The Decision‐Making Process for Ridge Preservation Procedures After Tooth Extraction

Abstract

Focused Clinical Question: How should the extraction socket be managed after tooth removal? Summary: Resorptive changes that take place after tooth extraction can result in a significant reduction in alveolar ridge width and height. This may create a problem for proper implant placement and fabrication of esthetic restorations. Ridge preservation has been shown to be effective in decreasing alveolar bone resorption after tooth removal. During ridge preservation, the extraction socket is filled with graft material, and a barrier is generally used to contain the graft. Flap reflection is usually not recommended if the socket walls are intact and the ridge width is sufficient after tooth removal. However, if significant breakdown of the buccal bony plate is present, mucoperiosteal flap elevation may be required to allow proper placement of the bone graft and membrane. Different types of bone grafts (autograft, allograft, and xenograft) and barrier membranes (resorbable and non‐resorbable) have been evaluated in clinical studies. They all are shown to be effective regardless of the material or technique used. Conclusions: Ridge preservation is an effective procedure for minimizing horizontal and vertical alveolar ridge resorption after tooth extraction. Current evidence does not support one technique as being superior to another. The selection of the technique to be used should be based on the clinical situation.

In vitro effect of mineralized and demineralized bone allografts on proliferation and differentiation of MG-63 osteoblast-like cells

“…But, due to shortcomings such as inconvenient access, risk of morbidity, time and cost of donor site surgery, limited volume and shape of bone required by the surgeon, the need for suitable alternatives is clear. Mineralized freeze-dried bone allografts (FDBA) and demineralized freezedried bone allografts (DFDBA) are not as valuable as autografts; but they have osteoconductive and osteoinductive activities (Khan et al 2005) and extensively used as suitable alternatives to autografts (Nkenke and Stelzle 2009;Beck and Maeley 2010;Chan et al 2013;Miron et al 2013;Frost et al 2014). Most previous reports have focused on osteoconductivity of mineralized bone allografts (providing a suitable structure and surface for cell attachment, proliferation and migration) and osteoinductivity of demineralized bone allografts (providing a biological stimulus and inducing osteoblastic differentiation).…”

Effect of Healing Time on New Bone Formation After Tooth Extraction and Ridge Preservation With Demineralized Freeze‐Dried Bone Allograft: A Randomized Controlled Clinical Trial

“…Ridge preservation has been shown to be a successful treatment for maintaining horizontal and vertical ridge dimension after extraction 3,4,7‐9 . The simple application of placing grafting material into an extraction socket significantly reduces dimensional changes 3 , 8 .…”

“…6 Ridge preservation has been shown to be a successful treatment for maintaining horizontal and vertical ridge dimension after extraction. 3,4,[7][8][9] The simple application of placing grafting material into an extraction socket significantly reduces dimensional changes. 3,8 This procedure is more predictable, offering reduction in patient morbidity, and cost, compared with other lateral and vertical ridge augmentation techniques that may be needed in the absence of ridge preservation.…”

“…3,8 This procedure is more predictable, offering reduction in patient morbidity, and cost, compared with other lateral and vertical ridge augmentation techniques that may be needed in the absence of ridge preservation. 7 Various materials, including autogenous grafts, allografts, xenografts, and alloplasts have been used for ridge preservation procedures with varying success. 9 Mineralized freeze-dried bone allograft (FDBA) and demineralized FDBA (DFDBA) are well-supported, common products used to reduce changes in ridge dimension after tooth extraction and provide adequate new vital bone for implant placement.…”

The Extraction Socket Management Continuum: A Hierarchical Approach to Dental Implant Site Development

“…. The authors prefer an immediate implant protocol when the following conditions are present: 1) adequate distance to vital structures, 2) adequate bone to achieve primary stability, 3) intact facial/buccal cortex, 4) width of attached gingiva > two millimeters, 5) gingival thickness > one millimeter (preferably > two millimeters), and 6) absence of gingival recession or disharmonious gingival architecture . Facial cortical bone is almost always thin at maxillary anterior extraction sites .…”