A Combined Approach for the Treatment of Resorbed Fresh Sockets Allowing Immediate Implant Restoration: A 2-Year Follow-Up

Figure 1. (a) Initial clinical aspect of the maxillary right first premolar. (b) Periapical radiograph showing advanced vertical bone loss, endodontic treatment, and a metal ceramic crown. (c and d) Atraumatic extraction of a hopeless tooth to preserve the osseous contour. Figure 2. (a–d) Immediate implant placement in an ideal tridimensional position to achieve the appropriate emergence profile: in the mesiodistal direction, at least 2 mm of the adjacent teeth and the implant shoulder placed 3 mm apical to the cement-enamel junction of the adjacent right maxillary canine, and the axis of the implant was with the incisal edges of the adjacent teeth or slightly palatal.

Figure 3. (a–d) Autogenous block bone graft harvested from the maxillary tuber adjacent to the first lefty molar. Figure 4. (a and b) Provisional abutment placed after implant installation. (c and d) Autogenous block bone graft placed immediately after implant installation, allowing immediate dentoalveolar restoration.

Figure 5. (a) Intrasulcular incision to allow insertion of the graft. (b–d) Particulate autogenous bone graft to fill the gap between the implant and the bone wall. Figure 6. (a and b) Autogenous connective tissue graft to improve the gingival contour and increase the keratinized gingiva, favoring esthetic results. (c and d) Simple suture and installation of provisional crown, reducing the treatment time and achieving immediately esthetic results.

Figure 7. (a–d) Prosthetic procedures 4 months after implant placement to the final restoration. Figure 8. (a–d) Placement of a custom abutment and the laboratorial procedures to create an ideal marginal contour of the crown.

Figure 9. (a–d) Installation of the definitive metal-free crown with feldspathic porcelain crown IPS Empress II. Figure 10. (a) Definitive all-ceramic CAD/CAM Zirconia abutments 2-year post-operative. Note the absence of gingival recession, stabilization of the achieved results, and optimal esthetic outcomes. (b) Periapical radiograph 2-year post-operative showing absence of bone loss and stabilization of the alveolar crest compared to the initial clinical and radiographic situation. (c) Pretreatment clinical view of the maxillary right first premolar. (d) Periapical pretreatment radiography.