Effects of the Facial Osseous Defect Morphology on Gingival Dynamics After Immediate Tooth Replacement and Guided Bone Regeneration: 1-Year Results

Purpose: This article describes different scenarios of facial osseous defects when the osseous-gingival relationship exceeds 3 mm and evaluates the effects of the morphology of the compromised facial bone on gingival dynamics after immediate tooth replacement and guided bone regeneration. The implant success rate and peri-implant bone change were also reported. Materials and Methods: Twenty-three patients treated consecutively with the mean age of 39.5 years (range, 25 to 63 years) underwent immediate tooth replacement and guided bone regeneration in sockets with facial bony defects exceeding 3 mm. Facial bony defects were categorized into V-, U-, and Ultra-U (UU)-shaped. The patients were evaluated clinically and radiographically at 1-year after implant placement. Results: At 1-year, the implant success rate was 100% (23/23). No marginal bone change of greater than 1 mm was observed. Greater than 1.5 mm of facial gingival recessions were noted in 8.3% (1/12) of V-shaped, 42.8% (3/7) of U-shaped, and 100% (4/4) of UU-shaped defects. Conclusions: U- and UU-shaped defects showed significantly higher frequency and magnitude of facial gingival recession (>1.5 mm) when compared with V-shaped defects 1-year after immediate tooth replacement and guided bone regeneration. It is important to identify the type of facial bony defect during diagnosis and treatment planning, so that appropriate treatment can be prescribed. The combination of delayed implant placement after staged reconstruction of unfavorable U- and UU-shaped labial extraction socket defects should be considered in areas of high esthetic concern. © 2007 American Association of Oral and Maxillofacial Surgeons.