Early Implant Placement Following Single Tooth Extraction in the Esthetic Zone with Contour Augmentation - Selection Criteria, Surgical Procedures and Long-Term Results

Implant placement post single tooth extraction in the esthetic zone is an important and frequent indication for implant therapy. Today, the clinician can choose from four different treatment approaches for the timing of implant placement. The decision for the most appropriate treatment plan should be based on a thorough clinical and radiographic examination and well-defined selection criteria. Early implant placement after soft tissue healing is one of the treatment options available. This approach is applied by our team in the case of a thin bone wall phenotype ( 1 mm) or a missing facial bone wall at the extraction site, and sufficient bone volume available in the palato-apical area to allow good primary stability of the implant. The surgical procedures include a flapless tooth extraction, a 4-to-8 week soft tissue healing period, implant placement in the correct 3-dimensional position, a simultaneous contour augmentation on the facial aspect with the GBR technique using a 2-layer composite graft with locally harvested autologous bone chips and a low-substitution bone filler, application of a double-layer collagen membrane, and a tension-free primary wound closure. Following 8 weeks of healing, the implant site is reopened with a punch technique, and the implant can be restored with a screw-retained single crown. The rationale for this surgical approach is presented including inclusion criteria, surgical procedures, case reports and long-term documentation. Keywords: Implant placement post extraction, immediate implant placement, early implant placement, late implant placement, GBR technique, contour augmentation, 2-layer composite graft