Joseph Kan: The science and biology of immediate implant and tooth replacement

Facial gingival tissue recessions can lead to considerable esthetic compromised results such as e.g. visible implant collars. Supported by a patient case, the lecture discusses how to stabilize the tissues and avoid tissue recessions. Dr Kan reviews the three mains considerations, gap size, socket size and implant diameter. To compensate for the facial ridge remodeling and achieve a proper prosthetic emergence, a combination of grafting the gap and facial graft shows the most promising results in comparison to no graft or grafting the gap only. In terms of socket size it is important to consider that the bucco-lingual dimension is usually smaller and therefore more critical than the mesio-distal dimension. Under this aspect implant diameters are often selected too big. Dr Kan concludes that to optimize facial gingival esthetics, the gap should be > 1.5 mm, grafting the gap should be combined with external augmentation, the socket will usually be < 7 mm and therefore the implant diameter should be choosen max 4.5 mm or smaller, and the implant be placed in a palatal position, to provide sufficient facial bone volume.