Preprosthetic bone remodeling – Fundamentals and clinical implications

Preprosthetic bone remodeling is a complex biological process that occurs in bone tissue prior to the insertion of dentures or dental prosthetic devices. This phenomenon of bone adaptation around implants or other prosthetic elements is of crucial importance in the success of prosthetic treatment and the long-term stabilization of the prosthesis.

This article aims to present the fundamental aspects of preprosthetic bone remodeling, including the physiological mechanisms involved, factors influencing this process and relevant clinical implications.

1. Preprosthetic bone remodeling is a critical step in the prosthetic rehabilitation process, having the role of adapting bone tissue to the new biomechanical demands induced by the prosthesis or dental implants. Understanding the mechanisms involved in preprosthetic bone remodeling is essential for predictable and successful treatment.

2. Physiological mechanisms of bone remodeling: Bone remodeling is a continuous process involving resorption and formation of new bone. In the case of preprosthetic bone remodeling, bone resorption is stimulated by mechanical pressure or tension exerted on the bone following the application of dentures or dental implants. Bone cells involved in this process, such as osteoclasts and osteoblasts, are regulated by various biochemical and mechanical factors.

3. Factors influencing preprosthetic bone remodeling: There are a number of factors that can influence preprosthetic bone remodeling. These factors may include initial bone quality and density, geometry of implants or prostheses, biomechanical loading exerted on the bone and the general health of the patient. It is important for clinicians to consider these factors when planning and executing prosthetic treatment to achieve optimal results.

4. Clinical implications: Preprosthetic bone remodeling has significant implications in clinical practice. A proper understanding of this phenomenon allows clinicians to assess and anticipate bone changes that will occur following the insertion of dentures or dental implants. The correct choice of denture or implant design and proper management of biomechanical loading can help reduce excessive bone resorption and achieve continued long-term denture stability. Also, monitoring of preprosthetic bone remodeling during the healing period and subsequent adjustment of the prosthesis may be necessary to ensure optimal integration of the prosthesis into the evolving bone tissue.

Another important clinical aspect related to preprosthetic bone remodeling is the increase in height of the alveolar ridge and the maintenance of adequate bone volume in the area where the dental implants will be placed.

In cases of prolonged edentulousness or massive bone loss, bone augmentation procedures may be necessary prior to implant insertion to ensure established and durable anchorage of the implants.

Prosthetic treatments aim to restore lost functions of the dento-maxillary apparatus mainly due to missing teeth.

Tooth loss is a common and undesirable phenomenon among patients and can lead to impaired confidence.

Whether it is poor hygiene that has led to this situation, trauma or periodontal disease, patients who present to the dentist want their teeth fixed.

The spaces remaining after tooth loss are called edentulous.

They consist only of the bone crest and the covering gum fibromucos, elements that become non-functional and are no longer required during chewing.

A non-functioning bone, like any other organ that is no longer required, atrophies.

This is why the longer the patient postpones a visit to the dentist’s surgery, the greater the risk of the edentulous ridges developing.

Among the reasons for which it is necessary to prosthetize edentulous spaces as early as possible, whether we are talking about implants, dental bridges or total dentures, we mention:

Occlusal restoration – neutral, functional ocular ratios are lost with the absence of dental units.

Teeth that limit the edentulous space undergo migration and take on greater masticatory tasks, which are transmitted poorly.

A dysfunctional occlusion results in most cases in pain in the temporomandibular joint.

Chewing, phonation or swallowing may also be impaired, depending on the area and extent of the edentulousness.

Aesthetics is a topic that often encourages the patient to visit the dentist. Especially when it comes to front edentulousness, the patient avoids contact with society and is deeply dissatisfied with his or her appearance.

It is not always easy to prosthetize edentulous spaces. If the edentations are older, there is a high risk of position changes, caries or periodontal pathologies occurring in the bordering teeth, which require the prosthetic treatment to be postponed until the other problems are solved.

Also, edentulous ridges that are no longer in demand may suffer resorption, which makes it even more difficult to put together a prosthetic plan.

Sometimes surgery is necessary to restore the ridges to a shape and appearance that is conducive to long-term prosthetics.

Ridges can also lose their smooth contour and become fracture-edged following tooth extractions where removal of prominent alveolar bone ridges has not been achieved.

In order to level the ridges, a panoramic radiograph should be taken prior to the procedure to capture the shape of the ridges as a whole, and working models should be made to predict the outcome.

These complementary methods are also useful for the patient to better understand the maneuvers they will undergo.

Intraoperatively, the doctor will perform a local anesthetic in the area where the bone crest protrudes and endangers the prosthetic plane. Also, if the patient is anxious, an intravenous sedative may be administered.

The gingival tissue will then be incised and the bone where the operation will be performed will be revealed.

Smoothing of the bone margins can be done with either a rotary or manual instrument, depending on the difficulty of the case and the doctor’s analysis.

At the end of the intervention, the gum will be sutured and returned to the desired position.

In conclusion, preprosthetic bone remodeling is a complex biological process that needs to be considered in the planning and implementation of prosthetic treatment.

Knowledge of the physiological mechanisms involved, factors influencing bone remodeling and relevant clinical implications is essential to achieve predictable and successful outcomes in oral rehabilitation. Improved diagnostic and treatment technologies and techniques can help optimize preprosthetic bone remodeling and improve the quality of life of denture patients.