Wisdom in healing: assessing the impact of DBBM-C on periodontal recovery after third molar extraction

Abstract

A Commentary on

Quach, S. S., N. Johnson, R. Dudhia, A. Puljich, S. Ivanovski, and R. S. B. Lee. 2025.

“The Periodontal Benefits of Alveolar Ridge Augmentation With Xenograft Following Third Molar Extraction: A Randomised Controlled Trial.” Journal of Clinical Periodontology 52, no. 10:1419–29. https://doi-org.plymouth.idm.oclc.org/10.1111/jcpe.14205.

Design

A 6-month randomised controlled trial was conducted to determine whether xenograft grafting using deproteinised bovine bone mineral with collagen (DBBM-C) affects periodontal healing at the distal aspect of the second molar (D2M) following third molar extraction. The study included 28 participants and a total of 42 extraction sites, which were allocated to either the test group (socket grafting with DBBM-C following extraction) or the control group (extraction without grafting). The surgical procedures in this study were carried out by two experienced specialist oral and maxillofacial surgeons.

Case selection

Participants in this study were initially assessed in a private dental practice, whilst all surgical procedures were performed at the Wesley Hospital in Brisbane. Adult patients aged 18–45 years with an ASA 1 status and one or two unerupted mandibular third molars with horizontal or mesio-angular impactions were included. These had either class I or II and position B or C impactions and demonstrated radiographic bone loss ≥5 mm on the distal aspect of the second molar on the CBCT. The study excluded patients with a history of periodontal disease, a full mouth plaque score ≥40%, and those who were not willing to return for review. Additionally, disto-angular impactions, extractions that required extensive surgery or pathology that required more than just extraction and primary wound closure were also excluded.

Data analysis

Outcomes were assessed radiographically and clinically. CBCT scans were obtained at baseline and 6 months post-surgery where the D2M and extraction sockets were evaluated by linear and volumetric CBCT measurements by a single blinded examiner. Linear CBCT measurements assessed bone height adjacent to the mandibular second molar (CEJ-C) from the CEJ to the most coronal aspect of the alveolar crest at distobuccal, distal and distolingual sites. Volumetric CBCT measurements recorded included the socket healing volume (SHV) and the periodontal healing volume (PHV) around the D2M. Clinically, a full mouth plaque index, gingival index and probing pocket depths of distobuccal, distal and distolingual sites around the D2M were measured, 6 months post-operatively. Sample size determination was calculated from previous bone height data, with a total of 18 extraction sites per group included. Intra-group differences were evaluated using paired t-tests, while inter-group differences were assessed via linear regression with robust standard errors to account for repeated measures. Data normality was assessed through skewness and kurtosis analyses. Measurement reliability was confirmed using intraclass correlation coefficients (ICC).

Results

Of the 28 participants initially recruited, only 17 completed the six-month follow-up and were included in the final analysis after accounting for dropouts and exclusions. Most teeth were Class II, position B and all of them were either mesio-angular or horizontal with mean impaction angle of 63.4° ± 17.79° in the control group and 57.54° ± 21.59° in the test group. At 6 months, SHV showed 86.2% ± 12.6% and 88.8% ± 7.1% bony infill in the control and test groups, respectively, while PHV improved to 73.6% ± 21.0% and 75.1% ± 13.9% in the control and test groups.

Conclusion

Overall both linear and volumetric measures showed significant bony healing at the D2M 6 months post-operatively. However, there were no significant differences between the test and control groups.