BIOBRIEF

Vertical Bone Augmentation with Bone Plate Technique and Soft Tissue Phenotype Modification

Muhammad Saleh, BDS, MSD, PhD

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
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 (#8 has been 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

Vertical ridge augmentation was performed using allogenic cortical plates fixed with microscrews to create a stable, space-maintaining box, which was densely packed with vallos^® mineralized cortico-cancellous granules hydrated with the rhPDGF-BB component of GEM 21S^®. Five months later, the implants were placed, and the peri-implant soft tissue phenotype was enhanced using Geistlich Mucograft^® and Geistlich Fibro-Gide^® to improve soft-tissue height and thickness.

Preoperative view showing the anterior maxillary defect with loss of #6 and #7; #5 and #8 are planned to be extracted because of severe mobility and advanced bone loss.

Full-thickness mucoperiosteal flap elevation revealing a vertically and horizontally deficient ridge in the #5–8 region, prepared for augmentation.

Adaptation and fixation of two allogenic cortical bone plates to the native ridge using micro screws to create a “box” configuration for vertical bone augmentation. The box between and around the plates is packed with vallos® mineralized cortico-cancellous granules mixed with rhPDGF-BB component of GEM 21S®, completing the three-dimensional reconstruction of the defect.

Immediate closure with PTFE sutures providing tension-free primary closure over the augmented site.

Re-entry after healing demonstrating well integrated cortical plates and a vertically augmented ridge suitable for implant placement.

Occlusal view showing well integrated particulate bone at relatively early stage.

Placement of two implants into the regenerat ed ridge, with a regular diameter implant anteriorly and a wide diameter implant posteriorly.

Geistlich Mucograft® is layed on top of the implants before flap closure to improve the tissue phenotype.

Occlusal view after the second stage for implant uncovery with Geistlich Fibro-Gide® left between the flap intentionally slightly exposed. Due to volume stability of Geistlich Fibro-Gide®, it aids in maintaining tissue verticality during healing.

Occlusal view after 2 weeks of the second stage showing excellent healing of Geistlich Fibro-Gide® with secondary intention with traces of keratinzed tissue forming between wound edges. Both healing abutments were replaced with bigger sizes to aid with tissue contouring before final restoration.

“The patient had high esthetic demands and specifically wanted to avoid autogenous grafting. Remarkably, this case was completed with 0% autogenous tissue, demonstrating that outcomes traditionally thought to require autogenous grafts can be achieved otherwise.”
— Dr. Muhammad Saleh

THE OUTCOME

Vertical ridge augmentation of the maxillary anterior was achieved using allogenic cortical bone plates fixed with microscrews to create a box configuration, filled with vallos^® mineralized cortico-cancellous granules mixed with rhPDGF-BB component of GEM21S^®. At implant placement, soft tissue phenotype was enhanced using Geistlich Mucograft^® and Geistlich Fibro-Gide^®.

Rigid fixation of cortical plates creating a stable, space-maintaining box with tension-free soft tissue closure are the most critical factors for predictable vertical ridge augmentation.”
Muhammad Saleh, BDS, MSD, PhD

Muhammad Saleh, BDS, MSD, PhD

Dr. Muhammad H. Saleh, Diplomate of the American Board of Periodontology, is a full-time faculty member at the University of Michigan and an internationally recognized lecturer in periodontology and implant dentistry. He has published over 140 peer-reviewed articles and reviews for leading Q1 journals. His numerous honors include the 2021 AAPF Schoor Award, 2022 Ramfjord Symposium Award, 2022 AAP Institute Award, 2024 AAPF LEAD and Nevins Awards, and the 2025 Roy H. Roberts Award.

BIOBRIEF

Vertical and Horizontal Maxillary Ridge Reconstruction with Advanced Grafting

Nikolaos Soldatos, DDS, PhD, MSD

THE SITUATION

A 26-year-old edentulous female presented for implant-supported maxillary rehabilitation. She was systemically healthy and classified as ASA I. Clinical and radiographic evaluation revealed a Seibert Class III maxillary ridge defect with combined horizontal and vertical deficiencies. The patient exhibited a medium smile line and reported a highly active lifestyle with regular physical activity, indicating the need for a stable, durable, and esthetically driven implant rehabilitation capable of meeting long-term functional demands.

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system Non-smoker	Light smoker	Impaired immune system
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
Soft-tissue anatomy	Intact		Compromised
Bone anatomy of the alveolar ridge	No defect	Horizontal defect	Vertical defect

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THE APPROACH

Horizontal and vertical ridge augmentation was performed using a full-thickness maxillary flap with two distal vertical releasing incisions. Extensive buccal periosteal release and cortical perforations were carried out. A composite graft of large-particle vallos^®allograft (demineralized cortical granules) and large-particle Geistlich Bio-Oss^® xenograft, combined with rhPDGF-BB, a component of GEM 21S^®, was placed and stabilized under a high-density PTFE membrane, which was secured with four horizontal mattress and multiple simple interrupted 4-0 PTFE sutures.

Pre‑operative occlusal photograph of the maxillary arch showing a pronounced Seibert Class III ridge deformity, with simultaneous horizontal and vertical soft and hard tissue loss in the edentulous area.

Intraoperative view following reflection of full‑thickness flaps, revealing a pronounced combined horizontal and vertical ridge deficiency.

Upper left view showing the mixture of large-particle vallos® allograft, demineralized cortical granules, and large-particle Geistlich Bio-Oss® xenograft, combined with rhPDGF-BB, a component of GEM 21S®.

Upper right view showing the mixture of large-particle vallos® allograft, demineralized cortical granules, and large-particle Geistlich Bio-Oss® xenograft, combined with rhPDGF-BB, a component of GEM21S®.

Closure of the maxilla was achieved using a PTFE barrier membrane and 4‑0 PTFE sutures. Horizontal mattress sutures were placed to provide initial tension relief and flap stabilization, while simple interrupted sutures were used for precise approximation of the wound margins.

Six‑month postoperative CBCT images with virtual implant planning reveal sites #5, 7, 10, and 12, exhibiting 5–7 mm of horizontal ridge augmentation and 3–4 mm of vertical ridge augmentation.

Intraoperative view demonstrating vertical and horizontal ridge augmentation at 7 months following the initial augmentation procedure.

A 4.3 × 8 mm tapered implant with crestal sinus elevation was placed at site #5, and a 4.3 × 10 mm tapered implant was placed at site #7.

(Left) A 4.3 × 10 mm implant was inserted at the site. (Right) Placement of a 4.3 × 10 mm implant in conjunction with a crestal sinus elevation.

“The patient’s young age and
excellent systemic health are favorable prognostic factors, but achieving optimal outcomes requires meticulous surgical execution, careful soft tissue management, and strict adherence to post-operative instructions to minimize complications and ensure long-term success.”
— Nikolaos Soldatos, DDS, PhD, MSD

THE OUTCOME

Horizontal (5–7 mm) and vertical (3–4 mm) ridge augmentation were successfully obtained, with stablewound management achieved through precise suturing techniques. The osteoinductive properties of the large vallos^®, demineralized granules combined with rhPDGF-BB, a component of GEM21S^® promoted high-quality bone regeneration, whereas the large Geistlich Bio‑Oss^®, xenograft particles contributed to volume preservation by moderating resorption. As a result, four 4.3 mm implants were placed with high primary stability, each exceeding 35 N·cm of insertion torque, providing a strong foundation for a predictable esthetic and functional restoration.

The combination of rhPDGF-BB, a component of GEM 21S®, promotes enhanced bone regeneration by stimulating cellular proliferation and osteogenesis. When supplemented with Geistlich Bio-Oss®, which maintains graft volume through slow resorption kinetics, this approach provides predictable ridge augmentation. Together, these graft components support stable, high‑quality bone formation and foster optimal conditions for long‑term implant integration.”
Nikolaos Soldatos, DDS, PhD, MSD

Nikolaos Soldatos, DDS, PhD, MSD

Dr. Soldatos is a tenure-track Associate Professor and Clinical Director of the Postgraduate Advanced Program in Periodontics at Oregon Health & Science University. He is a Board-Certified Periodontist and Implant Surgeon, he holds a DDS, PhD, and MSD, and has completed advanced periodontal and implant training in both the U.S. and Europe. Dr. Soldatos’ research focuses on translational implant biology and bone regeneration. He is also a Fellow of the Academy of Osseointegration.

BIOBRIEF

Horizontal Ridge Augmentation with a Layered Allograft-Xenograft Approach

Eswar Kandaswamy, BDS, MS

Amber Kreko, DDS

THE SITUATION

The patient presented to the clinic for a dental implant in the tooth #12 location. Clinical evaluation revealed a ridge deficiency. A Cone Beam Computed Tomography (CBCT) scan was taken, confirming insufficient ridge width for implant placement. As a result, the site was treatment planned for horizontal ridge augmentation.

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system	Light smoker	Impaired immune system
Patient’s esthetic requirements	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
Soft-tissue anatomy	Intact		Compromised
Bone anatomy of the alveolar ridge	No defect	Horizontal defect	Vertical defect

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THE APPROACH

Horizontal ridge augmentation was performed using a horizontal layering technique. An inner layer of demineralized freeze-dried bone allograft (DFDBA), featuring vallos^® demineralized cortical particles (to promote osteoinduction), was followed by an outer layer of deproteinized bovine bone, Geistlich Bio-Oss^® (to maintain space and volume). The graft was contained with a native bilayer collagen membrane, Geistlich Bio-Gide^®, and secured with titanium pins (tacks).

Image 1a depicts the pre-operative situation, while the inset shows a cross-sectional view of the deficient ridge in area #12.

Pre-operative view, post-flap reflection.

An inner layer of vallos® demineralized cortical particles (allograft) was applied to the defect.

An outer layer of Geistlich Bio-Oss® (xenograft) was applied on top of vallos® (allograft).

Bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Final sutured closure over the bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Four-week post-operative image demonstrating good soft tissue healing.

Sequential CBCT imaging comparisons, from pre-operative to 6 and 9 months post-operative, confirm the re-establishment of horizontal ridge width achieved through bone augmentation.

Comparative CBCT cross-sectional analysis of pre-operative (left) and 6-month post-operative (right) images reveals an increase in horizontal ridge width.

“By horizontally layering two distinct bone graft materials—Geistlich Bio-Oss® and vallos®—this approach was designed to tailor the regenerative environment, harnessing the unique osteoinductive potential of the allograft and the long-term space-maintaining properties of the xenograft to optimize both early bone formation and dimensional stability.”
— Eswar Kandaswamy, BDS, MS

THE OUTCOME

The 6-month post-operative CBCT evaluation demonstrated sufficient ridge width for restoratively driven implant placement, a result achieved through the utilization of vallos^® and Geistlich Bio-Oss^®bone graft materials.

The incorporation of vallos® demineralized cortical particles, leveraging its reliable osteoinductive properties, was paramount for achieving predictable and successful bone regeneration in this case.”
Eswar Kandaswamy, BDS, MS

The patient required horizontal ridge augmentation for successful placement of a dental implant.”
Eswar Kandaswamy, BDS, MS

Eswar Kandaswamy, BDS, MS

Dr. Eswar Kandaswamy, BDS MS, is an Assistant Professor at Louisiana State University Health Sciences Center, School of Dentistry. He earned his Dental Degree from Sri Ramachandra University, India, and practiced general dentistry for two years. He then completed his specialty training in Periodontics and a Master of Science at The Ohio State University.

Amber Kreko, DDS

Dr. Amber Kreko, DDS is a third-year Periodontics resident at Louisiana State University School of Dentistry, soon to earn her Master of Science. With a foundation in dental hygiene and six years of clinical practice in Southeast Louisiana,she returned to LSU for her DDS. Her comprehensive background enriches her approach to periodontal care. Upon graduation, she will transition to private practice.

BIOBRIEF

Prosthetic-Surgical Approach to Regenerative Treatment for Peri-Implantitis

Andrea Ravidà, DDS, MS, PhD

Anu Viswanathan DDS, MDS

THE SITUATION

A 68-year-old male patient, who received an implant in tooth position #31 about 8 years prior, presented for an examination. He reports bleeding during brushing around the implant and some discomfort. Clinically, there was severe vertical bone loss, profuse bleeding on probing, and deep probing depths, but no pain. The condition was diagnosed as peri-implantitis according to the 2018 classification.

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system	Light smoker	Impaired immune system
Patient’s esthetic requirements	Low	Medium	High
Height of smile line	Low	Medium	High
Gingival biotype	Thick – “low scalloped”	Medium – “medium scalloped”	Thin – “high scalloped”
Infection at implant sight	None	Chronic	Acute
Restorative status of adjacent tooth	Intact		Restored
Soft-tissue anatomy	Intact		Compromised
Bone anatomy of the alveolar ridge	No defect	Horizontal defect	Vertical defect

Additional Risk Factors: The patient exhibited bleeding on probing and deep pocket depths. He also reported occasional marijuana use and was inconsistent with periodontal maintenance and oral hygiene visits.

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THE APPROACH

The treatment goals were to eliminate peri-implant infection, regenerate lost hard and soft tissues, and ensure long-term implant stability. A closed regenerative approach was utilized, including crown removal, thorough implant decontamination with Perioflow®, an airpolishing technology, application of the correct bone grafting materials (Geistlich Bio-Oss®, vallos® and GEM 21S®), enclosed healing, and fabrication of a new crown to facilitate hygiene.

Clinical presentation of tooth #31 showing radiographic evidence of bone loss, profuse bleeding on probing (BOP), deep probing depths, and suppuration, indicative of peri-implantitis with a Class I-infraosseous (c) circumferential-type defect, as described in the study by Monje et al. (2019) Clin Implant Relat Res, 21(4)635-643.

Crown removal by the prosthodontist, followed by placement of a healing abutment for non-surgical therapy using PerioFlow®. After therapy, a cover screw was placed, and the tissue was allowed to heal over the implant for eight weeks.

Surgical treatment initiated with a midcrestal incision and full-thickness flap elevation. Granulation tissue was removed using a surgical curette, revealing a deep infrabony defect.

Implant thoroughly decontaminated using Perioflow® with erythritol powder to ensure a clean surface for regeneration.

rhPDGF-BB was used to hydrate bone grafting materials (vallos® Demineralized Cortical Granules and Geistlich Bio-Oss®), which were first hydrated with sterile water before rhPDGF-BB was added. The materials were mixed in a 1:1 ratio and allowed to sit for 10 minutes before being applied to the deep infrabony defect to promote regeneration.

Flap closed primarily with 5-0 PTFE horizontal mattress and single interrupted suture for secure closure.

Collagen membrane stabilized with 5-0 chromic gut sutures using the lasso technique.

After 5 months of healing, significant bone gain is evident. Geistlich Bio-Oss® was placed on the buccal site to enhance thickness, covered with an amnion-chorion membrane. A healing abutment was placed at this stage.

Two-year follow-up shows disease resolution with shallow probing depths, no bleeding or suppuration, and complete bone gain. A new crown was fabricated with an increased final abutment height (>2mm), contributing to optimal maintenance and long-term stability based on evidence supporting its role in promoting long-term success. A second surgery may be necessary to gain additional tissue thickness or cover residual thread exposure to achieve the desired long-term results.

“The implant presented with significant bone loss, deep probing depths, and bleeding on probing, placing it at risk of failure and requiring intervention to preserve function and longevity.”
— Andrea Ravidà, DDS, MS, PhD

THE OUTCOME

At the two-year follow-up, clinical and radiographic assessments showed disease resolution, complete bone gain, and stable peri-implant tissues. Probing depths were within healthy ranges, and no bleeding on probing was observed, confirming the long-term success of the treatment.

Enclosed healing, meticulous implant decontamination, appropriate selection of bone grafting materials, and customized crown design, combined with patient compliance and regular maintenance, contributed to disease resolution and complete bone regeneration.”
Andrea Ravidà, DDS, MS, PhD

The air polishing device with erythritol powder ensured thorough implant decontamination, while the bone grafting materials combined with rhPDGF-BB provided essential biologic support for regeneration and improved peri-implantitis treatment outcomes.”
Andrea Ravidà, DDS, MS, PhD

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 peri-implantitis, periodontitis and short implants. He has published more than 70 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.

Anu Viswanathan DDS, MDS

Dr. Anu Viswanathan is a Diplomate of the American Board of Periodontology and Implant Dentistry. She earned her Doctor of Dental Surgery degree from the University of Colorado School of Dental Medicine in 2019. Dr. Viswanathan completed a Certificate in Periodontics and earned a Master of Dental Science at the University of Pittsburgh School of Dental Medicine. She also obtained a Certificate in IV Sedation. Dr. Viswanathan is currently in private practice in Shoreline, Connecticut.

BIOBRIEF

Alveolar Ridge Preservation with vallos® Mineralized Cortico-Cancellous Allograft

Hanae Saito, DDS, MS, CCRC

Andrew Tong, DDS

THE SITUATION

A 68 year old female patient was referred from her general dentist for persistent minor discomfort on #31, suspected endo-perio lesion. Upon the examination, deep probing depth and grade 1 mobility were noted. Radiographic interpretation indicating a large J shaped lesion and possible root fracture. Patient had missing #30 and #32 has been mesially drifted and left a restorative space more than > 13 mm mesio-distally.

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system/Non-smoker	Light smoker	Impaired immune system
Patient’s esthetic requirements	Low	Medium	High
Height of smile line	Low	Medium	High
Gingival biotype	Thick – “low scalloped”	Medium – “medium scalloped”	Thin – “high scalloped”
Shape of dental crowns	Rectangular		Triangular
Infection at implant sight	None	Chronic	Acute
Bone height at adjacent tooth site	≤ 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

* The esthetic related risk factors are not needed for this case. Restorative space of more than 13 mm may be an additional risk factor.

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THE APPROACH

A successful treatment outcome comes with proper selection of the technique and materials. In order to facilitate an implant supported restoration in the site with > 13mm mesio-distal space, a staged approach was selected, with alveolar ridge preservation (ARP) performed using an atraumatic extraction technique and vallos^®mineralized cortico-cancellous bone allograft chosen as the material.

Preoperative radiograph of #31 with guarded prognosis due to potential root fracture and infection.

Atraumatic extraction was performed and intact furcation bone is noted.

vallos® mineralized cortico-cancellous bone allograft was placed.

A collagen plug was used to cover the bone allograft

Immediate post alveolar ridge preservation radiograph.

Healing at 2 weeks prior to implant placement.

Healing at 4 months prior to implant placement.

Implant was placed with 32 Ncm. Post implant placement radiograph.

6 months after the implant placement, the final restoration was delivered.

“Ensuring atraumatic extraction techniques, regardless of whether it’s in the anterior or posterior regions, is crucial for preserving the integrity of both hard and soft tissues. Equally important is the selection of biomaterials that not only offer structural support but also possess bone regeneration properties.”
— Dr. Hanae Saito

THE OUTCOME

The planned treatment of replacing a tooth with a dental implant in the regenerated alveolar ridge was achieved. By employing secondary intention healing following ARP and utilizing a lingual paracrestal incision, adequate keratinized tissue was preserved on the buccal side of the implant-supported restoration.

Removal of the infection and maintaining the ridge dimension for the implant supported restoration in the site with > 13 mm mesio-distal space were required.”
Dr. Hanae Saito

Hanae Saito, DDS, MS, CCRC

Hanae Saito, DDS, MS, CCRC serves as a clinical associate professor and oversees the Dual Perio-Pros program and predoctoral periodontal education within the Division of Periodontics, at the University of Maryland School of Dentistry. She is a Diplomate of the American Board of Periodontology. Dr. Saito obtained a Master of Science in Clinical Research and a certificate in Periodontics from New York University College of Dentistry. Additionally, she operates a faculty practice focused on periodontology and implant dentistry.

Andrew Tong, DDS

Andrew Tong, DDS earned his Bachelor of Science degree from the University of Maryland at College Park in 2015 before completing his Doctor of Dental Surgery (D.D.S) degree at the University of Maryland School of Dentistry in 2019. Following this, he undertook a General Practice Residency at the Newark Beth Israel Medical Center in New Jersey from 2019 to 2020. Dr Tong now practices general dentistry at Tong Dental Care in Gaithersburg, MD. Concurrently, he is pursuing a Master’s degree in Periodontics at the University of Maryland School of Dentistry.

BIOBRIEF

Selecting Biomaterials for Combined Complex Defects

Irina F. Dragan, DDS, DMD, MS, eMBA

THE SITUATION

The patient called the office complaining of sensitivity and swelling in the maxillary left quadrant. He was seen and prescribed an antibiotic. Tooth #12 was deemed hopeless, and the peri-apical and radicular lesion presented on the radiograph extended significantly on the mesial aspect, impacting the interproximal bone level for tooth #11. Patient presents with implant supported restorations distal to the affected area and was concerned about the infection spreading to that area as well. The area was treated successfully, and the patient was pleased with the outcome, allowing him to preserve the tooth, on the mesial aspect of the lesion and the implant distally.

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system/Non-smoker	Light smoker	Impaired immune system
Patient’s esthetic requirements	Low	Medium	High
Height of smile line	Low	Medium	High
Gingival biotype	Thick – “low scalloped”	Medium – “medium scalloped”	Thin – “high scalloped”
Shape of dental crowns	Rectangular		Triangular
Infection at implant sight	None	Chronic	Acute
Bone height at adjacent tooth site	≤ 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 goals of the procedure were to eliminate infection, the source of pain, and reduce periodontal problems to the adjacent tooth and implant. Full thickness flap was reflected, #12 was removed and the socket was debrided and irrigated. A peri-radicular lesion was removed and submitted for histopathological exam.

Full thickness flap elevation exposing the complex clinical situation.

Alveolar socket after the tooth removal exposing the loss of bone on the distal of tooth #11, prior to the debridement of the granulation tissue and root preparation.

Adaptation on the buccal defect prior to placement of bone grafting with vallos® mineralized cortical cancellous mix granules (bottom) followed Geistlich Bio-Oss® (top).

Post adaptation with Geistlich Bio-Gide® for alveolar ridge preservation and guided tissue regeneration, followed by final suturing of the site using ePTFE material.

Radiographic overview of the clinical procedure: initial presentation with the bony defect impacting distal of #11 and #12 – mesial and inter-radicular, site after the tooth #12 was extracted, radiographic bone fill of the defect post-operative.

Post-operative healing of the site, 4 weeks after the procedure was completed.

“A localized infection can easily spread and impact adjacent teeth and implants. It is critical for clinicians to intervene as soon as possible to prevent further complications. Patient education and motivation is key to successfully treat these types of clinical situations encountered in a daily practice.”
— Dr. Irina Dragan

THE OUTCOME

The combined defect: #11 distal guided tissue regeneration and #12 alveolar ridge preservation for #12. This area was treated with vallos®, Geistlich Bio-Oss Collagen®, and Geistlich Bio-Gide®. The xenograft was placed in the apical portion of the socket and the allograft towards the coronal surface.

Healing of the site at 4 weeks post-operative.

Considering today’s advancements in regeneration we are able to successfully treat complex clinical scenarios that involve combined therapeutic applications, such as guided tissue regeneration and alveolar ridge preservation.”
Dr. Irina Dragan

Periotomes were able to support with an atraumatic extraction of tooth #12 and maintaining as much as possible the soft and hard tissue present in this compromised area.”
Dr. Irina Dragan

Irina F. Dragan, DDS, DMD, MS, eMBA

Periodontology and Implant Dentistry
Dr. Irina Dragan is board certified and an examiner for the American Board of Periodontology and Implant Dentistry. She is part-time faculty in postgraduate periodontics at Harvard School of Dental Medicine and an adjunct associate professor of periodontology at Tufts University School of Dental Medicine. She is a periodontist and clinical researcher at The Perio Studio, a practice limited to periodontology and implant dentistry in Boston, MA.

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