Implant Site Guided Bone Regeneration and Pontic Site Ridge Preservation: A Case Report

Guided bone regeneration (GBR) is a therapeutic modality to achieve bone regeneration with the use of barrier membranes. The use of deproteinized bovine bone material (DBBM) for ridge preservation allows the preservation of the edentulous ridge dimensions. Here, we present a case of horizontal GBR using DBBM and a resorbable membrane, with simultaneous implant placement. Simultaneously, ridge preservation of the pontic area, using DBBM within a “socket seal” procedure was performed. Two implants were places at sites 23 and 26 to support a fixed partial denture (FPD). The mesial implant showed exposed buccal threads, which were then covered with autogenous bone particles and small size granules of DBBM. The collagen membrane was stabilized with periosteal mattress suture. Six months postoperatively, CBCT images revealed a stable buccal bone layer at the implant site, indicating a successful GBR procedure. At this point in time, tooth 24 was atraumatically extracted. A ridge preservation was done utilizing DBBM, and a soft tissue graft form the tuber. A ceramic-metal FPD with excellent “white aesthetics” and a harmonic transition zone to the soft tissue was fabricated. At 3 years follow up, the peri-implant bone levels were stable, and the clinical outcomes were excellent. It is concluded that a GBR procedure, utilizing DBBM and a collagen barrier membrane with simultaneous implant placement, as well as ridge preservation using DBBM, are predictable therapeutic methods. However, gentle manipulation of the soft tissues, and wound stability, with tension-free passive closure of the wound margins are prerequisites for a long-term clinical success.