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      Cortical and cancellous bone thickness on the anterior region of alveolar bone in Korean: a study of dentate human cadavers

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          Abstract

          PURPOSE

          The cortical bone thickness on the anterior region is important for achieving implant stability. The purpose of this study was to examine the thickness of the cortical and cancellous bones on the anterior region of the maxilla and mandible.

          MATERIALS AND METHODS

          Twenty-five cadaver heads were used (16 male and 9 female; mean death age, 56.7 years). After the long axis of alveolar process was set up, it was measured in 5 levels starting from 2 mm below the cementoenamel junction (L1) at intervals of 3 mm. All data was analysed statistically by one-way ANOVA at the .05 significance level.

          RESULTS

          The cortical bone thickness according to measurement levels in both the labial and lingual sides increased from L1 to L5, and the lingual side below L3 was significantly thicker than the labial side on the maxilla and mandible. In particular, the labial cortical bone thickness in the maxilla was the thinnest compared to the other regions. The cancellous bone thickness according to measurement levels increased from L1 to L5 on the maxilla, and on the mandible it was the thinnest at the middle level of the root.

          CONCLUSION

          For implant placement on the anterior region, a careful evaluation and full knowledge on the thickness of the cortical and cancellous bone are necessary, therefore, these results may provide an anatomic guideline to clinicians.

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          Dimensional ridge alterations following tooth extraction. An experimental study in the dog.

          Mauricio G Araújo, Jan Lindhe (2005)
          To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change. Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope. It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall. The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood. (c) Blackwell Munksgaard, 2005.
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            Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs.

            G Cardaropoli, M. Araujo, J Lindhe (2003)
            The aim of the present experiment was to study events involved in the healing of marginal, central and apical compartments of an extraction socket, from the formation of a blood clot, to bone tissue formation and remodeling of the newly formed hard tissue. Nine mongrel dogs were used for the experiment. The fourth mandibular premolars were selected for study and were divided into one mesial and one distal portion. The distal root was removed and the socket with surrounding soft and mineralized tissue was denoted "experimental unit". The dogs were killed 1, 3, 7, 14, 30, 60, 90, 120 and 180 days after the root extractions. Biopsies including the experimental units were demineralized in EDTA, dehydrated in ethanol and embedded in paraffin. Serial sections 7 microm thick were cut in a mesio-distal plane. From each biopsy, three sections representing the central part of the socket were selected for histological examination. Morphometric measurements were performed to determine the volume occupied by different types of tissues in the marginal, central and apical compartments of the extraction socket at different intervals. During the first 3 days of healing, a blood clot was found to occupy most of the extraction site. After seven days this clot was in part replaced with a provisional matrix (PCT). On day 14, the tissue of the socket was comprised of PM and woven bone. On day 30, mineralized bone occupied 88% of the socket volume. This tissue had decreased to 15% on day 180. The portion occupied by bone marrow (BM) in the day 60 specimens was about 75%, but had increased to 85% on day 180. The healing of an extraction socket involved a series of events including the formation of a coagulum that was replaced by (i) a provisional connective tissue matrix, (ii) woven bone, and (iii) lamellar bone and BM. During the healing process a hard tissue bridge--cortical bone--formed, which "closed" the socket.
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              Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations.

              Daniel Buser, William Martin, U Belser (2003)
              The placement of dental implants in the anterior maxilla is a challenge for clinicians because of patients' exacting esthetic demands and difficult pre-existing anatomy. This article presents anatomic and surgical considerations for these demanding indications for implant therapy. First, potential causes of esthetic implant failures are reviewed, discussing anatomic factors such as horizontal or vertical bone deficiencies and iatrogenic factors such as improper implant selection or the malpositioning of dental implants for an esthetic implant restoration. Furthermore, aspects of preoperative analysis are described in various clinical situations, followed by recommendations for the surgical procedures in single-tooth gaps and in extended edentulous spaces with multiple missing teeth. An ideal implant position in all 3 dimensions is required. These mesiodistal, apicocoronal, and orofacial dimensions are well described, defining "comfort" and "danger" zones for proper implant position in the anterior maxilla. During surgery, the emphasis is on proper implant selection to avoid oversized implants, careful and low-trauma soft tissue handling, and implant placement in a proper position using either a periodontal probe or a prefabricated surgical guide. If missing, the facial bone wall is augmented using a proper surgical technique, such as guided bone regeneration with barrier membranes and appropriate bone grafts and/or bone substitutes. Finally, precise wound closure using a submerged or a semi-submerged healing modality is recommended. Following a healing period of between 6 and 12 weeks, a reopening procedure is recommended with a punch technique to initiate the restorative phase of therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Adv Prosthodont
                Journal ID (iso-abbrev): J Adv Prosthodont
                Journal ID (publisher-id): JAP
                Title: The Journal of Advanced Prosthodontics
                Publisher: The Korean Academy of Prosthodontics
                ISSN (Print): 2005-7806
                ISSN (Electronic): 2005-7814
                Publication date (Print): August 2012
                Publication date (Electronic): 28 August 2012
                Volume: 4
                Issue: 3
                Pages: 146-152
                Affiliations
                [1 ]Department of Anatomy and Orofacial Development, School of Dentistry, Chosun University, Gwangju, Korea.
                [2 ]Department of Dental Prosthetics, School of Dentistry, Chosun University, Gwangju, Korea.
                Author notes
                Corresponding author: Chae-Heon Chung. Department of Dental Prosthetics, School of Dentistry, Chosun University, 375 Seosuk-dong, Dong-gu, Gwangju, 501-759, Korea. Tel. 82 62 220 3826, jhajung@ 123456chosun.ac.kr
                Article
                DOI: 10.4047/jap.2012.4.3.146
                PMC ID: 3439624
                PubMed ID: 22977722
                SO-VID: a65ba90f-5252-4b6e-bab9-a10e7c2dc790
                Copyright © © 2012 The Korean Academy of Prosthodontics
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 February 2012
                Date revision received : 08 June 2012
                Date accepted : 28 June 2012
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Dentistry
                Keywords: implant placement,anterior region,cortical bone thickness,cancellous bone thickness
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: implant placement, anterior region, cortical bone thickness, cancellous bone thickness

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