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The ARP Techniques in Dentistry

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Dental surgeons commonly recommend these current concepts of ARP for maintaining the alveolar bone height and volume after tooth extraction. Read the article to know more about it.

Medically reviewed by

Dr. Lekshmipriya. B

Published At April 19, 2022
Reviewed AtAugust 10, 2023

What Is ARP?

ARP (alveolar ridge preservation) is a method adopted by dental surgeons in which the bone height and physiology that is constantly reduced by resorption following a tooth extraction is maintained in a predictable way, preventing the ridge from further resorption and maintenance of bone volume and height. The techniques of ARP mainly revolve around the usage of guided bone regeneration material (GBR), growth factors, certain socket sealers, and fillers, all of which can aid in healthy bone preservation and remodeling process in spite of the tooth being removed for whatever reasons (periodontal damage, mobility, gross decay or non vitality).

What Is the Need for ARP Techniques?

The reason why ARP should be chosen by the patients before prosthetic implantation of the missing tooth or even in severely edentulous cases for wearing dentures is that post tooth extraction, the bundle bone (the bone that lines the alveolar socket and encloses periodontal or Sharpey's fibers for tooth support in the jaw) is absorbed almost immediately whereas the alveolar bone of the jaw takes time to be resorbed. However, once it starts being resorbed, the vertical height of the tooth socket and the bony contour are slowly lost over time.

ARP technique mainly helps prevent this reduction in height and contour over time, and this is a boon clinically to improve prosthetic outcomes successfully in patients post extraction of tooth or teeth. This progressive and irreversible phenomenon can give rise to aesthetic, functional, and prosthodontic challenges as well as interfere with ideal implant placement for tooth replacement therapy. Several therapeutic attempts aimed at minimizing the post-extraction ridge atrophy have been employed, a concept defined as ' alveolar ridge preservation (ARP).

Bone remodeling is almost always negatively impacted post a tooth extraction that has been left unattended by a prosthesis like an implant, crown, or bridge for a long time span. This is mainly because the aesthetics, the contour, and the height of the alveolar ridge may often be hindered by unfavorable resorptive processes. Hence ARP follows the current trend of bone conservation and height or bony contour and shape preservation as well as the alveolar ridge to preserve the natural tissue. The need for ARP before prosthetic replacement is also because the soft tissue and periodontal ligament that is a major source and vascular strength for the socket wall of the tooth is also severed when a tooth is extracted.

What Are the Current Concepts in ARP?

Several studies have also adopted the concept of guided bone regeneration (GBR), utilizing a barrier membrane for the prevention of soft tissue ingrowth and encapsulation of the graft particles in an attempt to promote bone formation. Other methods for ARP have involved flap procedures in minimizing the surgical trauma, under the assumption that this would facilitate greater bone gain. Combinations of membrane grafting alongside bone grafting is a tested procedure in the research documentation and success rates of prosthetic replacements after ARP procedures.

Bone grafting histologically, as researched, even post six months of placement, and eventual healing within the socket (used to augment, contour, and maintain the ridge height), usually shows no major changes either in horizontal or vertical dimensions if allografts or xenografts are used. However, with the advancement in bone grafting, newer age alloplastic materials such as tricalcium phosphate crystals and bioactive polymers (glass polymers) are a few examples of showing both horizontal and vertical bone height changes making the site suitable for dental implantation.

Many factors that could have influenced the pattern of ridge resorption (single vs. multiple-rooted teeth, grafting material, a reflection of a flap, or obtaining primary wound closure) are assessed through meta-regression analyses to determine their significance. The current results of clinical research indicate significantly less horizontal and mid-buccal vertical bone loss when the reflection of flaps was avoided during the surgical procedure. This analysis is further highlighted when analyzed for obtaining primary wound closure.

What Are the Studies That Prove ARP Reduces Bone Resorption?

In this method of research analysis, the changes in the outcome measures (alveolar ridge dimensions) must have been assessed either clinically or with standardization to ensure reliability in reporting. Therefore, studies without an appropriate control group (unassisted healing without socket grafting), without resorting to outcomes (such as pure histological research on bone quality or immunohistochemistry), or with the use of two-dimensional radiographic assessment of ridge dimensions were not considered for inclusion ·

Clinical procedures (grafting material, application and type of membrane used, whether flap was raised, if primary wound closure was achieved, the allocated time or healing). Meta-analysis confirms the effectiveness of ARP in reducing the ridge loss in all the investigated outcomes in comparison with unassisted healing of extraction sockets. In these clinical observations, the potential studies must have contained at least a test and a control group, comparing post-extraction ARP via socket grafting to unassisted natural healing in non-compromised intact extraction sockets, allowing at least three months for the healing process.

Investigating ARP techniques, patients are randomized to receive porcine bone and collagen membrane, either with a full-thickness mucoperiosteal flap followed by obtaining a primary soft tissue seal or with a flapless approach aiming for a secondary soft tissue closure.

Conclusion

ARP is defined as the procedure of arresting or minimizing the alveolar ridge resorption following tooth extraction for future prosthodontic treatment including placement of dental implants. ARP procedures are being successfully adopted and used in modern-day clinical practice with the use of atraumatic extraction procedures and then bone graft substitutes to increase or maintain the bone volume and height that have proven to reduce but not eliminate the physiological cascade of post-extraction bone remodeling.

Frequently Asked Questions

1.

What Are the Major Effects of Alveolar Ridge Preservation After Tooth Extraction?

Alveolar preservation strategies have been shown to minimize the ridge volume loss that normally occurs after tooth extraction. Ridge preservation, also called socket preservation, is a procedure in which dentists use bone grafting materials to prevent loss of bone structure and protect the alveolar ridge after tooth extraction. Losing teeth can be accompanied by the subsequent loss of bone structure, making it impossible to receive dental implants in the future. However, jaw retention prevents the loss of jawbone structure and keeps options open.

2.

How Is the Alveolar Ridge Bone Preserved?

By placing grafting materials, doctors create a framework for new bone growth and use the material's physical properties to maintain the space to prevent bone plate collapse and potential soft-tissue infiltration.
To preserve a ridge or graft a socket, the following protocol is followed:
 
 1. Atraumatic extraction of the tooth.
 2. Thorough cleaning of the socket.
 3. Placement of the graft material.
 4. Contain the graft material in the socket with sutures.
 5. Allow 4 to 6 months for healing, depending upon the graft material used.

3.

Why Is the Alveolar Ridge Important?

The alveolar ridge is an extension of the maxilla (upper jaw) and mandible (lower jaw) and is the bony ridge that holds the alveolar sockets. The alveolar ridge is an anatomical structure critical to healthy teeth and successful dental implants. Loss of alveolar ridge height can prevent a person from getting implants or any other prosthesis in the mouth.

4.

Can Alveolar Bone Regrow on Its Own?

The alveolar bone is an essential tissue for tooth retention. However, once the alveolar bone is lost, it cannot be regenerated naturally. Bone grafts and artificial bones are commonly used for alveolar bone regeneration. Alveolar bone height is very critical to the placement of the prosthesis.

5.

Which Bones Support the Alveolar Ridge?

The supporting alveolar bone structure is composed of both cortical and cancellous bone. Cortical bone, also called a cortical plate, consists of compact bony plates found on the facial and lingual surfaces of the alveolar bone. The alveolar bone is made up of ridges that support the teeth. The root of the tooth is located in a deep depression, the alveolar cavity of the bone. Alveolar bone develops during tooth eruption and atrophies after tooth loss. It readily reacts to external and systemic influences. The usual response to stimuli is absorption, but in some situations, it can be accompanied by deposition.

6.

What Is the Function of the Alveolar Process?

In addition to connecting the tooth to the jawbone, the alveolar process is important for tooth alignment and periodontal ligament (PDL) function. Due to its unique composition, the alveolar process can withstand the forces exerted on the mouth by mastication. The support of the alveolar process is vital to the chewing action.

7.

What Are the Different Types of Alveolar Ridge Defects?

There are two main types of bone loss patterns seen in the alveolar bone: horizontal bone loss and vertical bone loss. Horizontal bone loss is reflected in moderately even bone loss, resulting in an even reduction in bone height relative to the tooth. Vertical bone loss is defined as the resorption of at least 2 mm of interdental bone with a typical angulation.

8.

What Is the Socket Shielding Technique?

The Socket Shield Technique involves the bisection of the root and holds the buccal two-thirds of the root in the socket, leaving the tissues of the socket intact along with the bone. This technique shows promising post-extraction socket preservation results and great implant placement value.

9.

What Is the Code of Socket Preservation?

Socket preservation, or alveolar ridge preservation, is a procedure to reduce bone loss after tooth extraction. After tooth extraction, the jawbone naturally narrows and loses its original shape due to rapid bone resorption. Socket preservation is an attempt to prevent bone loss by placing a bone graft in a socket immediately after tooth extraction. During the procedure, the gums are pulled back; the tooth is removed, a bone graft is placed in the tooth socket, it is covered with a barrier membrane, and it is stitched.

10.

What Are the Different Parts of the Alveolar Process?

The alveolar process also has supporting bones with the same components, including Fibers, cells, intercellular substances, nerves, blood vessels, and lymphatics. The alveolar process is the lining inside the tooth socket and is called the alveolus. Alveolar bone can be divided into two main parts: a thin layer of dense bone and then a less dense bone beneath it.

11.

What Is the Location of the Alveolar Ridge?

The alveolar ridge, also called the alveolar margin, is one of the two maxillary ridge extensions of the lower or upper jaw, located on the palate between the upper teeth and the hard palate or at the base of the mouth behind the lower teeth. Most of the palate consists of hard and soft palates. The alveolar ridge contains the tooth cavity. It can be felt with the tongue in the area just above the upper teeth or under the lower teeth, the surface of which is covered with small ridges.

12.

Why Is the Alveolar Bone Called So?

The alveolar bone is associated with or forms the part of the jaw from which the teeth arise. The word alveolar also refers to the air-containing compartments of the lungs or glands with secretory cells around the central space. This air-containing property of the alveolar bone type gives it the name alveolar.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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