Jose Carlos Martins de Rosa@ASIO

Immediate dentoalveolar restoration technique IDRT

He starts without preliminaries his perfectly pictured presentation:

The problem: how to restore compromized sockets, with no buccal bone, without loosing the gingival hight.

The idea: replace all-in-one (step) hard & soft tissue: the bone of the tuberosity is mimikring the alveolar bone, is osteoconductive, at no add. cost;

  • Immediate loading with is possible if 30Ncm is obtainable.
  • flapless (except triple grafting)
  • infected sites: admin. antibiotics 7 days post op/5 days in advance when fistula is present and go 4 it

clinical evaluation

  1. buccal root volume
  2. changes in level of ginigval margin
  3. abszess location
  4. periodontal probing, median mesial distal
  5. history of endodontic surgery

Radiologic Diagnosis

recommends soft tissue enhanced CBCT scan (= simply use a lip retractor while taking the scan)


–>Intact socket:  bone substitute is enough

no bone buccally: compromized socket:

  • 1/3 missing
  • 2/3 missing
  • 3/3 missing
  • add. missing over apex add loss (!)
  • add. approx loss add (!)  —>  cancellous bone substitute only
  • palat. loss

reconstruction both in same surgery possible: triple graft

>> cancellous cortical bone and connective tissue graft for defects with recessions and bony defect                                                                             

Donor site (tuberosity)

– reception site must be congruent then no fixation ist nessessary

– high vitality means quick revascularization 

– mechanical resistance 3 months 

Receptor site

Immediate Restoration: no interferences at all

Dimension of the alveolar defect must be measured (soft tissue dimensions) to select the implant diameter. 3mm Distance to buccal bone is demanded

Diameter selection

Splint: on cast-model; removement of tooth to be extracted: make splint, bur hole through and select diameter

soft tissue distance: gap should be 3mm between imp and soft tussue

<7 mm NP

=7mm RP

>7mm WP

Extract tooth: good careful curretage (serrated curettes)

Implantation: 1st bur angulated seeking pal wall, 2nd correct to right angulation 

 – depth position 3mm below Gingiva level (similar to neighbouring tooth)

– if recession less deep (eg. 1.5mm loss, set to 1.5mm depth)

Fabrication of Temporary crown; 

pre surgery prepare the veneer on the cast

then connect after implantation to the temporary abutment und create the concave emergence profile (see pix below)

Bone substitution

  1. – mapping bone defect (triangel shape, rectangular, depth, width…)
  2. – harvesting graft and particles: get with indexed chisel, which is 2mm wider then the graft to be harvested.
  3. – inserting graft above shoulder of implant (overlooking implant shoulder)
  4. – crushing remaining particels and grafting/compaction into the socket, avoiding empty spaces (marked instruments/compactor)
    ( no overbuilding)
  5. – no grafting, the CC graft allone has the potential of remodelling the tissue
  6. Insert provisional crown (screwed) week contact to adjacent teeth, infraocclusally
  7. Oral hygiene with floss 1 w post op., soft brush two months /compromized cases: recessions , Q-tip only, for two months

Patient advisory NOT to bite                                                                                                                                                                                         


no stability over 30Ncm: Replica of temporary crown and cut it epigingivally as temporary coverscrew

donor site compromized: third molar, low mouth operning etc. : measure the thickness over root, and slice a piece of bone of it.


at least 58 month back –  no recession during the evaluation period 

periodonic & restorative dentistry 2015 ROSA JCM, 300 cases.

Experience >10 years

rad. diagnosis: CBCT pre and post op, 6 months 1 y later

Complications: 6 out of 300

sequester, take it out if no infection and put tissue graft inside and wait…

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