ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Cancellous Freeze-Dried Done Allograft (FDBA) Offers No Improvement in Clinical Healing Compared to Cortical FDBA When Used for Ridge Preservation
Clinical Question In adult patients receiving tooth extraction with ridge preservation, will the use of cancellous mineralized freeze-dried bone allograft (FDBA) promote better clinical healing in comparison with cortical FDBA?
Clinical Bottom Line For patients undergoing extraction of a tooth with ridge preservation, cortical mineralized FDBA offers slight improvement in lingual ridge height when compared with cancellous FDBA. This is supported by a randomized controlled trial of 40 patients. While this finding is statistically significant, further studies are required to show clinical significance between the two grafting materials.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23725026Eskow/201440 adult patientsRandomized Controlled Trial
Key results40 adult patients scheduled for extraction of a non-molar tooth and subsequent implant placement were randomly assigned to one of two groups: ridge preservation with 100% cortical FDBA and ridge preservation with 100% cancellous FDBA. A core of bone taken at the time of implant placement was analyzed histologically for new bone formation, residual graft material, and non-mineralized/connective tissue (primary study outcome). New bone formation showed no statistically significant difference between the two groups (16.08% cortical vs 12.98% cancellous). The cortical FDBA group had significantly more residual graft material remaining (28.38% vs. 19.94%) and significantly less non-mineralized/connective tissue (52.90% vs. 62.82%). The only clinical parameter (secondary study outcome) measured with a statistically significant difference was the change in lingual ridge height. The cortical group displayed a -1.10 mm change compared to a -1.94 mm change in the cancellous group. There was no significant difference in change in buccal height or change in ridge width between groups.
Evidence Search “Tooth Extraction” [Mesh] AND “Ridge Preservation” [Mesh] AND “Cancellous Bone Allograft” [Mesh]
Comments on
The Evidence
The study was an RCT that had a 95% completion rate with a relatively small sample size (n=40). Surgical techniques were identical between the two groups; graft material used for all subjects were obtained from the same human donor; the only difference was the graft material used in each group (cortical vs. cancellous FDBA). Examiners were blinded to study group when performing histologic analysis of the bone core. The authors concluded that there was no significant difference in percentages of new bone formations between the two groups. There was a statistically significant difference in change in lingual ridge height but further studies are needed to determine the clinical significance of this finding.
Applicability Ridge preservation is a common technique used by clinicians to preserve bone in an extraction site in preparation for implant placement. While more costly to the patient than extraction alone, ridge preservation can help avoid the need for a more expensive ridge augmentation procedure in a site requiring implant placement that had not previously undergone ridge preservation. It is important to note that there were no differences in ridge width or buccal bone height for the cancellous and cortical FDBA study groups. Cost of both graft materials is the same, and there is no evidence showing any difference in post-operative discomfort or healing for the patient.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Ridge preservation, bone graft, implants
ID# 2776
Date of submission: 11/20/2014spacer
E-mail demetter@uthscsa.edu
Author Randy Demetter, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Brian Mealey, DDS, MS
Faculty mentor/Co-author e-mail mealey@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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