Alveolar Ridge Preservation in the Esthetic Maxillary Zone: Tuberosity Punch Technique of Gingiva and Bone: A Pilot...

This paper aims to present an alveolar ridge preservation technique, using an autologous punch formed of hard and soft tissues harvested from the tuberosity area.

Ten residual sockets in the anterior maxilla were filled with a punch of hard and soft tissues harvested from the tuberosity area. Clinical and radiographical data were collected at the surgical extraction time 0 (T0) and 5 months during implant placement (T1), from clinical and radiological measurements using cone-beam computed tomography scans and periapical radiographs. Core biopsy was harvested during implant placement for histological and histomorphometrical analysis.

Clinically, the alveolar ridge presented a mean width of 10.3 mm before extraction which decreased to 8.85 mm at T1, where the mean horizontal loss is 1.45 mm (standard deviation [SD] 1.03 mm). The initial ridge mean height was 11.25 mm and increased to 12.85 mm after 5 months, where the mean vertical gain is 1.6 mm (SD 0.65 mm). The radiological evaluation shows a reduction in the horizontal dimension with a mean of 1 mm; however, the sockets show stability in the vertical dimensions. Histology showed a new lamellar bone formation with some areas of woven bone. Histomorphometric analysis showed that the percentage of new bone formed was 42.44 ± 5.54% and 48.62 ± 8.66% of the connective tissue and 8.94 ± 5.28% of the residual autogenous bone.

At T1, the extraction sockets showed significantly lower vertical and horizontal bone changes, compared to T0. The described preservation punch technique resulted in greater stability in the horizontal and vertical dimensions after 5 months.

Clinical and radiological results show that the punch of hard and soft tissue graft reduces hard and soft tissue dimensional alteration after tooth extraction. In addition, using autogenous bone showed histological new bone formation.