Abstract
Ways of keeping enough jaw bone to allow for dental implants after teeth have been taken out
Review question
The aim of this review is to assess the effectiveness of various materials and techniques for keeping enough bone in the jaw (alveolar ridge preservation) after teeth have been taken out (tooth extraction). These techniques are compared to tooth extraction alone or other methods of preserving the bone, or both, in patients that need dental implants after the tooth socket has healed.
Background
When a tooth has been taken out, the bone around the tooth socket shrinks. Artificial teeth can be used to replace missing teeth following extractions. However, loss of bone width and depth after tooth extraction can affect how successful the implant will be. This is especially the case when artificial teeth (crowns or bridges) need to be held in place by dental implants inserted into the bone of the jaw where the original teeth used to be. If the bone has shrunk too much following the loss of teeth, it makes it difficult or impossible to put dental implants into the jaw. This in turn leads to gum shrinkage.
A procedure known as socket preservation (ARP) may limit the shrinkage of bone following tooth loss although there is a need for evidence of its effectiveness. Several techniques and bone substitute materials can be used to fill the socket after tooth extraction. The socket may then be covered by gums or an artificial membrane and left to heal for several months. The aim is that the bone of the old tooth socket will have kept its shape and size allowing dental implants to be inserted to support crowns or bridges so that the patient’s appearance is improved and they can eat, talk and socialise with confidence. It is also hoped that the rate of failure of dental implants will be improved.
Study characteristics
Authors from Cochrane Oral Health carried out this review and the evidence is up to date from 22 July 2014. Eight trials were included with a total of 233 extraction sites (teeth taken out) in 184 participants. Participants were adults aged 18 years or older, in good general health, needing one or more permanent teeth to be taken out and the consideration of the use of ARP (alveolar ridge preservation techniques) with the possibility of using dental implants at a later date.
The review looked at the effects of four techniques and materials used for preserving the tooth extraction socket.
Three studies compared socket preservation to tooth extraction alone, while five studies compared two or more different materials.
Key results
There is limited evidence that socket preservation (ARP) can reduce bone loss compared to tooth extraction alone to allow for dental implant placement.
There is no evidence that socket preservation makes any important differences to the look or lasting quality of crowns or bridges.
There is no convincing evidence of any significant difference between different materials and barriers used for socket preservation.
Quality of the evidence
The quality of the evidence is judged as low due to high risk of bias of the majority of the included studies. Some evidence of reporting bias is suspected, as only two of the included trials did not receive any industry support. Further long‐term randomised controlled trials that follow CONSORT guidelines (
www.consort‐statement.org
) are required.