Sealing Socket Abutment: a novel digitalized strategy for immediate implant placement in molar sites
A clinical cases by our Community member Dr Gary Finelle.
Immediate implant placement after extraction of a molar is an attractive treatment alternative for the significant clinical benefits it provides to the patient, as well as for the dentist:
- Reduction of number of surgeries
- Reduction of overall length
- Reduction of morbidity
Many studies have reported similar implant survival rates when implantation is performed immediately after extraction (98.8%) or on healed site (99%) (Atieh 2010). Although the literature shows high survival rates, immediate implantation in molar sites must be carried out within favourable clinical conditions (attached gingival, buccal plate…) in combination with well controled technical procedures (ideal three-dimensional position, primary stability, Primary closure). One of the major challenges one clinician can face while performing immediate placement on molar site, is the ability of obtaining a hermetic primary closure of the soft tissue. This technical skill is nearly always combined with invasive surgical procedures and significant post op recovery (displacement of the muco-gingival line, periosteal releasing incision, flaps, sutures, membrane stabilization…).
To reduce invasiveness as well as technique sensitivity of the procedure the protocol illustrated in this article discusses the use of an anatomical Sealing Socket Abutment (SSA) (Finelle 2017, Finelle 2019) designed and manufactured using CAD-CAM technology to preserve peri-implant hard and soft tissue structure. The aims of the SSA are:
– To mechanically seal the surgical site following the outline of the extraction socket with its anatomical design
– To stabilize the blood clot and to favor bone regeneration space for the substitute material (Retzepi 2010)
– To support soft tissues to prevent them from collapsing during healing time.
– To develop an ideal prosthetic emergence profile, modeled on the anatomy of the existing tooth (Chu 2012).
Fig.1
A 45 years old patient presented at our clinic for consultation appointment. She complained about intense pain upon mastication in the area of 26. Clinical and radiographic examinations showed a clear vertical root fracture splitting mesial and distal fragment all the way to the inter-radicular area. The extraction of the tooth was unequivocally indicated as the only treatment alternative.
Fig.2
Immediate implant placement after extraction combined with customized Sealing Socket Abutment (SSA) will be implemented.
Minimally invasive extraction is a crucial step for succeeding in this protocol. In order to preserve surrounding structures (remaining inter-radicular bone septum, external alveolar table, soft tissue), so specific care and attention was paid while extracting the tooth during instrumentation and tissue manipulation. Once the extraction was successfully performed, accurate debridement and cleaning of the alveolar socket associated with a generous saline solution irrigation was done.
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