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Case Reports
. 2022 Aug 25;11(17):4985.
doi: 10.3390/jcm11174985.

A Novel Muco-Gingival Approach for Immediate Implant Placement to Obtain Soft- and Hard-Tissue Augmentation

Martina Stefanini  1 , Matteo Sangiorgi  1 , Diego Bianchelli  1 , Pietro Bellone  1 , Federico Gelpi  2 , Daniele De Santis  2 , Giovanni Zucchelli  1
Affiliations
Case Reports

A Novel Muco-Gingival Approach for Immediate Implant Placement to Obtain Soft- and Hard-Tissue Augmentation

Martina Stefanini et al. J Clin Med. .

Abstract

The aim of this article is to describe a novel approach combining muco-gingival, regenerative and prosthetics concepts for immediate implant insertion that overcomes the limits traditionally considered as contraindications for Type 1 flapless implant positioning, simultaneously obtaining soft- and hard-tissue augmentation. After pre-surgical CBCT evaluation, the surgical technique consisted in the execution of a lateral-approach coronally advanced envelope flap, with oblique submarginal interproximal incisions directed towards the flap's center of rotation (the tooth to be extracted); after buccal-flap elevation, the atraumatic extraction of the tooth was performed. Following guided implant insertion, a mixture of biomaterial and autologous bone was placed, stabilized by a pericardium membrane and a connective-tissue graft sutured in the inner aspect of the buccal flap. The peri-implant soft tissues were conditioned with a provisional crown until the shape and position for the mucosal scallop to resemble the gingival margin of the adjacent corresponding tooth were obtained; then, the definitive screw-retained restoration was placed. Within the limitations of this case report, the proposed immediate implant placement approach combining CTG application and buccal bone regeneration showed the possibility of obtaining 1-year-follow-up implant success, stable bone level, good esthetic results and high patient satisfaction.

Keywords: connective-tissue graft; hard-tissue augmentation; immediate implant placement; muco-gingival approach; soft-tissue augmentation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a–c) Forty-year-old patient with endodontic fistula on maxillary right canine.
Figure 2
Figure 2
Radiographic evaluation revealing internal root resorption.
Figure 3
Figure 3
(a,b) Pre-surgical CBCT evaluation in order to perform guided implant insertion.
Figure 4
Figure 4
(a,b) Lateral-approach coronally advanced envelope flap, with oblique submarginal interproximal incisions directed towards the flap’s center of rotation (the tooth to be extracted).
Figure 5
Figure 5
Atraumatic extraction of canine after buccal-flap elevation.
Figure 6
Figure 6
(a,b) Implant placement after guided preparation of implant site.
Figure 7
Figure 7
Biomaterial and autologous bone placed to cover the exposed implant threads and to fill the gap between implant surface and socket wall.
Figure 8
Figure 8
(a,b) Biomaterial stabilized by a thin pericardium membrane placed between bone particles and connective-tissue graft.
Figure 9
Figure 9
Connective-tissue graft sutured in inner aspect of buccal flap, 1 mm apical with respect to mucosal margin, with two horizontal internal mattress sutures.
Figure 10
Figure 10
Initial suture of the weakest papilla (the mesial one) before placing the provisional crown, obtaining an ideal adaptation of the surgical papilla on top of the smaller anatomical papilla.
Figure 11
Figure 11
(a,b) Suture of the second surgical papilla (the distal one) onto the larger anatomical papilla with a simple interrupted suture, after screwing the provisional.
Figure 12
Figure 12
Radiographic evaluation following implant placement.
Figure 13
Figure 13
Maturation of soft tissue at 1 month (a), 3 months (b) and 6 months (c) after surgery.
Figure 14
Figure 14
(a–c) Conclusion of the conditioning phase.
Figure 15
Figure 15
(a–c) One year after final restoration placement, the clinical outcome remained stable and fully satisfied the patient’s esthetic demands.
Figure 16
Figure 16
Marginal bone loss evaluated with periodical X-ray scans was minimal.
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References

    1. Nevins M., Wang H. Soft tissue management to augment implant success. In: Zucchelli G., Stefanini M., editors. Implant Therapy: Clinical Approaches and Evidence of Success. Quintessence Publishing; Batavia, IL, USA: 2019. pp. 367–394.
    1. Hartlev J., Kohberg P., Ahlmann S., Andersen N.T., Schou S., Isidor F. Patient satisfaction and esthetic outcome after immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment. Clin. Oral Implants Res. 2014;25:1245–1250. doi: 10.1111/clr.12260. - DOI - PubMed
    1. Khzam N., Arora H., Kim P., Fisher A., Mattheos N., Ivanovski S. Systematic review of soft tissue alterations and esthetic outcomes following immediate implant placement and restoration of single implants in the anterior maxilla. J. Periodontol. 2015;86:1321–1330. doi: 10.1902/jop.2015.150287. - DOI - PubMed
    1. Araújo M.G., Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J. Clin. Periodontol. 2005;32:212–218. doi: 10.1111/j.1600-051X.2005.00642.x. - DOI - PubMed
    1. Botticelli D., Berglundh T., Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J. Clin. Periodontol. 2004;31:820–828. doi: 10.1111/j.1600-051X.2004.00565.x. - DOI - PubMed

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