A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans : comparison of studies with non-fixed or fixed reference points

Abstract

Background: Removal of teeth results in both horizontal and vertical changes of hard and soft tissue dimensions. The magnitude of these changes is important for decision-making and comprehensive treatment planning, with provisions for possible solutions to expected complications during prosthetic rehabilitation.

Objectives: to review all English dental literature to assess the magnitude of dimensional changes of both the hard and soft tissues of the alveolar ridge up to 12 months following tooth extraction in humans.

Materials and methods: An electronic MEDLINE and CENTRAL search complemented by manual searching was conducted to identify randomised controlled clinical trials and prospective cohort studies on hard and soft tissue dimensional changes after tooth extraction. Only studies reporting on undisturbed post-extraction dimensional changes relative to a fixed reference point over a clearly stated time period were included. Assessment of the identified studies and data extraction was performed independently by two reviewers. Data collected were reported by descriptive methods. Weighted means and percentages of the dimensional changes over time were calculated where appropriate.

Results: The search provided 3954 titles and 238 abstracts. Full text analysis was performed for 104 articles resulting in 20 studies that met the inclusion criteria. In human hard tissue, horizontal dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months. Percentage vertical dimensional change was 11-22 % at 6 months. Percentage horizontal dimensional change was 32% at 3 months, and 29-63% at 6-7 months. Soft tissue changes demonstrated 0.4-0.5 mm gain of thickness at 6 months on the buccal and lingual aspects. Horizontal dimensional changes of hard and soft tissue (loss of 0.1 mm to 6.1 mm) was more substantial than vertical change (loss 0.9 mm to gain 0.4mm) during observation periods of up to 12 months, when study casts were utilised as a means of documenting the changes.

Conclusions: Human re-entry studies showed horizontal bone loss of 29-63% and vertical bone loss of 11-22% after 6 months following tooth extraction. These studies demonstrated rapid reductions in the first 3-6 months that was followed by gradual reductions in dimensions thereafter.