ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title For A Patient Undergoing Tooth Extraction Before Implant Placement, Ridge Preservation May Be More Effective In Maintaining The Alveolar Ridge Than Normal Healing
Clinical Question For a patient undergoing tooth extraction before implant placement, will ridge preservation maintain the alveolar ridge more effectively than normal healing?
Clinical Bottom Line In patients with buccal bone defects, ridge preservation post-extraction to maintain the alveolar ridge may offer a better prognosis for implant placement than normal healing.
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) 22150876Sisti/201220 patients scheduled for single extraction in maxilla from second to second premolarRandomized Controlled Trials
Key resultsPatients were split into a treatment group (TG) and a control group (CG). TG members received bone grafts while CG members were left to normal healing. The alveolar ridge density was measured by CT scan in multiple standardized locations. Measurements were made at T0 (baseline), T1 (two months later at implant insertion), and T2 (24 months). For the treatment group, each location had 2 measurements for T0; one before bone graft and one after graft placement. Comparing TG and CG, the VD (vertical distance) at T0 pregraft was 6.93mm ± 1.49 (median value of 6.65mm) for the TG and 7.55mm ± 1.05 (7.9mm) for the CG with a p-value of 0.353. VD at T0 grafted was 0.17mm ± 0.09 (0.18mm). The VD at T1 was 0.20mm ± 0.15 (0.2mm) for the TG and 0.25mm ± 0.12(0.24mm) for the CG with a p-value of 0.91. VD at T2 was 0.26mm ± 0.11 (0.24mm) for TG and 0.24mm ± 0.19 (0.23mm) for CG with a p-value of 0.96. These results show that ridge preservation doesn’t make a difference on vertical distance of bone. Comparing TG and CG, the TW4 (measurement 4 mm apical to the palatal bone crest) T0 pregraft was 1.66mm ± 0.88 for TG and 1.89mm ± 0.73 for CG with a p-value of 0.481. TW4 for T0 grafted was 9.1mm ± 1.3 (8.9) for TG and 1.89mm ± 0.73 for CG with a p-value of 0.00001. The TW4 at T1 was 9.55mm ± 1.3 (9.3mm) for TG and 7.93mm ± 0.73 (7.95mm) for CG with a p-value of 0.003. TW4 at T2 was 9.84mm ± 1.47 (9.55mm) for TG and 7.77mm ± 0.7 (7.6mm) for CG with a p-value of 0.0001. Other measurements that were done on TW1 (measurement 1mm apical to the palatal bone crest) and TW7 (measurement 7mm apical to the palatal bone crest) showed similar results in that ridge preservation produced statistically significant increases in bone density compared to normal healing alone.
Evidence Search ("Tooth Extraction"[Mesh]) AND "Alveolar Ridge Augmentation"[Mesh]
Comments on
The Evidence
The study was a RCT with >80% completion rate, groups treated the same, adequate follow up, adequate compliance, and unlikely recall bias. It is not clear whether there was double blinding or whether the groups were similar at start (no demographic data is given and it was a very small sample size, n=20). There were no competing interests.
Applicability The authors concluded that for buccal bone defects greater than 5mm, socket preservation can minimize alveolar crest resorption following tooth extraction.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Ridge preservation, implants, bone graft
ID# 2387
Date of submission: 03/04/2013spacer
E-mail Trinhj@livemail.uthscsa.edu
Author Johnny Trinh
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail SPACKMAN@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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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