Ridge Preservation in socket with preserved buccal bone wall

Clinical Challenge

Preserving hard and soft tissue volume following tooth extraction is crucial, especially in the esthetic zone. In this case, Ridge Preservation using Geistlich biomaterials allowed for late implant placement without the need for additional guided bone regeneration (GBR).

Clinical Situation

Tooth 21 required extraction due to periodontal deterioration. The buccal bone wall was intact, making this case ideal for Ridge Preservation using a flapless, minimally invasive approach.

Treatment Protocol

1. Extraction & Socket Management
   • Atraumatic, flapless extraction of tooth 21
   • Meticulous curettage of the socket to remove all granulation tissue
   • Socket filled with Geistlich Bio-Oss® Collagen, packed up to the palatal wall
2. Soft Tissue Sealing
   • Application of Geistlich Mucograft® Seal with the spongy side facing the graft material
   • Secured using single interrupted sutures to ensure precise adaptation to the surrounding soft tissue
3. Wound Healing & Outcome
   • At 2 weeks: Uneventful healing with a healthy pink appearance of the soft tissues
   • At 3 months: Full soft tissue closure with mature tissue architecture
   • At 5 months: Alveolar ridge dimensions well preserved, enabling implant placement without additional GBR
4. Implant Placement & Soft Tissue Management
   • Implant placed to replace tooth 21
   • Buccal soft tissue volume optimized with a connective tissue graft harvested from the left palate
   • Flap closed using suspension and single interrupted sutures (monofilament 6/0)
5. Follow-Up
   • (a) Radiograph at 3 months post-implant placement shows successful osseointegration
   • (b) Clinical follow-up at 28 months post-extraction confirms long-term stability

Clinical Approach

This case followed a delayed implant placement strategy, which is well-documented in literature for its reliability in achieving stable long-term outcomes. The chosen biomaterials, Geistlich Bio-Oss® Collagen and Geistlich Mucograft® Seal, enabled predictable Ridge Preservation and minimized the need for additional surgical interventions.

Conclusion

In this esthetically demanding case, the combination of Geistlich Bio-Oss® Collagen and Geistlich Mucograft® Seal effectively preserved the ridge following extraction. Five months post-op, the preserved hard  and soft tissue volume enabled successful implant placement without additional bone grafting. A connective tissue graft was used to enhance buccal soft-tissue contours, ensuring a pleasing esthetic outcome.