Biologically-Oriented Alveolar Ridge Preservation (BARP) in Intact and Compromised Extraction Sockets

Alveolar ridge preservation (ARP) remains challenging in extraction sockets, particularly in the presence of buccal bone dehiscence, where post-extraction remodeling predominantly affects the coronal ridge. The Biologically-oriented Alveolar Ridge Preservation (BARP) concept and its modified application for compromised sockets (mBARP) were developed as innovative biologically driven protocols based on selective compartmentalized grafting. Instead of completely filling the socket, these approaches preserve spontaneous healing in the apical compartment while reinforcing the coronal portion, where dimensional changes are greatest. The protocols combine a collagen sponge in the apical part of the socket with xenograft particles and a collagen sponge sealing the coronal compartment. In compromised sockets, an additional collagen sponge is positioned between the residual buccal or lingual wall and the mucoperiosteal flap to enhance graft containment and soft tissue support. Thirty extraction sites were treated using this approach. After 4-6 months, ridge dimensions were effectively preserved, with a slight vertical loss (+0.3 mm), limited horizontal reduction (0.7-1.0 mm), controlled buccal soft tissue contraction (2.0-2.2 mm), and substantial new bone formation (38%-40%), while residual graft particles remained mainly confined to the coronal compartment. Within the limitations of this study, the BARP concept and its modified application demonstrated favorable clinical, radiographic, and histological outcomes, supporting selective coronal grafting as an innovative strategy to preserve ridge dimensions while maintaining physiological healing in the deeper portion of the extraction socket.