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Background: The physiologic bone remodeling accompanying tooth extraction is a phenomenon well described in the dental literature. Extraction sockets severely compromised by local infection, trauma, iatrogenesis, or other factors may exhibit enhanced reduction in alveolar dimensions during healing. The purpose of this report is to present an alveolar ridge preservation (ARP) protocol specifically intended for use at severely compromised sites. Methods: Seven patients presented to the Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, requiring extraction of teeth with partial or near‐complete loss of the facial/buccal cortex. At each site, a cross‐linked bovine collagen membrane was used to prevent collapse of the facial/buccal soft tissue and maintain space, a freeze‐dried bone allograft was applied in the socket, and a dense polytetrafluoroethylene membrane covered the occlusal aspect. Results: All sites healed uneventfully and resulted in favorable alveolar ridge dimensions for implant placement. Conclusion: Few authors have proposed specific ARP methods for managing severely deficient extraction sockets. The predominant recommendation has been staged reconstruction of the site applying hard and soft tissue augmentation. Observations reported herein suggest that staged reconstruction is avoidable at some extraction sockets exhibiting severe alveolar compromise. Controlled clinical investigation of this protocol appears warranted. Key points: Few authors have proposed alveolar ridge preservation (ARP) methods specifically intended for use at severely compromised extraction sockets.The prevailing recommendation at such sites is a staged protocol involving tooth extraction with delayed hard and soft tissue augmentation.The presented bilaminar ARP technique may eliminate the need for staged reconstruction at some severely compromised extraction sockets. [ABSTRACT FROM AUTHOR]

Objectives: In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator‐, procedure‐, patient‐, and site‐associated factors on intraoperative and postoperative complication occurrence. Material and Methods: A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates. In addition, the severity of each postoperative complication was assessed using a standardized grading system. Results: A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6, 6.1; p <.001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p =.004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p =.011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p <.001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p =.008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p =.005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p =.039) were associated with higher odds of intraoperative complication occurrence. Conclusions: Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk‐benefit assessments will become progressively meaningful for patients. [ABSTRACT FROM AUTHOR]

Background: Delivery of a high‐quality provisional restoration at a maxillary anterior immediate implant site enhances patient‐centered outcomes and promotes development of favorable hard and soft tissue architecture. The purpose of this report is to present a protocol relying upon compatible guided surgery and laboratory systems for fabrication of a custom provisional crown prior to immediate implant surgery in the esthetic zone. Methods and Results: A female patient, aged 33 years, presented to the Army Postgraduate Dental School, Fort Gordon, Georgia, with an unfavorable prognosis for tooth #9. The patient elected extraction with immediate implant placement. Prior to the surgery, we utilized a cone‐beam computed tomography volume, stone models, implant planning software, and an implant indexing system to fabricate a custom provisional crown. Following extraction of tooth #9 and immediate implant placement, the provisional crown exhibited excellent fit and finish, requiring virtually no chairside adjustment. We noted minimal change in baseline mucosal contours throughout the healing phase. Conclusion: The clinical/restorative protocol described in this report assured accurate three‐dimensional implant positioning and permitted indirect fabrication of a high‐quality custom provisional crown in advance of surgery. The laboratory workflow—which dental technicians/auxiliaries can master—has the potential to shorten surgery, enhance treatment outcomes, and increase patient satisfaction. Key points: Why is this case new information? This report provides a stepwise workflow guiding indirect fabrication of a custom provisional crown prior to immediate implant placement. What are the keys to successful management of this case? The described technique requires compatible laboratory and guided surgery systems to assure that the restoration accounts for the three‐dimensional position and timing of the implant. What are the primary limitations to success in this case? Dental technicians/auxiliaries can master this protocol and independently produce high‐quality provisional implant restorations under supervision, potentially enhancing practice efficiency. However, practitioners should provide adequate staff training to optimize reliability and quality. [ABSTRACT FROM AUTHOR]

Focused clinical question: What factors identify the optimal bone augmentation techniques for managing slight, moderate, and severe horizontal alveolar ridge deficiency (ARD) at dental implant sites? Summary: Horizontal ARD is a concern at a high proportion of sites receiving dental implants, and clinicians have developed a variety of surgical procedures to address such defects. In a particular case, selection of the optimal treatment may depend predominantly on defect severity, location (anterior versus posterior), and configuration (contained versus noncontained). This report provides a framework for selecting an augmentation method when presented with a slight, moderate, or severe horizontal ARD at a site requiring dental implant placement. Conclusion: Multiple treatment options are available for planned implant sites exhibiting horizontal ARD; severe posterior and slight anterior defects intuitively call for different approaches. Although rigid guidelines for selecting the optimal augmentation method do not exist, some techniques are poorly suited for esthetically demanding sites. A framework considering defect severity, location, and configuration may help guide clinical decisions on this topic. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: Under what circumstances may a clinician consider dental implant placement at a site exhibiting a focal high or mixed density (HMD) osseous lesion radiologically? Summary: Some conditions and pathologic entities exhibiting high and mixed density radiological appearance pose low risk for dental implant failure or complications following implant surgery. However, other lesions represent contraindications to implant placement, and implant surgery at such sites can result in severe morbidity. Conclusion: Potential implant sites exhibiting focal HMD osseous lesions/conditions present varying levels of risk. In most cases, optimal management will include advanced imaging of the site, multidisciplinary consultations, and detailed informed consent to assure full understanding of procedural risks, benefits, and complications. Currently, clinical recommendations rely on case reports, opinion, and usual practice (level 3 evidence). The strength of each recommendation provided in this report is categorized as level C. [ABSTRACT FROM AUTHOR]

Purpose: Our purpose was to assess the frequency and impact of various site development procedures provided before, during, and after implant placement in an advanced dental education program. Methods: We evaluated all implant cases completed by two residents in each of three consecutive periodontics residency classes. Dependent variables included implant failure, complication occurrence, presence of radiographic bone loss, and need for tissue augmentation. We analyzed these outcomes against a panel of explanatory covariates. Results: Our study sample involved 370 site development procedures at 290 implant sites in 160 patients. Three factors exhibited statistically significant associations with need for tissue augmentation: alveolar ridge preservation (ARP) (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.13, 0.57), immediate implant placement (IIP) (OR 0.21; 95% CI 0.10, 0.47), and implant submergence (OR 8.3; 95% CI 4.5, 15.3). Four factors predicted treatment complications: ARP (OR 6.1; 95% CI 1.3, 29.1), IIP (OR 6.1; 95% CI 1.06, 35.3), implant submergence (OR 5.3; 95% CI 1.1, 24.9), and mandibular arch (OR 31.3; 95% CI 1.9, 500). Anterior sites (OR 2.7; 95% CI 1.3, 5.8) were more likely to receive IIP. Conclusions: In the evaluated sample, implant placement at a site exhibiting a favorable volume of native bone was rare. Seventy‐eight percent of sites received hard tissue grafting during the treatment phase. The use of ARP or IIP at tooth extraction reduced subsequent tissue augmentation requirements. Education and training in ARP and other site development procedures may enhance the clinical practice and treatment outcomes of implant surgeons. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this report was to document clinical responses to Nd:YAG laser energy in patients with surgical injury to terminal branches of the trigeminal nerve. Background: Limited evidence from in vitro, animal, and human studies suggests infrared laser energy may positively influence recovery after peripheral or cranial nerve injury, although clinical effects of neodymiumdoped yttrium aluminum garnet (Nd:YAG) lasers remain unstudied in this context. Methods: We applied Nd:YAG laser energy in the treatment of three consecutive patients presenting with altered neurosensory function following various oral and maxillofacial procedures. The time interval between surgical injury and laser photobiomodulation ranged from one week to two years. Results: All patients exhibited reduction in the area of diminished sensation and partial recovery of normal neurosensory function. The two patients with long-standing neurosensory deficiency experienced near complete recovery of intraoral sensation, with residual zones of diminished sensation from the perioral skin. Conclusions: Although all patients in this case series demonstrated clinical improvements compared with baseline, controlled studies are needed to determine whether Nd:YAG laser energy accelerates or enhances recovery of neurosensory function after surgical nerve injury. Studies establishing the relative efficacies of Nd:YAG and diode lasers appear warranted. [ABSTRACT FROM AUTHOR]

Introduction: Guided bone regeneration (GBR) is the most commonly utilized procedure for augmenting deficient alveolar ridges in support of dental implant placement. In a GBR procedure, barrier membrane dimensions, bone graft volume, and surgical complexity may influence the risk of postsurgical morbidity. Case presentation: A 25-year-old female in good general health received GBR at two mandibular first molar sites exhibiting horizontal ridge deficiency. High-density polytetrafluoroethylene membranes were intentionally limited in size, and small-volume freeze-dried bone allografts were applied only where clinically beneficial for implant site development. Treatment resulted in clinically favorable ridge augmentation with no appreciable swelling and minimal postoperative discomfort. Conclusion: At dental implant sites exhibiting modest alveolar ridge deficiency, limiting GBR barrier membrane dimensions and bone graft volumes may enhance patient-centered outcomes while accomplishing clinical goals. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to illustrate the efficacy of a novel imaging analysis technology to capture horizontal and vertical dimensional changes following horizontal alveolar ridge augmentation (HRA). Methods: Cone-beam computed tomography (CBCT) volumes from 65 HRA sites in 57 patients were available for evaluation, employing a three-dimensional analysis software to overlay preoperative and post-augmentation CBCT volumes. Horizontal and vertical alveolar ridge dimensional (HRD/VRD) changes were recorded considering a panel of patient-, site-, and procedure-related explanatory variables. Results: VRD changes ranged from -2.9 to 3.0 mm, more than half anterior sites losing alveolar ridge height. Mean HRD increase at the 3- and 5-mm levels apical to the alveolar crest amounted to 2.3±1.6 and 2.4±1.3 mm, respectively, membrane fixation and non-resorbable membrane use associated with significantly greater gains. Conclusions: To date, studies reporting dimensional changes following HRA predominantly rely on serial in situ orofacial caliper recordings omitting vertical alterations. The protocol employed in this study allows simultaneous HRD and VRD evaluations and assures baseline and post-augmentation recordings are made at the same alveolar ridge position. Compared with in situ recording, CBCT overlay analysis may achieve a more complete characterization of dimensional changes following HRA. [ABSTRACT FROM AUTHOR]

Introduction: Retained cement following delivery of an implant-supported crown is strongly associated with peri-implant mucositis and peri-implantitis, and screw retention is a strategy for avoiding this problem entirely. In the esthetic zone, screw retention compromises esthetics unless the screw access in the crown is concealed to the palatal of the incisal edge. To avoid positioning the implant platform excessively toward the palate, practitioners can design an angled screw access channel in the crown. Case Presentation: A healthy 22-year-old patient with nonrestorable tooth #9 received extraction and immediate implant placement with immediate provisionalization. The screw access channel for the provisional restoration involved the incisal edge. Rather than placing a custom abutment and cementing the definitive restoration, an angled screw access channel was employed. The implant-supported restoration exhibited favorable esthetics, and the possibility of retained cement was avoided. Conclusion: Up to a point, positioning maxillary anterior implants toward the palate is favorable. When the long axis of the implant is directed between the incisal edge and the cingulum of adjacent teeth, the implantsupported crown can be screw retained without compromising esthetics. In immediate implant situations, such positioning also increases the distance between the implant and the facial alveolar bone and encourages a favorable position of the marginal peri-implant mucosa. However, an excessively palatal platform position compels a restoration with irregular contours, which can frustrate proper oral hygiene and professional maintenance. Angled screw access channels allow screw retention without excessive palatal positioning of the platform, avoiding the possibility of cement-related peri-implant disease. [ABSTRACT FROM AUTHOR]

Introduction: Introduction of a surgical insult in conjunction with orthodontic therapy has been shown to accelerate treatment in minor tooth movement and comprehensive orthodontic cases by induction of the regional acceleratory phenomenon (RAP). When applying this concept to a molar tipped into an adjacent edentulous site, a dental implant can be planned to anchor the movement. Case Presentation: A generally and periodontally healthy 25‐year‐old patient presented missing tooth #19, with tooth #18 mesially tipped into the first molar crown space. A dental implant was placed in the #19 position. Following osseointegration, the implant anchored orthodontic movement of the adjacent tooth, which was initiated in conjunction with third molar extraction. Conclusion: Favorable biomechanics for molar uprighting can be achieved using an osseointegrated implant and a customized orthodontic device. The presented technique facilitates implant site development without delaying placement of the fixture and simplifies fabrication of a harmonious and anatomic implant‐supported restoration. Induction of the RAP may hasten treatment completion. [ABSTRACT FROM AUTHOR]

Introduction: Continuous and interrupted sling sutures (ISSs) are used around teeth in contemporary periodontics. However, conventional ISSs depend upon favorable tooth morphology for stability through the early healing period. The purpose of this report is to present a variation of the classic ISS that does not rely on favorable tooth morphology. Case Series: Tissue‐supported sling sutures (TSSs) were used for six patients undergoing root coverage, gingival augmentation, or pontic site development (guided bone regeneration) procedures. Conclusions: Although techniques such as vertical mattress suturing may support greater coronal flap advancement, the TSS technique does maintain coronal flap position while minimizing trauma to papillae. TSS stability is independent of tooth morphology and may offer clinicians flexibility in achieving reliable closure over hard and soft tissue implants. Like mattress sutures, TSSs reduce tension at the crestal incision line in tissue grafting procedures. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: What factors identify the optimal surgical technique when a distal wedge procedure is indicated at a terminal maxillary or mandibular molar site? Summary: Incision design for the distal wedge procedure is based primarily on the dental arch (maxilla or mandible), the distance from the terminal molar to the hamular notch or ascending ramus, and the dimensions of the attached gingiva. Conclusions: In most situations, favorable clinical results are achievable irrespective of the chosen distal wedge method, and technique selection is based more on operator preference than evidence. However, anatomic limitations can render distal wedge procedures challenging in some cases, and procedural advantages of specific techniques can simplify treatment. One systematic approach to distal wedge technique selection is presented in this report. Additionally, a laser‐assisted distal wedge protocol is presented for cases in which unfavorable tooth‐to‐ramus distance or presence of a prominent external oblique ridge contraindicates conventional distal wedge techniques. [ABSTRACT FROM AUTHOR]

The term "fracture necrosis" has been used to describe the condition found in a minimally restored tooth without a history of trauma when the suspected etiology for the loss of pulpal vitality is a crown-originating fracture. Teeth with fracture necrosis have a poor prognosis, and, when accompanied by characteristic radiographic findings, extraction may be considered the primary treatment option. Two adult men with crown-originating fractures and suspected fracture necrosis had localized periodontal bone and attachment loss associated with severe pain on mastication from mandibular second molars. In case 1, the patient desired to retain the tooth despite an unfavorable prognosis. Nonsurgical root canal therapy and a crown prolonged tooth survival for only 30 months. The patient in case 2 requested extraction after a thorough review of his dental condition and tooth prognosis. A tooth with fracture necrosis may continue to harbor virulent microorganisms after root canal therapy. When these microorganisms have access to the periodontal attachment, progressive loss of supporting tissues can be expected. When weighing treatment options for teeth with fracture necrosis associated with characteristic radiographic findings, preference toward extraction and tooth replacement, rather than treatment aimed at tooth retention, may represent a sound clinical approach. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative discomfort is a documented complication of the epithelialized palatal graft (EPG) procedure, and the expectation of an unpleasant patient experience may cause some practitioners to avoid EPG altogether. However, EPG affords distinct advantages in a variety of clinical situations, and the postoperative discomfort associated with the procedure can be minimized. Case Series: Three generally and periodontally healthy patients with gingival recession defects and minimal zones of attached gingiva received mandibular anterior EPG procedures. In all cases, collagen membranes were trimmed to fit the palatal donor sites and sutured in place. Two patients reported minimal donor site discomfort at any time point. One patient with large bilateral donor sites reported moderate palatal discomfort limited to the first postoperative week. All patients reported overall positive treatment experiences. Conclusions: Placement of a resorbable collagen membrane at large EPG harvest sites appears to limit topical irritation of the wound and may substantially improve patient comfort postoperatively. Combining local and systemic measures to minimize patient discomfort may render EPG procedures very tolerable for patients. Controlled clinical trials comparing patient‐centered outcomes following EPG harvest with and without collagen membrane placement appear warranted. [ABSTRACT FROM AUTHOR]

Introduction: The epithelialized palatal graft (EPG), introduced in 1963, has persisted as the gold standard for gingival augmentation, and in the present era, mucosal augmentation around dental implants has become an important concern. A limited body of evidence suggests peri‐implant mucosal augmentation may favorably impact bone and mucosal stability and peri‐implant health under some circumstances. Although more contemporary procedures for peri‐implant mucosal augmentation are often preferred based on convenience and esthetic considerations, EPG augmentation at dental implant sites is distinguishable from methods which do not deepen the vestibule and eliminate unfavorable superficial soft tissue. Implant sites augmented with EPG are qualitatively distinct from sites augmented using other methods. Case Series: Seven generally healthy patients received EPG augmentation before dental implant placement, at implant placement, before implant uncovering, or after implant uncovering. In each case, the patient exhibited a favorable zone of attached peri‐implant mucosa following treatment. Conclusions: Reliable mucosal augmentation with EPG is achievable at multiple phases in the course of dental implant therapy. EPG augmentation offers distinct clinical advantages and may be preferable to other mucosal augmentation strategies at some dental implant sites. [ABSTRACT FROM AUTHOR]

Background: Crestal bone thickness is a critical determinant of peri-implant tissue stability. This retrospective observational study sought to quantify the buccal bone thickness achieved adjacent to virtual dental implants following guided bone regeneration (GBR) surgery and evaluate the influence of patient- and procedure-related variables on buccal bone thickness.Methods: Cone-beam computed tomography (CBCT) images acquired from patients who had undergone GBR surgery between July 1, 2012, and November 7, 2016, were used for this analysis. In all cases, the GBR procedure involved a dense polytetrafluoroethylene (dPTFE) barrier membrane and a mineralized cortical particulate freeze-dried bone allograft (FDBA). Eighty-four virtual dental implants were placed at planned locations using CBCT images from 84 patients, and the adjacent buccal bone thickness was measured at each site. The effects of sex, age, estimated baseline ridge width, number of missing teeth in site, site type (tooth-bounded versus terminal position in arch), dental arch (mandibular or maxillary), arch location (anterior or posterior), smoking status, titanium reinforcement in the membrane, membrane fixation, and tenting screw use were assessed.Results: The mean post-GBR buccal bone thickness adjacent to virtual dental implants was 2.24 ± 1.01 mm. Fifty-nine of 84 virtual implants (70%) exhibited buccal bone thickness > 1.9 mm. GBR sites using membrane fixation produced significantly greater virtual implant buccal bone thickness than those without membrane fixation (2.31 ± 0.96 versus 1.15 ± 1.25 mm, P = 0.012). Virtual implant buccal bone thickness also exhibited moderate correlation with estimated initial ridge width (r = 0.43, P < 0.0001). The alveolar ridge at 81 virtual implant sites (96%) was classified as good or satisfactory, meaning dental implants were actually placed at these sites, with or without additional grafting at implant placement.Conclusions: Observations in this study suggest GBR procedures using dPTFE membranes and FDBA result in favorable ridge dimensions for dental implant placement in most cases. However, additional augmentation at implant surgery may be necessary at ≈ 30% of sites, if buccal bone thickness > 1.9 mm is intended. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: How should clinicians manage dental extraction sockets when immediate implant placement is contraindicated, and alveolar ridge preservation is expected to result in inadequate bone volume for implant placement? Summary: Three fundamental options for extraction socket management form a hierarchical continuum in sites where dental implant placement is planned: place an immediate implant, perform ridge preservation, or perform ridge augmentation. The available volume and quality of bone and keratinized mucosa are the primary considerations driving the decision, and each tier in the continuum encompasses a variety of techniques with attendant advantages and disadvantages. Conclusions: Some immediate implant protocols require no mucoperiosteal flap and possibly produce the most favorable clinical and patient‐centered outcomes compared with other extraction socket management approaches. Conversely, guided bone regeneration at dental extraction sites can result in substantial gains in alveolar ridge dimensions, although this treatment may adversely influence mucosal architecture and carry increased risk of postoperative morbidity. When favorable bone and mucosa are present at a dental extraction site, immediate implant placement may be the treatment of choice, barring unusual circumstances. Ridge preservation, typically associated with minimal postoperative morbidity, is a rational second choice when acceptable ridge dimensions are anticipated after healing. [ABSTRACT FROM AUTHOR]

Introduction: The mandibular anterior can be a challenging anatomic location for achieving root coverage irrespective of the selected graft and surgical technique. The epithelialized palatal graft (EPG), often dismissed in deference to esthetic and patient‐centered considerations, is well‐suited for treating gingival recession in this region. Although a considerable volume of data exists assessing root coverage procedure outcomes, little evidence supports superiority of any one technique specifically applied to the mandibular anterior. Case Presentation: Two periodontally and systemically healthy patients with multiple adjacent Class I and III recession defects in the mandibular anterior were treated with EPG. Recipient site dimensions in one case obligated bilateral palatal donor sites. In this case, the two autogenous grafts were carefully sutured extraorally before placement. Favorable increases in attached gingival dimensions and partial or complete root coverage were noted after 12‐ or 18‐month follow‐up periods. In the case requiring bilateral donor sites, no transition between the two grafts could be appreciated after healing. Conclusions: Overall, subepithelial connective tissue graft (SCTG)‐based techniques reportedly produce higher mean root coverage percentages and more frequent complete root coverage compared with EPG. However, when observations are limited to the mandibular anterior, there are insufficient data to conclude SCTG is superior to EPG. In the presented cases, EPG at multiple adjacent mandibular anterior recession defects produced favorable clinical outcomes. Extraoral suturing of bilaterally harvested grafts facilitated graft stabilization and minimized irregularities in gingival architecture after healing. [ABSTRACT FROM AUTHOR]

Introduction: Patient‐, site‐, and procedure‐related factors important for successful periodontal regeneration have been defined in the periodontics literature by insightful clinician‐researchers. Prevention of bacterial contamination of the surgical site through careful wound closure and meticulous postoperative care is a critical procedure‐related factor necessary for periodontal regeneration. Dense polytetrafluoroethylene (dPTFE) is a nonresorbable barrier material that may protect bone replacement grafts (BRG) against bacterial contamination for a short period during early wound healing if membrane exposure occurs. Case Presentation: A 35‐year‐old African American female with a deep/narrow infrabony periodontal defect and Hamp degree I furcation involvement at tooth #14 (mesial) underwent combination BRG/guided tissue regeneration (GTR) using a mineralized/demineralized freeze‐dried bone allograft and a dPTFE barrier membrane. Favorable clinical and radiographic outcomes were noted nine months following the procedure. Conclusions: Two reports evaluating clinical parameters following use of dPTFE membranes for GTR appear in the literature. The present case provides clinical and radiographic outcome assessments following combination BRG/GTR using a dPTFE membrane. This material may be of interest for periodontal regeneration due to an ability to temporarily limit bacterial influence if membrane exposure occurs. [ABSTRACT FROM AUTHOR]

Introduction: A contemporary protocol for managing horizontal alveolar defects adjacent to immediate implants includes placement of a well‐designed provisional restoration to contain graft material and seal the socket. However, immediate provisionalization is not always possible or practical. Case Presentation: A 39‐year‐old male presented with a non‐restorable tooth #29, which was extracted. An immediate implant was placed in the tooth #29 position, and a freeze‐dried bone allograft was placed in the horizontal defect between the implant platform and osseous walls. A neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser was used to create a stable fibrin clot over the graft material. After 31 months, favorable radiographic bone levels and complete papilla fill were noted. Conclusion: The present case illustrates use of an Nd:YAG laser in the management of an immediate implant horizontal defect in lieu of an immediate provisional restoration. [ABSTRACT FROM AUTHOR]