Implementing socket seal surgery as a socket preservation technique for pontic site development: surgical steps revisited--a report of two cases.

Background: Tooth removal is always followed by the loss of vital soft and hard tissues. When occurring in the anterior region of the maxilla, the resulting ridge deformation may cause severe functional and esthetic problems. Diverse soft and hard tissue regenerative procedures have been developed for correcting ridge defects with the aim of establishing functional and esthetically pleasing pontic or implant restoration sites. However, these technically demanding procedures may be regarded as non-predictable in the hands of most clinicians. To reduce the need for restoring challenging ridge defects, an alternative exists in the form of a simple, minimally invasive socket-preservation procedure immediately following tooth extraction known as socket seal surgery. This article describes the currently improved surgical steps to be implemented with the objective of achieving a functional and esthetically acceptable pontic site.

Methods: Immediately following tooth extraction, the socket bony walls are debrided and decorticated, and the soft tissue walls are de-epithelialized by a coarse round diamond bur. The socket is filled with particles of a slowly resorbing bone substitute material except for 2 to 3 mm coronally. A cylindrically shaped soft tissue graft that matches the socket orifice contours is harvested from the palatal mucosa and placed atop the bone graft. The soft tissue graft is usually stabilized with six to eight simple interrupted 6-0 monofilament polyamide or 7-0 polypropylene sutures or, when the case allows, by a broad-based pontic restoration that is placed at a minimal distance from the graft.

Results: Two cases, each representing a different technique for stabilizing the soft tissue graft, demonstrate successful graft survival. Clinically and radiographically, successful regeneration of the ridge's hard and soft tissues, including the ability to develop functional and esthetically acceptable pontic sites, was demonstrated.

Conclusions: Socket seal surgery is an efficacious procedure for ridge preservation and is effective in providing the necessary conditions for the development of functional and esthetic pontic sites.