Socket Augmentation: Rationale and Technique (Part 2)

Layers Technique (when buccal plate is ≤1 mm thickness)

The layers technique was developed to maximize bone healing in sockets with compromised healing potential.
A combination of a bone replacementgraft and a collagen wound dressing material should be used when the buccal socket wall is ≤1 mm thick at approximately 2–3mm below the alveolar crest and/or occurrence of dehiscence or fenestrations are found. Mineralized bone grafts that are quickly replaced by host bone are
preferable.
The bone graft should be tamped down lightly, and overfill should be avoided. Adequate space between the graft particles is critical to allow for revascularization to spread throughout the graft, bringing the proteins and growth factors necessary for new bone growth (Becker et al. 1992, Mellonig 1996).

The histologic data obtained from our unpublished data indicated 68% of vital bone, 5% of residual particle, and 27% of connective tissue. This is similar to the human host bone component. Sites that may also benefit from using this technique include those with thin bone ≤1 mm, periapical pathologies, and sockets of multirooted teeth associated with loss of the interradicular bone.

The histologic data obtained from our unpublished data indicated 68% of vital bone, 5% of residual particle, and 27% of connective tissue. This is similar to the human host bone component. Sites that may also benefit from using this technique include those with thin bone ≤1 mm, periapical pathologies, and sockets of multirooted teeth associated with loss of the interradicular bone.

Abd El Salam El Askary, Fundamentals of Esthetic Implant Dentistry, 2007

Future posts will describe cases,  in which the buccal plate is absent or was lost during exodontia require a different approach

Socket Augmentation: Rationale and Technique

Tooth extraction, either traumatic or atraumatic, results in alveolar bone loss, both in width and height (Bays
1986, Mecall and Rosenfeld 1996, Mecall and Rosenfeld 1992, Mecall and Rosenfeld 1991). An average of 40% to 60% of original height and width is expected to be lost after tooth extraction, with the greatest loss happening within the first year (Sevor and Meffert 1992, Polizzi et al. 2000, Grunder et al. 1999, Werbitt and Goldberg 1992, Werbitt and Goldberg 1991). This can negatively influence bone volume that is needed for future dental implant placement as well as proper ideal esthetic restoration. Research has demonstrated that the alveolar ridge at the maxillary anterior area can be reduced by 23% in the first six months after tooth extraction, and an additional 11% in the following five years (Artzi et al. 2000). In the posterior mandible, resorption happens primarily in the buccal/labial direction, resulting in a lingual displacement of alveolar crest (Artzi et al. 2000).

Traditional Socket Management with or without Collagen Wound Dressing Material (socket management when
buccal plate is ≥1 mm thickness):

Abd El Salam El Askary, Fundamentals of Esthetic Implant Dentistry, 2007

Future posts will describe cases, when buccal plate is ≤1 mm thickness and Cases in which the buccal plate is absent or was lost during exodontia require a different approach