Is alveolar ridge preservation an overtreatment?

Larger Vertical Ridge Augmentation: A Retrospective Multicenter Comparative Analysis of Seven Surgical Techniques

Background: Vertical alveolar ridge augmentation (ARA) > 3 mm is associated with increased surgical complexity and higher complication rates. Despite the availability of various ARA techniques and graft materials, robust comparative clinical data remain limited. This retrospective multicenter study aimed to evaluate and compare surgical and patient-relevant outcomes across seven established vertical ARA techniques. Methods: This retrospective multicenter study included 70 cases of vertical ARA > 3 mm using seven different techniques (10 cases each): an iliac crest graft (ICG), intraoral autogenous bone block (IBB), allogeneic bone block (ABB), CAD/CAM ABB, CAD/CAM titanium mesh (CAD/CAM TM), magnesium scaffold (MS), and the allogeneic shell technique (ST). The outcome parameters included harvesting and insertion time, bone gain (vertical and horizontal, after a minimum of one year), graft resorption (after one year), donor site morbidity, dehiscence rate, need for material removal, and biological and general financial costs. Results: Harvesting time significantly varied among the different ARA techniques (p = 0.0025), with the longest mean durations in ICGs (51.6 ± 5.8 min) and IBBs (36.5 ± 10.8 min), and no harvesting was required for the other techniques. Insertion times also significantly differed between the different ARA techniques (p < 0.0001) and were longest in IBBs (50.1 ± 7.5 min) and the ST (47.3 ± 13.9 min). ICGs achieved the highest vertical and horizontal bone gain (5.6 ± 0.4 mm), while ABBs and CAD/CAM ABBs showed the lowest (~3.0 mm). Resorption rates significantly differed between the different ARA techniques (p < 0.0001) and were highest for ICGs (25.9 ± 3.9%) and lowest for MSs (5.1 ± 1.5%). Donor site morbidity was 100% in ICGs and 50% in IBBs, with no morbidity in the other groups. Dehiscence rates were 10% in most techniques but 30% in CAD/CAM TMs. Removals were required in all techniques except MSs. Biological and financial costs were high for ICGs and CAD/CAM ABBs and low for MSs. Conclusions: Vertical ARA techniques significantly differ regarding harvesting and insertion time, bone gain, graft resorption, donor site morbidity, dehiscence rates, removals, and costs. While ICGs achieved the highest bone volume, less invasive techniques, such as CAD/CAM-based or resorbable scaffolds, reduced biological costs and complication risks. Technique selection should be individualized based on defects, patients, and reconstructive goals.

Electroactive membranes enhance in-situ alveolar ridge preservation via spatiotemporal electrical modulation of cell motility

Post-extraction alveolar bone resorption invariably compromises implant placement and aesthetic restoration outcomes. Current non-resorbable membranes exhibit limited efficacy in alveolar ridge preservation (ARP) due to insufficient cell recruitment and osteoinductive capabilities. Herein, we introduce a multifunctional electroactive membrane (PPy-BTO/P(VDF-TrFE), PB/PT) designed to spatiotemporally regulate cell migration and osteogenesis, harmonizing with the socket healing process. Initially, the membrane's endogenous-level surface potential recruits stem cells from the socket. Subsequently, adherent cell-migration-triggered forces generate on-demand piezopotential, stimulating intracellular calcium ion fluctuations and activating the Ca2+/calcineurin/NFAT1 signaling pathway via Cav3.2 channels. This enhances cell motility and osteogenic differentiation predominantly in the coronal socket region, counteracting the natural healing trajectory. The membrane's self-powered energy supply, proportional to cell migration velocity and manifested as nanoparticle deformation, mitigates ridge shrinkage, both independently and in conjunction with bone grafts. This energy-autonomous membrane, based on the spatiotemporal modulation of cell motility, presents a novel approach for in-situ ARP treatment and the development of 4D bionic scaffolds.

Alveolar ridge preservation in periodontally compromised molars with buccal or lingual bone defects: A retrospective case series

STATEMENT OF PROBLEM

Alveolar ridge preservation aims to limit alveolar resorption and promote bone formation after tooth extraction. However, evidence for its application in periodontally compromised molars with bone defects is limited.

PURPOSE

The purpose of this retrospective study was to evaluate the radiographic and clinical outcomes of alveolar ridge preservation in periodontally compromised molars with buccal or lingual bone wall deficiencies.

MATERIAL AND METHODS

This study included 65 participants. Radiographic measurements were made using cone beam computed tomography before extraction and at least 5 months after surgery. Factors influencing radiographic outcomes were analyzed, changes in keratinized tissue width assessed, and implant treatment outcomes evaluated. Paired t tests or Wilcoxon signed-rank tests were used to compare continuous variables before and after surgery. Linear regression analyses were conducted to identify influencing factors.

RESULTS

Significant increases were observed in central bone height (Maxilla: +4.69 mm, P<.001; Mandible: +7.82 mm, P<.001) and ridge width at 1 mm (Maxilla: +5.46 mm, P<.001; Mandible: +5.91 mm, P<.001) and 3 mm (Maxilla: +5.55 mm, P<.001; Mandible: +4.70 mm, P<.001) from the higher alveolar crests after alveolar ridge preservation. The height of socket bone walls significantly influenced the radiographic outcomes. Adequate keratinized tissue width was maintained (5.70 ±2.00 mm). Implant placement without additional bone augmentation was feasible in 69.5% of participants, with only 6.5% requiring staged bone augmentation.

CONCLUSIONS

Alveolar ridge preservation in periodontally compromised molar extraction sites with buccal or lingual bone wall deficiencies created favorable hard and soft tissue conditions, thereby facilitating implant placement.

Comparison of Autogenous Tooth Graft With Polylactic Co-Glycolic Acid in Postextraction Socket for Alveolar Ridge Preservation: A Randomized Control Trial

BACKGROUND

Preservation of alveolar ridge is required postextraction of tooth. Traditional bone graft materials such as autografts, allografts, xenografts, and alloplasts have been used for this purpose.

PURPOSE

The purpose of this study was to measure and compare clinical and radiographic parameters of autogenous tooth graft (ATG) versus resorbable bioscaffold polylactic co-glycolic acid (PLGA) for alveolar ridge preservation.

STUDY DESIGN, SETTING, AND SAMPLE

A prospective randomized controlled double-blind trial was conducted on patients who reported to our Department from 2019 to 2022 for the extraction of endodontically or periodontically compromised single rooted teeth. Patients with age >60 years, pregnant or lactating females, those with systemic and autoimmune diseases, parafunctional habits, history of tobacco or alcohol, and those on radiotherapy or chemotherapy in the last 12 months were excluded.

PREDICTOR VARIABLES

The predictor variable was the alveolar ridge preservation techniques and the subjects were randomly assigned to autogenous tooth grafting (ATG) and PLGA group.

MAIN OUTCOME VARIABLES

Main outcome variables were clinical and radiographic dimensions of alveolar ridge on postoperative day 1 and 6 months after grafting. The secondary outcomes were complications.

COVARIATES

The demographic details were age and gender.

ANALYSES

Bivariate analyses were performed using the parametric tests, ie, paired t-test and independent t-test for intragroup and intergroup comparison respectively, with level of statistical significance set at P value ≤ .05.

RESULTS

The study sample was composed of 20 subjects with a mean age of 47.40 ± 13.94 years. 45% (n = 9) were males and 55% (n = 11) females. On comparing bone levels, we found statistically significant difference in the horizontal dimension in the apical third between the 2 groups after 6 months of grafting (P = .01). There was also a statistically significant increase in the dimensions of alveolar ridge from baseline to 6 months in both the groups. No complications like wound dehiscence or presence of pus discharge were observed in Group A, while there was failure of regeneration in 2 patients in Group B.

CONCLUSION AND RELEVANCE

The results suggest that ATG may be better than PLGA for socket grafting due to lower risk of complications.

A deformable SIS/HA composite hydrogel coaxial scaffold promotes alveolar bone regeneration after tooth extraction

After tooth extraction, alveolar bone absorbs unevenly, leading to soft tissue collapse, which hinders full regeneration. Bone loss makes it harder to do dental implants and repairs. Inspired by the biological architecture of bone, a deformable SIS/HA (Small intestinal submucosa/Hydroxyapatite) composite hydrogel coaxial scaffold was designed to maintain bone volume in the socket. The SIS/HA scaffold containing GL13K as the outer layer, mimicking compact bone, while SIS hydrogel loaded with bone marrow mesenchymal stem cells-derived exosomes (BMSCs-Exos) was utilized as the inner core of the scaffolds, which are like soft tissue in the skeleton. This coaxial scaffold exhibited a modulus of elasticity of 0.82 MPa, enabling it to adaptively fill extraction sockets and maintain an osteogenic space. Concurrently, the inner layer of this composite scaffold, enriched with BMSCs-Exos, promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs) and BMSCs into the scaffold interior (≈3-fold to the control), up-regulated the expression of genes related to osteogenesis (BMP2, ALP, RUNX2, and OPN) and angiogenesis (HIF-1α and VEGF). This induced new blood vessels and bone growth within the scaffold, addressing the issue of low bone formation rates at the center of defects. GL13K was released by approximately 40.87 ± 4.37 % within the first three days, exerting a localized antibacterial effect and further promoting vascularization and new bone formation in peripheral regions. This design aims to achieve an all-around and efficient bone restoration effect in the extraction socket using coaxial scaffolds through a dual internal and external mechanism.

Efficacy of collagenated bone substitutes for bone regeneration in two-wall-damaged extraction sockets without barrier membranes

OBJECTIVES

To evaluate ridge dimensional changes following alveolar ridge augmentation in two-wall-damaged extraction sockets without a barrier membrane, using two types of collagenated bone substitutes i. cross-linked (CL-CB) and ii. non-cross-linked (NCL-CB).

MATERIALS AND METHODS

Two-wall defects were created in mandibles of seven beagle dogs and treated in three groups: (i) no grafting (control), (ii) sockets filled with NCL-CB, and (iii) sockets filled with CL-CB. No barrier membrane was used. One animal was sacrificed after 1 week of healing for tissue assessments (n = 1), and the other six were sacrificed after 8 weeks of healing for microcomputed tomography (micro-CT) and histological analyses (n = 6).

RESULTS

Compared to unextracted sites, radiographic analysis revealed that the alveolar ridge dimension decreased to 83.29 ± 24.96% in group NCL-CB, 73.46 ± 16.59% in group CL-CB and 55.41 ± 12.95% in non-grafted sites (intergroup p = 0.062). Histological analysis showed that compared to baseline values the ridge area decreased to 68.75 ± 14.20% in the non-grafted group, 79.88 ± 20.05% in the NCL-CB group and 76.10 ± 21.09% in the CL-CB group with no significant differences between the groups (p > 0.05). Qualitative histological analyses revealed significantly less mineralized tissue in both test groups, amounting to 25.28 ± 10.40% in group NCL-CB, 29.86 ± 12.04% in group CL-CB, and 67.15 ± 14.35% in non-grafted sites (intergroup p < 0.05).

CONCLUSION

The efficacy of alveolar ridge augmentation using either cross-linked or non-cross-linked collagenated bone substitutes alone might be limited in severely damaged sockets such as those with two-wall defects.

CLINICAL RELEVANCE

In situations where sockets are extensively damaged, like those with two-wall defects, relying solely on soft-type bone block substitutes without a barrier membrane may not provide sufficient bone regeneration. This study highlights the importance of considering additional regenerative strategies, such as the use of barrier membranes, to enhance clinical outcomes.

Does Injectable Platelet-Rich Fibrin Combined With Autogenous Demineralized Dentine Enhance Alveolar Ridge Preservation? A Randomized Controlled Trial

OBJECTIVE

The present trial evaluated the first-time application of autogenous demineralized dentin graft with injectable platelet-rich fibrin (ADDG + i-PRF) versus autogenous demineralized dentin graft (ADDG), in alveolar ridge preservation (ARP) in the maxillary aesthetic zone.

MATERIAL AND METHODS

Twenty-two maxillary (n = 22) non-molar teeth indicated for extraction were randomized into two groups (n = 11/group). Extracted teeth were prepared into ADDG, implanted into extraction sockets with or without i-PRF amalgamation and covered by collagen sponge. Cone-beam computed tomography scans at baseline and 6 months were compared to assess ridge-dimensional changes. Keratinized tissue width, patient satisfaction, pain score and chair time were recorded. In the course of dental implant placements at 6 months, bone core biopsies of engrafted sites were obtained and analysed histomorphometrically.

RESULTS

Reduction in ridge width was 1.71 ± 1.08 and 1.8 ± 1.35 mm, while reduction in ridge height was 1.11 ± 0.76 and 1.8 ± 0.96 mm for ADDG + i-PRF and ADDG, respectively (p > 0.05). Significant differences in keratinized tissue width reduction were notable between ADDG + i-PRF and ADDG (0.12 ± 0.34 and 0.58 ± 0.34 mm respectively; p = 0.008). Postoperative pain scores were significantly lower in ADDG + i-PRF (p = 0.012). All patients in the two groups were satisfied with no differences in chair time (p > 0.05). No differences in total percentage area of newly formed bone, soft tissue or graft particles were observed between the groups (p > 0.05).

CONCLUSIONS

ADDG alone or in combination with i-PRF yields similar results regarding ARP clinically, quality of the formed osseous tissues, as well as patients' satisfaction. Yet, the addition of i-PRF to ADDG tends to preserve the keratinized tissue and lessen postoperative pain.

Autologous platelet concentrates in alveolar ridge preservation: A systematic review with meta-analyses

In order to evaluate the therapeutic advantages of various autologous platelet concentrates (APC) as a single biomaterial during alveolar ridge preservation (ARP), a systematic review with meta-analyses was conducted. PubMed, EMBASE, Web of Science, and Scopus were screened for randomized controlled trials (RCTs) that were released prior to 2024. The selected papers compared an APC with either unassisted healing (blood clot) or another biomaterial during ARP (third molars were not included). The outcome parameters included alveolar bone dimension alterations, soft tissue healing, and post-op pain intensity. The search yielded 35 papers (33 studies), one applying platelet-rich plasma (PRP), six using plasma rich in growth factors (PRGF), and 28 using leukocyte- and platelet-rich fibrin (L-PRF). These studies showed a large heterogeneity (e.g., outcome parameters, timing, surgical approach, and inclusion criteria), which hindered drawing strong conclusions. In most studies, however, ARP with PRP, PRGF, and L-PRF alone produced faster soft tissue healing, less post-extraction pain, less alveolar ridge resorption, more socket bone fill, and a higher bone density when compared to unassisted (spontaneous) healing. The ultimate benefit appears to be significantly influenced by the surgical approach. Limited literature exists comparing APC with other biomaterials for ARP, resulting in inconclusive data. APC application for ARP is a promising strategy to improve soft and hard tissue healing and reduce post-extraction pain.

Effect of initial bone morphology on alveolar bone remodeling following molar extraction: A retrospective study

BACKGROUND

The clinical evidence about alveolar ridge changes following molar extraction and how the alveolar bone morphology influences the ridge dimensional changes remains limited.

METHODS

A total of 192 patients with 199 molar extractions were included in this retrospective study. Cone-beam computed tomography (CBCT) images of patients were obtained 0-3 months pre extraction and 6-12 months post extraction. Outcome variables included the change rate in ridge height and width. The effect of morphology on the outcomes was explored by single-factor analysis, correlation analysis, and a multiple linear regression model.

RESULTS

Significant resorption of alveolar bone occurred vertically and horizontally after molar extraction. Jaw, furcation involvement, number of roots, number of bone wall defects, extraction reasons, overall relative bone loss (RBL), bone height of the furcation region, thickness of the lingual/palatal wall, and height difference between buccal and lingual/palatal walls (|HB-HL|) were significantly correlated with the change in the height of the central alveolar bone (HC). The number of bone wall defects, overall RBL, and |HB-HL| were significantly correlated with horizontal width change. HC resorption was higher in sockets with |HB-HL| > 2.5 mm and overall RBL > 50%.

CONCLUSIONS

The alveolar bone presented significant resorption after extraction. Anatomical characteristics affected the dimensions of the alveolar bone after molar extraction. When the initial overall RBL was severe or |HB-HL| was larger, the loss of alveolar bone dimensions was even more.

PLAIN LANGUAGE SUMMARY

In recent years, it has been demonstrated that the local anatomical morphology of extraction sites may influence the process of alveolar bone remodeling. However, most studies have focused on the anterior teeth, with fewer investigations addressing molar extraction sites. Therefore, we aimed to describe ridge changes following molar extraction and investigate how alveolar bone morphology influences ridge dimensional changes. In this retrospective study, we included a total of 199 alveolar sockets from 192 patients with molar extractions and obtained the corresponding cone-beam computed tomography (CBCT) images 0-3 months pre extraction and 6-12 months post extraction. The results showed significant resorption of the alveolar bone following molar extraction. We found that anatomical characteristics significantly affect the dimensions of the alveolar bone after molar extraction. Specifically, the loss of alveolar bone dimensions was greater when the initial overall relative bone loss (RBL) was severe or when the difference between buccal and lingual/palatal walls was greater.

Advancements in Hyaluronic Acid Effect in Alveolar Ridge Preservation: A Narrative Review

Background/Objectives: Tooth extraction induces significant alveolar ridge dimensional changes and soft tissue modifications, often leading to challenges in implant placement or conventional prosthetic rehabilitation. Alveolar Ridge Preservation (ARP) strategies aim to mitigate post-extraction resorption of the alveolar ridge, enhancing both the quality and quantity of bone and soft tissue during healing. Hyaluronic acid (HYA) has emerged as a promising biological agent for ARP due to its osteoinductive, antimicrobial, and anti-inflammatory properties. However, the effects of HYA in ARP remain inconsistently reported. This study aims to assess current clinical and preclinical evidence regarding the biological effects of HYA and its application in ARP. Additionally, it evaluates HYA's impact-alone or in combination with other products-on hard and soft tissue dimensional changes, early wound healing, and implant success rates. Methods: A comprehensive electronic literature search was conducted, and studies meeting the inclusion criteria were critically evaluated. Relevant data were extracted from the final selection of articles. Results: Thirteen publications were evaluated. Some studies reported a significantly improved newly formed bone following ARP with intra-socket HYA application as a single approach (p = 0.004). Combining HYA with a bone graft and a free palatal graft resulted in significantly greater amounts of newly formed and mature bone, reduced clinical bone width changes, lower radiographic crestal bone loss (p < 0.01), and diminished radiological volumetric and linear bone resorption (p = 0.018). Short-term follow-up data indicated improved soft tissue healing associated with HYA-based ARP. While HYA appears to have a protective effect on ridge dimensional changes in ARP, other studies reported no significant differences in radiographic bone dimensional changes or soft tissue improvement. Conclusions: The addition of HYA to bone grafts may enhance some ARP outcomes. However, the variability in outcomes and methodologies across the evaluated studies precludes drawing definitive clinical conclusions. Further robust research is needed to clarify HYA's role in ARP. With respect to clinical significance enhancing the understanding of ARP management strategies and their effects on post-extraction sockets empowers clinicians to make more informed decisions. The knowledge of HYA effects facilitates the selection of personalized ARP approaches tailored to optimize outcomes for subsequent interventions.

Effect of alveolar ridge preservation at periodontally compromised molar extraction sockets: A retrospective cohort study

BACKGROUND

To date, the clinical evidence regarding the effectiveness of alveolar ridge preservation (ARP) in restricting alveolar bone height and width change after extraction at periodontally compromised molar extraction sockets still remains controversial. This retrospective cohort study aims to evaluate the effect of ARP in molars extracted for periodontal reasons.

METHODS

Retrospective data were collected from patient electronic records from January 2019 to December 2023. Patients with Stage III/IV periodontitis who underwent extraction of molars for periodontal reasons were screened for eligibility. The outcomes included the horizontal and vertical dimensions of alveolar bone. The need for additional augmentation procedure during implantation was also evaluated. A linear regression model was used to adjust for known confounders.

RESULTS

A total of 80 sockets were included in this study, of which 27 sockets received ARP therapy after extraction while 53 sockets experienced natural healing (NH). ARP resulted in significantly less bone height change in the periodontally compromised molar sites compared to the NH group (p < 0.001). In sockets displaying a height disparity of >2 mm between the buccal and palatal/lingual walls, the ARP group exhibited advantageous outcomes in terms of ridge width change, surpassing the NH group (p = 0.004). Moreover, the percentage for additional augmentation was significantly reduced in the ARP compared to the NH group (p = 0.006). Age, sex, smoking, jaw, location, and buccal wall thickness did not show any significant effect on bone height change.

CONCLUSION

ARP had benefits on limiting ridge resorption subsequent to molar extraction for periodontal reasons.

Healing patterns of alveolar bone following ridge preservation procedures

OBJECTIVES

Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing.

MATERIALS AND METHODS

Forty-two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4-month healing period. Forty-two samples underwent Back-Scattered Electrons -Scanning Electron Microscopy (BSE-SEM) imaging, with 15 samples examined using Xray Micro-Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration).

RESULTS

BSE-SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p < .004) and SS (27.62% ± 17.76/p < .005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE-SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS.

CONCLUSION

GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone.

Enhanced alveolar ridge preservation with hyaluronic acid-enriched allografts: a comparative study of granular allografts with and without hyaluronic acid addition

PURPOSE

Ridge preservation is essential to restore alveolar ridge volume and to enhance esthetic and functional outcomes for dental implants. The addition of hyaluronic acid to allogeneic bone substitute materials might enhance these outcomes. This clinical study evaluated the efficacy of ridge preservation after tooth extraction using granular allografts with and without hyaluronic acid addition.

METHODS

In this retrospective study, 40 patients with compromised extraction sockets were enrolled. Among them, 19 received particulate allogeneic bone substitutes (Allo), 21 received allogeneic bone substitutes with hyaluronic acid (AlloHya). Vertical and horizontal graft stability, graft shrinkage rate, and bone mineral density were assessed using radiographic measurements on CBCT scans conducted before tooth extraction, directly after ridge preservation and after four months. Patients were followed up 12 months post-implantation.

RESULTS

Vertical height loss after 4 months was significantly greater in the Allo group (-0.82 ± 0.95 mm) compared to the AlloHya group (-0.19 ± 0.51 mm; p = 0.011). Graft shrinkage rate was 16.9 ± 11.5% (Allo) and 10.3 ± 7.7% (AlloHya) (p = 0.038). After four months, average bone density was significantly higher in the AlloHya compared to the Allo group (p = 0.004). Nearly all implants (39 out of 40) were classified as "Success" according to the ICOI scheme, with no differences in implant quality between the two study groups.

CONCLUSIONS

Improved graft stability, reduced resorption, and increased bone density were observed in hyaluronic acid-enriched allografts compared to pure allografts. Adding hyaluronic acid to allogeneic bone grafts significantly enhanced outcomes in ridge preservation.

Perigraftitis and implant therapy: A case report

BACKGROUND

A previous case study reported periimplantitis and concomitant perigraftitis of a second implant placed at a site that had alveolar ridge preservation three decades earlier. Infection at the site persisted 4 months after implant removal by flapless implant reversal. A flap was subsequently reflected, the grafted bone was removed, and a second alveolar ridge preservation was performed with a freeze-dried bone allograft. The publication reported infection resolved, and the site healed uneventfully. However, it is unknown if placement of another implant at the site would be successful. The purpose of this paper is to report on the findings at surgical reentry and outcome of the third implant.

METHODS

Eleven months after the second alveolar ridge preservation, the site was reentered. The bone graft was found to be partially soft tissue encapsulated. All encapsulated graft materials and soft tissue were removed. An implant was placed, and the alveolar defect was grafted with a demineralized bone allograft. Seventeen months after implant placement, a buccal free gingival graft was performed during which the crestal bone adjacent to the implant was found to be hard and corticated. The implant was deemed to be osseointegrated and restored after soft tissue healing.

RESULTS

Twenty-five months after implant placement, the third implant remained functional and asymptomatic with the peri-implant bone exhibiting normal trabeculation.

CONCLUSIONS

Implant therapy can be successful following treatment and resolution of perigraftitis.

KEY POINTS

Perigraftitis may play a contributing role in the biologic complications of implants that have been placed into grafted bone. Perigraftitis may be successfully resolved by completely removing all grafted bone. Once perigraftitis has been eliminated, an implant may be successfully placed.

Internal Allo-Cortical Tenting: A Modified Ridge Split Technique in Three-Dimensional Ridge Augmentation

Three-dimensional (3D) alveolar ridge deficiencies necessitate horizontal and vertical bone reconstruction for optimal implant positioning. Despite several available techniques, achieving desired augmentation outcomes remains challenging. This case study aims to present a modified ridge split technique for bone reconstruction in horizontal and vertical dimensions. The proposed technique was used to reconstruct the horizontal and vertical ridge defect from removing a previously failed implant. This technique includes placing a cortical allograft plate as an internal tent in the split ridge. A portion of the plate was inserted into the ridge, while the other part was placed in the coronal of the vertical defect. Additional guided bone regeneration was performed around the tented plate on both the buccal and lingual sides. After 5 months, cone beam computerized tomography revealed sufficient bone formation in horizontal and vertical dimensions. Within the limitations of the present case study, internal cortical tenting would be a reliable method for 3D bone reconstruction in cases where the ridge split is feasible.

Healing of Extraction Sites after Alveolar Ridge Preservation Using Advanced Platelet-Rich Fibrin: A Retrospective Study

BACKGROUND

Over time, numerous surgical procedures and biomaterials have been proposed for the reconstruction of post-extraction bone defects, each with their advantages and disadvantages. The main objective of this study was to evaluate dimensional changes in the alveolar bone 3 months after tooth extraction, before implant planning, comparing alveolar ridge preservation (ARP) with spontaneous healing.

METHODS

A total of 84 patients with non-restorable molars were included in the study. Forty-two patients received ARP with advanced platelet-rich fibrin (A-PRF) and spontaneous healing was evaluated in these patients. Cone beam computed tomography (CBCT) analysis performed before and after surgical intervention was used to determine the changes in vertical and horizontal bone dimensions produced after tooth extraction.

RESULTS

CBCT measurements showed reduction in both vertical and horizontal alveolar bone size in both groups. For the study group, the alveolar parameters (height, width) were higher compared to the control group. The percentage variations between dimensional differences from the two groups were 38.58% for height, and for width were 36.88% at 0 mm, 35.56% at 3 mm, 36.61% at 5 mm, and 38.73% at 7 mm. The differences were statistically significant (p ˂ 0.0005).

CONCLUSIONS

The results obtained after ARP with A-PRF showed a reduced loss of bone volume compared to spontaneous healing.

A comparative analysis of particulate bovine bone substitutes for oral regeneration: a narrative review

PURPOSE

Particulate bovine bone substitutes (BS) are commonly used in oral regeneration. However, more literature is needed focusing on comparative analyses among various particulate bovine BS. This study evaluates pre-clinical and clinical data of different particulate bovine BS in oral regeneration.

METHODS

A narrative review was conducted by screening the PubMed database Included in the review were pre-clinical and clinical studies until 2024 comparing a minimum of two distinct particulate bovine BS. In addition to examining general data concerning manufacturing and treatment processes, biological safety, physical and chemical characteristics, and graft resorption, particular emphasis was placed on assessing pre-clinical and clinical data related to ridge preservation, sinus floor elevation, peri-implant defects, and various forms of alveolar ridge augmentation utilizing particulate bovine BS.

RESULTS

Various treatment temperatures ranging from 300 to 1,250 °C and the employment of chemical cleaning steps were identified for the manufacturing process of particulate bovine BS deemed to possess biosecurity. A notable heterogeneity was observed in the physical and chemical characteristics of particulate bovine BS, with minimal or negligible graft resorption. Variations were evident in particle and pore sizes and the porosity of particulate bovine BS. Pre-clinical assessments noted a marginal inclination towards favorable outcomes for particulate bovine BS subjected to higher treatment temperatures. However, clinical data are insufficient. No distinctions were observed regarding ridge preservation, while slight advantages were noted for high-temperature treated particulate bovine BS in sinus floor elevation.

CONCLUSIONS

Subtle variances in both pre-clinical and clinical outcomes were observed in across various particulate bovine BS. Due to inadequate data, numerous considerations related to diverse particulate bovine BS, including peri-implant defects, must be more conclusive. Additional clinical studies are imperative to address these knowledge gaps effectively.

Alveolar ridge changes 1-year after early implant placement, with or without alveolar ridge preservation at single-implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial

OBJECTIVES

To assess both the radiographic and profilometric outcomes of early implant placement with or without alveolar ridge preservation (ARP) (using two different ARP techniques) after 1 year of loading.

MATERIALS AND METHODS

Seventy-five patients with a failing single tooth in the anterior maxilla were randomly allocated to three groups (1:1:1): (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen matrix (CM), (b) ARP using DBBM-C covered with a palatal graft (PG), and (c) unassisted socket healing (control). Eight weeks after tooth extraction, early implant placement was performed in all patients. Cone-beam computed tomography (CBCT) and impressions were taken 8 weeks after tooth extraction (ARP/unassisted healing) prior to implant placement and 1-year post-loading. Radiographic and profilometric outcomes were evaluated.

RESULTS

Out of the 70 patients available for re-examination at 1-year post-loading, 55 datasets could be assessed (ARP-CM 19; ARP-PG 17; Control 19). The need for additional guided bone regeneration (GBR) at implant placement amounted to 31.6% (ARP-CM), 29.4% (ARP-PG), and 68.4% (unassisted healing). Adjusted models revealed that residual buccal bone height and additional GBR at implant placement significantly influenced the magnitude of the alveolar changes at 1 year (p < 0.05). In patients with ARP (group ARP-CM or ARP-PG) without additional GBR, the presence of bone convexity amounted to 36.0% (9/25) at 1-year post-loading. For patients that received ARP and additional GBR at implant placement, the frequency of bone convexity increased to 72.7% (8/11) (p = 0.042). Regarding profilometric measurements, a tendency toward agreement with radiographic outcomes was observed.

CONCLUSIONS

Early implant placement with ARP can attenuate alveolar ridge changes at 1-year post loading by minimizing both radiographic and profilometric alterations. However, early implant placement with simultaneous GBR consistently yields superior radiographic and profilometric outcomes, regardless of whether ARP is performed.

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.

Socket Preservation and Guided Bone Regeneration: Prerequisites for Successful Implant Dentistry

Implant success is measured not only by implant survival but also by the long-term aesthetic and functional results. Implant placement should be prosthetically driven, with proper three-dimensional positioning for optimal support and stability of the tissues. Several procedures could be performed to ensure this requirement. While socket preservation (SP) is performed at the stage of tooth extraction, guided bone regeneration (GBR) takes place before or simultaneous to implant placement. The current review aims to summarize and discuss the procedures used for the preparation of the implant site, the preservation of the existing tissues, and their augmentation in cases of deficiency. An electronic search using Google Scholar, PubMed, and Scopus was conducted up to October 2023, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review summarizes the current knowledge on SP and GBR as prerequisites for future implant placement. Their indications, advantages, and limitations have been thoroughly evaluated and some recommendations for further research have been suggested. Implant placement in sites with severe bone resorption is extremely challenging. It necessitates the application of different surgical techniques, especially augmentation procedures, including guided bone regeneration. The need for such procedures could be avoided or at least minimized by the execution of SP after tooth extraction or immediate/early implant placement.