Biologically-oriented alveolar ridge preservation to correct bone dehiscence at immediate implant placement.

Abstract

Background: The purpose of the present case study is to describe the application of a modification of the Biologically-oriented Alveolar Ridge Preservation (BARP) principles in cases of peri-implant bone dehiscence (PIBD) due to a compromised alveolus at immediate implant placement (IIP).

Methods: The technique is based on the stratification of three layers: a deep layer with a collagen sponge (CS) in the apical part of the alveolus (where the buccal bone plate was still present) to support the blood clot; a graft layer to correct the PIBD; and a superficial collagen layer to cover the graft thus providing space and enhancing clot/graft stability. Healing was obtained by primary closure.

Results: At the re-entry procedure for implant uncovering, a complete PIBD correction with newly formed peri-implant bone up to the level of the polished collar was observed in both cases.

Conclusions: These observations suggest that BARP based on the combined use of CS and deproteinized bovine bone mineral may be regarded as a simplified treatment option to correct a PIBD at IIP.

Key points: Why treat a Peri-Implant Bone Dehiscence (PIBD)? PIBD should be treated to avoid biological and esthetic complications over time. What plays a key role in this case? The stability of both the graft and the cloth is essential for providing space for bone formation to correct the PIBD; the extraction socket supports angiogenic and osteogenic properties; Primary intention closure is crucial to prevent potential infection.

Limitation: the efficacy of the technique must be assessed.

Plain language summary: This case study described the potential to correct a post-extraction osseous defect associated with a substantial portion of a dental implant which resulted exposed and without bone support on its buccal aspect. The application of a novel bone augmentation technique, namely the biologically oriented Alveolar Ridge Preservation, has been described. This simplified procedure is based on the stratification of i) a deep collagen layer in the apical part of the socket to support the blood clot and spontaneous bone formation, ii) a graft of bone substitute to correct the missing bone, and iii) a superficial collagen layer to protect the graft and the wound. After 5 months, a complete correction of the osseous defect with newly formed bone up to the head of the implant was observed in both treated cases.