Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization.

CLINICAL ARTICLE

Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization RAFAEL SCAF DE MOLON, DDS, MS*†, ERICA DORIGATTI DE AVILA, DDS‡, LUIZ ANTONIO BORELLI DE BARROS-FILHO, DDS§, WEBER ADAD RICCI, DDS, MS, PHD¶, SOTIRIOS TETRADIS, PHD**††, JONI AUGUSTO CIRELLI, DDS, MS, PHD‡‡, LUIZ ANTONIO BORELLI DE BARROS, DDS, MS, PHD¶

ABSTRACT Objective: The aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate provisionalization of the crown during the same operation. Clinical Considerations: A 66-year-old patient presented with a hopeless maxillary left central incisor with loss of the buccal bone wall. Atraumatic, flapless extraction was performed, and an immediate implant was placed in the extraction socket followed by preparation of an immediate provisional restoration. Subsequently, immediate reconstruction of the buccal bone plate was performed, using the tuberosity as the donor site, to obtain block bone and connective tissue grafts, as well as particulate bone. Finally, immediate provisionalization of the crown followed by simple sutures was performed. Cone-beam computed tomography and periapical radiographs were taken before and after surgery. After 4 months, the final prosthetic crown was made. After a 2-year follow-up, a satisfactory aesthetic result was achieved with lower treatment time and morbidity. Conclusion: This case demonstrates the effective use of immediate reconstruction of the buccal bone wall for the treatment of a hopeless tooth in the maxillary aesthetic area. This procedure efficiently promoted harmonious gingival and bone architecture, recovered lost anatomical structures with sufficient width and thickness, and maintained the stability of the alveolar bone crest in a single procedure.

CLINICAL SIGNIFICANCE If appropriate clinical conditions exist, immediate dentoalveolar restoration may be the most conservative means of reconstructing the buccal bone wall after immediate implant placement followed by immediate provisionalization with predictable healing and lower treatment time. (J Esthet Restor Dent 27:122–135, 2015)

*PhD student, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA † PhD student, Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Univ Estadual Paulista—UNESP, Araraquara, SP, Brazil ‡ PhD student, Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Univ Estadual Paulista—UNESP, Araraquara, SP, Brazil § MS student, Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Univ Estadual Paulista—UNESP, Araraquara, SP, Brazil ¶ Assistant Professor, Department of Social Dentistry, School of Dentistry at Araraquara, Univ Estadual Paulista—UNESP, Araraquara, SP, Brazil **Professor, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA 90095, USA †† Adjunctive Professor, Molecular Biology Institute, UCLA, Los Angeles, CA 90095, USA ‡‡ Assistant Professor, Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Univ Estadual Paulista—UNESP, Araraquara, SP, Brazil This work is attributed to the Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Univ Estadual Paulista—UNESP.

122

Vol 27 • No 3 • 122–135 • 2015

Journal of Esthetic and Restorative Dentistry

DOI 10.1111/jerd.12154

© 2015 Wiley Periodicals, Inc.

IMMEDIATE DENTOALVEOLAR RESTORATION de Molon et al

INTRODUCTION Immediate implant placement (IIP) followed by immediate loading has provided predictable treatment outcomes and a high success rate in selected cases of single maxillary tooth restoration,1–6 minimizing the need for costly and time-consuming alterations of gingival and osseous tissues after implant integration. However, IIP in a compromised socket in the aesthetic zone is a complex, meticulous, and challenging procedure. Post-extraction alveolar ridge remodeling can result in 3.8 mm (width) and 1.24 mm (height) of bone loss in the first 6 months and continues at a rate of 0.25–0.5% per year.7 Furthermore, collapse of the alveolar process and soft tissue alterations after tooth extraction result in the absence of interproximal papillae that compromises subsequent prosthetic restoration.8 Nevertheless, it has been stated that IIP alone cannot prevent alveolar bone resorption after tooth extraction.9–13 Importantly, in these studies, flap reflection and absence of bone and connective graft materials may have affected the treatment outcome. Moreover, buccal bone resorption that is faster than lingual bone plate resorption exacerbates the risk of gingival recession and papillary loss.14 The final goal of aesthetic dentistry is to restore peri-implant hard and soft tissue, allowing functional and aesthetic outcomes.15–18 The reasons for tooth extraction and IIP are associated with alveolar bone resorption and soft tissue loss in consequence of periodontal or periapical disease, dental trauma, or root fracture, making the achievement of optimal aesthetic and functional rehabilitation particularly difficult.1,15 To achieve an excellent aesthetic, functional, and stable outcome with IIP in compromised sockets, careful surgical and prosthetic protocols and reconstruction of the lost periodontal structures are crucial. To optimize aesthetics, preservation of hard and soft peri-implant tissues is mandatory.19 To ensure preservation of the buccal wall, tooth extraction has to be atraumatic with the use of a periotome, which facilitates the procedure by enlarging the space between the root and socket walls. The periotome is pushed into the periodontal ligament space along the crestal third of the


DOI 10.1111/jerd.12154

interproximal,20 and once proper root mobility is achieved the extraction may be easily performed. When properly planned and executed, IIP followed by immediate loading can offer many advantages, such as (1) reduced treatment time and number of procedures, (2) immediate function, (3) reduced number and length of office visits, (4) potentially lower cost, and (5) fewer provisional restorations.21–24 However, there are specific prerequisites for the clinically safe application of IIP, including sufficient bone beyond the tooth socket apex for initial implant stability, absence of active infection or acute inflammation, intact buccal bone plate after tooth removal, presence of adequate bone volume to accommodate an implant, no relationship with vital structures (maxillary sinus and nasal cavity), and absence of extensive gingival recession.25 The addition of bone and soft tissue grafts to the IIP protocol in compromised fresh sockets provides better aesthetic outcomes, as evidenced in a previous study.5 After a follow-up period of 58 months, the mean soft tissue dimensions of the gingival contour and papillae at baseline and final treatment were 12.85 ± 2.33 mm and 12.79 ± 2.48, respectively.5 Another study26 added soft tissue grafts to the IIP protocol and showed a lower clinical attachment level (>2.5 mm) and radiographic bone loss (>3.5 mm) after a follow-up period of 6–9 years. In a prospective study, Buser and colleagues27 evaluated the stability of peri-implant tissues after IIP with a simultaneous increase in tissue volume using guided bone regeneration and autogenous and deproteinized bovine bone. After a 5- to 9-year follow-up, all 41 implants demonstrated stability of the soft and hard tissues. Recently published case reports have shown stability of the soft and hard tissues after IIP in compromised sockets after 2 years of follow-up using a single combined approach involving soft and hard tissue grafts after implant placement.1,15 In an attempt to improve clinical efficacy, increase patient acceptance, allow faster restoration of function, minimize treatment time, and reduce bone resorption over time, a single-stage technique protocol was employed, utilizing autogenous bone and soft tissue grafts harvested from the maxillary tuberosity to restore


Vol 27 • No 3 • 122–135 • 2015

123


peri-implant buccal bone defects after IIP followed by immediate function of the crown.

CASE REPORT A 66-year-old woman was referred to the Department of Periodontology for the treatment of her maxillary left central incisor. The patient was complaining of spontaneous bleeding, pain, and swelling. She had no

relevant medical history and denied use of alcohol. Periodontal examination revealed a left central incisor with signs of class I tooth mobility, 5 mm of probing depth, and absence of buccal bone wall creating a functional defect requiring bone augmentation (Figure 1A–D). Periapical radiography showed a porcelain-fused-to-metal crown, localized vertical bone resorption on the buccal region, and endodontic treatment (Figure 2A). Bone height above the root apex was 8 mm. Based on clinical and radiographical

FIGURE 1. A and B, Initial clinical aspect of the maxillary left central incisor. C, Periodontal probing showing 5-mm loss of buccal bone plate. D, Bleeding after probing.

FIGURE 2. A, Periapical radiograph showing bone loss, endodontic treatment, and a metal ceramic crown. However, sufficient bone height for initial stability of the implant was present. B–E, Atraumatic extraction of a hopeless tooth to preserve the osseous contour.

124

Vol 27 • No 3 • 122–135 • 2015


DOI 10.1111/jerd.12154



examinations, an IIP followed by dentoalveolar reconstruction and immediate provisionalization of the crown was proposed and accepted by the patient. Written informed consent was obtained prior to initial treatment. The maxillary left central incisor was atraumatically extracted by a flapless technique under local anesthesia (mepivacaine 2% and epinephrine 1:100.000—Mepiadre®, DFL, Rio de Janeiro, RJ, Brazil) using a periotome, with pendular movements performed in the mesiodistal direction (Nobel Biocare, Yorba Linda, CA, USA) to preserve the remaining buccal bone architecture and the osseous structures as well as the papillae (Figure 2B–E). Thereafter, a careful curettage of the socket was performed to remove all granulation tissue. Then, the socket wall was probed to assess the bone damage, and as expected no buccal bone wall was present due to a fracture on the buccal side of the cervical third of the root. Measurements of the mesiodistal socket bone defect and the apical bone level were evaluated to determine the shape of the defect (Figure 3A–D). A dental implant (3.5 × 13 mm Cone Morse Drive, Neodent, Curitiba—PR, Brazil) was immediately inserted following all the necessary steps of drilling, i.e., implant bed preparation was started using a spear drill, a 2.0-mm cylindrical drill, and a 3.5-mm conical-shaped drill. The implant was installed

respecting the minimum distances established to optimize the aesthetic outcome and to achieve the appropriate emergence profile following the rule of restorative-driven three-dimensional placement28 (Figures 4A–D and 5A–D). The estimated depth of the drilling was based on the gingival level of the neighboring teeth as a reference. The implant platform was 1 mm from the vestibular gingival margin because the gingival contour of the homologous tooth was used as the reference. The initial implant stability was 60 Ncm due to the anchorage of the apical third of the implant in the palatal bone upper socket, allowing the immediate provisionalization of the crown through the placement of a prefabricated platform-switching titanium cylinder connected to the implant neck (Figure 6A–D). The crown of the extracted tooth was used as an immediate provisional crown, which was temporarily placed to correct the emergency profile, to create enough space for tissue accommodation and to promote improvement of the gingival contour (Figures 7A–D and 8A–D). Adjustment of the occlusion was performed, and any occlusal contact, i.e., centric and eccentric loading, was avoided by shortening the cervical region of the provisional crown, permitting the immediate but reduced functional loading of the implant. Thereafter, the provisional crown was removed for finishing and polishing, and to allow reconstruction of the socket defect.

FIGURE 3. A and B, Atraumatic extraction of the left central incisor root with the use of a periotome. C–D, Clinical evaluation of the extent of bone loss in the apical and mesio-distal direction. Note the absence of the buccal bone plate in consequence of a fracture at the cervical third of the root.


DOI 10.1111/jerd.12154


Vol 27 • No 3 • 122–135 • 2015

125


FIGURE 4. Initial surgical procedures for implant placement following all the necessary steps of drilling. The implant bed preparation was started using a spear drill, and then a 2.0 cylindrical drill and continued using a 3.5 conical-shaped drill.

FIGURE 5. Immediate implant placed in an ideal tridimensional position: in the mesio-distal direction, 2 mm of the adjacent teeth, and the implant shoulder placed 3 mm apical to the cement-enamel junction of the adjacent central incisor, and the axis of the implant was slightly palatal.

The next step consisted of reconstructing the buccal bone defect. Autogenous bone and a connective graft were removed from the maxillary tuberosity to increase both the horizontal and vertical dimensions of the alveolar socket. Infiltrative anesthesia (mepivacaine 2% and epinephrine 1:100.000—Mepiadre®, DFL) was used in the donor area. To harvest the bone and connective graft, a partial-thickness flap was elevated (at the center of the tuberosity crest running up to the last molar tooth), exposing the connective and periosteal tissue under the alveolar bone. Then, a straight chisel (2 mm

126

Vol 27 • No 3 • 122–135 • 2015


wider than the width of the defect) was used to perform the osteotomy and to remove the graft. After graft removal, a collagen-fibrin sponge was placed in position (Surgifoam®, Johnson & Johnson, Somerville, NJ, USA) (Figure 9A–D). The bone graft was customized according to the bone defect size and shape, which were previously mapped in the receptor area. After harvesting the bone graft from the maxillary tuberosity, a releasing sulcular incision was made in the receptor bed, and the graft was inserted at the level of

DOI 10.1111/jerd.12154



FIGURE 6. A and B, Initial implant stability of 60 Ncm allowing immediate provisionalization of the crown and ensuring primary stability of the implant. C, Occlusal view of the implant in an ideal 3D position; D, Provisional abutment placed after implant installation with the cervical portion narrower than the diameter of the implant (platform switching).

FIGURE 7. Prosthetic procedures for immediate provisionalization of the crown through the placement of a provisional titanium cylinder connected to the implant neck. The crown of the extracted tooth was used as a provisional crown placed temporarily to correct the emergency profile and to create enough space for tissue accommodation.

the implant platform, with its connective tissue portion facing the buccal area to increase gingival and bone thickness (Figure 10A–D). To fill the bone-to-implant gap, particulate bone marrow collected from the tuberosity was inserted between the inner portion of the bone graft and the implant to ensure primary graft stabilization (Figure 11A–D). Finally, a provisional crown was inserted and the graft was finally stabilized by suturing the connective tissue of the graft on the internal face of the flap with simple interrupted sutures (Figure 12A and B).


DOI 10.1111/jerd.12154

It is important to mention that all the necessary steps of provisional crown preparation were performed before graft harvesting and placement. This approach avoids the risk of graft contamination through handling the materials for constructing the provisional restoration (acrylic resin), as well as to facilitate the preparation and adjustment of the provisional crown and for clinical confirmation of its adaptation. The provisional restoration was removed 4 months post-operatively (Figure 12C and D). Prosthetic


Vol 27 • No 3 • 122–135 • 2015

127


FIGURE 8. Installation of the provisional crown. A concave contour was created in the cervical portion of the crown to better accommodate the gingival tissue. The construction, adjustment, and polishing of the provisional restoration were performed prior to the graft procedure.

FIGURE 9. A–C, Autogenous block bone graft and connective tissue graft harvested from the maxillary tuberosity with a straight chisel adjacent to the right first molar. D, After graft removal, a collagen-fibrin sponge was placed in position.

procedures were started by a transfer impression for coping fabrication (Figures 13A–D and 14A–D). A custom zirconia abutment, with its cervical portion being narrower than the implant diameter (platform switching), was made using a CAD/CAM system to create an aesthetic contour of the gingival margin (Figure 15A–D). Then, a feldspathic porcelain crown IPS Empress II—lithium-disilicate glass-ceramic restoration—was prepared and cemented (Multilink®, Ivoclar Vivadent, Schaan, Liechtenstein) over the abutment (Figure 16A and B).

128

Vol 27 • No 3 • 122–135 • 2015


At the 2-year follow-up, increased width and thickness of the gingival architecture, without probing depths or gingival recession, were noted (Figure 16C and D). Additionally, periapical radiographs and Cone-beam computed tomography showed correct implant position in relation to the adjacent teeth and bone, horizontal and vertical bone formation, and complete filling of the osseous defect without marginal bone loss (Figure 17A–D). The aesthetic and functional expectations of the patient were achieved in relation to the initial pretreatment situation.

DOI 10.1111/jerd.12154



FIGURE 10. A and B, Periosteal incision to allow positioning of the graft in the receptor bed. C–D, After reshaping to match the bone defect, the graft was placed in position with the connective portion facing the gingival mucosa, and the bone portion facing the implant.

FIGURE 11. Occlusal and frontal views of the central incisor showing the placement of the particulate autogenous bone graft to completely fill the remaining gap between the implant and the bone graft.

DISCUSSION IIP in compromised sockets is a complex clinical challenge, especially when advanced destruction of the buccal alveolar bone and gingival recession are present. The goal of this clinical report was to reestablish the buccal bone wall after immediate IIP. The socket defect was corrected with autogenous bone and a connective tissue graft removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal


DOI 10.1111/jerd.12154

bone and gingival tissue followed by immediate provisionalization of the crown during the same operation. In this case, atraumatic flapless extraction of the hopeless tooth was used to preserve the remaining bone and to optimize the functional and aesthetic outcome; afterwards, IIP in a palatal position to prevent bone resorption was performed as described previously.1 Flapless surgery allowed for maintenance of the soft


Vol 27 • No 3 • 122–135 • 2015

129


FIGURE 12. A and B, Installation of provisional crown. All centric and eccentric occlusal contact was avoided by shortening the cervical region of the provisional crown, with reduced functional loading of the implant. Interrupted sutures were used to ensure proper and final graft stabilization. C and D, After the 4-month follow-up, optimal aesthetic gingival appearance and sufficient gingival and bone height and width could be observed. This approach reduced the treatment time and favored immediate aesthetic results.

FIGURES 13. The provisional restoration and provisional abutment were removed 4 months post-operatively to start the final procedures for the prosthesis confectioning. Note the marginal gingival contour of the left central incisor.

tissue architecture and conservative tissue manipulation, leaving the periosteum intact to preserve the blood supply and increasing the predictability and success of IIP. Moreover, flapless implants are feasible and have been shown to reduce post-operative discomfort.29 Implant design and implant position are crucial for the long-term success of the implantation.4 In this case, a narrow-diameter implant was chosen because of the limited bucco-lingual width of the alveolar bone, which

130

Vol 27 • No 3 • 122–135 • 2015


could impair bone healing after graft placement, and to avoid the risk for a dehiscence defect. Covani and colleagues30 noted that the use of a narrow-diameter implant plays an important role in reducing the rate of the vertical buccal bone resorption of implants placed in fresh extraction sockets. Moreover, the narrow-diameter implant allowed sufficient space in the socket to position the bone and soft tissue grafts without over-tensioning the buccal gingival tissue, allowing the maintenance of blood supply to the graft. A conical-shaped implant was used to increase the

DOI 10.1111/jerd.12154



FIGURES 14. Prosthetic procedures of impression using squared impression copings with 2 mm prolongations, created with autopolymerizing acrylic resin after 4 months implant placement for the final restauration.

contact surface with the bone and to allow lateral compaction of the trabecular bone.31 Moreover, the implant was installed in a palatal position28 to minimize resorption of the buccal alveolar plate,32 maintaining an adequate gap dimension (>2 mm) between the implant and the remaining buccal bone. Appropriate implant length selection for initial stability was achieved with the use of a 13-mm-long implant, which allowed sufficient engagement of the apical third of the implant (>5 mm vertical bone-to-implant contact) in the palatal bone upper socket. To ensure adequate primary stability, an initial insertion torque of up to 32 Ncm must be attained for successful osseointegration of single-tooth implants with immediate provisionalization of the crown.33 Additionally, the use of an insertion torque between 32 and 50 Ncm may reduce the risk of implant failure in fresh extraction socket.34 A final insertion torque of 60 Ncm was obtained in this case, which allowed for immediate prosthetic procedures for the provisionalization of the implant. After implant placement, a platform-switching concept was used to create a provisional restoration because a recent study35 demonstrated lower stress levels in the peri-implant bone and a more uniform stress distribution. Furthermore, a previous study36 showed that platform switching preserves peri-implant bone


DOI 10.1111/jerd.12154

height and soft tissue levels, and reduces stress concentrations in the peri-implant bone.37 Canullo and Rasperini38 noted that immediate provisionalization with platform switching promotes greater stability of the hard and soft tissues around the implant. In the presented case, immediate provisionalization of the crown was performed because immediate loading of implants offers biological advantages, such as increased bone remodeling and bone density around the implant, and provides bone-to-implant contact that is similar to delayed implants.39 After preparation and adjustment of the provisional crown, bone and connective tissue grafts were harvested from the tuberosity and immediately installed in the receptor area, without incision, to reconstruct the facial osseous contour and to increase the bone and soft tissue height and thickness. Moreover, a particulate bone graft was placed to fill the gap between the implant and the block bone graft because bone gap distances greater than 0.5 mm result in unpredictable bone deposition.40 Autogenous bone grafts harvested from the tuberosity possess many advantages compared with bone grafts harvested from the chin or from the retro-mandibular area, such as (1) enhanced graft repair due to the periosteal cells of the tuberosity acting as


Vol 27 • No 3 • 122–135 • 2015

131


FIGURE 15. Custom zirconia abutment with a concave contour in its cervical portion to deliver lower stress levels in the peri-implant bone with a more uniform stress distribution.

FIGURE 16. A–B, Placement of a custom zirconia abutment to create an ideal marginal contour of the crown. C–D, Definitive all-ceramic CAD/CAM zirconia abutments 2 years post-operative.

osteoprogenitor cells5; (2) easy harvest and adaptation to the receptor area as a result of bone malleability; (3) high capacity for revascularization and release of growth factors in the receptor area due to the trabecular nature of grafts coming from the maxillary tuberosity41; (4) immediate function; (5) minimal additional surgical time and trauma; and (6) less discomfort, swelling, and pain compared with harvests from the chin or retromolar area. However, there are also disadvantages with this procedure, especially

132

Vol 27 • No 3 • 122–135 • 2015


related to the limited quantity of bone and surgical access. In conclusion, immediate reconstruction of the alveolar buccal bone plate after IIP was an efficient procedure for creating harmonious gingival and bone architecture, recovering lost anatomical structures with sufficient width and thickness, and maintaining the stability of the alveolar bone crest in a single procedure. Furthermore, with appropriate patient selection, precise

DOI 10.1111/jerd.12154



FIGURE 17. Cone-beam computed tomography and periapical radiograph 2-year post-operative showing increased bone height and width with absence of bone loss and stabilization of the alveolar crest.

techniques and implant selection, predictable healing, and optimal aesthetic results can be achieved with the proposed treatment.

DISCLOSURE The authors do not have any financial interest in any of the companies whose products are included in this article.

REFERENCES 1.

2.

3.

4.

5.

de Molon RS, Avila ED, Cirelli JA, et al. A combined approach for the treatment of resorbed fresh sockets allowing immediate implant restoration. A 2-year follow-up. J Oral Implantol in press. Available at: http://dx.doi.org/10.1563/AAID-JOI-D-13-00140. Bell C, Bell RE. Immediate restoration of NobelActive implants placed into fresh extraction sites in the anterior maxilla. J Oral Implantol 2014;40:455–8. Xu L, Wang X, Zhang Q, et al. Immediate versus early loading of flapless placed dental implants: a systematic review. J Prosthet Dent 2014;112(4):760–9. Vignoletti F, Sanz M. Immediate implants at fresh extraction sockets: from myth to reality. Periodontol 2000 2014;66:132–52. Rosa JC, Rosa AC, Francischone CE, Sotto-Maior BS. Esthetic outcomes and tissue stability of implant


DOI 10.1111/jerd.12154

placement in compromised sockets following immediate dentoalveolar restoration: results of a prospective case series at 58 months follow-up. Int J Periodontics Restorative Dent 2014;34:199–208. 6. Slagter KW, den Hartog L, Bakker NA, et al. Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis. J Periodontol 2014;85:e241–50. 7. Hammerle CH, Araujo MG, Simion M, Osteology Consensus Group. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res 2012;23(Suppl 5):80–2. 8. Chou YH, Du JK, Chou ST, et al. An interdisciplinary treatment approach combining orthodontic forced eruption with immediate implant placement to achieve a satisfactory treatment outcome: a case report. Clin Implant Dent Relat Res 2013;15:113–20. 9. Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol 2004;31:820–8. 10. Covani U, Bortolaia C, Barone A, Sbordone L. Bucco-lingual crestal bone changes after immediate and delayed implant placement. J Periodontol 2004;75:1605–12. 11. Araujo MG, Sukekava F, Wennstrom JL, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol 2005;32:645–52. 12. Araujo MG, Sukekava F, Wennstrom JL, Lindhe J. Tissue modeling following implant placement in fresh extraction sockets. Clin Oral Implants Res 2006;17:615–24.


Vol 27 • No 3 • 122–135 • 2015

133


13. Araujo MG, Wennstrom JL, Lindhe J. Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation. Clin Oral Implants Res 2006;17:606–14. 14. Kinaia BM, Shah M, Neely AL, Goodis HE. Crestal bone level changes around immediately placed implants: a systematic review and meta-analyses with at least 12 months follow up after functional loading. J Periodontol 2014;85(11):1537–48. 15. da Rosa JC, Rosa AC, Fadanelli MA, Sotto-Maior BS. Immediate implant placement, reconstruction of compromised sockets, and repair of gingival recession with a triple graft from the maxillary tuberosity: a variation of the immediate dentoalveolar restoration technique. J Prosthet Dent 2014;112:717–22. 16. de Barros LA, de Almeida Cardoso M, de Avila ED, et al. Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: achieving esthetic excellence with a multidisciplinary approach. Am J Orthod Dentofacial Orthop 2013;144:607–15. 17. de Avila ED, de Molon RS, de Assis Mollo F Jr, et al. Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants? Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:e22–8. 18. de Molon RS, de Avila ED, de Souza JA, et al. Forced orthodontic eruption for augmentation of soft and hard tissue prior to implant placement. Contemp Clin Dent 2013;4:243–7. 19. de Molon RS, de Avila ED, Cirelli JA, et al. Optimizing maxillary aesthetics of a severe compromised tooth through orthodontic movement and dental implants. Case Rep Dent 2014;2014:1–10. 20. Al-Sabbagh M, Kutkut A. Immediate implant placement: surgical techniques for prevention and management of complications. Dent Clin North Am 2015;59:73–95. 21. Chen ST, Wilson TG Jr, Hammerle CH. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants 2004;19(Suppl):12–25. 22. Esposito MA, Koukoulopoulou A, Coulthard P, Worthington HV. Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants). Cochrane Database Syst Rev 2006 Oct 18;(4):CD005968. 23. Schwartz-Arad D, Laviv A, Levin L. Survival of immediately provisionalized dental implants placed immediately into fresh extraction sockets. J Periodontol 2007;78:219–23. 24. Bahat O, Sullivan RM. Parameters for successful implant integration revisited part I: immediate loading considered in light of the original prerequisites for

134

Vol 27 • No 3 • 122–135 • 2015


25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

osseointegration. Clin Implant Dent Relat Res 2010;12(Suppl 1):e2–12. Schwartz-Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: a literature review. J Periodontol 1997;68:915–23. Bianchi AE, Sanfilippo F. Single-tooth replacement by immediate implant and connective tissue graft: a 1–9-year clinical evaluation. Clin Oral Implants Res 2004;15:269–77. Buser D, Chappuis V, Bornstein MM, et al. Long-term stability of contour augmentation with early implant placement following single tooth extraction in the esthetic zone: a prospective, cross-sectional study in 41 patients with a 5- to 9-year follow-up. J Periodontol 2013;84:1517–27. Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19(Suppl):43–61. Guarnieri R, Ceccherini A, Grande M. Single-tooth replacement in the anterior maxilla by means of immediate implantation and early loading: clinical and aesthetic results at 5 years. Clin Implant Dent Relat Res in press doi: 10.1111/cid.12111. Covani U, Cornelini R, Calvo JL, et al. Bone remodeling around implants placed in fresh extraction sockets. Int J Periodontics Restorative Dent 2010;30:601–7. Glauser R, Zembic A, Ruhstaller P, Windisch S. Five-year results of implants with an oxidized surface placed predominantly in soft quality bone and subjected to immediate occlusal loading. J Prosthet Dent 2007;97:S59–68. Lee EA, Gonzalez-Martin O, Fiorellini J. Lingualized flapless implant placement into fresh extraction sockets preserves buccal alveolar bone: a cone beam computed tomography study. Int J Periodontics Restorative Dent 2014;34:61–8. Ottoni JM, Oliveira ZF, Mansini R, Cabral AM. Correlation between placement torque and survival of single-tooth implants. Int J Oral Maxillofac Implants 2005;20:769–76. Atieh MA, Alsabeeha NH, Payne AG, et al. Insertion torque of immediate wide-diameter implants: a finite element analysis. Quintessence Int 2012;43:e115–26. Liu S, Tang C, Yu J, et al. The effect of platform switching on stress distribution in implants and periimplant bone studied by nonlinear finite element analysis. J Prosthet Dent 2014;112(5):1111–8. Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis. J Periodontol 2010;81:1350–66.

DOI 10.1111/jerd.12154



37. Calvo Guirado JL, Saez Yuguero MR, Pardo Zamora G, Munoz Barrio E. Immediate provisionalization on a new implant design for esthetic restoration and preserving crestal bone. Implant Dent 2007;16:155–64. 38. Canullo L, Rasperini G. Preservation of peri-implant soft and hard tissues using platform switching of implants placed in immediate extraction sockets: a proof-of-concept study with 12- to 36-month follow-up. Int J Oral Maxillofac Implants 2007;22:995–1000. 39. Romanos GE, Toh CG, Siar CH, Swaminathan D. Histologic and histomorphometric evaluation of peri-implant bone subjected to immediate loading: an experimental study with Macaca fascicularis. Int J Oral Maxillofac Implants 2002;17:44–51. 40. Rungcharassaeng K, Kan JY, Yoshino S, et al. Immediate implant placement and provisionalization with and


DOI 10.1111/jerd.12154

without a connective tissue graft: an analysis of facial gingival tissue thickness. Int J Periodontics Restorative Dent 2012;32:657–63. 41. Cicconetti A, Sacchetti B, Bartoli A, et al. Human maxillary tuberosity and jaw periosteum as sources of osteoprogenitor cells for tissue engineering. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:618.e1–12.

Reprint requests: Rafael Scaf de Molon, DDS, MS, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095-1668, USA; Tel.: 310-295-7391; email: [email protected]


Vol 27 • No 3 • 122–135 • 2015

135

Behaviour of the buccal crestal bone levels after immediate placement of implants subjected to immediate loading.

Management of Buccal Gap and Resorption of Buccal Plate in Immediate Implant Placement: A Clinical Case Report.

Central osteoma of the maxilla: implant rehabilitation with immediate loading in fresh extraction socket.

Immediate placement of a porous-tantalum, trabecular metal-enhanced titanium dental implant with demineralized bone matrix into a socket with deficient buccal bone: a clinical report.

Study on angle of immediate loading of immediate implant placement.

Immediate implant placement, reconstruction of compromised sockets, and repair of gingival recession with a triple graft from the maxillary tuberosity: a variation of the immediate dentoalveolar restoration technique.

Model-Guided Flapless Immediate Implant Placement and Provisionalization in the Esthetic Zone Utilizing a Nanostructured Titanium Implant: A Case Report.

Immediate placement and provisionalization of an implant after removal of an impacted maxillary canine: two case reports.

Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: a virtual implant placement study.

Lingualized flapless implant placement into fresh extraction sockets preserves buccal alveolar bone: a cone beam computed tomography study.

Immediate Implant Placement into Extraction Sockets with Labial Plate Dehiscence Defects: A Clinical Case Series.

Evaluation of buccal plate after human bone allografting: clinical and CBCT outcomes of immediate anterior implants in eight consecutive cases.

Alveolar bone expansion for implant placement in compromised aesthetic zone - case series.

Implant-based immediate breast reconstruction in the previously augmented patient.

Gingival margin changes in maxillary anterior sites after single immediate implant placement and provisionalization: a 5-year retrospective study of 47 patients.

Immediate implant placement for schizophrenic patient with outpatient general anesthesia.

Creating labial bone for immediate implant placement: a minimally invasive approach by using orthodontic therapy in the esthetic zone.

Soft Tissues Changes After Immediate and Delayed Single Implant Placement in Esthetic Area: A Systematic Review.

Immediate postextraction implant with simultaneous buccal plate augmentation, restored with lithium disilicate abutment and veneer: a clinical report.

Dental extraction, immediate placement of dental implants, and immediate function.

Abstract 45: broadening indications for immediate implant-based breast reconstruction.

Immediate direct-to-implant breast reconstruction using anatomical implants.

Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study.

Outcomes of immediate tissue expander breast reconstruction followed by reconstruction of choice in the setting of postmastectomy radiation therapy.