Cosmetic dentistry beauty & science

I case report _ delayed immediate implantation Case 1 Due to an extensive dental history, none of the anterior teeth of the maxilla were conservable (Fig. 1a) and had to be removed gently (Fig. 1b). Immediately following extraction of the teeth, collagen and membrane cones were inserted (Fig. 1c) for the purpose of socket preservation and integration of the previously produced (Fig. 1d) interim prosthesis. _Introduction Delayed immediate implantation is a viable alternative to immediate implantation, for which thereisnodistinctevaluationintheliterature,and a “regular” implantation after complete osseous healingoftheformerextractionarea,generallyas- sociated with volume loss. Lossofosseousvolumeafterextractionofanon- conservable tooth may be a limiting factor for later implantation. To avoid this problem, many authors recommend immediate implantation, where an implant is inserted immediately after careful and gentle tooth extraction. In cases where immediate implantation is not wanted or possible, delayed im- mediate implantation after reconstruction of the former tooth area, which is generally carried out threetofourweeksafterextractionofthenon-con- servable tooth, is a viable alternative. If the alveolus is (still) mostly intact after extraction, the precon- ditionforimmediateimplantationcanbeoptimised with a collagen membrane and cone unit. The procedure presented in the form of the following three exemplary patient cases also acknowledges this easy surgical procedure. The focus of interest is on procedures for pre- serving osseous volume after extraction—many authors emphasise the value of closing the wound by means of a “punch”, which they claim to have considerableadvantageswithregardtoprotection against resorption. Undisturbed growth of bone- forming cells in the former tooth socket is pro- moted by preventing the connective tissue from growingintothealveolus.However,thisprocedure presents more of a challenge for the surgical skills of the dental surgeon in terms of production and insertion,anditismoredemandingforthepatient, both surgically and financially. The insertion of so-called collagen membrane and cone units can simplify closure of the alveolus considerably and avoid removal of the punch at a later time. A second procedure is not required because of the absorbability of the material, since the collagen membrane cone unit does not have to be removed. _Procedure The manufacturer recommends the following procedure for the insertion of collagen membrane and cone unit: Structure and volume in delayed immediate implantation Authors_Dr Georg Bach & Christian Müller, Germany 28 I cosmeticdentistry 3_2013 Fig. 1bFig. 1a Fig. 1c