Vestibular Versus Trapezoid Flap in Immediate Implants

Overview

The vestibular socket therapy was introduced by Elaskary et al that allowed immediate implant placement and total socket rehabilitation at the same time in class 2 compromised sockets , that showed supreme esthetic and functional predictability over 1,2,3 years of follow up, and showed minimal or no post restorative mid facial recession . The Vestibular socket therapy (VST) entails socket augmentation through a minimally invasive vestibular access incision to allow the delivery of the grafting components thus bypass the deleterious effect of the classic mucoperiosteal flap reflection as well as the deleterious effect of the delay approach, regardless of the degree of socket compromise \[6-8\].

The concept of promptly replacing teeth using dental implants was introduced many years ago as a way to reduce the time between tooth extraction and the completion of prosthetic restoration. However, immediate implant placement was not recommended by many authors such as Buser D, and Yong , due to the lack of buccal bone, presence of infection, and the continuing post extraction bone remodeling that occurs along both buccal and lingual plates walls of the socket.It has been proposed that the subsequent resorption of the socket walls after tooth extraction should be taken into account when developing any future treatment plan. Furthermore, the labial plate of bone is already compromised in type II extraction socket and is indicated for guided bone regeneration (GBR) such as early placement protocol, using the contour augmentation procedure. Many authors have conducted immediate implant placement using the conventional immediate implant placement via reflecting a mucoperiosteal flap that enabled the accurate socket debridement , total visibility of the socket environment and the ability to graft the buccal osseous defect.To address the labial plate of bone defect, a conventional mucoperiosteal flap will be utilized along with guided bone regeneration (GBR). GBR is a surgical technique that involves the use of bone grafts and barrier membranes to reconstruct buccal osseous defects around dental implants \[10\]. Typically, this procedure is performed on defects that are equal to or greater than 2 mm in size, such as dehiscence or fenestration defects. Tension-free primary closure will then achieved either on a cover screw or a healing abutment, several flap designs were proposed to minimize the deleterious effect of the classic approach such as papilla preservative incision and buccal esthetic flaps technique.