Immediate implant placement in extraction sockets with buccal bone dehiscence: A case study.

Abstract

Background: Immediate implant placement (IIP) has been associated with a higher risk of esthetic complications and particularly buccal mucosal recession, which can be more pronounced in non-intact sockets or in the presence of thin phenotype in the esthetic zone. Nevertheless, multiple techniques have been published to address IIP in non-intact alveolar sockets with favorable outcomes. The purpose of this study is to present an approach on IIP in sites with buccal bone dehiscence.

Methods: Three patients requiring extraction of one or multiple teeth in the presence of buccal bone dehiscence were treated with flapless extractions, IIP, guided bone regeneration (GBR), and connective tissue grafting (CTG) through a tunneling approach with a simultaneous use of custom healing abutments.

Results: All sites exhibited 1-2 mm of buccal bone thickness at the level of the implant platform, as well as significant buccal soft tissue thickness with no recession and a favorable development of the emergence profile at 4 months to a year post implant placement.

Conclusions: IIP in sockets with buccal bone dehiscence can be managed by means of a flapless extraction, GBR and CTG through a tunneling approach exhibiting favorable hard and soft tissue responses.

Key points: When placing immediate implants in non-intact sockets, simultaneous connective tissue grafting is recommended, especially in the esthetic zone. Bone grafting in immediate implants in sockets with buccal bone dehiscence can be performed through a tunneling approach without the need for open flap approaches. Placement of CHAs over immediate implants may help promote maintenance of the buccolingual ridge contours and overall hard and soft tissue responses.

Plain language summary: Placing dental implants right after tooth extraction can lead to more visible aesthetic issues, especially gum recession. This is more common when the tooth socket is not intact or the gum tissue is thin. However, several techniques have shown good results even in these challenging situations. This study explores a method for implant placement right after tooth extraction in cases where there is bone missing on the socket. Three patients who needed teeth extracted and had bone loss on the outer side of their tooth sockets were treated. The treatment included: Extracting the teeth without cutting the gums, placing implants immediately, using GBR to help regrow bone, adding connective tissue grafts, and using custom healing cups to shape the gum tissue. After treatment, all the sites showed 1-2 mm of new bone on the outer side of the implants and thicker gum tissue without any recession. The gum and bone around the implants looked good 4 months to a year later. In conclusion, IIP in sockets with bone loss on the outer side can be effectively managed with this method, leading to good bone and gum tissue outcomes.