Socket Augmentation: Rationale and Technique

Socket Augmentation: Rationale and Technique
2004
Wang, Hom-Lay DDS, MSD*; Kiyonobu, Koichi DDS, PhDÇƒÜ; Neiva, Rodrigo F. DDSÇƒ?
Implant Dentistry: Volume 13(4) 2004 pp 286-296
Lippincott Williams & Wilkins
*Professor and Director of Graduate Periodontics, Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI.
ÇƒÜPrivate practice, Tokyo, Japan; and formal Visiting Research Fellow, Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI.
Çƒ?Clinical Assistant Professor, Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI.
Reprint requests and correspondence to:
Hom-Lay Wang, DDS, MSD; Professor and Director of Graduate Periodontics; Department of Periodontics/Prevention/Geriatrics; University of Michigan School of Dentistry; 1011 North University Avenue; Ann Arbor, MI 48109-1078; Phone: (734) 763-3383; Fax: (734) 936-0374; E-mail: homlay@umich.edu
Abstract
The consequences of exodontia include alveolar bone resorption and ultimately atrophy to basal bone of the edentulous site/ridges. Ridge resorption proceeds quickly after tooth extraction and significantly reduces the possibility of placing implants without grafting procedures. The aims of this article are to describe the rationale behind alveolar ridge augmentation procedures aimed at preserving or minimizing the edentulous ridge volume loss. Because the goal of these approaches is to preserve bone, exodontia should be performed to preserve as much of the alveolar process as possible. After severance of the supra- and subcrestal fibrous attachment using scalpels and periotomes, elevation of the tooth frequently allows extraction with minimal socket wall damage. Extraction sockets should not be acutely infected and be completely free of any soft tissue fragments before any grafting or augmentation is attempted. Socket bleeding that mixes with the grafting material seems essential for success of this procedure. Various types of bone grafting materials have been suggested for this purpose, and some have shown promising results. Coverage of the grafted extraction site with wound dressing materials, coronal flap advancement, or even barrier membranes may enhance wound stability and an undisturbed healing process. Future controlled clinical trials are necessary to determine the ideal regimen for socket augmentation.
Tooth extraction results in alveolar bone loss as a result of resorption of the edentulous ridge.1-4 An average of 40% to 60% of original height and width is expected to be lost after tooth extraction, with the greatest loss happening within the first 2 years.5-9 This can negatively influence bone volume that is needed for future dental implant placement. Research has demonstrated that the alveolar ridge at the maxillary anterior area can be reduced by 23% in the first 6 months after exodontia, and an additional 11% in the following 5 years.10 In the posterior mandible, resorption happens primarily in the buccal/labial direction, resulting in a lingual displacement of alveolar crest.10 The rate of reduction of residual alveolar ridges has shown to be greater in mandibular (0.4 mm/year) than in maxillary arches (0.1 mm/year).11 As a consequence, alveolar ridge atrophy may prohibit optimal implant placement, compromising the final esthetic and functional outcomes.12
Augmentation of the residual alveolar socket at the time of tooth extraction (ie, socket augmentation, socket preservation, ridge preservation) has been evaluated in many studies.13-15 Multiple bone graft regimens and techniques have been suggested to minimize alveolar ridge atrophy and to evaluate new bone growth within extraction sockets.16-18 Generally, these procedures are primarily aimed at preserving the current bone level and hopefully regenerating new bone.
This article presents the rationale behind socket augmentation for future implant placement and describes a technique that has shown to not only facilitate tooth extraction with minimal damage to the surrounding anatomic structures, but also to improve alveolar bone quality and quantity.
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