Alveolar ridge preservation (ARP) therapy is indicated to attenuate the physiologic resorptive events that occur as a consequence of tooth extraction with the purpose of facilitating tooth replacement therapy. This randomized controlled trial was primarily aimed at testing the efficacy of ARP as compared with unassisted socket healing. A secondary objective was to evaluate the effect that local phenotypic factors play in the volumetric reduction of the alveolar bone. A total of 53 subjects completed the study. Subjects were randomized into either the control group, which involved only tooth extraction (EXT n = 27), or the experimental group, which received ARP using a combination of socket grafting with a particulate bone allograft and socket sealing with a nonabsorbable membrane (dPTFE) following tooth extraction (ARP n = 26). A set of clinical, linear, volumetric, implant-related, and patient-reported outcomes were assessed during a 14-wk healing period. All linear bone assessments (horizontal, midbuccal, and midlingual reduction) revealed that ARP is superior to EXT. Likewise, volumetric bone resorption was significantly higher in the control group (mean ± SD: EXT = −15.83% ± 4.48%, ARP = −8.36% ± 3.81%, P < 0.0001). Linear regression analyses revealed that baseline buccal bone thickness is a strong predictor of alveolar bone resorption in both groups. Interestingly, no significant differences in terms of soft tissue contour change were observed between groups. Additional bone augmentation to facilitate implant placement in a prosthetically acceptable position was deemed necessary in 48.1% of the EXT sites and only 11.5% of the ARP sites ( P < 0.004). Assessment of perceived postoperative discomfort at each follow-up visit revealed a progressive decrease over time, which was comparable between groups. Although some extent of alveolar ridge remodeling occurred in both groups, ARP therapy was superior to EXT as it was more efficacious in the maintenance of alveolar bone and reduced the estimated need for additional bone augmentation at the time of implant placement (ClinicalTrials.gov NCT01794806).

Tooth extraction initiates a cascade of events that often leads to local anatomic changes in the alveolar ridge. Ridge preservation is a surgical approach aimed at minimizing hard and soft tissue volume loss. There have been contradicting reports on the efficacy of socket grafting for alveolar ridge preservation. Interestingly, there is a paucity of adequately powered randomized controlled clinical trials. The purpose of this study was to assess the effect of the application of a socket grafting technique on alveolar ridge dimensional changes following tooth extraction. Methods: Healthy patients requiring the extraction of one single-rooted tooth on either arch, from second premolar to second premolar, excluding mandibular incisors, and who met the eligibility criteria were recruited. Patients were then randomly assigned to either the control group, consisting of tooth extraction alone, or the experimental group, which consisted of extraction and simultaneous ridge preservation using an allograft bone material to fill the socket and a dense polytetrafluoroethylene membrane (dPTFE) to seal it. Cone beam computed tomography (CBCT) was obtained immediately prior to extraction (baseline) and at 14 weeks. Linear measurements with the use of a toothsupported stent were obtained immediately after extraction (baseline) and at 14 weeks. Linear and volumetric measurements were made using data obtained from the CBCTs. Masked, calibrated examiners performed all radiographic measurements. Measurements obtained included buccal keratinized tissue width, buccal and lingual plate height and width, alveolar ridge horizontal width (CBCT); and alveolar ridge volume changes.