Clin Oral Invest DOI 10.1007/s00784-014-1392-1
ORIGINAL ARTICLE
Immediate effects of tooth extraction on ridge integrity and dimensions Binnaz Leblebicioglu & Rachana Hegde & Vedat O. Yildiz & Dimitris N. Tatakis
Received: 27 August 2014 / Accepted: 18 December 2014 # Springer-Verlag Berlin Heidelberg 2015
Abstract Objectives This study aims to assess possible immediate postextraction changes in ridge integrity and width. Methods Tooth extractions (53 teeth in 30 adults) were performed following atraumatic techniques. Root trunk and ridge width were measured at the crest level in buccolingual direction. Similarly, socket width and buccal plate thickness were also determined. Pre- and post-extraction buccal plate dehiscence, fenestration, or fracture was recorded. Diameter and length of extracted tooth root were also measured. Multinomial logistic regression was used to reveal relationships between ridge outcome (expanded, stable, or collapsed groups) and assessed tooth/site parameters. Results Post-extraction, buccal plate fracture developed in 5 (9 %), dehiscence in 15 (28 %), and complete buccal plate loss in 2 sites (4 %). Following extraction, ridge width was expanded in 30 (57 %), collapsed in 12 (23 %), and remained unchanged in 11 (21 %) sites. In most sites (72 %), postextraction socket size was wider than pre-extraction root trunk width (p pre-extraction ridge width at 1 and 3 mm), collapse (e.g., collapse of the ridge defined as post-extraction ridge width < pre-extraction ridge width at 1 or 3 mm), or no change (equal pre- and post-extraction ridge width at 1 and 3 mm). If a site presented expansion at 1 mm and not at 3 mm, this was categorized as stable ridge since related changes were negligible (within 1 mm expansion at 1-mm level only). Multinomial logistic regression analysis was conducted to determine the relationship between the main outcome (expansion or collapse relative to stable ridge size) and the other covariates. The stable group of the main outcome was taken as referent group. Univariate logistic regression analyses were performed for each covariate, which was included in the full model if the covariate was significant (p0.05) (Table 1). The mean tooth mobility for all teeth was 0.7±0.1 [0(0–3)] (Table 1) with three teeth having class III (6 %) and five teeth having class II mobility (10 %). There was no statistical difference in postextraction ridge outcomes among teeth with different mobility (p>0.05). The mean GR was 2.2±0.2 (2[0–8]) mm (Table 1), with no statistically significant differences between the three outcome groups (p>0.05). The mean root trunk width at the alveolar crest was 8.0±0.2 [8(5–12)] mm, with molars (9.0± 0.3 [9(6–12)] mm) having wider trunk than premolars (7.0± 0.3 [6(5–8)] mm) and anterior (7.0±0.2 [7(6–9)] mm) teeth (p0.05
27 11 15
17 (63 %) 5 (45 %) 8 (53 %) 57 % molar 17 % premolar 27 % anterior
4 (15 %) 2 (18 %) 5 (33 %) 36 % molar 18 % premolar 45 % anterior
6 (22 %) 4 (36 %) 2 (13 %) 50 % molar 33 % premolar 17 % anterior
p>0.05
0.7±0.1 0 (0–3) 0 (51 %) I (32 %) II (10 %)
0.8±0.2 1 (0–3) 0 (43 %) I (40 %) II (10 %)
0.5±0.7 0 (0–2) 0(64 %) I (27 %) II (9 %)
0.8±0.3 0 (0–3) 0(58 %) I (17 %) II (8 %)
p>0.05
III (6 %)
III (7 %)
III (0 %)
III (17 %)
2.2±0.2 2 (0–8)
2.4±0.3 2 (0–6)
2±0.3 2 (1–4)
2.3±0.7 1 (0–8)
p>0.05
8±0.2 8 (5–12)
8±0.3 8 (6–11)
8±0.5 7 (6–11)
8±0.6 7 (5–12)
p>0.05
GR gingival recession, CEJ cementoenamel junction, BL buccolingual a
Based on Miller classification of tooth mobility
b
Multinomial Logistic Regression; stable outcome variable was assigned as reference category
significant predictor of ridge expansion or collapse (e.g., collapse of the ridge at 1 or at 3-mm level) (p>0.05) (Table 1). Pre-extraction dehiscence was noted in two sites (4 %) while pre-extraction fenestration was recorded for one site (2 %) (Table A). The mean pre-extraction alveolar ridge width was 9.3±0.3 and 11.0±0.3 mm at 1 and 3 mm apical to the alveolar crest, respectively (Table 2). Clinical parameters: post-extraction findings Five sites experienced buccal plate loss (9.4 %; three premolars and two molars; one maxillary and four mandibular sites). Dehiscence was noticed in 15 (28 %) post-extraction sites and most of these cases were either expanded or collapsed ridges (Table 2). The presence of post-extraction dehiscence was a statistically significant predictor for main outcome. It was significantly different for the collapsed group relative to the stable group (p0.05
9.3±0.3 9 (6-15) 10.2±0.3a 10 (6–16)b
9.4±0.3 9.5 (7-13) 11.0±0.4a 11 (8–15)
9.0±0.7 8 (6-14) 9.3±0.5 9 (7–13)
9.3±0.8 8 (7-15) 5.0±1.3a 6(0–11)
p=0.002
11.0±0.3 10 (8–16)
11.0±0.3 10 (8–15)
10.0±0.8 10 (8–16)
11.0±0.9 10 (7–16)
p=0.006
11.4±0.4a 12 (6–17) b
13.0±0.4a 12 (9–17)
10.0±0.8 9 (7–16)
7.4±1.3a 7 (0–14)
9.7±0.3 10 (6–15)
10.0±0.4 10 (7–14)
10.0±0.8 8 (7–15)
9.0±0.5 9 (6–11)
1.4±0.2 1 (0.3–5)
1.4±0.2 1 (1–3)
1.7±0.3 2 (0–3)
2.0±0.2 2 (0.3–5)
2.0±0.3 2 (1–4)
2.0±0.4 2 (1–4)
13.0±0.5 13 (8–19)
13.0±0.5 12 (10–15)
11.3±0.7 12 (8–15)
8.2±0.3 8 (5–11)
7.0±0.5 6 (5–10)
8.0±0.8 7 (3–13)
Buccal plate thickness at 1 mm (in mm) Mean±se 1.4±0.2 Median (range) 1 (0–5) Buccal plate thickness at 3 mm (in mm) Mean±se 2.0±0.2 Median (range) 2 (0.3–5) Longest root length (buccal; in mm) Mean±se 12.3±0.4 Median (range) 12 (8–19) Root diameter (widest region; in mm) Mean±se 7.7±0.3 Median (range) 8 (3–13) a
p>0.05
p≤0.02 p>0.05
p>0.05
p>0.05
p>0.05
Association between pre- and post-extraction (simple linear regression analysis; p0.05; data not shown) and between ridge width outcome groups (p>0.05; Table 2). The mean root diameter was 7.7±0.3 [8(3–13)] mm with expansion and collapse outcome groups having similar values (8.2±0.3 [8(6–11)] and 8±0.8 [7(3–13)] mm, respectively). Root diameter was smaller in the stable outcome group (7.2±
0.4 [7(6–10)]). However, between group differences were not statistically significant (p>0.05; Table 2). Excluding ridges with buccal plate loss, pre- and postextraction ridge width measurements at 1 and 3 mm were positively correlated to each other (r=0.77 and r=0.71, respectively; p
ORIGINAL ARTICLE
Immediate effects of tooth extraction on ridge integrity and dimensions Binnaz Leblebicioglu & Rachana Hegde & Vedat O. Yildiz & Dimitris N. Tatakis
Received: 27 August 2014 / Accepted: 18 December 2014 # Springer-Verlag Berlin Heidelberg 2015
Abstract Objectives This study aims to assess possible immediate postextraction changes in ridge integrity and width. Methods Tooth extractions (53 teeth in 30 adults) were performed following atraumatic techniques. Root trunk and ridge width were measured at the crest level in buccolingual direction. Similarly, socket width and buccal plate thickness were also determined. Pre- and post-extraction buccal plate dehiscence, fenestration, or fracture was recorded. Diameter and length of extracted tooth root were also measured. Multinomial logistic regression was used to reveal relationships between ridge outcome (expanded, stable, or collapsed groups) and assessed tooth/site parameters. Results Post-extraction, buccal plate fracture developed in 5 (9 %), dehiscence in 15 (28 %), and complete buccal plate loss in 2 sites (4 %). Following extraction, ridge width was expanded in 30 (57 %), collapsed in 12 (23 %), and remained unchanged in 11 (21 %) sites. In most sites (72 %), postextraction socket size was wider than pre-extraction root trunk width (p pre-extraction ridge width at 1 and 3 mm), collapse (e.g., collapse of the ridge defined as post-extraction ridge width < pre-extraction ridge width at 1 or 3 mm), or no change (equal pre- and post-extraction ridge width at 1 and 3 mm). If a site presented expansion at 1 mm and not at 3 mm, this was categorized as stable ridge since related changes were negligible (within 1 mm expansion at 1-mm level only). Multinomial logistic regression analysis was conducted to determine the relationship between the main outcome (expansion or collapse relative to stable ridge size) and the other covariates. The stable group of the main outcome was taken as referent group. Univariate logistic regression analyses were performed for each covariate, which was included in the full model if the covariate was significant (p0.05) (Table 1). The mean tooth mobility for all teeth was 0.7±0.1 [0(0–3)] (Table 1) with three teeth having class III (6 %) and five teeth having class II mobility (10 %). There was no statistical difference in postextraction ridge outcomes among teeth with different mobility (p>0.05). The mean GR was 2.2±0.2 (2[0–8]) mm (Table 1), with no statistically significant differences between the three outcome groups (p>0.05). The mean root trunk width at the alveolar crest was 8.0±0.2 [8(5–12)] mm, with molars (9.0± 0.3 [9(6–12)] mm) having wider trunk than premolars (7.0± 0.3 [6(5–8)] mm) and anterior (7.0±0.2 [7(6–9)] mm) teeth (p0.05
27 11 15
17 (63 %) 5 (45 %) 8 (53 %) 57 % molar 17 % premolar 27 % anterior
4 (15 %) 2 (18 %) 5 (33 %) 36 % molar 18 % premolar 45 % anterior
6 (22 %) 4 (36 %) 2 (13 %) 50 % molar 33 % premolar 17 % anterior
p>0.05
0.7±0.1 0 (0–3) 0 (51 %) I (32 %) II (10 %)
0.8±0.2 1 (0–3) 0 (43 %) I (40 %) II (10 %)
0.5±0.7 0 (0–2) 0(64 %) I (27 %) II (9 %)
0.8±0.3 0 (0–3) 0(58 %) I (17 %) II (8 %)
p>0.05
III (6 %)
III (7 %)
III (0 %)
III (17 %)
2.2±0.2 2 (0–8)
2.4±0.3 2 (0–6)
2±0.3 2 (1–4)
2.3±0.7 1 (0–8)
p>0.05
8±0.2 8 (5–12)
8±0.3 8 (6–11)
8±0.5 7 (6–11)
8±0.6 7 (5–12)
p>0.05
GR gingival recession, CEJ cementoenamel junction, BL buccolingual a
Based on Miller classification of tooth mobility
b
Multinomial Logistic Regression; stable outcome variable was assigned as reference category
significant predictor of ridge expansion or collapse (e.g., collapse of the ridge at 1 or at 3-mm level) (p>0.05) (Table 1). Pre-extraction dehiscence was noted in two sites (4 %) while pre-extraction fenestration was recorded for one site (2 %) (Table A). The mean pre-extraction alveolar ridge width was 9.3±0.3 and 11.0±0.3 mm at 1 and 3 mm apical to the alveolar crest, respectively (Table 2). Clinical parameters: post-extraction findings Five sites experienced buccal plate loss (9.4 %; three premolars and two molars; one maxillary and four mandibular sites). Dehiscence was noticed in 15 (28 %) post-extraction sites and most of these cases were either expanded or collapsed ridges (Table 2). The presence of post-extraction dehiscence was a statistically significant predictor for main outcome. It was significantly different for the collapsed group relative to the stable group (p0.05
9.3±0.3 9 (6-15) 10.2±0.3a 10 (6–16)b
9.4±0.3 9.5 (7-13) 11.0±0.4a 11 (8–15)
9.0±0.7 8 (6-14) 9.3±0.5 9 (7–13)
9.3±0.8 8 (7-15) 5.0±1.3a 6(0–11)
p=0.002
11.0±0.3 10 (8–16)
11.0±0.3 10 (8–15)
10.0±0.8 10 (8–16)
11.0±0.9 10 (7–16)
p=0.006
11.4±0.4a 12 (6–17) b
13.0±0.4a 12 (9–17)
10.0±0.8 9 (7–16)
7.4±1.3a 7 (0–14)
9.7±0.3 10 (6–15)
10.0±0.4 10 (7–14)
10.0±0.8 8 (7–15)
9.0±0.5 9 (6–11)
1.4±0.2 1 (0.3–5)
1.4±0.2 1 (1–3)
1.7±0.3 2 (0–3)
2.0±0.2 2 (0.3–5)
2.0±0.3 2 (1–4)
2.0±0.4 2 (1–4)
13.0±0.5 13 (8–19)
13.0±0.5 12 (10–15)
11.3±0.7 12 (8–15)
8.2±0.3 8 (5–11)
7.0±0.5 6 (5–10)
8.0±0.8 7 (3–13)
Buccal plate thickness at 1 mm (in mm) Mean±se 1.4±0.2 Median (range) 1 (0–5) Buccal plate thickness at 3 mm (in mm) Mean±se 2.0±0.2 Median (range) 2 (0.3–5) Longest root length (buccal; in mm) Mean±se 12.3±0.4 Median (range) 12 (8–19) Root diameter (widest region; in mm) Mean±se 7.7±0.3 Median (range) 8 (3–13) a
p>0.05
p≤0.02 p>0.05
p>0.05
p>0.05
p>0.05
Association between pre- and post-extraction (simple linear regression analysis; p0.05; data not shown) and between ridge width outcome groups (p>0.05; Table 2). The mean root diameter was 7.7±0.3 [8(3–13)] mm with expansion and collapse outcome groups having similar values (8.2±0.3 [8(6–11)] and 8±0.8 [7(3–13)] mm, respectively). Root diameter was smaller in the stable outcome group (7.2±
0.4 [7(6–10)]). However, between group differences were not statistically significant (p>0.05; Table 2). Excluding ridges with buccal plate loss, pre- and postextraction ridge width measurements at 1 and 3 mm were positively correlated to each other (r=0.77 and r=0.71, respectively; p
