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Journal of Oral Science & Rehabilitation No. 1, 2018

Fig. 4 Implant site preparation following the palatal wall of the socket. Fig. 5 Implant placement. The post-extraction socket presented a buccal V-shaped fenestration. Fig. 6 The gap, coronal area and fenestration were grafted with xenograft particles. Fig. 7 A resorbable collagen mem- brane was placed to cover the graft underneath the gingival margin. Fig. 8 Suture of the socket to stabilize the membrane. I m m e d i a t e i m p l a n t s i n t h e e s t h e t i c a r e a Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 In general, marginal bone changes around implants, when placed in fresh extraction sock- ets, may result in unfavorable bone thickness in the long term. For this reason, the use of guided bone regeneration techniques in this situation can be suggested. It is advisable to use cortico- cancellous porcine bone, which has a slow resorption rate, mixed or not with autogenous bone, and a resorbable membrane to stabilize the graft. The membrane can be left exposed, pro- vided that antibiotic therapy is prescribed to the patient (amoxicillin and clavulanic acid, 1 g twice a day for 5 days, starting the day before surgery). With this technique, it was demonstrated in a previous study that implants have a cumulative survival rate of 94.6% at 7 years (Figs. 6–8).12 All of the guided bone regeneration techniques applied in the implant–socket gap are useful to limit buccal wall resorption; however, a complete preservation of the initial contour is never pos- sible and a remodeling will always take place to some extent, although with a slower rate.41 6 . I m m e d i a t e v e r s u s d e l a y e d r e s t o r a t i o n Several studies have shown that there is no difference in the long-term survival of implants restored with immediate or delayed provisional crowns and that, concerning the success rate, the two restorative procedures seem to be very similar in terms of soft-tissue behavior at the buccal aspect.43–45 However, various studies regarding immediate implants placed in fresh extraction sockets suggested that wider pap- illary shrinkage was seen in delayed resto- rations than in immediate restorations.46 From our point of view, the prosthetic treatment, namely immediate or delayed restoration, has to be based on strict clinical criteria, for example, the insertion torque value that should not be higher than 45 Ncm. Nevertheless, immediate prosthetic restoration may guaran- tee more predictable results in terms of an excellent hard- and soft-tissue prognosis for 20 Volume 4 | Issue 1/2018 Journal of Oral Science & Rehabilitation

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