Fresh extraction sites

Sir, a patient attended with acute pain associated with a provisional bridge replacing the 22 using the 23 as an abutment. The bridge had been placed approximately two weeks previously by an emergency dentist whilst the patient was on holiday. The dentist had extracted the 22 and constructed a chairside acrylic replacement. Upon examination both 22 buccal sulcus region and the 23 were tender to percussion. Radiographic examination revealed radio-opacity of mixed density in the extraction site with considerable acute local osteitis. An apical rarefying osteitis was associated with the 23. This tooth had been root canal treated but the obturation was suboptimal in both length and condensation.

A diagnosis was made of persistent periapical periodontitis of the 23 and a possible foreign body in the extraction site. Surgical exploration and simultaneous re-root canal treatment was performed and a hard, off-white 'pellet' of acrylic removed from the site. It is most likely that this extrusion of acrylic occurred after the 22 had been removed and during the fabrication of the temporary bridge. The 23 and 22 area healed uneventfully.

The ability to provide immediate provisionalisation is essential in the aesthetic zone when extractions are planned. Given that post extraction and provisionalisation radiographs are rarely justified, an outcome such as this would be easy to miss. Perhaps, however, clinicians should approach fresh extraction sites with more caution, ensuring adequate clot formation or placing a resorbable haemostat prior to temporary construction. This should not be considered a novel technique for ridge preservation!

Figure 1

Pre-operative radiograph showing radio-opaque material in the 22 site

Figure 2

Surgical exposure and removal