Triple Immediate Therapy (ridge expansion, soft tissue augmentation, and provisional restoration) of Maxillary Anterior Single Implant

Journal of Periodontology
2007, Vol. 78, No. 7, Pages 1348-1353
(doi:10.1902/jop.2007.060487)

Yu-Lin Lai,* ­I-Chiang Chou,* ­Yu-Cheng Liaw,* ­Hen-Li Chen,* ­Yi-Chun Lin,* and ­Shyh-Yuan Lee*­

*Department of Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan.

†School of Dentistry, National Yang-Ming University, Taipei, Taiwan.

‡Department of Dentistry, Taipei City Hospital, Taipei, Taiwan.

Correspondence: Dr. Shyh-Yuan Lee, School of Dentistry, National Yang-Ming University, Taipei 112, Taiwan. Fax: 886-2-28264053; e-mail: sylee@ym.edu.tw.

Background: Immediate restoration during implant placement in the premaxillary area can achieve a favorable esthetic result. However, the treatment always poses a great challenge to clinicians, especially for patients with preexisting soft and hard tissue deficiencies. The aim of this clinical report was to present a protocol for a multidisciplinary approach to provide an immediate implant restoration for patients with ridge deficiency.

Methods: A 21-year-old female presented with a mesial shift of the maxillary right canine due to loss of a lateral incisor at an early age. The treatment protocol included orthodontic space redistribution to open a canine space for implant placement. Subsequently, ridge expansion and implant placement combined with connective tissue grafting for the reconstruction of the soft tissue profile were performed, and an immediate provisional prosthesis was delivered simultaneously. A definitive University of California at Los Angeles–style ceramometal crown was completed 6 months later with periodical clinical maintenance.

Results: The 18-month postoperative follow-up revealed that the implant was stable, and the buccal depression of the surgical area was reconstructed. Papillae were augmented, and a harmonious soft tissue margin was achieved in the esthetic zone. Radiographs demonstrated a normal vertical osseous height and excellent osseointegration of the implant.

Conclusions: The combination technique of ridge expansion and soft tissue augmentation can be applied to immediate implant restoration cases without the need for complicated bone grafting surgeries in atrophic ridges. This triple immediate strategy enabled us to reduce the number of surgeries, which simplified the overall procedure without compromising the esthetic results.