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Title For Socket Preservation, Calcium Sulfate Alloplast Shows Similar Results as Freeze-Dried Bone Allograft for Maintenance of Socket Dimension and New Bone Formation
Clinical Question Following extractions in adult patients, does socket preservation using the alloplast calcium sulfate result in a similar volume and dimension of bone compared to allograft materials?
Clinical Bottom Line Alloplast graft materials such as calcium sulfate have shown similar clinical results for socket preservation when compared to freeze-dried bone allografts (FDBA). However, calcium sulfate is more easily resorbed when compared to FDBA. This may help in replacement of graft material by native bone during the healing process.
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) 22166162Toloue/201221 patients & 31 sockets Randomized Controlled Trial
Key resultsAt 3 months post extraction/graft placement comparing calcium sulfate alloplast and FDBA, patients showed a loss of ridge width of 1.33 ± 1.22 mm for calcium sulfate alloplast and 1.03 ± 0.87 mm for FDBA. There was no significant difference between the groups (P=0.11). Change in vertical ridge dimension was 0.23 ± 1.69 mm for calcium sulfate and 0.05 ± 1.46 mm for the FDBA. There was no significant difference between the groups (P=0.87). A histological evaluation of bone core samples from healed sockets showed 31.74% ± 8.75% of new vital bone formation and only 2.54% of graft material remaining for calcium sulfate, and 16.66% ± 11.14% of new vital bone formation with 21.37% of freeze-dried bone allograft material remaining in the socket. “Total bone percentage was significantly higher (P=0.0015) and residual graft percentage significantly lower (P<0.0001) for the CS group than for the FDBA group.”
#2) 21403526Ruga/201160 SocketsNon Controlled Clinical Trail
Key resultsAt 3 months of healing following placement of calcium sulfate in extraction sites, a histological evaluation of 19 cores revealed an average of 63.16% new vital bone formation, with 2.1% of non-vital bone and 30% amorphous material present. No particles of calcium sulfate were observed in the bone cores.
Evidence Search MeSH: Tooth Socket/surgery and Calcium Sulfate/therapeutic use
Comments on
The Evidence
In the Toloue study, the initial site measurements were made by two calibrated examiners before randomization. However, the practitioner was not blinded in this study. At the final 3-month follow-up, 28 out of 31 sockets were examined, equaling a 90% completion rate. There was no table to show the test (calclium sulfate) and control (FDBA) socket groups were balanced on the basis of age, sex, location, and contributing factors. This study was also sponsored by Orthogen. The Ruga study had no control group for comparison, and only 19 of the 60 socket sites were examined histologically. All sites had intact bony walls with no dehiscence or fenestrations, which does not represent the entire graft population.
Applicability This research is mainly designed towards reaching the general dentist community who treat more straightforward extraction procedures. It has been proven most methods of grafting such as autograft, allograft, xenograft, or alloplast materials have clinical advantages compared to no grafting in extraction sockets. Calcium sulfate resulted in a higher volume of newly formed bone and greater percentage of resorption when compared to FDBA. Alloplasts have the added benefit of being synthetically made, which lessens the risk of an immune response.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Alloplast, allograft, freeze-dried bone allograft, calcium sulfate, socket preservation
ID# 3240
Date of submission: 04/24/2017spacer
E-mail Beardc@livemail.uthscsa.edu
Author Christopher Beard
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail Finlaysonr@uthscsa.edu
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