A comparison between anorganic bone and collagen-preserving bone xenografts for alveolar ridge preservation: systematic review and future perspectives

Abstract

After tooth extraction, dimensional changes affect the alveolar socket, leading to loss in alveolar bone height and width. Histological modifications also occur, with initial formation of a blood clot that is replaced with granulation tissue and subsequently with a provisional connective tissue matrix. Spontaneous healing ends with socket filling with woven bone, which is gradually replaced with lamellar bone and bone marrow. Adequate alveolar ridge dimensions and bone quality are required to assure optimal stability and osseointegration following dental implant placement. When a tooth is extracted, alveolar ridge preservation (ARP) procedures are an effective method to prevent collapse of the post-extraction socket. Heterologous bone is widely chosen by clinicians for ARP, and anorganic bone xenografts (ABXs) made bioinert by heat treatment represents the most used biomaterial in clinical applications. Collagen-preserving bone xenografts (CBXs) made of porcine or equine bone are fabricated by less invasive chemical or enzymatic treatments to remove xenogenic antigens, and these are also effective in preserving post-extraction sites. Clinical differences between anorganic bone substitutes and collagen-preserving materials are not well documented in the literature but understanding these differences could clarify how processing protocols influence biomaterial behavior in situ. This systematic review of the literature compares the dimensional changes and histological features of ABXs versus CBXs in ridge preservation procedures to promote awareness of different bone xenograft efficacies in stimulating the healing of post-extraction sockets.

Alveolar ridge preservation: Complications and cost‐effectiveness

“…Medline, Embase, Web of Science, Cochrane Central, and the grey literature were searched using the following terms: "tooth extract*" OR "dental extract*" OR "tooth socket" OR "alveolar ridge*" OR "socket preservation*" OR "socket grafting," combined with a list of alveolar ridge preservation techniques and biomaterials commonly reported in the literature. All issues of selected journals in the fields of periodontology and implant dentistry published between 1 January 2010 and 1 June 2022 were hand-searched, and references of previously published reviews 3,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were also cross-checked to supplement the electronic systematic search. No language limitation was set for the inclusion of articles.…”

Horizontal GBR with anorganic equine bone combined with a customized titanium mesh

“…Regarding the grafting materials, numerous types have been used in GBR over the years. These include bioceramic materials such as beta‐tricalcium phosphate (β‐TCP), 18 hydroxyapatite (HA), biphasic calcium phosphate (BCP), and freeze‐dried bone allograft (FDBA) 19 as well as heterologous bone substitutes 6,20–24 . Often, bone regeneration is performed using a mix of heterologous bone and autologous bone chips 25 .…”

“…These include bioceramic materials such as beta‐tricalcium phosphate (β‐TCP), 18 hydroxyapatite (HA), biphasic calcium phosphate (BCP), and freeze‐dried bone allograft (FDBA) 19 as well as heterologous bone substitutes. 6 , 20 , 21 , 22 , 23 , 24 Often, bone regeneration is performed using a mix of heterologous bone and autologous bone chips. 25 In this case report, we describe a 60‐year‐old male patient with a large horizontal bone defect in the fourth quadrant who was successfully treated using the GBR technique with a titanium mesh and anorganic equine bone, a slow resorbing biomaterial.…”

Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes

“…Following tooth extraction, a common physiological consequence is bone resorption due to the loss of physical stimuli to the alveolar bone, which can compromise the structural integrity of the alveolar ridge [ 1 , 2 ]. This morphological change is not only detrimental to the bone structure but also presents challenges for future dental implant placements [ 3 ].…”