Bioengineering and Alveolar Ridge Preservation: Can Synthetic Growth Factor-Releasing Scaffolds Overcome the Limitations of Autogenous Bone Grafts? A Narrative Review

Removing a tooth triggers a remodeling response that leaves the alveolar process narrower and shorter than before. Where an implant is planned, that contraction can be the difference between a site that accepts a fixture in its ideal position and one that does not, which is why managing the post-extraction socket has become a discipline in its own right. This narrative review asks a specific question: can synthetic scaffolds engineered to release growth factors in a controlled manner do what autogenous bone does, without the drawbacks autogenous bone brings? To address this, we examined socket-healing biology, the design criteria that govern scaffold performance, the mechanisms by which bioactive molecules are delivered and the clinical data available to date. Searches covered ridge preservation, autogenous grafting, bone tissue engineering, scaffold composition, fabrication methods and growth factor delivery; we retained preclinical work, clinical trials, systematic reviews and consensus documents where they bore directly on the question posed. The evidence indicates that controlled-release constructs improve osteogenesis and vascular ingrowth, limit ridge collapse and spare the patient a donor site, with sequential and sustained-release designs performing particularly well. What the evidence does not yet show is durability: nearly all comparative data come from animal models and the available human studies are too small and too short to establish whether these constructs outperform autogenous bone over time. The rationale is sound and the direction of travel is clear, but adequately powered trials reporting volumetric, histomorphometric and implant-related endpoints together remain the missing piece.