Comparison of procedures for immediate reconstruction of large osseous defects resulting from removal of a single tooth to prepare for insertion of an endosseous implant after healing.

This study evaluated the treatment outcome of immediate reconstruction of 45 large osseous defects resulting from removal of a single tooth with a 1:2 mixture of Bio-Oss and autologous tuberosity bone, and three different procedures for soft tissue closing (Bio-Gide membrane, connective tissue graft, full-thickness palatal mucosa graft; n=15 per group). All defects had an unfavourable osseous-gingival relationship and vertical bone loss of >5mm. The hard and soft tissues were immediately reconstructed after removal of the tooth. Implants were inserted after 3 months. Patients' acceptance, complications and postoperative morbidity were prospectively evaluated by standardized clinical and radiographic examinations up to 12 months after the augmentation procedure. The patients completed a questionnaire on subjective complaints related to the procedure. All hard-soft tissue procedures resulted in sufficient bone volume for the insertion of implants and a favourable aesthetic outcome. The gingival mid-buccal aesthetics before, and 1 year after, treatment significantly favoured the full-thickness palatal mucosa graft, showing a gain in gingival contour of 0.5+/-0.8mm; the other procedures resulted in a 1.2+/-1.6mm decrease. Of the procedures evaluated, a full-thickness palatal mucosa graft was the most predictable for immediate reconstruction of the socket after tooth removal.