Comparison of the efficacy of different techniques to seal the alveolus during alveolar ridge preservation: Meta‐regression and network meta‐analysis

Abstract

Aim: To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB]) during alveolar ridge preservation (ARP) in terms of horizontal ridge width resorption. Materials and Methods: Randomized trials of at least 2 months duration comparing at least two techniques to seal the alveolus against each other or against spontaneous healing (SH) were eligible. Searches were conducted in MEDLINE via PubMed, EMBASE, Scopus, and Cochrane Central. Conventional meta-analysis, meta-regression, and network meta-analysis (NMA) were conducted, with clinical and tomographic ridge width changes as outcomes. Predictive intervals (95% PI) were reported.Results: Twenty-two studies were included, accounting for 52 study arms. Meta-regression identified that the socket sealing technique and publication year explained the observed heterogeneity. NMA showed that FA and OHB led to significantly lower ridge resorption than SH, resulting in 1.18 mm (95% PI 0.21-2.13) and 1.10 mm (95% PI 0.49-1.69) wide alveolar ridges, respectively. No significant difference between OHNB and SH was found (0.46 mm, 95% PI -0.70 to 1.64). The treatment with the largest probability for ARP was FA (52.7%), followed by OHB (39.1%) and OHNB (8.2%).Conclusions: FA and OHB are efficacious techniques to seal the alveolus during ARP.

Silk Fibroin/Collagen/Hydroxyapatite Scaffolds Obtained by 3D Printing Technology and Loaded with Recombinant Human Erythropoietin in the Reconstruction of Alveolar Bone Defects

“…Moreover, the instability in the size of the alveolar fossa can compromise the accuracy of the installation of the removable denture or implant; the patient’s chewing function and facial image are affected during the healing time, and the quality of life is reduced. The alveolar process contracts to a certain extent due to the reduction of the biomechanical stimulation and the physiological remodeling of the alveolar bone to fill the postextraction space. − Some studies showed that bone remodeling results in 40–60% of the vertical and horizontal bone loss during the first two years of alveolar bone healing. , Bio-Oss is widely used in clinical practice for the preservation of the alveolar ridge, achieving good results to some extent. However, it is prone to collapse, and it does not maintain a good and stable shape .…”

Clinical evaluations of alveolar ridge preservation in compromised extraction sockets with cortical‐lamina anchoring technique: Case series study

“…Tooth extraction leads to dimensional changes in bone architecture and the mucosal tissue will also collapse immediately 1 . Moreover, compromised extraction sockets undergo more pronounced atrophy as a result of the natural remodeling process 2–4 . However, these soft and hard tissue changes in the required dental implant area are most likely to lead to increased difficulty in placing the implant in a suitable position for prosthodontics, especially, it might be a great challenge to achieve acceptable aesthetic outcome.…”

“…Preservation of hard tissue with a prolonged healing time before implant placement has been suggested when buccal bone plate loss reaches more than 50% 1 . Bone substitute was commonly used to fill the extraction socket during ARP, such as artificial synthetic materials, xenograft, and autogenous or allogenic graft materials, and barrier membrane were used to cover the bone‐grafting materials 2 . For counteracting pressure and muscular activity from soft tissue, it is difficult to maintain contour stability when using absorbable membrane with particulate bone grafts.…”

“… 1 Moreover, compromised extraction sockets undergo more pronounced atrophy as a result of the natural remodeling process. 2 , 3 , 4 However, these soft and hard tissue changes in the required dental implant area are most likely to lead to increased difficulty in placing the implant in a suitable position for prosthodontics, especially, it might be a great challenge to achieve acceptable aesthetic outcome. In order to resolve this problem, alveolar ridge preservation (ARP) and augmentation protocols have reported as an evidence‐based approach to manage these compromised extraction sockets.…”

“… 1 Bone substitute was commonly used to fill the extraction socket during ARP, such as artificial synthetic materials, xenograft, and autogenous or allogenic graft materials, and barrier membrane were used to cover the bone‐grafting materials. 2 For counteracting pressure and muscular activity from soft tissue, it is difficult to maintain contour stability when using absorbable membrane with particulate bone grafts. For avoiding ridge collapse, nonabsorbable such as e‐PTFE (expanded polytetrafluoroethylene) or titanium mesh reinforced e‐PTFE were widely applied; however, membrane exposure is a common complication, and the average exposure rates of 29.3% for e‐PTFE was reported by Thoma et al, once membrane exposure and the ensuing infection will frequently lead to early removal of the membrane.…”