PET of compromised teeth

Abstract

Background Various alveolar ridge preservation procedures and combinations of different techniques have been described. The revolutionary socket-shield technique was introduced in 2010 and entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results that are promising to esthetic implant treatment. Collectively, the above mentioned technique together with the pontic shield technique may be called partial extraction therapies (PET). Aim/Hypothesis The aim of the current research is to show the potential of the socket shield technique to prevent resorption of buccal tissues and to achieve predictable esthetic result. Material and Methods Patients with fractured or endodontic non treatable teeth were included in the study. The treatment plan included two stages- firstly biological approach to remove the granulation and inflamed periapical tissues (apicoectomy) and procedure for guided bone regeneration (GBR). After a complete healing process, 6 months later followed the second step.-conservative removal of the palatal root fragment and the apical buccal part of the root. The pulp chamber was used as initial guide to achieve maximum control and simplify the osteotomy. After full-depth implant site preparation, the remaining root was sectioned mesially and distally and carefully removed except for the buccal aspect. The retained buccal part was prepared for socket shield technique and an implant was inserted. Provisional crown or a healing abutment was placed after the surgery. After 3 months a first provisional crown was placed and two months later- the final crown. Results A single or two-step approach for a compromised teeth in the esthetic zone was provided on 18 patients. 16 implants were placed in the maxilla and 2 in the mandible. No complications and no exposure of the shield were observed during the healing period. After the 3 years follow up, there was no bone loss, no inflammation of the tissues and no changes in the vestibular volume. Conclusions and Clinical Implications Consequently, in such cases it is even more important to preserve as much tissue as possible over time and prevent the need to augment tissues. However, the applied technique enables the clinician to maximize tissue stability and reduce surgical intervention to a minimum. As all alternative treatment options were discussed with the patient, the presented technique proved to be a reasonable choice considering risk versus gain.