Surgical protocols for ridge preservation after tooth extraction. A systematic review. Ridge Preservation for Implant Therapy: a Review of the Literature A bone regenerative approach to alveolar ridge maintenance following tooth extraction. Report of 10 cases. Effectiveness of three different alveolar ridge preservation techniques: a pilot randomized controlled trial. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results. Ridge Preservation of the Molar Extraction Socket Using Collagen Sponge and Xenogeneic Bone Grafts A case-control study assessing oral-health-related quality of life after immediately loaded single implants in healed alveolar ridges or extraction sockets. Comparison of the effectiveness of two different bone substitute materials for socket preservation after tooth extraction: a controlled clinical study. Dimensional alterations of extraction sites after different alveolar ridge preservation techniques—a volumetric study Radiographic evaluation of different techniques for ridge preservation after tooth extraction: a randomized controlled clinical trial. Titanium Membranes in Prevention of Alveolar Collapse After Tooth Extraction Ridge preservation following tooth extraction using a polylactide and polyglycolide sponge as space filler: a clinical and histological study in humans. Alveolar ridge reconstruction and/or preservation using root form bioglass cones. Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphometric study. Ridge alterations following grafting of fresh extraction sockets in man. A randomized clinical trial. Novel 3D polycaprolactone scaffold for ridge preservation--a pilot randomised controlled clinical trial.
OBJECTIVE This systematic review aims to evaluate the scientific evidence on the efficacy in the surgical protocol s design ed 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 . R and omized clinical trials and prospect i ve 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 abstract s result ed 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 : I(2 ) = 13.1 % ; χ(2 ) P-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 : I(2 ) = 0 % ; χ(2 ) P-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 result ing 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 bio material , 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 Healing of the extraction socket after tooth removal involves retention of the blood clot followed by a sequence of events that lead to changes in the alveolar process in a three dimensional fashion . This normal healing event results in a minimal loss of vertical height ( around 1 mm ) , but a substantial loss of width in the buccal-lingual plane ( 4 - 6 mm ) . During the first three months following extraction that loss has been shown to be significant and may result in both a hard tissue and soft tissue deformity affecting the ability to restore the site with acceptable esthetics . Procedures that reduce the resorptive process have been shown to be predictable and potentially capable of eliminating secondary surgery for site preparation when implant therapy is planned . The key element is prior planning by the dental therapist to act at the time of extraction to prevent the collapse of the ridge due to the loss of the alveolus . Several techniques have been employed as ridge preservation procedures involving the use of bone grafts , barrier membranes and biologics to provide a better restorative outcome . This review will explore the evidence behind each technique and their efficacy in accomplishing site preparation . The literature does not identify a single technique as superior to others ; however , all accepted therapeutic procedures for ridge preservation have been shown to be more effective than blood clot alone in r and omized controlled studies TEN PATIENTS WHO REQUIRED two or more anterior teeth extraction s were utilized in this study . Extraction procedures were carried out with a full thickness surgical flap approach . After flap reflection , teeth were removed with a minimum of trauma to the surrounding bone . Following extraction silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions . One socket was covered with an exp and ed polytetrafluoroethylene ( ePTFE ) barrier membrane ( experimental site ) ; the other socket was a conventional control . The soft tissue flaps were then mobilized using periosteal releasing incision and the wound closed with ePTFE mattress sutures . Six months following extraction , patients were treated with flap surgery to expose both extraction s sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points . Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control ( P < or = 0.05 ) . Three patients with exposed membranes had similar dimensional changes as controls . Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry 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 r and omly 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 bio material for intraoral grafting The purpose of this study was to evaluate the clinical effectiveness of a bioabsorbable membrane made of glycolide and lactide polymers in preserving alveolar ridges following tooth extraction using a surgical technique based on the principles of guided bone regeneration . Sixteen patients requiring extraction s of 2 anterior teeth or bicuspids participated in the study ( split-mouth design ) . Following elevation of buccal and lingual full-thickness flaps and extraction of teeth , experimental sites were covered with bioabsorbable membranes ; control sites did not receive any membrane . Titanium pins served as fixed reference points for measurements . Flaps were advanced in order to achieve primary closure of the surgical wound . No membrane became exposed in the course of healing . Reentry surgeries were performed at 6 months . Results showed that experimental sites presented with significantly less loss of alveolar bone height , more internal socket bone fill , and less horizontal resorption of the alveolar bone ridge . This study suggests that treatment of extraction sockets with membranes made of glycolide and lactide polymers is valuable in preserving alveolar bone in extraction sockets and preventing alveolar ridge defects BACKGROUND The alveolar ridge undergoes reabsorption and atrophy subsequent to tooth removal and thus exhibits a wide range of dimensional changes . Preservation of the alveolar crest after tooth extraction is essential to enhance the surgical site before implant fixture placement . The aim of this r and omized clinical study is to investigate and compare the need for additional augmentation procedures at implant insertion , as well as the success rate and marginal bone loss for implants placed in the grafted sites versus those placed in naturally healed sites . METHODS Forty patients with ≥1 hopeless tooth were r and omly allocated to : 1 ) a test group , receiving extraction and grafting corticocancellous porcine bone ; and 2 ) a control group , receiving extraction without any graft . After 7 months of healing , implants were inserted in each of the sites . The implants were submerged and loaded after 4 months with metal-ceramic rehabilitation . The follow-up included evaluation of implant diameter and length , the need for additional augmentation procedures at implant placement , implant failure , and marginal bone level changes . All patients were followed over a 3-year period . RESULTS One implant failed in the control group at the second stage of surgery ( 6 months after placement ) ; one implant failed in the test group after 2 years of loading . The cumulative implant success rate at the 3-year follow-up visit reached 95 % for both groups . No statistically significant differences were detected for marginal bone changes between the two groups . CONCLUSIONS It was concluded that implants placed into grafted extraction sockets exhibited a clinical performance similar to implants placed into non-grafted sites in terms of implant survival and marginal bone loss . However , grafted sites allowed placement of larger implants and required less augmentation procedures at implant placement when compared to naturally healed sites Objective : The purpose of this study was to evaluate the efficacy of the alveolar ridge preservation technique using collagen sponge and xenograft after extraction . Study Design : 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 . Results : 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 material s was achieved well , and inflammation findings were not observed . Conclusion : 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 INTRODUCTION Tooth loss reduces oral-health-related quality of life ( OHRQoL ) as assessed with the 14-item Oral Health Impact Profile question naire ( OHIP-14 ) . OBJECTIVES This prospect i ve multicenter case-control study sought to ( i ) establish OHRQoL in patients requiring a single implant in the anterior maxilla and to ( ii ) compare these changes following implant placement and immediate provisionalization in extraction sockets with healed alveolar ridges up to 1 year . MATERIAL AND METHODS Ninety-six patients were enrolled in the study with 102 single implants ( OsseoSpeed AstraTech ) provisionalized immediately after placement in sockets or after placement in healed ridges . A final crown was cemented after 12 weeks . OHIP-14 was registered before surgery ( baseline ) , after 1 ( provisional crown ) , 6 and 12 months ( final crown ) . Repeated measures ANOVA was performed for the seven conceptual OHIP Domains , the treatment group ( extraction site socket vs. healed alveolar ridge ) and time as within subjects variables . RESULTS Two implants failed , 1/48 ( 2.1 % ) in the extraction group ( n=46 patients ) and 1/54 ( 1.8 % ) in the healed ridge group ( n=50 patients ) . From 82 patients ( 87.5 % ) , OHIP-14 was available at all time points . The overall OHIP-14 based on the mean of the seven domains increases between baseline and 6 months and remained stable afterward for the total study group and both treatment groups . Comparison between extraction and healed groups revealed no significant difference at baseline but the healed group showed a significantly higher improvement for functional limitation , physical disability , physical pain and psychological discomfort ( P<0.05 ) . Between baseline and 1 year in the healed bone group , all seven domains improved significantly compared with only three domains in the extraction group . However , the overall OHIP-14 score between groups was not substantially different . Hence , both treatment modalities lead to similar OHRQoL improvement . CONCLUSION Patients in need of a single-tooth replacement have limited OHRQoL problems as reflected by the OHIP-14 score but improvements in several domains related to oral health were evaluated when implants were placed and provisionalized in healed bone and extraction sites The aim of this study was to compare the effectiveness of two bone substitute material s for socket preservation after tooth extraction . Extraction sockets in 10 patients were filled with either inorganic bovine bone material ( Bio-Oss ) or with synthetic material consisting of hydroxyapatite and silicon dioxide ( NanoBone ) . Extraction sockets without filling served as the control . The results demonstrate the effectiveness of the presented protocol for socket preservation and that the choice of a suitable bone substitute material is crucial . The dimensions of the alveolar ridge were significantly better preserved with Bio-Oss than with NanoBone or without treatment . Bio-Oss treatment result ed in better bone quality and quantity for successful implant placement Material and methods : Following tooth extraction , 30 patients were r and omly assigned to the following treatments ( Tx ) : Tx 1 : xenogenic bone substitute ( mp3 OsteoBiol , Tecnoss , Torino , Italy ) and free gingival graft ; Tx 2 : free gingival graft alone ; Tx 3 : xenogenic bone substitute ( mp3 OsteoBiol , Tecnoss , Torino , Italy ) , and Gore-Tex-Membran ( Gore-Tex CV5 , W.L. Gore & Associates , Putzbrunn , Germany ) ; 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 taken via digital imaging analysis OBJECTIVE To evaluate the radiographic changes of the  alveolar ridge following application of different ridge preservation techniques  6 months after tooth extraction . MATERIAL S AND METHODS Four treatment modalities were r and omly 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 . RESULTS 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 ) . CONCLUSIONS Application of DBBM-C , covered with CM or PG , result ed in less vertical and horizontal changes of the alveolar ridge as compared with controls 6 months after extraction Background and Purpose : The resorption of alveolar bone following tooth extraction results in a narrowing and shortening of the residual ridge , which leads to esthetic and restorative problems , and reduces the bone volume available for implant therapy . The aim of this study was to evaluate the prevention of alveolar collapse after tooth extraction , using titanium membrane ( Frios Boneshield ; DENTSPLY Friadent , Mannheim , Germany ) , associated ( or not ) with autologous bone graft . Material s and Methods : A total of 10 nonsmoking healthy subjects , ranging from 35 to 60 years old , were selected for this study . Each patient had a minimum of 2 uni-radicular periodontally hopeless teeth , which were scheduled for extraction . After the procedure , 2 titanium pins were fixed on the vestibular bone surfaces that were used as references for the initial measures ( depth , width , and height ) of the socket . Of the sockets,1 was r and omly chosen to be filled with autologous bone graft ( test ) removed from superior maxillary tuber , and the other one did not receive the graft ( control ) . A titanium membrane was adapted and fixed , covering the sockets , which remained for at least 10 weeks . After a 6-month healing , the final measures were performed . Results : There was exposure of the membrane in 5 of the 10 treated subjects . Average bone filling ( ±st and ard deviation ) among the 10 subjects was 8.80 ± 2.93 mm ( range 4 - 13 ) in the control group and 8.40 ± 3.35 mm ( range 4 - 13 ) in the test group . Average bone loss in width in both group was 1.40 ± 1.97 mm ( range −4 - 1 ) in the control group and 1.40 ± 0.98 mm ( range −4 - 0 ) in the test group . There was no significant statistical difference between groups considering the evaluated st and ards . Conclusion : The use of titanium membrane , alone or in association with autogenous bone , favored the prevention of alveolar ridge after tooth extraction . This membrane seems to be a possible and safe alternative to other nonresorbable membranes when the prevention of alveolar ridge resorption is the objective BACKGROUND The placement of different graft material s and /or the use of occlusive membranes to cover the extraction socket entrance are techniques aim ed at preserving/reducing alveolar ridge resorption . The use of grafting material s in fresh extraction sockets has , however , been question ed because particles of the grafted material have been found in alveolar sockets 6 - 9 months following their insertion . AIM The aims of the study were to ( i ) . evaluate whether alveolar ridge resorption following tooth extraction could be prevented or reduced by the application of a bioabsorbable polylactide-polyglycolide sponge used as a space filler , compared to natural healing by clot formation , and ( ii ) . evaluate histologically the amount and quality of bone tissue formed in the sockets , 6 months after the use of the bioabsorbable material . MATERIAL AND METHODS Thirty-six patients , undergoing periodontal therapy , participated in this study . All patients were scheduled for extraction of one or more compromised teeth . Following elevation of full-thickness flaps and extraction of teeth , measurements were taken to evaluate the distance between three l and marks ( mesio-buccal , mid-buccal , disto-buccal ) on individually prefabricated stents , and the alveolar crest . Twenty-six alveolar sockets ( test ) were filled with a bioabsorbable polylactide-polyglycolide acid sponge ( Fisiograft ) , while 13 sockets ( controls ) were allowed to heal without any filling material . The flaps were sutured with no attempt to achieve primary closure of the surgical wound . Re-entry for implant surgery was performed 6 months following the extraction s. Thirteen biopsies ( 10 test and three control sites ) were harvested from the sites scheduled for implant placement . RESULTS The clinical measurements at 6 months revealed , in the mesial-buccal site , a loss of bone height of 0.2 mm ( 1.4 SD ) in the test and 0.6 mm ( 1.1 SD ) in the controls ; in the mid-buccal portion a gain of 1.3 mm ( 1.9 SD ) in the test and a loss of 0.8 mm ( 1.6 SD ) in the controls ; and in the distal portion a loss of 0.1 mm ( 1.1 SD ) in the test and of 0.8 ( 1.5 SD ) mm in the controls . The biopsies harvested from the test sites revealed that the new bone formed at 6 months was mineralized , mature and well structured . Particles of the grafted material could not be identified in any of the 10 test biopsies . The bone formed in the control sites was also mature and well structured . CONCLUSION The results of this study indicate that alveolar bone resorption following tooth extraction may be prevented or reduced by the use of a bioabsorbable synthetic sponge of polylactide-polyglycolide acid . The quality of bone formed seemed to be optimal for dental implant insertion Extraction of a tooth necessitated by factors such as developmental problems , trauma , severe periodontal disease and endodontic problems often causes deformities of the residual alveolar ridge in the maxillary anterior region . These cases are usually difficult to restore prosthetically and they result in poor esthetics and insufficient occlusal function . This study investigated the efficacy of root form bioactive glass cones implanted into ( a ) artificial sockets produced by bone splitting of previous extraction sites ( group BS ) and ( b ) fresh extraction sockets ( group FES ) . We included conventional extraction sockets sutured without implanting the root form bioactive glass cones as a control ( group C ) . A total of 16 patients were treated for whom extraction s had been indicated due to severe periodontitis . 6 patients with 7 implant sites having Class II or III alveolar ridge deformities comprised the BS group . 5 patients with 10 implant sites comprised the FES group . Group C , comprised 5 patients with 10 extraction sites .  Alveolar ridge width and height measurements were obtained using study casts preoperatively , immediately postoperatively , and at 3 and 12 months after operation . In the BS group , while the width of the alveolar ridge increased by 2.8+/-1.18 mm immediately after ridge augmentation procedure and by 2.4+/-0.93 mm at 1 year after operation ( p<0.01 ) , the height of the alveolar ridge increased by 1.8+/-1.99 mm and 1.4+/-1.74 mm respectively ( p<0.05 ) . In the FES group , the differences between preoperative original ridge height and width and postoperative measurements were not statistically significant , which demonstrated the efficiency of this method in preserving the alveolar ridge . In group C , while alveolar ridge width after 12 months had not significantly changed , alveolar ridge height decreased significantly ( 1.35+/-1.05 mm , p<0.01 ) . After 12 months , no dehiscences were detected and the differences in height between the groups remained significant . The results of this study indicate that this procedure is efficient in reconstructing alveolar ridges deformed as a result of extraction , particularly relevant in relation to preparation for subsequent restorative treatment BACKGROUND The preservation of bone volume immediately after tooth removal might be necessary to optimize the success of implant placement in terms of esthetics and function . The objectives of this r and omized clinical trial were two-fold : 1 ) to compare the bone dimensional changes following tooth extraction with extraction plus ridge preservation using corticocancellous porcine bone and a collagen membrane ; and 2 ) to analyze and compare histologic and histomorphometric aspects of the extraction -alone sites to the grafted sites . METHODS Forty subjects who required tooth extraction and implant placement were enrolled in this study . Using a computer-generated r and omization list , the subjects were r and omly assigned to the control group ( EXT ; extraction alone ) or to the test group ( RP ; ridge-preservation procedure with corticocancellous porcine bone and collagen membrane ) . The following parameters were assessed immediately after extraction and 7 months prior to implant placement : plaque index , gingival index , bleeding on probing , horizontal ridge width , and vertical ridge changes . A bone biopsy was taken from the control and test sites 7 months after the surgical treatment . Histologic and histomorphometric analyses were also performed . RESULTS A significantly greater horizontal reabsorption was observed at EXT sites ( 4.3+/-0.8 mm ) compared to RP sites ( 2.5+/-1.2 mm ) . The ridge height reduction at the buccal side was 3.6+/-1.5 mm for the extraction -alone group , whereas it was 0.7+/-1.4 mm for the ridge-preservation group . Moreover , the vertical change at the lingual sites was 0.4 mm in the ridge-preservation group and 3 mm in the extraction -alone group . Forty biopsies were harvested from the experimental sites ( test and control sites ) . The biopsies harvested from the grafted sites revealed the presence of trabecular bone , which was highly mineralized and well structured . Particles of the grafted material could be identified in all sample s. The bone formed in the control sites was also well structured with a minor percentage of mineralized bone . The amount of connective tissue was significantly higher in the extraction -alone group than in the ridge-preservation group . CONCLUSIONS The ridge-preservation approach using porcine bone in combination with collagen membrane significantly limited the resorption of hard tissue ridge after tooth extraction compared to extraction alone . Furthermore , the histologic analysis showed a significantly higher percentage of trabecular bone and total mineralized tissue in ridge-preservation sites compared to extraction -alone sites 7 months after tooth removal OBJECTIVE To evaluate dimensional alterations of the alveolar ridge that occurred following tooth extraction at sites grafted with Bio-Oss ( ® ) Collagen . MATERIAL AND METHODS Twenty-eight subjects with maxillary incisors , canines , and premolars scheduled for extraction were included . The tooth was carefully removed . The patients were r and omly assigned to a test or a control group . In the test group patients , Bio-Oss ( ® ) Collagen was placed in the fresh extraction socket while in the controls no grafting was performed . Radiographic examination ( cone beam computed tomograms , CBCT ) was performed immediately after tooth extraction and socket treatment . Four months later , a new CBCT was obtained . In the radiographs , ( i ) the distance ( mm ) between base of the alveolar process ( apex ) and the buccal and palatal crests was determined , ( ii ) the outer profile of alveolar process of the experimental sites was outlined , and the cross section of the area ( mm(2 ) ) determined . RESULTS After 4 months of healing , the buccal and to a less extent also the palatal bone plate had become markedly reduced in height . The placement of a bio material in the socket failed to prevent resorption of the buccal and palatal bone walls . The cross-sectional area of the control ridge was reduced about 25 % and of the test ridge with 3 % . CONCLUSION The placement of a xenograft in fresh extraction sockets markedly counteracted the reduction in the hard tissue component of the edentulous sites OBJECTIVES This pilot r and omised controlled clinical trial aim ed to evaluate the feasibility and effectiveness of using a polycaprolactone ( PCL ) scaffold in fresh extraction sockets for ridge preservation . The hypothesis was that the insertion of a 3D bioresorbable PCL scaffold in fresh extraction sockets allowed for normal bone healing and better maintenance of ridge dimensions after 6 months as compared to extraction sockets without the scaffold . MATERIAL AND METHODS Thirteen patients were r and omised to either the test group ( N = 6 ) where a PCL scaffold was inserted in the tooth socket after extraction or the control group ( N = 7 ) where no space filler was used .  Alveolar ridge height and width measurements were made at baseline and 6 months post- extraction , for the evaluation of bone resorption . At 6 months , a core of bone was trephined out from the healed ridge for microcomputed tomographic ( micro CT ) and histological analyses , immediately before Stage I dental implant surgery . Stage II dental implant surgery was performed 4 - 6 months later . RESULTS There was less vertical ridge resorption in the test group compared to the control group , and the difference was statistically significant in the mesio-buccal aspect ( P = 0.008 ) . Micro CT and histological observations showed mainly mineralised bone formation in both groups , except for one specimen in the test group . CONCLUSIONS The insertion of a 3D bioresorbable PCL scaffold in fresh extraction sockets allowed for normal bone healing , and there was better maintenance of ridge height after 6 months as compared to extraction sockets without the scaffold
The potential benefit of socket preservation therapies was demonstrated result ing 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 bio material , 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
OBJECTIVE This systematic review aims to evaluate the scientific evidence on the efficacy in the surgical protocol s design ed 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 .