الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
The placement of implants in fresh extraction sockets has been discussed increasingly frequently in the literature and performed by clinicians in daily practice, since the maintenance of bone architecture that results from this technique seems to significantly help esthetic outcome, especially with regard to the anterior maxilla or “esthetic zone”, and has been reported to be as predictable as placing implants into healed sites. Also, immediate implant placement in fresh extraction sockets has the advantage of reduced operative time, ideal implant location, and overall better patient satisfaction.
The point of the current study was to compare the effect of immediate flapless implant surgery on soft tissue profile in case of that the gap distance left to heal spontaneously, and if this gap is occupied by an injectable calcium phosphate cement (PD VitalOS Cement®). In this study all implants were conventionally loaded and healing abutments were placed in all cases immediately after surgery.
The current study included 12 patients ( 8 females and 4 males). All patients were in the same age range and medically free from any condition affecting bone healing. Esthetic zone was the area of concern in this study, and only single implant restorations were selected. The patients were randomly classified into two groups according to manipulation of the gap distance.
group I: The gap distance was left empty to heal spontaneously (control group).
group II: The gap distance was occupied by an injectable calcium phosphate cement ( PD VitalOs Cement®).
The examined clinical and radiographic parameters were recorded at baseline, 3 months, 6 months intervals. Probing depths (PDs), modified plaque index (mPI), modified bleeding index (mBI), width of keratinized mucosa (WKM), radiographic height of interdental (HIDP), soft tissue thickness (SST), crestal bone loss (CBL), success rate, and patient satisfaction (PS) were the clinical and radiographic parameters used in this study.
Intra-oral digital radiography was chosen to be used in this study because it has been proven that minute bone changes during a short-term period can be better viewed and followed-up using this technique.
All the implants of group I were successfully osseointegrated, and two implants failed in group II, with overall success rate 83% and failure rate 17%.
Our results indicate that there a significant difference between the two group at 6 months follow-up, with superiority of the results of group I (without-bone graft or control group) which reflects better esthetics and bone preservation when compared with the results group II (with-bone graft), especially seen in the significant changes in width of keratinized mucosa, height of interdental papillae, soft tissue thicknesses, crestal bone loss, and patient satisfaction.
In conclusion we found that, the immediate implant placement did not completely prevent bone resorption after tooth extraction.Also, flapless immediate implant placement may be combined with some soft tissue recession. In addition we found that, the gap distance between the implant body and the socket wall in case of implants placed completely within bony envelope can heal spontaneously without the use of any regenerative technique. Immediate implant placement is not recommended in cases of thin tissue biotype. Injectable Brushite Calcium Phosphate cement the is not recommended to occupy the gap distance in immediate implant placement as it showed a rapid rate of resorption without new bone formation, and it elicited an inflammatory reaction in the peri-implant tissue with poor clinical and radiographic results. Flapless approach is a blind technique, so, careful case selection must be done especially of high esthetic demand as in maxillary anterior zone. Orofacial position of immediate implant is very important step to decrease the risk of soft tissue recession. At last, the present study has several limitations, including small sample size, short-term follow-up (6 months), so, further follow-up is recommended with larger sample size.