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Relationship of buccal bone plate thickness and healing of extraction sockets with or without alveolar ridge preservation: a systematic review

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Relationship of buccal bone plate thickness and healing of extraction sockets with or without alveolar ridge preservation: a systematic review

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Content Copyright 2020 Christopher Pham

Relationship of buccal bone plate thickness and healing of extraction sockets with or without
alveolar ridge preservation: A systematic review

by

Christopher Pham, DDS

A Thesis Presented to the
FACULTY OF THE USC HERMAN OSTROW SCHOOL OF DENTISTRY
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
CRANIOFACIAL BIOLOGY

August 2020

ii

Table of Contents
List of Figures and Tables.............................................................................................................. iii
Abstract .......................................................................................................................................... iv
1. Introduction ................................................................................................................................. 1
2. Materials and Methods ................................................................................................................ 3
3. Results ......................................................................................................................................... 7
4. Discussion ................................................................................................................................. 13
5. Conclusions ............................................................................................................................... 16
References ..................................................................................................................................... 18
Tables and figures ......................................................................................................................... 21

iii

List of Figures and Tables
Figure 1 Flow chart of literature search process and article selection
Figure 2 Horizontal ridge resorption of included studies according to buccal bone thickness
Figure 3 Vertical ridge resorption of included studies according to buccal bone thickness
Table 1 Descriptive table of included studies
Table 2 Risk of bias assessment

iv

Abstract
Background
Reduced buccal bone thickness (BBT) is associated with greater dimensional changes in the
alveolar ridge following exodontia and may directly affect alveolar ridge preservation (ARP)
treatment outcomes. The primary objective of this systematic review was to critically evaluate
the current literature on the relationship of buccal bone thickness (BBT) on treatment outcomes
of ARP via socket grafting compared to spontaneously healed extraction sockets.
Materials and methods
An electronic database search of the United States National Library of Medicine, PubMed,
MEDLINE and manual search were performed by two independent reviewers to identify
randomized controlled trials (RCTs) comparing ARP via socket grafting to spontaneous healing
following exodontia. The evaluated endpoints included horizontal and vertical hard tissue
changes of the extraction site reported either clinically or radiographically. Studies that did not
report baseline buccal bone thickness or reported significant deficiencies of the extraction socket
(e.g. dehiscence, fenestration, surgical extraction) were excluded. Relevant data was obtained
and collated into evidence tables for descriptive analysis. Meta-analyses were conducted if two
studies reported on the same ARP treatment modality and outcome of interest.
Results
Initial electronic database and manual search resulted in 4,022 articles. After additional filters,
363 articles were identified for title and abstract review, and full text review was performed for
73 articles. Following addition of eligibility criteria, 11 RCTs were included for review. The
articles encompassed the following ARP socket grafting material and socket seal (SS): 90%
bovine bone granules and 10% porcine collagen (BBG) with SS, bovine bone particles (BBP)
with SS, collagenated cortico-cancellous porcine bone (CCPB) with SS, porcine bone particles
(PBP) with SS, alloplast particles (AP) with or without SS, allograft particles (AG) with SS, and
leukocyte-platelet rich fibrin (LPRF). The threshold value for a thick buccal bone plate was 1.0
or 1.5 mm. The average horizontal ridge resorption in the thin control groups varied between -
1.00 ± 0.63 to -4.14 ± 0.39 mm, and thin ARP groups varied between -0.55 ± 0.68 and -2.2 ± 1.3
mm. The average horizontal ridge resorption in the thick control groups varied between -1.17 ±
0.41 to -3.74 ± 0.75 mm, and thick ARP groups varied between -0.125 ± 0.35 and -2.2 ± 1.3 mm.
Statistically significant lower ridge resorption was present in thin ARP groups compared to thin
control groups; however, results were mixed when comparing thick buccal bone plates
subgroups. Regression analysis showed that a maximum of 10% bone volume reduction was
observed when BBT was 1 mm in control groups and 0.6 mm in ARP groups.
Conclusions
A buccal bone thickness greater than 1 or 1.5 mm was associated with reduced ridge reduction in
spontaneously healed sites. When BBT was less than 1 or 1.5 mm, ARP groups showed statically
significant less ridge reduction compared to control groups. Furthermore, buccal bone thickness
appeared to be a strong predictor of outcome in both groups. Additional RCTs are required to
further assess the relation of buccal bone thickness and ARP.
1

1. Introduction
Healing of the post-extraction socket is defined by four overlapping phases leading to
ridge remodeling and resorption of the alveolar ridge: hemostasis, inflammatory, proliferative,
and modeling and remodeling.
1–3
Immediately after dental extraction, the periodontal ligament,
and its associated vasculature is severed from the adjacent alveolar bone proper, or bundle bone.
Histologically, the bundle bone is a tooth-dependent structure invested with Sharpey’s fibers that
atrophies during the modeling and remodeling phase following extraction.
4
This process is
defined by contraction in the horizontal and vertical dimensions involving both hard and soft
tissues.
5–8
In a systematic review of 20 studies evaluating linear changes in single- and multi-
rooted teeth after up to 12 months of healing, the average ridge reduction in the horizontal was
3.79 ± 0.23 mm, and vertical ridge reduction was 1.24 ± 0.11 mm on the midfacial, 0.80 ± 0.71
mm on the distal, and 0.84 ± 0.62 mm on the mesial sites.
9
In addition, for long-term stability of
peri-implant bone levels, it is recommended to have a minimum of 1 to 2 mm of thickness on the
buccal and linguopalatal walls.
10,11
Occasionally, the contracted width and height of the alveolar
ridge may compromise functional and esthetic restoration of edentulous sites with endosseous
dental implants.
Alveolar ridge preservation (ARP) therapy via socket grafting with an osteoconductive
material is often used to attenuate alveolar ridge contraction, Some authors have speculated that
attenuation of ridge remodeling may reduce the need for ancillary ridge augmentation procedures
prior to or simultaneously with implant placement
12,13
However, the evidence is not conclusive
and is contrasted by findings from other authors.
14,15
When ridge resorption occurs, the particulate
bone grafting material, often combined with a barrier membrane, placed in the post-extraction
socket functions as a scaffold to maintain the dimensions of the alveolar ridge and prevent soft
2

tissue collapse. It is important to note that ARP is distinct from alveolar ridge augmentation
procedures where there is significant surgical trauma during extraction (e.g. buccal bone
dehiscence) or minimal ridge dimensions and grafting beyond the alveolar housing is required.
Numerous treatment modalities have been proposed for ARP, including the use particulate bone
grafting materials (e.g. allografts, alloplasts, xenografts), occlusive components (e.g. autologous
soft tissue graft, collagen matrix), biologics (e.g. rhPDGF-BB, rhBMP-2), and autologous blood-
derived products (e.g. L-PRF). In a systematic review of randomized controlled trials, pooled
quantitative analysis reported as mean difference of ARP via socket grafting reduced bone
resorption when compared to socket healing without grafting on the horizontal (M = 1.99),
vertical mid-buccal (M = 1.72 mm), and vertical mid-lingual (M = 1.16 mm).
16
However, the
clinical outcomes varied substantially amongst subjects and sites receiving the same therapy.
17

Several site-specific factors have been reported to impact extraction socket healing
dynamics: bony defects around teeth (e.g. dehiscence, fenestrations),
18
surgical trauma during
extraction,
19
presence of pathology (e.g. periapical pathoses),
20
and thickness of extraction socket
walls.
21,22
In a prospective clinical trial of extractions in the maxillary anterior, pre- and post-
operative CBCTs identified facial bone thicknesses ≤ 1 mm as a significant risk factor for
increased alveolar ridge resorption. In fact, vertical bone loss of thin-wall phenotypes was 3.5
times more severe when compared to thick-wall phenotypes.
23
In sites with thin-wall phenotypes
at baseline, ARP via socket grafting minimized the dimensional changes of the alveolar ridge.
Nevertheless, minimal buccal bone thickness was associated with greater bone volume resorption
regardless of the therapy administered.
24

3

The primary objective of this systematic review was to comprehensively analyze the
current evidence regarding the effect of buccal bone thickness on different ARP treatment
modalities compared to spontaneous healing alone.
2. Materials and Methods
This systematic review followed the guidelines of the Preferred Reporting of Systematic
Reviews and Meta-analyses (PRISMA) statement.
25

Types of studies included
Randomized controlled studies with parallel arms, or split-mouth design were included.
Non-randomized clinical trials, descriptive studies, case series, and cross-sectional studies were
excluded. No minimum number of subjects per group were defined for the inclusion criteria.
PICO question (Population, Intervention, Comparison, and Outcomes) and
Inclusion Criteria
What is the effect of baseline buccal bone thickness (BBT) on ARP via socket grafting
with or without socket seal performed following tooth extraction in adult human subjects
compared to socket healing without grafting in terms of clinical, and radiographic dimensional
changes of the alveolar ridge?
Population
 Adult human subjects (≥ 18 years old) requiring tooth extraction of single- and/or multi-
rooted teeth, with the exception of third molars, and planned for implant therapy.
 Intact extraction sites with minimal alveolar bone height loss. Extensive alveolar bone
height dehiscence, fenestrations, and bone removal at the time of extraction were
excluded.
4

 Minimum of three-month follow-up period.
Intervention
 ARP via socket grafting with particulate bone-grafting materials (e.g. allograft, alloplast,
autograft, xenograft), biologics, or autologous blood-derived product.
 Treatment may include, or solely consist of, an autogenous or exogenous occlusive
component (e.g. autogenous soft tissue graft, collagen matrix), commonly defined as
socket seal (SS), placed over the extraction socket.
Comparison
 Tooth extraction with spontaneous healing without graft material or socket seal.
Primary outcomes
 Clinical: Buccal bone thickness immediately following extraction and relationship to
linear horizontal and vertical changes (mesial, distal, mid-buccal, and mid-lingual) of the
residual alveolar bone.
 Radiographic: Buccal bone thickness immediately following extraction and relationship
to linear horizontal and vertical radiographic changes (mesial, distal, mid-buccal, and
mid-lingual) of the residual alveolar bone measured with CBCT.
 Histologic outcomes were excluded.
 Pre- and post-operative alveolar bone measurements must be made within the coronal 3
mm of the alveolar ridge.
Secondary outcomes
 Need for ancillary ridge augmentation procedures before or simultaneously with implant
placement.
5

 Marginal bone loss around implants.
 Implant survival and success rates.
 Implant outcomes were recorded only if functionally loaded for a minimum of 12
months.
Data sources and literature search protocol
An electronic database search of the United States National Library of Medicine,
PubMed, MEDLINE was performed independently and in duplicate by two reviewers (C.P., and
V.K.). The following search terms were used: alveolar ridge preservation OR ridge preservation
OR socket grafting OR socket filling OR socket preservation OR socket graft. Only randomized
controlled trials, human studies, and articles published in English were reviewed. No limits for
publication date or status was defined. In addition, hand search of bibliographies of systematic
reviews on the topic of ARP was conducted. The last search was performed on February 15,
2020.
Study selection
Titles, abstract, and full text review of papers was performed independently by two
reviewers (C.P. and V.K.). If insufficient information was present in the title or abstract was
present to exclude or include article, full text review was performed. Disagreements between
authors regarding study eligibility were resolved by open discussion with a third review author
(K.K.). The studies satisfying the inclusion criteria underwent review for risk of bias, and data
extraction. Excluded studies and their reason for exclusion were recorded in an exclusion table.
6

Data extraction
Data was extracted from the included studies by a single author (C.P.) and accuracy was
verified independently by a second author (V.K.). The following data was retrieved and placed in
a data extraction form on Microsoft Excel:
 author(s), publication year, study design (e.g. parallel arms or split mouth);
 methodological quality: inclusion criteria, method of randomization, patient/site selection
bias;
 characteristics of subjects/sites: sample size, age distribution, gender, inclusion of
smokers, history of periodontitis, reason for extraction, socket anatomy, socket integrity,
and buccal bone thickness;
 characteristics of intervention: ARP intervention, flap elevation during extraction,
primary or secondary closure, ridge healing time, buccal bone thickness, alveolar ridge
width/height changes, and evaluation method;
 implant related outcomes: implant follow-up time after loading, need for additional
augmentation, marginal bone loss, and success/survival rates.
Risk of bias assessment
Two authors (C.P., and V.K.) determined the risk of bias of included studies based on the
Cochrane Assessment of Allocation Concealment tool.
26
Disagreements were resolved through
open discussion and consensus with a third reviewer (K.K.) when necessary. The following
domains for risk of bias were evaluated:
 random sequence generation (selection bias);
 allocation concealment (selection bias);
 blinding of participants and researchers (performance bias);
7

 blinding of outcome assessment (detection bias);
 incomplete outcome data (attrition bias);
 selective reporting (reporting bias);
 other bias.
Following risk of bias assessment, studies were categorized as low, unclear, or high risk of bias
defined as follows:
 low risk of bias (bias, if present, is unlikely to alter the results seriously) if low risk of
bias for all key domains;
 unclear risk of bias (a risk of bias that raises some doubt about the results) if low or
unclear risk of bias for all key domains;
 high risk of bias (bias may alter the results seriously) if high risk of bias for one or more
key domains.
Data synthesis
Data was collated into evidence tables for qualitative and quantitative analysis.
Descriptive summary of findings was completed to assess quantity of data, variation of study
characteristics, quality of studies, and reported outcomes. Meta-analysis was performed if at least
two studies presented with the same ARP treatment modality and outcome of interest.
3. Results
Literature search results
A total of 4,022 articles were identified following initial search of electronic databases.
After the addition of filters for inclusion of randomized controlled trials, controlled clinical trials,
human subjects, and articles written in English, 361 articles remained. Two additional articles
8

were identified through hand search and cross referencing of bibliographies of systematic
reviews related to ARP. Following title and abstract review, 290 articles were excluded, and full
text review was completed for 73 articles to determine eligibility. A total of 62 articles were
excluded after full text review and application of inclusion criteria (Figure 1). As a result, ten
studies were included for qualitative analysis reported from ten articles (Table 1).
12,15,27–34
No
studies fulfilled the requirements for meta-analysis.
Study characteristics
Eleven randomized controlled trials (RCT) were included in this review.
12,15,27–34
One
RCT presented alveolar ridge preservation and implant outcomes following therapy in two
separate articles, resulting in nine studies for review.
12,15
Of the nine included studies, two were
conducted as a split-mouth design,
31,34
and eight according to a parallel arms design.
15,24,27–29,31–33

Three studies presented with one additional experimental group,
27,28,32
and two studies presented
with two additional experimental groups.
30
The majority of RCTs were conducted in a university
setting,
27,27,29–32,34
with two in a private practice setting,
15,33
and another one was unclear.
28
Five
studies reported no external funding,
27,29,33,34
and five reported partial funding or were provided
products from companies that were used in the intervention.
15,24,28,30–32

In four studies, current smokers were excluded,
24,29,33,34
while six studies allowed for the
inclusion of current smokers with a varying number of maximum cigarettes per day (ranging
from 10 to 20 cigarettes per day).
15,27,28,30–32
One study included smokers, but did not report the
number of smokers in each group.
31
History of periodontitis, if present, was not reported in the
included studies.
The rationale for extraction was presented in six studies and included a wide range of
indications, such as caries, crown/root fracture, periodontal, endodontic, orthodontic, and
9

prosthetic.
15,24,27,29,30,33
In regards to the type of tooth extracted, five studies included both multi-
and single-rooted teeth,
15,27–29,31
five studies included only single-rooted teeth,
24,30,32–34
and no
studies included multi-rooted teeth alone. Socket integrity following extraction was variable
amongst studies: three studies reported no significant defects,
24,27,33
four studies included
extraction sockets with at least a minimum of 50 to 80% of the bony wall intact,
15,28,30,34
and
three studies did not report the socket integrity following extraction.
29,31,32
Flap elevation at the
time of extraction was performed in two studies,
29,32
and only one study reported primary closure
at the time of extraction.
32
All other studies reported secondary intention healing.
The healing and final follow-up time varied amongst the studies reviewed. The healing
time was 3 months in two studies,
24,34
4 months in four studies,
15,27,32,33
and 6 months in three
studies.
29–31
One study presented with a variable follow-up period of 5 to 6 months.
28
A single
study evaluated implant related outcomes at 12 months post-functional loading.
12
Evaluation
methods of treatment outcomes was varied amongst studies and were performed with either
direct clinical measurements (e.g. bone caliper and/or periodontal probe), or radiographically
(e.g. CBCT) at varying heights relative to the crestal bone.
Treatment modalities
The following alveolar ridge preservation therapies were evaluated, the specific socket
seal (SS) technique is mentioned in Table 1: 90% bovine bone granules and 10% porcine
collagen (BBG) with SS, bovine bone particles (BBP) with SS, collagenated cortico-cancellous
porcine bone (CCPB) with SS, porcine bone particles (PBP) with SS, alloplast particles (AP)
with or without SS, allograft particles (AG) with SS, and leukocyte-platelet rich fibrin (LPRF).
All experimental groups were compared to spontaneous socket healing in each study.
10

Risk of bias assessment
According to the Cochrane Collaboration’s tool for assessing risk of bias in randomized
controlled trials, only one included study presented with a low risk of bias.
24
Six studies
presented with an unclear risk of bias.
28–32,34,34
The primary rationale for unclear risk of bias was
not reporting the method of allocation concealment (selection bias), and/or information for
blinding of participants and personnel in all outcomes (performance bias). Two studies presented
with a high risk of bias because of uneven distribution of premolars and molars between control
and experimental groups.
15,27
Another study presented with a high risk of bias because of
significant difference of number of subjects in the control and experimental group.
33

Qualitative assessment of clinical outcomes
Buccal bone thickness and linear bone outcomes
Three studies reported baseline buccal bone thickness as means; however, the relationship to
linear bone outcomes were not assessed.
30,32,34
The data of included studies are presented in
Table 1, and notable results of studies that investigated the influence of buccal bone thickness on
treatment outcomes are presented below.
 Avila-Ortiz et al. 2020: Linear regression analysis identified an inverse relationship
between BBT and bone volume after exodontia in both ARP and control groups. The
slope of the regression line between the groups was not statistically significant (ARP: -
8.92; Control: -10.59; P = 0.482). In addition, multivariate regression analysis was
performed to determine the threshold value of BBT associated with a maximum of 10%
volumetric bone loss. This analysis showed that the threshold BBT was 0.6 mm in the
ARP group, and 1 mm in the control group. As a result, minimal changes in volume are
expected when a sufficient BBT was present at baseline.
11

 Barone et al. 2017: BBT was categorized into <1.5 mm and ≥1.5 mm groups.
Intragroup analysis showed no statistically significant difference when comparing thin
and thick buccal bone plate for both ARP groups in terms of linear changes (P > 0.05);
however, the change in buccal-lingual width was statistically significant for the control
group with thin sites showing greater resorption (P < 0.05). Irrespective of grafting
material used, significantly less changes in buccal-lingual width were observed
compared to control in both thin and thick sites. However, no statistically significant
difference for buccal vertical bone loss in thin sites treated with pre-hydrated
collagenated cortico-cancellous porcine bone compared to control (P > 0.05).
27

 Cardaropoli et al. 2014: Bivariate correlation analysis on baseline BBT and percentage
horizontal bone loss at four months showed no linear correlation in the experimental
group (r = -0.055), and an inverse negative correlation in the control group (r = -0.752).
15

 Guarnieri et al. 2017: BBT was categorized into <1.5 mm and ≥1.5 mm groups.
Particulate bone graft + membrane, and membrane alone showed significantly less
vertical and horizontal resorption compared to control for both thin and thick groups (P <
0.0001). When buccal bone thickness was <1.5 mm, significantly greater horizontal and
vertical resorption was observed in the membrane alone group compared to groups with
additional particulate graft (P < 0.0001).
28

 Iorio-Siciliano et al. 2017: BBT was categorized into <1.0 mm and ≥1.0 mm groups.
Statistically significant differences between experimental and control groups were
observed in horizontal and vertical linear bone outcomes when BBT was < 1.0 mm (P >
0.05). However, when BBT was ≥1.0 mm no statistically significant differences in linear
12

bone outcomes were observed between groups. When data from thick and thin groups
were pooled, statistically significant difference in clinical outcomes was observed
between experimental and control groups.
29

 Jung et al. 2018: Descriptive analysis of BBT 1 mm apical to the buccal crest was
performed. The authors identified that independent of the treatment administered,
horizontal bone loss > 30% was not observed when BBT was > 1mm.
31

 Spinato et al. 2014: BBT was categorized into ≤1.0 mm and >1.0 mm groups. When the
BBT was ≤1.0 mm, differences between groups were statistically significant regards to
vertical, and horizontal changes. When the BBT was >1.0 mm, only horizontal changes
were statistically significant between groups (P = 0.006). Intragroup analysis showed no
statistically significant differences in horizontal or linear bone outcomes, excluding
horizontal changes in the control group with BBT ≤1.0 mm (8.17 to 5.5 mm, P =
0.025).
33

In general, sites presenting with greater buccal bone thickness showed more favorable outcomes
in both control and experimental groups when comparing within groups (Figure 2, Figure 3).
Horizontal and vertical bone changes
Differences in horizontal and vertical bone changes between control and experimental
groups were assessed with direct clinical measurements and/or radiographic measurements.
When buccal bone thickness groups were clustered according to study, alveolar ridge width
changes were more favorable in most experimental groups compared to control groups with
exceptions. Jung et al. (2013) reported significantly inferior results in the ARP group treated
with B-TCP coated poly(lactide-co-glycolide) compared to control for horizontal (-6.1 ± 2.5, -3.3
± 2.0; P < 0.05) and vertical outcomes (-2.0 ± 2.4, -0.5 ± 0.9; P < 0.05).
30
In terms of alveolar
13

ridge height changes, ARP groups were generally favored. However, no statistically significant
difference in vertical changes on the mesial and distal was reported in one study.
29

Implant related outcomes
Two studies presented with implant related outcomes.
12,24
Ancillary bone grafting
procedures were performed if the implant presented with dehiscence or fenestration defects at the
time of placement. Additional bone augmentation was required in both the non-grafted (n =
14/24) and grafted groups (n = 1/24). At 12 months post-functional loading of implants, no
statistically significant difference between control and experimental groups were observed for
survival rate (100 vs. 100%), success rate (91.66 vs. 95.83%), and marginal bone level.
12

Another study evaluating only anterior teeth performed further bone augmentation if peri-
implant bone thickness was < 1 mm. Here, 13 of the 27 non-grafted sites and 3 of the 26 grafted
sites required additional augmentation (P < 0.004).
24

4. Discussion
The objective of alveolar ridge preservation (ARP) is to minimize dimensional changes
of the ridge following exodontia. Variability of treatment outcomes amongst patients and sites
within the same patient suggest local and systemic contributory factors. Thus, the primary goal
of this systematic review was to comprehensively assess the current literature on the association
of buccal bone thickness and ARP treatment outcomes compared to spontaneously healing
extraction sockets.
The studies included in this systematic review varied in treatment methodology, outcome
measurements, and definition of “thick” and “thin” buccal bone. Four studies categorized buccal
bone thickness as a dichotomic variable with a threshold value of 1.0 or 1.5 mm to define
thickness.
27–29,33
Iorio-Siciliano et al. (2017) reported no statistically significant difference in
14

alveolar ridge width resorption between sites treated with bovine bone granules mixed with
collagen + SS and nongrafted sites when BBT >1 mm (ARP: -0.8 ± 1.2, C: -2.6 ± 1.3 mm; P =
0.55); however, less resorption was observed in the grafted group compared to the nongrafted
group with BBT ≤1 mm (ARP: -2.2 ± 1.3, C: -3.3 ± 0.6 mm; P = .03).
29
The study suggests that
minimal dimensional changes occur if sufficient BBT is present, and ARP may reduce the effects
of a thin buccal plate. On the other hand, Spinato et al. (2014) observed horizontal changes
between ARP sites treated with cancellous mineralized human bone allograft (MHBA – Puros)
compared to control sites when the buccal bone was thick (ARP: -0.125 ± 0.35, C: -1.17 ± 0.41,
P = 0.006), which was further exacerbated when the buccal bone was thin (ARP: -0.55 ± 0.68, C:
-2.67 ± 0.52; P = 0.002).
33
These findings were consistent with Guarnieri et al. (2017) where
treatment outcomes were more favorable in sites treated with ARP presenting with a buccal bone
plate ≥ 1.5 mm compared to control sites.
27,28

A threshold buccal bone thickness was identified where minimal changes to the alveolar
ridge were expected in non-grafted sites. Avila-Ortiz et al. (2020) showed that a maximum of
10% bone volume change was expected when BBT was 1 mm in the control group, and 0.6 mm
in sites treated with 30% DFDBA/70% FDBA and socket seal with PTFE membrane.
Furthermore, the inverse slope regression line was not statistically significant between the
control and experimental group, suggesting BBT was a strong predictor of outcomes in both
groups.
24
This is consistent with Jung et al. (2018) where no more than 30% of horizontal ridge
resorption was observed when BBT >1 mm regardless of the treatment administered.
31
On the
other hand, although Cardaropoli et al. (2014) showed an inverse relationship between BBT and
non-grafted sites, no correlation with BBT was observed when sites were grafted with bovine
bone granules mixed with collagen.
15

15

The number of sites requiring ancillary bone augmentation at the time of implant
placement was greater in control sites compared to experimental sites. When observing anterior
extractions, Avila-Ortiz et al. (2020) reported that 48.1% of control sites and 11.5% of
experimental sites required additional augmentation.
24
Cardaropoli et al. (2015) showed similar
results for both control (58.3%) and experimental sites (4.2%).
12
These findings were in
accordance with those published in a systematic review by Mardas et al. (2015), which showed
augmentation decreased when ARP was performed (Relative risk: 0.15, 95% CI: 0.07–0.3).
35
In
contrast, a cross-sectional study by Verdugo et al. (2020) showed that non-grafted posterior sites
with dehiscences ≥ 5 mm required no additional grafting at implant placement. In fact,
significant amounts of buccolingual width was observed post-extraction for stable implant
placement 10.1 ± 1.8 mm (Range: 7.7–14.3 mm).
14
It is important to note that in all studies
reported above that implant placement was feasible, and a staged bone augmentation procedure
was not necessary. Therefore, clinicians have to weigh the cost and risk benefits of grafting all
extraction sockets compared to grafting in conjunction with implant placement when indicated.
In addition, further research is necessary to identify local and systemic factors to identify sites
that are more at risk of future grafting needs following exodontia.
The effects of BBT on spontaneous healing in animal and human studies is well
documented, but there are limited RCTs with direct comparison to ARP therapy.
4,23
The included
studies showed less favorable outcomes in spontaneously healed sites when BBT was thin. This
is in congruence with other studies that suggest that 1 mm of buccal bone thickness is a critical
threshold that may be an indicator of the severity of alveolar bone resorption following
extraction.
23,33
Additionally, a recent systematic review and meta-analysis of RCTs reviewed the
effects of local and systemic factors on ARP, and reported that baseline BBT was a risk factor.
16

However, quantitative analysis was limited to two studies where BBT was reported in only one
of the two.
16
As a result, conclusions were primarily dependent on qualitative assessment of
studies, which continues to be a limiting factor in the current literature. Furthermore, in this
study and other systematic reviews, limited information is present on long-term implant related
outcomes (e.g. peri-implant marginal bone levels, success and survival rates, rates of peri-
implant disease).
Due to the heterogeneity of methodology and paucity of articles assessing the relationship
between BBT and ARP outcomes, no quantitative analysis of studies was performed. In addition,
no study presented with a low risk of bias. In fact, three studies presented with a high risk of bias
attributable to distribution of patients in the experimental and control groups.
15,27,33
As a result,
the conclusions of this study is currently limited. Additional studies are needed to validate if a
critical thickness of buccal bone where vertical and horizontal dimensional changes are minimal
when compared to ARP.
5. Conclusions
The results of comparative analysis of buccal bone thickness and control groups showed
that the amount of ridge resorption was minimized when BBT was at least 1 to 1.5 mm. When
compared to ARP dimensional changes, the results were more mixed: significant differences in
ARP and control groups both with thick buccal bone plates were not consistent amongst studies.
On the other hand, when the buccal bone plate was thin, ARP groups showed statically
significant less ridge resorption compared to control groups. Due to the extensive variability of
ARP treatment modalities, tooth type, healing periods, and outcome measurements, meta-
analysis or comparative analysis could not be performed. In addition, the majority of studies
17

presented showed either an unclear or high risk of bias, thus the conclusions of this review
should be interpreted with caution.

18

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21

Tables and figures
Figure 1 Flow chart of literature search process and article selection

22

Figure 2 Bar graph showing mean horizontal ridge resorption of included studies for both
“thick” and “thin” buccal bone groups. Means with the same alphanumeric value are statistically
significantly different within the author’s study (a,b,c, are used for “thick” groups, and 1,2,3 are
used for “thin” groups). C = control group; E = experimental group.

a
a
,
b
a
1
,
1
,
1
1
a
a
a
1
1
,
1
1
b
b
2
2
,
3
-1
0
1
2
3
4
5
B AR O N E E T A L . 2 0 1 7
( 1 . 5 )
G UA R N I E R I E T AL .
2 0 1 7 ( 1 . 5 )
I O R I O - S I C I L I AN O E T
A L . 2 0 1 7 ( 1 . 0 )
S P I N AT O E T AL . 2 0 1 7
( 1 . 0 )
RIDGE RESORPTION (MM)
BUCCAL BONE THICKNESS AND HORIZONTAL
RIDGE RESORPTION
(MEAN ± SD)
C-Thick C-Thin E1-Thick E1-Thin E2-Thick E2-Thin
23

Figure 3 Bar graph showing mean vertical ridge resorption of included studies for both “thick”
and “thin” buccal bone groups. Means with the same alphanumeric value are statistically
significantly different within the author’s study (a,b,c, are used for “thick” groups, and 1,2,3 are
used for “thin” groups). C = control group; E = experimental group.
a
,
b
a
,
b 1
1
1
1
a a
1
1
,
3
1
1
b
b
2,
3
-2
-1
0
1
2
3
4
B AR O N E E T A L . 2 0 1 7
( 1 . 5 )
G UA R N I E R I E T AL . 2 0 1 7
( 1 . 5 )
I O R I O - S I C I L I AN O E T A L .
2 0 1 7 ( 1 . 0 )
S P I N AT O E T AL . 2 0 1 7
( 1 . 0 )
RIDGE RESORPTION (MM)
BUCCAL BONE THICKNESS AND BUCCAL VERTICAL RIDGE
RESORPTION (MEAN ± SD)
C-Thick C-Thin E1-Thick E1-Thin E2-Thick E2-Thin
24

Table 1 Descriptive table of included studies
Author Year Study Design
Sample size and distribution of
groups
Alveolar ridge preservation
intervention
Socket sealed in ARP groups Age distritbution Gender distribution
Avila-Ortiz et al. 2020 RCT parallel arms 53 subjects with 53 sockets
Control (n = 27)
Experimenta (n = 26)
Allograft mixture 70% FDBA and 30%
DFDBA (enCore) with dPTFE
membrane (Cytoplast TXT-200
Singles)
dPTFE membrane (Cytoplast
TXT-200 Singles)
Control: 57.24 ±
11.82
Experimental:
58.46 ± 12.37
Control: 13 female/14
male
Experimental: 17
female/ 9 male
Barone et al. 2017 RCT parallel arms 90 subjects with 90 sockets
Control (n = 30)
Experimental 1 (n = 30)
Experimental 2 (n = 30)
Experimental 1: Cortico-cancellous
porcine bone particles (MP3) with
absorbable collagen membrane
(Evolution)
Experimental 2: Cortical porcine bone
particles (Apatos) with absorbable
collagen membrane (Evolution)
Absorbable collagen
membrane (Evolution) for
both experimental groups
Control: 46.9 ± 10.8
Experimental 1:
48.2 ± 12.8
Experimental 2:
47.2 ± 9.7
Control: 18 females/12
males
Experimental 1: 16
females/14 males
Experimental 2: 20
females/10 males
Cardaropoli et
al.
2014 RCT parallel arms 41 subjects with 48 sockets
Control (n = 24)
Experimental (n = 24)
90% bovine bone granules and 10%
collagen (Bio-Oss Collagen) and socket
sealed with porcine collagen
membrane (Bio-Gide)
Absorbable porcine collagen
membrane (Bio-Gide)
Mean: 47.2 ± 12.9
(Range: 24-71)
17 females/24males
Cardaropoli et
al.
2015 RCT parallel arms 41 subjects with 48 sockets
Control (n = 24)
Experimental (n = 24)
90% bovine bone granules and 10%
collagen (Bio-Oss Collagen) and socket
sealed with porcine collagen
membrane (Bio-Gide)
Absorbable porcine collagen
membrane (Bio-Gide)
Mean: 47.2 ± 12.9
(Range: 24-71)
17 females/24males
Guarnieri et al. 2017 RCT parallel arms 26 subjects with 26 sockets
Control (n = 9)
Experimental 1 (n = 9)
Experimental 2 (n = 8)
Experimental 1: Socket sealed with
porcine collagen membrane (Mem-
Lok Pliable)
Experimental 2: Porcine bone
particles (MinerOss XP) and socket
sealed with porcine collagen
membrane (Mem-Lok Pliable)
Resorbable porcine collagen
membrane (Mem-Lok
Pliable) in both experimental
groups
Control: Range 21-
56
Experimental 1:
Range 19-60
Experimental 2:
Range 20-63
Control: 4 females/5
males
Experimental 1: 6
females/3males
Experimental 2: 2
females/6 males
Iorio-Siciliano
et al.
2017 RCT parallel arms 20 subjects with 20 sockets
Control (n = 10)
Experimental (n = 10)
90% bovine bone granules and 10%
collagen (Bio-Oss Collagen) and socket
sealed with porcine collagen
membrane (Bio-Gide)
Porcine collagen membrane
(Bio-Gide)
Control: 40.2 ± 12.1
Experimental: 38.2
± 9.4
Control: 4 females/6
males
Experimental: 5
females/5 males
Jung et al. 2018 RCT split mouth 18 subects with 36 sockets
Control (n = 18)
Experimental (n = 18)
90% bovine bone granules and 10%
collagen (Bio-Oss Collagen) and socket
sealed with porcine collagen
membrane (Bio-Gide)
Native bilayer collagen
membrane (Bio-Gide)
NR NR
Jung et al. 2013 RCT parallel arms 40 subjects with 40 sockets
Control (n = 10)
Experimental 1 (n = 10)
Experimental 2 (n = 10)
Experimental 3 (n = 10)
Experimental 1: B-TCP with
poly(lactide-co-glycolide) coating
(easy-graft®)
Experimental 2: DBBM with 10%
collagen (Bio-Oss® Collagen) covered
with porcine collagen matrix
(Mucograft®)
Experimental 3: DBBM with 10%
collagen (Bio-Oss® Collagen) covered
with autogenous soft-tissue punch
graft
Experimental 1: None
Experimental 2: Porcine
collagen matrix (Mucograft®)
Experimental 3: Autogenous
soft tissue punch graft
Control: 48 ± 15
Experimental 1: 59
± 11
Experimental 2: 65
± 13
Experimental 3: 49
± 14
Control: 6 male/4
female
Experimental 1: 6
male/4 female
Experimental 2: 4
male/6 female
Experimental 3: 2
male/8 female
Machtei et al. 2019 RCT parallel arms 32 subjects with 32 sockets
Control (n = 10)
Experimental 1 (n = 11)
Experimental 2 (n = 11)
Experimental 1: Biphasic calcium
sulfate with hydroxyapatite (Bond-
apatite)
Experimental 2: Bovine derived
xenograft (Bio-oss)
NA 63.9 ± 8.1 12 females/21 males
Spinato et al. 2014 RCT parallel arms 31 subjects with 31 sockets
Control (n = 12)
Experimental (n = 19)
Allograft (particulate FDBA; Puros)
with bovine collagen sponge
(Collaplug)
Bovine collagen sponge
(Collaplug)
Mean: 48.5 (Range
27-74)
21 females/10 males
Temmerman et
al.
2016 RCT split mouth 22 subjects with 44 sockets
Control (n = 22)
Experimental (n = 22)
L-PRF L-PRF Mean: 54 ± 11 7 females/15 males

25

Table 1 (Continued)
Inclusion of smokers
History of
periodontitis
Reason for extraction
Socket anatomy
single/multi-rooted
Socket integrity
Flap
elevation
Primary
closure
Ridge
healing
time
No None Nonrestorable caries
Cracked teeth
Root resorption
Single rooted except
mandibular incisors
No significant defects No No 14 weeks
≤ 10 cigarettes/day
Control: 5
Experimental 1: 4
Experimental 2: 6
NR Decay/endodontic/fracture
Control: 14/3/13
Experimental 1: 10/16/4
Experimental 2: 14/6/10
Control
Single-rooted (n = 8)
Multi-rooted (n = 22)
Experimental 1
Single-rooted (n = 14)
Multi-rooted (n = 16)
Experimental 2
Single-rooted (n = 10)
Multi-rooted (n = 20)
No significant defects No No 4 months
>10 cigarettes/day
excluded
NR Root fractures, prosthetic failures,
endodontic treatment failures, caries
Control
Single-rooted (n = 6)
Multi-rooted (n = 18)
Experimental
Single-rooted (n = 10)
Multi-rooted (n = 14)
Three walls intact and at least 80% of the
fourth wall intact
No No 4 months
Yes NR Root fractures, prosthetic failures,
endodontic treatment failures, caries
Control
Single-rooted (n = 6)
Multi-rooted (n = 18)
Experimental
Single-rooted (n = 10)
Multi-rooted (n = 14)
At least 80% of bony wall intact No No 4 months
Control: 2
Experimental 1: 3
Experimental 2: 3
NR NR Control
Single-rooted (n = 4)
Multi-rooted (n = 5)
Experimental 1
Single-rooted (n = 6)
Multi-rooted (n = 3)
Experimental 2
Single-rooted (n = 4)
Multi-rooted (n = 4)
At least 50% buccal/palatolingual bone wall
present
No No 5-6 months
None NR Endodontic failure, caries, root fracture Both single-rooted
and multi-rooted
NR Yes No 6 months
NR NR NR 16 premolars, 20
molars
NR No No 6 months
<20 cig/day
Control: 1
Experimental 1: 1
Experimental 2: 2
Experimental 3: 7
NR Control:
Orthodontic (n = 1)
Endodontic complication (n = 5)
Fracture/Caries (n = 4)
Experimental 1:
Endodontic complication (n = 4)
Fracture/Caries (n = 6)
Experimental 2:
Endodontic (n = 2)
Fracture/Caries (n = 8)
Experimental 3:
Endodontic complication (n = 4)
Fracture/Caries (n = 6)
Single-rooted At least 50% of buccal wall present for
inclusion
No NA 6 months
Exclude heavy smokers
(>20 cigarettes/day)

Current smokers (n = 2)
Former smokers (n = 24)
NR NR 29 premolars, 2
canines, 2 incisors
NR Yes Yes 4 months
No NR Root fracture (n = 8)
Periodontal (n = 9)
Endodontic (n = 2)
Caries (n = 12)
Single-rooted
Incisors: 10
Canines: 3
Premolars: 18
No significant defects, minimum 10mm bony
support (Type 1 socket according to Elian et al.
2007)
No No 4 months
No NR NR Single-rooted Minimum 60% bony support radiographically No No 3 months

26

Table 1 (Continued)

Buccal bone thickness Evaluation method Alveolar ridge width change
Evaluation
method2
Alveolar ridge height change Evaluation method3
Linear regression analysis showed threshold
BBT to minimize bone volume resorption to 10
% was:
Control: 1 mm
Experimental 0.6 mm
Calipers 1mm apical from
crest
Control: -1.68 (95% CI, -1.49 to -
0.64)
Experimental: -1.07 (95% CI, -
1.49 to -0.64)

Bone volume change
Control: -154.51 ± 69.35 mm^3
Experimental: -77.61 ± 35.87
mm^3
CBCT 3mm apical
to adjacent CEJ
Median ridge height changes on
the buccal/lingual
Control: 1.17 (IQR, 0.7 to 2.1)/0.70
(IQR, 0.46 to 1.40)
Experimental: 0.61 (IQR, 0.46 to
0.94)/0.47 (IQR, 0.23 to 0.94)
CBCT
Categorized in to low (<1.5mm) and high (≥
1.5mm) buccal bone thickness (low/high)
Control (n = 7/23)
Experimental 1 (n = 20/10)
Experimental 2 (n = 14/16)
Measured at midfacial with
caliper and stent
Mean changes according to
buccal bone thickness (low, high)
Control: -3.14 ± 0.38, -3.74 ± 0.75
Experimental 1: -1.50 ± 0.73, -
1.00 ± 0.58
Experimental 2: -1.21 ± 0.38, -
0.69 ± 1.67
Periodontal probe
at crest
Mean changes vertical bone level
on buccal according to buccal
bone thickness (low/high)
Control: -2.14 ± 0.38, -2.09 ± 0.73
Experimental 1: -0.35 ± 1.42, -0.20
± 1.03
Experimental 2: -1.29 ± 1.07, 0.06
± 1.64
Periodontal probe and stent
Mean buccal plate thickness at 3mm
Control: 1.19 ± 0.59
Experimental: 1.23 ± 0.57
Calipers 3mm apical to crest Control: -4.04 ± 0.69
Experimental: -0.71 ± 0.91
Caliper and stent Control: -1.67 ± 0.43
Experimental: -0.56 ± 0.45
Periodontal probe and stent
Control: 1.19 ± 0.59
Experimental: 1.23 ± 0.57
3mm apical to crest NA NA NA NA
Categorized in to thin (<1.5mm) and thick (≥
1.5mm) buccal bone thickness
Measured 2mm apical with
calipers, <1.5mm was thin,
≥ 1.5mm was thick
Changes in alveolar ridge width
when buccal bone thickness was
thin, or thick
Control: -4.14 ± 0.39, -3.12 ± 0.58
Experimental 1: -1.24 ± 0.37, -
0.72 ± 0.36
Experimental 2: -1.18 ± 0.52, -
0.85 ± 0.19
Calipers 2mm
apical from crest
Mean ridge height changes on
buccal when buccal bone
thickness was thin, or thick
Control: -2.14 ± 0.08, -2.08 ± 0.71
Experimental 1: -1.27 ± 0.64, -0.42
± 0.64
Experimental 2: -1.21 ± 0.26, -0.39
± 0.26
Periodontal probe and anatomic
reference point (mesio-distal
midpoint of adjacent mid-facial
CEJ)
Buccal bone thickness <1.0mm, or ≥ 1.0mm
Control (n = 3, 7)
Experimental (n = 6, 4)
Calipers 1mm apical from
crest
Changes in alveolar ridge width
when buccal bone thickness was
<1.0mm, or ≥ 1.0mm
Control: -3.3 ± 0.6, -2.6 ± 1.3
Experimental: -2.2 ± 1.3, -0.8 ±
1.2
Calipers Changes in alveolar ridge height
when buccal bone thickness was
<1.0mm, or ≥ 1.0mm
Buccal
Control: -1.7 ± 0.6, -0.9 ± 1.1
Experimental: -0.3 ± 0.5, -0.3 ± 0.5
Linguopalatal
Control: -1.3 ± 0.6, -0.4 ± 0.5
Experimental: -0.2 ± 0.4, 0.0 ± 0.0
Periodontal probe and anatomic
reference point (mesio-distal
midpoint of adjacent mid-facial
CEJ)
Independent of treatment group, bone loss >
30% was not observed when buccal bone
thickness >1mm at 1mm apical to lingual crest
CBCT buccal plate thickness
1,3,5mm apical to lingual
crest
Mean changes measured at
1,3,5mm apical to lingual crest
Control: -2.17 ± 1.80, -1.33 ±
0.93, -1.18 ± 0.85
Experimental: -1.81 ± 1.50, -0.91
± 1.22, -0.43 ± 0.63
CBCT 1,3,5mm
apical to lingual
crest
Mean ridge height changes on
buccal, palatal
Control: -0.84 ± 0.67, -0.48 ± 0.60
Experimental: -0.32 ± 0.68, -0.31 ±
0.73
CBCT
1,3,5mm apical to lingual crest, and mean
Control: 1.1 ± 0.7, 1.7 ± 0.9, 1.8 ± 1.2, 1.5 ± 0.7
Experimental 1: 0.8 ± 0.3, 1.0 ± 0.5, 1.0 ± 0.4,
0.9 ± 0.3
Experimental 2: 0.6 ± 0.2, 0.8 ± 0.4, 1.1 ± 0.5,
1.0 ± 0.4
Experimental 3: 1.3 ± 0.7, 1.3 ± 0.8, 1.2 ± 0.7,
1.2 ± 0.7
CBCT 1,3,5mm apical to
lingual crest
Horizontal width at 1,3,5mm
below crest
Control: -3.3 ± 2.0, -1.7 ± 0.8, -0.8
± 0.5
Experimental 1: -6.1 ± 2.5, -3.1 ±
1.6, -5.7 ± 3.0
Experimental 2: -1.2 ± 0.8, -0.6 ±
0.6, -0.1 ± 0.2
Experimental 3: -1.4 ± 1.0, -0.6 ±
0.5, -0.6 ± 0.9
CBCT 1,3,5mm
below crest
CBCT buccal, lingual height change
Control: -0.5 ± 0.9, -0.6 ± 0.6
Experimental 1: -2.0 ± 2.4, -1.7 ±
0.6
Experimental 2: 0.0 ± 1.2, -0.4 ±
1.4
Experimental 3: 1.2 ± 2.9, 0.3 ± 1.1
CBCT
Mean buccal plate thickness at 3, 6mm
Control: 1.2 ± 0.3, 1.71 ± 0.8
Experimental 1: 1.1 ± 0.7, 1.28 ± 0.6
Experimental 2: 1.21 ± 0.6, 1.55 ± 0.6
Caliper buccal, lingual plate
thickness 3,6mm apical to
crest
Mean alveolar ridge width
change at 3, 6mm
Control: -2.96 ± 0.3, -1.81 ± 0.3
Experimental 1: -0.50 ± 0.4, -0.81
± 0.4
Experimental 2: -1.56 ± 0.4, -0.56
± 0.4
Caliper 3,6mm
apical from crest
Control: -1.71 ± 0.4
Experimental 1: -0.65 ± 0.5
Experimental 2: -0.25 ± 0.2
Periodontal probe and stent
Thick > 1mm
Control (n = 6)
Experimental (n = 8)

Thin ≤ 1mm
Control (n = 6)
Experimental (n = 11)
Caliper 3mm apical to crest Thick > 1mm
Control: -1.17 ± 0.41
Experimental: -0.125 ± 0.35

Thin ≤ 1mm
Control: -2.67 ± 0.52
Experimental: -0.55 ± 0.68
Caliper 3mm
apical to crest
Buccal height
Thick > 1mm
Control: -0.50 ± 0.55
Experimental: -0.38 ± 0.74
Thin ≤ 1mm
Control: -1.17 ± 0.40
Experimental: -0.27 ± 0.47

Palatal height
Thick > 1mm
Control: -0.50 ± 0.55
Experimental: -0.88 ± 0.83
Thin ≤ 1mm
Control: -1.00 ± 0.63
Experimental: -0.55 ± 0.52
Periodontal probe and anatomic
reference point (mesio-distal
midpoint of adjacent mid-facial
CEJ)
Control: 1.58 ± 1.4
Experimental: 1.15 ± 0.7
CBCT 1mm apical to crest Horizontal width at 1,3,5mm
below crest
Control: -5.4 ± 4.4, -1.2 ± 1.1, -0.5
± 0.5
Experimental: -2.4 ± 2.3, -0.6 ±
0.7, -0.4 ± 0.5
CBCT 1,3,5mm
apical to crest
Control (Buccal, Lingual): -1.6 ±
1.2, -0.7 ± 0.8
Experimental (Buccal, Lingual): -
0.1 ± 1.6, -0.3 ± 1.2
CBCT
27

Table 1 (Continued)
Implant follow-up
time after loading
Addititional augmentation Survival Rate Success Rate Marginal bone level Funding
NA Control: 13/27
Experimetnal: 3/26
NA NA NA Osteogenics Biomedical Inc. supplied
biomaterials and funding
NA NA NA NA NA No external funding reported
NA NA NA NA NA Geistlich Pharma supplied biomaterials
(Bio-Oss Collagen and Bio-Gide)
12 months Simultaneous bone grafting at the
time of implant placement

Control: 14
Experimental: 1
Control: 100%
Experimental:
100%
Control: 91.66%
Experimental:
95.83%
No statistically
significant difference
Geistlich Pharma supplied biomaterials
(Bio-Oss Collagen and Bio-Gide)
NA NA NA NA NA BioHorizons provided materials
NA NA NA NA NA No external funding reported
NA NA NA NA NA Research grants provided by Geistlich
Pharma
NR NR NR NR NR Research grants provided by Geistlich
Pharma
NA NA NA NA NA Partially funded by Augma Biotec.
NR NR NR NR NR No external funding reported
NA NA NA NA NA No external funding reported

28

Table 2 Risk of bias of included studies from low (green circle), unclear (yellow circle), and
high risk of bias (red circle). No studies presented with a low risk of bias.

Author Year
Random sequence generation
Allocation concealment
Blinding of participants and personnel
Blinding of outcome assessment
Incomplete outcome data
Selective reporting
Other bias
Avila-Ortiz 2020
Barone et al. 2017
Cardaropoli et al. 2014
Cardaropoli et al. 2015
Guarnieri et al. 2017
Iorio-Sicilliano et al. 2017
Jung et al. 2013 Key
Jung et al. 2018 Low risk of bias
Machtei et al. 2019 Unclear risk of bias
Spinato et al. 2014 High risk of bias
Temmerman et al. 2016

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Asset Metadata

Creator Pham, Christopher (author)

Core Title Relationship of buccal bone plate thickness and healing of extraction sockets with or without alveolar ridge preservation: a systematic review

School School of Dentistry

Degree Master of Science

Degree Program Craniofacial Biology

Publication Date 07/12/2020

Defense Date 05/20/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag alveolar bone graft(s),alveolar bone remodeling,alveolar ridge preservation,exodontia,OAI-PMH Harvest

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Kar, Kian (committee chair), Chen, Casey (committee member), Khoshkam, Vahid (committee member), Navazesh, Mahvash (committee member)

Creator Email christtp88@gmail.com,phamct@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-327128

Unique identifier UC11663430

Identifier etd-PhamChrist-8665.pdf (filename),usctheses-c89-327128 (legacy record id)

Legacy Identifier etd-PhamChrist-8665.pdf

Dmrecord 327128

Document Type Thesis

Rights Pham, Christopher

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

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