Wah Lay Tan A systematic review of post-extrac-

Terry L. T. Wong
May C. M. Wong
tional alveolar hard and soft tissue
Niklaus P. Lang dimensional changes in humans

Authors’ affiliations:
Wah Lay Tan, Terry L. T. Wong, May C. M. Wong,
Niklaus P. Lang, Implant Dentistry, The University
of Hong Kong, Prince Philip Dental Hospital,
Implant Dentistry, Hong Kong, China
Key words: alveolar bone, dimensional change, extraction, hard tissue, human, removal of
teeth, resorption, soft tissue, systematic review
Abstract

Corresponding author:
Background: Removal of teeth results in both horizontal and vertical changes of hard and soft
Prof. Niklaus P. Lang, DMD, MS, PhD, Dr odont.h. tissue dimensions. The magnitude of these changes is important for decision-making and
c. mult. comprehensive treatment planning, with provisions for possible solutions to expected
The University of Hong Kong Faculty of Dentistry
Prince Philip Dental Hospital complications during prosthetic rehabilitation.
34 Hospital Road, Sai Ying Pun Objectives: To review all English dental literature to assess the magnitude of dimensional changes
Hong Kong, China of both the hard and soft tissues of the alveolar ridge up to 12 months following tooth extraction
Tel.:+852 2859 0526
Fax: +852 2858 6114 in humans.
e-mail: nplang@dial.eunet.ch Methods: An electronic MEDLINE and CENTRAL search complemented by manual searching was
conducted to identify randomized controlled clinical trials and prospective cohort studies on hard
Conflicts of interest and soft tissue dimensional changes after tooth extraction. Only studies reporting on undisturbed
The authors declare no conflict of interest. post-extraction dimensional changes relative to a fixed reference point over a clearly stated time
period were included. Assessment of the identified studies and data extraction was performed
independently by two reviewers. Data collected were reported by descriptive methods. Weighted
means and percentages of the dimensional changes over time were calculated where appropriate.
Results: The search provided 3954 titles and 238 abstracts. Full text analysis was performed for 104
articles resulting in 20 studies that met the inclusion criteria. In human hard tissue, horizontal
dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on
buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months. Percentage
vertical dimensional change was 11–22% at 6 months. Percentage horizontal dimensional change
was 32% at 3 months, and 29–63% at 6–7 months. Soft tissue changes demonstrated 0.4–0.5 mm
gain of thickness at 6 months on the buccal and lingual aspects. Horizontal dimensional changes of
hard and soft tissue (loss of 0.1–6.1 mm) was more substantial than vertical change (loss 0.9 mm to
gain 0.4 mm) during observation periods of up to 12 months, when study casts were utilized as a
means of documenting the changes.
Conclusions: Human re-entry studies showed horizontal bone loss of 29–63% and vertical bone
loss of 11–22% after 6 months following tooth extraction. These studies demonstrated rapid
reductions in the first 3–6 months that was followed by gradual reductions in dimensions
thereafter.

The periodontium is an important structure tion or extraction of the tooth. Subsequent to

Date:
Accepted 15 October 2011
To cite this article:
Tan WL, Wong TLT, Wong MCM, Lang NP. A systematic
review of post-extractional alveolar hard and soft tissue
dimensional changes in humans.
Clin. Oral. Impl. Res. 23(Suppl. 5), 2012, 1–21
doi: 10.1111/j.1600-0501.2011.02375.x
that supports the tooth and is affected by any
changes that the tooth may undergo, includ-
ing eruption and extraction (Cohn 1966; Pie-
trokovski & Massler 1967, 1971). The
alveolar process is a tooth-dependent tissue;
the shape and volume of the alveolar process
is influenced by tooth form, as well as the
direction of eruption of the tooth (Marks
1995; Marks & Schroeder 1996), and the pres-
ence or absence of teeth (Tallgren 1972). Sim-
ilarly, gingival tissues undergo changes
together with eruption and eventual exfolia-
removal of a tooth, the periodontium under-
goes atrophy (Cohn 1966; Schropp et al.
2003), with the complete loss of attachment
apparatus including cementum, periodontal
ligament fibres and bundle bone (Araujo &
Lindhe 2005).
Tooth extraction is one of the most widely
performed dental procedures. In general, post-
extraction healing of both the hard and soft
tissues proceeds uneventfully. However, the
removal of a tooth will generally result in
some alveolar bone loss, as well as structural

© 2011 John Wiley & Sons A/S 1

Tan et al
Dimensional tissue changes post extraction
and compositional changes in the overlying
soft tissue (Schropp et al. 2003). Both hori-
zontal and vertical changes in dimensions are
expected in hard tissue (Van der Weijden
et al. 2009) as well as soft tissue. Studies in
the canine model (Araujo & Lindhe 2005;
Araujo et al. 2005) have demonstrated that
there are marked dimensional changes of the
alveolar ridge in the first 2–3 months post-
extraction, with the changes more pro-
nounced on the buccal (Araujo et al. 2005).
Critically, horizontal buccal bone resorption
has been shown reach as much as 56% while
lingual bone resorption has been reported to
be up to 30% (Botticelli et al. 2004); the over-
all reduction in width of the horizontal ridge
has been reported to reach 50% (Schropp
et al. 2003).
A narrower and shorter ridge can be an
expected sequelae of the resorptive process
(Pinho et al. 2006), and in effect, the process
of resorption often results in the relocation of
the ridge to a more lingual position (Botticelli
et al. 2004). The process of ridge remodelling
is further complicated if the buccal bone wall
is lost (Iasella et al. 2003) as a result of
inflammatory processes or the extraction
itself.
Extraction of one or more teeth results
not only in changes of the bony architec-
ture, but also affects the overlying soft tis-
sues of the alveolus (Schropp et al. 2003).
Immediately following tooth extraction,
there is absence of soft tissue covering over
the socket entrance, and hence the socket
defect is left to heal by secondary intention.
In the subsequent weeks, cell proliferation
will result in an increase in soft tissue vol-
ume, and a soft tissue covering will seal the
socket entrance. The changes in the muco-
sal contours are dependent on the corre-
sponding changes in the external profile of
the alveolar bone surrounding the extraction
site.
The magnitude of these dimensional
changes are important for informed decision-
making and comprehensive treatment plan-
ning, with provisions for possible solutions
to expected complications during prosthetic
rehabilitation. In addition, with the advent of
greater emphasis on aesthetics in the last
decade, a thorough understanding of the
resorptive pattern and alterations in bony and
mucosal contours post-extraction would
greatly enhance our ability to reconstruct our
patients to a level of optimal function cou-
pled with satisfactory aesthetics.
There have been numerous studies that
have researched the magnitude of hard tissue
changes post-extraction, with the consensus
2 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
that alveolar bone loss can be quite marked
after tooth removal (Araujo & Lindhe 2009),
especially in the horizontal dimension (Botti-
celli et al. 2004). Soft tissue changes
post-extraction have largely been described
qualitatively, and usually as a single entity
together with the hard tissue changes
assessed using serial study casts (e.g. Schropp
et al. 2003).
In recent years, there has been one system-
atic review addressing the dimensional
changes of the alveolar ridge after tooth
extraction (Van der Weijden et al. 2009);
however, there is as yet no systematic review
addressing the dimensional changes of both
the hard and soft tissues after tooth extrac-
tion.
This study aims to review all existing liter-
ature published between 1st January 1960
and 30th January 2011, to assess the magni-
tude of dimensional change of both the hard
and soft tissues of the alveolar ridge after
tooth extraction.
Material and methods
The Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) state-
ment was consulted throughout the process
of this systematic review.
Focused question
What is the magnitude of dimensional
changes in the hard and soft tissues of the
alveolar process, up to 12 months following
tooth extraction?
Search strategy
A comprehensive and systematic electronic
search of both the MEDLINE–Pubmed data-
base and the Cochrane Central Register of
Controlled Trials (CENTRAL) was con-
ducted, for articles published in English
between 1st January 1960 and 30th June
2010 in the dental literature. The search
was performed again at a later stage, to
include any relevant new studies published
between 1st July 2010 and 31st Janu-
ary 2011. The following key words were
used:
Intervention:
(<[MeSH terms/all subheadings] “Tooth
Extraction”>
OR
<[text words] Tooth Extraction OR Dental
Extraction OR Tooth Removal OR Tooth
Pulling OR Tooth Loss OR Exodontia OR
Surgery OR Surgical Tooth Extraction OR
Surgical Tooth Removal>
OR
<[text words] Tooth AND Extraction>)
AND
Outcome:
(<[MeSH terms/all subheadings] “Bone
Resorption “ OR “Alveolar Bone Loss” OR
“Periodontal Atrophy”>
OR
<[text words] Bone Defect OR Bone Resorp-
tion OR Alveolar Bone Loss OR Alveolar
Resorption OR Alveolar Healing OR Ridge
Changes OR Ridge Alterations OR Ridge
Resorption OR Ridge Healing OR Mucosal
Alterations OR Mucosal Changes OR Muco-
sal Atrophy OR Mucosal Healing OR Gingi-
val Alterations OR Gingival Changes OR
Gingival Atrophy OR Gingival Healing OR
Socket Healing OR Socket>)
The following journals between 2004 and
2010 inclusive, were hand-searched for rele-
vant articles: Clinical Oral Implants
Research, International Journal of Oral &
Maxillofacial Implants, Implant Dentistry,
Journal of Periodontology, Journal of Clinical
Periodontology and Journal of Oral Implan-
tology.
Furthermore, the bibliographies of all pub-
lications selected for inclusion in this review
were also scanned for potentially relevant
articles.
Selection criteria
Studies were included if they were published
in English and conducted on human subjects,
with the intervention being tooth extraction,
and the outcome to be assessed in the form
of changes in the clinical or radiographic
alveolar bone dimensions, as well as dimen-
sional soft tissue changes. Similarly, exclu-
sion criteria were applied; letters and
narrative or retrospective reviews, single case
reports, case series with less than three cases,
and third molar extraction cases were all
excluded. Only studies reporting on undis-
turbed post-extraction dimensional changes
relative to a fixed reference point over a
clearly stated time period were included. In
addition, in the event of duplicate publica-
tions, the study with the most inclusive data
was preferentially selected.
Selection of studies
Screening was performed independently by
two reviewers (L. T. Wong and W. L. Tan);
any disagreement between the reviewers was
resolved by discussion. The initial electronic
search resulted in the identification of 2843
titles from the MEDLINE–Pubmed database
and 1111 titles from the Cochrane Central
© 2011 John Wiley & Sons A/S
 Tan et al
Dimensional tissue changes post extraction

Potentially relevant Register of Controlled Trials (CENTRAL).

Potentially relevant
publications identified from
publications identified from
electronic search of
electronic search of
Cochrane Central Register of
MEDLINE-Pubmed database
Controlled Trials (CENTRAL) st
st
database from 1 January
from 1 January 1960 to 30
th
1960 to 30 June 2010
(n = 2843)
(n = 1111)
Potentially relevant full texts
retrieved for detailed
evaluation
(n = 104)
Studies included based on
the initial electronic search of
the MEDLINE-Pubmed and
CENTRAL database from 1
st
th
January 1969 to 30 June
2010
(n = 19)
Studies included in the
present systematic review
(n = 20)
Fig. 1. Search strategy. Post-extraction dimensional changes.
After careful independent screening of the
titles and elimination of duplicate titles by
th
both the examiners, a total of 238 titles were
June 2010
considered for possible inclusion. Retrieval of
the 238 abstracts and further perusal led to
104 full-text articles being selected. From
Publications excluded on the basis of title
and summary evaluation; also excluded these full-text articles, 19 were identified for
duplicate publications inclusion in the review.
(n = 3716)
Another article was deemed suitable from
the secondary electronic search, but no addi-
tional publications from the hand-search or
the bibliography search of the selected arti-
Publications excluded on the basis of full
text evaluation cles were identified for inclusion.
(n = 85) In total, 20 articles were identified for
eventual inclusion in this review (Fig. 1).
A j-score of 0.84 was obtained, for consen-
sus between the two reviewers.
Exclusion of studies
Publications included based on the hand- Of the 104 full-text articles examined, 85
search and bibliography search of
relevant articles were excluded from the final analysis
(n = 0)
(Table 1). The main reasons for exclusion
were that there were no actual measure-
Publications included based on the ments of the dimensional changes of the
secondary electronic search of the
MEDLINE-Pubmed and CENTRAL alveolar ridge, the reported parameters were
st st
database from 1 July 2010 to 31
January 2011
not useful for this review and that there was
(n = 1) the presence of a foreign material in the
extraction site during the healing phase,
among other reasons.
Data collection
From the selected papers that met the crite-
ria, data addressing dimensional changes

Table 1. Studies failing to meet inclusion criteria

Reference Rationale for exclusion
Richardson 1965; Guglielmotti & Cabrini 1985; Guglielmotti et al. 1985; Mathai et al. 1989; Reported parameters not relevant or not useful
Ubios et al. 1991; Boyne 1995; Gauthier et al. 1999; Teofilo et al. 2001; Brandao et al. 2002;
Indovina & Block 2002; Magro-Ernica et al. 2003; Altundal & Guvener 2004; Bianchi et al. 2004;
Gorustovich et al. 2004; Nevins et al. 2006; Ortega et al. 2007; Araujo et al. 2008; Iino et al. 2008;
Agbaje et al. 2009; Puia et al. 2009; Alissa et al. 2010; Normando et al. 2010
Pietrokovski & Massler 1967a; Matsumoto 1968 Length of observation period not reported
Amemori 1966; Mizutani & Ishihata 1976; Olson & Hagen 1982; Hahn et al. 1988; Oltramari et al. Studies carried out on animals
2007; Shi et al. 2007; Fickl et al. 2008a; Fickl et al. 2008b
Loo 1968; Ashman & Bruins 1985; Ashman & Bruins1987; Scheer & Boyne 1987; Sclar 1999; Descriptive report on procedure/ technique;
Minsk 2005 commentary
Guglielmotti et al. 1986; Hsieh et al. 1995; Fickl et al. 2008c; Rothamel et al. 2008; Araujo & No baseline data available for comparison, thus unable
Lindhe 2009a; Pessoa et al. 2009 to arrive at an estimate of dimensional change over
time
Carlsson & Persson 1967; Pietrokovski & Massler 1967b; Pietrokovski 1967; Green et al. 1969; No measurements of alveolar dimensional changes (e.g.
Huebsch & Hansen 1969; Berkovitz 1971; Pietrokovski & Massler 1971; Hars & Massler 1972; description of healing process or bony shape change,
Librus et al. 1973; Thilander & Astrand 1973; Horn et al. 1979; Olson et al. 1982; Quinn & or histology only)
Kent 1984; Lavelle 1985; Boyes-Varley et al. 1988; Magro-Filho & de Carvalho 1990; Dayan
et al. 1992; Alves-Rezende & Okamoto 1997; Anitua 1999; Pinto et al. 2002; Carmagnola
et al. 2003; Cardaropoli et al. 2005; Smith 1974; Ahn & Shin 2008; Serino et al. 2008; Sharan &
Madjar 2008; Luvizuto et al. 2010; Teofilo et al. 2010
Bergstedt et al. 1973; Michael & Barsoum 1976; Kangvonkit et al. 1986; Sattayasanskul et al. Study subjects had immediate dentures after extraction,
1988 hence they did not have undisturbed healing
post-extraction
Bahat et al. 1987; Iizuka et al. 1992; Yugoshi et al. 2002; Araujo et al. 2005; Lindeboom et al. Sample did not include untreated/undisturbed extraction
2006; Wu et al. 2008; Araujo & Lindhe 2009b; Nevins et al. 2009 sockets left to heal spontaneously
Araujo & Lindhe 2005 Only measured relative difference in height between
buccal and lingual plates of the alveolus

© 2011 John Wiley & Sons A/S 3 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction
of both soft and hard tissues of the alveolar
ridge were retrieved for analysis. Mean
values and standard deviations, where
available, were extracted in duplicate by
the two reviewers (L. T. Wong and W. L.
Tan).
Quality assessment
Assessment of study quality was performed
for all the included papers. The Cochrane
Collaboration’s tool for assessing risk of bias
was used in the case of randomized con-
trolled clinical trials and controlled clinical
trials. Methodological quality assessment of
cohort studies was based on the Newcastle–
Ottawa Quality Assessment Scale for Cohort
studies (Tables 2 and 3).
Data synthesis
Preliminary evaluation of the selected publi-
cations revealed that there was considerable
heterogeneity between the studies with
regard to study design, study population,
study period, method of assessment of
dimensional change of the alveolar ridge as
well as reference point from which the
changes were measured. Taking this into
consideration, it was not appropriate to con-
duct a quantitative data synthesis for all
studies, leading to a meta-analysis. In this
case, we attempted to report the data by
applying descriptive methods. In addition,
as a selected few of the included studies
demonstrated some similarity in measure-
ment methods and reference points, we pre-
sented weighted means of the dimensional
change of the alveolar ridge over time as
appropriate, taking into account the values
of the relevant standard deviation and
applying inverse variance weighting (Meier
1953).
Inverse variance weighting
For the weighted mean of the list of data for
which each mean xi comes from a different
probability distribution with a known
variance ri2, the weight for each study is
given by:
1
Wi ¼
ri2
The weighted mean in this case is:
Pn
ðxi =r2i Þ
x
¼ Pi¼1
n 2
i¼1 ð1=ri Þ
and the variance of the weighted mean is:
1 2009; Moya-Villaescusa & Sanchez-Pérez
r2x
¼ Pn 2
i¼1 ð1=ri Þ
4 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Assessment of heterogeneity
Statistical heterogeneity between all the
included studies was not assessed because all
the studies had different observation time
points as well as measurement methods,
making a statistical comparison impossible.
However, assessment of heterogeneity
between studies with similar characteristics
were performed using Cochran’s Q-test:
X
Q¼ wi ðxi  x
Þ
The P-value was then calculated for the Q
statistic and a value of P < 0.05 would indi-
cate significant statistical heterogeneity
between the studies.
When Q > df, where df is its degree of free-
dom, the I2 index was also calculated using
the following formula:
 
Q  df
I2 ¼  100%
Q chlorhexidine mouthrinse on post-extraction
where, I2 = 0% to 40% would indicate
there is little to no heterogeneity
I2 = 30% to 60% would indicate there is
moderate heterogeneity
I2 = 50% to 90% would indicate there is
substantial heterogeneity
I2 = 75% to 100% would indicate consider-
able heterogeneity
Similarly, the P-value was calculated for
the I2 statistic, and a value of P < 0.05 would
indicate a result that is statistically signifi-
cant.
Results
Collectively, a total of 20 studies satisfied
the inclusion criteria and were included in
this systematic review.
The 20 studies included 11 randomized
controlled clinical trials, five controlled clini-
cal trials and four cohort studies (Tables 2
and 3). The majority of studies did not state
the reasons for tooth extraction, but in the
studies that did, they included fractures, car-
ies, trauma, endodontic, prosthodontic,
orthodontic and periodontal reasons. Thirteen
papers only studied non-molar extraction
sites (Carlsson & Persson 1967; Lekovic et al.
1997, 1998; Yilmaz et al. 1998; Camargo
et al. 2000; Iasella et al. 2003; Serino et al.
2003; Fiorellini et al. 2005; Saldanha et al.
2006; Rodd et al. 2007; Barone et al. 2008;
Aimetti et al. 2009; Pelegrine et al. 2010),
while six studies (Bragger et al. 1994; Schropp
et al. 2003; Kerr et al. 2008; Crespi et al.
2010; Rasperini et al. 2010) reported on data
including molar extraction sites and one
study (Oghli & Steveling 2010) did not spec-
ify where the extractions were performed.
Most of the data extracted concerned teeth in
control groups of studies that evaluated vari-
ous ridge preservation procedures (Lekovic
et al. 1997, 1998; Yilmaz et al. 1998; Camar-
go et al. 2000; Iasella et al. 2003; Serino et al.
2003; Fiorellini et al. 2005; Barone et al.
2008; Aimetti et al. 2009; Crespi et al. 2009;
Oghli & Steveling 2010; Pelegrine et al. 2010;
Rasperini et al. 2010), but other studies were
either designed specifically to evaluate post-
extraction alveolar changes (Carlsson & Pers-
son 1967; Schropp et al. 2003; Rodd et al.
2007; Moya-Villaescusa & Sanchez-Perez
2010) or the effect of smoking (Saldanha
et al. 2006) or ultrasound treatment (Kerr
et al. 2008) on these changes. In addition,
one included study (Bragger et al. 1994) was
actually designed to test the effect of
healing. Each paper that was included in
this review contributed a number of extrac-
tion sites, ranging from three to over a
hundred sites. The age range of the patients
in these studies was between 10.8 and
53.3 years.
Included studies
There were a total of 20 studies addressing
the hard and soft tissue dimensional changes
of the alveolar ridge in humans, with sponta-
neous undisturbed healing. The studies were
grouped according to the reported changes in
hard tissue, soft tissue, or a combination of
both hard and soft tissue.
Hard tissue changes
Vertical and horizontal linear hard tissue
changes in humans were reported indepen-
dently or in combination by 17 studies
(Tables 4 and 7).
Vertical linear hard tissue alteration
All 17 studies that reported on post-extrac-
tion hard tissue changes looked into the ver-
tical linear dimensional change of the
alveolus. Eight studies (Lekovic et al. 1997,
1998; Camargo et al. 2000; Iasella et al. 2003;
Serino et al. 2003; Barone et al. 2008; Aimetti
et al. 2009; Pelegrine et al. 2010) utilized
re-entry procedures with stents or titanium
pins as reference points (Fig. 2), one other
study (Rasperini et al. 2010) did not carry out
a re-entry procedure but nevertheless utilized
a stent for reference. An additional eight
studies (Carlsson & Persson 1967; Bragger
et al. 1994; Schropp et al. 2003; Fiorellini
et al. 2005; Saldanha et al. 2006; Kerr et al.
© 2011 John Wiley & Sons A/S
 Tan et al
Dimensional tissue changes post extraction

Table 2. Cochrane Collaboration’s tool for assessing risk of bias

Carlsson & Persson (1967) Brägger et al. (1994)
Controlled clinical trial Randomized controlled clinical trial
Study design Parallel Parallel
Adequate sequence generation No Unclear
Remark Quote “alternate patients were assigned to respective Quote “then randomly assigned”
groups”
Insufficient information about sequence generation
Allocation concealment Unclear Unclear
Remark No information provided. No information provided.
Blinding Unclear Yes
Remark Study did not address this outcome. Quote “ double-blind clinical trial”
Incomplete outcome data addressed Yes No
Remark Quote “one patient from each group had to be Initially mentioned that 40 patients were enrolled in
discarded….one had moved…other case first radiograph study, but subsequently only obtained radiographs for
unsuccessful and could not be repeated..” 23 patients with no explanation
Free of selective reporting Yes No
Remark Initially mentioned that 40 patients were enrolled in
study, but subsequently only obtained radiographs for
23 patients with no explanation
Free of other sources of bias Yes Yes
Remark
Overall risk of bias High High

Lekovic et al. (1997) Lekovic et al. (1998)

Controlled clinical trial Randomized controlled clinical trial
Study design Split-mouth Split-mouth
Adequate sequence generation Unclear Yes
Remark No information provided Quote “ control and experimental sites were assigned by
the flip of a coin”
Allocation concealment Unclear Unclear
Remark No information provided No information provided
Blinding Unclear Yes
Remark Study did not address this outcome Quote “clinical measurements were performed by one
clinician who did not have knowledge of control and
experimental sites”
Incomplete outcome data addressed Yes Yes
Remark Mentioned that three patient had dehiscence in test No missing outcome data
group, hence did not measure values at 6 months;
re-entry was planned at 6 months, but if membrane
exposure occurred, re-entry and measurements was
done at 3 months. Refer to Tables 3–5 and will see that
they analysed the results with various combinations,
including with or without the patients that exited early,
suggesting an intention-to-treat analysis
Free of selective reporting Yes Yes
Remark
Free of other sources of bias Yes Yes
Remark
Overall risk of bias Unclear Unclear

Camargo et al. (2000) Iasella et al. (2003) Serino et al. (2003) Fiorellini et al. (2005)
Randomized controlled Randomized controlled clinical
Controlled clinical trial clinical trial Controlled clinical trial trial
Study design Split-mouth Parallel Parallel and split-mouth Parallel
Adequate sequence Unclear Yes Unclear Unclear
generation
Remark No information provided Quote “randomly selected No information provided Quote “ cohorts of 40 patient
using a coin toss” randomized in a double-blind
manner”
Insufficient information about
sequence generation
Allocation Unclear Unclear Unclear Unclear
concealment
Remark No information provided No information provided No information provided No information provided
Blinding Unclear Yes Unclear Yes
Remark Study did not address this Quote “measurements were No information provided Quote “all the patients in the study
outcome taken by 2 masked underwent the same surgical
examiners” procedure, regardless of the
treatment
Incomplete outcome Yes Yes Yes Yes
data addressed

© 2011 John Wiley & Sons A/S 5 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction

Table 2. (continued)
Camargo et al. (2000) Iasella et al. (2003) Serino et al. (2003) Fiorellini et al. (2005)
Randomized controlled Randomized controlled clinical
Controlled clinical trial clinical trial Controlled clinical trial trial
Study design Split-mouth Parallel Parallel and split-mouth Parallel
Remark No missing outcome data Quote “implants were Quote “nine subjects Quote “ No subjects were
successfully placed at all dropped out from the withdrawn or lost to follow-up”
sites….none have been study for reasons unrelated
subsequently lost” to the therapy”
Free of selective Yes Yes Yes Yes
reporting
Remark
Free of other sources Yes Yes Yes Yes
of bias
Remark
Overall risk of bias Unclear Unclear Unclear Unclear

Barone et al. (2008) Kerr et al. (2008) Aimetti et al. (2009)

Randomized controlled clinical
Randomized controlled clinical trial Randomized controlled clinical trial trial
Study design Parallel Split-mouth Parallel
Adequate sequence generation Yes Unclear Unclear
Remark Quote “using a Quote “ one site was assigned Quote “ were consecutively
computer-generated randomly as test, whereas the selected..” and “ all sockets were
randomisation list…” other site was assigned as control” measured and assigned randomly
to test or control”
Insufficient information about Insufficient information about
sequence generation sequence generation
Allocation concealment Unclear Unclear No
Remark No information provided No information provided Assignment not explicitly
concealed
Blinding Yes Yes Yes
Remark Quote “all measurements were Quote “examiner was masked as to Quote “recorded by the same
taken by one examiner who was whether sites were test or control” examiner, who was not involved
not involved in performing the in providing therapy”
surgical treatment…”
Incomplete outcome data addressed Yes Yes Unclear
Remark No loss to follow-up in test and No missing outcome data Study did not address this
control group outcome
Free of selective reporting Yes Yes Yes
Remark
Free of other sources of bias Yes Yes Yes
Remark
Overall risk of bias Unclear Unclear High

Crespi et al. (2009) Pelegrine et al. (2010) Rasperini et al. (2010)

Randomized controlled clinical
Controlled clinical trial Randomized controlled clinical trial trial
Study design Split-mouth Parallel Parallel
Adequate sequence generation No Unclear Yes
Remark Quote “sockets on right side of jaw Quote “teeth to be extracted were Quote “treatment regimens were
received MHA….sockets on left randomized into two groups” assigned randomly to the subjects
side received CS…” with a balanced random permuted
block approach”
Allocation by left or right side Insufficient information about
of jaw sequence generation
Allocation concealment Unclear Unclear Yes
Remark No information provided. No information provided. Quote “treatment regimens
assigned randomly…
communicated to the operator
immediately after tooth
extraction”
Blinding Yes Unclear Yes
Remark Quote “a masked examiner Study did not address this outcome Quote “tubes included into the
measured the bone level changes.” stent by a blind examiner…..after
surgery, blinded examiner
positioned the stent.”
Incomplete outcome data addressed Yes Unclear Yes
Remark No missing outcome data Study did not address this outcome. Missing outcome data balanced in
numbers across groups
Free of selective reporting Yes Yes Yes
Remark
Free of other sources of bias Yes Yes Yes
Remark
Overall risk of bias High Unclear Low

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 Tan et al
Dimensional tissue changes post extraction

Table 2. (continued)
Yilmaz et al. (1998) Oghli & Steveling (2010)
Controlled clinical trial Randomized controlled clinical trial
Study design Parallel Parallel
Adequate sequence generation Unclear Unclear
Remark No information provided Quote “patients were divided randomly into three groups”
Insufficient information about sequence generation
Allocation concealment Unclear Unclear
Remark No information provided No information provided
Blinding Unclear Unclear
Remark Study did not address this outcome Study did not address this outcome
Incomplete outcome data addressed Unclear Yes
Remark Study did not address this outcome All exclusions accounted for
Free of selective reporting Yes Yes
Remark
Free of other sources of bias Yes Yes
Remark
Overall risk of bias Unclear Unclear

2008; Crespi et al. 2009; Moya-Villaescusa &
Sanchez-Pérez 2010) utilized imaging meth-
ods to obtain the required information.
Only one re-entry study (Aimetti et al.
2009) addressed the vertical linear change of
the alveolar hard tissue post-extraction at
3 months. In this study, 3 months after
extraction of anterior maxillary teeth, a mean
vertical reduction of 1.2 ± 0.8 mm on the
buccal, 0.9 ± 1.1 mm on the palatal and
0.5 ± 0.9 mm on the mesial and distal sites
were reported when an acrylic stent was used
as a fixed reference during re-entry.
A total of six re-entry studies (Lekovic et al.
1997, 1998; Camargo et al. 2000; Iasella et al.
2003; Serino et al. 2003; Pelegrine et al. 2010)
reported data on 6-month post-extraction ver-
tical linear hard tissue changes of the alveolus;
four studies (Lekovic et al. 1997, 1998; Camar-
go et al. 2000; Pelegrine et al. 2010) utilized a
titanium screw or pin, while two studies (Ia-
sella et al. 2003 and Serino et al. 2003) used an
acrylic stent as a fixed reference point.
Six months following the extraction of
anterior teeth or premolars, Lekovic et al.
(1997) reported a mean reduction of
1.2 ± 0.13 mm in buccal vertical ridge height,
while Lekovic et al. (1998) and Camargo
et al. (2000) reported a mean reduction of
1.50 ± 0.26 mm and 1.00 ± 2.25 mm respec-
tively. Later, Pelegrine et al. (2010) showed
that 6 months after extraction of maxillary
anterior teeth, the mean buccal vertical alve-
olar ridge height reduction was
1.17 ± 0.26 mm. All the four studies men-
tioned above measure changes relative to a
titanium pin or screw at re-entry.
Iasella et al. (2003) and Serino et al. (2003)
utilized re-entry procedures and acrylic stents
as fixed references, 6 months after extraction
of non-molar teeth. The former study reported
an average alveolar vertical hard tissue reduc-
tion of 0.9 ± 1.6 mm at the mid-buccal,
0.4 ± 1.0 mm at the mid-lingual, 1.0 ± 0.8
mm at the mesial and 0.8 ± 0.8 mm on the
distal sites; the latter study recorded a mean
reduction of 0.7 ± 1.2 mm on the buccal.
Taking into consideration the similarities
between these six re-entry studies that
reported 6-month data (Lekovic et al. 1997,
1998; Camargo et al. 2000; Iasella et al. 2003;
Serino et al. 2003; Pelegrine et al. 2010), the
weighted mean was calculated for the rele-
vant sites, using the inverse variance
method, to give a more robust value of the
6-month post-extraction vertical change
(Fig. 3). On the buccal, all six studies were
included to give a weighted mean reduction
of 1.24 ± 0.11 mm (Q = 1.3, P = 0.94). Only
two studies (Iasella et al. 2003; Serino et al.
2003) were included when mesial and distal
sites were investigated; the respective
weighted reductions were 0.84 ± 0.62 mm on
the mesial (Q = 0.10, P = 0.75) and
0.80 ± 0.71 mm on the distal (Q = 0, P = 1).
After a 7-month undisturbed healing period
in non-molar extraction sites, Barone et al.
(2008) observed vertical linear reduction of
3.6 ± 1.5 mm, 3.0 ± 1.6 mm, 0.4 ± 1.2 mm
and 0.5 ± 1.0 mm on the mid-buccal, mid-lin-
gual, mesial and distal sites respectively, at re-
entry. A stent was used as a fixed reference.
Rasperini et al. (2010) reported on 3- and 6-
month dimensional changes of the alveolar
ridge after extraction of maxillary molar
teeth, using a custom acrylic stent and a peri-
odontal probe or endodontic file to obtain the
measurements; measurements were made
from the surface of the bone to the external
surface of the stent. The observed reduction
in height of the buccal plate at 3 and
6 months were 2.2 and 5.7 mm respectively,
when the buccal plates were intact after
extraction. However, when the buccal plates
were lost at time of extraction, there was a
corresponding gain of buccal bone height of 1
and 0.6 mm at 3 and 6 months respectively.
Radiographic methods used for the relevant
studies were: lateral cephalometric radiogra-
phy in one study (Carlsson & Persson 1967),
cone beam computed tomography in two
studies (Fiorellini et al. 2005 and Kerr et al.
2008), linear tomography in one study (Salda-
nha et al. 2006), and intraoral peri-apical radi-
ography in four studies (Bragger et al. 1994;
Schropp et al. 2003; Crespi et al. 2009 and
Moya-Villaescusa & Sanchez-Pérez 2010).
Carlsson & Persson (1967) attempted to
use lateral cephalometric radiography to dem-
onstrate the longitudinal height change in
the mandibular alveolar ridge after extraction
of at least five to six lower anterior teeth and
loading with conventional full dentures
2 months post-extraction. The study had
observation time points at 2, 4, 6, 12, 24 and
60 months. The reductions in alveolar height
were 2.0 mm at 2 months, 2.9 mm at
4 months, 3.4 mm at 6 months and 4.1 mm
at 12 month, compared to baseline. From this
study, we can see a trend where there is a
large reduction in alveolar bone height in the
first 2 months post-extraction, followed by a
continual gradual resorption thereafter. Take
note that we should interpret the values
obtained in this study, with observation time
points greater than 2 months, with caution;
2 months after teeth extraction, full dentures
were inserted in the conventional group, and
we cannot with full confidence, state that
insertion and use of denture prostheses did
not have an impact on the resorptive pattern
and extent of the alveolar hard and soft tis-
sues in this case.
Two studies (Fiorellini et al. 2005; Kerr
et al. 2008) utilized computed tomography to
detect vertical height changes in the alveolar

© 2011 John Wiley & Sons A/S 7 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction

Table 3. Newcastle–Ottawa Quality Assessment Scale for Cohort Studies (max 9*)
Schropp et al. (2003) Saldanha et al. (2006)
Study design Cohort Cohort
Selection
Representativeness of the exposed Truly representative of the average implant Representative of the average patient
cohort patient in the community requiring extraction in the community
Rating * *
Selection of non exposed cohort No description of the derivation of non-exposed No description of the derivation of the non-exposed
cohort cohort
Rating
Ascertainment of exposure Secure record (radiograph, study model, clinical Secure record (radiograph, linear tomography, clinical
exam) exam)
Rating * *
Demonstration that outcome of Yes Yes
interest was not present at
start of study
Rating * *
Comparability
Comparability of cohorts on the No mention of control of any confounding factors (e.g. Controlled for confounding factors (smoking, oral
basis of the design or analysis smoking, health) hygiene, ethnicity, systemic health)
Rating **
Outcome
Assessment of outcome Records (radiograph, study models) Independent blind assessment
Rating * *
Was follow-up long enough for Yes; 12 months follow up (early soft/hard tissue healing Yes; 6 months (early hard tissue healing usually
outcomes to occur usually 6–8 weeks) 6–8 weeks)
Rating * *
Adequacy of follow up of cohorts Description of those lost to follow-up No statement
Rating *
Overall 6* 7*

Rodd et al. (2007) Moya-Villaescusa & Sanchez-Pérez (2010)

Study design Cohort Cohort
Selection
Representativeness of the exposed Truly representative of the average young patient Representative of the average patient requiring
cohort with dental trauma in the community extraction in the community
Rating * *
Selection of non exposed cohort No description of the derivation of non-exposed No description of the derivation of non-exposed
cohort cohort
Rating
Ascertainment of exposure Secure record (study model, photograph, clinical Secure record (radiograph, clinical exam)
exam)
Rating * *
Demonstration that outcome of interest Yes Yes
was not present at start of study
Rating * *
Comparability
Comparability of cohorts on the basis Sample size too small to allow statistical Controlled for confounding factors (smoking, number
of the design or analysis adjustment of confounders of roots, oral hygiene, periodontal disease)
Rating **
Outcome
Assessment of outcome Records (study model, photograph) Records (radiograph)
Rating * *
Was follow-up long enough for Yes; 4–61 months follow up (early soft/hard tissue Yes; 3 months follow up (early hard tissue healing
outcomes to occur healing usually 6–8 weeks) usually 6–8 weeks)
Rating * *
Adequacy of follow up of cohorts No statement No statement
Rating
Overall 5* 7*

hard tissue. Fiorellini et al. (2005) reported a
4-month mean height reduction of
1.17 ± 1.23 mm in patients after extraction
of maxillary non-molar teeth; of note is that
all the patients in this sample had a buccal
defect of  50% bone loss of the extraction
socket at baseline. In the study by Kerr et al.
(2008), following extraction of a permanent
tooth, the corresponding vertical resorption
of the alveolar ridge were 1.01 ± 0.39 mm on
the buccal, 0.62 ± 0.28 mm on the lingual at
1 month and 0.95 ± 0.39 on the buccal,
1.12 ± 0.28 on the lingual at 3 months.
Six months after extraction of upper ante-
rior teeth, Saldanha et al. (2006) observed a
vertical resorption of 1.5 mm in smokers and
1.0 mm in non-smokers when using linear
tomography.
Assessing interproximal bone height
change on intraoral periapical radiographs,
Bragger et al. (1994) demonstrated a vertical
reduction of 0.61 ± 0.67 mm, 0.67 ±
0.66 mm, 1.19 ± 1.50 mm and 0.93 ± 0.74
mm at 1, 2, 3 and 6 months respectively,
while Schropp et al. (2003) documented a
0.3 mm loss at 12 months. Crespi et al.
(2009) went on to show an overall 3-month

8 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21 © 2011 John Wiley & Sons A/S
 Tan et al
Dimensional tissue changes post extraction

Table 4. Characteristics of studies included for hard tissue change only

No. of
Author, Sample extraction
Title publishing year Species QA Tissue Methods size sites
Morphologic changes of the mandible after extraction Carlsson 1967 human CCT Hard Radio 17 5–6 per pt
and wearing of denture
Effect of chlorhexidine(0.12%) rinses on periodontal Bragger 1994 Human RCCT Hard Radio 12 21
tissue healing after tooth extraction(II)radiographic
parameters
A bone regeneration approach to alveolar ridge Lekovic 1997 Human CCT Hard Re-entry (pin) 10 10
maintenance following tooth extraction. Report of
10 cases
Preservation of alveolar bone in extraction sockets Lekovic 1998 Human RCCT Hard Re-entry 16 16
using bioabsorbable membranes (pin 2–5 mm)
Influence of bioactive glass on changes in alveolar Camargo 2000 Human CCT Hard Re-entry 16 16
process dimensions after exodontia (pin 1–8 mm)
Ridge preservation with freeze-dried bone allograft Iasella 2003 Human RCCT Soft Re-entry 12 12
and a collagen membrane compared to extraction + hard (stent)
alone for implant site development: a clinical and
histological study in humans
Ridge preservation following tooth extraction using Serino 2003 Human CCT Hard Re-entry 12 13
a polylactide and polyglycolide sponge as space filler: (stent)
a clinical and histological study in humans
Bone healing and soft tissue contour changes Schropp 2003 Human Cohort Hard Radio 46 46
following single-tooth extraction: a clinical and
radiographic 12-month prospective study
Randomized study evaluating recombinant human Fiorellini 2005 Human RCCT Hard CT scan 20 ?
bone morphogenetic protein-2 for extraction socket
augmentation
Smoking may affect the alveolar process dimensions Saldanha 2006 Human Cohort Hard Radio 21 21
and radiographic bone density in maxillary extraction
sites: a prospective study in humans
Xenograft vs. extraction alone for ridge preservation Barone 2008 Human RCCT Hard Re-entry 20 20
after tooth removal: a clinical and histomorphometric (stent)
study
The effect of ultrasound on bone dimension changes Kerr 2008 Human RCCT Hard CBVT (ref 12 12
following extraction: a pilot study plate)
Clinical and histological healing of human extraction Aimettl 2009 Human RCCT Hard Re-entry 18 18
sockets filled with calcium sulphate (stent)
Magnesium-enriched hydroxyapatite compared to Crespi 2009 Human RCCT Hard Radio 15 15
calcium sulphate in the healing of human extraction
sockets: radiographic and histomorphometric
evaluation at 3 months
Measurement of ridge alterations following tooth Moya-Villaescusa Human Cohort Hard Radio 100 100
removal:a radiographic study in humans 2010
Clinical and histomorphometric evaluation of Pelegrine 2010 Human RCCT Hard Re-entry (pin) 6 15
extraction sockets treated with an autologous bone
marrow graft
Socket grafting in the posterior maxilla reduces the Rasperini 2010 Human RCCT Hard Stent 3 3
need for sinus augmentation

loss of 3.75 ± 0.63 mm when the buccal plate
was lost during extraction. One study (Moya-
Villaescusa & Sanchez-Pérez 2010) further
discerned between the bone loss at 3 months
after extraction of single-rooted teeth
(4.16 ± 0.32 mm) vs. multiple-rooted teeth
(4.48 ± 0.39 mm loss), although the differ-
ence was not statistically significant. The
average bone loss when both groups were
combined was 4.32 ± 0.24 mm.
Percentage change of vertical linear hard tissue
alteration
All the four re-entry studies (Lekovic et al.
1997, 1998; Camargo et al. 2000; Pelegrine
et al. 2010) utilizing a titanium pin or screw
had data on the baseline internal socket
height. This facilitated a calculation of the
percentage reduction of the vertical dimen-
sion of the alveolus post-extraction as fol-
lows:
%vertical linear change ðhard tissueÞ
vertical linear resortion ðhard tissueÞ
¼
baseline internal socket height
The calculated percentage vertical change
of the alveolar hard tissue ranged from 11%
to 22% (Fig. 4) at buccal sites, 6 months
post-extraction.
Horizontal linear hard tissue alteration
A total of eight studies (Lekovic et al. 1997,
1998; Camargo et al. 2000; Iasella et al. 2003;
Barone et al. 2008; Kerr et al. 2008; Aimetti
et al. 2009; Pelegrine et al. 2010) reported on
horizontal changes over time in the hard tis-
sue at the level of the alveolar crest (Fig. 5).
Two studies (Kerr et al. 2008; Aimetti et al.
2009) reported 3-month horizontal reduction
to be between 2.20 and 3.20 mm; another
study (Barone et al. 2008) reported 7-month
reduction to be 4.5 ± 0.8 mm. Lekovic et al.
(1997, 1998), Camargo et al. (2000), Iasella
et al. (2003) and Pelegrine et al. (2010) docu-
mented 6-month horizontal reduction in the
hard tissue of the alveolar ridge to be 4.40,
4.56, 3.06, 2.63 and 2.46 mm respectively.
The five latter studies (Lekovic et al. 1997,
1998; Camargo et al. 2000; Iasella et al. 2003
and Pelegrine et al. 2010) have quite a few
methodological similarities, however, results
of the heterogeneity testing reveal that there
is considerable heterogeneity between the

© 2011 John Wiley & Sons A/S 9 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction

Fig. 5. Horizontal (linear) hard tissue change for re-

entry studies only.

Fig. 2. Vertical (linear) hard tissue change for re-entry

studies only.

Fig. 3. Vertical (linear) hard tissue change for re-entry

Fig. 6. Horizontal (linear) hard tissue change for re-
studies (Q = 17.8, P < 0.05; I2 = 77.6%, studies only; weighted means shown.
entry studies only; weighted means shown.
P < 0.05). In this case, although the weighted
mean was calculated by applying the inverse
variance method to arrive at a value of
The calculated percentage horizontal
3.79 ± 0.23 mm horizontal reduction at
change of the alveolar hard tissue at the alve-
6 months (Fig. 6) across all five studies, the
olar crest ranged from 32% at 3 months, and
robustness and applicability of this value
between 29% and 63% after 6–7 months
should be questioned.
post-extraction (Fig. 8).
Saldanha et al. (2006) reported the horizon-
tal reduction of the alveolar bone at 0% and
Overall hard tissue changes
50% the distance from the crest. This study
In general, with regard to vertical dimen-
demonstrated a 6-month reduction of 0.6 and
sional change, we can see a trend where
1.3 mm for non-smokers and smokers respec-
there is a greater reduction on the buccal and
tively at 0% from the alveolar crest and cor-
lingual sites as compared to the mesial and
responding values of 0.1 and 0.8 mm at 50%
distal sites. Looking at the horizontal dimen-
from the crest. This study utilized linear
sional change, there is a distinct pattern of
tomography to track the changes. Fig. 4. Vertical (linear) hard tissue percentage change in resorption where the resorption decreases
Of note, Kerr et al. (2008) demonstrated four studies.
with increased distance from the alveolar
beautifully that 3 months after tooth extrac-
baseline ridge width immediately post-extrac- crest. Overall, the observed horizontal resorp-
tion, there was a relative decrease in horizon-
tion. This facilitated a calculation of the per- tion of the hard tissues (29–63%) is far
tal ridge reduction as the distance from the
centage reduction of the horizontal dimension greater than the resorption in the vertical
alveolar crest increased (Fig. 7).
of the alveolus post-extraction as follows: dimension (11–22%), over an observation per-
iod of 3–7 months. It can be seen that the
Percentage change of horizontal linear hard tissue
alteration %horizontallinear changeðhard tissueÞ bulk of the resorption occurs in the first
All but one study (Kerr et al. 2008) reporting horizontal linear resortionðhard tissueÞ 3 months post-extraction, and the changes
¼
changes in the ridge width also reported the baseline internal socket height are much more subtle thereafter.

10 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21 © 2011 John Wiley & Sons A/S
 Tan et al
Dimensional tissue changes post extraction

Fig. 9. Change in soft tissue dimensions over time.

pendently or in combination; in one study

(Rodd et al. 2007) the overall areal change of
Fig. 8. Horizontal (linear) hard tissue percentage the alveolar hard and soft tissue combined,
change. was reported.

Vertical linear combined hard and soft tissue

Fig. 7. Horizontal (linear) hard tissue change with
respect to distance from alveolar crest.
Soft tissue changes
Only a single study (Iasella et al. 2003)
reported on longitudinal changes of soft tis-
sue dimensions in the alveolus post-extrac-
tion (Tables 5 and 7). This study
demonstrated a 0.4–0.5 mm gain of soft tis-
sue thickness at 6 months, measured at buc-
cal and lingual sites 3 mm from the alveolar
crest. Occlusally, soft tissue with thickness
of 2.1 mm developed after 6 months to com-
plete soft tissue coverage of the wound
(Fig. 9).
Combined hard and soft tissue changes
To date, a total of five studies (Carlsson &
Persson 1967; Yilmaz et al. 1998; Schropp
et al. 2003; Rodd et al. 2007; Oghli & Stevel-
ing 2010) presented data on the longitudinal
change in the combined hard and soft tissue
dimension of the alveolus post-extraction
(Tables 6 and 7). One study (Carlsson & Pers-
son 1967) utilized lateral cephalometric radi-
ography whereas study casts were employed
in the other four studies (Yilmaz et al. 1998;
Schropp et al. 2003; Rodd et al. 2007; Oghli
& Steveling 2010). Vertical and horizontal
linear tissue alterations were reported inde-
alteration
Three studies (Carlsson & Persson 1967; Yil-
maz et al. 1998 and Schropp et al. 2003)
addressed the combined hard and soft tissue
changes in the vertical dimension of the alve-
olus.
With the aid of lateral cephalometric radi-
ography, Carlsson & Persson (1967) was able
to demonstrate the combined hard and soft
tissue changes of the mandibular alveolus in
the vertical dimension over time. The verti-
cal reductions of the conjugated tissue
dimension from baseline were 2.1 mm at
2 months, 2.9 mm at 4 months, 3.4 mm at
6 months and 4.0 mm at 12 month. This
degree of resorption of the combined hard
and soft tissues followed a similar trend as
that of hard tissue alone.
Utilizing sectioned study casts, Yilmaz
et al. (1998) demonstrated a vertical reduc-
tion of 0.1 ± 0.52 mm and 0.5 ± 0.76 mm at

Table 5. Characteristic of study included for soft tissue change only

Author, No. of
Title Publishing Year Species QA Tissue Methods Sample size extraction site
Ridge preservation with freeze-dried bone allograft Iasella 2003 Human RCCT Soft + hard Re-entry (stent) 12 12
and a collagen membrane compared to extraction
alone for implant site development: a clinical and
histological study in humans

Table 6. Characteristics of studies included for both hard and soft tissue changes combined
No. of
Title Authors Species QA Tissue Method Sample size extraction sites
Morphologic changes of the mandible after extraction Carlsson 1967 Human CCT Soft + hard Radio 17 5/6 per pt
and wearing of denture
Alveolar ridge reconstruction and/or preservation Yilmaz 1998 Human CCT Soft + hard Cast 5 10
using root form bioglass cones
Bone healing and soft tissue contour changes Schropp 2003 Human CCT Soft + hard Cast 46 46
following single-tooth extraction: A clinical and
radiographic 12-month prospective study
Change in supporting tissue following loss of a Rodd 2007 Human Cohort Soft + hard Cast 16 16
permanent maxillary incisor in children
Ridge preservation following tooth extraction: Oghli 2010 Human RCCT Soft + hard Cast 72 101
A comparison between atraumatic extraction and
socket seal surgery

© 2011 John Wiley & Sons A/S 11 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction

Table 7. Overall results from all studies

No. of
Author, Sample extraction Vertical dimensional Horizontal dimensional
Publishing Year Species Tissue Methods size sites change change
Carlsson 1967 Human Hard Radio 17 5–6 per pt 2 month: 2.0(0.9) 2 month: 2.2(1.1)
4 month: 2.9(1.7) 12 month: 3.6(0.5)
6 month: 3.4(2.1) 60 month: 4.0(1.5)
12 month: 4.1(2.7)
24 month: 4.9(3.7)
60 month: 7.3(3.7)
Bragger 1994 Human Hard Radio 12 21 1 month: 0.61(0.67)
2 month: 0.67(0.66)
3 month: 1.19(1.50)
6 month: 0.93(0.74)
Lekovic 1997 Human Hard Re-entry (pin) 10 10 6 month: 1.2(0.13) 6 month: 4.4(0.61)
Lekovic 1998 Human Hard Re-entry (pin2– 16 16 6 month: 1.50(0.26) 6 month: 4.56(0.33)
5 mm)
Camargo 2000 Human Hard Re-entry (pin1– 16 16 6 month: 1.00(2.25) 6 month: 3.06(2.41)
8 mm)
Iasella 2003 Human Soft+ Re-entry (stent) 12 12 6 month: B 0.9(1.6) 6 month: 2.6(2.3)
hard L 0.4(1.0)
M 1.0(0.8)
D 0.8(0.8)
Iasella 2003 Human Soft Re-entry (stent) 12 12 6 month: B 0.4(0.6)
L 0.5(1.5)
(Soft tissue thickness change)
Serino 2003 Human Hard Re-entry (stent) 12 13 6 month: B 0.8(1.6)
M 0.6(1.0)
D 0.8(1.5)
Schropp 2003 Human Hard Radio 46 46 12 month: M 0.3
D 0.3
Schropp 2003 Human Soft+ Cast 46 46 3 month: B 0.1 3 month: 3.8
hard L 0.8 6 month: 5.1
6 month: B 0.1 12 month: 6.1
L 0.9
12 month: B 0.4
L 0.8
Fiorellini 2005 Human Hard CT scan 20 ? 4 month: 1.17(1.23)
Saldanha 2006 Human Hard Radio 21 21 6 month: 1.0 to 1.5 6 month: 0.1 to 1.3
Barone 2008 Human Hard Re-entry (stent) 20 20 7 month: B 3.6(1.5) 7 month: 4.5(0.8)
L 3.0(1.6)
M 0.4(1.2)
D 0.5(1.0)
Kerr 2008 Human Hard CBVT 12 12 1 month:B 1.01(0.39) 1 month: 0.16(0.96)
(ref plate) L 0.62(0.28) 0.62(0.24)
3 month:B 0.95(0.9) 0.26(0.17)
L 1.12(0.28) 0.10(0.10)
3 month: 2.20(0.81)
1.30(0.24)
0.59(0.17)
0.28(0.10)
Aimettl 2009 Human Hard Re-entry (stent) 18 18 3 month: B1.2(0.6)
L 0.9(1.1)
M 0.5(0.9)
D 0.5(1.1)
Crespi 2009 Human Hard Radio 15 15 3 month: 3.75(0.63)
Moya-Villaescusa Human Hard Radio 100 100 3 month: 4.32(0.23)
2010
Pelegrine 2010 Human Hard Re-entry (pin) 6 15 6 month: 1.17(0.26)
Rasperini 2010 Human Hard Stent 3 3 3 month: 2.2
6 month: 5.7(4.2)
Yilmaz 1998 Human Hard Cast 5 10 3 month: 0.1(0.52) 3 month: 0.1(0.23)
12 month: 0.5(0.76) 12 month: 0.4(0.48)
Rodd 2007 Human Hard Cast 16 16 3 month: 15.7%
6 month: 25.3%
9 month: 22%
(Bone surface area)
Oghli 2010 Human Hard Cast 72 101 3 month: 0.3(0.5)

3 and 12 months respectively, post-extrac- well as 3, 6 and 12 months after extraction was followed by a net gain of 0.1 mm at
tion of maxillary incisor teeth (Fig. 10). of maxillary posterior teeth. Taking the 6 months and 0.4 mm at 12 months of the
Schropp et al. (2003) took measurements occlusal surfaces of adjacent teeth as refer- buccal sites. Lingual sites demonstrated a
from study casts taken immediately after as ence, a reduction of 0.1 mm at 3 months loss of 0.8–0.9 mm between 3 and 6 months,

12 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21 © 2011 John Wiley & Sons A/S

Fig. 10. Vertical (linear) change of hard and soft tissues
combined.
with a net loss of 0.8 mm at 12 months
(Fig. 10).
Horizontal linear combined hard and soft tissue
alteration
Four studies (Carlsson & Persson 1967; Yil-
maz et al. 1998; Schropp et al. 2003; Oghli &
Steveling 2010) presented data on the com-
bined hard and soft tissue change in the hori-
zontal dimension following extraction.
The only study using radiographic methods
(Carlsson & Persson 1967) demonstrated a
reduction of the alveolar width in the magni-
tude of 2.2 mm at 2 months, which subse-
quently increased to 3.6 mm at 12 months;
this measurement was taken 3 mm from the
alveolar crest.
Study casts were used in some of the stud-
ies (Yilmaz et al. 1998; Schropp et al. 2003;
Oghli & Steveling 2010) to evaluate the
change in the horizontal dimension (Fig. 11).
Yilmaz et al. (1998) showed a 3- and 12-
month reduction in width of 0.1 ± 0.23 mm
and 0.4 ± 0.48 mm respectively, while Oghli
& Steveling (2010) reported a 3-month reduc-
tion of 0.3 ± 0.5 mm. Horizontal resorption
of the alveolar hard and soft tissue between 3
and 12 months was also reported by Schropp
et al. (2003); at 3 months the resorption was
3.8 mm, this increased to 5.1 mm at
6 months and culminated to a value of
6.1 mm at 12 months.
The latter three studies (Yilmaz et al.
1998; Schropp et al. 2003; Oghli & Steveling
2010) had quite many similarities and an
attempt to calculate the weighted means for
these three studies was launched. However,
the study by Schropp et al. (2003) failed to
© 2011 John Wiley & Sons A/S
Tan et al
Dimensional tissue changes post extraction
always more substantial than the vertical
change.
Discussion
The 20 included studies in this systematic
review were of different study designs and
measured dimensional change in various
ways.
Eleven randomized controlled clinical tri-
als, five controlled clinical trials and four
cohort studies were included in this review.
Fig. 11. Horizontal (linear) change of hard and soft tis- It is common knowledge that randomized
sues combined.
controlled clinical trials and the systematic
review of randomized controlled clinical tri-
als provide the highest level of evidence
provide any information on the standard related to intervention and therapy. However,
deviations in the study, so it was impossible in the case of post-extractional dimensional
to utilize the inverse variance method to cal- changes of the alveolar hard and soft tissues,
culate the weighted means. there are no randomized controlled clinical
trials where the control procedure is where
Cross-sectional surface area alteration of combined the tooth was left in situ and the test proce-
alveolar hard and soft tissues
dure was extraction. Hence, the cohort stud-
A single study reported on change in alveolar
ies where post-extraction alveolar hard and
surface area of the hard and soft tissues com-
soft tissues changes were monitored longitu-
bined (Rodd et al. 2007); measurements were
dinally might provide better insight and be
obtained from study casts acquired prior to,
the more appropriate study design.
and at 3, 6 and 9 months following extrac-
The three main measuring methods uti-
tion of maxillary central incisors in children.
lized were: (i) re-entry (ii) imaging and (iii)
The reductions in surface area were presented
study models. The re-entry method consti-
as a percentage of the surface area on the pre-
tuted of elevating a flap during extraction
extraction cast, and were as follows: 15.7%
and again at re-evaluation. All the studies
at 3 months, 25.3% at 6 months and 22% at
using the re-entry method measured the
9 months.
parameters from a fixed reference, namely an
acrylic stent or a titanium pin or screw. The
Overall combined hard and soft tissue changes
imaging method included the utilization of
With the aid of various assessment methods,
periapical radiographs, lateral cephalometric
a longitudinal change of the combined hard
radiography, or computer tomography. The
and soft tissues in the vertical dimension
method where study models were utilized
was found to be anywhere between a loss of
required that study impressions be taken
4.0 mm to a gain of 0.4 mm over a period of
before, or immediately after extraction, and
2–12 months.
again at re-evaluation.
Study casts and radiographs were employed
Re-entry studies evaluated hard tissue as
to assess the reduction of the combined hard
well as soft tissues as separate entities, while
and soft tissues in the horizontal dimension.
imaging studies evaluated either hard tissue
This reduction was demonstrated to be
dimension only, or the combined hard and
between 0.1 and 6.1 mm when the observa-
soft tissue changes. Study model studies
tion periods varied from 3 to 12 months, and
focused on combined hard and soft tissue
the measurements were taken at the alveolar
dimensional changes. During data analysis
crest. When the measurements were taken
process, we subdivided the data into different
3 mm apical to the alveolar crest, the corre-
groups, mainly according to measurement
sponding horizontal reductions of the com-
methods and the tissues involved. The
bined hard and soft tissues were 2.2 mm at
groups include (i) hard tissue group, (ii) soft
2 months and 3.6 mm at 12 months. Reduc-
tissue group, and (iii) combined hard and soft
tions in cross-sectional surface area of the tis-
tissue group.
sues were up to 22% after 9 months.
Mimicking the changes of the alveolar hard
Heterogeneity assessment
tissue, there is a similar pattern of resorption
The 20 included studies had different obser-
when we look at the combined hard and
vation time points, methodologies, and
soft tissue entity; the horizontal alteration is
13 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction
measurement methods. Heterogeneity assess-
ment was performed in six re-entry studies
(Lekovic et al. 1997, 1998; Camargo et al.
2000; Iasella et al. 2003; Serino et al. 2003
and Pelegrine et al. 2010) calculating mean
vertical hard tissue change, and five studies
(Lekovic et al. 1997, 1998; Camargo et al.
2000; Iasella et al. 2003 and Pelegrine et al.
2010,) calculating horizontal hard tissue
change. These studies had similarity in terms
of the method of measurements employed.
The studies all employed re-entry methods,
utilizing an acrylic stent or a titanium pin or
screw as a fixed reference from which to
measure the dimensional changes. The differ-
ences in sample sizes, different behaviours of
study populations, varied observation time
points and measurement parameters contrib-
uted to the heterogeneity. Although weighted
means were calculated, the resultant values
should really only be used for reference pur-
poses. The robustness and applicability of the
weighted means should be interpreted with
caution.
Hard tissue vertical dimensional change
Buccal/lingual vs. mesial/distal
Three studies (Iasella et al. 2003; Barone
et al. 2008; Aimetti et al. 2009) measured
vertical dimensional changes of all the buc-
cal, lingual, mesial and distal bone plates.
Two of the three studies, namely Barone
et al. (2008) and Aimetti et al. (2009), demon-
strated that buccal/lingual sites (0.9–3.6 mm
loss at 3–7 months) had more resorption than
mesial/distal sites (0.4–0.5 mm loss at 3–
7 months). Referring to the calculated values
of the respective weighted mean, buccal bone
plates (1.24 mm loss at 3–7 months) also had
a tendency to resorb more than mesial/distal
bone sites (0.8–0.84 mm at 3–7 months)
(Fig. 2). One possible explanation for this
trend is that the mesial and distal bone levels
are partially determined by the presence or
absence of neighbouring teeth; mesial/distal
bone levels are held stable by the presence of
adjacent teeth.
Buccal vs. lingual
Iasella et al. (2003), Barone et al. (2008) and
Aimetti et al. (2009) measured vertical
dimensional changes at both buccal and lin-
gual bone plates. All three studies showed
that the buccal plate resorption (0.9–3.6 mm
at 3–7 months) was of greater magnitude
than that of the lingual plate (0.4–3 mm at 3
–7 months). This finding was similar to pre-
vious studies in the canine model (Araujo &
Lindhe 2005; Araujo et al. 2005). This pattern
14 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
of resorption can be explained by the bundle
bone concept as proposed by Araujo & Lind-
he (2005). According to this theory, a larger
proportion of the buccal plate is made up of
bundle bone relative to the lingual plate; as
bundle bone is a tooth-dependent tissue, it is
quickly resorbed after tooth extraction and
with its resorption, a substantial portion of
the buccal plate is lost. In our review of the
literature, however, the relative height differ-
ence between the buccal and lingual bone
plates in humans was less marked compared
to the canine model by Araujo & Lindhe
(2005). The relative difference in height of
the buccal and lingual plate is estimated to
be around 0.3–0.6 mm over a period of 3 and
7 months, in our review. One possible expla-
nation for the observed differences between
human models and canine models is that the
buccal plate in humans is on average equally
prone to resorption as the lingual aspect of
the ridge (Van der Weijden et al. 2009).
Mesial vs. distal
Four studies (Iasella et al. 2003; Serino et al.
2003; Barone et al. 2008 and Aimetti et al.
2009) measured vertical dimensional changes
of both mesial and distal bone plates. All four
studies showed the extent of resorption to be
between 0.4 and 0.8 mm over an observation
period of 3–7 months.
Hard tissue vertical dimensional percentage
change
Lekovic et al. (1997, 1998), Camargo et al.
(2000), Pelegrine et al. (2010) reported base-
line data of the internal socket height imme-
diately post-extraction. Internal socket height
is a measurement from buccal bone crest to
the bottom of the extraction socket. The pro-
vision of baseline internal socket height
enabled us to calculate the percentage change
in height of the buccal bone wall relative to
the baseline height of the buccal bone wall
over time. The percentage change reflected
the amount of vertical resorption of the buc-
cal plate only; this was found to be between
11% and 22% six months post-extraction.
Percentage changes of lingual, mesial and
distal bony plates could not be calculated due
to lack of baseline data, but it is expected to
be less than 11–22%, as the amount of
resorption in these areas have been shown to
be of a comparatively lesser magnitude. Cor-
respondingly, from this this percentage, we
can interpret that there might be 78–89%
bone fill of the original socket height, calcu-
lated as percentage vertical bone fill equals
one minus vertical dimensional percentage
change.
Hard tissue horizontal dimensional change
Five re-entry studies (Lekovic et al. 1997,
1998; Camargo et al. 2000; Iasella et al. 2003;
Pelegrine et al. 2010) showed that there was
range of 2.46–4.56 mm horizontal bone loss
and weighted mean resorption of 3.79 mm at
6 months. However, theses studies only pro-
vided data for horizontal resorption at the
level of the alveolar crest, no data was avail-
able on magnitude of horizontal resorption a
distance away from the alveolar crest. Kerr
et al. (2008) demonstrated a relative decrease
in horizontal ridge reduction as the distance
from the alveolar crest increased. This find-
ing was similar to a dog study done by Ara-
ujo & Lindhe (2009), which observed more
resorption at coronal third and least resorp-
tion at apical third of the alveolar ridge.
Hence, it is expected that the amount of hor-
izontal resorption might be less than
weighted mean of 3.79 mm at 6 months
when the measurement is taken at a distance
from the alveolar crest.
Hard tissue horizontal dimensional percentage
change
There was 32% reduction at 3 months, and
29–63% reduction in horizontal dimension
at 6 months. This demonstrated that possi-
bly more than half of the ridge width could
be resorbed after 6 months in some patients.
However, a definite conclusion cannot be
drawn from these data, on whether the
resorption was from the buccal or lingual.
Studies by Pietrokovski & Massler (1967),
Schropp et al. (2003), Araujo & Lindhe
(2005) and Barone et al. (2008) all suggest
that tissue loss is more pronounced on the
buccal aspect than from the lingual or pala-
tal aspect.
Vertical hard tissue vs. horizontal hard tissue
change
The amount of horizontal dimensional
change was found to be greater than that of
the vertical dimension, in both absolute val-
ues and percentage change. Horizontal reduc-
tion (3.79 ± 0.23 mm) was more than vertical
reduction (1.24 ± 0.11 mm on buccal, 0.84 ±
0.62 mm on mesial and 0.80 ± 0.71 mm on
distal) at 6 months. Percentage vertical
change was 11–22% at 6 months while per-
centage horizontal change was 32% at
3 months, and 29–63% between 6 and
7 months.
Soft tissue changes
Only one study by Iasella et al. (2003) was
found to have measured soft tissue thickness
change after extraction. There was a 0.4–
© 2011 John Wiley & Sons A/S

0.5 mm gain in soft tissue thickness on buc-
cal and lingual sites at 6 months. Interest-
ingly, from this study, a difference was found
in the change of soft tissue thickness over a
natural healing socket, and sockets aug-
mented using bio-resorbable membranes and
grafts. There was net gain of soft tissue
thickness in the natural healing group and a
net loss in the augmented group. One possi-
ble explanation for this observation was that
the membrane or graft placed might have
interfered with the soft tissue vascularity in
the augmented group. We must remember
that the vascular supply to the soft tissue is
derived from the underlying bone, and the
placement of membranes or grafts might
interfere with re-vascularization of the soft
tissues. In contrast, there is no interposing
material between the bone and the overlying
soft tissues in the naturally healing sockets.
Although there was an observed gain in soft
tissue thickness over a naturally healing
socket, a robust conclusion cannot be drawn
from this single study.
In addition, this study also demonstrated a
trend where the lingual soft tissues were
thicker than that on the buccal; lingual soft
tissues were nearly twice as thick. The meth-
ods and materials in the study could explain
this difference; majority of teeth extracted
within the study were maxillary teeth where
palatal soft tissue is expected to be much
thicker than that of the buccal. Hence, this
finding may only be applicable to the maxil-
lary extraction sockets, but not mandibular
ones. Note that this study only had a sample
size of 12 non-molar extraction sockets,
hence we should be cautious when trying to
interpret the results of this study.
Vertical combined hard and soft tissue change
Two studies by Yilmaz et al. (1998) and Sch-
ropp et al. (2003) demonstrated very subtle
changes in the vertical dimension of the hard
and soft tissues combined, between 3 and
12 months post-extraction. The changes ran-
ged from a gain of 0.1 mm to a loss of
0.9 mm at 6 months and a gain of 0.4 mm to
a loss of 0.8 mm at 12 months. Schropp et al.
(2003) also observed a small increase buccally
and a reduction orally.
Horizontal combined hard and soft tissue
change
Three studies (Yilmaz et al. 1998; Schropp
et al. 2003 and Oghli & Steveling 2010)
reported data on horizontal hard and soft tis-
sue changes. The studies by Yilmaz et al.
(1998) and Schropp et al. (2003) had a follow-
up of up to 12 months; both studies exhib-
© 2011 John Wiley & Sons A/S
Tan et al
Dimensional tissue changes post extraction
ited a trend where there was a rapid reduc-
tion in first 3 months and gradual change
from thereafter, up to 12 months. Weighted
mean reduction showed this change to be
1.3 mm at 3 months and 5.1 mm at
12 months.
Vertical vs. horizontal combined hard and soft
change
Hard and soft tissue showed a combined hori-
zontal reduction of 0.1–3.8 mm and 5.1 mm
at 3 and 6 months respectively. Correspond-
ingly, in the vertical dimension, this change
was between 0.1 and 0.8 mm reduction at
3 months, and 0.1 mm gain to 0.9 mm
reduction at 6 months. Overall, the demon-
strated horizontal change was more substan-
tial than the vertical change.
Combined hard and soft tissue change vs. hard
tissue change only
In the horizontal dimension, the combined
hard and soft tissue reduction was 5.1 mm at
6 months, while the corresponding hard
tissue reduction was between 2.46 and
4.56 mm, with a weighted mean reduction of
3.79 mm.
Hence, at 6 months post-extraction, the
combined hard and soft tissues demonstrated
a tendency towards a more substantial reduc-
tion than hard tissue only; this observation is
not corroborated in the vertical aspect.
In the vertical dimension, when consider-
ing only hard tissue change (loss of 0.4–
1.5 mm at 6 months), the magnitude of this
change was greater than that of the hard and
soft tissues combined (0.1 mm gain to
0.9 mm reduction at 6 months). A plausible
explanation might be that the increase in soft
tissue thickness (gain of 2.1 mm occlusally
vs. gain of only 0.4–0.5 mm on buccal/lin-
gual) compensated for the reduction in hard
tissue height.
Possible factors affecting dimensional change
after tooth extraction
Flap vs. flapless
Using a canine model, Fickl et al. (2008a)
demonstrated that there was significant dif-
ference of the extent of bone resorption
between flap and flapless extractions. The
flapless group had lower extent of resorption
compared to the flap group. Blanco et al.
(2008) also showed similar trend in another
study, although the study was investigating
ridge alterations after immediate implants
with or without flap. However, Araujo &
Lindhe (2009) found that the differences
between the flap and flapless groups in their
15 |
study were negligible after 6 months. Hence,
raising a flap during extraction may only
affect the short-term dimensional alterations
of the alveolar ridge.
Overeruption of adjacent teeth
Mizutani & Ishihata (1976) found that the
over-eruption of teeth adjacent to the extrac-
tion socket affected the overall dimensional
change of ridge. The vertical alveolar ridge
height in this study decreased slightly ini-
tially, followed by a gradual increase later on,
which negated the previous reduction or even
surpassed the amount of resorption to result
in a net gain. The study speculated that the
over-eruption of teeth adjacent to extraction
sites might have affected the pattern of
dimensional change observed.
Smoking
Smoking may affect the extent of vertical
reduction of the alveolar ridge after extrac-
tion. Saldanha et al. (2006) showed that
there was a significant difference in dimen-
sional reduction between smoking and non-
smoking groups. There was vertical alveolar
ridge reduction of 1.5 mm in smokers and
1.0 mm in non-smokers, 6 months post-
extraction.
Single-rooted vs. multiple-rooted teeth
Moya-Villaescusa & Sanchez-Pérez (2010)
study showed there was no significant differ-
ence in vertical dimensional change between
single-rooted (4.16 mm loss) and multi-rooted
teeth (4.48 mm loss), although there was a
tendency that multi-rooted teeth exhibited
greater resorption of the alveolar ridge.
Chlorhexidine
Rinsing with 15 ml of 0.12% chlorhexidine
digluconate mouthrinse twice daily for
1 month, starting 2 days after extraction may
have some effect on the observed vertical
change of the mesial and distal bone. Bragger
et al. (1994) showed that patients rinsing for
1 month with a placebo solution lost almost
1 mm of bone height over a 6-month period
after extraction, while in patients rinsing
with the chlorhexidine solution, the crestal
alveolar bone level was maintained.
Immediate denture
Carlsson & Persson (1967) showed that there
was no significant difference in alveolar
dimensional change between patients with
immediate or conventional dentures in the
long-term. Take note, however, that the
usage of immediate dentures had a tendency
to affect dimensional change in short-term,
Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction
but the effect would be negligible after
2 years post-extraction.
Bone resorption pattern after 12 months
Only one study (Carlsson & Persson 1967)
followed dimensional changes in human
alveolar ridge for up to 5 years. This study
displayed a similar pattern where there was a
relatively rapid reduction in the first
6 months in both vertical and horizontal
dimension, followed by a gradual reduction
thereafter; the reduction continued at a
steady rate for up to 5 years. This finding
could suggest that bone resorption will con-
tinue throughout life once the teeth are
extracted. Take note, however, that all the
patients in this study wore complete den-
tures; dentures were inserted 2 months after
extractions in the conventional group and
immediately after extractions in the immedi-
ate group. We can speculate that the usage of
removable complete dentures may also affect
the pattern of resorption of the alveolar tis-
sues.
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Conclusions
In conclusion, the studies included in this
review demonstrated that horizontal bone
loss (29–63%, 2.46–4.56 mm, weighted mean
3.79 mm at 6 months) was more substantial
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List of included articles:
Aimetti, M., Romano, F., Griga, F.B. & Godio, L.
(2009) Clinical and histologic healing of human
extraction sockets filled with calcium sulfate.
The International Journal of Oral & Maxillofa-
cial Implants 24: 902–929.
Barone, A., Aldini, N.N., Fini, M., Giardino, R.,
Calvo Guirado, J.L. & Covani, U. (2008) Xenograft
versus extraction alone for ridge preservation
after tooth removal: a clinical and histomorpho-
metric study. Journal of Periodontology 79: 1370–
1377.
Bragger, U., Schild, U. & Lang, N.P. (1994) Effect of
chlorhexidine (0.12%) rinses on periodontal tissue
healing after tooth extraction. (II). Radiographic
parameters. Journal of Clinical Periodontology
21: 422–430.
Camargo, P.M., Lekovic, V., Weinlaender, M., Klok-
kevold, P.R., Kenney, E.B., Dimitrijevic, B.,
Nadic, M., Jancovic, S. & Orsini, M. (2000) Influ-
ence of bioactive glass on changes in alveolar pro-
cess dimensions after exodontia. Oral Surgery
Oral Medicine Oral Pathology Oral Radiology &
Endodontology 90: 581–586.
Carlsson, G.E. & Persson, G. (1967) Morphologic
changes of the mandible after extraction and
wearing of dentures. A longitudinal, clinical, and
x-ray cephalometric study covering 5 years. Od-
ontologisk Revy 18: 27–54.
Crespi, R., Cappare, P. & Gherlone, E. (2009) Mag-
nesium-enriched hydroxyapatite compared to cal-
cium sulfate in the healing of human extraction
sockets: radiographic and histomorphometric
evaluation at 3 months. Journal of Periodontol-
ogy 80: 210–218.
Fiorellini, J.P., Howell, T.H., Cochran, D., Malm-
quist, J., Lilly, L.C., Spagnoli, D., Toljanic, J.,
List of excluded full text articles and the reason for exclusion:
Agbaje, J.O., Jacobs, R., Michiels, K., Abu-Ta’a, M.
& van Steenberghe, D. (2009) Bone healing after
dental extractions in irradiated patients: a pilot
© 2011 John Wiley & Sons A/S
Tan et al
Dimensional tissue changes post extraction
posterior maxilla reduces the need for sinus aug-
mentation. International Journal of Periodontics
& Restorative Dentistry 30: 265–273.
Rodd, H.D., Malhotra, R., O’Brien, C.H., Elcock, C.,
Davidson, L.E. & North, S. (2007) Change in sup-
porting tissue following loss of a permanent max-
illary incisor in children. Dental Traumatology
23: 328–332.
Saldanha, J.B., Casati, M.Z., Neto, F.H., Sallum, E.
A. & Nociti, F.H. Jr (2006) Smoking may affect
the alveolar process dimensions and radiographic
bone density in maxillary extraction sites: a pro-
spective study in humans. Journal of Oral &
Maxillofacial Surgery 64: 1359–1365.
Schropp, L., Wenzel, A., Kostopoulos, L. & Karring,
T. (2003) Bone healing and soft tissue contour
changes following single-tooth extraction: a clini-
cal and radiographic 12-month prospective study.
International Journal of Periodontics & Restor-
ative Dentistry 23: 313–323.
Jones, A. & Nevins, M. (2005) Randomized study
evaluating recombinant human bone morphoge-
netic protein-2 for extraction socket augmenta-
tion. Journal of Periodontology 76: 605–613.
Iasella, J.M., Greenwell, H., Miller, R.L., Hill, M.,
Drisko, C., Bohra, A.A. & Scheetz, J.P. (2003)
Ridge preservation with freeze-dried bone allo-
graft and a collagen membrane compared to
extraction alone for implant site development: a
clinical and histologic study in humans. Journal
of Periodontology 74: 990–999.
Kerr, E.N., Mealey, B.L., Noujeim, M.E., Lasho, D.
J., Nummikoski, P.V. & Mellonig, J.T. (2008) The
effect of ultrasound on bone dimensional changes
following extraction: a pilot study. Journal of
Periodontology 79: 283–290.
Lekovic, V., Camargo, P.M., Klokkevold, P.R., We-
inlaender, M., Kenney, E.B., Dimitrijevic, B. &
Nedic, M. (1998) Preservation of alveolar bone in
extraction sockets using bioabsorbable mem-
branes. Journal of Periodontology 69: 1044–1049.
Lekovic, V., Kenney, E.B., Weinlaender, M., Han, T.,
Klokkevold, P., Nedic, M. & Orsini, M. (1997) A
bone regenerative approach to alveolar ridge main-
tenance following tooth extraction. Report of 10
cases. Journal of Periodontology 68: 563–570.
Moya-Villaescusa, M.J. & Sanchez-Pérez, A. (2010)
Measurement of ridge alterations following tooth
removal: a radiographic study in humans. Clini-
cal Oral Implants Research 21: 237–242.
Oghli, A.A. & Steveling, H. (2010) Ridge preserva-
tion following tooth extraction: a comparison
between atraumatic extraction and socket seal
surgery. Quintessence International 41: 605–609.
Pelegrine, A.A., da Costa, C.E., Correa, M.E. &
Marques, J.F. Jr (2010) Clinical and histomorpho-
study on a novel technique for volume assess-
ment of healing tooth sockets. Clinical Oral
Investigations 13: 257–261.
17 |
Serino, G., Biancu, S., Iezzi, G. & Piattelli, A.
(2003) Ridge preservation following tooth extrac-
tion using a polylactide and polyglycolide sponge
as space filler: a clinical and histological study in
humans. Clinical Oral Implants Research 14:
651–658.
Tallgren, A. (1972) The continuing reduction of
the residual alveolar ridges in complete denture
wearers: a mixed-longitudinal study covering
25 years. Journal of Prosthetic Dentistry 27: 120
–132.
Van der Weijden, F., Dell’Acqua, F. & Slot, D.E.
(2009) Alveolar bone dimensional changes of
post-extraction sockets in humans: a systematic
review. Journal of Clinical Periodontology 36:
1048–1058.
Yilmaz, S., Efeoglu, E. & Kilic, A.R. (1998) Alveolar
ridge reconstruction and/or preservation using
root form bioglass cones. Journal of Clinical Peri-
odontology 25: 832–839.
metric evaluation of extraction sockets treated
with an autologous bone marrow graft. Clinical
Oral Implants Research 21: 535–542.
Rasperini, G., Canullo, L., Dellavia, C., Pellegrini,
G. & Simion, M. (2010) Socket grafting in the
posterior maxilla reduces the need for sinus aug-
mentation. International Journal of Periodontics
& Restorative Dentistry 30: 265–273.
Rodd, H.D., Malhotra, R., O’Brien, C.H., Elcock, C.,
Davidson, L.E. & North, S. (2007) Change in sup-
porting tissue following loss of a permanent max-
illary incisor in children. Dental Traumatology
23: 328–332.
Saldanha, J.B., Casati, M.Z., Neto, F.H., Sallum, E.
A. & Nociti, F.H. Jr (2006) Smoking may affect
the alveolar process dimensions and radiographic
bone density in maxillary extraction sites: a pro-
spective study in humans. Journal of Oral &
Maxillofacial Surgery 64: 1359–1365.
Schropp, L., Wenzel, A., Kostopoulos, L. & Karring,
T. (2003) Bone healing and soft tissue contour
changes following single-tooth extraction: a clini-
cal and radiographic 12-month prospective study.
International Journal of Periodontics & Restor-
ative Dentistry 23: 313–323.
Serino, G., Biancu, S., Iezzi, G. & Piattelli, A.
(2003) Ridge preservation following tooth extrac-
tion using a polylactide and polyglycolide sponge
as space filler: a clinical and histological study in
humans. Clinical Oral Implants Research 14:
651–658.
Yilmaz, S., Efeoglu, E. & Kilic, A.R. (1998) Alveolar
ridge reconstruction and/or preservation using
root form bioglass cones. Journal of Clinical Peri-
odontology 25: 832–839.
Exclusion criteria: reported parameters not
relevant or not useful.
Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction
Ahn, J.J. & Shin, H.I. (2008) Bone tissue formation
in extraction sockets from sites with advanced
periodontal disease: a histomorphometric study
in humans. The International Journal of Oral &
Maxillofacial Implants 23: 1133–1138.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Alissa, R., Esposito, M., Horner, K. & Oliver, R.
(2010) The influence of platelet-rich plasma on
the healing of extraction sockets: an explorative
randomised clinical trial. European Journal of
Oral Implantology 3: 121–134.
Exclusion criteria: reported parameters not
relevant or not useful.
Altundal, H. & Guvener, O. (2004) The effect of
alendronate on resorption of the alveolar bone fol-
lowing tooth extraction. The International Jour-
nal of Oral & Maxillofacial Surgery 33: 286–293.
Exclusion criteria: reported parameters not
relevant or not useful.
Alves-Rezende, M.C. & Okamoto, T. (1997) Effects
of fibrin adhesive material (tissucol) on alveolar
healing in rats under stress. Brazilian Dental
Journal 8: 13–19.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Amemori, H. (1966) An experimental study of
changes in the form of the mandible after extrac-
tion of lower posterior teeth. I. The areal change
of mandibular frontal sections.. Bulletin of Tokyo
Medical & Dental University 13: 59–74.
Exclusion criteria: study carried out on ani-
mals.
Anitua, E. (1999) Plasma rich in growth factors: pre-
liminary results of use in the preparation of
future sites for implants. The International Jour-
nal of Oral & Maxillofacial Implants 14: 529–
535.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Araujo, M., Linder, E., Wennstrom, J. & Lindhe, J.
(2008) The influence of bio-oss collagen on heal-
ing of an extraction socket: an experimental
study in the dog. International Journal of Peri-
odontics & Restorative Dentistry 28: 123–135.
Exclusion criteria: reported parameters not
relevant or not useful.
Araujo, M.G. & Lindhe, J. (2005) Dimensional ridge
alterations following tooth extraction. An experi-
mental study in the dog.. Journal of Clinical Peri-
odontology 32: 212–218.
Exclusion criteria: only measured relative
difference in height between buccal and lin-
gual plates of the alveolus.
Araujo, M.G. & Lindhe, J. (2009a) Ridge alterations
following tooth extraction with and without flap
elevation: an experimental study in the dog. Clin-
ical Oral Implants Research 20: 545–549.
18 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Exclusion criteria: no baseline data avail-
able for comparison, thus unable to arrive at
an estimate of dimensional change over time.
Araujo, M.G. & Lindhe, J. (2009b) Ridge preserva-
tion with the use of bio-oss collagen: a 6-month
study in the dog. Clinical Oral Implants
Research 20: 433–440.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Araujo, M.G., Sukekava, F., Wennstrom, J.L. &
Lindhe, J. (2005) Ridge alterations following
implant placement in fresh extraction sockets: an
experimental study in the dog. Journal of Clin
Periodontology 32: 645–652.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Ashman, A. & Bruins, P. (1985) Prevention of alveo-
lar bone loss postextraction with htr grafting
material. Oral Surgery Oral Medicine & Oral
Pathology 60: 146–153.
Exclusion criteria: descriptive report on
procedure/technique; commentary.
Ashman, A. & Bruins, P. (1987) Prevention of alveo-
lar bone loss postextraction with htr polymer
grafting material. Journal of Oral Implantology
13: 270–281.
Exclusion criteria: descriptive report on
procedure/technique; commentary.
Bahat, O., Deeb, C., Golden, T. & Komarnyckij, O.
(1987) Preservation of ridges utilizing hydroxyapa-
tite. International Journal of Periodontics &
Restorative Dentistry 7: 34–41.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Bergstedt, H., Wictorin, L. & Lundquist, G. (1973)
Transplantation of bone treated with ethylenedia-
mine into tooth sockets in immediate denture
patients. Sven Tandlak Tidskr 66: 39–48.
Exclusion criteria: study subjects had
immediate dentures after extraction, hence
they did not have undisturbed healing post-
extraction.
Berkovitz, B.K. (1971) The healing process in the
incisor tooth socket of the rat following root
resection and exfoliation. Archives of Oral Biol-
ogy 16: 1045–1054.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Bianchi, J., Fiorellini, J.P., Howell, T.H., Sekler, J.,
Curtin, H., Nevins, M.L. & Friedland, B. (2004)
Measuring the efficacy of rhbmp-2 to regenerate
bone: a radiographic study using a commercially
available software program. International Journal
of Periodontics & Restorative Dentistry 24: 579–
587.
Exclusion criteria: reported parameters not
relevant or not useful.
Boyes-Varley, J.G., Cleaton-Jones, P.E. & Lownie, J.
F. (1988) Effect of a topical drug combination on
the early healing of extraction sockets in the ver-
vet monkey. The International Journal of Oral &
Maxillofacial Surgery 17: 138–141.
Exclusion criteria: no measurements of
alveolar dimensional changes (e.g. description
of healing process or bony shape change, or
histology only).
Boyne, P.J. (1995) Use of htr in tooth extraction
sockets to maintain alveolar ridge height and
increase concentration of alveolar bone matrix.
General Dentistry 43: 470–473.
Exclusion criteria: reported parameters not
relevant or not useful.
Brandao, A.C., Brentegani, L.G., Novaes, A.B. Jr,
Grisi, M.F., Souza, S.L., Taba Junior, M. & Salata,
L.A. (2002) Histomorphometric analysis of rat
alveolar wound healing with hydroxyapatite alone
or associated to bmps. Brazilian Dental Journal
13: 147–154.
Exclusion criteria: reported parameters not
relevant or not useful.
Cardaropoli, G., Araujo, M., Hayacibara, R., Sukek-
ava, F. & Lindhe, J. (2005) Healing of extraction
sockets and surgically produced – augmented and
non-augmented – defects in the alveolar ridge. An
experimental study in the dog.. Journal of Clini-
cal Periodontology 32: 435–440.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Carlsson, G.E., Thilander, H. & Hedegard, B. (1967)
Histologic changes in the upper alveolar process
after extractions with or without insertion of an
immediate full denture. Acta Odontolologica
Scandinavica 25: 21–43.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Carmagnola, D., Adriaens, P. & Berglundh, T.
(2003) Healing of human extraction sockets filled
with bio-oss. Clinical Oral Implants Research
14: 137–143.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Dayan, D., Bodner, L. & Horowitz, I. (1992) Effect
of salivary gland hypofunction on the healing of
extraction wounds: a histomorphometric study in
rats. Journal of Oral & Maxillofacial Surgery 50:
354–358.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Fickl, S., Zuhr, O., Wachtel, H., Bolz, W. & Huerz-
eler, M. (2008b) Tissue alterations after tooth
extraction with and without surgical trauma: a
volumetric study in the beagle dog. Journal of
Clinical Periodontology 35: 356–363.
Exclusion criteria: study carried out on ani-
mals.
Fickl, S., Zuhr, O., Wachtel, H., Stappert, C.F.,
Stein, J.M. & Hurzeler, M.B. (2008c) Dimensional
© 2011 John Wiley & Sons A/S

changes of the alveolar ridge contour after differ-
ent socket preservation techniques. Journal of
Clinical Periodontology 35: 906–913.
Exclusion criteria: study carried out on ani-
mals.
Fickl, S., Zuhr, O., Wachtel, H., Bolz, W. & Huerz-
eler, M.B. (2008c) Hard tissue alterations after
socket preservation: an experimental study in the
beagle dog. Clinical Oral Implants Research 19:
1111–1118.
Exclusion criteria: no baseline data avail-
able for comparison, thus unable to arrive at
an estimate of dimensional change over time.
Gauthier, O., Boix, D., Grimandi, G., Aguado, E.,
Bouler, J.M., Weiss, P. & Daculsi, G. (1999) A
new injectable calcium phosphate biomaterial for
immediate bone filling of extraction sockets: a
preliminary study in dogs. Journal of Periodontol-
ogy 70: 375–383.
Exclusion criteria: reported parameters not
relevant or not useful.
Gorustovich, A., Veinsten, F., Costa, O.R. & Gug-
lielmotti, M.B. (2004) Histomorphometric evalua-
tion of the effect of bovine collagen granules on
bone healing. An experimental study in rats. Acta
Odontologica Latinoamericana 17: 9–13.
Exclusion criteria: reported parameters not
relevant or not useful.
Green, L.J., Gong, J.K. & Neiders, M.E. (1969) Rela-
tionship between sr85 uptake and histological
changes during healing in dental extraction wounds
in rats. Archives of Oral Biology 14: 865–872.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Guglielmotti, M.B. & Cabrini, R.L. (1985) Alveolar
wound healing and ridge remodeling after tooth
extraction in the rat: a histologic, radiographic,
and histometric study. Journal of Oral & Maxil-
lofacial Surgery 43: 359–364.
Exclusion criteria: reported parameters not
relevant or not useful.
Guglielmotti, M.B., Ubios, A.M. & Cabrini, R.L.
(1985) Alveolar wound healing alteration under
uranyl nitrate intoxication. Journal of Oral
Pathology 14: 565–572.
Exclusion criteria: reported parameters not
relevant or not useful.
Guglielmotti, M.B., Ubios, A.M. & Cabrini, R.L.
(1986) Alveolar wound healing after x-irradiation:
a histologic, radiographic, and histometric study.
Journal of Oral & Maxillofacial Surgery 44: 972–
976.
Exclusion criteria: no baseline data avail-
able for comparison, thus unable to arrive at
an estimate of dimensional change over time.
Hahn, E., Sonis, S., Gallagher, G. & Atwood, D.
(1988) Preservation of the alveolar ridge with
hydroxyapatite-collagen implants in rats. Journal
of Prosthetic Dentistry 60: 729–734.
Exclusion criteria: study carried out on ani-
mals.
Hars, E. & Massler, M. (1972) Effects of fluorides,
cortico-steroids and tetracyclines on extraction
© 2011 John Wiley & Sons A/S
Tan et al
Dimensional tissue changes post extraction
wound healing in rats. Acta Odontologica Scan-
dinavica 30: 511–522.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Horn, Y., Sela, M.N., Shlomi, B., Ulmansky, M. &
Sela, J. (1979) Effect of irradiation-timing on the
initial socket healing in rats. International Jour-
nal of Oral Surgery 8: 457–461.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Hsieh, Y.D., Devlin, H. & McCord, F. (1995) The
effect of ovariectomy on the healing tooth socket
of the rat. Archives of Oral Biology 40: 529–531.
Exclusion criteria: no baseline data avail-
able for comparison, thus unable to arrive at
an estimate of dimensional change over time.
Huebsch, R.F. & Hansen, L.S. (1969) A histopatho-
logic study of extraction wounds in dogs. Oral
Surgery Oral Medicine & Oral Pathology 28: 187
–196.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Iino, G., Nishimura, K., Omura, K. & Kasugai, S.
(2008) Effects of prostaglandin e1 application on
rat incisal sockets. The International Journal of
Oral & Maxillofacial Implants 23: 835–840.
Exclusion criteria: reported parameters not
relevant or not useful.
Iizuka, T., Miller, S.C. & Marks, S.C. Jr (1992)
Alveolar bone remodeling after tooth extraction
in normal and osteopetrotic (ia) rats. Journal of
Oral Pathology & Medicine 21: 150–155.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Indovina, A. Jr & Block, M.S. (2002) Comparison of 3
bone substitutes in canine extraction sites. Journal
of Oral & Maxillofacial Surgery 60: 53–58.
Exclusion criteria: reported parameters not
relevant or not useful.
Kangvonkit, P., Matukas, V.J. & Castleberry, D.J.
(1986) Clinical evaluation of durapatite sub-
merged-root implants for alveolar bone preserva-
tion. The International Journal of Oral &
Maxillofacial Surgery 15: 62–71.
Exclusion criteria: study subjects had
immediate dentures after extraction, hence
they did not have undisturbed healing post-
extraction.
Lavelle, C.L. (1985) Preliminary study of mandibu-
lar shape after tooth loss. Journal of Prosthetic
Dentistry 53: 726–730.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Librus, H., Pietrokovski, J., Ulmanski, M. & Geda-
lia, I. (1973) The effect of fluoride on molar
19 |
socket healing in the rat. Archives of Oral Biol-
ogy 18: 1283–1289.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Lindeboom, J.A., Tjiook, Y. & Kroon, F.H. (2006)
Immediate placement of implants in periapical
infected sites: a prospective randomized study in
50 patients. Oral Surgery Oral Medicine Oral
Pathology Oral Radiology & Endodontology 101:
705–710.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Loo, W.D. (1968) Ridge preservation with immedi-
ate treatment dentures. Journal of Prosthetic
Dentistry 19: 5–11.
Exclusion criteria: descriptive report on
procedure/technique; commentary.
Luvizuto, E.R., Queiroz, T.P., Dias, S.M., Okamoto,
T., Dornelles, R.C., Garcia, I.R. Jr & Okamoto, R.
(2010) Histomorphometric analysis and immunol-
ocalization of rankl and opg during the alveolar
healing process in female ovariectomized rats
treated with oestrogen or raloxifene. Archives of
Oral Biology 55: 52–59.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Magro Filho, O. & de Carvalho, A.C. (1990) Appli-
cation of propolis to dental sockets and skin
wounds. Journal of Nihon University School of
Dentistry 32: 4–13.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Magro-Ernica, N., Magro-Filho, O. & Rangel-Garcia,
I. (2003) Histologic study of use of microfibrillar
collagen hemostat in rat dental sockets. Brazilian
Dental Journal 14: 12–15.
Exclusion criteria: reported parameters not
relevant or not useful.
Mathai, J.K., Chandra, S., Nair, K.V. & Nambiar, K.
K. (1989) Tricalcium phosphate ceramic as imme-
diate root implants for the maintenance of alveo-
lar bone in partially edentulous mandibular jaws.
A clinical study. Australian Dental Journal 34:
421–426.
Exclusion criteria: reported parameters not
relevant or not useful.
Matsumoto, M. (1968) Changes in residual ridge of
the mandible after extraction and wearing exten-
sion saddle type of removable partial dentures. (a
longitudinal, clinical and roentgenographic inves-
tigation). Bulletin of Tokyo Medical & Dental
University 15: 67–89.
Exclusion criteria: length of observation
period not reported.
Michael, C.G. & Barsoum, W.M. (1976) Comparing
ridge resorption with various surgical techniques
in immediate dentures. Journal of Prosthetic
Dentisty 35: 142–155.
Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Tan et al
Dimensional tissue changes post extraction
Exclusion criteria: study subjects had
immediate dentures after extraction, hence
they did not have undisturbed healing post-
extraction.
Minsk, L. (2005) Extraction-site ridge preservation.
Compendium of Continuing Education in Den-
tistry 26: 272.
Exclusion criteria: descriptive report on
procedure/technique; commentary.
Mizutani, H. & Ishihata, N. (1976) Decrease and
increase in residual ridges after extraction of
teeth in monkeys (part I). Bulletin of Tokyo Med-
ical & Dental University 23: 157–168.
Exclusion criteria: study carried out on ani-
mals.
Nevins, M., Camelo, M., De Paoli, S., Friedland, B.,
Schenk, R.K., Parma-Benfenati, S., Simion, M.,
Tinti, C. & Wagenberg, B. (2006) A study of the
fate of the buccal wall of extraction sockets of
teeth with prominent roots. International Journal
of Periodontics & Restorative Dentistry 26: 19–
29.
Exclusion criteria: reported parameters not
relevant or not useful.
Nevins, M.L., Camelo, M., Schupbach, P., Kim, D.
M., Camelo, J.M. & Nevins, M. (2009) Human his-
tologic evaluation of mineralized collagen bone
substitute and recombinant platelet-derived
growth factor-bb to create bone for implant place-
ment in extraction socket defects at 4 and
6 months: a case series. International Journal of
Periodontics & Restorative Dentistry 29: 129–139.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Normando, A.D., Maia, F.A., Ursi, W.J. & Simone,
J.L. (2010) Dentoalveolar changes after unilateral
extractions of mandibular first molars and their
influence on third molar development and posi-
tion. World Journal of Orthodontics 11: 55–60.
Exclusion criteria: reported parameters not
relevant or not useful.
Olson, H.M. & Hagen, A. (1982) Inhibition of post-
extraction alveolar ridge resorption in rats by di-
chloromethane diphosphonate. Journal of Peri-
odontal Research 17: 669–674.
Exclusion criteria: study carried out on ani-
mals.
Olson, R.A., Roberts, D.L. & Osbon, D.B. (1982) A
comparative study of polylactic acid, gelfoam,
and surgicel in healing extraction sites. Oral Sur-
gery Oral Medicine & Oral Pathology 53: 441–
449.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Oltramari, P.V., Navarro Rde, L., Henriques, J.F.,
Taga, R., Cestari, T.M., Janson, G. & Granjeiro, J.
M. (2007) Evaluation of bone height and bone
density after tooth extraction: an experimental
study in minipigs. Oral Surgery Oral Medicine
Oral Pathology Oral Radiology & Endodontology
104: 9–16.
20 | Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21
Exclusion criteria: study carried out on ani-
mals.
Ortega, K.L., Rezende, N.P., Araujo, N.S. & Ma-
galhaes, M.H. (2007) Effect of a topical antimicro-
bial paste on healing after extraction of molars in
hiv positive patients: randomised controlled clini-
cal trial. British Journal of Oral & Maxillofacial
Surgery 45: 27–29.
Exclusion criteria: reported parameters not
relevant or not useful.
Pessoa, R.S., Oliveira, S.R., Menezes, H.H. & de
Magalhaes, D. (2009) Effects of platelet-rich
plasma on healing of alveolar socket: split-mouth
histological and histometric evaluation in cebus
apella monkeys. Indian Journal of Dental
Research 20: 442–447.
Exclusion criteria: no baseline data avail-
able for comparison, thus unable to arrive at
an estimate of dimensional change over time.
Pietrokovski, J. (1967) Healing of the socket
following tooth extraction. Alpha Omegan 60:
126–129.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Pietrokovski, J. & Massler, M. (1967a) Alveolar
ridge resorption following tooth extraction. Jour-
nal of Prosthetic Dentistry 17: 21–27.
Exclusion criteria: length of observation
period not reported.
Pietrokovski, J. & Massler, M. (1967b) Ridge remod-
eling after tooth extraction in rats. Journal of
Dental Research 46: 222–231.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Pietrokovski, J. & Massler, M. (1971) Residual ridge
remodeling after tooth extraction in monkeys.
Journal of Prosthetic Dentistry 26: 119–129.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Pinto, J.R., Bosco, A.F., Okamoto, T., Guerra, J.B. &
Piza, I.G. (2002) Effects of nicotine on the healing
of extraction sockets in rats. A histological study.
Brazilian Dental Journal 13: 3–9.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Puia, S.A., Renou, S.J., Rey, E.A., Guglielmotti, M.
B. & Bozzini, C.E. (2009) Effect of bismuth sub-
gallate (a hemostatic agent) on bone repair; a his-
tologic, radiographic and histomorphometric
study in rats. The International Journal of Oral
& Maxillofacial Surgery 38: 785–789.
Exclusion criteria: reported parameters not
relevant or not useful.
Quinn, J.H. & Kent, J.N. (1984) Alveolar ridge
maintenance with solid nonporous hydroxylapa-
tite root implants. Oral Surgery Oral Medicine &
Oral Pathology 58: 511–521.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Richardson, A. (1965) The pattern of alveolar bone
resorption following extraction of anterior teeth.
Dental Practitioner & Dental Record 16: 77–80.
Exclusion criteria: reported parameters not
relevant or not useful.
Rothamel, D., Schwarz, F., Herten, M., Engelhardt,
E., Donath, K., Kuehn, P. & Becker, J. (2008)
Dimensional ridge alterations following socket
preservation using a nanocrystalline hydroxyapa-
tite paste: a histomorphometrical study in dogs.
The International Journal of Oral & Maxillofa-
cial Surgery 37: 741–747.
Exclusion criteria: no baseline data avail-
able for comparison, thus unable to arrive at
an estimate of dimensional change over time.
Sattayasanskul, W., Brook, I.M. & Lamb, D.J. (1988)
Dense hydroxyapatite root replica implantation:
measurement of mandibular ridge preservation.
The International Journal of Oral & Maxillofa-
cial Implants 3: 203–207.
Exclusion criteria: study subjects had
immediate dentures after extraction, hence
they did not have undisturbed healing post-
extraction.
Scheer, P. & Boyne, P.J. (1987) Maintenance of alve-
olar bone through implantation of bone graft sub-
stitutes in tooth extraction sockets. Journal of
the American Dental Association 114: 594–597.
Exclusion criteria: descriptive report on
procedure/technique; commentary.
Sclar, A.G. (1999) Preserving alveolar ridge anatomy
following tooth removal in conjunction with
immediate implant placement. The bio-col tech-
nique. Atlas of the Oral & Maxillofacial Surgery
Clinics of North America 7: 39–59.
Exclusion criteria: descriptive report on
procedure/technique; commentary.
Serino, G., Rao, W., Iezzi, G. & Piattelli, A. (2008)
Polylactide and polyglycolide sponge used in
human extraction sockets: bone formation fol-
lowing 3 months after its application. Clinical
Oral Implants Research 19: 26–31.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Sharan, A. & Madjar, D. (2008) Maxillary sinus
pneumatization following extractions: a radio-
graphic study. The International Journal of Oral
& Maxillofacial Implants 23: 48–56.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Shi, B., Zhou, Y., Wang, Y.N. & Cheng, X.R. (2007)
Alveolar ridge preservation prior to implant place-
ment with surgical-grade calcium sulfate and
platelet-rich plasma: a pilot study in a canine
© 2011 John Wiley & Sons A/S

model. The International Journal of Oral & Max-
illofacial Implants 22: 656–665.
Exclusion criteria: study carried out on ani-
mals.
Smith, N. (1974) A comparative histological and
radiographic study of extraction socket healing in
the rat. Australian Dental Journal 19: 250–254.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Teofilo, J.M., Brentegani, L.G. & Carvalho, T.L.
(2001) A histometric study in rats of the effect of
the calcium antagonist amlodipine on bone heal-
ing after tooth extraction. Archives of Oral Biol-
ogy 46: 375–379.
Exclusion criteria: reported parameters not
relevant or not useful.
© 2011 John Wiley & Sons A/S
Tan et al
Dimensional tissue changes post extraction
Teofilo, J.M., Leonel, D.V. & Lamano, T. (2010)
Cola beverage consumption delays alveolar bone
healing: a histometric study in rats. Brazilian
Oral Research 24: 177–181.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Thilander, H. & Astrand, P. (1973) The effect of tet-
racyclines on socket healing. Acta Odontologica
Scandinavica 31: 131–139.
Exclusion criteria: no measurements of
alveolar dimensional changes (eg. description
of healing process or bony shape change, or
histology only).
Ubios, A.M., Jares Furno, G. & Guglielmotti, M.B.
(1991) Effect of calcitonin on alveolar wound
healing. Journal of Oral Pathology & Medicine
20: 322–324.
21 |
Exclusion criteria: reported parameters not
relevant or not useful.
Wu, Z., Liu, C., Zang, G. & Sun, H. (2008) The
effect of simvastatin on remodelling of the alveo-
lar bone following tooth extraction. The Interna-
tional Journal of Oral & Maxillofacial Surgery
37: 170–176.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Yugoshi, L.I., Sala, M.A., Brentegani, L.G. & Lama-
no Carvalho, T.L. (2002) Histometric study of
socket healing after tooth extraction in rats trea-
ted with diclofenac. Brazilian Dental Journal 13:
92–96.
Exclusion criteria: sample did not include
untreated/undisturbed extraction sockets left
to heal spontaneously.
Clin. Oral. Impl. Res. 23(Suppl. 5), 2012/1–21