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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (1): 33-41. doi: 10.19723/j.issn.1671-167X.2025.01.006

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Evaluation of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis

Yutong SHI1,2, Yiping WEI1, Wenjie HU1,*(), Tao XU3, Haoyun ZHANG1   

  1. 1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    2. Department of Oral Medicine, Peking University International Hospital, Beijing 102206, China
    3. Department of Emergency, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2024-10-08 Online:2025-02-18 Published:2025-01-25
  • Contact: Wenjie HU E-mail:huwenjie@pkuss.bjmu.edu.cn
  • Supported by:
    the Capital's Funds for Health Improvement and Research(2022-2-4103);Capital Foundation for Clinical Characteristics and Application Research(Z161100000516042)

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Abstract:

Objective: To evaluate the clinical and radiographic efficacy of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis compared with natural healing, and to preliminarily propose the surgical indication. Methods: A retrospective analysis was conducted on clinical data from patients with mandibular molars with severe periodontitis either receiving micro crestal flap-alveolar ridge preservation (MCF-ARP group) or undergoing natural healing in department of periodontology, Peking University School and Hospital of Stomatology from September 2013 to June 2021. Cone-beam computed tomography scannings performed before/immediately after extraction (as baseline) and repeated before implantation (after the extraction socket healing) were used to measure the ridge width, height and volumetric changes of the sockets, and the proportion of guided bone regeneration (GBR) during implant therapy were compared between the two groups. Results: Between baseline and healing, significant differences in changes of MCF-ARP group [(8.34±2.81) mm] and natural healing group [(3.82±3.58) mm] in the distances from mandibular canal to center of the tooth socket were recorded (P < 0.001). The ridge width at 1 mm below the most coronal aspect of the crest increased by (3.50±4.88) mm in the MCF-ARP group but decreased by (0.16±5.70) mm in the natural healing group, respectively (P=0.019). After healing, the MCF-ARP group showed the distances from mandibular canal to center of the tooth socket >8 mm in all the cases, with 97.1% exceeding 10 mm. Natural healing group displayed 23.1% of the cases with center bone height < 8 mm and 61.5% exceeding 10 mm. Volume changes at the buccal and lingual aspect as well as the total socket were significantly greater in the MCF-ARP group compared with natural healing group (P < 0.001).At the time of implantation, GBR was performed in 5 out of 68 subjects (8.3%) in the MCF-ARP group, whereas 8 out of 26 subjects (30.8%) in the natural healing group required GBR, reflecting significant difference (P=0.003). Conclusion: In the sites of mandibular molars with severe periodontitis, when the distances from mandibular canal to center of the tooth socket was not enough (less than 7 mm), clinicians could consider performing the micro crestal flap-alveolar ridge preservation to achieve augmentation for alveolar ridge and reduce the proportion of guided bone regeneration during implant therapy to reduce the difficulty and risk of injuries during implant therapy.

Key words: Severe periodontitis, Mandibular molars, Alveolar ridge preservation, Dental implant

CLC Number: 

  • R782.1

Figure 1

The representative case of the MCF-ARP group A, pre-operative photography; B, extraction socket after thorough debridement grafted with deproteinized bovine bone mineral; C, collagen membrane covered; D, collagen sponge inserted to the upper area and cross-mattress sutures; E, maturation of the soft tissues after a 6-month healing period; F, implant placed in the preserved socket in a prosthetically guided position. MCF-ARP, micro crestal flap-alveolar ridge reservation."

Figure 2

The representative case of the natural healing group A, pre-operative photography; B, extraction socket after thorough debridement; C, maturation of the soft tissues after a 6-month healing period; D, implant placed in the preserved socket in a prosthetically guided position."

Figure 3

Representative coronal CBCT slices image at the center of mandibular right first molar extraction site in the MCF-ARP group A, the image performed immediately after ridge preservation, the blue lines are the horizontal reference lines at the most coronal spot of man-dibular canal, the white circle is the mandibular canal contour; B, the image derived from superimposing the socket images of immediate (yellow lines) and 6-month recall time frames (red lines). BH, height of the buccal bone; LH, height of the lingual bone; CH, height in the center of the socket; W, bucco-lingual l width at 1 mm below the most coronal aspect of the crest; MCF-ARP, micro crestal flap-alveolar ridge preservation; CBCT, cone-beam computed tomography."

Figure 4

Select the defined region of interest of CBCT socket images of mandibular left first molar extraction site in the MCF-ARP group to measure volumetric changes A, the defined region of interest of extraction socket in the baseline CBCT images; B, the defined region of interest of extraction socket in the healing CBCT images, which is defined by the same planes as the baseline; C and D, volumetric changes are also assessed from the buccal aspects (blue part) and lingual aspects (pink part) in the baseline and healing CBCT images. MCF-ARP, micro crestal flap-alveolar ridge preservation; CBCT, cone-beam computed tomography."

Table 1

Demographics of the patients"

ItemsMCF-ARP group (n=63)Natural healing group (n=24)P value
Age/years51 (46, 57)59 (54, 64)0.003
Gender0.376
   Male41 (65.1)18 (75.0)
   Female22 (34.9)6 (25.0)
Smoke0.906
   No60 (95.2)23 (95.8)
   Yes3 (4.8)1 (4.2)
General condition
   No systemic diseases50 (82.5)18 (75.0)0.660
   Hypertension8 (12.7)3 (12.5)0.980
   Diabetes2 (3.2)2 (8.3)0.307
   Coronary heart disease1 (1.6)0 (0.0)0.476
   Hepatitis B2 (3.2)1 (4.2)0.822

Table 2

Demographics and clinical characteristics of the teeth"

ItemsMCF-ARP group(n=68)Natural healing group (n=26)P value
Tooth position0.778
   Mandibular first molar23 (33.8)8 (30.8)
   Mandibular second molar45 (66.2)18 (69.2)
Healing time/months6 (6, 7)7 (5, 8)0.849
Clinical characteristics
   Plaque index1.4±0.61.1±0.50.182
   Probing depth/mm5.7±1.76.6±1.30.212
   Gingival recession/mm1.8±1.41.8±1.00.925
   Bleeding index3.5±0.73.2±1.20.703
   Keratinized tissue width/mm3.5±1.33.4±1.10.876
Thickness of the alveolar wall/mm
   TB12.20±2.072.22±1.850.973
   TL11.86±1.202.24±1.800.442
Alveolar septum0.963
   Yes16 (23.5)6 (23.1)
   No52 (76.5)20 (70.9)

Table 3

The height of the tooth socket in the baseline /mm"

ItemsMandibular first molar (n=31)Mandibular second molar (n=63)P
BH12.05±2.5411.26±2.640.168
LH14.24±2.7411.83±3.490.001
CH7.88±3.295.37±2.79< 0.001

Table 4

ridge width, height and changes of the sockets in the MCF-ARP group and natural healing group /mm"

ItemsBHLHCHW
BaselineMCF-ARP11.49±2.62#12.53±3.46#6.03±3.08#5.36±4.93#
NH11.60±2.66#12.88±3.46#6.62±3.43#5.15±5.07
P value0.8670.6600.8490.872
6 monthsMCF-ARP10.65±2.61#11.22±3.66#14.38±2.85#8.85±3.01#
NH10.33±2.88#11.53±3.71#10.44±4.70#5.00±4.18
P value0.5210.720< 0.001< 0.001
ChangesMCF-ARP-0.84±1.13-1.31±1.098.34±2.813.50±4.88
NH-1.26±1.48-1.35±0.963.82±3.58-0.16±5.70
P value0.3700.735< 0.0010.019

Table 5

The height and distribution in the center of the socket in the MCF-ARP group and natural healing group after healing"

Group< 8 mm8-10 mm>10-12 mm>12 mm
MCF-ARP0 (0.0)2 (2.9)12 (17.7)54 (79.4)
Natural healing6 (23.1)4 (15.4)5 (19.2)11 (42.3)
P value< 0.001

Table 6

The volume changes of the sockets in the MCF-ARP group and natural healing group /mm3"

ItemsTotal volumeBuccal volumeLingual volume
BaselineMCF-ARP1 205.26±544.91#636.54±366.59#568.72±230.29#
NH1 226.83±536.97#648.57±341.94#578.26±227.18#
P value0.9530.9390.716
6 monthsMCF-ARP1 785.73±797.43#905.82±465.46#879.90±367.04#
NH1 511.65±755.96#776.58±410.39#735.07±377.94#
P value0.0380.1680.016
ChangesMCF-ARP580.46±333.92269.28±150.64311.18±210.28
NH284.82±367.33132.98±163.80156.81±217.72
P value< 0.001< 0.001< 0.001

Figure 5

Percentage tacked column chart of GBR during implant therapy MCF-ARP, micro crestal flap-alveolar ridge preservation; GBR, guided bone regeneration."

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