20 December 2021

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How to prevent Bone Resorption: ESP Techniques

Alessandra Abbà

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Tooth extraction causes vertical and horizontal alveolar bone resorption with a spontaneous volumetric hard and soft tissue remodeling. This unfavourable healing could also lead to further difficulty in restoration with a compromised aesthetic outcome.
To prevent bone resorption process various surgical techniques were suggested. One of this is the extraction socket preservation (ESP) procedure with the use of membranes and graft materials used alone or combined. The use of membrane alone in ESP aim to exclude soft tissues from the wound allowing osteogenic cells to colonize the osseous defect. On the other hand, graft materials provide a mechanical support to the membrane during the healing.  

Material and Methods
 The aim of this randomized controlled study was to compare and evaluate the clinical outcomes of three techniques. 30 patients underwent a single-tooth extraction in the premolar/molar areas. Post-extraction sites were treated with the following procedures with a random distribution:
1. Group M: ESP with a collagen membrane alone (10 sites);
2. Group GM: ESP with a collagen membrane and porcine-derived bone (10 sites);
3. Group S: natural spontaneous healing (10 sites).
Alveolar ridge dimension were measured after tooth extraction and after 3-month.

Results
- Group M: vertical -0.55 [SD 0.11] mm, and horizontal -1.21 [SD 0.69] mm;
- Group GM:  vertical -0.37 [SD 0.7] mm, and horizontal -0.91 [SD 0.53] mm;
- Group S: vertical -2.09 [SD 0.19] mm, and horizontal -3.96 [SD 0.87] mm.
The vertical and horizontal bone changes at the extraction sockets of group M and group GM were significantly lower (P < 0.001) compared to group S.

Conclusions
An entire prevention of the bone remodeling is not possible, especially in the vestibular side, regardless of the technique used. Nonetheless some procedures such as socket preservation with membrane alone or together with graft materials may help to compensate the reabsorption of the alveolar ridge compared to a natural healing.

For additional information:  Extraction Socket Preservation Using Porcine-Derived Collagen Membrane Alone or Associated with Porcine-Derived Bone. Clinical Results of Randomized Controlled Study