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.

Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment

Esposito M, Grusovin MG, Worthington HV, Coulthard P

The Cochrane Database of Systematic Reviews 2007 Issue 1
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.

Date of last Subtantial Update: February 21. 2006

Authors' conclusions

Major bone grafting procedures of extremely resorbed mandibles may not be justified. Bone substitutes (Bio-Oss or Cerasorb) may replace autogenous bone for sinus lift procedures of extremely atrophic sinuses. Both guided bone regeneration (GBR) procedures and distraction osteogenesis can augment bone vertically, but it is unclear which is the most efficient technique. It is unclear whether augmentation procedures at immediate single implants placed in fresh extraction sockets are needed, and which is the most effective augmentation procedure, however, sites treated with barrier + Bio-Oss showed a higher position of the gingival margin, when compared to sites treated with barriers alone. Non-resorbable barriers at fenestrated implants regenerated more bone than no barriers, however it remains unclear whether such bone is of benefit to the patient. It is unclear which is the most effective technique for augmenting bone around fenestrated implants. Bone morphogenetic proteins may enhance bone formation around implants grafted with Bio-Oss. The use of particulated autogenous bone from intraoral locations, also taken with dedicated aspirators, might be associated with an increased risk of infective complications. These findings are based on few trials including few patients, having sometimes short follow up, and being often judged to be at high risk of bias.

Augmentation procedures for the rehabilitation of deficient edentulous ridge with oral implant

Matteo Chiapasco, Marco Zaniboni, Maurizio Boisco,
Clin. Oral Impl. Res. 17 (Suppl. 2), 2006; 136–159

Unit of Oral Surgery, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy

Results: Success rates of surgical procedures ranged from 60% to 100% for GBR, from 92%
to 100% for onlay bone grafts, from 98% to 100% for ridge expansion techniques, from
96,7% to 100% for DO, and was 87.5% for revascularized flaps, whereas survival rates of
implants ranged from 92% to 100% for GBR, from 60% to 100% for onlay bone grafts, from
91% to 97.3% for RE, from 90.4% to 100% for DO, and, finally, was 88.2% for
revascularized flaps.
Conclusion: On the basis of available data it was shown that it was difficult to demonstrate
that a particular surgical procedure offered better outcome as compared to another. The
main limit encountered in this review has been the overall poor methodological quality of
the published articles. Therefore larger well-designed long term trials are needed.