Extra oral digital scanning and imaging superimposition for volume analysis of bone remodeling after tooth extraction with and without 2 types of particulate porcine mineral insertion: A randomized controlled trial

Background: Incorporation of bone substitute material into the extraction socket could minimize the edentulous ridge volume loss or maximize the bone formation within the healing area. Purpose: The aim of the study was to test the effectiveness in maintaining the volumetric contour of fresh extraction sockets grafted with or without 2 types of porcine biomaterials and covered with a resorbable barrier. Materials and Methods: In the present multi-center single-blind randomized control trial, 55 patients underwent 1-tooth extraction, were surveyed, and randomly allocated to control- (25 sites, nat-group) or test groups (15 sites grafted with pre-hydrated collagenated cortico-cancellous porcine bone, coll-group, and 15 with cortical porcine bone, cort-group). Before extraction, and then 4 months later, contours of the sockets were acquired through a laser scanner, voxelized, and ghosts of each patient were superimposed with a matrix laboratory. Volumetric and area evaluations of the virtual superimposed models were performed with dentascan tools to create a volume of interest extending between the 2 residual teeth. Intra- and inter-group comparisons of the outcomes were performed. Non-parametric tests were applied with a level of significance set at P <.05. Results: Intergroup analysis at 4 months' survey revealed that percentage loss of alveolar ridge volume of the coll-group (28.8% ± 8.8%) and of the cort-group (30.2% ± 7.1%) was significantly lower (P <.0001) than that of the naturally-healing group (46.4% ± 4.1%). No statistically-significant differences in outcomes were observed between the 2 test groups at any of the observation periods. Moreover, tooth position (bicuspids vs molars) seemed to affect neither volume loss nor basal shrinkage. Conclusion: At the 4-month analysis both test groups showed reduced bone loss when compared to naturally healing sockets. However, the 2 grafting materials were not able to preserve the alveolar crest, and a reduction close to 30% in the estimates was registered after healing