Ridge Preservation Techniques to Avoid Invasive Bone Reconstruction: A Systematic Review and Meta-analysis: Naples Consensus Report Working Group C

Purpose: To analyse and compare the dimensional changes of unassisted extraction sockets with alveolar ridge preservation (ARP) techniques and investigate any factors that impact the resorption of the alveolar bone.

Materials And Methods: A systematic search was conducted to identify randomised clinical trials (RCTs). All data were extracted, and a meta-analysis was performed for the changes in all buccolingual ridge width, midbuccal and midlingual ridge height, and mesial and distal ridge height, and horizontal width at reference points apical to the crestal area.

Results: Based on 14 RCTs, the effectiveness of ARP in reducing the dimensions of the postextraction alveolar socket was confirmed. The clinical magnitude of this effect was 1.95 mm in the buccolingual ridge width, 1.62 mm in the midbuccal ridge height, and 1.26 mm on the midlingual ridge height. Additionally, 0.45 mm and 0.34 mm for mesial and distal ridge height, and 1.21 mm, and 0.76 mm for ridge width changes at points 3 and 5 mm apical to the crest were noted. Meta-regression analyses revealed that the reflection of flaps and primary wound coverage during ARP may have detrimental effects on bone remodelling, while no statistical significance was observed for any of the bone graft substitutes or the percentage of molar sockets.

Conclusions: Regardless of the protocol, ARP can only minimise ridge resorption. ARP is most effective on horizontal ridge width, providing the most benefit coronally (approximating the crest), followed by the midbuccal ridge height.