Alveolar Ridge Preservation: a Cochrane Systematic Review and Metaanalysis

Abstract

Background: Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used.

Aim: To evaluate the effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP in patients requiring dental implant placement.

Materials and Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Data were analysed using a statistical software program.

Results: A total of 16 RCTs with 524 extraction sockets in 426 participants were included. The meta-analysis showed a very low certainty evidence of a reduction in loss of alveolar ridge width (mean difference (MD) -1.18 mm, 95% confidence interval (CI) -1.82 to -0.54; P = 0.0003) and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P < 0.0001) in favour of xenograft when compared to extraction alone. There are no significant differences in the need for additional augmentation or implant failure between xenograft and extraction alone. No serious adverse events were reported with most trials indicating that the procedure was uneventful.

Conclusion: ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction but the evidence is very uncertain. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP.