Mauricio, do the alveolar ridge preservation measures belong exclusively in the hands of specialists?
No, every general practitioner is capable of pulling a tooth. But it is a fact that performing ridge preservation techniques requires more planning and causes some immediate additional costs for the patient. This is probably one of the main reasons why practitioners are less willing to propose more sophisticated treatments. The big challenge is to educate the practitioners on the advantages of ridge preservation for the benefits of a better long-term outcome. It is therefore indispensable to create more awareness for this topic.
Is ridge preservation limited to the anterior region, or can you also see advantages in applying in the posterior region?
Of course there is no limitation. Due to aesthetic reasons, the anterior region is probably the most common region where you perform ridge preservation. But there is no reason to rule out using it for the posterior region when it is beneficial to the patient. By performing ridge preservation in this region you may, for example, prevent a sinus lift procedure as suggested in the study of Rasperini et al (2010).
How do you routinely treat fresh extraction sockets?
It depends on the aesthetic requirements of the particular case. If aesthetic requirements are low or moderate, I may perform socket graft and four months later implant placement or in anatomically favourable sites, immediate implant placement combined with socket graft. On the other hand, in cases with high aesthetic requirements, I may extract and perform implant installation combined with ridge augmentation six to eight weeks later, but this is my personal approach and to choose the appropriate treatment depends just as much on the patient's expectations.
What indications do you use Geistlich Bio-Oss collagen for, and how do you apply it?
Besides treating the extraction socket the most common indications are small defects such as periodontal Or peri-implant defects and 'filling the gap'. I never apply it as a whole block. We moisten it with saline solution a few minutes before application and cut the block into very small pieces with scissors. This allows me to form the block and adapt it to the shape of the respective socket or defect.
Where do you see the benefits of the embedded 10 per cent collagen in comparison to the loose granules of Geistlich Bio-Oss?
I have a personal hypothesis regarding this, but this is not based on scientific investigation. In my opinion, if you press together the Geistlich Bio-Oss collagen, the bone granules might be displaced towards the bottom of the extraction socket. The collagen forms a layer on the coronal portion, thus protecting the graft and possibly supporting the healing process. Even if the socket is not perfectly sutured the collagen cover layer on top may contribute to less contamination and better wound healing. The other advantage that is well known to everyone is the excellent handling characteristics of the material and the easy application. The only way to prove the difference between both biomaterials and the advantage of the 10 per cent collagen is by running a study where you compare Geistlich Bio-Oss' granules directly to Geistlich Bio-Oss collagen application following tooth extraction.
Based on your previous preclinical findings on the topic of extraction sockets are you planning to perform similar clinical experiments?
Yes, such a study is actually already on-going. The goal is to confirm the results of our dog studies. But this is still being researched and the results will be published very soon.
What is, in your view, the most unanswered question in relation to extracting teeth?
Personally I am very interested to discover why I cannot prevent the loss of the buccal bone. The current ridge preservation techniques only allow compensating for the loss of bundle bone. However, it is still not possible to maintain it after a tooth extraction.