J Periodontal Implant Sci.  2018 Aug;48(4):236-250. 10.5051/jpis.2018.48.4.236.

Alveolar ridge preservation with a collagen material: a randomized controlled trial

• Schnutenhaus S
• Doering I
• Dreyhaupt
• Rudolph H
• Luthardt R

• KMID: 2465389
• DOI: http://doi.org/10.5051/jpis.2018.48.4.236

Abstract

PURPOSE
Resorption of the alveolar bone is an unavoidable consequence of tooth extraction when appropriate alveolar ridge preservation (ARP) measures are not taken. The objective of this trial was to test the hypothesis that dimensional changes in the alveolar bone after tooth extraction would be reduced by inserting an equine collagen membrane and a collagen cone to fill and seal the alveolus (as ARP), in comparison to extraction with untreated alveoli.
METHODS
In this randomized clinical trial, 31 patients were directly treated with the collagen material after extraction of a tooth from the maxilla (the ARP group). Twenty-nine patients served as the control group. After extraction, no further treatment (i.e., no socket preservation measures) was performed in the control group. Changes in the alveolar process immediately after extraction and after an 8 (±1)-week healing period were evaluated 3-dimensionally. Blinded analyses were performed after superimposing the data from the digitalized impressions and surfaces generated by cone-beam computed tomography.
RESULTS
Both the ARP and control groups showed a reduction of bone in the alveolar area after tooth extraction. However, significantly less bone resorption was detected in the clinically relevant buccal region in the ARP group. The median bone reduction was 1.18 mm in the ARP group and 5.06 mm in the control group (P = 0.03).
CONCLUSIONS
The proposed hypothesis that inserting a combination material comprising a collagen cone and membrane would lead to a difference in alveolar bone preservation can be accepted for the clinically relevant buccal distance. In this area, implantation of the collagen material led to significantly less alveolar bone resorption. German Clinical Trials Register at www.drks.de, DRKS00004769.

Keyword

Alveolar bone loss; Alveolar ridge augmentation; Bone regeneration; Biocompatible materials; Tooth extraction

MeSH Terms

Alveolar Bone Loss
Alveolar Process*
Alveolar Ridge Augmentation
Biocompatible Materials
Bone Regeneration
Bone Resorption
Collagen*
Cone-Beam Computed Tomography
Humans
Maxilla
Membranes
Tooth
Tooth Extraction
Biocompatible Materials
Collagen

Figure

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  Figure 1 (A) Atraumatic tooth extraction with periotomes and forceps. (B) Introduction of the collagen cone with the membrane. (C) Temporary sutures to stabilize the combination material. (D) Status 3 months after implantation. (E) Impression of the alveolar cavity immediately after tooth extraction.

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  Figure 2 Cone-beam computed tomography image of the alveolus at 8 (±1) weeks after extraction.

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  Figure 3 Matching of the models at time T0 and T1 via the hard tooth tissues.

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  Figure 4 (A) Exposed surface of the post-extraction alveolus at time T0, immediately after tooth extraction. (B) Exposed surfaces from the impression at time T0 superimposed on the cone-beam computed tomography image (T1) at 8 (±1) weeks post extraction. (C) Specification of measurement points for the sextant measurements. (D) By using the intersections of the diagonal of the measuring aid and the 2 boundary curves, corner points were defined for the creation of 2 individual hexagons. (E) The distance of these constructed corner points was measured in the vertical direction. (★ to ★).

• 

  Figure 5 Three-dimensional measurements of the distances using boundary curves. Based on the 2 applied edge curves, the boundary curve difference was calculated. In each case, a lot was cut from the edge curve of alveolar impression at T0 on the edge curve of the cone-beam computed tomography image of the alveolus at T1. The resulting quantitative results provided the maximum deviation of 2 boundary curves, the mean, and the standard deviation.

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  Figure 6 Flow diagram of this randomized trial comparing extraction alone to a ridge-preserving procedure for the treatment of alveolar bone after tooth removal. ARP: alveolar ridge preservation, CBCT: cone-beam computed tomography.

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  Figure 7 Significantly less bone degeneration was found along the buccal distance in the ARP group (mm). ARP: alveolar ridge preservation.

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  Figure 8 Almost complete destruction of the buccal bone was noted at 8 weeks after tooth extraction.

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