A randomized, controlled, multicentre clinical trial of post-extraction alveolar ridge preservation

Eric Todd Scheyer; Rick Heard; Jim Janakievski; George Mandelaris; Marc L Nevins; Stephen R Pickering; Christopher R Richardson; Bryan Pope; Gregory Toback; Diego Velásquez; Heiner Nagursky

doi:10.1111/jcpe.12623

A randomized, controlled, multicentre clinical trial of post-extraction alveolar ridge preservation

J Clin Periodontol. 2016 Dec;43(12):1188-1199. doi: 10.1111/jcpe.12623. Epub 2016 Oct 21.

Authors

Eric Todd Scheyer^{1

2}, Rick Heard^{1

3}, Jim Janakievski^{1

4

5}, George Mandelaris^{1

6

7}, Marc L Nevins^{1

8

9}, Stephen R Pickering^{1

10}, Christopher R Richardson^{1

11

12}, Bryan Pope^{1

10}, Gregory Toback^{1

13}, Diego Velásquez^{1

14

15}, Heiner Nagursky¹⁶

Affiliations

¹ The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.
² Private Practice, Houston, TX, USA.
³ Private Practice, Victoria, TX, USA.
⁴ Private Practice, Tacoma, WA, USA.
⁵ Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA, USA.
⁶ Private Practice, Oakbrook Terrace, IL, USA.
⁷ Department of Graduate Periodontics, College of Dentistry, University of Illinois, Chicago, IL, USA.
⁸ Private Practice, Boston, MA, USA.
⁹ Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, USA.
¹⁰ Private Practice, San Mateo, CA, USA.
¹¹ Private Practice, Richmond, VA, USA.
¹² Department of Graduate Periodontics, Virginia Commonwealth School of Dentistry, Richmond, VA, USA.
¹³ Private Practice, New London, CT, USA.
¹⁴ Private Practice, Fenton, MI, USA.
¹⁵ University of Michigan School of Dentistry, Ann Arbor, MI, USA.
¹⁶ Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany.

Abstract

Aim: To compare the effectiveness of two-ridge preservation treatments.

Materials and methods: Forty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross-linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post-operatively, and biopsies were retrieved for histomorphometric analysis at 6 months.

Results: Primary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty-seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites.

Conclusion: DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.

Keywords: collagen membrane; demineralized allograft; extraction; guided bone regeneration; private practice; randomized controlled trial; ridge preservation; xenogeneic graft.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Alveolar Bone Loss
Alveolar Process*
Alveolar Ridge Augmentation
Animals
Bone Transplantation
Cattle
Collagen
Humans
Membranes, Artificial
Tooth Extraction
Tooth Socket

Substances

Membranes, Artificial
Collagen