Soft tissue dimensional changes after alveolar ridge preservation using different sealing materials: a systematic review and network meta-analysis

Abstract

Background Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature. Objective To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance. Materials and methods The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health’s Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow‐up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed. Results A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT). Conclusions NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage. Clinical relevance Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.

Tooth as graft material: Histologic study

“…8 While all materials presented good results in terms of bone regeneration and volume maintenance, a recent literature systematic review with network meta-analysis, suggested animal matrices as the best material for post-extraction site development. 9 However, different studies highlighted as this group of graft materials may produce a delayed bone healing as it was hypothesized that the bone substitute material, although providing a scaffold for bone regeneration, is not substituted easily by newly formed bone. 8 The use of tooth material as autogenous bone substitute was proposed more than 50 years ago, considering the characteristics of the dentin and enamel and in search of absolute biocompatibility.…”

“…While all materials presented good results in terms of bone regeneration and volume maintenance, a recent literature systematic review with network meta‐analysis, suggested animal matrices as the best material for post‐extraction site development 9 …”

Effect of Enamel Matrix Derivative and bone grafts on Alveolar Ridge Preservation in Bone Healing: A Systematic Review and Meta-Analysis

“…When collagenated porcine bone with cross-linked collagen membrane was compared to it with non-cross-linked collagen membrane during ARP, a randomized clinical trial 43 found that there was no signi cant difference in the change in bone width. However, the change of bone height was more obvious 43 .Crosslinked collagen membranes and autogenous soft tissue grafts were found to be the best options for sealing ARP sockets to reduce the dimensional shrinkage of the soft tissue after tooth extraction, according to a network meta-analysis 44 . As a result, we can speculate that ARP may be affected by various membrane and graft materials.…”

Preservação do rebordo alveolar e gengiva ceratinizada utilizando matriz dérmica de colágeno e substituto ósseo inorgânico em extrações sem retalho. Uma série de casos de biomaterial exposto ao meio bucal

“…Além disso, várias revisões sistemáticas publicadas recentemente sobre PRA (BASSIR et al, 2018;CANULLO et al, 2022;HÄMMERLE;SIMION, 2012;HORVÁTH et al, 2013;MACBETH et al, 2017;TAN et al, 2012;VIGNOLETTI et al, 2012aVIGNOLETTI et al, , 2012b concluíram que mesmo que os procedimentos de PRA sejam realizados é improvável que as dimensões do rebordo alveolar sejam completamente preservadas após a extração.…”

“…Alguns estudos clínicos (CARDAROPOLI et al, 2012;NATTO et al, 2017) e revisões sistemáticas (CANULLO et al, 2022;MACBETH et al, 2017;MAJZOUB et al, 2019) confirmam a existência de uma relação entre a espessura, a perda óssea vertical da cortical vestibular e as alterações dimensionais da crista óssea após a PRA, onde uma revisão sistemática com meta-análise demonstrou resultados superiores na preservação do rebordo associado à espessura da cortical vestibular >1 mm (AVILA-ORTIZ; CHAMBRONE; VIGNOLETTI, 2019).…”