A Periodontal Expert: Staged Approach with Ridge preservation / augmentation + Esthetic dental implantation

How can a ridge be preserved when the tooth it contains an advanced periodontal disease?

Nemcovsky CE, Serfaty V. Alveolar Ridge Preservation Following Extraction of Maxillary Anterior Teeth. Report on 23 Consecutive Cases. J. Periodontol. 1996; 67(4):390-395.

Commentary: There is no doubt that post-extraction bone loss is a serious problem for periodontally involved teeth. However, the use of hydroxyapatite to augment ridges and repair periodontal defects has been received with mixed reviews in the periodontal community. Some clinicians swear by it and others refuse to use it. One of the major criticisms has been its motility and migrative tendencies when not placed properly. The authors in this case report suggest that the deeper flap secures the HA in place to reduce migration. According to these investigators, packing the alveolus with HA may indeed preserve alveolar bone; but the limitation of not being able to place implants in sites treated so, make it an irreversible process. Clinicians need to consider where a patient is going to be long term and other author have suggested the use of guided tissue regeneration as ridge maintenance procedure. Hence, it is critical to understand where a patient wants to go with treatment. If finances are a concern, they may not always be. The practitioner must then consider which service is really best for the long-term prognosis of the patient. A maintained ridge is great but not if it requires a future corrective procedure for patients who may have other options available to them in the future. Nonetheless, this preservation option may be well suited to many patients.

**A clinical case of long-term root resorption, ridge preservation with GBR technique and esthetic dental implantation and restoration later! --- Surgery and Prosthetic reconstruction by Dr. Perio

* R't piture is pre-extraction ; L't picture is final restoration (total 1 year!)