# Effect of Different Bone Graft Materials on Buccal Wall Dimensions During Socket Preservation: A 3D Retrospective Pilot Study

## TL;DR

This study compares how different bone graft materials affect the preservation of jawbone structure after tooth extraction, finding that xenografts best maintain the outer wall thickness in visible areas.

## Contribution

The study introduces a 3D CBCT and AI-based analysis to compare autografts, allografts, and xenografts in preserving buccal wall dimensions during socket preservation.

## Key findings

- Xenografts preserved buccal wall thickness better at the coronal level compared to autografts and allografts.
- All graft types showed significant buccal wall resorption over time, with no significant difference in overall resorption rates.
- Buccal wall dimensions decreased significantly at all measured levels from preoperative to postoperative assessments.

## Abstract

Introduction

Socket preservation is a fundamental procedure in dental implantology aimed at minimizing post-extraction alveolar ridge resorption. Buccal wall integrity plays a crucial role in implant stability and esthetic outcomes. However, limited research has compared the effects of different bone graft materials on buccal wall preservation. The objective of this study is to evaluate and compare the impact of three bone graft materials, namely autografts, allografts, and xenografts, on buccal wall dimensions in socket preservation procedures using cone beam computed tomography (CBCT) and AI-based superimposition techniques.

Methodology

A retrospective comparative cohort study was conducted on 23 patients who underwent socket preservation between 2017 and 2024. Patients were categorized into three groups based on graft material: allografts, xenografts, and autografts. High-resolution preoperative (T0) and six months postoperative (T1) CBCT scans were analyzed using 3D Slicer® software. Superimposition techniques enabled precise measurement of buccal wall thickness at three levels (L2, L4, L6). Statistical analyses, including Kruskal-Wallis and Wilcoxon signed-rank tests, were performed to assess differences in buccal wall dimensions and resorption rates.

Results

At follow-up (T1), xenografts exhibited significantly better preservation of buccal wall thickness at L2 compared to autografts and allografts (P = 0.02 and P = 0.04, respectively). However, no significant differences were observed at deeper levels (L4, L6) (P > 0.05). Buccal wall resorption occurred in all groups, but no statistically significant differences in overall resorption rates were found (P > 0.05). Buccal wall dimensions significantly decreased from T0 to T1 at all levels (L2, L4, and L6) (P < 0.001).

The findings suggest that xenografts offer superior preservation at the coronal level, making them a preferred choice in esthetic areas. However, all graft materials showed comparable effects in deeper regions over time. The absence of significant differences in overall resorption rates may be attributed to the study’s small sample size and follow-up duration. These results align with prior literature indicating the prolonged structural support of xenografts but also highlight the ongoing challenge of post-extraction bone loss.

Conclusions

This study underscores the importance of graft material selection in socket preservation, particularly for maintaining coronal ridge dimensions. Despite grafting, significant buccal wall resorption was observed, emphasizing the potential need for additional augmentation techniques. Future research with larger sample sizes and longer follow-up periods is essential to refine clinical protocols and improve long-term implant success.