Alveolar ridge alterations in the maxillary anterior region after tooth extraction through orthodontic forced eruption for implant site development: a clinical CBCT study

Summary Objective To investigate the effects of orthodontic forced eruption (OFE) with the straight-wire appliance in the dimensions of the alveolar process when used for extracting compromised maxillary anterior teeth and implant site development. Material and Methods Cone-beam computed tomography (CBCT) scans of 7 patients needing extraction of 17 maxillary anterior teeth were obtained before and immediately after OFE. Alveolar plate height and thickness measurements were performed on the buccal and palatal socket walls in CBCT sagittal cross sections. Statistical analysis included sample size calculation, paired t-test, and Wilcoxon test to evaluate alveolar plate dimensional changes and linear regression analysis to assess whether bone changes and the feasibility of implant insertion were associated to tooth type and root length, baseline alveolar plate thickness, and age. Results OFE caused statistically significant reduction of the buccal alveolar plate height (1.95 ± 1.83 mm) and significant increase of the palatal alveolar plate height (1.31 ± 2.41 mm) in the central tooth socket areas. Buccal reduction was associated positively to the baseline root length and negatively to the thickness of the corresponding plate in the apical level. A non-significant increase was noted in both buccal (0.23 ± 0.93 mm) and palatal (0.63 ± 1.59 mm) proximal bone. Inadequate buccal bone support hindered immediate implant placement in six sockets; however, all inserted implants showed adequate and gradually increasing stability from insertion to final restoration. Conclusions OFE resulted in favourable increase in the heights of the palatal and proximal alveolar bone and significant reduction in the buccal plate height, which inhibited implant placement in 35% of the treated sockets.