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Conozca La Importancia de La Preservación Alveolar Al Momento de Extraer Un Diente
Conozca La Importancia de La Preservación Alveolar Al Momento de Extraer Un Diente
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DOI: 10.1111/jcpe.13057
SUPPLEMENT ARTICLE
1
Department of Periodontics, University of
Iowa, Iowa City, Iowa Abstract
2
School of Dentistry, Ibirapuera University, Aim: The aim of this systematic review was to critically analyse the available evidence
São Paulo, Brazil
on the effect of different modalities of alveolar ridge preservation (ARP) as compared
3
Department of Periodontology, Universidad
to tooth extraction alone in function of relevant clinical, radiographic and patient-
Complutense de Madrid, Madrid, Spain
centred outcomes.
Correspondence
Material and Methods: A comprehensive search aimed at identifying pertinent litera-
Gustavo Avila-Ortiz, Department of
Periodontics, The University of Iowa, Iowa ture for the purpose of this review was conducted by two independent examiners.
City, IA.
Only randomized clinical trials (RCTs) that met the eligibility criteria were selected.
Email: gustavo-avila@uiowa.edu
Relevant data from these RCTs were collated into evidence tables. Endpoints of in-
terest included clinical, radiographic and patient-
reported outcome measures
(PROMs). Interventions reported in the selected studies were clustered into ARP
treatment modalities. All these different ARP modalities were compared to the con-
trol therapy (i.e. spontaneous socket healing) in each individual study after a 3- to
6-month healing period. Random-effects meta-analyses were conducted if at least
two studies within the same ARP treatment modality reported on the same outcome
of interest.
Results: A combined database, grey literature and hand search identified 3,003
records, of which 1,789 were screened after removal of duplicates. Following the
application of the eligibility criteria, 25 articles for a total of 22 RCTs were in-
cluded in the final selection, from which nine different ARP treatment modalities
were identified: (a) bovine bone particles (BBP) + socket sealing (SS), (b) construct
made of 90% bovine bone granules and 10% porcine collagen (BBG/PC) + SS, (c)
cortico-c ancellous porcine bone particles (CPBP) + SS, (d) allograft particles
(AG) + SS, (e) alloplastic material (AP) with or without SS, (f) autologous blood-
derived products (ABDP), (g) cell therapy (CTh), (h) recombinant morphogenic
protein-2 (rhBMP-2) and (i) SS alone. Quantitative analyses for different ARP mo-
dalities, all of which involved socket grafting with a bone substitute, were feasible
for a subset of clinical and radiographic outcomes. The results of a pooled quanti-
tative analysis revealed that ARP via socket grafting (ARP-SG), as compared to
tooth extraction alone, prevents horizontal (M = 1.99 mm; 95% CI 1.54–2.44;
p < 0.00001), vertical mid-buccal (M = 1.72 mm; 95% CI 0.96–2.48; p < 0.00001)
and vertical mid-lingual (M = 1.16 mm; 95% CI 0.81–1.52; p < 0.00001) bone re-
sorption. Whether there is a superior ARP or SS approach could not be determined
on the basis of the selected evidence. However, the application of particulate
J Clin Periodontol. 2019;1–29. wileyonlinelibrary.com/journal/jcpe © 2019 John Wiley & Sons A/S. | 1
Published by John Wiley & Sons Ltd
|
2 AVILA-ORTIZ et al.
KEYWORDS
alveolar bone atrophy, alveolar bone grafting, alveolar ridge, bone graft(s), bone remodelling,
evidence-based dentistry
1 | I NTRO D U C TI O N
Clinical Relevance
Maintenance of the natural dentition in optimal conditions of
health, function and aesthetics, with the ultimate goal of enhancing Scientific rationale for the study: There is limited information
the well-b eing of patients, remains as the main objective of peri- available regarding the effect of specific alveolar ridge
odontal therapy (AAP, 2011, Chapple & Wilson, 2014). However, preservation (ARP) treatment modalities on the basis of
dental extraction is inevitable under certain circumstances that relevant endpoints that could be used to make decisions in
subsequently require the consideration of tooth replacement daily clinical practice. Principal findings: ARP is an effective
options. Among them, fixed dental prostheses (FDPs) are re- approach to attenuate the dimensional reduction of the
garded as a highly predictable and therapeutically versatile alter- alveolar ridge that normally takes place after tooth
native, also associated with long-term patient quality of life (Ali, extraction. The beneficial effects of ARP seem to be more
Baker, Shahrbaf, Martin, & Vettore, 2018; Wolleb, Sailer, Thoma, pronounced in preventing horizontal bone resorption,
Menghini, & Hammerle, 2012). Nonetheless, FDPs, whether they followed by vertical mid-buccal and vertical mid-lingual
are tooth-or implant-supported, cannot fully replace all the in- bone changes. The magnitude of this effect was larger in
herent functions and properties of natural teeth (Giannobile & patients receiving xenogenic and allogenic bone substi-
Lang, 2016; Levin & Halperin-Sternfeld, 2013) and are not exempt tutes covered by an absorbable collagen barrier. Practical
of complications and diseases (Berglundh et al., 2018; Pjetursson, implications: ARP should be considered in conjunction with
Sailer, Makarov, Zwahlen, & Thoma, 2015; Sailer, Makarov, Thoma, minimally traumatic tooth extraction in order to minimize
Zwahlen, & Pjetursson, 2015), some of which represent a major alveolar ridge reduction.
2 | M ATE R I A L A N D M E TH O DS
socket integrity) and (c) patient-related (i.e. age, smoking habits and
history of periodontitis).
2012; Vittorini Orgeas et al., 2013; Weng, Stock, & Schliephake, • Other bias.
2011; Willenbacher et al., 2016) was also performed. Additionally, in
an attempt to identify relevant information in the grey literature, two Based on the overall risk of bias, individual studies were catego-
open databases, OpenGrey (www.opengrey.eu) and Grey Literature rized as being at low, high or unclear risk of bias according to the fol-
Report (www.greylit.org), were searched on 15 September 2018 lowing criteria:
using the term “alveolar ridge preservation.”
• Low risk of bias (plausible bias unlikely to seriously alter the re-
sults) if all domains were at low risk of bias;
2.5 | Article selection
• High risk of bias (plausible bias that seriously weakens confidence
Two reviewers (G.A. and F.V.) independently read the title and in the results) if one or more domains were at high risk of bias; or
abstract of the entries yielded from the initial electronic database • Unclear risk of bias (plausible bias that raises some doubt about
search. After this initial assessment, both reviewers read separately the results) if one or more domains were at unclear risk of bias.
the full-text versions of the studies that could be potentially included
in this systematic review. The final selection of articles was made on
the basis of the eligibility criteria described above. Any disagreement
2.8 | Data synthesis
in the final selection was resolved by open discussion between both
reviewers. In the case that no agreement could be reached, the other Data were collated into evidence tables and clustered according
co-author (L.C.) acted as arbiter. to the treatment modality and outcome parameters. Descriptive
summary was performed to determine the quantity of data, checking
further for study variations in terms of study characteristics, study
2.6 | Data extraction
quality and results. Random-effects meta-analyses of continuous
Data from the studies included in the final selection were extracted data were pooled outcomes and expressed as weighted mean
by one of the authors (G.A). The accuracy of the data was verified differences (MD) with their associated 95% confidence intervals
independently by the other two co-authors (F.V. and L.C.). Aside (CI). The analyses were conducted using the generic inverse variance
from the aforementioned clinical, radiographic and patient- statistical method where the MD and standard error (SE) are entered
reported outcome measures, additional extracted data included for all studies in order to accommodate data pooling from split-mouth
year of publication and first author, study design (i.e. parallel arms and parallel-group studies in a single meta-analysis and facilitate
or split-mouth), initial number of participants, distribution of sites data synthesis (Stedman, Curtin, Elbourne, Kesselheim, & Brookhart,
by treatment groups, number of dropouts, details of the ARP 2011). For split-mouth trials, an intra-cluster correlation coefficient
intervention(s), age and gender of participants, smoking habits, of 0.05 was assumed, while for parallel trials, a coefficient of zero
reason for extraction, socket anatomy (single-or multi-
rooted), for the calculation of SE. Statistical heterogeneity was assessed by
integrity of extraction site, buccal bone thickness, SS and modality, calculation of the Q statistic. The significance of discrepancies in
flap elevation, primary closure, healing period, whether implant the estimates of the treatment effects from the different trials was
placement was performed and follow-
up time after functional assessed by means of Cochrane's test for heterogeneity and the I2
loading. statistic. Analyses were performed using RevMan software (Review
If data were missing, the authors of the original articles were Manager, version 5.3; Nordic Cochrane Centre, Copenhagen,
contacted and asked to provide further details. Denmark).
Alveolar ridge
preservation
intervention(s) (We can
subclassify the
Study design Initial number of interventions after the Age
Publication(s) Parallel arms participants and data extraction is Socket sealed in distribution
Author(s) and year or split-mouth distribution by groups Dropouts completed) ARP group(s) (years) Gender distribution
Iasella et al. (2003) RCT 24 subjects for a total of 24 No Allograft (particulate Yes Range: 28–76 14 females
Parallel arms sockets FDBA) Bovine collagen Mean: 10 males
Divided into two groups: Socket sealed with membrane 51.5 ± 13.6 (Details on group
Control (n = 12) and absorbable collagen (Details on distribution not
Experimental (n = 12) membrane group reported)
distribution
not reported)
Fiorellini et al. RCT 80 subjects for a total of 95 No Experimental 1: ACS No Mean: 47.4 37 females
(2005) Parallel arms sockets But 4 subjects alone (Details on 43 males
Divided into four groups:* had to be Experimental 2: group (Details on group
Control (n = 20), excluded due 0.75 mg/mL of rhBMP-2 distribution distribution not
Experimental 1 (n = 17), to inherent in ACS not reported) reported)
Experimental 2 (n = 22) study errors Experimental 3:
and Experimental 3 1.50 mg/mL of rhBMP-2
(n = 21) in ACS
*Specific number of sites
per group not reported
Aimetti et al. (2009) RCT 40 subjects for a total of 40 No Alloplast No Range: 36–68 18 females
Parallel arms sockets (medical-grade calcium Mean: 22 males
Divided into two groups: sulphate hemihydrate 51.2 ± 8.4 (Control group: 8
Control (n = 18) and [MGCSH]) (Control females and 10 males/
Experimental (n = 22) group: Experimental group: 10
51.8 ± 8.6/ females and 10 males)
Experimental
group:
50.8 ± 8.4)
Alissa et al. (2010) RCT 23 subjects for a total of 29 Yes Autologous blood-derived No Control group 15 females
Parallel arms sockets Control group product (Platelet-rich Range: 20–52 8 males
Divided into two groups: n = 3 plasma gel) Mean: 30.4 (Control group: 8
Control (n = 12 subjects Experimental Experimental females and 3 males/
and 15 sockets) and group n = 4 group Experimental group: 7
Experimental (n = 11 Range: 21–40 females and 5 males)
subjects and 14 sockets) Mean: 30.6
Pelegrine et al. RCT 13 subjects for a total of 30 No Cell therapy No Control group 6 females
(2010) Parallel arms sockets (Autologous bone Range: 36–54 7 males
Divided into two groups: marrow graft) Mean: 43.5 (Control group: 2
Control (n = 6 subjects and Experimental females and 4 males/
15 sockets) and group Experimental group: 4
Experimental (n = 7 Range: 28–70 females and 3 males)
subjects and 15 sockets) Mean: 51
Rasperini et al. RCT 11 subjects for a total of 11 Yes Xenograft (Construct with Yes Mean: 54 N/R
(2010) Parallel arms sockets Control group 90% bovine bone Porcine collagen (Details on
Divided into two groups: n = 1 granules and 10% membrane group
Control (n = 4)* and Experimental porcine collagen) distribution
Experimental (n = 7) group n = 1 Socket sealed with not reported)
*Only data from control absorbable porcine
sites presenting no collagen membrane
significant bone defects
are included in this
systematic review, since
no sites with dehiscence
defects were allocated in
the Experimental group
Cardaropoli et al. RCT 41 subjects for a total of 48 No Xenograft (Bovine bone Yes Range: 24–71 17 females
(2012, 2014, Parallel arms sockets particles) Porcine collagen Mean: 24 males
2015) Divided into two groups: Socket sealed with membrane 47.2 ± 12.9 (Details on group
Control (n = 24 sockets) absorbable porcine (Details on distribution not
and Experimental (n = 24 collagen membrane group reported)
sockets) distribution
not reported)
Specific number of
patients per group is
unclear
AVILA-ORTIZ et al. |
9
N/R N/R N/R Single-rooted Buccal N/A Yes Yes 4 months N/A
dehiscence (Only sites
defects presenting
(At least 50% buccal
of buccal wall dehiscences
missing) were included)
N/A N/R Root or crown Single-rooted No significant N/R No N/A 3 months N/A
(Smoking was fractures, defects
an exclusion non-restorable
criterion) caries, and
residual roots
(Details on group
distribution not
reported)
Control group: N/R Caries (60.9%) Control: 7 N/R N/R Yes Yes 3 months N/A
3 smokers Endodontic single-rooted and 7
Experimental failure (21.7%) multi-rooted
group: 7 Others (17.4%) Experimental: 5
smokers (Details on group single-rooted and
distribution not 10 multi-rooted
reported)
N/A N/R N/R Single-rooted No significant Control: 1.83 ± Yes Yes 6 months N/A
(Smoking was defects 0.77
an exclusion Experimental:
criterion) 0.9 ± 0.81
(Continues)
|
10 AVILA-ORTIZ et al.
TA B L E 1 (Continued)
Alveolar ridge
preservation
intervention(s) (We can
subclassify the
Study design Initial number of interventions after the Age
Publication(s) Parallel arms participants and data extraction is Socket sealed in distribution
Author(s) and year or split-mouth distribution by groups Dropouts completed) ARP group(s) (years) Gender distribution
Barone et al. (2013) RCT 58 subjects for a total of 58 No Xenograft Yes Control group 38 females
Parallel arms sockets (Cortico-cancellous Porcine collagen Range: 29–57 20 males
Divided into two groups: porcine bone particles) membrane Mean: (Control group: 18
Control (n = 29) and Socket sealed with 39.3 ± 15.5 females and 11 males/
Experimental (n = 29) absorbable porcine Experimental Experimental group: 20*
collagen membrane group females and 9 males)
Range: 32–62
Mean: *There is likely a typo in
41.8 ± 14.0 Table 1 of the article
Festa et al. (2013) RCT 15 subjects for a total of 30 No Xenograft Yes Range: 28–58 9 females
Split-mouth sockets (Cortico-cancellous Porcine collagen 6 males
Divided into two groups: porcine bone particles) membrane
Control (n = 15) and Socket sealed with
Experimental (n = 15) absorbable porcine
collagen membrane
Jung et al. (2013), RCT 40 subjects for a total of 40 No Experimental 1: alloplast Yes Control: Control: 4 females/6 males
Schneider et al. Parallel arms sockets Although data (bTCP with a Experimental 48 ± 15 Experimental 1: 4 females
(2014) Divided into four groups: of four polylactide–co- Group 2: Experimental /6 males
Control (n = 10), patients (two glycolide coating) collagen matrix 1: 59 ± 11 Experimental 2: 6 females
Experimental 1 (n = 10), from the Experimental 2: Experimental Experimental /4 males
Experimental 2 (n = 10) Control group, xenograft (construct Group 3: 2: 65 ± 13 Experimental 3: 8 females
and Experimental 3 one from with 90% bovine bone autologous soft Experimental /2 males
(n = 10) Experimental granules and 10% tissue punch 3: 49 ± 14
Group 1 and porcine collagen) and
one from socket sealed with a
Experimental porcine collagen matrix
Group 2) could Experimental 3:
not be xenograft (construct
obtained for with 90% bovine bone
the cast granules and 10%
analyses-soft porcine collagen) and
tissue socket sealed with
measurements autologous soft tissue
punch
Thalmair et al. RCT 30 subjects for a total of 30 No Experimental 1: xenograft Yes Control: Control: 5 females/3 males
(2013) Parallel arms sockets (cortico-cancellous Experimental 46.4 ± 8.9 Experimental 1: 4 females
Divided into four groups: porcine bone particles) Groups 2 and 3: Experimental /6 males
Control (n = 7), and socket sealed with autologous soft 1: 50.5 ± 13.5 Experimental 2: 1 female
Experimental 1 (n = 8), autologous soft tissue tissue punch Experimental /7 males
Experimental 2 (n = 8) and punch 2: 41.7 ± 6.5 Experimental 3: 2 females
Experimental 3 (n = 7) Experimental 2: socket Experimental / 5 males
sealed with autologous 3: 52.0 ± 14.6
soft tissue punch
Experimental 3:
xenograft (cortico-
cancellous porcine bone
particles alone)
AVILA-ORTIZ et al. |
11
Yes N/R Control: Caries 8 single-rooted and No significant Measured at No N/A 4 months N/A
Insufficient (45%), Fracture 21 multi-rooted in defects baseline, but
data provided (41%), each group specific data
Endodontic not reported
(14%),
Periodontal (1%)
Experimental:
Caries (47%),
Fracture
(38%),Endodontic
(10%),
Periodontal (4%)
*There is a
discrepancy
between the data
reported in the
text and in the
graphs
N/A N/R N/R Single-rooted No significant N/R Yes Yes 6 months N/A
(Smoking was defects
an exclusion
criterion)
(Continues)
|
12 AVILA-ORTIZ et al.
TA B L E 1 (Continued)
Alveolar ridge
preservation
intervention(s) (We can
subclassify the
Study design Initial number of interventions after the Age
Publication(s) Parallel arms participants and data extraction is Socket sealed in distribution
Author(s) and year or split-mouth distribution by groups Dropouts completed) ARP group(s) (years) Gender distribution
Kotsakis et al. RCT 24 subjects for a total of 30 No Experimental 1: alloplast YES Control: 43.8 Control: 1 female/5 males
(2014) Parallel arms sockets (calcium phosphosilicate Experimental Experimental Experimental 1: 4
Divided into three groups: putty) and socket sealed Groups 1 and 2: 1: 43.3 females/6 males
Control (n = 6 for 6 with a bovine collagen Bovine collagen Experimental Experimental 2: 2
sockets), Experimental 1 sponge sponge 2: 39.8 females/6 males
(n = 10 for 12 sockets) and Experimental 2:
Experimental 2 (n = 8 for xenograft (bovine bone
12 sockets) particles) and socket
sealed with a bovine
collagen sponge
Madan et al. (2014) RCT 15 subjects for a total of 60 No Alloplast (polylactide– No Range: 20–45 8 females
Split-mouth sockets polyglycolide [PLA-P GA] 7 males
Divided into two groups: sponge)
Control (n = 30 sockets)
and Experimental (n = 30
sockets)
Pang et al. (2014) RCT 30 subjects for a total of 30 No Xenograft (bovine bone Yes Range: 22–47 16 females
Parallel arms sockets particles) Porcine collagen Mean: 37 14 males
Divided into two groups: Socket sealed with membrane (Details on (Details on group
Control (n = 15) and absorbable porcine group distribution not reported)
Experimental (n = 15) collagen membrane distribution
not reported)
Spinato et al. (2014) RCT 31 subjects for a total of 31 No Allograft (particulate Yes Range: 27–74 21 females
Parallel arms sockets FDBA) Bovine collagen Mean: 48.5 10 males
Divided into two groups: Socket sealed with sponge (Details on (Details on group
Control (n = 12) and bovine collagen sponge group distribution not reported)
Experimental (n = 19) distribution
not reported)
Araujo et al. (2015) RCT 28 subjects for a total of 28 No Xenograft (construct with Yes Range: 21–50 N/R
Parallel arms sockets 90% bovine bone Autologous soft (Details on
Divided into two groups: granules and 10% tissue punch group
Control (n = 14) and porcine collagen) distribution
Experimental (n = 14) Socket sealed with not reported)
autologous soft tissue
punch
Karaca et al. (2015) RCT 10 subjects for a total of 20 No Socket sealed with Yes Range: 36–60 5 females
Split-mouth sockets* autologous soft tissue Autologous soft Mean: 46.7 5 males
Divided into two groups: punch tissue punch
Control (n = 10) and
Experimental (n = 10)
Temmerman et al. RCT 22 subjects for a total of 44 No Autologous blood-derived No Mean: 54 ± 11 7 females
(2016) Split-mouth sockets* product (L-PRF clot) 15 males
Divided into two groups:
Control (n = 22) and
Experimental (n = 22)
AVILA-ORTIZ et al. 13|
N/A N/R N/R Unclear N/R N/R Yes Yes 6 months 12 months
(Smoking was
an exclusion
criterion)
N/A N/R Root fracture Single-rooted No significant Categorized in No N/A 4 months N/A
(Smoking was (n = 8), defects thick (>1 mm) or
an exclusion periodontal thin (≤1 mm)
criterion) involvement Control: 6 thick
(n = 9), and 6 thin
endodontic Experimental: 8
failure (n = 2) and thick and 11
untreatable thin
caries (n = 12)
(Details on group
distribution not
reported)
N/R N/R Caries and root Single-rooted No significant N/R No N/A 4 months N/A
fracture defects
(Details on group
distribution not
reported)
N/A N/R N/R Single-rooted Most sites 1 mm apical to No N/A 3 months N/A
(Smoking was presented no the crest
an exclusion significant Control:
criterion) defects, but 1.58 ± 1.4
one control Experimental:
and three 1.15 ± 0.7
experimental
sockets
presented a
buccal
dehiscence
ranging from
3 to 6 mm
(Continues)
|
14 AVILA-ORTIZ et al.
TA B L E 1 (Continued)
Alveolar ridge
preservation
intervention(s) (We can
subclassify the
Study design Initial number of interventions after the Age
Publication(s) Parallel arms participants and data extraction is Socket sealed in distribution
Author(s) and year or split-mouth distribution by groups Dropouts completed) ARP group(s) (years) Gender distribution
Barone, Toti, RCT 55 subjects for a total of 55 Yes Experimental 1: xenograft Yes Control: Control: 15 females/
Menchini-Fabris, Parallel arms sockets A total of 12 (cortico-cancellous Porcine collagen 46.3 ± 11.1 7 males
et al. (2017) Divided into three groups: patients did porcine bone particles) membrane Experimental Experimental 1: 7
Control (n = 25), not complete and socket sealed with 1: 47.2 ± 10.2 females/4 males
Experimental 1 (n = 15) the study, absorbable collagen Experimental Experimental 2: 7
and Experimental 2 which resulted membrane 2: 50.7 ± 8.7 females/3 males
(n = 15) in a final Experimental 2:
sample of 22 xenograft (pre-hydrated
sites in the collagenated
Control group, cortico-cancellous
11 sites in porcine bone particles)
Experimental and socket sealed with
Group 1 and absorbable collagen
10 sites in membrane
Experimental
Group 2
Barone, Toti, RCT 90 subjects for a total of 90 No Experimental 1: xenograft Yes Control: Control: 18 females/
Quaranta, et al. Parallel arms sockets (cortico-cancellous Porcine collagen 46.3 ± 11.1 2 males
(2017) Divided into three groups: porcine bone particles) membrane (range 28–70) Experimental 1: 20
Control (n = 30), and socket sealed with Experimental females/10 males
Experimental 1 (n = 30) porcine collagen 1: 47.2 ± 10.2 Experimental 2: 16
and Experimental 2 membrane (range 25–63) females/14 males
(n = 30) Experimental 2: Experimental
xenograft (pre-hydrated 2: 50.7 ± 8.7
collagenated (range 31–64)
cortico-cancellous
porcine bone particles)
and socket sealed with
porcine collagen
membrane
Guarnieri et al. RCT 30 subjects for a total of 30 Yes Experimental 1: socket Yes Control: range Control: 4 females/5 males
(2017) Parallel arms sockets A total of 4 sealed with porcine Porcine collagen 21–56 Experimental 1: 6
Divided into three groups: patients did collagen membrane membrane Experimental females/3 males
Control (n = 10), not complete Experimental 2: 1: range Experimental 2: 2
Experimental 1 (n = 10) the study, xenograft (porcine bone 19–60 females/6 males
and Experimental 2 which resulted particles) and socket Experimental
(n = 10) in a final sealed with porcine 2: range
sample of 9 collagen membrane 20–63
sites in the
Control group,
9 sites in
Experimental
Group 1 and 8
sites in
Experimental
Group 2
Iorio-Siciliano et al. RCT 20 subjects for a total of 20 No Xenograft (construct with Yes Control: Control: 4 females/6
(2017) Parallel arms sockets 90% bovine bone Porcine collagen 40.2 ± 12.1 males
Divided into two groups: granules and 10% membrane Experimental: Experimental: 5 females/
Control (n = 10) and porcine collagen) 38.2 ± 9.4 5 males
Experimental (n = 10) Socket sealed with
porcine collagen
membrane
AVILA-ORTIZ et al. |
15
Control: 5 N/R Control: Caries Control: 8 Sites Buccal bone No N/A 3 months N/A
smokers (n = 14), single-rooted and presenting thickness
Experimental endodontic 22 multi-rooted buccal bone <1.5 mm
1: 6 smokers (n = 3), fracture Experimental 1: 14 damage Control: 7/30
Experimental (n = 13) single-rooted and Control: 13 Experimental 1:
2: 4 smokers Experimental 1: 16 multi-rooted out of 30 20/30
Caries (n = 10), Experimental 2: Experimental Experimental 2:
endodontic 10 single-rooted 1: 18 out of 14/30
(n = 16), fracture and 20 30
(n = 14) multi-rooted Experimental
Experimental 2: 2: 10 out of
Caries (n = 14), 30
endodontic
(n = 6), fracture
(n = 10)
N/A N/R N/R Combination of Unclear Buccal bone Yes No 6 months N/A
(Smoking was single- and thickness
an exclusion multi-rooted teeth, <1.0 mm
criterion) but distribution per Control: 3/10
group is unclear Experimental:
6/10
|
16 AVILA-ORTIZ et al.
F I G U R E 4 Diagram illustrating risk of bias for all selected randomized clinical trials
into nine treatment modalities, namely (a) bovine bone particles Cardaropoli et al., 2012, 2014, 2015; Festa et al., 2013; Guarnieri
(BBP) + SS, (b) construct made of 90% bovine bone granules and et al., 2017; Iasella et al., 2003; Iorio-Siciliano et al., 2017; Madan
10% porcine collagen (BBG/PC) + SS, (c) cortico-c ancellous por- et al., 2014; Pelegrine et al., 2010; Rasperini et al., 2010; Spinato
cine bone particles (CPBP) + SS, (d) allograft particles (AG) + SS, (e) et al., 2014), while mid-lingual changes were reported in nine stud-
alloplastic material (AP) with or without SS, (f) autologous blood- ies (Aimetti et al., 2009; Barone et al., 2013; Barone, Toti, Quaranta,
derived products (ABDP), (g) cell therapy (CTh), (h) recombinant et al., 2017; Festa et al., 2013; Guarnieri et al., 2017; Iasella et al.,
morphogenic protein-2 (rhBMP-2) and (i) SS alone. All these dif- 2003; Iorio-Siciliano et al., 2017; Madan et al., 2014; Spinato et al.,
ferent ARP modalities were compared to the control therapy (i.e. 2014) and mesial and distal changes in five studies (Aimetti et al.,
spontaneous socket healing) in each individual study. The specific 2009; Barone et al., 2013; Iasella et al., 2003; Iorio-Siciliano et al.,
distribution of the nine treatment modalities by study, subcatego- 2017; Madan et al., 2014). ARP therapies rendered more favourable
rized by primary or secondary intention healing, is displayed in results than the control for all these vertical parameters, except in one
Table 2. study in which there were no differences between groups in terms of
mesial and distal height changes (Iorio-Siciliano et al., 2017). In one
study, it was observed that sites exhibiting a buccal bone thickness
3.5 | Qualitative assessment of outcomes in
of more than 1 mm at baseline were associated with more favour-
selected studies
able horizontal, vertical mid-buccal and vertical mid-lingual linear
outcomes, regardless of the treatment group (Spinato et al., 2014).
3.5.1 | Clinical outcomes
The collected data pertaining to clinical outcomes of interest are dis- Linear and volumetric soft tissue changes
played in Table S1. Differences between groups in terms of horizontal soft tissue
changes were reported in four studies (Cardaropoli et al., 2012,
Horizontal bone changes 2014, 2015; Iasella et al., 2003; Jung et al., 2013; Schneider et al.,
Differences in horizontal bone changes between control and ex- 2014; Thalmair et al., 2013), while mid-buccal vertical soft tissue
perimental groups assessed by direct clinical measurement were changes were only reported in one study (Cardaropoli et al., 2012,
reported in eleven studies (Aimetti et al., 2009; Barone et al., 2013; 2014, 2015). None of the selected studies reported on mid-lingual
Barone, Toti, Quaranta, et al., 2017; Cardaropoli et al., 2012, 2014, vertical soft tissue changes between groups. Two studies reported
2015; Festa et al., 2013; Guarnieri et al., 2017; Iasella et al., 2003; soft tissue volumetric (contour) differences between control and
Iorio-Siciliano et al., 2017; Kotsakis et al., 2014; Pelegrine et al., different experimental groups (Barone, Toti, Menchini-Fabris, et al.,
2010; Spinato et al., 2014). In these studies, all ARP therapies ren- 2017; Thalmair et al., 2013). For all soft tissue parameters analysed,
dered more favourable results than the control. the results observed in association with the control group were con-
sistently inferior to the corresponding ARP treatment.
Vertical bone changes
Differences in vertical bone changes between control and experi- Implant-related outcomes
mental groups at the mid-buccal were reported in 12 studies (Aimetti Five studies reported on the feasibility of implant placement with
et al., 2009; Barone et al., 2013; Barone, Toti, Quaranta, et al., 2017; no additional bone grafting (Barone et al., 2013; Cardaropoli et al.,
TA B L E 2 Distribution of treatment modalities by study, subcategorized by primary (orange shading) or secondary intention healing (green shading)
AVILA-ORTIZ et al.
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17
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18 AVILA-ORTIZ et al.
Complications
3.6 | Pooled estimates (Quantitative Analyses)
Only four studies reported the occurrence of complications (Alissa
et al., 2010; Araujo et al., 2015; Fiorellini et al., 2005; Temmerman Meta-a nalyses were only performed if at least two studies within
et al., 2016), but there did not seem to be a pattern of association the same ARP treatment modality reported on the same outcome
with any particular therapy. of interest. As depicted in Figure 3, of the 22 RCTs included in
this systematic review, 16 studies (Aimetti et al., 2009; Araujo
et al., 2015; Barone et al., 2013; Barone, Toti, Menchini-Fabris,
3.5.2 | Radiographic outcomes
et al., 2017; Barone, Toti, Quaranta, et al., 2017; Cardaropoli et al.,
All radiographic outcomes of interest are shown in Table S1. 2012, 2014, 2015; Festa et al., 2013; Guarnieri et al., 2017; Iasella
Differences between control and experimental groups in et al., 2003; Iorio-S iciliano et al., 2017; Jung et al., 2013; Kotsakis
terms of radiographic horizontal bone linear changes measured in et al., 2014; Madan et al., 2014; Rasperini et al., 2010; Schneider
CBCT scan images were reported in four studies (Fiorellini et al., et al., 2014; Spinato et al., 2014; Thalmair et al., 2013) could be
2005; Jung et al., 2013; Pang et al., 2014; Schneider et al., 2014; employed to conduct meta-a nalyses for a total of six comparisons.
Temmerman et al., 2016), while data on mid-buccal and mid-lingual Studies were subdivided in function of the anatomy of the
lingual radiographic changes were available in five (Araujo et al., treated extraction sites (single-or multi-rooted) when feasible.
2015; Fiorellini et al., 2005; Jung et al., 2013; Karaca et al., 2015;
Schneider et al., 2014; Temmerman et al., 2016) and four studies
3.6.1 | Comparison 1—All bone substitutes
(Araujo et al., 2015; Jung et al., 2013; Karaca et al., 2015; Schneider
versus Control
et al., 2014; Temmerman et al., 2016), respectively. None of the se-
lected studies reported on radiographic linear changes at mesial and Three outcomes of interest could be analysed.
distal sites. For all linear radiographic parameters, ARP therapies
consistently rendered more favourable results than the control, with Outcome 1.1. Clinical horizontal bone change (mm):
the exception of two studies (Araujo et al., 2015; Jung et al., 2013). There was strong evidence of a reduced amount of alveolar bone
In the trial by Araujo et al., the control group exhibited slightly better resorption for ARP-SG using a bone substitute compared to control
results in terms of radiographic mid-buccal and mid-lingual vertical therapy (p < 0.00001, MD = 1.99 mm, 95% CI 1.54–2.44, χ2 = 96.82,
reduction as compared to the experimental therapy (BBG/PC + SS); df = 11, p < 0.00001, I2
= 89.0%). Particulate bovine xenografts
however, these differences were not clinically or statistically signifi- (MD = 2.24 mm, CI 0.10–4.39), porcine xenografts (MD = 2.25 mm,
cant. In the study by Jung et al., one of the three experimental ther- CI 1.86–2.64) and particulate allografts (MD = 2.01 mm, CI 0.54–
apies, which consisted of the application of an alloplast (βTCP with a 3.48), in combination with an absorbable collagen membrane or a
polylactide–co-glycolide coating) without any additional membrane, rapidly absorbable sponge, rendered more favourable results than
rendered significantly inferior results as compared to the control in collagenated bovine xenografts covered with a collagen membrane
terms of horizontal (−6.1 ± 2.5 mm vs. 3.3 ± 2.0 mm), mid-buccal (MD = 1.20 mm, CI 0.14–2.26) or alloplastic materials left exposed or
(−2.0 ± 2.4 mm vs. −0.5 ± 0.9 mm) and mid-lingual linear changes covered with a rapidly absorbable collagen sponge (MD = 1.25 mm,
(−1.7 ± 0.6 mm vs. −0.6 ± 0.6 mm). CI 0.79–1.71), as displayed in Figure 5.
Only one study reported on bone volumetric outcomes (Pang
et al., 2014), revealing less contour reduction in the experimen- Outcome 1.2. Clinical vertical mid-buccal bone change (mm):
tal group compared to the control (−262.06 ± 33.08 mm3 vs. There was strong evidence of a reduced amount of alveolar
−342.32 ± 36.41 mm3). Similarly, data on peri-implant marginal bone bone resorption for ARP-S G using a bone substitute (i.e. xeno-
level changes were available only in one study (Cardaropoli et al., graft with SS, allograft with SS or alloplastic material without
2012, 2014, 2015). In this study, mesial and distal pooled marginal SS) compared to control therapy (p < 0.00001, MD = 1.72 mm,
bone changes were virtually the same between the experimental 95% CI 0.96–2.48, χ 2 = 479.96, df = 10, p < 0.00001, I 2 = 98.0%).
and the control group (0.33 ± 0.28 vs. 0.35 ± 0.28). Collagenated bovine xenografts covered with a collagen
AVILA-ORTIZ et al. |
19
Outcome 3.2. Radiographic vertical mid-buccal bone change (mm): Outcome 4.2. Clinical vertical mid-buccal bone change (mm):
There was insufficient evidence of a difference between BBG/ There was evidence of a reduced amount of alveolar bone re-
PC + SS (with autologous soft tissue punch) and control (p = 0.75, sorption for CPBP + SS (with a porcine collagen membrane or au-
MD = 0.37 mm, 95% CI −1.86 to 2.59, χ2 = 5.28, df = 1, p = 0.02, tologous tissue punch) compared to control therapy (p < 0.0001,
I2 = 81.0%). MD = 1.76 mm, 95% CI 1.29–2.23, χ2 = 14.15, df = 3, p = 0.003,
I2 = 79.0%).
Outcome 3.3. Radiographic vertical mid-lingual bone change (mm):
There was insufficient evidence of a difference between BBG/ Outcome 4.3. Clinical vertical mid-lingual bone change (mm):
PC + SS (with autologous soft tissue punch) and control (p = 0.76, There was evidence of a reduced amount of alveolar bone resorp-
MD = 0.13 mm, 95% CI −0.70 to 0.96, χ2 = 4.00, df = 1, p = 0.05, tion for CPBP + SS (with a porcine collagen membrane or autologous
I2 = 75.0%). tissue punch) compared to control therapy (p < 0.0001, MD = 1.82 mm,
95% CI 0.99–2.65, χ2 = 11.89, df = 3, p = 0.003 I2 = 83.0%).
There was insufficient evidence of a difference between membrane or sponge) compared to control therapy (p < 0.00001,
CPBP + SS (with a porcine collagen membrane or autologous tissue MD = 1.33 mm, 95% CI 0.81–1.86, χ2 = 3.35, df = 2, p = 0.19,
punch) and control (p = 0.20, MD = 0.39 mm, 95% CI −0.20 to 0.97, I 2 = 40.0%). Data from one study (Spinato et al., 2014) revealed
2 2
χ = 5.00, df = 1, p = 0.03, I = 80.0%). that sites exhibiting >1 mm of buccal bone thickness at baseline
underwent less vertical mid-b uccal bone resorption, as compared
to sites presenting a buccal bone thickness of ≤1 mm (average
horizontal bone reduction values were 0.88 ± 0.3 mm in sites
3.6.5 | Comparison 5—AG with SS versus Control
with thick bone and 1.44 ± 0.2 mm in sites with thin bone).
Three outcomes of interest could be analysed.
Outcome 5.1. Clinical horizontal bone change (mm): Outcome 5.3. Clinical vertical mid-lingual bone change (mm):
There was evidence of a reduced amount of alveolar bone re- There was evidence of a reduced amount of alveolar bone re-
sorption for AG (freeze-dried bone particles) + SS (with a collagen sorption for AG (freeze-dried bone particles) + SS (with a collagen
membrane or sponge) compared to control therapy (p = 0.008, membrane or sponge) compared to control therapy (p = 0.0001,
MD = 2.01 mm, 95% CI 0.54–3.48, χ2 = 29.71, df = 2, p < 0.00001, MD = 1.17 mm, 95% CI 0.57–1.78, χ2 = 4.09, df = 2, p = 0.13,
I2 = 93.0%). Noteworthy, data from one study (Spinato et al., 2014) I2 = 51.0%). Buccal bone thickness did not appear to influence the
revealed that sites exhibiting >1 mm of buccal bone thickness at outcomes for this specific clinical parameter (Spinato et al., 2014).
baseline underwent less horizontal bone resorption, as compared
to sites presenting a buccal bone thickness of ≤1 mm (average
horizontal bone reduction values were 1.29 ± 0.2 mm in sites with
thick bone and 3.22 ± 0.2 mm in sites with thin bone).
3.6.6 | Comparison 6—AP with or without SS
Outcome 5.2. Clinical vertical mid-buccal bone change (mm):
versus Control
There was evidence of a reduced amount of alveolar bone re- Three outcomes of interest could be analysed.
sorption for AG (freeze-d ried bone particles) + SS (with a collagen Outcome 6.1. Clinical horizontal bone change (mm):
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22 AVILA-ORTIZ et al.
There was evidence of a reduced amount of alveolar bone re- 2010; Rasperini et al., 2010; Schneider et al., 2014; Spinato
sorption for AP (calcium sulphate hemihydrate or calcium phospho- et al., 2014; Temmerman et al., 2016; Thalmair et al., 2013), as
silicate putty) with (rapidly absorbable collagen sponge) or without shown in Table 2. Third, outcomes of interest relevant to the
SS compared to control therapy (p < 0.00001, MD = 1.25 mm, 95% aim of this review (i.e. critically analyse the available evidence
CI 0.79–1.71, χ2 = 0.02, df = 1, p = 0.90, I2 = 0%). regarding the effect of different modalities of ARP as com-
pared to extraction alone) were selected and subdivided into
Outcome 6.2. Clinical vertical mid-buccal bone change (mm): three categories (i.e. clinical, radiographic and patient-r eported
Although the weighed MD showed a positive effect in fa- outcomes). Histologic and histomorphometric outcomes were
vour of the ARP-SG therapy, there was insufficient evidence of a intentionally not included in this systematic review. This is be-
difference between AP (calcium sulphate hemihydrate or poly- cause, although pertinent to gain further understanding on the
lactide–polyglycolide sponge) without SS and control therapy biological characteristics of the tissue formed following the ap-
(p = 0.14, MD = 2.21 mm, 95% CI −0.73 to 5.15, χ2 = 113.49, df = 1, plication of different biomaterials (Barallat et al., 2014; Chan
p < 0.00001, I2 = 99.0%). et al., 2013; Corbella et al., 2017), they do not provide valuable
information to evaluate the effect of ARP as an approach that is
Outcome 6.3. Clinical vertical mid-lingual bone change (mm): primarily aimed at minimizing the reduction of the alveolar ridge
Although the weighed MD showed a positive effect in favour after tooth extraction to subsequently facilitate implant place-
of the ARP-SG therapy, there was insufficient evidence of a differ- ment, and to enhance implant and patient-r eported outcomes.
ence between AP (calcium sulphate hemihydrate or polylactide– Fourth, quantitative analyses were only performed if at least
polyglycolide sponge) without SS and control therapy (p = 0.12, two studies within the same ARP treatment modality reported
MD = 0.69 mm, 95% CI −0.17 to 1.54, χ2 = 8.70, df = 1, p = 0.003, on the same outcome of interest.
I2 = 89.0%).
3.2, 3.3, 4.4, 4.5 and 6.3), although in favour of ARP-S G therapy,
4.2.2 | Quantitative analyses of
there was insufficient evidence to claim superiority over the con-
outcomes of interest
trol, as the MD was ≤0.6 mm for all comparisons. Interestingly,
Quantitative analyses for Comparison 1 revealed that ARP-S G the vast majority of comparisons (16 out of 18) were based on
using a bone substitute (i.e. xenograft with SS, allograft with SS clinical outcome measures, which illustrates the need for further,
or alloplastic material with or without SS) was clearly superior well-conducted RCTs involving the collection of radiographic and
to the control in terms of preservation of horizontal bone width patient-reported data using standardized methods. It is important
(1.99 mm [95% CI: 1.54–2.44; p < 0.00001]), mid-b uccal bone to remark that one of the potential limitations of this systematic
height (1.72 mm [95% CI: 0.96–2.48; p < 0.00001]) and mid- review is the total number of studies included in some of the sub-
lingual bone height (1.99 mm [95% CI: 0.81–1.52; p < 0.00001]), category meta-a nalyses, which calls for caution when interpreting
measured clinically. Overall, these findings are in alignment these findings.
with the results of quantitative analyses reported in previous Another option for the assessment of the effects of different
systematic reviews on this topic (Atieh et al., 2015; Avila-O rtiz ARP treatment modalities would have been the use of Bayesian
et al., 2014; MacBeth et al., 2017; Troiano et al., 2017; Vignoletti network meta-analysis. This type of estimates has been proposed
et al., 2012; Vittorini Orgeas et al., 2013; Willenbacher et al., to increase the statistical power, as well as to permit indirect com-
2016). parisons among different therapies with the purpose of facilitating
Additionally, this systematic review, which to our knowledge rep- the clinical applicability of the findings (Ades et al., 2006; Faggion,
resents the most comprehensive analysis of the evidence regarding Chambrone, Listl, & Tu, 2013; Rabelo et al., 2015; Tu, Needleman,
the effect of ARP compared to extraction alone to date, involved Chambrone, Lu, & Faggion, 2012). Bayesian network meta-
the conduction of pooled estimates exploring the effect of specific analyses may be conducted if the studies of interest present simi-
ARP-SG treatment modalities. Several of these specific analyses pro- lar clinical scenarios and a comparable methodology. However, the
vided strong evidence indicating that ARP-SG therapy was superior precision of these analyses can be significantly reduced if the in-
to the control, particularly in terms of horizontal, mid-buccal and herent characteristics of the studies are substantially discrepant.
mid-lingual bone preservation measured clinically. This is shown in Therefore, in the light of the high degree of clinical heterogeneity
the forest plots for Outcomes 2.1 (clinical horizontal bone change that exists between the majority of trials included (e.g. smoking
between control and BBP + SS for a MD of 2.24 mm), 4.1 (clinical habits, anatomy and integrity of the sockets, flap elevation, fol-
horizontal bone change between control and CPBP + SS for a MD low-up period and methods use for the assessment of outcomes,
of 2.25 mm), 4.2 (clinical vertical mid-buccal bone change between among others), the conduction of a network meta-analysis was not
control and CPBP + SS for a MD of 1.76 mm), 4.3 (clinical vertical justified, which could be considered a limitation of this systematic
mid-buccal bone change between control and CPBP + SS for a MD review.
of 1.82 mm), 5.1 (clinical horizontal bone change between control
and AG + SS for a MD of 2.01 mm), 5.2 (clinical vertical mid-buccal
4.2.3 | Potential influence of local and systemic
bone change between control and AG + SS for a MD of 1.33 mm),
factors on outcomes of interest
5.3 (clinical vertical mid-lingual bone change between control and
CPBP + SS for a MD of 1.17 mm) and 6.1 (clinical horizontal bone With the exception of buccal bone thickness (in Comparison 5),
change between control and AP with and without SS for a MD of the effect of other local and systemic factors in the observed
1.25 mm). For these comparisons, xenograft and allografts rendered outcomes could not be assessed as part of the quantitative
more favourable results than alloplastic materials, which is in agree- analyses. This is mainly due to insufficient data reported and/
ment with the findings from a previous systematic review (Avila- or marked methodological discrepancies in the study protocols
Ortiz et al., 2014). of the selected clinical trials. For example, influence of history
Although the weighed MD showed a strong positive effect in of periodontitis could not be assessed, since it was not reported
favour of the ARP-S G therapy for Outcomes 3.1 (clinical horizon- in any of the articles included in this review. Also, feasibility of
tal bone change between control and BBG/PC + SS for a MD of implant placement with no need for ancillary grafting could not
2.62 mm) and 6.2 (clinical vertical mid-b uccal bone change be- be analysed because this is a dichotomic variable associated to
tween control and AP for a MD of 2.21 mm), the strength of the a high level of subjectivity. Whether the presence of an alveolar
evidence may be questionable due to the marked heterogeneity bone defect influences the outcomes of ARP therapy could not
observed between pooled studies. This could be explained on be ascertained either, due to the wide heterogeneity of eligibil-
the basis of important methodological differences. For example, ity criteria and clinical descriptions provided in the few selected
one of the two RCTs that evaluated the effect of BBG/PC + SS in studies that included non-intact extraction sites (Barone, Toti,
terms of clinical horizontal bone change (i.e. Outcome 2.1) only Quaranta, et al., 2017; Fiorellini et al., 2005; Guarnieri et al.,
included molar sites (Rasperini et al., 2010), while the other trial 2017; Jung et al., 2013; Rasperini et al., 2010; Schneider et al.,
combined the data obtained from single-rooted and multi-rooted 2014; Temmerman et al., 2016). Similarly, the effect of sealing
sites (Iorio-S iciliano et al., 2017). For the rest of the outcomes (i.e. the alveolar socket as a sole modality could not be assessed
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24 AVILA-ORTIZ et al.
C O N FL I C T O F I N T E R E S T Avila-Ortiz, G., Elangovan, S., Kramer, K. W., Blanchette, D., & Dawson, D.
V. (2014). Effect of alveolar ridge preservation after tooth extraction:
Gustavo Avila-Ortiz declares having received support for the con- A systematic review and meta-analysis. Journal of Dental Research,
duction of research projects and lecture fees from Osteogenics 93, 950–958. https://doi.org/10.1177/0022034514541127
Barallat, L., Ruiz-Magaz, V., Levi, P. A. Jr, Mareque-Bueno, S., Galindo-
Biomedical, Geistlich Pharma and Dentsply Implants, and support
Moreno, P., & Nart, J. (2014). Histomorphometric results in ridge
to conduct research from Sunstar Americas and BioHorizons. He is
preservation procedures comparing various graft materials in ex-
also a member of the Osteology Foundation Expert Council and the traction sockets with nongrafted sockets in humans: A systematic
developing team of The Box (https://box.osteology.org). review. Implant Dentistry, 23, 539–554. https://doi.org/10.1097/
Fabio Vignoletti declares having received support for the conduc- ID.0000000000000124
Barone, A., Ricci, M., Tonelli, P., Santini, S., & Covani, U. (2013). Tissue
tion of research projects and lecture fees from Sunstar, Osteogenics
changes of extraction sockets in humans: A comparison of spon-
Biomedical, Dentium, Osteology Foundation, Geistlich Pharma, MIS taneous healing vs. ridge preservation with secondary soft tissue
Implants and Sweden Martina. healing. Clinical Oral Implants Research, 24, 1231–1237. https://doi.
Dr. Leandro Chambrone declares no conflicts of interest. org/10.1111/j.1600-0501.2012.02535.x
Barone, A., Toti, P., Menchini-Fabris, G. B., Derchi, G., Marconcini, S.,
& Covani, U. (2017). Extra oral digital scanning and imaging su-
perimposition for volume analysis of bone remodeling after tooth
ORCID
extraction with and without 2 types of particulate porcine mineral
Gustavo Avila-Ortiz https://orcid.org/0000-0002-5763-0201 insertion: A randomized controlled trial. Clinical Implant Dentistry
and Related Research, 19, 750–759. https://doi.org/10.1111/
Leandro Chambrone https://orcid.org/0000-0002-2838-1015 cid.12495
Fabio Vignoletti https://orcid.org/0000-0002-4574-3671 Barone, A., Toti, P., Quaranta, A., Alfonsi, F., Cucchi, A., Negri, B., …
Nannmark, U. (2017). Clinical and Histological changes after ridge
preservation with two xenografts: Preliminary results from a mul-
ticentre randomized controlled clinical trial. Journal of Clinical
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28 AVILA-ORTIZ et al.
How to cite this article: Avila-Ortiz G, Chambrone L, Hauser et al. (2013) Surgical re-entry at 8 weeks and no
outcomes of interest reported
Vignoletti F. Effect of alveolar ridge preservation
Suttapreyasri et al. (2013) Assessment of outcomes at 8 weeks
interventions following tooth extraction: A systematic review
maximum
and meta-analysis. J Clin Periodontol. 2019;00:1–29. https://
doi.org/10.1111/jcpe.13057
AVILA-ORTIZ et al. |
29
Articles excluded Reason for exclusion Articles excluded Reason for exclusion
Avila-Ortiz et al. (2014) Invalid control group (a collagen plug Fickl et al. (2017) Outcomes of interest not reported as
was applied) a mean value and the corresponding
Barboza et al. (2014) No outcomes of interest reported SD
Kim et al. (2014) Invalid control group (bone graft was Geishari et al. (2017) Invalid control group (bone graft was
applied) applied)
Lindhe et al. (2014) No outcomes of interest reported Jiang et al. (2017) No outcomes of interest reported
Mahesh et al. (2014) No outcomes of interest reported Joshi et al. (2017) Invalid control group (socket was
sealed with a membrane)
De Sarkar et al. (2015) No outcomes of interest reported
Kivovics et al. (2017) No outcomes of interest reported
Flügge et al. (2015) No outcomes of interest reported
Levi et al. (2017) Assessment of outcomes between 6
Goh et al. (2015) Invalid control group (socket was and 11 months
sealed by flap advancement)
Mozzati et al. (2017) No outcomes of interest reported
Loveless et al. (2015) No outcomes of interest reported Assessment of outcomes at 8 weeks
Ribeiro et al. (2015) No outcomes of interest reported maximum
Abdelhamid et al. (2016) No outcomes of interest reported Sbordone et al. (2017) Non-randomized clinical trial
Araujo-Pires et al. (2016) No outcomes of interest reported Walker et al. (2017) Invalid control group (a collagen plug
Joshi et al. (2016) Invalid control group (socket was was applied)
sealed with a membrane) Aimetti et al. (2018) Assessment of outcomes at
Mayer et al. (2016) Invalid control group (socket was 12 months
sealed by flap advancement) Al Qabbani et al. (2018) Invalid control group (socket was
Pang et al. (2016) Insufficient information to collect sealed with a membrane)
data for any outcomes of Kumar et al. (2018) Not a proper split-mouth RCT
interest Nunes et al. (2018) Invalid control group (a collagen
Zadeh et al. (2016) No outcomes of interest reported membrane was applied)
Alzahrani et al. (2017) Assessment of outcomes at 8 weeks Tomasi et al. (2018) Invalid control group (a collagen
maximum membrane was applied)
Zhao et al. (2018) Non-randomized clinical trial