Immediate Implant Placement With Immediate Provisionalization Into Extraction Sockets With Labial Plate Dehiscence Defects Within the Maxillary Esthetic Zone

Overview

Immediate tooth replacement with implants into extraction sockets has become a common clinical procedure regarding implant survival, osseointegration and esthetics. Basically, when there is a labial bone plate loss after extraction 2 stage GBR procedure would be carried out to allow adequate amount of bone formation to be reconstructed and receive the dental implant. The challenge is when there is a partial or complete loss of labial plate of bone resulting from severe trauma or chronic inflammation or vertical fracture affecting the periodontal attachment

Elian etal. classified extraction sockets into 3 types: type 1 sockets have labial plate of bone and soft tissue completely intact, type 2: where the soft tissue is intact while there is a dehiscence bony defect indicating partial or complete loss of labial bone plate, and type 3 where a midfacial recession occurred indicating loss of labial bone plate and soft tissue loss. The clinical outcomes of type 2 sockets reconstructions: Noelken etal. Published survival of 16 implants immediately placed in sockets with complete loss of labial bone plate and buccal gaps were filled with autogenous bone without using barrier membrane. IN this study immediate implant is to be placed in type 2 sockets filing the gap with a mix of autogenous bone harvested from tuberosity and xenograft in addition to a resorbable collagen membrane lining the socket and healing abutment . Immediate implant placement concurrent with provisional restoration has been advocated to improve the esthetic restorative outcome for the patients. The success of this procedure depends on many variables including gingival health and morphology, bone dimensions and primary stability of the implants. Immediate implant placement is most commonly indicated when tooth extraction is due to trauma,endodontic lesion, root fracture, root resorption, root perforation, unfavorable crown to root ratio(not due to periodontal loss and bony walls of alveolus are still intact. Contraindications includes presence of active infection, insufficient bone (\<3 mm) beyond the tooth socket apex for initial implant stability and wide and/or long gingival recession. Immediate implant placement even in the aesthetic zone is a literature supported treatment modality with success comparable to alternative placement protocols.3, 4 Immediate placement reduces the number of surgical interventions, shortens time to final restoration, may offer a fixed provisional restoration alternative to a removable interim prosthesis, and may partially support the peri-implant tissues prior to collapse from the extraction socket remodeling. Certain clinical criteria however need to be met in order to achieve a successful treatment outcome, namely: intact extraction socket walls, facial bone residual at ≥ 1 mm, thick gingival biotype, absence of acute infection, and sufficient residual bone at the palatal and apical tooth socket. Current knowledge suggests that implant placement should be at least 3 to 4 mm in depth from the midfacial free gingival margin and 2 mm palatally from the facial osseous crest.