Utilization of Chronic Intrasocket Granulation Tissue for Immediate Implantation in the Type III Extraction Socket of a Maxillary Anterior Tooth
Traditionally, intrasocket granulation tissue (IGT) has been regarded as infected tissue to be removed during extraction to facilitate bone healing. However, recent findings suggest that IGT can support primary closure, preserving keratinized mucosa and enhancing healing potential without requiring additional soft tissue grafting. This case series explores the application of IGT as an extended flap in immediate implant placement within type III extraction sockets, specifically in the anterior maxilla of healthy patients. A dense, thick IGT was utilized to extend the gingival flap, achieving tension-free primary closure and maintaining mucogingival junction stability. This technique allowed for socket preservation with sufficient vestibular depth and reduced surgical intervention. Consequently, this approach may offer a viable alternative for immediate implantation in type III extraction sockets, particularly in esthetic areas in which keratinized mucosa and soft tissue stability are essential.
Case 1. (a) Radiography image shows the alveolar bone loss around tooth #21. (b) Occlusal view of tooth #21. (c) After tooth extraction, dense and thick IGT was observed at the buccal side. (d and e) After dental implant placement and bone grafting, IGT was used as an extended flap to cover the extraction socket. (f) The implant was placed adequately, and bone graft materials surrounded the implant on the CT image. (g) One week after surgery, socket healing was good. (h) Three months after surgery, an implant prosthesis was delivered. (i) Dental implant condition was maintained well for at least 2 years.
Case 2. (a) Radiography image indicates that tooth #22 is splinted to #21 and #23, and there was severe bone resorption to the apical part. (b) After tooth extraction, thick IGT at the buccal side is discernible, coinciding with the buccal defect. (c) The dental implant was immediately placed well. (d) Bone grafting was performed to augment the ridge. (e) Primary closure was performed using extended IGT. (f) The implant was placed well, and the bone graft was filled around the implant on the radiograph. (g) One month after surgery, the gingival healing condition was good. (h) The healing abutment was connected 3 months after surgery. (i) The implant prosthesis was delivered.
Case 3. (a) Radiograph image shows severe alveolar resorption around tooth #21. (b) Supraeruption and labioversion of tooth #21 are observed. (c) The dental implant was placed immediately after tooth extraction, and the thick IGT’s inner part was taken out to extend the gingiva. (d) The extraction socket was covered with IGT, gaining primary closure. (e) The dental implant was placed well on the radiograph. (f through h) Three months after the surgery, the healing abutment was connected. (i) The implant prosthesis was delivered.
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