The three-layer technique for immediate implants on teeth without a buccal bone wall: a case report

The buccal bone wall is the part of the socket of an anterior tooth that is most susceptible to resorption. Immediate implants offer advantages in terms of time, comfort, and esthetics, especially regarding the maintenance of the papillae architecture. However, the loss of the buccal bone wall is often a limitation for such a therapy. This case report describes a clinical procedure designed to reconstruct the buccal bone wall to restore an anterior tooth where this wall was absent. The approach involved a flapless immediate implant based on the principles of guided bone regeneration (GBR), and consisted of the preparation of a large, flapless recipient bed ad modum envelope, immediate implant placement, deposition of xenograft surrounding the implant surface, and coverage with a collagen membrane. Finally, a palatal connective tissue graft (CTG) was placed, and the natural tooth crown acting as a temporary restoration was delivered. One year later, a zirconia-ceramic crown was delivered. Two years after implant placement, the soft tissue level was stable. No signs of inflammation or bleeding were observed, and periapical radiographic examination revealed bone stability.