Digital workflow for alveolar ridge preservation with equine-derived bone graft and subsequent implant rehabilitation

Abstract

It is known that postextraction socket resorption may lead to a mean loss of buccal-lingual width of approximately 4 mm as well as a mean loss of height of approximately 2 mm, primarily in the first 3 months. Such alterations, in turn, may lead to esthetic problems and even prevent implant placement. In this context, alveolar ridge preservation with particulate bone grafts has been considered a valid technique to prevent postextraction socket resorption. Several types of bone grafts have been used in dentistry. While autogenous grafts promote osteoinduction, osteogenesis, and osteoconduction, they have limitations such as risk of trauma to the patient and donated bed morbidity. Allogeneic grafts, in turn, also have limitations such as high cost, possibility of virus transmissibility, and triggering immunological reactions. On the other hand, all of these aforementioned limitations can be avoided by using xenografts. Among the available xenografts, bovine and porcine have been described in the literature on dentistry as predictable options for ridge preservation. Another xenograft recently studied in dentistry is an enzymatic form of equine bone. Because of the enzymatic process, it ends up preserving the type I bone collagen in its undenatured native state, thus allowing an improved bone regeneration process. Such equinederived material also has the elasticity to be properly shaped to match the bone defect. However, there is a lack of evidence regarding clinical results of equine-derived bone grafts for alveolar ridge preservation. Alveolar bone-grafting techniques also require cone-beam computerized tomographic (CBCT) scans for virtual surgical planning, which can belong to a digital workflow for dental implant rehabilitation. Nevertheless, little is known about the methods for estimating the volume of the particulate synthetic graft required to properly fill the alveolar socket to achieve satisfactory ridge preservation results. Thus, the aim of this study was to describe a digital workflow used for 3 main purposes: to predict the volume of particulate grafting material required to perform alveolar ridge preservation, to conduct subsequent virtual implant planning, and to digitally design the respective implant supported crown.