Male patient *1986 by Dr. V. Kokovic (02-10/2007). Anterior single implant placement after orthodontic extrusion and ridge preservation.

When a tooth is considered to be irrational to treat and needs to be extracted every dentist needs to take decisions on whether to let the socket heal spontaneously with a blood clot or whether to perform alveolar ridge preservation procedures. In this module you are going to learn all the important decision-making factors and the clinical handling after tooth extraction to chose either between spontaneous healing after tooth extraction or immediate implant placement or alveolar ridge preservation procedures.

Objectives: The objective of this study was to evaluate the approximation of maxillary tooth roots to the sinus, the incidence of root penetration into the sinus, and its influence on extraction of maxillary posterior teeth. A technique for repairing oroantral communication aimed to augment the extraction site and provide valuable bone volume for implant insertion and final restoration. Methods: Forty-six patients were evaluated by x-ray and perpendicular measurement of sinus approximation from the tip of the root of the posterior teeth to the sinus. The number of root penetration into the sinus were counted. Ten cases had oroantral communications post-extraction and were enrolled in the study. The repair intervention was delayed in two, and eight were operated on at the time of extraction. Sinus floor was elevated noninvasively through the socket and collagen matrix was inserted into the lateral wall of the sinus and rotated to close the oroantral communication of the palatal wall. Corticocancellous bone chips were used to augment the site. Collagen matrix was used again to cover the site, with soft tissue closure. The sites were evaluated by x-ray four months later, to evaluate bone volume and density. Implants were inserted and final restoration was done after four months. The average follow-up of patients as 2.5 years. Results: Both the left and right sides were evaluated for sinus approximation and root penetration. The combined average distances were recorded for the upper first premolars (9.4mm), upper second premolars (4.55mm), upper first molars (4.065mm), upper second molars (1.87mm) and upper third molars (3.6mm). The mean percentage penetration was calculated for the upper first premolars (1.25%), upper second premolars (8.53%), upper first molars (46.4%), upper second molars (27.65%) and upper third molars (21.82%). In this case series, all oroantral communications were successfully closed and all sites were augmented without postoperative complications. Clinical and radiographic evaluations revealed successful implant restoration. Conclusion: Within the limitations of this study, oroantral communications can be repaired and augmented for implant restoration by proper preoperative evaluation of sinus approximation using this novel technique.