Non-Cochrane · intervention · PM41440314
Histological Outcomes of Alveolar Ridge Preservation Versus Spontaneous Healing Following Tooth Extraction: A Systematic Review and Meta-Analysis.
Benekou Ioanna, Fragkioudakis Ioannis, Chatzopoulos Georgios S, et al. · Dentistry journal · 2025 · PubMed · doi:10.3390/dj13120556
Findings
Population Patients undergoing tooth extraction
20 findings
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | Residual graft material (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: Alloplast without membrane vs allograft + membrane | Meta-regression coefficient (MD) -3.28 [-15.70, 9.14] GRADE not reported Studies not reported |
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: healing duration (per month) | Meta-regression coefficient (MD per month) -5.51 GRADE not reported Studies not reported |
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | Residual graft material (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: Xenograft with membrane vs allograft + membrane | Meta-regression coefficient (MD) -5.55 [-16.83, 5.73] GRADE not reported Studies not reported |
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | Residual graft material (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: Xenograft without membrane vs allograft + membrane | Meta-regression coefficient (MD) 9.31 [-4.19, 22.80] GRADE not reported Studies not reported |
| Alveolar ridge preservation (ARP) with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Overall (all 22 RCTs) | MD -5.86 [-13.84, 2.11] Moderate Downgraded: risk of bias, inconsistency 22 studies · 816 participants |
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: membrane application (yes vs no) | Meta-regression coefficient (MD) 15.37 GRADE not reported Studies not reported |
| Alveolar ridge preservation (ARP) with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry More than 3 months · Long-term healing (more than 3 months) | MD -10.55 [-20.27, -0.83] GRADE not reported 16 studies · 574 participants |
| Alveolar ridge preservation (ARP) with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry More than 3 months · Long-term healing (more than 3 months), sensitivity analysis excluding outliers | MD -16.3 [-21.61, -10.98] GRADE not reported Studies not reported |
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | Residual graft material (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: Allograft + membrane (reference category, intercept) | Meta-regression intercept (mean %) 22.54 [12.81, 32.27] GRADE not reported Studies not reported |
| Alveolar ridge preservation (ARP) with any graft material and/or membrane | Spontaneous (unassisted) socket healing | Residual graft material (%), histomorphometry At biopsy · Pooled across ARP study arms (17 arms) | Pooled mean (%) 20.49 [16.78, 24.2] GRADE not reported 17 studies |
| Alveolar ridge preservation (ARP) with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Overall, all graft material subgroups combined (HKSJ) | MD -7.48 [-17.23, 2.27] GRADE not reported 24 studies · 701 participants |
| Alveolar ridge preservation (ARP) with any graft material and/or membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 3 months or less · Short-term healing (3 months or less) | MD 6.53 [-1.57, 14.64] GRADE not reported 6 studies · 242 participants |
| Alveolar ridge preservation with any graft material and/or membrane | Spontaneous (unassisted) socket healing | Residual graft material (%), histomorphometric 2 to 6 months post-extraction · Meta-regression: Alloplast + membrane vs allograft + membrane | Meta-regression coefficient (MD) -16.34 [-33.74, 1.06] GRADE not reported Studies not reported |
| ARP with autologous growth factors (PRF, PRP, CGF) | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Autologous growth factors (graft material subgroup) | MD 16.28 [7.53, 25.03] GRADE not reported 8 studies · 262 participants |
| ARP with autologous growth factors (PRF, PRP, CGF) | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Autologous growth factors, sensitivity analysis excluding high risk of bias studies | MD 16.28 [7.53, 25.03] GRADE not reported Studies not reported |
| ARP with xenograft alone (without membrane) | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Xenograft alone (graft material subgroup) | MD -25.52 [-97.6, 46.56] GRADE not reported 3 studies · 130 participants |
| ARP with xenograft plus collagen membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Xenograft + collagen membrane (graft material subgroup) | MD -22.47 [-33.59, -11.34] GRADE not reported 6 studies · 164 participants |
| ARP with xenograft plus collagen membrane | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Xenograft + collagen membrane, sensitivity analysis excluding high risk of bias studies | MD -22.47 [-33.59, -11.34] GRADE not reported Studies not reported |
| ARP with allograft | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Allograft (graft material subgroup) | MD -16.33 [-47.9, 15.24] GRADE not reported 4 studies · 80 participants |
| ARP with alloplast | Spontaneous (unassisted) socket healing | New bone formation (%), histomorphometry 2 to 6 months after extraction (biopsy) · Alloplast (graft material subgroup) | MD -14.76 [-62.97, 33.45] GRADE not reported 3 studies · 65 participants |
Included primary studies 22
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Canellas 2020 Tomographic and histomorphometric evaluation of socket healing after tooth extraction using leukocyte- and platelet-rich fibrin: A… PMID:31810848 | 2020 | 3 other reviews | not stated | not extracted yet |
| Areewong 2019 Platelet-rich fibrin to preserve alveolar bone sockets following tooth extraction: A randomized controlled trial. PMID:31647177 | 2019 | 2 other reviews | not stated | not extracted yet |
| Dhamija 2020 Socket preservation with demineralized freeze-dried bone allograft and platelet-rich fibrin for implant site development: A randomized… PMID:33223701 | 2020 | 1 other review | not stated | not extracted yet |
| Hauser 2013 Clinical and histological evaluation of postextraction platelet-rich fibrin socket filling: a prospective randomized controlled study. PMID:23644909 | 2013 | 1 other review | not stated | not extracted yet |
| Ivanova 2021 Comparison Study of the Histomorphometric Results after Socket Preservation with PRF and Allograft Used for Socket Preservation-Randomized… PMID:34299902 | 2021 | 1 other review | not stated | not extracted yet |
| Ma 2021 The impact of autologous concentrated growth factors on the alveolar ridge preservation after posterior tooth extraction: A prospective,… PMID:34159704 | 2021 | 1 other review | not stated | not extracted yet |
| Stumbras 2020 Randomized and Controlled Clinical Trial of Bone Healing After Alveolar Ridge Preservation Using Xenografts and Allografts Versus Plasma… PMID:32315435 | 2020 | 1 other review | not stated | not extracted yet |
| Zampara 2022 A Histologic and Histomorphometric Evaluation of an Allograft, Xenograft, and Alloplast Graft for Alveolar Ridge Preservation in Humans: A… PMID:35446950 | 2022 | 1 other review | not stated | not extracted yet |
| Bakhshalian 2018 Histological and Histomorphometric Response to SocketKAP™ and SocketKAGE™ Used for Ridge Preservation and Repair: Results From a… PMID:29738746 | 2018 | this review only | not stated | not extracted yet |
| Barone 2017 Clinical and Histological changes after ridge preservation with two xenografts: preliminary results from a multicentre randomized… PMID:27883211 | 2017 | this review only | not stated | not extracted yet |
| Ben Amara 2021 Is ridge preservation effective in the extraction sockets of periodontally compromised teeth? A randomized controlled trial. PMID:33316099 | 2021 | this review only | not stated | not extracted yet |
| Bonta 2022 The Effect of an Alloplastic Bone Substitute and Enamel Matrix Derivative on the Preservation of Single Anterior Extraction Sockets: A… PMID:35472112 | 2022 | this review only | not stated | not extracted yet |
| Brownfield 2012 Ridge preservation with or without an osteoinductive allograft: a clinical, radiographic, micro-computed tomography, and histologic study… PMID:21942791 | 2012 | this review only | not stated | not extracted yet |
| Cardaropoli 2012 Socket preservation using bovine bone mineral and collagen membrane: a randomized controlled clinical trial with histologic analysis. PMID:22577648 | 2012 | this review only | not stated | not extracted yet |
| Fontes Martins 2021 Bone marrow aspirate concentrate and platelet-rich fibrin in fresh extraction sockets: A histomorphometric and immunohistochemical study… PMID:33349509 | 2021 | this review only | not stated | not extracted yet |
| Gabay 2022 Histological and dimensional changes of the alveolar ridge following tooth extraction when using collagen matrix and collagen-embedded… PMID:35298865 | 2022 | this review only | not stated | not extracted yet |
| Iasella 2003 Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a… PMID:12931761 | 2003 | this review only | not stated | not extracted yet |
| Lim 2019 Ridge preservation in molar extraction sites with an open-healing approach: A randomized controlled clinical trial. PMID:31444908 | 2019 | this review only | not stated | not extracted yet |
| MacBeth 2024 Healing patterns of alveolar bone following ridge preservation procedures. PMID:39105326 | 2024 | this review only | not stated | not extracted yet |
| Machtei 2019 Prospective randomized controlled clinical trial to compare hard tissue changes following socket preservation using alloplasts, xenografts… PMID:30592368 | 2019 | this review only | not stated | not extracted yet |
| Mayer 2016 Ridge Preservation Using Composite Alloplastic Materials: A Randomized Control Clinical and Histological Study in Humans. PMID:26922214 | 2016 | this review only | not stated | not extracted yet |
| Sayed 2019 THE USE OF NANO GRAFT COMBINED WITH LEUKOCYTEPLATELET RICH FIBRIN IN RIDGE PRESERVATION (A RANDOMIZED CONTROLLED CLINICAL AND HISTOLOGICAL… DOI:10.21608/asdj.2019.164532 | 2019 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing tooth extraction | Patients undergoing tooth extraction (505 ARP and 311 spontaneous healing; 816 total) |
| Intervention | Alveolar ridge preservation (ARP) using any graft material (xenograft, allograft, alloplast, demineralized bone matrix, autologous platelet concentrates) and/or membrane | ARP with PRF/CGF/PRGF, xenografts (with or without collagen membrane), allografts, alloplasts, sometimes with Emdogain or BMAC |
| Comparison | Spontaneous (unassisted) socket healing without grafts or membranes | Spontaneous healing |
| Outcomes | Histomorphometric parameters: percentage of new bone formation (primary), residual graft material, connective or non-mineralized tissue | New bone formation (%) in 22 RCTs; residual graft material (%) in 17 ARP arms; connective tissue planned but not pooled |
| Study designs | Randomized controlled trials in humans | 22 RCTs (RoB 2: 10 low, 6 some concerns, 5 high as stated) |
| Timing | Minimum follow-up of 2 months post-extraction | Follow-up 2 to 6 months post-extraction |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Yes | Partial Yes | no |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |