Ridge Preservation Techniques Research Articles

Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development.

Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets. The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 22 July 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 6), MEDLINE via OVID (1946 to 22 July 2014), EMBASE via OVID (1980 to 22 July 2014), LILACS via BIREME (1982 to 22 July 2014), the Meta Register of Current Controlled Trials (to 22 July 2014), ClinicalTrials.gov (to 22 July 2014), the World Health Organization International Clinical Trials Registry Platform (to 22 July 2014), Web of Science Conference Proceedings (1990 to 22 July 2014), Scopus (1966 to 22 July 2014), ProQuest Dissertations and Theses (1861 to 22 July 2014) and OpenGrey (to 22 July 2014). A number of journals were also handsearched. Trial authors were contacted to identify unpublished randomised controlled trials. There were no restrictions regarding language and date of publication in the searches of the electronic databases. We included all randomised controlled trials (RCTs) on the use of alveolar ridge preservation techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of alveolar ridge, changes in the vertical height of the alveolar ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation. Two review authors extracted data independently and assessed risk of bias for each included trial. Corresponding authors were contacted to obtain missing information. Results were combined using random-effects models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings. A total of 50 trials were potentially eligible for inclusion, of which 42 trials were excluded. We included eight RCTs with a total of 233 extraction sites in 184 participants. One trial was judged to be at unclear risk of bias and the remaining trials were at high risk of bias. From two trials comparing xenograft with extraction alone (70 participants, moderate quality evidence), there was some evidence of a reduction in loss of alveolar ridge height (MD -2.60 mm; 95% CI -3.43 to -1.76) and width (MD -1.97 mm; 95% CI -2.48 to -1.46). This was also found in one trial comparing allograft with extraction (24 participants, low quality evidence): ridge height (MD -2.20 mm; 95% CI -0.75 to -3.65) and width (MD - 1.40 mm; 95% CI 0.00 to -2.80) and height. From two RCTs comparing alloplast versus xenograft no evidence was found that either ridge preservation technique caused a smaller reduction in loss of ridge height (MD -0.35 mm; 95% CI -0.86 to 0.16) or width (MD -0.44 mm; 95% CI -0.90 to 0.02; two trials (55 participants); moderate quality evidence). There was insufficient evidence to determine whether there are clinically significant differences between different ARP techniques and extraction based on the need for additional augmentation prior to implant placement, complications, implant failure, or changes in peri-implant marginal bone levels and probing depths of neighbouring teeth. We found no trials which evaluated parameters relating to clinical attachment levels, specific aesthetic or prosthodontic outcomes. There is limited evidence that ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction. There is also lack of evidence of any differences in implant failure, aesthetic outcomes or any other clinical parameters due to the lack of information or long-term data. There is no convincing evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.

Intervention for replacing missing teeth: Alveolar ridge preservation techniques for dental implant site development - evidence summary of Cochrane review.

The Cochrane reviews have transparent reporting of the methodology to clarify the reader the methods used for writing the review; hence, each review becomes a large volume of scientific literature. This evidence summary of the Cochrane review published in 2015 for the question, what are the clinical effects (preservation of both width and height of bone, esthetic outcomes, complications, and failure of implant) for different alveolar ridge preservation techniques (ARP) and materials used in patients planning implant placement following extraction after 6 months follow-up. This review provides evidence for efficacy of different ARP techniques, materials, and superiority of one over the other. It also tries to settle the controversy of timing of placement of implant after grafting. Of the 8 included studies from 50, two trials provide moderate evidence for xenografts versus extraction favoring xenografts in preserving the width and height of bone by 1.97 mm (2.48–1.46) and 2.60 mm (3.43–1.76), respectively in pooled estimates of meta-analysis. Using different material, five-trial were found; of which, two trials provide moderate evidence for alloplast versus xenografts favoring alloplast in preserving the width by 0.44 mm (0.90–0.02) and low-grade evidence for height of bone by 0.35 mm (0.86–0.16) in pooled estimates of meta-analysis. There is a paucity of randomized controlled trial to address other primary and secondary outcomes addressed in this review.

Ridge preservation using a new 3D collagen matrix: a preclinical study.

The success of ridge preservation techniques in reducing bone resorption is well documented, but no clear guidelines have been provided regarding the type of the biomaterial or technique to be used. This experimental animal study aimed at comparing the effectiveness of two ridge preservation techniques. Following the extraction of the distal roots of the mandibular second and fourth premolars of four dogs, the sockets were preserved using a combination of a collagen membrane intimately covering the socket plus a collagen matrix or a collagen membrane alone. The mandibular quadrants were randomly assigned to one of the treatment groups. Histomorphometrical analyses as well as microscopic observations were performed. After 5months of healing, the histological analysis revealed a similar picture of bone formation in both groups. No significant differences between the buccal and lingual dimensions were calculated between the two treatment groups. The mucosa covering the alveolar ridges is significantly more abundant in post-extraction sockets preserved with the double-layered approach. The double-layered approach used to treat post-extraction sockets may result in a better preservation of the mucosal seal than the single-layered approach. The use of the new collagen matrix associated with a collagen membrane could be a clinical option to preserve post-extraction ridges, especially when an improvement in soft tissue dimension and quality is desired. However, the cost-benefit ratio of this approach should be thoroughly evaluated in further studies.

Effectiveness of three different alveolar ridge preservation techniques: a pilot randomized controlled trial.

The aim of this pilot study was to obtain preliminary data regarding the effectiveness of three different alveolar ridge preservation modalities as compared with a control. Subjects in need of single-rooted tooth extraction were recruited and randomly allocated to one of four treatment groups: group 1 (control)--collagen plug; group 2--socket grafting and polytetrafluoroethylene (PTFE) barrier; group 3--socket grafting, buccal overbuilding, and PTFE barrier; group 4--socket grafting, collagen barrier, and PTFE barrier. The grafting material used in all groups was an allograft. At 16 weeks, surgical reentry was performed, and a bone core biopsy was harvested for histomorphometric analysis. A cone beam computed tomography scan was obtained at baseline and before surgical reentry. Clinical (keratinized mucosa [KM] and buccolingual ridge width [RW] changes) and volumetric outcomes were statistically analyzed. A total of 20 patients were recruited (5 patients per group). KM and buccolingual RW changes were minimal during the 16-week healing period for all groups, with no statistically significant differences. Volumetric analyses revealed comparable alveolar ridge resorption values for groups 1, 2, and 4 (3%, 7%, and 5%, respectively), while group 3 exhibited more reduction (16%). Histomorphometric analysis revealed the presence of adequate average values of mineralized tissue (group 1, 46.4%; group 2, 28.88%; group 3, 48.81%; group 4, 41.13%). Based on the clinical and volumetric outcomes, none of the ridge preservation modalities was superior to the control. The combination allograft (freeze-dried bone allograft and demineralized freeze-dried bone allograft) employed in this study appears to be a safe and adequate biomaterial for intraoral grafting.

Advances in implant dentistry.

Implant is becoming a mainstream practice in dentistry. Considerable advances have been made in this field with regard to applications, techniques, and materials used for dental implants. This communication is intended to provide general practitioners, educators, and dental students with an overview of recent advances in implant dentistry. It covers a review of the history of implant in dentistry, approaches used for ridge preservation, ridge augmentation, guided bone regeneration, methods used for treatment peri-implantitis, and advances in implant dentistry for edentulous patients. Below is a brief description of the topics covered in this issue: 1. Historical Perspective on Dental Implant Coatings and Surface Treatment. This manuscript provides a chronological history of dental implants, the physical, chemical, and biologic properties of dental implant coatings and mechanisms by which they augment the osseointegrative process. 2. Ridge Preservation for Implant Therapy: A Review of the Literature. The requirement to have implants mimic the natural tooth in both function and esthetics makes the use of ridge preservation an essential element in the treatment planning for implant therapy. This review covers the healing dynamics of the extraction socket, the use of bone grafting materials and barrier membranes, and the evidence based literature supporting ridge preservation techniques. 3. Mechanism of Guided Bone Regeneration: A Review. Crestal ridge bone resorption is an unavoidable consequence of tooth extraction, which often leads to a significant reduction in ridge dimensions. Guided bone regeneration is often required to provide adequate support for dental implant. Angiogenesis and ample blood supply plays a critical role in promoting bone regeneration. This article reviews techniques used to promote preservation of alveolar ridge dimensions. 4. Detoxification of Implant Surfaces Affected by Peri-Implant Disease: An Overview of Non-Surgical Methods. This article provides an overview of non-surgical approaches for detoxification of the surfaces of dental implant and treatment of peri-implant diseases. 5. The Evolution of Dental Materials for Hybrid Prosthesis. This manuscript is a review of the progress in dental implant technologies and materials used for the treatment of edentulism. The authors of this document are educators and practicing dentists; it is our hope that our colleagues and students find this document informative and useful.

Labial soft tissue volume evaluation of different techniques for ridge preservation after tooth extraction: a randomized controlled clinical trial

To volumetrically evaluate soft tissue changes of different ridge preservation techniques compared to spontaneous healing 6months after tooth extraction. In each of 40 patients, one single-rooted tooth was extracted and four treatment modalities were randomly assigned to the following groups (n=10 each): A) ß-tricalcium-phosphate-particles with a polylactid coating (ß-TCP), B) demineralized bovine bone mineral with 10% collagen covered with a collagen matrix (DBBM-C/CM), C) DBBM with 10% collagen covered with an autogenous soft tissue punch graft (DBBM-C/PG), D) spontaneous healing (control). Impressions were obtained before extraction and 6months later, casts were digitized and volumetric changes at the buccal soft tissues were determined. One-way anova was performed and pair-wise Wilcoxon rank sum test with Bonferroni-Holm method was applied for comparison of differences between two groups. After 6months, horizontal contour changes accounted for -1.7±0.7mm (A), -1.2±0.5mm (B), -1.2±0.7mm (C) and -1.8±0.8mm (D). None of the group comparisons reached statistical significance. Six months after tooth extraction all groups revealed a horizontal volume change in the buccal soft tissue contour. Application of DBBM-C/CM or DBBM-C/PG reduced the amount of volume resorption compared to ß-TCP or spontaneous healing without reaching statistically significant difference.

Extraction Socket Healing in Humans After Ridge Preservation Techniques: Comparison Between Flapless and Flapped Procedures in a Randomized Clinical Trial

The preservation of hard and soft tissue volume, partially lost after tooth removal, can potentially reduce the need for the more demanding augmentation procedures used in implant-supported rehabilitation. The objective of this research study is to investigate the effect of filling with xenogeneic material the postextractive sockets of two surgical procedures (flapless versus flapped). In this prospective randomized clinical survey, two types of socket preservation were performed on two groups of patients: the control, treated via full-thickness mucoperiosteal flap, and the test, via a flapless procedure. Anatomic measurements and related outcome variables at the third month were analyzed using multiway analysis of variance. Multiple comparison tests, using Tukey honestly significant difference test, and appropriate pairwise comparison tests for independent samples were carried out. Sixty-four patients were treated, 32 for each of the two socket preservation procedures. Statistically significant differences were registered for the output variables -- changes in width of keratinized gingiva, changes in bucco-lingual width, and vertical bone changes at four sites -- between the two socket preservation techniques, with P values of <0.001, <0.001, and 0.0105, respectively. A full-thickness mucoperiosteal flap gave significantly more negative results than that of the less-demanding flapless procedure, with an increased width resorption of the postextraction site. Moreover, the increased value of the keratinized gingival width attested to the positive outcome of a flapless procedure in terms of soft tissue preservation and improvement. On the other hand, the flapped technique seemed to show less vertical bone resorption on the buccal aspect than the flapless technique.

Alveolar ridge preservation techniques: a systematic review and meta-analysis of histological and histomorphometrical data.

The aim of this article was to systematically review histological and histomorphometrical data from literature that provide information regarding the effect of alveolar ridge preservation procedures on healing after tooth extraction in humans. The MEDLINE-PubMed and the Cochrane CENTRAL databases were searched up to September 2012; 38 papers were selected from 646 founded. A meta-analysis was performed regarding the variations in the mean percentage of Bone, Connective Tissue and Residual Graft Material between three different types of Procedures. The highest value regarding bone percentages is produced at 3 months by Procedures with Allografts (54.4%), while the lowest is obtained, at 5 months, by those using Xenografts (23.6%). Referring to connective tissue, the highest and lowest values are shown at 7 months, with Allografts (67%) and Alloplasts (27.1%), respectively. Regarding residual graft material, the lowest rates are displayed by Procedures with Allografts (12.4-21.11%), while those using Xenografts and Alloplasts showed the best results at 7 months (37.14 and 37.23%). No statistical difference was found. With the limitations due to the features of the selected papers, no major histological and histomorphometrical differences arose among different procedures or when compared to spontaneous healing. Thus, it might be argued that in preserved sites it is unnecessary to wait over 3 to 4 months prior to implant insertion.

Dimensionsveränderungen nach Extraktion und unterschiedlichen alveolarkammerhaltenden Maßnahmen – eine volumetrische Untersuchung

Dimensionsveränderungen nach Extraktion und unterschiedlichen alveolarkammerhaltenden Maßnahmen – eine volumetrische Untersuchung

Current perspectives on the role of ridge (socket) preservation procedures in dental implant treatment in the aesthetic zone

Augmentation of the extraction socket (ridge preservation) is increasingly being advocated in anticipation of implant placement. The aim of this article is to review the available evidence with regards to ridge preservation procedures, investigating whether these techniques improve dental implant treatment outcomes. Evidence is examined to compare these techniques to other treatment alternatives such as implant placement with simultaneous lateral augmentation. An electronic PubMed search was conducted using search terms relevant to assessing treatment outcomes in association with ridge preservation. Titles were screened and full text obtained where relevant. Further full text articles were obtained from analysis of those papers yielded from the original search. Twenty-two papers were finally selected for analysis. Ridge preservation techniques are effective in minimizing post-extraction alveolar ridge contraction. However, there is insufficient evidence to suggest that the use of these techniques in conjunction with dental implant treatment improves implant treatment outcomes. Furthermore, ridge preservation does not necessarily eliminate the need for further simultaneous augmentation at the time of implant placement. The delayed healing associated with ridge preservation using socket grafting necessitates a commitment to a delayed placement protocol. The extended treatment time, compromised healing and expense related to ridge preservation suggests a more cautious approach with regards to the indication of such techniques.

Dimensional alterations of extraction sites after different alveolar ridge preservation techniques – a volumetric study

The aim of this randomized controlled clinical study was to assess soft tissue contour changes after different alveolar ridge preservation procedures. Following tooth extraction, 30 patients were randomly assigned to the following treatments (Tx) - Tx 1: xenogenic bone substitute (pre-hydrated collagenated cortico-cancellous porcine bone) and free gingival graft; Tx 2: free gingival graft alone; Tx 3: xenogenic bone substitute; Tx 4: no further treatment (control). Impressions were obtained before tooth extraction (baseline) and 4 months after surgery. Cast models were optically scanned, digitally superimposed and horizontal measurements of the contour alterations between time points were performed using digital imaging analysis. All groups displayed contour shrinkage at the buccal aspect ranging from a mean horizontal reduction of -0.8±0.5mm (Tx 1) to -2.3±1.1mm (control). Statistically significant differences were found between Tx 1 and Tx 4 as well as Tx 2 and Tx 4. A significant positive influence of the free gingival graft on the maintenance of the ridge width was recorded (p<0.001). In this study, alveolar ridge preservation techniques were not able to entirely compensate for alveolar ridge reduction. Covering the orifice of the extraction socket with a free gingival tissue graft seems to have the potential to limit but not avoid the post-operative external contour shrinkage based on optical scans.

Buccal Bone Crest Dynamics After Immediate Implant Placement and Ridge Preservation Techniques

To review morphometric studies performed in animals assessing the dynamics of the buccal bone crest after immediate implant placement and ridge preservation techniques. A bibliographic search in PubMed was performed. Studies that analyzed morphometrically in animals the buccal bone crest dynamics after immediate implant placement or ridge preservation techniques were included. Twenty-five studies met the inclusion criteria. Immediate implant placement does not prevent the resorption of the buccal bone crest. To minimize this resorption, 2 mm width of the buccal bone crest, palatal/lingual implant placement, and an adequate implant diameter for the width of the ridge are required. The regeneration of the gap after immediate implant placement limits the resorption of the buccal bone crest. Flap elevation and implant surface showed no relation with this resorption. Ridge preservation techniques associated with mucogingival surgery minimize buccal bone crest resorption. Biomaterials are more effective than autograft. Immediate implant placement does not prevent the resorption of the buccal bone crest after dental extraction. Ridge preservation techniques minimize this resorption.

Radiographic evaluation of different techniques for ridge preservation after tooth extraction: a randomized controlled clinical trial

To evaluate the radiographic changes of the alveolar ridge following application of different ridge preservation techniques 6 months after tooth extraction. Four treatment modalities were randomly assigned in 40 patients: β-tricalcium-phosphate-particles with polylactid coating (β-TCP), demineralized bovine bone mineral with 10% collagen covered with a collagen matrix (DBBM-C/CM), DBBM-C covered with an autogenous soft-tissue graft (DBBM-C/PG) and spontaneous healing (control). Cone-beam computed tomography scans were performed after treatment and 6 months later. After 6 months, the vertical changes ranged between -0.6 mm (-10.2%) for control and a gain of 0.3 mm (5.6%) for DBBM-C/PG on the lingual side, and between -2.0 mm (-20.9%) for β-TCP and a gain of 1.2 mm (8.1%) for DBBM-C/PG on the buccal side. The most accentuated ridge width changes were recorded 1 mm below the crest: -3.3 mm (-43.3%, C), -6.1 mm (-77.5%, β-TCP), -1.2 mm (-17.4%, DBBM-C/CM) and -1.4 mm (-18.1%, DBBM-C/PG). At all three levels, DBBM-C with either CM or PG was not significantly differing (p > 0.05), while most other differences between the groups reached statistical significance (p < 0.05). Application of DBBM-C, covered with CM or PG, resulted in less vertical and horizontal changes of the alveolar ridge as compared with controls 6 months after extraction.

Flapless alveolar ridge preservation utilizing the ''socket-plug'' technique: clinical technique and review of the literature

Abstract It has been documented that after every extraction of one or more teeth, the alveolar bone of the respective region undergoes resorption and atrophy. Therefore, ridge preservation techniques are often employed after tooth extraction to limit this phenomenon. The benefits of a flapless procedure include maintenance of the buccal keratinized gingiva, and prevention of alterations to the gingival contours and migration of the mucogingival junction that are often experienced after raising a flap. The purpose of this article is to review the literature concerning flapless ridge preservation techniques with the aid of collagen plugs for occlusion of the socket. The term ''socket plug technique'' is introduced to describe these techniques. The basic steps of the ''socket-plug technique'' consist of atraumatic tooth extraction, placement of the appropriate biomaterials in the extraction site, preservation of soft tissue architecture employing a flapless technique and placement and stabilization of the collagen plug. A case example is presented that illustrates the steps used in this technique.

A Review on Alveolar Ridge Preservation Following Tooth Extraction

Context The question that clinicians face is whether the use of bone replacement grafts and/or barrier membranes enhance their ability to provide for the future placement of a dental implant or to maximize ridge dimensions following the extraction of a tooth versus no additional treatments.Evidence Acquisition The evidence was obtained by search of Entrez PubMed and manual search of The International Journal of Oral and Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implant Research, The Journal of Periodontology, The Journal of Clinical Periodontology, and The Compendium of Continuing Education in Dentistry. Key search words included Guided Bone Regeneration, Dental Extraction, Tooth Extraction, Bone Replacement Graft, Alveolar Ridge. The years of search included from January 2011 through February 2012.Evidence Synthesis The recurring theme was that there was considerable heterogeneity to study designs, time periods, and methods of evaluation. This created great difficulty in trying to answer with good high-quality evidence questions about the techniques and materials to be used for maximizing regeneration at the time of tooth extraction or in which situations this ought to be used.Conclusions There appears to be consensus from the reviewed literature supporting ridge preservation techniques as a whole. Multiple studies demonstrated less ridge resorption occurring when alveolar ridge preservation procedures were used versus the placement of no graft material in fresh alveolar sockets. The analysis did not show any grafting materials demonstrating a clear benefit over any others or that a barrier membrane is necessary. The evidence is also too premature about whether socket preservation efforts require primary closure. In the emerging area of growth factors, there is no high-quality evidence to either support or refute their use.Background Tooth extraction is one of the most widely performed procedures in dentistry today and it has been historically well documented that this procedure may induce significant dimensional changes of the alveolar ridge. The dilemma that clinicians face is how to manage tooth extractions to provide for the future placement of a dental implant or to maximize ridge dimensions for the fabrication of a fixed or removable prosthesis. If performed inadequately, the resulting deformity can be a considerable obstacle to the esthetic, phonetic, and functional results that both our patients and we clinicians expect at this current time.

Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. ridge preservation with secondary soft tissue healing

As a consequence of extraction, the height of the buccal wall tends to decrease and results in the disappearance of bundle bone. To modify bone remodelling after extraction, various ridge preservation techniques have been proposed. The present research was drawn up with the following considerations in mind: to evaluate and to compare changes of hard and soft tissues in post-extraction sockets which received a ridge preservation procedure, with post-extraction sockets which had healed naturally. Each patient was randomly allocated to a test or control group using a specific software package. After extraction, the sockets were carefully inspected and any granulation tissue was removed. The control sites received silk sutures to stabilize the clot without any grafting material. The test sites were grafted with corticocancellous porcine bone and a collagen membrane. All experimental sites had the membranes left exposed to the oral cavity with a secondary wound healing. The thickness of the buccal alveolar bone, if present, was carefully measured at the time of tooth extraction using a calliper at 1 mm from the edge of the wall. The following clinical parameters were evaluated at baseline and after 4 months at implant placement: vertical bone changes, horizontal bone changes and width of keratinized gingiva. The length, diameter and need for additional bone augmentation were assessed for both groups at the time of implant insertion. The control group showed vertical bone resorption of 1 ± 0.7 mm, 2.1 ± 0.6 mm, 1 ± 0.8 mm and 2 ± 0.73 mm at the mesial, vestibular, distal and lingual sites respectively. Moreover, changes in horizontal dimension showed an average resorption of 3.6 ± 0.72 mm. The test sites showed a horizontal bone remodelling of 0.3 ± 0.76 mm, 1.1 ± 0.96 mm, 0.3 ± 0.85 mm, 0.9 ± 0.98 mm at the mesial, vestibular, distal and lingual sites respectively. The horizontal bone resorption at the test sites was 1.6 ± 0.55 mm. The keratinized gingiva showed a coronal shift of 0.7 mm in the control group when compared to 1.1 mm in the test group. In addition, 42% of sites in the control group required an additional bone augmentation at implant placement, when compared to 7% in the test sites. This study clearly points out that an alveolar ridge preservation technique performed with collagenated porcine bone and a resorbable membrane--according to the procedure reported in this study--was able to limit the contour changes after tooth extraction. Finally, the test sites showed a better preservation of facial keratinized tissue when compared to control sites; grafted sites allowed the placement of longer and wider implants when compared to implants inserted in non-grafted sites.

A methodological approach to assessing alveolar ridge preservation procedures in humans: hard tissue profile

Multiple surgical protocols using biomaterials have been proposed to limit the typical post-extraction bone resorption. However, because of the heterogeneity of the studies, particularly the differences in assessment methods, it is difficult to determine the superiority of one technique over another. The objective of this study was to describe a new radiographic method to draw a map of alveolar bone remodelling after alveolar ridge preservation procedures to compare different surgical techniques more accurately. The newly developed measuring method was applied to a case series describing a specific preservation technique. Fourteen extraction sites (in 14 patients) located in the upper anterior maxilla were treated with bovine hydroxyapatite (0.25- to 1-mm particles) and a saddled connective tissue graft. A radiographic three-dimensional assessment of the hard tissues was performed at baseline and 3months after the procedure. Standardized horizontal measurements were taken at three corono-apical levels (-2, -5 and -9mm) and at three mesio-distal levels (mesial, centre and distal) in the buccal and palatal aspects. Vertical measurements were also recorded in nine regions superior to the alveolar crest. The measurements were performed by two independent observers and intra- and inter-observer effects were evaluated. No inter- and intra-observer effects were found when analysing the measurements from these two observers. The horizontal dimension of the crest decreased by 1.6mm (20%) in the cervical regions (-2mm level), decreased moderately, by 1mm (12%), at the -5mm level and decreased very little, 0.5mm (6%), at the apical (-8mm) level. The losses were always significantly higher in the buccal than in the palatal aspect. Buccally, the maximal bone remodelling at the cervical level remained below 1mm. Vertical bone resorption was homogeneous and<1mm in the nine measured regions. The radiographic measuring methodology proved to be reproducible. It can be applied in other clinical settings. It successfully assessed the alveolar ridge preservation technique (BHA+saddle connective tissue graft).

Alveolar Ridge Preservation Utilizing the ‘Socket-Plug’ Technique

It is proven that after every extraction of one or more teeth the alveolar bone of the respective region undergoes resorption and atrophy. Therefore ridge preservation techniques are often employed after tooth extraction to limit the volume of the alveolar bone that is going to be resorbed. There are many benefits in employing a flapless ridge preservation procedure. The purpose of this article is to present the literature concerning flapless ridge preservation techniques with collagen plugs for occlusion of the socket. The term 'socket-plug technique' is introduced to include these techniques. The basic steps of the 'socket-plug technique' are:�Atraumatic tooth extraction�Preservation of soft tissue architecture with the flapless technique�Placement of the appropriate biomaterials in the extraction site�Collagen plug stabilization A case is presented to illustrate the steps used in this technique.

Ridge Preservation of the Molar Extraction Socket Using Collagen Sponge and Xenogeneic Bone Grafts

The purpose of this study was to evaluate the efficacy of the alveolar ridge preservation technique using collagen sponge and xenograft after extraction. Twenty patients were divided into the control group and the experimental group, which contained about 10 patients each. The control group patients were planned 3-unit bridge without performing implant and without special treatments for the extraction socket, and prosthetic treatments were performed after 3 months. In the experimental group, using collagen sponge and xenogeneic bone graft, alveolar ridge preservation was performed simultaneously with tooth extraction; implants were placed after 3 months. Clinical and histological evaluations and statistical analysis were performed. The resorption rate of the width of alveolar bone 3 mm below the alveolar ridge of the control group was shown to be 20.74% and of the experimental group was an average of 14.26%, approximately a difference of 6% was observed, and it was statistically significant. New bone formation in the vicinity of bone graft materials was achieved well, and inflammation findings were not observed. The results indicated that in the ridge preservation using collagen sponge and xenograft, xenograft prevents the horizontal resorption of the alveolar ridge, and the upper collagen sponge blocks the infiltration of soft tissues to the lower area, and thus it has the advantage of the enhancement of bone fill.

The effect of permanent grafting materials on the preservation of the buccal bone plate after tooth extraction: an experimental study in the dog

The aim of the present study was to evaluate the effects of a novel bone substitute system (Natix(®)), consisting of porous titanium granules (PTG) and a bovine-derived xenograft (Bio-Oss(®)), on hard tissue remodelling following their placement into fresh extraction sockets in dogs. Six modalities were tested; Natix(®) granules with and without a covering double-layered Bio Gide(®) membrane; Bio-Oss(®) with and without a covering double-layered Bio Gide(®) membrane; and a socket left empty with and without a covering double-layered Bio Gide(®) membrane. Linear measurements, indicative of buccal bone height loss, and an area measurement indicative of buccal bulk bone loss were made. The statistical analysis was based on the Latin Square design with two blocking factors (dog and site). Tukey's post hoc test was used to adjust for multiple comparisons. Histological observation revealed that while bone formed around both the xenograft and the titanium particles, bone was also noted within titanium granules. Of the five modalities of ridge preservation techniques used in this study, no one technique proved to be superior. The titanium granules were observed to have promising osseoconductive properties.