Objectives: To date, most previous work evaluating healing after tooth extraction has included only fresh extraction sockets. In normal clinic practise, however, the indications for extractions are more complex and certain pathologies are associated with destruction of the socket walls, often resulting in severe resorption. The aim of this study was to evaluate the safety of ridge preservation in infected sockets. Methods: A total of 320 dental records from Seoul National University Dental Hospital archives (January 2011–November 2015) including patients who received extraction due to infection and immediate ridge preservation in the Department of Periodontics were evaluated. the exclusion criteria were as follows: i) ridge preservation in fresh sockets which were extracted due to caries and fracture (excluding retained roots); ii) ridge preservation performed with non-resorbable membrane; iii) age less than 20 years; iv) repetitive medication administration with anti-inflammatory drugs (excluding rheumatoid disease); iv) current pregnancy; and v) history of autoimmune disease. Records were reviewed to identify cases where infection was present (endodontic origin, periodontal origin, and combined endodontic–periodontal origin), which was removed by meticulous debridement and immediately grafted with a biomaterial. The following data were retrieved from the hospital database records: pathologic origin, success and failure rates of the attempted ridge procedure technique, and preservation in infected sockets. Results: A total of 320 ridge preservation surgeries were performed and 13 cases not meeting the inclusion criteria were excluded. Of the 307 eligible subjects, 9 cases (2.93%) were classified as endodontic origin, 198 (64.50%) as periodontal, 90 (29.31%) as combined endodontic-periodontal and 10 (3.26%) unknown. Uneventful healing was observed in 299 sites (97.39%) with no additional medication, whereas six sites (1.95%) needed additional medication (5 days of additional antibiotics) due to inflammatory symptoms. Re-infection occurred in two sites and the biomaterials within the socket were removed. Clinical symptoms included abscess with pus formation, caustic odour, pain and severe bleeding. The cause for failure in site 1 may be attributed to overfilling of the biomaterial attracting new infection source and complicating the closure of the wound. In site2, necrotic bone plate and/or retained root-like radiopacity observed in the CT, suggesting incomplete removal of the infection source within the socket. Besides these two cases of infection, ridge preservation was successful in 305 sites, yielding a high success rate of 99.35%. Conclusion: Within the limitation of this study, our observations suggest that immediate ridge preservation with various biomaterials is a safe procedure, despite the need to graft immediately following tooth extraction and to remove the infection source using the conventional debridement method. Caution is needed when performing debridement so as not to leave root fragments or necrotic bone plates unremoved. Also, overfilling may compromise wound stability at the entrance of the socket and must be avoided for optimum results.

Gliederung: - Apikale Lappenreposition - Trisektion des oberen Molaren - Extraktion der distobukkalen Wurzel - Tangentialpräparation der Pfeiler - Unterfütterung des Provisoriums Inhalt: Furkationsbefallene Molaren zeigen im Vergleich zu einwurzeligen Zähnen eine geringere Langzeitprognose hinsichtlich des Zahnerhaltes auf. Neben dem Ersatz durch Implantate gibt es die therapeutische Möglichkeit, die Furkationsbereiche zu eliminieren und einwurzelige Verhältnisse durch Hemisektion oder Trisektion zu schaffen. Studien zur Langzeitstabilität zeigen ein sehr gemischtes Bild. Während einige Studien Misserfolge von 40% zeigten, konnte die Gruppe um G. Carnevale Daten mit Erfolgsraten von mehr als 90% innerhalb von 10 Jahren publizieren. Vorbehandlung: 6 bis 8 Wochen nach konservativer Parodontaltherapie erfolgte die initiale Präparation der Pfeilerzähne, die eine Furkationsbeteiligung Grad II-III aufwiesen. Die Präparation wurde tangential bis auf Knochenniveau durchgeführt, um möglichst wenig Zahnhartsubstanz zu opfern und alle Wurzelkonkavitäten zu eliminieren. Ein metallverstärktes Langzeitprovisorium diente zur Schienung. Daraufhin erfolgte die endodontische Versorgung. Chirurgischer Eingriff: Es erfolgte eine Apikalverschiebung der Gingiva im Bereich der betroffenen Zähne. Anschließend erfolgte die Präparation eines Mukosallappens auf der bukkalen und palatinalen Seite und die Trisektion. Nach Durchtrennung und Entfernung der distobukkalen Wurzel wurde die intraoperative Präparation der Pfeilerzähne durchgeführt. Ein wichtiger Schritt ist das Unterfüttern des Provisoriums, um die Wurzeln zu schienen und deren Einkippen zu verhindern. Weiterbehandlung: Abdrücke für die definitive Versorgung erfolgten 6 Monate postoperativ. Die Restaurationsränder der Tangentialpräparation wurden am Meistermodell festgelegt, die definitive Rekonstruktion weist fein auslaufende Metallränder auf.

Objectives: Oro-antral communications (OAC) can occur after extraction of teeth in the maxilla. Several closure techniques can be used to treat the complication, including conservative flapless techniques. The aim of this study was to compare different techniques for closure of OAC and evaluate their efficiencies. Methods: Ninety-five patients with OAC were divided into five groups of 15 patients for treatment with: a flapless technique with Mucograft Sealä/®, a flapless technique with collagen in root design, a Wasmundä/® buccal flap, free-flap from palate, and a sandwich technique (collagen–Bio-Ossä/®-collagen-free gingival graft). In the first 2 weeks after intervention, patients recorded their perceptions of bleeding, swelling, pain and bruising on a visual analogue scale (VAS). Post-surgical complications were assessed clinically at 1 week, 2 weeks, 1 month and 6 months post-surgery. Results: Closure of all wounds was achieved from 2 weeks to 1 month. There were no post-surgical complications. All VAS parameters decreased to almost zero by day 14 and were maintained after 6 months. Scores for swelling and bruising peaked on days 2 and 3, respectively, before decreasing. Conclusions: Using a flap or flapless technique depends on personal choice and skills of the surgeon. The use of Mucograftä/® for closure of OAC is effective and safe, and is associated with low morbidity and no post-surgical complications.