Volume 34, Number 3, 2014 399 Jocelyn H.P. Tan-Chu, DDS 1 Frank J. Tuminelli, DMD 2 Kenneth S. Kurtz, DDS 3 Dennis P. Tarnow, DDS 4 Analysis of Buccolingual Dimensional Changes of the Extraction Socket Using the “Ice Cream Cone” Flapless Grafting Technique The socket or ridge preservation approach known as the “ice cream cone” technique was used in type 2 sockets in this retrospective analysis of 11 extraction sites. A type 2 extraction socket is defined as having the presence of facial soft tissue with a partial or complete dehiscence of the buccal bone plate. All teeth were extracted atraumatically without flap elevation. A resorbable collagen membrane was contoured into an ice cream cone– shape, placed into the socket defect, and grafted with human freeze-dried bone allograft. Buccolingual dimensional changes were measured manually with a digital caliper sensitive to 0.01 mm on pre- and posttreatment casts using an acrylic template and a three-dimensional (3D) digital scanner, as well as radiographically with pre- and post-cone beam computed tomography (CBCT) scans. All implants were placed 6 months after socket preservation and achieved primary stability with a minimum torque value of 35 Ncm with a mean buccal-lingual dimensional loss of 1.32 mm. The dimensional change of the ridge from pre- to postextraction reflective of the healed grafted site ranged from a loss of 0.46 to 2.25 mm with a mean of 1.28 mm (CBCT), 0.31 to 2.71 mm with a mean of 1.36 mm (digital calipers), and 0.21 to 2.80 mm with a mean of 1.32 mm (3D digital scanner). All 11 implants were immobile and clinically osseointegrated. The so-called ice cream cone technique allows for the reconstruction of a buccal plate dehiscence to enable the placement of an implant; however, the ridge dimension was diminished by 1.32 mm compared with the width of the extraction socket prior to tooth removal. (Int J Periodontics Restorative Dent 2014;34:399–403. doi: 10.11607/prd.1605) Morphologic and dimensional changes of the alveolar ridge oc- cur after tooth extraction. Van Der Weijden et al 1 demonstrated that the mean buccolingual dimension- al change of a human extraction socket was approximately 4 mm if no preservation technique was performed. Other studies have shown that up to 50% of the hori- zontal bone can be lost within 12 months postextraction. 2–4 The greatest change in ridge contour occurs during the first month after tooth extraction, which is both sta- tistically and clinically significant. The mean ridge width decrease after 6 months is 3 to 5 mm. 3,4 The resorption of the buccal plate may compromise esthetic outcomes in treatment for implant-supported prostheses as the periodontium undergoes atrophy after tooth ex- traction. 5–8 Changes are not limited to hard and soft tissue contours and can also include tissue discol- oration due to collapse with loss of the buccal bone plate. It is there- fore important to maintain the nat- ural contours of the residual ridge and minimize the resorption of the buccal bone plate, especially 1 Private practice, New York, New York, USA. 2 Diplomate, American Board of Prosthodontics; Immediate Past President, Greater New York Academy of Prosthodontics; Director of Graduate Prosthodontics, New York Hospital Queens, Flushing, New York, USA. 3 Clinical Associate Professor and Associate Director, Advanced Education Program in Prosthodontics, New York University College of Dentistry, New York, New York; Director of Maxillofacial Prosthetics, Graduate Prosthodontics, New York Hospital Queens, Flushing, New York, USA. 4 Clinical Professor and Director of Implant Education, Columbia University College of Dental Medicine, New York, New York, USA. Correspondence to: Jocelyn H.P. Tan-Chu, 630 5th Avenue, Suite 1810, New York, NY 10111, USA; email: ddsjtan@gmail.com. ©2014 by Quintessence Publishing Co Inc. © 2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.