Alveolar Ridge Preservation Using Different Biomaterials: Report of Two Cases

Case Report

Austin Dent Sci. 2023; 8(1): 1039.

Alveolar Ridge Preservation Using Different Biomaterials: Report of Two Cases

Aysha Jebin A¹*; Avexilla Nogrum²

¹Department of Periodontics, Krishnadevaraya College of Dental Sciences and Hospital, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India

²Department of Periodontics, Vydehi Institute of Dental Sciences, Bangalore, Karnataka, India

*Corresponding author: Aysha Jebin A Department of Periodontics, Krishnadevaraya College of Dental Sciences and Hospital, Krishnadevaraya Nagar, New Airport Road, Bangalore, Karnataka, India Tel: +91 98995205190, +91 9448757407; Fax: 08028467084 Email: ayshpathu3@gmail.com

Received: August 23, 2023 Accepted: September 25, 2023 Published: October 02, 2023

Abstract

Background: The underlying bone framework always determines the soft tissue contours. Numerous aetiologies are linked to tooth loss, which frequently causes abnormalities of the alveolar ridge. Alveolar bone changes in volume as a result of physiologic bone remodelling after tooth extraction, which impacts the way how edentulous area is treated with prosthetic rehabilitation. By limiting the natural post-extraction resorption process, socket preservation methods following tooth extraction will lessen the need for additional ridge augmentation techniques before implant placement while maintaining the existing bone.

Case Report: Two male patients, ages 36 and 32, were referred for the extraction of their severely deteriorated first molars in the mandible and for the placement of dental implants to restore the area. Patients were identified as having periodontitis and root caries respectively. In one example, the socket was promptly grafted with Platelet Rich Fibrin with xenograft, and in the other with a collagen sponge, after the irreparable tooth was “atraumatically” excised without creating a flap. After suturing the region, a periodontal dressing was applied and no membrane was employed.

Conclusion: After six months, the ridge’s architecture was preserved, and clinical examination showed outstanding soft tissue healing. At six months, a clinical and radiological follow-up evaluation demonstrated consistent and positive outcomes. This article discusses and emphasises the significance of socket preservation after tooth extraction utilising different biomaterials in different case scenarios.

Keywords: Socket preservation; Ridge preservation; Resorption; Implants

Introduction

Following tooth extraction, volumetric changes in the remaining ridge are expected [1]. Difficult tooth extraction procedures can result in further bone loss due to surgical trauma [1]. According to Botticelli et al. study, buccal bone resorption is more severe than lingual bone resorption. By preserving the alveolar ridges after the tooth is removed, it facilitates the eventual placement of implants. Since it supports healthy keratinized tissue and sets the soft tissue profile, which reflects the underlying bone form, alveolar bone is crucial for long-term cosmetic success [1].

Socket preservation is a suitable remedy for the low bone volume as well as rapid bone loss following tooth extraction [2]. "In an approach known as "socket preservation," bone grafts materials are placed in the socket at the time of tooth extraction [2]." There are several bone graft materials, including autologous grafts, allogenic materials, and xenografts, that can be used to preserve extraction sockets [3]. These bio-materials in the extraction socket mainly act as volume preservers and space makers, and they generated a relatively little change in the extraction socket. However, the materials choose depends on how the socket will be preserved [3].

Here, we show two distinct cases of socket preservation employing Platelet Rich Fibrin (PRF) with xenograft and collagen plugs. These cases were done in view of the significance of hard and soft tissue healing at extraction sites as well as investigations of the role of various bio-materials for the same.

CASE 1: Socket Preservation Using Platelet Rich Fibrin (PRF) and Bone Grafts

Clinical History and Management

A 36 year old male patient who visited the department of periodontics with a chief complaint of mobile teeth with mandibularr right back tooth region. The patient's medical history was normal, and no drugs were being taken by him. Oral clinical examination reveals grade 3 mobility with mandibular right first molar (Figure 1A). The Intra Oral Perapical (IOPA) Radiograph showed there is no bone support with mandibular right first molar (Figure 1B). After discussing the treatment options with the patient, he agreed for extraction of the teeth, followed by socket preservation with bone regeneration for implant placement. From the patient informed written consent was obtained. Two weeks before the surgery, a thorough scaling and root planing was carried out. 9 ml each of venous blood samples were taken prior to extraction on the day of procedure. The PRF manufacturing procedure was strictly followed when the blood samples were taken. Using a specific centrifuge, the Hettich® Universal 320, the venous blood was immediately centrifuged at 400xg at room temperature for 10 min. It was then set aside for 3-5 min. Red Blood Cell (RBC) debris was placed at the bottom layer, PRF gel was placed in the middle, and supernatant was placed at the top layer (Figure 1C). During surgery, under local anaesthesia a periotome was utilized to separate the periodontal fibers and subsequently luxate the tooth. After that, extraction forceps were used to remove the tooth. (Figure 1D) Following extraction, the residual granulation tissue was removed by curettage in the socket using a spoon excavator and saline irrigation was done (Figure 1E). The RBC layer was removed from the PRF gel using sterile tweezers. After saline irrigation, PRF membranes were cut to the appropriate size, mixed with (CERABONE PLUS) bone graft, and implanted (Figure 1F) into the extraction socket (Figure 1G). Following suturing (Figure 1H) and periodontal pack placement, the patient was given post-operative instructions and medications to reduce the risk of infection. The patient was given the prescriptions for 500 mg of amoxicillin TDS for 5 days and 400 mg of metronidazole TDS for 5 days. In order to lessen the patient's postoperative pain, paracetamol was administered. The sutures were removed after a week. The patient was recalled for a clinical and radiological assessment after six months. Six months from the procedure, the patient was reevaluated for implant placement. Clinical assessment of the socket preservation location revealed that the tissues had healed properly (Figure 1I) and radiographic analysis revealed radiopacity at the grafted site, indicating bone regeneration at the socket preservation area (Figure 1J).