Minimally invasive extraction and immediate implant placement: the preservation of esthetics

Extraction sites in the esthetic zone present an obvious restorative challenge. This case report describes a surgical technique for the preservation of anterior esthetics that combines minimally invasive extraction with immediate implant placement. This single-stage approach preserves site morphology by protecting and supporting existing hard and soft tissues. Clinical success appears to be attributable to several important features of the technique. The first step involves the elevation, luxation, and extraction of the tooth using either a flapless or minimally invasive approach that reduces trauma to the adjacent tissues. The second step involves appropriate orientation, placement, and stabilization of the implant to preserve facial bone and soft tissue contours. Implant placement is accomplished using particulate freeze-dried bone allograft and enamel matrix derivative to achieve ridge preservation and bone augmentation. The composite graft material is considered critical for predictably resolving osseous voids and promoting implant integration, and consideration is given to the concept of osteogenic "jumping distance" between the implant and the eccentric walls of the alveolus. Finally, preservation of the soft tissue architecture during wound healing is achieved by placement of either a fixed or removable restoration. Consistent implant integration and preservation of the hard and soft tissue complexes have been achieved using this approach.