Xenograft Versus Extraction Alone for Ridge Preservation After Tooth Removal: A Clinical and Histomorphometric Study

BACKGROUND: The preservation of bone volume immediately after tooth removal might be necessary to optimize the success of implant placement in terms of esthetics and function. The objectives of this randomized clinical trial were two-fold: 1) to compare the bone dimensional changes following tooth extraction with extraction plus ridge preservation using corticocancellous porcine bone and a collagen membrane; and 2) to analyze and compare histologic and histomorphometric aspects of the extraction-alone sites to the grafted sites. METHODS: Forty subjects who required tooth extraction and implant placement were enrolled in this study. Using a computer-generated randomization list, the subjects were randomly assigned to the control group (EXT; extraction alone) or to the test group (RP; ridge-preservation procedure with corticocancellous porcine bone and collagen membrane). The following parameters were assessed immediately after extraction and 7 months prior to implant placement: plaque index, gingival index, bleeding on probing, horizontal ridge width, and vertical ridge changes. A bone biopsy was taken from the control and test sites 7 months after the surgical treatment. Histologic and histomorphometric analyses were also performed. RESULTS: A significantly greater horizontal reabsorption was observed at EXT sites (4.3+/-0.8 mm) compared to RP sites (2.5+/-1.2 mm). The ridge height reduction at the buccal side was 3.6+/-1.5 mm for the extraction-alone group, whereas it was 0.7+/-1.4 mm for the ridge-preservation group. Moreover, the vertical change at the lingual sites was 0.4 mm in the ridge-preservation group and 3 mm in the extraction-alone group. Forty biopsies were harvested from the experimental sites (test and control sites). The biopsies harvested from the grafted sites revealed the presence of trabecular bone, which was highly mineralized and well structured. Particles of the grafted material could be identified in all samples. The bone formed in the control sites was also well structured with a minor percentage of mineralized bone. The amount of connective tissue was significantly higher in the extraction-alone group than in the ridge-preservation group. CONCLUSIONS: The ridge-preservation approach using porcine bone in combination with collagen membrane significantly limited the resorption of hard tissue ridge after tooth extraction compared to extraction alone. Furthermore, the histologic analysis showed a significantly higher percentage of trabecular bone and total mineralized tissue in ridge-preservation sites compared to extraction-alone sites 7 months after tooth removal.