Dr Marek Gatz, DDS, M.Sc.

W 1991r. ukończył studia na Akademii Medycznej w Gdańsku ( obecnie GUMED- Gdański Uniwersytet Medyczny)

Od 1991r. prowadzi działalność stomatologiczną pod nazwą DENS ®, w ramach której znajdują się:

1. Firma Polskie Centra Stomatologiczne sp. z o.o. „DENS” z 6 oddziałami (www.dens.com.pl) w której jest kierownikiem medycznym

oraz od 2000r. autorski gabinet

2. Prywatny Gabinet Implantologii i Stomatologii Estetycznej DENS V.I.P. (www.implanty-densvip.pl) gdzie zajmuje się implantologią i protetyką stomatologiczną

Ważniejsze szkolenia

2009r. – ukończenie prestiżowego szkolenia - Curiculum implantologiczne w Niemczech na Uniwersytecie im. Johanna Wolfganga Goethe we Frankfurcie n/ Menem i uzyskanie tytułu implantologa

2013r. – ukończenie studiów podyplomowych na Uniwersytecie im. Johanna Wolfganga Goethego we Frankfurcie nad Menem i uzyskanie najwyższego tytułu naukowego z implantologii Master of Science in Oral Implantology (MSc ).

Abstakt pracy dyplomowej:

"Socket preservation by means of socket grafting or immediate implant placement – a review of the literature "

Statement of problem and background

After tooth extractions the tooth-related bone will resorb and the absence of functional stimuli will lead to an involution of the alveolar process. As a result the ridge volume will be substantially reduced. In the course of conventional, and especially implant-retained prosthetic treatment, this may lead to serious functional, biological and aesthetic problems.

The purpose of the study is to evaluate if socket preservation or immediate implant placement has the potential to preserve the alveolar ridge after tooth extractions, and if there is a difference between the results achieved with both approaches.

Hypothesis

The hypothesis is that both approaches have the equal potential to maintain the width and height of the alveolar bone at the extraction site reduce the tissue loss normally found after extractions.

Materials and Methods

The impact of socket preservation techniques and immediate implant placement on the maintenance of the ridge volume following tooth extraction were analyzed based on the existing literature.

Results

In the present thesis differences between test and control groups were evaluated in the selected studies concerning socket preservation and immediate implant placement. After an initial assessment of the selected documents, a marked heterogeneity of the study designs was found.
For example, both clinical, radiological, histological and histomorphometrical parameters were analyzed in the different studies. Moreover a great number of materials were used. Therefore, a statistically valid analysis of quantitative data was not possible. Instead, a descriptive presentation of the data was chosen.
The studies analyzed in this thesis revealed that during the natural process of healing of the alveolus after extraction there was a substantial loss of alveolar ridge width and height. This loss was found to be significantly reduced by means of various socket preservation procedures.
Concerning specific techniques the vast majority of researchers supported the use of graft materials for the preservation of alveolar bone after tooth extractions.
Various types of materials and agents were used for socket preservation or augmentation, including autogenous, allogenic or xenogenic graft materials, synthetic biomaterials (alloplast materials), and growth factors (e.g. BMPs, TGF-β, PDGF). The membranes used for guided bone regeneration procedures included non-resorbable and resorbable products.
The present literature review also revealed that the immediate placement of an implant following tooth extraction may reduce the loss of alveolar bone. It was noted that this approach has positive effects on maintaining the bone structure and soft tissues in the periphery of the alveolus. There was also found a positive impact of immediate implant placement on peri-implant soft tissues.
The studies presented in available materials show that the loss of width during a natural extraction socket healing process can range from 1.4mm [44] to 7mm [57] after a year – mean score 3.74 mm , and that the loss of height can be in the range of 0.3mm [42] to 1.5mm [28] after a year – mean score 0.76mm.
When socket preservation procedure was used, the loss of alveolar bone width remained between 0.1mm [40] and 5.53mm [41] – mean score 1.31mm - while the loss of height was within the range of 0.23mm [42] do 2.1mm [39] – mean score 0.36mm. The decisive majority of researchers (except for Becker [29], Zubigalla [39]) support the use of biomaterials for the purpose of alveolar bone preservation after tooth extraction.
The use of immediate implantation as one of the methods of socket preservation resulted in the reduction of the loss of height of socket wall. The loss of height was between 0.26mm [253] and 1.2mm [272][249] at 12 months; to 2.6mm [236] at 27 months – mean score 0.56mm. The majority of researchers provided a positive evaluation of immediate implantation as one of the methods of socket preservation. Negative evaluation was provided by only two authors (Araujo [5][48] and Botticelli [252].

Discussion

To prevent the post-extraction bone deficiencies socket preservation procedures can be applied. The aim of these treatments is to significantly enhance the functional and aesthetic quality of the planned prosthesis which results in an improved patient smile and appearance. These factors are dependent on an intact alveolar ridge, with sufficient hard and soft tissue volume. An intact alveolar ridge also increases the success rate for implant surgery. However, despite the use of atraumatic surgical techniques, socket preservation procedures (and immediate implant placement) do not prevent resorption of the tooth-related bundle bone. Moreover, based on the available literature, it was found that data on socket preservation techniques are very heterogeneous and therefore of limited statistical validity. For example, a vast variety of graft materials and techniques have been applied and there are only few prospective studies which compare different approaches. Some studies are based on histological or histomorphometric methods, others on clinical, radiological or photographic information. The literature analysis revealed that immediate implant placement is also a suitable method for preservation of ridges after extractions.

This result is supported by most researchers. As an innovation, some authors propose the additional use of immediate loading. They argue that this protocol contributes to better osseointegration and an increased bone density around implants and find favorable results concerning loss of crestal alveolar bone.

Conclusion

Various socket preservation techniques and an immediate implant placement significantly help to reduce the horizontal and vertical loss of ridge volume after extractions. Moreover, immediate implant placement has the potential to enhance the quality and quantity of peri- implant bone and to improve soft tissue healing, resulting in better esthetics.

However, these procedures will not completely prevent bone resorption because a certain loss of the alveolar bone height and width can still be expected. In an innovative approach immediate loading of implants is suggested, as this improves their osseointegration and increases bone density around the implant. It also has a beneficial effect on the condition of soft tissues surrounding the crown attached to the implant.

Based on the available literature, it has been determined that the data concerning socket preservation are very differentiated and limited and do not allow for straightforward conclusions to be drawn.