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:

Titanium Mesh for Ridge Augmentation

The use of titanium mesh is a reliable method for ridge augmentation to provide adequate[...]


Watch Now!
Implant Grafting Techniques: Demineralized Sponge Strip and Tunneling

This video reviews several unique grafting and surgical techniques, including the use of demineralized cancellous[...]

Watch Now!
Mandibular Fixed Screw Retained Restoration

This video shows the use of a surgical guide for a mandibular fixed screw retained[...]

1 Comment

Watch Now!
Clinical Tip for Fixation of a Collagen Membrane

This video provides a clinical tip with regards to the fixation of a collagen membrane.[...]

Watch Now!
Lower Molar Extraction with Graft

Video showing lower left first molar extraction, followed by a socket graft, and then immediate[...]


Watch Now!
Maxillary Bone Reconstruction

This video demonstrations Maxillary Bone Reconstruction using Subnasal Floor Elevation and an Osteotome Closed Approach[...]

Watch Now!
Infection of Lower Premolar: Extract and Place Implant

In this video, the lower left 2nd premolar was extracted due to infection, and implants[...]

Watch Now!
Flapless Immediate Implant and Provisional

This video shows a technique showing using the patient's own tooth as a provisional at[...]

Watch Now!
Extraction and Immediate Implant with Luxator LX

Extraction of tooth #8, using Luxator LX, and then an immediate implant and provisional.[...]


Watch Now!
Dealing with the Implant Gap

This short video discusses how to best deal with the gap after immediate implant insertion[...]

1 Comment

Watch Now!
Lower Right Molar Extraction & Immediate Implant Placement Using i-PRF

In this video, the lower right second molar was extracted and grafted with i-PRF and[...]


Watch Now!
Maxillary Implantation with Treatment of Chronic Sinusitis

This video shows two cases where implants were placed following treatment of Sinusitis. [...]


Watch Now!