The Effect of Periodontal Phenotype Characteristics on Post-Extraction Dimensional Changes of The Alveolar Ridge: A Prospective Case Series.

Couso-Queiruga, Emilio; Graham, Zachary A; Peter, Tabitha; Gonzalez-Martin, Oscar; Galindo-Moreno, Pablo; Avila-Ortiz, Gustavo (2023). The Effect of Periodontal Phenotype Characteristics on Post-Extraction Dimensional Changes of The Alveolar Ridge: A Prospective Case Series. Journal of clinical periodontology, 50(5), pp. 694-706. Wiley 10.1111/jcpe.13781

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AIM

This study was primarily aimed at assessing the effect that specific periodontal phenotypic characteristics have on alveolar ridge remodeling after tooth extraction.

MATERIALS AND METHODS

Patients in need of extraction of a non-molar maxillary tooth were enrolled. Baseline phenotypic characteristics (i.e., mid-facial and mid-palatal soft tissue and bone thickness, and supracrestal soft tissue height [STH]) were recorded upon extraction. A set of clinical, digital imaging (linear and volumetric), and patient-reported outcomes were assessed over a 14-week healing period.

RESULTS

A total of 78 subjects were screened. Forty-two subjects completed the study. Linear and volumetric bone changes, as well as, vertical linear soft tissue and alveolar ridge volume (soft tissue contour) variations, were indicative of a marked dimensional reduction of the alveolar ridge over time. Horizontal facial and palatal soft tissue thickness gain was observed. Thin facial bone (≤1mm) upon extraction, compared with thick facial bone (>1mm), was associated with greater linear horizontal (-4.57±2.31mm vs. -2.17±1.65mm, P=0.003), and vertical mid-facial (-0.95±0.67mm vs. -4.08±3.52mm, P<0.001) and mid-palatal (-2.03±2.08mm vs. -1.12±0.99mm, P=0.027) bone loss, as well as greater total (-34±10% vs. 15±6%, P<0.001), facial (-51±19% vs. 28±18%, P=0.040), and palatal bone volume reduction (-26±14% vs. -8±10%, P<0.001). Aside from alveolar bone thickness, it was also observed that STH is a predictor of alveolar ridge resorption since this variable was directly correlated with bone volume reduction. Patient-reported discomfort scores progressively decreased over time and mean satisfaction upon study completion was 94.5±0.83 out of 100.

CONCLUSIONS

Alveolar ridge remodeling is a physiologic phenomenon that occurs after tooth extraction. Post-extraction alveolar ridge atrophy is more marked on the facio-coronal aspect. These dimensional changes are more pronounced in sites exhibiting a thin facial bone phenotype (Clinicaltrials.gov NCT02668289).

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