Alveolar ridge

The alveolar ridge (/ælˈvələr, ˌælviˈlər, ˈælviələr/;[1] also known as the alveolar margin) is one of the two jaw ridges, extensions of the mandible or maxilla, either on the roof of the mouth between the upper teeth and the hard palate or on the bottom of the mouth behind the lower teeth. Most of the roof of one's mouth is the hard palate and the soft palate. The alveolar ridges contain the sockets (alveoli, singular "alveolus") of the teeth. They can be felt with the tongue in the area right above the top teeth or below the bottom teeth. Its surface is covered with little ridges.

The [upper] alveolar ridge is a small protuberance just behind the upper front teeth that can easily be felt with the tongue.[2]

A sagittal or side view image of a human head. The upper alveolar ridge is located between numbers 4 and 5.

Structure

The alveolar ridges are the thickened, bony borders of the mandible and maxilla that are covered in soft tissue.[3] They contain the alveolar processes which hold the teeth within the oral cavity.[3] The alveolar ridges are supported by alveolar bone, a dynamic tissue which provides flexibility and resilience for the embedded teeth as they encounter numerous multi-directional forces.[4][5] The alveolar ridge is an area of particular interest in dentistry, as preservation of the ridges results in a higher success rate of therapeutic dental treatments.[6]

Clinical Implications

Congenital Epulis

Congenital epulis, also known as Congenital Granular Cell Epulis, is a rare, benign mesenchymal tumour which usually presents at birth.[7] It can be found growing on the alveolar ridge of new-borns, presenting as non-ulcerated, pedunculated, reddish pink masses of varying sizes and numbers.[7][8] Congenital epulis can occur in either of the alveolar ridges, but they are found three times more frequently on the maxillary alveolar ridge than on the mandibular alveolar ridge. They also more commonly present in females compared to males.[8]

Diagnosis of the condition was previously incidental, however, with improvements in imaging technology, prenatal diagnosis is now possible at 26 weeks (about 6 months). Furthermore, these benign lesions can be treated by surgical excision.[7]

Dentistry

Grafting materials

Grafting is an effective technique to reduce the inevitable changes in dimension of the alveolar ridge after tooth extraction.[9] The type of grafting material is important as different materials are more effective than others in maintaining the alveolar ridge.[10]

No biomaterial can prevent alveolar bone loss entirely after extraction, however, there are five grafting materials with the greatest efficacy in height resorption prevention; three of which are xenograft materials (Gen-Os, Apatos, and MP3), one a platelet concentrate (A-PRF) and one composed of A-PRF and the allograft material AlloOss  combined.[11][10]

For the best outcomes with respect to horizontal alveolar ridge preservation, application of a xenogenic (non-living bone material from another species) or allogenic grafting material (bone donated by another human) surrounded by a resorbable collagen membrane or sponge is ideal.[12] These membranes promote wound healing, osteogenesis and have a high biocompatibility.[13] Other reliable options for surgeons may include Bio-Oss and Bio-Oss Coll, primarily due to the strong scientific evidence behind their efficacy and recorded successful outcomes particularly in lateral ridge augmentation surgery.[10] L-PRF is also preferred in many clinical situations because of its low cost of preparation.[10]  

Dental Implants

The alveolar ridge refers to one of the two thickened bony crests, that exists in the upper and lower portions of the jawbone and house the sockets of the teeth.[9] As the rate of tooth loss in the population increases either due to early extraction, trauma, or other systemic diseases, the use of implant therapy has increased as a form of tooth replacement therapy.[9][14] Dental implants are a way to replace missing teeth, as they consist of a titanium surgical component that is placed in the alveolar ridge of the jawbone.[15] The implant then acts as a prosthetic device that can hold either a crown, bridge, or denture on its external surface.[15] For the implant placement to be successful, there needs to be enough alveolar bone to support and stabilize the dental implant.[15] It has been determined that many factors can contribute to the loss of both the vertical and horizontal height of the alveolar bone.[16] These factors can include resorption of the bone after tooth removal (affecting the quality and quantity of the bone), the presence of periodontal disease, the age and gender of the patient, smoking habits, the presence of other systemic diseases, and oral hygiene habits.[17] Although dental implants tend to have a high success rate, of about 99%,[18] studies show that if an implant were to fail, it occurs more often in the front portion of the upper jaw.[19] More research is required to determine why this occurs, but it has been theorized that the alveolar bone in the upper jaw has a thinner cortical plate and lower bone density than that of the lower jaw.[19] As bone loss in the alveolar ridge becomes an increasing problem for the success of dental implants, research has been focused on the development of new surgical techniques and biomaterials that can be used to either maintain current bone levels, or to stimulate the growth of new alveolar bone through osteogenesis.[20][21][22]

Articulation

Consonants whose constriction is made with the tongue tip or blade touching or reaching for the alveolar ridge are called alveolar consonants. Examples of alveolar consonants in English are, for instance, [t], [d], [s], [z], [n], [l] like in the words tight, dawn, silly, zoo, nasty and lurid. There are exceptions to this however, such as speakers of the New York accent who pronounce [t] and [d] at the back of their top teeth (dental stops). When pronouncing these sounds the tongue touches ([t], [d], [n]), or nearly touches ([s], [z]) the upper alveolar ridge, which can also be referred to as gum ridge. In many other languages, consonants transcribed with these letters are articulated slightly differently, and are often described as dental consonants. In many languages consonants are articulated with the tongue touching or close to the upper alveolar ridge. The former are called alveolar plosives (such as [t] and [d]), and the latter alveolar fricatives (such as [s] and [ʃ]) or (such as [z] and [ʒ]).

See also

References

  1. Wells JC (2008). Longman Pronunciation Dictionary (3rd ed.). Longman. ISBN 9781405881180.
  2. Phonetics at the Encyclopædia Britannica Accessed: 12 September 2018.
  3. Singh OP, Kaur R, Nanda SM, Sethi E (2016). "Residual ridge resorption: A major oral disease entity in relation to bone density". Indian Journal of Oral Sciences. 7 (1): 3. doi:10.4103/0976-6944.176383. ISSN 0976-6944.
  4. Monje A, Chan HL, Galindo-Moreno P, Elnayef B, Suarez-Lopez del Amo F, Wang F, Wang HL (November 2015). "Alveolar Bone Architecture: A Systematic Review and Meta-Analysis". Journal of Periodontology. 86 (11): 1231–1248. doi:10.1902/jop.2015.150263. hdl:2027.42/141748. PMID 26177631.
  5. MacBeth N, Trullenque-Eriksson A, Donos N, Mardas N (August 2017). "Hard and soft tissue changes following alveolar ridge preservation: a systematic review". Clinical Oral Implants Research. 28 (8): 982–1004. doi:10.1111/clr.12911. PMID 27458031. S2CID 27295301.
  6. Willenbacher M, Al-Nawas B, Berres M, Kämmerer PW, Schiegnitz E (December 2016). "The Effects of Alveolar Ridge Preservation: A Meta-Analysis". Clinical Implant Dentistry and Related Research. 18 (6): 1248–1268. doi:10.1111/cid.12364. PMID 26132885.
  7. Sohal KS, Moshy JR, Owibingire SS, Kashmiri RA (2018). "Congenital Granular Cell Epulis: A Systematic Review of Cases from 2000-2017" (PDF). Archives of Dentistry and Oral Health. 1 (1): 56–65. doi:10.22259/2638-4809.0101009. ISSN 2638-4809.
  8. Gan J, Shi C, Liu S, Tian X, Wang X, Ma X, Gao P (May 2021). "Multiple congenital granular cell tumours of the maxilla and mandible: a rare case report and review of the literature". Translational Pediatrics. 10 (5): 1386–1392. doi:10.21037/tp-21-32. PMC 8192993. PMID 34189098.
  9. Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV (October 2014). "Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis". Journal of Dental Research. 93 (10): 950–958. doi:10.1177/0022034514541127. PMC 4293706. PMID 24966231.
  10. Canellas JV, Soares BN, Ritto FG, Vettore MV, Vidigal Júnior GM, Fischer RG, Medeiros PJ (November 2021). "What grafting materials produce greater alveolar ridge preservation after tooth extraction? A systematic review and network meta-analysis". Journal of Cranio-Maxillo-Facial Surgery. 49 (11): 1064–1071. doi:10.1016/j.jcms.2021.06.005. PMID 34176715. S2CID 235659457.
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  12. Avila-Ortiz G, Chambrone L, Vignoletti F (June 2019). "Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis". Journal of Clinical Periodontology. 46 (Suppl 21): 195–223. doi:10.1111/jcpe.13057. PMID 30623987. S2CID 58649044.
  13. Sbricoli L, Guazzo R, Annunziata M, Gobbato L, Bressan E, Nastri L (February 2020). "Selection of Collagen Membranes for Bone Regeneration: A Literature Review". Materials. 13 (3): 786. Bibcode:2020Mate...13..786S. doi:10.3390/ma13030786. PMC 7040903. PMID 32050433.
  14. Khalifa AK, Wada M, Ikebe K, Maeda Y (December 2016). "To what extent residual alveolar ridge can be preserved by implant? A systematic review". International Journal of Implant Dentistry. 2 (1): 22. doi:10.1186/s40729-016-0057-z. PMC 5120622. PMID 27878769.
  15. Motamedian SR, Khojaste M, Khojasteh A (January–June 2016). "Success rate of implants placed in autogenous bone blocks versus allogenic bone blocks: A systematic literature review". Annals of Maxillofacial Surgery. 6 (1): 78–90. doi:10.4103/2231-0746.186143. PMC 4979349. PMID 27563613.
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  17. Kuć J, Sierpińska T, Gołębiewska M (2017). "Alveolar ridge atrophy related to facial morphology in edentulous patients". Clinical Interventions in Aging. 12: 1481–1494. doi:10.2147/CIA.S140791. PMC 5602450. PMID 28979109.
  18. Makowiecki A, Hadzik J, Błaszczyszyn A, Gedrange T, Dominiak M (May 2019). "An evaluation of superhydrophilic surfaces of dental implants - a systematic review and meta-analysis". BMC Oral Health. 19 (1): 79. doi:10.1186/s12903-019-0767-8. PMC 6509828. PMID 31077190.
  19. Fouda AA (June 2020). "The impact of the alveolar bone sites on early implant failure: a systematic review with meta-analysis". Journal of the Korean Association of Oral and Maxillofacial Surgeons. 46 (3): 162–173. doi:10.5125/jkaoms.2020.46.3.162. PMC 7338630. PMID 32606277.
  20. Pérez-Sayáns M, Martínez-Martín JM, Chamorro-Petronacci C, Gallas-Torreira M, Marichalar-Mendía X, García-García A (November 2018). "20 years of alveolar distraction: A systematic review of the literature". Medicina Oral, Patologia Oral y Cirugia Bucal. 23 (6): e742–e751. doi:10.4317/medoral.22645. PMC 6261008. PMID 30341270.
  21. Strauss FJ, Stähli A, Gruber R (October 2018). "The use of platelet-rich fibrin to enhance the outcomes of implant therapy: A systematic review". Clinical Oral Implants Research. 29 (Suppl 18): 6–19. doi:10.1111/clr.13275. PMC 6221166. PMID 30306698.
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Further reading

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