A Novel Method for Immediate Implant Placement in Defective Fresh Extraction Sites

Purpose: This study assessed a novel treatment protocol for immediate implant placement in defective fresh extraction sockets. Materials and Methods: A single-arm clinical study was conducted including 12 fresh extraction sockets divided into two groups: those with intact and those with a deficient facial plate of bone. Hopeless teeth were atraumatically extracted, a vestibular access horizontal incision was made 3 to 4 mm apical to the mucogingival junction, a mucoperiosteal tunnel was created from the labial orifice of the socket, a slowly resorbing membrane shield was stabilized under the tunnel, implants were placed using a surgical guide, and a subepithelial connective tissue graft was harvested and secured over the membrane shield. Definitive restorations were delivered at 3 months postoperatively. Cone beam computed tomography (CBCT) scans were taken at baseline and after 6 and 13 months to measure facial bone thickness and height. Pink esthetic score (PES) was recorded at 6 and 13 months. Results: At 6 months, the mean ± SD facial bone thickness was 1.88 ± 0.73 mm for sockets with intact facial bone compared to 0.76 ± 0.42 at baseline and 2.34 ± 0.78 mm for sockets with deficient facial bone compared with 0 ± 0 at baseline, whereas at 13 months, the thickness was 1.84 ± 0.74 and 2.18 ± 0.73 mm, respectively. The facial bone crest coincided with the implant platform in sockets with an intact facial bone plate and those with a deficient facial bone plate at 6 months, whereas at 13 months, the distance for sockets with a deficient facial bone plate increased to 0.20 ± 0.13 mm. The mean PES at 6 and 13 months was 11.33 for both groups out of a maximum score of 14. Conclusion: The proposed technique provided a minimally invasive treatment with predictable esthetic outcome allowing immediate implant placement in sockets with intact and with deficient facial plates. Keywords: bone grafting, facial bone plate, fresh extraction socket, immediate implant, xenograft