Human histologic verification of osseointegration of an immediate implant placed into a fresh extraction socket with excessive gap distance without primary flap closure, graft, or membrane: a case report.

The aim of this research was to verify clinically and histologically whether an excessively large horizontal and vertical gap distance of an implant placed into an immediate extraction socket would osseointegrate coronally at the implant-socket interface without primary flap closure, a bone graft, or a barrier membrane. An immediate implant and straight-profile healing abutment were placed at the palatal aspect of the extraction socket replacing a nonrestorable maxillary left canine. The residual horizontal defect measured 4.2 mm buccolingually and was allowed to heal by secondary intention. The implant was loaded after 5 months and biopsied after 10 months of placement, using the coronal portion of the buccal bone. The histologic section of the coronal aspect of the implant interface revealed intimate bone contact to the first thread. There was reestablishment of the implant biologic width coronal to the bone contact with connective tissue and junctional epithelium. This case report provides clinical and histologic proof that the immediate placement of implants into extraction sockets with an intact buccal wall allows healing and osseointegration despite a large gap distance and without primary flap closure, a bone graft, or a barrier membrane.