Title: Immediate implant placement in esthetic sites: Treatment of dimensional bone and soft tissue alterations post-extraction
The key to achieving pleasing esthetics in implant dentistry is a thorough understanding of the biological processes driving dimensional bone and soft tissue alterations post?extraction.
The aim of my oral presentation is first to characterize the extent of bone and soft tissue changes post?extraction and second to identify potential factors influencing tissue preservation in order to facilitate successful treatment outcomes.
The facial bone wall thickness has been identified as the most critical factor influencing bone resorption and can be used as a prognostic tool in order to identify sites at risk for future facial bone loss subsequent to tooth extraction. The knowledge of the biological events driving dimensional tissue alterations post?extraction should be integrated into the comprehensive treatment plan in order to limit tissue loss and to maximize esthetic outcomes.
Over the past two decades it has become evident that post-extraction dimensional alterations inevitably occur due to the resorption of the bundle bone as a tooth-dependent structure, and to related factors such as a lack of functional stimulus and a lack of vascular blood supply due to the missing periodontal ligament and genetic information. Even though numerous bone and soft tissue augmentation techniques have been suggested for regenerating the lost tissue structures, establishing clear guidelines for facilitating implant placement and achieving predictable treatment outcomes remain a significant challenge in clinical practice.
Several surgical techniques have the potential to modulate the degree of these inevitable changes, such as flapless tooth extraction, ridge preservation and immediate implant placement.
Flapless tooth extraction is important to avoid additional bone resorption from the bony surface related to the elevation of the mucoperiosteal flap. Flapless tooth extraction has been shown to reduce the amount of bone loss in the early healing phase 4–8 weeks post extraction compared with full-thickness flap elevations.
Even though attempts to preserve the ridge have failed to arrest the inevitable biological process of dimensional ridge alterations post-extraction, in particular with respect to the preservation of the alveolar bone volume, studies have shown that grafting of extraction sockets with biomaterials and the use of barrier membranes is able to reduce the degree of dimensional alterations.
It has been suggested that placement of implants into fresh extraction sockets with a bone-to-implant gap of 2 mm or less would prevent remodeling and hence maintain the original shape of the ridge.