Maintenance of Keratinised Tissue
Socket seal of posterior alveole in late implant placement
Aim: Conservation of hard and soft-tissue volume after teeth extraction for late implant placement without sinus floor augmentation.
Conclusion: Extraction with late implant placement is an extremely reliable procedure, which has been proven repeatedly in the international literature. The alveolar socket seal technique used in this clinical case, however, is relatively new. The time intervals between the healing of the alveolar socket and implant placement are the same as for the „tissue punch“ technique. The technique of this clinical case has the following advantages: ridge volume preservation, lack of a second operation site, less surgical time, simplification of the procedure, soft-tissue volume preservation due to a socket sealing with Geistlich Mucograft®, and finally a sinus lift procedure is spared thanks to the hard-tissue preservation with Geistlich Bio-Oss®.
Examination of an unstable bridge between 25 and 27 revealed deep pockets as well as bleeding due to periodontal infection (terminal phase).
Extractions are performed atraumatically and without raising a flap. The alveolar sockets have been curetted with precision and prepared for receiving a biomaterial.
Occlusal clinical image: the alveolar sockets are filled and packed gently without excess of pressure.
Instead of using a tissue punch, alveolar sockets are sealed using Geistlich Mucograft®, which is fitted to the defect and held in place with crosssuturing (3.0 non-resorbable).
Healing after 1 week, just before suture removal. The gum shows a nice pink colour, indicating perfect tolerance of the biomaterial
Healing after 2 weeks showing incomplete closure of the sockets but no exposed biomaterial. The collagen matrix effectively protected the site as the blood clot formed.
Healing after 4 months with soft-tissue maturation and maintenance of the horizontal volume of the crest.
Maturation and maintenance of tissue volume around the integrated implants 2 months after implant placement (or 8 months after extraction).
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