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: fbrugnami@gmail.com
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
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