Relate Tooth Alveolar Extraction Socket Anatomy to Alveolar Remodeling Rate

Study of Tooth Alveolar Extraction Socket Anatomy and Its Relation to Alveolar Post-extraction Changes

In patients that are going to be subjected to a tooth extraction in the anterior maxillary (from canine to canine) does the position of the intact alveolar socket related to maxillary basal bone interferes with the rate of resorption and remodeling process of the alveolar ridge ?

Study Overview

• Status: Unknown
• Conditions: Bone Resorption; Alveolar Bone Loss; Loss of Teeth Due to Extraction
• Intervention / Treatment: Procedure: Tooth Extraction; Radiation: Cone-Beam technology evaluation; Other: Measure Alveolar Socket Remodeling

Detailed Description

We intend to demonstrate the physiologic process of the post-extraction socket and we hypothesized that the position of the socket in relation to basal bone, may project the remodeling process through three different equations.

A- tooth-periodontal apparatus is placed buccally of the basal bone - Equation 1

Anatomy Features- only 1-2 mm of lamina dura on the buccal part, 1-2mm of lamina dura on the palatal, plus basal bone.

Physiologic features - when the alveolar apparatus remodels, after tooth extraction, the amount that we project for resorption is : 1-2 mm of buccal lamina dura, the buccal-palatal dimension of the tooth that was extracted plus the 1-2 mm of palatal lamina dura.

At 6 month we hypothesized that 3 mm of trabecular bone may be present, so we may account for 2-3 mm more.

Due to conical anatomy of anterior teeth, the amount of trabecular bone will be more pronounced in the coronal area than in apical area, so we also account for that variation.

At this stage we project that the amount of ridge dimension will be :

buccal soft tissue (BST) + trabecular alveolar bone (ATB) + basal bone (BB) + palatal soft tissue (PST) Equation at 6 Month = (BST + ATB + PST).

But at 1 year the trabecular bone may be absent, so we project that the equation will be :

buccal soft tissue+basal bone+palatal soft tissue. Equation at 1 Year (BST + BB + PST)

at the end, ridge dimension will be : palatal basal bone plus soft tissue buccally and palatally.

Numbers for Buccal placed alveolus apparatus :

At Pre-extraction appointment (estimate) :

BST+ Lamina Dura Buccal + tooth buccal lingual dimension + palatal lamina dura + BB + PST (3mm + 1mm + X+ 1mm + Y + 3mm) = 8 mm + X (a or b or c) + Y (a or b or c)

X = For Anterior Teeth= 3 measures = coronal (Xa) + middle (Xb) + apical (Xc) Y- Basal bone is genetically predetermined and vary from person to person but geometrically can have two measures one middle (Ya) and one apical (Yb)

Note : the buccal-lingual dimensions vary from coronal to apical (either in the tooth root and in basal bone), so we hypothesize that the subtraction from pre-extraction values to post-extraction will more pronounced in coronal area than in the apical area.

At 6 month post-extraction :

BST+ ATB (varies coronal (a) , middle (b) , apical (c)) + BB + PST (3mm + ATB (a or b or c) + Y + 3mm) = 6 mm + ATB (a or b or c) + Y (a or b)

At 1 Year post-extraction

BST + BB + PST (3mm + X1 + 3mm) = 6 mm + Y (a or b )

Example For Central Incisor :

Before Extraction (estimate)

at coronal part pre-extraction : 3 + 1 + 10 (Xa) + 1 + 3 (Ya) + 3 = 21 mm at middle part pre-extraction : 3 + 1 + 5 (Xb) + 1 + 5 (Yb) + 3 = 18 mm at apical part pre-extraction : 3 + 1 + 2 (Xc) + 1 + 8 (Yc) + 3 = 18 mm

After Extraction 6 month (estimate)

at coronal part post-extraction : 3 + 3 (ATBa) + 3 + 3 = 12 mm at middle part post-extraction : 3 + 2 (ATBb) + 5 + 3 = 13 mm at apical part post-extraction : 3 + 1 (ATBc) + 8 + 3 = 15 mm

Variation expected (estimate) from Pre-extraction to 6 month post-extraction in buccally placed alveolar socket will be (estimate):

At coronal part ⨺ (variation) = 9 mm (43% reduction) at middle part ⨺ (variation) = 5 mm (28% reduction) at middle part ⨺ (variation) = 3 mm (17% reduction)

After Extraction 1 Year (estimate)

at coronal part post-extraction : 3 + 3 + 3 = 9 mm at middle part post-extraction : 3 + 5 + 3 = 11 mm at apical part post-extraction : 3 + 8 + 3 = 14 mm

Variation expected (estimate) from Pre-extraction to 1 year post extraction in buccally placed alveolar socket will be:

At coronal part ⨺ (variation) = 12 mm (57% reduction) at middle part ⨺ (variation) = 7 mm (39% reduction) at middle part ⨺ (variation) = 4 mm (22% reduction)

B- Tooth-periodontal apparatus is inferior of the basal bone (true socket) - Equation 2

Anatomy features- only 1-2 mm of lamina dura on the buccal and palatal part, no basal bone palatal, the basal bone is superior to the alveolar process.

Physiologic features - when the alveolar apparatus remodels after tooth extraction we project that the amount of resorption will be 1-2 mm of buccal lamina dura, the buccal-palatal dimension of the tooth that was extracted, plus the 1-2 mm of palatal lamina dura.

At 6 month, we hypothesized that 3 mm of trabecular bone may be present, so we may account for 2-3 mm more. At this stage the amount of ridge dimension will be composed by :

buccal soft tissue (BST) + trabecular alveolar bone (ATB) + palatal soft tissue (PST), (BST+ATB+PST).

note : lamina dura disappears, but because periosteum has to adhere to bone an outer cortical forms that surrounds remaining trabecular bone.

Numbers for Inferior placed alveolus apparatus :

At Pre-extraction appointment (estimate) :

BST+ Lamina Dura Buccal + tooth buccal-lingual dimension + palatal lamina dura + PST Equation = (3mm + 1mm + X+ 1mm + 3mm) = 8 mm + X (a or b or c)

X = For Anterior Teeth = 3 measures = coronal (Xa) + middle (Xb) + apical (Xc)

note : the buccal-lingual dimensions vary from coronal to apical (either in the tooth root and in basal bone), so we hypothesize that the subtraction from pre-extraction values to post-extraction will more pronounced in coronal area than in the apical area

At 6 month post-extraction (estimate) :

BST+ ATB (varies coronal (a) , middle (b) , apical (c) + PST Equation = (3mm + ATB (a or b or c) + 3mm) = 6 mm + ATB (a or b or c)

At 1 Year post-extraction (estimate)

BST + ATB (a or b or c) + PST (3mm + X1 + 3mm) = 6 mm + ATB (a or b or c)

Example For Central Incisor :

Before Extraction (estimate)

at coronal part pre-extraction : 3 + 1 + 10 (Xa) + 1 + 3 = 18 mm at middle part pre-extraction : 3 + 1 + 5 (Xb) + 1 + 3 = 13 mm at apical part pre-extraction : 3 + 1 + 2 (Xc) + 1 + 3 = 10 mm

After Extraction 6 month (estimate)

at coronal part post-extraction : 3 + 3 (ATBa) + 3 = 9 mm at middle part post-extraction : 3 + 2 (ATBb) + 3 = 8 mm at apical part post-extraction : 3 + 1 (ATBc) + 3 = 7 mm

Variation expected (projected) from Pre-extraction to 6 month post-extraction in inferior placed alveolar socket will be (estimate):

At coronal part ⨺ (variation) = 9 mm (43% reduction) at middle part ⨺ (variation) = 5 mm (28% reduction) at middle part ⨺ (variation) = 3 mm (17% reduction)

After Extraction 1 Year (estimate)

at coronal part post-extraction : 3 + 2 + 3 = 8 mm at middle part post-extraction : 3 + 2 + 3 = 8 mm at apical part post-extraction : 3 + 2 + 3 = 8 mm

Variation expected (estimate) from Pre-extraction to 1 year post-extraction in inferior placed alveolar socket will be:

at coronal part ⨺ (variation) = 10 mm (57% reduction) at middle part ⨺ (variation) = 5 mm (38% reduction) at middle part ⨺ (variation) = 2 mm (20% reduction)

C- tooth-periodontal apparatus is in (imbedded) the basal bone - Equation 3

Anatomy features- only 1-2 mm of lamina dura on the buccal part, 1-2mm of lamina dura on the palatal plus basal bone on the buccal and on the lingual part.

Physiologic features - when the alveolar apparatus remodels after tooth extraction, we project that the amount of resorption will be 1-2 mm of buccal lamina dura the buccal-palatal dimension of the tooth that was extracted plus the 1-2 mm of palatal lamina dura.

At 6 month, we hypothesized that 3 mm of trabecular bone may be present so we may account for 2-3mm more. At this stage the amount of ridge dimension will be composed by:

buccal soft tissue (BST) + Buccal basal bone (BBB) + trabecular alveolar bone (ATB)+ palatal basal bone (LBB)+ palatal soft tissue (PST), Equation = (BST+BBB+ATB+PBB+PST)

Numbers for Imbedded alveolus apparatus :

At Pre-extraction appointment (estimate):

BST+ BBB (Y1 a or b or c) + Lamina Dura Buccal + tooth buccal lingual dimension (X a or b or c) + palatal lamina dura + PBB (Y2 a or b or c or d) + PST (3mm + 1mm + X+ 1mm + 3mm) = 8 mm +Y1 + X (a or b or c or d) +Y2

X = For Anterior teeth = 3 measures = coronal (Xa) + middle (Xb) + apical (Xc)

Y1- Buccal Basal bone is genetically predetermined and vary from person to person geometrically 3 measures coronal (a) middle (b) and apical (c)

Y2- Palatal Basal bone (PBB) is genetically predetermined and vary from person to person geometrically 3 measures coronal (a) middle (b) and apical (c)

note : the buccal-lingual dimensions vary from coronal to apical (either in the tooth root and in basal bone), so we hypothesize that the subtraction from pre-extraction values to post-extraction will more pronounced in coronal area than in the apical area

At 6 month post-extraction (estimate):

BST+ BBB (Y1 a or b or c) + ATB (varies coronal (a) , middle (b) , apical (c)) + PBB (Y2 a or b or c) + PST (3mm + Y1+ ATB (a or b or c) + Y2 + 3mm) = 6 mm + ATB (a or b or c)

At 1 Year post-extraction (estimate)

BST+ BBB (Y1 a or b or c) + ATB (a or b or c) + PBB (Y2 a or b or c) + PST (3mm + X1 + 3mm) = 6 mm + Y1 (a or b or c) + ATB (a or b or c) + + PBB (Y2 a or b or c)

Example For Central Incisor :

Before Extraction (estimate)

at coronal part pre-extraction : 3 + 3 + 1 + 10 (Xa) + 1 + 3 + 3 = 24 mm at middle part pre-extraction : 3 + 5 + 1+ 5 (Xb) + 1 + 5 + 3 = 23 mm at apical part pre-extraction : 3 + 8 + 1 + 2 (Xc) + 1 + 8 + 3 = 26 mm

After Extraction 6 month (estimate)

at coronal part post-extraction : 3 + 3 + 10 (ATBa) + 3 + 3 = 22 mm at middle part post-extraction : 3 + 5 + 5 (ATBb) + 5 + 3 = 21 mm at apical part post-extraction : 3 + 8 + 2 (ATBc) + 8 + 3 = 24 mm

Variation expected (estimate) from Pre-extraction to 6 month post-extraction in imbedded placed alveolar socket will be:

At coronal part ⨺ (variation) = 2 mm (8% reduction) at middle part ⨺ (variation) = 2 mm (8% reduction) at middle part ⨺ (variation) = 2 mm (8% reduction)

After (estimate) Extraction 1 Year

at coronal part post-extraction : 3 + 3? + 10 + 3 ?+ 3 = 14 mm at middle part post-extraction : 3 + 5?+ 5 + 5? + 3 = 18 mm at apical part post-extraction : 3 + 8 ? + 2 + 8? + 3 = 8 mm

Variation expected (estimate) from Pre-extraction to 1 year post-extraction in imbedded placed alveolar socket will be:

At coronal part ⨺ (variation) = 2 mm (8% reduction) at middle part ⨺ (variation) = 2 mm (8% reduction) at middle part ⨺ (variation) = 2 mm (8% reduction)

• Study Type: Observational
• Enrollment (Anticipated): 45

Contacts and Locations

Study Locations

• Portugal
  • Lisbon, Portugal, 1500-662
    • Instituto de Implantologia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients that require at least on tooth extraction of the upper anterior jaw (maxilla) canine, central incisor and lateral incisor.

Description

Inclusion Criteria:

• Patient that require a maxillary anterior extraction
• Sign Informed Consent
• Indication for a two-stage implant placement

Exclusion Criteria:

• Indication for immediate implants
• Indication for alveolar socket preservation or bone regeneration
• Indication for soft tissue graft
• Diabetes
• taking oral or intravenous biphosphonates

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Alveolar Socket Below Basal Bone; Tooth and the alveolar socket are positioned below basal bone. Measure Alveolar Socket remodeling, after Tooth Extraction with cone-beam technology evaluation	Procedure: Tooth Extraction; Tooth from the maxillary anterior area extracted and alveolar socket remains intact; Radiation: Cone-Beam technology evaluation; Patient is submitted to a localized cone-beam image before tooth extraction and 6 month later, prior to implant installation.; Other Names: Computerized Tomography; Imaging exams; Other: Measure Alveolar Socket Remodeling; In a computer, cone-beam images are superimposed to measure total the amount of ridge dimension; Other Names: Digital Measurements
Alveolar Socket in Basal Bone (imbedded); Tooth and alveolar socket are positioned in basal bone. Measure Alveolar Socket remodeling, after Tooth Extraction with cone-beam technology evaluation	Procedure: Tooth Extraction; Tooth from the maxillary anterior area extracted and alveolar socket remains intact; Radiation: Cone-Beam technology evaluation; Patient is submitted to a localized cone-beam image before tooth extraction and 6 month later, prior to implant installation.; Other Names: Computerized Tomography; Imaging exams; Other: Measure Alveolar Socket Remodeling; In a computer, cone-beam images are superimposed to measure total the amount of ridge dimension; Other Names: Digital Measurements
Alveolar Socket Buccal to Basal Bone; Tooth and alveolar socket are positioned buccally in relation to maxillary basal bone. Measure Alveolar Socket remodeling, after Tooth Extraction with cone-beam technology evaluation	Procedure: Tooth Extraction; Tooth from the maxillary anterior area extracted and alveolar socket remains intact; Radiation: Cone-Beam technology evaluation; Patient is submitted to a localized cone-beam image before tooth extraction and 6 month later, prior to implant installation.; Other Names: Computerized Tomography; Imaging exams; Other: Measure Alveolar Socket Remodeling; In a computer, cone-beam images are superimposed to measure total the amount of ridge dimension; Other Names: Digital Measurements

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in alveolar ridge dimensions	report the change in alveolar extraction socket dimensions from tooth extraction to 1 year, measured in digital computer, from Cone-Beam originated images.	From Tooth extraction (baseline T0) to T1 (6 month) to T2 (12 month)

Collaborators and Investigators

• Sponsor: Implantology Institute
• Investigators: Principal Investigator: Andre Chen, Msc, Implantology Institute; Study Chair: Helena Francisco, Msc, Implantology Institute

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (ANTICIPATED): January 1, 2016
• Study Completion (ANTICIPATED): August 1, 2016

Study Registration Dates

• First Submitted: October 12, 2013
• First Submitted That Met QC Criteria: October 12, 2013
• First Posted (ESTIMATE): October 16, 2013

Study Record Updates

• Last Update Posted (ESTIMATE): October 16, 2013
• Last Update Submitted That Met QC Criteria: October 12, 2013
• Last Verified: October 1, 2013

More Information

Terms related to this study

• Keywords: Dental Implants; Extraction Sockets; Ridge dimensions; Dental Alveolar Anatomy; Bone Physiology
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Stomatognathic Diseases; Periodontal Diseases; Mouth Diseases; Bone Diseases; Periodontal Atrophy; Bone Resorption; Alveolar Bone Loss
• Other Study ID Numbers: II-04