Putty grafts for socket preservation: what the new 4‑month RCT means for your chair

Both putty grafts limited post‑extraction width loss, but a combination demineralized/mineralized allograft putty showed more mineralised tissue at 4 months — a small, practical advantage when you need earlier implant placement or have a thin buccal plate.

A pragmatic randomized clinical study in The International Journal of Periodontics & Restorative Dentistry examined ridge changes and histology after socket grafting with two commercially available putty forms: a combination demineralized/mineralized putty allograft (DMP) and a synthetic calcium‑phosphosilicate putty alloplast (CPS). Thirty non‑molar extraction sites were randomized, all covered with an acellular dermal matrix, and re‑entered at four months for CBCT measurements and trephine biopsies. The authors reported that both materials reduced post‑extraction horizontal shrinkage and allowed implant placement, but the DMP group had significantly more mineralized tissue on histology at four months (DMP 38.2% vs CPS 20.2%). ([visualize.jove.com](

Measured radiographic changes were small but measurable: mean horizontal width fell in the CPS group from 8.60 ± 1.97 mm to 6.47 ± 2.11 mm (mean change −2.13 mm, about −25%), and in the DMP group from 7.83 ± 1.49 mm to 6.55 ± 1.88 mm (mean change −1.28 mm, about −16%). Both within‑group changes reached statistical significance; the between‑group difference in width change was modest. The study recorded implant primary stability at placement but did not report large clinical failures. ([visualize.jove.com](

Put these numbers in perspective: systematic reviews show that, without any socket preservation, average horizontal loss across sites is typically 2.5–3.8 mm in the first months after extraction. Socket grafting commonly reduces that loss by about 1–2 mm compared with extraction alone, so the 1 mm smaller mean loss with the DMP in this trial fits the range of incremental benefits we already expect from ARP. In plain terms, both putty grafts keep you out of a larger reconstruction in most sites, and the observed extra one millimetre of hard tissue at four months with DMP may matter most where the buccal plate is thin or aesthetic contours are critical. ([onlinelibrary.wiley.com](

How to apply this in a modest clinic: if you routinely delay implant placement for ~4 months, both putty materials are reasonable choices to preserve width and allow standard implant placement without major augmentation. If you need to place an implant earlier, or you face a very thin buccal plate (≤1 mm) where every millimetre matters, favouring a combination demineralized/mineralized allograft putty may give a faster appearance of mineralised tissue at 4 months and therefore a small biological advantage for primary stability. Remember the trial used an acellular dermal matrix barrier over the putty; results may be different if you leave sockets open or use other sealing techniques. ([visualize.jove.com](

Limitations to keep in mind: the study is small (30 sites) and the follow‑up reported here is only four months — histology at an earlier time point can show differences that disappear by 6–12 months. The trial used CBCT and trephine cores at re‑entry, which are robust for the questions asked, but the small sample means the implant‑level clinical outcomes (need for additional augmentation, long‑term survival) were underpowered. Cost, patient preference, product availability and regulatory status in our countries also matter; synthetic CPS putties remain useful when allografts are not available or when patients decline human‑derived material.

Practical checklist for your chair on Monday morning: perform careful buccal plate assessment (CBCT or probe), consider ARP with either putty when you plan delayed implants, choose a demineralized/mineralized putty if you want to maximise early mineralised tissue at four months, always protect the socket (membrane, soft‑tissue seal or ADM as used in the study), and counsel patients that ARP reduces but does not eliminate the common 2–4 mm horizontal shrinkage after extraction. ([visualize.jove.com](