Optimizing Alveolar Ridge Preservation and GBR: A Systematic Review of Membranes, Grafts, and Soft Tissue Strategies for Personalized Care.

Background: Alveolar bone loss following tooth extraction remains one of the main challenges in implant dentistry. To counteract the physiological resorption that occurs post-extraction, regenerative techniques such as alveolar ridge preservation (ARP) and guided bone regeneration (GBR) have been developed. These approaches use bone graft materials and barrier membranes to preserve or restore alveolar architecture, facilitating optimal implant placement. Objective: This systematic review aims to critically evaluate the most relevant and methodologically robust clinical studies comparing the effectiveness of ARP and GBR techniques. Specific attention is given to membrane types, graft materials, surgical timing, and soft tissue management strategies, assessing their impact on biological, functional, and esthetic outcomes. Methods: Fourteen high-quality randomized controlled trials were selected and analyzed. Key outcome measures included vertical and horizontal bone gain, implant survival rates, soft tissue stability, postoperative complications, and patient-reported satisfaction. Results: Modern resorbable membranes demonstrate comparable bone regeneration outcomes to nonresorbable ones, while minimizing surgical invasiveness. Titanium mesh offers superior bone gain in complex defects but is associated with a higher complication rate. Early intervention may improve outcomes. The choice of graft material influences both osteogenic potential and structural stability. However, generalizability is limited by small sample sizes, short follow-up periods, and exclusion of patients with systemic comorbidities. Conclusions: Successful alveolar regeneration requires a personalized treatment approach, considering defect morphology and individual patient characteristics. Future research should prioritize larger, long-term, multicenter studies that include real-world patient populations to support the development of more predictive and patient-centered clinical protocols.