# Modified Periosteal Inhibition (MPI) Technique for Extraction Sockets: _A Case Series Report_
###### Abstract  
Several Alveolar Ridge Preservation (ARP) procedures have been proposed over the years. The purpose of this study was to describe the new Modified Periosteal Inhibition (MPI) technique for ARP. Seven patients were enrolled (age range: 28-72 years old; 5 males, 2 females). In total, nine hopeless teeth were treated. Following the elevation of a full-thickness flap, atraumatic tooth extraction was conducted, preserving the buccal bone of the alveolar socket. OsteoBiol(r) Lamina Soft (Tecons(r), Giaveno, Italy), 0.5 mm thick, was suitably shaped (8-10 mm in height, extending from the mesial and to the distal corners of the socket). The lamina was gently positioned between the buccal perisoteum and the buccal bone plate. Tisseel(r) (Baxter Healthcare Corporation, Deerfield, IL, USA) was applied to seal the cortical membrane. The flaps were sutured with PTFE 4-0 (Omnia, Fidenza, Italy). Postoperative instructions were provided. Patients were strictly monitored during the follow-up. No early or late biological complications were experienced. Cone Beam Computed Tomography (CBCT) exams were performed at baseline and 4 months later. The thickness of the buccal cortical bone at baseline was 1.18 \(\pm\) 0.57 mm. The pre-operative and post-operative ridge widths were 10.74 \(\pm\) 1.54 mm and 11.16 \(\pm\) 1.57 mm, respectively. A horizontal ridge increase of 0.41 \(\pm\) 0.21 mm was observed during the healing period. At 4 months of healing, the bone volume was adequate for implant placement and no additional bone regeneration procedures were required. MPI technique was effective in preventing the horizontal contraction of the post-extraction socket. Further studies will be needed in the future to confirm our positive results. Alveolar Ridge Preservation; Socket Preservation; Periosteal Inhibition; cortical lamina; fibrin glue; collagen sponge +
Footnote †: journal: Medical Imaging  
1
Footnote †: journal: Medical Imaging  
1 Private Practice, 42124 Reggio Emilia, Italy1  
recent years it has been clear that soft tissues play a key role in the long-term success of dental implants [11; 12; 13]. Therefore, the clinician's attention should not only be limited to hard tissues but also include peri-implant soft tissues. Recently, [PERSON] et al. correlated the apical-coronal position of an implant to the thickness of the soft tissues [14]. This protocol prevented the fixture's exposure due to the formation of a new biological width during the healing process [15; 16]. In 2019, [PERSON] et al. introduced a new ARP outside the alveolus, modifying the area of interest [17]. Periosteal Inhibition Technique (PI) aimed to inhibit the osteolytic activity on the outer surface of buccal bone. A d-PTFE membrane was placed between the vestibular periosteum and the cortical bone, and no bone grafts were inserted in the sockets. The authors hypothesized that the precursors of osteoclals (9.5 um in diameter) were unable to come into contact with the outer surface of buccal bone and differentiate due to the porosity of the membrane (0.2-0.3 um), which acted as a barrier [18; 19; 20; 21]. This prevented the osteoclality of the deep periosteum, consequentially reducing the buccal bone resorption. The preliminary results showed a non-significant average loss of 0.4 \(\pm\) 0.3 mm of the soft tissue and 0.2 \(\pm\) 0.4 mm of the bony ridge width after 4 months. However, the main drawback of the PI was the second-stage surgery required for the membrane removal. Modified Periosteal Inhibition (MPI) overcomes the limit of the technique described by [PERSON] et al. [17]. The MPI technique aims not only to preserve the vestibular bone by exploiting Periosteal Inhibition but also to increase its thickness by bonding a single or double layer of OsteoBiol(r) Lamina Soft (Tencross(r), Giaveno, Italy) 0.5 mm thick. The use of the cortical bone lamina also allows the inclusion of extraction sockets with partial deficiencies in the cortical bone among the indications of the technique.