Root Submergence Technique and Dental Implant Placement

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

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