ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Ridge Preservation with DFDBA Yields More Vital Bone Compared to FDBA; Both Materials Yield Similar Clinical Ridge Dimensions Following Healing
Clinical Question In adult human patients undergoing tooth extraction with human allograft placement, does ridge preservation with demineralized freeze-dried bone allograft (DFDBA) result in better outcomes than mineralized freeze-dried bone allograft (FDBA)?
Clinical Bottom Line Ridge preservation with DFDBA resulted in more vital bone formation compared to FDBA histologically, while both materials maintained similar ridge dimensions clinically.
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) 21749166Wood/201233/40 patients completed; Age 20-78 years (Mean 56.7 years)Randomized Controlled Trial
Key results33 patients who required extraction of a non-molar tooth and were interested in tooth replacement with a dental implant. Patients underwent extraction and then were randomly assigned to two groups for ridge preservation by either FDBA or DFDBA, derived from a single donor. Primary outcomes were histologic evaluation of a trephined bone core harvested at 18-20 weeks at implant placement for % vital bone, % residual graft, and % connective tissue/other, while secondary outcomes were evaluation of clinical changes in ridge width and height. DFDBA showed significantly more % vital bone compared to FDBA: 38.42% vs 24.63% respectively. DFDBA showed significantly less % residual graft compared to FDBA: 8.88% vs 25.42% respectively. There were no significant differences in clinical measurements of ridge width or height, with both losing a mean < 1 mm height and mean ~2 mm width.
Evidence Search freeze dried bone allograft AND alveolar process
Comments on
The Evidence
Validity: The referenced RCT represents a high level of evidence in the hierarchy of literature. Authors made several attempts to reduce bias through: use a single donor for FDBA and DFDBA grafts, in vivo testing of inductivity of DFDBA ensuring a low level of inductivity of DFDBA graft, randomization immediately prior to bone grafting, use of identical surgical procedures between groups, and blinding examiners as to treatment group during histologic analysis of tissue samples. Perspective: The use of either graft material remains indicated for the clinician, yet there seems to be a benefit to grafting with DFDBA if more vital bone is the desired outcome. Future studies may evaluate whether there is a benefit relative to implant outcomes to more vital bone and less residual graft in the preserved site.
Applicability Ridge preservation to minimize dimensional changes following tooth extraction has become common in dental practice, especially when tooth replacement is planned with a dental implant. The cost of ridge preservation is higher to the patient than extraction alone, but is more cost efficient than ridge augmentation after complete healing of an extraction site without preservation. DFDBA and FDBA maintain similar dimensions of the alveolar ridge and have similar costs; however, DFDBA shows a higher percentage of vital bone formation within the grafted site compared to FDBA, according to the above study.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords ridge preservation, mineralized freeze-dried bone allograft, demineralized freeze-dried bone allograft
ID# 2781
Date of submission: 11/23/2014spacer
E-mail calahan@uthscsa.edu
Author Blaine Calahan, 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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