Delayed Dental Implants in Pristine Large Buccal Bone Defects in the Anterior Maxilla

Purpose: To investigate the remodeling process of hard tissue components in fresh extraction sockets that underwent natural healing followed by localized alveolar split-crest surgery for implant placement. Materials and Methods: Patients with bone defects in the maxillary esthetic zone, characterized by decreased mineral density around the affected tooth were treated via socket healing without bone substitutes, delayed alveolar splitting, and subsequent implant placement. Preoperative (baseline: before the stage-one and stage-two surgeries) and postoperative CBCT scans were analyzed to assess changes in bone volume and crestal width. Statistical analysis was performed using nonparametric tests, with a significance level set at P < .05. Results: A total of 13 incisors were retrospectively evaluated. No major postoperative adverse events were recorded. After 2 years, the implants achieved a 100 survival rate. No episodes of peri-implant mucositis or peri-implantitis were reported. Radiographs taken 3 months after tooth extraction revealed bone mineralization without the use of bone substitutes; however, the volume was insufficient for immediate implant placement. Following tooth extraction, the split procedure, and implant placement (stage-one and stage-two surgeries), total bone volume showed a significant increase (P = .0105) from baseline (919 ± 179 mm³) to the 2-year follow-up (955 ± 176 mm³). Similarly, crestal width demonstrated a significant increase (P = .0012), increasing from 6.1 ± 2.7 mm at baseline to 7.5 ± 2.0 mm at 2 years, with a mean gain of 1.4 ± 1.0 mm due to the split-crest procedure. Conclusions: After 2 years, the results indicated that natural healing of the extraction socket without the use of bone substitutes, followed by delayed localized alveolar splitting, led to a significant increase in bone volume and preservation of the outermost alveolar bone layer. The observed postextraction site augmentation was concentrated in the esthetic zone.