Creating labial bone for immediate implant placement: a minimally invasive approach by using orthodontic therapy in the esthetic zone.

Orthodontic extrusion of nonrestorable teeth has been used for almost 20 years as an alternative to bone grafting in preparation for implant placement. Although this technique predictably creates bone and soft tissue, and improves the socket diameter and depth, most of the bone apposition occurs in the marginal alveolar and periapical areas of the extruded tooth. To create more labial bone, the standard orthodontic extrusion technique was modified to apply pressure on the hopeless tooth both coronally and palatally, which allowed bone at the site to develop apically and labially. Gingival thickness on the labial aspect was also increased, and the tissue biotype was improved. A clinical treatment is presented that illustrates the use of this technique.