Delayed Dental Implants in Pristine Large Buccal Bone Defects in the Anterior Maxilla

Objectives: This study investigated the remodeling process of hard tissue components in fresh extraction sockets that underwent natural healing, followed by localized alveolar split-crest surgery for implant placement. Methods: Subjects with bone defects in the aesthetic maxillary region, characterized by decreased mineral density around the affected tooth, were treated through socket healing without bone substitutes, delayed alveolar splitting, and subsequent implant placement. Preoperative (baseline, before the first and second surgeries) and postoperative cone-beam computerized tomographic (CBCT) scans were analyzed to assess changes in bone volume and crestal width. Statistical analysis was performed using non-parametric tests, with a significance level set at p < 0.01. Results: Thirteen incisors were retrospectively evaluated. No major postoperative adverse events were recorded. After two years, the implants achieved a 100% survival rate. No episodes of peri-implant mucositis or peri-implantitis were reported. Radiographs taken three months after tooth extraction revealed bone mineralization without the use of bone substitutes; however, the volume was insufficient for immediate implant placement. Following tooth extraction, the split procedure and implant placement (first and second surgeries), total bone volume showed a significant increase (p = 0.0105) from baseline (919 ± 179 mm3) to the 2-year follow-up (955 ± 176 mm3). Similarly, crestal width demonstrated a significant augmentation (p = 0.0012), increasing from 6.1 ± 2.7 mm at baseline to 7.5 ± 2.0 mm at 2 years, with a mean gain of +1.4 ± 1.0 mm due to the split-crest procedure. Conclusions: After two years, the results indicated that natural healing of the extraction socket, without the use of bone substitutes, followed by delayed localized alveolar splitting, led to a significant increase in bone volume and preservation of the outermost alveolar bone layer. The observed post-extraction site augmentation was concentrated in the frontal area.