title: Subclassification and Clinical Management of Extraction Sockets with Labial Dentoalveolar Dehiscence Defects.
abstract: Immediate implant therapy involving implants placed into intact Type 1 extraction sockets has become a consistent clinical technique. The classification of Type 2 extraction sockets, where the mucosal tissues are present but there is a midfacial osseous dehiscence defect, has been described according to the extent of the buccal bone plate absence. The literature has offered different techniques in the treatment of Type 2 sockets; however, the extent of the defect has never been defined or delineated. In this article, the authors describe a subclassification of Type 2 sockets: Type 2A presents with a dehiscence defect roughly 5 mm to 6 mm from the free gingival margin (FGM) involving the coronal one-third of the labial bone plate; Type 2B presents with a dehiscence defect involving the middle one-third of the labial plate, approximately 7 mm to 9 mm from the FGM; and in Type 2C the dehiscence defect involves the apical one-third of the labial osseous plate roughly 10 mm or greater from the FGM. The authors also offer a protocol and technique employing immediate implant placement, guided bone regeneration, and bone graft containment with a custom two-piece healing abutment that can lead to consistent and satisfactory clinical outcomes in low-smile-line patients. The treatment protocol and sequence is outlined in a clinical case presentation involving a Type 2B socket.
authors.affiliation: Clinical Associate Professor, Ashman Department of Periodontology and Implant Dentistry,New York University College of Dentistry, New York, New York.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Chu
authors.forename: Guido O
authors.initials: GO
authors.lastname: Sarnachiaro
authors.forename: Mark N
authors.initials: MN
authors.lastname: Hochman
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Tarnow
mesh_terms: D000369:Aged, 80 and over; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001641:Bicuspid; D001861:Bone Regeneration; D016025:Bone Transplantation; D000044:Dental Abutments; D019250:Dental Implants, Single-Tooth; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D014081:Tooth Extraction; D020390:Tooth Socket / Q000473:pathology*