Indication Sheet

Treatment of Extraction Sockets

601679/1706/e
Product range A new classification Background information
Various classification systems for extraction sockets have been proposed thus far1–5 mostly focusing on the anterior teeth.1–3 Classifying different
types of sockets should not solely be based on defect location. Information regarding as to soft and hard tissue breakdown and the number of
remaining walls of the socket is crucial for determining the appropriate treatment protocol.
In the following extraction sockets impaired due to chronic pathology are classified into 5 types depending on the residual bone morphology
Geistlich Bio-Oss® TYPE I and the level of soft tissue. Mesial and distal proximal bone peaks of single tooth extraction sockets are assumed to be intact if not described
Small granules (0.25–1 mm) | Quantities: 0.25 g, 0.5 g, 1.0 g, 2.0 g (1 g ≈ 2.05 cm3) soft tissue height intact (CEJ) otherwise in the case.
Large granules (1–2 mm) | Quantities: 0.5 g, 1.0 g, 2.0 g (1 g ≈ 3.13 cm3) hard tissue intact
The small Geistlich Bio-Oss® granules are recommended for smaller 1–2 socket defects and for Inflammation damage limited to apical area Surgical Procedure
contouring auto­genous block grafts. The large Geistlich Bio-Oss® granules enable improved rege- Special attention to immediate implant placement is possible,
neration over large distances and provide enough space for the ingrowing bone. fill-the-gap using biomaterials is necessary

Geistlich Bio-Oss® Collagen

Geistlich Bio-Oss® (small granules) + 10% collagen (porcine) TYPE II
Sizes: 100 mg, 250 mg, 500 mg
soft tissue height intact (CEJ)
Geistlich Bio-Oss® Collagen is indicated for use in periodontal defects and extraction sockets.
Through the addition of collagen, Geistlich Bio-Oss® Collagen can be tailored to the morphology hard tissue loss of 1 wall either buccal or lingual
of the defect and is particularly easy to apply. Inflammation damage buccal/lingual wall destruction Fig. 1 Atraumatic tooth extraction followed Fig. 2 Bone replacement material with slow Fig. 3 A bilayer collagen membrane or colla- Fig. 4 Suturing the defect without tension to
Special attention to mostly buccal wall destruction by meticulous debridement is mandatory.6 resorption rate and good biofunctionality gen matrix with good biofunctionality is used avoid moving the mucogingival line which may
Inflammatory tissues must be completely (Geistlich Bio-Oss® or Geistlich Bio-Oss® to cover the augmented area for bone graft narrow the keratinized zone. Hidden X sutures

Geistlich Bio-Gide® removed using the surgical curette or the he-

mostat. Inflammatory tissues adhering to the
Collagen) is used to fill the socket to coun-
teract bone resorption/increase the bone
protection, graft stabilization and supporting
early wound healing. The membrane can be
and healing by secondary intention can be
used to prevent loss of keratinized tissue.7–10
soft tissue should be removed with a blade. volume. applied in single or double layer fashion, the
Bilayer collagen membrane matrix should be applied in one layer.
Sizes: 25 × 25 mm, 30 × 40 mm
Geistlich Bio-Gide ® consists of porcine collagen and has a bilayer structure – a rough side that TYPE III
faces the bone and a smooth side that faces the soft tissue. Geistlich Bio-Gide ® is easy to handle:
it can be positioned easily, adheres well to the defect, and is resistant to tension and tearing. soft tissue height recession Literature references
hard tissue buccal defect
Prof. Ki-Tae Koo, Dr. Jung-Ju Kim and 
1
Funato A, Salama MA, Ishikawa T, Garber DA, Salama H. Timing, positioning, and sequential staging in esthetic implant therapy: a four-dimen-
Inflammation damage mostly buccal wall destruction
Dr. Heithem Ben Amara sional perspective. Int J Periodontics Restorative Dent 2007;27:313-323.
Special attention to ridge augmentation combined with simultaneous 2

Elian N, Cho SC, Froum S, Smith RB, Tarnow DP. A simplified socket classification and repair technique. Pract Proced Aesthet Dent 2007;19:99-
Geistlich Bio-Gide® Shape Seoul National University, Korea soft tissue augmentation needed
104.
Pre-shaped, bilayer collagen membrane 3

Caplanis N, Lozada JL, Kan JY. Extraction defect assessment, classification, and management. J Calif Dent Assoc 2005;33:853-863.
Size: 14 × 24 mm
Geistlich Bio-Gide ® Shape consists of porcine collagen and has a bilayer structure – a rough side TYPE IV-A 4

Smith RB, Tarnow DP. Classification of molar extraction sites for immediate dental implant placement: technical Note. Int J Oral Maxillofac
that faces the bone and a smooth side that faces the soft tissue. Geistlich Bio-Gide ® Shape is Implants 2013;28:911-916.
pre-shaped for increased application comfort and reduced preparation time. soft tissue height intact (CEJ) 5

Al-Shabeeb MS, Al-Askar M, Al-Rasheed A, Babay N, Javed F, Wang HL, Al-Hezaimi K. Alveolar Bone remodeling around immediate implants
hard tissue bucco-lingual destruction ≤ 50% placed in accordance with the extraction socket classification: A three-dimensional microcomputed tomography analysis. J Periodontol
Inflammation damage mostly buccal and lingual wall destruction 2012;83:981-987.
Special attention to the flap serves as barrier to preserve and augment
Geistlich Mucograft® Seal simultaneously
6

Crespi R, Capparè P, Gherlone E. Fresh-socket implants in periapical infected sites in humans. J Periodontol 2010;81:378-383.
Collagen matrix
7

Park JC, Koo KT, Lim HC. The hidden X suture: a technical note on a novel suture technique for alveolar ridge preservation. J Periodontal Im-
Size: 8 mm diameter plant Sci. 2016;46(6):415-425.
8

Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U. Extraction socket healing in humans after ridge preservation techniques: comparison
Geistlich Mucograft® Seal consists of a compact structure that gives stability while a­ llowing
open healing, and a spongy structure that supports blood clot stabilisation and ingrowth of
TYPE IV-B between flapless and flapped procedures in a randomized clinical trial. J Periodontol. 2014;85(1):14-23
soft-tissue cells.
soft tissue height intact (CEJ) 9

Barone A, Borgia V, Covani U, Ricci M, Piattelli A, Iezzi G. Flap versus flapless procedure for ridge preservation in alveolar extraction sockets: a
hard tissue bucco-lingual destruction > 50% histological evaluation in a randomized clinical trial. Clin Oral Implants Res. 2015;26(7):806-13.
Inflammation damage mostly buccal and lingual wall destruction 10
Cardaropoli D, Tamagnone L, Roffredo A, Gaveglio L, Cardaropoli G. Socket preservation using bovine bone mineral and collagen membrane: a
Special attention to the flap serves as barrier, more augmentation than randomized controlled clinical trial with histologic analysis. Int J Periodontics Restorative Dent. 2012;32(4):421-30.
preservation due to destruction

Contacts
TYPE V
> Prof. Ki-Tae Koo; E-mail: periokoo@snu.ac.kr
soft tissue height recession
hard tissue bucco-lingual destruction > Dr. Jung-Ju Kim; E-mail: freetist@gmail.com
Inflammation damage mostly buccal and lingual wall destruction > Dr. Heithem Ben Amara; E-mail: benamarahaitham@yahoo.fr
Special attention to additional vertical augmentation may be necessary
Geistlich Pharma AG
©
to achieve desired crestal height
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Type I Type III Type IV-B

Defect configuration 4-wall defect / No loss of soft tissue Defect configuration 3-wall defect / Loss of soft tissue Defect configuration 2-wall defect / No loss of soft tissue

Pathology Endodontic origin / Fracture / Severe caries Pathology Periodontal origin / Periodontal-Endodontic combined Pathology Periodontal origin / Periodontal-Endodontic combined

Bone graft Geistlich Bio-Oss or Geistlich Bio-Oss Collagen

® ®
Bone graft Geistlich Bio-Oss Collagen
®
Bone graft Geistlich Bio-Oss® or Geistlich Bio-Oss® Collagen

Membrane / matrix Geistlich Mucograft® Seal Membrane / matrix Geistlich Bio-Gide® Membrane / matrix Geistlich Bio-Gide®

Time of implant placement Immediate or delayed Time of implant placement Delayed Time of implant placement Delayed

Predictability Highly predictable Predictability Highly compromised, soft tissue augmentation necessary Predictability Highly compromised, vertical augmentation might be necessary

Ridge preservation potential Good Ridge preservation potential Poor Ridge preservation potential Very poor

Fig. 1 Classical type I defect in region 21. The pre- Fig. 2 Application of Geistlich Bio-Oss® Collagen Fig. 3 Geistlich Mucograft® Seal is applied and secu- Fig. 1 Type 3 defect in region 14 with both soft and Fig. 2 Situation after atraumatic extraction of tooth Fig. 3 Application of Geistlich Bio-Oss® Collagen Fig. 1 Radiographic view in region 37. Clinical situa- Fig. 2 Application of Geistlich Bio-Oss® Collagen Fig. 3 Fixation of the Geistlich Bio-Gide® with
dictability of the treatment is good. after debridement. red with a cross-suture. hard tissue deficiency. Radiographic view of the de- 14. after debridement. Geistlich Bio-Oss® Collagen is tion after tooth extraction. Buccal and lingual bone after debridement of the socket. cross-suture and healing with secondary intention.
fect prior to extraction. trimmed to shape to fit the defect. walls are missing, only the soft tissue remains in
normal position

Fig. 4 The surgery site shows good healing by se- Fig. 5 Placement of the implant at 4 months, the Fig. 6 Follow-up at 1 year after prosthesis delivery Fig. 4 Adaptation of Geistlich Bio-Gide® over Geist- Fig. 5 A connective tissue graft from the palate is Fig. 6 Stable clinical situation and radiographic view Fig. 4 Good soft tissue healing at 3 months post-op. Fig. 5 Clinical and radiographic control during im- Fig. 6 Stable clinical situation 1 year after prosthesis
condary intention at 2 weeks post-op. bony width of the ridge is preserved. shows good esthetic results. Radiographic control lich Bio-Oss® Collagen. added to the defect to compensate for the soft tis- at 1 year follow-up after loading. plant placement at 4 months show sufficient crestal delivery.
1 year after prosthesis delivery shows stable bony sue loss. ridge width.
situation.

Type II Type IV-A Type V

Defect configuration 3-wall defect / No loss of soft tissue Defect configuration 4-wall defect / No loss of soft tissue Defect configuration 4- or 2-wall defect / Loss of soft tissue

Pathology Periodontal origin/ Periodontal-Endodontic combined Pathology Periodontal origin / Periodontal-Endodontic combined Pathology Periodontal origin / Periodontal-Endodontic combined

Bone graft Geistlich Bio-Oss or Geistlich Bio-Oss Collagen

® ®
Bone graft Geistlich Bio-Oss or Geistlich Bio-Oss Collagen
® ®
Bone graft Geistlich Bio-Oss® or Geistlich Bio-Oss® Collagen

Membrane / matrix Geistlich Bio-Gide® or Geistlich Bio-Gide® Shape Membrane / matrix Geistlich Bio-Gide® Membrane / matrix Geistlich Bio-Gide®

Time of implant placement Immediate or delayed Time of implant placement Delayed Time of implant placement Delayed

Predictability Slightly compromised Predictability Compromised Predictability Compromised, vertical augmentation necessary

Ridge preservation potential Good Ridge preservation potential Poor Ridge preservation potential Poor

Fig. 1 Radiographic and clinical situation of the Fig. 2 Situation after extraction. Note the buccal Fig. 3 Covering of the grafted area with Geistlich Fig. 1 Type IV-A defect in region 26. Radiographic Fig. 2 Extraction site immediately after tooth ext- Fig. 3 Application of Geistlich Bio-Oss® Collagen Fig. 1 Clinical situation of type V defect in region 16. Fig. 2 Radiographic view prior to extraction docu- Fig. 3 After extraction and debridement the defect
defect. Main medical conditions include swelling, bone resorption and granulation tissue at the bot- Bio-Gide® in two layers. The flap margin is fixed view of region 26 prior to extraction displays exten- raction. after debridement. The augmented site is covered ments extended loss of bone. is filled with Geistlich Bio-Oss® Collagen. A Geistlich
acute pain and pus formation in region 36. tom of the socket. Application of Geistlich Bio-Oss® across the membrane without tension. ded bone defect. with a Geistlich Bio-Gide® membrane. Bio-Gide® is used to protect the grafted area.
Collagen after debridement of the socket.

Fig. 4 Slightly resorbed ridge contour with healed Fig. 5 Sufficient ridge width for implant placement Fig. 6 Prosthesis delivery 4 months after implant Fig. 4 Radiographic view at 4 months after extrac- Fig. 5 Clinical view at 1 year after implant loading. Fig. 6 The radiographic view at 1 year after implant
Fig. 4 Good healing by secondary intention at 2 Fig. 5 Situation prior to implant placement at 9 Fig. 6 Stable clinical/radiographic situation at 3 years soft tissue situation after 3 months of healing. after 4 months of healing. placement. Stable radiographic situation after 1 tion. The ridge preservation is limited to the height loading documents a stable bony situation.
weeks. months shows good bony situation. after loading. year of loading. of the surrounding soft and hard tissue at the time
of extraction. Additional vertical augmentation is
indicated to increase the crestal height.

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