A randomized, controlled, multicentre clinical trial of post‐extraction alveolar ridge preservation

Abstract

AimTo compare the effectiveness of two‐ridge preservation treatments.Materials and MethodsForty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross‐linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post‐operatively, and biopsies were retrieved for histomorphometric analysis at 6 months.ResultsPrimary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty‐seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites.Conclusion DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.

Alveolar ridge regeneration of damaged extraction sockets using deproteinized porcine versus bovine bone minerals: A randomized clinical trial

“…Minimal dimensional alteration within 2 mm were shown in both horizontal and vertical aspects, but with large variations. These were in agreement with a recent multicenter clinical study of grafting at buccal‐bone‐deficient extraction sockets18 showing significantly larger dimensional alterations and a much larger standard deviation (2–4 mm) than previous results for intact socket grafting. Previous clinical studies19 of alveolar ridge preservation in intact extraction sockets have found minimal changes in the horizontal and vertical dimensions by grafting xenogenous and allogenous bone substitutes, with small ranges for each value (around 1 mm in most of these studies).…”

“…Based on previous results for the mean and standard deviation of horizontal changes in the ridge dimensions in two experimental groups,18 the effect size was calculated as 0.74. About 40 sites per group were required in the present study, and so 50 sites per group were used on the assumption of a dropout rate of 25%.…”

Ridge preservation in molar extraction sites with an open‐healing approach: A randomized controlled clinical trial

“…There being no significant difference might be attributable to the characteristics of the bone substitute: the collagen component of DBBM‐C seems to contribute the stability of the augmentation. Previously, one study using DBBM‐C only (25%) (Heberer et al, ) demonstrated a similar level of new bone formation as the studies using DBBM‐C + NBCM (26%–30%) (Cardaropoli et al, ; Scheyer et al, ). Comparable soft tissue thickness and minimal fibrous tissue ingrowth into the hard tissue area in both groups also underlines the advantages of DBBM‐C, despite disoriented collagen fibres and some scattered DBBM particles observed in the soft tissue area of test group 2.…”

Deproteinized bovine bone mineral is non‐inferior to deproteinized bovine bone mineral with 10% collagen in maintaining the soft tissue contour post‐extraction: A randomized trial

“…The natural repair response of an intact socket after tooth extraction is composed of bone resorption and neoformation (Devlin & Ferguson, 1991). In order to increase the predictability of implant therapy and esthetic outcomes, different techniques using a variety of materials were used to limit alveolar ridge resorption following tooth extraction (Araújo & Lindhe, 2009;Araújo, Silva, Misawa, & Sukekava, 2000;Barone et al, 2008;Jung et al, 2013;Meloni et al, 2015;Nart et al, 2017;Natto et al, 2017;Scheyer et al, 2016). A recent systematic review (Avila-Ortiz, Chambrone, & Vignoletti, 2019) evaluating radiographic outcomes found a significant reduction in the vertical ridge resorption, while the horizontal resorption was inconsistent.…”