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The Effect of Different Socket Types on Implant Therapy While Using Flapless Ridge Preservation

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The Effect of Different Socket Types on Implant Therapy While Using Flapless Ridge Preservation applied sciences Article The Effect of Different Socket Types on Implant Therapy While Using Flapless Ridge Preservation Li-Ching Chang 1,2,* and Yu-Min Cheng 3 1 Department of Dentistry, Chang Gung Memorial Hospital, Chiayi 613, Taiwan 2 Department of Nursing, Chang Gung University of Science and Technology, Chiayi 613, Taiwan 3 Cheng’s Dental Office, Pingtung 900, Taiwan; [email protected] * Correspondence: [email protected]; Tel.: +886-5-3621000 (ext. 2277) Featured Application: Considering socket types in flapless ridge preservation may improve im- plant therapy. Abstract: This retrospective study compared the effects of different extraction sockets when using flapless ridge preservation during dental implant therapy. The extraction sockets were divided into four groups: Class I, intact soft tissue wall and bone walls; Class II, intact soft tissue wall with the destruction of at least one bone wall; Class III, the recession of all soft tissue walls by ≤5 mm; and Class IV, the recession of at least one soft tissue wall by >5 mm. We compared clinical parameters of dental implant therapy using flapless ridge preservation among these groups. Seventy patients with 92 dental implants, including 53 maxillary and 39 mandibular implants, involving flapless ridge preservation were enrolled. The implant survival rate was not affected by socket morphology. Total treatment time from extraction to final prosthesis placement was significantly longer in Class II and III than in Class I, among the maxillary sockets. However, there was no significant difference in the total treatment time among the different groups in the mandible. Therefore, implant survival rates did not differ according to socket morphology; however, total treatment time was significantly affected by Citation: Chang, L.-C.; Cheng, Y.-M. socket morphology in the maxilla and was longer in socket classes associated with periodontitis. The Effect of Different Socket Types on Implant Therapy While Using Keywords: implant survival rate; ridge preservation; extraction socket; dental implant Flapless Ridge Preservation. Appl. Sci. 2021, 11, 970. https://doi.org/ 10.3390/app11030970 1. Introduction Academic Editor: Nissan Joseph Alveolar ridge resorption occurs rapidly during the first 6 months after extraction, Received: 30 November 2020 resulting in aesthetic, phonetic, and functional problems, and complicates implant place- Accepted: 19 January 2021 Published: 21 January 2021 ment [1,2]. Thin buccal plates undergo progressive bone resorption, even when a ridge preservation method is used [3,4]. Although ridge preservation is useful for decreasing Publisher’s Note: MDPI stays neutral post-extraction alveolar ridge contraction, it cannot eliminate ridge resorption after tooth with regard to jurisdictional claims in extraction [5,6]. Ridges with damaged extraction socket walls benefit more from alveolar published maps and institutional affil- ridge preservation (ARP) than ridges with intact extraction sockets [7]. iations. Various methods are used in ARP, including closed (flapless procedure) and open (flap procedure) approaches [8,9]. There is no significant histological difference between flapped and flapless groups; thus, the percentage of new bone, connective tissue, and residual bone graft is similar between these two groups [10]. However, more buccal bone resorption is found in extraction sockets with full-thickness flap elevation, which would disturb the Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. surrounding periosteum [9,11–13]. The flapless procedure is less traumatic and results in This article is an open access article more keratinized tissue than the flap procedure [8,9,14]. Flapless ridge preservation is made distributed under the terms and possible either by rapid formation of a biological seal under a non-resorbable membrane or conditions of the Creative Commons substitution of a resorbable barrier by a connective matrix [9,10,15]. Moreover, soft tissue Attribution (CC BY) license (https:// grafts or primary closure did not provide beneficial effects in preserving alveolar bone in creativecommons.org/licenses/by/ previous studies [16–18]. Therefore, a simplified flapless procedure is desirable for both 4.0/). patients and surgeons. Appl. Sci. 2021, 11, 970. https://doi.org/10.3390/app11030970 https://www.mdpi.com/journal/applsci Appl. Sci. 2020, 10, x FOR PEER REVIEW 2 of 13 [9,10,15]. Moreover, soft tissue grafts or primary closure did not provide beneficial effects Appl. Sci. 2021, 11, 970 in preserving alveolar bone in previous studies [16–18]. Therefore, a simplified flapless2 of 12 procedure is desirable for both patients and surgeons. A buccal wall thickness >1.0 mm in a socket has been reported to show better ridge preservation outcomes than achieved with a thinner buccal wall [5]. In a previous animal study,A the buccal final wall alveolar thickness ridge >1.0 profile mm of in so a socketckets with has beenbuccal reported plate destruction to show better was ridgemore favorablepreservation after outcomes using flapless than achieved ridge preservation with a thinner than buccal after natural wall [5 ].healing In a previous [19–21]. animal Addi- tionally,study, the in finalextraction alveolar sockets ridge of profile maxillary of sockets anterior with teeth buccal with plate buccal destruction plate dehiscence was more or withfavorable sockets after of molars using flapless with deficient ridge preservation bone plates, thanflapless after ridge natural preservation healing [could19–21 ].mini- Ad- mizeditionally, ridge inresorption extraction after sockets tooth of extraction maxillary anteriorand improve teeth soft with tissue buccal outcomes plate dehiscence [22–26]. or with sockets of molars with deficient bone plates, flapless ridge preservation could Thus, buccal plate loss is a predictor of alveolar ridge-remodeling when flapless ridge minimize ridge resorption after tooth extraction and improve soft tissue outcomes [22–26]. preservation is used [27]. Thus, buccal plate loss is a predictor of alveolar ridge-remodeling when flapless ridge Though there are a few studies that have focused on the association between ridge preservation is used [27]. preservation and socket morphology [28–30], none have analyzed the relationship be- Though there are a few studies that have focused on the association between ridge tween dental implant treatment and flapless ridge preservation in the different socket preservation and socket morphology [28–30], none have analyzed the relationship between types with distinct hard and soft tissue characteristics. We hypothesized that there would dental implant treatment and flapless ridge preservation in the different socket types be differences in clinical parameters of implant therapy among the different socket types with distinct hard and soft tissue characteristics. We hypothesized that there would be when flapless ridge preservation is used. Thus, the aim of this retrospective study was to differences in clinical parameters of implant therapy among the different socket types compare the effects of the different extraction socket types on various parameters of dental when flapless ridge preservation is used. Thus, the aim of this retrospective study was to implantcompare therapy the effects when of the flapless different ridge extraction preservation socket is typesused. on various parameters of dental implant therapy when flapless ridge preservation is used. 2. Materials and Methods 2. MaterialsThis was and a retrospective Methods study involving adults who underwent flapless ridge preser- vationThis and was dental a retrospective implant insertion study involving between adultsJanuary who 2013 underwent and August flapless 2019 ridge by a preser-single surgeonvation and (L.C.C). dental Implant implant sites insertion were exclu betweended Januaryif final prosthesis 2013 and placement August 2019 was by not a single com- pletedsurgeon before (L.C.C). this Implant study commenced. sites were excluded The retrospective if final prosthesis study was placement conducted was in not accord- com- ancepleted with before the thisHelsinki study Declaration commenced. of The1975, retrospective as revised in study 2013. was The conducted protocol was in accordance approved bywith Chang the Helsinki Gung Medical Declaration Foundation of 1975, Institutional as revised in Review 2013. The Board protocol (IRB No. was 201901611B0) approved by andChang the Gungneed Medicalto obtain Foundation informed patient Institutional consent Review was waived Board due (IRB to No. the 201901611B0) retrospective andna- turethe need of the to study. obtain informed patient consent was waived due to the retrospective nature of the study. 2.1. Classification of Extraction Sockets 2.1. Classification of Extraction Sockets The extraction sockets were divided into different groups according to the authors’ socketThe classification extraction socketssystem, werewhich divided was modified into different from groupsElian et accordingal.’s classification to the authors’ of ex- tractionsocket classification sockets of anterior system, teeth which [31]. was Chang’ modifieds classification from Elian etsystem al.’s classification was based on of the extrac- se- veritytion sockets of tissue of anteriordestruction teeth of [the31]. extraction Chang’s classificationsocket walls, systemincluding was buccal, based palatal/lingual, on the severity mesial,of tissue and destruction distal walls, of the as extraction shown in socketFigure walls, 1. including buccal,
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