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Alveolar ridge preservation. A systematic review

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Abstract

Objective

The objective of this paper is to examine the effect of alveolar ridge preservation (ARP) compared to unassisted socket healing.

Methods

Systematic review with electronic and hand search was performed. Randomised controlled trials (RCT), controlled clinical trials (CCT) and prospective cohort studies were eligible.

Results

Eight RCTs and six CCTs were identified. Clinical heterogeneity did not allow for meta-analysis. Average change in clinical alveolar ridge (AR) width varied between −1.0 and −3.5 ± 2.7 mm in ARP groups and between −2.5 and −4.6 ± 0.3 mm in the controls, resulting in statistically significantly smaller reduction in the ARP groups in five out of seven studies. Mean change in clinical AR height varied between +1.3 ± 2.0 and −0.7 ± 1.4 mm in the ARP groups and between −0.8 ± 1.6 and −3.6 ± 1.5 mm in the controls. Height reduction in the ARP groups was statistically significantly less in six out of eight studies. Histological analysis indicated various degrees of new bone formation in both groups. Some graft interfered with the healing. Two out of eight studies reported statistically significantly more trabecular bone formation in the ARP group. No superiority of one technique for ARP could be identified; however, in certain cases guided bone regeneration was most effective. Statistically, significantly less augmentation at implant placement was needed in the ARP group in three out of four studies. The strength of evidence was moderate to low.

Conclusions

Post-extraction resorption of the AR might be limited, but cannot be eliminated by ARP, which at histological level does not always promote new bone formation. RCTs with unassisted socket healing and implant placement in the ARP studies are needed to support clinical decision making.

Clinical relevance

This systematic review reports not only on the clinical and radiographic outcomes, but also evaluates the histological appearance of the socket, along with site specific factors, patient-reported outcomes, feasibility of implant placement and strength of evidence, which will facilitate the decision making process in the clinical practice.

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Acknowledgments

The authors wish to express their gratitude to Aviva Petrie for her invaluable contribution to the statistical assessment.

Conflict of interest and source of funding

There was no known conflict of interest among the review team. The trial was self funded and supported by the Research Discretionary Account of the Unit of Periodontology, UCL Eastman Dental Institute. This work was undertaken at UCLH/UCL who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme.

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Authors and Affiliations

  1. Unit of Periodontology, Department of Clinical Research, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London, WC1X 8LD, UK

    Attila Horváth, Nikos Mardas, Luis André Mezzomo, Ian G. Needleman & Nikos Donos

  2. Department of Periodontology, Semmelweis University, Budapest, Hungary

    Attila Horváth

  3. Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil

    Luis André Mezzomo

  4. International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK

    Ian G. Needleman

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  1. Attila Horváth
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  2. Nikos Mardas
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  3. Luis André Mezzomo
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  4. Ian G. Needleman
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  5. Nikos Donos
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Correspondence to Nikos Donos.

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Horváth, A., Mardas, N., Mezzomo, L.A. et al. Alveolar ridge preservation. A systematic review. Clin Oral Invest 17, 341–363 (2013). https://doi.org/10.1007/s00784-012-0758-5

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  • DOI: https://doi.org/10.1007/s00784-012-0758-5

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