J Periodontal Implant Sci.  2017 Dec;47(6):372-380. 10.5051/jpis.2017.47.6.372.

Alveolar ridge preservation with an open-healing approach using single-layer or double-layer coverage with collagen membranes

• Choi HK
• Cho HY
• Lee SJ
• Cho IW
• Shin HS
• Koo KT
• Lim HC
• Park JC

• KMID: 2399743
• DOI: http://doi.org/10.5051/jpis.2017.47.6.372

Abstract

PURPOSE
The aim of this prospective pilot study was to compare alveolar ridge preservation (ARP) procedures with open-healing approach using a single-layer and a double-layer coverage with collagen membranes using radiographic and clinical analyses.
METHODS
Eleven molars from 9 healthy patients requiring extraction of the maxillary or mandibular posterior teeth were included and allocated into 2 groups. After tooth extraction, deproteinized bovine bone mineral mixed with 10% collagen was grafted into the socket and covered either with a double-layer of resorbable non-cross-linked collagen membranes (DL group, n=6) or with a single-layer (SL group, n=5). Primary closure was not obtained. Cone-beam computed tomography images were taken immediately after the ARP procedure and after a healing period of 4 months before implant placement. Radiographic measurements were made of the width and height changes of the alveolar ridge.
RESULTS
All sites healed without any complications, and dental implants were placed at all operated sites with acceptable initial stability. The measurements showed that the reductions in width at the level 1 mm apical from the alveolar crest (including the bone graft) were −1.7±0.5 mm in the SL group and −1.8±0.4 mm in the DL group, and the horizontal changes in the other areas were also similar in the DL and SL groups. The reductions in height were also comparable between groups.
CONCLUSIONS
Within the limitations of this study, single-layer and double-layer coverage with collagen membranes after ARP failed to show substantial differences in the preservation of horizontal or vertical dimensions or in clinical healing. Thus, both approaches seem to be suitable for open-healing ridge preservation procedures.

Keyword

Alveolar process; Bone regeneration; Cone-beam computed tomography; Tooth extraction

MeSH Terms

Alveolar Process*
Bone Regeneration
Collagen*
Cone-Beam Computed Tomography
Dental Implants
Humans
Membranes*
Miners
Molar
Pilot Projects
Prospective Studies
Tooth
Tooth Extraction
Transplants
Vertical Dimension
Collagen
Dental Implants

Figure

• 

  Figure 1 Schematic presentation of the study schedule and design. CBCT: cone-beam computed tomography, DBBM-C: deproteinized bovine bone mineral with 10% porcine collagen.

• 

  Figure 2 Surgical procedures of the SL and DL open membrane healing technique. The procedures of the SL and DL groups were only different in the number of the resorbable collagen membranes used to cover the bone graft. (A) Extraction in the SL group. (B) DBBM-C insertion in the SL group. (C) Single-layer of collagen membrane coverage in the SL group. (D) The hidden X or the figure of 8 suture in the SL group. (E) Just before S-O. (F) Four months after extraction, immediately followed by dental implant placement. (G) Occlusal view of the final prosthesis. (H) Extraction in the DL group. (I) DBBM-C insertion in the DL group. (J) Double-layers of collagen membrane coverage in the DL group. (K) The hidden X or the figure of 8 suture in the DL group. (L) Just before S-O. (M) Four months after extraction, immediately followed by dental implant placement in the DL group. (N) Occlusal view of the final prosthesis in the DL group. SL: the socket was filled with deproteinized bovine bone mineral with 10% collagen and covered by a single-layer of a collagen membrane, DL: the socket was filled with deproteinized bovine bone mineral with 10% collagen and covered by a double-layer of a collagen membrane, DBBM-C: deproteinized bovine bone mineral with 10% porcine collagen, S-O: stitch-out, 4M: 4 months after alveolar ridge preservation procedure.

• 

  Figure 3 Paraxial views from CBCT obtained 4 months after SL (A) and DL (B) ARP procedures. CBCT: cone-beam computed tomography, SL: the socket was filled with deproteinized bovine bone mineral with 10% collagen and covered by a single-layer of a collagen membrane, DL: the socket was filled with deproteinized bovine bone mineral with 10% collagen and covered by a double-layer of a collagen membrane, ARP: alveolar ridge preservation, DBBM-C: deproteinized bovine bone mineral with 10% porcine collagen, CM: collagen membrane.

• 

  Figure 4 Schematic drawing of references for measurements in the radiographic analysis.
P-A line: perpendicular line to the longitudinal axis at apex of the socket, BC: buccal crest, B height: height of the buccal cortical plate from the P-A line, LC: lingual/palatal crest, L height: height of the lingual/palatal plate from the P-A line, MC: mid-alveolar crest, M height: height of the mid-alveolar crest from the P-A line.

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