Dental Tribune Middle East & Africa Edition

buccal bone aspect of the bony ridge19 . The rate of residual ridge resorption is related to the time extended since the tooth was re- moved11 . Many factors such as trauma can cause loss of alveolar bone, since many extractions are done with no regard for maintaining the al- veolar bone volume12 . With time bone re- sorption will evolve up to 2 mm in verti- cal and 4 mm in horizontal directions the first year following the extraction18 . An ar- ticle published by Araujo in 2006, showed that implants placed directly after extrac- tion will not preserve the dimension of the ridge, which results in marginal bone loss21 . It is demonstrated that flap elevation will disturb the thin cellular layer of cells in periosteum which causes more resorption than conservative flapless technique6, this is why it is recommended in socket preser- vation surgeries in order to enhance heal- ing and lower or stabilize bone resorp- tion. On the other hand bone fillers may in- terfere with the earliest stages of alveolar bone healing and it may need several years to be absorbed8 , still it can lack resorption9 . It was found that implants placed into grafted sockets expressed a clinical perfor- mance similar to implants placed into non- grafted sites in terms of survival and mar- ginal bone loss. On the other hand, graft- ed sites made the placement of larger im- plants easier and did not required augmen- tation procedures compared to naturally healed sites17 . Another article published by Araujo in 2009, demonstrated that the placement of a biomaterial in an extraction socket will en- hance bone modeling and compensate the marginal ridge contraction20 . As shown in the clinical case, the socket preservation technique led to an esthetic success for several reasons, the absence of gray hue in the free gingiva with the pres- ervation of the interproximal bone between tooth 11 and implant 21. Note the dimen- sion of the preserved bone lead us to place a narrow neck implant in ideal position, the resulting occlusal forces did not cause any overload and conserved an excellent prog- nosis. It was noted that ridge resorption in the mandible is more than the maxilla14 . To- day many have investigated that BIC (Bone implant contact) of the natural compared to regenerated bone. Trisi and coll. found that BIC in rough surfaced implants is enhanced with time up to 72%15 . Valentini published an article showing that the BIC at the sites grafted with bovine bone fillers is greater than in the nongrafted sites16 . The aim of this article is to focus on the healing patterns of bone after socket pres- ervation techniques with focusing the light on the rationale for preservation of the di- mensions of the extraction sockets. Conclusion: Loss of teeth due to caries or traumas, of- ten result in hard and soft tissue collapse, therefore the preservation of bone vol- ume is of major importance in order to in- sure the proper implant and esthetic reha- bilitations. In order to insure the success of implant therapies, a sufficient volume of healthy bone at recipient site at the time of implant placement is mandatory. Today the commonly used method for ridge preservation procedure is a bone graft ma- terial placed in the extraction socket and covered by a cross or non-cross linked membrane followed by complete or par- tial flap closure. The decision to use socket preservation technique should be made on a case-by-case basis. Surgeons should fa- miliarize with the wide array of techniques and materials used in order to optimize and preserve the anatomy of bone and soft tissues. The following article offers infor- mations that can help clinicians to imple- ment the socket preservation technique in their daily practice. In conclusion the sock- et preservation technique seems to show important results concerning bone volume conservation and favorable architecture of the alveolar ridge in order to obtain ideal functional and esthetic prosthesis after im- plant rehabilitations12 . References: 1- Cardaropoli G., Araujo M. Dynamic of bone tis- sue formation in tooth exraction sites. An exper- imental study in dogs. J Clin Periodontal. 2003; 30(9): 809-18. 2- Araujo M., Linder E. Effect of a xenograft on ear- ly bone formation in extraction sockets: an experi- mental study in dog. Clin Oral Implants Res. 2009; 20(1): 1-6. 3- G.Huynh-Ba. Analysis of the socket bone wall di- mensions in the upper maxilla in relation to imme- diate implant placement. Clin Oral Implants Re- Figure 8: Periapical radiograph showing the resorbed apex of tooth 21. Figure 9: Clinical view after extraction of tooth 21, note the resorbed apex. Figure 10: Intraoral view of the socket of tooth 21 after been filled with porous bovine bone minerals. Figure 11: Periapical radiograph showing the xenograft in place in socket of tooth 21. Figure 12: Temporary crowns prepared in order to guide the healing of the surrounding tissues. Figure 13: Implant in place six months after the healing, the figure shows successful preservation of the ridge and placement of a regular-platform implant. Figure 14: Temporary crowns placed on tooth 11 and a single piece, direct-to-fixture provisional screw-retained restoration on site 21 to guide the healing process. search 2010; 21(1): 37-42. 4- P.J.Boyne. Osseous repair of the postextraction alveolus in man. Oral Surg Oral Med. Oral Pathol 1966; 21(6): 805-813. 5- J.Pietrokovski and M. Massler. Alveolar ridge re- sorption following tooth extraction. The journal of Prosthetic Dentistry 1967; 17(1): 21-27. 6- S.Fickl, O. Zuhr. Tissue alterations after tooth ex- traction with or without surgical trauma: a volu- metric study in the beagle dog. J.of Clin Periodon- tology 2008; 35(4): 356-363. 7- Z.Artzi, H.Tal.Porous bovine bone mineral in healing of human extraction sockets: Histochemi- cal observations at 9 months. J. of Periodontology 2001; 72(2): 152-159. 8-M.Araujo, E.Linder. The influence of Bio-Oss col- lagen on healing of an extraction socket: an ex- perimental study in dog. Int. J. of Periodontics and Res. Dentistry 2008; 28(2): 123-135. 9-A.Mordenfeld, M.Hallman. Histological and his- tomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone. Clin Oral Implants Research 2010; 21(9): 961-970. 10-Carlsson GE. Morphological changes of the mandible after extraction and wearing of den- tures. A longitudinal, clinical, and x-ray cephalo- metric study covering 5 years. Odontol Revy 1967; 18(1): 27-54. 11-Ulm C, Solar P. Reduction of the compact and cancellous bone substances of the edentulous mandible caused by resorption. Oral Surg Oral Med Oral Pathol 1992; 74(2): 131-6. 12-Marcus SE. Tooth retention and tooth loss in the permanent dentition of adults: United states, 1988-1991. J Dent Res 1996; 75: 684-95. 13-Zubillaga G. Changes in alveolar bone height and width following post-extraction ridge aug- mentation using a fixed bioabsorbable membrane and demineralized freeze-dried bone osteoinduc- tive graft. J Periodontol 2003; 74(7): 965-75. 14-Tallegren A. Changes in adult face height due to aging, wear and loss of teeth and prosthetic treatment. Acta Odontol Scand 1957; 15(24): 73- 122. 15-Trisi P. Bone-implant contact on machined and dual acid-etched surfaces after 2 months of healing in the human maxilla. J Periodontol 2003; 74(7): 945-56. 16-Valentini P. Histological evaluation of Bio-Oss in a 2-stage sinus floor elevation and implanta- tion procedure. A human case report. Clin Oral Im- plants Res 1998; 9(1): 59-64. 17- Barone A, Orlando B. A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extrac- tion sockets: 3-year results. J Periodontol. 2012; 83(7):836-46. 18-Rothamel, Quintessence 2010; 61(11): 1379-89. 19-Lekovic V. Preservation of alveolar bone in ex- traction sockets using bioabsorbable membranes. J Periodontol 1998; 69: 1044-9. 20-Araujo MG., Lindhe J. Ridge alterations follow- ing tooth extraction with and without flap eleva- tion: an experimental study in the dog. Clin Oral Implants Res 2009; 20(6): 545-9. 21-Araujo MG., Wennstrom JL. Modeling of the buccal and lingual bone walls in fresh extraction sites following implant installation. Clin Oral Im- plants Res 2006; 17: 600-614. Figure 15: Clinical view showing the healthy soft tissue surrounding the temporary crowns. Figure 16: Ideal biotype of the surrounding soft tissue ready for impres- sion. Figure 17, 18: Impression on the head of the implant simulating the surrounding soft tissues. Figure 19: Clinical presentation of the final esthetic result with the healthy surrounding soft tissues. The clinical crowns conserved the gingival architecture and met the patient’s esthetic demands. MEDIA CME Self-Instruction Program How to earn CME Credits? Contact CAPP: events@cappmea.com; +971 43616174 Rabih Abi Nader, DDS, MSc Oral Surg. and Im- plantology, Dipl. Patho. Oral. rader680@hotmail.com Carine Tabarani, DDS, MSc Oral Surg. and Im- plantology, Dipl. Patho. Oral. ctabarani@hotmail.com Contact Information Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 14 Fig. 16Fig. 15 Fig. 19Fig. 18Fig. 17 Fig. 13Fig. 12 13MEDIA CME – IMpLANT TRIBUNEDental tribune Middle East & Africa Edition | March-April 2013