Treatment of an Erratic Extraction Socket for Implant Therapy in a Patient with Chronic Periodontitis
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Auteurs : Yusuke Hamada [États-Unis] ; Srividya Prabhu [États-Unis] ; Vanchit John [États-Unis]Source :
- Case Reports in Dentistry [ 2090-6447 ] ; 2016.
Abstract
As implant therapy becomes more commonplace in daily practice, preservation and preparation of edentulous sites are key. Many times, however, implant therapy may not be considered at the time of tooth extraction and additional measures are not taken to conserve the edentulous site. While the healing process in extraction sockets has been well investigated and bone fill can be expected, there are cases where even when clinicians perform thorough debridement of the sockets, connective tissue infiltration into the socket can occur. This phenomenon, known as “erratic healing,” may be associated with factors that lead to peri-implant disease and should be appropriately managed and treated prior to surgical implant placement. This case report describes the successful management of an erratic healing extraction socket in a 62-year-old Caucasian male patient with chronic periodontitis and the outcomes of an evidence-based treatment protocol performed prior to implant therapy. Careful preoperative analysis and cone beam computed tomography imaging can help detect signs of impaired healing in future implant sites and prevent surgical complications.
Url:
DOI: 10.1155/2016/1746961
PubMed: 27807485
PubMed Central: 5078642
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<author><name sortKey="Hamada, Yusuke" sort="Hamada, Yusuke" uniqKey="Hamada Y" first="Yusuke" last="Hamada">Yusuke Hamada</name>
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<wicri:regionArea>Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry, Indianapolis, IN 46204</wicri:regionArea>
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<author><name sortKey="Prabhu, Srividya" sort="Prabhu, Srividya" uniqKey="Prabhu S" first="Srividya" last="Prabhu">Srividya Prabhu</name>
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<front><div type="abstract" xml:lang="en"><p>As implant therapy becomes more commonplace in daily practice, preservation and preparation of edentulous sites are key. Many times, however, implant therapy may not be considered at the time of tooth extraction and additional measures are not taken to conserve the edentulous site. While the healing process in extraction sockets has been well investigated and bone fill can be expected, there are cases where even when clinicians perform thorough debridement of the sockets, connective tissue infiltration into the socket can occur. This phenomenon, known as “erratic healing,” may be associated with factors that lead to peri-implant disease and should be appropriately managed and treated prior to surgical implant placement. This case report describes the successful management of an erratic healing extraction socket in a 62-year-old Caucasian male patient with chronic periodontitis and the outcomes of an evidence-based treatment protocol performed prior to implant therapy. Careful preoperative analysis and cone beam computed tomography imaging can help detect signs of impaired healing in future implant sites and prevent surgical complications.</p>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Dent</journal-id>
<journal-id journal-id-type="iso-abbrev">Case Rep Dent</journal-id>
<journal-id journal-id-type="publisher-id">CRID</journal-id>
<journal-title-group><journal-title>Case Reports in Dentistry</journal-title>
</journal-title-group>
<issn pub-type="ppub">2090-6447</issn>
<issn pub-type="epub">2090-6455</issn>
<publisher><publisher-name>Hindawi Publishing Corporation</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27807485</article-id>
<article-id pub-id-type="pmc">5078642</article-id>
<article-id pub-id-type="doi">10.1155/2016/1746961</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group><article-title>Treatment of an Erratic Extraction Socket for Implant Therapy in a Patient with Chronic Periodontitis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-8544-8418</contrib-id>
<name><surname>Hamada</surname>
<given-names>Yusuke</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Prabhu</surname>
<given-names>Srividya</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-4803-1845</contrib-id>
<name><surname>John</surname>
<given-names>Vanchit</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
</contrib-group>
<aff id="I1">Department of Periodontics and Allied Dental Program, Indiana University School of Dentistry, Indianapolis, IN 46204, USA</aff>
<author-notes><corresp id="cor1">*Yusuke Hamada: <email>yuhamada@iupui.edu</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: Sukumaran Anil</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>11</day>
<month>10</month>
<year>2016</year>
</pub-date>
<volume>2016</volume>
<elocation-id>1746961</elocation-id>
<history><date date-type="received"><day>26</day>
<month>7</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>19</day>
<month>9</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2016 Yusuke Hamada et al.</copyright-statement>
<copyright-year>2016</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>As implant therapy becomes more commonplace in daily practice, preservation and preparation of edentulous sites are key. Many times, however, implant therapy may not be considered at the time of tooth extraction and additional measures are not taken to conserve the edentulous site. While the healing process in extraction sockets has been well investigated and bone fill can be expected, there are cases where even when clinicians perform thorough debridement of the sockets, connective tissue infiltration into the socket can occur. This phenomenon, known as “erratic healing,” may be associated with factors that lead to peri-implant disease and should be appropriately managed and treated prior to surgical implant placement. This case report describes the successful management of an erratic healing extraction socket in a 62-year-old Caucasian male patient with chronic periodontitis and the outcomes of an evidence-based treatment protocol performed prior to implant therapy. Careful preoperative analysis and cone beam computed tomography imaging can help detect signs of impaired healing in future implant sites and prevent surgical complications.</p>
</abstract>
</article-meta>
</front>
<floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Panoramic radiograph at the initial appointment (#30 was extracted by the referring dentist).</p>
</caption>
<graphic xlink:href="CRID2016-1746961.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>Preoperative views: (a) intraoral; (b) periapical radiograph.</p>
</caption>
<graphic xlink:href="CRID2016-1746961.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>Guided bone regeneration procedure was performed on the erratic extraction site (a–f). After a full-thickness flap was elevated, granulation tissue was noted filling the previously extracted site (a and b). Following thorough debridement and irrigation, the site was determined to be a containable defect (c). FDBA was gently packed in the socket and covered with non-cross-linked collagen membrane (d and e). Complete primary closure was achieved with a combination of horizontal mattress and single interrupted sutures (f).</p>
</caption>
<graphic xlink:href="CRID2016-1746961.003"></graphic>
</fig>
<fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label>
<caption><p>The removed specimen and histopathological picture (H&E stain). Approximate 5 × 5 × 3 mm elastic hard granulation tissue was removed from the erratic extraction site (a). Fibrous connective tissue with inflammatory cells infiltration (b).</p>
</caption>
<graphic xlink:href="CRID2016-1746961.004"></graphic>
</fig>
<fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label>
<caption><p>Implant placement five months after the graft procedure. The erratic healing extraction site showed increased radioopacity five months after the bone graft surgery (a). Bone fill was found on the crestal portion of the site (b). Implant was placed at a restoratively driven position (c).</p>
</caption>
<graphic xlink:href="CRID2016-1746961.005"></graphic>
</fig>
<fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label>
<caption><p>One-year follow-up after crown delivery. There is no evidence of inflammation or symptoms (a). Crestal bone loss or typical retrograde peri-implantitis was not noted on the periapical radiograph (b).</p>
</caption>
<graphic xlink:href="CRID2016-1746961.006"></graphic>
</fig>
</floats-group>
</pmc>
</record>
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