Quality Resource Guide

Alveolar Ridge Preservation Following Tooth Extraction 3rd Edition

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a combination of FDBA and a non resorbable

dPTFE membrane was used. Three months after

extraction, radiographic ridge dimensions were

assessed prior to single implant placement. The

authors reported that no significant ridge width

reduction difference was seen. However, the

sites which did not received ridge preservation

required more frequently bone grafting at the time

of implant placement (25% of the time in extraction

alone sites vs. 10% in ridge preserved sites).

Technique

After local anesthesia has been delivered, the least

traumatic possible extraction is performed with

care to maintain all the bony walls of the extraction

socket intact. For this purpose, periotomes may be

preferred over larger, bulkier traditional elevators.

Once the tooth has been extracted, the integrity

of the buccal bone wall plate should be checked

and if all the walls are intact, the grafting procedure

can be performed. Small quantities of graft should

be applied successively and condensed in the

extraction socket. This allow for an optimal filling of

the socket. The most coronal part of the socket can

be covered with a collagen wound dressing before

a figure eight suture is placed over the extraction

site to maintain the stability of the graft.

In instances where, despite careful extraction, the

buccal plate has fractured, digital pressure applied

on the buccal surface of the extraction site will lead

to soft tissue depression into the extraction site

confirming the loss of integrity of the buccal wall

plate. A full-thickness mucoperiosteal flap should

be elevated to expose the full extent of the extracted

site including the buccal dehiscence.

A releasing

incision, at least a tooth away from the extraction

site, may be necessary to allow flap elevation and

access for visualization of the defect. Grafting

and contouring of the site should be performed

and a membrane placed over the grafted site. A

periosteal incision may help in advancing the flap

coronally before it is sutured back. The healing

time should be extended considering the absence

of buccal bone plate.

Post-operative

care

usually

includes

the

prescription of systemic antibiotics for 7 to 10 days,

analgesics and rinsing with a 0.12% cChorhexidine

solution twice a day for 7 to 14 days.

Conclusion

Ridge preservation is a straightforward procedure

and, if performed at the time of extraction, may

prevent drastic ridge dimensions alterations. This, in

turn, maximizes the chances to proceed with dental

implant placement, once healing has occurred, with

little or no need for technique-sensitive guide bone

regeneration (GBR) procedures.

Figures 2 and 3

Tooth #10 is scheduled for extraction and

replacement with an implant is planned

Figure 4

Tooth #10 has been extracted with a least

traumatic technique

Acknowledgements

All the clinical illustrations in the present

manuscript are the courtesy of the Graduate

Periodontics Program at the University of

Texas Health Science Center at San Antonio

(UTHSCSA) and the United States Air Force

Periodontics Residency Program at Lackland Air

Force Base, TX.

Figures 5 and 6

All the walls were intact and the site was

grafted with FDBA and a resorbable collagen

wound dressing (CollaTape®) was placed

over the graft and the site was sutured.