What grafting materials produce greater alveolar ridge preservation after tooth extraction? A systematic review and network meta-analysis

A systematic review and network meta-analysis was conducted to compare different bone-substitute materials used for alveolar ridge preservation after tooth extraction. The electronic search was carried out on Embase, PubMed, Cochrane Library, Web of Science, Scopus, LILACS, and grey literature up to March 22, 2020 (registration number INPLASY202030005). Only randomized controlled trials were included to answer the following PICOS question: ‘What grafting materials produce greater alveolar ridge preservation after tooth extraction?’ The primary outcomes were the alveolar width resorption 1 mm below the alveolar crest and buccal height resorption in millimeters. Of the 4379 studies initially identified, 31 studies involving 1088 patients were included in the quantitative analyses. Out of 25 revised biomaterials, eight showed a statistically significant difference compared with unassisted healing in both alveolar width and height measurements (mean width differences: ApatosⓇ, 2.27 [1.266–3.28]; Bio-OssⓇ, 0.88 [0.33–1.42]; Bio-Oss CollⓇ, 0.53 [0.04–1.01]; Bond-apatiteⓇ, 2.20 [1.30–3.11]; freeze-dried bone allograft, 1.35 [0.44–2.26]; Gen-OsⓇ, 1.90 [0.60–3.20]; platelet-rich fibrin, 1.66 [0.66–2.67]; and MP3Ⓡ, 2.67 [1.59–3.75]). Overall, xenograft materials should be considered as among the best of the available grafting materials for alveolar preservation after tooth extraction.