Pre-extraction alveolar buccal bone overbuilding: a preclinical investigation

Background: The pre-extraction overbuilding procedure was designed aiming to mitigate buccal bone resorption following tooth extraction. The objective of this study was to compare the efficacy of pre-extraction and juxta-extraction buccal overbuilding treatments in preserving buccal bone volume following tooth extraction.

Material and methods: At the test sites (pre-extraction sites), an alveolar crest overbuilding was performed on the buccal aspect of the distal root of the fourth premolar using a xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both fourth premolars were extracted and the alveoli were filled with a collagenated xenograft. An overbuilt procedure was performed also at the control sites (juxta-extraction sites). After 3 months, biopsies were collected.

Results: Considering the initial height difference between the lingual and buccal bone plates at the time of extraction, histological evaluation revealed that the resorption of the buccal bone relative to the lingual bone wall was 3.2 mm at the pre-extraction sites and 3.3 mm at the juxta-extraction sites. New bone originated from the residual pre-existing bone crest in an attempt to restore the original dimension.

Conclusion: The buccal overbuilding procedures performed three months before tooth extraction did not contribute to preserve the buccal bone crest, despite necessitating an additional surgical procedure. Evidence of ongoing bone regeneration was observed within the augmented space maintained by the biomaterial, suggesting that a prolonged healing period, potentially exceeding six months as indicated by this study, might be required to achieve optimal outcomes.