Extraction Site Management in the Esthetic Zone Using Autogenous Hard and Soft Tissue Grafts: A 5-Year Consecutive Clinical Study

This study evaluates whether alveolar ridge preservation and new bone formation is possible through extraction site management using autogenous hard and soft tissue grafts, in cases of buccal alveolar bone defects. Fifty-eight extraction sockets were consecutively completely filled with autogenous bone chips after tooth extraction in 49 patients from 2004 to 2006. At least half of the buccal alveolar wall was absent after tooth extraction in all cases. A free gingival-connective tissue graft from the palate sealed the grafted extraction site. Approximately 10 to 12 (mean, 10.9) weeks after socket augmentation, implants were inserted. A histomorphometric analysis was performed on trephine bone cores removed from the grafted sockets in seven consecutive cases. Standardized volumetric measurements of the buccal alveolar contour were evaluated before tooth extraction, 1 year, and 5 years after prosthetic incorporation. Implants could be inserted into 47 (81.0%) treated extraction sockets without additional grafting procedures. In 11 patients (19.0%), implant placement was combined with local grafting techniques. Bone grafts were mature and well revascularized 10 to 12 (mean, 10.9) weeks after socket augmentation. The mean amount of vital bone was 52.0% +/- 8.6%. Standardized volumetric measurements showed that 83.3% of the reference points representing the outer alveolar contour did not change significantly from baseline to 1 year after prosthetic incorporation and from baseline to 5 years after prosthetic incorporation. None of the reference points showed a statistically significant change in volume from 1 to 5 years after prosthetic incorporation. Extraction site management using autogenous hard and soft tissue grafts enables new bone formation in cases of buccal alveolar bone defects, offers a long-term alveolar ridge preserving technique, and reduces total implant treatment time.