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CASE REPORT

Socket sealing with mucoderm® in the aesthetic zone

Dr. Massimo Frosecchi

This case report shows successful socket sealing technique after tooth extraction with a partially exposed mucoderm® of the upper central incisor in an aesthetically demanding case.

Initial situation

A 46-year old patient, non-smoker, ASA 1 and no periodontal disease presents with mild pain in the upper central incisor. Her central left incisor #21 showed a mobility and swelling. Additionally, the probing depth was 7-8 mm in buccal area. The preoperative radiographic control revealed a previous endodontically treated tooth with a fractured root.
Another factor that rendered the situation more complicated was that patient had a high smile line and high esthetic expectations.
The treatment plan was extraction and immediate socket sealing with mucoderm® in order to maintain the alveolar structure and soft tissues, and to create an ideal situation for delayed implant placement.


Surgical procedure

At the same time of extraction an acellular porcine dermis matrix (mucoderm®) was placed to occlude the socket and stabilize the blood clot. The matrix was applied partially under the periosteal tissue and only a minimal part remained exposed.

 

A fixed temporary crown was fixed to the adjacent teeth to ensure esthetics without interfering with healing process.

 

No additional bone substitutes were used.  Three months after extraction second stage surgery was performed. At that time, soft tissue had healed and matured, and the hard tissue had partially healed.
At 3 months a buccal volume deficiency was observed with a concavity related to hard tissue remodeling.

 

At 3 months a 3.3 implant (Straumann BLT 3.3 12 mm) was placed in a prosthetically driven way.
The narrow implant allowed a sufficient amount of hard and soft tissue volume maintenance.

 

In order to rebuild a more natural convexity of the buccal wall an additional mucoderm® was applied in sub- periosteal position.


Prosthetic restoration

A customized healing abutment was placed to guide soft tissue to achieve the right conditioning during healing. A Maryland bridge was repositioned in place in order to ensure esthetics during healing time for the patient.

 

After one week, the papillae looked remodeled and missing, but after 3 months, soft tissue proliferation filled the prosthetic spaces.

 

After 3 months, a digital impression was taken and a screw retained temporary crown integrated to continue tissue conditioning and to facilitate following prosthetic stages.

 

After 12 weeks, the temporary crown was removed and the ceramic screw retained crown finalized.

 

A screw retained Lithium disilicate crown was integrated and the follow-up period established.


Conclusion

Tooth extraction in the esthetic zone leads to a higher complexity of the treatment due to limited hard and soft tissue occurrence after tooth extraction.
Implant positioning alone, is mostly insufficient to achieve an optimal outcome. The correct surgical technique and selection of the right biomaterials are important factors to consider in order to determine the desirable result.
Furthermore, the treatment strategy is very important to limit risks. Therefore, a staged approach is often a good way to obtain better results, even if overall treatment time is increased.

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