Immediate Implant Placement in Infected Type II Socket with Immediate Temporization

A 35-year-old woman presented to the dental clinic complaining of pain and mobility in tooth 21. Clinical and radiographic (CBCT) examination revealed a horizontal root fracture apical to the cementoenamel junction, loss of the labial plate of bone, and periapical pathosis. Atraumatic tooth extraction was performed using a periotome, followed by thorough curettage to remove periapical pathosis. Drilling was performed and an immediate implant was placed. A collagen membrane was sutured to the buccal soft tissue, and a connective tissue graft harvested from the maxillary tuberosity was positioned at the coronal area of the soft tissue. Xenograft bone particles were added into the gap space between the implant and collagen membrane. Immediate temporization was performed using the patient’s own crown after adjustment of the cervical contour with composite. At baseline, buccal bone thickness was 0 mm at the crest and 3 mm from crest, and 0.3 mm at 6 mm from the crest. Nine months postoperatively, buccal plate thickness increased to 1.46 mm at crest, 2.39 mm at 3 mm, and 2.53 mm at 6 mm from the crest. The pink esthetic score was excellent, with complete papillae and natural soft tissue contour, color, and texture compared to reference tooth (tooth 11). Immediate implant placement and temporization in an infected Type II socket with buccal bone loss can achieve favorable esthetic and functional outcomes when meticulous infection control, hard and soft tissue management, and immediate provisionalization are employed.