Tissue conservation and implant surgery : immediate implant after extraction and bone expansion - ROS - 2008 - Tome 37 - N°4

When tissue conservation is addressed, it unconsciously refers to conservative treatment while less destructive care has been an objective and a vital principle for all practitioners in dentistry. Tooth tissue conservation for aesthetic restorations such as cosmetic veneers also closely followed this logic. What is the status of surgery in general and particularly implantology in this direction ? Implantology positions itself as the main actor in tissue conservation due to its own indication. A removal of dental organs in order to replace the absent organ by conventional fixed prosthesis violates the evoked tissue conservation. The legal obligation of medical information for this technique (as in conventional techniques) and the notion of evoked "intentional removal", when this alternative is not proposed, are absolute proofs. A preservation of bone for implant placement is essential. Even if implant placement in weakly altered bone volumes remains possiblej, the resulting deficient aesthetics as well as the adjusted axes of adopted implant, not conforming to the force application, compromise the treatment success compared to the current standards. When bone resorption is significant, autogenic grafts are indicated. This practice is, however, contracdictory to the tissue conservation principle due to a partial repair of the harvest site leading to a reduced volume of the final bone tissue. The purpose of this article is to review two implant approaches with an objective to preserve and optimize the intial bon capital without bone harvest and secondary grafting. Immediate implant after extraction will thus be firstly approached and bone expansion in the second.