Correction of Buccal Dehiscence During Immediate Implant Placement Using the Flapless Technique: A Tomographic Evaluation

Abstract

Immediate implant placement at dehiscence buccal bone sites using flapless surgery combined with xenograft blocks provided complete formation of the buccal bone wall up to the implant shoulder.

Flapless immediate implant placement and provisionalization in periodontal patients: A retrospective consecutive case‐series study of single‐tooth sites with dehiscence‐type osseous defects

“…In reconstruction and restorative treatments after tooth extraction where buccal plate has been affected, flapless immediate implants with simultaneous reconstruction of the alveolar facial bone wall, filling of the residual defect and implant-supported provisional immediate dental replacement (FIIR&P) can play an important role. However, the scarce evidence to this respect is based on case series (Assaf et al, 2017;Kan et al, 2007;Noelken et al, 2011;Rosa et al, 2014;Sarnachiaro et al, 2016;Slagter, Meijer, Bakker, Vissink, & Raghoebar, 2016;Tripodakis et al, 2016) mostly of retrospective nature or on clinical cases (Albiero et al, 2014;de Molon et al, 2015) evaluating a small number of implants (114 in 109 patients), with great methodological and clinical heterogeneity and variable follow-up periods ranging from 6 to 60 months. Despite this, most studies share the type of osseous dehiscence to be treated (Elian Type II sockets), the use of conical implants and post-extraction flapless immediate implant placement with gap-filling methods.…”

“…principles (Harris et al, 2002(Harris et al, , 2012 and (b) because CBCT technology does not offer enough reliability to detect narrow alveolar crests (Gonzalez-Martin et al, 2016). Nevertheless, several authors used control CBCTs to assess the "radiographic reconstruction" and/ or the "buccal plate evolution" in this type of techniques, observing good results (Albiero et al, 2014;Assaf et al, 2017;de Molon et al, 2015;Noelken et al, 2011;Rosa et al, 2014;Sarnachiaro et al, 2016;Slagter et al, 2016;Tripodakis et al, 2016).…”

“…On the other hand, many studies (mainly observational) suggest that combining certain technical details can help us to reliably obtain satisfactory results: minimally traumatic extractions, flapless implant placement in the ideal prosthetic location with good primary stability, filling the residual bone defect (also known as "GAP") and immediate tooth replacement with an provisional screwed-retained implant-supported restoration (Canullo, Iurlaro, & Iannello, 2009;Degidi, Nardi, Daprile, & Piattelli, 2012;Kan et al, 2018;Kinaia, Shah, Neely, & Goodis, 2014;Pieri, Aldini, Marchetti, & Corinaldesi, 2011;Shanelec, 2005;Shanelec & Tibbetts, 2011;Wohrle, 1998;Yoshino, Kan, Rungcharassaeng, Roe, & Lozada, 2014). Nevertheless, there is scarce information about minimally invasive treatments of such nature in alveoli with buccal plate loss (Assaf, Assaf, Antoniazzi, Osorio, & Franca, 2017). The best documented approach covering this type of scenario with compromised tissues involves deferred implant placement with simultaneous bone regeneration.…”

“…In order to seal the extraction socket and support the tissues, the most commonly used option is an implant-supported provisional immediate restoration (Albiero, Benato, & Degidi, 2014;de Molon et al, 2015;Kan, Rungcharassaeng, Sclar, & Lozada, 2007;Noelken, Kunkel, & Wagner, 2011;Rosa, Rosa, Francischone, & Sotto-Maior, 2014;Tripodakis, Gousias, Mastoris, & Likouresis, 2016), despite some authors have resorted to using a tailor-made healing abutment to fit the gingival contour (Sarnachiaro, Chu, Sarnachiaro, Gotta, & Tarnow, 2016) or a removable provisional prosthesis suitably adapted (Assaf et al, 2017). On the other hand, to rebuild the buccal plate deficiency and filling the residual defect (or gap), some have only used a particulate graft consisting of autogenous bone chips (Noelken et al, 2011), particulate deproteinized bovine bone mineral (DBBM), with autogenous bone or not (Kan et al, 2007;Tripodakis et al, 2016), or a combination of platelet concentrates and allogeneic mineral bone (Norero & Ibanez, 2018), while others have used cancellous bone block grafts harvested from tuberosity (Rosa et al, 2014) or DBBM mini-blocks with collagen (Albiero et al, 2014;Assaf et al, 2017). Finally, some authors have identified the need to strengthen the connective tissue of the buccal plate combining an autogenous connective tissue with a cancellous bone block from the maxillary tuberosity to fill the gap (de Molon et al, 2015), or to improve the graft's stability and isolation using a collagen membrane (Sarnachiaro et al, 2016).…”

The four‐layer graft technique, a hard and soft tissue graft from the tuberosity in one piece

“…Results from clinical studies have shown a high risk of midfacial recession following immediate implant placement in cases of an incomplete buccal bone wall . However, case series studies have reported reconstitution of the absent labial bone plate through different techniques . Because of this, hard and soft tissue augmentation procedures have been proposed to minimize buccal bone resorption and to maintain the soft tissue volume following tooth extraction .…”