Major clinical outcomes of minimally traumatic and aesthetic post-tooth extraction: a systematic review

Abstract

Introduction: After tooth extraction, the alveolar ridge will commonly decrease in volume and change morphologically. These changes can be difficult or even impede the placement of dental implants and prosthetic rehabilitation. Minimizing bone remodeling means optimizing the aesthetics and functional aspects, and mainly, the success of implant treatment. To avoid residual ridge resorption different techniques and bone graft materials have been proposed. Objective: A systematic review was carried out to identify the main clinical outcomes of minimally traumatic and aesthetic tooth extraction. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to February 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 189 articles were found, 45 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies with a high risk of bias and 41 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=72.5%>50%. The present study suggests that the alveolar graft technique may increase the risk of disease transmission, cost, and time of treatment. Several studies have stated that the graft material is not fully incorporated into the newly formed bone, indicating less vital bone tissue. Spontaneous scarring is still the most used feature since, in intact alveoli and small defects, it is a procedure that does not present significant losses that justify the use of edge preservation techniques. In larger defects, techniques after spontaneous healing, such as a block graft, can be used without the drawbacks of alveolar grafting, such as delayed healing and poor bone quality. The use of a buccal subepithelial connective tissue graft for extraction sockets in the anterior maxilla can be considered a predictable approach to preserving the contour of the alveolar ridge