Treatment Alternatives Following Extraction of Teeth with Periodontal-Endodontic Lesions

Following extraction of tooth/teeth with advanced loss of periodontal support, as those with periodontal-endodontic lesions, the remaining bone architecture should be carefully evaluated, especially where implant-supported restoration is planned. Marked resorption of the residual alveolar bone is usually appreciated 3 months after tooth extraction. This process may impair implant-supported restoration outcome, especially in the upper jaw, where esthetics is a key factor. Different treatment alternatives are available at the time of tooth extraction, namely immediate implant placement, primary soft tissue closure of the extraction site that may be followed by early implant placement, ridge preservation, and ridge augmentation. For each clinical case, treatment possibilities should be considered and evaluated according to tooth location, esthetics, soft tissue characteristics, infection, number of implants simultaneously placed, available bone volume, bony defects, and treatment convenience. The immediate post-extraction implant may present certain advantages compared to implant placement in healed sites, mainly concerning the possibility for immediate restoration and reduction of overall treatment time and surgical sessions. Advantages and risks related to implant placement in infected sockets following the extraction of teeth with advanced loss of supporting bone should be carefully evaluated. Surgical procedures based on rotated full and/or split palatal flaps that allow for primary soft tissue closure over the extraction sites may be a useful treatment approach for improved results in the maxilla. Although, the benefit of immediate implant placement and socket preservation procedures is not evident. Treatment rationales that allow preservation and/or augmentation of soft and hard tissues at the time of maxillary tooth extraction could offer benefits for the overall long-term functional and esthetic success of the future implant-supported rehabilitation. Defect morphologies that allow improved bone regeneration are present shortly after extraction; however, primary soft tissue closure and maintenance over the barrier membrane and bone graft seems to be one of the most important factors for success of GBR procedures, disregarding the timing of implant placement related to tooth extraction. The different treatment alternatives will be discussed and evaluated based on literature review and clinical studies. The objective is to provide the scientific evidence for the different approaches to facilitate the election of the most appropriate treatment alternative for each clinical situation.