Ridge augmentation in delayed implant placement

BioBrief - Ridge Preservation

The Situation

An adult female patient presented with an endodontic and prosthetic failure on the maxillary left lateral incisor. She requested a definitive implant-supported single crown. Clinical examination revealed recession of the free gingival margin, and CBCT evaluation showed a missing buccal bone plate, contraindicating immediate implant placement. The treatment plan involved a staged approach with ridge augmentation at the time of tooth extraction to recreate the buccal bone plate and reduce gingival recession. By repositioning the free gingival margin, keratinized tissue was gained through an open-healing approach.

The Approach

Treatment Goals

The treatment goals were to improve soft tissue levels and regenerate the buccal bone plate.

Flapless Extraction and Ridge Augmentation

After performing a flapless extraction, a specifically designed resorbable bilayer collagen membrane, Geistlich Bio-Gide® Shape, was inserted into the socket with the long wing contacting the buccal surface and the smooth, compact upper layer facing outward.

Grafting with Geistlich Bio-Oss® Collagen

The alveolus was then grafted with Geistlich Bio-Oss® Collagen. The three smaller wings of the membrane were folded over the graft material and sutured to the surrounding soft tissue, allowing for open healing.

The Outcome

This case demonstrates the potential to improve the clinical and esthetic situation presented at baseline. Despite the defective buccal bone plate and recession of the free gingival margin, the ridge preservation procedure using Geistlich Bio-Gide® Shape and Geistlich Bio-Oss® Collagen achieved a positive ridge volume, facilitating prosthetically guided implant placement.

Keys to Success

• Minimally invasive, flapless extraction
• Immediate grafting with Geistlich Bio-Oss® Collagen
• Protection of the bone substitute with Geistlich Bio-Gide® Shape
• Proper adaptation of Geistlich Bio-Gide® Shape on the buccal surface of the alveolus
• Open-healing capability of Geistlich Bio-Gide® Shape
• Prosthetically driven implant placement