Application of extraction site preservation in the anterior aesthetic zone of patients with chronic periodontitis scheduled for tooth extraction

doi:10.12337/zgkqzzxzz.2025.10.004

Abstract

Abstract: Objective To evaluate the effect of extraction site preservation in the maxillary anterior aesthetic zone of patients with StageⅢ orⅣ, Grade C periodontitis. Methods A total of 80 patients who were required extraction of anterior maxillary teeth due to chronic periodontitis and were treated at Saisi Stomatological Hospital of Henan University from January 2022 to June 2024 were retrospectively included. Among them, 40 patients were assigned to the experimental group and underwent minimally invasive extraction followed by extraction site preservation, while 40 patients were assigned to the control group and underwent only minimally invasive extraction. Changes in the three-dimensional contour of the alveolar bone before and after treatment, as well as postoperative pain assessed by the visual analogue scale (VAS), were compared between the two groups. Results At 6 months postoperatively, compared with the immediate postoperative CBCT measurements, the vertical height of the alveolar bone decreased in both groups, but the decrease was significantly less in the experimental group than in the control group (P=0.0060). At 2 mm apical to the alveolar crest, both groups exhibited horizontal bone resorption, but the experimental group showed significantly less resorption (P=0.0008). At 4 mm apical to the alveolar crest, both groups showed an increase in horizontal bone width, with the experimental group showing a significantly greater increase than the control group (P=0.0390). Over time, VAS pain scores decreased in both groups. At 3 days and 7 days postoperatively, VAS scores in the experimental group were significantly lower than those in the control group (3 days: P=0.0007; 7 days: P=0.0050). Conclusion Extraction site preservation can significantly reduce the resorption of alveolar bone height and width following extraction of anterior maxillary teeth in patients with chronic periodontitis, thereby providing favorable conditions for subsequent prosthetic rehabilitation. In addition, it can alleviate postoperative pain.

Key words: StageⅢ orⅣ,Grade C periodontitis, Extraction site preservation, Minimally invasive tooth extraction

Liu Jianxing, Fu Yan, Liu Kezhao, Zhang Wei. Application of extraction site preservation in the anterior aesthetic zone of patients with chronic periodontitis scheduled for tooth extraction[J]. Chinese Journal of Oral Implantology, 2025, 30(5): 449-455.

References

[1] Sedghi LM, Bacino M, Kapila YL.Periodontal disease: the good, the bad, and the unknown[J]. Front Cell Infect Microbiol, 2021,11:766944. DOI: 10.3389/fcimb.2021.766944.
[2] Chen MX, Zhong YJ, Dong QQ, et al.Global, regional, and national burden of severe periodontitis, 1990-2019: an analysis of the global burden of disease study 2019[J]. J Clin Periodontol, 2021,48(9):1165-1188. DOI: 10.1111/jcpe.13506.
[3] 李舜航, 宋信杰, 管唯珍, 等. 1990-2019年中国牙周病疾病负担情况分析及预测[J].中国慢性病预防与控制,2023,31(11):807-811. DOI: 10.16386/j.cjpccd.issn. 1004-6194.2023.11.002.
Li SH, Song XJ, Guan WZ, et al.Analysis and prediction of the burden of periodontal disease in China from 1990 to 2019[J]. Chin J Chronic Dis Prev Control, 2023,31(11):807-811. DOI: 10.16386/j.cjpccd.issn.1004-6194.2023.11.002.
[4] Sclar AG.Preserving alveolar ridge anatomy following tooth removal in conjunction with immediate implant placement. The Bio-Col technique[J]. Atlas Oral Maxillofac Surg Clin North Am, 1999,7(2):39-59.
[5] Keranmu D, Nuermuhanmode N, Ainiwaer A, et al.Clinical application of concentrate growth factors combined with bone substitute in alveolar ridge preservation of anterior teeth[J]. BMC Oral Health, 2022,22(1):54. DOI: 10.1186/s12903-022-02091-8.
[6] Jensen MP, Chen C, Brugger AM.Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain[J]. J Pain, 2003,4(7):407-414. DOI: 10.1016/s1526-5900(03)00716-8.
[7] Schropp L, Wenzel A, Kostopoulos L, et al.Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study[J]. Int J Periodontics Restorative Dent, 2003,23(4):313-323.
[8] Aimetti M, Manavella V, Corano L, et al.Three-dimensional analysis of bone remodeling following ridge augmentation of compromised extraction sockets in periodontitis patients: a randomized controlled study[J]. Clin Oral Implants Res, 2018,29(2):202-214. DOI: 10.1111/clr.13099.
[9] Ahn JJ, Shin HI.Bone tissue formation in extraction sockets from sites with advanced periodontal disease: a histomorphometric study in humans[J]. Int J Oral Maxillofac Implants, 2008,23(6):1133-1138.
[10] Bell RB, Blakey GH, White RP, et al.Staged reconstruction of the severely atrophic mandible with autogenous bone graft and endosteal implants[J]. J Oral Maxillofac Surg, 2002,60(10):1135-1141. DOI: 10.1053/joms.2002.34986.
[11] Schwartz Z, Weesner T, van Dijk S, et al. Ability of deproteinized cancellous bovine bone to induce new bone formation[J]. J Periodontol, 2000,71(8):1258-1269. DOI: 10.1902/jop.2000.71.8.1258.
[12] Tapety FI, Amizuka N, Uoshima K, et al.A histological evaluation of the involvement of bio-oss in osteoblastic differentiation and matrix synthesis[J]. Clin Oral Implants Res, 2004,15(3):315-324. DOI: 10.1111/j.1600-0501.2004.01012.x.
[13] Heberer S, Al-Chawaf B, Hildebrand D, et al.Histomorphometric analysis of extraction sockets augmented with bio-oss collagen after a 6-week healing period: a prospective study[J]. Clin Oral Implants Res, 2008,19(12):1219-1225. DOI: 10.1111/j.1600-0501.2008.01617.x.
[14] 李佳, 何东宁. CGF在种植中促进成骨的研究探讨及应用进展[J].口腔颌面修复学杂志,2021,22(1):76-80. DOI: 10.19748/j.cn.kqxf.1009-3761.2021.01.017.
Li J, He DN.Research and application progress of CGF in promoting osteogenesis in implant[J].J Oral Maxillofac Prosthodont, 2021,22(1):76-80. DOI: 10.19748/j.cn.kqxf.1009-3761.2021.01.017.
[15] Xu P, Wu Y, Zhou L, et al. Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization[J]. Burns Trauma, 2020,8:tkaa028. DOI: 10.1093/burnst/tkaa028.
[16] Hunger S, Krennmair S, Krennmair G, et al.Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study[J]. Clin Oral Investig, 2023,27(6):2713-2724. DOI: 10.1007/s00784-022-04846-7.
[17] Pang KM, Um IW, Kim YK, et al.Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone[J]. Clin Oral Implants Res, 2017,28(7):809-815. DOI: 10.1111/clr.12885.
[18] Hong CE, Lee JY, Choi J, et al.Prediction of the alveolar bone level after the extraction of maxillary anterior teeth with severe periodontitis[J]. J Periodontal Implant Sci, 2015,45(6):216-222. DOI: 10.5051/jpis.2015.45.6.216.
[19] 赖思煜, 侯建霞. 牙槽嵴保存在非牙周炎与牙周炎患牙拔牙位点的应用进展[J].中华口腔医学杂志, 2020,55(4):266-270. DOI: 10.3760/cma.j.cn112144-20190718-00283.
Lai SY, Hou JX.Progress in the application of alveolar ridge preservation at extraction sites in non-periodontitis and periodontitis patients[J].Chin J Stomatol, 2020,55(4):266-270. DOI: 10.3760/cma.j.cn112144-20190718-00283.
[20] Wei Y, Xu T, Zhao L, et al.Ridge preservation in maxillary molar extraction sites with severe periodontitis: a prospective observational clinical trial[J]. Clin Oral Investig, 2022,26(3):2391-2399. DOI: 10.1007/s00784-021-04204-z.
[21] 杨莉, 路立花. 位点保存引导骨再生术后不同阶段生物力学及临床特点[J].现代仪器与医疗,2017,23(1):58-59. DOI: 10.11876/mimt201701023.
Yang L, Lu LH.Biomechanical and clinical characteristics at different stages after socket-preservation guided bone regeneration[J]. Mod Instrum Med, 2017,23(1):58-59. DOI: 10.11876/mimt201701023.
[22] Stumbras A, Kuliesius P, Januzis G, et al.Alveolar ridge preservation after tooth extraction using different bone graft materials and autologous platelet concentrates: a systematic review[J]. J Oral Maxillofac Res, 2019,10(1):e2. DOI: 10.5037/jomr.2019.10102.
[23] Quisiguiña Salem C, Ruiz Delgado E, Crespo Reinoso PA, et al.Alveolar ridge preservation: a review of concepts and controversies[J]. Natl J Maxillofac Surg, 2023,14(2):167-176. DOI: 10.4103/njms.njms_224_22.
[24] Hu KF, Lin SW, Lin YC, et al.Using cone-beam computed tomography to assess changes in alveolar bone width around dental implants at native and reconstructed bone sites: a retrospective cohort study[J]. J Pers Med, 2021, 11(10):1011. DOI: 10.3390/jpm11101011.
[25] 孙徐麟, 戴安娜, 黄佳萍, 等. 牙槽嵴保存术在牙周感染位点中的应用:从软硬组织再生到后续种植修复[J].口腔医学, 2024,44(2):130-138. DOI: 10.13591/j.cnki.kqyx.2024.02.010.
Sun XL, Dai AN, Huang JP, et al.Application of alveolar ridge preservation technique in periodontally compromised extraction sockets: from soft and hard tis-sue regeneration to followed implant restoration[J]. Stomatology, 2024,44(2):130-138. DOI: 10.13591/j.cnki.kqyx.2024.02.010.
[26] 张超颖, 龚佳幸, 俞梦飞, 等. 牙槽嵴保存术在牙周炎拔牙患者中的应用进展[J].口腔医学,2023,43(2):159-165. DOI: 10.13591/j.cnki.kqyx.2023.02.012.
Zhang CY, Gong JX, Yu MF, et al.Application progress of alveolar ridge preservation in patients with tooth extracted due to periodontitis[J]. Stomatology, 2023,43(2):159-165. DOI: 10.13591/j.cnki.kqyx.2023.02.012.
[27] 张勇. 应用牙槽窝保存技术减少拔牙后骨吸收的研究进展[J].国际口腔医学杂志,2011,38(3):288-291.DOI:10. 3969/j.issn.1673-5749.2011.03.012.
Zhang Y.Research progress on reducing post-extraction bone resorption by socket preservation[J]. Int J Stomatol, 2011, 38(3): 288-291. DOI:10.3969/j.issn.1673-5749.2011.03.012.
[28] Juodzbalys G, Stumbras A, Goyushov S, et al.Morphological classification of extraction sockets and clinical decision tree for socket preservation/augmentation after tooth extraction: a systematic review[J]. J Oral Maxillofac Res, 2019,10(3):e3. DOI: 10.5037/jomr.2019.10303.
[29] 戈怡, 姜秀瑛, 宿玉成. 上颌单颗中切牙拔牙位点保存后种植的长期美学效果分析[J].中国口腔种植学杂志, 2021,26(1):7-12. DOI: 10.12337/zgkqzzxzz. 2021.02.003.
Ge Y, Jiang XY, Su YC.Long term esthetic effect of implant restoration after alveolar ridge preservation of maxillary central incisor[J].Chin J Oral Implantol, 2021,26(1):7-12. DOI: 10.12337/zgkqzzxzz.2021.02.003.
[30] Jiang A, Zhang Q, Luo W, et al.Early changes of interproximal ridge height with alveolar ridge preservation of maxillary single anterior teeth[J]. Hua Xi Kou Qiang Yi Xue Za Zhi, 2019,37(4):394-397. DOI: 10.7518/hxkq.2019.04.010.