In a past article about socket preservation, I discussed the importance of considering what will happen after we remove teeth and how it can impact the future overall bone volume and quality in the extraction site. And with dental implants being a growing part of treatment for missing teeth, it is something that has to be considered. Once we realize that a tooth is going to be lost, there are a variety of methods and materials to help with socket preservation. We preserve the bone by not necessarily stopping the bone from resorbing, but we can help decrease the dimensional changes and volumetric contraction post-extraction.

socket preservation

Which socket preservation method do you choose and what works?

Bovine bone, mineralized versus demineralized allograft, autogenous bone, tricalcium phosphate, membrane versus non-membrane, etc. Well, the good news is that most, if not all, of these socket preservation techniques work or help by decreasing dimensional changes in the bone in the extraction site area. But, often times the question is: What socket preservation method is best? Well, what we find is that there is no one best way and, in fact, some research states: “The scientific evidence does not provide clear guidelines in regards to the type of biomaterial, or surgical procedure.”1

In fact, another review paper states: “There is limited data regarding the effectiveness of alveolar ridge preservation therapies when compared to the control. Overall the socket intervention therapies did reduce alveolar ridge dimensional changes post-extraction, but were unable to prevent resorption. Histology did demonstrate a large proportion of residual graft material that may account for some of the difference in alveolar ridge dimensions at follow up.”2

Recent research does show that the use of demineralized allograft (DFDBA) versus mineralized allograft (FDBA) accounts for more vital bone versus residual graft material present in the socket after grafting.3 In fact, “this study provides the first histologic and clinical evidence directly comparing ridge preservation with DFDBA versus FDBA in humans and demonstrates significantly greater new bone formation with DFDBA.”

When it comes to having to raise a full thickness flap, recent research shows that “significantly more negative results than that of the less-demanding flapless procedure, with an increased width resorption of the post-extraction site.”4

With implants becoming more common in dentistry, it is important to consider whether or not your patient is considering implants in the future. If so, the research is clear - doing nothing will definitely lead to significant changes in the overall bony architecture surrounding the extraction site and doing something will help. So, what’s best? Stayed tuned as research continues to search for what will provide the best long term, but at least consider doing something!

Jeff Lineberry, DDS, FAGD, Visiting Faculty and Contributing Author [ http://www.jefflineberrydds.com/ ]

References:

  1. Clin Oral Implants Res. 2012 Feb;23 Suppl 5:22-38. doi:10.1111/j.1600-0501.2011.02331.x. Surgical protocols for ridge preservation after tooth extraction. A systematic review. Vignoletti F1, Matesanz P, Rodrigo D, Figuero E, Martin C, Sanz M.
  2. Clin Implant Dent Relat Res. 2014 Feb;16(1):1-20. doi: 10.1111/j.1708-8208.2012.00450.x. Epub 2012 Mar 8. Bone healing after tooth extraction with or without an intervention: a systematic review of randomized controlled trials. Morjaria KR1, Wilson R, Palmer RM.
  3. J Periodontol. 2012 Mar;83(3):329-36. doi: 10.1902/jop.2011.110270. Epub 2011 Jul 12. Histologic comparison of healing after tooth extraction with ridge preservation using mineralized versus demineralized freeze-dried bone allograft. Wood RA1, Mealey BL.
  4. J Periodontol. 2014 Jan;85(1):14-23. doi: 10.1902/jop.2013.120711. Epub 2013 May 20. Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. Barone A1, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U.
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Comments

Commenter's Profile Image Carter Yokoyama
November 3rd, 2014
Nice article Jeff. Thanks for doing the research. From my experience I would have to agree. Doing something (in my case, mostly demineralized allograft) does generally tend to be better than doing nothing.
Commenter's Profile Image Spence Bloom
December 31st, 2014
Early in the decision as to what materials to use, isn't there a major branching off between preserving for a Pontic site vs preserving for an Implant? Which materials should be used for a Pontic site? (I'm guessing it would be the synthetics, but which?) Are some choices going to screw up a future change in plan? (Eg, a material great for keeping volume for a Pontic but forever useless for integrating an implant?) Is there a difference in material choices between preserving for an implant to be placed say, within 12 months because the pt's commitment is definite, vs preserving for an implant to be placed in 12-36 months because the pt thinks they might be able to get an implant done in the indefinite future?
Commenter's Profile Image Spence Bloom
December 31st, 2014
Another way to phrase it is: If we graft with demineralized allograft because it yields more vital bone than mineralized allograft, what is the longevity of that bone? Will it be there in adequate volume in 2-3 years for a future implant placement? Will it be there to support a Pontic site for 5-15 yrs?