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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (1): 74-83. doi: 10.19723/j.issn.1671-167X.2026.01.010

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Clinical comparison of xenograft versus synthetic bone graft materials in micro crestal flap-alveolar ridge preservation following extraction of molars

Siqiao ZHANG1, Jian LIU1, Tao XU2,*(), Wenjie HU1,*(), Haoyun ZHANG1, Yiping WEI1   

  1. 1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2025-10-10 Online:2026-02-18 Published:2025-12-09
  • Contact: Tao XU, Wenjie HU
  • Supported by:
    the Clinical Research Foundation of Peking University School and Hospital of Stomatology(PKUSS-2023CRF505)

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Abstract:

Objective: To compare the clinical outcomes between xenogeneic bone graft materials primarily composed of deproteinized bovine bone mineral (DBBM) and synthetic bone graft materials primarily composed of hydroxyapatite (HA) used in micro crestal flap-alveolar ridge preservation (MCF-ARP) of periodontally compromised molars, so as to provide a reference for their application and promotion. Methods: In this retrospective case series study, patients who received treatment between October 2024 and April 2025 were enrolled. All the patients underwent MCF-ARP, using either DBBM or HA. Hard tissue changes and alveolar ridge contour collapse were evaluated and compared between the two groups preoperatively and 6 months postoperatively using cone beam computed tomography (CBCT) and intraoral scanning. Soft tissue healing process after the surgery was also assessed. Results: A total of 14 molars from 14 patients were included. No significant differences were found in hard tissue changes between the two groups 6 months after the surgery (P>0.05). Two weeks and 1 month postoperatively, the vertical collapse of the contour at the ridge center was significantly greater in the HA group compared with the DBBM group [2 weeks: (2.73±1.89) mm vs. (0.00±0.79) mm, P < 0.05; 1 month: (2.74±1.13) mm vs. (0.35±2.34) mm, P < 0.05]. No significant differences were found in other sites at any other follow-up points (P>0.05). In terms of wound healing, the HA group showed a significantly higher percentage of wound area lacking keratinized tissue coverage compared with the DBBM group both 2 weeks and 1 month after the surgery (2 weeks: 47.88%±6.56% vs. 29.43%±14.25%, P < 0.05; 1 month: 25.68%±13.06% vs. 7.19%±7.18%, P < 0.01). Conclusion: Within the limitations of this study, the analysis suggests that there is no statistically significant difference in hard tissue and alveolar ridge contour parameters 6 months after MCF-ARP following extraction of periodontally compromised molars. However, early soft tissue healing is faster when using DBBM. Future randomized controlled trials with histological analysis are warranted for further validation.

Key words: Periodontitis, Alveolar ridge preservation, Alveolar bone grafting, Heterografts

CLC Number: 

  • R782.1

Figure 1

The surgical procedure of minimally invasive tooth extraction combined with MCF-ARP using DBBM or HA A1-F1, DBBM group; A2-F2, HA group; A1 and A2, preoperative occlusal view; B1 and B2, minimally invasive tooth extraction, thorough debridement of the socket, and minimal flap reflection to expose the bone surface; C1 and C2, bone graft material placed in the socket, absorbable membrane placed between the gingival flap and the crestal bone; D1 and D2, absorbable membrane covering the bone graft material extending to the apical aspect of the contralateral crestal bone; E1 and E2, absorbable collagen sponge covering the membrane; F1 and F2, coronally repositioned flap, fixed with 4-0 non-absorbable interrupted sutures. MCF-ARP, micro crestal flap-alveolar ridge preservation; DBBM, deproteinized bovine bone mineral; HA, hydroxyapatite."

Figure 2

Data collection MCF-ARP, micro crestal flap-alveolar ridge preservation; DBBM, deproteinized bovine bone mineral; HA, hydroxyapatite; CBCT, cone beam computed tomography."

Figure 3

Clinical photographs and CBCT cross-sectional images of DBBM group at different time points A1-A7, preoperative occlusal view; B1-B7, tooth socket; C1-C7, immediate postoperative occlusal view; D1-D7, immediate postoperative CBCT; E1-E7, 6 months follow-up; F1-F7; CBCT taken 6 months postoperative. Abbreviations as in Figure 2."

Figure 4

Clinical photographs and CBCT cross-sectional images of HA group at different time points A1-A7, preoperative occlusal view; B1-B7, tooth socket; C1-C7, immediate postoperative occlusal view; D1-D7, immediate postoperative CBCT; E1-E7, 6 months follow-up; F1-F7; CBCT taken 6 months postoperative. Abbreviations as in Figure 2."

Figure 5

Measurement of CBCT radiographic indicators a, height at the center of the socket (CH), buccal bone height (BH) and lingual/palatal bone height (LH); b, bone wall thicknesses at 1 mm and 3 mm apically below the buccal and lingual/palatal bone crests (TB1, TB3, TL1, TL3); c, ridge widths at 1 mm and 3 mm apically below the higher bone crests (WH1, WH3); d, postoperative height at the center of the socket (PCH), postoperative buccal bone height (PBH) and postoperative lingual/palatal bone height (PLH); e, postoperative ridge widths at 1 mm and 3 mm apically below the higher bone crests (PWH1, PWH3). Yellow curve, baseline alveolar bone contour; Green curve, 6-month postoperative alveolar bone contour. B, buccal; L, lingual; CBCT, cone beam computed tomography."

Figure 6

Measurement of alveolar ridge contour parameter by intraoral scanning a, changes in soft tissue contour at follow-up time points; b, vertical reduction of the contour on the buccal free gingival margins (VBGM), vertical reduction of the contour on the lingual/palatal free gingival margins (VLGM) and vertical reduction of the contour on the center of gingival margins (VCGM); c, horizontal reduction of the buccal or lingual/palatal contour at 1 mm, 3 mm apically (HRB1, HRB3, HRL1, HRL3). Green curve, preoperative; Red curve, immediately postoperative; Blue curve, 2 weeks postoperative; Purple curve, 1 month postoperative; Orange curve, 3 months postoperative; Yellow curve, 6 months postoperative. B, buccal; P, palatal."

Figure 7

Measurement of wound area at different time points A, immediately postoperative; B, 2 weeks postoperative; C, 1 month postoperative; D, 3 months postoperative. Red curve, wound area."

Table 1

Comparison of patient baseline characteristics"

Items DBBM (n=7) HA (n=7) t/Z P
Age/years 52.29±9.90 53.86±11.17 -0.28a 0.785
Gender 0.266
  Female 4 1
  Male 3 6
Tooth position >0.999
  Maxillary 5 6
  Mandibular 2 1
BH/mm 5.32±3.69 4.28±4.00 0.51a 0.618
LH/mm 5.85±3.97 4.67±3.74 0.57a 0.577
CH/mm 5.08±3.53 3.65±2.04 0.93a 0.374
TB1/mm 1.40±1.02 1.09±0.89 0.61a 0.555
TB3/mm 1.64±1.39 1.65±1.60 -0.02a 0.987
TL1/mm 1.46±0.40 1.58±1.07 -0.29a 0.780
TL3/mm 2.07±0.79 2.18±1.99 -0.13a 0.897
WH1/mm 1.83 (1.52, 2.19) 1.70 (1.31, 8.28) -0.06b 0.949
WH3/mm 6.83 (2.57, 13.26) 5.67 (1.60, 12.77) -0.06b 0.949

Table 2

Comparison of changes in hard tissue parameter"

Items DBBM (n=7) HA (n=7) t/Z P
PBH/mm 3.45±4.01 6.11±3.38 -1.34a 0.204
PLH/mm 5.85±3.64 5.46±2.32 0.24a 0.813
PCH/mm 13.61±4.07 10.43±5.03 1.30a 0.217
DBH/mm -1.88±1.48 1.83±2.36 -3.53a 0.004*
DLH/mm 0.00±3.07 0.89±3.34 -0.52a 0.615
DCH/mm 8.53±2.56 6.77±3.45 1.09a 0.298
PWH1/mm 8.84±2.66 8.66±3.14 0.12a 0.908
PWH3/mm 10.55±2.65 11.37±2.46 -0.60a 0.558
DWH1/mm 7.10 (4.73, 8.94) 7.22 (-0.54, 9.58) -0.19b 0.848
DWH3/mm 3.13±6.10 4.59±5.17 -0.48a 0.637

Figure 8

Alveolar ridge contour reduction at follow-up time points of the two groups A, vertical reduction of the contour on the buccal free gingival margins (VBGM); B, vertical reduction of the contour on the lingual/palatal free gingival margins (VLGM); C, horizontal reduction of the buccal contour at 1 mm apically (HRB1); D, horizontal reduction of the lingual/palatal contour at 1 mm apically (HRL1); E, horizontal reduction of the buccal contour at 3 mm apically (HRB3); F, horizontal reduction of the lingual/palatal contour at 3 mm apically (HRL3). DBBM, deproteinized bovine bone mineral; HA, hydroxyapatite."

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