Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Jun 2007

Immediate Bone Augmentation After Infected Tooth Extraction Using Titanium Membranes

DDS,
DDS, and
MD
Page Range: 133 – 138
DOI: 10.1563/1548-1336(2007)33[133:IBAAIT]2.0.CO;2
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Abstract

Infectious process frequently results in extensive bone resorption and defect, periradicular or periapical lesions, or vertical fracture with infected sinus tract. When tooth extraction is mandated it typically results in additional bone loss in the buccal or lingual cortical plate. Immediate guided bone regeneration (GBR) and implant fixation at an infected site is frequently complicated by soft-tissue dehiscence, membrane exposure, and implant failure. The objective of this research is to assess the feasibility of immediate bone augmentation (IBA) after purulent tooth extraction, employing a dedicated titanium membrane. An intrasulcular incision was made around the tooth to be extracted and extended to 2 adjacent teeth while maintaining the papillae. Vertical releasing incisions were made to mobilize the mucoperiosteal flap. Cautious tooth extraction was executed utilizing conventional measures and was followed by meticulous curettage of the infected and granulated tissue in the socket. Titanium membranes were applied to the socket walls followed by socket filling with autologous platelet-rich fibrin and primary closure. Eight or more weeks later membrane removal and implant placement were performed. Of the 15 patients who underwent this procedure, 7 patients (47%) had early membrane exposure (between weeks 2 and 6), which was treated conservatively. No infection or early membrane removal was reported. All patients achieved sufficient bone augmentation, and 8 patients received implants without any additional GBR. IBA after infected tooth extraction, using titanium membrane application was feasible and safe and yielded adequate bone filling to support implant fixation at ≥8 weeks. Further studies need to evaluate if the titanium membrane helped in any way to inhibit plaque accumulation or resist infection in cases of early membrane exposure.

Copyright: American Academy of Implant Dentistry
Figure 1.
Figure 1.

(a) Absence of lingual cortical plate after tooth extraction. (b) Membrane application after socket debridement. (c) Socket filling with platelet-rich fibrin. (d) Primary closure. (e) 1 Week after tooth extraction. (f) 8 Weeks after tooth extraction—implant fixation.


Figure 2.
Figure 2.

(a) Extensive loss of buccal and cortical plate. (b) Membrane application after socket debridement.


Figure 3.
Figure 3.

(a) Pre-extraction—after vertical fracture. (b) Immediately postextraction of tooth #25 and titanium membrane application with socket filling using platelet-rich fibrin. (c) 16 Weeks postextraction. (d) Implant fixation.


Contributor Notes

Efraim Kfir, DDS, is in private practice at the Dental Clinic in Petah-Tikvah, Israel.

Vered Kfir, DDS, is in private practice at the Dental Clinic in Kupat Holim Clalit, Rehovot, Israel.

Edo Kaluski, MD, associate professor of medicine, director of cardiac catheterization laboratories and invasive cardiology, University of Medicine and Dentistry of New Jersey, Newark. Address correspondence to Dr. Kaluski at 812 Sun Valley Way, Florham Park, NJ 07932 (ekaluski@gmail.com).

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