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

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.