Several Alveolar Ridge Preservation (ARP) procedures have been proposed over the years. The purpose of this study was to describe the new Modified Periosteal Inhibition (MPI) technique for ARP. Seven patients were enrolled (age range: 28–72 years old; 5 males, 2 females). In total, nine hopeless teeth were treated. Following the elevation of a full-thickness flap, atraumatic tooth extraction was conducted, preserving the buccal bone of the alveolar socket. OsteoBiol^® Lamina Soft (Tecnoss^®, Giaveno, Italy), 0.5 mm thick, was suitably shaped (8–10 mm in height, extending from the mesial and to the distal corners of the socket). The lamina was gently positioned between the buccal periosteum and the buccal bone plate. Tisseel^® (Baxter Healthcare Corporation, Deerfield, IL, USA) was applied to seal the cortical membrane. The flaps were sutured with PTFE 4-0 (Omnia, Fidenza, Italy). Postoperative instructions were provided. Patients were strictly monitored during the follow-up. No early or late biological complications were experienced. Cone Beam Computed Tomography (CBCT) exams were performed at baseline and 4 months later. The thickness of the buccal cortical bone at baseline was 1.18 ± 0.57 mm. The pre-operative and post-operative ridge widths were 10.74 ± 1.54 mm and 11.16 ± 1.57 mm, respectively. A horizontal ridge increase of 0.41 ± 0.21 mm was observed during the healing period. At 4 months of healing, the bone volume was adequate for implant placement and no additional bone regeneration procedures were required. MPI technique was effective in preventing the horizontal contraction of the post-extraction socket. Further studies will be needed in the future to confirm our positive results.

Background: Alveolar socket preservation is a topic of serious interest, and researchers have investigated this problem quite extensively. In terms of aesthetics, it is very important to avoid bone resorption if the clinician decides to insert the implant immediately after the extraction. Recently, a new approach utilizing a barrier external to the socket has been developed, which has advanced the evolution of this technique. Immediate implants have also created some difficulty when re-evaluated in long-term follow-up, especially when an aesthetic result is part of the goal of the procedure. Methods: The modified periosteal inhibition (MPI) technique, which has shown interesting outcomes, is evaluated in this paper on a large group of patients. In this case series, among 14 patients, 11 received immediate implants using the MPI technique and immediate provisionalization, and 3 received immediate implants using the MPI technique and customized healing abutment. All patients showed ridge preservation to different degrees, ranging from 0.02 to 1.17 mm, with an average gain of 0.51 mm. Results: all of the 14 patients maintained the original ridge shape, and 1 showed an increase in bucco-lingual size. Conclusions: This case series confirms the promising information reported in earlier studies on this technique. Larger samples will be necessary to confirm the predictability of this new approach.

Background: Bone grafting in post-extractive site improves tissue regeneration. Soft tissue sealing of the grafted post-extractive alveolus is supposed to limit microbiological contamination from the oral cavity and to stabilize the coagulum. Several techniques are presented in the literature to reach this goal using different heterologous matrices or autogenous grafts. In addition, recently, a technique based on the use of granulation tissue in the post-extractive alveolus has been proposed. Aim: To compare the effect of different graft sealing approaches in post-extractive sites by qualitatively evaluating their healing process. Materials and Methods: This retrospective investigation included 30 patients requiring post-extractive site regeneration in the aesthetic area. Post-extractive sites were regenerated using a bovine bone matrix and patients were divided into three groups (10 patients in each group) according to the material used to seal the alveolar socket. In the UD group, the granulation tissue was used to seal the defect; in the PC group, epithelial-connective soft tissue graft was used, and in the COLL group, a collagen-based membrane was employed. Images of the post-extractive sites at different follow-up periods (2 and 12 weeks) were taken and the healing process was blindly evaluated by two independent practitioners. The Healing Index (HI) by Landry, Turnbull and Howley was used to assess the quality of the healing process. The combination of presence/absence of five clinical criteria defines an HI ranging from 1 (very poor) to 5 (excellent). Patients’ clinical-pathological variables were recorded. One-way ANOVA was used to explore the dependence of HI on the different socket preservation protocols. Results: Based on clinical-pathological characteristics of the included patients, there were no statistically significant differences among the different sealing techniques. At the 2-week follow-up appointment, HI did not differ among the socket preservation protocols evaluated. Moreover, smoking status and reason for extraction did not influence the HI among the three groups (two-way ANOVA p-value = 0.686, p-value = 0.248 respectively). At the 2-week follow-up appointment, HI was significantly different among the socket preservation protocols investigated. Specifically, the group undergoing collagen-based socket preservation procedure reported the highest HI, compared to the other two techniques (COLL mean 4.60 ± 0.5; PC mean 3.5 ± 1.2; UD mean 3.4 ± 0.5, one-way ANOVA p-value 0.006). Conclusions: The use of collagen porcine membranes may represent a suitable option to improve the patient healing process in grafted post-extractive sites together with reducing the surgical intervention time compared to alternative sealing techniques.

Background: Extracted tooth material has been seen as a valuable alternative to synthetic biomaterials. Aims: A novel flapless alveolar socket preservation (ASP) procedure with demineralized extracted tooth dentin graft material covered by three reabsorbable membranes was histologically and clinically evaluated 4 months after bone healing. Methods: Ten patients were enrolled and separated into two groups. Five post-extractive sites without buccal and/or palatal bone walls were treated with the flapless ASP procedure with demineralized tooth dentin covered with three reabsorbable membranes (Group A—GA). Five patients were treated with primary wound closure covered only with a reabsorbable membrane (Group B—GB). Bone biopsies were performed for histologic and histomorphometric analyses. Results: In both procedures, all clinical outcomes showed good healing of hard and soft tissue and a good maintenance of maxillary architecture. The histological analysis showed no necrosis or inflammatory areas in either group. The histomorphometric analysis showed higher total bone volume in GA (62.78 ± 7.97%) compared to GB (48.04 ± 9.32%), higher vital new bone in GA (57.53 ± 11.16%) compared to GB (42.41 ± 13.06%) and similar values for residual graft in GA (5.24 ± 5.82%) compared to GB (5.29 ± 4.83%). Conclusions: The data obtained show how this novel technique, mixed with the dentin-derived graft material, seems to promote higher bone regeneration.

Following tooth extraction, alveolar ridge undergoes a physiological and inevitable remodeling process that could influence the prosthodontic rehabilitation. Therefore, augmentation of an insufficient bone volume is often indicated, although it remains a significant challenge in clinical practice. The aim of this case report was to scientifically validate a new minimally invasive surgery technique called “Simplified Apposition Technique” (S.A.T), which consists in the use of deproteinized bovine bone, human fibrin glue and collagen membrane in association with a post-extraction socket, in order to obtain an increase of the horizontal ridge dimension in the nearby atrophic bone crest. A 69-years-old man patient was enrolled in this study. The hopeless tooth 4.7 was extracted and the ridge reconstruction and the socket preservation were carried out following S.A.T. After 11 months, the formation of newly bone was evaluated through radiographic analysis (Cone Beam Computed Tomography, CBCT) comparing the status before and after surgery and at 2.5 years of follow-up. Simultaneously, an implant was placed in the regenerated site and the bone chips remaining in the drills were used for the histological evaluation. The CBCT revealed an increase of the bone crest width from 3.7 to 6.5 mm and, after 2.5 years of follow-up, the bone width has remained stable. The histological evaluation showed various stages of bone formation and maturation with a good integration of the regenerated area. According to these results, S.A.T can be considered a good surgical technique for horizontal ridge augmentation in the atrophic bone, near the extraction site.

Background/Obectives: Alveolar bone resorption after tooth extraction compromises esthetics and implant placement. Conventional alveolar ridge preservation (ARP) relies on grafting. This randomized controlled study evaluated a graft-free, lamina-based approach aimed at preserving ridge morphology by protecting the buccal cortical plate. Methods: Forty alveoli were randomly assigned to Guided Alveolar Ridge Preservation (G-ARP) with a subperiosteally positioned cortical lamina (test) or unassisted healing (control; CTRL). Cone-beam computed tomography (CBCT) was performed before extraction and after five months. Vertical and horizontal dimensional changes were statistically compared. Results: Healing was uneventful. At five months, the G-ARP group showed a vertical gain of 0.5 mm and a horizontal reduction of 0.2 mm, whereas the CTRL group exhibited a vertical loss of 1.7 mm (p < 0.01) and a horizontal loss of 2.7 mm (p < 0.001). Effect sizes were large for vertical change and very large for horizontal change (Hedges’ g = 0.95 and 2.19, respectively). Regeneration occurred through native bone formation without grafts. Conclusions: Subperiosteal placement of a cortical lamina effectively preserved ridge dimensions after extraction. This graft-free approach may offer technical and biological advantages while supporting new bone regeneration.