Application of Immediate Dentoalveolar Restoration in Alveolus Compromised with Loss of Immediate Implant in Esthetic Area

In the reported clinical case, the immediate dentoalveolar restoration (IDR) technique was applied to reconstruct the buccal bone wall, with autogenous graft of the maxillary tuberosity, which had been lost due to a root fracture, and to provide the necessary bone substrate for the installation of an implant and its provisioning. One of the greatest risks inherent in the survival of immediate implants is the maintenance of their stability during the healing period. In this case, due to a mechanical trauma in sports activity in the first postoperative month, there was a total failure in the osseointegration process, confirmed by tomographic examination of both the implant and the bone graft. The deleterious effects of this accident were compensated with a new approach and reapplication of IDR technique using a smaller-diameter implant and with conical macrogeometry in conjunction with the new bone reconstruction under the same compromised alveolus; associated, after the period of osseointegration, with the maneuvers of volume increase of the gingival tissue by subepithelial connective tissue graft. The tomographic result demonstrated the success of the surgical procedures, and the clinical/photographic analysis obtained showed the stability of the gingival margin without compromising the esthetic result of the prosthetic restoration.