Preservation Of Tooth Socket In Upper Premolar: Case Report

Abstract

Background: Socket preservation (SP) is a technique that aims to reduce the dimensional changes that occur in the socket and soft tissues (ST) after tooth extraction, to facilitate subsequent rehabilitation with implants1,2,9. The advantages of this procedure include the maintenance of existing hard tissues (HT) and ST, conservation of the volume of the alveolar ridge in order to improve aesthetic and functional results, and optimize future procedures2 . The objectives are to preserve post-extraction alveolar volume, manage HT and ST to an optimal situation regardless of the moment chosen for implantation, and improve aesthetic results.

Clinical Presentation: Female patient, 18 years old, ASA II, passive smoker 2/day, her reason for consultation was a fractured tooth that required rehabilitation treatment. The clinical examination revealed tooth 1.4 in a residual state with associated gingival hyperplasia, gingivitis induced by generalized plaque, and a thin gingival biotype. The periapical radiograph showed a biradicular tooth with a radiolucent area immediately on the camera. As the tooth had no possibility of treatment, extraction with PDA technique was indicated, for future implant rehabilitation. A xenograft of bovine origin and Jason's membrane (MDJ) was used. In the first control, the detachment of MDJ was observed. At 6 months the collapse of the vestibular table was evident.

Clinical Relevance: The treatment aims to maintain the volume of HT and ST since the rehabilitation with implants would be delayed and it is documented that in nonpreservative techniques at 6 months there is a loss of 40% in height and 60% in thickness3 , the facial alveolar bone (FAB) being the most affected7,8,9. Although the fact of performing an atraumatic extraction is also considered a PDA technique, the use of bioactive materials further reduces dimensional changes4 , in addition, the use of resorbable membranes avoids subjecting patients to a second intervention6 . The most frequent complication is ST dehiscence4,5, an inconvenience that may have influenced the detachment of MDJ.

Conclusion: Although the results were not as expected due to the aforementioned complication, it should be noted that the use of this technique is favorable not only aesthetically but also functionally for greater success in future treatment.