Subperiosteal peri-implant augmented layer to correct bone dehiscence at immediate implant placement

The purpose of the present case report is to describe the potential of the subperiosteal peri-implant augmented layer (SPAL) technique in peri-implant bone dehiscence (PIBD) correction at immediate implant placement (IIP).

This case report describes the application of the SPAL technique in two patients undergoing IIP at compromised sockets resulting in a PIBD. A split-thickness flap was raised to preserve the periosteal layer, which was coronally advanced to compensate the missing portion of buccal bone plate. A deproteinized bovine bone mineral graft, with or without autogenous bone, was placed beneath the periosteal envelope to reconstruct the buccal defect. Mucosal layer was used to achieve primary closure.

Both patients exhibited uneventful healing. At re-entry, complete PIBD correction was observed, with newly formed peri-implant bone extending to the level of the implant collar. Clinical and radiographic evaluation assessed healthy peri-implant tissues at prosthetic rehabilitation.

SPAL technique may be considered a simplified option in the treatment of PIBD at IIP.

Peri-implant bone dehiscence (PIBD) requires treatment to prevent long-term biological complications, such as peri-implant disease and progressive bone loss and soft tissue dehiscence. Periosteal layer (PL) plays a key role by serving as a biologically active barrier that compensates for the absence of the buccal socket wall and converts the defect into a self-contained one, thereby supporting graft stabilization and bone regeneration. Severity of the PIBD, on one hand, and the extent of coronal advancement of the PL at surgical manipulation, on the other, may represent relevant limitations for the generalizability of the application of PL-based procedures for bone augmentation.

Immediate implant placement after tooth extraction can be complicated when part of the buccal bone is missing. This condition may compromise implant stability, peri-implant tissue health, and esthetic outcomes if not properly managed. This case report presents a surgical approach that uses the patient's own periosteum, a thin tissue layer covering the bone, to help reconstruct buccal bone defects at the time of immediate implant placement. The periosteum was carefully separated and repositioned to act as a natural biological membrane, creating a protected space that contained the bone graft and supported new bone formation. Two patients with buccal bone defects were treated using this technique in combination with bone graft materials. Healing occurred without complications. Clinical and radiographic evaluations showed complete correction of the bone defects, stable peri-implant tissues, and favorable esthetic outcomes. These findings suggest that the surgical use of the periosteum may represent a reliable option for managing buccal bone dehiscence during immediate implant placement, helping to reduce complications and improve long-term implant outcomes.