Discussion
infection, bone loss, PES
INFECTION, COLLAPSE, BLOOD CLOT, BONE LOSS
An optimum treatment outcome should be presented to the patient specifically in the maxillary esthetic region where immediate implants are considered. Post restorative bone remodeling followed with mid facial post restorative gingival recession should be taken into consideration. To date, several techniques have been developed to counteract this inevitable bone loss [The use of platform switched dental implants maintained crestal bone levels, and enhanced the peri-implant tissue stability [By using particulated bone graft in the MinerOss X group, the autogenous cortical bone chips offered a sustained release soluble signals that can modulate differentiation of mesenchymal cells in vitro involving TGF-β1 signaling within 10 min & Bmp-2 in 40 min that allowed the biological activity of the bone graft and induced the activation of the osteogenic properties of bone graft components [Combining the xenogeneic bone graft particles to the particulated bone graft assisted in providing a stable graft matrix due to its slow remodeling speed [In the collagen plug group, there was a significant decrease in the overall thickness (1.01 mm) of the labial bone after 12 months compared to the Grafton and MinerOss X groups (1.11 & 1.44 mm). That was in line with a previous published work by Bakkali et al. and Novaes et al. revealed that grafting coupled with implant placement significantly reduced horizontal bone resorption and showed superior outcomes compared to the reliance on blood clot reorganization alone [Nonetheless, due to the small sample size of the present study, the differences were not statistically significant. In the current study, patients with thin soft tissue phenotypes were excluded to avoid confounding results [This study showed that the vestibular socket therapy protocol is predictable in maintaining high esthetic outcome in all groups in class II fresh extraction sockets with immediate implant placement. Soft tissue vertical height was maintained for all sockets included in the present study and showed a successful outcome at the end of the study period (12 months). The same rates were observed in a recently published prospective 2-year follow-up clinical studies with provided evidence for long-term stability of both bone and soft tissue architectures with predictable radiographic and esthetic outcomes advocating the use of the VST for immediate implant placement in class II fresh extraction sockets with or without signs of infection [Using a slow biodegradable and flexible cortical xenograft shield along with VST provided support to the overlying mucosa, minimized postoperative tissue collapse, allowed the labial bone plate to undergo the resorption phase followed by bone regeneration with no dimensional changes in the socket size, and protected the labial gap from epithelial invasion [It is worth noting that all implants were positioned at 2– 3 mm below the zenith of the mid-facial gingival point to provide a proper emergence profile and establish an optimal biological width with the regenerated bone de-nuvo. Additionally, a sufficient gap between the implant and the facial bone was left for the graft materials or the blood clot to increase the regenerative space. This allowed more room for regeneration, thus providing a thicker buccal bone to be regenerated [Furthermore, customized healing abutments used at the same time of immediate implant placement preserved the socket architecture during treatment phases, sealed the socket environment from oral bacteria, and minimize the prosthetic soft tissue profiling needed in the restorative phase [The currently presented findings demonstrated that the overall PES values after 12 months were 12.00 in group I (collagen plug), while group II (Grafton) showed scores of 11.00 and group III (MinerOss X) showed scores of 13.00, without a statistically significant difference observed between the studied groups. This suggested that optimum esthetics were achieved when the vestibular socket protocol for immediate implant placement was performed. Similarly, Elaskry and coworkers [Immediate implant placement offers the benefits of reducing patient visits and preserving alveolar bone and its related soft tissues. The short-lived satisfaction is then followed by compromised esthetics and patient dissatisfaction resulting from possible post-restorative long term marginal recession and crestal bone loss. To date, there is no single technique or treatment regimen with substantiating evidence to address all clinical scenarios with long-term stability. However, with the use of VST along with biologically active bone grafting components, VST has shown evidence of a superior treatment outcome in treating hopeless maxillary anterior failed dentition.The limitations of this study remains in the small sample size of the groups and the inapplicability of the technique for use in failed posterior teeth. Emphasis should be placed on adequately filling the socket defects and the jumping gap with bone graft components to achieve an optimal regeneration of the lost labial plate of bone [