Vertical Ridge Height Research Articles

Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures - a prospective clinical study.

To compare effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters. Thirty subjects with indication of mandibular posterior teeth extraction were randomly assigned to either test or control group. After atraumatic extraction, ridge preservation was performed using APD or DFDBA mixed with i-PRF in test and control groups respectively. Both groups had sockets sealed with A-PRF membrane. Clinical parameters (plaque, gingival and healing indices) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Statistical analysis was performed using an independent t-test to compare clinical and radiographic parameters between the groups. Both groups had significant decreases in ridge dimensions over 6 months (p < 0.001). The test group showed less reduction in ridge dimensions than control group at 6 months (p < 0.001). Mean change in vertical height was not significant (1.37 ± 1.32, 1.7311 ± 0.563), but in horizontal ridge width (1.3120 ± 1.13, 1.8093 ± 1.16) was significantly different between test and control groups respectively. There was no statistical difference in clinical parameters between the groups at 6 months (p > 0.001). APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to DFDBA group. Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.

Concentrated growth factor and collagen as barrier materials in alveolar ridge preservation for posterior teeth: a prospective cohort study with one-year follow-up.

This study aims to evaluate the efficacy of concentrated growth factor (CGF) membrane and collagen as barrier materials in sealing the alveolar socket in alveolar ridge preservation (ARP) in the posterior region during a one-year follow-up. A total of 24 patients who underwent ARP in the posterior region were selected for inclusion and randomly assigned to the CGF group (12 cases) and Collagen group (12 cases). The patients in both groups underwent extraction of posterior teeth. The extraction sockets were filled with a bone substitute to the level of the pre-extraction buccal and lingual or palatal alveolar bone plates. The wounds in the CGF group were closed with a fabricated CGF overlaying the upper edge of the bone substitute material, whereas those in the Collagen group were closed with Bio-Oss Collagen. The implants were placed after 6 months. The evaluation was based on implant retention, re-grafting rate, and vertical and horizontal alveolar ridge bone volume changes measured by cone beam computed tomography (CBCT). Data were statistically analyzed using SPSS 28.0 software. No patient withdrew throughout the follow-up period. No implant failure and no severe peri-implant or mucosal soft tissue complications were observed. Six months after the operation, the degree of vertical alveolar ridge height resorption in the CGF group was lower than that in the Collagen group (P<0.05). There were no statistically difference between the groups at 1 year after the operation (P>0.05). The amount of bone reduction in horizontal alveolar ridge width showed no difference between the groups at 6 months and 1 year after surgery (P>0.05). CGF membrane and Bio-Oss Collagen as barrier materials for posterior ARP inhibited reduction in alveolar ridge bone mass.

Marginal Mandibulectomy Defect Rehabilitated with Cast Partial Denture: A Case Report

The primary prosthetic objectives for marginal mandibulectomy defects are to restore mastication, speech and appearance by replacement of teeth. With marginal resection of mandible followed by reconstruction with submental flap, the major prosthesis concern is related to soft tissue potential for support due to loss of vertical ridge height, loss of vestibular depth, mobility and displaceability of the flap that frequently unseats the prosthesis. This article describes prosthetic rehabilitation with a cast partial denture for missing teeth and restoring function for a patient who had undergone wide lesion excision of verrucous carcinoma with marginal mandibulectomy.

Efficacy of Bovine Hydroxyapatite and Collagen Along With Platelet-Rich Fibrin as a Scaffold and Human Chorion as a Membrane for Ridge Preservation: A Case-Control Study

Aim: The present study aims to determine the efficacy of bovine hydroxyapatite and collagen (G-graft) mixed with platelet-rich fibrin (PRF) used as a scaffold and chorion membrane as a barrier in post-extraction sockets with extraction sites alone.Methods and material: Thirty individuals were randomly assigned into two groups. In the control group, after debridement of the extracted tooth socket, no additional treatment was done. In the test group, after debridement of the extracted tooth socket, the sockets were filled with bovine hydroxyapatite and collagen (G-graft) mixed with PRF. They were covered by a chorion membrane, and a non-absorbable suture material was used to secure the membrane in place. Clinical parameters assessed were plaque index, gingival index, buccolingual width, buccal bone plate height, and lingual bone plate height at baseline and at six months.Results: Clinically, there was a more significant reduction in the buccolingual width of the control group than the test group after six months. A statistically significant difference between the two groups for vertical ridge height at the mesial and distal socket sites was observed. No statistically significant difference in buccal and lingual bone plate height was observed between the two groups (p>0.05).Conclusions: Both groups showed a significant reduction in the Buccolingual width, but it was less in the ridge preservation group. Thus, the use of G-graft with PRF and chorion membrane was highly effective in ridge preservation.Key messages: Natural bovine bone mineral, along with PRF and chorion as a membrane, can be utilized effectively for ridge preservation in extracted tooth sockets due to periodontal disease.

Optimizing dimensional changes of soft tissue in alveolar ridge preservation using rotational palatal pedicle flap in posterior maxilla – A randomized controlled clinical trial

After tooth extraction, it is critical to maintain alveolar bone proportions as well as soft tissue integrity for rehabilitation. The common procedure for closing the socket is a coronally advanced flap, however, it compromises the keratinized tissue dimensions. As a result, the current study's goal is to assess and compare the soft tissue dimensional alterations caused by the new palatal rotational pedicle flap versus the conventional coronally advanced flap as an adjunct to alveolar ridge preservation. Fifty-four participants requiring extraction of single maxillary posterior teeth were randomized into two groups. While both groups used a 1:1 mixture of demineralized freeze dried bone allograft and platelet rich fibrin to preserve the ridge after atraumatic extraction, the control group used a coronally advanced flap to seal the socket, whereas the test group used a rotational palatal pedicle flap to close the socket. At baseline, 3 and 6 months after surgery, the clinical parameters, i.e., vertical ridge height (VRH), horizontal ridge width (HRW), width of keratinized gingiva (WKG), thickness of keratinized gingiva (TKG), and papillary height (PH) were measured. Intergroup comparison demonstrated a significantly greater gain in WKG (P = 0.001), TKG (P = 0.029) and PH (P = 0.021) in the test group. The VRH and HRW, on the other hand, were preserved in both groups. The data were analyzed using unpaired t-test for intergroup and analysis of variance for intragroup comparison. Both groups effectively preserved hard tissue dimensional changes, with the test group showing superior soft tissue enhancement.

Prerequisite for Successful Implant Placement with a Comparative Study on Novel Bone Ring Technique: A Review

Implant placement is getting space day by day. However, in every case, we never get the ideal condition of alveolar bone for implant placement. Alveolar bone loss is seen due to periodontitis, tooth loss, tooth extraction, and periapical infection, etc.&#x0D; Resorption of alveolar bone varies from person to person and side to side. It has been noted that the size of the residual ridge shrinks more quickly within the first six months.&#x0D; There is new demand for reconstruction of the alveolar ridge for implant placement. Various techniques are available for increasing the ridge height and width by using bone graft, membrane, etc., one of these is the vertical ring procedure.&#x0D; Bone ring technique (BRT) has been described as a one-stage approach to restore vertical ridge height defects, in which an autogenous or allogeneic bone block graft is used and the implant is placed simultaneously.&#x0D; This review aims to focus on the importance of the implant placement, consequences of complete edentulism, the problem with removable partial denture (RPD) placement, as a result of bone loss in fully edentulism patients, and the use of vertical ring technique for the implant placement.

Sandwich osteotomy of the atrophic posterior mandible with interpositional autogenous bone block graft compared with bone substitute material: a systematic review and meta-analysis.

The objective of the present systematic review was to test the hypothesis that there were no differences in outcome of implant treatment after sandwich osteotomy in the atrophic posterior mandible with interpositional autogenous bone block graft, compared with bone substitute material. A MEDLINE/PubMed, Embase and Cochrane Library search in combination with hand-search of selected journals was conducted. Two short-term randomised controlled trials with a split-mouth study design and low risk of bias fulfilled the inclusion criteria. High survival rate of suprastructures and implants was disclosed with no significant difference between interpositional autogenous bone block graft compared with bone substitute material. Meta-analysis revealed patient-based implant survival risk ratio of 1.05 (95% CI: 0.88 to 1.25) and peri-implant marginal bone loss of 0.31mm (95% CI: -0.29 to 0.90) indicating no significant differences between the two treatments. High implant stability values, gain in vertical alveolar ridge height, bone formation, and few complications were reported with both treatments. Sandwich osteotomy with interpositional grafting material appears to be a predictable surgical technique for enhancement of the vertical alveolar ridge height in the atrophic posterior mandible prior to implant placement.

Perforation Risk Assessment in Maxillary Sinus Augmentation with Lateral Wall Technique.

Maxillary sinus augmentation is a procedure commonly performed in patients in need of maxillary posterior implants with loss of vertical ridge height and sinus pneumatization. Previous studies have identified some factors associated with sinus membrane perforation during lateral-wall sinus elevation procedures. Although membrane perforation does not directly link to future implant failure, it has been shown to have an association with postoperative complications. In order to promote more predictable results and reduce complications during the sinus elevation procedure, especially for the lateral window approach, articles published in peer-reviewed journals were reviewed to support the proposal of a new risk-evaluation system prior to the sinus surgery. This article reviews anatomical and patient-related factors that might affect the risk of perforation during the surgery and also aims to provide a risk assessment table to enable clinicians to analyze these factors prior to the lateral sinus augmentation surgery.

Maxillary Sinus Elevation Difficulty Score with Lateral Wall Technique

Maxillary sinus augmentation is a procedure commonly performed in patients in need of posterior maxillary implants with limited vertical ridge height and sinus pneumatization. However, minimal information has been presented to evaluate the complexity of the sinus elevation procedure via a lateral window approach based on patient examination, including extraoral findings, anatomical factors, and the possible influence from the surgeon's experience. Therefore, this article presents a new scheme of maxillary sinus floor elevation difficulty score based on comprehensive patient- and surgical-related factors. The proposed scoring tool aims to aid surgeons in performing a comprehensive presurgical evaluation prior to the lateral wall sinus augmentation surgery and also enhance communication between clinicians and patients regarding the complexity of the case.

A Comparison of the Effect of Barrier Membranes on Clinical and Histologic Hard and Soft Tissue Healing with Ridge Preservation.

Twenty patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a bioabsorbable polylactic acid membrane (PLA group) compared to an acellular dermal matrix membrane guided bone regeneration (ADMG group). An intrasocket corticocancellous allograft plus a facial overlay xenograft was used for both groups. Final crestal ridge width was significantly greater for the ADMG group (P < .05). Soft tissue thickness, conversely, was thicker for the PLA group. Vertical ridge height change increased significantly for the midbuccal site of the ADMG group. Histologic evaluation showed high percentages of vital bone for both groups.

Ridge Preservation Comparing the Clinical and Histologic Healing of Membrane vs No-Membrane Approach to Buccal Overlay Grafting.

Twenty-four patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a membrane (acellular dermal matrix graft [ADMG]) vs no membrane on buccal overlay graft technique. An intrasocket corticocancellous allograft with a facial overlay xenograft was used for both groups, and an ADMG was used as a membrane with guided bone regeneration in the ADMG group (control group). In the No Membrane group (test group), ADMG was used to cover only the occlusal surface for graft containment, with no membrane on the buccal overlay graft. Final crestal ridge width and vertical ridge height had no significant difference between groups (P > .05). Facial contour was preserved for the ADMG group compared to No Membrane group. Histologic examination showed a high percentage of vital bone for both groups with no significant difference between groups.

REPRODUCIBILITY OF LINEAR ALVEOLAR RIDGE MEASUREMENTS IN 2 DICOM CBCT VIEWING SOFTWARE PROGRAMS: A PILOT STUDY

Objectives The aim of the study was to determine if the same critical measurement of vertical alveolar ridge height at a dentoalveolar implant recipient site can be measured to the same degree of accuracy from cone beam computed tomography (CBCT) volumetric data with 2 very popular but different commercially available DICOM (Digital Imaging and Communications in Medicine) imaging software: InVivoDental (Anatomage, San Jose, CA, USA) and CareStream 3D (CareStream Dental, Rochester, NY, USA). To determine the degree of precision of alveolar ridge height measurements, we used 2 different DICOM imaging software: InVivoDental (Anatomage, San Jose, CA, USA) and CareStream 3D (CareStream Dental, Rochester, NY, USA). Methods Fifteen maxillary and 15 mandibular posterior implant sites were selected from CBCT patient records (institutional review board # 5160188) at the Loma Linda University School of Dentistry (Loma Linda, CA). The sites also had radiographic stents with directional guide holes for the proposed implant. Two observers, one for each software, used the measurement tools to record the measurements. The measurement line was along the guide hole path from the peripheral crestal cortex to the peripheral cortex of the sinus floor (maxilla) and to the superior mandibular canal border (mandible). The examiners were calibrated on identifying the inferior maxillary sinus border, superior mandibular canal border, and the radiographic stent guide holes. The 2 examiners then independently performed measurements in the paracoronal and parasagittal planes. The means of the 4 independent linear measurements at each of the implant locations in each software were tested with the GraphPad QuickCalcs t test calculator for paired samples at the 5% level of significance. Results There was no difference (P > .05) between linear measurement distances made in 2 different DICOM compliant 3D viewer software when comparing only sagittal, only coronal, or combined sagittal and coronal implant recipient site measurements in the posterior maxilla or mandible. Discussion No difference can be expected when making measurements from a CBCT scan when data are converted to the DICOM file format and measured with the 2 programs used in this study. However, to obtain agreement, the measurement process is very rigorous. Any variation in the technique could cause variation and clinical inaccuracy. Future studies are suggested to determine if proprietary volumetric data set file formats or other DICOM third-party software would also demonstrate the same degree of measurement comparability. In support of such research, the data from this study suggest that if clinicians make measurements relative to predefined reference points, then a similar degree of accuracy in the measurements can be expected. Conclusions There is no difference in vertical linear measurements of implant sites in the posterior maxilla or the posterior mandible when measuring DICOM-compatible volumetric data sets with either InVivoDental or CareStream viewer software.

Combination of bone graft and resorbable membrane for alveolar ridge preservation: A systematic review, meta-analysis, and trial sequential analysis.

Alveolar ridge preservation (ARP) techniques aim to reduce resorption after tooth extraction. The combination of a graft material covered with a resorbable membrane represents one of the most common strategies performed in the clinical practice. The aim of this systematic review is to analyze evidence regarding potential benefits of ARP procedures performed with allogenic/xenogenic grafts in combination with a resorbable membrane coverage in comparison with spontaneous healing. Electronic databases were screened independently to select studies suitable for inclusion in this review. Horizontal ridge width reduction (HRWR) and vertical ridge height reduction (VRHR) were investigated as primary outcomes and volume changes (VC) as a secondary outcome. Meta-analysis was performed using the inverse of variance test with a random effect model. Adjustment for Type I and II errors and analysis of the power of evidence was performed with trial sequential analysis (TSA). Seven studies met the inclusion criteria and were included in the quantitative synthesis. Meta-analysis revealed that the combination therapy resulted in a lower rate of resorption for both HRWR (-2.19 mm, 95% confidence interval [CI]:-2.67 to-1.71 mm) and VRHR (-1.72 mm, 95% CI:-2.14 to-1.30 mm). For VC no meta-analysis was performed due to insufficient data. Analysis of the power of the evidence performed with TSA showed that the number of both studies and sockets analyzed is sufficient to validate such findings, despite the high rate of heterogeneity. Use of bone graft covered by a resorbable membrane can decrease the rate of alveolar ridge horizontal and vertical resorption after tooth extraction. The power and reliability of the evidence is strong enough to confirm the above-mentioned findings, despite the high rate of heterogeneity of included studies.

Buccal Bone Formation After Flapless Extraction: A Randomized, Controlled Clinical Trial Comparing Recombinant Human Bone Morphogenetic Protein 2/Absorbable Collagen Carrier and Collagen Sponge Alone

Flapless extraction of teeth allows for undisturbed preservation of the nearby periosteum and a source of osteoprogenitor cells. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has been used for different bone augmentation purposes with great osteoinductive capacity. The aim of this study is to compare the bone regenerative ability of rhBMP-2 on an absorbable collagen sponge (ACS) carrier to a collagen sponge (CS) alone in extraction sites with ≥50% buccal dehiscence. Thirty-nine patients requiring extraction of a hopeless tooth with ≥50% buccal dehiscence were enrolled. After flapless extraction and randomization, either rhBMP-2/ACS carrier or CS alone was placed in the extraction site. After extraction, a baseline cone beam computed tomography (CBCT) scan was obtained of the site, and a similar scan was obtained 5 months postoperatively. Medical imaging and viewing software were used to compare the baseline and 5-month postoperative images of the study site and assess ridge width measurements, vertical height changes, and buccal plate regeneration. Radiographically, CBCT analysis showed that with ≥50% of buccal bone destruction, rhBMP-2/ACS was able to regenerate a portion of the lost buccal plate, maintain theoretical ridge dimensions, and allow for implant placement 5 months after extraction. The test group performed significantly (P <0.05) better in regard to clinical buccal plate regeneration (4.75 versus 1.85 mm), clinical ridge width at 5 months (6.0 versus 4.62 mm), and radiographic ridge width at 3 mm from the alveolar crest (6.17 versus 4.48 mm) after molar exclusion. There was also significantly (P <0.05) less remaining buccal dehiscence, both clinically (6.81 versus 10.0 mm) and radiographically (3.42 versus 5.16 mm), at 5 months in the test group. Significantly (P <0.05) more implants were placed in the test group without the need for additional augmentation. The mean loss in vertical ridge height (lingual/palatal) was less in the test sites but was not significantly (P = 0.514) different between the test and control groups (0.39 versus 0.64 mm). rhBMP-2/ACS compared to CS alone used in flapless extraction sites with a buccal dehiscence is able to regenerate lost buccal plate, maintain theoretical ridge dimensions, and allow for implant placement 5 months later.

A guided bone regeneration technique for vertical bony augmentation in the maxilla

Vertical defects of the anterior alveolar crest limit esthetic and functional success of the implant supported prosthesis. Hard tissue grafting is often required before implant grafting. Although many techniques exist for hard tissue augmentation the outcome of vertical alveolar ridge augmentation is often unpredictable. Vertical bone augmentation historically has been a very difficult objective to complete. Due to soft tissue tension it often results in the displacement or complete resorbtion of the graft, dehiscence of the overlying soft tissue and subsequent loss of the graft. This case report describes a new approach to vertical alveolar ridge augmentation using a titanium mesh scaffold, Bio-GIde collagen membrane, and an admixture of cortico-cancellous anterior iliac crest bone and Bio-Oss xenograft material. The titanium mesh scaffold was used to establish and contain the desired height and bulk of the graft. The collagen membrane which was laid over the titanium mesh was used to isolate and seal the graft from the oral cavity as well and to prevent infiltration of granulation tissue into the hard tissue matrix. There was a small area of membrane perforation over the titanium mesh during the healing period. This area was noted to have some soft tissue infiltration and a small loss of graft material. The overall bulk and height of the graft under the mesh was maintained, and significant alveolar ridge height and bulk was achieved. The titanium scaffold technique showed promising initial results for vertical ridge height and bulk augmentation. It is a tool that can be used to augment large defects where other techniques may be less predictable. Our hypothesis is that if there were not a membrane perforation complete retention of the graft would have been achievable. This may be rectified in using a dual membrane or a thicker material. More cases and further study are needed to establish predictability and long-term retention of the graft.

Growth Factor–Mediated Vertical Mandibular Ridge Augmentation: A Case Report

Posterior vertical alveolar ridge deficiencies are challenging defects to treat predictably and often require autogenous bone-harvesting procedures. Traditional treatment modalities, eg, guided bone regeneration, distraction osteogenesis, and autogenous grafts, present with a number of potential complications and limited success when used to restore vertical ridge height. Recent advances in recombinant growth factor technology may provide viable, alternative therapies for the treatment of significant alveolar ridge deficiencies. This proof-of-principle case report examines the utility and effectiveness of using a composite graft of freeze-dried bone allograft and recombinant human platelet-derived growth factor BB in conjunction with an overlying titanium mesh to regenerate well-vascularized bone in a significant posterior mandibular ridge defect prior to implant placement. The important role of the overlying periosteum as a possible key source of osteogenic cells during growth factor-enhanced regenerative procedures is emphasized.

A Clinical and Histomorphometric Study of Calcium Sulfate Compared With Freeze‐Dried Bone Allograft for Alveolar Ridge Preservation

Many materials have been found to be effective in ridge preservation. The purpose of this study is to determine whether calcium sulfate (CS) is as effective as freeze-dried bone allograft (FDBA) in preserving postextraction ridge dimensions and to evaluate the amount of new bone formation and graft clearance through histologic analysis. Thirty-one extraction sites were selected. Postextraction clinical measurements were made, and sites were divided randomly into the test group (CS) or the control group (FDBA). After graft placement, all individuals received the same postoperative treatment and instructions. Participants were recalled after 3 months, measurements were made, and sites were re-entered. Bone samples were harvested and analyzed with histologic methodology for new bone formation and remaining residual graft. Thirteen test and 15 control sites were evaluated. There was no significant change in vertical ridge height before or after surgery within the test and control groups (P = 0.57, P = 0.68, respectively). There was a significant decrease in bucco-lingual ridge width for both groups (P = 0.0003, P = 0.0075, respectively), but the difference between groups was not significant (P = 0.11). Histologic analysis revealed an average of 32% new bone formation with 2.5% graft remaining for the test group and 16.7% new bone formation with 21% graft remaining for the control. Results indicate that CS is as effective as FDBA in preserving postextraction ridge dimensions in non-molar extraction sites. There is greater clearance of CS with more new bone formation after ≈3 months compared with FDBA in these sites. This paper received the Maynard K. Hine Award for Excellence in Dental Research presented by the Indiana Section of the American Association for Dental Research and supported by Procter & Gamble.

Ridge Preservation With or Without an Osteoinductive Allograft: A Clinical, Radiographic, Micro‐Computed Tomography, and Histologic Study Evaluating Dimensional Changes and New Bone Formation of the Alveolar Ridge

The aim of this randomized, controlled clinical trial is to determine whether ridge preservation using an osteoinductive allograft (test) would prevent ridge resorption and promote bone maturation compared to extraction alone (control). Seventeen patients (20 total sites), in need of a non-molar extraction and delayed implant placement were randomly selected to receive either ridge preservation or extraction alone. A cone-beam computed tomography was completed with a radiographic stent in place before extraction and 10 to 12 weeks postoperatively for dimensional and buccal plate analyses. Bone cores were taken for micro-computed tomography (microCT) and histologic analyses. Resorption of the alveolar ridge occurred at all sites with no statistically significant differences found between test and control sites. A significant correlation was found between the initial buccal plate thickness and the loss of vertical ridge height. microCT and histologic analyses found a mean new bone volume of 44.9% with microCT and 37.4% with histology in test sites and 39% and 35.5%, respectively, in control sites. The residual graft volume was 2.4% with microCT and 4.5% with histology. Test and control sites lost similar amounts of alveolar ridge, with the loss of buccolingual width occurring predominantly at the expense of the buccal bone. A thicker buccal plate was associated with less ridge loss in the vertical dimension. The percentage of new bone was not statistically significant between either the test or control sites, using either microCT or histologic analyses.

Flapless Implant Surgery Using a Mini‐Incision

Traditional flapless implant surgery using a soft tissue punch device requires a circumferential excision of keratinized tissue at the implant site. A new flapless implant technique that can submerge implant fixtures is needed. This article describes a flapless implant surgery method using a mini-incision and compares the effects of soft tissue punch and mini-incision surgery on both the amount of osseointegration and the bone height around the implants using a canine mandible model. Bilateral, edentulated, flat alveolar ridges were created in the mandibles of six mongrel dogs. After a 3-month healing period, two implants were placed on each side of the mandible using either soft tissue punch or mini-incision procedures. After an additional 3-month healing period, a second stage surgery and transmucosal abutment attachment was performed for mini-incision implant cases. Following a 2-month healing period, the dogs were sacrificed to evaluate the osseointegration and bone height around the implants. Average bone height was 9.6 ± 0.4 mm in the soft tissue punch group and 9.8 ± 0.3 mm in the mini-incision group (p > .05). Average osseointegration was 70.4 ± 6.3% in the soft tissue punch group and 71.2 ± 7.1% in the mini-incision group (p > .05). No significant differences were noted between the two groups in vertical alveolar ridge height or bone/implant contact. Our findings support the clinical use of mini-incision implant surgery at sites where implants need to be protected below the soft tissue during the early phase of healing, particularly for patients with poor bone quality and/or low primary implant stability.

Porcine‐Derived Xenograft Combined with a Soft Cortical Membrane versus Extraction Alone for Implant Site Development: A Clinical Study in Humans

An adequate alveolar crest is essential for implant placement in terms of esthetics and function. The objective of this randomized clinical trial was to compare the preservation of the alveolar ridge dimensions following tooth extraction using porcine-derived xenograft combined with a membrane versus extraction-alone (EXT) sites. Fifteen patients who required double extraction of contralateral premolars and delayed implant placement were randomly selected to receive both ridge-preservation procedure and EXT. The test sites (alveolar ridge preservation [ARP]) included 15 sockets treated using a corticocancellous porcine bone xenograft (OsteoBiol® Gen-Os; Tecnoss srl, Giaveno, Italy) associated with a soft cortical membrane (OsteoBiol® Lamina; Tecnoss srl), while the corresponding control sites (EXT) were left without grafting for EXT. Horizontal and vertical ridge dimensions were recorded at baseline and 6 months after extractions. After 6 months, the EXT sites showed a significantly greater reabsorption of the buccolingual/palatal dimension of the alveolar ridge (3.7 ± 1.2 mm) compared with the ARP sites (1.8 ± 1.3 mm). The mean vertical ridge height reduction in the control sockets was 3.1 ± 1.3 mm at the buccal sites and 2.4 ± 1.6 mm at the lingual sites compared with 0.6 ± 1.4 and 0.5 ± 1.3 mm, respectively, in the test sockets. The differences between test and control sockets were not significant for the mesial and distal measurements. The placement of a porcine xenograft with a membrane in an extraction socket can be used to reduce the hard tissue reabsorption after tooth extraction compared with EXT.