Root submergence in the esthetic zone. A technique for pontic site esthetic enhancement in full mouth implant restorations

Abstract

Background: Achieving high esthetic results in the pontic sites of fixed implant-supported restorations is a challenging task for the clinician and requires appropriate surgical and prosthodontic management of the soft tissues. In order to obtain an esthetic soft tissue frame, the underlying alveolar bone must be present to support it. Socket preservation and soft tissue augmentation techniques have been suggested to maintain the ridge contour at the pontic site. The root submergence is another technique that has been proposed instead of the commonly used bone and soft tissue augmentation procedures. The root is sectioned at the level of the bone and covered with a buccal or buccolingual flap. The attachment apparatus of the natural root maintains the contour of the alveolar ridge and prevents bone resorption and soft tissue collapse that are observed after extraction of a tooth. Aim: The aim of this poster is to present a clinical procedure that can obtain high esthetic results in the pontic sites of fixed implant restorations, utilizing the root submergence technique. Methods: A 71 years old male with a severely compromised dentition presented for treatment. The patient had high esthetic demands and desired fixed restorations. Thesuggested treatment included fabrication of cement retained Fixed Dental Prostheses supported by six implants in the maxilla and a screw retained hybrid bridge supported by five implants in the mandible. The upper canines and central incisors, despite their poor prognosis, were maintained temporarily in order to support a fixed transitional restoration for the osseointegration period. All implants osseointegrated successfully and a screw-retained implant-supported transitional restoration was fabricated in the maxilla. The crowns of the canines were sectioned at the level of the bone and the roots were submerged. The central incisors were extracted due to excessive root caries. Selective pressure was applied at the soft tissues of the pontic sites with the provisional restoration. A natural scallop of the soft tissues was formed and the fabrication of the definitive Fixed Dental Prostheses with ovate pontics was followed. Results: After 3 years in function, no biologic complications on the natural submerged roots were observed. The esthetic appearance of the restorations at the pontic sites was excellent. Conclusions and clinical implications: The utilization of the root submergence technique in the pontic sites of fixed implant restorations is a predictable clinical procedure, which maintains the alveolar ridge contour and enhances the final esthetic result.