The 'Compensatory Alveolar Socket Seal' (CASS) Treatment Concept Combining Immediately Placed Implants, Autologous...

The aim of this retrospective case series is to provide evidence of the performance of a surgical concept, the 'Compensatory Alveolar Socket Seal' (CASS) by sealing not only the coronal part of the alveolar socket but also its buccal aspect using a subepithelial connective tissue graft to enhance soft tissue volume and adequately restore a proper emergence profile.

In this retrospective case series, 389 patients underwent treatment with this modified surgical technique (CASS). This treatment includes minimally traumatic extraction, immediate implant placement and a connective tissue sealing the buccal aspect of the socket. Radiographic bone level (RBL) was stablished as the main outcome variable. Other variables such as implant osteointegration or need for secondary subepithelial connective tissue graft surgery were also recorded. Additionally, Pink Esthetic Score (PES) was also evaluated.

Although no statistical differences in RBL were observed, a trend was seen for increased bone level changes in the upper first left premolar (0.97 mm (SD=0.89)) while the least was observed in the upper left canine (0.07 mm (SD=0.88)). Bone level changes varied according to implant site and type of connection. Implants with an external connection had a deeper bone remodeling compared with an internal connection (0.65 mm SD=1.12 vs 0.47 mm SD=1.34 respectively. PES levels improved during the follow up period. The highest increase (1.61) was found between baseline (V1) and 12 weeks postoperatively (V2) (p < 0.001).

The CASS technique appears to be a reliable technique for preserving the alveolar process without requiring hard tissue replacement strategies, with excellent aesthetic results.