EAO Consensus Report
Does ridge preservation following tooth extraction improve implant treatment outcomes: a systematic review
Group 4: Therapeutic concepts & methods
Nikos Mardas,
Anna Trullenque-Eriksson,
Neil MacBeth,
Aviva Petrie,
Nikolaos Donos,
Corresponding Author
Nikos Mardas
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Corresponding author:
Nikos Mardas
Unit of Periodontology
UCL Eastman Dental Institute
256 Gray's Inn Road
London WC1X 8LD, UK
Tel.: +44 (20) 7915 2379
Fax: +44 (20) 7915 1137
e-mail: [email protected]
Search for more papers by this authorAnna Trullenque-Eriksson
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorNeil MacBeth
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Defense Dental Service, RAF, London, UK
Search for more papers by this authorAviva Petrie
Biostatistics Unit, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorNikolaos Donos
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorNikos Mardas,
Anna Trullenque-Eriksson,
Neil MacBeth,
Aviva Petrie,
Nikolaos Donos,
Corresponding Author
Nikos Mardas
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Corresponding author:
Nikos Mardas
Unit of Periodontology
UCL Eastman Dental Institute
256 Gray's Inn Road
London WC1X 8LD, UK
Tel.: +44 (20) 7915 2379
Fax: +44 (20) 7915 1137
e-mail: [email protected]
Search for more papers by this authorAnna Trullenque-Eriksson
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorNeil MacBeth
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Defense Dental Service, RAF, London, UK
Search for more papers by this authorAviva Petrie
Biostatistics Unit, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorNikolaos Donos
Unit of Periodontology, UCL Eastman Dental Institute, London, UK
Search for more papers by this authorAbstract
Objective
(1) Primary focused question (Q1): to evaluate the effect of alveolar ridge preservation (ARP) on implant outcomes (implant placement feasibility, need for further augmentation, survival/success rates, marginal bone loss) compared with unassisted socket healing (USH) and (2) secondary focused question (Q2): to estimate the size effects (SE) of these outcomes in three different interventions (GBR, socket filler, socket seal).
Material and methods
Electronic (MEDLINE, EMBASE, Cochrane Central Register LILACS; Web of Science) and hand search was conducted up to July 2014. Randomised controlled trials (RCT), controlled clinical trials (CCT) and prospective cohort studies with USH as controls were eligible in the analysis for Q1. RCTs, CCTs and prospective case series, with or without USH as control, were eligible for Q2.
Results
Ten (8 RCTs, 2 CCTs) and 30 studies (21 RCTs, 7 CCTs, 2 case series) were included in the analysis for Q1 and Q2, respectively. The risk for bias was unclear or high in most of them. Q1: Implant placement was feasible in ARP-treated and USH sites. These implants presented similar survival/success rates and marginal bone levels. The need for further augmentation decreased when ARP was performed (Relative risk: 0.15, 95% CI: 0.07–0.3). Q2: The SE for implant placement feasibility was 98.5% (95% CI: 96.4–99.6) in GBR and 96.2 (95% CI: 93.1–98.2) in socket filler group. The SE for need for further augmentation was 11.9 (95% CI: 5.6–19.9) for GBR and 13.7% (95% CI: 5.0–25.6) for socket filler groups. GBR and socket filler presented similar SE for survival/success rates and average marginal bone loss. Limited data were available for implant-related outcomes in sites treated with socket seal.
Conclusions
There is limited evidence to support the clinical benefit of ARP over USH in improving implant-related outcomes despite a decrease in the need for further ridge augmentation during implant placement. Similar implant placement feasibility, survival/success rates and marginal bone loss should be anticipated following ARP or USH. Currently, it is not clear which type of ARP intervention has a superior impact on implant outcomes.
References
- Albrektsson, T., Zarb, G., Worthington, P. & Eriksson, A.R. (1986) The long-term efficacy of currently used dental implants: a review and proposed criteria of success. International Journal of Oral Maxillofacial Implants 1: 11–25.
- Araujo, M.G., da Silva, J.C., de Mendonca, A.F. & Lindhe, J. (2014) Ridge alterations following grafting of fresh extraction sockets in man. A randomized clinical trial. Clinical Oral Implants Research 26: 407–412 [Correction added after first online publication: volume and page numbers corrected].
- Araújo, M.G. & Lindhe, J. (2005) Dimensional ridge alterations following tooth extraction. An experimental study in the dog. Journal of Clinical Periodontology 32: 212–218.
- Atwood, D.A. (1971) Reduction of residual ridges: a major oral disease entity. Journal Prosthetic Dentistry 26: 266–279.
- Avila-Ortiz, G., Rodriguez, J.C., Rudek, I., Benavides, E., Rios, H. & Wang, H.-L. (2014) Effectiveness of three different alveolar ridge preservation techniques: a pilot randomized controlled trial. The International Journal of Periodontics and Restorative Dentistry 34: 509–521.
- Barone, A., Aldini, N.N., Fini, M., Giardino, R., Calvo Guirado, J.L. & Covani, U. (2008) Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphometric study. Journal of Periodontology 79: 1370–1377.
- Barone, A., Orlando, B., Cingano, L., Marconcini, S., Derchi, G. & Covani, U. (2012) A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results. Journal of Periodontology 83: 836–846.
- Barone, A., Ricci, M., Tonelli, P., Santini, S. & Covani, U. (2013a) Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. Ridge preservation with secondary soft tissue healing. Clinical Oral Implants Research 24: 1231–1237.
- Barone, A., Todisco, M., Ludovichetti, M., Gualini, F., Aggstaller, H., Torres-Lagares, D., Rohrer, M.D., Prasad, H.S. & Kenealy, J.N. (2013b) A prospective, randomized, controlled, multicenter evaluation of extraction socket preservation comparing two bovine xenografts: clinical and histologic outcomes. International Journal of Periodontics and Restorative Dentistry 33: 795–802.
- Barone, A., Toti, P., Piattelli, A., Iezzi, G., Derchi, G. & Covani, U. (2014) Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. Journal of Periodontology 85: 14–23.
- Beck, T.M. & Mealey, B.L. (2010) Histologic analysis of healing after tooth extraction with ridge preservation using mineralized human bone allograft. Journal of Periodontology 81: 1765–1772.
- Becker, W., Becker, B.E. & Caffesse, R. (1994) A comparison of demineralized freeze-dried bone and autologous bone to induce bone formation in human extraction sockets. Journal of Periodontology. 65: 1128–1133.
- Becker, W., Urist, M., Becker, B.E., Jackson, W., Parry, D.A., Bartold, M., Vincenzzi, G., De Georges, D. & Niederwanger, M. (1996) Clinical and histologic observations of sites implanted with intraoral autologous bone grafts or allografts. 15 human case reports. Journal of Periodontology 67: 1025–1033.
- Cardaropoli, G., Araujo, M. & Lindhe, J. (2003) Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs. Journal of Clinical Periodontology 30: 809–818.
- Cardaropoli, D., Tamagnone, L., Roffredo, A. & Gaveglio, L. (2014) Relationship between the buccal bone plate thickness and the healing of postextraction sockets with/without ridge preservation. The International Journal of Periodontics and Restorative Dentistry 34: 211–217.
- Chen, S.T. & Buser, D. (2009) Clinical and esthetic outcomes of implants placed in post extraction sites. International Journal of Oral & Maxillofacial Implants 24(Suppl.): 186–217.
- Cook, D.C. & Mealey, B.L. (2013) Histologic comparison of healing following tooth extraction with ridge preservation using two different xenograft protocols. Journal of Periodontology 84: 585–894.
- Coomes, A.M., Mealey, B.L., Huynh-Ba, G., Barboza-Arguello, C., Moore, W.S. & Cochran, D.L. (2014) Buccal bone formation after flapless extraction: a randomized, controlled clinical trial comparing recombinant human bone morphogenetic protein 2/absorbable collagen carrier and collagen sponge alone. Journal of Periodontology 85: 525–535.
- Crespi, R., Cappare, P. & Gherlone, E. (2009a) Dental implants placed in extraction sites grafted with different bone substitutes: radiographic evaluation at 24 months. Journal of Periodontology 80: 1616–1621.
- Crespi, R., Cappare, P. & Gherlone, E. (2009b) Magnesium-enriched hydroxyapatite compared to calcium sulfate in the healing of human extraction sockets: radiographic and histomorphometric evaluation at 3 months. Journal of Periodontology 80: 210–218.
- Crespi, R., Cappare, P. & Gherlone, E. (2011a) Comparison of magnesium-enriched hydroxyapatite and porcine bone in human extraction socket healing: a histologic and histomorphometric evaluation. The International Journal of Oral & Maxillofacial Implants 26: 1057–1062.
- Crespi, R., Cappare, P., Romanos, G.E., Mariani, E., Benasciutti, E. & Gherlone, E. (2011b) Corticocancellous porcine bone in the healing of human extraction sockets: combining histomorphometry with osteoblast gene expression profiles in vivo. The International Journal of Oral & Maxillofacial Implants 26: 866–872.
- De Risi, V., Clementini, M., Vittorini, G., Mannocci, A. & De Sanctis, M. (2013) Alveolar ridge preservation techniques: a systematic review and meta-analysis of histological and histomorphometrical data. Clinical Oral Implants Research 26: 50–68. [Correction added after first online publication: volume and page numbers corrected]
- Donos, N., Mardas, N. & Chadha, V. (2008) Clinical outcomes of implants following lateral bone augmentation: systematic assessment of available options (barrier membranes, bone grafts, split osteotomy). Journal Clinical Periodontology 35(8 Suppl): 173–202.
- Eskow, A.J. & Mealey, B.L. (2014) Evaluation of healing following tooth extraction with ridge preservation using cortical versus cancellous freeze-dried bone allograft. Journal of Periodontology 85: 514–524.
- Farmer, M. & Darby, I. (2014) Ridge dimensional changes following single-tooth extraction in the aesthetic zone. Clinical Oral Implants Research 25: 272–277.
- Festa, V.M., Addabbo, F., Laino, L., Femiano, F. & Rullo, R. (2013) Porcine-derived xenograft combined with a soft cortical membrane versus extraction alone for implant site development: a clinical study in humans. Clinical Implant Dentistry and Related Research 15: 707–713.
- Fiorellini, J.P., Howell, T.H., Cochran, D., Malmquist, J., Lilly, L.C., Spagnoli, D., Toljanic, J., Jones, A. & Nevins, M. (2005) Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation. Journal of Periodontology 76: 605–613.
- Freeman, M.F. & Tukey, J.W. (1950) Transformations related to the angular and the square root. The Annals of Mathematical Statistics 21: 607–611.
10.1214/aoms/1177729756 Google Scholar
- Froum, S., Cho, S.-C., Rosenberg, E., Rohrer, M. & Tarnow, D. (2002) Histological comparison of healing extraction sockets implanted with bioactive glass or demineralized freeze-dried bone allograft: a pilot study. Journal of Periodontology 73: 94–102.
- Gholami, G.A., Najafi, B., Mashhadiabbas, F., Goetz, W. & Najafi, S. (2012) Clinical, histologic and histomorphometric evaluation of socket preservation using a synthetic nanocrystalline hydroxyapatite in comparison with a bovine xenograft: a randomized clinical trial. Clinical Oral Implants Research 23: 1198–1204.
- Hämmerle, C.H.F., Araujo, M.G., Simion, M. & Araujo, M.G. (2012) Evidence-based knowledge on the biology and treatment of extraction sockets. Clinical Oral Implants Research 23: 80–82.
- Higgins, J.P.T., Green, S. (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 The Cochrane Collaboration.
- Higgins, J.P., Thompson, S.G., Deeks, J.J. & Altman, D.G. (2003) Measuring inconsistency in meta-analyses. British Medical Journal 327: 557–560.
- Hoang, T.N. & Mealey, B.L. (2012) Histologic comparison of healing after ridge preservation using human demineralized bone matrix putty with one versus two different-sized bone particles. Journal of Periodontology 83: 174–181.
- Horváth, A., Mardas, N., Mezzomo, L.A., Needleman, I.G. & Donos, N. (2013) Alveolar ridge preservation. A systematic review. Clinical Oral Investigations 17: 341–363.
- Iasella, J.M., Greenwell, H., Miller, R.L., Hill, M., Drisko, C., Bohra, A.A. & Scheetz, J.P. (2003) Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. Journal of Periodontology 74: 990–999.
- Jung, R.E., Fenner, N., Hammerle, C.H.F. & Zitzmann, N.U. (2013) Long-term outcome of implants placed with guided bone regeneration (gbr) using resorbable and non-resorbable membranes after 12-14 years. Clinical Oral Implants Research 24: 1065–1073.
- Jung, R.E., Siegenthaler, D.W. & Hammerle, C.H.F. (2004) Postextraction tissue management: a soft tissue punch technique. The International Journal of Periodontics and Restorative Dentistry 24: 545–553.
- Leblebicioglu, B., Salas, M., Ort, Y., Johnson, A., Yildiz, V.O., Kim, D.G., Agarwal, S. & Tatakis, D.N. (2013) Determinants of alveolar ridge preservation differ by anatomic location. Journal of Clinical Periodontology 40: 387–395.
- Lekovic, V., Kenney, E.B., Weinlaender, M., Han, T., Klokkevold, P., Nedic, M. & Orsini, M. (1997) A bone regenerative approach to alveolar ridge maintenance following tooth extraction. Report of 10 cases. Journal of Periodontology 68: 563–570.
- Lindhe, J., Cecchinato, D., Donati, M., Tomasi, C. & Liljenberg, B. (2014) Ridge preservation with the use of deproteinized bovine bone mineral. Clinical Oral Implants Research 25: 786–790.
- Mardas, N., Chadha, V. & Donos, N. (2010) Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clinical Oral Implants Research 21: 688–698.
- Mardinger, O., Vered, M., Chaushu, G. & Nissan, J. (2012) Histomorphometrical analysis following augmentation of infected extraction sites exhibiting severe bone loss and primarily closed by intrasocket reactive soft tissue. Clinical Implant Dentistry and Related Research 14: 359–365.
- Morjaria, K.R., Wilson, R. & Palmer, R.M. (2014) Bone healing after tooth extraction with or without an intervention: a systematic review of randomized controlled trials. Clinical Implant Dentistry and Related Research 16: 1–20.
- Neiva, R.F., Tsao, Y.-P., Eber, R., Shotwell, J., Billy, E. & Wang, H.-L. (2008) Effects of a putty-form hydroxyapatite matrix combined with the synthetic cell-binding peptide p-15 on alveolar ridge preservation. Journal of Periodontology 79: 291–299.
- Patel, K., Mardas, N. & Donos, N. (2013) Radiographic and clinical outcomes of implants placed in ridge preserved sites: a 12-month post-loading follow-up. Clinical Oral Implants Research 24: 599–605.
- Pellegrini, G., Rasperini, G., Obot, G., Farronato, D. & Dellavia, C. (2014) Soft tissue healing in alveolar socket preservation technique: histologic evaluations. International Journal of Periodontics and Restorative Dentistry 34: 531–539.
- Perelman-Karmon, M., Kozlovsky, A., Liloy, R. & Artzi, Z. (2012) Socket site preservation using bovine bone mineral with and without a bioresorbable collagen membrane. The International Journal of Periodontics and Restorative dentistry 32: 459–465.
- Pietrokovski, J. & Massler, M. (1967) Ridge remodeling after tooth extraction in rats. Journal Dental Reseach 46: 222–231.
- Poulias, E., Greenwell, H., Hill, M., Morton, D., Vidal, R., Shumway, B. & Peterson, T.L. (2013) Ridge preservation comparing socket allograft alone to socket allograft plus facial overlay xenograft: a clinical and histologic study in humans. Journal of Periodontology 84: 1567–1575.
- Serino, G., Biancu, S., Iezzi, G. & Piattelli, A. (2003) Ridge preservation following tooth extraction using a polylactide and polyglycolide sponge as space filler: a clinical and histological study in humans. Clinical Oral Implants Research 14: 651–658.
- Serino, G., Rao, W., Iezzi, G. & Piattelli, A. (2008) Polylactide and polyglycolide sponge used in human extraction sockets: bone formation following 3 months after its application. Clinical Oral Implants Research 19: 26–31.
- Sisti, A., Canullo, L., Mottola, M.P., Covani, U., Barone, A. & Botticelli, D. (2012) Clinical evaluation of a ridge augmentation procedure for the severely resorbed alveolar socket: multicenter randomized controlled trial, preliminary results. Clinical Oral Implants Research 23: 526–535.
- Spinato, S., Galindo-Moreno, P., Zaffe, D., Bernardello, F. & Soardi, C.M. (2014) Is socket healing conditioned by buccal plate thickness? A clinical and histologic study 4 months after mineralized human bone allografting. Clinical Oral Implants Research 25: e120–e126.
- Tan, W.L., Wong, T.L.T., Wong, M.C.M. & Lang, N.P. (2012) A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clinical Oral Implants Research 23: 1–21.
- Van der Weijden, F., Dell'Acqua, F. & Slot, D.E. (2009) Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. Journal of Clinical Periodontology 36: 1048–1058.
- Vance, G.S., Greenwell, H., Miller, R.L., Hill, M., Johnston, H. & Scheetz, J.P. (2004) Comparison of an allograft in an experimental putty carrier and a bovine-derived xenograft used in ridge preservation: a clinical and histologic study in humans. The International Journal of Oral & Maxillofacial implants 19: 491–497.
- Vignoletti, F., Matesanz, P., Rodrigo, D., Figuero, E., Martin, C. & Sanz, M. (2012) Surgical protocols for ridge preservation after tooth extraction. A systematic review. Clinical Oral Implants Research 23(Suppl 5): 22–38.
- Vignoletti, F., Nunez, J. & Sanz, M. (2014) Soft tissue wound healing at teeth, dental implants and the edentulous ridge when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Journal of Clinical Periodontology 41: S23–S35.
- Wallace, S.C., Snyder, M.B. & Prasad, H. (2013) Postextraction ridge preservation and augmentation with mineralized allograft with or without recombinant human platelet-derived growth factor bb (rhpdgf-bb): a consecutive case series. The International journal of Periodontics & Restorative dentistry 33: 599–609.
- Wang, R.E. & Lang, N.P. (2012) Ridge preservation after tooth extraction. Clinical Oral Implants Research 23: 147–156.
- Wood, R.A. & Mealey, B.L. (2012) Histologic comparison of healing after tooth extraction with ridge preservation using mineralized versus demineralized freeze-dried bone allograft. Journal of Periodontology 83: 329–336.
