What role do collagen plugs play in socket preservation and can other biomaterials enhance the benefits of collagen plugs?
Socket preservation is a surgical procedure aimed at limiting the physiological resorption of the alveolar ridge that occurs after a dental extraction. One of the primary goals is to maintain sufficient bone volume to facilitate future implant placement. The procedure helps compensate for the resorption of the facial bone wall. The socket preservation procedure involves the use of various biomaterials to prevent bone resorption and accelerate bone formation.
Suggested Treatment Options for various Socket Type situations
Source: Classification Based on Extraction Socket Buccal Bone Morphology and Related Treatment Decision Tree Materials (Basel). 2022 Jan 19;15(3):733. - Larissa Steigmann 1, Riccardo Di Gianfilippo 1, Marius Steigmann 2, Hom-Lay Wang 1
The Socket Plug Technique
Source: Classification Based on Extraction Socket Buccal Bone Morphology and Related Treatment Decision Tree Materials (Basel). 2022 Jan 19;15(3):733. - Larissa Steigmann 1, Riccardo Di Gianfilippo 1, Marius Steigmann 2, Hom-Lay Wang 1
(**A** ): Clinical view of alveolar socket after extraction of a second molar. The buccal bone was preserved in height but thinner than 1.0 mm. The case was classified as Socket type 1B (ST1B). (**B** ): The socket was filled with particulate bone-grating material and coronally sealed with a collagen plug. (**C** ): Surgical re-entry at the time of implant placement showed successful ridge preservation.Extraction and PRF with Collagen Plug
Source: A clinico-radiographic and histomorphometric analysis of alveolar ridge preservation using calcium phosphosilicate, PRF, and collagen plug Maxillofac Plast Reconstr Surg. 2019 Sep 2;41(1):32. - Tarun Kumar AB 1, Chaitra N T 2, Gayatri Divya PS 3,, M G Triveni 1, Dhoom Singh Mehta
Summary
Benefits of Collagen Plugs
The main benefits of a collagen plugs are:
- Wound Healing: Collagen is highly biocompatible, meaning it integrates well with the body’s tissues without causing adverse reactions. Its hemostatic properties help in controlling bleeding, which is crucial for clot formation and wound stabilization.
- Tissue Regeneration and Socket Stability: By filling the extraction socket, collagen plugs help stabilize the area, preventing the collapse of the surrounding tissues. This stability is important for maintaining the dimensions of the socket, which is beneficial for future dental implant placement. Furthermore, collagen plugs provide a scaffold that supports the growth of new bone and soft tissue and serves as a chemotactic agent for fibroblasts.
Collagen Plugs: To Graft or Not?
Intact buccal bone and Thickness
Because of the above mentioned benefits of collagen plugs, various protocols have been suggested based on the clinical case and the socket type classification (ST). Interestingly, in cases of an extraction socket with intact buccal bone and with buccal bone thickness of ≥1.0 mm, research suggests that simply using a collagen-based material, like a collagen plug is sufficient and no further grafting is necessary. However, in cases of intact buccal bone with buccal bone thickness of <1.0 mm, some type of grafting will be necessary. A suggested technique, in this situation, is the socket-plug technique. The basic steps of the “socket-plug” technique consist of atraumatic tooth extraction, placement of the appropriate biomaterials in the extraction site, preservation of soft tissue architecture employing a flapless technique, and placement and stabilization of the collagen plug with an appropriate suture technique. Various studies have shown that this technique is effective for socket augmentation.
Buccal bone fenestration or Dehiscence
Finally, it is very important to note that in all other cases, where the buccal bone is NOT intact, such as buccal bone fenestration or dehiscence, some type of more advanced grafting procedures is required. We will address these techniques in a future post, as this beyond the scope of this particular topic (but, see the decision tree below)
Using Collagen Plugs with PRF
One interesting technique to mention is the use of PRF in conjunction with collage plugs, which has been the subject of various studies. One study indicated that PRF combined with a collagen plug was more effective in preserving bone width compared to PRF alone, although the overall differences in bone height and density were not statistically significant. Another study highlighted the efficacy of using a collagen plug with PRP (platelet-rich plasma) in socket preservation, showing reasonable outcomes in preserving the alveolar ridge. Overall, the combination of PRF and a collagen plug appears to enhance the clinical outcomes in socket preservation procedures, but further research with larger sample sizes is needed to substantiate these findings. For those interested in learning more about collagen plugs and PRF, you maybe interested in this video PRF Sticky Collagen Plugs.
References
- Effect of socket grafting with deproteinized bone mineral: An RCT on dimensional alterations after 6 months. Clinical oral implants research. Volume: 29, Issue: 5, 2018 - Cristiano Tomasi , Mauro Donati , Denis Cecchinato , Isacco Szathvary , Enrico Corrà , Jan Lindhe
- Classification Based on Extraction Socket Buccal Bone Morphology and Related Treatment Decision Tree Materials (Basel). 2022 Jan 19;15(3):733. - Larissa Steigmann 1, Riccardo Di Gianfilippo 1, Marius Steigmann 2, Hom-Lay Wang 1
- An overview of socket preservation. Journal of biological regulators and homeostatic agents. Volume: 33, Issue: 1 Suppl. 1, 2019 Jan-Feb - D De Santis , S Sinigaglia , P Pancera , P Faccioni , M Portelli , U Luciano , S Cosola , D Penarrocha , D Bertossi , R Nocini , A Iurlaro , M Albanese
- Consensus Report by the Italian Academy of Osseointegration on the Use of Graft Materials in Postextraction Sites. The International journal of oral & maxillofacial implants. Volume: 37, Issue: 1, 2022 Jan-Feb - Alfonso Caiazzo , Luigi Canullo , Anon Anon , Paolo Pesce
- Extraction socket preservation. Journal of the Korean Association of Oral and Maxillofacial Surgeons. Volume: 46, Issue: 6, 2020 - Young-Kyun Kim , Jeong-Kui Ku
- Evaluation of a collagen scaffold for cell-based bone repair. The International journal of oral & maxillofacial implants. Volume: 29, Issue: 1, 2014 Jan-Feb - Ingeborg J De Kok , Deepali Jere , Ricardo J Padilla , Lyndon F Cooper
- Assessment of Regeneration of Bone in the Extracted Third Molar Sockets Augmented Using Xenograft (CollaPlug Zimmer) in Comparison with the Normal Healing on the Contralateral Side. Journal of pharmacy & bioallied sciences. Volume: 9, Issue: Suppl 1, 2017 - Murugan Ranganathan , M Balaji , R Krishnaraj , Vivek Narayanan , Annamalai Thangavelu
- A nouveau collagen scaffold to simplify lateral augmentation of deficient ridges between natural teeth. Quintessence international (Berlin, Germany : 1985). Volume: 50, Issue: 7, 2019 - Ami Smidt , Zvi Gutmacher , Eldad Sharon
- Histomorphometric evaluation of human extraction sockets treated with autologous fibrin, sticky bone or biphasic calcium phosphate. Acta odontologica latinoamericana : AOL. Volume: 34, Issue: 3, 2021 - José S Ponte , Jesús A Pérez-Guerrero , Francisco Aa Aragão , Yasmin At Menezes , Marcelo M Melo , Igor I Castro-Silva
- Efficacy of PRF vs PRF + Biodegradable Collagen Plug in Post-extraction Preservation of Socket. The journal of contemporary dental practice. Volume: 20, Issue: 11, 2019 - Nida Ahmed , Vivek Gopalakrishna , Akshay Shetty , Vaibhav Nagraj , Mohammed Imran , Praveen Kumar
- Extraction socket preservation using a collagen plug combined with platelet-rich plasma (PRP): A comparative clinico-radiographic study. Journal of dental research, dental clinics, dental prospects. Volume: 14, Issue: 2, 2020 Spring - Numaan Nisar , Kumar Nilesh , Mushtaq Ishaq Parkar , Prashant Punde
- To assess the efficacy of socket plug technique using platelet rich fibrin with or without the use of bone substitute in alveolar ridge preservation: a prospective randomised controlled study. Oral and maxillofacial surgery. Volume: 22, Issue: 2, 2018 - N Girish Kumar , Rupanzal Chaudhary , Ish Kumar , Srimathy S Arora , Nilesh Kumar , Hem Singh
- An Analysis of Different Techniques Used to Seal Post-Extractive Sites-A Preliminary Report. Dentistry journal. Volume: 10, Issue: 10, 2022 - Paolo Pesce , Eitan Mijiritsky , Luigi Canullo , Maria Menini , Vito Carlo Alberto Caponio , Andrea Grassi , Luca Gobbato , Domenico Baldi
- Clinical and Histological Comparison of Extraction Socket Healing Following the Use of Autologous Platelet-Rich Fibrin Matrix (PRFM) to Ridge Preservation Procedures Employing Demineralized Freeze Dried Bone Allograft Material and Membrane. The open dentistry journal. Volume: 3, Issue: , 2009 - B I Simon , A L Zatcoff , J J W Kong , S M O’Connell
- Regenerative Potential of Platelet Rich Fibrin (PRF) in Socket Preservation in Comparison with Conventional Treatment Modalities: A Systematic Review and Meta-Analysis. Tissue engineering and regenerative medicine. Volume: 19, Issue: 3, 2022 - Yasser Alrayyes , Reham Al-Jasser
- Mineralized bone allograft-plug socket augmentation: rationale and technique. Implant dentistry. Volume: 16, Issue: 1, 2007 - Hom-Lay Wang , Yi-Pin Tsao