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Year : 2013  |  Volume : 24  |  Issue : 6  |  Page : 784-786
Technique to assess the alveolar bone width for immediate implant placement in fresh extraction sockets


1 Department of Prosthodontics, Government Dental College, Bangalore, India
2 Rajarajeshwari Dental College, Bangalore, India
3 Department of Implantology, Changing Faces India, Raipur, India

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Date of Submission14-Jan-2013
Date of Decision27-Feb-2013
Date of Acceptance23-Mar-2013
Date of Web Publication20-Feb-2014
 

   Abstract 

Aim: To determine labial and lingual plate width at extraction site, using extracted tooth.
Materials and Methods: Pre-extraction ridge mapping and arch impression using putty consistency elastomeric impression material is recorded, followed by atraumatic tooth extraction, extracted tooth is cleaned and reoriented in the earlier recorded elastomeric putty impression. The cast obtained is used to measure bone width.
Results: The amount of available labial and palatal bone of an extracted socket can be assessed accurately.
Conclusion: This technique will help the surgeon understand the thickness of labial plate especially the apical region without reflecting the flap, also aid in selection of proper dimension of dental implant, and if bone graft is needed.

Keywords: Dental implants, diagnostic, extracted socket, extraction socket, ridge mapping

How to cite this article:
Chandraker NK, Chowdhary R, Verma A. Technique to assess the alveolar bone width for immediate implant placement in fresh extraction sockets. Indian J Dent Res 2013;24:784-6

How to cite this URL:
Chandraker NK, Chowdhary R, Verma A. Technique to assess the alveolar bone width for immediate implant placement in fresh extraction sockets. Indian J Dent Res [serial online] 2013 [cited 2020 Jan 29];24:784-6. Available from: http://www.ijdr.in/text.asp?2013/24/6/784/127637
The predictability of dental implants using the traditional Branemark protocol has been well- documented. Since its inception, this protocol has been progressively challenged to decrease treatment time, minimize the number of surgical procedures, and maximize esthetic outcomes. [1],[2],[3] Success of dental implant is not only defined by osseointegration of the implant, but a harmonious and natural blending of the restoration with the surrounding tissues and dentition. [2] Biological, functional, and biomechanical parameters must be examined, and potential problems have to be identified preoperatively. Such influencing factors are the amount of available alveolar bone, morphologic type of the soft tissue; correct positioning of the implant in all three dimensions, the provisional phase, the design and material of the implant abutment, and material and design of the definitive crown. [3],[4]

Ideally, implants should be surrounded by at least 1 mm of bone. In the anterior maxilla, accurate assessment of bone dimensions is complicated by irregular resorption patterns and thickness of the overlying mucosa. Commonly used radiographic techniques such as intraoral periapical and panoramic views are hampered by image distortion and inability to image in a buccolingual cross section. [4] The use of tomography [5] and computed tomography (CT) [6] provided practitioners with the ability to assess the quantity and quality of bone and critical anatomic structures an had some disadvantages of the length of time to produce an image (20-25 min), the cumulative radiation dose to the head and neck area, and, the possibility of a distorted image with metallic tooth restorations and/or patient movement. A further consideration with CT imaging is financial cost. [4]

The use of ridge mapping to assess bone levels available for implant placement in the anterior maxilla avoids some of the problems associated with CT scanning. [7] But ridge mapping does not provide the width of individual facial and palatal cortical plates over the roots. A simplified method is presented in this article to find the amount of labial and palatal bone available for placement of implant immediately after extraction.


   Materials and Methods Top


  1. In the initial appointment, impression is made and a diagnostic cast is poured with type II dental stone. A stent is prepared using a vacuum-adapted thermoplastic sheet on the cast. A series of calibrated holes every 2 mm are made on the labial and palatal region of the stent covering the tooth to be extracted.
  2. Ridge mapping procedure is to be performed clinically - In the ridge mapping procedure, following administration of local anesthetic, the stent was located in the patient's mouth and calibration is done with endodontic files to measure the thickness of the mucosa covering the bone [Figure 1].
  3. Record an accurate impression of the arch using an elastomeric impression material of putty consistency using a stock tray.
  4. Atraumatic tooth extraction is done under local anesthesia. Care has to be taken not to fracture the tooth while extraction.
  5. Extracted tooth to be cleaned and reoriented in the earlier recorded elastomeric putty impression [Figure 2], and pour the impression in a type III dental stone [Figure 3].
  6. Then section the cast along the long axis of the extracted tooth [Figure 4].
  7. Transfer the ridge mapping reading recorded earlier clinically to the sectioned cast [Figure 5].
  8. Scrap the cast in the labial and palatal region as per the transferred ridge mapping reading to eliminate the soft tissue covering the bone. As a result of the scrapping of the working cast, the exact amount of labial and palatal plate bone width can be measured from the sectioned cast [Figure 6].
Figure 1: Ridge mapping procedure performed clinically

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Figure 2: Cleaned extracted tooth, reoriented in the earlier recorded elastomeric putty impression

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Figure 3: Cast with extracted teeth

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Figure 4: Sectioned cast (along the long axis of the extracted tooth)

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Figure 5: Transfer of ridge mapping reading to sectioned cast

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Figure 6: Scrapped working cast (depicts the exact amount of labial and palatal plate bone width)

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This technique will help the surgeon understand the thickness of labial plate especially the apical region without reflecting the flap, also to know whether adequate bone coverage can be achieved after the implant placement, and if bone graft is needed. Even the dimension of the implant to be placed can be determined. And can be used in root stem, fractured tooth, avulsed tooth condition wherein immediate implantation is planned. As this procedure is to be carried out immediately after the extraction, additional chairside time is needed prior to surgery.[8]

 
   References Top

1.Brånemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 1969;3:81-100.  Back to cited text no. 1
    
2.Sclar AG. Strategies for management of single-tooth extraction sites in aesthetic implant therapy. J Oral Maxillofac Surg 2004;62(9 Suppl 2):90-105.  Back to cited text no. 2
    
3.Belser UC, Schmid B, Higginbottom F, Buser D. Outcome analysis of implant restorations located in the anterior maxilla: A review of the recent literature. Int J Oral Maxillofac Implants 2004;19(Suppl):30-42.  Back to cited text no. 3
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4.Allen F, Smith DG. An assessment of the accuracy of ridge-mapping in planning implant therapy for the anterior maxilla. Clin Oral Impl Res 2000:11:34-8.  Back to cited text no. 4
    
5.Kassebaum DK, Nummikoski PV, Triplett RG, Langlais RP. Cross sectional radiography for implant site assessment. Oral Surg Oral Med Oral Pathol 1990;70:674-8.  Back to cited text no. 5
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6.Schwarz M, Rothman SL, Rhodes ML, Chafetz N. Computed tomography: Part II. Preoperative assessments of the maxilla for endosseous implant surgery. Int J Oral Maxillofac Implants 1987;2:143-8.  Back to cited text no. 6
    
7.Wilson, DJ. Ridge mapping for determination of alveolar ridge width. Int J Oral Maxillofac Implants 1989;4:41-3.  Back to cited text no. 7
    
8.Touati B, Guez G. Immediate implantation with provisionalization: From literature to clinical implications. Pract Proced Aesthet Dent 2002;14:699-707.  Back to cited text no. 8
[PUBMED]    

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Correspondence Address:
Neeraj Kumar Chandraker
Department of Prosthodontics, Government Dental College, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.127637

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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