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Journal of Oral Science & Rehabilitation No. 1, 2018

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. 9 Fig. 10 Fig. 11 all aspects. 47 In their study, Barone et al. showed that, with delayed restorations, loss of papillary soft tissue and bone resorption were faster and localized, whereas with imme- diate restorations, tissue modifications appeared slow and gradual, allowing more predictable results with an excellent soft- tissue prognosis regarding, above all, the mesial and distal aspects.47 Moreover, treat- ment time until the final restoration is longer with delayed restoration than with immediate restoration.44 Finally, delayed restoration had higher costs than immediate restoration did, 26% more, owing to both the adjunctive second- stage surgery and the higher number of visits required (Figs. 9–11).48 Conclusion Nowadays, the improvement in implant tech- nology and knowledge of healing patterns after tooth extraction has made it possible to achieve adequate success rates and favorable esthetic outcomes with immediate implants. It should be pointed out that immediate implant placement can be considered as a pos- sible treatment option only when strict clinical criteria are met, such as integrity of the buccal bone plate, integrity of bone peaks of the adja- cent teeth, integrity of soft tissue (adequate amount of keratinized gingiva, adequate gin- gival scallop and adequate interdental papillae) and a thick gingival biotype. Under these clin- ical conditions, immediate implant placement could be considered as a viable treatment option that shows predictable outcomes. For these reasons, the following points, as dis- cussed in this review, should be considered and reviewed before implant placement in fresh extraction sockets: – Case selection should be made according to Fig. 9 Placement of the final crown 5 months after implant placement. Fig. 10 Follow-up at 6 years: The papillae had completely filled the interdental spaces. Fig. 11 Periapical radiograph at 6 years, showing optimal maintenance of the marginal bone level. inclusion and exclusion criteria. – The extraction of the tooth or root remnant should be done as atraumatically as possible in order to avoid any damage to the hard and soft tissue. – Soft-tissue integrity should be preserved by avoiding flap elevation or, if necessary, only performing a minimal flap elevation. This will also decrease buccal bone resorption. – The implant placement should follow the pal- atal wall and a vestibular orientation should be avoided as far as possible to avoid possible fenestration of the implant after unavoidable bone remodeling. – The gap between the implant and the buccal bone wall should be grafted to avoid resorption and exposure of the buccal aspect of the implant and to provide support to the soft tissue. – Immediate restoration, when possible, should be preferred because it can guarantee better support to the interdental soft tissue and is less expensive for the patient. In addition, it should be taken into consideration that, when all of the clinical conditions for imme- diate placement are present, this procedure is still considered as a complex procedure that requires high surgical skills. When the clinician is not sufficiently experienced or when all of the requirements are not satisfied, other techniques should be considered, such as early implant placement with soft- or hard-tissue healing and late implant placement with or without socket grafting.9 Competing interests The authors declare that they have no compet- ing interests and have not received any support from any companies. Journal of Oral Science & Rehabilitation Volume 4 | Issue 1/2018 21

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