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Background:
Review

Adjunctive Use of Biologics in Alveolar Ridge Preservation: A Narrative Review

by
Celine Soon
*,
Pradeep Koppolu
and
Leticia Algarves Miranda
Dental School, The University of Western Australia, Perth 6009, Australia
*
Author to whom correspondence should be addressed.
Oral 2025, 5(3), 60; https://doi.org/10.3390/oral5030060
Submission received: 16 June 2025 / Revised: 8 August 2025 / Accepted: 13 August 2025 / Published: 15 August 2025
Versions Notes

Abstract

Background: The purpose of alveolar ridge preservation (ARP) is to minimise the physiological alveolar ridge reduction occurring after dental extraction, which can prevent the need for future alveolar ridge augmentation. Biologic materials (biologics) promote tissue regeneration based on their effect on wound healing at a cellular level. By integrating biologics into ARP biomaterials, there is a potential to enhance the regeneration of both hard and soft tissues with greater efficacy. Aim: This narrative review aims to evaluate the clinical efficacy of the addition of biologics to existing ARP materials on the physiological changes following ARP of an extraction site. Methods: A search of the PubMed electronic database was conducted, and relevant articles were examined. Sixty-three articles met the inclusion and exclusion criteria and were included in this review. Results and Conclusions: A review of the existing literature found that the combination of biologics with ARP materials resulted in similar dimensional changes when compared to using ARP materials alone. Existing research has identified an enhancement in bone density, increased wound healing capacity of soft and hard tissue, and a reduction in post-operative pain. Whilst the addition of biologics to ARP materials has shown an increase in bone density, its effectiveness in improving implant outcomes and reducing the need for future alveolar ridge augmentation is unclear. Recognising the limitations within the existing literature, along with the risk of bias and heterogeneity, renders it unwise to make definite conclusions about the benefits of integrating biologics with ARP materials. This narrative review found possible benefits in the use of biologics in ARP to optimise patient-related and treatment outcomes, indicating the need for additional research.

1. Introduction

Dental implants are a common treatment option in tooth replacement. A body of the existing literature has assessed methods of preventing or limiting alveolar bone resorption through alveolar ridge preservation following dental extraction. It is recognised that the preservation of alveolar bone decreases the potential requirement for alveolar ridge augmentation to facilitate dental implant placement and, as such, patient morbidity. Physiological changes following dental extraction are anticipated with remodelling of both hard and soft tissues as part of the healing process [1,2,3]. A decrease in the alveolar ridge and narrowing of the keratinised mucosa with reduced soft tissue thickness often follows a dental extraction [1,2,4,5]. Within the first six months following tooth extraction, a mean of 1.5–2 mm vertical bone loss accompanied by a reduction of approximately 50% in the horizontal alveolar ridge width occurs [1].
Dental practitioners must have a comprehensive understanding of the different graft materials and surgical techniques available for preserving both hard and soft tissues, with the ultimate goal of optimising healing and mitigating alveolar bone resorption, subsequently facilitating implant placement or prosthodontic rehabilitation. Biologic materials (biologics) constitute a class of therapeutic agents that actively promote tissue regeneration by modulating key cellular events involved in the physiological process of wound healing. This involves platelet-rich fibrin (PRF), platelet-rich plasma (PRP), recombinant human bone morphogenetic protein-2 (rhBMP-2), and enamel matrix derivative (EMD). This narrative review evaluates the existing literature researching the effect of biologics incorporation into biomaterials in alveolar ridge preservation (ARP).

2. Methods

A review of the existing literature was conducted of the PubMed database, with the search strategies: (tooth extraction OR teeth extraction OR extraction) AND (alveolar ridge preservation OR socket seal OR socket grafting OR bone preservation OR hard and soft tissue preservation); (alveolar ridge preservation) AND (biologics); (alveolar ridge preservation) AND (platelet-rich plasma); (alveolar ridge preservation) AND (platelet-rich fibrin); (alveolar ridge preservation) AND (recombinant human bone morphogenetic protein-2), (alveolar ridge preservation) AND (enamel matrix derivatives), and (alveolar ridge preservation) AND (Hyaluronic acid with polynucleotides).
To conduct this review, databases were searched using Medical Subject Headings terms, keywords, and other relevant terms without language limitations. Boolean operators were used in conducting the literature search. As part of this literature review, clinical trials, cohort studies, review articles, guidelines, animal research, and in vitro research were included for analysis (refer to Table A1) The publication year was not restricted. Additionally, a manual search was completed of the Journal of Periodontology, Periodontology 2000, and Journal of Clinical Periodontology for relevant literature for inclusion. Establishing historical context, reference lists of the primary articles related to this topic were also examined. Search results were screened by a single reviewer who examined the titles and abstracts of each article in selection for inclusion.
A comprehensive analysis was conducted for relevant articles, including significant historical research. Owing to significant heterogeneity in the included literature meta-analysis was not conducted. In total, 59 articles were included for analysis, comprising in vitro, animal, and human studies (refer to Table A2).

3. Results

3.1. Platelet Rich Fibrin and Platelet Rich Plasma

Of the 59 articles included in this review, 7 studies evaluated the influence of PRF and PRP used in conjunction with ARP. All seven articles included were completed as randomised controlled trials. An evaluation summary and study results are included in Table 1.

3.2. Enamel Matrix Derivative

Five included publications assessed the impact of EMD when used in ARP, all of which conducted randomised controlled trials. Table 2 displays these studies and key findings.

3.3. Bone Morphogenetic Proteins (Recombinant Human Bone Morphoprotein-2)

Three included publications researched the use of rhBMP-2 in ARP, with all three conducted randomised controlled trials. Table 3 presents these studies and key findings.

3.4. Hyaluronic Acid

Three studies included assessed the effect of hyaluronic acid when used as a biologic in ARP. These included two randomised controlled studies and one animal study. Table 4 displays these studies and key findings.

4. Discussion

4.1. Alveolar Ridge Preservation

Alveolar ridge preservation aims to minimise alveolar ridge resorption following dental extraction, preserving soft and hard tissue ridge contours and promoting the formation of new bone within the extraction socket. Ultimately, this maximises the retention of sufficient soft and hard tissue volume to facilitate prosthetic reconstruction, permitting implant placement in a prosthetically driven position to achieve optimal peri-implant health, function, and aesthetics without requiring further alveolar ridge augmentation [23]. While ARP attenuates post-extraction dimensional changes, there are clinical indications whereby alveolar ridge augmentation may be more suitable, especially when there is extensive destruction of the alveolar bone.
Several clinical factors should be considered when determining the suitability of ARP. These include the timing of implant placement and the condition of the extraction site [24,25]. Successful implant treatment outcomes require minimum dimensions of both hard and soft tissue, which may not be present in cases of tissue deficiency. Additionally, it is necessary to determine whether optimisation of soft tissue, hard tissue or both is indicated [24,26].
Whilst the choice of grafting material and socket seal technique are important considerations, the outcome of ARP is also influenced by patient-related factors (such as systemic health, smoking status, and history of periodontal disease) and local site conditions, including buccal bone thickness and integrity, socket morphology, history of trauma, and the presence of adjacent teeth [27,28,29].
Current ARP methods employ a range of grafting materials and techniques tailored to enhance both hard and soft tissue outcomes. Hard tissue graft materials are typically used to fill the socket to the alveolar crest following extraction. Various systematic reviews [30] and clinical studies [31] have evaluated autografts [32], allografts [33], xenografts [34], alloplasts [17], autogenous dentine chips [35], and their combinations. Although no single material has demonstrated clear superiority, the use of ARP biomaterials has consistently been shown to reduce alveolar ridge resorption [36,37].
Although ARP has traditionally focused on hard tissue preservation, there is increasing interest in soft tissue regeneration, particularly in cases where mucosal deficiency exists before or after extraction [38]. Soft tissue grafting materials include autogenous free gingival grafts, autogenous subepithelial connective tissue grafts, collagen membranes (cross-linked and non-cross-linked), and soft tissue substitutes such as collagen matrix and acellular dermal matrix [26,39,40]. A recent systematic review assessed the influence of various ARP techniques and graft materials on soft tissue dimensions, suggesting that these, along with patient and site-specific factors, can affect keratinised mucosal thickness, vertical tissue height, and overall ridge contour [29].
Effective soft tissue management is essential for maintaining adequate keratinised mucosa, which contributes to favourable implant positioning, oral hygiene access, and aesthetic outcomes [41]. Whilst most studies have focused on hard tissue outcomes, limited evidence suggests that unassisted healing may result in greater soft tissue thickness compared to ARP-treated sites, potentially due to compensatory expansion of the soft tissue in response to underlying bone resorption [27]. Canullo et al. identified cross-linked collagen membranes and autogenous soft tissue grafts as the most effective in limiting soft tissue contraction, although their findings were limited by small sample sizes, short follow-up, and methodological inconsistencies [29]. Other influencing factors include the condition of the buccal plate, type of graft material used, and patient habits such as smoking [29,42].
In summary, various materials and techniques are used in ARP, yet no individual graft biomaterial has been shown to be universally superior. Most materials appear comparably effective in reducing horizontal and vertical ridge resorption [26]. Although ARP may simplify subsequent implant placement by preserving ridge volume, its long-term benefits on implant-specific outcomes remain inconclusive [28,31,43,44,45]. Consistent methodology and standardised reporting in future research are essential to minimise evaluation bias and allow for better comparison across studies. This may ultimately support the identification of more tailored material selection strategies for both hard and soft tissue preservation.

4.2. Biologics in Alveolar Ridge Preservation

Biologics are a class of therapeutic agents that aim to promote hard and soft tissue regeneration by acting on the cellular pathways in wound healing [46]. These agents exert their effects by targeting DNA synthesis, chemotaxis, cellular differentiation, mitogenesis, and matrix biosynthesis [47]. In addition to regenerative properties, biologics also possess anti-inflammatory and analgesic properties that can help alleviate postoperative pain and inflammation [33,34]. Emerging literature has assessed the effect of biologics when used in conjunction with ARP biomaterials, which can positively affect post-extraction healing [46]. This may result in faster recovery times and a potential decrease in hard and soft tissue volume changes [16,46,47,48].
The biologics included in this narrative review were not exhaustive and are used either in monotherapy or as an enhancing agent alongside existing ARP graft materials. Of the 59 articles evaluated, biologic growth factors researched included PRP, PRF, rhBMP-2, EMD, and hyaluronic acid with polynucleotides. Growth factors can be used in addition to existing ARP materials to convert them from osteoconductive to osteoinductive by stimulating undifferentiated mesenchymal cells to differentiate into osteoblasts, forming de novo bone [49,50,51].

4.3. Autologous Blood Product Derived Products

Platelet-rich plasma promotes hemostasis and healing of the extraction sockets with an anti-inflammatory effect [11]. PRP is prepared from autologous blood, which is then activated by thrombin or collagen [49]. Activation causes platelets to release granules containing platelet-derived growth factor (PDGF), transforming growth factor-β1 (TGF-β1), fibrinogen, vascular endothelial growth factor, fibronectin, and von Willebrand factor, resulting in the initiation of the coagulation cascade. It is noted that PRP may have the potential to impact dimensional changes in the alveolar ridge following tooth extraction, although the existing literature presents inconsistent results [10,52,53].
Platelet-rich fibrin is a new generation of platelet concentrate for PRP and was first introduced by Choukroun et al. [54]. PRF has “an autologous leukocyte–platelet-rich fibrin matrix” [55], which contains cytokines, platelets, and stem cells, acting as a biodegradable scaffold allowing for vascularisation and epithelial cell migration. PRF may also act as a carrier for cells involved in tissue regeneration, with the release of growth factors noted to continue for 1–4 weeks. Some of the advantages of PRF are the fibrin clot’s ability to stabilise and maintain the graft, and the incorporation of a fibrin mesh network in the regeneration site enables migration of cells, allowing for angiogenesis, resulting in increased graft survival potential. Throughout the wound healing process, several platelet cytokines, including PDGF, TGF-β1, and IGF-1, are released to promote healing. Moreover, leukocytes and cytokines present in the fibrin network serve to regulate inflammation and protect against infection during grafting procedures [54,55].
The addition of PRF in ARP has shown inconsistent results in the existing literature. Canellas et al. (2021) demonstrated reduced bone resorption and higher bone formation at 3 months following extraction and ARP [6,8]. Conversely, Castro et al. (2021) noted no differences compared to sites with unassisted healing [6,8]. Similarly, PRGF also showed conflicting results, with some studies showing an increase in bone fill and mature bone, whereas others showed no enhancement in early bone deposition (Table 1). Anitua et al. in 1999 and subsequently in 2015 found that extraction socks treated with PRGF had additional bone fill and mature bone than unassisted sites [10,11]. Whilst Farina et al. identified no difference in bone deposition when using PRGF [12].
A systematic review by Siawasch et al. highlighted variability in outcomes with autologous blood products [56]. The majority of the 25 included randomised controlled trials assessing L-PRF found a reduced alveolar bone resorption, greater socket fill, improved bone quality, faster soft tissue healing, and less postoperative pain; however, a few studies found no significant benefits [56]. PRGF results were more modest and inconsistent. Meta-analyses confirmed that L-PRF reduced bone loss and improved vertical buccal height with statistical significance [56]. Despite these findings, heterogeneity in protocols and study quality limits firm conclusions on the efficacy of PRF and PRGF in alveolar ridge preservation [56].

4.4. Enamel Matrix Derivatives

Enamel Matrix Derivatives are growth factors extracted from a piglet’s tooth bud and placed into a polyglycerol gel medium. EMD comprises 95% amelogenin, with the remaining 5% being enamelin and other proteins [49]. These derivatives have been claimed to promote wound healing and bone growth in intrabony and recession defects, in addition to reducing post-operative pain [15,49].
EMD has been used to treat peri-implantitis and in periodontal regenerative procedures [57]. The mechanism and evidence supporting the use of EMD require further research, with limited research available detailing the effects of combining EMD and ARP grafting materials (Table 2). Some literature has demonstrated that socket sites treated with EMD exhibit increased formation of new bone [16,17]. There are notable conflicts in results between studies, with Alkan et al. identifying similar bone formation between control (Bio-Oss) and test (EMD) groups [13]. It is recognised that this was a small pilot study with a moderate to high risk of bias, and neither the clinician nor examiner was blinded. In spite of potential impact on new bone formation, the available literature fails to present improvements in the horizontal and vertical dimensions of the alveolar ridge with the use of EMD [14,15,16]. There does appear to be some benefit in EMD use specific to patient-related outcomes, with extraction sockets treated with EMD exhibiting a shorter period of postoperative discomfort and inflammation [52].

4.5. Bone Morphogenetic Proteins

Recombinant human bone morphogenetic protein-2 is a bone morphogenetic protein. Through the migration and proliferation of stem cells, rhBMP-2 may induce angiogenesis and osteoblastic differentiation. There have been reports of successful bone formation and implant placement using rhBMP-2 and collagen sponge [20]. The carriers available for rhBMP-2 are collagen sponge, synthetic polymer, β-tricalcium phosphate (β-TCP), and hydroxyapatite. Collagen sponges lack strength and have a rapid resorption time of 2 weeks. Therefore, hydroxyapatite may be a better carrier for rhBMP-2, as it is more resistant to mechanical forces and has a high affinity for rhBMP-218.
Table 3 presents a summary of the literature using a collagen sponge as a carrier for rhBMP-2, with some promising outcomes noted. Although most studies have demonstrated that rhBMP-2 promotes the growth of new bone, there is substantial heterogeneity in study design, rendering it challenging to reach a conclusive evaluation regarding the effectiveness of rhBMP-2 in preserving the alveolar ridge.

4.6. Hyaluronic Acid and Polynucleotides

Hyaluronic acid (HA) is a “naturally occurring non-sulphated glycosaminoglycan” [21] that has an essential role in the extracellular matrix of periodontal tissues [58]. HA has been found to enhance bone formation by stimulating osteocalcin [22,59]. This, in turn, affects the mineralisation process of the alveolar bone matrix [21,58]. The desirable properties of HA include bacteriostatic and anti-inflammatory effects, which make it useful for treating infected sockets [22]. The studies analysed in Table 4 demonstrate that the addition of hyaluronic acid during the extraction socket process results in notable improvements in bone mineralisation and density [18,21,22]. However, no significant differences were observed in alveolar ridge measurements between the groups that received ARP with hyaluronic acid and those that did not. Additional research is required to evaluate the effectiveness of HA in enhancing ARP materials.
Polynucleotides (PN) are naturally occurring in the human body and externally obtained through “highly purified DNA polymers derived from trout gonads” [60]. Due to their hydrophilic properties, they can bind molecules, have viscoelastic properties, and form a 3-dimensional viscoelastic gel [61]. Recently, PN was co-formulated with HA in an in vitro study that investigated the effectiveness of PN with and without HA in a gingival fibroblast model [62]. It has been demonstrated that while PN alone can stimulate the growth of gingival fibroblasts, the addition of HA was more effective in encouraging wound healing by synergistically stimulating cell growth and migration with the synthesis of the collagen’s extracellular matrix [62]. Additionally, integrating HA and PN within a viscoelastic gel has proven to be a valuable adjunctive therapy in periodontal regeneration treatment for addressing periodontitis with some literature demonstrating a reduction in inflammation and an increased wound healing capacity [60,63,64]. Currently, there is limited research investigating the effectiveness of viscoelastic gels containing HA and PN in ARP, and further research is required.

4.7. Limitations

This review was conducted in a narrative format and did not adhere to a systematic review framework. Broad inclusion criteria were applied, with no restrictions on publication year, language, study design, or study type, thereby encompassing a diverse range of in vitro, animal, and human studies. While this inclusive approach enabled a more comprehensive overview of the current evidence, it also introduced greater heterogeneity and limited direct comparisons between studies. Furthermore, no formal risk of bias or quality assessment was undertaken. In addition, due to the narrative nature of this review, no statistical analysis was performed, limiting the ability to quantify treatment effects or assess the consistency of outcomes across studies.
Limitations were also evident within the included studies. Research on biologics in ARP often involves novel techniques and emerging materials, with few studies replicating similar protocols. This lack of methodological consistency further complicates data interpretation and limits the potential to draw conclusions across studies in future systematic reviews.
These limitations highlight the importance of developing well-designed, standardised clinical trials and systematic reviews to establish the efficacy and clinical relevance of the adjunctive use of biologics in alveolar ridge preservation.

5. Conclusions

ARP has been shown to provide some benefit in attenuating alveolar ridge resorption. However, the existing literature has not conclusively provided evidence that the addition of biologics in ARP improves the outcome. Although limited, some emerging evidence demonstrates promising results with the implementation of biologics in ARP, which is consistent with the cellular mechanism that they promote. A limitation of existing literature with heterogeneity and risk of bias is noted, and with inconclusive effectiveness reported. Further research is required to validate the use of biologics as part of ARP.

Author Contributions

Conceptualisation, methodology, writing—original, review and editing, C.S.; supervision, review, validating and editing, P.K. and L.A.M. All authors have read and agreed to the published version of the manuscript.

Funding

No funding was received for this study.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Table A1. PICO—Inclusion and Exclusion Criteria.
Table A1. PICO—Inclusion and Exclusion Criteria.
CriterionInclusion/Exclusion Criteria
Study and Information TypesInclusion
  • Peer-reviewed literature
  • Historic papers until May 2023
  • Study types include systematic and literature reviews, meta-analyses, randomised controlled trials, clinical trials, and case reports/series.
Exclusion
  • Non-peer reviewed publications
  • Publications not in the English language
  • Commentaries and editorials
PopulationInclusion:
  • Healthy individuals with no age limit undergoing ARP following permanent tooth extraction. Studies including smokers and history of periodontal disease.
InterventionInclusion:
  • Graft and socket seal materials are used in extraction sockets post-extraction.
  • Biologics: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), recombinant human bone morphogenetic protein-2 (rhBMP-2), enamel matrix derivatives (EMD), and hyaluronic acid with polynucleotides
Exclusion
  • Literature that does not include a graft material
ComparisonInclusion:
  • Literature that compares grafting and socket materials with unassisted socket healing
  • Literature that compares grafting materials with the addition of biologics that could enhance the socket graft and seal material
OutcomeInclusion:
  • Reporting clinical and radiographic measurements for soft and hard tissue
  • Reporting of soft tissue characteristics, including increased or decreased healing rate, the risk for infection
Table A2. Summary of Literature Analysed.
Table A2. Summary of Literature Analysed.
Area of Interest of Included ArticlesNumber of Articles
Alveolar ridge preservation29
Biologics30
Study design
Systematic review/meta-analysis12
Randomised controlled trials29
Pilot study1
Case report1
Animal research study1
In-vitro laboratory study1
Literature review11
Expert opinions and consensus statement3

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Table 1. Studies evaluating the use of Platelet Rich Fibrin and Platelet Rich Plasma in ARP.
Table 1. Studies evaluating the use of Platelet Rich Fibrin and Platelet Rich Plasma in ARP.
AuthorStudy DesignGroups ComparedHealing Time (Months)Clinical/Radiographic/Histomorphometric Outcomes
Canellas et al. [6] (2020)RCTL-PRF vs. UH3L-PRF had the higher bone formation and lower bone resorption compared to UH radiographically.
Ibrahim et al. [7]
(2022)		RCTCPS vs. CPS + PRF vs. UH6Increased horizontal bone dimensional changes in CPS and CPS + PRF groups.
Castro et al. [8]
(2021)		RCT (Split Mouth)L-PRF vs. A-PRF+ vs. None3All groups did not attenuate dimensional ridge changes. Bone resorption for L-PRF and A-PRF+, and UH groups had similar bone resorption. However, both PRF matrices showed radiographically superiority for socket fills with histological analysis reporting more newly formed bone.
Wang et al. [9] (2022)RCT (Split Mouth)L-PRF vs. UH5The L-PRF group had increased GF concentration than UH. However, the increased concentration did not provide clinical benefits in early wound healing or decreased bone resorption.
Anitua [10]
(1999)		RCTPRGF vs. PRGF + autologous bone vs. UH2Greater buccolingual/palatal width was found in the PRGF + autologous bone group. Biopsies of defects treated with PRGF showed more mature bone and better organised trabeculae with more significant bone regeneration.
Anitua et al. [11]
(2015)		RCTPRGF vs. UH2.5PRGF group had more bone filling compared to the UH group radiographically. Bone biopsy showed more new bone formation in the PRGF group. Less post-operative pain was reported in the PRGF group.
Farina et al. [12]
(2013)		RCTPRGF vs. UH2PRGF did not show any enhancement in early bone deposition.
A-PRF: Advanced Platelet Rich Fibrin; CPS: Calcium Phosphosilicate; FDBA: Freeze-Dried Bone Allograft; PRF: Platelet Rich Fibrin; PRGF: Plasma Rich Growth Factor; RCT: Randomized Controlled Trial; UH: Unassisted Healing.
Table 2. Studies evaluating the use of Enamel Matrix Derivative in ARP.
Table 2. Studies evaluating the use of Enamel Matrix Derivative in ARP.
AuthorStudy DesignGroups ComparedHealing Times (Months)Clinical/Radiographic/Histomorphometric Outcomes
Alkan et al. [13]
(2013)		RCT
(Pilot study)		EMD vs. (DBBM-C) 3Histomorphometric analysis: New bone formation was similar between EMD and DBBM-C sites with no significant differences between groups.
Lee, Kim, & Jeong [14]
(2020)		RCTDBBM-C + EMD + Non-crosslinked resorbable collagen membrane (test)
vs.
DBBM-C + Non-crosslinked resorbable collagen membrane (control)		5There were no discernible differences in either horizontal or vertical bone dimension changes or soft tissue wound healing outcomes among the tested groups. Yet, the groups that underwent EMD treatments reported less post-operative pain and swelling.
Lee & Jeong [15]
(2020)		RCTDBBM-C + EMD + Non-crosslinked resorbable collagen membrane (test group 1)
vs.
DBBM-C + non-crosslinked resorbable collagen membrane (test group 2)
vs.
UH 		5UH showed more significant horizontal bone width resorption compared to the test groups. No significant difference between all three groups for vertical height changes.
Mercado et al. [16]
(2021)		RCTDBBM-C (control) vs. DBBM-C + EMD (test)4Both groups lost alveolar ridge width but no buccal or palatal bone height change.
The addition of EMD to DBBM-C resulted in more new bone formation in the test group.
Bonta et al. [17]
(2022)		RCTAlloplast (test 1)
vs.
Alloplast + EMD
(test 2)
vs.
UH (control)		6Histomorphometric analysis revealed a significant increase in new bone tissue formation in test group 2 compared to test group 1 and UH.
DBBM-C: Deproteinized Bovine Bone Mineral with 10% Collagen; EMD: Enamel Matrix Derivatives; RCT: Randomized Controlled Trial; UH: Unassisted Healing.
Table 3. Studies Evaluating the use of Bone Morphogenetic Proteins (Recombinant Human Bone Morphoprotein-2) in ARP.
Table 3. Studies Evaluating the use of Bone Morphogenetic Proteins (Recombinant Human Bone Morphoprotein-2) in ARP.
AuthorStudy DesignGroups ComparedHealing Times (Months)Clinical/Radiographic/
Histomorphometric Outcomes
Shim et al. [18]
(2018)		RCT (Parallel)rhBMP-2+HAX synthetic bone (test)
vs.
DBBM (control)		3The alveolar ridge was clinically and histologically preserved in both groups, but the test group had increased new bone formation than the control group.
Jo et al. [19]
(2019)		RCT (Parallel)rhBMP-2-soaked absorbable collagen sponge + collagen membrane (test)
vs.
β-tricalcium phosphate and hydroxyapatite particles immersed in rhBMP-2 and collagen membrane (control group)		3Both delivery methods of rhBMP were equally effective in preserving the Alveolar Ridge, and there were no negative effects observed.
Fiorellini et al. [20]
(2005)		RCTrhBMP-2 (0.75mg/mL) + bioabsorbable collagen sponge (test 1)
vs.
rhBMP-2 (1.50mg/mL) + bioabsorbable collagen sponge (test 2)
vs.
Bioabsorbable sponge (test 3)
vs.
No Treatment		4Test group 2 performed the best bone augmentation compared to other groups. Additionally, this group had fewer patients requiring secondary augmentation before implant placement.
DBBM: Deproteinized Bovine Bone Mineral; HAX: Hydroxyapatite; RCT: Randomized Controlled Trial; rhBMP-2: Recombinant Human Bone Morphogenetic Protein-2.
Table 4. Studies evaluating the use of hyaluronic acid in ARP.
Table 4. Studies evaluating the use of hyaluronic acid in ARP.
AuthorStudy DesignGroups ComparedHealing Times (Months)Clinical/Radiographic/
Histomorphometric Outcomes
Lee et al. [21]
(2021)		Animal StudyACS (group 1)
vs.
ACS + 1% HA gel (group 2)
vs.
DBBM-C + Collagen membrane (group 3)
vs.
DBBM-C + Collagen membrane + 1% HA gel (group 4)		3Ridge width remained higher in groups 3 and 4. Groups 2 and 4 had the highest proportion of mineralised bone and bone volume density compared with other groups.
Shim et al. [18]
(2018)		RCT (Parallel)rhBMP-2+HA synthetic bone (test)
vs.
DBBM		3In both groups, the clinical and histological preservation of the alveolar ridge was observed. However, the test group demonstrated a higher level of new bone formation compared to the control group.
Kim et al. [22]
(2016)		RCT1% HA gel
vs.
UH		3The sockets of the test group had denser mineralised bone compared to the control group. Clinical measurements of dimensional changes were not provided in this study.
ACS: Absorbable Collagen Sponge; DBBM: Deproteinized Bovine Bone Mineral; DBBM-C: Deproteinized Bovine Bone Mineral with 10% collagen; HA: Hyaluronic Acid; rhBMP-2: Recombinant Human Bone Morphogenetic Protein-2; UH: Unassisted Healing; RCT: Randomized Controlled Trial.
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Soon, C.; Koppolu, P.; Miranda, L.A. Adjunctive Use of Biologics in Alveolar Ridge Preservation: A Narrative Review. Oral 2025, 5, 60. https://doi.org/10.3390/oral5030060

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Soon C, Koppolu P, Miranda LA. Adjunctive Use of Biologics in Alveolar Ridge Preservation: A Narrative Review. Oral. 2025; 5(3):60. https://doi.org/10.3390/oral5030060

Chicago/Turabian Style

Soon, Celine, Pradeep Koppolu, and Leticia Algarves Miranda. 2025. "Adjunctive Use of Biologics in Alveolar Ridge Preservation: A Narrative Review" Oral 5, no. 3: 60. https://doi.org/10.3390/oral5030060

APA Style

Soon, C., Koppolu, P., & Miranda, L. A. (2025). Adjunctive Use of Biologics in Alveolar Ridge Preservation: A Narrative Review. Oral, 5(3), 60. https://doi.org/10.3390/oral5030060

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