Objective
This systematic review aims to evaluate the scientific evidence on the efficacy in the surgical protocols designed for preserving the alveolar ridge after tooth extraction and to evaluate how these techniques affect the placement of dental implants and the final implant supported restoration.

Material and methods
A thorough search in MEDLINE-PubMed, Embase and the Cochrane Central Register of controlled trials (CENTRAL) was conducted up to February 2011. Randomized clinical trials and prospective cohort studies with a follow-up of at least 3 months reporting changes on both the hard and soft tissues (height and/or width) of the alveolar process (mm or %) after tooth extraction were considered for inclusion.

Results
The screening of titles and abstracts resulted in 14 publications meeting the eligibility criteria. Data from nine of these 14 studies could be grouped in the meta-analyses. Results from the meta-analyses showed a statistically significant greater ridge reduction in bone height for control groups as compared to test groups (weighted mean differences, WMD = −1.47 mm; 95% CI [−1.982, −0.953]; P < 0.001; heterogeneity: I2 = 13.1%; χ2P-value = 0.314) and a significant greater reduction in bone width for control groups compared to the test groups (WMD = −1.830 mm; 95% CI [−2.947, −0.732]; P = 0.001; heterogeneity: I2 = 0%; χ2P-value = 0.837). Subgroup analysis was based on the surgical protocol used for the socket preservation (flapless/flapped, barrier membrane/no membrane, primary intention healing/no primary healing) and on the measurement method utilized to evaluate morphological changes. Meta-regression analyses demonstrated a statistically significant difference favoring the flapped subgroup in terms of bone width (meta-regression; slope = 2.26; 95% IC [1.01; 3.51]; P = 0.003).

Conclusions
The potential benefit of socket preservation therapies was demonstrated resulting in significantly less vertical and horizontal contraction of the alveolar bone crest. The scientific evidence does not provide clear guidelines in regards to the type of biomaterial, or surgical procedure, although a significant positive effect of the flapped surgery was observed. There are no data available to draw conclusions on the consequences of such benefits on the long-term outcomes of implant therapy.

Surgical protocols for ridge preservation after tooth extraction. A systematic review.

Alveolar ridge preservation strategies are indicated to minimize the loss of ridge volume that typically follows tooth extraction. The aim of this systematic review was to determine the effect that socket filling with a bone grafting material has on the prevention of postextraction alveolar ridge volume loss as compared with tooth extraction alone in nonmolar teeth. Five electronic databases were searched to identify randomized clinical trials that fulfilled the eligibility criteria. Literature screening and article selection were conducted by 3 independent reviewers, while data extraction was performed by 2 independent reviewers. Outcome measures were mean horizontal ridge changes (buccolingual) and vertical ridge changes (midbuccal, midlingual, mesial, and distal). The influence of several variables of interest (i.e., flap elevation, membrane usage, and type of bone substitute employed) on the outcomes of ridge preservation therapy was explored via subgroup analyses. We found that alveolar ridge preservation is effective in limiting physiologic ridge reduction as compared with tooth extraction alone. The clinical magnitude of the effect was 1.89 mm (95% confidence interval [CI]: 1.41, 2.36; p < .001) in terms of buccolingual width, 2.07 mm (95% CI: 1.03, 3.12; p < .001) for midbuccal height, 1.18 mm (95% CI: 0.17, 2.19; p = .022) for midlingual height, 0.48 mm (95% CI: 0.18, 0.79; p = .002) for mesial height, and 0.24 mm (95% CI: -0.05, 0.53; p = .102) for distal height changes. Subgroup analyses revealed that flap elevation, the usage of a membrane, and the application of a xenograft or an allograft are associated with superior outcomes, particularly on midbuccal and midlingual height preservation.

/pdf/effect-of-alveolar-ridge-preservation-after-tooth-extraction-4an2xeagbz.pdf

Effect of Alveolar Ridge Preservation after Tooth Extraction: A Systematic Review and Meta-analysis

Post-extraction crestal bone resorption is common and unavoidable which can lead to significant ridge dimensional changes. To regenerate enough bone for successful implant placement, Guided Bone Regeneration (GBR) is often required. GBR is a surgical procedure that uses barrier membranes with or without particulate bone grafts or/and bone substitutes. There are two approaches of GBR in implant therapy: GBR at implant placement (simultaneous approach) and GBR before implant placement to increase the alveolar ridge or improve ridge morphology (staged approach). Angiogenesis and ample blood supply play a critical role in promoting bone regeneration.

/pdf/mechanisms-of-guided-bone-regeneration-a-review-23lf5007oo.pdf

Mechanisms of guided bone regeneration: a review

Purpose: The aim of this clinical trial was to evaluate the influence of gingival tissue thickness on crestal bone loss around dental implants after a 1-year follow-up. Materials and Methods: Forty-six implants (23 test and 23 control) were placed in 19 patients. The test implants were placed about 2 mm supracrestally, whereas the control implants were positioned at the bone level. Before implant placement, the tissue thickness at implant sites was measured with a periodontal probe. After healing, metal-ceramic cement-retained prostheses were constructed. According to tissue thickness, the test implants were divided into A (thin) and B (thick) groups. Intraoral radiographs were performed and crestal bone changes were measured at implant placement and after 1 year. Results: Mean bone loss around the test implants in group A (thin mucosa) was 1.61 ± 0.24 mm (SE; range, 0.9 to 3.3 mm) on the mesial and 1.28 ± 0.167 mm (range, 0.8 to 2.1 mm) on the distal. Mean bone loss in test group B (thick mucosa) implants was 0.26 ± 0.08 mm (range, 0.2 to 0.9 mm) on the mesial aspect and 0.09 ± 0.05 mm (range, 0.2 to 0.6 mm) on the distal aspect. Mean bone loss around control implants was 1.8 ± 0.164 mm (range, 0.6 to 4.0 mm) and 1.87 ± 0.166 mm (range, 0.0 to 4.1 mm) on the mesial and distal aspects, respectively. Analysis of variance revealed a significant difference in terms of bone loss between test A (thin) and B (thick) groups on both the mesial and the distal. Conclusion: Initial gingival tissue thickness at the crest may be considered as a significant influence on marginal bone stability around implants. If the tissue thickness is 2.0 mm or less, crestal bone loss up to 1.45 mm may occur, despite a supracrestal position of the implant-abutment interface. INT J ORAL MAXILLOFAC IMPLANTS 2009;24:712–719

/pdf/the-influence-of-soft-tissue-thickness-on-crestal-bone-1px60o73y1.pdf

The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial.

Preparation and characterization of PLA/PCL/HA composite scaffolds using indirect 3D printing for bone tissue engineering.

The biologic principle of guided bone regeneration has been successfully used to prevent bone loss in extraction sites. This study comprises 420 cases of alveolar ridge maintenance in preparation for dental implant placements. Nonexpanded polytetrafluoroethylene membranes were positioned over all ex

Guided bone regeneration using nonexpanded polytetrafluoroethylene membranes in preparation for dental implant placements--a report of 420 cases.

The successful maintenance of crestal bone surrounding dental implants is imperative for long-term implant success. Crestal bone loss is reportedly related to stress. However, early perforation and partial exposure of the implant’s covering device are a focus for plaque accumulation, which, if left untreated, may result in inflammation. The objective of this study was to evaluate the crestal bone levels adjacent to submerged and exposed unloaded dental implants during the initial healing phase. In addition, the microbiota around exposed implants were studied. Bilateral implants were placed in the mandible of 10 patients. In one quadrant, the implants were covered by the flap. In the other quadrant, the flap was sutured, leaving the cover screws completely exposed. Standardized periapical radiographs were obtained at implant placement and 4 months later. Radiographs were digitalized, aligned, and analyzed with a computer-assisted method. Cultures were obtained from exposed implant sites. All patients showed more crestal bone loss around exposed dental implants compared to submerged implants. Prevotella sp., Streptococcus beta-hemoliticus, and Fusobacterium sp. were the microorganisms identified in most of the sites. The exposure of the implant covering device created foci for bacterial plaque accumulation, which may have facilitated periimplant crestal bone loss. The initial healing phase follow-up may be critical for implant success.

Crestal bone loss around submerged and exposed unloaded dental implants: a radiographic and microbiological descriptive study.

This clinical report presents a restorative option for the partially edentulous maxilla utilizing an implant-retained removable partial denture without retentive clasps. This approach required (1) fewer patient visits and laboratory procedures; (2) the use of minimal number of implants; (3) lower financial obligations; and (4) no sinus elevation surgery. The use of O-ring attachments provided excellent retention and stability. The detachable prosthesis over implants allows easier oral hygiene by the patient and provides superior esthetics and phonetics in cases involving advanced ridge resorption.

Implant-retained removable prosthesis with ball attachments in partially edentulous maxilla.

The success rates of implants placed in the posterior region of both jaws are less than the anterior segments. Anatomic features, masti- cation dynamics, and adequate im- plant selection are all significant for long-term prognosis in the molar re- gion. This article discusses important aspects in planning the use of dental implants in the areas of first molars. (Implant Dent 2004;13:328 -335)

Implants for single first molar replacement: important treatment concerns.

This randomized, blinded study compared, contralaterally, the dimensions of supracrestal gingival tissue (SGT) in healthy human periodontium. Sulcular probing reaching the crestal bone was performed in 100 dental students (400 teeth [first molars and second premolars] and 1,600 sites). Contralateral measurements were statistically analyzed by one-way analysis of variance. SGT measurements ranged from 1.0 to 6.0 mm. Contralateral measurements showed no statistical difference (P = .096). Measurement of SGT contralaterally prior to crown lengthening or restorative procedures may dictate the needed amount of bone removal or tooth preparation into the sulcus.

Supracrestal gingival tissue measurements in healthy human periodontium.

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