PMC6421788_01
(a) Periapical radiograph of tooth 46 from the initial examination. (b) Buccal view of tooth 46 at the initial examination. (c) Implant inserted into interradicular septum. (d) Clinical condition after gap filling with autologous particulate bone. (e) Clinical condition after the installation of a cylinder-type healing abutment. (f) Occlusal view after the application of silicone cap on healing abutment. (g) Buccal view after the application of silicone cap on healing abutment. (h) Periapical radiograph immediately after surgery.
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A 56-year-old female patient with an overall healthy oral state visited the clinic for implant placement after the removal of a retained right mandibular 1st molar (tooth 46) root (Figures 2(a) and 2(b)). The gap between the inserted fixture and extraction socket was about 4 mm in both the buccolingual and mesiodistal directions (Figure 2(c)). The gap between the extraction socket and implant was filled with autologous particulate bone obtained by grinding the bone core made by the trephine bur (Figure 2(d)). After equipping it with a cylinder-type healing abutment (Figure 2(e)), a silicone cap was fabricated as described earlier and then placed over the healing abutment because it was easily stretched using the pincettes (Figure 2(f)). Except for the force that exerted light pressure on the soft tissues around the extraction socket, the installed silicone cap showed no movement (Figure 2(g)). The silicone cap is seen as a radiopacity on a radiograph (Figure 2(h)).
(a) Clinical condition before the removal of the silicone cap at 2 weeks postoperatively. (b) Soft tissue condition after the removal of the silicone cap at 2 weeks postoperatively. (c) Clinical condition at 2.5 months postoperatively. (d) Clinical condition at 6 months postoperatively before the application of the final prosthesis. (e) Buccal view at 6 months postoperatively with the final prosthesis. (f) Radiograph at 6 months postoperatively. (g) Radiograph at 22 months postoperatively.
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On clinical images taken at 2 weeks postinsertion, plaque bacteria were observed adhering to the healing abutment, but not the silicon cap, with only slight discoloration (Figure 3(a)). Although the surrounding gingival margin was temporally suppressed by compression due to the silicon cap, healthy soft tissue regenerated, completely sealing the extraction socket (Figure 3(b)). At 2 months after the removal of the cap, the suppressed soft tissue had healed completely (Figure 3(c)). A final prosthesis was provided at 6 months after implant insertion, and healthy attached gingiva formed around the final prosthesis (Figure 3(d)), showing integration with the surrounding gingival margin, including the mucogingival junction (MGJ) line (Figure 3(e)). Furthermore, regenerated bone tissue was observed on the radiograph (Figure 3(f)). A radiograph taken at 22 months postoperatively also showed a well-maintained alveolar bone height (Figure 3(g)).
PMC6421788_02
(a) Occlusal view at the initial examination. (b) Cone beam computerized tomography image at the initial examination. (c) Occlusal view immediately after the insertion of the implant. (d) Clinical condition of the interrupted sutures after gap filling of the extraction socket with allogenic bone and PRF. (e) Application of the silicone cap. (f) Radiograph taken immediately after implant insertion.
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A 42-year-old male patient was admitted for a retained dental root and root apex lesion at tooth 16 and required an implant prosthesis for an extracted tooth 17 (Figure 4(a)). Computed tomography (Figure 4(b)) revealed that the retained bone height was insufficient due to the large root apex lesion of tooth 16. A 13 mm long and 6 mm diameter implant (AnyOne, Megagen Implant Co., Seoul, Korea) was then immediately inserted with insertion torque exceeding 40 N cm (Figure 4(c)); the implant was inserted 1 mm deeper than the height of the alveolar ridge of the extraction socket. After application of the cylinder-type healing abutment, the gap in the extraction socket was filled with allograft material (SureOss, Osstem Implant Co., Seoul, Korea) up to the height of the alveolar ridge of the extraction socket, followed by filling with the PRF membrane up to the height of the soft tissue in the extraction socket (Figure 4(d)). After fabricating a silicone cap as described earlier, it was placed over the healing abutment (Figures 4(e) and 4(f)).
(a) Clean silicone cap at 2 weeks postoperatively. (b) Healing condition of the extraction socket at 2 weeks postoperatively. (c) Clinical condition before the application of the final prosthesis at 8 months after surgery. (d) Radiograph taken after the application of the final prosthesis at 8 months after surgery. (e) Buccal view at 2 years after surgery. (f) Radiographic view at 2 years after surgery.
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At 2 weeks postinsertion, the cleanly maintained silicone cap and sutures were removed (Figure 5(a)); the extraction socket showed satisfactory healing, with soft tissue formation (Figure 5(b)). The soft tissue initially suppressed by the silicone cap was restored, and a well-formed attached gingiva was observed (Figure 5(c)). In addition, stable bone tissue was observed around the inserted implant neck, and increased vertical alveolar bone was observed under the implant (Figure 5(d)). Clinical and radiographic evaluation at 2 years postoperatively revealed a healthy gingival margin and satisfactory stability (Figures 5(e) and 5(f)).