Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta‐analysis

Abstract

Aim The aim of this systematic review was to critically analyse the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient‐centred outcomes. Material and Methods A comprehensive search aimed at identifying pertinent literature for the purpose of this review was conducted by two independent examiners. Only randomized clinical trials (RCTs) that met the eligibility criteria were selected. Relevant data from these RCTs were collated into evidence tables. Endpoints of interest included clinical, radiographic and patient‐reported outcome measures (PROMs). Interventions reported in the selected studies were clustered into ARP treatment modalities. All these different ARP modalities were compared to the control therapy (i.e. spontaneous socket healing) in each individual study after a 3‐ to 6‐month healing period. Random‐effects meta‐analyses were conducted if at least two studies within the same ARP treatment modality reported on the same outcome of interest. Results A combined database, grey literature and hand search identified 3,003 records, of which 1,789 were screened after removal of duplicates. Following the application of the eligibility criteria, 25 articles for a total of 22 RCTs were included in the final selection, from which nine different ARP treatment modalities were identified: (a) bovine bone particles (BBP) + socket sealing (SS), (b) construct made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, (c) cortico‐cancellous porcine bone particles (CPBP) + SS, (d) allograft particles (AG) + SS, (e) alloplastic material (AP) with or without SS, (f) autologous blood‐derived products (ABDP), (g) cell therapy (CTh), (h) recombinant morphogenic protein‐2 (rhBMP‐2) and (i) SS alone. Quantitative analyses for different ARP modalities, all of which involved socket grafting with a bone substitute, were feasible for a subset of clinical and radiographic outcomes. The results of a pooled quantitative analysis revealed that ARP via socket grafting (ARP‐SG), as compared to tooth extraction alone, prevents horizontal (M = 1.99 mm; 95% CI 1.54–2.44; p < 0.00001), vertical mid‐buccal (M = 1.72 mm; 95% CI 0.96–2.48; p < 0.00001) and vertical mid‐lingual (M = 1.16 mm; 95% CI 0.81–1.52; p < 0.00001) bone resorption. Whether there is a superior ARP or SS approach could not be determined on the basis of the selected evidence. However, the application of particulate xenogenic or allogenic materials covered with an absorbable collagen membrane or a rapidly absorbable collagen sponge was associated with the most favourable outcomes in terms of horizontal ridge preservation. A specific quantitative analysis showed that sites presenting a buccal bone thickness >1.0 mm exhibited more favourable ridge preservation outcomes (difference between ARP [AG + SS] and control = 3.2 mm), as compared to sites with a thinner buccal wall (difference between ARP [AG + SS] and control = ...

Advanced platelet‐rich fibrin and freeze‐dried bone allograft for ridge preservation: A randomized controlled clinical trial

“…reported ridge preservation with PRF mixed with demineralized freeze‐dried bone allograft (DFDBA) resulted in significantly less ridge dimensional changes compared to treatment with DFDBA alone . Further, ridge dimensional changes using A‐PRF or A‐PRF+FDBA in the current study compare favorably with a systematic review of reports for ridge preservation using various mineralized bone substitutes. That review of eight included studies reported ridge height reductions ranging from 0.5 ± 1.1 mm to 1.6 ± 0.9 mm and ridge width reductions ranging from 1.1 ± 1.1 mm to 3.48 ± 2.68 mm using various ridge preservation protocols .…”

“…One clinical challenge is in areas with inadequate alveolar bone volume to support implant placement after dental extraction. To overcome this challenge many surgical techniques and materials have been developed to preserve or regenerate tissues in order to provide an optimal site to place an implant of adequate size in the ideal position …”

“…Matrix scaffolding materials are typically osteoconductive and are able to provide cell scaffolding and dimensional stability of the wound through space maintenance . These materials can be derived from allogeneic, xenogeneic, synthetic, or autogenic sources . Biologic agents are molecular mediators with typical osteoinductive properties to promote de novo bone formation .…”

Minimally invasive esthetic ridge preservation with growth‐factor enhanced bone matrix

“…There have been RCTs supporting growth factor intervention for ridge preservation with rhBMP‐2 and case reports with flapless socket preservation demonstrating growth‐factor enhanced healing with these techniques . The use of flapless techniques for bone preservation does not eliminate the need for connective tissue grafting to enhance the soft tissue thickness for improved bone preservation and reduction of gingival recession …”

“…This would require more invasive therapy and associated morbidity for the patient. It is important to note that the case examples presented had soft tissue grafting with connective tissue grafts at the time of implant placement to augment the tissue biotype and enhance long‐term soft and hard tissue stability …”