Is ridge preservation/augmentation at periodontally compromised extraction sockets safe? A retrospective study

Half- and full-grafting alveolar ridge preservation with different sealing materials: A three-arm randomized clinical trial

OBJECTIVE

The objective of this study is to investigate the effect of different alveolar ridge preservation (ARP) approaches on bone resorption and their potential for facilitating implant placement.

MATERIALS AND METHODS

Patients who underwent one or two tooth extractions with a desire for restoration were included in the study. The participants were randomly assigned to one of three groups for ARP. The groups were as follows: (1) Half grafting of bovine bone mineral (DBBM-C) covered with non-resorbable dense polytetrafluoroethylene (dPTFE) membrane (Test 1 group); (2) Half grafting of bovine bone mineral (DBBM-C) covered with collagen membrane (Test 2 group); and (3) Full grafting with collagen membrane (DBBM-C + Collagen membrane) as the Control group. After 6-month healing period, the evaluation encompassed clinical, radiographic, implant-related outcomes, and the factors contributing to hard and soft tissue alterations.

RESULTS

Enrollment in this study comprised 56 patients. At the 6-month follow-up, radiographic analysis in computed beam computed tomography images was conducted for 18, 19, and 19 patients with 18, 20, and 20 tooth sites in Test 1, Test 2, and Control groups, respectively. Additionally, a total of 15, 17, and 17 patients with 15, 18, and 17 implants were evaluated. Based on radiographic analysis, all groups showed limited ridge resorption at 1 mm from crest horizontally (Test 1: 1.29 ± 1.37; Test 2: 1.07 ± 1.07; Control: 1.54 ± 1.33 mm, p = 0.328), while the Control group showed greater radiographic bone height gain in mid-crestal part vertically (Test 1: 0.11 ± 1.02; Test 2: 0.29 ± 0.83; Control: -0.46 ± 0.95 mm, p = 0.032). There were no significant intergroup differences in terms of keratinized mucosal width, bone density, insertion torque, and the need of additional bone graft. However, the use of a dPTFE membrane resulted in a significantly higher vertical mucosal thickness (Test 1: 2.67 ± 0.90; Test 2: 3.89 ± 1.08; Control: 2.41 ± 0.51 mm, p < 0.001).

CONCLUSIONS

The study showed comparable dimensional preservation with limited vertical shrinkage, while thin buccal bone plate, non-molar sites, and large discrepancy between buccal and palatal/lingual height may contribute to greater shrinkage. Thicker mucosa with dPTFE membrane required further investigation for interpretation.

CLINICAL TRIAL REGISTRATION NUMBER

NCT06049823. This clinical trial was not registered prior to participant recruitment and randomization.

The adjunctive effect of polydeoxyribonucleotide on bone formation in alveolar ridge preservation: A pre-clinical in vivo study

AIM

This study investigated the adjunctive effect of polydeoxyribonucleotide (PDRN) on bone formation in alveolar ridge preservation (ARP) sockets.

MATERIALS AND METHODS

Both mandibular second, third and fourth premolars of eight beagle dogs were randomly divided into ARP and ARP/PDRN groups. Following tooth extraction, ARP procedures were conducted using collagenized alloplastic graft material and bilayer collagen membrane soaked with normal saline (ARP group) or PDRN (ARP/PDRN group) for 10 min before application. Both groups were also randomly allocated to 2-, 4- or 12-week healing subgroups. The primary endpoint of this study was to compare histomorphometric differences between ARP and ARP/PDRN. The secondary endpoints of this study were to compare micro-CT analysis and three-dimensional volumetric measurement between the two groups.

RESULTS

In the histomorphometric analysis, the ARP/PDRN group exhibited greater new bone formation at coronal, middle and total position compared with the ARP group at 2-week healing. The number of newly formed blood vessels was higher in the ARP/PDRN group than in the ARP group at 2- and 4-week healing. In micro-CT analysis, the mean new bone volume/total bone volume between ARP and ARP/PDRN was statistically significant at 2-week healing. Ridge volume alterations were significantly decreased in the ARP/PDRN group during entire healing time compared with the ARP group, especially on the buccal side.

CONCLUSIONS

The application of PDRN in ARP might provide additional benefits for early bone regeneration and maintenance of buccal ridge volume.

Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis

AIM

To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites.

METHODS

An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates.

RESULTS

Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence.

CONCLUSIONS

Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.

Effectiveness of a collagen matrix seal and xenograft in alveolar ridge preservation: an experimental study in dogs

Majority of previous studies on alveolar ridge preservation (ARP) used collagen membranes as barrier membranes, and further evidence for ARP in dehiscent extraction sockets with a deproteinized bovine bone mineral (DBBM) and matrix is needed. The aim of this study is to assess the impact of non-cross linked collagen membranes (membrane) and crosslinked collagen matrices (matrix) on ARP using DBBM in extraction sockets with buccal dehiscence. In six mongrel dogs, the mesial roots of three mandibular premolars (P2, P3, and P4) were extracted 1 month after dehiscence defect induction. Two experimental groups were randomly assigned: (1) DBBM with a membrane (DBBM/membrane group) and (2) DBBM with a matrix (DBBM/matrix group). Three-dimensional (3D) volumetric, microcomputed tomography (μCT), and histologic analyses were performed to assess the ridge preservation. Both groups were effective to maintain the ridge width (p > 0.05), and the DBBM/matrix group showed more favorable soft tissue regeneration and bone quality in the histological analysis (p = 0.05). Based on these results, DBBM/matrix could be better choice for ARP in cases of buccal dehiscence defects.

Alveolar ridge preservation in sockets with severe periodontal destruction using autogenous partially demineralized dentin matrix: A randomized controlled clinical trial

BACKGROUND

The preservation and reconstruction of alveolar ridge volume in extraction sockets of molars affected by severe periodontitis is a critical challenge that requires clinical attention.

PURPOSE

This randomized controlled clinical trial was designed to evaluate the efficiency of autogenous partially demineralized dentin matrix (APDDM) for alveolar ridge preservation (ARP) in severely periodontally compromised sockets compared to spontaneous healing (SH) on radiographic and histomorphometric outcomes.

MATERIALS AND METHODS

Thirty-two patients with 32 periodontally compromised molars were randomized into either the test group, which received ARP using APDDM covered with a collagen sponge, or the control group, which underwent SH. Linear and volumetric changes were assessed using superimposed cone-beam computed tomography (CBCT) acquired pre-extraction and after a 4-month healing time. Histomorphometric evaluation was performed on trephine cores harvested during implant placement.

RESULTS

All sites healed uneventfully. The ridge width at 1 mm apical to the bone crest increased by 5.03, 4.50, and 5.20 mm in the mesial, middle, distal area in the APDDM group, while decreasing by -1.98, -2.19, and -1.98 mm in the SH group, respectively (p < 0.05). The height increase of the central bone was significantly higher in the APDDM group than in the SH group (p < 0.05). The height decrease of the buccal (mesial, middle, distal) bone plate was lower in the APDDM group than in the SH group (p < 0.05). After a 4-month healing time, bone volume increased by 37.07% in the APDDM group and by only 2.33% in the SH group (p < 0.05). Histomorphometric analysis revealed that APDDM particles were surrounded by newly formed bone, with partially absorbed residual APDDM materials observed. New bone, APDDM remnants, and connective tissue occupied 39.67 ± 8.28%, 23.66 ± 9.22%, and 36.67 ± 17.05% of the areas in the APDDM group, respectively.

CONCLUSIONS

ARP using APDDM was effective, resulting in a significant increase in both linear and volumetric changes in severely periodontally compromised extraction sockets compared to SH. These findings suggest that APDDM may serve as a promising new clinical option for the reconstruction of alveolar ridge dimensions.

Evaluation of alveolar ridge preservation in sockets with buccal dehiscence defects using two types of xenogeneic biomaterials: An in vivo experimental study

OBJECTIVES

Alveolar ridge preservation (ARP) has been extensively investigated in various preclinical and clinical studies, yielding favorable results. We aim to evaluate the effects of ARP using collagenated bovine bone mineral (CBBM) alone or particulated bovine bone mineral with a non-cross-linked collagen membrane (PBBM/NCLM) in tooth extraction sockets with buccal dehiscence in an experimental dog model.

MATERIALS AND METHODS

The mesial roots of three mandibular premolars (P2, P3, and P4) were extracted from six mongrel dogs 4 weeks after inducing dehiscence defects. ARP was randomly performed using two different protocols: 1) CBBM alone and 2) PBBM/NCLM. Three-dimensional (3D) volumetric, micro-computed tomography, and histological analyses were employed to determine changes over a span of 20 weeks.

RESULTS

In 3D volumetric and radiographic analyses, CBBM alone demonstrated similar effectiveness to PBBM/NCLM in ARP (p > .05). However, in the PBBM/NCLM group (3.05 ± 0.60 mm), the horizontal ridge width was well maintained 3 mm below the alveolar crest compared with the CBBM group (2.11 ± 1.01 mm, p = .002).

CONCLUSION

Although the radiographic changes in the quality and quantity of bone were not significant between the two groups, the use of PBBM/NCLM resulted in greater horizontal dimensions and more favorable maintenance of the ridge profile.

The Bone Bridge Technique Utilizing Bone from the Lateral Wall of the Maxillary Sinus for Ridge Augmentation: Case Reports of a 1-7 Year Follow-Up

The post-extraction socket of a periodontally compromised tooth/implant is oftentimes accompanied by a very wide-deep alveolar ridge defect. The commonly utilized treatment is ridge preservation followed by delayed implant placement 4 to 6 months after extraction. In the four cases presented in this study, a novel technique of utilizing a bone block obtained from the lateral wall of the maxillary sinus is introduced. Due to the severe localized vertical ridge deficiency, an intraoral autogenous bone block was obtained from the ipsilateral sinus bony window. After the obtained bone block was properly trimmed, it was fixed in the form of a bridge over the vertical defect by the press-fit method. In two cases, the gap between the autogenous bone and defect was filled with a particulate synthetic bone graft, and in another two cases, the gap was left without grafting. All cases were covered with a resorbable collagen membrane. At the time of re-entry after 5 to 6 months, the bone bridge was well incorporated beside the adjacent native bone and helped by the implant placement. Uncovering was performed after 3 to 6 months, and prostheses were delivered after 2 months. Oral function was maintained without any change in the marginal bone level even after the 1- to 7-year post-prosthesis delivery. This case series showed that the bone bridge technique performed using an ipsilateral sinus bony window for a localized vertical deficiency of a post-extraction socket can be used for successful vertical ridge augmentation (VRA).

Assessment of soft and hard tissue characteristics of ridge preservation at molar extraction sites with severe periodontitis: a randomized controlled trial

Background

Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients.

Methods

This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation.

Discussion

This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets.

Trial registration

Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0.

Flap Extension Technique Using Intrasocket Granulation Tissue in Peri-Implant Osseous Defect: Case Series

A compromised extraction socket is characterized by severe bone resorption around neighboring teeth and is often occupied with thick intrasocket granulation tissue (IGT). Guided bone regeneration (GBR) is a procedure that can preserve the bone volume around extraction sockets, and it can also be combined with immediate implant placement. However, an early exposure of GBR sites is a possible complication because it increases the risk of infection and can inhibit successful bone regeneration. The purpose of these case series is to introduce a novel, surgical procedure that can prevent the exposure of GBR sites by using IGT for flap extension during immediate implant placement in compromised extraction sockets. The technique was successfully performed in six patients. For successful flap closure, the inner portion of the IGT was dissected so that the flap was properly extended with the base of IGT attached to the flap for blood supply. Periosteal releasing incisions were not performed. The IGT was first sutured to the palatal flap with resorbable sutures, and then the overlying flap was closed with additional sutures. There was no post-operative exposure of the surgical GBR site in any of the patients, and the location of the mucogingival junction remained unchanged. All grafted sites also achieved sufficient bone regeneration. Within the limitations, this case series demonstrates the potential use of IGT, a concept which was previously obsolete.

Evaluation of implant placement following ridge preservation in periodontally compromised molar extraction sockets: Three-year results of a prospective cohort study

OBJECTIVE

To investigate the 3-year implant-related outcomes following alveolar ridge preservation in periodontally compromised molar sockets.

MATERIAL AND METHODS

Thirty implants were placed in 26 patients following either ridge preservation (test, n = 16) or natural healing (control, n = 14) at deficient molar extraction sites after a 6-month healing period. The need for additional augmentation procedures at implant placement was recorded. Patients were assessed for 3 years following a definitive restoration. Patient information being collected are modified plaque index, the modified sulcus bleeding index, the peri-implant probing depth clinically, and alterations of marginal bone level (MBL) radiographically.

RESULTS

There was a 100% survival rate of implants in both groups after 3-year follow-up. During implant placement operation, 35.7% in the control group and 6.3% in the test group required additional augmentation procedures. No statistically significant differences were determined for peri-implant parameters and marginal bone levels between the two groups. The overall mean difference of MBL was 0.072 mm (95% CI [-0.279, 0.423]) during the 3 years of follow-up. The success rate was 81.2% in the test and 78.6% in the control group.

CONCLUSIONS

Implants placed into periodontally compromised molar extracted sites after ridge augmentation resulted comparable outcomes to implants placement at naturally healed sites after 3-year functional loading.

Effects of hyaluronic acid and deproteinized bovine bone mineral with 10% collagen for ridge preservation in compromised extraction sockets

BACKGROUND

The aim of this study was to evaluate the efficacy of deproteinized bovine bone mineral with 10% collagen (DBBM-C) soaked with hyaluronic acid (HA) for ridge preservation in compromised extraction sockets.

METHODS

Bilateral third, fourth premolars and first molar were hemisected, distal roots were extracted, and then combined endodontic periodontal lesion was induced in the remaining mesial roots. After 4 months, the mesial roots were extracted and the following four treatments were randomly performed: Absorbable collagen sponge (ACS), ACS soaked with HA (ACS+HA), ridge preservation with DBBM-C covered with a collagen membrane (RP), ridge preservation with DBBM-C mixed with HA and covered with a collagen membrane (RP+HA). Animals were sacrificed at 1 and 3 months following treatment. Ridge dimensional changes and bone formation were examined using microcomputed tomography, histology, and histomorphometry.

RESULTS

At 1 month, ridge width was significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups, while the highest proportion of mineralized bone was observed in ACS+HA group. At 3 months, ridge width remained significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups. ACS+HA and RP+HA treatments featured the highest proportion of mineralized bone and bone volume density compared with the other groups. No statistical difference was observed between ACS+HA and RP+HA treatments.

CONCLUSIONS

Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.

Ridge preservation in maxillary molar extraction sites with severe periodontitis: a prospective observational clinical trial

OBJECTIVES

To assess alveolar bone changes and treatment modality alterations after ridge preservation on maxillary molar extraction sockets with severe periodontitis, compared to natural healing.

MATERIAL AND METHODS

Thirty-six maxillary infected-molar teeth either receiving ridge preservation (RG group) or undergoing natural healing (NT group) were investigated. Cone-beam computed tomography (CBCT) scanning was performed immediately after surgery (the baseline) and repeated 6 months later to measure the linear and volumetric changes of the sockets.

RESULTS

Based on radiographic measurements, alveolar bone width decreased by 1.58 ± 4.61 mm in the NT group but increased by 3.74 ± 4.17 mm in the RG group (p < 0.05). Significant increases in ridge height at the center of both the NT (7.54 ± 4.54 mm) and RG (9.20 ± 3.26 mm) groups were observed. Mean sinus pneumatization was 0.19 ± 0.45 mm in the RG group and 0.59 ± 0.63 mm in the NT group (p < 0.05). The relative increase in total ridge volume was 8.0% and 35.5% in the NT and RG group, respectively (p < 0.05). Implant placement with additional sinus augmentation procedure was performed in 16.7% of the RG group cases, whereas 50% in the NT group cases.

CONCLUSIONS

Ridge preservation in the maxillary molar extraction sockets with severe periodontitis can improve alveolar ridge dimensions and decrease the necessity of advanced regenerative procedures at implant placement compared to natural healing.

CLINICAL RELEVANCE

Ridge preservation on maxillary molar extraction sockets with severe periodontitis maintained the vertical bone height more efficiently and resulted in less need for sinus augmentation procedures at 6 months compared to natural healing.

Alveolar ridge regeneration in two-wall-damaged extraction sockets of an in vivo experimental model

Aim

To determine the healing outcome following grafting with deproteinized porcine bone mineral (DPBM) with or without collagen membrane coverage in two‐wall (both buccal and lingual)‐damaged extraction sockets.

Materials and methods

Distal roots of three mandibular premolars in six beagle dogs were extracted, and the whole buccal and lingual bony walls were surgically removed. Three treatment protocols were then applied according to the following group allocation: no graft (None), grafting DPBM (BG), and grafting DPBM with coverage by a collagen membrane (BG + M). Two observational periods (2 and 8 weeks) were used with the split‐mouth design, and quantitative and qualitative analyses were performed by microcomputed tomography and histology.

Results

The dimensions of the alveolar ridge at both grafted sites (BG and BG + M) remained similar to those of the pristine ridge in the histologic and radiographic analyses, whereas the ungrafted sites (None) collapsed both vertically and horizontally. Both grafting protocols produced substantial bony regeneration, but the addition of a covering membrane enhanced the proportion of mineralized tissue within the augmented area, and the BG + M group also showed a significantly larger area of regenerated ridge than the None group (p < .05).

Conclusions

Bone grafting with collagen membrane can maintain the alveolar ridge dimensions with substantial bone regeneration in a two‐wall‐damaged extraction socket.

Retrospective study of alveolar ridge preservation compared with no alveolar ridge preservation in periodontally compromised extraction sockets

Background

To minimize alveolar bone resorption, alveolar ridge preservation (ARP) has been proposed. Recently, interest in improving the feasibility of implant placement has gradually increased, especially in situations of infection such as periodontal and/or endodontic lesions. The aim of this study was to investigate if ARP improves feasibility of implant placement compared with no ARP in periodontally compromised sites. Secondary endpoints were the necessity of bone graft at the time of implant placement and implant failure before loading at ARP compared with no ARP.

Material and methods

This retrospective study was performed using dental records and radiographs obtained from patients who underwent tooth extraction due to chronic periodontal pathology. Outcomes including the feasibility of implant placement, horizontal bone augmentation, vertical bone augmentation, sinus floor elevation, total bone augmentation at the time of implant placement, and implant failure before loading were investigated. Multivariable logistic regression analysis was performed to examine the influence of multiple variables on the clinical outcomes.

Results

In total, 418 extraction sites (171 without ARP and 247 with ARP) in 287 patients were included in this study. The ARP group (0.8%) shows significantly lower implant placement infeasibility than the no ARP group (4.7%). Horizontal and vertical bone augmentations were significantly influenced by location and no ARP. Total bone augmentation was significantly influenced by sex, location, and no ARP.

Conclusion

ARP in periodontally compromised sites may improve the feasibility of implant placement. In addition, ARP attenuate the severity of the bone augmentation procedure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-021-00305-2.

Is ridge preservation effective in the extraction sockets of periodontally compromised teeth? A randomized controlled trial

OBJECTIVE

To verify whether ridge preservation is effective in the reduction of dimensional loss and in bone formation compared to spontaneous healing in extraction sockets of periodontally compromised teeth.

METHODS

Twenty-six subjects requiring tooth extraction for stage III/IV periodontitis were randomly assigned to one of two interventions: alveolar ridge preservation using collagenated bovine bone mineral and a resorbable collagen membrane (test, RP) or spontaneous healing (control, SH). Six months later, postoperative cone-beam computed tomography (CBCT) was performed to measure the linear and volumetric changes of the sockets compared to baseline scans. Biopsies were retrieved at the implant site for histomorphometric calculations. Nonparametric tests were applied for statistical analysis.

RESULTS

Significantly less shrinkage occurred in RP compared to SH, mainly in the crestal zone. The width loss difference between groups was 3.3 mm and 2.2 mm at 1 mm and 3 mm below the crest, respectively (p < .05). RP yielded a gain in socket height of 0.25 mm, whereas a loss of -0.39 mm was observed in SH (p < .05). The percentage of volume loss recorded in RP was also less than that recorded in SH (-26.53% vs -50.34, p < .05). Significantly less bone proportion was detected in biopsies from RP (30.1%) compared with SH (53.9%). A positive association between baseline bone loss and ridge shrinkage was found in SH but not in RP.

CONCLUSION

Ridge preservation in extraction sockets of periodontally compromised teeth was effective in reducing the amount of ridge resorption.

Compromised extraction sockets: a new classification and prevalence involving both soft and hard tissue loss

PURPOSE

Previous studies have solely focused on fresh extraction sockets, whereas in clinical settings, alveolar sockets are commonly associated with chronic inflammation. Because the extent of tissue destruction varies depending on the origin and the severity of inflammation, infected alveolar sockets may display various configurations of their remaining soft and hard tissues following tooth extraction. The aim of this study was to classify infected alveolar sockets and to provide the appropriate treatment approaches.

METHODS

A proposed classification of extraction sockets with chronic inflammation was developed based upon the morphology of the bone defect and soft tissue at the time of tooth extraction. The prevalence of each type of the suggested classification was determined retrospectively in a cohort of patients who underwent, between 2011 and 2015, immediate bone grafting procedures (ridge preservation/augmentation) after tooth extractions at Seoul National University Dental Hospital.

RESULTS

The extraction sockets were classified into 5 types: type I, type II, type III, type IV (A & B), and type V. In this system, the severity of bone and soft tissue breakdown increases from type I to type V, while the reconstruction potential and treatment predictability decrease according to the same sequence of socket types. The retrospective screening of the included extraction sites revealed that most of the sockets assigned to ridge preservation displayed features of type IV (86.87%).

CONCLUSIONS

The present article classified different types of commonly observed infected sockets based on diverse levels of ridge destruction. Type IV sockets, featuring an advanced breakdown of alveolar bone, appear to be more frequent than the other socket types.

Morphological Classification of Extraction Sockets and Clinical Decision Tree for Socket Preservation/Augmentation after Tooth Extraction: a Systematic Review

Objectives

The aim of present study was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area.

Material and Methods

The search protocol used the electronic MEDLINE (PubMed) and EMBASE databases for articles published between January 1 2009 and May 1 2019. The search included only human studies published in English. Outcomes were the indications and reasons for socket preservation/augmentation and classification of extraction sockets.

Results

Ten studies fulfilled the inclusion criteria and were selected for the study. Although there are various types of extraction socket classifications none of them could completely evaluate all morphological parameters of alveolar ridge. Furthermore, present study revealed that indications for extraction socket preservation/augmentation have wider spectrum than socket morphology and are related to surrounding tissue anatomy or dental implantation operation indications and timing. Based on currently proposed extraction socket classifications and rationales, a novel decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic area was suggested.

Conclusions

The need of extraction socket preservation/augmentation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint. A novel clinical decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic zones can be useful tool in socket preservation/augmentation procedures.

Preservation and augmentation of molar extraction sites affected by severe bone defect due to advanced periodontitis: A prospective clinical trial

BACKGROUND

Studies of the extracted infected-molar ridge preservation are limited.

PURPOSE

To compare alterations of hard and soft tissue in infected-molar sockets receiving ridge preservation compared with natural healing.

MATERIALS AND METHODS

Thirty-five infected-molar extraction sites either preserving with Bio-Gide membrane covered the Bio-Oss material or receiving natural healing procedure as controls. The soft tissue profile was evaluated before tooth extraction and after 6-month healing. Cone-beam computed tomography scans were taken immediately and 6 months after extraction. Vertical and horizontal bone changes were assessed radiographically. Data were analyzed with Mann-Whitney U test and α = 0.05.

RESULTS

No significant differences in soft tissue and vertical bone changes in the medium region of the sockets were found (P > .05). Buccal bone changes in the mesial and distal sites in the test group were significantly lower than the control group (P < .05). Ridge width increased from 0.21mm to 5.30mm at 1mm apical from the crest in the test and reduced from 0.12 mm to 1.00 mm in the control groups.

CONCLUSION

Ridge preservation at periodontally compromised molar extraction sites might compensate for ridge width and buccal bone resorption that occurs with natural healing alone.