Immediate Implant Placement and Provisionalization After Long-Axis Root Fracture and Complete Loss of the Facial Bony Lamella

The aim of this research was to explore the performance of a flapless surgical approach for immediate implant placement, simultaneous alveolar ridge augmentation, and immediate provisionalization in patients with complete loss of the facial bony lamella resulting from long-axis root fracture. Eighteen NobelPerfect implants were placed in 16 patients (follow-up, 13 to 36 months) who had sustained complete loss of the facial bony lamellae. Implants were inserted simultaneous to subperiostal bone augmentation with autogenous bone chips and underwent immediate provisionalization. Outcome variables included implant success, marginal bone levels, and pink esthetic score (PES). All implants achieved excellent primary stability. There were no implant losses. On average, interproximal marginal bone levels stabilized at 1.0 to 1.3 mm above the first thread. Postoperative cone beam computed tomography scans were available for 16 implant sites and confirmed restoration of the facial lamella in the vast majority of patients. Marginal esthetics, as assessed by the PES, was by and large preserved (mean postoperative PES, 12.5). Oral hygiene was highly predictive for the esthetic result. Survival rates, marginal bone levels, and esthetic results suggest a proof-of-principle for the new flapless immediate implant placement technique in patients with complete loss of the facial bony lamella. Oral hygiene status may be considered as a negative prognostic factor for the esthetic outcome.