Evaluation of poly lactic‐co‐glycolic acid‐coated β‐tricalcium phosphate for alveolar ridge preservation: A multicenter randomized controlled trial

Abstract

Background Alveolar ridge preservation via socket grafting (ARP‐SG) is indicated to attenuate physiologic alveolar bone resorption as a consequence of tooth extraction. However, a specific bone grafting material that is patently superior has not been identified yet. The aim of this randomized controlled trial was to evaluate the efficacy of a moldable alloplastic graft, Poly Lactic‐Co‐Glycolic Acid‐Coated β‐Tricalcium Phosphate (PLGA‐β‐TCP), for ARP purposes [Group A] compared to freeze‐dried bone allograft (FDBA) particles covered with a rapidly absorbable collagen dressing (RACD) (Group B) in function of a panel of radiographic, histomorphometric, and implant‐related outcomes. Methods Patients in need of extraction of a single posterior tooth (premolar or molar) and subsequent replacement with a dental implant were recruited and randomly allocated into one of the two treatment groups. Follow‐up visits took place at 1, 2, 4, 8, and 16 weeks. Cone‐beam Computed Tomography (CBCT) scans were obtained at baseline and at 16 weeks. Sites were re‐entered at 20 weeks for bone core biopsy harvesting and subsequent implant placement. After delivery of the final implant‐supported restoration, follow‐up visits were scheduled at 6 and 12 months to monitor peri‐implant tissue health and marginal bone levels using standardized intraoral periapical radiographs. Results A total of 45 patients were initially enrolled in the study, of whom 43 received an implant and 32 completed the study. Healing was uneventful in all sites after ARP‐SG and implant placement. No site required bone augmentation to allow for implant placement. CBCT scan analyses showed no statistically significant differences between groups in terms of reduction of horizontal width, midbuccal / midlingual height and ridge volume. Histomorphometric assessments revealed a statistically significant difference between both groups in terms of mineralized tissue formation (Group A = 27.0% ± 22.1% versus Group B = 38.2% ± 12.5%; P < 0.05). On the contrary, no significant differences were observed regarding percent of remaining bone grafting material and non‐mineralized tissue. No implant failed throughout the study period and marginal bone level change was negligible in both groups. Conclusions Although a higher proportion of mineralized tissue was associated with the use of FDBA+RACD compared to PLGA‐β‐TCP alone, both ARP‐SG approaches rendered comparable outcomes in terms of maintenance of alveolar bone dimensions, feasibility of implant placement, implant survival, and peri‐implant bone level stability up to 12 months post‐loading.

A retrospective cohort study of how alveolar ridge preservation affects the need of alveolar ridge augmentation at posterior tooth implant sites

“…Therefore, to avoid underestimation of the effect of ARP, we evaluated only the effect of ARP at the posterior teeth. Meanwhile, increasing studies found that alveolar ridge preservation at posterior teeth with an intact alveolar socket [40] or non-molar and molar teeth with non-intact alveolar sockets [41] could observe significantly reduced requirement for bone augmentation at implant placement. This study has some limitations.…”

Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy

“…Tooth extraction inevitably leads to a variable degree of alveolar ridge atrophy 1–3 . Among other interceptive therapies, 4,5 contemporary evidence strongly supports the effectiveness of alveolar ridge preservation (ARP) therapy to prevent extensive alveolar ridge resorption after tooth extraction compared with unassisted socket healing (USH), 6,7 whether immediate implant placement is simultaneously performed or not 8 …”

“…Tooth extraction inevitably leads to a variable degree of alveolar ridge atrophy. [1][2][3] Among other interceptive therapies, 4,5 contemporary evidence strongly supports the effectiveness of alveolar ridge preservation (ARP) therapy to prevent extensive alveolar ridge resorption after tooth extraction compared with unassisted socket healing (USH), 6,7 whether immediate implant placement is simultaneously performed or not. 8 A systematic review and meta-analysis evaluating the efficacy of different ARP modalities, concluded that ARP via socket grafting as compared with tooth extraction alone, prevents horizontal (1.99 mm), vertical midbuccal (1.72 mm) and vertical mid-lingual (1.16 mm) bone resorption.…”

Application of β-Tricalcium Phosphate in Adhesive Dentin Bonding

“…β-TCP is a biocompatible material that is of particular interest for various clinical applications as it can be synthesized with consistent batch quality because it has well-defined properties [ 15 ]. In the last two decades, their use in dentistry has increased and β-TCP has shown its efficacy in many applications, especially in the vital pulp therapy as a direct pulp-capping agent [ 16 , 17 ], in treating periodontal infra-bony defects [ 18 ], and in alveolar ridge preservation for implant placement [ 19 ]. Schiroky et al formerly incorporated TCP nanoparticles in their experimental adhesive (EA) and reported higher Knoop hardness and polymerization rate as compared with the controls [ 13 ].…”