The “Combo Technique”: A Case Series Introducing the Use of a d-PTFE Membrane in Immediate Postextraction Guided Bone Regeneration

(a) Sites #29, #30 after atraumatic extraction of #29 and full-thickness flap reflection. (b) The dense polytetrafluoroethylene membrane placed over the resorbable collagen membrane at #29 and allowed to heal via secondary intention. (c) Four weeks postoperatively. (d) Cone beam computerized tomography 3 months postoperatively. (e) Clinical view of #29, #30 after full-thickness flap reflection for first stage #29, #30. Note the alveolar ridge width availability of >10 mm. (f) Healing abutments seated on #29, #30 due to adequate primary stability at placement. Note the available keratinized gingiva width. (g) Clinical view of the keratinized tissue before seating of the final prosthesis. (h) Clinical view of restored implants #29, #30 with screw-retained prosthesis. (i) Eighteen-month follow-up of restored implants #29, #30. Note the stability of the crestal bone levels.

(a) Sites #23, #24, #25, #26 after extraction and full-thickness flap reflection. Note the dehiscence of the buccal plate at #23, #24 due to previous endodontic lesion. (b) The dense polytetrafluoroethylene membrane was placed over the resorbable collagen membrane and left to heal exposed. Note the fistula at #24 due to a chronic abscess. (c) Six weeks postoperatively. Note the connective tissue proliferation that will become a wide zone of keratinized tissue. (d) Cone beam computerized tomography 3 months postoperatively. (e) Periapical radiograph of #23, #26 at implant placement. (f) Clinical view of #23, #26 before seating of the final prosthesis. Note the achieved buccolingual alveolar width and the presence of a wide zone of keratinized gingiva. (g) Twelve-month follow-up of restored implants #23, #26. Note the stability of the crestal bone levels.

(a) Teeth #30, #31 present with horizontal bone loss and class 3 furcation involvement. (b) After extraction, allograft was packed, a collagen membrane was secured, and a dense polytetrafluoroethylene membrane was placed at #31, whereas a collagen sponge was placed at #30. (c) Six weeks postoperatively. Note the connective tissue proliferation that will become a wide zone of keratinized tissue. (d) Cone beam computerized tomography 3 months postoperatively. (e) Periapical radiograph of #30, #31 at implant placement. (f) Clinical view of #30, #31 before seating of the final prosthesis. Note the achieved alveolar width and the presence of a wide zone of keratinized gingiva. (g) Occlusal view of the restored #30, #31 with screw-retained prosthesis. (h) Twelve-month follow-up of the restored implants #30, #31. Note the stability of the crestal bone levels for #31 and the crestal bone remodeling mesial of #30.

(a) Extraction socket of #8. (b) Following extraction, allogenic bone graft was packed and covered by a collagen membrane and a dense polytetrafluoroethylene (d-PTFE) nonresorbable membrane. (c) The nonresorbable d-PTFE membrane was secured with crossed horizontal mattress and single interrupted 5/0 Vicryl sutures. (d) Six weeks postoperatively. Immature connective tissue is noted. (e) Clinical view of the edentulous space 7 months following the extraction. Note the increased zone of keratinized tissues. (f) Cone beam computerized tomography 3 months postoperatively showing 7 mm of alveolar ridge width. (g) Periapical radiograph immediately after the implant placement. (h) Periapical radiograph 12 months following the implant placement. Note the stability of the crestal bone levels.