PURPOSE The goal of this study was to compare bone graft materials in mandibular third molar extraction sockets and to monitor bone remodeling and complications. MATERIALS AND METHODS Patients with bilateral, impacted mandibular third molars were involved. Twenty-four patients were planned to be randomly assigned to three possible treatments: (1) the control sockets were left empty; (2) the socket was
filled with bovine xenograft (Bio-Oss); or (3) the socket was filled with albumin-impregnated bone allograft (BoneAlbumin). Postoperative pain during the first week was determined with the visual analog scale. Cone beam computed tomography (CBCT) images were taken at 6 and 12 weeks and 1 year postoperatively for micromorphologic analysis and measurement of pocket depth at the second molar. Patients and image analyses were blinded toward the treatment group (randomized double-blind split-mouth design). RESULTS Postoperative pain was lowest in the allograft group (control: 5.06 +/- 0.53; xenograft: 5.85 +/- 0.42; allograft: 3.94 +/- 0.52; P < .05). At weeks 6 and 12, early signs of remodeling were observed in the allograft group and the controls, while bone xenograft was still demarcated from the host bone. The 1-year CBCT images showed complete remodeling and integration of allograft with natural trabecular structure, while the xenograft particles were still visible. Support for the second molar was significantly better, as evidenced by less deep and prevalent pockets in the allograft-filled group compared with the controls (P = .017). CONCLUSION Filling an extraction socket with albumin-integrated allografts provides superior bone regeneration compared to either native bone buildup or xenograft application or socket regeneration without bone grafting.