BIOBRIEF

2-Stage Implant Placement in the Posterior Mandible Using the Sausage Technique™

Andrea Ravidà, DDS, MS, PhD

Jasper Wu, DDS, MDS

THE SITUATION

A 49-year-old female patient presented for periodontal treatment and implant consultation. Tooth 22* required extraction as it exhibited 100% bone loss on initial presentation with calculus deposits to apex. After extraction the site demonstrated a Siebert Class I defect with a significant horizontal discrepancy. The final goal was to restore the site with dental implants after treatment of periodontal disease and guided bone regeneration to correct the horizonta discrepancy.

*Universal Numbering System

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system/ Non-smoker	Light smoker Impaired immune system/	Heavy smoker
Patient’s esthetic requirements	Low	Medium	High
Height of the smile line	Low	Medium	High
Gingival biotype	Thick – “low scalloped”	Medium – “medium scalloped”	Thin – “high scalloped”
Infection at implant sight	None	Chronic	Acute
Bone height at adjacent tooth	≤ 5 mm from contact point	5.5 – 6.5 mm from contact point	≥ 7 mm from contact point
Restorative status of adjacent tooth	Intact		Restored
Width of tooth gap	1 tooth (≥ 7 mm)	1 tooth (≤ 7 mm)	2 teeth or more
Soft-tissue anatomy	Intact		Compromised
Bone anatomy of the alveolar ridge	No defect	Horizontal defect	Vertical defect

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THE APPROACH

The treatment goal in this case is restoration of bone dimensions via guided bone regeneration and subsequent implant placement. The Sausage Technique™ was used for reconstruction of bone volume together with resorbable collagen membrane, fixation pins, and bone graft material.

Initial clinical presentation showing the reduced ridge width.

Initial clinical presentation showing the reduced ridge width: Post extraction of #22 with bone loss to apex.

Initial clinical presentation showing the reduced ridge width: #22 calculus involving entire length of root.

Initial clinical presentation showing the reduced ridge width: #22 with 100% bone loss with no buccal or lingual plate.

Pre-operative intraoral view of the edentulous ridge demonstrating horizontal deficiency prior to flap elevation.

Decortication is performed and the flap is mobilized.

Fixation of Geistlich Bio Gide® Forte using the Sausage Technique™ was initiated on the lingual aspect.

The space beneath the membrane is filled with a 50:50 mixture of Geistlich Bio-Oss® and autologous bone.

The densely packed membrane is secured with pins on the buccal aspect (Sausage TechniqueTM).

Three-month follow-up shows visible horizontal bone gain and favorable soft-tissue conditions.

Three-month occlusal view demonstrating increased ridge width and favorable soft-tissue maturation following horizontal augmentation.

Five month CBCT cross sections showing consistent horizontal ridge augmentation and implant ready bone.

Six-month re-entry showing a stable, well-integrated graft ready for implant placement, with a Geistlich Panorama retractor used to enhance visibility and access.

Six-month occlusal view showing implant placement following successful graft maturation

Prosthetically driven implant placement awaiting uncovery and crown fabrication.

“A significant discrepancy in bone dimensions would compromise implant placement and positioning if approached without guided bone regeneration.”
— Dr. Andrea Ravidà

THE OUTCOME

Significant horizontal gain in bone volume was achieved utilizing guided bone regeneration with the Sausage Technique™ and Geistlich Bio-Gide® Forte resorbable collagen membrane, allowing for prosthetically driven implant placement.

Geistlich Bio-Gide® Forte offers excellent handling, especially when fixed with pins as in the Sausage Technique™. It adapts seamlessly around pins and can be repositioned or stretched without folding or wrinkling.”
Dr. Andrea Ravidà

Andrea Ravidà, DDS, MS, PhD

Dr. Andrea Ravidà is the Director of the Graduate Periodontics Program in the department of Periodontics at the University of Pittsburgh. He conducts clinical research focusing on periimplantitis, periodontitis, and short implants. He has published more than 90 peer-reviewed articles and conference abstracts/presentations related to periodontics and implant therapy. He is section editor of the International Journal of Oral Implantology and the Journal of Translational Medicine.

Jasper Wu, DDS, MDS

Dr. Jasper K. Wu received his Doctor of Dental Surgery degree from SUNY University at Buffalo School of Dental Medicine in 2019. He practiced both private and hospital-based dentistry in Buffalo, NY. Dr. Wu completed a Certificate in Periodontics and earned an MDS degree at the University of Pittsburgh School of Dental Medicine in 2026. He has received advanced training in periodontal plastic surgery, dental implant therapy, and regenerative procedures.