Title	Longer Healing Time Correlates With More Vital Bone Formation Following Ridge Preservation with DFDBA after Single Tooth Extraction
Clinical Question	In adult human patients undergoing tooth extraction with human allograft placement, does more vital bone form using demineralized free-dried bone allograft (DFDBA) when graft heals for a longer period of time?
Clinical Bottom Line	Ridge preservation with DFDBA resulted in significantly more vital bone formation at the 18-20 week group as compared to the 8-10 week group.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 27133791 Whetman/2016 46 patients (21 M, 25 F) ages 20-81, mean age: 55.7 Randomized Controlled Trial Key results 46 patients were enrolled in the study, with a total of 41 patients completing the treatment protocol. These patients required extraction of a non-molar tooth and also desired placement of a dental implant to restore edentulous space. Patients were randomly assigned to either the study group (8-10 weeks) or the control group (18-20 weeks). During implant placement, a trephine core was harvested from the original dental socket and measured histologically. The % vital bone, % connective tissue/other, and % residual graft were all assessed microscopically. Measurements were taken at the time of extraction and time of implant placement to compare buccal thickness, ridge width, and height. The 8-10 week group had a mean of 32.63% vital bone while the 18-20 week group had 47.41%. The short-term group had more residual bone graft (37.42% vs 26.80%). These results were not statistically significant, but were trending towards that (P = 0.06) No statistically significant differences were found in the clinical measurements taken. Similarly, initial buccal plate thickness post-extraction did not correlate with any significant differences between the short-term and long-term group.
Evidence Search	DFDBA healing time ridge preservation
Comments on The Evidence	Validity: Randomized Control Trials are deemed a higher level of evidence considering the levels of evidence pyramid. This RCT protocol has been used in study 10+ times due its efficacy, low bias and recurring statistical significance. A single donor was used for the DFDBA material to help eliminate bias that would occur using two different donors with a high potential of different bone quality. Patients were randomly assigned to their respective study group after the initial surgical procedure was complete to help avoid clinician bias. Without being able to quantitatively measure the quality of bone at implant placement, the author stated his opinion that on average, the bone quality was better, more stable, when the graft was able to heal for a longer period of time (control group) as compared to the study group. Perspective: Ridge preservation procedures, when utilized in cases involving immediate implant placement, have been consistent in providing positive results. While this study answered a question or two, it created a new question: what are the implant outcome measures when an immediate load implant is placed in a lower percentage of vital bone at 8-10 weeks; 10-12 weeks; and 12-14 weeks? Further research needs to be completed in order to determine the answer to these scenarios.
Applicability	Ridge preservation is a dependable and reliable procedure to maintain maximum alveolar ridge width and height following dental extraction. Ridge preservation at time of extraction is more predictable and cost effective then performing such procedures months post extraction. This study found more vital bone was generated during a healing over 18-20 weeks compared to 8-10 weeks. This study was a healing study, therefore, did not look at implant success past the one week post-op visit. More research needs to be done in this area to determine if implants will survive predictably in sites after extended weeks of healing.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics) (Restorative Dentistry)
Keywords	ridge preservation, demineralized freeze-dried bone allograft, healing time, DFDBA
ID#	3275
Date of submission	11/03/2017
E-mail	nelsonac@uthscsa.edu
Author	Aaron Nelson
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Faculty mentor
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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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Joelle Foster (San Antonio, TX) on 10/05/2022 A Pubmed search in October 2022 found a RCT related to this CAT published by Allen et al. in 2022 (PMID: 35044692). This study presented CBCT data showing that there was no significant difference in buccal or lingual ridge height up to 12 months after ridge preservation. This implied that delaying implant placement up to 1 year has no significant negative impact on ridge dimension.