J Periodontal Implant Sci.  2011 Oct;41(5):253-258. 10.5051/jpis.2011.41.5.253.

Secondary closure of an extraction socket using the double-membrane guided bone regeneration technique with immediate implant placement

• Yun JH
• Jun CM
• Oh NS

• KMID: 1783621
• DOI: http://doi.org/10.5051/jpis.2011.41.5.253

Abstract

PURPOSE
Immediate implantation presents challenges regarding site healing, osseointegration, and obtaining complete soft-tissue coverage of the extraction socket, especially in the posterior area. This last issue is addressed herein using the double-membrane (collagen membrane+high-density polytetrafluoroethylene [dPTFE] membrane) technique in two clinical cases of posterior immediate implant placement.
METHODS
An implant was placed immediately after atraumatically extracting the maxillary posterior tooth. The gap between the coronal portion of the fixture and the adjacent bony walls was filled with allograft material. In addition, a collagen membrane (lower) and dPTFE membrane (upper) were placed in a layer-by-layer manner to enable the closure of the extraction socket without a primary flap closure, thus facilitating the preservation of keratinized mucosa. The upper dPTFE membrane was left exposed for 4 weeks, after which the membrane was gently removed using forceps without flap elevation.
RESULTS
There was considerable plaque deposition on the outer surface of the dPTFE membrane but not on the inner surface. Moreover, scanning electron microscopy of the removed membrane revealed only a small amount of bacteria on the inner surface of the membrane. The peri-implant tissue was favorable both clinically and radiographically after a conventional dental-implant healing period.
CONCLUSIONS
Secondary closure of the extraction socket and immediate guided bone regeneration using the double-membrane technique may produce a good clinical outcome after immediate placement of a dental implant in the posterior area.

Keyword

Bone regeneration; Dental implantation; Tooth socket

MeSH Terms

Bacteria
Bone Regeneration
Collagen
Dental Implantation
Dental Implants
Keratins
Membranes
Microscopy, Electron, Scanning
Mucous Membrane
Osseointegration
Polytetrafluoroethylene
Surgical Instruments
Tooth
Tooth Socket
Transplantation, Homologous
Collagen
Dental Implants
Keratins
Polytetrafluoroethylene

Figure

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  Figure 1 Schematic drawing showing the appropriate membrane position after immediate implant placement and bone graft. The grafts and implant cover screw were covered with a porcine collagen membrane (lower) and a density polytetrafluoroethylene membrane (upper). It is important to extend the membrane at least 4 to 5 mm over all remaining bony walls and place the top of the implant at least 1 to 2 mm beneath the top of the surrounding bony wall.

• 

  Figure 2 (A) Immediate implant placement after the extraction of tooth #27 (left second molar). (B) Allogenic bone grafting in the coronal gap around the dental implant. (C) Collagen membrane covering the bone-grafted extraction socket and cover screw. (D) Density polytetrafluoroethylene membrane covering the collagen membrane without primary flap closure.

• 

  Figure 3 (A) One month after implant surgery. Note the plaque accumulation on the outer surface of the density polytetrafluoroethylene (dPTFE) membrane. (B) Removal of the dPTFE membrane. Note the well-formed soft tissue below the dPTFE membrane.

• 

  Figure 4 (A) Buccal view of the definitive restoration 16 months postoperatively. (B) Radiographic view 16 months postoperatively. Note the favorable peri-implant soft tissue and the well-maintained crestal bone around the #27 implant.

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  Figure 5 Placement of a collagen membrane and density polytetrafluoroethylene membrane after immediate implantation (tooth #17, right second molar) and bone grafting.

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  Figure 6 (A) One month after implant surgery. Note the relatively favorable soft-tissue healing without signs of inflammation. (B) Removal of the density polytetrafluoroethylene membrane. Note that the mucogingival junction has not changed after surgery.

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  Figure 7 Scanning electron microscopy (SEM) view of the density polytetrafluoroethylene membrane after removal. (A) Outer (oral) surface. Note the heavy bacterial deposition on the surface of the membrane. (B) Inner (tissue) surface. Note the small amount of bacteria in the SEM image of the surface (original magnification, ×2,000).

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  Figure 8 (A) Buccal view of #17 implant with definitive restoration 8 months postoperatively. (B) Radiographic view 9 months postoperatively.

Reference

1. Covani U, Cornelini R, Barone A. Bucco-lingual bone remodeling around implants placed into immediate extraction sockets: a case series. J Periodontol. 2003. 74:268–273.

2. Paolantonio M, Dolci M, Scarano A, d'Archivio D, di Placido G, Tumini V, et al. Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man. J Periodontol. 2001. 72:1560–1571.

3. Wilson TG Jr, Schenk R, Buser D, Cochran D. Implants placed in immediate extraction sites: a report of histologic and histometric analyses of human biopsies. Int J Oral Maxillofac Implants. 1998. 13:333–341.

4. Bartee BK. The use of high-density polytetrafluoroethylene membrane to treat osseous defects: clinical reports. Implant Dent. 1995. 4:21–26.

5. Bartee BK, Carr JA. Evaluation of a high-density polytetrafluoroethylene (n-PTFE) membrane as a barrier material to facilitate guided bone regeneration in the rat mandible. J Oral Implantol. 1995. 21:88–95.

6. Crump TB, Rivera-Hidalgo F, Harrison JW, Williams FE, Guo IY. Influence of three membrane types on healing of bone defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996. 82:365–374.

7. Walters SP, Greenwell H, Hill M, Drisko C, Pickman K, Scheetz JP. Comparison of porous and non-porous teflon membranes plus a xenograft in the treatment of vertical osseous defects: a clinical reentry study. J Periodontol. 2003. 74:1161–1168.

8. Hoffmann O, Bartee BK, Beaumont C, Kasaj A, Deli G, Zafiropoulos GG. Alveolar bone preservation in extraction sockets using non-resorbabledPTFE membranes: a retrospective non-randomized study. J Periodontol. 2008. 79:1355–1369.

9. Irinakis T. Rationale for socket preservation after extraction of a single-rooted tooth when planning for future implant placement. J Can Dent Assoc. 2006. 72:917–922.

10. Juodzbalys G, Wang HL. Soft and hard tissue assessment of immediate implant placement: a case series. Clin Oral Implants Res. 2007. 18:237–243.

11. Oh TJ, Meraw SJ, Lee EJ, Giannobile WV, Wang HL. Comparative analysis of collagen membranes for the treatment of implant dehiscence defects. Clin Oral Implants Res. 2003. 14:80–90.

12. Moses O, Pitaru S, Artzi Z, Nemcovsky CE. Healing of dehiscence-type defects in implants placed together with different barrier membranes: a comparative clinical study. Clin Oral Implants Res. 2005. 16:210–219.

13. Caffesse RG, Nasjleti CE, Morrison EC, Sanchez R. Guided tissue regeneration: comparison of bioabsorbable and non-bioabsorbable membranes. Histologic and histometric study in dogs. J Periodontol. 1994. 65:583–591.

14. Barber HD, Lignelli J, Smith BM, Bartee BK. Using a dense PTFE membrane without primary closure to achieve bone and tissue regeneration. J Oral Maxillofac Surg. 2007. 65:748–752.

15. Brägger U, Hämmerle CH, Lang NP. Immediate transmucosal implants using the principle of guided tissue regeneration (II). A cross-sectional study comparing the clinical outcome 1 year after immediate to standard implant placement. Clin Oral Implants Res. 1996. 7:268–276.

16. Lang NP, Brägger U, Hämmerle CH, Sutter F. Immediate transmucosal implants using the principle of guided tissue regeneration. I. Rationale, clinical procedures and 30-month results. Clin Oral Implants Res. 1994. 5:154–163.

17. Lekovic V, Camargo PM, Klokkevold PR, Weinlaender M, Kenney EB, Dimitrijevic B, et al. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. J Periodontol. 1998. 69:1044–1049.

18. Lekovic V, Kenney EB, Weinlaender M, Han T, Klokkevold P, Nedic M, et al. A bone regenerative approach to alveolar ridge maintenance following tooth extraction. Report of 10 cases. J Periodontol. 1997. 68:563–570.

19. Iasella JM, Greenwell H, Miller RL, Hill M, Drisko C, Bohra AA, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol. 2003. 74:990–999.

20. Wang HL, Boyapati L. "PASS" principles for predictable bone regeneration. Implant Dent. 2006. 15:8–17.

21. Trombelli L, Farina R, Marzola A, Bozzi L, Liljenberg B, Lindhe J. Modeling and remodeling of human extraction sockets. J Clin Periodontol. 2008. 35:630–639.