Aim: To present the healing, development, and long-term clinical results after a combined gingival–bone graft as an alternative treatment for the management of critical extraction sites in the esthetic zone.
Background: To enhance the knowledge of in vivo soft and hard tissue remodeling, in this case report, we observed the healing, development, and long-term clinical results after a case of a combined gingival–bone graft as an alternative treatment for the management of critical extraction sites.
Case description: Autogenous grafts of gingival and bone tissue were placed in a 56-year-old female patient, where a hopeless upper left central incisor with an evident loss of both the buccal and the palatal bony plates and with endodontic problems was due for extraction. In order to obtain enough autogenous tissue for filling the defect, a cylindrical free gingival and bone graft was retrieved from the retromolar area with a trephine drill, to obtain hard and soft tissues for grafting the postextraction defect. After 6 months, following soft tissue maturation and once esthetic and natural gingival contours were achieved, the surgical site was prosthetically restored with a porcelain fused to a metal bridge and scheduled for regular follow-up.
Conclusion: No complications were observed either from the donor site or from the recipient site. The post-treatment result was esthetically pleasing, based upon successful architectural stability of both hard and soft tissues. Although more studies are needed to confirm the beneficial use of this approach, the procedure can be considered a viable option in the management of soft and hard tissue remodeling in esthetically compromised cases.
Clinical significance: The gingival–bone graft may be considered as an alternative treatment for the management of critical extraction sites in the esthetic area.
Pietrokovski J, Massler M. Alveolar ridge resorption following tooth extraction. J Prosthet Dent 1967;17(1):21–27. DOI: 10.1016/0022-3913(67)90046-7.
Johnson K. A study of the dimensional changes occurring in the maxilla following tooth extraction. Aust Dent J 1969;14(4):241–244. DOI: 10.1111/j.1834-7819.1969.tb06001.x.
Schropp L, Wenzel A, Kostopoulos L, et al. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Period Restor Dent 2003;23(4):313–323. PMID: 12956475.
Trombelli L, Farina R, Marzola A, et al. Modeling and remodeling of human extraction sockets. J Clin Periodontol 2008;35(7):630–639. DOI: 10.1111/j.1600-051X.2008.01246.x.
Azzi R, Carranza F, Etienne D. Surgical reconstruction of the interdental papilla. Int J Period Restor Dent 1998;18(5):466–473. PMID: 10093523.
Rebaudi A, Massei G, Trisi P, et al. A new technique for bone augmentation and papilla reconstruction with autogenous free gingival–bone grafts. Int J Period Restor Dent 2007;27(5):429–439. PMID: 17990439.
Landsberg CJ. Socket seal surgery combined with immediate implant placement: a novel approach for single-tooth replacement. Int J Period Restor Dent 1997;17(2):140–149. PMID: 9497708.
Nozawa T, Sugiyama T, Satoh T, et al. Connective tissue-bone onlay graft with enamel matrix derivate for treatment of gingival recession: a case report. Int J Period Restor Dent 2002;22(6):559–565. PMID: 12516827.
Keller EE, Tolman DE, Eckert S. Maxillary antral-nasal inlay autogenous bone graft reconstruction of compromised maxilla: a 12-year retrospective study. Int J Oral Maxillofac Implants 1999;14(5):707–721. PMID: 10531743.
Landsberg CJ. Implementing socket seal surgery as a socket preservation technique for pontic site development: surgical steps revisited--a report of two cases. J Periodontol 2008;79(5):945-954. doi: 10.1902/jop.2008.070298.
Rebaudi A, Trisi P, Silvestrini P. Use of a resorbable HA—collagen condroitin-sulfate material on immediate post-extraction sites. A clinic and histologic study. Int J Period Restor Dent 2003;23(4):371–379. PMID: 12956481.
Nevins M, Mellonig JT. The advantages of localized ridge augmentation prior to implant placement: a staged event. Int J Period Restor Dent 1994;14(2):96–111. PMID: 7928133.
Tarnow DP, Eskow RN. Preservation of implant aesthetics: soft tissue and restorative considerations. J Esthet Dent 1996;8(1):12–19. DOI: 10.1111/j.1708-8240.1996.tb00904.x.
Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995–996. DOI: 10.1902/jop.19126.96.36.1995.
Grunder U. Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results. Int J Period Restor Dent 2000;20(1):11–17. PMID: 11203544.