Buccal Bone Thickness in Anterior and Posterior Teeth-A Systematic Review

Abstract

(1) Background: Immediate dental implant placement has been a subject of great interest over the last decade. Here, information regarding the anatomy and bone thickness of the jaw prior to dental implant placement is crucial to increase the surgery's success and the patient's safety. The clinical premises for this approach have been controversially discussed. One of those heavily discussed premises is a buccal bone thickness of at least 1 mm thickness. This meta-analysis aims to systematically review buccal bone thickness (BBT) in healthy patients. Thus, the feasibility of immediate dental implant placement in daily practice can be assessed. (2) Methods: A search in the electronic databases was performed to identify articles reporting on BBT that was measured by computed tomography in adults. (3) Results: We were able to find 45 studies, including 4324 patients with 25,452 analyzed teeth. The analysis showed a BBT at the alveolar crest of 0.76 ± 0.49 mm in the maxillary frontal and of 1.42 ± 0.74 mm in the maxillary posterior region. In the mandible, the average measured values were similar to those in the maxilla (front: 0.95 ± 0.58 mm; posterior: 1.20 ± 0.96 mm). In the maxillary frontal region 74.4% and in the mandibular frontal region 61.2% of the crestal buccal bones showed widths <1 mm. (4) Conclusions: In more than 60% of the cases, the BBT at the alveolar crest is <1 mm in maxillary and mandibular frontal regions. This anatomic data supports careful pre-surgical assessment, planning of a buccal graft, and critical selection of indication for immediate implant placement, especially in the maxillary and mandibular frontal and premolar region.

Keywords: alveolar bone; buccal bone thickness; dental implant; dental implant loading; immediate; tomography.

Figure 1

PRISMA flow diagram.

Figure 2

Boxplot diagram. Shown are the data plots for the six regions analyzed. The different measuring points were located at 1–3 mm and 4–9 mm apical to the alveolar crest and in the region of the tooth apex. On the one hand, the increase of the buccal bone thickness (BBT) from crestal to apical, as well as from frontal to posterior, is displayed. The bone lamella in the mandible is also significantly thicker than in the maxilla, especially in the apical regions.

Figure 3

Buccal bone thickness at different regions. This figure shows (1) the measurement region as height between the tooth apex and the alveolar crest and (2) the average bone thickness as measurements taken between the respective tooth and the outer surface of the buccal bone at different regions of the radix. (A). Buccal bone thickness in maxillary frontal teeth. (B). Buccal bone thickness in mandibular front teeth. (C). Buccal bone thickness in maxillary premolar teeth. (D). Buccal bone thickness in mandibular premolar teeth. (E): Buccal bone thickness in maxillary molar teeth. (F). Buccal bone thickness in mandibular molar teeth.

Figure 4

Kernel density. (A) Maxilla front. The figure shows the kernel density estimates (Gaussian kernel) for the simulated values of the maxillary frontal teeth (central incisor to canine). The proportions of simulated values that were smaller than 1 mm (dashed line) were: 74% at the alveolar crest (height: 1–3 mm), 70% at 4 to 9 mm from the alveolar crest, and 39% at the apex of the radix. (C) Maxilla premolar. The proportions of simulated values that were smaller than 1 mm (dashed line) were: 33% at the alveolar crest (height: 1–3 mm), 44% at 4 to 9 mm from the alveolar crest, and 26% at the apex of the radix. (E) Maxilla molar. The proportions of simulated values that were smaller than 1 mm (dashed line) were: 32% at the alveolar crest (height: 1–3 mm), 35% at 4 to 9 mm from the alveolar crest, and 19% at the apex of the radix. (B) Mandible anterior. The proportions of simulated values that were smaller than 1 mm (dashed line) were: 61% at the alveolar crest (height: 1–3 mm), 68% at 4 to 9 mm from the alveolar crest, and 12% at the apex of the radix. (D) Mandible premolar. The proportions of simulated values that were smaller than 1 mm (dashed line) were: 66% at the alveolar crest (height: 1–3 mm), 67% at 4 to 9 mm from the alveolar crest, and 13% at the apex of the radix. (F) Mandible molar. The proportions of simulated values that were smaller than 1 mm (dashed line) were: 52% at the alveolar crest (height: 1–3 mm), 18% at 4 to 9 mm from the alveolar crest, and 6% at the apex of the radix.