Caroliene Meijndert

146 Chapter 8 studies, a fair number of the implant shoulders were not covered sufficiently or had a thin facial bone wall thickness at implant placement, leading to a risk of soft tissue recession (Zuiderveld et al., 2019). Hence, alveolar ridge preservation does not rule out entirely that no additional augmentation is needed to achieve a satisfying aesthetic outcome. However, the additional augmentation is usually minor and can be performed with bone scrapes from the osteotomy bur, mixed with a bone substitute, thus avoiding donor site surgery and the associated morbidity. Alveolar ridge preservation – immediate implant placement Alveolar ridge preservation is also advised when placing implants in fresh extraction sockets (Jung et al., 2018). The rationale behind combining these two procedures is that alveolar ridge preservation reduces the alveolar ridge resorption and thus avoids soft tissue recession compared to an unassisted healed socket with immediate implant placement. The indication for a treatment is somewhat under debate as some authors pose that bonefill will also occur spontaneously when the horizontal infra-bony defect size is <2mm and the buccal bone wall is intact (Benic et al., 2014; Naji et al., 2020). Considering the aesthetic risk associated with the unpredictability of the resorption patterns, we decided to combine immediate implant placement with alveolar ridge preservation in the aesthetic region ( Chapter 6 ). We added a mixture of autologous bone and demineralized bovine bone in the gap between the implant and the facial bone wall. The first results were promising in this small case series, but larger studies with a longer follow-up are needed. Peri-implant soft tissues Peri-implant mucosa level change Peri-implant mucosa level stability is of utmost importance in the aesthetic region. It is aesthetically pleasing when the mucosa around a prosthetic crown is in harmony with the mucosa around the natural neighbouring dentition. Buser et al. (2004) found that the thickness of the buccal bone at the implant site plays a fundamental role in the aesthetic predictability of the rehabilitation. A buccal bone plate of >1.5mm is less prone to resorption (Zheng et al., 2020) and less prone to mid-buccal mucosa recessions (Farronato et al., 2020). All the studies described in this thesis aimed to have at least 2 mm of bone at the buccal side of the implant during implant placement. This might explain the minor change in mid-buccal mucosa