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: 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