Protocol for ridge preservation at severely compromised extraction sockets: Consecutive case series

Background

The physiologic bone remodeling accompanying tooth extraction is a phenomenon well described in the dental literature. Extraction sockets severely compromised by local infection, trauma, iatrogenesis, or other factors may exhibit enhanced reduction in alveolar dimensions during healing. The purpose of this report is to present an alveolar ridge preservation (ARP) protocol specifically intended for use at severely compromised sites.

Methods

Seven patients presented to the Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, requiring extraction of teeth with partial or near-complete loss of the facial/buccal cortex. At each site, a cross-linked bovine collagen membrane was used to prevent collapse of the facial/buccal soft tissue and maintain space, a freeze-dried bone allograft was applied in the socket, and a dense polytetrafluoroethylene membrane covered the occlusal aspect.

Results

All sites healed uneventfully and resulted in favorable alveolar ridge dimensions for implant placement.

Conclusion

Few authors have proposed specific ARP methods for managing severely deficient extraction sockets. The predominant recommendation has been staged reconstruction of the site applying hard and soft tissue augmentation. Observations reported herein suggest that staged reconstruction is avoidable at some extraction sockets exhibiting severe alveolar compromise. Controlled clinical investigation of this protocol appears warranted.

Key points

• Few authors have proposed alveolar ridge preservation (ARP) methods specifically intended for use at severely compromised extraction sockets.
• The prevailing recommendation at such sites is a staged protocol involving tooth extraction with delayed hard and soft tissue augmentation.
• The presented bilaminar ARP technique may eliminate the need for staged reconstruction at some severely compromised extraction sockets.