Root Submergence Technique and Dental Implant Placement

Last Updated August 11, 2016
Reviewed By:  OsseoNews Team

This video from Ioannis Vergoullis, DDS, MS shows a case that was referred to their clinic for DI on site #1.6 and extractions of roots #1.3, 1.5. Since the roots were asymptomatic we proceeded with submerging protocol in order to maximise ridge contours preservation for the long term and DI #1.6.

Watch the Video and Leave Your Comments/Questions Below

### Additional Information on the Root Submergence Technique

From A root submergence technique for pontic site development in fixed dental prostheses in the maxillary anterior esthetic zone (J Periodontal Implant Sci. 2015 Aug; 45(4): 152–155.Sunyoung Choi et al.):

The esthetic rehabilitation of missing teeth in the maxillary anterior region is often plagued with problems, such as uneven tooth recovery and issues related to the gingiva in adjacent teeth [1,2]. Alveolar ridge resorption following a tooth extraction is inevitable, and continues throughout the patient’s lifetime [3,4]. Eventually, papilla loss and atrophy of the residual ridge compromise esthetic outcomes. These undesirable consequences present challenges when restoring the maxillary anterior esthetic region with conventional prostheses. Pink porcelain restorations and surgical socket preservation techniques have been used to compensate for compromised tissue [2]. However, neither technique has solved the problem of compromised esthetic outcomes by ensuring predictable results [2,5,6,7].

The root submergence technique preserves the periodontium surrounding a root without requiring an extraction [8,9,10,11,12,13,14,15]. A submerged root maintains the periodontal attachment complex, preventing the resorption of the alveolar bone on the buccal and lingual walls, as well as on the interproximal area [9,13]. As a result, this technique maintains the dimension of the alveolar ridge and the surrounding tissue [9,12,13,14,15]. Root submergence was first introduced to prevent residual alveolar ridge resorption in order to increase the retention and resistance of a complete denture [8]. Clinical and histological studies found that non-infected vital or endodontically treated roots reduced at the level of the bone crest or below the crest and completely submerged within the alveolus were able to effectively preserve the residual ridge [9,10,11]. Recently, this concept has also been applied to rehabilitation with fixed dental prostheses [12,13,14,15]. Under the pontic site, a root was retained at the crestal bone level to preserve ridge form and no exposure of the root was expected, due to the absence of direct pressure over it [12]. The root submergence technique has also been applied in implant-supported prostheses in the maxillary anterior region [13,14,15]. Although successful esthetic outcomes without papilla loss or collapse of the arch have been reported, the long-term results of the root submergence technique have not been published.

References

1. Ishida Y, Fujimoto K, Higaki N, Goto T, Ichikawa T. End points and assessments in esthetic dental treatment. J Prosthodont Res. 2015 Forthcoming. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/26077379)\]
2. Fradeani M. Esthetic analysis: a systematic approach to prosthetic treatment. Chicago (IL): Quintessence Publishing; 2004.
3. Atwood DA, Coy WA. Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent. 1971;26:280–295. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/5284182)\]
4. Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23:313–323. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/12956475)\]
5. Jambhekar S, Kernen F, Bidra AS. Clinical and histologic outcomes of socket grafting after flapless tooth extraction: a systematic review of randomized controlled clinical trials. J Prosthet Dent. 2015;113:371–382.\[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/25749077)\]
6. Avila-Ortiz G, Elangovan S, Kramer KW, Blanchette D, Dawson DV. Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis. J Dent Res. 2014;93:950–958. \[[PMC free article](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293706/)\]\[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/24966231)\]
7. Morjaria KR, Wilson R, Palmer RM. Bone healing after tooth extraction with or without an intervention: a systematic review of randomized controlled trials. Clin Implant Dent Relat Res. 2014;16:1–20. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/22405099)\]
8. Casey DM, Lauciello FR. A review of the submerged-root concept. J Prosthet Dent. 1980;43:128–132.\[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/6766189)\]
9. O’Neal RB, Gound T, Levin MP, del Rio CE. Submergence of roots for alveolar bone preservation. I. Endodontically treated roots. Oral Surg Oral Med Oral Pathol. 1978;45:803–810. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/276798)\]
10. Gound T, O’Neal RB, del Rio CE, Levin MP. Submergence of roots for alveolar bone preservation. II. Reimplanted endodontically treated roots. Oral Surg Oral Med Oral Pathol. 1978;46:114–122. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/355969)\]
11. Welker WA, Jividen GJ, Kramer DC. Preventive prosthodontics–mucosal coverage of roots. J Prosthet Dent.1978;40:619–621. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/281517)\]
12. Harper KA. Submerging an endodontically treated root to preserve the alveolar ridge under a bridge–a case report. Dent Update. 2002;29:200–203. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/12050887)\]
13. Salama M, Ishikawa T, Salama H, Funato A, Garber D. Advantages of the root submergence technique for pontic site development in esthetic implant therapy. Int J Periodontics Restorative Dent. 2007;27:521–527.\[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/18092446)\]
14. Wong KM, Chneh CM, Ang CW. Modified root submergence technique for multiple implant-supported maxillary anterior restorations in a patient with thin gingival biotype: a clinical report. J Prosthet Dent.2012;107:349–352. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/22633589)\]
15. Çomut A, Mehra M, Saito H. Pontic site development with a root submergence technique for a screw-retained prosthesis in the anterior maxilla. J Prosthet Dent. 2013;110:337–343. \[[PubMed](http://www.ncbi.nlm.nih.gov/pubmed/24035254)\]

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