Interim Endodontic Therapy for Alveolar Socket Bone Regeneration of Infected Hopeless Teeth Prior to Implant Therapy

Abstract

The immediate placement of implants in the fresh extraction sockets of infected teeth with periradicular and periapical lesions is contraindicated because of both the infection and the loss of architecture required for proper implant placement. There are 4 approaches for implant replacement of a hopeless tooth with lesions: (1) extraction and delayed implant placement; (2) extraction, debridement, guided bone regeneration (GBR), guided tissue regeneration (GTR), and delayed implant placement; (3) extraction, intrasocket debridement, and immediate implant placement; or (4) extraction, debridement, GBR, GTR, and simultaneous implant placement. The extraction of such hopeless teeth often results in large bone and soft tissue defects that are difficult to repair. This article introduces an alternative approach: interim endodontic implant site preparation, defined as a transitional, surgical, or nonsurgical endodontic treatment to regenerate the hopeless tooth bone defects and prepare the site for proper implant placement. This article describes 3 distinct interim endodontic protocols used to manage 5 patients, all of whom had severely infected hopeless teeth with large lesions and were treatment planned for implant replacement: the first, interim nonsurgical endodontic treatment to restore the normal anatomy of the infected hopeless tooth; the second, interim surgical endodontics on the hopeless tooth with preexisting endodontic treatment to regenerate apical bone for primary implant stability, thus avoiding the involvement of the maxillary sinus and other critical anatomic structures; and the third, interim surgical endodontics on the hopeless tooth with preexisting endodontic treatment to confine the size of the osseous defect and simplify the GBR and GTR procedures. The outcome of interim endodontic treatment on these 5 patients demonstrated that tooth extraction would have been a less predictable approach. The interim treatment changed the overall direction of the patients' dental care. When treated, these hopeless teeth served many preventive, biologic, and esthetic functions. The infections of the alveolar sockets were eliminated, the alveolar bone defects were repaired through normal bone regeneration, and sockets anatomies were maintained or restored. Furthermore, the patients were spared maxillary sinus surgery and the possible complications resulting from major GBR and GTR procedures. In summary, the interim treatment facilitated tooth extraction and immediate implant placement.

Immediate Placement of Implants into Infected Sites: A Systematic Review

“…Thus, 32 studies were identified without repetition. Of the 32 studies found, six were excluded for being case report articles and three others for being review articles. Additional hand‐searching of the reference lists of selected studies yielded five additional papers .…”

Antibacterial and Osteogenic Functionalization of Titanium With Silicon/Copper-Doped High-Energy Shot Peening-Assisted Micro-Arc Oxidation Technique

“…However, there are still some contraindications that restrict the clinical promotion of immediate implantation ( Koh et al, 2010 ). At present, socket infection has been considered as one of the most commonly faced complications of immediate implantation ( Rass, 2010 ; Narad et al, 2018 ). An incomplete pre-implantation curettage (conventional surgical treatment of infected socket before implantation) of infected tissues will leave residual bacteria around the implant which significantly increases the risk of multiple complications and ultimately results in implant failure ( Narad et al, 2018 ).…”

Contemporary management of tooth replacement in the traumatized dentition

“…Once post-trauma stabilization has been achieved, an objective assessment of the dentition can commence. Where non-vital teeth have questionable restorability but are amenable to endodontic treatment, the primary aim of preventing the development of an apical lesion and postponing extraction can be considered an astute way of preserving the alveolar form (15,16). Maintenance of teeth in this way can aide implant provision especially where extraction and immediate placement is envisaged once growth is complete.…”