Flapped versus flapless alveolar ridge preservation: a systematic review and meta-analysis

Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. Flapped and flapless surgical approaches have been used for ARP; however, there is a lack of strong scientific evidence regarding their specific influences on the clinical outcomes of ARP. The aim of this systematic review and meta-analysis was to evaluate the effects of flapped and flapless surgical approaches on the dimensional changes of hard and soft tissues and patient-reported outcomes following ARP. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared flapped ARP by means of a coronally advanced flap to flapless ARP where barrier membranes were left exposed. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. Data were analysed using a statistical software program. A total of 754 studies were identified, of which five studies with 149 extraction sockets in 128 participants were included. Overall, meta-analysis did not show any significant differences in the changes in ridge width or height between flapped and flapless ARP. The use of flapless ARP was associated with significantly less postoperative pain, thicker labial soft tissues, and marginally more favourable changes in width of the keratinized tissues compared to the flapped approach. The short-term hard tissue changes following ARP with a flapped or flapless approach are comparable. Postoperative pain and labial soft tissue changes are more favourable following ARP using a flapless approach. Further evidence from long-term RCTs is still required to substantiate the current findings.     

Combination of bone graft and resorbable membrane for alveolar ridge preservation: A systematic review,meta‐analysis,and trial sequential analysis

1 Introduction

Alveolar ridge preservation (ARP) techniques aim to reduce resorption after tooth extraction. The combination of a graft material covered with a resorbable membrane represents one of the most common strategies performed in the clinical practice. The aim of this systematic review is to analyze evidence regarding potential benefits of ARP procedures performed with allogenic/xenogenic grafts in combination with a resorbable membrane coverage in comparison with spontaneous healing.

2 Methods

Electronic databases were screened independently to select studies suitable for inclusion in this review. Horizontal ridge width reduction (HRWR) and vertical ridge height reduction (VRHR) were investigated as primary outcomes and volume changes (VC) as a secondary outcome. Meta‐analysis was performed using the inverse of variance test with a random effect model. Adjustment for Type I and II errors and analysis of the power of evidence was performed with trial sequential analysis (TSA).

3 Results

Seven studies met the inclusion criteria and were included in the quantitative synthesis. Meta‐analysis revealed that the combination therapy resulted in a lower rate of resorption for both HRWR (?2.19 mm, 95% confidence interval [CI]: ?2.67 to ?1.71 mm) and VRHR (?1.72 mm, 95% CI: ?2.14 to ?1.30 mm). For VC no meta‐analysis was performed due to insufficient data. Analysis of the power of the evidence performed with TSA showed that the number of both studies and sockets analyzed is sufficient to validate such findings, despite the high rate of heterogeneity.

4 Conclusions

Use of bone graft covered by a resorbable membrane can decrease the rate of alveolar ridge horizontal and vertical resorption after tooth extraction. The power and reliability of the evidence is strong enough to confirm the above‐mentioned findings, despite the high rate of heterogeneity of included studies.     

Alveolar ridge preservation: Complications and cost-effectiveness

Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.     

Alveolar bone dimensional changes of post‐extraction sockets in humans: a systematic review

Objective: To review the literature to assess the amount of change in height and width of the residual ridge after tooth extraction. Material and Methods: MEDLINE‐PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through up to March 2009. Appropriate studies which data reported concerning the dimensional changes in alveolar height and width after tooth extraction were included. Approximal height change, mid‐buccal change, mid‐crestal change, mid‐lingual change, Alveolar width change and socket fill were selected as outcome variables. Mean values and if available standard deviations were extracted. Weighted mean changes were calculated. Results: Independent screening of the titles and abstracts of 1244 MEDLINE‐PubMed and 106 Cochrane papers resulted in 12 publications that met the eligibility criteria. The reduction in width of the alveolar ridges was 3.87 mm. The mean clinical mid‐buccal height loss was 1.67 mm. The mean crestal height change as assessed on the radiographs was 1.53 mm. Socket fill in height as measured relative to the original socket floor was on an average 2.57 mm. Conclusion: During the post‐extraction healing period, the weighted mean changes as based on the data derived from the individual selected studies show the clinical loss in width to be greater than the loss in height, assessed both clinically as well as radiographically.