Table 1.
Study design
| Study | Design | Number of patients | Test (n) | Control (n) | Manage | Case definition | Socket definition | Surgical procedure | Region/tooth | Healing time until implantation |
|---|---|---|---|---|---|---|---|---|---|---|
| Castro et al. [41] | Split mouth RCT | 21 (15 females, 6 males) | 21 | 21 | Not reported | Patients in need of at least three tooth extractions in the aesthetic zone were | Not reported | Tooth extractions were performed under local anesthesia and sterile conditions with a flapless approach | Premaxilla | 3 months |
| Sharma et al. [54] | Split mouth RCT | 30 (16 females and 14 males) | 30 | 30 | 23.90 | Patients requiring extraction of bilateral mandibular molars except third molars | Not reported | Extraction of the tooth on both case and control side was done as atraumatic as possible in the same appointment | Not reported | Not reported |
| Mourao et al. [56] | Parallel RCT | 32 (19 females and 13 males) | 16 | 16 | 37 | Patients requiring posterior tooth extraction (third molar exception) in the mandible or maxilla region were included | Not reported | All teeth were extracted using a minimally traumatic procedure. No vertical releasing incisions were performed. To avoid root and bony fractures, the molar teeth were sectioned using a multilaminated drill. Luxation of the teeth was performed using a periotome followed by removal using forceps | Molars and premolars | Not reported |
| Canellas et al. [47] | Parallel RCT | 48 (27 females, 21 males) | 24 | 24 | 44.8 | Patients in good general health requiring a single, non-molar tooth extraction | Presence of buccal and palatal/lingual bone walls | Teeth were extracted using small levers without any osteotomy or mucoperiosteal flap, to minimize trauma | Incisors, canines and premolars | 3 months |
| Srinivas et al. [48] | CCT split moth | 30 (not further specified) | Not reported | Not reported | Not reported | Healthy subjects with chronic periodontal conditions and who had teeth indicated for extractions | Not reported | Extraction of teeth was performed with emphasis on atraumatic extraction methods. A periosteal elevator was used to reflect the gingival tissues surrounding the tooth. Tooth was luxated from its socket using periotomes and/or luxators. Appropriate forceps were used depending on the availability of tooth structure to complete the extraction process in the maxilla or the mandible | Maxilla and mandible | Not reported |
| Ahmed et al. [53] | Parallel RCT | 54 (22 females, 32 males) | Test 1:18, test 2: 18 | 18 | Not reported | Patients requiring extractions of maxillary or mandibular teeth and who desire replacement of teeth by dental implants | Not reported | Not reported | Not reported | Not reported |
| Areewong et al. [55] | Parallel RCT | 36 (21 females and 15 males) | 18 | 18 | 50.67 | Healthy volunteers above 20 year of age, no systemic pathoses, that could disturb implant placement; Single rooted premolars and/or maxillary anterior teeth with an indication to extract and to be replaced with a dental implant | Intact surrounding alveolar bone (remaining bone at least two-third of root length) | A minimally traumatic extraction technique was performed. The periodontal ligaments were gently cut with a Piezotome. The tooth was carefully mobilized using forceps without flap reflection | Single rooted premolars and/or maxillary anterior teeth | 2 months |
| Ustaoglu et al. [42] | Parallel RCT | 57 (29 females and 28 males) |
Test1:19 Test2: 19 |
19 |
Female: 35.9 Male:37.91 |
Patients in need of single-rooted tooth extraction with the persistence of 50% or more of bone support (anterior or premolar teeth); demanded a single implant-supported prosthetic restoration in a premolar or anterior site | Persistence of 50% or more of bone support | The tooth was extracted using a flapless technique with as little trauma to the bone and soft tissue | Single-rooted tooth | Not reported |
| Giudice et al. [40] | Split mouth RCT | 40 (12 females and 28 males) | 40 | 40 | 60.9 | Patient taking long-term oral antiplatelets and requiring at least four extractions of non-adjacent teeth | Not specified |
Teeth extractions were performed as atraumatically as possible attempting to preserve the alveolar bone. Molars were sectioned with drills in two or three parts. Extraction sockets were carefully cleaned from any remains of granulation tissue. Flapless extractions were attempted, but if necessary flaps were elevated at the discretion of the Operator |
All regions | Not reported |
| Zhang et al. [49] | Parallel CCT | 28 (14 females and 14 males) | 14 | 14 | 34.6 | Patients with upper and lower mandibular molars diagnosed as fractured tooth or could not be retained for other reasons | Not reported | All patients were treated with the non‑flap minimally invasive extraction technology | Molars | 3 months |
| Kumar et al. [43] | RCT Parallel/Split | 48 (not further specified) | Not reported | Not reported | 44.4 | Patients requiring tooth extraction | Not reported | All teeth were extracted atraumatically using periotomes and luxators without raising mucoperiosteal flap | All regions | Not reported |
| Asmael et al. [58] | RCT split mouth | 20 males | 20 | 20 | 44.2 | Smoker patient with multiple teeth extraction | Not reported | Extraction in atraumatic manner | All regions | Not reported |
| Clark et al. [39] | Parallel RCT | 45 enrolled 40 analyzed (22 females and 18 males) |
Test 1:10 Test2:10 |
Control1:10 Control2:10 |
58 | Patients with single-rooted tooth requiring extraction and replacement with a dental implant supported restoration | Teeth were excluded if they demonstrated a buccal dehiscence of more than 25% of the length of the tooth or presence of acute infection of endodontic origin | Non-traumatic tooth extraction was completed without the elevation of a mucoperiosteal flap | Not reported | 3.75 months |
| Alzahrani et al. [44] | Parallel RCT | 24 (15 females and 9 males) | 12 | 12 | 37.8 |
Subjects with at least one site bordered by minimum of one tooth, nonsmokers, teeth with root fracture, patients having teeth with hopeless periodontal prognosis, teeth with failed endodontic therapy or advanced carious lesion |
Not reported | The teeth were extracted with minimal trauma and without flap elevation, using periotomes by single experienced periodontist | Not reported | Not reported |
| Temmerman et al. [50] | Split moth RCT | 22 (15 females and 7 males) | 22 | 22 | 54 | Symmetrical bilateral (e.g., premolar versus premolar, incisor versus incisor) tooth extractions in the maxilla or mandible | Not specified | A flapless approach, as atraumatically as possible using periotomes, was used. Sites with loss of the buccal or palatal bone plate (< 50% of the initial height) were not excluded. Sockets were carefully cleaned using curettes | Incisors, canines and premolars | Not reported |
| Marenzi et al. [57] | Split mouth RCT | 26 (17 females and 9 males) | 53 | Patients who needed bilateral paired dental extractions | All extraction sites were simple with alveolar walls preserved | The teeth were extracted in a nontraumatic manner without elevation of full-thickness flaps and preserving the buccal and lingual walls of the sockets | Canines, premolars and molars | Not reported | ||
| Suttapreyasri et al. [45] | Split mouth RCT | 8 (5 women and 3 men) | 8 | 8 | 20.3 | Patients who are physically healthy, with no underlying systemic disease, as determined by medical history records. Need for symmetrical premolars extraction | Not reported | The tooth was gently luxated with an elevator and carefully extracted with extraction forceps, attempting to minimize the trauma to the bone circumscribing the alveolus | Premolars | Not reported |
| Hauser et al. [46] | Parallel RCT | 23 (9 females and 14 males) |
Test 1: 19 Test 2: 6 |
8 | 47.43 | Patients, who required the extraction of an upper or lower premolar before its replacement by a dental implant | Presence of the buccal and palatal/lingual bony walls evaluated clinically by measuring the thickness of the alveolar ridge and radiologically by a periapical radiograph, and residual periodontal attachment of at least 6 mm | A scalpel for the syndesmotomy; a buccal and palatal/lingual mucosal flap without discharge for the PRF-flap group; use of dental elevators, extraction with forceps, curettage, and socket filling with PRF membranes for PRF and PRF-flap groups; placement of the PRF membranes over the alveolar crest for the PRF-flap group; hemostasis by compression; and suture with a point cross | Premolars | 2 months |
| Thakkar et al. [52] | RCT (not further defined) | 36 sites (Number of patients not defined) | Not reported | Not reported | Not reported | Patients between the age group of 20 and 55 years, requiring extraction of at least one maxillary or mandibular nonrestorable single‑rooted tooth | Not described | Periotomes and forceps were used with great care taken to maintain the buccal bone and the surrounding soft and hard tissues | Single rooted teeth | Not reported |
| Yewale et al. [51] | Parallel RCT | 20 (9 females and 11 males) | Not reported | Not | 35 | Sites in maxilla were selected which where, single non restorable teeth and indicated for extraction | Intactness of buccal cortical plate was examined and assessed | Extraction was carried out atraumatically. Subsequent to atraumatic extraction, height of buccal and palatal bone plate was clinically inspected at mid buccal and mid lingual region with aid of periodontal probe. With #15 blade, intrasulcular incision was made elevating marginal gingiva and adjacent interdental papilla. Flap reflection was done by Periosteal elevator resulting in exposure of crestal bone around socket. This aided in direct visualization and measurement of crestal bone level. Bone curette was used to debride extraction socket if granulation tissue is present | Single rooted teeth | Not reported |