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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]

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]