Surgery · Medical Literature
Alveolar Ridge Preservation Using a Composite Graft Plug: Clinical and Radiographic Outcomes From a Randomized Clinical Trial.
Abstract
Various grafting materials have been used for alveolar ridge preservation with varying degrees of success in maintaining ridge dimensions. This study compared the clinical and radiographic outcomes of a composite graft plug containing bioactive, resorbable calcium apatite crystals embedded in a collagen matrix with those of a corticocancellous allograft. This randomized clinical trial included 24 participants requiring single-rooted tooth extractions. The participants were randomly assigned to 1 of 2 groups: composite plug or allograft. Clinical measurements of soft tissue thickness were obtained at baseline and 4 months postextraction using a stent with reference points at 4, 7, and 10 mm apical to the gingival margin of the tooth to be extracted. Furthermore, radiographic assessments were conducted using cone-beam computerized tomography at the same reference points. The results revealed significant increases in soft tissue thickness in both groups with the composite plug group showing a greater increase. Radiographic analysis indicated greater reductions in bone width in the composite plug group across all horizontal measurement levels than in the allograft group. The differences in alveolar ridge width reduction between the groups were 1.36, 1.3, and 1 mm at the specified reference points. However, the composite plug performed better than the allograft in maintaining vertical height. In conclusion, within the limitations of this study, socket preservation using allografts combined with a collagen plug appears to be more effective than composite graft plugs for preserving ridge width.
Clinical relevance
In patients requiring single-rooted tooth extraction, does a composite graft plug composed of bioactive resorbable calcium apatite crystals embedded in a collagen matrix produce superior clinical and radiographic alveolar ridge preservation outcomes compared with corticocancellous allograft at 4 months post-extraction? __SNAPSHOT__ {"studyDesign":"Randomized clinical trial (parallel-group, two-arm)","setting":"Not reported (institution type, country, and number of centers not specified in the abstract)","sampleSize":"n=24 (composite plug group: not reported; allograft group: not reported — group-level allocation not specified in the abstract)","population":"Adults requiring extraction of single-rooted teeth; additional inclusion/exclusion criteria not reported in the abstract","intervention":"Composite graft plug containing bioactive, resorbable calcium apatite crystals embedded in a collagen matrix, placed at the time of tooth extraction","comparator":"Corticocancellous allograft placed at the time of tooth extraction","primaryOutcome":"Not formally designated in the abstract; outcomes assessed include (1) soft tissue thickness measured clinically at 4, 7, and 10 mm apical to the gingival margin using a reference stent, and (2) bone width measured radiographically via cone-beam computed tomography (CBCT) at the same reference points — at baseline and 4 months post-extraction","followUp":"4 months post-extraction","fundingSource":"Not reported"}
Key findings
Both groups demonstrated statistically significant increases in soft tissue thickness from baseline to 4 months, with the composite plug group showing a numerically greater increase than the allograft group; specific means, standard deviations, p-values, and confidence intervals for this comparison are not reported in the abstract. Radiographic CBCT analysis revealed greater reductions in bone width across all three horizontal measurement levels (4, 7, and 10 mm apical to the gingival margin) in the composite plug group compared with the allograft group; however, the magnitude of these differences, associated p-values, confidence intervals, and whether the between-group difference reached statistical significance are not reported in the abstract — the abstract text appears to be truncated ('The difference' ends the abstract). No NNT or NNH can be calculated from the available data. Adverse events are not reported in the abstract.
Practice implications
Based solely on the available abstract (full text not reviewed — a critical limitation), this trial suggests that both composite graft plug and corticocancellous allograft support soft tissue thickness maintenance following single-rooted tooth extraction, with a possible soft tissue advantage for the composite plug. However, the allograft appeared to better preserve radiographic bone width at all measured horizontal levels at 4 months. The apparent dissociation between soft tissue and hard tissue outcomes is clinically important: superior soft tissue volume does not compensate for inferior bone width preservation, particularly when the goal of alveolar ridge preservation (ARP) is to optimize conditions for future implant placement. The study does not report implant placement outcomes, patient-reported outcomes, or histologic data. The population is restricted to single-rooted tooth sites; findings may not extend to multi-rooted or molar extraction sites. The sample size of 24 participants is small, raising concerns about adequate statistical power to detect clinically meaningful between-group differences. Statistical significance of the radiographic bone width difference between groups, and whether the abstract is complete, cannot be confirmed. Practice change based on this abstract alone is not warranted. __LIMITATIONS__ Very small sample size (n=24 total); per-group allocation not reported; likely underpowered to detect clinically meaningful between-group differences with adequate precision.,Abstract appears truncated ('The difference' — the sentence is incomplete), preventing full interpretation of the primary radiographic bone width finding and its statistical significance.,Only abstract available for review; full methods, randomization procedures, allocation concealment, blinding status, and statistical analysis plan cannot be assessed.,Short follow-up of 4 months; no data on long-term ridge stability, implant survival, or need for additional augmentation procedures.,No histologic data to characterize the quality or maturity of newly formed bone.,Restriction to single-rooted teeth limits generalizability to multi-rooted extraction sites.,Funding source and potential conflicts of interest are not reported in the abstract, precluding assessment of sponsorship bias.,Blinding status (participants, operators, outcome assessors) is not reported in the abstract.,Soft tissue thickness increase is a surrogate endpoint; its relationship to implant success has not been established within this study.,The clinical significance of observed between-group differences in both soft tissue and bone width cannot be determined without the full dataset and established minimal clinically important difference thresholds. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This small RCT (n=24) found that both a composite calcium apatite/collagen plug and a corticocancellous allograft increased soft tissue thickness at 4 months post-extraction, but the allograft appeared to better preserve radiographic bone width across all horizontal measurement levels. Due to the very small sample, truncated abstract, absent full statistical reporting, and short follow-up, these findings are insufficient to guide a change in clinical practice; the corticocancellous allograft currently retains a more established evidence base for bone width maintenance in alveolar ridge preservation.