Read full study here: https://www.mdpi.com/2077-0383/11/17/4985
Stefanini M, Sangiorgi M, Bianchelli D, Bellone P, Gelpi F, De Santis D, Zucchelli G. A Novel Muco-Gingival Approach for Immediate Implant Placement to Obtain Soft- and Hard-Tissue Augmentation. J Clin Med. 2022 Aug 25;11(17):4985. doi: 10.3390/jcm11174985. PMID: 36078914; PMCID: PMC9456498.

This paper describes a novel approach combining muco-gingival, regenerative and prosthetics concepts for immediate implant insertion that overcomes the limits traditionally considered as contraindications for Type 1 flapless implant positioning, simultaneously obtaining soft- and hard-tissue augmentation. cerabone®, autologous bone and Jason® membrane are applied together with a connective tissue graft upon immediate implant placement.

Summary:

Patient history
A 40-year-old patient presented with an endodontic fistula (Fig. 1) on the maxillary right canine without any systemic conditions contraindicating implant placement or regenerative surgery. Internal root resorption was validated by the radiographic evaluation (Fig. 2 and 3) and due to its extent the tooth was considered hopeless.

Surgical procedure
In a lateral-approach a coronally advanced envelope flap was performed and the flap was elevated in a split–full–split manner (Fig. 4 a, b). The tooth was extracted atraumatically while preserving the integrity of the anatomical papillae mesial and distal with respect to the canine (Fig. 5).

Biomaterials used in combination with immediate implant placement
After guided implant placement (Fig. 6) , a mixture of cerabone® and autologous bone was placed to cover the exposed implant threads and the remaining buccal bone as well as to fill the gap between the implant surface and the socket wall (Fig. 7).

The biomaterial was then stabilized using Jason® membrane (Fig. 8) and connective tissue graft was placed over the membrane and sutured in the inner aspect of the buccal flap (Fig. 9).

The peri-implant soft tissues were conditioned with a provisional crown until the shape and position for the mucosal scallop to resemble the gingival margin of the adjacent corresponding tooth were obtained; then, the definitive screw-retained restoration was placed (Fig. 10 and 11).

Results on soft & hard tissue
Maturation of soft tissue at 1 month, 3 months and 6 months after surgery showed satisfying outcomes (Fig. 13 & 14). One year after final restoration placement, stable clinical outcomes were reported, as well as full patient satisfaction regarding esthetic demands (Fig. 15). The soft tissues remained morphologically and dimensionally stable, with no evidence of inflammation. The periodic X-ray scans revealed only slight marginal bone loss (Fig. 16)

Conclusion
The proposed novel approach for immediate implant placement was successfully demonstrated to result in stable bone level, good esthetic results and high patient satisfaction in a 1-year-follow-up. cerabone® and Jason® membrane were successfully applied together with a connective tissue graft upon immediate implant placement.