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ePaper created 2017-03-17, 12:34:42 | version 1.38.0
| case report Fig. 9–11: Perioperative image, implant inserted in the correct position, occlusal view. Fig. 9 Results The insertion of biomaterial to fill the BIG even be- fore insertion of the implant seems to determine the best functional results in prosthetic-implant rehabil- itation. This protocol, indeed, not only results in an improvement in the primary stability of the implant, but also allows regeneration of those alveolar parts otherwise inaccessible with other techniques. Discussion The positioning of an implant in a bone defect usu- ally leaves a space between the implant surface and the alveolar bone wall. With the aim to improve osse- ointegration and limit resorption of the ridge, autolo- gous, heterologous and alloplastic bone, with/with- out membrane, has been used in combination in order to improve bone formation in these defects.38-40 Nev- ertheless, procedures for regeneration of the post-ex- traction site associated with immediate implant placement have been shown to limit resorption, al- though a complete preservation of the site has never been documented.9, 11, 41 Another fundamental parameter is the size of the BIG. A value of 1.5 to 2 mm can determine healing without compromising the degree of osseointegra- tion. However, whether the width of the space be- tween the surface of the implant and the bone crest Fig. 12: Postoperative periapical X-ray evidenced the correct position of dental implant. Fig. 12 20 implants 1 2017 Fig. 10 Fig. 11 plays a role in the remodelling is still under discus- sion.20 Also currently considered important is the lo- cation of the implant in relation to the level of the crestal bone of the site. Other studies have shown that vertical resorption may be limited not only by filling the gap, but also by excess regeneration of the upper portion of the crest. To achieve this, the graft material should be placed in the most coronal portion of the site and on the buccal side of the outer surface of the alveolus.46–48 Taken together, current knowledge indicates that post-extraction implant placement cannot prevent dimensional changes of the ridge, but association with biomaterials seems, to date, to be the treatment of choice to limit resorption. Nevertheless, if the ele- ment to be extracted is associated with periapical dis- ease and/or uncontrolled periodontal disease, post-extraction placement of the implant is to be ex- cluded; in this case, the resorption of the alveolar ridge cannot be preserved and a more traditional im- plant procedure should be performed.49 Finally, our findings are consistent with previous results,14–16, 29, 36, 37 showing that the insertion of bio- material to fill the BIG even before insertion of the implant determine the best functional results in prosthetic-implant rehabilitation. Further investiga- tion need to evaluate the resorption of the alveolar ridge associated with the placement of post- extraction implants using the surgical protocol de- scribed by the authors._ contact Prof. Dr Mauro Labanca Studio Professor Mauro Labanca Corso Magenta, 32 20123 Milano, Italy Tel.: +39 02 804246 mauro@maurolabanca.com Author details