Alveolar Ridge Preservation with The Use of Demineralized Bone Matrix Putty: Clinical, Radiographic and Histological Observations in A Case Series

Abstract

Alveolar ridge preservation (ARP) can minimize alveolar ridge resorption following tooth ex¬traction and facilitate restorative-driven implant placement. Demineralized bone matrix (DBM) comprises a human allograft that is osteoinductive and osteoconductive. This report describes radiographic, histologic and clinical findings of ARP using DBM putty and non-resorbable high-density polytetrafluoroethylene (d-PTFE) membrane in three cases. Materials and Methods: From January 2018 to May 2018, three patients underwent the ARP procedure. The surgery involved atraumatic extraction, socket debridement, filling the socket with DBM putty, applying a d-PTFE membrane, and suturing with 5-0 nylon. After healing for 6–7 months, an implant was placed and biopsy specimens were collected simultaneously. Using the same customized surgical stent and computed tomography, the preoperative and postoperative alveolar ridge heights and widths were measured. Histological evaluations in¬cluding the percentage of newly formed bone, residual graft particles, and fibrous connective tissue were performed. Results: In all three cases, the health status of the hard and soft tissue improved (mean fol¬low-up: 54 months). Guided bone regeneration was not required during implant placement. Radiographically, the mean change was 0.5 mm in the alveolar ridge height and 1.2, 0.87, and 0.73 mm in the alveolar ridge width at 2, 4, and 6 mm apical to the initial vertical measure¬ment, respectively. Histologically, the mean percentage of new bone, residual graft particles, and fibrous connective tissue was 40.5±5.9%, 10.7±6.9%, and 48.8±9.6%, respectively, and the voids were not included in these calculations. Conclusion: This case series demonstrated the effectiveness of DBM putty as a biocompatible filler in extraction sockets for ridge preservation prior to implantation. Further longitudinal studies regarding the efficacy and stability of DBM putty in ridge preservation are required.