Preservation of ridge dimensions following grafting with coral granules of 48 post-traumatic and post-extraction dento-alveolar defects

Abstract

This prospective clinical analysis reports on the use of coral granules in alveolar ridge preservation procedures in a population of young, growing patients. The sample consisted of 21 patients, 12 females and 9 males, with a mean age of 13.6 years. These 21 patients had 48 dento-alveolar defects suitable for augmentation with coral granules, and were followed clinically and radiographically for 3-7 years after augmentation. There were two areas of augmentation: 17 defects in the anterior maxilla resulted from traumatic tooth loss, and 31 defects in the posterior maxilla and mandible resulted from the extraction of ankylosed retained primary molars with no permanent succedaneous teeth. Between 1-2 ml of coral granules were implanted into the alveolar bone defects left by the extraction of teeth in both the areas. This was in order to preserve the remaining edentulous ridge from further alveolar ridge resorption. The goal of the procedure was to preserve the alveolus so that in the future, a dental implant could be placed to replace the missing tooth, after jaw growth had stopped, without the need for a bone graft. The coral granules appeared to be totally replaced by the host bone on follow-up clinical and radiographic examinations. The two areas of the jaws behaved quite differently. In the anterior maxilla, where tooth loss was secondary to trauma, the coral granules restored the alveolar ridges temporarily. However, over the years of follow-up in this study, the coral granules failed to provide sufficient bone to support the placement of a dental implant without using a bone graft in 14 of the 17 defects or 82.4% of sites. In the posterior maxilla and mandible, where tooth loss was due to the elective removal of ankylosed primary molars, 29 of the 31 defects or 93.5% of sites were successful as they were able to support the placement of an osseo-integrated dental implant without the use of a bone graft. The alveolar sparing technique was more successful in maintaining an alveolar ridge sufficient for the placement of a dental implant without bone grafting in the posterior maxilla and mandible, where tooth loss was secondary to the elective removal of ankylosed deciduous molars than in the anterior maxilla, where tooth loss was secondary to trauma. Coral granules seem to be more suitable in the posterior maxilla and mandible where there were ankylosed deciduous teeth and congenitally absent permanent teeth than in the traumatized anterior maxilla. In successful sites, coral granules can spare the alveolus from residual ridge atrophy or resorption, obviating the need for a bone graft. This reduces patient morbidity, as a second surgical donor site is avoided because bone graft harvesting is made unnecessary.