Background information
Dr. Stefan Reinhardt:
Immediate implant placement with or without immediate loading is still discussed controversial in
the literature. A recently published Cochrane study including randomized controlled clinical trials
on immediate, delayed, and late implant placement summarized that due to the low level of
scientific evidence to date none of the treatment concepts can be regarded as preferred 1 .
In case of immediate implant placement, various factors have to be considered. Besides the
primary stability, a slightly palatine positioning of the implant 2 and grafting of the gap between the
implant and the vestibular bone wall 3,4 are mandatory requirements for long-term success of im-
mediate placed implants. Patients with a thin mucosal biotype and a thin facial bone plate tend to
show a higher risk for the occurrence of buccal recession 6,7 . In most cases, the facial bone thickness
is found to be less than 1 mm in the maxillary anterior region 8 . Therefore, the use of implants with
a platform switch is intended to minimize the loss of bone and soft-tissue, especially in the area of
the papillae 5 .
A recent case study with a 2 year follow-up showed that a similar technique to the one described
here, i.e. a vestibular bone augmentation with a simultaneous autologous connective tissue graft 9 ,
lead to mucosal thickening in all cases. The mean gain in soft-tissue volume was 2.8 mm and vesti-
bular recessions did not occur. The mean gain of attached mucosal width was 2.4 mm after
2 years.
However, harvesting of connective tissue grafts is accompanied by high morbidity and risk of
prolonged bleeding or swelling and sometimes infection of the donor site. Therefore, the use of a
substitute material as the collagenous matrix Geistlich Mucograft ® aims to minimize the exposure
of the patient. Avoiding harvest of palatine grafts can reduce operation time and simplify the
procedure, suiting it more comfortable for the patient.
As to the observation in our practice, the modification to the published technique has proven to
show predictable and comparable results with regards to recession and implant failure, while being
far less invasive.
Medication:
Since simultaneous bone augmentation and immediate implant placement is combined with
transmucosal healing, patients are prescribed for antibiotics starting one day before surgery
with 1000 mg Amoxicillin three times a day and continuing for 7 days post-op.
2. Aims of the therapy
> > The aim of this flapless surgical technique is to predictably develop a stable soft-tissue around
immediate placed implants to avoid gingiva recession in all types of mucosa
> > The consequence of using Geistlich Mucograft ® is less morbidity and a better patient satisfaction
3. Surgical procedure
Fig. 1 Lateral view of the tooth to be extracted.
Fig. 2 Socket after tooth extraction. Note the lack
of soft tissue.
2
Fig. 3 Sharp pre-paration of a split flap above the
mucogingival line similar to the envelope technique
developed from Raetzke 10 .