Periosteal-guided bone regeneration on severely damaged sockets with simultaneous implant placement: The cortical...

Bone regeneration and simultaneous implant placement in severely damaged sockets are challenging and may require multiple grafting. Periosteal-guided bone regeneration enhances osteogenesis and wound healing shortening immediate and delay implant protocols. Clinical outcomes of a group of individuals that entered a longitudinal clinical trial from 2019 to 2021 are reported describing a novel surgical approach of simultaneous reconstruction and implant placement.

Eight individuals requiring an implant and presenting severe facial bone loss were followed for 2-4 years (37-month average) after the completion of a 12-month longitudinal clinical trial NCT04827693. Socket reconstruction and simultaneous implant placement were performed by encasing the implant in a customized shield of autogenous cortical bone. Peri-implant tissues and pink esthetics data were assessed following established success criteria. Mean healing time, before second stage surgery, after implant placement and reconstruction, was 12.5 ± 0.9 weeks (range: 12-14 weeks). Success rates were 100% at 2-4 years. Cone beam computed tomography (CBCT) data showed stable facial cortical bone >2.1 mm in thickness. Pink esthetic scores (PESs) were above optimal (9.5 ± 0.5, range: 9-10), with no significant difference between delayed and immediate individuals (p > 0.05). Facial implant transparency at follow-up was absent and all had a band of keratinized tissue >2 mm with healthy probing depths ranging from 3 to 4 mm.

Facial bone regeneration and simultaneous implant placement are feasible through periosteal-guided bone regeneration after a short healing period in severely damaged sockets following immediate or delay protocols. The assisted regenerated intrasocket bone provides high pink esthetics and functional implant stability.

Regeneration and simultaneous implant placement of severely damaged sockets is feasible. Periosteal-guide bone regeneration can shorten healing times. Teeth with fragile alveolar foundation can be successfully reconstructed achieving high pink esthetics.

Simultaneous dental implant placement and bone regeneration are possible in severely damaged sockets that require reconstruction achieving, after a short healing period, highly esthetic outcomes.