Impact of Bone Particle Size on Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites

Introduction and aims: The clinical efficacy of alveolar ridge preservation (ARP) is well-documented in the literature. However, there is a lack of evidence regarding ARP in the posterior area and in periodontally compromised sites. There is no clinical decision-making guideline on the choice of bone substitute particle size for ARP in periodontally compromised molar sockets. This study aimed to compare the radiographic outcomes and implant feasibility of two deproteinized bovine bone mineral (DBBM) particle sizes for alveolar ridge preservation (ARP) in periodontally compromised molar extraction sockets. Methods: A total of 96 patients (96 sites) with stage III/IV periodontitis requiring molar extraction were divided according to DBBM particle size (small particle [SP]: 0.25-1 or large particle [LP]: 1-2 mm). Dimensional and volumetric changes of the alveolar ridge and level of implant placement difficulty (LIPD) were evaluated. Multivariable linear regression was used to adjust for potential confounders. Results: LP-DBBM showed a non-significant trend toward increased vertical central socket height (VC; 8.54 ± 2.34 vs 7.76 ± 1.93 mm; P = .077). No significant differences between SP and LP groups were observed for the remaining alveolar dimensional and volumetric changes. However, multivariable linear regression found that socket integrity (number of socket walls with height ≥5 mm; P < .001), jaw (P = .007), and particle size (P = .041) showed significant effects on VC. Conclusion: A trend of higher VC using LP after ARP in periodontally compromised molar extraction sockets was observed. The choice of DBBM particle size should be considered alongside site-specific factors, especially socket integrity. Clinical Relevance: Understanding the impact of graft particle size on ridge dimensional changes and implant placement feasibility can provide clinical decision-making guidance for ARP in periodontally compromised molar sockets. Larger particle size facilitates superior VC and increases the predictability of subsequent implant treatment.