TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background: Tooth loss requires replacement with an effective artificial restoration, among which dental implantation is considered the best option. However, when immediate implantation is contraindicated, wound healing is accompanied by collapse of the tooth socket, resulting in a reduction of its volume. Bone deficiency often complicates dental implant placement, necessitating quantitative bone augmentation through the use of bone substitute materials (1,2). Aim: The aim of this study is to perform preventive socket augmentation immediately after tooth extraction to preserve socket volume. In this approach, an osteoconductive mineral graft is combined with an osteoinductive agent— bone morphogenetic protein (BMP)—to achieve quantitatively and qualitatively adequate bone formation (8,11). Methods: Following tooth extraction and curettage, the socket is filled with a bone substitute material (xenogeneic bone combined with BMP) and covered with a resorbable collagen membrane. Dental implant placement is performed after 4–6 months. Ethical approval for this single-case study was obtained, and informed consent was acquired from the patient. Results: The study confirms preservation of the residual alveolar ridge volume with minimal changes (~8% reduction in buccolingual width and ~10% in vertical height), accompanied by formation of well-developed trabecular bone and vascularization. This approach helps avoid secondary, invasive augmentation procedures. Conclusion: Socket augmentation performed in a single visit simultaneously with tooth extraction ensures optimal preservation of socket volume with virtually no loss after healing. The combined use of a mineral xenogeneic bone graft and BMP results in fully mature, high-quality bone formation. Future perspectives: Larger cohort studies with long-term follow-up are warranted to confirm these results and optimize BMP-graft combinations.

Bone augmentation, Xenograft, Bone morphogenic protein, Bone graft protein,

References:

Tallgren A. The continuing reduction of the residual alveolar ridges in

complete denture wearers: a mixed-longitudinal study covering 25 years. J

Prosthet Dent. 1972;27:120–132.

Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue

changes at tooth extraction sites: a clinical and radiographic study in

humans. Int J Periodontics Restorative Dent. 2003;23:313–323.

Araújo MG, Lindhe J. Dimensional ridge alterations following tooth

extraction. J Clin Periodontol. 2005;32:212–218.

Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post

extraction alveolar hard and soft tissue dimensional changes in humans.

Clin Oral Implants Res. 2012;23(Suppl 5):1–21.

Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res.

;174:28–42.

Miyazawa K, Shinozaki M, Hara T, Furuya T, Miyazono K. Two major Smad

pathways in TGF-β superfamily signalling. Genes Cells. 2002;7:1191–1204.

Kim SY, Lee YJ, Cho WT, Hwang SH, Heo SC, Kim HJ, Huh JB. Preliminary

animal study on bone formation ability of commercialized particle-type

bone graft with increased operability by hydrogel. Materials (Basel).

;14:4464.

Kim CS, Kim JI, Kim J, et al. Ectopic bone formation associated with

recombinant human bone morphogenetic protein-2 using absorbable

collagen sponge and beta-tricalcium phosphate as carriers. Biomaterials.

;26:2501–2507.

Hong SJ, Kim CS, Han DK, et al. The effect of a fibrin-fibronectin/beta

tricalcium phosphate/recombinant human bone morphogenetic protein-2

system on bone formation in rat calvarial defects. Biomaterials.

;27:3810–3816.

Schwarz F, Rothamel D, Herten M, Ferrari D, Sager M, Becker J. Lateral

ridge augmentation using particulated or block bone substitutes biocoated

with rhGDF-5 and rhBMP-2: an immunohistochemical study in dogs. Clin

Oral Implants Res. 2008;19:642–652.

Yuan H, Fernandes H, Habibovic P, de Boer J, Barradas AMC, de Ruiter A, et

al. Osteoinductive ceramics as a synthetic alternative to autologous bone

grafting. Proc Natl Acad Sci USA. 2010;107:13614–13619.

Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based on

osseointegration: 50 years of progress, current trends and open questions.

Periodontol 2000. 2017;73:7–21.

Ripamonti U, Roden LC. Induction of bone formation by morphogenetic

proteins: role of the extracellular matrix. Clin Orthop Relat Res.

;468:3144–3153.

World Medical Association. Declaration of Helsinki: ethical principles for

medical research involving human subjects. JAMA. 2013;310:2191–2194.