A review on alveolar ridge preservation following tooth extraction.

CONTEXT: The question that clinicians face is whether the use of bone replacement grafts and/or barrier membranes enhance their ability to provide for the future placement of a dental implant or to maximize ridge dimensions following the extraction of a tooth versus no additional treatments. EVIDENCE ACQUISITION: The evidence was obtained by search of Entrez PubMed and manual search of The International Journal of Oral and Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implant Research, The Journal of Periodontology, The Journal of Clinical Periodontology, and The Compendium of Continuing Education in Dentistry. Key search words included Guided Bone Regeneration, Dental Extraction, Tooth Extraction, Bone Replacement Graft, Alveolar Ridge. The years of search included from January 2011 through February 2012. EVIDENCE SYNTHESIS: The recurring theme was that there was considerable heterogeneity to study designs, time periods, and methods of evaluation. This created great difficulty in trying to answer with good high-quality evidence questions about the techniques and materials to be used for maximizing regeneration at the time of tooth extraction or in which situations this ought to be used. CONCLUSIONS: There appears to be consensus from the reviewed literature supporting ridge preservation techniques as a whole. Multiple studies demonstrated less ridge resorption occurring when alveolar ridge preservation procedures were used versus the placement of no graft material in fresh alveolar sockets. The analysis did not show any grafting materials demonstrating a clear benefit over any others or that a barrier membrane is necessary. The evidence is also too premature about whether socket preservation efforts require primary closure. In the emerging area of growth factors, there is no high-quality evidence to either support or refute their use. BACKGROUND: Tooth extraction is one of the most widely performed procedures in dentistry today and it has been historically well documented that this procedure may induce significant dimensional changes of the alveolar ridge. The dilemma that clinicians face is how to manage tooth extractions to provide for the future placement of a dental implant or to maximize ridge dimensions for the fabrication of a fixed or removable prosthesis. If performed inadequately, the resulting deformity can be a considerable obstacle to the esthetic, phonetic, and functional results that both our patients and we clinicians expect at this current time.

Horizontal ridge augmentation utilizing a composite graft of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier combined with a resorbable membrane: a retrospective evaluation of 73 consecutively treated cases from private practices.

Ridge deficiency is an unfortunate obstacle in the field of implant dentistry. Many techniques are available to rebuild the deficient ridge. Some of these techniques are associated with significant morbidity and often require a second surgical site. With the advent of guided bone regeneration (GBR), one may now graft the deficient ridge with decreased morbidity and without a second surgical site. The purpose of this retrospective consecutive case series from 5 private practices is to report on the outcomes of a composite material of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier (Regenaform RT) when combined with a resorbable membrane for GBR of lateral ridge defects in human patients. The specific aim was to quantify clinical results through direct measurement. Data were obtained from 73 consecutively treated lateral ridge augmentations performed on 67 partial and/or completely edentate patients. Clinical data (presurgical ridge width, ridge width at implant placement, and bone density at implant placement) were obtained retrospectively from 5 private practices via an exhaustive retrospective chart review, which was pooled and averaged for analysis. The average gain in horizontal ridge width was 3.5 mm (range, 3-6 mm). The density of the bone was noted to be type 2 to 3, with type 3 being the predominant finding. This retrospective case series from 5 clinical private practices suggests that the use of a composite material of demineralized freeze-dried allograft, mineralized cortical cancellous chips, and a biologically degradable thermoplastic carrier, when covered by a resorbable collagen membrane for GBR, is an effective means of horizontal ridge augmentation.