Alveolar ridge resorption after tooth extraction: A consequence of a fundamental principle of bone physiology

Stig Hansson, Anders Halldin, Stig Hansson, Anders Halldin

Abstract

It is well established that tooth extraction is followed by a reduction of the buccolingual as well as the apicocoronal dimension of the alveolar ridge. Different measures have been taken to avoid this bone modelling process, such as immediate implant placement and bone grafting, but in most cases with disappointing results. One fundamental principle of bone physiology is the adaptation of bone mass and bone structure to the levels and frequencies of strain. In the present article, it is shown that the reduction of the alveolar ridge dimensions after tooth extraction is a natural consequence of this physiological principle.

Keywords: bone resorption; implant; tooth extraction.

Figures

Figure 1.
Figure 1.
(a) Tensile/compressive stresses and shear stresses on the surfaces of an infinitesimal cubic element, (b) principal stresses and (c) principal strains.
Figure 2.
Figure 2.
(a) A piece of a material that is unloaded and (b) a distributed tensile force (F) elongates the piece of material.
Figure 3.
Figure 3.
A beam, with a symmetric cross section, subjected to pure bending. The bending moment (M) induces tensile stresses and strains in the lower half of the beam and compressive stresses and strains in the upper half.
Figure 4.
Figure 4.
Schematic picture of a section of a mandible seen from above. The section contains a tooth, the periodontal ligament and the surrounding bone. The mandible section is subjected to bending in the horizontal plane. The tensile and compressive strains and the length changes are the highest buccally and lingually.
Figure 5.
Figure 5.
(a) A section of a mandible containing one tooth. The mandible section is subjected to bending in a vertical plane, which creates strains. The strains are highest in the upper and lower extremities of the section. (b) The mandible section seen from above. The length changes in the uppermost part are shown.
Figure 6.
Figure 6.
(a) A mandible section containing one tooth (bottom) or one extraction socket (top), as seen from above. The mandible section is subjected to bending in a horizontal plane with a specific bending moment (Mz). The stiffness of the mandible section is the same in these two cases. Consequently, the strains are the same. (b) When the extraction socket is filled with bone, it becomes stiffer and the strains are reduced. (c) A mandible section containing one tooth (bottom) or one extraction socket (top). The mandible section is subjected to bending in a vertical plane with a specific bending moment (My). The stiffness of the mandible section is the same in these two cases. Consequently, the strains are the same. (d) When the extraction socket is filled with bone, it becomes stiffer and the strains are reduced.
Figure 7.
Figure 7.
(a) A mandible section, containing an implant, as seen from above. The mandible section is subjected to bending in the horizontal plane. The implant makes the mandible section stiffer, and the strains are reduced. (b) A mandible section containing an implant. The mandible section is subjected to bending in a vertical plane. The implant makes the mandible section stiffer, and the strains are reduced.

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