement was 1.07 mm horizontally and 0.78 mm vertically [42]. The weighted mean palatal bone dimensional reduction was 0.62 mm horizontally and 0.50 mm vertically. Meta-analysis results showed that the only factor affecting labial bone resorption was buccal plate thickness of the post-extraction socket. In the thinner buccal plate of an immediate implantation site, there was a tendency for vertical bone resorption to be higher, but for horizontal bone resorption to be lower than with a thicker buccal plate. The reduction of crestal bone height at sites with a thin buccal plate poses a significant clinical problem, even if the horizontal bone dimensional change may be less than at a site with a thick buccal plate. Chen et al. compared the esthetic outcomes between immediate placement and early placement in the anterior maxilla [43]. Recession of the midfacial mucosa of more than 1 mm was observed in 26% (9–41%) on average. When immediate implant placement with a bone graft was performed, the facial bone wall was not detectable on CBCT at 36–57% of sites, and these non-detectable sites had more recession of midfacial mucosa than sites with detectable facial bone. In immediate placement with simultaneous GBR, there is a high risk of membrane exposure. In early placement with simultaneous GBR, facial bone wall was confirmed on CBCT in more than 90% of cases. It was reported that the thickness of facial bone and the position of the facial bone crest are important factors affecting long-term esthetic stability after immediate placement. A systematic review of early implant
placement by Sanz et al. demonstrated that such placement is effective for soft and hard tissue preservation compared with delayed implant placement [44]. The proportions of bone height and width reductions were 13.11% and 19.85%, respectively. There was no significant difference in the implant survival rate compared with that for a delayed implant. Although a high success rate has been reported in both immediate and early placements, there is a high risk for gingival recession in the former. Therefore, caution should be exercised for smokers, and those with buccal bone of less than 1 mm, gingival biotype, and labial side implant being positioned in the esthetic zone [44,45]. Although the molar area shows a high success rate and a low rate of complications, soft and hard tissue augmentation is often required, depending on the size of the extraction socket. Although immediate and early placement is suggested in the premolar area due to a high percentage of thick buccal bone width and low esthetic requirements compared with those in the anterior area, it is safe to choose early placement in the anterior area, where esthetic requirements are greater.
5. Hard tissue augmentation in implant therapy A number of ridge augmentation methods of implant therapy have been reported, including guided bone regeneration (GBR) [46,47], maxillary sinus floor augmentation (MSFA) [48–51], vertical and/or lateral alveolar ridge augmentation [52–55], and distraction [56,57]. In the GBR method, barrier membrane with or without titanium reinforcement composed of expanded polytetrafluoroethylene (e-PTFE) is used [58]. However, biodegradable membranes composed of dura mater, poly-Llactic acid, and polyglycolic and collagen have been introduced to avoid second surgery for membrane removal [59,60]. A systematic review on the effectiveness of barrier membranes on bone regeneration [61] showed that the use of such membranes would increase the amount of vertical augmented bone (mean difference, 0.32 mm; P = 0.006). Furthermore, membranes do not increase postoperative infection, wound dehiscence, or membrane/bone graft exposure in either human or animal models. A systematic review comparing bone substitute materials (BSM) and autogenous bone (AB) showed that the mean implant survival rates were 98.6% for BSM, 88.6% for BSM mixed with AB, and 97.4% for AB alone, regarding MSFA [62]. A meta-analysis showed a trend towards higher implant survival when using BSM rather than AB, but the difference was not statistically significant. Concerning vertical and/or lateral alveolar ridge augmentation, mean implant survival rates were 97.4% for BSM, 100% for BSM mixed with AB, and 98.6% for AB alone. A meta-analysis of these studies showed no statistically significant difference between BSM and AB. Cochrane systematic review [63] on this topic showed that, although it is effective to use a bone substitute (Bio-Oss) for horizontal bone augmentation, implants placed in bone augmented with Bio-Oss showed an increased failure rate, and the healing time was increased by 3 months compared with that of autogenous bone. Although the distraction technique costs more than GBR and bone grafting, it could shorten the treatment period, so
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
5
Fig. 3 – The summary of hard tissue augmentation in implant therapy.
this technique is effective for vertical ridge augmentation. However, the distraction technique is difficult to apply to thin knife-edge bone. In any case, vertical augmentation techniques are associated with high complication rates (20–60%) [56,64]. Moreover, when comparing whether vertical augmentation procedures were more advantageous than short implants, a meta-analysis of two trials showed more implant failure, OR = 5.74 (95% CI, 0.92–35.82; borderline significance, P = 0.06), and statistically significantly more complications, OR = 4.97 (95% CI, 1.10–22.40), in the vertically augmented group. These results suggested that clinicians and patients should carefully evaluate the benefits and risks of possible treatment before deciding whether to use vertical ridge augmentation techniques or not (Fig. 3).
6. Soft tissue augmentation in implant therapy Berglundh and Lindhe proposed that mucosal attachment with certain minimum dimensions is necessary to protect osseointegration in an animal study, which is regarded as the ‘‘biological width’’ of the implant [65]. The 1-year prospective controlled clinical trial showed a potential of crestal bone loss after implant placement up to 1.45 mm within a year, even if the implant-abutment interface was in a supracrestal position when the initial gingival tissue thickness was 2.0 mm or less [66]. Nozawa et al. reported that there was a close relationship between the height and width of supra-implant mucosa, and proposed a hypothesis that the ratio of the height and width was approximately 1:1.5 [67]. It is considered that mucosal thickness is important for the stability of an implant surrounding bone, and a connective tissue graft (CTG) that increases the mucosal width is effective to maintain the height of surrounding mucosa. In terms of the CTG effect around implants, a 3-year retrospective study showed mucosal thickness gain of 1.4 mm on average 3 years after soft tissue grafting [68]. A split-mouth randomized controlled clinical trial that evaluated the effect of CTG for thickening peri-implant tissue in premolar or molar areas showed that the soft tissue at augmented sites was 1.3 mm thicker (P < 0.001) and had a significantly better pink esthetic score (P < 0.001) at 1 year after loading. Although patients were highly satisfied, half of the patients did not desire second surgery of CTG [69]. A one-year prospective cohort study evaluating peri-implant tissue volume gain and
stability after bone and soft tissue augmentation showed an increase of 1.3 mm on average between the preoperative period and immediately after crown placement. Labial thickness had decreased by only 0.04 mm on average at 1 year after prosthesis placement, and gingival recession was approximately 0.2 mm [70]. The effectiveness of CTG against immediate implant placement has also been reported. Yoshino et al. compared immediate placement with and without subepithelial connective tissue graft (SCTG) [71]. The results showed that mean gingival level change at 1 year postoperatively was significantly more pronounced in the control group ( 0.70 mm) than in the test group ( 0.25 mm). These findings suggested the effectiveness of CTG for maintenance of the peri-implant facial gingival level. There are two methods for collecting connective tissue, namely, those for vascularized interpositional periosteal-connective tissue and for free subepithelial connective tissue. A randomized controlled clinical trial by Akcalı et al. demonstrated that both soft tissue augmentation techniques were effective in increasing the volume of defective alveolar ridge in the anterior maxilla [72]. However, after 6 months, sites treated with a pediculated graft were superior in terms of maintaining the initially augmented volume and showed less shrinkage of the graft. A common donor site of free subepithelial connective tissue is the palate, so it is necessary to understand the anatomy of the palatal area. The distance from the gingival margin to the greater palatine artery was shown to range from 12 mm at the canine level to 14 mm at the mid-palatal aspect of the second molar level [73]. The greater palatine nerve is located in the apical area of the second to third molars [74], and it is said that the thickness of the palatal mucosa is greatest in the premolar area and smallest in the first molar area [75]. Caution is required to avoid an incision of more than 10 mm in depth from the CEJ of the upper molar area between the canine and the mesial side of the first molar. Maxillary tuberosity has been used as a donor site in addition to the palate in recent years. The connective tissue grafted from the tuberosity is stable in the first few months, but hyperplastic reaction and unesthetic white tissue patch appearance are often observed [76,77]. There is a report on the keratinized mucosa around implants describing that a significant correlation was found between keratinized gingiva of more than 2 mm in width and resorption of the surrounding bone [78,79]. In contrast, there is also a report describing that there was no correlation between the keratinized mucosa width and
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9
6
journal of prosthodontic research xxx (2015) xxx–xxx
Fig. 4 – The summary of soft tissue augmentation in implant therapy.
inflammation of the surrounding gingiva [80], or between keratinized mucosa and bone resorption [81]. When the keratinized mucosa width is more than 2 mm, the risk of bone resorption is low. However, it is necessary to consider whether the peri-implant area is easy to clean [82]. On the other hand, since these autogenous techniques require an additional donor site and have associated morbidity, allogenic graft materials have been introduced. A study comparing the effect between acellular dermal matrix (ADM) and SCTG showed that both groups exhibited increased tissue thickness (SCTG: 63% and ADM: 105%), reduced concavity measures (SCTG: 82% and ADM: 96%), and improved recessions (SCTG: 40% and ADM: 28%) from baseline to 6 months [83]. A randomized controlled prospective clinical trial evaluating the efficacy of a xenogeneic collagen matrix (Mucograft1) to augment the keratinized tissue around implants showed that there were similar esthetic results and significant increases in the vestibular depth in both groups as a result of the surgery. However, the patients treated with the Mucograft1 reported less pain, needed less pain medication, and the surgical time was shorter, although these differences from the CTG group were not statistically significant [84]. ADM and collagen matrix grafting materials will be used instead of connective tissue in the future to reduce patient burden (Fig. 4).
7.
Conclusion
It is important to understand alveolar ridge alteration and to minimize bone resorption after tooth extraction in order to achieve esthetic outcomes. Bone resorption cannot be avoided completely even if gentle tooth extraction, ridge preservation, and immediate or early placement are performed. Therefore, hard and soft tissue grafting is essential in esthetic implant treatment. The selection of grafting materials and augmentation methods should be carefully planned for bone augmentation, and it is ideal to ensure sufficient thickness of the soft tissue for long-term implant stability. It is also important to consider the burden and level of satisfaction of patients, such as in terms of donor site morbidity in hard and soft tissue grafting, and to pay attention to appropriate indications to avoid overtreatment.
Conflict of interest The authors have no conflict of interest with respect to the manuscript content or funding.
references
[1] Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19 Suppl.:43–61. [2] Grunder U, Gracis S, Capelli M. Influence of the 3-D boneto-implant relationship on esthetics. Int J Periodontics Restorative Dent 2005;25:113–9. [3] Arau´jo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 2005;32:212–8. [4] Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res 2012;23(Suppl. 5):1–21. [5] Blanco J, Nun˜ez V, Aracil L, Mun˜oz F, Ramos I. Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery. J Clin Periodontol 2008;35:640–8. [6] Arau´jo MG, Lindhe J. Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog. Clin Oral Implants Res 2009;20:545–9. [7] Saldanha JB, Casati MZ, Neto FH, Sallum EA, Nociti Jr FH. Smoking ay affect the alveolar process dimensions and radiographic bone density in maxillary extraction sites: a prospective study in humans. J Oral Maxillofac Surg 2006;64:1359–65. [8] Moya-Villaescusa MJ, Sa´nchez-Pe´rez A. Measurement of ridge alterations following tooth removal: a radiographic study in humans. Clin Oral Implants Res 2010;21:237–42. [9] Carlsson GE, Persson G. Morphologic changes of the mandible after extraction and wearing of dentures. A longitudinal, clinical, and X-ray cephalometric study covering 5 years. Odontol Revy 1967;18:27–54. [10] Chappuis V, Engel O, Reyes M, Shahim K, Nolte LP, Buser D. Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res 2013;92: 195S–201S. [11] Janua´rio AL, Duarte WR, Barriviera M, Mesti JC, Arau´jo MG, Lindhe J. Dimension of the facial bone wall in the anterior maxilla: a cone-beam computed tomography study. Clin Oral Implants Res 2011;22:1168–71. [12] Braut V, Bornstein MM, Belser U, Buser D. Thickness of the anterior maxillary facial bone wall – a retrospective radiographic study using cone beam computed tomography. Int J Periodontics Restorative Dent 2011;31:125–31. [13] Froum S, Cho SC, Rosenberg E, Rohrer M, Tarnow D. Histological comparison of healing extraction sockets implanted with bioactive glass or demineralized
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
freeze-dried bone allograft: a pilot study. J Periodontol 2002;73:94–102. Zubillaga G, Von Hagen S, Simon BI, Deasy MJ. Changes in alveolar bone height and width following post-extraction ridge augmentation using a fixed bioabsorbable membrane and demineralized freeze-dried bone osteoinductive graft. J Periodontol 2003;74:965–75. Artzi Z, Nemcovsky CE. The application of deproteinized bovine bone mineral for ridge preservation prior to implantation. Clinical and histological observations in a case report. J Periodontol 1998;69:1062–7. Carmagnola D, Adriaens P, Berglundh T. Healing of human extraction sockets filled with Bio-Oss. Clin Oral Implants Res 2003;14:137–43. Sa`ndor GK, Kainulainen VT, Queiroz JO, Carmichael RP, Oikarinen KS. Preservation of ridge dimensions following grafting with coral granules of 48 post-traumatic and postextraction dento-alveolar defects. Dent Traumatol 2003;19:221–7. Guarnieri R, Pecora G, Fini M, Aldini NN, Giardino R, Orsini G, et al. Medical grade calcium sulfate hemihydrate in healing of human extraction sockets: clinical and histological observations at 3 months. J Periodontol 2004;75:902–8. Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, et al. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol 1998;69:1044–9. Die`s F, Etienne D, Abboud NB, Ouhayoun JP. Bone regeneration in extraction sites after immediate placement of an e-PTFE membrane with or without a biomaterial. A report on 12 consecutive cases. Clin Oral Implants Res 1996;7:277–85. Bartee BK. Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique. J Oral Implantol 2001;27:194–7. Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol 2003;74: 990–9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Br Med J 2009;339:b2700. Nevins M, Camelo M, De Paoli S, Friedland B, Schenk RK, Parma-Benfenati S, et al. A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots. Int J Periodontics Restorative Dent 2006;26:19–29. Arau´jo MG, Lindhe J. Ridge preservation with the use of Biooss collagen: a 6-month study in the dog. Clin Oral Implants Res 2009;20:433–40. Arau´jo MG, Liljenberg B, Lindhe J. Dynamics of Bio-Oss Collagen incorporation in fresh extraction wounds: an experimental study in the dog. Clin Oral Implants Res 2010;21:55–64. Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res 2014;93:950–8. Aimetti M, Romano F, Griga FB, Godio L. Clinical and histologic healing of human extraction sockets filled with calcium sulfate. Int J Oral Maxillofac Implants 2009;24:902–9. Azizi A, Moghadam SA. A study on the effect of Bio-Oss and collagen membrane on the repair of dental socket. J Isfahan Dent Sch 2009;5:133–9.
[30] Barone A, Aldini NN, Fini M, Giardino R, Calvo Guirado JL, Covani U. Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphometric study. J Periodontol 2008;79: 1370–7. [31] Barone A, Orlando B, Cingano L, Marconcini S, Derchi G, Covani U. A randomized clinical trial to evaluate and compare implants placed in augmented versus nonaugmented extraction sockets: 3-year results. J Periodontol 2012;83:836–46. [32] Camargo PM, Lekovic V, Weinlaender M, Klokkevold PR, Kenney EB, Dimitrijevic B, et al. Influence of bioactive glass on changes in alveolar process dimensions after exodontia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:581–6. [33] Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L, Cardaropoli G. Socket preservation using bovine bone mineral and collagen membrane: a randomized controlled clinical trial with histologic analysis. Int J Periodontics Restorative Dent 2012;32:421–30. [34] Festa VM, Addabbo F, Laino L, Femiano F, Rullo R. Porcinederived xenograft combined with a soft cortical membrane versus extraction alone for implant site development: a clinical study in humans. Clin Implant Dent Relat Res 2013;15:707–13. [35] Chan HL, Lin GH, Fu JH, Wang HL. Alterations in bone quality after socket preservation with grafting materials: a systematic review. Int J Oral Maxillofac Implants 2013;28:710–20. [36] Gholami GA, Najafi B, Mashhadiabbas F, Goetz W, Najafi S. Clinical, histologic and histomorphometric evaluation of socket preservation using a synthetic nanocrystalline hydroxyapatite in comparison with a bovine xenograft: a randomized clinical trial. Clin Oral Implants Res 2012;23:1198–204. [37] Paolantonio M, Dolci M, Scarano A, d’Archivio D, di Placido G, Tumini V, et al. Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man. J Periodontol 2001;72:1560–71. [38] Arau´jo MG, Sukekava F, Wennstro¨m JL, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol 2005;32:645–52. [39] Esposito M, Grusovin MG, Polyzos IP, Felice P, Worthington HV. Timing of implant placement after tooth extraction: immediate, immediate-delayed or delayed implants? A Cochrane systematic review. Eur J Oral Implantol 2010;3:189–205. [40] Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res 2012;23(Suppl. 5):39–66. [41] Schropp L, Isidor F. Papilla dimension and soft tissue level after early vs. delayed placement of single-tooth implants: 10 year results from a randomized controlled clinical trial. Clin Oral Implants Res 2015;26:278–86. [42] Lee CT, Chiu TS, Chuang SK, Tarnow D, Stoupel J. Alterations of the bone dimension following immediate implant placement into extraction socket: systematic review and meta-analysis. J Clin Periodontol 2014;41: 914–26. [43] Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla – a systematic review. Int J Oral Maxillofac Implants 2014;29 Suppl.:186–215. [44] Sanz I, Garcia-Gargallo M, Herrera D, Martin C, Figuero E, Sanz M. Surgical protocols for early implant placement in post-extraction sockets; a systematic review. Clin Oral Implants Res 2012;23(Suppl. 5):67–79.
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
7
JPOR-280; No. of Pages 9
8
journal of prosthodontic research xxx (2015) xxx–xxx
[45] Ha¨mmerle CH, Arau´jo MG, Simion M. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res 2012;23(Suppl. 5):80–2. [46] Rakhmatia YD, Ayukawa Y, Furuhashi A, Koyano K. Current barrier membranes: titanium mesh and other membranes for guided bone regeneration in dental applications. J Prosthodont Res 2013;57:3–14. [47] Chiapasco M, Romeo E, Casentini P, Rimondini L. Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: a 1–3-year prospective study on humans. Clin Oral Implants Res 2004;15:82–95. [48] Hallman M, Sennerby L, Lundgren S. A clinical and histologic evaluation of implant integration in the posterior maxilla after sinus floor augmentation with autogenous bone, bovine hydroxyapatite, or a 20:80 mixture. Int J Oral Maxillofac Implants 2002;17:635–43. [49] Merli M, Moscatelli M, Mariotti G, Rotundo R, Nieri M. Autogenous bone versus deproteinised bovine bone matrix in 1-stage lateral sinus floor elevation in the severely atrophied maxilla: a randomised controlled trial. Eur J Oral Implantol 2013;6:27–37. [50] Sbordone L, Levin L, Guidetti F, Sbordone C, Glikman A, Schwartz-Arad D. Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning. Clin Oral Implants Res 2011;22:485–91. [51] Velich N, Ne´meth Z, To´th C, Szabo´ G. Long-term results with different bone substitutes used for sinus floor elevation. J Craniofac Surg 2004;15:38–41. [52] Dottore AM, Kawakami PY, Bechara K, Rodrigues JA, Cassoni A, Figueiredo LC, et al. Stability of implants placed in augmented posterior mandible after alveolar osteotomy using resorbable nonceramic hydroxyapatite or intraoral autogenous bone: 12-month follow-up. Clin Implant Dent Relat Res 2014;16:330–6. [53] Lopez-Cedrun JL. Implant rehabilitation of the edentulous posterior atrophic mandible: the sandwich osteotomy revisited. Int J Oral Maxillofac Implants 2011;26:195–202. [54] Meijndert L, Raghoebar GM, Meijer HJ, Vissink A. Clinical and radiographic characteristics of single-tooth replacements preceded by local ridge augmentation: a prospective randomized clinical trial. Clin Oral Implants Res 2008;19:1295–303. [55] Simion M, Jovanovic SA, Tinti C, Benfenati SP. Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up. Clin Oral Implants Res 2001;12:35–45. [56] Bianchi A, Felice P, Lizio G, Marchetti C. Alveolar distraction osteogenesis versus inlay bone grafting in posterior mandibular atrophy: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:282–92. [57] Vega LG, Bilbao A. Alveolar distraction osteogenesis for dental implant preparation: an update. Oral Maxillofac Surg Clin North Am 2010;22:369–85. [58] Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg 1988;81:672–6. [59] Simion M, Misitano U, Gionso L, Salvato A. Treatment of dehiscences and fenestrations around dental implants using resorbable and nonresorbable membranes associated with bone autografts: a comparative clinical study. Int J Oral Maxillofac Implants 1997;12:159–67. [60] Merli M, Moscatelli M, Mariotti G, Rotundo R, Bernardelli F, Nieri M. Bone level variation after vertical ridge augmentation: resorbable barriers versus
[61]
[62]
[63]
[64]
[65]
[66]
[67]
[68]
[69]
[70]
[71]
[72]
[73]
[74]
[75]
titanium-reinforced barriers. A 6-year double-blind randomized clinical trial. Int J Oral Maxillofac Implants 2014;29:905–13. Khojasteh A, Soheilifar S, Mohajerani H, Nowzari H. The effectiveness of barrier membranes on bone regeneration in localized bony defects: a systematic review. Int J Oral Maxillofac Implants 2013;28:1076–89. Al-Nawas B, Schiegnitz E. Augmentation procedures using bone substitute materials or autogenous bone – a systematic review and meta-analysis. Eur J Oral Implantol 2014;7(Suppl. 2):S219–34. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The efficacy of horizontal and vertical bone augmentation procedures for dental implants – a Cochrane systematic review. Eur J Oral Implantol 2009;2:167–84. Felice P, Marchetti C, Iezzi G, Piattelli A, Worthington H, Pellegrino G, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-controlled clinical trial. Clin Oral Implants Res 2009;20:1386–93. Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 1996;23:971–3. Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants 2009;24:712–9. Nozawa T, Enomoto H, Tsurumaki S, Ito K. Biologic heightwidth ratio of the buccal supra-implant mucosa. Eur J Esthet Dent 2006;1:208–14. Speroni S, Cicciu M, Maridati P, Grossi GB, Maiorana C. Clinical investigation of mucosal thickness stability after soft tissue grafting around implants: a 3-year retrospective study. Indian J Dent Res 2010;21:474–9. Wiesner G, Esposito M, Worthington H, Schlee M. Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory split-mouth randomised controlled clinical trial. Eur J Oral Implantol 2010;3:27–35. Schneider D, Grunder U, Ender A, Ha¨mmerle CH, Jung RE. Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study. Clin Oral Implants Res 2011;22:28–37. Yoshino S, Kan JY, Rungcharassaeng K, Roe P, Lozada JL. Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study. Int J Oral Maxillofac Implants 2014;29:432–40. Akcalı A, Schneider D, Unlu¨ F, Bıcakcı N, Ko¨se T, Ha¨mmerle CH. Soft tissue augmentation of ridge defects in the maxillary anterior area using two different methods: a randomized controlled clinical trial. Clin Oral Implants Res 2015;26:688–95. Monnet-Corti V, Santini A, Glise JM, Fouque-Deruelle C, Dillier FL, Lie´bart MF, et al. Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site. J Periodontol 2006;77:899–902. Klosek SK, Rungruang T. Anatomical study of the greater palatine artery and related structures of the palatal vault: considerations for palate as the subepithelial connective tissue graft donor site. Surg Radiol Anat 2009;31:245–50. Studer SP, Allen EP, Rees TC, Kouba A. The thickness of masticatory mucosa in the human hard palate and
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
JPOR-280; No. of Pages 9 journal of prosthodontic research xxx (2015) xxx–xxx
[76]
[77]
[78]
[79]
[80]
tuberosity as potential donor sites for ridge augmentation procedures. J Periodontol 1997;68:145–51. Jung UW, Um YJ, Choi SH. Histologic observation of soft tissue acquired from maxillary tuberosity area for root coverage. J Periodontol 2008;79:934–40. Dellavia C, Ricci G, Pettinari L, Allievi C, Grizzi F, Gagliano N. Human palatal and tuberosity mucosa as donor sites for ridge augmentation. Int J Periodontics Restorative Dent 2014;34:179–86. Roos-Jansa˚ker AM, Lindahl C, Renvert H, Renvert S. Nine- to fourteen-year follow-up of implant treatment. Part I: implant loss and associations to various factors. J Clin Periodontol 2006;33:283–9. Bouri Jr A, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 2008;23: 323–6. Wennstro¨m JL, Bengazi F, Lekholm U. The influence of the masticatory mucosa on the peri-implant
[81]
[82]
[83]
[84]
soft tissue condition. Clin Oral Implants Res 1994;5:1–8. Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 2006;77:1410–20. Wennstro¨m JL, Derks J. Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Clin Oral Implants Res 2012;23(Suppl. 6):136–46. Anderson LE, Inglehart MR, El-Kholy K, Eber R, Wang HL. Implant associated soft tissue defects in the anterior maxilla: a randomized control trial comparing subepithelial connective tissue graft and acellular dermal matrix allograft. Implant Dent 2014;23:416–25. Lorenzo R, Garcı´a V, Orsini M, Martin C, Sanz M. Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clin Oral Implants Res 2012;23:316–24.
Please cite this article in press as: Masaki C, et al. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res (2015), http://dx.doi.org/10.1016/j.jpor.2015.04.005
9
