Australasian Dentist Issue 89

Category 78 AustrAlAsiAn Dentist Socket seal in the upper anterior site preserving alveolar bone for future implant placement lInICal Surgery by: Prof. Ronald E. Jung (Zurich) aim: Preservation of hard and soft tissue volume after extraction in the anterior region for late implant placement. Figure 1 As a consequence of previous trauma and concomitant external root resorption, tooth 21 required extraction. Care was taken to minimise trauma to the alveolar bone. Figure 4 Geistlich Bio-Oss®Collagen was then inserted into the extraction socket and carefully adapted to the dimensions of the socket reaching but not exceeding the level of the palatal bone margin. Figure 7 The Geistlich Mucograft®collagen matrix is secured in position with multiple 6-0 simple interrupted sutures. Figure 2 Occlusal view of the socket immediately following extraction. No flaps were raised during the extraction procedure. A slight labial bone defect was detected. Figure 5 The dimensions of the socket opening was measured and based on this, a punch of appropriate diameter was used to modify Geistlich Mucograft®to the desired dimension. Alternatively, Geistlich Mucograft®Seal (8mm diameter) could be used for this purpose. Figure 8 1-week following the extraction, the soft tissues demonstrate progressive and uneventful healing. Figure 3 The socket was gently curetted in order to remove any retained granulation tissue. The wound margins were de-epitheliased using a diamond bur in a hand-piece with water cooling. Figure 6 Geistlich Mucograft®(or Geistlich Mucograft®Seal) is placed on top of the Geistlich Bio-Oss®Collagen in order to seal the grafted socket. Figure 9 The clinical presentation 7.5 months after extraction. The tissues have healed well with maintenance of the keratinised tissues. There is a slight dip on the labial aspect; if necessary, this can be managed with a minor hard or soft tissue augmentation at a later time. Conclusion: Volume preservation of hard and soft tissue after tooth extraction is important to prevent extensive guided bone regeneration procedures at implant placement. With this minimally invasive procedure, the volume of hard and soft tissue can be better preserved with Geistlich Bio-Oss ® Collagen and Geistlich Mucograft ® , respectively, compared to spontaneous healing. 1 u References: 1 Jung re, et al. J Clin Periodontol. 2013 Jan;40(1):90-8 (Clinical study) Prof. Ronald E. Jung