J Periodontal Implant Sci.  2017 Feb;47(1):51-63. 10.5051/jpis.2017.47.1.51.

A comparison of different compressive forces on graft materials during alveolar ridge preservation

• Cho IW
• Park JC
• Shin HS

• KMID: 2368887
• DOI: http://doi.org/10.5051/jpis.2017.47.1.51

Abstract

PURPOSE
Following tooth extraction, alveolar ridge preservation (ARP) can maintain the dimensions of ridge height and width. Although previous studies have demonstrated the effects of ARP, few if any studies have investigated the compressive force applied during grafting. The aim of this study was to determine the effects of different compressive forces on the graft materials during ARP.
METHODS
After tooth extraction, sockets were filled with deproteinized bovine bone mineral with 10% porcine collagen and covered by a resorbable collagen membrane in a double-layered fashion. The graft materials were compressed using a force of 5 N in the test group (n=12) and a force of 30 N in the control group (n=12). A hidden X suture was performed to secure the graft without primary closure. Cone-beam computed tomography (CBCT) was performed immediately after grafting and 4 months later, just before implant surgery. Tissue samples were retrieved using a trephine bur from the grafted sites during implant surgery for histologic and histomorphometric evaluations. Periotest values (PTVs) were measured to assess the initial stability of the dental implants.
RESULTS
Four patients dropped out from the control group and 20 patients finished the study. Both groups healed without any complications. The CBCT measurements showed that the ridge volume was comparably preserved vertically and horizontally in both groups (P>0.05). Histomorphometric analysis demonstrated that the ratio of new bone formation was significantly greater in the test group (P<0.05). The PTVs showed no significant differences between the 2 groups (P>0.05).
CONCLUSIONS
The application of a greater compressive force on biomaterials during ARP significantly enhanced new bone formation while preserving the horizontal and vertical dimensions of the alveolar ridge. Further studies are required to identity the optimal compressive force for ARP.

Keyword

Alveolar bone grafting; Alveolar ridge augmentation; Histology; Tooth extraction

MeSH Terms

Alveolar Bone Grafting
Alveolar Process*
Alveolar Ridge Augmentation
Biocompatible Materials
Collagen
Cone-Beam Computed Tomography
Dental Implants
Humans
Membranes
Miners
Osteogenesis
Sutures
Tooth Extraction
Transplants*
Vertical Dimension
Biocompatible Materials
Collagen
Dental Implants

Figure

• 

  Figure 1 Digital force gauge (Model DS2-50 N, Imada, Tokyo, Japan) (left) and extension shaft (right), (unit=mm).

• 

  Figure 2 The measurement parameters of horizontal and vertical changes in radiographic images. HW1, change in horizontal ridge width 1 mm; HW3, change in horizontal ridge width 3 mm; HW5, change in horizontal ridge width 5 mm; VHB, change in ridge height at the buccal crest; VMC, change in the vertical height measured at the mid-crestal area; VHL, change in ridge height at the lingual crest.

• 

  Figure 3 Clinical photographs showing the procedures from extraction to implantation. The clinical procedures were identical in the 2 groups except for the magnitude of the compressive force used in bone grafting. (A) Preoperative; (B) Extraction; (C) Bone grafting; (D) Double-layered membrane; (E) Hidden X suture; (F) Stitch-out; (G) 1 month; (H) 3 months; (I) Biopsy and flap elevation; (J) Implantation and suture; (K) 2 weeks; (L) 2 months.

• 

  Figure 4 Comparison of radiographic images taken after the ridge preservation (baseline) and after 4 months of healing before the implantation. (A) Baseline, test group; (B) 4 months later, test group; (C) Baseline, control group; (D) 4 months later, control group. White arrows indicate the apical boundary of the extraction socket. The graft materials are well impacted in the test group (30 N of compressive force), whereas an area of radiolucency can be observed along the boundary in the control group (5 N of compressive force), (scale bar=1 cm).

• 

  Figure 5 Representative image of histologic specimens of the test group (30 N of compressive force). Hematoxylin and eosin (left panels, A, B, C, D) and Masson trichrome (right panels, E, F, G, H) staining. The inset boxes in the less magnified image indicate the relevant areas in the more magnified images.

• 

  Figure 6 Representative image of histologic specimens from the control group (5 N of compressive force). Hematoxylin and eosin (left panels, A, B, C, D) and Masson trichrome (right panels, E, F, G, H) staining. The inset boxes in the less magnified image indicate the relevant areas in the more magnified images.

• 

  Figure 7 Box plot with whiskers for PTVs of the control and test groups. PTV, Periotest value.

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