Minimizing Alteration in Soft Tissue Esthetics

The loss of an anterior tooth quickly creates an esthetic dilemma with the soft tissues. In restorative dentistry it's critical to be able to deal with that scenario to minimize the immediate and long-term effects of the loss of an anterior tooth.

Allowing the extraction site to remain empty for an extended period of time will not maintain the embrasure tissue and may require surgical augmentation later on.

As restorative dentists, we want to offer the most conservative treatment option for our patients. To avoid surgical augmentation, it's necessary to preserve the extraction site with a provisional to help maintain tissue height and preserve the socket. So, what are some things we can do to minimize these gingival changes in soft tissue esthetics?

Extraction with provisional support: This procedure allows you to maintain the papilla by placing an emergence profile into the extraction site immediately after tooth removal. After removing the tooth, you may notice that the papilla starts moving into the extraction site. You must extend a provisional in the area to prevent the site from shrinking 1 – 2mm, such as, a shell temporary.

Root-banking: Much less common than the former option, this procedure leaves the tooth in its current location. This is a good option when your patient has healthy teeth periodontally but structurally unrestorable. If your patient has a biologically healthy root on an anterior tooth, this procedure can assure that there will be no resorption in the pontic site.

Socket preservation: There are some teeth that may not have any bone to start with. There will be cases where you may go through several procedures to get that tooth exactly where you want it. Because of the variety of techniques and results, the success of this procedure is dependent on the patient.