Extraction and bone resorption

Bone loss after tooth extraction

pierderea osului dupa extractia dentara

A certain bone quantity is lost even during dental extraction, being followed by a dramatic volume loss, right in the first 6 months after extraction (See “Types of bone atrophy”)

Most frequent, bone can be lost due to periodontal disease, root canal infections or facial and oral area trauma. Along with tooth loss, a large quantity of valuable bone can be lost which should normally serve as a foundation for the dental implant that will replace the lost tooth.

At Implantodent we can limit these volume losses through special techniques:

  • Non-traumatic extraction (performed by experienced surgeons with special technology such as laser, piezotome and other devices and minimally invasive instruments);
  • Dental alveoli preservation – which implies filling the alveoli, immediately after tooth extraction, with bone grafting biomaterials, in order to maintain bone volume unaltered, necessary for implant insertion, during the few months when healing takes place (bone regeneration)

Extraction and bone atrophy

extractia si atrofia osoasa

Dental implant insertion simultaneously with extraction (immediate implant) or shortly after extraction, will lead to a proper bone healing, by keeping its volume unaltered.

In any case, the more time that passes between extraction and implant insertion, the less bone will be available for implant procedure. Therefore, we will either complicate things having to resort to bone addition or augmentation techniques or having to choose compromise solutions, using implants with inadequate diameters and lengths for the tooth to be replaced.

lungime implant

As noticed in the image above, each dental group corresponds with a different implant diameter. Deviation from these rules (implant shorter than indicated) can limit treatment’s success in time (implant will no longer support mechanical forces appropriately).

Alveoli preservation

Dental alveoli (lat. Alveolus dentalis) is a depression in the maxilla or mandible, in which a tooth with its roots is laying. The tooth doesn’t grow together with the alveolar bone, but it is fixed through its fibers. Sharpey (engl) – Wikipedia

Dental alveoli preservation represents the most efficient method of bone preservation when extraction is indicated, but implant insertion is not possible or not wanted at that moment.

Normally, after tooth extraction, it is advised to immediately insert an implant within the dental alveoli (post extraction implant). Yet, this thing is not possible when inside the alveoli an acute infection emerged, when alveoli bone was also damaged or when remaining bone presents an extremely low quantity and implant cannot anchor even on 2/3 of its length. The biggest mistake is to let the alveoli heal, because in a few months it will drastically decrease its volume!

We very well know that during the healing process, dental alveoli decreases volume and the gum always follows bone. Therefore, after a few weeks or months, post extraction we can find ourselves in the situation where at the extraction place a deformity will emerge, a depression that suggests bone melting.

This is a natural process, bone no longer receiving stimuli through the extracted dental root, which holds no advantage when wanting to insert an implant. Due to deficient bone volume and density, we will need to perform addition and wait several months for bone healing, unjustifiably prolonging treatment and also inflating costs.

Thus, alveoli preservation procedure involves inserting a quantity of bone immediately after extraction was performed and alveoli was cleaned (biomaterial, generally of bovine origin). This biomaterial will function as a scaffold on which the body will deposit its own bone, resorbing the added one (process named guided bone regeneration). Bone supplement is covered with barrier role membranes and after a few months, when we will insert the implant, we will discover an integrated and properly complied bone crest, able to ensure firm implant anchoring, as well as a thick, healthy gum, properly keratinized, able to efficiently “seal” the implant neck, where microorganisms can enter causing peri-implantitis, disorders that can lead to dental implant loss.

extractia si resorbtia osoasa

 

Conservarea alveolei dentare, augmentarea osoasa a alveolei

Digital x-ray showing radicular fracture, tooth extraction and alveoli preservation.

 

Conservarea alveolei dentare, augmentarea osoasa a alveolei

Root fracture on dental tomography (three dimensional)

 

Conservarea alveolei dentare, augmentarea osoasa a alveolei

Fractured tooth extraction and alveoli preservation

 

Conservarea alveolei dentare, augmentarea osoasa a alveolei

Virtual insertion (digital planning) on dental tomography of a future dental implant.