Therapeutic management for immediate implant placement in sites with periapical deficiencies where coronal bone is present: technique and case report.

A surgical approach is presented that enables the clinician to repair apical bony defects during immediate dental implant placement without compromising the integrity of the coronal bone and gingiva. This apical surgical technique retains the soft tissue form in the coronal aspect of the gingiva and allows the clinician to repair the apical bone loss or fenestration. A clinical case is presented to describe the technique. This technique is utilized in cases of immediate implant placement. After extraction of the tooth, the socket is evaluated. In cases where coronal bone is intact but apical bone is deficient, a flap technique is utilized to expose the defect. The implant osteotomy is prepared, and the implant is placed. A healing cap or gingival prosthetic component is connected. The bony defect is repaired with a bone graft and, where necessary, a membrane. The apicoectomy flap is sutured. The clinical results obtained using this technique will enable the clinician to accomplish the bone regenerative procedure without extending the flap to the coronal aspect of the socket during immediate implant placement. This technique assists in the maintenance and integrity of the soft tissue form, which is critical for optimal esthetic results.