Caroliene Meijndert

83 Alvoalar ridge preservation in defect sockets in the maxillary aesthetic zone Patients were excluded when there was: − presence of active clinical periodontal disease as expressed by probing pockets depths ≥ 4 mm combined with bleeding on probing in the natural dentition other than the affected tooth; − smoking; − a history of radiotherapy to the head and neck region; − use of bisphosphonates less than 10 years ago. Treatment procedures Participants with a failing tooth and not suitable for immediate implant placement were eligible for this study. They were informed about and consented to the research protocol prior to tooth extraction. All the participants started antibiotic therapy the day before extraction (amoxicillin 500mg, 3 times daily for 7 days, or clindamycin 300 mg, 4 times daily for 7 days in case of an amoxicillin allergy) and a 0.2% chlorhexidine mouth rinse, twice daily for 7 days. After administering local anaesthesia, the tooth was removed as atraumatically as possible using a periotome and forceps. The socket was cleaned and the granulation tissue was removed. A bone graft, harvested from the maxillary tuberosity or retromolar area, was shaped to fit the labial bone wall defect and inserted in the alveolus. Next, the socket was augmented with a mixture of autologous bone and anorganic bovine bone (Geistlich Bio-Oss®, Geistlich Pharma AG) (Raghoebar et al., 2009). The alveolus was closed with a mucosa graft from the maxillary tuberosity or palate. Wound healing and suture removal was checked two weeks after surgery. The participants wore a removable partial denture during the healing period. The implants were placed 3 months after the augmentation procedure. One day before implant placement, all the participants started antibiotic therapy (amoxicillin 500mg, 3 times daily for 7 days, or clindamycin 300 mg, 4 times daily for 7 days in case of an amoxicillin allergy) and a 0.2% chlorhexidine mouth rinse, twice daily for 7 days. All the surgeries were performed by the same, experienced, surgeon (GMR). After administering local anaesthesia, a mid-crestal incision with a divergent reliving incision was made next to the distal tooth for a small muco-periosteal flap elevation. The implant position was dictated by a (semi-guided) surgical template and the implant bed was prepared following the manufacturers’ surgical guidelines. All the participants received a Straumann Bone Level Tapered (BLT) implant (Institute Straumann AG, Basel, Switzerland) according to the pre-operative planning. The implants were installed 3 mm apically of the prospective gingival margin of the future restoration, with an insertion torque of at least 45 Ncm. If the thickness of the labial 5