INTRODUCTION: Tissue preservation after tooth removal is crucial for the subsequent implant and/or prosthodontic rehabilitation. A variety of ridge preservation procedures have been suggested. Socket sealing surgery with free gingival grafts was introduced to minimize soft tissue volumetric alterations and protect the clot or the bone grafting material in the socket. However, the method has some disadvantages, such as postoperative patient discomfort and a need for a second-stage surgery.
AIM: This literature review aims to analyze, compare, and summarize the results on the application of free gingival grafts for ridge preservation and define the research gaps that necessitate further assessments.
MATERIALS AND METHODS: The present review is based on the existing scientific electronic database, including 42 articles. It provides a comparative analysis of the reported results on socket sealing with free gingival grafts
RESULTS: The database showed heterogeneity regarding graft survival and postoperative complications. Authors report that the method gives promising results and successfully preserves the hard and soft tissue volume. It is still disputable, however, whether it is superior to other ridge preservation procedures.
CONCLUSION: Further investigation based on randomized clinical trials and precise clinical, histologic, and radiological evaluation is needed to clarify the role of free gingival grafts as a method for ridge preservation. Its application in the different areas of the ridge should be carefully evaluated.
Fickl S, Zuhr O, Wachtel H, Stappert CF, Stein JM, Hürzeler MB. Dimensional changes of the alveolar ridge contour after different socket preservation techniques. J Clin Periodontol. 2008;35(10):906-13. doi: 10.1111/j.1600-051X.2008.01305.x.
Landsberg CJ. Socket seal surgery combined with immediate implant placement: a novel approach for single-tooth replacement. Int J Periodontics Restorative Dent. 1997;17(2):140-9.
Nevins M, Mellonig JT. The advantages of localized ridge augmentation prior to implant placement: a staged event. Int J Periodontics Restorative Dent. 1994;14(2):96-111.
Kadkhodazadeh M, Ghasemianpour M, Soltanian N, Sultanian GR, Ahmadpour S, Amid R. Effects of fresh mineralized dentin and cementum on socket healing: a preliminary study in dogs. J Korean Assoc Oral Maxillofac Surg. 2015;41(3):119-23. doi: 10.5125/jkaoms.2015.41.3.119.
Evian CI, Cutler S. Autogenous gingival grafts as epithelial barriers for immediate implants: case reports. J Periodontol. 1994;65(3):201-10. doi: 10.1902/jop.1994.65.3.201.
Grunder U. Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results. Int J Periodontics Restorative Dent. 2000;20(1):11-7.
Gher ME, Quintero G, Assad D, Monaco E, Richardson AC. Bone grafting and guided bone regeneration for immediate dental implants in humans. J Periodontol. 1994;65(9):881-91. doi: 10.1902/jop.1994.65.9.881.
Rosenquist B. A comparison of various methods of soft tissue management following the immediate placement of implants into extraction sockets. Int J Oral Maxillofac Implants. 1997;12(1):43-51.
Becker W, Becker BE. Guided tissue regeneration for implants placed into extraction sockets and for implant dehiscences: surgical techniques and case report. Int J Periodontics Restorative Dent. 1990;10(5):376-91.
Zuhr O, Fickl S, Wachtel H, Bolz W, Huerzeler M. Die Versorgung der Extraktionsalveole aus prothetischer Sicht. Detailaspekt für klinisch relevante Situationen. Implantologie. 2006;14:339-353.
Fickl S, Zuhr O, Wachtel H, Bolz W, Huerzeler M. Tissue alterations after tooth extraction with and without surgical trauma: a volumetric study in the beagle dog. J Clin Periodontol. 2008;35(4):356-63. doi: 10.1111/j.1600-051X.2008.01209.x.
Thalmair T, Hinze M, Bolz W, Wachtel H. The Healing of Free Gingival Autografts for Socket-seal Surgery: a Case Report. Eur J Esthet Dent. 2010 Winter;5(4):358-68.
Kim SY, Kim YK, Kim HS, Yun PY, Kim SG, Choi YH. Extraction socket sealing using palatal gingival grafts and resorbable collagen membranes. Maxillofac Plast Reconstr Surg. 2017;39(1):39. doi: 10.1186/s40902-017-0137-x.
Tal H. Autogenous masticatory mucosal grafts in extraction socket seal procedures: a comparison between sockets grafted with demineralized freeze-dried bone and deproteinized bovine bone mineral. Clin Oral Implants Res. 1999;10(4):289-96. doi: 10.1034/j.1600-0501.1999.100405.x.
Jung RE, Siegenthaler DW, Hämmerle CH. Postextraction tissue management: a soft tissue punch technique. Int J Periodontics Restorative Dent. 2004;24(6):545-53.
Misch CE, Dietsh-Misch F, Misch CM. A modified socket seal surgery with composite graft approach. J Oral Implantol. 1999;25(4):244-50. doi: 10.1563/1548-1336(1999)025<0244:AMSSSW>2.3.CO;2.
Negri B, Zuhr O, Fickl S, Ciurana XR, Navarro Martínez JM, Blanco VM. Socket seal surgery: Clinical uses in implant dentistry and guided bone regeneration procedures for single tooth replacement in the esthetic zone. Quintessence Int. 2016;47(2):123-39. doi: 10.3290/j.qi.a34455.
Landsberg CJ, Bichacho N. A modified surgical/prosthetic approach for optimal single implant supported crown. Part I--The socket seal surgery. Pract Periodontics Aesthet Dent. 1994;6(2):11-7; quiz 19.
Bichacho N, Landsberg CJ. A modified surgical/prosthetic approach for an optimal single implant-supported crown. Part II. The cervical contouring concept. Pract Periodontics Aesthet Dent. 1994;6(4):35-41; quiz 41.
Landsberg CJ, Bichacho N. Implant placement without flaps--Part 2: Utilizing a two-stage surgical protocol. Pract Periodontics Aesthet Dent. 1999;11(2):169-76; quiz 178. doi: 10.1097/00008505-199903000-00011.
Fickl S, Zuhr O, Wachtel H, Bolz W, Huerzeler MB. Hard tissue alterations after socket preservation: an experimental study in the beagle dog. Clin Oral Implants Res. 2008;19(11):1111-8. doi: 10.1111/j.1600-0501.2008.01575.x.
Seibert JS, Louis JV. Soft tissue ridge augmentation utilizing a combination onlay-interpositional graft procedure: a case report. Int J Periodontics Restorative Dent. 1996;16(4):310-21. Erratum in: Int J Periodontics Restorative Dent 1996;16(6):521.
Stimmelmayr M, Allen EP, Reichert TE, Iglhaut G. Use of a combination epithelized-subepithelial connective tissue graft for closure and soft tissue augmentation of an extraction site following ridge preservation or implant placement: description of a technique. Int J Periodontics Restorative Dent. 2010;30(4):375-81.
Stimmelmayr M, Güth JF, Iglhaut G, Beuer F. Preservation of the ridge and sealing of the socket with a combination epithelialised and subepithelial connective tissue graft for management of defects in the buccal bone before insertion of implants: a case series. Br J Oral Maxillofac Surg. 2012;50(6):550-5. doi:10.1016/j.bjoms.2011.09.014.
Karaca Ç, Er N, Gülşahı A, Köseoğlu OT. Alveolar ridge preservation with a free gingival graft in the anterior maxilla: volumetric evaluation in a randomized clinical trial. Int J Oral Maxillofac Surg. 2015;44(6):774-80. doi: 10.1016/j.ijom.2015.01.015.
Oghli AA, Steveling H. Ridge preservation following tooth extraction: a comparison between atraumatic extraction and socket seal surgery. Quintessence Int. 2010;41(7):605-9.
Han T, Jeong CW. Bone and crescent shaped free gingival grafting for anterior immediate implant placement: technique and case report. J Implant Adv Clin Dent. 2009;5(1):23-33.
Segnini B, Borges-Filho FF, Nicoli LG, Gonçalves M, Marcantonio C, Oliveira GJ, Jr Marcantonio E. Impact of soft tissue graft on the preservation of compromised sockets: a randomized controlled clinical pilot study. Acta Odontol Latinoam. 2021;34(1):119-26.
Frizzera F, de Freitas RM, Muñoz-Chávez OF, Cabral G, Shibli JA, Marcantonio E Jr. Impact of Soft Tissue Grafts to Reduce Peri-implant Alterations After Immediate Implant Placement and Provisionalization in Compromised Sockets. Int J Periodontics Restorative Dent. 2019;39(3):381–9. doi: 10.11607/prd.3224.
Cosyn J, Cleymaet R, De Bruyn H. Predictors of Alveolar Process Remodeling Following Ridge Preservation in High-Risk Patients. Clin Implant Dent Relat Res. 2016;18(2):226-33. doi: 10.1111/cid.12249.
Stein JM, Hammächer C. Postextraction Socket Seal Surgery with an Epithelized Connective Tissue Graft Using a Subpapillar Tunneling Procedure. Int J Periodontics Restorative Dent. 2015;35(6):877-84. doi: 10.11607/prd.2203.
Thalmair T, Fickl S, Schneider D, Hinze M, Wachtel H. Dimensional alterations of extraction sites after different alveolar ridge preservation techniques - a volumetric study. J Clin Periodontol. 2013;40(7):721-7. doi: 10.1111/jcpe.12111.
Younes R, Khairallah CM. The "One Piece" Autologous Tuberosity Graft: A Contemporary Concept in Ridge Preservation. Case Rep Dent. 2020;2020:3945076. doi: 10.1155/2020/3945076.
Rabelo GD, de Paula PM, Rocha FS, Jordão Silva C, Zanetta-Barbosa D. Retrospective study of bone grafting procedures before implant placement. Implant Dent. 2010;19(4):342-50. doi: 10.1097/ID.0b013e3181e416f9.
Gapski R, Satheesh K, Cobb CM. Histomorphometric analysis of bone density in the maxillary tuberosity of cadavers: a pilot study. J Periodontol. 2006;77(6):1085-90. doi: 10.1902/jop.2006.050118.
Amin PN, Bissada NF, Ricchetti PA, Silva APB, Demko CA. Tuberosity versus palatal donor sites for soft tissue grafting: A split-mouth clinical study. Quintessence Int. 2018;49(7):589-98. doi: 10.3290/j.qi.a40510.
Harris RJ. Histologic evaluation of connective tissue grafts in humans. Int J Periodontics Restorative Dent. 2003;23(6):575-83.
Landsberg C, Bender O, Weinreb M, Wigler R, Chackartchi T, Matalon S, Weinberg E. Postextraction Ridge Width Alterations Following Socket Seal Surgery—A Retrospective Study. Applied Sciences. 2021;11(1):324. doi:10.3390/app11010324.
Landsberg CJ. Implementing socket seal surgery as a socket preservation technique for pontic site development: surgical steps revisited--a report of two cases. J Periodontol. 2008;79(5):945-54. doi: 10.1902/jop.2008.070298.
Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol. 2003;8(1):303-20. doi: 10.1902/annals.2003.8.1.303.
Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA. Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review. J Periodontol. 2010;81(4):452-78. doi: 10.1902/jop.2010.090540.
Mathews DP. Soft tissue management around implants in the esthetic zone. Int J Periodontics Restorative Dent. 2000;20(2):141-9.