A 67-year-old male patient presented reporting on masticatory pain in his right maxilla. A thorough examination revealed that tooth #12 (FDI) / #7 (US) had to be extracted due to a transverse fracture right below the crown. The patient opted for a delayed implant placement with immediate provisionalization since this solution was the most promising for achieving an optimal esthetic outcome.
In immediate loading situations like the present one the preference is not to graft but to keep the treatment as simple as possible. The only option would be a connective tissue graft. However in the present case the biotype was thick enough so the decision was taken to reduce the morbidity for the patient by proceeding without any grafting procedures.
The treatment approach in the esthetic zone typically consists of the following steps: anesthesia and bone sounding, atraumatic extraction, removal of the epithelial lining of the sulcus and evaluation of the socket.
If the buccal wall is present and intact, the 3D implant placement (flapless) is the preferred option. Bone grafting inside the socket is performed in combination with a connective tissue graft in order to compensate for the shrinkage. If the buccal wall is absent, then the preferred option is to go with delayed implant placement.