Practical Procedures in Implant Dentistry. Группа авторов
Читать онлайн книгу.
remaining, the condition of the extraction socket after tooth removal, the influence of hard and soft tissue biotype, and the use of an interim prosthesis [15].
5.1.2 Effects of Tooth Loss on the Individual Level
There is variability not only in the way which individuals heal from an extraction of a tooth, but also how the individual responds to the loss of the tooth from a functional, emotional, and quality of life perspective. While initial soft tissue healing occurs consistently during the first few weeks post‐extraction in almost all individuals, there is a greater variability in the period of time during which mineralised bone is formed in the socket [5]. Tooth loss in general can be the cause of functional or aesthetic impairment, creating difficulties in chewing efficiency, phonetics, or aesthetic challenges, depending upon the location and number of teeth lost (Figure 5.5). Notably there is strong evidence that the distribution and location of tooth loss has an impact on the oral health‐related quality of life. Oral health‐related quality of life scores tend to drop sharply when lacking a minimum number of occluding pairs of teeth (10 occluding pairs) or total remaining teeth (20 teeth) [1], consistent with the concept of a shortened dental arch [16]. Studies on the impact of tooth loss on an individual's quality of life consist of pooled data reported at the population level and thus may mask heterogeneous data at the individual level. There appears to be wide variation in the emotional response to tooth loss among individuals that cannot be linked closely to the distribution or number of teeth lost [17].
Figure 5.5 Loss of vertical dimension and facial soft tissue support. (a, b) Clinical image of patient's edentulous maxilla (a) and mandible (b). (c) Resulting effect on patient's facial profile, vertical dimension, and soft tissue support without prosthetic replacement of teeth.
5.1.3 Effects of Tooth Loss on the Population Level
Rates of complete edentulism have been decreasing, particularly in the past few decades, in a number of countries [18]. However, considerable variation exists in the rate of edentulism in many populations, with no simple observable relationship between socio‐economic and socio‐demographic indicators and complete edentulism rates, nor enhanced access to care and complete edentulism rates [19]. There is a growing trend towards retention of teeth longer into life, leading to increased rates of partial edentulism, particularly in middle‐aged populations and older [20]. Partially dentate individuals appear to have changing expectations and preferences to treatment strategies focused on conservation and restoration of missing teeth by fixed prostheses [21].
5.2 Procedures
Discussion of both short‐ and long‐term effects of tooth loss should be a part of establishing meaningful informed consent for extraction of a tooth or teeth. During the pre‐surgical consultation a thorough medical history should be taken with special consideration given to aspects which may be indicative of contraindications to surgical treatment or influence effective wound healing. A comprehensive extra‐ and intra‐oral examination should be conducted and informed consent to the planned treatment and extractions should be obtained. Previous extraction sites should be examined closely as well, discussing the history and reason for extraction while evaluating the healing response to the extraction. An evaluation of the patient's temporomandibular joint and occlusal stability may help determine if the individual is a candidate for a shortened dental arch. Lastly, an open discussion on the anticipated effect of tooth loss on patient function, aesthetics, and phonetics should be conducted.
5.3 Tips
Evaluate the pre‐extraction hard and soft tissue contours at the site of anticipated tooth loss. Carefully consider how the mean horizontal and vertical (3.87 and 1.67 mm, respectively) reduction of the ridge might influence the planned surgical and restorative treatment.
Utilise conventional radiography and, where indicated, three‐dimensional imaging via cone beam computed tomography (CBCT) to assess the condition of the alveolar process, the buccal plate thickness, presence or absence of periapical pathology, and the proximity of important anatomical features prior to tooth extraction.
Extract the tooth in an atraumatic manner in order to preserve the bone of the residual extraction socket and avoid iatrogenic trauma to the bone or soft tissues, which may lead to increased dimensional changes of the healed ridge.
Upon removal of the tooth, thoroughly debride and explore the socket. Eliminate any soft tissue remnants and determine the relative continuity of the bony walls of the socket. Consider the benefits of no intervention versus ridge preservation versus ridge augmentation on the site of tooth loss and any future restorative treatment.
The bone biotype can be estimated by running a gloved finger across the buccal surfaces of the maxillary and mandibular arches, feeling for root prominences. A smooth ridge may indicate a favourable bony contour following extraction, whereas a ridge which has significant bony prominences may result in considerable buccal bone loss following exodontia.
References
1 1 Gerritsen, A., Allen, P., Witter, D. et al. (2010). Tooth loss and oral‐health related quality of life: A systematic review and meta‐analysis. Health and Quality of Life Outcomes 8: 126–136.
2 2 Schroeder, H. (1986). The periodontium. In: Handbook of Microscopic Anatomy, vol. 5 (eds. A. Oksche and L. Vollrath), 233–246. Berlin: Springer.
3 3 Amler, M. (1969). The time sequence of tissue regeneration in human extraction wounds. Oral Surgery Oral Medicine Oral Pathology 27: 309–318.
4 4 Cardaropoli, G., Araujo, M., and Lindhe, J. (2003). Dynamics of bone tissue formation in tooth extrtaction sites. Journal of Clinical Periodontology 30: 809–818.
5 5 Trombelli, L., Farina, R., Marzola, A. et al. (2008). Modeling and remodeling of human extraction sockets. Journal of Clinical Periodontology 35: 630–639.
6 6 Evian, C., Rosenberg, E., Coslet, J., and Corn, H. (1982). The osteogenic activity of bone removed from healing extraction sites in humans. Journal of Periodontology 53: 81–85.
7 7 Van der Weijden, F., Dell'Acqua, F., and Slot, D. (2009). Alveolar bone dimensional changes of post‐extraction sockets in humans: A systematic review. J Clin Periodontol 36: 1048–1058.
8 8 Lekovic, V., Camargo, P., Klokkevold, P. et al. (1998). Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. Journal of Periodontology 69: 1044–1049.
9 9 Lekovic, V., Kenney, E., Weinlaender, M. et al. (1997). A bone regenerative approach to alveolar ridge maintenance following tooth extraction. Report of 10 cases. Journal of Periodontology 68: 563–570.
10 10 Pinho, M., Roriz, V., Novaes, A. Jr. et al. (2006). Titanium membranes in prevention of alveolar collapse after tooth extraction. Implant Dentistry 15: 53–61.
11 11 Chappuis, V., Engel, O., Shahim, K. et al. (2015). Soft tissue alterations in esthetic post‐extraction sites: A three dimensional analysis. Journal of Dental Research 94 (Suppl): 187–193.
12 12 Zweers, J., Thomas, R., Slot, D. et al. (2014). Characteristics of periodontal biotype, its dimensions, associations, and prevalence: A systematic review. J Clinical Periodontology 41: 958–971.
13 13 Farmer, M. and Darby, I. (2014). Ridge dimensional changes following single‐tooth extraction in the aesthetic