Alveolar ridge regeneration of damaged extraction sockets using deproteinized porcine versus bovine bone minerals: A randomized clinical trial

Jung-Seok Lee, Jae-Kook Cha, Chang-Sung Kim, Jung-Seok Lee, Jae-Kook Cha, Chang-Sung Kim

Abstract

Backgrounds: Clinical benefits in bone grafting of intact extraction socket have been widely known, but limited evidence is available for the procedure in damaged extraction sockets due to periodontal disease.

Purpose: This study aimed to determine the dimensional alteration of alveolar ridge following bone grafting of damaged extraction sockets, and compare the outcomes of using deproteinized bovine (DBBM) versus porcine bone mineral (DPBM) in the damaged sockets.

Materials and methods: One hundred patients (n = 50 for each group) with periodontitis-induced damaged extraction socket were included in this randomized, single-blind trial. After removal of tooth and granulation tissue, sites were grafted with either DBBM (DBBM group) or DPBM (DPBM group), and covered with collagen membrane. Linear/volumetric analyses of hard and soft-tissue dimensions were performed on reconstructed/superimposed computed tomography and scanned cast images, taken immediately and 4 months after surgery.

Results: The two groups showed comparable hard tissue augmentation with minimal reductions in the grafted volume, as well as in vertical (1.22 ± 2.16 and 1.45 ± 1.92 mm for DPBM and DBBM group, respectively) and horizontal (1.43 ± 3.40 and 1.83 ± 2.85 mm on the central section, respectively) dimensions at 4 months after surgery. However, several cases showed large variations in maintenance of the grafted volume. None of the measured parameters in hard and soft tissue dimensions differed significantly between DBBM and DPBM sites.

Conclusions: DBBM and DPBM can comparably augment damaged extraction sockets with minimal postoperative reduction of the grafted volume. However, the large variations in the results should be further evaluated for application in routine dental clinics.

Keywords: alveolar ridge reconstruction; bone grafting; extraction socket; randomized controlled trial; tooth extraction.

© 2018 The Authors. Clinical Implant Dentistry and Related Research Published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Clinical and radiographic photographs of the representative case in the present clinical trial (DPBM group). Initial periapical radiograph A, showed severe periradicular radiolucency related to vertical root fracture, and preoperative photograph B, revealed gingival inflammation around the tooth. After mucoperiosteal flap elevation and tooth removal (C and D), bony destruction extending to buccal/lingual bony walls and an interradicular septum could be found. Test bone substitute was grafted up to the extension line between the adjacent bony walls (E), and collagen membrane covered the graft (F). Delayed healing at the entrance of extraction socket was observed in the serial photographs; G, immediately, H, 1 week, I, 1 month, J, 4 months after the graft surgery. Regenerated alveolar ridge could be seen at the time of implantation with relatively poor density of bone (K and L)
Figure 2
Figure 2
Flow chart illustrating the procedure of the clinical trial
Figure 3
Figure 3
Representative radiographs and overlapped 3D‐scanned study casts (the same case with Figure 1) and linear measurements. Cross‐sectional view from computed tomography taken at the time of surgery (A and C) and 4 months after the surgery (B and D). In the automatically superimposed images from the two time‐points (E), vertical and horizontal changes of the alveolar bone dimension were measured. Surface information from the 3D‐scanned study casts (S1 at the time of surgery; S2 at 4 months after the surgery) were superimposed with the computed tomography at 4 months after the surgery (F). In this view, horizontal soft tissue dimension was measured at the most‐crestal level of the regenerated alveolar bone at two time‐points (SH1 and SH2), and horizontal reduction was calculated by their subtraction. Vertical change of soft tissue dimension was measured at both buccal and lingual gingival margins around the extracted tooth (SVB and SVL)
Figure 4
Figure 4
Box plots of the horizontal width reduction of the DBBM (black) and the DPBM group (blue). Box plot revealed the first and the third quartiles, median, and maximum/minimum of the data. C, coronal; M, middle; A, apical level
Figure 5
Figure 5
Box plots of the vertical height and volume reduction in alveolar ridge and changes in soft tissue dimension. Box plot revealed the first and the third quartiles, median, and maximum/minimum of the data

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