Journal of Oral Implantology June 2013 - (Page 380)

CASE LETTER Immediate Placement and Provisionalization With Buccal Plate Preservation: A Case Report of a New Technique Federico Brugnami, DDS1* Alfonso Caiazzo, DDS2 INTRODUCTION A lveolar ridge resorption after tooth extraction is a frequently observed phenomenon that may either decrease the predictability of dental implant placement or impair the final esthetic results.1,2 Better understanding of the biologic process behind extraction-socket healing has led to the development of techniques to preserve the natural architecture of the alveolus after extraction, such as immediate implant placement in fresh sockets and the use of osseous graft materials.3 It is now known that resorption will especially target the buccal plate if the socket is not grafted immediately after dental extraction,3,4 thereby increasing the risk for facial soft tissue recession.4 Even when minimal, such resorption usually has significant adverse clinical effects, particularly in the esthetic zone. Despite successful osseointegration of a dental implant, an anterior implant restoration may be judged to be a failure if the soft tissue appearance is poor.5–8 Surgical techniques meant to preserve natural bone and soft tissue contours after tooth extraction are thus of great interest to contemporary clinicians, especially true if an implant is placed and provisionalized immediately after tooth extraction. Numerous studies have focused on immediate functional loading of dental implants to minimize the delay between the surgical and prosthetic treatment phases.9,10 This technique is increasingly being applied when replacing teeth in the maxillary anterior region, where esthetic outcomes are important.11–17 However, some studies12,15,16 have reported that recession of the marginal peri-implant 1 Private practice, Rome, Italy. Private practice, Salerno, Italy. * Corresponding author, e-mail: DOI: 10.1563/AAID-JOI-D-11-00154 2 380 Vol. XXXIX /No. Three / 2013 mucosa may occur after immediate implant placement. This recession, in turn, may adversely affect the final esthetic outcome. Factors that have been reported to influence the frequency and extent of marginal mucosal recession include the tissue biotype,17 the condition and thickness of the facial bone,18 and the orofacial position of the implant shoulder.19,20 Connecting a provisional crown immediately after implant insertion8,21 and grafting of the facial peri-implant marginal defect with bone or bone substitutes21–23 also have been cited as factors. In addition to these parameters, an experimental study24 showed that the facial socket wall, which is composed almost entirely of bundle bone, may be susceptible to resorption in the vertical and horizontal planes. Such crestal bone resorption may lead to recession of the facial marginal mucosa. Any alteration of the soft or hard tissues may impair the final esthetic outcome of immediately loaded implants in the anterior area. To better preserve the alveolar ridge and maintain optimal soft tissue contours, we previously introduced a novel buccal plate preservation (BPP) technique.25,26 This simple surgical technique may help to prevent recession of the facial wall of the extraction socket without interfering with the healing process. It involves placement of particulate bone-graft material underneath the soft tissues in a surgically created pouch adjoining the buccal plate. It thus maintains optimal soft tissue contours and predictably provides a solid base for optimal esthetics and functional replacement of a missing tooth. Although we originally used this technique in the wake of tooth extraction when a delayed implant placement was planned, it also can be used effectively in conjunction with immediate implant placement and provisionalization, as the following case report illustrates.

Table of Contents for the Digital Edition of Journal of Oral Implantology June 2013

Congratulations to Duke Heller, DDS, MS—Pioneer, Teacher, and Mentor
In Vitro Analysis of Resistance to Cyclic Load and Preload Distribution of Two Implant/ Abutment Screwed Connections
Mandibular Implant-Supported Overdenture: An In Vitro Comparison of Ball, Bar, and Magnetic Attachments
An Exploratory Study on Assessment of Gingival Biotype and Crown Dimensions as Predictors for Implant Esthetics Comparing Caucasian and Indian Subjects
A New Approach to the All-on-Four Treatment Concept Using Narrow Platform NobelActive Implants
Regular and Switching Platform: Bone Stress Analysis With Varying Implant Diameter
Comparison Between Immediate and Delayed Laser-Treated Implants Surface With Switching Platform: A Clinical Retrospective Study
Effect of a Multiporous Beta–Tricalicum Phosphate on Bone Density Around Dental Implants Inserted Into Fresh Extraction Sockets
The Effect of Varying Implant Position in Immediately Loaded Implant-Supported Mandibular Overdentures
Bone Regeneration Around Immediate Implants Utilizing a Dense Polytetrafluoroethylene Membrane Without Primary Closure: A Report of 3 Cases
Socket Preservation and Sinus Augmentation Using a Medical Grade Calcium Sulfate Hemihydrate and Mineralized Irradiated Cancellous Bone Allograft Composite
Implant Placement and Immediate Loading With Fixed Restorations in Augmented Sockets. Five-Year Results. A Case Report
Immediate Placement and Provisionalization With Buccal Plate Preservation: A Case Report of a New Technique
Clinical Importance of Recipient Site Characteristics for Vertical Ridge Augmentation: A Systematic Review of Literature and Proposal of a Classification
Postextraction Implant in Sites With Endodontic Infection as an Alternative to Endodontic Retreatment: A Review of Literature
Letter to the Editor

Journal of Oral Implantology June 2013