Vertical and horizontal alveolar bone loss follows tooth removal. Maintaining good alveolar ridges has an impact on future treatment options. As a consequence a range of approaches have been investigated with a view to ridge preservation. The aim of this review was to determine the effect of socket grafting to prevent post-extraction ridge volume loss as compared to tooth extraction alone in non-molar teeth.
Searches were conducted in MEDLINE-PubMed, Web of Knowledge, Google Scholar, the Cochrane Central Register of Controlled Trials (CENTRAL), and ProQuest Dissertations and Theses . Additional hand searching was carried out in the journals (i.e., Journal of Dental Research, Journal of Periodontology, Journal of Clinical Periodontology, Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, Clinical Implant Dentistry and Related Research, Implant Dentistry, International Journal of Periodontics and Restorative Dentistry, International Journal of Oral and Maxillofacial Surgery)
Only randomised controlled trials (RCTs) were considered. Studies had to compare alveolar ridge preservation (ARP) post-extraction via socket filling to untreated sockets (controls). The approach must have involved use of a bone-grafting material (i.e., autograft, xenograft, allograft, or alloplast), covered or not with a barrier/membrane, and had a minimum healing time of 12 weeks. The outcome measures of interest in this systematic review were mean ridge dimensional changes. Study selection was conducted independently by 3 reviewers and data abstraction by 2 reviewers. Risk of bias assessment was also carried out.
- 8 studies (195 patients – 228 sockets [118 experimental, 110 controls]) were included with 6 contributing to a meta-analysis
- Ridge preservation effects in favour of the experimental group (ARP via socket grafting) was seen for each of the measured dimensions
- Buccolingual Width = 1.89 mm (95% CI: 1.41, 2.36; p < .001; heterogeneity: I2 = 59.3%
- Midbuccal height = 2.07 mm (95% CI: 1.03, 3.12; p < .001; I2 = 89.8% ).
- Midlingual height changes = 1.18 mm (95% CI: 0.17, 2.19; p = .022; I2 = 88.8%).
- Mesial height changes =0.48 mm (95% CI: 0.18, 0.79; p = .002; I2 = 24.9%).
- Distal height changes = 0.24 mm (95% CI: –0.05, 0.53; p = .102; I2 = 0%)
The authors concluded
The results of this review showed that ARP via socket filling with a bone graft can be an effective therapy to prevent physiologic bone loss after extraction of non-molar teeth, in both the horizontal and the vertical dimension. Subgroup analyses showed that flap elevation, the usage of a membrane, and the application of a xenograft or an allograft may contribute to enhance the outcomes, particularly on midbuccal and midlingual height preservation.
While the results from this review support the use of ARP with socket filling there are only a small number of available studies and the follow up period range from 3 months to a maximum of 7 months. The authors have also presented a subgroup analysis for flap elevation, membrane usage and the applications of a xenograft or an allograft. However as only a small number of studies are available these should be treated with caution as noted by the authors. A previous systematic review by Horváth et al (Dental Elf 26th July 2012 ) included 8 RCTs but also 6 clinical controlled trials. They were concerned about the clinical heterogeneity of the available studies so did not conduct a meta-analysis as the authors of this current trial have. In our 2012 blog we also highlighted a number of other relevant reviews and we include below some other relevant review that have been published since then.
Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of Alveolar Ridge Preservation after Tooth Extraction: A Systematic Review and Meta-analysis. J Dent Res. 2014 Jun 25. pii: 0022034514541127. [Epub ahead of print] Review. PubMed PMID: 24966231.
De Buitrago JG, Avila-Ortiz G, Elangovan S. Quality assessment of systematic reviews on alveolar ridge preservation. J Am Dent Assoc. 2013 Dec;144(12):1349-57. PubMed PMID: 24282264.
Vittorini Orgeas G, Clementini M, De Risi V, de Sanctis M. Surgical techniques for alveolar socket preservation: a systematic review. Int J Oral Maxillofac Implants. 2013 Jul-Aug;28(4):1049-61. doi: 10.11607/jomi.2670. Review. PubMed PMID: 23869363.
Shanbhag S, Shanbhag V. Clinical Applications of Cell-Based Approaches in Alveolar Bone Augmentation: A Systematic Review. Clin Implant Dent Relat Res. 2013 Jul 2. doi: 10.1111/cid.12103. [Epub ahead of print] PubMed PMID: 23815469.
Chan HL, Lin GH, Fu JH, Wang HL. Alterations in bone quality after socket preservation with grafting materials: a systematic review. Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):710-20. doi: 10.11607/jomi.2913. Review. PubMed PMID: 23748301.