Tomlin Elizabeth M, Nelson Shelby J, Rossmann Jeffrey A
Department of Periodontics, Texas A&M University, Baylor College of Dentistry, Dallas, TX.
Open Dent J. 2014 May 16;8:66-76. doi: 10.2174/1874210601408010066. eCollection 2014.
Healing of the extraction socket after tooth removal involves retention of the blood clot followed by a sequence of events that lead to changes in the alveolar process in a three dimensional fashion. This normal healing event results in a minimal loss of vertical height (around 1 mm), but a substantial loss of width in the buccal-lingual plane (4-6 mm). During the first three months following extraction that loss has been shown to be significant and may result in both a hard tissue and soft tissue deformity affecting the ability to restore the site with acceptable esthetics. Procedures that reduce the resorptive process have been shown to be predictable and potentially capable of eliminating secondary surgery for site preparation when implant therapy is planned. The key element is prior planning by the dental therapist to act at the time of extraction to prevent the collapse of the ridge due to the loss of the alveolus. Several techniques have been employed as ridge preservation procedures involving the use of bone grafts, barrier membranes and biologics to provide a better restorative outcome. This review will explore the evidence behind each technique and their efficacy in accomplishing site preparation. The literature does not identify a single technique as superior to others; however, all accepted therapeutic procedures for ridge preservation have been shown to be more effective than blood clot alone in randomized controlled studies.
拔牙后拔牙窝的愈合包括血凝块的保留，随后是一系列事件，这些事件会导致牙槽突在三维方向上发生变化。这种正常的愈合过程会导致垂直高度的最小损失（约1毫米），但在颊舌平面上宽度会有显著损失（4 - 6毫米）。在拔牙后的头三个月里，这种损失已被证明是显著的，并且可能导致硬组织和软组织畸形，影响以可接受的美学效果修复该部位的能力。已证明减少吸收过程的程序是可预测的，并且在计划进行种植治疗时，有可能消除用于位点准备的二次手术。关键因素是牙科治疗师在拔牙时进行预先规划，以防止由于牙槽骨缺失导致牙槽嵴塌陷。已经采用了几种技术作为牙槽嵴保存程序，包括使用骨移植、屏障膜和生物制剂，以提供更好的修复效果。本综述将探讨每种技术背后的证据及其在完成位点准备方面的功效。文献中没有确定一种技术优于其他技术；然而，在随机对照研究中，所有公认的牙槽嵴保存治疗程序都已被证明比单纯的血凝块更有效。
