Soft tissue dimensional changes after alveolar ridge preservation using different sealing materials: a systematic review and network meta-analysis

Abstract Background Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature. Objective To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance. Materials and methods The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health’s Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow‐up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed. Results A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT). Conclusions NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage. Clinical relevance Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.

Download Full-text

The Use of a Non-Absorbable Membrane as an Occlusive Barrier for Alveolar Ridge Preservation: A One Year Follow-Up Prospective Cohort Study

Antibiotics ◽

10.3390/antibiotics9030110 ◽

2020 ◽

Vol 9 (3) ◽

pp. 110 ◽

Cited By ~ 1

Author(s):

Piero Papi ◽

Bianca Di Murro ◽

Marco Tromba ◽

Pier Carmine Passarelli ◽

Antonio D’Addona ◽

...

Keyword(s):

Ridge Preservation ◽

Alveolar Ridge ◽

Dimensional Changes ◽

Ptfe Membrane ◽

Implant Placement ◽

Alveolar Ridge Preservation ◽

Mean Width ◽

Ridge Width ◽

One Year

The aims of this study were to obtain preliminary data and test the clinical efficacy of a novel nonporous dense-polytetrafluoroethylene (d-PTFE) membrane (permamem®, botiss) in alveolar ridge preservation (ARP) procedures with a flapless approach. A traumatic extraction was performed in the premolar maxillary area, and a d-PTFE membrane was used to seal the alveolar cavity: no biomaterial was used to graft the socket and the membrane was left intentionally exposed and stabilized with sutures. The membrane was removed after four weeks and dental implants were placed four months after the procedure. The primary outcome variables were defined as the dimensional changes in the ridge width and height after four months. A total of 15 patients were enrolled in this study. The mean width of the alveolar cavity was 8.9 ± 1.1 mm immediately after tooth extraction, while four months later a mean reduction of 1.75 mm was experienced. A mean vertical reduction of 0.9 ± 0.42 mm on the buccal aspect and 0.6 ± 0.23 mm on the palatal aspect were recorded at implant placement. Within the limitations of this study, the d-PTFE membrane proved to be effective in alveolar ridge preservation, with the outcomes of the regeneration not affected by the complete exposure of this biomaterial.

Download Full-text

Postextraction Ridge Width Alterations Following Socket Seal Surgery—A Retrospective Study

Applied Sciences ◽

10.3390/app11010324 ◽

2020 ◽

Vol 11 (1) ◽

pp. 324

Author(s):

Cobi Landsberg ◽

Omer Bender ◽

Miron Weinreb ◽

Ronald Wigler ◽

Tali Chackartchi ◽

...

Keyword(s):

Retrospective Study ◽

Soft Tissue ◽

Tooth Extraction ◽

Healing Time ◽

Alveolar Ridge ◽

Dimensional Changes ◽

Post Surgery ◽

Contour Following ◽

Tissue Grafts ◽

Soft Tissue Grafts

Background and objectives: Preservation of alveolar ridge contour following tooth extraction is important to allow for restoration with prosthetics and implants. Socket seal surgery was introduced more than two decades ago for preservation of the form, volume and bone quality of the postextraction ridge. The aim of this retrospective study was to assess the changes in alveolar ridge contour following socket seal surgery and to evaluate the survival of the soft tissue grafts sealing the extraction site. Materials and Methods: Digital images of the extraction sites treated with the socket seal surgery were obtained immediately after extraction and after a healing time of 6 months to measure the changes in the alveolar width. In addition, the sites were photographed 1 week postsurgery to evaluate the vitality of the soft tissue grafts. Results: The overall mean loss of buccal width following socket seal surgery was 5.3% (SD = 13.4%). The mean change in width at the incisor area (1.5% ± 13.1) was significantly lesser than those in the canine area (−17.0% ± 2.1, p < 0.01) or premolar area (−10.5% ± 11.2, p < 0.01). One-week post-surgery 69% of the grafts were vital, and 31% were partially vital. Complete necrosis of the grafts did not occur. Conclusions: Our results suggest that socket seal surgery has a beneficial effect on alveolar dimensional changes 6 months following tooth extraction and that the teeth that benefit mostly from socket seal surgery are incisors.

Download Full-text

Sealing materials for post-extraction site: a systematic review and network meta-analysis

Clinical Oral Investigations ◽

10.1007/s00784-021-04262-3 ◽

2021 ◽

Author(s):

Massimo Del Fabbro ◽

Grazia Tommasato ◽

Paolo Pesce ◽

Andrea Ravidà ◽

Shahnawaz Khijmatgar ◽

...

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Bone Formation ◽

Meta Analysis ◽

Controlled Trials ◽

New Bone Formation ◽

Hard Tissue ◽

Significant Difference ◽

Tissue Grafts ◽

Soft Tissue Grafts

Abstract Aim By means of a systematic review and network meta-analysis, this study aims to answer the following questions: (a) does the placement of a biomaterial over an extraction socket lead to better outcomes in terms of horizontal and vertical alveolar dimensional changes and percentage of new bone formation than healing without coverage? And (b) which biomaterial(s) provide(s) the better outcomes? Materials and methods Parallel and split-mouth randomized controlled trials treating ≥ 10 patients were included in this analysis. Studies were identified with MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials, and Scopus. Primary outcomes were preservation of horizontal and vertical alveolar dimension and new bone formation inside the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes. For NMA, prediction intervals were calculated to estimate clinical efficacy, and SUCRA was used to rank the materials based on their performance; multidimensional ranking was used to rank treatments based on dissimilarity. The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). Results Twelve trials were included in the qualitative and quantitative analysis: 312 sites were evaluated. Autologous soft tissue grafts were associated with better horizontal changes compared to resorbable membranes. A statistically significant difference in favor of resorbable membranes, when compared to no membrane, was found, with no statistically significant heterogeneity. For the comparison between crosslinked and non-crosslinked membranes, a statistically significant difference was found in favor of the latter and confirmed by histomorphometric NMA analysis. Given the relatively high heterogeneity detected in terms of treatment approaches, materials, and outcome assessment, the findings of the NMA must be interpreted cautiously. Conclusions Coverage of the healing site is associated with superior results compared to no coverage, but no specific sealing technique and/or biomaterial provides better results than others. RCTs with larger sample sizes are needed to better elucidate the trends emerged from the present analysis. Clinical relevance Autologous soft tissue grafts and membranes covering graft materials in post-extraction sites were proved to allow lower hard tissue shrinkage compared to the absence of coverage material with sealing effect. Histomorphometric analyses showed that non-crosslinked membranes provide improved hard tissue regeneration when compared to crosslinked ones.

Download Full-text

Flapped versus flapless alveolar ridge preservation: a systematic review and meta-analysis

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2021.05.023 ◽

2021 ◽

Author(s):

M.A. Atieh ◽

L. Alfardan ◽

N.H.M. Alsabeeha

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Ridge Preservation ◽

Alveolar Ridge ◽

Alveolar Ridge Preservation

Download Full-text

A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites

Scientific Reports ◽

10.1038/s41598-021-81402-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kwantae Noh ◽

Daniel S. Thoma ◽

Jung-Chul Park ◽

Dong-Woon Lee ◽

Seung-Yun Shin ◽

...

Keyword(s):

Soft Tissue ◽

Tooth Extraction ◽

Case Series ◽

Tissue Level ◽

Ridge Preservation ◽

Bone Augmentation ◽

Implant Placement ◽

Alveolar Ridge Preservation ◽

Tissue Changes ◽

Facial Area

AbstractInformation regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4–8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04–0.35 mm in group LP/ARP, 0.04–0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm3 in group LP/ARP, 0.96 mm3 in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.

Download Full-text