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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 579-585. doi: 10.19723/j.issn.1671-167X.2019.03.030

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Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis

Li-ping ZHAO1,2,Wen-jie HU1△(),Tao XU1,2,Ya-lin ZHAN1,3,Yi-ping WEI1,Min ZHEN1,Cui WANG1   

  1. 1. Department of Periodontology
    2. Department of Emergency
    3. Department of General Dentistry, First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-03-18 Online:2019-06-18 Published:2019-06-26
  • Supported by:
    Supported by the Capital Foundation for Clinical Characteristics Application Research (Z161100000516042), the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program (BMU2019LCKXJ010)

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Abstract: Objective: To evaluate and to compare dimensional alterations of hard and soft tissues in molar extraction sites with irregular deficiency of bone plates due to advanced periodontitis receiving two different procedures, namely the flapped and flapless techniques with Bio-Gide? membrane covering the Bio-Oss? material for ridge preservation. Methods: Twenty-three patients with 24 infected-molar extraction sites received ridge preservation procedure, the first consecutive 12 sites belonged to the flap group (a full thickness mucoperiosteal flap and primary soft tissue closure) and the following 12 sites belonged to the flapless group (minimal flap with a collagen sponge and a secondary soft tissue closure). Width of keratinized tissue was evaluated before tooth extraction and after 6-month healing. Parallel periapical radiographs were taken immediately and 6 months after extraction to evaluate vertical bone changes. The width of the ridge was measured in the center of the ridge at the time of tooth extraction and after 6 months at implant placement. Results: After 6 months, width of keratinized tissue decreased (1.6±1.5) mm in the flap group (P=0.004) when compared with (0.3±1.6) mm in the flapless group (P>0.05). Both groups showed increases in ridge height from the central aspect, (5.53±4.20) mm for flap group and (7.70±4.35) mm for flapless group. These differences between the groups were not statistically significant (P=0.226). The ridge widths were (9.5±2.2) mm for flap group and (9.3±1.0) mm for flapless group at the time of implant insertion, and no statistical significance was observed between the flap and flapless groups. Conclusion: The study points out that both ridge preservation techniques were effective in increasing ridge height and minimizing ridge resorption after tooth extraction, and the ridge width allowed the placement of implants 6 months after ridge preservation. The flapless technique gave positive outcome in terms of the keratinized gingival width than that of the flap technique.

Key words: Periodontal diseases, Alveolar ridge augmentation, Molars, Parallel periapical radiograph

CLC Number: 

  • R782.1

Figure 1

Step-by-step flap procedures for ridge preservation with a flap procedure Flap procedure: A, view of the hopeless mandible molar; B, site after atraumatic extraction; C, socket filled and condensed with Bio-Oss? under light pressure; D, collagen membrane trimmed and placed over bone graft; E, advanced coronally flap and soft tissue primary closure; F, site evaluation after 6 months; G, periapical image before extraction; H, periapical image 6 months after ridge preservation; I, periapical image immediately after implant placement."

Figure 2

Step-by-step flapless procedures for ridge preservation with a flapless procedure Flapless procedure: A, view of the hopeless mandible molar; B, site after atraumatic extraction; C, socket filled, condensed with Bio-Oss? under light pressure and covered by collagen membrane; D, collagen sponge; E, collagen sponge to cover collagen membrane and wound sutured; F, site evaluation after 6 months; G, periapical image before extraction; H, periapical image 6 months after ridge preservation; I, periapical image immediately after implant placement."

Figure 3

Parallel periapical radiographs obtained immediately (A) and after 6 months (B) healing after ridge preservation MHplate, the distance between the alveolar ridge and reference at the mesial aspect; CHplate, the distance between the alveolar ridge and refe-rence at the central aspect; DHplate, the distance between the alveolar ridge and reference at the distal aspect; CEJ, cemento-enamel junction."

Table 1

Patient- and site-related characteristics in the two procedure groups"

ItemsFlap groupFlapless groupP
Age/years, x?±s49.3±7.446.1±5.90.247
Gender (male ∶female), n9 ∶38 ∶4
Total number of teeth, n1212
Tooth position, n
Maxillary molar22
Mandible molar1010
Probing depth/mm, x?±s5.9±1.45.9±2.00.972
Gingival recession/mm, x?±s1.0±0.91.4±1.20.442
Bleeding index, x?±s3.1±0.63.3±0.90.517
Healingtime/months, x?±s6.5±0.67.2±3.10.423

Table 2

Mean changes in keratinized width from baseline to 6 months"

ItemsFlap groupFlapless groupP
Baseline/mm, x?±s5.1±1.64.5±1.50.362
6 months/mm, x?±s3.5±2.14.2±1.30.325
Differences/mm, x?±s-1.6±1.5-0.3±1.60.054
P0.0040.478

Table 3

Changes in ridge width and ridge width 6 months after alveolar ridge preservation"

ItemsFlap groupFlapless groupP
BLWC/mm, x?±s-2.5±1.3-1.9±2.50.510
BLW/mm, x?±s9.5±2.29.3±1.00.772

Table 4

Vertical dimensional changes after alveolar ridge preservation"

ItemsBaseline6 monthsDifferencesP
MHplate/mm, x?±sFlap group4.47±3.183.80±1.380.67±2.390.875
Flapless group5.06±2.543.81±1.771.25±2.410.100
P0.561
CHplate/mm, x?±sFlap group9.45±4.593.92±2.165.53±4.200.001
Flapless group11.86±4.394.17±2.267.70±4.350.000
P0.226
DHplate/mm, x?±sFlap group5.35±3.453.07±1.842.28±2.460.008
Flapless group3.45±1.712.93±2.160.52±1.380.222
P0.044
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