Introduction of a Semi-Quantitative Image-Based Analysis Tool for CBCT-Based Evaluation of Bone Regeneration in Tooth Extraction Sockets

After tooth extraction, resorptive changes in extraction sockets and the adjacent alveolar ridge can affect subsequent tooth replacement and implantation. Several surgical concepts, including the application of autologous blood concentrate platelet-rich fibrin (PRF), aim to reduce these changes. While PRF's wound-healing and pain-relieving effects are well-documented, its impact on bone regeneration is less clear due to varying PRF protocols and measurement methods for bone regeneration. This study aimed to develop a precise, easy-to-use non-invasive radiological evaluation method that examines the entire extraction socket to assess bone regeneration using CBCT data from clinical trials. The method, based on the freely available Image J-based software "Fiji", proved to be precise, reproducible, and transferable. As limitation remains the time requirement and its exclusive focus on radiological bone regeneration. Nevertheless, the method presented here is more precise than the ones currently described in the literature, as it evaluates the entire socket rather than partial areas. The application of the novel method to measure mineralized socket volume and radiological bone density of newly formed bone in a randomized, controlled clinical trial assessing solid PRF for socket preservation in premolar and molar sockets showed only slight, statistically non-significant trends toward better regeneration in the PRF group compared to natural healing.