Ridge Preservation Procedures: Review of Current Literature

Abstract

Alveolar ridge preservation (ARP) procedures have become one of the most commonly performed surgical procedures in dentistry, due to increased demand for dental implant therapy. Previous studies have repeatedly shown a naturally healed socket could lose up to 50% of its buccolingual width, which in turn would negatively impact the future implant placement. ARP procedures have been shown to consistently reduce the amount of post-extraction horizontal and vertical bone loss; however, it is still not conclusive which biomaterial or technique is the most superior. The purpose of this article is to review current evidence on various ARP procedures. The electronic database search was limited to the past 3 years (publication dates between January 1, 2017, and February 29, 2020) and to human clinical studies (including controlled clinical trials and randomized controlled trials) investigating dimensional changes in alveolar sockets after various ARP techniques with outcomes measured from 3 to 6 months postoperatively. A total of 31 articles were reviewed, with approximately half of the selected studies using bovine (14) bone substitutes. Other biomaterials used in the studies included porcine bone substitutes, allografts (both freeze-dried and solvent-dehydrated), alloplasts (biphasic calcium phosphate, β-tricalcium phosphate, and hydroxyapatite), biologics (platelet-rich fibrin and recombinant bone morphogenetic protein-2), collagen and high-density polytetrafluoroethylene membranes, and micro-titanium stent. Collagenated deproteinized bovine bone matrix (DBBM-C) was the most studied biomaterial in the past 3 years. Most studies showed DBBM-C plus barrier membranes resulted in comparable clinical and radiographic outcomes with DBBM and allografts. Consistent with previous studies, most of the ARP procedures reviewed in this article demonstrated effective reduction of alveolar ridge dimensional changes. Based on the selected articles and recent systematic reviews and meta-analysis, ARP procedure using bovine and porcine xenografts, as well as allografts, in conjunction with either collagen membranes or high-density polytetrafluoroethylene membranes gives similar results and should be considered when indicated.