Multiple extractions(cont)
E) Rongeur forceps are used to remove only bone that is sharp and protrudes above reapproximated soft tissue. (F) The alveolar plates are compressed firmly together to reestablish the presurgical buccolingual width of the alveolar process. Because an implant may be placed in the future, care should be taken to not overly reduce the alveolar width with compression. Because of mild periodontal disease, excess soft tissue is found, which will be trimmed to prevent redundant tissue on the crest of the ridge. (G) After soft tissue has been trimmed and sharp bony projections removed, tissue is checked one final time for completeness of soft tissue surgery. Tissue is closed with interrupted black silk sutures across the papilla. This approximates soft tissue at the papilla but leaves the tooth socket open. Soft tissue is not mobilized to achieve primary closure because this would tend to reduce the vestibular height. (H–I) The patient returns for suture removal 1 week later. Normal healing has occurred, and sutures are ready for removal. The broad band of attached tissue remains on the ridge, similar to that which existed in the preoperative situation (see A).
