Synergistic Effects of BMP-2 and VEGF with Calcined Bovine Bone for Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial

Background: Alveolar ridge remodeling following tooth extraction can result in significant dimensional loss, compromising future implant placement. While calcined bovine bone (CBB) has shown promise in socket preservation, the synergistic effects of combining CBB with bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF) remain inadequately studied. Objective: To evaluate the clinical efficacy of different growth factor combinations with CBB for alveolar ridge preservation following tooth extraction through a randomized controlled trial. Methods: Eighty patients requiring molar or premolar extraction were randomly allocated into four groups (n=20 each): control (no treatment), CBB alone, CBB+BMP-2, and CBB+BMP-2+VEGF. Primary outcomes included alveolar ridge dimensional changes assessed by cone-beam computed tomography at baseline and 3 months post-extraction. Secondary outcomes encompassed soft tissue healing evaluation using the Landry Wound Healing Index, pain assessment via Visual Analog Scale, and patient satisfaction scores. Bone density was evaluated through grayscale analysis of CBCT images. Results: All groups showed comparable baseline characteristics. At 3 months, the CBB+BMP-2+VEGF group demonstrated superior ridge preservation with minimal buccal height loss (0.25±0.03 mm vs. 2.33±0.24 mm in controls, p<0.01) and optimal width preservation across all measurement levels. Hounsfield unit values increased most significantly in the combination group (1093.94±42.63 HU increase vs. 526.87±93.50 HU in controls, p<0.01). The CBB+BMP-2+VEGF group achieved significantly lower pain scores throughout the observation period, enhanced soft tissue healing scores, and higher patient satisfaction ratings (9.2±0.6 vs. 7.5±1.1 in controls, p<0.05). Conclusions: The combination of CBB with BMP-2 and VEGF provides superior alveolar ridge preservation compared to conventional approaches, demonstrating enhanced dimensional stability, accelerated healing, and improved patient-reported outcomes. These findings support the clinical implementation of growth factor-enhanced socket preservation protocols for optimal implant site development.