Immediate implant placement combined with titanium granules

The immediate implant placement even in the esthetic zone is an often performed procedure. The position of the implant is closed to the palatal part of the socket. There are different concepts for the management of the remaining gap between the implant and the buccal bone plate. The aim is to keep the contour of the alveolar process. In this study, the gap was filled up with titanium granules. 28 implants were placed in the region of the upper incisors and canines. After the placement, a healing abutment in the same diameter as the implant was connected. The granules were mixed with blood and pushed with gentle pressure into the gap. The "small" healing abutment was removed and replaced by an abutment in a diameter corresponding to the replaced tooth. A temporary crown was fixed to the abutment and adhered to the adjacent teeth. After a healing time of 3 months, the abutments and temporary crowns were replaced by definite reconstruction. To evaluate the stability of the alveolar process, clinical pictures were taken before extraction and after the delivery of the final crown. In addition measuring was made using the planning model and the master cast. The healing period was uneventful in all cases. The restorations showed a healthy gingival margin and no discoloration of the soft tissue. All patients were satisfied with the clinical results so the minimal collapse of the alveolar process as the result of the measuring of the models seems not to result in a compromised clinical situation. These early results justify further use for this indication. Keywords: immediate placement, bone substitutes, red-white esthetic