Autogenous Gingival Grafts for Socket Seal Technique

Objectives: Autogenous gingival grafts are used as epithelial barriers following extractions and immediate implant sites. Such technique, also referred to as the socket seal technique, is used to cover the augmented alveolar socket and was introduced to minimize soft tissue shrinkage, optimize esthetic results of the implant restoration and obtain primary closure. The flapless protocol could help to stabilize the marginal soft tissue and prevent future recession. The aim of the study is to quantify keratinized tissue augmentation following socket seal procedure.
Methods: A retrospective review of patient records of one periodontics clinic was performed. Inclusion criteria was the use of socket seal technique following atraumatic extractions, limited to the anterior region, with at least one subsequent follow-up. Primary outcome evaluated is the quantity of keratinized tissue present on the facial aspect of the tooth at baseline and at subsequent follow-up, both measured clinically and on photographs taken on day of surgery. Secondary outcome consists of quantity of bone fill.
Results: Seven of the 131 free gingival graft cases seen between 2015-2018 met the selection criteria for socket seal, following extraction or in conjunction with immediate implant placement. Mean age of group was 58.2 ± 14.0. Keratinized tissue was measured from the mucogingival junction and extending to the free gingival margin. Mean pre-operative keratinized tissue in comparison to post-operative was 4.25mm and 6.75mm, respectively.
Conclusions: Our limited experience suggests the use of autogenous gingival grafts to seal the gingival margin leading to increased keratinized tissue width and a superior esthetic outcome. The amount of bone fill expected is yet to be investigated and may be due to superior isolation from bacterial invasion. Presenting clinical features in our periodontics clinic were consistent with those previously published.