What is this about?
- Preserve bone, simplify implants: Learn how Straumann
XenoFlex supports alveolar ridge preservation after tooth extraction, minimizing the need for complex bone augmentation like sinus lifts. - Clinical study insights: Discover results from a new prospective study showing reduced surgical interventions and high implant success rates when using XenoFlex and a collagen membrane.
- Improved patient outcomes: Understand how this biomimetic bone substitute can lead to less invasive procedures, faster healing, and enhanced predictability in implantology treatments.
A new study indicates that the use of a biomimetic composite material similar to native bone [1] after tooth extraction reduces the need for sinus augmentation in implantology. When bone is missing, implant rehabilitation becomes complex. Especially in cases of atrophy in the posterior maxilla, implant placement usually requires augmentation procedures such as sinus floor elevations to compensate for insufficient bone volume. To put it bluntly: no bone, no implant!
Against this background, any forward-looking solution that preserves bone at the time of tooth extraction and counteracts atrophy is a clear benefit for patients. A team from the Clinic and Polyclinic for Oral and Maxillofacial Surgery at the University Medical Center Mainz in Germany has demonstrated a practical solution using an alveolar filling material of bovine origin in a prospective clinical study recently published in the international journal “Clinical Implant Dentistry and Related Research.” [2] Prof. Dr. med. Dr. med. dent. Eik Schiegnitz summarizes the encouraging study results and practice-relevant findings in a conversation with Dr. med. dent. Aneta Pecanov-Schröder and provides insight into ongoing research by the team of authors.
The preservation of bone structures is a basic prerequisite for a functional and aesthetic result of implant-supported rehabilitation. [3] Typically, tooth extractions are followed by atrophy of the alveolar ridge in both the vertical and horizontal dimensions, caused by the resorption of the periodontal bone. In the edentulous posterior region of the maxilla, resorption of the alveolar bone and sinus pneumatization—a process in which the maxillary sinus volume increases—require additional measures, usually internal or external sinus floor elevations, to compensate for insufficient bone volume.
New study from Mainz
The extent to which the preservation of the alveolar ridge using an alveolar bone substitute (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane) significantly reduces the need for sinus floor elevations compared to natural wound healing after tooth extraction was investigated by (dental) physicians and scientists Dr. Elias Jean-Jacques Khoury, apl. Prof. Dr. Dr. Eik Schiegnitz, Prof. Dr. Dr. Bilal Al-Nawas (Director of the Clinic) and colleagues investigated the extent to which preserving the alveolar ridge using an alveolar bone substitute (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane) significantly reduces the need for sinus floor elevations compared to natural wound healing after tooth extraction.
Alveolar ridge preservation with KEM
The team designed a comparative clinical study with two parallel groups. Forty patients requiring a total of 53 tooth extractions were assigned to a test group and a control group. In the test group (22 patients, 31 extracted teeth), the extraction socket was treated with a bone replacement material (Straumann® XenoFlex), which consists of 90 percent bovine bone granules and 10 percent porcine collagen. [1] Perioperatively, the patients in the test group received prophylactic antibiotic therapy. The bone replacement material was inserted directly into the alveolus using an applicator. The augmentation area was then covered with a resorbable porcine collagen membrane (Jason® membrane) as a barrier membrane. The wound was closed with Ethilon™ resorbable suture material. In the control group, the extraction sockets were left to heal spontaneously.
After six months, implant planning was carried out based on a current digital volume tomography (DVT) scan. Depending on the bone level, implants with a diameter of 3.5 mm, 3.75 mm, 4 mm, and 4.5 mm and a length of 6 mm, 8 mm, 10 mm, and 12 mm were used. The following protocol was applied:
- ≥6 mm remaining vertical bone height: placement of the Straumann® BLX implant
- 3–5 mm remaining vertical bone height: internal sinus lift with simultaneous implant placement
- 0–3 mm remaining vertical bone height: external sinus lift with implant placement after a further four months
All implant insertions were performed under perioperative antibiotic prophylaxis without complications. The survival rate of the implants was 100% in the control group and 96.77% in the test group. After an average healing period of around five months, all osseointegrated implants received their final crown replacement.
Product information: Straumann® XenoFlex
A combination of 90% bone mineral (100% pure hydroxyapatite) with 10% Collagen type I. Tested to eliminate antigenicity and provide a favorable environment for new bone growth; it is composed of bovine bone and porcine collagen. Its slow resorption rate delivers extended stability – a critical advantage in cases that require a strong scaffold for long-term tissue support and esthetic needs. The collagen fibers facilitates the adhesion of proteins and signals molecules from the blood to the embedded granules to further improve the fast bony integration of Straumann® XenoFlex. Learn more
Current results and outlook
The use of bovine bone substitute material as alveolar filling material immediately after tooth extraction (keyword: “alveolar ridge preservation,” ARP) in combination with a porcine collagen membrane reduced the need for sinus floor elevations compared to natural wound healing after tooth extraction.
In the control group, seven sinus floor elevations (including one external sinus lift) were performed, compared to four in the test group. “Although the results in the present study are not statistically significant with p=0.168,” notes Prof. Dr. Dr. Schiegnitz, “it is clear that the alveolar ridge preservation procedure with bovine bone replacement material and a porcine membrane after tooth extraction allows us to make the overall treatment less invasive and reduce morbidity.”
Although sinus augmentations are an effective and successful treatment option for increasing the alveolar bone and thus enabling the insertion of implants in the posterior maxilla [4,5], the additional procedures carry a risk of complications such as perforation of the sinus membrane or infection. [6]
“Reduced surgical effort means less stress, shorter treatment times, and potentially fewer complications for our patients,” emphasizes the experienced oral and maxillofacial surgeon, pointing out another advantage in terms of the implantology workflow: “The procedure presented also simplifies implant planning, as better bone preservation allows for less complex implantation and makes implant success more predictable.”
Further studies, including with XenoFlex in GBR & patient satisfaction surveys
For experts, the current results provide a “solid basis for future research with the aim of intensifying the use of Straumann® XenoFlex and investigating its clinical benefits in more detail.” The Mainz team is currently investigating the use of XenoFlex in various clinical indications. “We are investigating the clinical outcome of XenoFlex in gap filling after immediate implantation and in guided bone regeneration (GBR),” explains Prof. Schiegnitz. “The results so far are very promising in both indications.”
Further studies are also evaluating long-term implant survival after ARP with XenoFlex. “The aim is to investigate the influence of the biomimetic material on the long-term stability of the peri-implant bone and on the long-term implant prognosis,” explains Prof. Schiegnitz. “To this end, patients will be closely monitored in a prospective follow-up study.”
The team is also working on the so-called “patient-reported outcome” (PRO), an approach in which patients themselves report on the results of their treatment, for example in questionnaires. “In our further investigations into XenoFlex, we want to focus more on the success of the treatment as documented by the patients themselves,” explains Prof. Schiegnitz. Health-related quality of life (HRQoL) and patient satisfaction are important parameters for this investigation.
Conclusion for practice
“The method we illustrate in our recently published study offers a promising basis for more efficient and patient-friendly treatment and shows that ARP with Xenoflex in the test group makes external sinus floor elevation unnecessary compared to the control group,” summarizes Prof. Schiegnitz. The change in bone height measured by X-ray before and after surgery showed no significant difference between the two groups. To confirm the results, a larger sample size is recommended, according to Prof. Schiegnitz.
"It can be concluded that alveolar ridge preservation with bone replacement materials is a promising treatment option for maintaining bone volume after tooth extraction and reducing the need for invasive augmentation procedures in the future. Colleagues should therefore consider this method as part of their strategic treatment planning in order to achieve better clinical results in the long term and reduce patient morbidity. In our opinion, alveolar ridge preservation is a recommended treatment option, especially for tooth extractions with already reduced bone availability, and our patients should definitely be informed about this option."
Key takeaways
- Reduced Need for Sinus Elevation: Using XenoFlex with a collagen membrane after tooth extraction lowered the need for sinus lifts (4 vs. 7 cases), helping minimize invasive procedures despite no statistical significance.
- Simplified Workflow & Lower Morbidity: The ARP approach made implant planning easier, reduced surgical complexity, and improved patient outcomes with fewer complications and high implant survival rates.
- Ongoing Research & Patient Focus: Studies continue on XenoFlex for GBR, immediate implants, and long-term outcomes, with added focus on patient-reported satisfaction and quality of life.
Image credits: All images Dr. Elias Jean-Jacques Khoury, University of Mainz
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