Case: Ridge Augmentation with OSSIF-i Demineralized Sponge Strip

This case is presented by Dr. Kevin Frawley, DDS.

Pre-op (see case photos below)
This asymptomatic patient presented with an existing 3-unit hybrid Maryland bridge from #29-31 that had been in place for over 10 years. The esthetics were poor, and #31 showed signs of Periapical Radiolucency (PARL). After close monitoring for several months, the PARL worsened, and a buccal fistula developed. After treatment options were discussed, extraction and implant therapy was selected by the patient. Treatment aims included: improved esthetic spacing and contours, improved soft tissue health, and removal of any infection associated with the PARL.

Extraction/Graft(see case photos below)
The existing prosthesis was removed without complication. After reviewing CBCT data, it was clear that there was not enough buccal-lingual bone thickness for successful implant placement in site #30. A full thickness flap was elevated and CBCT measurements were confirmed. #31 was sectioned, atraumatically extracted, the socket cleaned with a serrated curette, and grafted with Surgical Esthetics OSSIF-i Mineralized Cancellous .25-1mm particulate allograft.

A PTFE membrane was sized and placed on the buccal of #30, ensuring coverage past the margin of the defect in all directions. Decortication potholes were made with a high-speed round carbide bur, with copious irrigation, on the buccal of site #30. Once bleeding was induced, a Surgical Esthetics OSSIF-i Demineralized Sponge Strip allograft (10x6x7mm) that had been hydrated with sterile water for 10 minutes, was placed into the buccal defect. No fixation screws or pins were used. Surgical Esthetics OSSIF-i Mineralized Cancellous .25-1mm particulate allograft was placed surrounding the sponge. The ePTFE membrane then covered the graft material, and was tucked under the lingual flap. Nylon 5-0 monofilament interrupted sutures secured the graft and membrane in place. A simultaneous root-coverage procedure was done on #29, using a bonded-suture technique. We chose not to get primary closure, to preserve the vestibule and maintain the amount of keratinized tissue. ePTFE membrane and sutures were removed after 1 month.

Implant Placement (see case photos below)
After 5 months of healing, CBCT and surgical examination confirm readiness for implant placement. Compared to pre-op CBCT data, the Surgical Esthetics OSSIF-i Demineralized Sponge Strip allograft yielded >5mm of horizontal ridge augmentation! Two implants were placed and healing caps utilized. Papilla-saving suture techniques were employed.

Restorative (see case photos below)
After 1 month, impression and restorative process commenced. Final screw-retained restorations were secured. All treatment goals were achieved. Three years later, the tissue, bone, and restoration/implant complexes are very stable.

About Dr. Kevin Frawley, DDS.
Dr. Kevin Frawley, D.D.S. is an exceptional person and a professional dedicated to helping his patients create the smile they were meant to have. He practices in Beverly Hills with his son, Dr. Shawn Frawley and his daughter, Dr. Michele Frawley.

He received his undergraduate degree from UCLA with a B.S. in Biology in 1977. He enjoyed being a Bruin so much that he completed his dental degree at UCLA as well in 1981. After a year residency at the Veterans’ Administration in Westwood, he established his private practice in cosmetic and implant dentistry in Beverly Hills. Dr. Frawley taught at the UCLA School of Dentistry for 15 years passing on his knowledge to the dentists of tomorrow.

Dr. Frawley is committed to the development of dentistry on all levels and is involved with both local and national dental associations. He is a member of the American Dental Association, California Dental Association and many other dental organizations. He is past president of the Beverly Hills Academy of Dentistry and past president of the Los Angeles Dental Society. Dr. Frawley served as a CDA delegate for over 25 years and as a trustee for the California Dental Association for 6 six years.
Dr. Frawley also lectures nationally and internationally on bone grafting and implants. He teaches live surgical courses as well that enable practicing dentists to gain the experience they need to feel confident to begin placing implants.

Dr. Frawley is the Founder and CEO of Surgical Esthetics, a regenerative material and education company.

3 thoughts on “Case: Ridge Augmentation with OSSIF-i Demineralized Sponge Strip

    • Kevin Frawley says:

      Yes, the sutures under the Barricaid are left for a month. I used the Surgical Esthetics PTFE sutures, but as long as you are using any monofilament suture bacteria will not grow on the material. So I would not use silk in this situation

  1. Arsenio B Lim Jr says:

    How many months do you wait before implants are placed and how many months after implants placement do you load this implants?

Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Cases, Regenerative.
Bookmark Case: Ridge Augmentation with OSSIF-i Demineralized Sponge Strip

Videos to Watch:

Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!
Guided Implant Surgery & Immediate Temporisation

This video demonstrates the placement of a missing pre-molar using computer-guided surgery and immediate temporization.[...]

1 Comment

Watch Now!
Implantoplasty to Treat Peri-implantitis

This video shows the use of the Implantoplasty technique to treat peri-implantits. Granulation tissue and[...]

9 Comments

Watch Now!
Placement of Implant Using EZ Devices

This video demonstrates the placement of a dental implant in the upper jaw using the[...]

Watch Now!
BonePen: Improve Positioning of Implants

A short video demonstrating close up the use of the BonePen Kit, a set of[...]

Watch Now!
Vertical and Horizontal Bone Augmentation with Khoury Bone Plates

This video shows a way to utilize thin autogenous bone plates to create stunning bone.[...]

4 Comments

Watch Now!
Maxgraft bonering: immediate implant placement

This video shows a live surgery using the maxgraft bonering, which is a pre-fabricated[...]

1 Comment

Watch Now!