Efficacy of Alveolar Ridge Preservation: A Randomized Controlled Trial

Abstract

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).

Buccal bone thickness of maxillary anterior teeth: A systematic review and meta‐analysis

“…Considering that ARP outcomes can vary substantially across different sites (Avila-Ortiz, Elangovan, Kramer, Blanchette, & Dawson, 2014;Iocca, Farcomeni, Pardinas Lopez, & Talib, 2017), site-specific factors can play a major role (Avila-Ortiz, Chambrone, & Vignoletti, 2019). Specifically, it has been shown that 0.6 mm of baseline buccal bone thickness is associated with at least 10% bone volume loss in sites receiving ARP (Avila-Ortiz et al, 2020).…”

Post‐extraction dimensional changes: A systematic review and meta‐analysis

“…Differences in horizontal bone changes between baseline and final follow-up assessed in CBCT scan images were reported in eleven studies (Avila-Ortiz et al, 2020 ;Canellas et al, 2020 ;Cha et al, 2019 ;Clementini et al, 2019 ;Fiorellini et al, 2005 ;Jiang et al, 2017 ;Jung et al, 2013 ;Lim et al, 2019 ;Pang et al, 2016 ;Qabbani et al, 2017 ;Sun et al, 2019 ). Seven studies assessed horizontal changes at different levels (i.e.…”

“…Differences in bone volumetric changes between baseline and final follow-up assessed by CBCT scan images were reported in two studies including non-molar teeth (Avila-Ortiz et al, 2020 ;Canellas et al, 2020…”

“…Clinical evidence indicates that some phenotypic factors may influence bone resorption patterns (Avila-Ortiz et al, 2020 ;Chappuis et al, 2013 ). Two previous systematic reviews (SRs) on this topic evaluated bone and soft tissue changes (Tan et al, 2012 ;Van der Weijden et al, 2009 ).…”

Monitoring Alveolar Ridge Remodelling Post-Extraction Using Sequential Intraoral Scanning over a Period of Four Months

“…It is dependent on a host of local and systemic factors [ 1 ]. Studies have previously used in-vivo cone beam computed tomographic (CBCT) scanning or extraoral surface scanning of patient casts to monitor and quantify bone remodelling up to four months post-extraction [ 2 , 3 ]. Indeed, a recent study involving ten patients demonstrated the use of CBCT to measure volumetric changes post vertical ridge augmentation in the form of vertical bone gain, planned bone volume, lacking bone volume, and regenerated bone volume, using computer-aided design/computer-aided manufacturing customised titanium meshes [ 4 ].…”