The Clinical Challenge: Combating Bundle Bone Resorption in the Maxilla

Following tooth extraction, the inevitable resorption of the tooth-dependent bundle bone frequently results in significant alterations to the alveolar ridge. This biological process is especially problematic in the maxillary anterior region, where a thin buccal bone plate and high aesthetic demands—such as a high smile line—increase the risk of procedural failure. For patients with advanced periodontal disease, traditional grafting often struggles to prevent the collapse of the ridge volume required for stable implant placement.

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Key Methodology & Insights (PET and Dentine Autografts)

The treatment protocol for this 58-year-old patient utilized a multi-modal biological approach to maximize tissue stability:

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• Partial Extraction Therapy (PET): Leaving either the whole root (Root Submergence Therapy) or a buccal fragment (Socket Shield Technique) reduces resorption by preserving the healthy periodontal ligament and vital blood supply to the surrounding tissues.
• Root Submergence Therapy (RST): Central incisors were decapitated and reduced to 3 mm below the gingival margin to prevent damage to the buccal socket wall and enable physiological pontic site development.
• Autologous Dentine Grafting: Extracted premolars were processed into particulate dentine using the Smart Dentin Grinder, providing a highly biocompatible matrix rich in growth factors like BMP-2.
• Osseodensification: Utilizing Densah burs allowed for simultaneous bone expansion, compaction, and crestal sinus elevation during molar site preparation.
• Biological Tissue Sealing: Extraction sockets and peri-implant gaps were grafted with dentine and sealed with platelet-rich fibrin (PRF) membranes or connective tissue grafts using tunnel preparations to ensure rapid healing.
• Two-Year Stability: Long-term follow-up confirmed excellent aesthetic conditions and no radiographic bone loss at the implant sites or submerged roots.

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"The presence of the periodontal ligament seems to preserve a higher amount of surrounding hard and soft tissue, compared with conventional socket preservation techniques."

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From Research to Practice

This case illustrates that "biology-first" protocols—leveraging the patient's own roots and teeth—provide superior dimensional stability compared to many conventional synthetic materials. By mastering the technical demands of SST, RST, and autologous dentine processing, clinicians can reduce surgical morbidity and patient costs while achieving high-end aesthetic results. These advanced workflows are a core pillar of the MAXI Hybrid course, providing surgeons with the evidence-based tools to manage even the most compromised maxillary sites.

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Expert Tip: For successful Root Submergence Therapy (RST) at pontic sites, reducing the root height to at least 3 mm below the gingival margin is a prerequisite. This ensures sufficient space for soft-tissue thickness and a dense primary closure—ideally using a connective tissue graft or PRF membrane—to facilitate a rapid, uneventful healing process.