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Alveolar preservation technique with phenotype increase: A case report

Manuel Feregrino Mendez

Alveolar bone preservation techniques are the surgical acts that are performed during the extraction of a tooth to prevent the loss of alveolar bone and gingival volume. In a systematic review Van Der Weijden et al. Found If after extraction an alveolar preservation technique is not performed, an average reduction in width of the alveolar ridge was 3.87 mm and height was 1.67 mm. The main reason for this collapse is the vestibular bone wall, which is almost always very thin or in some cases absent, which causes it to have very little blood supply due to the cortical nature of this bone. After extraction, the irrigation from the periodontal ligament is eliminated and this leads to reabsorption and clinical collapse horizontally and vertically. Due to the loss of dental volume, the gum loses its insertion of the fibers above the bone crest and the junctional epithelium, promoting the collapse of gingival height. The blood clot formed after extraction is not enough to preserve the vertical and horizontal dimensions of the alveolar process, which is why alveolar preservation techniques are justified. Plasma rich in growth factors (PRGF) is a technique where blood is obtained from the patient prior to surgery in order to obtain platelet-rich plasma that has proven to be a predictable technique to promote healing of soft and hard tissues as well as a increase the phenotype. Gingival thickness and keratinized tissue width are important parameters used to determine the periodontal phenotype. Subjects with a thin gum have been shown to tend to have more gingival recession compared to those with a wide gum. The aesthetic result of the anterior maxilla is particularly related to the soft tissue profile in the buccal area, although alveolar preservation techniques reduce bone remodeling after extraction, there is still few research on techniques that improve the profile of soft tissue in the mouth. Vanhoutte et al. described a alveolar preservation technique using a "saddled" connective tissue graft (CTG) combined with the insertion of slowly resorbable biomaterials into the alveoulos. In this article we present the alveolar preservation technique with phenotype increase. In this post-extraction technique, we use PRGF and CTG obtained from the palate or tuberosity to invaginated it in the buccal area and suture it coronally.