Histologic Outcomes of the Use of Different Biomaterials for Socket Regeneration in Fresh Extraction Sockets: A Split-Mouth Randomized Clinical Trial

Purpose: To analyze the quality of bone regeneration in fresh sockets using four different materials at different time points.
Materials and Methods: A split-mouth randomized clinical trial was designed to evaluate the histologic and histomorphometric characteristics of 82 fresh sockets from 30 patients. One socket per patient healed spontaneously (control), and at least one fresh socket was grafted with a material chosen randomly from a sealed envelope: plateletrich growth factor (PRGF; n = 20 sites), PRGF + autologous bone (n = 9 sockets), autologous bone (n = 10 sites), or PRGF + demineralized freeze-dried bone allograft (DFDBA; n = 13). Biopsy specimens were taken at different time points divided into three assessment groups: short duration (2 to 4 months), intermediate duration (5 to 6 months), and long duration (7 to 12 months). The histologic findings were assessed to quantify the trabeculae pattern, the degree of mineralization, and the quality of bone regeneration.
Results: A total of 26 patients with 73 sockets completed the study. Mineralization after a short duration was found to be significantly higher among sockets treated only with autologous bone (47.3% ± 3.6%) or with PRGF+autologous bone (45.1% ± 13.6%). During the intermediate time point, this difference was not observed; also, the control sites were found to have the highest amount of mineralization (37.7% ± 14.9%). After a long duration of wound healing, the PRGF+DFDBA group had the greatest percentage of mineralized tissue (54.7% ± 28.7%), which was significantly higher than the sites treated only with PRGF (30.0% ± 13.2%).
Conclusion: From a histologic point of view, the use of autologous graft with or without PRGF seems to be the best strategy for socket regeneration within a short period of time (2 to 4 months). However, the application of PRGF alone inside fresh sockets may interfere with normal bone healing compared with control sites healed spontaneously.