Amin ur Rahman, Adam Rosenberg, Zeerak Samuel, Saqib Rasheed, Franke R Berres, Bilal Sheikh.
Site Preservation in association with replacement therapy with a single tooth implant.
J Pak Dent Assoc Jan ;11(1):33-8.

The preservation of ridge and alveolar bane should be considered to avoid usual sequelae of tooth loss. The dentist needs to preserve both the height and the width at the time of surgery. This ensures suitable quantity and contour of bone for the subsequent placement of implant. The case report describes the preservation of extraction site and technique for implant placement after site development.

Case Report: A 70-year-old Caucasian male presented with a fractured palatal cusp of tooth number 14 (upper right first premolar). The segment had fractured right into the pulp chamber causing severe discomfort. Clinical and radiological evaluation revealed a deep vertical root fracture with separation of the palatal cusp. There was also a deep angular bony defect on the distal side of the tooth accounting for about 50% bone loss. A treatment plan was devised to extract the tooth atraumatically and to preserve the site for future restoration with a single tooth implant. A full mouth scaling root planning was performed (ultra sonic and hand instrumentation) and oral hygiene instructions were given prior to extraction of the fractured tooth. Under local anesthesia a buccal flap was raised and the roots removed individually using periotomes to prevent any unnecessary bone fragmentation. The socket was debrided and filled up with a natural porous bone mineral matrix (Bio-Oss(r)) and an absorbable membrane (Bio-Mend(r)) composed of crosslinked bovine type I collagen was used to cover up the graft. 5-0 Chromic sutures were placed to approximate the flap. Since primary closure was not achieved the patient was put on 0.12% chlorhexidine mouth wash (PerioGuard(r)) twice a day and oral hygiene instructions were given. Healing was uneventful and follow-up after one month revealed complete soft tissue closure. Slight indentation of the extraction site was present but the gingival color and consistency was normal. Patient was put on regular monthly follow up appointments to ensure optimum periodontal maintenance. One year from the time of site preservation surgery the patient was scheduled to have the implant surgery done. Radiographs revealed adequate bone fill for the desired implant placement. The cortical border was continuous regarding the alveolar ridge and palate. The trabecular pattern was normal in appearance and was fine and moderately dense. Approximately 22mm of alveolar bone height was available for implant placement at the site. Buccal and palatal flaps were lifted under local anesthesia and the site curetted to remove all soft tissue tags. An ITI Straumann 0 4.1,lOmm aesthetic plus implant was placed. Good primary stability was achieved and a healing cap was put on. 40 Gortex(r) sutures were used for approximation of the flaps. Clindamycin 500mg twice daily was prescribed for ten days because the patient was allergic to penicillin. Sutures were removed one week postoperatively. Impression for the crown was taken four months later and a porcelain fused to metal crown was fabricated to fit the implant. Six monthly recall revealed excellent peri-implant gingival health and no complications were noted.

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