Radiographic evaluation of alteration of peri-implant bone following immediate implant placement associated with the use of a synthetic bone substitute

After tooth extraction,resorption of the alveolarwalls has been observed. Since the buccal bone wall is predominantly composedof bundle bone, resorption is greater in this area, whereas less resorption ofthe lingual walls has been found, since they are thicker and composed ofsubstantial proportions of lamellar bone.1,2

On average,a loss of about 50% of the buccal bone contour has to be expected within 3months after extraction.2,3Various strategies like socketpreservation techniques and immediate implants have been tested to minimize theresorption and maintain the ridge dimensions after extraction.2

The placement of the implant into the fresh extractionsocket is called as   Immediate implant. Theadvantages of the immediate implant includes reduced number of visits andsurgical procedures, diminishing patient morbidity, and in some cases, enableimmediate restoration.4,5,6

Despite these advantages, however, immediate implantplacement has always been a challenge for clinicians because of itsunpredictable outcome associated with implant position and soft tissuestability.7

Studies have demonstrated that buccolingual hardtissue resorption occurs irrespective of implant insertion.8,9Severalapproaches have been suggested in order to minimize the resorption process and/orpromote better healingwith immediate implants. This includes implants withdifferent geometries, collagen membranes, use of various graft or filler materialsbetween the implant and the buccal bone wall.10

 Commercially, bioactive glasses are available indifferent morphologic forms. A putty form (Novabone Dental Putty)of premixed composite of bioactive calcium silicophosphate has beenmade available.11

 It is composed of elements naturally occurring in the body,which signals genetic pathways to accelerate natural bone growth. This processis defined as Osteostimulation. Osteostimulationleads to a catalytic response that accelerates the natural healing process andbone regeneration.NovaBone DentalPutty is available in multiple delivery mechanisms: clamshells, syringes and **‘CartridgeDelivery System’.**It is dispensed in a pre-mixed state and can beplaced directly into the defect site from the package.

 It has found its multiple clinical applications in dentistry in thetreatment of bone defects, ridge and socket preservations, and periodontalosseous defects including furcation defects.11

Aim:

To evaluate radiographic(CBCT) outcomes of the alveolar ridge following palatal flapless Immediateimplant placement associated with the use of a synthetic bone graft placed betweenthe implant and inner surface of the buccal alveolar plate.

 Objectives:

 1. To evaluate and compare the horizontal alveolarridge changes on facial and palatal cortical plates after placement ofimmediate implant associated with synthetic bone graft.

 2. To evaluate and compare totalbucco-lingual dimensional changesafter   placement of immediate implantassociated with synthetic bone graft.

 3. To evaluate and compare the verticalbuccal alveolarridge changes after the placement of immediate implant associated with syntheticbone graft.