Root Membrane

The "Root membrane" technique is an original technique, first internationally applied in our practice (Siormpas K.) since 2007, which is advantageous, compared to the current data, in preserving the aesthetics of restorations with implants in the anterior aesthetic zone of the jaws. The purpose of the "Root membrane" technique is, through the preservation of the periodontal ligament of the part of the preserved root, to achieve the preservation of the peri-implant tissues (and consequently the aesthetics), around the directly placed implant. This goal is feasible and biologically proven both by in vivo animal studies and more recently by human histological results.

It is known that the main criterion of the aesthetics of the teeth is the symmetrical appearance of the dentition, the color, the volume and the harmony of the soft tissues of the periodontium.

Every clinical implantologist has the responsibility, when called upon to restore an anterior dentition with implants, to achieve, but above all to maintain this symmetrical aesthetic result. However, this effort is not always an easy task in restorations with implants. The resorption of the alveolar crest in the anterior sensory areas and especially, the degree of resorption of the thin bony buccal plate, affects the morphology of the socket in the alveolus. Making it particularly difficult to immediately place an implant in the optimal prosthetic restoration position, affecting the overall aesthetic result (Nevins M et al.2006, Hurzeler M et al 2010, Braut, et al. 2012, Zekry, et al.2013).

It is also known that: Immediate implant placement does not prevent resorption at the alveolar ridge (Lee CT, et al. J Clin Periodontol 2014). After the immediate placement of the implant, the tissues undergo volumetric changes in all three dimensions (buccal, mainly in the horizontal dimension), in a continuous remodeling process that is not predictable (Botticelli D, et al. J Clin Periodontol 2004, Araujo MG , et al.  J Clin Periodontol 2005). In order to minimize the effects mentioned above, various advanced surgical techniques have been proposed to date, which, however, can only partially compensate for the change in tissue dimensions at the ridge of the alveolar ridge (Kotsakis et al. 2014). As an important causative factor of bone resorption occurring at the ridge of the alveolar ridge, it has been characterized to be the loss of blood supply originating from the periodontal ligament (PDL), which is lost after the extraction of a tooth (Kotsakis et al. 2014). For more than 40 years, the concept of retaining submerged roots has been used to ensure dimensional stability of the hard and consequently soft tissues in the apex.

The "Root membrane" technique is based on the preservation of the periodontal ligament and blood supply, through the selective preservation (immersion) of the buccal part of the tooth root with the aim of preserving the buccal bone plate and consequently the aesthetics by preserving the peri-implant tissues (Mitsias , M, et al.  2014 Feb) [Under publication]. This new approach has a twofold goal. The intentionally preserved buccal part of the root helps in the strategy of preserving the periodontal tissues ("Root membrane"), while the immediately placed implant allows the immediate functional and aesthetic restoration of the area. In vivo animal studies (Hurzeler MB, et al. 2010) provide proof-in-principle evidence for the feasibility of immediate implant placement near a retained tooth root fragment as part of a tissue preservation strategy post-extraction cell. Recently presented in the International Journal of Oral and Maxillofacial Implants for the first time long-term results of our study, from the successful application of this technique to the direct placement of implants in the anterior regions of the maxilla (Siormpas, K, et al. 2014).

Conclusion: The preservation of the periodontal ligament and the blood supply to the sensitive (thin bony buccal lobe) anterior sensory area of the maxilla through the intentional immersion of the buccal part of the root in combination with the immediate placement of an implant in close proximity to it ("Root membrane" technique ”), can lead to predictable and sustainable clinical stability of the directly placed and loaded implant. Offering the advantage over other solutions of tissue preservation and aesthetics.

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