Managing cases

An immediate protocol cannot be performed without a careful evaluation of the patient. Testori emphasised that favourable cases should have:

• good anatomy: at least 4mm of palatal bone is required to stabilise the implant
• good implant positioning: with 2–3mm gap left to fill with graft materials, and non-vestibular positioning
• good abutment shape: the thinner the abutment, the thicker the soft tissue around the implant neck will be

According to Araújo, narrow-diameter implants are mostly recommended in the anterior region; ridge preservation may be indicated in the molar region when the alveolar process is in close contact with the sinus floor.

“Narrow-diameter implants are mostly recommended in the anterior region”

The socket shield technique may be a good option when the root is oriented towards the buccal aspect and the bony wall is very thin. But the procedure is labour-intensive and complex, and should be limited to cases when it is clinically indicated.