Alternative Ridge Augmentation for Esthetic Implant Placement: Case Series

Backgrounds: With the advantage of maximizing esthetic results and minimizing treatment procedures, immediate implant placement and provisionalization (IIPP) would be the first choice when planning to replace failing teeth in esthetic zone. However, the previous cone-beam computed tomography (CBCT) analysis of maxillary anterior teeth in Taiwanese patients revealed that the higher probability of labial bony perforation (LBP) when immediate implant surgery due to undesirable labial ridge concavity. Therefore, this case series demonstrated an alternative strategic approach that combined prophylactic root resection and simultaneous guided bone regeneration (GBR), which could effectively achieve the prerequisites for IIPP and decrease the risks of LBP. Materials and Methods: In this retrospective case-series study, four clinical cases with one or more failing anterior teeth were included. Following the initial CBCT analysis, all cases showed insufficient implant bone support due to apical lesion or buccal bone concavity. Besides, all patient were highly esthetic demand. Thus, we performed the prophylactic root resection with an attempt to maintain gingiva contour, and simultaneous GBR for ridge augmentation. After 8-month uneventful healing, IIPP was accomplished in all cases. The change of bone volume was compared by the preoperative computed tomography scans with those obtained eight months later. The quantitative analysis was calculated by Wilcoxon Signed-Rank Test and Kruskal-Wallis Test. Results: In all cases, significant bone fill was observed and adequate bone volume for IIPP in ideal position in CBCT planning after our alternative bone augmentation procedure. There were no biological or mechanical complications of implant restoration upon clinical and radiographic examination at follow up. Conclusion: This approach could not only preserve the architecture of hard and soft tissue, fulfill the patients’ expectation, but also achieve esthetic and functional outcomes.