Description of the bone-remodeling pattern after socket preservation procedures in human: a methodological study

Background: The bone remodeling after tooth extraction can
result in the loss of as much as 50% of the buccal wall and a
global crestal reduction in width of 3.87mm according to a
recent systematic review. Multiple surgical protocols using
biomaterials are proposed in order to limit the typical postextraction
bone resorption. However, because of the heterogeneity
of the studies and, more specifically, of the assessment methods,
it is difficult to assert the superiority of one technique over
another.
Aim: The objective of this study was to develop a new radiographic
method to assess alveolar bone remodeling after socket
preservation procedures.
Methods: Sixteen extraction sites (in 14 patients) localized in
the upper anterior maxilla were treated with bovine hydroxyapatite
(0.25–1mm particles) and a saddled connective tissue
graft. A radiographic 3-dimensional assessment of the hard
tissues was performed at baseline and at 3 months after the
procedure. Standardized horizontal measurements were taken at
three corono apical levels ( 2, 5, and 9mm) and at three
mesio-diatal level (Mesial, Center, and Distal) in the buccal and
palatal aspects. Vertical measurements were also recorded in
nine regions over the top of the alveolar crest.
Results: Extraction socket-preservation technique assessed in
the present study significantly reduced horizontal bone remodeling.
The horizontal dimension of the crest decreased by
1.6mm (20%) in the cervical regions ( 2mm level), experienced
a moderate decrease of 1mm (12%) at the 5mm level,
and experienced a very low decrease of 0.5mm(6%) in the apical
( 8mm) level. The losses were always significantly higher in
the buccal than in the palatal aspect. Buccally, the maximal
bone remodeling at the cervical level remained below 1mm.
Vertical bone resorption was homogeneous and was < 1mm in
the nine measured regions.
Conclusions and clinical implications: The radiographic measuring
methodology proved to be accurate and reproducible. It can
be applied in other clinical settings. Moreover, the surgical
procedure evaluated in the present study, significantly limits
the postextraction buccal bone remodeling compared with the
data found in the literature for untreated extraction socket in
the aesthetic area. However, a complete inhibition of the bone
remodeling was not reached and the authors suggest a surgical
technique using a ‘‘saddled’’ connective tissue graft to thicken
buccal soft tissue biotype and consequently compensate for
cervical bone loss.