In an effort to better understand single tooth implant replacement and gingival esthetics, we evaluated a number of variables that can affect gingival esthetics. The one surprising negative influencer was suturing.
Suturing is a necessary evil to properly close and secure a surgical wound. It is time consuming, requires considerable skill, compresses the tissue restricting blood flow, and distorts the normal anatomy of the gingiva. In addition, sutures can be more irritating to the patient than the surgery and induces significant inflammation over time. We have found that suturing has a significant negative effect on gingival esthetics and will now present a case that reflects our findings to demonstrate how you can streamline your surgeries by using an adhesive to secure your membranes and produce additional gingival tissues rather than recession.
Sutureless Socket Membraneswith Oral Bond
The sutureless membrane technique begins with atraumatic extraction. (see Atraumatic Tooth Extraction)
Sulcular incisions are made to separate the periodontal ligament from the tooth. The crown is removed and the roots are sectioned.
After the roots are elevated, the interradicular septum is removed. Removal of the interradicular septum facilitates early implant placement in 4 weeks. For any multirooted tooth that will receive an early implant, the interradicular septum should be removed to prevent the septum from displacing the drill during preparation of the osteotomy for the early implant. Remove any granulation tissue but please do not destroy the socket bone by introducing trauma to the bone or applying any lasers or chemicals. (See Killing Regeneration)
Envelope flaps are made buccal and lingual and the d-PTFE membrane is inserted in the lingual flap to exclude saliva. Socket Graft Injectable is filling the socket. Socket Graft in trays can also be used.
The socket is slightly overfilled.
The membrane is tucked under the buccal flap and the site is prepared for bonding with Oral Bond. Please note the gauze in the buccal and lingual to retain the Oral Bond from flowing past the surgical site when applied.
Oral Bond is applied and either an instrument or a wet finger is immediately applied to the edges of the gingiva to bond the tissue to the membrane.
When using SteinerBio regenerative bone graft materials, the membrane should be placed approximately 6 mm apical to the alveolar crest. During the regenerative phase, the membrane will be displaced coronally, approximately 3 mm. As the gingival and bone is regenerated, the membrane will be displaced coronally approximately 3 mm and deeper placement of the membrane will prevent the membrane from becoming dislodged as the membrane moves coronally. Membrane removal is at 4 weeks after extraction and is this is usually accompanied by early implant placement when using SteinerBio regenerative bone graft materials.
If you are interested in what happens in the socket during the one month time period, see the article:
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American Society for Bone and Mineral Research (ASBMR)
Tissue Engineering and Regenerative Medicine International Society (TERMIS)