Alveolar ridge dimensional changes after two socket sealing techniques. A pilot randomized clinical trial



This pilot study aimed to assess dimensional changes following two different alveolar socket sealing techniques.

Material and methods

Twenty-one patients requiring tooth extraction and implant placement were randomly allocated to two different alveolar ridge preservation techniques. In the control group, demineralized bovine bone mineral (DBBM) and a gingival soft tissue punch were used to fill and seal the socket, whereas in the test group, the extraction socket was filled with DBBM and sealed with a hemostatic gelatin sponge. Digitalized impressions were taken before and 6 months after tooth extraction. The comparison was made on horizontal and vertical dimensional changes.


The mean vertical loss was 0.8 ± 0.6 mm for the control group and 0.7 ± 0.5 mm for the test one. No statistical difference was found between groups for the vertical shrinkage. The horizontal dimensional narrowing of the alveolar socket was respectively 7.1/4.0/2.5 mm at levels 1, 3, and 5 mm from a coronal reference level for the control group. The test group showed dimensional changes of 4.8/2.3/1.3 mm at the three different levels, respectively. A significant difference was found at levels 3 and 5 mm. Referring to a visual analog pain scale, patients reported more severe pain in the control group (5.7/10) when compared with the test group (2.8/10). The difference was statistically highly significant (P ≤ 0.001).


A significant difference was found between control and test groups regarding the horizontal dimensional changes and the post-operative pain.

Clinical relevance

Regarding this primary result, the socket sealing technique with a hemostatic sponge provides an effective and inexpensive protocol with less post-operative pain.

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  1. 1.

    Amler MH, Johnson PL, Salman I (1960 Jul) Histological and histochemical investigation of human alveolar socket healing in undisturbed extraction wounds. J Am Dent Assoc 61:32–44

    Article  Google Scholar 

  2. 2.

    Cardaropoli G, Araújo M, Lindhe J (2003 Sep) Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs. J Clin Periodontol 30(9):809–818

    Article  Google Scholar 

  3. 3.

    Schropp L, Wenzel A, Kostopoulos L, Karring T (2003 Aug) Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 23(4):313–323

    PubMed  Google Scholar 

  4. 4.

    Araújo MG, Lindhe J (2005a Feb) Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 32(2):212–218

    Article  Google Scholar 

  5. 5.

    Tan WL, Wong TLT, Wong MCM, Lang NP (2012) A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res 23(Suppl 5):1–21

    Article  Google Scholar 

  6. 6.

    Botticelli D, Berglundh T, Lindhe J (2004 Oct) Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol 31(10):820–828

    Article  Google Scholar 

  7. 7.

    Araújo MG, Sukekava F, Wennström JL, Lindhe J (2005b Jun) Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol 32(6):645–652

    Article  Google Scholar 

  8. 8.

    Araújo MG, Lindhe J (2011 Jan) Socket grafting with the use of autologous bone: an experimental study in the dog. Clin Oral Implants Res 22(1):9–13

    Article  Google Scholar 

  9. 9.

    Camargo PM, Lekovic V, Weinlaender M, Klokkevold PR, Kenney EB, Dimitrijevic B, Nedic M, Jancovic S, Orsini M (2000 Nov) Influence of bioactive glass on changes in alveolar process dimensions after exodontia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(5):581–586

    Article  Google Scholar 

  10. 10.

    Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, Scheetz JP (2003 Jul) Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol 74(7):990–999

    Article  Google Scholar 

  11. 11.

    Barone A, Aldini NN, Fini M, Giardino R, Calvo Guirado JL, Covani U (2008 Aug) Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphometric study. J Periodontol 79(8):1370–1377

    Article  Google Scholar 

  12. 12.

    Jung RE, Philipp A, Annen BM, Signorelli L, Thoma DS, Hämmerle CHF, Attin T, Schmidlin P (2013 Jan) Radiographic evaluation of different techniques for ridge preservation after tooth extraction: a randomized controlled clinical trial. J Clin Periodontol 40(1):90–98

    Article  Google Scholar 

  13. 13.

    Lindhe J, Cecchinato D, Donati M, Tomasi C, Liljenberg B (2014 Jul) Ridge preservation with the use of deproteinized bovine bone mineral. Clin Oral Implants Res 25(7):786–790

    Article  Google Scholar 

  14. 14.

    Nevins M, Camelo M, De Paoli S, Friedland B, Schenk RK, Parma-Benfenati S et al (2006 Feb) A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots. Int J Periodontics Restorative Dent 26(1):19–29

    PubMed  Google Scholar 

  15. 15.

    Fickl S, Zuhr O, Wachtel H, Bolz W, Huerzeler MB (2008b Nov) Hard tissue alterations after socket preservation: an experimental study in the beagle dog. Clin Oral Implants Res 19(11):1111–1118

    Article  Google Scholar 

  16. 16.

    Fickl S, Zuhr O, Wachtel H, Stappert CFJ, Stein JM, Hürzeler MB (2008c Oct) Dimensional changes of the alveolar ridge contour after different socket preservation techniques. J Clin Periodontol 35(10):906–913

  17. 17.

    Iocca O, Farcomeni A, Pardiñas Lopez S, Talib HS (2017 Jan) Alveolar ridge preservation after tooth extraction: a Bayesian network meta-analysis of grafting materials efficacy on prevention of bone height and width reduction. J Clin Periodontol 44(1):104–114

    Article  Google Scholar 

  18. 18.

    Tomlin EM, Nelson SJ, Rossmann JA (2014) Ridge preservation for implant therapy: a review of the literature. Open Dent J 8:66–76

    Article  Google Scholar 

  19. 19.

    MacBeth N, Trullenque-Eriksson A, Donos N, Mardas N (2016) Hard and soft tissue changes following alveolar ridge preservation: a systematic review. Clin Oral Implants Res 26

  20. 20.

    Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U (2014 Jan) Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. J Periodontol 85(1):14–23

    Article  Google Scholar 

  21. 21.

    Fickl S, Zuhr O, Wachtel H, Bolz W, Huerzeler M (2008a Apr) Tissue alterations after tooth extraction with and without surgical trauma: a volumetric study in the beagle dog. J Clin Periodontol 35(4):356–363

    Article  Google Scholar 

  22. 22.

    Jung RE, Siegenthaler DW, Hämmerle CHF (2004 Dec) Postextraction tissue management: a soft tissue punch technique. Int J Periodontics Restorative Dent 24(6):545–553

    PubMed  Google Scholar 

  23. 23.

    Karaca Ç, Er N, Gülşahı A, Köseoğlu OT (2015 Jun) Alveolar ridge preservation with a free gingival graft in the anterior maxilla: volumetric evaluation in a randomized clinical trial. Int J Oral Maxillofac Surg 44(6):774–780

    Article  Google Scholar 

  24. 24.

    Meloni SM, Tallarico M, Lolli FM, Deledda A, Pisano M, Jovanovic SA (2015) Postextraction socket preservation using epithelial connective tissue graft vs porcine collagen matrix. 1-year results of a randomised controlled trial. Eur J Oral Implantol 8(1):39–48

    PubMed  Google Scholar 

  25. 25.

    Van der Velden U (2009 Dec) The Dutch periodontal screening index validation and its application in the Netherlands. J Clin Periodontol 36(12):1018–1024

    Article  Google Scholar 

  26. 26.

    Ender A, Attin T, Mehl A (2016 Mar) In vivo precision of conventional and digital methods of obtaining complete-arch dental impressions. J Prosthet Dent 115(3):313–320

    Article  Google Scholar 

  27. 27.

    Fickl S, Kauffmann F, Stappert CF, Kauffmann A, Schlagenhauf U (2018 Feb) Scar tissue formation following alveolar ridge preservation: a case control study. Int J Periodontics Restorative Dent 38(1):e1–e7

    Article  Google Scholar 

  28. 28.

    Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, Nedic M (1998 Sep) Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol 69(9):1044–1049

    Article  Google Scholar 

  29. 29.

    Serrano Méndez CA, Lang NP, Caneva M, Ramírez Lemus G, Mora Solano G, Botticelli D (2017) Comparison of allografts and xenografts used for alveolar ridge preservation. A clinical and histomorphometric RCT in humans. Clin Implant Dent Relat Res août 19(4):608–615

    Article  Google Scholar 

  30. 30.

    Moya-Villaescusa MJ, Sánchez-Pérez A (2010 Feb) Measurement of ridge alterations following tooth removal: a radiographic study in humans. Clin Oral Implants Res 21(2):237–242

    Article  Google Scholar 

  31. 31.

    Geurs NC, Vassilopoulos PJ, Reddy MS. Soft tissue considerations in implant site development. Oral Maxillofac Surg Clin North Am 2010;22(3):387–405, vi – vii

  32. 32.

    Zigdon H, Machtei EE (2008 Apr) The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res 19(4):387–392

    Article  Google Scholar 

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The work was supported by the Department of Periodontology of Université catholique de Louvain, School of Dentistry, Cliniques Universities Saint-Luc, Brussels, Belgium.

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Correspondence to M. Debel.

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Conflict of interest

Maxim Debel declares that he has no conflict of interest. Selena Toma declares that she has no conflict of interest. Bart Vandenberghe declares that he has no conflict of interest. Michel Brecx declares that he has no conflict of interest. Jérôme Lasserre declares that he has no conflict of interest.

Ethical approval

This study followed the Helsinki Declaration and was registered with the local ethical committee of the Medical School of the Université catholique de Louvain, Brussels, Belgium (ref: 2015/16DEC/681).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Debel, M., Toma, S., Vandenberghe, B. et al. Alveolar ridge dimensional changes after two socket sealing techniques. A pilot randomized clinical trial. Clin Oral Invest (2020).

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  • Alveolar ridge preservation
  • Bone substitute
  • Extraction
  • Socket sealing
  • Soft tissue management