A prospective cohort study of immediate implant placement into posterior compromised sockets with or without primary wound closure of reactive soft tissue

Abstract

Background Conventional wisdom states that reactive soft tissue consisting of granulation tissue and long junctional epithelium in compromised sites should be curetted completely, while others approve of its preservation in implant surgeries. Purpose To evaluate the presence of reactive soft tissue as wound closure for immediate implantation in posterior compromised sockets. Materials and Methods Thirty‐three implants were included in this study: (a) experimental group (EG), the reactive soft tissue was raised as the primary wound closure for the implant; (b) control group (CG), the reactive soft tissue was also elevated but failed to cover the site. Implants were inserted immediately after the tooth extraction. The bone dimensional changes were observed instantly after surgery (T1) and 6 months later (T2) by cone beam computed tomography. Soft tissue alterations were evaluated before tooth extraction (T0), at prosthesis delivery and at 1‐year follow‐up (T3). Measurements of marginal bone level (MBL) was obtained at the time of prosthesis placement and at T3. Results In all, 100% implant survival was reported during the study period. The buccal bone height and width of keratinized mucosa decreased less in the EG compared to the CG. At the 1‐year follow‐up, MBL and soft tissue changes were not significantly different between the two groups. Conclusions Within the limitations of this study, the presence of reactive soft tissue as primary closure may contribute to hard‐soft tissue augmentation during immediate implants into posterior compromised sockets.

Application of biomaterials in periodontal tissue repair and reconstruction in the presence of inflammation under periodontitis through the foreign body response: Recent progress and perspectives

“…The granulation gradually becomes normal regenerative epithelium and regenerative connective tissue. 53 In GBR, in contrast to traditional techniques, the membrane is replaced by reactive soft tissue. The dominant view is that granulation tissue should be completely removed from the surgical site before bone augmentation, 58,59 because reactive soft tissue forms fibrous scars, thus increasing tissue fragility and the difficulty of reoperation, 60 as described below.…”

“…52 (b) After the infected teeth are removed, the granulation tissue can be lifted from the bottom to the surface of the oral tissue to close the surgical wound filling with bone substitute materials. 53 (c) Six months later local soft and hard tissues are regenerated. (a1) As bacterial stimulation the cells from granulation tissue can differentiate to fibroblasts, proinflammatory macrophages.…”

“…However, recent clinical research has indicated that granulation tissue can be preserved and elevated from the surgical surface to the oral surface to close the primary incision and seal the bone space. The granulation gradually becomes normal regenerative epithelium and regenerative connective tissue 53 . In GBR, in contrast to traditional techniques, the membrane is replaced by reactive soft tissue.…”

“…The periodontitis inflammatory microenvironment changes from an imbalanced to a balanced state through various regulatory mechanisms 149 . In a previous clinical study, 53 reactive soft tissue, also known as granulation tissue, has been preserved to achieve primary wound closure and maintain positive conditions for healing. Tissue surrounding the bone‐substituted materials is affected by the FBR and regulated in the immune microenvironment.…”

“…(a) After extracting the teeth with infection including attached dental plaque and calculus, the residual granulation tissues around the teeth have the strong ability of regeneration 52 . (b) After the infected teeth are removed, the granulation tissue can be lifted from the bottom to the surface of the oral tissue to close the surgical wound filling with bone substitute materials 53 . (c) Six months later local soft and hard tissues are regenerated.…”