Ghanaati Shahram, Śmieszek-Wilczewska Joanna, Al-Maawi Sarah, Heselich Anja, Sader Robert
FORM-Lab (Frankfurt Orofacial Regenerative Medicine-Research Laboratory), Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany.
Denticus Clinic, Lelewela 1/1, 44-100 Gliwice, Poland.
Bioengineering (Basel). 2025 Jan 29;12(2):128. doi: 10.3390/bioengineering12020128.
The alveolar ridge undergoes a loss in volume and atrophy after tooth extraction. Understanding the wound healing and bone regeneration process after tooth extraction is a key factor in the insertion of dental implants. Therefore, the aim of the present study was to analyze the socket healing process after the extraction of upper premolars based on cone beam computed tomography (CBCT) over six months. Special focus was placed on the morphological changes in the alveolar crest and within the socket. A retrospective analysis of patients in need of tooth extraction in the upper premolar region was performed in this study. All patients received flapless tooth extraction under local anesthesia and CBCT immediately after tooth extraction. Further CBCT analysis was performed after three months for the first group ( = 18) and after six months for the second group ( = 18). The results showed that all sockets underwent an inward movement of the defect walls towards the defect center, resulting in reduced total alveolar ridge volume and defect volume. This result was observed after three months and persisted after six months. The inward movement was quantified as a vertical socket collapse of up to 30.1 ± 9.0% after three months and 34.3 ± 6.7% after six months. The horizontal inward movement was quantified as a buccal socket collapse of 47.7 ± 12.3% after three months and 55.7 ± 29.1% after six months. New bone formation within the socket was evident, especially in the occlusal part of the socket. Additionally, bone formation was primarily observed as bone apposition along the socket walls and did not reach the defect center in most cases. The combination of socket collapse and bone apposition led to the formation of cavitations inside the socket that were mostly localized under the occlusal part. These novel findings with respect to socket collapse and formation of cavitation represent a paradigm shift and call for reconsidering the current understanding of socket healing. Based on the data, socket healing should be understood as a patient-specific process that requires 3D radiographic analysis for planning dental implants.
拔牙后牙槽嵴会出现体积丧失和萎缩。了解拔牙后的伤口愈合和骨再生过程是植入牙种植体的关键因素。因此，本研究的目的是基于锥形束计算机断层扫描（CBCT）分析上颌前磨牙拔除后六个月内的牙槽窝愈合过程。特别关注牙槽嵴和牙槽窝内的形态变化。本研究对需要拔除上颌前磨牙区域牙齿的患者进行了回顾性分析。所有患者均在局部麻醉下接受非翻瓣拔牙，并在拔牙后立即进行CBCT检查。第一组（n = 18）在三个月后进行进一步的CBCT分析，第二组（n = 18）在六个月后进行分析。结果显示，所有牙槽窝的缺损壁均向缺损中心向内移动，导致牙槽嵴总体积和缺损体积减小。这一结果在三个月后观察到，并在六个月后持续存在。向内移动量化为三个月后牙槽窝垂直塌陷高达30.1±9.0%，六个月后为34.3±6.7%。水平向内移动量化为三个月后牙槽窝颊侧塌陷47.7±12.3%，六个月后为55.7±29.1%。牙槽窝内有新骨形成，尤其是在牙槽窝的咬合部分。此外，骨形成主要表现为沿牙槽窝壁的骨附着，在大多数情况下未到达缺损中心。牙槽窝塌陷和骨附着的结合导致牙槽窝内形成空洞，这些空洞大多位于咬合部分下方。这些关于牙槽窝塌陷和空洞形成的新发现代表了一种范式转变，需要重新考虑目前对牙槽窝愈合的理解。基于这些数据，牙槽窝愈合应被理解为一个因人而异的过程，需要进行三维影像学分析以规划牙种植体。
