Post-Operative Complications of Implant Placement

With the increasing acceptance of dental implants as a viable tooth replacement therapy, complications & failure rates have also increased proportionately.

A range of possible post-operative complications & their prevention are described below:

  1. Infection: Implants are made of titanium, which is strong & biocompatible, which means that is not rejected by the body. So the chances of developing post-operative infection are extremely rare. At times when dentist do not follow effective & strict protocol of sterilization, patient might be vulnerable to post operative infection.

Post-operative infection causes pain & discomfort to the patient, reason being- bacterial contamination of implant or surgical site during the procedure.

If the infection is limited to the soft tissue, a small gum boil will be noticed over the implant site. It can be punctured using a sharp probe & irrigated with chlorhexidine solution or citric acid. It heals & the pain subsides within 24hrs.                                                                                        In case of continuous pus discharge & severe pain which is not relieved by analgesics, this depicts that the infection has reached to the bone-implant body interface.

Prevention: one should follow strict protocol of sterilization in the operatory in order to avoid any bacterial contamination. Also, in such cases, the implant should be removed immediately & prescribe good antibiotic like tab Augmentin 1000mg twice a day for 5-7 days. A new implant can be inserted when the site gets healed in 6 weeks.

  1. Post-operative Edema: Post-operative edema develops in cases of traumatic implant placement. High speed drilling & no constant stream of chilled saline causes bone to overheat & this leads to accumulation of fluids in tissue spaces i.e. edema.

 

Prevention: Unnecessary trauma to the bone must be avoided during osteotomy preparation. Drilling speed must be set according to the density of bone along with a pumping motion of the drill should be employed during drilling to allow the saline to cool down the bone. This prevents overheating & necrosis of the bone.

Patient must be advised to apply an ice pack over the facial   skin of the surgical site intermittently for 45 min to cool down the bone in order to suppress heat generation & inflammatory oedema.

        prevention

  1. Pressure necrosis: results in cases where implant has been inserted & screwed at a very high torque, it may lead to pressure necrosis of the surrounding bone & the patient will complain of continuous pain not relieved by analgesics, for weeks after the surgery.

 

Prevention: Drilling at higher speed with maximum amount of chilled saline irrigation flow to cool down the bone. Use of final drill with the diameter only 0.2mm less than the implant diameter along with the use of bone tap to prepare threads in the bone to accommodate implant threads. Following these instructions help in reduction of post-operative pressure necrosis.

  1. Suture line opening: leads to exposure of implant threads in the oral environment & may cause the collection of plaque over the exposed rough surface of the implant, which may further cause peri-implantitis & loss of hard & soft tissue around the implant.

 

Causes of implant thread exposure

  • Suture line opening & loss of graft in cases where simultaneous bone grafting has been performed with implant placement also leads to implant exposure.
  • More superficial implant placement.
  • Thin mobile soft tissue recedes with muscle pull.

        Management:

  • Tension free sutures should be used to avoid the suture line opening because of the tension in the flap.
  • The open suture line should not be re-sutured but the patient should be instructed to keep it clean, as it heals by secondary intention in 2-3 weeks.
  • If soft tissue healing has not covered the exposed threads, either cover the threads using soft tissue grafting with or without simultaneous bone grafting, or adequate grinding & polishing should be done to make the surface smooth & prevent accumulation of plaque.

  1. Bone resorption: one of the most common complication in dental implantology. When occlusal forces are not distributed equally i.e. is off-axis to the implant prosthesis leads to resorption. Also, when implant with a wider platform is placed into the narrow crestal bone causes crestal bone resorption.

 

Prevention: Implant must be placed along the axis of the future prosthesis. For large mesio-distal diameter two implants should be placed with narrow occlusal table of prosthesis. Along with the maintenance of oral hygiene, soft tissue grafting for compromised soft tissue around the implant must be addressed.

  1. Peri-implantitis: is an inflammatory reaction with the loss of supporting bone in the tissues surrounding a functioning implant. Peri-implantitis is characterized by bleeding/suppuration on probing, together with loss of supporting bone.

The peri-implantitis lesion exhibits histopathological features that similar, but not identical, to those in periodontitis. Similar to periodontitis, the treatment of peri-implantitis must be based on infection control. Under these conditions, progression of the disease may be arrested & subsequent, lost peri-implant tissues may be generated by bone augmentation & soft tissue grafting procedures.

peri-implantitis

With this increasing trend of replacing the lost tooth with an implant, at Dr. Sachdeva’s Dental Institute, we incorporate several associated procedures like bone augmentation to provide this therapy to the maximum number of patients. We follow strict protocol for sterilization & restore implants to minimize postoperative or post loading complications.

Root canal , Apicoectomy and Cancer

What Is Apicoectomy And Why It Is Done?

root canal procedure is a treatment to save a damaged, infected or badly decayed tooth.

Although root canal infections can be treated by conventional root canal therapy, but in some cases when the infection persists after root canal treatment or re-treatment, an APICOECTOMY is considered to be important to solve the infection and treat the problem.

  1. What Does Apicoectomy Mean?
  • Apicoectomy is a microsurgical treatment procedure where the very end of the tooth’s root (Apex) is removed along with the infection attached to the root tip. The apex is sealed with a filling to prevent micro leakage.

  1. What About Apicoectomy Procedure I Need To Know?
  • The endodontist gives local anesthetic to the already RCT treated tooth to numb the surgical site of the patient.
  • The gum and bone is cut and lifted to access and visualize the root tip/apex.
  • The root tip is resected and the infected tissue is curetted. The end part of root canal is cleaned and sealed with biocompatible sealer material. The endodontist then sutures the tissue back in the original place.

  1. Does The Procedure Hurt?
  • The endodontist will give local anesthesia to make sure that the treatment is painless and more comfortable.
  • Other than that, patients are prescribed with appropriate pain medications to help ease the discomfort.

  1. How Long Does The Apicoectomy Treatment Take?
  • The treatment is generally done in single sitting appointment.
  • The procedure takes about 1-2 hours depending upon the tooth location and complexity of the roots.

  1. If The Patient Doesn’t Want The Treatment?
  • If the patient is not willing for the treatment, then the tooth needs to be extracted and an implant can be surgically placed to replace the missing tooth.

Root Canal and Cancer

  • In new studies, Researchers found that patients had a 45% reduced risk of cancer with multiple endodontic treatments.

Till date, there is no valid, scientific evidence that proves any link between root canal-treated teeth and disease elsewhere in the body.

 A 2013 study published in a journal found that a patient’s risk of cancer doesn’t alter after a root canal therapy. Researchers also found that patients with multiple endodontic treatments had a 45% reduced risk of cancer.

There are also few myths about Root Canal Treatment shared by a large section of people onto which we would like to shed some light.

  1. MYTH –The Root canal treatment is painful.
  • TRUTH – In fact Root canal treatment doesn’t cause pain, it actually relieves it.
  1. MYTH – Root canal treatment makes you ill/sick.
  • TRUTH – There is no substantial, scientific valid proof which links root canal-treated teeth and disease elsewhere in the body.
  1. MYTH – An excellent substitute to root canal treatment is extraction of the tooth.
  • TRUTH – Saving your natural teeth, is always the ultimate best option if the tooth is not damaged beyond repair.
  1. MYTH – Root canal therapies often requires many visits, wasting your precious time.
  • TRUTH – Now due to introduction of advanced technologies, Root canal therapies can be completed in one or maybe two appointments.
  1. MYTH – If you’re not feeling any pain in your tooth, you do not need a root canal treatment.
  • TRUTH – Teeth are not always painful that require root canal therapy.

We at Dr. Sachdeva Dental Institute And Implant Center try to leave no question unanswered.

We practice endodontics with dental microscope which provides enhanced visualization and access to the most difficult angles of the teeth, mouth and jaws, and allows for a better and more accurate diagnosis and treatment.

It significantly improves quality of treatment and improved after treatment results.

For more information, contact us at: Contact us at
• Phone : +919818894041,01142464041
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10 Frequently Asked Questions about Caries

The world has almost 60–90% of teenagers and about 100% of adults suffering from dental cavities.

People often get confused about what to follow for their dental health and hygiene so here we present you some answers for the most often asked queries.

  1. None of my teeth hurt; does that mean I don’t have cavities?

There is no such evidence that proves relation between pain and cavity, which means that even though you might not experience any pain but cavities still are present. Smaller cavities are generally associated with sensitivity to cold or sweet as similarly with the wrong brushing techniques, teeth grinding, abrasive food or beverages etc. these conditions are present without any painful symptom but already in queue for dental care attention.

These conditions are treated with minimally invasive restorations at an early stage but if ignored, it is always going to deteriorate into a much painful and worse condition. It is always preferred to ask help from a dentist when a person suspects anything unusual and better get it treated earlier before you get more problems.

.

  1. What happens inside cavity?

A cavity always starts with the enamel damage that gradually grows deeper into dentin. It takes a long time for an enamel damage to develop into a cavity. There is always time to prevent decay at initial stage.

When the decay reaches the deeper layers, it will form a cavity which needs to be cleaned and filled before it reaches pulp. If the pulp is affected, a person is going to have every symptom from sensitivity to cold, sweet, hot food to severe pain on biting.

  1. Does a decayed tooth ever heal by itself?

A cavity is a permanent destruction to the tooth surface caused by bacteria which will never heal by it-self. There’s one and only one thing a person can do is to visit your dentist and get it cleaned and filled to stop the further decay of the tooth. If a person wishes to wait to decide for the treatment, the caries would be progressing towards the pulp therefore creating more damage to the tooth.

In case if decay reaches the pulp, only one treatment is left which is root canal treatment in which the dentist removes the infected pulp and filling is done. If the damage is even more, then it goes for extraction.

  1. How a dentist treats a cavity?

Firstly the dentist cleans the decayed portion on the surface of tooth, after the surface is cleaned, the dentist fills the cavity with the filling material which are either self-hardening or cures (hardens) by light. Then the surface is shaped, finished and adjusted to a height which doesn’t hinder in biting.

  1. What does a dentist do to relive the pain?

A dentist always tries to num the pain using topical gel and sprays, followed by injections if needed. It is always advisable to tell your dentist about your discomforts and anxiety so that he could address them properly.

  1. What if a person has more than one cavity? How many appointment a person generally needs?

A filling normally takes about 20-30 minutes depending upon their size. It also depends on how a person is comfortable with opening their mouth for the time required for filling. The longer a person is comfortable with their mouth open, the less time it will take to fill the cavity

Also it depends on the number of cavities. A dentist always evaluates about the damage teeth has and the most damaged tooth is given the priority in such cases.

When crowns are concerned, they always take more than one appointment. In first appointment the tooth is shaped and prepared for the crown, and the impression is taken in that sitting and a temporary crown is given. One week later the new customized crown is ready to e bonded over the prepared tooth. Adjustments are done and patient is called for a follow-up and the patients if have any discomfort is corrected.

  1. Who needs a filling?

When a tooth has small fractures, it usually doesn’t require filling. May be polishing and minor shape adjustments are enough for that. Bigger fractures may require fillings and in some cases, crowns.

  1. Is the filling is as strong as natural tooth?

Small and mediums fillings are generally strong enough to withstand some amount of force. Bigger damaged tooth may require crown if adequate strength is needed. A big filling may also provide some strength but may not work well under tremendous pressure and might end up breaking and is some cases it breaks along with tooth. In such cases, the tooth is even more damaged than before. Therefore dentists generally prefer crown in such cases.

  1. Fillings last for how long?

Researches show that amalgam filling has survived over 12 years and composite fillings up to 9-10 years. Crowns and veneers can survive for at least 10-20 years and even longer depending upon the care taken. Studies have shown that a filling is safe after 8-12 years and crowns lasting for 30-40 years depending on the situation and the precautions taken.

  1. Should one expect soreness or pain after the treatment?

A person may feel slight discomfort for a few days after your tooth has gone under drilling and filling. The symptoms only last for few days or less.

The tooth may feel more sensitive if the cavity was large than usual. The symptoms will gradually fade away after certain time. In such cases monitoring the cavity is recommended for the symptoms and the healing.

Therefore it is important to visit your dentist regularly for dental check-ups and when you feel any discomfort and pain so that you can control the situation at the earliest to avoid the risk in future.

Intraoral welding of implants-known since decades- conveyed to practice

In cases of complete oral rehabilitation there are multitudes of complications which may occur with either the surgical or prosthetic phase of implant dentistry. In order to mend this, intraoral welding technique has been introduced as a rescue.

In cases of deficient bone or atrophic ridges, higher chances of implant failure occur due to micromotion of implants during healing phase.

This is one phase procedure to attain the goal of primary stabilization of implants while fabricating immediate prosthesis to the patient on the same day of the surgery or within a few days.

 Discussing about the advantages of welding, it rigidly splints the implants, helps in healing, distributes the force to all implants, and increases the success through Osseo integration of implants. In cases of implant overdenture, absolute stabilization of implants can lead to immediate loading and oral rehabilitation on the same day of surgery.

The welding of the implant abutments with titanium bars is done directly in the mouth. It also has an advantage of eliminating the possible errors or distortions due to the impression.

 The rigid splinting of the implant abutments done before the immediate loading provides retention to the implants & decreases the stress exerted on the implants. The method incorporates either welding a titanium bar or a wire to the abutments of these implants. Once the implants have achieved the stability and retention, they can be loaded with crowns/ bridges or over dentures.

weldone

This has been reported leading to lesser degree of implant fractures. This means ensuring success for the longevity of the implants, in a short period of time. For example in a case of complete rehabilitation of a patient required extractions are done followed by insertion of implants (either 6 or more if required) into the jaw bones.

 During the surgical stage the curettage of the gums is done simultaneously. The bite of the jaws is recorded at first before commencing any procedure.post implant insertion the intra oral welding of the abutments is done. Afterwards the fabrication of the hybrid denture prosthesis is done and fixed in the mouth.

 The stabilized prosthesis helps in chewing & speech of the patients along with the natural aesthetic look. The discomfort due to the movement and clicking of the dentures is avoided in such cases. The aim of this new technique is to find the optimal conditions for the success of the implants through continuous joint without alterations in the intraoral welding of titanium by electric resistance technique.

The proposed technique allows intraoral welding of titanium for solidarization of dental implants to improving their primary stability. Commercially pure titanium (c.p. Ti) wires and dental screws were welded by electric resistance technique. Worldwide, clinical cases have demonstrated the effectiveness of this technique in the improvement of dental implants primary stability practically.

“Start-Up” Program in Implant Dentistry Mentoring

Mentoring by Surgical Master Dr.Rajat Sachdeva

If you are looking for a Mentor to help you with your dental implant career then we may be able to help.

Dr Rajat Sachdeva has mentored and trained many Dentists over the years through formal courses and individually on a one-to-one basis.

If you have no experience of dental implants then it may be helpful to take a look at the section http://www.sachdevadentalcare.com/implanto-dontia.html

where details of our courses can be found. These courses are a great way to get started with dental implants.

Alternatively if you already have experience with dental implants but want to increase your confidence in certain areas then individual mentoring with Dr.Sachdeva may be more appropriate. For example, if you have already completed a few cases but want help with overall treatment planning then one-to-one Interaction with Dr Rajat could be very beneficial. Or, if you place implants confidently but want help with bone grafting techniques, Dr Rajat will be pleased to assist you.

Basically we can tailor individual mentoring to whatever level or area you require.

If you want to consider being mentored by Dr Rajat Sachdeva contact him directly on 01142464041 for an informal chat.

How to overcome dental anxiety

Have a visit due to your dentist that you have been avoiding for a long time? Is there a general sense of fear associated with that dental chair and the various sounds and noises it produces? Do not worry. You are not the only one. The idea of going to a dentist can cause as much anxiety as the pain that a decayed tooth may be causing. The responses are not age related. Different people could have different reactions dealing with dental anxiety. Some may be calm and composed and some may be total wrecks. A lot depends on the dentist and the environment he/ she creates for the patients. Understanding the patients and their levels of anxiety could be crucial in assessing their levels of anxiety and help them overcome it.

Assessment of dental anxiety

There are numerous ways available to assess dental anxiety, both in children and adults. A five point scale that is reliable and quick to administer. It has cut-offs for mild, moderate, and phobic levels of anxiety.

Interventions for individuals with low levels of anxiety

 For children attending with low levels of dental fear, approaches that can be adopted include:

  • Rapport building: like use of a magic trick. The use of magic trick increases cooperation when compared to no intervention or the use of tell-show-do technique.
  • Voice control: using loud voice with deep tone is more effective in reducing disruptive behavior of a child & interaction more pleasurable than the normal voice level
  • Distraction: there are number of ways which can be used for distraction such as: the use of video-taped cartoons, audio-taped stories and video games. Distraction techniques are equally effective as relaxation-based techniques, and superior to no intervention.
  • Modeling: modeling has been used extensively with children and is generally most effective if the observed child is similar in age, gender and level of dental anxiety to the child watching, if the child enters and leaves the surgery without adverse consequences.
  • Environmental change: three studies have sought to make the dental environment more attractive to children attending the dental surgery.

Approaches can be used in patients with low dental fear:

  • Enhancing the sense of control: One of the most commonly used techniques to do this is the stop signal.  In this patient can raise the hand and give signal to the dentist.
  • Cognitive distraction: the patient is encouraged to think about something other than the dental situation, be in  a happy place or think of a less stress causing situation.
  • Environmental change: soothing smell of lavender in dental waiting area to reduce the immediate fear of the patient but it will not reduce the underlying cognitive factor.

Interventions for individuals with moderate levels of anxiety

 Patients with moderate levels of dental anxiety may benefit from the prior preparatory information.

  • Information about what will happen (procedural information)
  • Information about what sensations the individual will experience (sensory information)
  • Information about what the individual can do to cope with the situation (coping information).

Interventions for individuals with high levels of anxiety

Pharmacological management

This includes relative analgesia, conscious sedation and general anesthesia. These management techniques are not much used but there are ongoing needs for such services when patient is not regular to visit for treatment or to the point where they are in severe pain or with compromised oral health

Cognitive behavioural therapy

It is a synthesis of behaviour therapy and cognitive therapy and uses both behaviour modification techniques and cognitive restructuring procedures to change maladaptive beliefs and behaviours. Behavioural aspects of CBT include learning relaxation skills, conducting mini-experiments and systematic desensitization. An important principle underlying CBT is its focus on the ‘here and now’ as what started a problem is often not the same as what is keeping it going.

Treatment of Gummy Smiles

How awkward are you to imagine yourself to flash your smile with those extra gums being visible when you have been invited to a momentous event? This is usually followed by an embarrassing condition & hesitation to communicate, isn’t it? These are called as gummy smiles. At Dr. Sachdeva’s Dental Institute, we offer an exquisite treatment to ensure that people don’t have to go through such self conscious circumstances. This is repaired under supervision of experts after discussing various possible treatment options implants, crowns etc of best quality ensuring that your gummy smile vanishes without any side effects.

How can we help with those gummy smiles?

If you are struggling to get rid of a gummy smile, we are here to guide with the treatment options. Contouring of gums is one of the widely advocated options by making your teeth look longer to cover the excess part of your gums in order to repair the smile. However, before proceeding with the treatment, it’s required to do a detailed study of the dental structure, undergo series of tests and identify the source of the problem. Quite often the irregularity in the structure of your gums is a consequence of genetic disorder. In some cases, the treatment is often a combination of the contouring of gums along with fixing of veneers.

This procedure including a surgery seems to be painful, isn’t it?

Gum surgery is not a cup of tea for everyone. Hence, if you opt for treatment at a reputed place like Dr.Sachdeva’s Dental Institute; we don’t fail to deliver the best treatment with all the required precautions to minimize risk of any pain or discomfort. In addition, we aim to finish this hassle free for the patient who can take advantage at the convenience of all facilities under one roof. We provide every facility from implants to various other treatments made available at one place. This is to assure that when you step in for treatment at our clinic, you don’t have to rush from pillar to post with the burden.

Post treatment safety measures

Previously repairing gums used to be a tiresome process. Nowadays you don’t have to spare days recovering because after the treatment, soon you can get back to most of your daily routine. The doctors will help you follow the precautions that are must for the intial few days. Also, our doctors are most likely to advice routine follow-ups in order to keep a check on your progress. This is done to provide the additional instructions to follow during your healing time to increase the pace of recovery.

Porcelain Laminate Veneers – INSIGHT

With the recent increase in patient’s demand for esthetics in the anterior region porcelain laminate veneers have become the esthetic alternative to ceramic crowns and the traditional porcelain-fused-to-metal. Its use has been advocated as it exhibits natural fluorescence, enamel mass and absorb, reflect, and transmit light exactly as natural tooth structure with conservative preparation. The actual approximate thickness of a porcelain laminate veneer is 0.4 to 0.7 mm which closely resembles that of the natural tooth enamel. The application & case selection of the porcelain veneers ranges from the restoration of small proximal lesions, moderate incisal chipping, developmental defects of the facial surface of the tooth, intact anterior damaged by staining,Diastema,cover discolored or misshapen tooth. As compared to composite restorations with a questionable longevity being susceptible to discolorations, marginal fractures and wear porcelain veneers are superior in esthetic quality and longevity as the biocompatibility and nonporous surface of the porcelain prevents plaque adherence, the applicability of the supragingival technique ensures excellent periodontal health.

Regards :

Dr.Rajat Sachdeva

Soft Tissue Grafting to improve the Attached Mucosa at Dental Implants

This is in preposition of a treatment planning of an appropriate surgical technique for increasing the width of the attached mucosa in order to maintain Peri-implant health. The soft tissue around gingival being divided into gingival and mobile alveolar mucosa, the gingival width varies individually as 2-9 mm.There is a time-point to distinguish the peri-implant mucosa from the gingival around the teeth:

  • The peri-implant connective tissue has less number of fibroblasts & more collagen fibers’ as compared to gingiva.
  • The junctional epithelium is more permeable with scarce number of blood vessels than that of around the tooth.
  • The peri-implant connective tissue fibers’ run in a parallel direction to the implant or abutment surface without being attached rather being perpendicular to the root cementum.

It has been concluded that presence of non-elastic collagen fibers’ in the connective tissue is responsible for keratinization.

Based on findings, >2 mm of keratinized tissue is required for maintenance of healthy gingival tissues.However,around the dental implants, the crucial role of an adequate width of keratinized /attached mucosa for the clinical success is still controversial.

Recent studies have shown that lack of adequate width of

Keratinized alveolar mucosa around dental implants is associated with more plaque accumulation, inflammation, soft tissue recession, attachment loss. Since implant surgery includes one or two stage bone augmentation procedures, displacement of the mucogingival Junction does occur.hence, in order to regulate the width of keratinized attached mucosa, two different peri-implant soft tissue augmentation procedures can be concluded:

  • Increase in soft tissue volume using a sub epithelial connective tissue graft or soft tissue replacement graft
  • Enlargement of keratinized mucosa width by means of an apically repositioned flap/vestibuloplasty.

Alveolar Ridge Preservation

Tooth loss and subsequent ridge collapse continue to burden restorative implant treatment. Henceforth careful management of the post-extraction tissues is required to preserve the alveolar ridge.

The dimensional changes of the alveolar ridge after tooth extraction occurs due to alveolar atrophy by the osteoclastic resorption of the bundle bone in a more apical and lingual/palatal level resulting into modification of the alveolar ridge in both vertical & horizontal directions.

Clinical trials have been reported that mean loss of 3.87mm in the width and 1.67 mm in the height of the ridge post 3 months of healing.

Alveolar ridge preservation has been suggested to preserve ridge dimensions & soft tissue contour to facilitate implant placement with an emergence profile in the pontic area.

 This technique includes minimally traumatic tooth extraction with or without a flap approach,autogenous bone graft,freeze dried bone allografts,guided bone generation,use of growth factors or bone morphogenic protein or plasma rich fibrin.

Few alveolar ridge preservation procedures with a positive outcome in limiting post-extraction ridge dimensional loss & promoting partial bone regeneration in the extraction sockets are:-

Alveolar ridge preservation using GBR & barrier technique

-A full thickness flap is elevated through intracrevicular incisions depending upon osseous defect not extending more than 3-4 months from the buccal/lingual bony crest

-The tooth is atraumatically extracted by means of periotomes/luxators.During luxation extreme forces are avoided in the buccal plate & granulation tissue or any residual pathology is removed by means of bone curettes followed by saline rinsing

-before grafting any blood clot formed in the extraction socket is removed to ensure the graft is placed at the buccal & lingual/palatal plate to restore any possible fenestration/dehiscence defects avoiding any overfilling.

-A single or double layer of a resorbable barrier used to cover the graft is stabilized under the lingual & buccal flap extending 3mm on the sound bone surface.The flaps are coronally positioned & sutured by vertical mattress/double interrupted sutures interproximally & horizontal cross mattress suture in the mid part of socket

Alveolar ride preservation using the socket seal technique

– In-lieu of surgical augmentation to correct a ridge defect, the socket-shield technique offers a promising solution to support the buccofacial tissues

-Intracrevicular/intraligamentary incisions are made around the tooth to be extracted to dissect   epithelial and connective tissue attachment without raising any flaps.

-After atraumatic extraction followed in the previous technique marginal soft tissues are    deepitheliased by means of a fast angled hand piece & a thin diamond or micro scalpel.

-A free gingival epitheliased graft with a thickness of 2-3 mm harvested from the palatal site is filled into the socket.

By comparison, ridge preservation techniques may reduce the amount of ridge resorption but cannot prevent the loss of interdental bone and papillae. Preservation of supracrestal fibers however can better develop pontic sites in turn preserving the papillae.

Thus it has been shown that the retention of the tooth contiguous with the PDL, its fibers interconnected with bundle bone, avoids the physiological remodeling of the alveolar crest.