Ridge Preservation

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Ridge Preservation for Optimum Aesthetics
and Function

The primary goal of any ridge preservation technique should be to preserve both the hard and soft tissues, especially the interdental papillae, in such a way as to optimize aesthetics and function.

Biological goals

Whenever there is an aesthetic concern, the blood supply and the natural soft-tissue anatomy at the edentulous site should be preserved. Ultimately, the avoidance of post-extraction bone resorption and the preservation of the natural soft-tissue anatomy at the endentulous site become the key elements to obtaining an optimal aesthetic rehabilitation at the site.

The Bio-Col Socket Preservation Technique

With an understanding of these goals and biological considerations, the "Bio-Col" socket preservation technique was developed. The surgical protocol ensures the preservation of both hard and soft tissues at the time of tooth extraction, and it virtually eliminates the bone resorption that would normally follow tooth removal.

1. Top View: Bleeding Extraction Socket with No Defect. Tooth is extracted atraumatically without flap reflection. Note intact bony walls of extraction socket and preservation of surrounding gingival anatomy.

2. Top View: Grafted Extraction Socket in Preparation for Conventional Prosthesis. Socket with intact bony walls is grafted up to alveolar crest with Bio-Oss® natural bone mineral. CollaPlug®* absorbable dressing is placed over the Bio-Oss® graft and sutured in place with a horizontal matress suture.

3. Buccal View in Transparency: Bio-Col Technique for Conventional Prosthesis. Socket with intact bony walls is grafted up to alveolar crest with Bio-Oss® graft material. CollaPlug® absorbable dressing is placed over the Bio-Oss® graft and maintained with suture. A removable or fixed provisional restoration with an ovate pontic extending 3 mm to 4 mm subgingivally is placed, compressing the CollaPlug® and supporting the surrounding soft tissue.

4. Top View: Bio-Col Technique With Immediate Implant Placement. Immediate implant placed into intact bony socket. Bio-Oss® bone mineral grafted between implant and bony socket walls. Implant fixture and Bio-Oss® graft covered with CollaPlug® absorbable collagen dressing. Horizontal mattress suture placed to maintain position of collagen wound dressing.

5. Buccal view in Transparency: Bio-Col Technique With Immediate Implant Placement. Procedure same as step 4 with the following addition: Tooth borne provisional restoration with a modified ovate pontic to avoid pressure over cover screw. Ovate pontic extends subgingivally to support surrounding soft tissues.

6. Top View: Compromised Extraction Socket With Buccal Wall Defect. After extraction, socket presents with a large buccal wall bone defect. Note the partial soft-tissue collapse into the defect area.

7. Top View: Grafted Compromised Extraction Socket in Preparation for Delayed Implant Placement or Conventional Prosthesis. After tooth removal, Bio-Gide® resorbable collagen membrane placed in prepared subperiosteal pocket, covering bony socket wall defect. Bio-Oss® bone mineral placed into the socket and defect area. Note that Bio-Oss® slightly expands the adjacent Bio-Gide® membrane and overlying soft tissues. CollaPlug® absorbable dressing is placed over the Bio-Oss® graft and maintained with suture.

8. Buccal View in Transparency: Grafted Compromised Socket in Preparation for Delayed Implant Placement or Conventional Prosthesis. Note Bio-Gide® membrane covering buccal wall socket defect. Procedure same as step 7 with the following addition: Provisional restoration with ovate pontic extending 3 mm to 4 mm subgingivally against CollaPlug® dressing, supporting surrounding soft tissues.

*CollaPlug® is a registered trademark of Colla-Tec, Inc.

Human histology demonstrates successful bone
formation after using Bio-Oss^®

Histologic documentation is important to assess the biological response to any regenerative therapy. The photomicrographs below document the lack of any immunologic response to Bio-Oss®; rather new bone formation is present on the surface of the Bio-Oss® and forms bridges between the particles. In approximately six months, Bio-Oss® becomes integrated with newly formed lamellar bone; it is subsequently included in the physiologic remodeling process.

Extraction Socket
Case by Dr. Michael Marxer, Histology by Dr. Robert Schenk; Berne, Switzerland

Six month core biopsy showing Bio-Oss^® particles (right side) integrated into new bone (6.3x)

Higher magnification showing Bio-Oss^®(*) completely integrated into bone tissue (20x).

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