Journal of Oral Implantology April 2013 - (Page 198)
CASE REPORT
A Novel Approach to Preserve the Buccal Wall in
Immediate Implant Cases: A Clinical Report
Manuel Neves, DMD
´
Andre Correia, DMD, PhD*
´lia
Ce Coutinho Alves, DMD
The aim of this article is to present a novel approach to preserve the buccal wall when performing immediate
implants. After immediate implant site preparation, the socket is filled with Bio-Oss collagen and trimmed in a
cone form to closely adapt to the buccal wall. Then, the implant is placed with low-rotation-speed condensing
Bio-Oss collagen buccally. With this technique, the remodeling of buccal wall after immediate implant
placement may be reduced.
Key Words: immediate implantation, alveolar bone loss, bone remodeling, Bio-Oss collagen
INTRODUCTION
T
he procedure of immediate implants,
especially in the esthetic zone, is a
challenge to clinicians because of the
modeling/remodeling (external changes/
internal changes) of the buccal wall with
direct consequences on the stability of both hard
and soft tissues. This is a physiological phenomenon
that occurs during the healing process of the
wound,1,2 after tooth extractions, and even following an immediate implant. Many authors3–13 state
that this clinical procedure does not prevent vertical
or horizontal bone resorption, there is a significant
bone reduction, and bone regeneration techniques
should be applied in most of the cases.
The Proceedings of the Third ITI Consensus
Conference13 about implants in postextraction sites
present some of the consensus statements regarding this theme:
External resorption (modeling) of the socket walls
occurs during bone healing.
There is spontaneous bone healing and osseointegration of implants with a horizontal defect
dimension of 2 mm or less.
Dr. Manuel Neves Dental Clinic, Porto, Portugal
*Corresponding author, e-mail: andrecorreia@manuelneves.com
DOI: 10.1563/AAID-JOI-D-11-00082
198
Vol. XXXIX /No. Two / 2013
Bone regeneration procedures are recommended
when there is a horizontal defect dimension
larger than 2 mm and/or nonintact socket walls.
However, the same Consensus Conference13
concludes that there is a lack of comparative
analysis of different methods of bone augmentation
with regard to the stability over time, especially
concerning the behavior of the buccal bone plate.
Buccal wall changes are dependent mostly on
the thickness of the buccal plate, which should be
at least 1.8- to 2-mm thick,14–17 although the
trajectory of the implant16 more toward the buccal
wall, or an excessive insertion torque,18 can also
promote these changes because of an inadequate
blood supply.
However, an adequate buccal plate thickness is
not present in most clinical situations,17,19 and bone
regeneration procedures should be considered.
Also, to prevent this buccal wall modeling/remodeling, the implant should be placed more palatally
to avoid pressure against the buccal plate and to
facilitate bone-grafting outcomes, since a gap is
always left between the implant and the buccal
bone.16 When this gap is greater than 2 mm,6 bone
gap filling is indicated, and it can be executed with
a natural bone-grafting material, such as Bio-Oss
(Geistlisch Pharma AG, Switzerland) made from the
mineral portion of bovine bone or with a grafting
material that combines bone particles with colla-
Table of Contents for the Digital Edition of Journal of Oral Implantology April 2013
Evidence-Based Practice or Practice-Based Evidence?
Evaluation of Optimal Taper of Immediately Loaded Wide-Diameter Implants: A Finite Element Analysis
A Prospective, Randomized Controlled Preclinical Trial to Evaluate Different Formulations of Biphasic Calcium Phosphate in Combination With a Hydroxyapatite Collagen Membrane to Reconstruct Deficient Alveolar Ridges
Retention of Implant-Supported Overdenture With Bar/Clip and Stud Attachment Designs
The Clinical and Histologic Outcome of Dental Implant in Large Ridge Defect Regenerated With Alloplast: A Randomized Controlled Preclinical Trial
Fluoride-Treated Bio-Resorbable Synthetic Hydroxyapatite Promotes Proliferation and Differentiation of Human Osteoblastic MG-63 Cells
Resonance Frequency Analysis of 208 Straumann Dental Implants During the Healing Period
A Simplified Technique for Solving the Transfer Problem of Implant-Supported Fixed Partial Dentures for Patients With Microstomia
Esthetic Evaluation of Single-Tooth Morse Taper Connection Implants Placed in Fresh Extraction Sockets or Healed Sites
A Technique for Improving the Retention of Dentures Retained by Ramus Frame Implants
Treatment of Congenitally Missing Maxillary Lateral Incisors: An Interdisciplinary Approach
Use of Titanium Mesh in Lieu of a Fixation Screw to Stabilize an Autogenous Block Graft: A Case Report
A Novel Approach to Preserve the Buccal Wall in Immediate Implant Cases: A Clinical Report
Implant Failure Associated With Actinomycosis in a Medically Compromised Patient
Replacement of Mandibular Posterior Teeth With Implants in a Postmandibular Resection Case: A Case Report
Zygomatic Implants/Fixture: A Systematic Review
An Overview of Immediate Root Analogue Zirconia Implants
Letter to the Editor
Reviews of Current Literature
Journal of Oral Implantology April 2013
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