Healing of the post extractive socket: technique for conservation of alveolar crest by a coronal seal

The first aim of the following experimental study was to assess bone changes in the horizontal and vertical dimension when using different socket preservation procedures. The second objective of our work was also to compare two clinical methods of coronal seal's management: an experimental group was treated using the natural extracted tooth; another experimental group saw the use of a provisional resin preformed as a seal technique. In twelve patients a premolar tooth was extracted without elevation of a mucoperiosteal flap and the patients were randomly distributed into four groups. The first and second group was considered as a control groups: in the first, the extraction socket was left with its blood clot and interrupted sutures were applied; In the second, the extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and a free gingival graft was sutured to cover the socket. The third and fourth groups was considered as a test group. In the third group, after tooth extraction, for aesthetic reasons, the root of the natural dental element is cut to allow immediate temporary prosthesis. In the fourth group, as in group 3, the patient is discharged through a temporary restoration performed or by the dental technician or directly to the chair. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES. To assess the level of bone healing at the extraction site, the following parameters were evaluated: 1) changes in soft tissue and 2) changes in bone level. As for soft tissues, they were assessed using the PES score by two assessments, four weeks apart. The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 3), 6.62 (SD 3.24, group 4). The differences between groups 1 and 2 and were statistically significant (P=0.015 and P=0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity. As regards hard tissue, during the 6-month period, bone remodeling occurred in all four experimental groups with different percentages. The mean vertical loss of the buccal bone plate for the Tx 1 group was -2 ± 0.2 mm. The Tx 2 group showed vertical loss of - 0.34 ± 0.2 mm. The Tx 3 group demonstrated - 0.3 mm of mean vertical loss and the 4 groups demonstrated -0.46 of mean vertical loss. The horizontal dimension of the alveolar process was 13.5 ± 0.1 mm, 7.6 ± 0.1 mm e 6.7 ± 0.1 mm at the three different levels for the Tx 1 group. The Tx 2 group depicted bone dimensions of 14.4 ± 0.2 mm, 13.7 ± 0.3 mm e 13.4 ± 0.1 mm. The horizontal dimension of the Tx 3 - Tx 4 group was 13.7 ± 0.3 mm, 13.1 ± 0.1 mm e 13 ± 0.1 mm and 13.5 ± 0.1 mm, 13.2 ± 0.1 mm e 12.9 ± 0.1 mm. The findings from the present study disclose that incorporation of coronal seals define a particular respect to the buccal bone plate.