Buccal Plate Augmentation With Different Hydroxyapatite Based Material
Condition: Edentulous
MeSH terms: Mouth, Edentulous
Study type: Observational

Summary: 
      The purposes of this study are : (first) to evaluate comparatively the effectiveness of 2
      HA-based biomaterials when used for socket preservation with Buccal Plate Augmentation
      technique; (second) to evaluate clinical outcomes of socket preservation procedures performed
      using the Buccal Plate Augmentation technique.
    

Detailed description: 
      Tooth loss results physiologically in a significant remodeling of the alveolar ridge. The
      bone resorption process begins immediately after extraction, leading to an average 40-60%
      decrease in the horizontal and vertical dimensions of the alveolar ridge, during the first 2
      years (Amler 1969, Johnson 1969)1,2. The majority of post-extraction bone loss is more
      evident on the buccal aspect of the ridge (Pietrokovski & Massler 1967)3 and occurs mainly
      within the first 3 months (Johnson 1969; Schropp et al. 2003)2,4. It is now known that
      crestal remodeling is strictly related to bundle bone resorption5 and that is more evident on
      the buccal plate where, especially in thin periodontal biotypes, can result in significant
      facial hard and soft tissue recessions. Bundle bone vascularization comes from periodontal
      ligament and it is interrupted by tooth extraction: for this reason bundle bone resorption
      and, consequent socket remodeling are impossible to prevent. Furthermore, modeling and
      remodeling of extraction sockets have a great variability in timing: a recent study
      (Trombelli et al. 2008) reports that bone organization and architecture is not completed 24
      weeks after tooth extraction6.

      In order to preserve ridge volumetry after extraction, many clinical techniques and various
      biomaterials have been suggested for grafting of post-extraction wounds7-12. Grafting of
      sockets provides stable clinical results but some studies demonstrate that, unless using a
      membrane, at histological examination most of the graft particles are encapsulated by fibrous
      tissue, especially in the coronal area 9,11. Recently, a study on an animal model (Araújo et
      al. 2009) reported that the presence of bone graft material in fresh extraction socket leads
      to a delayed healing response13.

      On account of these observations, a novel surgical technique was presented in literature
      (Caiazzo et al. 2010)14, with the name of Buccal Plate Augmentation (BPA). After performing a
      gentle tooth extraction and verifying the integrity of the alveolar walls, BPA consists in
      placing a HA-based bone graft material over the intact buccal bone plate, underneath the soft
      tissues and the periosteum in a surgically created pouch with the aim to maintain or augment
      crestal volumetry and soft tissue aesthetics of the region. This approach allows for avoiding
      recession of the alveolar facial wall without interfering with the natural healing mechanism
      of the extraction socket, which is left undisturbed. To date, however, there is still no
      evidence regarding the most suitable biomaterial for maintaining predictably crestal
      volumetry and soft tissues contour overtime.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        primary care clinic
      
Keywords: Buccal Plate Augmentation technique; socket preservation; porcine biomaterial