title: Predictors of Alveolar Process Remodeling Following Ridge Preservation in High-Risk Patients.
abstract: OBJECTIVE
  (1) To clinically evaluate horizontal remodeling of the alveolar process (hard and soft tissues) following ridge preservation in high-risk patients and (2) to identify predictors of such remodeling.
  
  
  METHODS
  Periodontally healthy nonsmoking patients with a failing tooth in the anterior maxilla (15-25) were selected for a prospective case series. All were in need of a single implant and demonstrated high risk for aesthetic complications given an incomplete buccal bone wall and/or thin-scalloped gingival biotype. Following flapless tooth extraction, ridge preservation was performed using one or more collagen-enriched, bovine-derived block grafts (Geistlich Bio-Oss® Collagen® 100 mg, Geistlich Pharma AG, Wolhusen, Switzerland) without the additional use of membranes or soft tissue grafts. The change in buccopalatal dimension of the alveolar process between baseline (prior to tooth extraction) and 4 months was assessed on the basis of superimposed occlusal slides. Regression analysis was performed to identify predictors of alveolar process remodeling.
  
  
  RESULTS
  Forty-two patients (21 females, 21 males; mean age 38) met the selection criteria and consented to the treatment. Mean alveolar process remodeling was 14% (SD 7, range 4-30) with minimal remodeling (≤ 10%) in 16 patients (38%) and advanced remodeling (>20%) in 10 patients (24%). A single implant could be installed in all subjects without additional guided bone regeneration. Connective tissue grafting was performed later on in the treatment for aesthetic purposes, hereby compensating for tissue loss at the buccal aspect. Predictors of alveolar process remodeling were tooth location (central incisors and cuspids > laterals incisors and premolars), tooth abscess (p = .025), and buccal bone loss (p = .035).
  
  
  CONCLUSIONS
  Alveolar process remodeling seems inevitable yet acceptable following ridge preservation in high-risk patients. Proper case selection may reduce the incidence of advanced remodeling.
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.|Faculty of Medicine and Pharmacy, Dental Medicine, Department of Periodontology and Oral Implantology, Free University of Brussels (VUB), Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
authors.affiliation: Faculty of Medicine and Pharmacy, Dental Medicine, Free University of Brussels (VUB), Brussels, Belgium.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cleymaet
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.|Faculty of Odontology, Department of Prosthodontics, Malmö University, Malmö, Sweden.
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000209:etiology; D000539:Alveolar Process; D000818:Animals; D016723:Bone Remodeling; D002417:Cattle; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla; D011446:Prospective Studies; D014081:Tooth Extraction / Q000009:adverse effects; D020390:Tooth Socket
keywords: alveolar process; extraction socket; remodeling; ridge preservation; tooth extraction; xenograft