Clinical evaluation of different alveolar ridge preservation techniques after tooth extraction: a randomized clinical trial

• Published in: Clinical oral investigations 2023-08, Vol.27 (8), p.4471-4480
• Main Authors: El-Sioufi, Iosif, Oikonomou, Ilias, Koletsi, Despina, Bobetsis, Yiorgos A., Madianos, Phoebus N., Vassilopoulos, Spyridon
• Format: Article
• Language: English
• Subjects: Allografts; Bone grafts; Bone implants; Bone loss; Bone resorption; Clinical trials; Collagen; Collagen (type I); Dental implants; Dental prosthetics; Dentistry; Medicine; Skin & tissue grafts; Statistical analysis; Teeth; Tooth extractions; Xenografts
• ISSN: 1436-3771; 1432-6981; 1436-3771
• DOI: 10.1007/s00784-023-05068-1

Objective The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements. Background Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures, a bone grafting material is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane, and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness. Materials and methods Forty-one patients were randomly assigned in four treatment groups: (A) freeze-dried bone allograft (FDBA) covered with collagen sponge (CS), (B) FDBA covered with free gingival graft (FGG), (C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG, and (D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss. Results Overall, groups A, B, and C presented significantly less vertical and horizontal bone resorption compared to group D. No statistically significant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically significantly reduced bone loss compared to allograft (group C vs group B: adjusted β coef: 1.07 mm; 95%CI: 0.01, 2.10; p  = 0.05). No significant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA. Conclusions No differences between FDBA and DBBM could practically be confirmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and t