1.Atraumatic extraction of the tooth.

2.An ovate pontic (removable) was placed for 8 weeks healing.

3.Two-stage implant placement followed using full thickness flaps and GBR non-resorbable membranes

4.After 6 months healing, full thickness flaps again with connective grapts (from the palate) placed on the buccal aspect.

5.After four weeks healing, the abutment connection was placed after uncovering the screw.

6.Four weeks later, impressions and a temporary placed.

7.Three weeks later, the final restoration placed.

The conclusions at year one follow-up were that the clinician should expect about .6mm shrinkage in the buccal area and an increase in volume in the papilla area of soft tissue.

Now, let’s review. Total treatment time was 11 months. There were five separate surgical procedures, four in one area (the extraction site) and one in the palate. There were also two full thickness flap procedures in the area we were trying to maintain tissue.

Let’s start at the beginning. At the time of the extraction, no mention was made of bone regeneration in the extraction site itself. We have to assume that the site healed by secondary intention. If that was the case, the protocol was responsible for most of the initial bone and soft tissue loss in the area.

A removable pontic will also cause problems with tissue loss and that was what was used to presumably shape the pontic area.

Every full thickness flap done results in bone loss. The more times it’s done the more problems you can have. To do two full thickness surgeries in these areas will only increase the likelihood of complications.

And besides that, there is no need to do any of this. There was never any mention of initial bone loss or soft tissue defects at the time of extraction. The pictures in that article actually show the optimum condition of an extraction for implant placement.

The soft tissue architecture is perfect and the author states that there was no bone loss in any case. There was also no loss of the buccal plate.

The biggest cause of bone loss and soft tissue architecture is surgery or disease. The latter is when GBR procedures are warranted. The former is to be avoided. Either immediate implant placement (one-stage) or GBR should follow atraumatic extractions in the extraction site.

If the latter is used, there should then follow, (after healing), a transmucosal placement of an implant, never in either case, disturbing the soft tissue and it’s natural architecture.

In today’s world of implants, there are systems and procedures which, when used in cases such as these, cut the restorative time from 11 months to as little as six weeks. It will also reduce the surgical procedures from five to one-just the atraumatic extraction and the immediate implant placement in the same visit.

There are times when the impression and temporization can be done at the placement visit also. This then restores the case with the final restoration in as little as three weeks.

This article has no new information and the techniques, though still relevant, are not in the cases and situations presented.

RATING: NO TEETH