Bone grafts and biomaterials for alveolar ridge preservation and augmentation: current trends and developments

Bone deficiency often arises due to tooth loss caused by periodontal disease, tooth fractures, dentofacial trauma, periapical lesions, or other pathological conditions. Following tooth extraction, dimensional changes occur in the alveolar socket, leading to reductions in both alveolar bone height and width. Histological changes follow a sequential process, beginning with the formation of a blood clot, which is gradually replaced by granulation tissue and a provisional connective tissue matrix. Spontaneous healing results in socket filling with woven bone, which is eventually remodeled into lamellar bone and bone marrow. Maintaining adequate alveolar ridge dimensions and bone quality is essential for ensuring optimal stability and osseointegration of dental implants. To address alveolar bone insufficiency, bone grafts and substitutes are increasingly utilized in implant dentistry. Alveolar ridge preservation (ARP) procedures play a critical role in preventing post-extraction socket collapse. Among the various bone graft materials, autologous and homologous bone are widely used, while heterologous bone, particularly inorganic bone xenografts (IBXs) processed through heat treatment, is commonly chosen in clinical practice. Additionally, collagen-preserving bone xenografts (CBXs), derived from porcine or equine sources, undergo chemical or enzymatic treatments to remove xenogeneic antigens while preserving collagen, making them effective for post-extraction site preservation. Biocompatibility is a key factor in the success of bone graft materials, as they must not only interact safely with host tissues but also support bone cell adhesion and proliferation. Recent research suggests that sericin, due to its proteinaceous nature and high biocompatibility, holds promise for enhancing cellular attachment and growth, making it a potential candidate for bone graft applications. Furthermore, sericin's biodegradability allows for its gradual replacement by the patient's own cells, further supporting bone regeneration. The long-term success of implant-supported restorations depends on maintaining peri-implant bone levels, which in turn relies on successful osseointegration. This process is largely dependent on achieving sufficient primary stability of the implant within the surrounding bone at the time of placement. Comparative analyses of different bone substitutes can provide valuable insights into how processing protocols influence their performance in alveolar ridge preservation and reconstruction, ultimately guiding clinicians in selecting the most effective biomaterials for implant therapy.