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logo 49 | The Camlog Partner Magazine Case study | 23 Discussion In addition to the long-term preservation of the implants, the focus in modern implant dentistry is on protecting the marginal soft tissue architecture and the bony structures. To prevent the resorptive changes after tooth extraction, the concept of immediate implantation has been increasingly applied in recent years. Sufficient primary stability is essential, as immediate implants cannot be fully anchored in the alveolar bone. In addition to shortening the duration of treatment, this form of therapy offers several other advantages. For example, under certain conditions, the implant can be restored immediately, either with a gingiva former or a temporary screw-retained crown. Postoperative pain or swelling are also reduced due to a minimally invasive procedure and the original gingival architecture and bone structure can be preserved [1]. In the field of esthetics, a surgically atraumatic procedure is preferable, provided there is sufficient bone supply and attached gingiva, without having to prefer the preparation of a mucoperiosteal flap [2]. This is because mobilization of the periosteum cuts the blood supply, which can result in resorption of the bucco-oral dimension and lead to a vertical change. According to existing studies, chronic apical foci do not appear to be problematic for immediate implantation [3]. However, inflammation of the adjacent tooth can affect the success of implants [4]. Imaging procedures such as a DVT, digital impression taking by means of an intraoral scan and virtual representation of the definitive restoration enable comprehensive diagnostics as well as precise three-dimensional positioning of the implants. A drilling template with sleeves created from digital planning, which allows both the drills as well as implantation to be completely guided, increases both therapeutic and patient safety. State-of-the-art implant systems adapted to the digital workflow and immediate restoration concepts achieve the required primary stability (35 Ncm), better survival rates and shorter healing times than was possible in the past due to their macrodesign [5,6]. Conclusion Navigated implant bed preparation in combination with optimal implant design enables a safe form of therapy with immediate implants. Furthermore, the precise transfer of 3D planning and controlled achievement of the necessary primary stability speak in favor of completely navigated implant surgery. [1] Slagter, K.W., et al., Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis. J Periodontol, 2014. 85(7): p. e241-50. [2] Stricker A, Fleiner J, Stübinger S, Schmelzeisen R, Dard M, Bosshardt DD. Bone loss after ridge expansion with or without reflection of the periosteum. Clin Oral Implants Res 2016; 26:529-536 [3] Fugazzotto, P., A retrospective analysis of immediately placed implants in 418 sites exhibiting periapical pathology: results and clinical considerations. Int J Oral Maxillofac Implants, 2012. 27(1): p. 194-202. [4] Bell, C.L., et al., The immediate placement of dental implants into extraction sites with periapical lesions: a retrospective chart review. J Oral Maxillofac Surg, 2011. 69(6): p. 1623-7. [5] Chen, J., et al., Influence of custom-made implant designs on the biomechanical performance for the case of immediate post-extraction placement in the maxillary esthetic zone: a finite element analysis. Comput Methods Biomech Biomed Engin, 2017: p. 1-9. [6] Shin, S.Y. and D.H. Han, Influence of a microgrooved collar design on soft and hard tissue healing of immediate implantation in fresh extraction sites in dogs. Clin Oral Implants Res, 2010. 21(8): p. 804-14. • Study of dentistry in Munich • Postgraduate studies in periodontology with diploma from the University of Berne • 2021 Establishment Implantology Competence Munich • Specialized training in implant dentistry and associated Master of Oral Medicine in the field of implant dentistry • Specialization "Implant Dentistry" of the DGI Dr. Wenninger Implantology Competence Munich Görresstraße 39 80798 Munich Dr. Christoph Wenninger References • State examination for dentistry in 1993 at the Ludwig Maximilian University Munich • since 1998 in own practice with Dr. Brigitte Schmidtner • Special focus: prosthetic restorations, pediatric dentistry, implant dentistry, esthetic dentistry • Member of the German Association for Implant Dentistry Joint practice Römerstr. 47 82205 Gilching Dr. Christoph Schmidtner