Vestibular Socket Therapy: A Novel Approach for Implant Placement in Defective Fresh Extraction Sockets With or Without Active Socket Infection (One-Arm Cohort Study).

PURPOSE: This study aimed to assess the radiographic, esthetic, and periodontal outcomes after 1 year of implant placement in compromised fresh extraction sockets in the esthetic zone using vestibular socket therapy. MATERIALS AND METHODS: Implants were placed in type 2 sockets using vestibular socket therapy, which includes immediate implant placement, vestibular incision, and cortical bone shield stabilization, along with filling the socket gap with particulate bone graft, then sealing the socket orifice with a customized healing abutment in one visit. A 6-day protocol of antimicrobial therapy for treating sockets with active infection was also described. Assessment included measuring bone height and labial plate thickness at three levels at baseline and after 1 year, in addition to pink esthetic score and periodontal parameters (modified sulcus Bleeding Index and peri-implant probing depth) after 1 year. SPSS was used to calculate descriptive statistics of outcome measures. RESULTS: All 16 implants used in the study showed success. There was a significant increase of bone height and bone thickness at the middle and crestal thirds (mean [SD] gain = 6.08 [3.07], 1.65 [0.91], and 1.18 [1.51]). The mean (SD) pink esthetic score was 12.63 (1.71), the mean (SD) modified sulcus Bleeding Index was 1.19 (0.40), and the mean (SD) peri-implant probing depth was 1.97 (0.46) mm. CONCLUSION: Vestibular socket therapy was successfully used in compromised sockets with optimum radiographic, esthetic, and periodontal outcomes in addition to minimizing treatment time and number of surgical interventions. The 6-day protocol was able to eliminate infection and prepare sockets for implant placement.

A Novel Method for Immediate Implant Placement in Defective Fresh Extraction Sites.

PURPOSE: This study assessed a novel treatment protocol for immediate implant placement in defective fresh extraction sockets. MATERIALS AND METHODS: A single-arm clinical study was conducted including 12 fresh extraction sockets divided into two groups: those with intact and those with a deficient facial plate of bone. Hopeless teeth were atraumatically extracted, a vestibular access horizontal incision was made 3 to 4 mm apical to the mucogingival junction, a mucoperiosteal tunnel was created from the labial orifice of the socket, a slowly resorbing membrane shield was stabilized under the tunnel, implants were placed using a surgical guide, and a subepithelial connective tissue graft was harvested and secured over the membrane shield. Definitive restorations were delivered at 3 months postoperatively. Cone beam computed tomography (CBCT) scans were taken at baseline and after 6 and 13 months to measure facial bone thickness and height. Pink esthetic score (PES) was recorded at 6 and 13 months. RESULTS: At 6 months, the mean ± SD facial bone thickness was 1.88 ± 0.73 mm for sockets with intact facial bone compared to 0.76 ± 0.42 at baseline and 2.34 ± 0.78 mm for sockets with deficient facial bone compared with 0 ± 0 at baseline, whereas at 13 months, the thickness was 1.84 ± 0.74 and 2.18 ± 0.73 mm, respectively. The facial bone crest coincided with the implant platform in sockets with an intact facial bone plate and those with a deficient facial bone plate at 6 months, whereas at 13 months, the distance for sockets with a deficient facial bone plate increased to 0.20 ± 0.13 mm. The mean PES at 6 and 13 months was 11.33 for both groups out of a maximum score of 14. CONCLUSION: The proposed technique provided a minimally invasive treatment with predictable esthetic outcome allowing immediate implant placement in sockets with intact and with deficient facial plates.