Immediate tooth replacement seems to be a reliable therapy for patients as they can benefit from time gain. Unfortunately, tooth extraction is usually followed by a variable amount of bone resorption, due to the modelling and remodelling processes in the empty alveolus. The dimensional ridge contour changes may compromise the results of implant treatment and, in the case of implant placement in fresh extraction sockets, volumetric changes should be prevented. Different procedures have been proposed to reduce bone resorption and to maintain the original ridge volume after tooth extraction with simultaneous implant placement. The management of the bone-to-implant gap, through a revised concept, could be interpreted as the application of a ridge preservation procedure with the implant inserted in the middle. A contemporary technique describes the grafting of the bone-to-implant gap before and not after implant insertion, in order to provide a more accurate tridimensional filling. This approach seems to able to compensate for marginal bone remodelling, preserving both the horizontal and vertical dimension of the ridge. Instant provisionalization of immediate single and multiple teeth implants results in a more stable maintenance of the soft tissue contour and aesthetics, when compared with the pre-treatment evaluation of the gingival harmony. Interdental, midfacial and horizontal soft tissue dimensions tend also to remain stable, while new perspectives involving the use of enamel matrix protein around immediate implants confirm the possibility of enhancing wound healing around immediate post-extraction implants.
Learning Objectives:
- To learn about the dynamics of healing in post-extraction sites
- To learn about the clinical indications for immediate implant placement
- To learn about the rationale for grafting the gap
- To learn about how to graft the peri-implant gap before implant placement
- To learn about the rationale for immediate restoration